Role of diet in hypertension, anemia,
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Role of diet in hypertension, anemia,
- 1. Role of Diet in Hypertension, Anemia, Rickets, Osteomalacia Dr.Rittu Chandel Dr. Rittu Chandel,Grant Government Medical College, Mumbai 1
- 2. HYPERTENSION • Leading causes of global burden of disease • Approximately 7.6 million deaths a year and 92 million Disability Adjusted Life Years • Doubles the risk of Congestive Heart Failure, Cardiovascular Diseases, Stroke, Renal failure • Man is the only animal suffering from hypertension • INTERSALT study -1988 Dr.Rittu Chandel 2
- 3. HYPERTENSION • ↑ salt intake, simultaneous ↓ potassium intake Expansion of extracellular fluid • ↑ Cardiac Output Autoregulation - ↑ Peripheral resistance Dr.Rittu Chandel 3
- 4. BLOOD PRESSURE CLASSIFICATION Systolic mmHg Diastolic Normal <120 And <80 Pre Hypertension 120-139 Or 80-89 Hypertension Stage 1 140-159 Or 90-99 Hypertension Stage 2 ≥ 160 Or ≥ 100 Isolated Systolic Hypertension >140 mmHg And <90 Dr.Rittu Chandel 4
- 7. DASH DIET (DIETARY APPROACHES TO STOP HYPERTENSION) • DASH diet formed the basis for the new USDA MyPyramid • Also adopted by: • The National Heart, Lung, and Blood Institute • The American Heart Association • The 2005 Dietary Guidelines for Americans • US guidelines for treatment of high blood pressure Dr.Rittu Chandel 7
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- 9. DASH Diet DASH Diet – Dietary Approaches to Stop Hypertension – Promotes fruits, vegetables, whole grains and low fat dairy products – Adequate Calcium, Potassium, Magnesium – Low in red meat, sweets and sugar beverages DASH Reduces Homocysteine Levels Dr.Rittu Chandel 9
- 10. Magnesium • Evidence suggests an association between lower dietary magnesium intake and high blood pressure • Not enough evidence exists to justify a recommendation of increased Mg intake • vasodilator Calcium • American Heart Association Statement – Increasing calcium intake may preferentially lower blood pressure in salt-sensitive people – Benefits more evident with low initial calcium intakes (300-600 mg/day) Dr.Rittu Chandel 10
- 11. • • • • 1 tsp salt = 6 grams and contains about 2400 mg. of sodium (and 3600 mg. of chloride). Recommendation: everyone reduce daily sodium intake to 2400 mg. Those with high blood pressure get only a modest decrease at 2400 mg For significant results sodium to 1500 mg. a day. Dr.Rittu Chandel 11
- 13. POTASSIUM • POTASSIUM INTAKE IS CRITICAL. • A good balance between potassium & sodium is 3/1. • For 1500 mg. sodium one should aim for 4500 mg. potassium. • Clinical trials and meta-analyses indicate potassium (K) supplementation lowers BP • 2005 Dietary Guidelines 4.7 grams/day 9 - 10 servings of fruits and vegetables 1.Reduces peripheral vascular resistance by direct arteriolar dilatation 2.Increase loss of water and sodium from body 3.Suppression of renin angiotensin secretion Dr.Rittu Chandel 13
- 15. POTASSIUM • Potatoes • Soups with natural meat broth and veggies, tomatoes • Fish -- halibut, salmon, flounder, tuna are rich in K+ • International cuisines..lentil soups, chick peas, black beans • Fruits - berries, bananas, citrus, melons, grapes, raisins, apricots • Nuts - peanuts, almonds Dr.Rittu Chandel 15
- 16. Garlic its bioactive sulphur compound S-allyl cysteine sulphoxide (SACS) antihypertensive and cardioprotective activities Dr.Rittu Chandel 16
- 17. CHOCOLATE -Possibly Effective for Hypertension (Nat. Med.Database) Dark or milk chocolate 46-105 grams/day, -provides 213-500 mg of cocoa polyphenols, -modestly lowers systolic by 4.7 mmHg and -diastolic by 2.8 mmHg in normo- and hypertensive people. • Kuna Indians activation of nitric oxide and antioxidant and antiinflammatory effects After oral intake of cocoa, both the flavanol content and the total antioxidant capacity in plasma increase Dr.Rittu Chandel 17
- 18. • A 45-year-old woman • a 3-month history of generalized body pains that were nonresponsive to analgesic agents • low back pain, progressive difficulty in getting up from sitting and supine positions and in walking • no history of trauma or any medication intake • wears a black veil outdoors and is completely covered, with little exposure to the sun, even in her courtyard On examination • a waddling gait with painful movements of both thighs • serum calcium level = 8.4 mg per deciliter • phosphate level 1.5 mg per deciliter • alkaline phosphatase level 916 U per liter • the 25-hydroxyvitamin D level 9 nmol per liter (reference range, 18 to 100). Dr.Rittu Chandel 18
- 19. An anteroposterior radiograph of the pelvis showed an undisplaced transverse fracture of the shaft of both femurs . Dr.Rittu Chandel 19
- 21. Rickets and Osteomalacia Calcium Dairy products- milk, yogurt and cheese are all good sources of calcium. Pulses, nuts, dried fruit and green vegetables, such as spinach, provide calcium In the UK, white flour is fortified with calcium Vitamin D sunlight cod liver oil, egg yolks, butter and oily fish Dr.Rittu Chandel 21
- 22. • Chronic alcoholic are more predisposed to Vit D def • Chronic ingestion of ethanol deficiency • Stimulates hepatic Cyto P450 • Accelerated bio degradation of Vit D Dr.Rittu Chandel 22
- 24. Prevalance of anaemia Dr.Rittu Chandel 24
- 27. unprocessed whole foods fresh fruits and vegetables, unrefined grains, lean animal protein, legumes, nuts, seeds and beans The foods with the highest iron content, containing a minimum of 5 mg of iron per serving, are kidney beans, liver and beef, oysters, rice bran, raw beet , mustard Dried apricots, dates, cooked spinach, peas and lean meats are moderately high in iron 1.8 mg iron must be absorbed daily Dr.Rittu Chandel 27
- 28. • Cobalamin – fish, meat and dairy products • Folate – liver, spinach, nuts • Vitamin C - fruits and vegetables • It's best to combine vegetables with fish, as that combination is thought to produce a synergetic effect and maximize iron absorption. • In U.S., 20 mg iron added/lb of flour • Baked bread contains ~28 mg iron/kg • Equivalent to the iron content of beef • Iron cooking pots Dr.Rittu Chandel 28
- 29. • Plants are generally not good sources because of oxalate, phytate, tannins • Other -carbonates, phosphates • - tea (reduces absorption by 50%) • - EDTA ( food preservative – reduces absorption by 50%) • - egg yolk ( phosvitin) • Spinach has a lot of iron, but has ~780 mg oxalate/100 g Heme iron absorption from diet not affected by ascorbate or phytate Dr.Rittu Chandel 29
Notas del editor
- man
- Chocolate is loaded with saturated fat and is bad for cholesterol. Fact:Stearic acid, the main saturated fat found in milk chocolate, is unique. It doesn’t raise cholesterol levels like other types ofsaturated fats. In fact, eating a 1.4 ounce chocolate bar instead of a carbohydrate-rich snack has been shown to increase HDL (good) cholesterol levels.
- Because of human milk contains only a small amount of vitamin D, the American Academy of Pediatrics (AAP) recommends that all breast-fed infants receive 400 IU of oral vitamin D daily beginning during the first two months of life and continuing until the daily consumption of vitamin D-fortified formula or milk is two to three glasses, or 500 mL.