The

Lecture 9- 29 October 2013

Blood pressure-really it is elevated blood pressure or hypertension that is the focus of our discussion today

Outline of todays talk

I. Pathology  

 

II. Socioeconomic factors contributing to the disease 

III. Elementary nutritional approaches to be taken to avoid and treat these diseases including foods

available to those at risk 

 

IV. First Nations and other Cape Breton individuals at risk

 

V. How is nutritional assessment made for blood pressure? 

VI. How would one assess from a nutritional perspective the socioeconomics, pathology and success of

nutritional interventions relative to blood pressure?  

Blood pressureI. PathologyVolume and viscosity of blood in a given

volume of arterial lumen plus arterial pressure inwards gives blood pressure

Blood pressure-systolic -diastolic

>140 mm Hg systolic or > 90 mm Hg diastolic represents hypertension in otherwise healthy persons

Blood pressureI. Pathology

So there are really two main factors in blood pressure

volume and viscosity of water pushing outward

pressure of artery pushing inward

Blood pressureI. PathologyDecrease blood pressure:If one can reduce water volume by

reducing blood sodium, heart rate, stroke volume and hence cardiac output OR

Decrease blood viscosity by reducing salt in blood serum and cholesterol, trans-and saturated fats in the blood cells

Blood pressureI. Pathology

or decrease blood pressure via:

reduction in pressure of artery by relaxing the artery (vasodilation) and hence reduce vasoconstriction

Socioeconomic factors

Food and hence nutritional choices depend on:

Personal preference

what foods should be avoidedwhat foods should be encouraged

Habitfattening foods bring on obesitywhich increases blood pressure

Food and hence nutritional choices depend on:Ethnic heritage or tradition

which groups would avoid the offendingfoods?

Social interactionteenagers and younger children gathering at fast food establishments

eat fattening and atherosclerosis producing foods and eat these foods in greater quantities due to repeated gatherings at these establishments

Food and hence nutritional choices depend on:Availability of food

if only offending foods available this can be concern

food borne pathogens(H. pylori and cytomegalovirus) may be an issue here- how?

Convenience of food

convenience foods are frequently cholesterol, trans fat, saturated fat and salt laden- what is the issue here?

Food and hence nutritional choices depend on:

Economy of foodbag of potato chips, bag of frozen fries

Positive and negative association-child may have associations of fast foods

with pleasant experiences

-negative- examples?

Food and hence nutritional choices depend on:

Emotional conflictelevates blood pressure on its own- this may be coupled with lack of judgment and eating blood pressure elevating foods

Values-restrictions on prepared beef, pork may

lower incidence of hypertension

-contrast this point to values that allowprepared beef, pork

Food and hence nutritional choices depend on:Body image

if blood pressure elevating foods are believed to be fattening such foods may be avoided

Advertisingfast food companies selling blood pressure elevating foods spend lots of money to promote via ease and price,the use of such foods

BREAK

More on socioeconomic factors

Prestige-occupational-not necessarily an impact on risk or presence of hypertension in terms of diet but there is a relation between the lower the occupation of one’s father and oneself and both elevated diastolic and systolic blood

pressure

More on socioeconomic factors

Prestige

-societal perceptions- may have an impact on risk or presence of hypertension

-education- not necessarily an impact on risk or presence of hypertension

More on socioeconomic factors

Power-may have an impact on risk or presence of hypertension

Income-may have an impact on risk or presence of hypertension

More on socioeconomic factors

Wealth-may have an impact on risk or presence of hypertension

Education-may have an impact on risk or presence of hypertension

More on socioeconomic factors

Social stratification-ancestry-groups with certain dietary habits-gender-males-race-blacks-ethnicity-see ancestry-mobility-see convenience of foods-mental and physical activity-

mental-comfort foods

physical activity-blood pressure lowered by chronic aerobic activity

More on socioeconomic factors

Class-uppers-lower uppers-upper middles-average middles-working class-lower class

How might each of these classes have an impact risk or presence of hypertension ?

More on socioeconomic factors

Global economy--bringing fast foods to the world-obesity is becoming an issue even in the third world

Government-government can both help and hurt in the fight against hypertension-how?

More on socioeconomic factors

Business-advertising, development of fast, convenient foods and marketing them to individuals facing the fast life profile

Psychology-comfort foods -business uses behaviour modification techniques to obtain business today

“you deserve a break today”

History-movement toward fast paced society and the historical factors that have lead to that fast pace-such factors would be?

Elementary nutritional biochemistry of nutritional approaches that use foods available to those at risk

Planning a healthy diet 

To do this bear in mindAdequacy

BalanceEnergy controlNutrient densityModerationVariety

Elementary nutritional biochemistry of nutritional approaches that use foods available to those at risk

Prevention-eat foods in accordance with low salt (if salt-sensitive) and eat in

accordance with keeping blood plasma lipids and lipoproteins to target levels specified in the lectures on atherosclerosis

Elementary nutritional biochemistry of nutritional approaches that use foods available to those at risk?

prevention-increase fruits and vegetables and low fat foods(DASH diet)

DASH-Dietary approaches to stop hypertension

Elementary nutritional biochemistry of nutritional approaches that use foods available to those at risk

Post-onset-eat foods in accordance with low salt (if salt-sensitive) and eat in

accordance with modifying blood plasma lipids and lipoproteins to target levels specified in the lectures on atherosclerosis

antioxidant vitamins and minerals

Elementary nutritional biochemistry of nutritional approaches that use foods available to those at risk?

post onset-increase fruits and vegetables and low fat foods(DASH diet)

DASH-Dietary approaches to stop hypertension

Elementary nutritional biochemistry of nutritional approaches that use foods available to those at riskPrevention-obesity, salt, dietary components detailed in the lectures on atherosclerosis to achieve a healthy blood lipid and lipoprotein profile

Post-onset-obesity, salt, dietary components detailed in the lectures on atherosclerosis to achieve a healthy blood lipid and lipoprotein profile

BREAK

IV. First nations and other Cape Breton individuals at risk.

Aboriginals

Retired

Unemployed

Genetics

Others?

How is nutritional assessment made for blood pressure-prevention and cure?Nutrient intake analysis

salt intakedietary lipids

-saturated fat-trans-fatty acids-cholesterol

-other dietary components adjusted in accordance with recommendations made in lecture on atherosclerosis

How is nutritional assessment made for hypertension- prevention and cure?

Daily food record/Diary

what are potential problems with this approach?

How is nutritional assessment made for hypertension-prevention and cure?

Retrospective data

-24 hour recall

-food frequency questionnaire

both 24 hour recall and are used to cross check one another-how?

How is nutritional assessment made for hypertension--prevention and cure?

Anthropometry-focus on overweight andobesity

skin foldsunderwater weighingbioimpedancewaist circumferenceweight, heightBMI

How is nutritional assessment made for hypertension--prevention and cure?

Nutrition focussed physical exam:

body weight and height, waist circumference

direct blood pressure determinationheadachesdizzinesspalpitationseasy fatigabilityblurred vision

How is nutritional assessment made for hypertension--prevention and cure?

Skin testing-not applicable

How is nutritional assessment made for hypertension--prevention and cure?

Biochemical analysisblood lipids-which raise bpblood lipoproteins-which

raise bp

blood sodium-raises bpblood potassium-lowers bpblood calcium-lowers bpblood magnesium-lowers bp

How is nutritional assessment made for hypertension--prevention and cure?

CLASSIFYING MALNUTRITION

obesity is the main issue here

thin individuals are much less at risk than obese persons

VI. GROUP DISCUSSION-HOW WOULD ONE ASSESS FROM NUTRITIONAL PERSPECTIVE THE SOCIOECONOMICS, PATHOLOGY AND SUCCESS OF NUTRITIONAL INTERVENTIONS RELATIVE TO HYPERTENSION ?