NUTRITION IN CHRONIC DISEASE MANAGEMENT - A physician's guide to CANCER CHRONIC OBSTRUCTIVE PULMONARY DISEASE
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
A physician’s guide to
NUTRITION IN CHRONIC
DISEASE MANAGEMENT
for older adults
CANCER
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
CONGESTIVE HEART FAILURE
CORONARY HEART DISEASE
DEMENTIA
DIABETES MELLITUS
HYPERTENSION
OSTEOPOROSIS
INCLUDES PATIENT NUTRITION GUIDEacknowledgements
The Nutrition Screening Initiative would like to acknowledge the following organizations
and individuals who made it possible to put together credible, scientific-based nutrition
information for physicians and their patients.
A special thanks to Albert Barrocas, MD, FACS, John Coombs, MD, MNS, Jane V. White, PhD,
RD, FADA for tirelessly leading the effort to create this comprehensive nutrition guide.
Partner Organizations
American Academy of Family Physicians
American Dietetic Association
Authors
Cancer Hypertension Judy Dausch, PhD, RD, Senior Manager for
Regulatory Affairs, American Dietetic
Albert Barrocas, MD, FACS, Vice President, Jane V. White, PhD, RD, FADA, Professor,
Association, Washington, DC
Medical Affairs, Pendleton Memorial Department of Family Medicine, Graduate
Methodist Hospital, New Orleans, Louisiana School of Medicine, University of Tennessee- Rebecca Kirby, MS, RD, MD, Family Practice
Knoxville, Knoxville, Tennessee Physician, El Paso, Texas
*Dana Purdy, RD, LDN (posthumous),
Jean L. Lloyd, MS, RD, Nutritionist, U.S.
Consultant Dietitian, NutriPro Inc, New Osteoporosis
Administration on Aging, Washington, DC
Orleans, Louisiana Johanna Dwyer, D.Sc., R.D., Professor of
Leah-Rae Mabry, MD, American Academy
Patrick Brady, RN, BSN, OCN, CPT, Medicine and Community Health, Schools of
of Family Physicians, Public Health
Community Nurse Educator, Wellspring Medicine and Nutrition and Senior Scientist,
Commission, Pleasanton, Texas
Jean Mayer Human Nutrition Research Center
Coordinator, Pendleton Memorial Methodist
on Aging at Tufts University, and Director, Velimir Matkovic, MD, DSc, Professor,
Hospital, New Orleans, Louisiana
Frances Stern Nutrition Center, New England Departments of Physical Medicine and
Debra Troutman, RN, OCN, Patient Care Medical Center Hospital (In 2001-2 Dr. Dwyer Rehabilitation, Medicine, and Nutrition,
Coordinator, Radiation Therapy, Cancer is serving as Assistant Administrator for Director Osteoporosis Prevention and
Center, Pendleton Memorial Methodist Human Nutrition, Agricultural Research Treatment Center and Bone and Mineral
Hospital, New Orleans, Louisiana Service, US Department of Agriculture, Metabolism Laboratory, The Ohio State
Washington, DC) University, Columbus, Ohio
Chronic Obstructive Pulmonary Disease
Todd Semla, MS, Pharm D, FCCP, BCPS,
Sandra Harmon-Weiss, MD, Head of Associate Director, Psychopharmacology
Government Programs, Aetna U.S.
Reviewers Clinical Research Center, Department of
Healthcare, Blue Bell, Pennsylvania Jacqelyn Admire-Borgelt, MSPH, Assistant Psychiatry and Behavioral Sciences, Evanston
Division Director of Scientific Activities, Northwestern Healthcare, Evanston, Illinois;
Congestive Heart Failure American Academy of Family Physicians, Clinical Assistant Professor, Section of
Leawood, Kansas Geriatric Medicine, University of Illinois at
Eric Tangalos, MD, Professor of Medicine and
Chicago College of Medicine, Chicago, Illinois
Chair, Division of Community Internal George Blackburn, MD, PhD, Associate
Medicine, Mayo Clinic, Rochester, Minnesota Professor of Surgery and Nutrition, Harvard Mary Sue Walker, PhD, RD, LDN, Consultant
Medical School, Beth Israel Deaconess in private practice, Knoxville, Tennessee
Coronary Heart Disease Medical Center, Boston, Massachusetts
Nancy Wellman, PhD, RD, FADA, Professor
Jan Verderose, MS, RD, CDN, Territory Dan Brewer, MD, Associate Professor, and Director, National Policy and Resource
Specialty Manager - Cardiovascular Science, Department of Family Medicine, Graduate Center on Nutrition and Aging, Florida
Wyeth-Ayerst Pharmaceuticals, Saratoga School of Medicine, University of Tennessee- International University, Miami, Florida
Springs, New York Knoxville, Knoxville,Tennessee
Sue Finch-Brown, RN, A-CCC, Director of *The NSI would like to recognize the outstanding
Dementia Managed Care; President of MMC, Medical work of Dana Purdy and her contributions to
Richard Ham, MD, SUNY Distinguished Chair Management Consultants, Ripen, Wisconsin promoting the important role of nutrition in the
in Geriatric Medicine, Professor of Medicine, management of cancer. Dana recently succumbed
Donna Cohen, PhD, Professor, Department of
Professor of Family Medicine, SUNY Upstate to her own battle with cancer.
Aging and Mental Health, University of South
Medical University, Syracuse, New York Florida, Tampa, Florida
Diabetes Mellitus John Coombs, MD, MNS, TJ Phillips
Professor of Family Medicine, Associate Vice
Jane V. White, PhD, RD, FADA, Professor, President for Medical Affairs and Associate
Department of Family Medicine, Graduate Dean, University of Washington Academic
School of Medicine, University of Tennessee- Medical Center, Seattle, Washington
Knoxville, Knoxville, Tennessee
Copyright ©2002 by the Nutrition Screening Initiative (NSI)
The inclusion of information in “A Physician's Guide to Nutrition in Chronic Disease Management in Older Adults” constitutes neither approval nor endorsement by the American Academy
of Family Physicians, the American Dietetic Association, and the Nutrition Screening Initiative of any brand or specific nutritional products. 64573A GUIDE TO THE MATERIALS
PURPOSE PHYSICIAN-DIETITIAN
PARTNERSHIP
Older people have special nutritional needs due to
age and disease processes. Physician
Public interest in food and nutrition information is • Responsible for assessing, diagnosing and
treating conditions associated with or
at an all time high. The medical community must
contributing to poor nutrition status.
respond with a scientific basis for the nutrition
therapies they prescribe. To help you, the Nutrition • Works independently and with a registered
Screening Initiative (NSI) offers this guide. dietitian (RD) to develop a nutrition care plan.
Registered Dietitian (RD)
These materials are a concise, brief source of
disease-specific nutrition information for physicians • Provides medical nutrition therapy to patients
caring for older individuals. They are not a substitute and their families, physicians and their staff.
for a patient consultation with a registered dietitian. • Tailors interventions to individual patient
The information in this booklet is based on needs.
The Role of Nutrition in Chronic Disease Care. • To locate an RD, contact the American
A print copy may be ordered from the NSI, ph. 202- Dietetic Association (ADA),
625-1662 or nsi@gmmb.com. It is also located on findnrd@eatright.org or the ADA’s Nationwide
the American Academy of Family Physicians (AAFP) Nutrition Network, 800-877-1600, ext. 5000.
Web site http://www.aafp.org/nsi Office staff (e.g. nurses)
• Provides basic nutrition information and
support.
FORMAT Health care team and patient’s family
This booklet has two sections: • Supports the patient’s nutrition evaluation,
interventions, and adherence to the nutrition
PHYSICIANS — care plan.
Eight diseases are summarized with an emphasis on
essential nutrition information for each disease including NUTRITION SERVICE
nutrition screening parameters and interventions for REIMBURSEMENT
each disease.
Reimbursement for coverage of physician,
A comprehensive version of each disease synopsis, and/or RD nutritional services is determined by
including references and a bibliography, is on the AAFP individual patient health plans but is optimized
Web site, www.aafp.org/nsi by a physician referral.
PATIENTS— Medicare provides coverage for medical
nutrition therapy (MNT) for diabetes mellitus
Patient education materials accompany the disease and renal disease. Cardiovascular and other
summaries and include a basic chronic disease diseases may be covered in the near future.
nutrition guide for older adults. There are also nutrition
tips for specific diseases and patient resources. The
patient materials may be copied and given to patients.
1
Sponsored in part through a grant from Ross Products Division, Abbott LaboratoriesSELECTED NUTRITION SCREENING TOOLS FACTORS TO CONSIDER:
These nutrition screening tools are referenced in the following disease VITAMINS/MINERALS, COMPLEMENTARY OR
summaries. (Please note, this is not a comprehensive list.)
ALTERNATIVE THERAPIES AND NON-PRESCRIPTION
Body Mass Index (BMI) MEDICATIONS
• Validated measure of nutrition status which serves as an indicator
of over-nourishment and under-nourishment Patients are treating themselves with a wide range of
• The NSI suggested BMI range is 22-27 (values outside this range vitamins/minerals, complementary/alternative therapies,
indicate over or under weight) and non-prescription medications often without the
• Relationship between height and weight = weight (kg) ÷ height (m2) knowledge of their physician or other health care
• http://www.nhlbi.nih.gov/guidelines /obesity /bmi_tbl.htm professionals.
http://www.nhlbisupport.com/bmi /bmicalc.htm
It is important to ask patients about their use of these
Serum albumin of < 3.5 g/dl therapies since some compromise or complicate other
• Non-specific, initial indicator of individuals who may be at risk for interventions. For more information:
poor nutritional status, including malnutrition
• Associated with increased risk of morbidity and mortality • PDR for Herbal Medicines, Medical Economics Co.,
Adult Treatment Panel (ATP) III Guidelines (NCEP) - total cholesterol
http://www.pdr.net
• A sharp decline can indicate poor nutritional status • American Dietetic Association, www.eatright.org
• http://www.nhlbi.nih.gov/about/ncep/ncep_pd.htm • American Herbal Products Association
http://www.nhlbi.nih.gov/guidelines/cholesterol/atglance.pdf http://www.ahpa.org/
Functional Health Status Assessment Tools • NIH - National Center for Complementary and
Self-administered patient surveys of health status useful in
determining functional outcomes and therapeutic changes.
Alternative Medicine (NCCAM),
http://altmed.od.nih.gov/ nccam/
• DETERMINE Checklist – checklist for patients to help identify
warning signs of poor nutritional health. www.aafp.org/nsi/ • NIH - Office of Dietary Supplements,
• SF-36 Health Survey – short-form, 36-item questionnaire that http://www.cc.nih.gov/ccc/supplements /intro.html
measures eight parameters of physical and mental health. There
are also shorter forms, SF-12, SF-8, that offer the same eight- LIFESTYLE CHANGES
dimension health profile. www.sf-36.com/
• Quality of Life Indicators – survey based on five domains (health In addition to nutrition interventions the NSI endorses:
and wellness, relationships, community, personal growth and self- • Smoking cessation
esteem) to assess quality of life in cancer patients.
www.supportinc.com/Outcomes.htm • Regular physical activity/exercise
Dietary Reference Intakes (DRIs) and Recommended Dietary • Moderation in alcohol consumption
Allowances (RDAs) • Diet appropriate for the specific disease condition
• DRIs – nutrient-based reference values used for planning and
assessing diets of healthy people (RDAs and three • Stress reduction
other suggested nutrient intake levels)
• RDAs – average daily nutrient intake levels to meet the needs of DEPRESSION
healthy individuals. • Depression, often undetected in older adults with
• National Academy of Sciences, Institute of Medicine chronic conditions, affects self-care and compliance
The National Academy Press with treatments (medications and food intake).
http://www.nap.edu/catalog/6015.html
http://www.nap.edu/books /0309071836/html/ • Careful screening is essential since depression may
• Florida International University, National Policy and Resource
not be obvious. Symptoms may include: weight loss
Center on Nutrition and Aging or gain, feeling bored or empty, lack of interest in
http://www.fin.edu/nutreldr/resources/dris/dri_references.htm activities, agitation, memory problems, difficulty
Activities of Daily Living (ADLs) performing ADLs, non-specific complaints.
• Measures self-care ability (e.g. transferring, bathing, eating, toileting) • Validated, self-administered instruments:
Instrumental Activities of Daily Living (IADLs) – Geriatric Depression Scale (GDS) –
• Measures ability to live independently (e.g. transportation, http://www.stanford.edu/~yesavage/GDS.html
managing medication, managing money, light housework, grocery
shopping, meal preparation) – Center for Epidemiological Studies-Depression Test
• Initial decline in cognitive function often appears as impaired ability (CES-D), National Institutes of Mental Health
to manage money and medications. http://www.fmhi.usf.edu/amh/homicide-suicide/
2
Sponsored in part through a grant from Ross Products Division, Abbott LaboratoriesCANCER
NUTRITION INTERVENTIONS
SCREENING PARAMETERS
• Body weight assessment • History of reduced calories
– Unintended weight loss and/or protein intake
– BMI < 22 • Use of vitamins/minerals and
complementary/alternative therapies
• Serum albumin < 3.5g/dl
• Depression
• Unintended decline in
cholesterol < 150 mg/dl
Definitions
Cancer:
TREATMENT OPTIONS THERAPEUTIC OBJECTIVES
A group of related diseases
Consider consulting a registered • Optimize food intake and diet quality characterized by the
dietitian (RD) for nutrition evaluation • Minimize the effect of disease process uncontrolled growth and
and care or treatment on food intake potential spread of
Nutrition Education • Optimize nutritional status to maximize abnormal cells.
therapeutic regimen
• Adequate calories, fat, protein
and fluids to regain/maintain • Avoid nutritional deficiency states Cancer Anorexia:
reasonable weight during active Absence of appetite
treatment OUTCOME MEASURES common in cancer patients;
• Modify meal frequency, content and may be potentiated or
• BMI between 22-27 or attain
presentation as needed; use creative individually prescribed weight goals relieved by treatment.
feeding strategies to encourage eating
• Serum albumin > 3.5g/dl
Cancer Cachexia:
Supplements May not be achievable
Wasting with anorexia,
• Consider high calorie, nutrient-rich • Serum cholesterol 150 mg/dl
abnormal metabolism and
foods or liquid supplements for Prevent or mitigate a sharp decline
negative energy balance
malnutrition associated with disease • Maintain or improve functional status disproportionate to nutrient
and/or treatment
intake.
• Consider vitamin/mineral supplements Some measures may not be achievable when
appropriate to patient's condition patient is frail or palliative care is indicated.
Prevalence
Medications • Nearly 9 million Americans
have a history of CA
• Recognize that radiation,
chemotherapy and/or surgery may • 2nd leading cause of
negatively impact nutritional and/or death in the U.S.
metabolic status and/or anatomical • 550,000 deaths annually
function • Accounts for 1 in 4 deaths
• Consider use of appetite stimulants, • 1.2 million new cases
antinausea and/or anabolic diagnosed annually
drugs for management of
anorexia or cachexia Risk Factors
• Tobacco use
• Excessive alcohol use
• Poor diet quality
• Family history
• Environmental factors
3CHRONIC OBSTRUCTIVE
PULMONARY DISEASE (COPD)
NUTRITION INTERVENTIONS
SCREENING PARAMETERS
• Body weight assessment • Dietary intake of vitamins/
– Subject to poor nutrient intake and minerals and calories
involuntary weight loss • Use of vitamins/minerals and
– BMI 22-27 complementary/alternative therapies
– Serum albumin < 3.5 g/dl • Depression
– Unintended rapid decline in serum
Definition cholesterol 3.5g/dl
Medications • Maintain serum cholesterol 200
mg/dl
• Drugs commonly associated
with COPD may have a
significant impact on nutritional status.
Common examples:
– Xanthine derivatives (e.g. theophylline)
- anorexia, nausea
4CONGESTIVE HEART FAILURE
NUTRITION INTERVENTIONS
CHF may be associated with co-morbidities including but not limited to:
CHD, hypertension and diabetes mellitus. Refer to corresponding summaries.
SCREENING PARAMETERS • Pedal/presacral (dependent) edema
• Body weight assessment and/or ascites
– Involuntary loss or gain (check for • Serum electrolytes
fluid retention) • Use of vitamins/minerals and
– BMI 22-27 complementary/alternative therapies
• Blood pressure (watch for hypotension) • Depression Definition
• Nutritional intake of electrolytes, Note: Unrecognized cardiac cachexia Inadequate cardiac output
including: excessive sodium, with protein depletion may go to meet perfusion and
inadequate potassium, magnesium undetected, even when screening oxygenation requirements
and calcium parameters appear normal. leading to pulmonary and/or
systemic edema.
TREATMENT OPTIONS Medications
Consider consulting a registered • Some medications commonly used Prevalence
dietitian (RD) for nutrition evaluation to treat CHF may have nutritional • 4.8 million Americans
and care implications, e.g.: • Most common diagnosis
– Diuretics - some may lead to in hospitalized patients
Nutrition Education
electrolyte abnormalities, especially 65 years and older
• Adjust nutrient and fluid intakes to sodium and potassium and/or • 400,000 new cases
meet disease-specific needs thiamine deficiency (furosemide). annually
• Keep sodium intake low, i.e. 2400 – Cardiac glycosides (digitalis) - may
mg sodium daily (1 tsp. total salt that result in anorexia and/or nausea Risk Factors
includes naturally occurring salt in food • Hypertension
and 1/4 tsp. added salt or salt in THERAPEUTIC OBJECTIVES
• Previous heart attack
processed food). • Maintain reasonable weight (absent • History of cardiomyopathy
• Consider Dietary Approaches to Stop fluid weight) • Coronary heart disease
Hypertension (DASH)* [See • Reduce signs/symptoms of CHF • Chronic obstructive
Hypertension summary] pulmonary disease
• Optimize sodium intake
• Reduce fluid intake if needed (COPD)
• Minimize fluid retention
• Change number, timing and content • Obesity
of meals as needed • Limit or eliminate alcohol intake
• Diabetes mellitus
• Ensure adequate calories and protein OUTCOME MEASURES • Excessive alcohol intake
• Limit/eliminate alcohol
• Maintain reasonable weight (irrespective
Self Management Education of fluid retention) or attain individually
• Check compliance with medications prescribed weight goals
• Consider a graded activity regimen • Reduce hospital admissions/
consistent with patient needs and readmissions
abilities • Reduce sodium intake < 2400 mg/day
Supplements • Reduce alcohol intake (eliminate if
needed)
• Consider vitamin/mineral supplements
– 1 drink/day for women
if food intake is poor
– 2 drinks/day for men
• Consider high calorie, nutrient-rich • Maintain or improve functional health
foods or liquid supplements status assessment
• Increase exercise/activity tolerance
See NY Heart Association Classification of
*Functional Capacity and Objective Assessment
*See References
5CORONARY HEART DISEASE
NUTRITION INTERVENTIONS
CHD may be associated with co-morbidities including but not limited to:
CHF, hypertension and diabetes mellitus. Refer to corresponding summaries.
SCREENING PARAMETERS • Determine serum cholesterol, (LDL,
HDL) triglycerides and C-reactive
• Body weight assessment
protein (CRP)
– BMI 22-27
• Diabetes mellitus
– Waist circumference 40 inches
Definition for men, 35 inches for women). • Depression
Progressive occlusion • Use of vitamins/minerals and
• Dietary history of cholesterol,
of coronary arteries saturated and total fat, and calories complementary/alternative
compromises blood flow therapies
and oxygenation leading to
angina and increased risk Medications
TREATMENT OPTIONS
of myocardial infarction
Consider consulting a registered • Commonly used drugs may have
and possible death.
dietitian (RD) for nutrition evaluation nutritional implications, e.g.:
and care – Cardiac glycosides (digitalis) may
Prevalence result in anorexia and/or nausea
• 61 million Americans have Nutrition Education
– Statins may result in elevated liver
plaque formation • Moderate total fat intake (maximum enzymes
• 250,000 sudden deaths 1-3 Tbsp. added fat/day)
annually
– High doses of niacin (nicotinic acid)
– Reduce intake of saturated fat may be associated with flushing,
• Leading cause of death in (fat solid at room temperature, i.e. hyperglycemia, hypotension, hypo-
both men and women animal fats, hydrogenated fats and albuminemia, upper GI distress and
• 1 death per minute in U.S. tropical oils and trans-fatty acids) liver enzyme elevation
due to CHD – Monounsaturated fats may lower (hepatotoxicity)
triglycerides (e.g. olive oil,
Risk Factors peanut oil, and canola oil) THERAPEUTIC OBJECTIVES
• Dyslipidemia – Polyunsaturated fats may lower • Maintain healthy weight
• Smoking LDL levels (e.g. safflower oil, • Maintain serum lipid levels consistent
• Hypertension sunflower oil and corn oil) with the ATP III Guidelines (NCEP)*
• Diabetes mellitus • Three or more broiled/baked fish • Improve levels of physical activity
• Family history meals/week (e.g. salmon, mackerel, See NY Heart Association Classification of
*
Functional Capacity and Assessment Objective
• Inactivity tuna and herring)
• Obesity • Increase daily intake of foods rich in
OUTCOME MEASURES
• Race/ethnicity and gender or fortified with folate (e.g. leafy green
• Imbalance in diet/nutrients vegetables, whole grains) • Maintain reasonable weight:
• Calorie intake to achieve optimal – BMI 22-27 or attain individually
weight prescribed weight reduction goals
– BMI 27-30, weight reduction
Supplements measures may be indicated
• Consider high calorie, nutrient-rich – Serum albumin > 3.5 g/dl
foods or liquid supplements if food – Smaller waist circumference, if
intake is poor. appropriate
• Caution: high doses of fish oil • Achieve recommended lipid levels
supplements (e.g. omega-3 fatty acid per ATP III Guidelines (NCEP)*
capsules) may increase the risk of • Maintain/improve functional status
hemorrhagic stroke • Increase levels of physical activity
*See References
6MANAGING CHRONIC DISEASE
a nutrition guide for older adults
from your doctor:
Daily Servings
Liquids: 6-8 glasses per day
GUIDE
recommendations for:
1 c. (8 oz.) fruit juice, milk, tea, coffee
Grains: 4-8 or more servings per day
High in fiber
This guide will help you manage your chronic disease with good
1 slice whole grain bread
nutrition choices. This page applies to most older people with a
1 c. ready-to-eat cereal
chronic disease, and the next two pages have nutrition information for 1/2 c. cooked cereal, rice, pasta
specific chronic diseases. Talk to your doctor about which information 4 small crackers, 1/2 bagel,
applies to you. Also, it may be important for you to consult with a 1/2 hotdog or hamburger bun
registered dietitian for help with your food plan.
NUTRITION
Fruits: 2-4 servings per day
Rich in vitamins/minerals, High in fiber
Fewer calories but more vitamins/minerals 1 med. banana, orange, pear, apple
As an older adult, you need fewer calories, but you 1/2 c. chopped, cooked, canned fruit
still need plenty of vitamins and minerals. This 1/4 c. dried fruit
means you need more calcium and vitamin D to 3/4 c. (6 oz.) fruit juice
decrease your risk of fractures. You may also need
more vitamin B-12, which is important in brain Vegetables: 2-5 servings per day
function. Rich in vitamins/minerals, High in fiber
1 c. raw leafy green vegetables
Plenty of liquids 1/2 c. other cooked/raw vegetables
3/4 c. (6 oz.) vegetable juice
As you get older you may not feel as thirsty, even
when your body needs fluid. So it’s important to drink
plenty of water and other liquids without caffeine. Meat: 2-3 servings (5-7 oz. per day)
Rich in protein, Meat contains
vitamin B-12
Lots of fiber 2-3 oz. cooked lean meat/fish/poultry
Your gastrointestinal tract slows down with age. So 1/2 c. cooked dried beans/peas
PAT I E N T
be sure to eat fiber-rich foods, like beans, oatmeal, 1/2 c. tofu
fruits, vegetables, whole grain breads and cereals to 2 Tbsp. peanut butter
help prevent constipation. 1 egg
Enough protein Milk: 2-4 servings per day
Rich in protein, calcium, vitamin D
Protein builds muscles and helps repair body tissue 1 c. low-fat or fat-free (skim) milk
when you are sick. Make sure you eat protein-rich foods 1 c. low-fat yogurt
like fish, skinless chicken, lean meats and eggs
1-1/2 oz. aged cheese (cheddar/swiss)
or egg substitutes.
2 oz. processed cheese (American)
Limited alcohol Fats: 1-3 servings per day
1 Tbsp. oils or soft margarine
Your alcohol tolerance changes with age.
1-2 Tbsp. nuts or seeds
Women should have no more than one drink a
day, and men no more than two.
Dietary Supplements:
Calcium, vitamin D, vitamin B-12
Ask your doctor about your need for
supplements 7
Sponsored in part through a grant from Ross Products Division, Abbott LaboratoriesMANAGING CHRONIC DISEASE
food tips for heart conditions and
diabetes mellitus
Eating wisely means you will feel better and may even need fewer medications. If you have a disease that affects your
heart and blood vessels, your diet is a key part of your treatment. It is important to keep a healthy weight, and discuss
what you need to eat with your doctor and a dietitian. Ask if your medications may give you a poor appetite.
CORONARY HEART DISEASE DIABETES MELLITUS
Choose foods low in saturated fatty acids, trans-fatty Keep your carbohydrates (starch/sugar) and calorie
acids and cholesterol intake constant
Choose fat-free (skim) or low-fat milk products. Ask for a referral to a registered dietitian (RD) or a certified
Choose skinless poultry, lean meats, dried beans or fish. diabetes educator (CDE).
Choose fruits, vegetables and whole grains. Choose foods that contain carbohydrates (sugar and starch)
in amounts that help keep your blood sugar normal.
Liquid or soft margarine is a better choice.
Carbohydrate needs may change with your daily activity.
HYPERTENSION
Use less salt Choose foods low in saturated fat, trans-fatty acids and
cholesterol
Choose fresh or frozen meats and vegetables and canned Choose fat-free (skim) or low-fat milk products.
or processed foods without added salt.
Choose skinless poultry, lean meats, dried beans or fish.
Limit added salt when cooking or at the table to no more
than 1/4 tsp. per day. Choose fruits, vegetables and whole grains.
Use herbs, spices, lemon juice, vinegar to flavor foods. Liquid or soft margarine is a better choice.
Before using a salt substitute, ask your doctor.
Notes:
Ask if you need vitamins or other dietary supplements.
CONGESTIVE HEART FAILURE
Use less salt
Choose fresh or frozen meats and vegetables and canned
or processed foods without added salt.
Limit added salt when cooking or at the table to no more
than 1/4 tsp. per day.
Use herbs, spices, lemon juice, vinegar to flavor foods.
Before using a salt substitute, ask your doctor.
Ask if you need vitamins or other dietary supplements.
Limiting liquid intake may be needed
Limiting the amount of liquids you drink may help reduce the
workload on your heart. Ask your doctor for the amount that
is right for you.
8
Sponsored in part through a grant from Ross Products Division, Abbott LaboratoriesMANAGING CHRONIC DISEASE
food tips if you need extra nutrients
OSTEOPOROSIS
GUIDE
The foods that you eat may help protect you from bone Ask your doctor about supplements, especially calcium and
loss. Here are some nutrition tips: vitamin D.
Avoid taking large doses of fish liver oils, especially cod liver oil.
Increase calcium and vitamin D It contains large amounts of vitamin A.
Eat foods high in calcium and vitamin D such as milk,
yogurt and cheese. Moderate alcohol intake
Eat fortified foods that are high in calcium, including fortified
Limit alcoholic drinks per day to one for women, two for men.
fruit juice, cereals, and soy products.
Dementia, cancer and chronic obstructive pulmonary disease (COPD) often make it hard for people to eat enough to keep their
NUTRITION
weight stable. If you are losing weight without trying, you may need to eat more calories, protein, liquids. You may also need to
take vitamin supplements. While these tips are helpful, if you have one of these conditions, you should talk with your doctor and a
dietitian about your food choices.
DEMENTIA CANCER
Tell the doctor about any eating problems the person with
mental confusion or memory loss may have. For extra help with Choose foods and liquids that are high in calories and protein.
these problems, you may wish to talk to a registered dietitian. Eat 6 or more small meals and snacks.
Examples of eating problems: Drink high calorie liquid supplements or milk shakes when your
appetite is poor.
Easily distracted.
Eat high calorie foods first.
Unable to choose.
Use sugar to add calories and improve taste.
Forgets to eat.
Ask if your medications cause you to have poor appetite.
Poor judgement.
Forgets to swallow, chokes or gags. CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)
[Emphysema, chronic bronchitis, bronchiectasis]
PAT I E N T
Eats too fast or slowly.
Agitation. Choose foods and liquids that are high in calories and protein.
Spits or plays with food. Eat 6 or more small meals and snacks.
Drink high calorie liquid supplements or milk shakes when your
Tips that may help with eating problems: appetite is poor.
Reduce choices: serve one food at a time. Eat high calorie foods first.
Offer smaller meals and more snacks between meals. Eating a diet with less carbohydrate (sugar/starch) and more fat
may make it easier to breathe.
Serve high calorie foods.
Using sugar adds calories and may improve taste.
Consider high calorie liquid supplements.
Rest before eating if eating makes you short of breath.
Provide help with eating as needed.
Ask if your medications cause you to have a poor appetite
Reduce distractions.
Offer finger foods.
Notes:
Allow enough time for eating.
Offer meals when ability to think and function
is best, often at breakfast or lunch.
9
Sponsored in part through a grant from Ross Products Division, Abbott LaboratoriesPATIENT RESOURCES
GENERAL CONGESTIVE HEART FAILURE DIABETES MELLITUS
Nutrition Screening Initiative American Heart Association American Diabetes Association
1010 Wisconsin Avenue, NW 7272 Greenville Avenue 1701 North Beauregard Street
Suite 800 Dallas, TX 75231-4296 Alexandria, VA 22311
Washington, DC 20007 800-AHA-USA1 (800-242-8721) 800-DIABETES (800-342-2383)
202-625-1662 www.americanheart.org www.diabetes.org
nsi@gmmb.com NIH/National Heart, Lung, Joslin Diabetes Center
and Blood Institute One Joslin Place
31 Center Drive, MSC 2480 Boston, MA 02215
American Academy of Family Physicians Room 4A21 617 732-2400
11400 Tomahawk Creek Parkway Bethesda, MD 20892-2480 www.joslin.harvard.edu
Leawood, KS 66211-2672 301-496-4236
NIH/National Institute of Diabetes
800-274-2237 www.nhlbi.nih.gov
and Digestive and Kidney Diseases
http://www.aafp.org
31 Center Dr., MSC 2560
CORONARY HEART DISEASE Bethesda, MD 20892-2560
301-496-4236
American Dietetic Association American Heart Association
http://www.niddk.nih.gov
216 West Jackson Blvd. 7272 Greenville Avenue
Chicago, IL 60606-6995 Dallas, TX 75231-4296
800-366-1655 800-AHA-USA1 (800-242-8121) HYPERTENSION
http://www.eatright.org www.americanheart.org
American Heart Association
National Cholesterol Education Program 7272 Greenville Avenue
NIH/National Heart, Lung, Dallas, TX 75231-4296
and Blood Institute 800-AHA-USA1 (800-242-8721)
CANCER P.O. Box 30105 www.americanheart.org
American Cancer Society Bethesda, MD 20824-0105
NIH/National Heart, Lung, and Blood
1599 Clifton Road, NE 301-592-8573
Institute
Atlanta, GA 30329 www.nhlbi.nih.gov/about/ncep
31 Center Drive, MSC 2480
800-ACS-2345 (800-227-2345) Room 4A21
http://www.cancer.org DEMENTIA Bethesda, MD 20892-2480
800-496-4236
Alzheimer's Association
NIH/National Cancer Institute www.nhlbi.nih.gov
919 North Michigan Avenue
9000 Rockville Pike
Suite 1100
Bethesda, MD 20892
Chicago, IL 60611-1676 OSTEOPOROSIS
800-4-CANCER (800-422-6237)
800-272-3900
www.nci.nih.gov/ National Dairy Council
http://www.alz.org
10255 W Higgins Road, Suite 900
American Heart Association Rosemont, IL 60018-5616
CHRONIC OBSTRUCTIVE PULMONARY
(vascular dementias) 847-803-2000
DISEASE (COPD)
7272 Greenville Avenue www.nationaldairycouncil.org
NIH/National Heart, Lung, Dallas, TX 75231-4296
National Osteoporosis Foundation
and Blood Institute 800-AHA-USA1 (800-242-8121)
1232 22nd Street, NW
31 Center Drive, MSC 2480 www.americanheart.org
Washington DC 20037-1292
Room 4A21
NIH/National Institute of Neurological 800-223-9994
Bethesda, MD 20892-2480
Disorders and Stroke http://www.nof.org
301-496-4236
P.O. Box 5801
www.nhlbi.nih.gov NIH/Osteoporosis and Related
Bethesda, MD 20824
Bone Disease
800-352-3424
1232 22nd Street, NW
American Lung Association www.ninds.nih.gov
Washington, DC 200371292
1740 Broadway
800-624-BONE (800-624-2663)
New York, NY 10019
www.osteo.org
800-LUNG-USA (800-586-4872)
http://www.lungusa.org
10 Copyright ©2002 by the Nutrition Screening Initiative (NSI) Sponsored in part through a grant from Ross Products Division, Abbott Laboratories
The inclusion of information listed on the center insert, “Managing Chronic Disease: A Nutrition Guide for Older Adults” constitutes neither approval nor endorsement by the American Academy of Family
Physicians, the American Dietetic Association, and the Nutrition Screening Initiative of any brand or specific nutritional products. 64573DEMENTIA
NUTRITION INTERVENTIONS
SCREENING PARAMETERS • Cognitive, functional and behavioral
• Body weight assessment assessment
– BMI < 22 • Ability to access/choose/prepare
foods and need for feeding assistance
– Serum albumin < 3.5 g/dl
(often reduced by concurrent illness) • Presence/absence of dysphagia or
aspiration
• Dietary intake of calories, protein,
vitamins/minerals • Use of vitamins/minerals and
complementary/alternative therapies
• Functional status - Activities of Daily Definition
Living (ADLs) and Instrumental • Depression Multiple cognitive defects
Activities of Daily Living (IADLs)* Note: Weight loss is a common early including memory loss and at
• Alcohol intake symptom of dementia and is frequently least one of the following:
unrecognized in frail patients.
aphasia, apraxia, agnosia,
and disturbance in executive
TREATMENT OPTIONS medications functioning, severe enough to
Consider consulting a registered dietitian • Cholinesterase inhibitors (donepezil, interfere with daily function.
(RD) for nutrition evaluation and care rivastigmine, tacrine or galantamine), Of the nearly 50 common
frequently used in mild/moderate dementias of later life, the
Nutrition Education AD – may cause nausea, diarrhea most common is Alzheimer’s
• Modify meal frequency, content and • Choose antipsychotics/antidepressants disease (AD)
presentation as needed without anti-cholinergic side effects
• Use creative feeding strategies: (dry mouth, delayed gastric emptying,
e.g. serve frequent small constipation)
Prevalence
meals/continuous access to food, • Antidepressants may enhance appetite
• 4 million Americans have AD
offer one food at a time in depressed patients but SSRIs may
• 19 million Americans have
• Adjust food texture (e.g. thicker liquids, cause a decrease in appetite
a family member with AD
finger foods) • One in ten over 65 years of
THERAPEUTIC OBJECTIVES
• Offer high calorie, fresh, nutrient-rich foods age and nearly half over 85
• Maintain optimal weight, calorie and have AD
Lifestyle Modifications fluid intake
• Consider the need for home services, • Improve patient/caregiver satisfaction Risk Factors
assisted living/institutionalization,
• Minimize medication effects on food • Diabetes mellitus
based on functional assessment
intake (OTC and prescribed) • Cerebrovascular diseases,
(ADLs/IADLs)*
• Prevent or decrease nutritional including stroke
• Consider altering the eating • Family history
co-morbidities
environment: reduce distractions,
• Head injury
provide increased privacy, increase • Maintain or increase functional status
• Depression
socialization, use special techniques
• Hypertension
for eating behavior problems OUTCOME MEASURES
• Thromboembolism
Supplements • Optimize ability to function to delay • Hyperlipidemia
institutionalization • Deficiencies of B-complex
• Consider B-complex supplements if
deficiencies are suspected • Maintain BMI 22-27; may not be vitamins
achievable in patients with advanced • Female
• Vitamin E generally indicated in
dementia • Age
Alzheimer’s disease (2000 IU/day)
unless contraindicated • Maintain hydration
• Consider vitamins/mineral supplements • Reduce hospital
for older adults admissions/readmissions
• Consider high calorie, nutrient-rich *Screening tools page 2
foods or liquid supplements. 11DIABETES MELLITUS
NUTRITION INTERVENTIONS
Diabetes mellitus may be associated with co-morbidities including but not
limited to: CHD, CHF, hypertension and dementia. Refer to corresponding
summaries.
SCREENING PARAMETERS
• Body weight assessment • HbA1c
– BMI 22-27
• Lipids
– Waist circumference (men 40 in.,
Definition women 35 in.) • Compliance with nutrition plan
Group of metabolic • Blood glucose (reference American • Use of vitamins/minerals and
diseases characterized by Diabetes Association guidelines)* complementary/alternative therapies
hyperglycemia resulting from • Blood pressure 120/80 mm Hg • Depression and dementia
defects in insulin secretion,
insulin action. Chronic
hyperglycemia is associated TREATMENT OPTIONS
with long-term damage,
A referral to a registered dietitian (RD) – A (alpha) glucose inhibitors – elevated
dysfunction and failure of
and/or a certified diabetes educator liver enzymes, flatulence, diarrhea
various organs, especially (CDE) is important for this disease – Glitazones – anemia, elevated
the eyes, kidneys, nerves,
Nutrition Education liver enzymes
blood vessels.
– Nateglinide/repaglinide – hypoglycemia
• Promote caloric intake to achieve
Prevalence optimal weight
THERAPEUTIC OBJECTIVES
• 16 million Americans • Select from a variety of culturally-
• More than 5 million are specific educational options, e.g. • Normalize blood sugar
undiagnosed
exchange lists, point systems, a • Achieve blood pressure consistent
constant carbohydrate regimen. with JNC VI guidelines*
• 7th leading cause of
death in the U.S. • Reduce saturated fat and cholesterol • Maintain serum lipid levels consistent
• Type 2, diabetes accounts
intakes with ATP II Guidelines (NCEP)*
for 90-95% of all • Consider protein intake formulated to • Achieve/maintain optimal weight
diabetes cases meet disease-specific indications
Supplements OUTCOME MEASURES
Risk Factors
• Consider carbohydrate modified drink • Maintain blood glucose levels (tested
• Obesity
or snack bar to keep blood sugar through home-monitoring) 110-140
• Inactivity stable when food intake is not mg/dl
• Gestational diabetes possible • HbA1c < 6.5 mg/dl
or history of delivery
Medications • Achieve recommended blood lipid
of infants large for
levels per ATP III Guidelines (NCEP)*
gestational age • Drugs commonly used to treat diabetes
• Genetic predisposition may cause hypoglycemia, especially if • Optimize blood pressure
• Ethnicity nutritional intake is erratic and/or if – Systolic 120 mm Hg*
increased or decreased appetite or – Diastolic 80 mm Hg*
diarrhea occurs.
• Maintain optimal weight
– Insulin – hypoglycemia
– Maintain BMI between 22-27 or
– Sulfonylureas – epigastric fullness,
attain individually prescribed weight
heartburn, hypoglycemia, nausea,
reduction goal
skin rash
– Weight loss, if obese
– Biguanides – anorexia, diarrhea,
*See References vomiting, lactic acidosis (if renal
12 disease is present)HYPERTENSION
NUTRITION INTERVENTIONS
Hypertension may be associated with co-morbidities including but not
limited to: CHD, CHF and diabetes mellitus. Refer to corresponding summaries.
SCREENING PARAMETERS
• Body weight assessment • Assess alcohol intake
– BMI 22-27 • Use of vitamins/minerals and
– Waist circumference complementary/alternative therapies
(men 40 in., women 35 in.) • Depression and dementia
• Dietary intake of calcium, magnesium, Definition
potassium, sodium Sustained systolic blood
pressure >140 mm Hg
and/or diastolic blood
pressure >90 mm Hg,
TREATMENT OPTIONS
regardless of the underlying
Consider consulting a registered • Centrally acting anti-hypertensives cause. Lower parameters
dietitian (RD) for nutrition evaluation may result in a decline in food intake
are indicated in diabetes
and care due to sedation, confusion and
mellitus: systolic blood
depression
Nutrition Education pressure < 120 mm Hg
• Consider impact of drug/food
• Reduce intake of sodium, saturated interactions on nutritional status, e.g. and/or diastolic blood
fat and cholesterol beta blockers may cause constipation pressure < 80 mm Hg (see
• Caloric intake to achieve optimal and delayed gastric emptying diabetes mellitus summary)
weight
• If BMI > 27, weight reduction is THERAPEUTIC OBJECTIVES Prevalence
indicated • 50 million Americans (1 in 4)
• Maintain adequate intake of dietary • Achieve optimal or reasonable • Most common chief
potassium, calcium and magnesium reduction of blood pressure complaint in ambulatory
• Consider Dietary Approaches to Stop • Maintain optimal weight care settings
Hypertension (DASH) Diet:* • Limit alcohol intake to moderate level
– Level I - 2400mg sodium daily (1 or less. Risk Factors
tsp. total salt that includes • Maintain optimal calcium, potassium • Obesity
naturally occurring salt in food and and magnesium intake • Excess sodium intake (5-
1/4 tsp. added salt or salt in 15% population)
processed food) OUTCOME MEASURES • Inadequate intake of
– Level II - 1500 mg sodium daily calcium and/or potassium
• Normalize systolic blood pressure • Excess alcohol intake
Supplements 120 mm Hg and/or 80 mm Hg per • Inactivity
• Consider mineral supplements JNC VI guidelines* • Smoking
(calcium, magnesium, potassium) if • Maintain a reasonable weight • African American
dietary intake insufficient – BMI 22-27 or attain individually • Living in SE United States
• Consider high calorie, nutrient-rich prescribed weight reduction goals
foods or liquid supplements if weight • Limit sodium intake 1500-2400 mg/d
loss is a problem
• Reduce alcohol intake (eliminate
Medications if needed)
• Use of diuretics may negatively impact – 1 drink/day for women
nutritional status with depletion of – 2 drinks/day for men
sodium, calcium, magnesium and/or
potassium
*See References
13OSTEOPOROSIS
NUTRITION INTERVENTIONS
SCREENING PARAMETERS
• Body weight assessment
• Annual height measurement,
especially in patients with increased – BMI < 22 as a potential risk factor
risk factors • History of frequent fractures
•Assessment of bone density • History of chronic glucocorticoid use
(T-score > -1 to -2.5) • Use of vitamins/minerals and
• Dietary intake of calcium/vitamin D complementary and alternative
intake/sunlight exposure therapies
Definitions
• Screen for bone-wasting drugs • Depression
Systemic disorder
characterized by decreased Medications
TREATMENT OPTIONS
bone mass, micro-
Consider consulting a registered • Medications used in long-term
architectural deterioration of
dietitian (RD) for nutrition evaluation treatment of other conditions may
bone tissue, increased lead to loss of bone density and
and care.
bone fragility, and increased fracture, e.g.:
risk of bone fracture. Nutrition Education – Glucocorticoids
• Increase intake of foods high in – Anti-seizure drugs (phenytoin,
Prevalence calcium (1000-1200 mg/d) and barbiturates)
• 28 million Americans vitamin D (10-20 µg/day or 200-400 • High doses of other minerals,
annually, 80% of whom IU) and products fortified with calcium e.g. iron, phosphorus may interfere
are women and vitamin D; 75% of calcium intake with effective calcium absorption
• By age 75 years 1/3 of
comes from milk products
Therapeutic Objectives
men will develop • Maintain adequate nutrient intake of
osteoporosis protein and calories • Optimize calcium and vitamin D intake
• Death rate for men, 1 year
• Reduce alcohol intake (eliminate if • Keep alcoholic beverage intake
after diagnosis, is 26% needed) within recommended parameters
higher than in women – 1 drink/day for women • Keep weight bearing exercise
– 2 drinks/day for men consistent with health and ability
Risk Factors • Prevention is the best treatment: • Reduce fracture risk
• Estrogen/testosterone
beginning early in life, adequate calcium • Preserve height
deficiency and protein, intake, and weight bearing • Reduce progression of spinal
• Poor calcium, vitamin D exercise are essential, particularly in deformity
and/or vitamin K intakes adolescence and during pregnancy
• Provide analgesia to reduce pain and
• Inactivity/immobilization
Lifestyle Modification improve food intake
• Tobacco use
• Excess alcohol • Minimize risk of falls Outcome Measures
• Female • Encourage 10-30 minutes exposure • Maintain reasonable weight
• Hyperthyroidism to sunlight/day or attain individual weight
• Low BMI (small frame, low reduction goals
muscle mass) Supplements
• BMI = 22-27
• Chronic steroid therapy • If intake is inadequate consider: • Maintain height
• History of bulimia/anorexia
– Calcium 500-600 BID (1200 mg/d > • Reduce fractures
• Caucasian and Asian 51 yrs)
• Family history • Improve functional status
– Vitamin D 10-20 ug. (10 µg > 50
• Preserve independent living
yrs, and 20µg > 70 yrs)
• Consider high calorie, calcium and
nutrient-rich foods or liquid
supplements if weight loss is a
14 problemREFERENCES
CANCER
Bibliography
Barrocas A, Purdy D, Brady P, Troutman D. Chapman KM, Winter L. COPD: Using nutrition to
Cancer: Nutrition Management for Older Adults. prevent respiratory decline. Geriatrics.
NSI: 2002. nsi@gmmb.com 1996;51(12):37-42.
American Cancer Society. Guide to Donahoe M. Nutritional aspects of lung disease. CORONARY HEART
complementary and alternative cancer methods: Resp Care Clinics of North America. 1998;4(1):85- DISEASE
Washington, DC: ACS; 2000. 112.
Barrocas A. Complementary and alternative Resources Bibliography
medicine: Friend, foe or owa? J Am Diet Assoc. Verderose J. Coronary Heart Disease: Nutrition
American Lung Association www.lungusa.org,
1997;97:1373-76. Management for Older Adults. NSI: 2002.
800-LUNGUSA (800-586-4872)
Eisenberg DM, Davis RB, Ettner SL, Appel S, nsi@gmmb.com.
US Department of Health and Human Services
Wilkey S, Van Rompay M, Kessler RC. Trends in Executive Summary of the Third Report of the
www.os.dhhs.gov, 877-696-6775
alternative medicine use in the United States, National Cholesterol Education Program (NCEP)
1990-1997. JAMA. 1998;280:1569-1575. NIH/National Heart, Lung, and Blood Institute Expert Panel on Detection, Evaluation and
www.nhlbi.nih.gov, 301-496-4236 Treatment of High Blood Cholesterol in Adults
Greenlee RT, Hill-Harmon MB, Murray T, Thun M.
Cancer Statistics 2001. CA:Cancer J Clin. (Adult Treatment Panel III). JAMA. 2001;
2001;51:(1):15-36. 285:19:2486-2497.
Langer CJ, Hoffman JP, Ottery FD. Clinical CONGESTIVE HEART Krauss RM, Eckel RH, Howard B, Appel LJ,
significance of weight loss in cancer patients: Daniels SR, et al. AHA Dietary Guidelines:
FAILURE
Rationale for the use of anabolic agents in the Revision 2000: A statement for healthcare
treatment of cancer related cachexia. Nutrition. professionals from the nutrition committee of the
Bibliography
2001;Suppl:17:1:F1-F20. American Heart Association. Circulation. 2000;
Tangalos E. Congestive Heart Failure: Nutrition 102:2284-2299. http://www.circulationaha.org/
Moldawer LL, Copeland EM. Proinflammatory Management for Older Adults. NSI: 2002.
cytokines, nutritional support and the cachexia Krumholtz HM, Chen YT, Wang Y, Vaccarine V,
nsi@gmmb.com
syndrome. Cancer. 1979; 9:1828-1839. Radford MD, Horwitz RI. Predictors of
Institute for Clinical Systems Improvement. readmission among elderly survivors of admission
National Cancer Institute. Cancer Fact Book 2000. Health care guideline: Congestive heart failure in with heart failure. Am Heart J. 2000;139
(http://www.nci.nih.gov/admin/fmb/Factbook2000 adults. Bloomington, MN: ICSI; 1999. (1P1):72-77.
.htm) 2001.
Krauss RM, Eckel RH, Howard B, Appel LJ, Nicolosi R, Becker D, Elmer P, Forcyt J, Karmally
Shikany JM, White GL. Dietary guideline for Daniels SR, et al. AHA Dietary Guidelines: W, McManus K, et al. Guidelines for Weight
chronic disease prevention. South Med J. Revision 2000: A statement for healthcare Management Programs for Healthy Adults.
2000;93:1138-1152. professionals from the nutrition committee of the Dallas, TX: American Heart Association; 1994.
American Heart Association. Circulation. 2000;
Resources 102:2284-2299. http://www.circulationaha.org/ Resources
American Cancer Society http://www.cancer.org, Obarzanek E, Sacks FM, Vollmer WM, Bray GA, American Heart Association
800-227-2345 Miller III ER, Lin P-H, et al. Effects on blood lipids www.americanheart.org, 800-242-8721
of a blood pressure lowering diet: the dietary
Faith Ottery and Associates, Oncology Care NIH/National Heart, Lung and Blood Institute
approaches to stop hypertension (DASH) trial.
Consultants, noatpres@pol.net, National Cholesterol Education Program
Am J Clin Nutr. 2001; 74:80-89.
http://cancereducation.uams.edu/Modules/ www.nhlbi.nih.gov/about/ncep, 301-592-8573
Nutrition/Resources.html, 215-351-4050 Wiseman S, LeJemtel TH, Sonnenblick EH.
Congestive heart failure in the elderly. In:
NIH/National Cancer Institute
Cardiovascular Disease in the Elderly Patient.
http://www.nci.nih.gov, 800-4-CANCER
Second edition. Tresch DD, Arnow WS, editors.
(800-422-6237)
New York, NY:Marcel Dekkere, Inc.; 1999.
Resources
CHRONIC OBSTRUCTIVE American Heart Association
www.americanheart.org, 800-AHA-USA1
PULMONARY DISEASE (800-242-8721)
Bibliography NIH/National Heart, Lung and Blood Institute
www.nhlbi.nih.gov, 301-496-4236
Harmon–Weiss S. COPD: Nutrition Management
for Older Adults. NSI: 2002. nsi@gmmb.com NY Heart Association Functional Classification of
Congestive Heart Failure
American Lung Association. Confronting COPD in http://www.aafp.org/afp/20000301/1319.html
America. New York: Amer Lung Assoc; 2001.
15REFERENCES
Executive Summary of the Third Report of the The dietary approaches to stop hypertension
National Cholesterol Education Program (NCEP) (DASH) trial. J Am Diet Assoc. 1999;99:(8 suppl):
Expert Panel on Detection, Evaluation and S1-S104.
Treatment of High Blood Cholesterol in Adults
The sixth report of the joint national committee on
(Adult Treatment Panel III). JAMA. 2001;
prevention, detection, evaluation and treatment of
285:19:2486-2497.
high blood pressure (JNC VI). Arch Int Med.1997;
DEMENTIA Nicolosi R, Becker D, Elmer P, Forcyt J, Karmally 157:2413-2446. http://www.nhlbi.nih.gov/
W, McManus K, et al. Guidelines for Weight guidelines/hypertension/jncintro.htm
Bibliography Management Programs for Healthy Adults.
Dallas, TX: American Heart Association; 1994. Resources
Ham R. Dementia: Nutrition Management for
Older Adults. NSI: 2002. nsi@gmmb.com. The sixth report of the joint national committee on American Heart Association
prevention, detection, evaluation and treatment of www.americanheart.org, 800-242-8121
Birkerhager WH, Forette F, Seux M, Wang, JG, high blood pressure (JNC VI). Arch Int Med.1997;
Staessen JA. Blood pressure, cognitive functions, 157:2413-2446. http://www.nhlbi.nih.gov/ NIH/ National Heart, Lung and Blood Institute
and prevention of dementias in older patients guidelines/hypertension/jncintro.htm www.nhlbi.nih.gov, 800-496-4236
with hypertension. Arch Intern Med.
2001;161:152-156.
Resources
Cohen D. Dementia and depression and OSTEOPOROSIS
American Diabetes Association
nutritional status in old age. In: Primary Care
www.diabetes.org, 800-DIABETES (800-342-2383)
Clinics. Ham R, editor. Philadelphia, PA:WB Dwyer J. Osteoporosis: Nutrition Management for
Saunders;1994;21:107-119. American Dietetic Association Older Adults. NSI: 2002. nsi@gmmb.com.
www.eatright.org, 800-366-1655,
Cohen D, Eisdorfer C. The Loss of Self: A Heaney RP, Abrams S, Dawson-Hughes B,
Family Guide to Alzheimer’s Disease and Related International Diabetes Center Looker A, Marcus R, Matkovic V, Weaver C. Peak
Disorders. New York, NY:Norton;2001. www.idcdiabetes.org, 888-825-6315 bone mass. Osteo Int. 2000;11:985-1009.
Ham R. The Dementias (and Delirium) in Primary Joslin Diabetes Center www.joslin.harvard.edu, NIH/National Institute on Aging (NIA). Age Page:
Care Geriatrics: A Case-Based Approach. Ham R, 617-732-2400 Osteoporosis: The Silent Bone Thinner.
Sloane P, Warshaw G, editors. St. Louis, MO: Washington, DC: NIA;1997.
NIH/National Institute of Diabetes and Digestive
Mosby;2002. www.nih.gov/nia/health/pubpub/osteo
and Kidney Diseases (NIDDK) www.niddk.nih.gov,
301-496-4236. Osteoporosis and Related Bone Diseases-
Resources
National Resource Center (ORBD-NRC).
Alzheimer’s Association www.alz.org, Osteoporosis. Washington, DC: ORBD-NRC;
800-272-3900 1997. www.osteo.org/ostes
HYPERTENSION
American Heart Association Osteoporosis Prevention, Diagnosis, and Therapy.
www.americanheart.org, Bibliography NIH Consensus Statement 2000;March 17
800-AHA-USA1 (800-242-8721) (2):1-34.
White J. Hypertension: Nutrition Management for
NIH/National Institute on Aging www.nih.gov/nia, Older Adults. NSI: 2002. nsi@gmmb.com.
301-496-1752 Resources
Krauss RM, Eckel RH, Howard B, Appel LJ,
NIH/National Institute of Neurological Disorders Daniels SR, et al. AHA Dietary Guidelines: National Dairy Council
and Stroke www.ninds.nih.gov, 800-352-3424 Revision 2000: A statement for healthcare www.nationaldairycouncil.org, 847-803-2000
professionals from the nutrition committee of the National Osteoporosis Foundation www.nof.org,
National Depressive and Manic-Depressive
American Heart Association. Circulation. 2000; 202-223-2226
Association http://www.ndmda.org/depover.htm,
102:2284-2299. http://www.circulationaha.org/
800-826-3632 NIH/Osteoporosis and Related Bone Diseases-
NIH/National Heart, Lung and Blood Institute National Resource Center www.osteo.org,
(NHLBI). The dash diet. 800-624-BONE (800-624-2663)
www.dash.bwh.harvard.edu and http://rover.nhlbi.
DIABETES nih.gov/health/public/heart/hbp/dash/
Bibliography Obarzanek E, Sacks FM, Vollmer WM, Bray GA,
Miller III ER, Lin P-H, et al. Effects on blood lipids
White J. Diabetes Mellitus: Nutrition Management of a blood pressure lowering diet: the dietary
for Older Adults. NSI: 2002. nsi@gmmb.com. approaches to stop hypertension (DASH) trial.
American Diabetes Association. Clinical practice Am J Clin Nutr. 2001; 74:80-89.
recommendations 2001. Diabetes Care. 2001;24 Sacks FM, Svetkey LP, Vollmer WM, et al. Effects
(Suppl 1). on blood pressure of reduced dietary sodium and
the dietary approaches to stop hypertension
(DASH) diet. N Eng J Med. 2001;344(1):3-10.
16You can also read
