ANC-1 CHD (Coronary Heart Disease) dietary modifications/preventive measures

ANC-1 CHD (Coronary Heart Disease) dietary modifications/preventive measures

IGNOU ANC-1 Solved Assignment 2018-2019 

Application Oriented Course in Nutrition for the Community

Assignment Code: ANC-1/AST-1/TMA-1/2018-19

ANC-1 Solved Assignment Question 4

4. Briefly discuss the dietary modifications/preventive measures for the following: (2+2)

a) CHD

Coronary heart disease or CHD is the heart disease due to inadequate supply of blood to the heart muscle. It is a multifactorial disease having a number of risk factors (which ultimately lead to the onset of the disease). It may manifest itself in three forms-angina pectoris, myocardial infarction, and congestive heart failure. Fat controlled, energy-restricted diets are mainly used to prevent the development of such a disorder.

Dietary management of coronary heart disease has several phases. During the acute phase of illness (myocardial infarction or congestive heart failure) the patient is generally hospitalized. The diet is given to the patient under the supervision of trained dietitians.

The main principles for prevention of CHD are

·       to keep fat and cholesterol levels in the blood in normal limits

·       to prevent clinical manifestations like angina pectoris, myocardial infarction or congestive heart failure.

The following modifications in requirement of various nutrients need to be made

Energy-Energy restriction is needed in case of obese individuals. Energy intake should be just enough to maintain ideal body weight. If the person is of normal weight, energy intake should be according to recommended dietary intakes for energy. If the person is obese or overweight suitable modifications are to be made under the supervision of a dietitian or physician.

Protein- The recommended dietary intake of 1g protein/kg body weight is suitable for these patients.

Fat- As fat and fat-rich foods have a direct connection with heart disease; one has to carefully monitor the intake of fat by the patient. Normally not more than 10 to 15g (2 to 3 tsp.) of visible fat in the form of cooking oils should be allowed. In addition, restriction of other fat-rich foods (especially foods containing saturated fatty acids and cholesterol is essential)

Vitamins and Minerals- Vitamins and minerals should be present in adequate amounts according to recommended dietary intakes. Particular care has to be taken with regard to fat- soluble vitamins (&cause of fat-restricted diets)

DIETARY MODIFICATIONS

The main crux of dietary management is to provide a fat controlled and energy restricted diet to the patient. The following points summarize the major changes to be made in the diet.

Energy restriction

The patient needs to make the following modifications:

·       Cut down the intake of total food.

·       Avoid consumption of fat-rich foods.

·       Give cereals in moderation. Cut down intake of refined cereals, encourage use of whole grain cereals.

·       Give more of pulses especially the whole pulses. Other body-building foods like milk and milk products and flesh foods have to be given by taking their fat content into consideration.

·       Increase the intake of fruits and vegetables (especially fibrous ones).

·       Cut down the intake of sugar and other sweeteners.

Fat restriction

i) Reduce the intake of fats and oils.

ii) Replace saturated fats like ghee, hydrogenated fats, and butter with unsaturated fats like groundnut oil, soya oil, and safflower oil.

iii) Oils like mustard oil and coconut oil have more saturated fatty acids than unsaturated fatty acids. Their use should be limited.

iv) Use low fat milk or toned milk instead of whole milk. Whole milk can be given after removing the fat or cream (which comes on top after boiling).

v) Give eggs in moderation. If possible not more than one egg should be given to the patient (or otherwise, 'it should be given after removing the yolk portion of it).

vi)  Avoid giving fat-rich portions of flesh foods. Select lean cuts of meat. Trim visible fat from it before cooking.

vii) Use roasting, baking, boiling and steaming as methods of cooking instead of frying (both shallow and deep frying).

viii) Don't give nuts like groundnuts, cashewnuts, walnuts etc. They are rich in fat.

ix) Avoid giving other fat-rich desserts and fried snacks like cakes, pastries, samosas etc.

Sodium restriction

Hypertension or high blood pressure is one of the risk factors for CHD. Sodium intake influences blood pressure. Thus, high intake of sodium indirectly becomes a risk factor for CHD also. Those individuals who have hypertension or their family members are suffering from hypertension, should keep a check on intake of sodium (common salt).