Medical Nutrition Therapy in Cardiovascular Disease
Medical Nutrition Therapy in Cardiovascular Disease
Medical Nutrition Therapy in Cardiovascular Disease
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
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
Asupan yg dianjurkan
Total lemak
- Lemak jenuh (SAFA)
- Lemak PUFA
- Lemak MUFA
Karbohidrat
Serat
30 gr per hari
Protein
Kolesterol
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:
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
NUTRITION SUPPORT
Liquid supplement
Duodenal tube feeding
Parenteral nutrition
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