Medical nutrition therapy

in Cardiovascular Disease
Imelda Pardede
Bagian Gizi Medik
Fakultas Kedokteran UNRI

CVD
leading cause of death:
- western countries
- developing countries
Indonesia:
SKRT 1972 peringkat ke-11
SKRT 1986 peringkat ke-3
SKRT 1995 peringkat ke-1

Most prevalent CVDs:

CAD or CHD
HHD
CHF

Coronary Artery Disease

CVD pd usia produktif CAD
CAD penyakit jantung iskemik
iskemia terjadi t.u. akibat aterosklerosis

Faktor risiko
- Dapat dimodifikasi
- Tidak dapat dimodifikasi

Patofisiologi
Aterosklerosis A. koronaria manifestasi
klinis penyakit jantung iskemik: angina pektoris
& infark miokard
Inisiasi aterosklerosis fatty streak
hasil interaksi:
modifikasi oksidatif LDL
&
mediator inflamasi

Penatalaksanaan Nutrisi
Dislipidemia faktor utama penentu
risiko
kadar k-LDL tiang utama
penatalaksanaan dislipidemia
tujuan: mencapai kadar k-LDL sasaran
(sesuai kelompok risiko penderita) &
mencegah kejadian PJK

NCEP/ATP III:
- non farmakologis TLC
- terapi farmakologis

TLC: - terapi nutrisi medis

- peningkatan pola aktivitas fisik
- menghindari rokok
- penurunan berat badan
- pembatasan asupan alkohol

Komposisi makanan yg dianjurkan untuk

hiperkolesterolemia
Makanan

Asupan yg dianjurkan

Total lemak
- Lemak jenuh (SAFA)
- Lemak PUFA
- Lemak MUFA

20 25% dari kalori total

<7% kalori total
Sampai 10% dari kalori total
Sampai 10% dari kalori total

Karbohidrat

60% dari kalori total (terutama

karbohidrat kompleks)

Serat

30 gr per hari

Protein

Sekitar 15% dari kalori total

Kolesterol

<200 mg per hari

Hypertensive Heart Disease

Hypertension common PH problem in
developed countries
Untreated
Degenerative diseases:
CHF
PVD
ESRD

Hypertension:
- Definition
- Classification
- Treatment

Excessive
Na
consumption

Overweight

Elevated systolic
& or
diastolic BP

Stress

Low
K, Mg, Ca
intakes

Physical
inactivity

Excessive
alcohol
consumption

Elevated systolic
& or
diastolic BP

DIAGNOSIS
SBP:
DBP:

TARGET ORGAN DISEASE

Cardiac
Cerebrovascular
Peripheral
Renal
Retinopathy

Elevated systolic
& or
diastolic BP

MEDICAL MANAGEMENT
ANTIHYPERTENSIVE
DRUG TH/
Diuretics
Beta blockers
Vasodilators
ACE Inhibitors
Ca channel blockers

LIFESTYLE
MODIFICATION
Exercise
Stress reduction
Lifestyle counseling

NUTRITIONAL MANAGEMENT

Weight management
Na restriction
Alcohol restriction
Improved mineral intake
Nutrition education

Heart Failure
CHF
Impairment of LV function
Inadequate blood flow
Symptoms

Disease
Of
The heart

Left
Ventricular
Systolic
dysfunction

RISK FACTORS:
Hypertension
LVH
CHD
Valvular disease

CONGESTIVE
HEART FAILURE

CLASSIFICATION
Class I
Class II
Class III
Class IV

SYMPTOMS:
Fatigue
Shortness of breath
Congestion
Altered fluid balance
Cardiac cachexia

CONGESTIVE
HEART FAILURE

MEDICAL MANAGEMENT

NUTRITIONAL MANAGEMENT

FLUID RESTRICTION
DRUG THERAPY:
ACE Inhibitor
Diuretics
Digitalis
Vasodilators
Beta-blockers

Sodium restricted diets

Adequate energy & protein intake
Small frequent meal

NUTRITION SUPPORT
Liquid supplement
Duodenal tube feeding
Parenteral nutrition

Nutritional status assessment

- BW
- Lean body mass: calf & thigh circ.
Energy requirement
current BW
obese: LCD
malnourished: 30 50% above BME
35 kcal/kg BW

Sodium restricted diets:

1. No-added-salt diet
3g (131 mEq) of Na/day
high Na foods are limited
< tbs table salt p.o/day
2. Mild sodium restriction
2g (87 mEq) of Na/day
high sodium foods are eliminated
moderate sodium foods are limited
< tbs table salt p.o/day

3. Moderate sodium restriction

1g (43 mEq) of Na/day
high & moderate Na foods are eliminated
table salt is not allowed
canned processed foods are omitted
baked foods are limited

4. Strict sodium restriction

500mg (22 mEq) of Na/day
high & moderate Na foods are eliminated
table salt is not allowed
canned processed foods are omitted

Sodium labeling (FDA)

Sodium free: <5mg Na/serving
Very Low sodium: <35mg
Na/serving
Low sodium: <140mg Na/serving

Fluid
intake limited to 500 2000 cc/day
balance fluid status
Urine specific gravity
Serum electrolyte
Clinical oedema
Small-frequent meal: 5 6x daily

References
Krauses Food, Nutrition & Diet
Therapy, 11th ed. Saunders, 2004
Hursts Manual of Cardiology, 11th
ed. McGraw-Hill, 2005