Medical Nutrition Therapy Manual



Helen Diodore

KNH 413 MNT Diet

April 19, 2012

Medical Nutrition Therapy Diet-Congestive Heart Failure

1. Purpose

a. Nutrition Indicators

In patients who are at risk for, or diagnosed with CHF, nutrition indicators to monitor include:

● Blood lipids

● Weight/BMI

● Cigarette smoking

● Lipoproteins

● Hypertension BP>140/90 mm HG

● Cholesterol

○ Low HDL 45 years, Women > 55 years

● CO-Q10

● L-Lysine, L-Carnitine, L-Taurine

● B-Complex Vitamins

● Vitamin C, E, Selenium

● Essential Fatty Acids (EFA’s)

Heart disease is often associated with nutritional deficiency of EFA’s, CO-Q10, amino acids, and other vitamins. Body weight, B-blockers, and thiazide drugs, glucose tolerance, physical activity level, exogenous steroids, and diabetes and thyroid diseases may affect cholesterol levels and should be monitored by the dietitian in at risk patients.and Fluid retention or edema may also be present. Saturated fatty acids, trans-fatty acids, and excessive poly-unsaturated fatty acid (omega-6) intakes, and specifically SFA intakes are correlated to disease progression and should be monitored in CHF.

b. Criteria to Assign the Diet

Those with metabolic syndrome, risk factors for CVD, family history of CHF, previous MI, and diagnosis of CHF. High cholesterol levels have shown a direct correlation with an increased risk of CHF, and lifestyle changes or drug therapy should be implemented depending on the stage of CHF. In particular elevated LDL cholesterol levels and decreased HDL levels are problematic and are grounds for intervention.

c. Rationale for Diet

Sodium and fluid are the primary concerns for heart failure patients because of edema and fluid build up. CHF patients have a decreased ability to handle plasma volume, so water retention raising BP weakens the heart muscle, increasing the risk of failure. Excess fluid intake may increase a CHF patient’s body weight, and which may be confused with fluid retention due to heart failure. The AHA recommends fluid be restricted to less than 2 liters (68 oz)per day. 60 oz allows 8 oz of flex room for fluids ingested from food that the patient may not account for in their diet.

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2. Population

a. Overview

CHF failure results from cardiovascular disease and the resulting damage to the heart organ that eventually leads to failure of some area of the heart. Primary causes are ischemic heart disease, hypertension, and dilated cardiomyopathy. Heart disease is characterized by either right side failure or left side failure. The difference is that right sided failure is characterized with symptoms that result from systemic backup of the circulatory system, or failure of the left ventricle to accept blood, and left sided failure occurs when the left ventricle loses the ability to pump blood or to relax between beats. The general symptoms of heart failure are dyspnea, fatigue, weakness, exercise intolerance, and poor adaptation to cold temperatures.

b. Disease Process

Typical pathophysiology of CHF begins with an injury to the heart or with left ventricle hypertrophy that impairs overall function of the heart. The renin-angiotensin-aldosterone system causes changes in BP to compensate for the heart damage, furthering damage. After MI cardiac remodeling causes structural changes to the heart, resulting in a dilated left ventricular chamber. Cardiac remodeling will occur before symptoms appear and progress even throughout treatment. The progression of heart failure is mediated by neuro-hormanal systems, and patients typically have elevated blood and tissue levels of norepinephrine, angiotensin II, aldosterone, endothelin, vasoprestandem, and cytokines. Hypertension can lead to left ventricular hypertrophy impairing contractibility, which decreases cardiac output and ejection fraction.

c. Biochemical and Nutrient Needs

B Vitamins are typically an issue with CHF patients, especially those who are prescribed to diuretics to manage edema. Supplementation with a B-Complex vitamin is recommended. MUFAs, resveratrol, and moderate alcohol intakes have all been associated with decreased risk of MI in CHF patients. Plant sterols, fiber, soy protein, calcium supplementation, Vitamin E and other antioxidants have all been shown to have positive impacts on heart health.

3. General Guidelines

a. Nutrition Rx

A 2 g sodium and 60 fl oz diet is the recommendation for patients with CHF to limit blood sodium levels and fluid retention. A TLC Lifestyle Change would be most beneficial for CHF patients. In addition to 2 grams of sodium and no more than 60 oz of fluid per day, the macronutrient and fiber goals are broken down in the chart below.

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b. Adequacy of Nutrition Rx

It is recommended by the Academy of Nutrition and Dietetics as well as the American Heart Association, and numerous other reputable authorities that a diet restricting sodium and fluids is best for CHF patients.

c. Goals

● Keep a food journal

● Record daily sodium intakes in mg ( ................
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