1 / 10

Clinical Cases

Clinical Cases. CLINICAL CASE: NUTRITION AND CARDIOVASCULAR DISEASES CASE #1 A 49-year-old man is found to have a total cholesterol of 8.1 mmol/L. His family history is negative, he smokes 1 pack of cigarettes per day, and states that he once tried to quit but gained 20 lbs in 1 month.

declan
Download Presentation

Clinical Cases

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Clinical Cases

  2. CLINICAL CASE: NUTRITION AND CARDIOVASCULAR DISEASES CASE #1 A 49-year-old man is found to have a total cholesterol of 8.1 mmol/L. His family history is negative, he smokes 1 pack of cigarettes per day, and states that he once tried to quit but gained 20 lbs in 1 month. History: Weight history: 65 Kg at 20 years of age, 70 Kg at 35 years of age, 84 Kg presently Height: 1.72m Blood pressure: 135/85 Xanthomas, Xanthelasmas: none Fasting lipid profile: Total Cholesterol: 8.1 mmol/l HDL Cholesterol: 1.12 mmol/l Triglycerides: 2.20 mmol/l Urinalysis and thyroid function tests: normal 28.3 (+) (-) Male Family Hx Age BP Chol, LDL No Xanth. Smokes Overweight = 5.9 Risk Factors BMI = 84 / (1.72)2 = ____ Calculate VLDL and LDL Cholesterol

  3. Diet History (2 days): « Worst Offenders »

  4. Dietitian’s Assessment CALORIES 3328 2306 PROTEIN 121 g 69 g CARBOHYDRATE 414 g 248 g TOTAL FAT 131 g 115 g Saturated 52 g 44 g Monounsaturated 45 g 51 g Polyunsaturated 34 g 20 g CHOLESTEROL 395 mg 416 mg FIBER 20 g 13 g What is your assessment of his diet? Calculate the % of total calories for protein, carbohydrate and each type of fat. 30% fat 45% fat

  5. What are your recommendations to the patient? List Diet → diet substitutions Exercise Smoking

  6. When do you want to see the patient again? At that time, the following results are found: Total cholesterol: 6.4 mmol/L HDL Cholesterol: 1.08 mmol/L Triglycerides: 1.95 mmol/L LDL Cholesterol: 4.43 mmol/L What are your recommendations at this point? • How much weight was lost? • Quit smoking • Change in exercise • → Encourage to continue, but need to consider a more • agressive approach

  7. CASE #2 A 37-year-old woman comes for screening for cholesterol. Her brother suffered from a myocardial infarct last week at the age of 43. She is a non smoker, and works as an accountant. History: Her weight is 57 Kg, and has been stable for the last 10 years (Height: 1.65 m) Blood pressure: 150/90 Tendinous xanthomas and xanthelasmas present Lipid profile: Total cholesterol: 11.96 mmol/L HDL cholesterol: 1.45 mmol/L Triglycerides: 1.25 mmol/L Urinalysis, thyroid tests and fasting glucose: normal = 20.9 (+) (-) Family Hx Age BP BMi Xanth. Chol + LDLC = 9.8 Risk Factors BMI = 57 / (1.65)2 Calculate VLDL and LDL cholesterol

  8. Diet History (2 days) « Worst Offenders » None!

  9. 20% 55% 24% 9% 9% 6% 20% 50% 29% 9% 12% 8% Dietitian’s Assessment CALORIES 1624 1823 PROTEIN 83 g 91 g CARBOHYDRATE 224 g 232 g TOTAL FAT 44 g 59 g Saturated 16 g 18 g Monounsaturated 17 g 24 g Polyunsaturated 11 g 17 g CHOLESTEROL 124 g 274 mg FIBER 24 g 13 g

  10. What is your assessment of her diet? What is the expected evolution? What else should be done?

More Related