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Principles of nutrition see again

Alcohol

It is shown that alcohol consumption greater than 30 g pure alcohol / day leads to an increase in blood pressure 3 mm Hg. It is therefore recommended to avoid alcohol or they do not exceed 30 g alcohol / day halved the value of women or weak men [14.15].


Other dietary factors

Potassium - its contribution in the diet is inversely proportional to the amount of blood. As the amount of potassium consumed is higher, so the value is lower blood pressure. There are studies showing that doubling the amount of potassium in the diet decreases between 3-5 mm Hg diastolic pressure, thus lowering the risk of stroke [16].
The mechanisms by which potassium acts are:
- Reduces peripheral vascular resistance (by direct vasodilation);
- Favor the elimination of body water and Na;
- Inhibiting the renin-angiotensin system;
- Decreases the adrenergic tone.
Increased intake of K can be achieved by increasing consumption of fruits and green vegetables.

Principles of nutrition new

Vitamins

The pathogenesis of atherosclerosis, LDL are involved in plaque buildup. The oxidation of LDL stimulates monocytes to vascular endothelium favoring their accession. The oxidized LDL is cytotoxic and vascular cells, stimulating the release of lysosomal enzymes into the extracellular space. Normally, vascular endothelium prevents joining leukocytes, platelets and the vascular spasm by releasing a nitric oxide derivative called. Oxidation of LDL cholesterol prevents the release of nitric oxide in normal arteries.
There have been numerous studies to determine whether administration of antioxidants to block oxidation of LDL cholesterol consequent evolution can prevent atherosclerosis. The conclusion reached is that some antioxidants may limit the clinical expression of atherosclerosis by stabilizing the atheroma plaque and not by preventing the formation of new plates. This product antioxidants increase resistance and prevent LDL cholesterol from oxidation of nitric oxide reduction. Of these the most important antioxidants are vitamin E, vitamin C, vitamin A.
Vitamin E is the most powerful natural antioxidant, protecting cell membranes and lipoproteins, thereby preventing cancer and cardiovascular diseases. The main sources are the vegetable oils and its action is potentiated by the presence of vitamin C. The recommended daily intake is 12 mg.
Vitamin C is also a powerful antioxidant and an immune stimulator. The recommended daily dose is 60 mg / day. In smokers indicated a daily intake greater than 20-40 mg. The main sources are the raw vegetables (citrus, kiwi, parsley, cranberries, etc..) Vitamin C enhances the action of vitamin E, protects the vascular membranes, participates in regulation of lipid exchange processes, reduce serum cholesterol, increases the activity lipoproteineinlipazei (reducing trigliceridemia) has anticancer action.
Provitamin A (carotenoids) in addition to blocking the action of oxidation of LDL cholesterol has a strong action and photoprotection. The main sources are fruits and vegetables. In high doses, vitamin A promotes peroxidation and thus atherogenesis. It is recommended therefore that the contribution to be made from natural sources to prevent overdosing.
Vitamin PP influenteza both cholesterol metabolism, and that of triglycerides. It may reduce cholesterol by decreasing its hepatic synthesis, also reduce the conversion of very low density lipoproteins to low density lipoprotein.
Supplementing the diet with antioxidant large scale is not currently possible and probably is not indicated. It prefers instead use natural antioxidant-rich foods (fruits, green vegetables).


Minerals

Zinc is a potent antioxidant and immunostimulant. Inhibit lipid peroxidation, reduces production of hydroxyl radical (OH). Recommended daily intake is 8-12 mg. The main sources are shellfish, seafood and meat.
Selenium is part of the structure of several antioxidant enzymes. Recommended daily intake is 70 mg / day.
Magnesium prevents lipid peroxidation. Recommended daily intake is 400 mg. The main sources are chocolate, cereals, dried fruit.
Calcium, at a dose of 1.2 grams / day serves lipid lowering it decreases by 4.4% LDL-Ch-Ch and HDL increases of 4.1% [12].

Principles of nutrition 2

Lipids

Should represent 30% of daily caloric intake, a healthy diet requiring a percentage of 10% is represented by saturated fatty acids, polyunsaturated fatty acids 10% and 10% monounsaturated fatty acids.

Saturated fatty acids (SFA) - increase serum cholesterol with all its subfractiunile. Most of them are atherogenic myristic acid, lauric acid and palmitic acid.
Myristic acid is found in large quantities in butter, coconut and palm oil, lauric acid found in palm oil and coconut while palmitic acid is generally found in animal products. Their excessive consumption is correlated with progression of atherosclerosis. In people who have restricted products rich in saturated fatty acids, there was stabilization of atherosclerosis lesions.

Polyunsaturated fatty acids (PUFA) - are divided into omega 6 and omega 3.

Omega-6 PUFA is mainly represented by linoleic acid. Major source of these acids found in vegetable oils (corn oil, sunflower, peanut, walnut). Increased intake of omega-6 PUFA in the diet lowers LDL cholesterol and increase HDL cholesterol. Still to lower cholesterol, eliminate SFA is two times more effective than increasing intake of omega-6 PUFA [5].
Omega-3 polyunsaturated fatty acids represented mainly eicosapentaenoic and docosahexaenoic acid, found in large quantities in oily fish, blue fish, mackerel, herring, sardines. It seems that they have remarkable properties antiatherogenous, not only by acting on total serum cholesterol, but the level of triglycerides. Their effect is both dose dependent (with both source and thus is more concentrated dose is higher, so the effect is stronger), and type of dyslipidemia (greater effect in type IIb, III, IV, V) in which increased triglyceride levels. Omega-3 fatty acids also occur in other parts of the process of atherosclerosis. They are precursors of prostaglandins involved in blood clotting, which is highlighted in populations with high consumption of omega 3 (and therefore with a lower incidence of cardiovascular diseases), such as the Eskimo population, which has an increased bleeding.
As a conclusion, recommends an omega-3 fatty acid consumption of about 1.5 ounces per week (corresponding to consumption of foods rich in these acids 2-3 times per week).

Monounsaturated fatty acids - are divided into two forms: cis form and trans form.
Form cis-monounsaturated fatty acids (MUFA) - represented mainly oleic acid. They are found mainly in olive oil, peanut, partially hydrogenated soybean. A MUFA-rich diet lowers serum cholesterol and triglycerides, HDL cholesterol effect depends on the total fat content of that diet. When fat and MUFA intake is high (if the Mediterranean diet), HDL cholesterol did not change or increase slightly. If a diet low in fat (less than 30% fat), HDL cholesterol decreases. However, although a diet rich in MUFA can be effective in lowering cholesterol, it should be used with caution because the high caloric density of lipids, which may cause weight gain (it should be noted that the Mediterranean diet is rich in fruits and vegetables).

Trans monounsaturated fatty acids as occur in the hydrogenation process, widely used in food industry to solidify vegetable oils (eg margarine). As margarine is consistently louder even as the percentage of trans fatty acids is higher. Trans fatty acids are also found in commercial baked goods (especially cookies), in animal products and in smaller amounts in butter and milk fat.
Although in the early '60s is considered as saturated fatty acids increase serum cholesterol in a greater extent than trans fatty acids, thus recommending against consumption of margarine in butter, more recent studies (Katana & Mensink 1995) [6] have shown the opposite . These studies show that increased consumption of saturated fatty acids increase LDL cholesterol without affecting HDL cholesterol, while increasing consumption of trans fatty acids increase LDL cholesterol as HDL cholesterol and decreases, and thus greater atherogenic. Producing companies have realized lately margarine products that are extracted form trans fatty acids (margarine semisolid and liquid), but still prevalent pastries hydrogenated vegetable fats.
Summarizing, it reduced its intense solidified margarine, commercial baked products, fatty meat, butter and cream should be eaten in moderation.

Principles of nutrition general

General principles

The diet will be:
- Normocaloric or calorie for those overweight or obese. Achieving ideal weight will be an essential component of treatment. Weight loss reduces labor and lowers heart precm circulating lipids and blood pressure.
- Salt restriction, and even in severe forms desodat quantity of salt is allowed depending on the existence of edema and hypertension.
- Hipolipidic (see step I or step II diet hipolipidica), depending on the associated dyslipidemia.
- Normoproteic or hipoproteic, knowing that in general a diet rich in protein and contains a large amount of salt. Preference will be given high biological value protein, vegetable protein.
- Will be assessed when fluid intake is decompensated heart failure
- K intake assessment is required, especially in patients treated with diuretics, kidney failure, etc..
It will also take into account the associated pathology (diabetes, renal disease), heart failure diet is actually a mixed diet.
Can be avoided foods that cause stomach discomfort, sodium-rich foods (cabbage, celery, spinach, dried legumes, beets). It also avoid very cold or very hot foods, foods that contain stimulants (caffeine).
In heart failure, average sodium diet alone can prevent edema. In severe heart failure and patients desodata diet will be fed with a spoon to avoid any extra effort (to reduce edema and resumption of cardiac function).
Foods allowed are:
- Skimmed milk, cheese, unsalted cheese.
- Lean meat, preferably fish, chicken or beef in the amount of 150-200 g / day 2-3 times a week, prepared by cooking, grill or oven.
- 2-3 eggs per week, only in food preparations.
- Occasionally butter, vegetable oil daily, added to raw food, the amount depending on calorie needs.
- Unsalted bread one day old in relation to caloric needs.
- Cooked vegetables and fruits (compotes, soteuri, smoothies, soufflees, pudding), or raw state.
- Instead of salt will prefer aromatic spices (parsley, dill, tarragon, thyme).
- Acrirea food will be made with lemon juice.
- Sweets to be cooked at home, without bicarbonate and without salt, preferably dry dough or biscuit dough, fruit gelatin, peltele.
- Drinks allowed: herbal tea, fruit and vegetable juice, buttermilk, skim milk, yogurt, coffee, barley, carbonated drinks are contraindicated.
The patient will eat 4-5 meals per day, meals will be served in an atmosphere of calm. Avoid talking during meals, drinking liquids with meals. Dinner will be served 2-3 hours before bedtime.
From time to time (once a week or more often in overweight or obese patients), the patient may follow a so-called discharge regime, consisting solely of fruits and vegetables throughout the day.

Overweight or obesity

Body weight influences blood pressure greatly value. A BMI = 27 is correlated with increased blood pressure (Joint National Committee). Much of this is true to abdominal obesity, its presence signifying a constellation of cardiovascular risk factors.
Weight gain realized along life also explain the tendency of blood pressure increases with age. It was observed that in human societies where people do not gain weight as advancing age, blood pressure usually remains stable along life.
It is necessary therefore, as a measure for prevention of hypertension, an overweight and obesity screening conducted since childhood, and early establishment of lifestyle changes. Children should be encouraged to attend as many sporting activities, to limit the intake of products like fast food, fruits and vegetables, preferring instead, to control the salt and fat.

Increased salt intake

Several studies have demnostrat etiologic role in developing salt hypertension. Populations with a lower salt intake of 4.5 g / day had a lower incidence of hypertension, and, usually, blood pressure in these populations remains stable along life. Also, populations with a higher salt intake 6g/day have a much higher incidence of hypertension and its once a trend of increasing with age [9,14,15].
If the role of Na in the development of hypertension is very well established, the same can not say about his role in its treatment. There are two types of individuals: sodium sensitive and sodium-resistant. Moderate sodium diet can lower blood pressure about 50% of hypertensive. In these, the reduction of Na intake in half can lower systolic pressure by 5 mm Hg and diastolic blood pressure by 4 mm Hg. (Individuals "sodium sensitive"). At rest, the TA does not change significantly by limiting the intake of sodium (sodium-resistant ").
In conclusion, we say:
- Avoid excess salt is beneficial for all individuals, even for normotensive;
- Those at risk of developing hypertension, we recommend a diet that is low sodium and do not add salt to food, to avoid excessively salty foods;
- To prove the hypertensive, low sodium diet is required, it brings only benefits.