DIET RELATED DISEASES

Medical Nutrition Therapy

Diet and CVD
CVD
 Cardiovascular Disease (CVD): Affect heart and blood
vessels.
 Myocardial infarction (MI): heart attack caused by
blockage of an artery leading to the heart.
 Atherosclerosis: a condition in which the arteries become
harden making the passage of blood become difficult.
 In this condition cholesterol, fats and other substances accumulate
overtime and form a deposit in the inner lining of the arteries that
is called plaque.
 plaque reduce the size of lumen and the blood flow
 Low blood flow reduce the supply of nutrient and oxygen and
cause ischemia in surrounded tissue.
 Thrombus is a blood clot that forms within narrow arteries.
 Risk factors for atherosclerosis
 Risk factors for the development of atherosclerosis:
 Major risk:
 Hyperlipidemia
 Saturated fat intake increase serum cholesterol
 Monounsaturated fat reduce serum cholesterol
 LDL a lipoprotein that carries cholesterol to the cells
 (high LDL contribute to atherosclerosis).
 HDL a lipoprotein that carries cholesterol from tissues to the liver for excretion
 (low HDL contribute to atherosclerosis).

 Hypertension
 Smoking.
 Other risks: obesity, diabetes, being a male, heredity, personality
(ability to handle stress), age, sedentary lifestyle.
 Dietary control can: alleviate hypertension, reduce obesity &
control diabetes.
 Exercise can: help lose weight, lower blood pressure and increase
HDL (good cholesterol).
 MNT for Hyperlipidemia
 Reduce the quantity and types of fat and total calories in
the diet.
 Weight loss can help reduce serum cholesterol levels
 Serum cholesterol levels:
 <200mg/dl desirable serum cholesterol level.
 200-239mg/dl  boarder line
 >240mg/dl  high
 Recommended dietary intake:
 <200mg of dietary cholesterol/day
 No more than 30% of calories from fat
 7% from saturated, 8% from polysaturated, 15% form monosaturated.
 50-55% of the calories from CHO
 12-20% of the calories form proteins
 Low-fat diet (Dietary changes)
 Low fat diet
 Low fat diet unpalatable: gradual changes is important for dietary
behavior maintenance (it take 2-3 months to adjust to a low-fat diet).
 Patient education should include learning about fat content in food,
low-fat cooking methods and high fiber intake.
 Limit food high in cholesterol like animal food and organ meats
 Limit saturated fat intake such as that found in animals, coconut oil, palm oil.
 Increase water-soluble fiber intake found in oats, legumes & fruits.
 25-35% of soluble-fiber intake per day reduce serum cholesterol by 15%.
 If limiting caloric intake to 1200 or less fat-soluble vitamins need to be
prescribed.
 Drugs
 are prescribed to lower cholesterol if after 6 months diet didn’t
lower the cholesterol levels
 Cholesterol lowering drugs such as Lipitor or Zocor
 Diet-drug interaction: avoid grapefruit intake when taking those drugs.
 Hypertension
 Hypertension: when blood pressure is chronically high.
 Blood pressure (systolic>140/diastolic >90 mm Hg)
 Hypertension (silent disease): can be asymptomatic and lead to heart attack,
stroke, heart failure & kidney failure.
 Factors that contribute to hypertension:
 Heredity, obesity, smoking, stress, excessive use of table salt.
 Excess sodium  edema  pressure on blood vessels.
 Therapy:
 Weight loss lower hypertension.
 Sodium restricted-diet with diuretic used to alleviate edema and treat hypertension.
 Limit sodium to less than 2400mg/day
 Increasing intake of high potassium fruits and vegetables (6-10 servings) help lower
blood pressure.
 Increase intake of Calcium and magnesium rich food (control blood pressure).
 Dash Diet: a therapeutics diet specifically developed to treat hypertension.
 Limits the intake of: sodium, cholesterol and saturated fat, red meat, and sugary food.
 Focus on the intake of: high in whole grains, fruits & vegetables & low fat dairy & nuts.
Diabetes Mellitus
Diabetes (to follow through) mellitus (honeyed)

 Is the name for a group of serious and chronic

disorders affecting the metabolism of carbohydrates.
 Hyperglycemia
 Is a major cause of death, blindness, heart and
kidney disease, amputations.
 Pancreas
 Insulin
 Glucagon
Symptoms
 The abnormal concentration of glucose in the blood draws water from the
cell to the blood.
 Glycosuria
 Glucose excreted in the urine. Occur when hyperglycemia exceeds the
renal threshold.
 Polyuria
 Excessive urination, due to loss of cellular fluids.
 Polydipsia
 Excessive thirst.
 Polyphagia
 Excessive appetite cause the break down of body fat and protein.
 Ketonemia (ketons in blood), Ketonuria (ketons in urine)
 Break down of fat (ketones = CO2 + H2O) = acidosis low pH
 Diabetic coma
 Muscle waste, weight loss, weakness, and fatigue.
Additional symptoms
 Vascular system
 Atherosclerosis

 Retinal degeneration
 Retinopathy

 Nerve damage
 Neuropathy
Etiology
 Nott confirmed, but may be
 Heredity
 Environmental
Classification
 Insulin-dependent diabetes mellitus (type I)
 Occur suddenly between ages 1 and 40
 Pancreas secrets little or no insulin
 Require insulin injection and carefully controlled diet.
 Non-insulin-dependent diabetes mellitus (type II)
 Occurs after age 40
 Gradual onset with gradual insulin diminish.
 Controlled by diet and exercise.
 Gestational diabetes
 Occur between the 16th and 20th week of pregnancy.
 May require insulin injection if not responsive to diet and exercise.
Normal blood glucose control
Type I Diabetes
TYPE II Diabetes
Treatment of Diabetes Mellitus
 Control blood sugar levels
 Provide optimal nourishment for the client.
 Prevent symptoms and thus delay the complications of
the disease.
 Treatment is typically begun when blood tests indicates
hyperglycemia or related symptoms occur.
 Normal blood glucose levels FBS
 70 – 110 mg/dl.
 Nutritional Management of DM
 Diets based on exchange system list and carbohydrates counting.
 Type I
 needs a nutritional plan that balances kcal and nutrient needs with insulin therapy and
exercise.
 Meals and snacks are composed of similar nutrients and kcal, eaten at regular times each day.
 Type II
 Weight loss and exercise.

 Carbohydrates
 50 – 60 %
 40 – 50 % complex (starch)
 10 – 20% simple (sugar)
 Fat
 30% of total kcal
 Protein
 15 – 20 % of total kcal
 Miscellaneous Concerns

 Fiber
 25 – 30 g/day
 Alternative sweeteners
 Sucralose (indigestible sugar) Aspartame (phynyl + aspartic acid)
 Diebetic foods
 Must be calculated in the total day’s diet.
 Alcohol
 Not recommended.
 Exercise
 Can complicate diet With type I.
 Insulin therapy
 Indogenous, insulin produce within the body
 Exogenous, is produced outside the body (injection)
 Insulin reaction
 Hypoglycemic episodes, taking insulin without eating.
 Treated with glucose tablets or sugary beverages or intravenous with dextrose if
patients is unconscious.
Kidney Stones
Kidney Stones
 Nephrolithiasis
 Stones develop in the kidneys.
 Symptoms
 Sometimes asymptomatic
 Hematuria (blood in urine).

 Infection

 Obstruction

 Intense pain with stone movements

Kidney Stones
 What cause stones?
 Metabolic disturbances
 Patient immobilization

 Stones classification (based on their composition)

 Calcium oxalate
 Uric acid
 Cystine (a nonessential amino acid)
 Magnesium ammonium phosphate (struvite)
Dietary Treatment of Renal Stones
 For all types:
 Drink plenty of fluids especially water.
 Eat a balanced diet.
 Calcium Oxalate Stones
 Most common type (~80%)
 Studies did not support A low calcium diet theory! And higher calcium intake
may decrease kidney stones.
 Avoid excessive intake of animal protein because it is a risk factor.
 Avoid diets rich in oxalate found in:
 Beets, wheat bran, chocolate, tea, strawberries, spinach.
 Uric Acid Stones
 Associated with:
 Gout.
 GI diseases that cause diarrhea.
 Malignant disease.
 Limit the intake of purine-rich foods found in:
 all meats, fish, and poultry, organ meats, broth, anchovies, sardines, meat extract.
 Purines are the end products of nucleicprotein metabolism.
 Dietary Treatment of Renal Stones
 Cystine Stones
 Cystine is an amino acid.
 These stones develop due to a hereditary metabolic disorder that
cause excess concentration of cystine in urine.
 Treated with increased fluids and alkaline-ash diet.
 Alkaline-ash diet:
 mainly consist of fruits, vegetables, and milk with little meat, fish, eggs,
cheese, and grains, that when catabolized leaves an alkaline residue to be
excreted in the urine.
 Limiting meat, poultry, cheese, and grains in order to make the urine more
alkaline (higher pH).
 Struvite Stones (magnesium ammonium phosphate)
 Called infection stones, develop following urinary tract infections.
 Treated with a low phosphorus diet focus on eliminating milk and
cola products.
Cancer
Causes of cancer!
 The etiology is unknown, it could be related to:
 Heredity

 Viruses linked to cancer:

 Epstein Barr, hepatitis B, & herpes simplex II.
 Environmental carcinogens
 Emotional stress (could contribute to the development
of disease)
 FOOD & Cancer
BAD:
 Cretin substance in food are considered carcinogens (cancer causing substances)

 Nitrtes in smoked food change to nitrosamines (carcinogen) during cooking. cause stomach &
esophagus cancers.
 High-fat diet  cause prostate, breast, uterus & colon cancers.
 Excess calorie cause gallbladder cancer.
 Smoking & alcohol cause mouth, pharynx, lung cancer.
 Malnutrition: poor protein intake  decrease immune system may lead to cancer.
GOOD:
 certain substances found in plants are considered Antioxidants (anticarcinogenic agents that
protect the cells from carcinogens).
 Vitamin C  protect against stomach & esophagus cancer.
 Vitamin A & Beta-carotene protect against lung, larynx & bladder cancer.
 Flavonoids, phenols & indules are antioxidants that protect against cancer found in fruits and
vegetables.
 High fiber diet protect against colorectal cancer.
 Legumes high in vitamins, minerals & fiber  protect against cancer.
 Effects of Cancer
 General effect:
 Unexplained weight loss as nutrients utilized for cancer cell growth and
increase metabolism.
 Mainly loss of muscle tissue, hypoalbuminemia (low protein in blood) that can lead
to anemia.
 Weakness
 Anorexia
 Abnormal sense of taste & smell mainly because of nutrient deficiency.
 Early satiety due to decrease digestive secretions.
 Abnormal insulin production (hyperglycemia)  delay stomach emptying
poor appetite.
 Specific effect:
 Depends on tumor site.
 Untreated cancer  anorexia & weight loss  malnutrition 
cacheixa (severe malnutrition and body wasting caused by chronic
disease) death.
 Cancer Treatment
 Medical treatment side effects:
 Surgical removal
 Can affect the organ function (e.g. removing part of the stomach
because of cancer affects digestion).
 Radiation
 Change smell & taste senses especially with head & neck cancers.
 Decrease salivary secreation & cause dry mouth (xerostomia) &
difficulty swallowing (dysphagia).
 Reduce the amount of absorptive tissue in small intestine
 Bowel obstruction or diarrhea.
 Chemotherapy
 Reduce small intestine ability to regenerate absorptive cells
hemorrhagic colitis
 Or combination (chemo+radiation)
 Decrease appetite, cause vomiting, nausea, diarrhea.
 Nutritional care for cancer patients
 High metabolic rate  due to higher energy and nutrient requirement than usual in non-
diseased state.
 Sufficient calorie & nutrient are important for survival.
 High protein/high calorie diet is prescribed during chemotherapy & radiation therapy
 Patient on high-protein & high-calorie diet better tolerate the side-effect of therapy.
 40-50Kcal/Kg body weight. &
 Well nourished 1-1.2g protein/Kg body weight.
 Malnourished 1.3-2g protein/Kg body weight.
 Multivitamin & minerals tablet.
 Carbohydrates & ft needed to spare proteins for building tissues & immune system.
 Drinking fluid important to help kidneys eliminate metabolic wastes.
 Anorexia: major problem in cancer patients (they develop food aversion because of
chemotherapy).
 Usually client improve nutritional status between chemotherapy sessions during recovery period.
 Favorite food prepared in familiar way & served attractively.
 Soft diet for those with chewing problems.
 Add sugar to fruit juices to overcome the bitter taste.
 Serve food covered and cold to reduce nausea.