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各位朋友，大家好，现在是“每天健康三分钟”时间，我是道简-心血管康复医生集团的护士梁金锦，今天有我来给大家讲讲心脏康复五大处方-营养处方

膳食营养是影响心血管病的主要环境因素之一。总能量、饱和脂肪和胆固醇摄入过多、蔬菜水果摄入不足等不平衡膳食增加心血管病发生的风险，合理科学膳食可降低心血管疾病风险。医学营养治疗和/或治疗性生活方式改变作为二级预防的措施之一，能降低冠心病发病率和死亡率，且经济、简单、有效、无副作用。

既往认为营养膳食指导是营养师的责任，心血管医生对营养学知识了解较少，给予的健康膳食指导多较含糊，但心血管病患者最多接触的医生是心血管医生，也更容易接受心血管医生的建议，心血管医生有必要了解一般的营养膳食原则，以给予患者初步指导。

膳食处方制定步骤如下：

1） 评估：包括营养问题和诊断，即通过膳食回顾法或食物频率问卷，了解、评估每日摄入的总能量、膳食所含的脂肪、饱和脂肪、钠盐和其他营养素摄入水平；饮食习惯和行为方式；身体活动水平和运动功能状态；以及体格测量和适当的生化指标。

2） 制定个体化膳食营养处方：根据评估结果，针对膳食和行为习惯存在的问题，制定个体化膳食营养处方。

3） 膳食指导：根据营养处方和个人饮食习惯，制定食谱；健康膳食选择；指导行为改变，纠正不良饮食行为。

4） 营养教育：对患者及其家庭成员，使其关注自己的膳食目标，并知道如何完成它；了解常见食物中盐、脂类和水分的含量，各类食物营养价值，《中国居民膳食指南》，食品营养标签等。

5） 注意事项：将行为改变模式与贯彻既定膳食方案结合起来。膳食指导和生活方式调整应根据个体的实际情况考虑可行性，针对不同危险因素进行排序，循序渐进，逐步改善。

医学营养治疗计划须3-6个月时间。首先是行为干预，主要是降低饱和脂肪酸和反式脂肪酸摄入量，清淡饮食，以谷类为主，包括米、面、杂粮等，多吃蔬菜水果，及薯类，比如马铃薯、甘薯、木薯等，吃适量蛋白，包括肉、禽、鱼、奶、蛋等。肥肉和荤油为高能量和高脂肪食物，摄入过多往往会引起肥胖，并是某些慢性病的危险因素，应当少吃。

其次是给予个体化的营养治疗膳食6周。在第2次随访时，需要对患者血脂、血压和血糖变化进行评估，若有必要，可加强治疗。此外，第2次随访时可指导患者学习有关辅助膳食营养知识，增加膳食中钾、镁、钙的摄入量，该阶段须对患者饮食依从性进行监控。在第3次随访时，如果患者血脂或血压没有达到目标水平，则应开始代谢综合征的治疗。

最后祝大家生活愉快，身体健康！想了解更多心血管科普小知识，请关注我们，咱们下期见。

【英文版】

Nutrition prescription: one of the top five prescriptions for cardiac rehabilitation

Dear friends, nice to meet you!Now it is time for “health talk for three minutes every day”,My name is Liang Jinjin, a nurse of Daojian Doctor Group of Cardiovascular Rehabilitation.Today, I'd like to tell you about one of the five major prescriptions for cardiac rehabilitation, it’s nutritional prescription.

Dietary nutrition is one of the main environmental factors affecting cardiovascular disease.The risk of cardiovascular disease is increased by excessive intake of total energy, saturated fat and cholesterol, and insufficient intake of vegetables and fruits, while easonable and scientific diet can reduce the risk of cardiovascular disease. Medical nutrition therapy and / or treatment lifestyle change as a two level preventive measurecan reduce the incidence rate and mortality of coronary heart disease,and it is economical, simple, effective without side effects.

In the past, it was considered that it was the responsibility of nutritionists to give nutritional guidance to patients.Cardiovascular doctors knew less about nutrition knowledge and gave more vague guidance on healthy diet. However, the doctor most contacted by patients with cardiovascular diseases was cardiovascular doctors, and patients were more likely to accept the suggestions of cardiovascular doctors. It is necessary for cardiovascular doctors to understand the general principles of nutritional diet in order to give preliminary guidance to patients.

The steps for formulating dietary prescription are as follows

1) Assessments.

Assessments include nutritional assessment and diagnosis,i.e. to understand and evaluate daily total energy intake, dietary fat, saturated fat, sodium and other nutrients intake levels;dietary habits and behavior patterns; physical activity level and motor function status;and physical measurement and appropriate biochemical indicators.

2) Inpidual dietary nutrition prescription is formulated.

According to the evaluation results, the inpidualized dietary nutrition prescription will be formulated according to the problems of diet and behavior habits.

3) Dietary guidance.

According to the nutrition prescription and personal eating habits, we should formulate the diet, guide the choice of healthy diet, and guide the patients to change their behaviors and correct their bad eating behaviors.

4) Nutrition education.

It is mainly aimed at patients and their family members, so as to increase their understanding of their dietary goals and know how to achieve the goals,help patients and their families understand the content of salt, lipid and water in common foods, the nutritional value of various foods, “Dietary guidelines for Chinese residents”, and food nutrition labels.

5)Caution.

Combine behavior change patterns with the implementation of established dietary programs. Dietary guidance and lifestyle adjustment should be based on the actual situation of inpiduals to consider the feasibility,according to different risk factors, the recommendations should be sequenced and completed step by step, and nutrition guidance should be continuously improved in the implementation process.

The implementation of the medical nutrition treatment plan takes 3-6 months.

The first is behavioral intervention, which mainly includes reducing the intake of saturated fatty acids and trans fatty acids, and suggesting light diet for patients. The diet is mainly composed of Cereals, including rice, flour, coarse grains, etc. eat more vegetables, fruits and potatoes, such as potatoes, sweet potatoes, cassava, etc., and eat appropriate amount of protein, including meat, poultry, fish, milk, eggs, etc. Animal fat is a high-energy and high-fat food.Excessive intake of animal fat will lead to obesity and other chronic diseases, so patients should eat less.

The second is to give inpidualized nutrition treatment diet for 6 weeks.At the second follow-up, the changes of blood lipid, blood pressure and blood glucose need to be evaluated.If necessary, treatment can be strengthened. In addition, the second follow-up can guide patients to learn about supplementary dietary nutrition knowledge, and increase the intake of potassium, magnesium and calcium in the diet. At this stage, the diet compliance of patients should be monitored. At the third follow-up, if the patient's blood lipid or blood pressure does not reach the target level, the treatment of metabolic syndrome should be started.

Finally, I wish you all a happy life and good health!To learn more about cardiovascular disease, please pay attention to us. See you next time.