Lesson 10 hypertension coeliac disease


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Lesson 10 hypertension coeliac disease

  1. 1. Dietetics and Nutrition in the Mediterranean<br />By Dr. Alberto Fatticcioni<br />
  2. 2. Hypertension<br />Between 1991 and 2000, the prevalenceofhypertension in the US increased by 3,7%, and more than half of this increase was attributed to an increased prevalence of obesity. <br />Hypertension continues to be a major risk factor for cardiovascular disease. As many 58 million people in the United States have elevated blood pressure (systolic blood pressure > 140 mm Hg and/or diastolic blood pressure > 90 mm Hg) or are taking antihypertensive medications. Blood pressure level is predictive of mortality from stroke, heart disease and renal impairment. <br />
  3. 3. Hypertension<br />Based on a reviewof data from the third National Health and NutritionExaminationServeys (NHANES III), the southernregionof the UnitedStates, whichincludes the “strokebelt”, hasdietarypatternsthatmaycontributeto the high prevalenceofhypertension and cardiovasculardisease in thatregion. Comparedwithotherregionsof the US, residents in the southreported the highestsodiumconsumption, and the lowestconsumptionofpotassium, calcium and magnesium. <br />
  4. 4. Hypertension and sodium<br />A high sodiumchloride (NaCl) intakecontributestoelevatedarterialbloodpressure in populations; blood pressures increased progressively with progressive increases in dietary NaCl. The effect of NaCl on blood pressure increases with age, with the height of the blood pressure, and, in normotensive persons, with a family history of hypertension. Current estimates of NaCl intake in the United States are in range of 8 to 10 g/day. Specific guideline of the American Heart Association recommended that dietary NaCl be restricted to no more than 6 g/day, and more rigorous NaCl restriction (2-3 g/day) for hypertensive persons. <br />
  5. 5. Sodium rich food mg/100g<br />Prosciutto crudo di Parma 2578<br />Prosciutto crudo 2238<br />Caviar 2200<br />Smoking Salmon 1880<br />Salami 1827<br />Pecorino1800<br />Bresaola 1597<br />Speck 1557<br />Fetacheese 1440<br />Tomato ketchup 1120<br />Cornflakes 1100<br />MarinatedHerring1030<br />Wurstel (hot dog) 930<br />Taleggio 873<br />Provolone 860<br />Margarine 800<br />Pizza 767<br />Grana 700<br />Gorgonzola 600<br />Parmigiano 600<br />
  6. 6. Hypertension and potassium<br />Potassiumloadingprevents or amelioratesdevelopmentofhypertension in severalanimalmodelsofgenetic and NaClinducedHypertension.<br />A low potassiumintakeresults in bloodpressureelevation and renalvascularremodeling, indicatingincreasedrenalvascularresistence. <br />Reducedsodium (< 6 g/day) and increasedpotassiumintake (> 4 g day) loweredbloodpressure in men and women withmildto moderate hypertension. <br />
  7. 7. Potassiumrichfood mg/100g<br />Soybeans 1740<br />Borlotti beans 1478<br />Cannellini beans 1411<br />Driedapricots 1260<br />Driedfigs 1010<br />Peas 990<br />Lentils 980<br />Pistachios 972<br />Chickpeas 881<br />Sultans 864<br />Chestnutflour 847<br />Driedplums 824 <br />
  8. 8. Potassiumrichfood mg/100g<br />Drieddates 750<br />Tinned oil sardines 700<br />Peanuts 680<br />Fresh borlotti beans 650<br />Sardines, anchovies 630<br />Potatoes 570<br />Spinach 530<br />Wholewheat 494<br />Arugula 468<br />Hezelnuts 466<br />Brusselssprouts 450<br />Blackolives 433<br />
  9. 9. Top 10 fruitsforpotassiumcontent/100g<br />kiwi 400<br />bananas 350<br />melon 333<br />apricots 320<br />pomegranate 290<br />watermelon 280<br />figs 270<br />peches, blackberries 260<br />ananas, medlar, 250<br />grapefruit 230<br />cherries 229<br />raspberries 220<br />clementines210<br />oranges 200<br />grape 192<br />plums, susine 190<br />kaki 170<br />strawberries, blueberries 160<br />pear 127<br />apple 125<br />
  10. 10. Hypertension and calcium<br />More than 80 studieshavereportedthatbloodpressureisloweredbyincreasingdietarycalcium; “isan inverse associationbetweendietarycalciumintake and bloodpressure, and low calciumintakeisassociatedwithanincreasedprevalenceofhypertension”. Dietswithlessthan 600 mg calcium/day are mostclearlyassociatedwithhypertension. The National Academyfor Science recommendationsforcalciumconsumption are 1300 mg/dayforadolescents (9-18 years), 1000 mg/dayforadultslessthan 50 yearsofage, and 1200 mg/dayforthose more than 50 yearsold.<br />
  11. 11. Foodsrichest in Calciumcontent mg/100g <br />Pecorino 1160<br />Parmigiano 1159<br />Arugula 309<br />Ricotta 295<br />Almonds 240<br />Driedfigs 186<br />Oyster 186<br />Green beet 160<br />Mozzarella 160<br />Hazelnuts 152<br />Cicory 150<br />Anchovies 148<br />Octopus 144<br />Squid 143<br />Chickpeas 142<br />Cannellini 132<br />Walnuts 131<br />Agretti 131 <br />Pistachios 130 <br />Yogurt 125<br />Milk 119<br />Radicchio 115<br />Shrimp 110<br />Buckwheat 110<br />Borlotti 102<br />Broccoli 97<br />Cardoons 96<br />Endive 93<br />Fava beans 90<br />Mussels 88<br />Artichoke 86<br />Driedapricot 85<br />Spinach 78<br />Raisin 78<br />Dates 69<br />Chard 67<br />JhonDory 65<br />Hare 64<br />Olive 63<br />Kale 62<br />Cauliflower 60<br />
  12. 12. Hypertension and lipids<br />Bothanimal and human data suggestthat omega-3 and omega-6 fattyacids play a role in bloodpressureregulation.In experimentalmodelsofhypertension, bothlinoleic acid (omega-6) and fish oil (omega-3) attenuate the developmentofhypertension. <br />Epidemiologicevidencesuggests a directassociationbetweendiets high in saturatedfats and bloodpressure; conversely, diets high in omega-3 fattyacidsmaybeassociatedwithlowerbloodpressure.<br />
  13. 13. Seafood is high in Omega-3<br />
  14. 14. MediterraneanDietRules<br /><ul><li>vegetables (at least 300-400 g a day)
  15. 15. fruit (at least 4 pieces or 400 g a day)
  16. 16. legumes and pulses
  17. 17. grains, pasta and/or bread (mostlywhole)
  18. 18. olive oil and nuts
  19. 19. water (more than 2 liters per day)
  20. 20. wine duringmeals ( maximum 2 glasses per day)
  21. 21. seafood (fish, shellfish, mollusc), 4-6 times a week
  22. 22. yoghurt, 2 - 4 times per week
  23. 23. cheese, 1 - 4 times per week
  24. 24. milk, 1 - 2 times per week
  25. 25. eggs, 1 - 4 eggs per week (maximun 1 per day)
  26. 26. poultry, 1 - 2 times per week
  27. 27. redmeat, 0 - 1 time a week
  28. 28. sweets, 0 - 1 time per week </li></li></ul><li>Whatisceliacdisease?<br />Celiac disease (from the greekKoil, cavity, stomach), also known as celiac disease or celiac sprue (for "sprue" identifies a chronic disease characterized by diarrhea and anemia leading to cachexia) is a permanent intolerance to gliadin. Gliadin is the alcohol-soluble component of gluten, a mixture of proteins contained in wheat, barley, rye, in 'oats in barley, kamut in. Therefore, all foods derived from these cereals containing gluten or after contamination should be considered toxic for patients suffering from this disease. Although the disease has a Mendelian genetic transmission, it is characterized by a degree of familiarity, due to both major histocompatibility complex genes and other genes not yet identified. Gluten intolerance causes serious injury to the mucosa of the small intestine, which were resolved by eliminating gluten from the diet. The reversibility of the disease is closely related to non-recruitment by the subject of food containing gluten or celiac still contaminated by it. Celiac disease does not heal: the subject celiac remain so throughout his life, the only cure is to adopt a strict gluten-free diet.<br />
  29. 29. ETIOLOGYThe causes of celiac disease includes both genetic and environmental factors<br />Environmental factors<br />Environmental factors are represented by gluten, which is the protein component of wheat flour, barley, rye and oats. The wheat gluten is in turn composed of gliadins, proteins that are soluble in alcohol, and glutenins, alcohol-insoluble proteins<br />Genetic factors<br />The importance of genetic factors in the pathogenesis of celiac disease is confirmed by studies of families of celiac patients have shown a prevalence of celiac disease to 10% among first-degree relatives and 30% if brothers and sisters HLA identical. A recent study showed the hypothesis that the initiation of celiac disease can occur on genetically susceptible (HLA DQ2/DQ8), following a common response to infection with rotavirus protein "VP7" rotavirus ( a common virus that causes enteritis in children, 90% of Italians in their lives they have made contact)<br />
  30. 30. CLINICAL<br />Celiac disease may present with a wide spectrum of clinical manifestations ranging from signs and symptoms of frank malabsorption checked more subtle and nuanced. There is talk of celiac disease increased in the presence of symptoms typical of severe malabsorption, namely diarrhea, steatorrhea and marked weight loss. It speaks of celiac disease in case of minor children and extraintestinal symptoms (anemia, osteoporosis, skin lesions typical, infertility, miscarriages, etc.). It speaks of silent celiac disease for those patients diagnosed, usually between family members, who show no symptoms. In addition, there are many diseases associated with celiac disease.<br />
  31. 31. DIAGNOSIS<br />The diagnosis of celiac disease is based on gastroscopy with duodenal biopsy and detection of antibodies specific for celiac disease. The duodenal biopsy must show the histological features for celiac disease and that atrophy of intestinal villi, hypertrophy of crypts and increased number of intraepithelial lymphocytes. The development of these lesions, however, is a dynamic process that can occur in varying degrees, and then with injuries more or less marked, ranging from total atrophy of the mucosa (villi completely disappeared) to a normal intestinal architecture in which the only fault is measurable represented by an increase in intraepithelial lymphocytes.Diagnosis is necessary to demonstrate that the patient is also positive for antibodies specific for celiac disease, especially antiendomysialantitransglutaminasi and tissue. It is very important to keep in mind that both the intestinal lesions that antibodies specific for celiac disease is gluten-dependent and then disappear once the patient has removed the gluten from the diet. So when you think a patient is suffering from celiac disease, duodenal biopsy should be run and must seek specific antibodies when the patient is still eating gluten.<br />
  32. 32. Treatment<br />Currently, the gluten-free diet is the only therapy but are investigating other therapeutic strategies. The gluten-free diet must be very strict because small amounts of gluten are enough to prevent the histological improvement and should be carefully followed throughout life. Need to be removed from the diet not only food containing wheat and dairy products, but also those containing barley, rye and oats. Initially it may be difficult to stick to a strict diet aglutinata because gluten can be contained in various foods contained in the normal diet: wheat flour is one of the most common ingredients in several foods. Therefore, we need properly inform the patient to prevent inadvertent violations and offer, with periodic checks, a service continued. In the early stages of the diet may also be necessary supportive therapy that is limited to the correction of specific deficits due to the presence of a mucosal still damaged. The dietary treatment is the only necessary in more than 70% of celiacs. In ways that do not respond to a gluten-free diet, is used to immunosuppressive treatment.<br />
  33. 33. DIET<br />Celiac disease is fought so with a gluten-free diet: rice, corn, buckwheat, millet, soy, amaranth, quinoa, in combination with fruits, vegetables, fish, meat, cheese, vegetables and other can however, be easily incorporated in the daily of celiac. It is worth emphasizing that a person with celiac disease, by keeping a proper diet, can lead a completely normal life. According to studies made the highest concentration of gluten a celiac can take in food is 20 ppm (parts per million), the threshold beyond which the gluten becomes toxic. It is important to understand minimal contact with those of foods containing gluten for celiac may contaminate them, for example using the same utensils to stir the pasta is cooked in different pots to be avoided. The ingestion of a small amount of gluten can override the diet, so it's important to make sure that celiac can not ingest food that contain gluten in any form (eg wheat starch. Is often used as a thickener and in structuring many foods, for the same reason it is added to pharmaceutical preparations in tablet form, which people with celiac disease need to check the ingredients under the heading of the ingredients). We must also avoid beer (although there are some brands on the market and types of gluten-free) and pay attention to the espresso bar (because it can be contaminated with barley), spices, sugar, usually pre-cooked food, prepared food flavored (eg. yoghurt fruit) or flavored drinks.<br />