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3 Nutrition in Cardiac Rehabilitation
3 Nutrition in Cardiac Rehabilitation Gene Erb, Jr, and Julie Pruitt CONTENTS Introduction 15 Dietary Intake and the Management of Heart Disease 16 Fruits and Vegetables 16 Dietary Fats 17 Dairy Products 19 Whole Grains and Starches 19 Additional Dietary Components 20 Alternative Dietary Patterns 21 Calories and Dietary Pattern 21 Suggested Meal Plans for Healthy Eating 22 Summary 23 References 23 INTRODUCTION Healthy nutrition plays an essential role in improving the cardiovascular risk profile following a cardiac event. Recognizing the impact that healthy dietary behaviors can have on recovery, the American Heart Association stated that “nutritional counseling should be provided to all participants in cardiac rehabilitation” (1). Research has shown that the combination of regular exercise and healthy nutrition together significantly slows the progression of coronary heart disease (2). Increasing fruit and vegetable intake and managing fat in the diet are also critical in the management of other heart disease risk factors such as hypertension, type 2 diabetes mellitus, and dyslipidemias of many varieties. National guidelines published by the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) (3) specifically require assessment of and targeted intervention on the nutrition status of all cardiac rehabilitation participants. The methods and tools used to achieve these requirements vary from program to program. The size of the program, additional state regulatory requirements, program resources, and other considerations will all influence the choice of tools and methods employed by each program. One element essential for all programs to include, regardless of size or From: Contemporary Cardiology: Cardiac Rehabilitation Edited by: W. E. Kraus and S. -
Differences in Renal Diet and Medical Symptom Knowledge in Diet Adherent and Diet Nonadherent Adult Hemodialysis Patients
DIFFERENCES IN RENAL DIET AND MEDICAL SYMPTOM KNOWLEDGE IN DIET ADHERENT AND DIET NONADHERENT ADULT HEMODIALYSIS PATIENTS A thesis submitted to the Kent State University College of Education, Health and Human Service in partial fulfillment of the requirements for the degree Master of Science in Nutrition and Dietetics By Kelsey Lynn Hagens May 2019 © Copyright, 2019 by Kelsey L. Hagens All Rights Reserved ii A thesis written by Kelsey Lynn Hagens B.S., Indiana University of Pennsylvania, 2017 M.S., Kent State University, 2019 Approved by ________________________, Director, Master’s Thesis Committee Natalie Caine-Bish ________________________, Member, Master’s Thesis Committee Eun-Jeong (Angie) Ha ________________________, Member, Master’s Thesis Committee Tanya Falcone Accepted by ________________________, Director, School of Health Sciences Ellen Glickman ________________________, Dean, College of Education, Health, and Human Services James C. Hannon iii HAGENS, KELSEY LYNN, M.S., May 2019 Nutrition and Dietetics THE EFFECT OF RENAL DIET AND RENAL SYMPTOM KNOWLEDGE ON DIETARY ADHERENCE IN ADULT HEMODIALYSIS PATIENTS Director of Thesis: Natalie Caine-Bish, Ph.D, R.D., L.D. pp 111 Most end stage renal disease patients utilize hemodialysis as a treatment to sustain kidney function. Hemodialysis requires adherence to a complex diet that restricts nutrients in order to reduce complications and improve quality of life. However, dietary nonadherence is extremely prevalent in this population with many etiologies considered. The purpose of this study was to determine if renal nutrition knowledge differed between patients who are adherent and nonadherent to a renal diet. Participants were adult hemodialysis patients with a diagnosis of end stage renal disease who completed a questionnaire that tested their knowledge of renal diet components and the medical complications associated with nonadherence. -
1.11 Diet Reference Guide
RENAL DIET The guidelines below have been developed as a quick reference to help you guide your patients in regards to any queries regarding their renal diet. Goals of the Renal Diet Help prevent nutritional deficiencies Help prevent fluid retention Keep blood level within normal limits, by controlling potassium, phosphorous and sodium intake Maintain and protect bone strength Maintain a healthy body weight 1) Protein Intake: An adequate protein intake is important for growth and repair of body tissues. It helps fight infections and prevents muscle loss. The amount of protein required depends on individual requirements and form of renal replacement therapy. Most protein foods are high in phosphate. During dialysis patients lose some of their good protein, Albumin. Here are some ideas to help boost protein intake while maintaining a normal phosphate level. Protein is found in plant and animal foods. The protein from animal origin is more readily absorbed by the body. The plant sources tend to be high in phosphate or potassium so the animal sources are better for the body. ANIMAL SOURCES PLANT SOURCES (limit) Red meat (lamb/beef) Lentils Chicken Beans Fish Dried peas Cottage Cheese Soya Egg white Peanuts Fish paste Peanut butter Tuna Try to include a low phosphate protein with 2 meals every day. Although dairy products like milk and cheese are good sources of protein, they are high in phosphate. One can include a ½ cup of milk or yoghurt + either 1 egg or a small amount of cheese in the diet daily. HIGH PROTEIN BOOSTERS Try and include 1 – 2 of these high protein boosters in the diet every week to help boost your Albumin level. -
Advanced Diet As Tolerated/Diet of Choice This Is for Communication Only
SVMC INTERPRETATION OF DIET ORDERS SVMC menu plans are developed using best evidenced based practice guidelines. The Clinical Diet Manual is the basis for our menu planning and patient education materials. Listed below is a brief summary of the menu plans provided by SVMC and any specifics that may differ from the Clinical Diet Manual. Our regular non select menu serves as the basis for all our menu plans and follows the Dietary Reference Intake (DRI’s/RDA’s) for our population of male 51-70 years old. Menus are designed to meet nutritional requirements specified by the 2011 update of the DRI’s from the Food and Nutrition Board, Institute of Medicine, National Academies of Science’s guidelines. This menu is then further modified to meet the specific needs of each patient based on diet order, nutritional status, food allergies, age, cultural preferences and food likes and dislikes. Current Dietary Reference Intakes recommend that Sodium intake remain less than 2300 mg per day. In order to meet their preferences and maintain intake, most diets that do not indicate a Sodium restriction will exceed this value. A sodium restriction should be ordered if needed. Due to limitations within our nutrient database (CBORD) we do not have values available to us for all nutrients. Currently our database is incomplete for: biotin, choline, chromium, molybdenum, fluoride, iodine, chloride, linoleic acid and alpha-linolenic acid and sometimes other micronutrients. Thin liquids are a default for all diets. Nectar, honey, pudding fluid consistency or fluid restriction needs to be ordered under “DIET CATEGORY”. If oral nutrition supplements (ONS) are ordered BID with meals, i.e. -
Diet and Lifestyle for Healthy Kidneys
Diet and Lifestyle for Healthy Kidneys Meyeon Park, MD MAS FASN UCSF PKD Center of Excellence Special thanks to Mary Ellen di Paola UCSF Registered Dietitian Osher Mini Med School October 16, 2019 Disclosures • Site PI for Kadmon, Reata, Sanofi‐Genzyme trials in PKD • Advisory board Otsuka Pharmaceuticals • Consultant for Abalone Bio • Spouse works for Merck Outline • What are the health outcomes we are trying to prevent with a healthy diet and lifestyle? • Brief overview of some common diets • General guidelines • Discussion Disclaimer • These are general recommendations that integrate data with common sense and should NOT take the place of a formal registered dietitian / medical evaluation • Nutrition science is an evolving field and I am a nephrologist – not a dietitian • Patients with clinical chronic kidney disease may have different requirements depending on disease severity Case 1 • 52 year old gentleman with high blood pressure, kidney stones, obesity (BMI 34), knee pain • This patient does NOT currently have kidney disease as assessed by blood or urine tests • He could be at risk for kidney disease due to high blood pressure, kidney stones, obesity, and risk of diabetes Case 1 diet • Coffee, bagel in the morning • Instant ramen noodles for lunch • Steak and potatoes for dinner • Eats out at restaurants frequently • Not sure how much water he drinks What are the health outcomes we’re trying to accomplish? • Prevent – Heart disease – Stroke – Kidney disease – Diabetes – High blood pressure – Obesity – All of these are intertwined -
CARDIAC DIET: How to Place an Order Your Physician Has Ordered a Cardiac Diet for You
Breakfast Entrees (please Choice 7) BREAKFAST Eggs: Scrambled - Egg Whites - Hard–Boiled eggs (2) Beverages Omelet: Egg - Egg White Coffee:Regular - Decaffeinated Choice of 4 Toppings: Red Onions - Broccoli - Spinach Tea: Regular - Decaffeinated - Chamomile Fresh Brewed Ice Tea Peppers - Mushroom - Turkey - Swiss Cheese Hot Chocolate: Sugar-Free Pancakes: Buttermilk - Blueberry - Banana Milk: Skim - Lactaid - Vanilla Soy French Toast: Plain - Blueberry - Banana Low Fat Chocolate Soda: Ginger-Ale - Diet Ginger - Ale - Seltzer Healthy Sandwich Option: Juice: Orange - Apple - Cranberry - Prune - V8 Egg Whites Condiments Fresh Turkey & Lacy Swiss on Whole Wheat Kaiser Roll Smart Balance - Grape Jelly –Strawberry Jelly - Diet Jelly - Lite Cream Cheese - Lemon Juice - Coffee Creamer - Syrup - pepper Breakfast Bakery-(please choose 1 item only) Herb Seasoning - Peanut Butter - Ketchup - Honey Muffins:Blueberry - Corn - Bran Honey Mustard - BBQ Sauce - Lite Mayo - Salsa Bagels: Plain - Sesame - Everything - Whole Wheat - Kaiser Roll Fruit Whole Fruit: Banana - Orange - Apple - Grapes Chilled Fruit: Peaches - Pears - Applesauce Mandarin Oranges - Fruit Salad - Seasonal Melon Yogurt Lite: Strawberry - Peach - Vanilla - Plain Cereal Hot: Oatmeal - Cinnamon Oatmeal - Cream of Wheat Cold: Corn Flakes - Cheerios - Rice Krispies Raisin Bran - Rice Chex *Breakfast Ends Daily at 10:00AM* Limited Items are available all day long. Scrambled Eggs, Omelets, Cereal and Bagels 1 LUNCH & DINNER ‘Shake It Up’ Salad Station Choice of (1)Lettuce: Romaine - Baby -
Mechanical Soft Cardiac Diet: Lunch: 11 AM - 1 PM This Diet Is Beneficial for the Treatment and Dinner: 4 - 5 PM Prevention of Heart Disease
Ordering About Your Diet Breakfast: 7 - 9 AM Mechanical Soft Cardiac Diet: Lunch: 11 AM - 1 PM This diet is beneficial for the treatment and Dinner: 4 - 5 PM prevention of heart disease. The diet is low fat, low cholesterol, low sodium and limits caffeine. When ordering, please dial extension 6255. After Fried, fatty and salty foods such as ham, bacon, placing your order, you can expect your meal to sausage, cream sauces, whole milk, whole milk arrive within 45 minutes. Please remember, the cheeses, salt and caffeinated beverages are nursing staff is available to assist you with menu limited. All ground meat will have either gravy or selections during your stay. sauce to keep it moist to ease the chewing and swallowing. Guest Meals Your 100% satisfaction is our number one goal. Lucas County Health Center offers guest meals for If, for any reason, our meal service does not meet Mechanical delivery to the patient rooms. Guests may order your expectations, please items from the patient menu at the following cost: call the Dietary Manager at Soft Cardiac extension 3206 and let us Breakfast: $3 Lunch: $5 Dinner: $5 know how we can better Diet serve you, our guest. Room Service Menu Each meal includes one entree selection (excluding breakfast) and the side dishes and/or dessert you would like to enjoy with your meal. When deciding what to have for your meal, The envelope with the price of the meal will be please make one placed on your guest tray for payment. entree selection from the Lunch & When ordering, please dial extension 3244. -
Acute Malnutrition
Jordan Guidelines for Management of Acute Malnutrition 2013 These Guidelines are based on international standards. However, some changes have been introduced to adapt them to Jordanian specific working conditions and environment. Protocols for the management of acute malnutrition followed in these guidelines have been endorsed by the Jordanian Ministry of Health in 2013. 1 Contents Jordan Guidelines for Management of Acute Malnutrition ................................................................. 1 List of Field Cards................................................................................................................................ 3 Using these guidelines ......................................................................................................................... 4 Introduction .......................................................................................................................................... 5 1 – Malnutrition: an overview. ............................................................................................................. 7 Components of Nutrition ................................................................................................................. 7 Causes of Malnutrition ..................................................................................................................... 8 Types of Malnutrition: Definitions ................................................................................................ 10 Acute malnutrition: types and classification -
Food and Nutrition: What Should You Eat If You Have Kidney Disease?
Food and Nutrition: What should you eat if you have kidney disease? Haewook Han, PHD, RD, CSR, LDN Harvard Vanguard Medical Associate Department of Nephrology Content Basics of Kidney What Should You Eat for Your Chronic Kidney Disease (CKD)? Is Herbal Supplement Beneficial or Harmful for CKD? Aristolochic acid Echinacea Basics of Kidney Maintain homeostatic balance Fluid Electrolytes Excretion of metabolic waste Urine Produce hormones Renin Erythropoietin Vitamin D Basics of Kidney Measurement of Kidney Function Glomerular Filtration Rate (GFR): GFR is measure of how well your kidneys filter blood Use estimated GFR called” eGFR”. Stages of Chronic Kidney Disease (CKD) 5 stages (1-5) Stage 3- 5 CKD Stages Stage Description eGFR 1 Kidney damage but normal 90 or more eGFR 2 Kidney damage with mild 60 - 89 decrease of eGFR 3 Kidney damage with 30 - 59 moderate decrease of eGFR 4 Kidney damage with severe 15 - 29 decrease of eGFR 5 Kidney failure: need renal Less than 15 replacement therapy CKD Risk Factors Diabetes Hypertension Family history of kidney failure Polycystic kidney disease (PKD) Cardiovascular disease Prolonged consumption of over the counter medication (i.e. ibuprofen) or herbal supplements (Aristolochic acid, Echinacea, Creatine, Chromium, Cat’s claw) What Should You Eat for Your CKD? Purpose To maintain good nutritional status Slow progression of CKD To treat complications Key Diet Components Controlling blood pressure: Low sodium intake Reducing protein intake if EXCESS Managing diabetes There -
FDA's Comprehensive, Multi-Year Nutrition Innovation Strategy 7/26/18
FDA’s Comprehensive, Multi-Year Nutrition Innovation Strategy 7/26/18 Page 1 FDA’s COMPREHENSIVE MULTI-YEAR NUTRITION INNOVATION STRATEGY Docket No. FDA-2018-N 2381 Thursday, July 26, 2018 Hilton Washington DC/Rockville Hotel 1750 Rockville Pike Rockville, Maryland 20852 Reported by: Natalia Thomas FDA’s Comprehensive, Multi-Year Nutrition Innovation Strategy 7/26/18 Page 2 A P P E A R A N C E S Kari Barrett Advisor for Strategic Communications and Public Engagement, Office of Foods and Veterinary Medicine, FDA Scott Gottlieb Commissioner, FDA Susan Mayne Director, Center for Food Safety and Applied Nutrition, FDA David Portalatin Vice President and Food Industry Advisor, The NPD Group Christopher Waldrop Senior Public Health Educator, Office of Analytics and Outreach, CFSAN, FDA Neal Hooker Professor of Food Policy, John Glenn College of public Affairs, Ohio State University Rob Post Senior Director, Health and Wellness/Corporate Affairs, Chobani Laura MacCleery Policy Director, Center for Science in the Public Interest Robin McKinnon Senior Advisor for Nutrition Policy, CFSAN, FDA Douglas Balentine Director, Office of Nutrition and Food Labeling, CFSAN, FDA Felicia Billingslea Director, Food Labeling and Standards Staff, Office of Nutrition and Food Labeling, CFSAN, FDA Steve Bradbard Director, Consumer Studies Branch, Office of Analytics and Outreach, CFSAN, FDA Blakeley Fitzpatrick Interdisciplinary Nutrition Scientist, Nutrition Assessment and Evaluation Team, Nutrition Programs Staff, Office of Nutrition and Food Labeling, CFSAN, FDA FDA’s Comprehensive, Multi-Year Nutrition Innovation Strategy 7/26/18 Page 3 C O N T E N T S SPEAKER PAGE Opening remarks 4 Scott Gottlieb 5 Susan Mayne 10 David Portalatin 13 Christopher Waldrop 35 Neal Hooker 35 Rob Post 41 Laura MacCleery 46 Open Public Comments 63 Robin McKinnon 121 FDA’s Comprehensive, Multi-Year Nutrition Innovation Strategy 7/26/18 Page 4 P R O C E E D I N G S MS. -
A Plant-Based Diet Prevents and Treats Chronic Kidney Disease
Review Article JOJ uro & nephron Volume 6 Issue 3 - January 2019 Copyright © All rights are reserved by Stewart D Rose DOI: 10.19080/JOJUN.2019.06.555687 A Plant-Based Diet Prevents and Treats Chronic Kidney Disease Stewart D Rose* and Amanda J Strombom Plant-based diets in Medicine, USA Submission: January 03, 2019; Published: January 23, 2019 *Corresponding author: Stewart D Rose , Plant-Based Diets in Medicine, 12819 SE 38th St, #427, Bellevue, WA 98006, Washington, USA. Abstract (CKD) is now the 8th leading cause of death in the United States and its treatment consumes substantial amounts of medical resources and money. Interest in the dietary treatment of chronic kidney disease has been growing as its incidence has been increasing. Chronic Kidney Disease increased risk among omnivores, especially those who eat red and processed meats. Although the practice started long ago, research on the use Several lines of epidemiological research have shown a lower risk of chronic kidney disease among vegetarians. It also shows a substantially vegetarianof a low-protein diet, oftenplant-based supplemented diet to treat with chronic keto analogues, kidney disease has been diet shownhas intensified to reduce in acidosis,recent years. phosphotemia, This research uremia, has shown proteinuria that a andlow-protein to slow progression.vegetarian diet Research is safe showsand efficacious that this treatmentat both treating does not and result slowing in malnutrition. the progression Research of chronic has also kidney shown disease. that larger Treatment amounts with of aplant low-protein protein preventing and treating common comorbidities such as type 2 diabetes and coronary artery disease. -
Cardiac Diet Menu
Cardiac Diet - Dining On Call Menu (All items in Bold Print require a choice.) Breakfast Beverages Entrées – (Your choice of 1 selection below) Water Pancakes: Blueberry Buttermilk Juice: Orange Apple Cranberry Prune Cinnamon French toast: Wheat White Milk: 1% Chocolate Soy Vanilla Build your own omelet Low Cholesterol Soy Chocolate Egg Whites Regular Iced Tea (decaf Unsweetened) Cheese: Swiss Cheddar Pepper Jack Decaf Coffee Vegetables: Spinach Onions Tomatoes Hot Tea: Black Decaf Decaf Chai Herbal Mushrooms Green Peppers Chocolate: Hot Cocoa (Your choice of 3 selections below) Sugar Free Hot Cocoa Sodas: Gingerale Diet Gingerale Scrambled Eggs: Low Cholesterol Lemon-lime Diet Lemon-Lime Egg Whites Regular Diet Caffeine Free Cola Turkey Bacon – slice (Limit 1) or Turkey Sausage link (Limit 1) Crystal Light: Lemon ♦Raspberry Ice Seasoned Breakfast Potatoes High Protein Nutritional Shake: Vanilla Chocolate Hot and Cold Cereals: Condiments Cream of Wheat® Oatmeal Grits Cheerios® Corn Flakes® Special K® Pepper Herb Seasoning Raisin Bran® Rice Krispies® Cinnamon Raisins Lemon Honey Toast Wheat Multigrain White Creamer Gluten Free Sweetener: White Sugar Brown Sugar Bagel (1/2): Wheat Plain Cinnamon Raisin Equal® Sucralose Equal® Saccharin Muffin: Blueberry Orange Cranberry Ketchup Mayonnaise (low-fat) English muffin Mustard Butter (limit 2) Sour Cream (low fat) Salsa Fresh Fruits : Banana Orange Grapes Cream Cheese (low fat) Pineapples Apple Peanut Butter Seasonal Fruit: Fresh Fruit Cup Strawberries Jelly: Grape Strawberry Diet Jelly Cantaloupe Honeydew Melon Soft Fruits : Peaches Pears Applesauce Crackers: Wheat Unsalted Graham Yogurt: Vanilla Strawberry Greek Plain Cardiac/ Heart Healthy Diet Information Fruit Parfait Your diet, like your medication, is an important part of your treatment and may speed your recovery.