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Summary nutrition and cardiometabolic diseases (HNH-32106)
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Nutrition and Cardiometabolic diseaseLecture 1- introduction
Cardiovascular diseases= CHD + stroke + peripheral artery disease(PAD); obstructed blood flow
Atherosclerosis: fatty streak fibrous plaque complicated lesion
Thrombosis
- Thrombus: blood clot inside a blood vessel or cavity of the heart
- Embolus: blood clot that moves through the blood stream until it ends up in a narrowed
vessel and blocks the circulation
Atherothrombosis in coronary arteries may result in heart attack (myocardial infarction)
Acute coronary syndrome
- ST elevation myocardial infarction, complete blockage of heart artery
- Non-ST elevation myocardial infarction, severe narrowed artery but not completely blocked
- Unstable angina pectoris= pijn op borst/hartkramp
Heart failure occurs after myocardial infarction
- Ejection fraction below 40%= percentage of blood leaving your heart each time it squeezes;
(SV/EDV) x 100
- Left ventricular failure: fluid builds up in the lungs due to congestion (dyspnoea)
- Right ventricular failure: fluid accumulates in the body legs and abdominal organs
Peripheral artery disease (PAD)
- Intermittent claudication: muscle pain caused by ischemia, mostly in the calf muscle, which
occurs during exercise and is relieved by a short period of rest; window-shoppers
disease/smoker’s legs
- Diagnosis PAD: ankle/brachial blood pressure index(ABI)
Thrombo embolism
- Arterial embolism
Artery in the leg or elsewhere
When it ends up in coronary artery myocardial infarction
Can also start in carotid artery or in the heart due to atrial fibrillation travels to the
brain ischemic stroke
- Venous embolism (VTE)
Arises in systemic vein travels to the lung pulmonary embolism
After deep venous thrombosis DVT
Cerebrovascular disease(stroke)
- Blocked brain artery ischemic stroke
- Thrombus from elsewhere embolic stroke
- Ruptured brain vessel hemorrhagic stroke
- TIA mini stroke, symptoms less than 24 hours
CT scan stroke diagnosis
- White area bleeding
- Dark area infarction
,Diagnostic criteria diabetes
- FPG= fasting plasma glucose
- OGTT= oral glucose tolerance test
- HbA1c= glycosylated haemoglobin, reflects blood glucose over past 2-3 months
normal prediabetes Diabetes
FPG <5.5 mmol/L 5.5-7.0 mmol/L >7.0 mmol/L
OGTT <7.8 mmol/L 7.8-11.1 mmol/L > 11.1 mmol/L
HBA1C <42 mmol/L 42-47 mmol/L >47mmol/L
HBA1C < 6.0% 6.0-6.4 % >6.4 %
- 3 main types
Type 1
Type 2
Gestational: high blood glucose during pregnancy, between week 24-28, disappears
after birth, babies are bigger in size, complication during pregnancy and obstructed
labour
- Complications
Cerebrovascular disease
Eye damage
Peripheral neuropathy(nerve damage)
Coronary heart disease
Diabetic nephropathy(kidney damage)
Lecture 2- cardiometabolic risk
Risk factors
- Non-modifiable
Gender
Genetics
Age
ethnicity
- modifiable
obesity
LDL, HDL
Smoking
Alcohol
Stress
Low physical activity
High blood pressure
High blood glucose
, Other classification
- Endogenous(biological/intrinsic factors)
Age
Sex
Genetics
Blood lipids
Blood pressure
Body composition
Diabetes
Chronic inflammation
- Exogenous
Smoking
Diet
Physical activity
Alcohol
Stress
Sleep quality
Other lifestyle/environmental factors
- CV risk factors affect also kidney, brain and eye
Cardiometabolic disease process
- Healthy: able to adapt
- Early changes: small abnormalities who do not yet affect the functioning of the body
- Preclinical phase
Elevated risk factors: insulin resistance, low-grade inflammation, changes of arterial
wall, high blood pressure and cholesterol
Screening: oral glucose tolerance test, heart scan
- Clinical phase: disease event with hospitalisations and specialist care
New pathways cardiometabolic disease
- Obesity, chronic injuries, diabetes increased inflammation(IL-6, TNF-a, neutrophils,
macrophages) decreased vasodilation, increased shear stress, increased vascular
damage endothelial dysfunction]
Hypertension
- Systolic blood pressure above 140 mmHg or diastolic blood pressure above 90 mmHg
- Systolic blood pressure is stronger predictor for CVD, because that is when the heart pumps
blood into the body= upper reading
- DBP= when heart is at rest, lower reading
- Blood pressure is strong risk factor for CHD and stroke mortality at all ages. Cholesterol is
only a risk factor for CHD mortality
Cut off values blood cholesterol
Best < 5.2 mmol/L
Borderline high 5.2-6.2 mmol/L
High >6.2 mmol/L= hypercholesterolemia
- Plasma total cholesterol: < 5.0mmol/L
- Plasma LDL-cholesterol: <3.0mmol/L
- Plasma triglyceride: <1.7mmol/L
- LDL cholesterol is more important than total cholesterol
- Role of HDL is doubted
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