Long term postoperative nutritional management of ischemic patients
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Long term postoperative nutritional management of ischemic patients. By Amr Abdelmonem,MD. Assistant professor of anesthesia ,surgical intensive care and clinical nutrition in faculty of medicine, Cairo university

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Long term postoperative nutritional management of ischemic patients

Long term postoperative nutritional management of ischemic patients

By

Amr Abdelmonem,MD.

Assistant professorof anesthesia ,surgical intensive care and clinical nutrition in faculty of medicine, Cairo university

Member of North American Association For The Study Of Obesity

Member of the American society of regional anesthesia and pain medicine


Pathophysiologic mechanisms of appetite regulation
PathoPhysiologic Mechanisms Of Appetite Regulation management of ischemic patients

Levin, BE. (2004) The drive to regain is mainly in the brain

Am J Physiol Regul Integr Comp Physiol. 287,R1297-R1300

Woods, SC, Seeley, RJ. (2002) Understanding the physiology of obesity: review of recent developments in obesity research Int J Obes Relat Metab Disord. 26(Suppl 4),S8-S10

Horvath, TL, Diano, S. (2004) The floating blueprint of hypothalamic feeding circuits Nat Rev Neurosci. 5,662-667


Long term postoperative nutritional management of ischemic patients

CCK management of ischemic patients

serotonin

GLP-1

PYY(3-36)

Glucagon

Amylin

Ghrelin

Arc

NTS

AP

Vegally dependent

NPY-AGRP

↑Satiety

↑Feeding

↑Satiety


Long term postoperative nutritional management of ischemic patients

NTS management of ischemic patients

Leptin


The metabolic syndrome
The metabolic syndrome management of ischemic patients


Long term postoperative nutritional management of ischemic patients

ATP III Guidelines WHO Guidelines

Abdominal Obesity

Waist CircumferenceWaist/Hip Ratio

Men > 40 inches (102 CM)  >0.90

Women > 35 inches (88 CM)  >0.85

Triglycerides150 mg/dL 150 mg/dL

HDL-Cholesterol

Men < 40 mg/dL <35 mg/dL

 Women < 50 mg/dL <39 mg/dL

Blood Pressure130/ 85 mm Hg >140/>90 mm Hg

Fasting Glucose110 mg/dL 110 mg/dL


Long term postoperative nutritional management of ischemic patients

IDF NCEP

International Diabetes Federation National Cholesterol

Education Program

Central Obesity

Waist Circumference

Men  90 CM

Women  80 CM

Triglycerides150 mg/dL

HDL-Cholesterol

Men < 40 mg/dL

 Women < 50 mg/dL

Blood Pressure130/ 85 mm Hg

Fasting Glucose100mg/dL



Coronary heart disease
Coronary Heart Disease concentrations



Behavioral modifications
Behavioral Modifications physical activity


Long term postoperative nutritional management of ischemic patients

  • SELF-MONITORING physical activity

  • STIMULUS CONTROL

  • COGNITIVE RESTRUCTURING

  • STRESS Management

  • SOCIAL SUPPORT



Atp iii nutritional components of the tlc diet

Nutrient physical activity

Total fat

Saturated fat

Polyunsaturated fat

Monounsaturated fat

Cholesterol

Carbohydrate (esp.complex)

Protein

Dailly recommended intake

25-35%of total calories

<7%of total kilocalories

Up to 10 %of total calories

Up to 20% of total calories

<200 mg

50-60 %of total calories

15 % of total calories

ATP III nutritional components of the TLC diet


Evaluation of the program by the physician
Evaluation of the program by the physical activityphysician

  • The match between the program and the consumers

  • The soundness and safety of the program:

  • Assessment of physical health and psychological status

  • Attention to diet and pharmacotherapy

  • Attention to physical activity

  • Program safety

  • Outcome of the program

  • Long-term weight loss

  • Improvement in obesity related comorbidities

  • Improved heath practice

  • Monitoring adverse effects that might result from the program


Caloric restri ction
Caloric physical activityrestriction

  • Normal caloric intake 20-25 calories for each Kg of the body weight or

  • According to Harris-Benedict equation:

    For males RMR= 66.4+ 13.8 W + 5H – 6.8A

    For females RMR= 665+ 9.6W+ 1.8H – 4.7A

    W=weight (kg), H = height (cm), and A= age (yr)

    e.g. weight : 120 kg H= 175 A=35

    RMR= 66.4 + 13.8(120)+5(175) – 6.8(35)=2359.5

  • Less than 500 calories deficit per day➞ weight loss of .5 Kg per week


Energy density
Energy physical activity Density

  • Definition

    Amount of energy in a given weight of food

    (kcal/g)

  • For the same amount of energy ,a greater weight of food can be consumed when the food is low in energy density than when its energy density is high

    Barbara j ,et al. J Am Diet Assoc.2005;105:S89


Glycemic index
Glycemic Index physical activity

  • Jenkins and his collegues developed the GI.

  • The GI for a food was defined relative to a standard food (glucose or white bread).

  • Over a 2-hour period, the area under the glucose response curve after consuming 50 grams of carbohydrate from the test food was compared with the area under the glucose response curve after consuming 50 grams of carbohydrate from the reference food.

  • Both levels were given as the difference from fasting blood glucose levels .

  • The tests have been done in both healthy people and people with diabetes.


Jenkins and his colleagues have proposed that
Jenkins and his colleagues have proposed that physical activity

  • All carbohydrates are not equivalent and that the rate of absorption of carbohydrate foods into the bloodstream is a critical factor in hyperinsulinemia.

  • Slowly absorbed foods would be beneficial because they trigger less of a rise and fall in blood glucose and, thus, less of a rise and fall in insulin levels


Long term postoperative nutritional management of ischemic patients

  • American Society for Clinical Nutrition physical activity, has noted that a number of diet strategies exist for weight loss and that different individuals may find different strategies useful.

  • Although they do not specifically endorse either the GI or energy density as methods for choosing foods, they have noted that both have some support in the literature and that further research into them is warranted

  • Klein, S, Sheard, NF, Pi-Sunyer, X, et al (2004) Weight management through lifestyle modification for the prevention and management of type 2 diabetes: rationale and strategies. A statement of the American Diabetes Association, the North American Association for the Study of Obesity, and the American Society for Clinical Nutrition Am J Clin Nutr. 80,257-263


Final comment
Final Comment physical activity