Question

DX is a 39-year-old man who is seeking nutritional advice for weight loss and dyslipidemia.

Medical Diagnosis by MD:  Dyslipidemia, obesity

Initial Assessment of DX:

B/P: 118/75

Height: 6’0”

Weight: 238.8 lbs

Body fat: 24.1%

BMI: 32.4

History:  

DX is the owner/manager of a construction company and is somewhat active at his job. However, he reports that he mainly oversees jobs rather than doing the manual labor so estimates his activity level as between lightly and moderately active. He wants to lose weight and reports successfully losing about 20 lbs 6 years ago after working with a nutritionist. He has re-gained the weight but is confident that he can lose it again with some guidance. His health is good overall. However, he reports that he has struggled with very high triglycerides since he was in his early twenties. About 10 years ago he had his thyroid removed due to thyroid cancer. He manages this with Synthroid and feels well.

Medication and Supplements:

Synthroid- 200 mcg daily

Dietary Intake (recall data for a “typical” day):

Breakfast

no breakfast- only coffee with cream and sugar; occasionally eats pancakes on the week-ends

Lunch

usually buys lunch such as a grinder, chips, and diet coke or 3-4 slices pizza and diet coke (drinks 1 diet coke daily)

Dinner

most often chicken or pork and a large salad and bread or take-out

DX identifies after dinner snacking as a significant problem, with his food of choice being candy. He loves gummy bears.

He reports drinking “lots” of water; estimates about 64 oz daily

Alcohol intake described as a “few drinks” on the week-end

Questions:

1. What is the chief complaint to be addressed with DX?
2. What is your assessment of his diet? Please include both positive observations as well as areas that could be revised. It is not necessary to provide a full dietary plan here. You will be asked to provide recommendations in Part 2 of this case.
3. What further information would you elicit? Keep in mind the four types of nutritional assessment- clinical, anthropometric, dietary, and biochemical. Explain your rationale for the assessments you suggest.

Answer 1

1.The chief complaint to be addressed with dx is obesity.

2.The diet consumed by DX is exactly opposite to recommended for person with dylipedimia..The diet should contain low carbohydrate Vegetables like spinach, broccoli, green leafy, etc. High fibre diet, consumption of healthy fats such fish intake eg salmon, tuna, olive oils, canola, nuts, avocados etc. And omega 3 fatty acid intake, ..which is completely lacking in the above mentioned diet of DX. .Rather than this it is full of cholesterol intake, saturated fat intake Which should be restricted from the diet to certain extent.

3. Dietary recommendations : water soluble fiber- like grape fruit, pectin, oat bran aids in reducing the levels of LDL cholesterol.

• Addition of stanol and sterol Ester margarine to the diet- All plant food contain sterols, the substances that have capacity to lower cholesterol.
• Addition of healthy fats to diet-fatty fish such as salmon, tuna olive oils, nuts helps in reduction of cholesterol and triglycerides levels..
• Intake of low carbohydrate Vegetables and whole fruits
• Intake of omega 3 fatty acid.

4.A nutritional assessment is an in depth evaluation of both objective and subjective data related to an Individuals food and nutrient intake, lifestyle and medical history.

• Anthropometric - are the objective measurements of body muscle and fat. They are used to compare individuals , to compare growth in the young, and to assess weight loss or gain in the mature individual. Weight and height are most frequently used Anthropometric measurements.
• Biochemical- laboratory tests based on blood and urine are important indicators of nutritional status. But they are influenced by non nutritional factors as well. Lab results can be altered by medications, hydration status and disease states or other metabolic processes such as stress.
• Clinical - data provides information about the individuals medical history including acute and chronic illness and diagnostic procedures, therapies or treatments that may increase nutrient needs or induce malabsorption.
• Dietary- there are many ways to document dietary intake. During a nutrition interview the practitioner may ask wt the individual ate during the previous 24 hrs., beginning with the ladt item eaten prior to the interview. Practitioner can train individuals in completing a food diary, and they can request that the record be kept forgetting either 3days or one week. Documentation should include portion sizes and how the food was prepared. Brand names or the restaurant where the food was eaten can assist in assessing the details of the intake.