Summary nutrition and cardiometabolic diseases (HNH-32106)

Nutrition and Cardiometabolic disease
Lecture 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