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General Principles of Nutrition Support in Cardiac Rehabilitation

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Cardiac Rehabilitation Manual

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Abstract

An unfavorable diet in terms of quality and quantity contributes to the development of cardiovascular disease. Obesity is one of the challenges our society has to face. Environmental factors seducing to physical inactivity as well as the ubiquitous availability of foods with high caloric density and sugar-sweetened drinks make weight control and weight loss difficult. There is also a social and educational gradient. Weight loss is less dependent on the type of diet consumed but rather on the frequent contact with the physician or dietician to keep up the motivation for a healthy lifestyle change.

The concept of prevention has moved from focusing on individual components of a diet to recommending a food pattern. The Mediterranean diet is in many aspects the most favorable dietary pattern with a balanced mixture of components that have metabolically favorable and anti-inflammatory effects such as vegetables, legumes, fruits and cereals (primarily unprocessed), frequent fish consumption, less dairy products, rarely meat, a small amount of saturated fatty acids, but a high proportion of unsaturated fatty acids, particularly olive oil. A moderate consumption of alcoholic beverages mostly as wine and preferably with meals is probably beneficial. The effect of the Mediterranean diet has been evaluated in more than half a million persons, in middle (>55 years) and older (70–90 years) age groups, in Greek, European and American populations and has been confirmed in the 52-country INTERHEART Study. A high adherence to the Mediterranean diet – as judged by the Mediterranean diet score – is associated with a lower heart attack and a lower stroke rate, a lower cardiac, cardiovascular, and cancer mortality and probably also a lower incidence of Alzheimer and Parkinson’s disease.

Black tea (without milk) has a beneficial effect on endothelial function and on prognosis; up to five cups of coffee probably delay the onset of diabetes and have no unfavorable effects on the heart. Nuts are snacks with a beneficial prognostic impact, and also a specific 70% chocolate has some beneficial effect on endothelial function. Thus even the optimal preventive diet can be a joyful and diversified experience.

A dietary modification aiming at reducing the global cardiovascular risk will require a long term commitment to improve daily dietary habits in the direction of a calorie adapted Mediterranean diet. This is valid for healthy persons as well as for patients with vascular disease and patients after myocardial infarction.

Randomized interventional studies however will be necessary to allow detailed dietary recommendations for the reduction of cardiovascular events for patients with cardiovascular disease with defined metabolic disturbances.

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  1. Chefarzt Abt. Klinische Kardiologie II, Herz-Zentrum, Bad Krozingen, D-79189, Germany

    Helmut Gohlke

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    Josef Niebauer

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Gohlke, H. (2010). General Principles of Nutrition Support in Cardiac Rehabilitation. In: Niebauer, J. (eds) Cardiac Rehabilitation Manual. Springer, London. https://doi.org/10.1007/978-1-84882-794-3_2

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