NS 210: Seminar 8 Nutritional Assessment in Disease Prevention

1. NS 210: Seminar 8Nutritional Assessment in Disease Prevention

2. How was everyone's week?

3. Overview • The prominent role of diet and nutritional status ins several leading causes of death for North Americans give nutritional assessment an important role to play in disease prevention • Risk factors of Coronary Heart Disease • Leading cause of death for North Americans • Are related to diet • Elevated serum total and LDL cholesterol • Hypertension • Diabetes

4. Ok Jeopardy Time Coronary Heart Disease (CHD) is causally associated with several risk factors What are these Risk Factors?

5. Coronary Heart Disease • Coronary Heart Disease (CHD) • Leading cause of death in the US despite >26% decline in CHD death rates since 1988 • Associated with several risk factors • Elevated blood cholesterol • High blood pressure • Cigarette smoking

6. I will take HDL for 100 Alex • What number do we want our High Density Lipid (HDL) level to be to help prevent onset on CHD?

7. Coronary Heart Disease (CHD) Risk Factors • Risk factors for CHD • Positive risk factors • Cigarette smoking • Hypertension (blood pressure >140/90) • Low HDL cholesterol <40 • Goals • Women >55 • Men > 45 • Family history of premature CHD • Age (men >45 yo, women >55 yo) • Negative Risk Factors • HDL Cholesterol >60

8. Heart Attack Warning Signs • Heart attack warning signs • Chest discomfort • Discomfort in other areas of the upper body • Arm, back, neck, jaw • Shortens of breath • Other signs • Cold sweat, nausea, lightheadedness

9. Alex, I will take Cholesterol Levels for 100 • Having a cholesterol level of >200 is a good or bad thing?

10. CHD Risk – Elevated Cholesterol • CHD risk is directly related to serum levels of total cholesterol and LDL cholesterol • CHD risk is inversely related to levels of high HDL cholesterol • National Cholesterol Education Program (NCEP) desirable levels of total cholesterol in adults • <200mg/dL

11. Atherosclerosis

12. How is CHD Diagnosed? • Dr. will diagnosis CHD based on: • Your medical and family history • Risk factors • Results of a physical exam and diagnostic test procedures • EKG (Electrocardiogram) • Stress Testing • Echocardiography • Chest X-Ray • Blood tests • Electron-Beam Computed Technology • Coronary Angiography and Cardiac Catheterization

13. Ways to Help Treat CHD for 600 Hundred • DAILY DOUBLE!!! • What are some way to help treat CHD?

14. How is CHD Treated? • Lifestyle Changes • Reduce high blood pressure • Reduce high cholesterol • Follow a Heart Healthy Eating Plan • Therapeutic Lifestyle Changes • DASH Diet • Increased Physical Activity • Maintain a Healthy Weight • Smoking Cessation • Stress Reduction • Medications • Cardiac Rehab

15. Addressing High Cholesterol • Two ways of addressing high cholesterol levels • Population based approach • Patient based approach • Population based approach • Emphasizes dietary and lifestyle changes for people to lower cholesterol levels in the entire population • Patient based approach • Identification and treatment of individuals with elevated cholesterol levels by physicians

16. Dietary Factorsand Cholesterol • Factors that can influence cholesterol and lipoprotein levels • Saturated fats • Raise LDL cholesterol • Unsaturated Fats • Polyunsaturated Fats • Lower LDL and HDL • Monounsaturated Fats • Lower LDL • Maintain HDL cholesterol

17. CHD and Hypertension • Hypertension is one of the most common risk factors for cardiovascular disease and renal disease • 1 in 4 Americans has hypertension or is taking antihypertensive medications • Systolic >120mm HG and diastolic >80mmg HG increases risk for cardiovascular disease • Most important risk factors for hypertension • Sodium intake • Excessive energy consumption • Physical inactivity • ETOH consumption • Inadequate potassium intake

18. Nutrition Assessment in Disease Prevention: Osteoporosis • Osteoporosis • Bone mineral content is decrease • Resulting in great susceptibility to fracture • Common fracture sites - pelvis vertebrae, hip, distal forearm, humorous • Peak bone mass • Varies considerably among individuals because of • Heredity • Sex • Race • Environmental factors

19. Nutritional Assessment in Disease Prevention • Osteoporosis • Cost • In 2005 • Osteoporosis-related fractures were responsible for an estimated $19 billion in costs • By 2025 • Experts predict that these costs will rise to approximately $25.3 billion http://www.nof.org/osteoporosis/diseasefacts.htm#gender

20. EER • Adult males: EER=662 (9.53*AGE)+PA*(15.91*WT+539.6*HT) • • Adult females: EER=354-(6.91*AGE)+PA*(9.36*WT+726*HT)

21. CASE STUDY • Male: • 6’0 • 198# • Activity: low activity • 56

22. Weight in Kg • Height in Meters • PA= for activity level

23. Prevention http://www.girlshealth.gov/bones/

24. Bone Densitometry • Bone densitometry • The measurement of bone mineral content • Important in early detection and treatment of osteoporosis and monitoring progression and response to treatment • Dual-energy X-Ray Absorptiometry (DXA) is the most widely used technology for determining bone mineral density • Quantitative Ultrasongoraphy (QUS) • Identify those persons likely to benefit from DXA testing

25. Unit 8 Project Section • Discuss your clients risk of Coronary Heart Disease • Compare your clients current diet to the Nutrient Composition of the Therapeutic Lifestyle Change diet Use the MEDFICTS dietary assessment questionnaire (appendix E)

26. Questions