MNT 1: CVD & LGP Exam

What are the steps of the Renin Angiotensin System (RAS)?

1. Renin release from kidney

2. Renin converts angiotensin to angiotensin I

3. ACE releases from lungs, converts angiotensin I to form angiotensin II (constrictor)

4. Angiotensin II acts on adrenal gland to stimulate release of aldosterone

5. Aldosterone acts on kidney to stimulate reabsorption of salt and water

6. Blood pressure raises

What are two important functions of the cardiovascular system

blood flow and thermoregulation

systole vs diastole

systole (contraction) and diastole (relaxation)

What is the formula for blood pressure (BP)?

BP = Cardiac Output (CO) x Peripheral Vascular Resistance (PVR).

increase of PVR = increase of blood pressure

How is cardiac output (CO) calculated?

CO = Stroke Volume (SV) x Heart Rate (HR).

Blood pressure ranges

Normal 120/90

Elevated 120-129/ <80

Stage 1 130-139/ 80-89

Stage 2 140/ 90+

What are the dietary modifications recommended for hypertension?

DASH diet, low sodium diet, reduce calories, physical activity, and moderate alcohol intake.

detailed DASH diet

· 7-8 servings grain

· 4-5 veggies

· 4-5 fruit

· 2-3 dairy

· 2-3 lean meat

· 4-5 nuts, seeds

· 2-3 fats and oils

sodium limits

HTN <1500 mg/d

no HTN <2400 mg/d

What is primary vs secondary hypertension?

Primary hypertension has no identifiable cause.

Secondary is related to a case

What is atherosclerosis?

Atherosclerosis is the thickening and narrowing of arterial walls caused by inflammation and plaque accumulation. due to damage of endothelial cells

What are the consequences of atherosclerosis?

It can lead to myocardial infarction (MI), cerebrovascular accident (CVA), coronary heart disease (CHD), peripheral vascular disease (PVD), and heart failure (HF).

What is the role of HDL and LDL in cardiovascular health?

HDL carries fat away from the heart and is protective, while LDL carries fat to the heart and can contribute to heart disease.

HDL-carry fat away from heart > 60mg/dl- protective, 40-59 mg/dl- normal

LDL- carry fat to heart- Optimal is <100 mg/dl

What is the definition of heart failure?

Heart failure is the impairment of the ventricles' capacity to eject blood or fill with blood.

coronary heart disease

angina, MI, sudden death

cerebral heart disease

CVA and TIA

procedures for atherosclerosis

PCI percutaneous coronary intervention- balloon inflated to break up plaque

Coronary stent- tube that holds artery open

CABG Coronary artery bypass graft- artery from chest is used to redirect blood flow around diseased vessel

How fats affect lipid panel

Pro inflammatory- omega 6, vasoconstriction

- Seed oils

- Linoleic acid

Anti-inflammatory-omega 3, vasodilation

- Linolenic acid

Cause of HF in woman

Hypertension is the most common cause of heart failure in women.

Cause of HF in males

ischemic heart disease

What are the stages of heart failure?

Stage A: high risk but no structural abnormalities

Stage B: structural abnormalities but no symptoms

Stage C: past/current symptoms with structural abnormality

Stage D: end-stage disease.

What is the dietary recommendation for patients with heart failure?

Low sodium intake and sometimes fluid restriction, especially when hyponatremic.

What are the sodium labeling definitions?

o Sodium FREE- <5mg

o VERY LOW sodium- 35mg or less

o REDUCED sodium- 140 mg or less

o LIGHT in sodium- at least 50% less sodium than regular

o NO ADDED salt- no added salt in process

Medication treatment of heart failure

Loop diuretics- hypokalemia/hypomagnesemia

o Thiamine deficiency

o Can waste electrolytes

o Excretes thiamin and magnesium

· ACE/beta blockers- decreased zinc

Fluid balance to heal heart failure

35 ml/kg of fluid

Restrict fluid to 1000-1500 ml/day when sodium <130mEg/L

nutrition therapy for heart failure

Sodium and fluid intake, early satiety, drug-nutrient reactions

30-35 kcals/kg energy

1.5 g/kg protein

what're the livers main functions

-storage/metabolism of carbs, pro, fat

-cholesterol synthesis

-storage/breakdown of glycogen

- bile acid metabolism ( aids in cholesterol formation)

-vitamin metabolism (D, B1, B3, B6, B12, folate)

labs used for liver function and kidney

ALT, AST, ALP, GGT

types of hepatitis

A- fecal oral route, 95% recover

B- blood, semen, saliva, 90% recover

C- blood or body fluids, cirrhosis, 15-30% recover

nutrition therapy for hepatitis

1- maintain good nutrition intake (increase calories)

2- small frequent meals(due to N/V/D)

3. diet same as healthy individuals

4. avoid alcohol

3 forms of alcoholic liver disease

1 hepatic steatosis (fatty liver disease)

2 alcoholic hepatitis

3 cirrhosis

alcohol metabolism

-Alcohol converted to acetaldehyde by alcohol dehydrogenase (ADH), creating a toxin

high NADH + H+ :NAD + ratio

low fatty acid breakdown

increase uptake of fatty acids

increase hepatic lipogensis

lactic acidosis

- all make cells starved of O2

alcohol and vitamin deficiencies

folate and thiamine

-hinders absorptions

stage 1- fatty liver disease (steatosis)

increase fat metabolism

increase synthesis of fatty acids

decreased fatty acid oxidation

increase TG

- can be reversed with abstinence of alcohol

stage 2- alcoholic hepatitis

N/V/D

elevated LFTs

low serum albumin

- may be reversed with abstinence of alcohol

stage 3- cirrhosis of liver

irreversible

destruction of normal hepatic structure

complications- portal HTN, ascites, jaundice

ascites

abnormal accumulation of fluid in the abdomen

treated with paracentesis

hepatorenal syndrome

renal failure-- secondary to end stage liver failure

- low blood flow

- high BUN

- low urine output

- low GFR

Hepatic encephalopathy

- liver can no longer metabolize amino acids properly

- hyperammonia- lead to cerebral toxin

- lower serum BCAA relative to AAA, compete at blood brain barriers and leads to higher AAA in brain

- higher BCAA and AAA decrease ammonia

-lactulose and neomycin-decrease bacteria that produces ammonia

Hepatic encephalopathy treatment (energy needs)

30-35 kcal/kg

fluid restriction

Hepatic encephalopathy treatment

Rx: main treatment- lactulose, neomycin

low protein, safety, rest

30-35 kcal/kg

fluid restriction

complications of cirrhosis

portal hypertension- high resistance to blood flow

varices- stretches

jaundice- yellow coloring

What is the most common cause of acute pancreatitis

Alcohol abuse

Recommendation for patient with cirrhosis due to fluid retention

Low sodium, <2000 mg

In hepatic encephalopathy what amino acids increase

Aromatic amino acids

Medical therapy for encephalopathy

Lactose and neomycin

Nutrition therapy for hepatic encephalopathy

Increase BCAAs

What are the endocrine functions of the pancreas

pancreatic islets produce hormones insulin and glucagon

- glycemic control

What are the exocrine functions of the pancreas?

Acinar cells secretes bicarbonate and digestive enzymes

Acute pancreatitis

Sudden inflammation of the pancreas.

Acute pancreatitis causes

Gallstones, alcohol (most common), ERCP, trauma, druga

Acute pancreatitis MNT

Initially NPO, progress to TPN after 1 week

- enteral support with MCT

- 25-35 kcal

- 1.2-1.5 pro

Fat with acute and chronic pancreatitis

Moderate fat WITH pancreatic enzymes

Low fat WITHOUT pancreatic enzymes

Chronic pancreatitis

Irreversible progressive destruction of the pancreas

Chronic pancreatitis symptoms

Scarring (varices)

Poor absorption

Low glycemic control

Chronic pancreatitis MNT

MCT

-30-35 kcal

-1.2-1.5 pro

Gallbladder anatomy

Storage bile, emulsify fat, removal of H2Oand inorganic electrolytes for bile

cholelithiasis

Gallstones

Inorganic compounds leftover or forming together (billary sludge or statis)

-cholesterol, pigment, mixed stones

-cholecystectomy and then clear liquid diet until regular

Gallstones causes

Too much absorption of water

Too much absorption of bile acids

Too much cholesterol

Inflammation of epithelium

Biliary obstruction

Gallstone blocks bile duct

colecystitis

Inflammation of gallbladder

Cholangitis

inflammation of the bile ducts

-life threatening

lab markers related to pancreatitis

amylase and lipase

what results in increased portal pressure caused by cirrhosis

ascites

chronic pancreatitis can lead to

diabetes due to insulin resistance

production vs storage of bile

production in the liver

storage in the gallbladder

cholelithiasis nutrition intervention

low fat, modest protein

small frequent meals

diet after cholecystectomy

high fiber

no low fat diet-liver compensates

clear liquids until regular diet tolerated