NUTRITION IN MEDICAL DISEASES

Chronic Non-Communicable Diseases (NCDs), also known as chronic diseases, are often long-lasting and result from a combination of genetic, physiological, environmental and behavioural factors. NCDs are much more common in older age and up to 80% of people have at least one of these conditions before the age of 70. They disproportionately affect people in lower middle-income countries and are occurring at increasingly younger ages.

The main types of NCDs are cardiovascular diseases (such as heart attacks and strokes), cancer, chronic respiratory diseases (such as chronic obstructive pulmonary disease and asthma) and diabetes. Modifiable behaviours, such as tobacco use, physical inactivity, unhealthy diet and harmful use of alcohol, increase the risk of CVD. Metabolic risk factors contribute to four major metabolic changes that increase the risk of NCDs:

• High Blood Pressure

• Overweight and obesity

• hyperglycaemia (elevated blood glucose levels)

• Hyperlipidaemia (high blood fat levels).

  Examples of chronic pathologies that we can treat at Kuzmar Clinic:

Hypertension: Hypertension is when the blood pressure in our blood vessels is too high (140/90 mm Hg or more). It is a common problem that can be serious if left untreated. Sometimes it causes no symptoms and the only way to detect it is to take your blood pressure. The risk of hypertension may increase in these cases:

• Advanced age

• Genetic causes

• Overweight or obesity

• Lack of physical activity

• Eating too much salt

• Drinking too much alcohol

• Chronic Kidney Disease: Chronic kidney disease (CKD) is defined by the presence of renal lesions and/or a decrease in glomerular filtration rate (GFR) of more than 3 months' duration, and can be classified into five stages. A diagnosis of renal failure is established when GFR is less than 60 ml/min/1.73 m2. This definition helps to guide management at each stage of the disease. Early detection of CKD is based on the determination of creatininaemia, estimation of GFR and determination of microalbuminuria in patients with risk factors for developing CKD.

• Chronic Heart Failure: The inability of the heart to pump blood in adequate volumes to meet the body's needs; exertional dyspnoea is the most common symptom, although it is very non-specific; other symptoms are orthopnoea, paroxysmal nocturnal dyspnoea, and lower limb oedema. The most frequent associated comorbidities are: hypertension, diabetes mellitus, chronic obstructive pulmonary disease, sleep disordered breathing, renal dysfunction, anaemia/ferropenia, depression and cognitive impairment. Arrhythmias are also very common and worsen the prognosis.

• Diabetes: Since long before the era of modern scientific medicine, nutritional therapy has been the cornerstone of diabetes prevention and treatment. Before the discovery of insulin, diabetes was treated with a starvation diet (Allen diet) with a very low calorie content (400-500 calories/day), with the later emergence of other diets with an extreme carbohydrate restriction of about 2% and a very high fat content of about 70%. Although there was no clear distinction between what is now known as type 1 and type 2 diabetes, these eccentric diets were remarkably successful in controlling diabetes and even keeping patients with type 1 diabetes alive for some years. Years ago, diabetes was commonly defined as a disease of carbohydrate intolerance. After the discovery of insulin, the amount of carbohydrate in the diabetic diet was increased to a maximum of 35-40% of total daily caloric intake. In the late 1970s, there was a strong call for a reduction in total dietary fat and saturated fat intake due to the increased incidence of cardiovascular death, particularly in patients with diabetes. Reducing fat intake by approximately 10% required a compensatory increase in other nutrients, in this case dietary carbohydrates, which rose to approximately 55% to 60%.

  Although medical nutrition therapy is widely recognised by leading diabetes organisations around the world, their dietary recommendations are slightly different. In principle, the main goal is to achieve and maintain optimal glycaemic control and metabolic improvement through healthy food choices, taking into account patients' personal needs, preferences and lifestyle patterns. Appropriate medical nutrition therapy has been shown to reduce HbA1c by 0.5% to 2% in patients with T2 diabetes and by 0.3% to 1% in patients with type 1 diabetes. Medical nutrition therapy has also been shown to be particularly beneficial after the initial diagnosis of diabetes and in patients with poor glycaemic control. At Kuzmar Clinic we are medical researchers specialised in clinical nutrition with extensive national and international experience, and we can treat your disease very well to help you have a better quality of life.

• Alzheimer's disease and other forms of dementia: The ageing of the world's population is a process unprecedented in human history and a source of complexity for health and social care provision from a public health perspective. Increased longevity and survival has led to an increase in the prevalence of chronic diseases and a compression of morbidity in older age. Dementia is a common clinical syndrome from the age of 65 years and older, characterised by a persistent impairment of higher mental functions leading to an impairment of the individual's ability to carry out activities of daily living in people who do not suffer from altered levels of consciousness.

• Chronic Obstructive Pulmonary Disease (COPD): Chronic obstructive pulmonary disease (COPD) is a chronic degenerative disease that occurs in adults over 45 years of age and represents one of the leading causes of morbidity and mortality. Clinically it is characterised by emphysema and chronic bronchitis leading to the development of airway obstruction. It is a common, preventable and treatable disease characterised by persistent respiratory symptoms and airflow limitation due to airway or alveolar abnormalities caused by exposure to noxious particles or gases.

• Dyslipidaemia: Hypercholesterolaemia is a highly prevalent risk factor in patients with cardiovascular disease and confers particular risk for ischaemic heart disease. Patients with acute coronary syndrome often have intermediate low-density lipoprotein cholesterol values, reflecting the importance of interaction with other risk factors in increasing cardiovascular risk. However, statin therapy improves the prognosis of patients after ACS, especially intensive therapy, and irrespective of low-density lipoprotein cholesterol values, making this therapeutic strategy the best option for all such patients and, by extension, all patients with established cardiovascular disease.

• Hyperuricaemia and gout: These are pathological conditions characterised by the overproduction or under-excretion of uric acid, a product of purine catabolism that is physiologically excreted in the urine. Both conditions are often associated with chronic diseases such as hypertension, diabetes mellitus, metabolic syndrome, renal and cardiovascular diseases. Consequently, control of uriccaemia is essential, as is monitoring uric acid levels over time.

Bibliographical references:

• Hamdy, Osama et al.Nutrition in Diabetes. Endocrinology and Metabolism Clinics, 2016; 45(4) : 799 – 817

• Boffa, J.-J., & Cartery, C. Insuficiencia renal crónica o enfermedad renal crónica. EMC - Tratado de Medicina, 2015; 19(3),:1–8. doi:10.1016/s1636-5410(15)72803-5

• Robles Gamboa, C. Insuficiencia cardíaca crónica. Medicine - Programa de Formación Médica Continuada Acreditado, 2017; 12(35) : 2100–2115. doi:10.1016/j.med.2017.06.003

• OMS. Enfermedades no transmisibles. 2023 Acceso el: 08.2024 Disponible en : https://www.who.int/es/news-room/fact-sheets/detail/noncommunicable-diseases

• Garre-Olmo, J. Epidemiología de la enfermedad de Alzheimer y otras demencias. Rev Neurol, 2018; 66(11): 377-386.

• Martínez Luna, M., Rojas Granados, A., Lázaro Pacheco, R. I., Meza Alvarado, J. E., Ubaldo Reyes, L., & Ángeles Castellanos, M. Enfermedad pulmonar obstructiva crónica (EPOC). Bases para el médico general. Revista de la Facultad de Medicina (México), 2020; 63(3): 28-35.

• Cordero, A., & Fácila, L. Situación actual de la dislipemia en España: La visión del cardiólogo. Revista Española de Cardiología Suplementos, 2015;15: 2-7

• Gliozzi, M., Malara, N., Muscoli, S., & Mollace, V. The treatment of hyperuricemia. International journal of cardiology, 2016; 213: 23-27.

  
  

The Process

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