Introduction
Van Horn et al (2008) defined cardiovascular disease or CVD as diseases that affect the heart and blood vessels. Cardiovascular diseases include coronary heart disease or CHD, coronary artery disease, dyslipidemia, and hypertension. CVD is one of the top causes of mortality in the United States. The public health agenda therefore consider CVD prevention on its priorities.
It is fortunate for many to note that studies showed reduction of the incidence of CHD through diet as possible (Giugliano, 2006). Dietary factors play a prominent role in coronary atherosclerosis as proposed by the National Cholesterol Education Program Adult Treatment Panel III (ATP III). Hence, diet practice important in the prevention of CVD as well as during intervention process (ATP III, 2001). Evidence from epidemiological, experimental, and clinical trials for decades now has indicated positive correlation between lifestyle and dietary factors with blood lipid levels, blood pressure, and CHD (Van Horn et al, 2008).
Previous studies already pointed out that diet high in red meat and all its components both fresh and processed, sweets and desserts, breads and pastries, potatoes, French fries, and refined grains, causes inflammation specifically in heart blood vessels. Diets high in fruits, vegetables, legumes, whole grains, poultry, and fish are found to cool inflammation down (Giugliano, 2006).
Giugliano (2006) likewise suggested that dietary patterns high in refined starches, sugar, saturated and trans fatty acids increases risk of inflammation. In contrast, a diet high natural antioxidants and fiber from fruits, vegetables, and whole grains make individuals resistant to CHD incidence.
Heart disease remain the top discharge diagnosis for the majority of aging U.S. population as older adults aged 65 years older account for the most hospital discharges and highest hospital day care in the United States (DeFrances, 2007). DeFrances (2007) has noted that operations on the cardiovascular system are the most performed surgical procedures among older patients. Disease may include coronary artery bypass graft or CABG. Likewise, more and more patients that undergo cardiac surgery in many medical centers in the United States are those ages 65 or over (Baumgartner et al, 2005). DiMaria-Ghalili (2005) also noted that older adults are vulnerable to under nutrition so that it becomes imperative to consider the nutrition status of these patients (DiMaria-Ghalili, 2005).
Dietary Intake
When sick, many individuals have decreased dietary intake. This usually leads to weight loss and malnutrition. Among hospitalized patients, Dupertuis (2003) have noted that dietary intake is usually inadequate as plate waste or food attempted to be eaten by the patient but not totally consumed, was found to be 30% in one Swedish hospital and as high as 41% on geriatric units. It has also been observed that hospitalized elder adults were able to eat only about 50% of prescribed energy and 57% of needed energy. It is no longer surprising that patients who consumed less than 70% of prescribed energy intake felt weak appetite, unable to chew food well, and unable to taste food (Incalzi et al, 1996). In another study, Sullivan et al (1999) found in a study that 21% of hospitalized, nonterminally ill elder patients consumed less of their daily hospitalized dietary intake and less that half of their energy requirements. Those patients had cardiac surgery or coronary artery bypass graft.
Dietary Fiber
Extensive research and epidemiologic data have shown that dietary fiber has an inverse relationship to CVD risk. The studies suggested that dietary fiber is important for the TLC diet (Hu FB, 2002). Among the 2 types of dietary fiber — soluble and insoluble— the insoluble fiber insignificant effect on lowering cholesterol. Soluble fiber on the other hand, significantly reduced cholesterol so that ATP III recommends an intake of 10–25 g/d of soluble fiber (ATP III, 2001).
Studies have shown that the soluble fiber lowers cholesterol and decreases dietary fat absorption in the intestines (Retelny, Neunendorf and Roth, 2008). Fibrous foods high in protective nutrients that include unsaturated fatty acids, minerals, folate, and antioxidant vitamins is helpful among CVD patients (Jenkins et al, 2002).
Jenkins et al (2002) suggested that consumption of high-fiber foods with 7.2 g of psyllium and 0.75 g of ß-glucan daily lessens the risk of CVD by 4.2% ± 1.4%. Thus, a high-fiber diet along with the National Cholesterol Education Program step II diet decreased total cholesterol to 2.4% (P =.015).
It was reported in a 2005 meta-analysis on fiber that examined soluble fiber and its effect on blood pressure that there is a modest reductions in systolic blood pressure of 1.13 mm Hg (95% confidence interval, -2.49 to 0.23) and in diastolic blood pressure of 1.26 mm Hg (-2.04 to -0.48) (Retelny et al, 2008). Most notably, the greatest reductions in blood pressure occurred among older adults 40 years or older and in hypertensive populations and normotensive ones (Streppel MT, 2005). Another study in 2001 also indicated that consumption of 16 g of total fiber with 7 g of soluble fiber coming from oats and a hypocaloric diet led to reduced systolic blood pressure. Serum levels of total and LDL cholesterol were also reduced, showing that fibrous diet usually intended for weight loss also reduce CVD risk. The process improved blood pressure and overall blood lipid profile (Saltzman, 2001).
The Institute of Medicine recommends a fiber intake of 14g per 1000 kcal while the clinical practice guidelines of the ATP III, the American Heart Association (AHA), and the American Diabetes Association recommend increased intake of soluble fiber as an integral component of LDL cholesterol–lowering therapy (Retelny et al, 2008). It is highly recommended that total dietary fiber should be 25g per day. It is also advisable for hypercholesterolemic or dysglycemic patients to increase the amount to 50g/d or 10-25g of soluble fiber per day. Patients are also advised to increase intake of fresh fruits and vegetables (Szapary, 2004). Ideally, about 5 servings per day, and whole grains at about 6-11 servings per day should be maintained
ω-3 Fatty Acids in CVD Prevention
Two ω-3 fatty acids, docosaexaenoic acid (DHA) and eicosapentanoic acid (EPA) decrease the risk of sudden cardiac death in animal studies and in epidemiologic, metabolic, and small clinical trials(Retelny et al, 2008).The mentioned nutrition contents are found in cold-water fish such as mackerel, salmon, herring, trout, sardines, and tuna. Kris-Etherton (2001) further noted that these long-chain ω -3 fatty acids from fish oil reduced serum triglyceride levels and improves platelet function. Alpha-linolenic acid (ALA), a shorter chain ω-3 fatty acid is found in plant sources flaxseed, walnuts, canola oil, and soybeans. It was suggested that ALA interfere with the production of proinflammatory eicosanoids for protection against CVD (Retelny et al, 2008). Giugliano et al (2006) recommended increase of the 3 dietary strategies for CHD prevention through consumption of ω -3 fatty acids from fish or plant sources. This is expected to reduce generation of a proinflammatory milieu or anti-inflammatory activity (Connor, 2000).
Plant Sterols and Stanols in CVD Prevention
Plant sterol and stanols also known as phytosterols are found to have cholesterol-lowering effects (Retelny et al, 2008). In addition, vegetarian diets may provide upward of 500 mg/day while the average American diet has about 200 mg of plant sterols/stanols daily. Plant sterols/stanols are naturally present in plant foods nuts, vegetable oils, fruits, and vegetables (Retelny et al, 2008). The FDA recommends a minimum of 800 mg per day of plant sterols/stanols for CHD prevention. It is known to lower serum total and LDL cholesterol (Fed Regist, 2006).
Cardioprotective Effects of Alcohol
Rimm, (1996) suggested that 1-2 weeks of moderate alcohol consumption have a positive effect on HDL cholesterol levels. Moderate consumption of alcohol according to the Dietary Guidelines for Americans (2005) is 1 drink per day for women and about 2 drinks per day for men and must be taken with meals. It is to be noted, however, that consumption of large amounts of alcohol leads to alcoholism as well as liver disease, cancer, accidents and even death. Thus, moderation is recommended for individuals who choose to consume alcohol (Van Horn et al, 2008).
Conclusion
As indicated in the discussion, diet has a very important role not only in the prevention of CVD but also as an intervention measure to improve the condition of existing patients. Intervention support also noted how increased intake of fruits and vegetables of about 9-11 servings per day and dietary fiber (25 g/d), regular consumption of ω -3 fatty acids from cold-water fish at least 2 times per week, plant sterol/stanols (2 g/d), and nuts (1 oz/day) significantly improve the conditions of patients. Moderate alcohol intake of 1-2 drinks per day with meals is also recommended although this should be closely monitored to maintain healthy dose.
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Volume 23 Number 2008 468-476 © 2008 American Society for Parenteral and Enteral Nutrition 10.1177/0884533608323425.