Louisiana Professional Medical care group

Diets for Cardiovascular Diseases

An Evaluation of Two Diets for Treatment

Ashish Pokharel

11/4/2013

Prepared for Louisiana Professional Medical Care Group (LPMCG) and in partial fulfillment of Mrs. Susan Eller’s English 303 Technical Writing Class

602 S. Trenton St.Ruston, LA71270November 4, 2013

Dr. David Sheringham, Chief of Medical Diagnostic Team Louisiana Professional Medical Care Group1687 Lake roadRuston, LA, 71272

Dear Dr. Sheringham:

Attached with this letter is my analytical research recommendation report on analyzing and evaluating two of the best diets for treating cardiovascular disease (CVD) patients. For this report, I compared two highly recommended diets for CVD patients: Dietary Approaches to Stop Hypertension (DASH) diet and Therapeutic Lifestyle Changes (TLC) diet.

To evaluate these two diets, I used criteria of cost, health outcomes, and long-term compliance. After my primary and secondary research, I determined the best diet for Louisiana Professional Medical Care Group to recommend would be the DASH diet. This diet provides better health outcomes and is more feasible than the TLC diet. Although the DASH diet costs seem to higher, the difference is negligible.

I appreciate the opportunity to research the diet options for treating CVD patients and to present my recommendations to Louisiana Professional Medical Care Group. I look forward to more research opportunities in the future. If you have any queries, please contact me at ashish_pokharel@hotmail.com or 201-716-9100.

Sincerely,

Ashish Pokharel

IntroductionCardiovascular Diseases1 (CVD) and related complications are the leading causes of death in USA. Various interrelated diseases like hypercholesterolemia, hypertension, heart failure, cerebrovascular accident (stroke), coronary artery diseases etc. classify as CVD. The incidence of CVD is on the rise. According to a report by Division of Vital Statistics (2012), the leading cause of death among Americans is heart disease. The same report states that cerebrovascular accident or Stroke, which is similar complication of blood vessels, is the fourth leading causes of death in USA. According to a CVD future forecast report by American Heart Association (AHA), about 40.5% of Americans will have some form of CVD by 2030 (Heidenreich et al., 2011). The following projection table from the same report shows the estimated increase in CVD and related complications prevalence from 2010-2030.Projections of Crude CVD Prevalence (%), 2010-2030 in the United States

Year All CVD Hypertension Coronary heart disease

Heart failure

Stroke

2010 36.9 33.9 8 2.8 3.22015 37.8 34.8 8.3 3 3.42020 38.7 35.7 8.6 3.1 3.62025 39.7 36.5 8.9 3.3 3.82030 40.5 37.3 9.3 3.5 4% change 9.9 9.9 16.6 25 24.9

Source: Adapted from Heidenreich et al. (2011). Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association. Circulation, 123.

As the table predicts, the incidence of all forms of CVD among US population will increase by 10%.

Currently, heart diseases make up one sixth of the entire healthcare expenditure. R. Morgan Griffin of webmd.com (2013) writes that about four hundred and forty four billion dollars were spent on heart disease in America in 2010. Various projections predict increase in the prevalence of CVD. Along with the rising prevalence of CVD, the medical costs, both direct and indirect, will increase. In the future, direct expenses like medicines, hospital checkups, treatment follow-up, surgery etc. will make up a significant portion of the healthcare expenses for both government and individuals. Direct costs related to hypertension, the most prevalent CVD disease, are projected to increase by 130.4 billion dollars by 2030 (Heidenreich et al., 2011). Similarly, indirect costs related to CVD disease like loss of productivity, sick leaves, and mortality will also increase. The following table from future forecast report by AHA shows the projected increase in direct medical costs from 2010-2030.

1 All the italicized text in this report are defined in the glossary

Projected Direct (Medical) Costs of CVD , 2010-2030 (in billions 2008$) in the United States

All CVD

Hypertension

Coronary Heart Disease

Heart Failure

Stroke Hypertension as risk factor

2010 272.5 69.9 35.7 24.7 28.3 130.72015 358 91.4 46.8 32.4 38 170.42020 470.3 119.1 61.4 42.9 51.3 222.52025 621.6 155 81.1 57.5 70 293.62030 818.1 200.3 106.4 77.7 95.6 389% change

200 186 198 215 238 198

Source: Adapted from Heidenreich et al. (2011). Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association. Circulation, 123.

The table above predicts that Americans will spend about 818 billion dollars on CVD by 2030 and this is 200 % increase from 2010. Thus, medical expenses will be a major issue for both government and individuals.

Problem

With increasing health risks and increasing costs issue of CVD diseases, the development of effective measures to treat CVD is a priority for healthcare organizations. Healthcare Organizations need to design and implement effective preventive and treatment strategies in order to attain the best health and cost outcome. Most prevention and treatment plan for CVD diseases underline proper diet and exercise as their principle area of focus. Considering prevalence and expenses related to heart disease, the Center for Disease Control and Prevention (CDC) recommends eating a healthy diet as one of the key strategy to stop CVD.

With awareness about diet plans increasing in the general public, various popular media like television, internet, and magazines target people with advertisements about diet plans. Common people debate about which diet works for them and how to approach diets. Many people deprive themselves of essential nutrients while striving to lose weight through popular diets. This dilemma holds true for people trying to decide on a diet for medical purposes like treating CVD. Proper advice and recommendation about diet is essential as many people have CVD or they are genetically prone to develop CVD in later years of life.

Louisiana Professional Medical Care Group (LPMCG) serves many patients with CVD and related complications. According to LPMCG’s annual report, about 35 percent of its patients have CVD and related issues. In future, there will be more patients with CVD because of its increasing prevalence. As Louisiana Professional Medical Care Group (LPMCG) specializes in nutrition therapy and care, recommending the best diet for improving patients’ health outcomes is of primary importance. Giving the best treatment based on scientific data, research is one of our organizational goals, and we need to implement the best treatment plan for every patient based on evidence-based practice.

Improving health outcomes through the most effective diet plan will improve customer satisfaction as well as our organization’s image in medical community. Thus, there is a need to implement and recommend the best diet plan for CVD patients.

Purpose

The major purpose of this analytical research report is to analyze two of the best diet plans for CVD patients and to recommend LPMCG the best diet plan for treating its CVD patients. In this report I will discuss about two highly recommended diets to treat CVD, and compare and contrast between them. Providing the best treatment for CVD patients requires evaluation of these two scientifically proven diets based on cost, health outcomes, and long-term compliance. Sufficient data and knowledge about these two diets will provide nutrition and healthcare professionals of Louisiana Professional Medical Care Group (LPMCG) a strong basis for diet recommendation and treatment.

Solutions Various healthcare institutions have researched and formulated a wide range of diet plans for CVD. National Heart, Lung, and Blood Institute (NHLBI), a leading government organization in heart disease research, have developed many diets based on scientific research and results. Dietary Approaches to Stop Hypertension (DASH) plan and Therapeutic Lifestyle Changes Diet (TLC) are two prominent diet plans designed by NHLBI to tackle CVD causative factors like hypertension and cholesterol.

A. Dietary Approaches to Stop Hypertension(DASH)

Dietary Approaches to Stop Hypertension (DASH) is a diet plan that focuses on limiting sodium or salt from regular diet of individuals along with increasing heart healthy food. The diet emphasizes consumption of food which meets basic nutritional criteria along with increasing intake of protein, fiber, and minerals like potassium, calcium, and magnesium. The DASH diet aims to control hypertension and hypercholesterolemia among patients and ordinary individuals. Medical professionals recommend the DASH diet along with regular physical activity to lower bad cholesterol (LDL cholesterol), blood pressure, and thus lower the risk of heart diseases.

The DASH diet gives various recommendations regarding various food groups and their daily servings. The DASH diet recommendations for major food groups are shown in the table below.

Food Group Daily ServingsGrains 6-8Vegetables 4-5Fruits 4-5Fat-free or Low-fat milk and milk products 2-3Lean meat, poultry, and fish 6 or lessNuts, Seeds, Legumes 4-5 times/weekFats and Oils 2-3Sweets and Sugars 5 or less/week

Source: Your guide to lowering your blood pressure with DASH, 2011. US department of health and human services.

As the table shows, the DASH diet primarily focuses on increasing grain, fruits and vegetable intake while reducing saturated fat intake through consumption of low fat dairy and lean meats.

B. Therapeutic Lifestyle Changes (TLC)

Therapeutic Lifestyle Changes (TLC) diet plan focuses on lowering LDL cholesterol and thus, reducing the risk of CVD. The TLC also reduces blood triglycerides (TG) among patients. Furthermore, the diet also improves other risk factors like obesity and diabetes which is closely associated with CVD. The diet plan along with weight management and physical activity is recommended for improving CVD patients’ outcome. Firstly, the TLC diet plan categorizes the patients into four risk group: high risk, next high risk, moderate risk, and low to moderate risk. The TLC classifies patients based on risk factors like age, family history, smoking habits, LDL and HDL cholesterol. Next, TLC recommends healthy cholesterol intake levels to individuals based on the risk category.

The TLC plan differs from the DASH plan as it recommends plant sterols/ stanols in diet plans. The major recommendation for food groups according to the TLC plan is shown in the table below.

Food Group Daily ServingsGrains 6 or moreVegetables 3-5Fruits 2-4Fat-free or Low-fat milk and milk products

2-3Lean meat, poultry, and fish 5 or less ounces per dayEggs 2 or fewer yolks per

weekPlant sterols/stanols About 2 gms per daySource: Your guide to lowering your cholesterol with TLC, 2005. US department of health and human services.

As the table shows, the primary focus of the diet is to provide the adequate macronutrient and calories while reducing the cholesterol intake of patients through lean meat, yolk free eggs, and low fat milk. The TLC diet also focuses on promoting plant sterols intake of 2 gms a day which reduces LDL cholesterol up to 15 % within a few weeks (Your Guide to lowering cholesterol with TLC, 2005).

CriteriaA. Cost

The average cost of a diet plan is always important for health professionals and patients. Reasonable costs provide better implementation on the part of patients and better health outcomes. As the cost influences the diet plan and health results, it is an important factor to consider for health professionals before they recommend a diet plan. The higher costs of healthy foods especially fruits and vegetables make recommending the proper diet more challenging than before. Thus, in order to get a fair estimate of the costs, I will calculate total price of sample diets of the DASH diet and the TLC diet. For consistency, I will use prices set by Wal-Mart in order to determine the cost of ingredients. The prices information will be obtained online through Wal-mart website www.walmart.com. Nevertheless, if prices are not found online, I will personally visit Wal-mart located in Ruston, Louisiana to determine the price. The costs of sample diets will be then evaluated.

B. Health Outcome

The health outcome result is perhaps the most criteria for health professionals while recommending a diet plan. Adherence to the diet plan must give positive outcomes in terms of blood lipid profile, blood pressure, and anthropometric measurements for CVD patients. Health recommendations are based on scientific evidence showing the effectiveness of a diet plan for a specific disease condition. If a diet does not have sufficient evidence to prove efficiency, then there is no point in recommending it. Hence, I will examine scientific evidence and results of both the TLC and the DASH diet in order to determine which diet will provide the best outcome for treating CVD patients.

C. Long-term Compliance

The patient’s compliance to a diet plan usually determines the health outcomes over a course of time. Although compliance is primarily of a patient’s concern, medical professionals must be aware about which diet is followed by their patients consistently. If patients find it hard to comply with a diet, recommending the diet will be futile. As compliance may be the difference between a successful nutritional intervention and a non-successful one, determining which diet provides better compliance is very important. Therefore, I will examine the present literature to find information regarding long-term compliance of each diet.

Methods

A. Primary Research

I calculated the total costs of the sample TLC diet and the sample DASH diet through the prices of ingredients at Wal-Mart. I used Walmart.com to get the prices of the food items. When the prices were not available on the website, I went to the Wal-Mart in Ruston, Louisiana to get the prices of the ingredients.

I interviewed Mrs. Susan Hughes, a Dietetics and Nutrition professor at Louisiana Tech University, for her views on the TLC and the DASH diet. She is also a consulting dietitian at Turin Lakes Rehabilitation and Care Center in Texas. Mrs. Hughes has knowledge about medical nutrition therapy and has worked with patients with CVD in her professional career. In our email interview, she shared her ideas and views about the TLC and the DASH diet.

B. Secondary Research

I studied recent peer reviewed journals about the TLC and the DASH diet. Many journals have published articles about the TLC and the DASH diets and their outcomes. Many journals contained results from experiments, health study, and research designs about the DASH and the TLC.

I also looked for information on US government website and publications as US government does a lot of research on CVD. DASH and TLC handouts by National Institute of Health were two very useful resources while writing this report. Along with the government websites, I also looked into literature published by reputed organizations like American Heart Association, Academy of Nutrition and Dietetics.

Results

A. Cost Analysis

The DASH Diet

One sample daily menu of the DASH diet was evaluated in terms of cost. Wal-Mart prices of the food items were used either through the Wal-Mart website or the store price on 10/25/13. The following table shows a sample DASH menu with its prices.

Bre

akfa

st

Food Items COST(approx.)

¾ cup of bran flakes cereal with 1medium banana and 1 cup of milk 2.15

1 slice of whole wheat bread with 1 tsp of soft margarine

1 cup of orange juice

Lun

ch

¾ cups of chicken salad with 1 tbsp of Dijon mustard 3.5

2 slices of whole wheat bread

1 cup of salad(cucumber, tomato, sunflower seeds)

½ cup of fruit cocktail, juice pack

Din

ner

3 oz beef with 2 Tbsp of beef gravy 4.15

1 cup green beans sauteed with 1 tsp of canola oil

1 small baked potato with 1 tbsp sour cream, cheddar cheese, chopped scallions1 small wheat roll with 1 tsp soft tub margarine

1 small apple

1 cup low fat milk

Snac

k

1/3 cup of almonds 1.75

¼ cup of raisins

½ fruit yogurt

Total 11.55

Source: Adapted from Your guide to lowering your blood pressure with DASH, 2011. US department of health and human services.

As the table shows, the estimate of total cost of a sample DASH diet is about 11.55 dollars per day. This averages up to about 350 dollars per month. However, this table does not include other expenses like the cost of preparation including water, utensils, electricity and

gas expenses. The prices of the food items may also vary on a day-to-day basis at Walmart.com and Wal-Mart store.

The TLC Diet

Similarly, the cost of food items of a sample TLC diet was evaluated. For consistency Wal-Mart website and store prices were attained on 10/25/13 for sample TLC diet. The following table shows sample TLC diet and its prices.

Food Items COST(approx.)

Bre

akfa

st

1 cup oatmeal with fat free milk and raisins 2.10

1 cup Honeydew melon

1 cup calcium fortified Orange juice

1 cup coffee with fat-free milk

Lun

ch

Roast beef sandwich( whole wheat bun, lean beef, swiss cheese, lettuce, tomato, mustard

3.85

¼ cup Pasta salad with ¼ cup of mixed vegetables and 1 tsp olive oil

1 medium Apple

1 cup unsweetened ice tea

Din

ner

1 cup of Rice with 1 tsp soft margarine 3.15

½ cup of broccoli with 1 tsp soft margarine

1 cup of Strawberries with ½ cup of low fat yogurt

1 orange cooked with 2 tsp olive oil

Snac

k 2 cups of popcorn cooked with 1 Tbsp canola oil 1.50

1 cup peaches canned in water

Total 10.60

Source: Adapted from Your guide to lowering your cholesterol with TLC, 2005. US department of health and human services.

As the table shows, the estimate of a TLC diet plan is about 10.60 dollars per day. This averages up to about 320 dollars in a month. As with the DASH diet cost, this table does not include other expenses like the cost of preparation including water, utensils, electricity, and gas expenses. Like mentioned previously, the prices of the food items may also vary on a day-to-day basis at Walmart.com and Wal-Mart store.

.

B. Health Outcomes

The DASH diet

There have been numerous studies regarding the efficiency of the DASH diets. A study linking DASH diet adherence to risks of CVD shows that the DASH diet reduces the incidences of CVD accidents among adult population. The study observed that the risks of venous thromboembolism significantly decreased by 25% in adults with higher fruit consumption and 23% in adults with higher nut consumption (Fitzgerald et al., 2012).

Another DASH diet study in India notes that there were changes in the systolic and diastolic blood pressure of several participants who followed DASH diet for 2 months. The Systolic blood pressure decreased in 23 participants (76.6% of the total) and the diastolic blood pressure decreased in 20 participants (66.6% of the total). The mean blood pressure decreased among 21 participants (70% of the total). Although, the results were not statistically significant, DASH diet still proved effective in reducing blood pressure among most of the participants (Koley et al., 2013).

The DASH diet is often modified to suit the preferences of individuals from different regions of the world. A study that used modified version of the DASH diet in UK population found that there were significant reductions in the blood pressure of the individuals who participated in the DASH study for duration of a month. The systolic blood pressure and the diastolic blood pressure decreased significantly by 4.6 and 3.9 mm of Hg (Harnden, Frayn,& Hodson, 2010).

The TLC diet

Various scientific studies have published the results of the TLC diet. In one study where TLC diet with high fish contents , Ooi et al. (2012) reported that TLC diets with higher fish content showed 24% decrease in blood triglycerides (TG) than low fish diet. Since higher total TG level correlates with increased risk for CVD, a significant decrease of TG shows that the TLC diet has positive health outcomes. However, the same study showed that high-density lipoprotein (HDL) decreases along with the decrease in TG and low-density lipoprotein (LDL). As HDL helps in preventing CVD, medical professionals do not favor this outcome.

Similarly, Han et al. (2003) argues that older adults can benefit from enhanced cell immune response along with decrease in LDL cholesterol levels. This study shows 10% decrease in LDL cholesterol with about 6% decrease in HDL cholesterol. Again, the decrease in HDL cholesterol is not a positive outcome as HDL cholesterol is beneficial to stop plague formation in blood vessels and reduce the risks of CVD.

Health professionals frequently prescribe the TLC diet and other TLC recommendations like lifestyle changes in order to improve health outcomes. A six-month intervention study aimed at understanding clinical and behavioral effects of TLC diet shows that the

participants had reductions in systolic and diastolic blood pressure. The systolic and diastolic blood pressure decreased from 129 and 78.3 mm of Hg to 124 and 72.8 mm of Hg (Aldana et al., 2006). The role of the TLC diet in reducing hypertension is a favorable outcome.

C. Long-term Compliance The DASH Diet

Measuring the recommended nutrition intake of any diet is the best way to assess the diet compliance. A Polish study measuring the compliance of DASH diet to 159 hypertensive patients found that the total fat intake percentage of the male participants was 126.3± 24.5 (mean±SD) to the percentage recommended by DASH. This intake was classified as high intake that is 111 to 130 % of the recommended intake of fats. By using similar reasoning, the intakes of cholesterol among male participants were classified into very high intake. Nevertheless, the DASH diet was successful in limiting the sodium intake in the recommended level for male participants and the DASH resulted in low intake of sodium in female participants. (Gajewska, Niegowska, & Kucharska, 2010).

Harnden, Frayn, & Hodson (2010) state that subjective communication with the patients highlighted that modified DASH diet is acceptable to the study population. The researchers also found that there were no complications in going to a low salt intake once the participants were accustomed to the low salt taste. The researchers point out that this finding is very important as the main goal of the DASH diet is to lower blood pressure among hypertensive people through lower intake of sodium. The compliance and the ease of switching to low salt dietary pattern make the DASH diet an effective diet in treating hypertension.

The TLC Diet

The TLC diet primarily focuses on decreasing cholesterol and saturated fat intake along with increasing plants sterol and stanols intake. In an article published in the Journal of American Heart Association, Fletcher et al. (2005) state that about one fourth of the patients with CVD problems discontinue drug therapy and diet adherence. The main problems with following a low saturated fat and cholesterol diet are the availability and use of fats in daily foods. Unlike the DASH diet, which lowers high salt intake by omitting it, the TLC diet cannot reduce fats easily as fats are required in many cooking recipes. As most protein sources are also fat sources, it is difficult to limit fats in the diet with protein. In the book “Fat Detection: Taste, Texture, and Post Ingestive Effects” the author states that fats do have an effect on satiety and appetite hormones (National Center for Biotechnology Information, 2010) Thus, reducing fats as recommended in the TLC diet might cause quicker hunger response and thus more food consumption. This cause and effect is important as more consumption leads to poor adherence to the TLC diet.

Conclusions and Analysis

Cost: In terms of cost, both DASH diet and TLC diet have reasonable prices. A sample DASH diet for a day was 11.55 dollars and a sample TLC diet for a day was 10.60 dollars. The results of the sample diet cost analysis of these two diets show that there is a minor difference in price of the sample diets. This minor difference cannot be significant as the ingredients and cost for other TLC and DASH diets may change daily. With different food options available for making TLC and DASH menus, there will be fluctuations in price of the daily menus. In addition, as Wal-Mart pricing was used for consistency purposes, one must be aware that other food vendors can also be used. This influences the cost of food item largely. The DASH diet may have been slightly higher in costs as the DASH diet places an emphasis on fruits and vegetables in a diet. As both of these food groups have higher prices compared to other food groups, the DASH diet has higher food costs. Similarly, the DASH diet also recommends nuts and seeds in diets, which has higher prices than other foods.

Nonetheless, cost is an important criterion to consider even if there are many limitations to cost estimation. Many people who suffer from CVD in Louisiana are from low-income group. Thus, cost of the food products will concern this affected group of people. According to World Health Organization (WHO)’s official website, low socio-economic status plays a role in incidents of deaths due to CVD. Hence, in order to address issues of CVD among low-income group, cost must be considered while giving the prevention and treatment recommendation.

Although, the TLC diet edges the DASH diet on the criteria of cost, LPMCG needs to weigh them equally. Due to the limitations in the primary research and fluctuations in market price, LPMCG can estimate both of these diets to be of the same cost for the patients.

Health Outcomes: Each of the diets was scientifically designed and there have been various studies conducted to examine the health outcomes of each diet. Through literature research, one can find that various short-term and long-term studies have been done with the DASH and the TLC diet.

According to the results, the DASH diet was very successful in reducing venous thromboembolism, which is a type of CVD. Furthermore, the DASH was effective in reducing sodium intake and increasing potassium intake, and the DASH diet was successful in reducing hypertension among patients. Likewise, the results of the studies show that patients following a DASH plan have significant decrease in their systolic and diastolic blood pressure. This result means that the DASH diet is successful in meeting its goals. The diet can be modified to suit the taste preference and there are menus that help patients to adopt a southern style of diet. Availability of modified diet is important as LPMCG mostly serves southern people. Thus, medical professionals can easily recommend the modified DASH diet to suit the patient’s preferences.

Similarly, there have been numerous study about the health outcomes of the TLC diet which shows that TLC diet is useful in reducing blood triglycerides and cholesterol levels. The TLC diet high in fish intake was effective at reducing triglycerides by 25%. The studies have also

shown that the TLC diet has effectively reduced cholesterol and LDL levels. As the main aim of the TLC diet is to reduce LDL cholesterol and triglycerides, the TLC works very well to meet the goals. However, the literature studies also show that TLC resulted in lowering of HDL cholesterol as well. As HDL cholesterol is beneficial in preventing various forms of CVD, this effect of TLC diet is not favored. The decrease in HDL will undermine the efficiency of the TLC diet.

In addition, there is no scientific literature that clearly states that the TLC diet has modified menus for various people. Medical professionals at LPMCG must consider this lack of flexibility in the TLC diet while giving recommendations to the patients.

Long-term Compliance: Very few studies studied the long-term compliance to a diet. Most of the scientific literature focuses on health outcomes during a scientific study period. The DASH diet and the TLC diet have few studies regarding adherence to the diet.

The long-term compliance results of the DASH diet shows that patients generally overestimate their consumption in food group while underestimating other food groups. The statistics of the study show that the compliance with the DASH diet controlled sodium intake, but increased the calorie intake. The subjective communication with patient highlights that the DASH diets modified to suit the patient’s preferences is well tolerated and adhered. Considering these facts about reduced sodium intake, medical professionals at LPMCG can recommend the DASH diet.

The long-term compliance results of the TLC diet are more complicated. There are no clear studies aimed directly at adherence to the TLC diet. From literature studies, one can deduce that reducing fat in a diet may create satiety and appetite hormones issue. Diets lowering fats can be counterproductive as people might overindulge in food in the long-term. Similarly, fats are used in most cooking procedures and fats play an important role in promoting the taste of the food. Thus, reducing or eliminating fats in a diet is difficult . This reasoning works against the compliance of the TLC diet as the diet aims at reducing fats from the diet.

In terms of practice, dietitians favor a balanced diet with appropriate macronutrient distribution. Mrs. Susan Hughes who works as a consulting dietitian at Twin Lakes Rehabilitation and Care Center says that in long- term care of geriatric patients the diets used for patient care are more liberalized than restricted. She adds that diets are more balanced and general to make them more feasible and more valuable to the patients (Personal Communication, 10/27/2013). Considering the TLC diet’s poor feasibility in long-term care, LPMCG can recommend TLC diet to patients with very specific CVD symptoms, but not to general patients.

Recommendation

Based on the analysis of the DASH and the TLC diet by the criteria of cost, health outcomes, and long-term compliance, I am able to mention Louisiana Professional Nutrition Care Group (LPNCG) to recommend the DASH diet while treating their CVD patients. Clearly, the DASH diet is more feasible in terms of modification and compliance. The DASH diet has sufficient scientific studies proving its efficiency with health outcomes in patients. The DASH diet clearly improves hypertension along with blood lipid profiles; whereas, the TLC diet only improves the blood lipid profile.

While the TLC diet proves to be cost effective, the difference in costs of the two diets is negligible. LPNCG needs to be aware that the costs are subjective to the market costs of food that fluctuates every day. I am confident that the higher costs of the DASH diet will not be a flaw of the DASH diet.

The DASH diet is scientifically studied and proven by many reputed healthcare organizations. It is endorsed the US government as well. Overall, the DASH diet is the best recommendation to prevent and treat CVD patients.

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Thomas, C. C. (2006). The behavioral and clinical effects of therapeutic lifestyle change

on middle-aged adults. Preventing Chronic Disease, 3, A05.

Fitzgerald, K. C., Chiuve, S. E., Buring, J. E., Ridker, P. M., & Glynn, R. J. (2012). Comparison

of associations of adherence to a dietary approaches to stop hypertension (DASH)-style

diet with risks of cardiovascular disease and venous thromboembolism. Journal of

Thrombosis & Haemostasis, 10, 189-198.

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Managing abnormal blood lipids: a collaborative approach. Circulation, 112, 3184-3209

Gajewska, D., Niegowska, J., & Kucharska, A. (2010). Compliance to DASH diet by patients

with essential hypertension. Polish Journal Of Food And Nutrition Sciences, 60(1), 71-76

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Han, S., Leka, L. S., Lichtenstein, A. H., Ausman, L. M., & Meydani, S. N. (2003). Effect of a

therapeutic lifestyle change diet on immune functions of moderately

hypercholesterolemic humans. Journal of Lipid Research, 44, 2304-2310.

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GlossaryBlood triglycerides (TG): any of a group of lipids that are esters formed from one molecule of

glycerol and three molecules of one or more fatty acids, are widespread in adipose tissue,

and commonly circulate in the blood in the form of lipoproteins—called also neutral fat.

Cardio vascular diseases: diseases affecting heart and blood vessels.

Cerebrovascular accident (stroke): sudden diminution or loss of consciousness, sensation, and

voluntary motion caused by rupture or obstruction (as by a clot) of a blood vessel of the

brain.

Coronary artery diseases: a condition and especially one caused by atherosclerosis that reduces

the blood flow through the coronary arteries to the heart muscle and typically results in

chest pain or heart damage

Diastolic blood pressure: the lowest arterial blood pressure of a cardiac cycle occurring during

diastole of the heart

HDL cholesterol: a lipoprotein of blood plasma that is composed of a high proportion of protein

with little triglyceride and cholesterol and that is associated with decreased probability of

developing atherosclerosis

Heart failure: a condition in which the heart is unable to pump blood at an adequate rate or in

adequate volume.

Hypercholesterolemia: the presence of excess cholesterol in the blood.

Hypertension: abnormally high arterial blood pressure that is usually indicated by an adult

systolic blood pressure of 140 mm Hg or greater or a diastolic blood pressure of 90 mm

Hg or greater, is chiefly of unknown cause but may be attributable to a preexisting

condition (as a renal or endocrine disorder), that typically results in a thickening and

inelasticity of arterial walls and hypertrophy of the left heart ventricle, and that is a risk

factor for various pathological conditions or events (as heart attack, heart failure, stroke,

end-stage renal disease, or retinal hemorrhage).

LDL cholesterol: a lipoprotein of blood plasma that is composed of a moderate proportion of

protein with little triglyceride and a high proportion of cholesterol and that is associated

with increased probability of developing atherosclerosis.

Sterols/ stanols: any of various sterols derived from plants.

Systolic blood pressure: the highest arterial blood pressure of a cardiac cycle occurring

immediately after systole of the left ventricle of the heart.

Venous thromboembolism: the blocking of a vein by a particle that has broken away from a

blood clot at its site of formation.

Source : National Institute of Health .Medline Plus. Merriam Webster Online Medical Dictionary