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Nutrition Lecture 5
Pulmonary and Cardiovascular Dz
70
Health Care
Professional
08/02/2012

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Term
With COPD pts, the increased work of breathing increases the what?
Definition
calorie requirements.
Term
COPD pts have chronic SOB and are O2 dependent, in what 2 ways do they have difficulty getting the nutrition they need?
Definition
challenging to shop and prepare meals
mayhave changes in taste due to excess sputum
Term
Does dairy increase mucous and thereby worsen SOB?
Definition
no, unless have an allergy to it.
Term
Why do COPD pts have multiple infections?
Definition
due to their chronic use of steroids
Term
Steroid use is good bc ______
Bad bc_______.
Definition
good: increases people's appetites

bad: they increase blood sugars and can cause steroid induced diabetes... this can only be treated with insulin, not diet
Term
Why do people with COPD have swallowing dysfxn with eating?
Definition
-when people are unable to breathe they do not wan to eat bc disrupts breathing
-aspiration pneumonia can be a problam
-may need to do enteral feeds
-may not be able to eat around a trach if pt has one.
-If are so malnourished and they do get aspiration pneumonia, the abx will not help the pneumonia... bc when become really sick body feeds on muscle protein stores.
Term
In cystic fibrosis, how does malabsorption occur? what does this cause?
Definition
through mucous obstruction of the pancreas
this causes growth retardation and issues with pancreatic enzymes (the body makes insulin but it cannot leave the pancreas... these patients need insulin)
cannot absorb vitamins and minerals properly (A,D,E,K)
Term
In cystic fibrosis, why are there increased calorie needs?
Definition
due to increased work of breathing
need high calorie foods and supplements and supplemental enteral feeds
Term
What is the male weight gain goal in CF? female?
Definition
23
22
-weight gain can be done by insulin alone but that is not healthy... want a healthy weight gain (through exercise) bc want to put on lean tissue not fat.
Term
Do you want CF pts to gain the weight in the ICU?
Definition
NO, want them to gain it at home once they feel better and are able to put on lean muscle and not just fat.
Term
What is given to CF pts in the ER?
Definition
elemental formulas, bc they dont need to be broken down by the pancreas.... these are EXPENSIVE!
Term
Is there any conclusive evidence that asthma can be improved by diet changes? (besides food allergies)
Definition
no
Term
Why is there weight loss with lung cancer?
Definition
due to N/V/D associated with treatments
can have swallowing dysfxn if the cancer is in the trachea
Term
What may help lung cancer pts get them through the lung cancer since they have no appetite and a change since of tasre due to chemo and surgery?
Definition
feeding tube.
-dont need it once the cancer is gone.
Term
What is obstructive sleep apnea mostly caused by?
Definition
excess weight, these pts need to lose weight
Term
Nearly ___________ Americans have at least one form of CVD
Definition
82.6 million
-HTN (76 million)
-CHD (16 million)
-Stroke (7 million)
-Heart failure (5.7 million)
Term
As defined by the AHA, metabolic syndrome is when you have 3 or more of the following..
Definition
Abdominal obesity
Men > 40”
Women > 35”
Triglyceride level of 150 mg/dL or greater
HDL cholesterol of less than 40 mg/dL in men or less than 50 mg/dL in women
Systolic blood pressure of 130 mm Hg or greater
Diastolic blood pressure of 85 mm Hg or greater
Fasting glucose of 100 mg/dL or greater
Insulin resistance or glucose intolerance
Term
What might insulin resistant pts have?
Definition
darkened lines around their neck
Term
What is the main cause of cardiac dz?
Definition
metabolic syndrome
Term
What kind of pts have a higher triglyceride and cholesterol levels?
Definition
pts with central obesity when the abd is fat
Term
Why are women expected to have a higher HDL level than men?
Definition
bc estrogen increases HDL in the bloodstream
Term
A high serum cholesterol level causes what?
Definition
CHD and mortality
Term
What are the desirable levels for total cholesterol, HDL, LDL, and triglycerides?
Definition
total cholesterol: <200
HDL: >45 women and >35 men
LDL: <100 and <70 with other risk factors
Triglycerides: <150
Term
What are 5 factors that modify LDL goals?
Definition
cigarette smoking

HTN (BP>140/90 or is on HTN meds)

Low HDL (<40 mg/dl)
-HDL >60 mg/dl

Family Hx of premature CHD:
-CHD in male 1st degree relative <55y
-CHD in female 1st degree relative <65y

Age
-Men >45y
-Women >55y
Term
Dietary cholesterol raises total cholesterol and LDL, but not as significantly as what?
Definition
SFA
TFA
Term
what is the threshold effect with dietary cholesterol?
Definition
as cholesterol intake is increased, a smaller increase in cholesterol levels are seen
Term
Dietary SFA and cholesterol have a __________ effect on LDL level.
Definition
synergistic
Term
What are the food sources of cholesterol?
Definition
meats, high-fat dairy products, eggs
Term
saturated fats and trans fats drive up LDL and TGs and drive down what?
Definition
HDL
Term
What is the goal for saturated fat intake?
Definition
<7% total calories
15 grams on 2000 calorie diet
Term
What is the goal for trans fat intake?
Definition
<1% total calories
2 g on 2000 calorie diet
Term
What is the goal for cholesterol intake?
Definition
<200 mg per day (for those who have CHD or LDL >100)
<300 mg per day for all others
Term
When is the risk reduction most effective?
Definition
when SFA and TFA are replaced with unsaturated fats, particularly omega-3 fatty acids
Term
What do omega 3's do?
Definition
drive up HDL
have less thrombotic and pro-inflammatory effects
Term
what are trans fats?
Definition
man made fat.. taste good and elongate the shelf life of food
-so prety much want to eliminate these from your diet
Term
The type of fat in meat from an animal on a corn fed diet is Omega 6s, which cause what?
Definition
more thrombotic and pro-inflammatory metabolites
Term
What are the 3 omega-3 fatty acids?
Definition
EPA
DHA
ALA
Term
What do EPA and DHA DO?
Definition
reduces TG levels
decreases platelet adhesion
favorably effects endothelial fxn
decreases vasoconstriction
reduces inflammation
decreased ventricular arrhythmias
Term
What does ALA do?
Definition
protects against CVD by interfering with the production of proinflammatory eicosanoids produced via the N-6 pathway
Term
Secondary prevention with omega-3 fatty acids is done when pt has many risk factors and need to do a little more than just eat fish, what is this prevention?
Definition
850-1000 mg of EPA and DHA
Term
what is primary prevention with omega-3 fatty acids?
Definition
2 or more servings (4 oz each) of oily fish/ week
inclusion of foods rich in ALA
Term
For high triglyceride levels, how much omega-3s should be taken?
Definition
2-4 grams EPA and DHA
Term
T or F: Omega-3 fatty acid diets should be supplemented under the care of physician
Definition
TRUE
-EPA and DHA enhance blood thinner effects, so PT and PTT need to be watched, don't want them to come in with a bleed.
Term
What are the sources of DHA/EPA?
Definition
Herring
Salmon
Tuna
Mackerel
Sardines
Trout
Term
What are the sources of ALA?
Definition
Walnuts
Walnut oil
Flaxseed & Flax oil (so small that can get through the body whole, so need to grind it up)
Soybeans & Soybean oil
Canola oil
Pumpkin seeds
Term
At the end of the day, still worried about weight gain so pt still needs to take their sources on omega-3 how?
Definition
in normal portions.
Term
FDA requires all manufacturer to list trans fat content on food label, what are the limitations on this?
Definition
if less than 1 serving of food has <.5 g they are allowed to round it down to 0... so they just list the servings as being smaller.

So must look at the ingredients, trans fats are anything with hydrogenated oil
Term
Trans fatty acids are produced by the hydrogenation of what?
Definition
liquid oils
Term
What are the food sources of trans fatty acids?
Definition
shortening, margarine, commercial frying fats, high fat baked goods.
Term
Trans fats are rigid and not smooth like natural fats... this is why a diet high in trans fats is associated with what?
Definition
an increased risk of cancer
Term
High fiber diets (>25 g) are associated with what?
Definition
decreased risk for CVD
Term
Soluble fiber has a greater LDL lowering potential than what?
Definition
insoluble fiber
Term
What should you aim for per day with fiber? soluble fiber?
Definition
fiber: 25-30 g/ day
soluble fiber: 7-13 g/ day
Term
Soluble fiber removes what from the diet?
Definition
cholesterol, forms a gel in the small bowel and those bile salts (made from cholesterol) become trapped in it.
Term
What are the sources of soluble fiber?
Definition
kidney beans: 6g
Oats: 4g
strawberries: 3.4 g
metamucil: 2.4 g
sweet potatoes: 2.8 g
apple: 3 g
Term
How many plant sterols and stanols do you need per day? what does this cause?
Definition
2-3 g
causes a 6-14% decrease in LDL and a 4-9% decrease in TG
can decrease fat-soluble vitamin absorption
Term
plant sterol displaces __________ in micelles.
Definition
cholesterol
Term
How should you replace food with sterol sources?
Definition
isocalorically
Term
What are the natural sources of plant sterols and stanols?
Definition
avocado, corn oil, soybeans, chickpeas, almonds, olive oil
Term
What are the natural sources of plant sterols and stanols?
Definition
avocado, corn oil, soybeans, chickpeas, almonds, olive oil
Term
What are you checking when you check cholesterol?
Definition
you're measuring the amt of cholesterol in micelles floating around in the bloodstream
Term
What are some commercially produced sterol and stanol product supplements? (they will be placed in a food that has fat in there bc they are a fat)
Definition
benecol
promise ACTIV
Smart balance omega peanut butter
minute maid premium heart wise orange juice
Term
What is NCEP?
Definition
National Cholesterol Education Program
-started in 1985, now with third report
focuses on hypercholesterolemia

Designed ATP III
-calls for more LDL lowering therapy
-focuses on primary prevention for those with multiple risk factors
-ATP III dietary recommendations: therapeutic lifestyle change (TLC) diet
Term
What is the nutrient composition of TLC?
Definition
Total kcals-->
saturated fat: <7%
PUFA: up to 10%
MUFA: up to 20%
total fat: 25-35%
CHO: 50-60%
fiber: 20-30 g/d
protein: approx 15% of total kcal
cholesterol: <200mg/d
total kcal: balance energy intake and expenditure to maintain desirable wt and or prevent wt gain

*vast majority of diet should come from CHOs
Term
what are some dietary approaches to stop HTN (DASH)?
Definition
Low sodium 1500mg/day

High potassium 4700mg/day

High fiber 30g/day

Total fat 27% calories

Saturated fat 6% calories

Cholesterol 150mg/day
Term
Excessive consumption of alcohol is associated with increased risk of what?
Definition
CHD
Term
Moderate levels of alcohol are associated with decreased risk of MI and CHD mortality, what is "moderate"?
Definition
1 glass/ day for women
2 glasses/ day for men
Term
Is supplementation of antioxidants and B-vitamins recommended for CVD prevention?
Definition
No, esp folic acid and antioxidant supplementation
-Vitamin E and C shouldn't be given
-vitamin k is usually contraindicated with the use of anticoagulants.
Term
Moderation is key with caffeine and risk for CVD, how should this be done?
Definition
1-2 cups of coffee
-best to use paper filter to reduce saturated fats
Term
When does leah worry about caffeine intake?
Definition
if in hospital for an arrhythmia or have caffeine sensitivity
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