Cardiac Nutrition Healthy eating for a strong heart beating

Transcription

1 Cardiac Nutrition Healthy eating for a strong heart beating Julia Shih VMD, DACVIM (Cardiology)

2 Key Topics Role of Nutrition Optimal Weight Important Nutrients Restricted Nutrients Supplements

3 The Individual Body Composition Obesity Increased work Oxidative stress Contributes to CHF signs Cardiac Cachexia Inflammatory cytokines TNF-α, IL-1 Anorexia Increased energy requirements Loss of lean body mass Cardiac myocyte hypertrophy Fibrosis Negative inotropy

4 Protein

5 Protein Avoid Protein Restriction Promotes lean body mass loss and malnutrition Maintenance Protein Requirements Preclinical Heart Disease Canine: 45g/1000kcal (AAFCO minimum requirements) Feline: 65g/1000kcal Heart Failure Canine: 61g/1000kcal Feline: 75g/1000kcal

6 Protein - Canine Dry 41g/1000kcal Can 38g/1000kcal Dry 60g/1000kcal Dry 46g/1000kcal Can 48g/1000kcal Dry 33g/1000kcal Can 32g/1000kcal

7 Protein - Feline Dry 82g/1000kcal Can 79g/1000kcal Dry 65g/1000kcal Can 66g/1000kcal

8 Fat

9 Fat Omega-3 Fatty Acids Decrease inflammatory cytokine production TNF-α IL-1 Improves cardiac cachexia Improves muscle mass Improves appetite Improves myocyte energy metabolism Suppresses arrhythmias Omega-3 fatty acids in Boxer dogs with arrhythmogenic right ventricular cardiomyopathy. Smith et al, JVIM 2007;21(2). Fish oil supplementation for 6 weeks reduced median number of ventricular premature complexes

10 Omega-3 Fatty Acids Dosing Avoid n-6:n-3 ratio EPA 40mg/kg/day DHA 25mg/kg/day Avoid Alpha-linolenic acid Found in plant products (flaxseed oil, linseed oil, canola oil) Not well converted to EPA and DHA Cod Liver Oil, Krill Oil Contain fat soluble vitamins (Vit A, Vit D)

11 Fat - Omega-3 Fatty Acids Potential Concerns Altered platelet function Diarrhea Pancreatitis Altered immune function Impaired wound healing Lipid peroxidation Potential for toxin exposure and nutrient excess Hyperglycemia/Insulin sensitivity Nutrient-drug interactions

12 Salt Restriction Decrease water retention Allow use of lower diuretic doses Help control blood pressure

13 Salt Restriction Heart Disease Category Allowable sodium as a % of DRY matter Mg of Sodium per 100 kcal of food Asymptomatic patient (No active heart failure, At risk of heart failure) Symptomatic patient (History of heart failure) Symptomatic patient with refractory heart failure Mild sodium restriction Moderate sodium restriction Marked sodium restriction < 0.2 < 50

14 Salt Restriction Educate clients on salt content in foods and treats Avoid Baby food Bread Canned vegetables (unless no salt added) Cheeses (unless labeled low sodium) Condiments Lunch meat/cold cuts Many pet treats Pickled foods Pizza Processed foods (potato mixes, macaroni and cheese, rice mixes) Snack foods (potato chips, packaged pop corn, crackes) Soups (unless home made without salt) Teach clients how to administer medication without food

15 Salt Restriction Acceptable treats and foods Plain pasta Plain rice Lean cooked meat (chicken, turkey, beef, fish) Low sodium cheese Low salt breakfast cereal Fresh vegetables/fruit (carrots, green beans, apple, banana) Cooked eggs Honey or maple syrup Tufts Heart Smart Website

16 Taurine - Cats Essential amino acid in cats Taurine-deficiency induced myocardial failure Suspect in cats with homemade or vegetarian or otherwise unbalanced diet Supplementation Taurine 250mg PO BID

17 Taurine - Dogs Non-essential amino acid Cocker Spaniels Other: Newfoundland, Golden Retrievers, Portuguese Water Dogs Associations Lamb & Rice Diets High Fiber diets Cystinuria Causes Inadeqate intake or limited bioavailablity of precursor amino acids Higher nutritional requirement for precursor amino acids Increased fecal taurine loss Supplementation Taurine mg PO BID L-Carnitine 50mg/kg PO TID

18 New Nutritional Cardiomyopathy Golden Retrievers Atypical Breeds Grain Free Diets Theories Low concentrations of sulfur based amino acids Plant-based proteins (Legumes) Less organ meat High fiber Increased fecal clearance of taurine Not all dogs are taurine deficient

19 L-Carnitine Essential amino acid Fatty acid metabolism and energy production Myocardial Carnitine Deficiency 1 family of Boxers Supplementation Dose: Systemic deficiency 50mg/kg PO TID Myocardial deficiency 200mg/kg PO TID Side Effects Diarrhea

20 Coenzyme Q10 & Antioxidants Coenzyme Q10 Cofactor in energy production pathways Antioxidant Need controlled prospective studies to judge efficacy Dose: 30-90mg PO BID Sensitive to UV Light Use oil based emulsion in amber colored capsule Antioxidants CHF causes elevated oxidative stress and reduced Vit E Antioxidant supplementation reduces oxidative stress Superoxide dismutase, catalase, glutathione peroxidase, Vitamin C, Vitamin E, beta-carotene Long-term benefits in dogs and cats with CHF unknown

21 Electrolytes Potassium Hypokalemia Diuretics Inadequate Hyperkalemia ACE Inhibitors Spironolactone Magnesium Hypomagnesemia Diuretics Digoxin

22 Feeding Practices

23 Feeding Practices Offer multiple choices of appropriate pet foods Palatability enhancers Cooked meat, low sodium tuna, cooked fish (Cats) Cooked meat, yogurt, applesauce, maple syrup (Dogs) Food Temperature Omega-3 Fatty acids More frequent, smaller meals Treats Salt content Medication administration

24 Key Points Feed the individual! Severity of cardiac disease Body condition Concurrent disease

25 Questions?