Nutritional Intervention for Cardiovascular Disease: Case Study of Mr. G, Study notes of Nutrition

Download Nutritional Intervention for Cardiovascular Disease: Case Study of Mr. G and more Study notes Nutrition in PDF only on Docsity! 1 FND 431: Group CVD Case Study Mr. G is a 50 y.o. WM who is an architect with a successful business in Texas. He has a history of Type 2 DM that he states had been controlled with diet. His weight is 250 lbs and he is 6’2” tall. He has been gradually increasing in weight, about a pound a year since he was 30 years old. He is an intelligent man and knows a lot about diabetes, but he has not been following his diet. He takes pride in the fact that he eats anything he wants. He does not have a family history of cardiovascular disease or diabetes. He is married and has two children. He likes his work, and is not under any particular kind of stress. Other than light activity at work, MR. G does not have an exercise routine. A few weeks ago, after a heavy snow, Mr. G was clearing the sidewalk in front of his house with a snow shovel. After about 15 to 20 minutes of shoveling, he felt a sharp pain toward the center of his chest below the sternum. He got very light-headed and weak. His respirations increased and his wife reported that he became very pale. After lying down for a while the pain passed. He thought he had overworked himself and did nothing about it. The next week he was visiting a client on the fourth floor of a building. Because of the large crowd waiting for the elevator, he decided to take the stairs. He was going up the stairs at a brisk pace, partly to see if he would have chest pain again. When he reached to top of the stairs, he had chest pain behind the sternum in the center of his chest. He knew that this could be serious, so he made an appointment with his family physician. The physician ran the usual tests, EKG, blood work, and CXR. All the tests were WNL except that Mr. G’s cholesterol and triglycerides were elevated. Blood Pressure was 125/88. Mr. G’s physician agreed with him that it still could be serious, so he sent him to see a cardiologist. The cardiologist completed a treadmill stress test. Mr. G was not able to get halfway through the test. He was admitted to the hospital for further evaluation. A cardiac cath revealed that Mr. G had 50 percent blockage in two arteries and 80 percent blockage in a third artery. The cardiologist believed that this could be corrected with angioplasty. This procedure was attempted and was successful in opening the 80 percent blocked vessel. The physician recommended that Mr. G go on a weight reduction diet, low in saturated fat, and high in fiber with no more than two grams of sodium, and a calorie level as recommended by the RDN. Mr. G’s fasting lab values were as follows: 2 Lab Result Normal Values Glucose 138 mg/dL 60-90 Cholesterol 330 mg/dl 140-199 mg/dL Na 144 mEq/L 135-145 mEq/L K 4.2 mEq/L 3.5-5.3 mEq/L Cl 102 mEq/L 98-106 mEq/L BUN 14 mg/dL 7-8 mg/dL Crea .9 mg/dL .6-1.3 mg/dL Trig 340 mg/dL 40-160 mg/dL Troponin 1 .015 < .2 QUESTIONS: 1. List the modifiable/controllable risk factors for heart disease. Tobacco use, physical inactivity, poor diet, stress, inadequate sleep and excessive alcohol. (McDermott, 2023) 2. What is the relationship between DM and CAD? What percentage of patients with DM die from CAD events? People with type 2 diabetes have a greatly increased risk of developing coronary heart disease (CAD) Death rates are 2-4x higher with CVD if a person has diabetes. CVD is the #1 killer of men and women in the US, one of every 3 deaths is attributed to CVD (Raymond & Morrow, 2021). Cardiovascular disease (CVD), where the heart and blood vessels are negatively impacted, is the number one cause of death in people living with diabetes, resulting in 2/3 of deaths in people with type 2 diabetes (American Diabetes Association, 2024, diabetes.org). 3. Determine Mr. G’s IBW (using the Hamwi Equation from your text) and percent of IBW. 160lb + (6lbs for every inch above 5 feet) = 106 + (6lbs x 14in) = 190lb 190 x .9 (10% below) = 171lb 190 x 1.1 (10% above) = 209lb IBW range = 171- 209lb % IBW = 250lb / 190lb x 100 = 131.578 = 131.6% 4. Calculate Mr. G’s BMI. (using the NCM calculator) kg/m2 250 lbs / 2.2 = 113.6kg 6’2” = 74in x 2.54 = 187.96cm = 1.8796m x 1.8796m = 3.53m2 5 · Cardiologist: Medical professional who specializes in prevention and treatment of disorders of the heart and cardiovascular system. · Cardiac Cath: Catheter(s) inserted into various locations within the heart for purposes of diagnosis or therapeutic purposes. · EKG: An abbreviation for an electrocardiogram, a test that measures the electrical activity of the heart and can detect problems. · Treadmill Stress Test: a diagnostic test where cardiovascular measurements such as heart rate, blood pressure and electrical activity are recorded while the heart is being stressed on a treadmill. · Polyunsaturated Fat: a fatty acid in which the carbon chain has 2 or more double bonds between the carbon molecules. · Monounsaturated Fat: A fatty acid in which the carbon chain has 1 double bond between carbon molecules. · Saturated Fat: A fatty acid in which there are no double bonds between carbon atoms in the fatty acid chain. (for these we used online-medical-dictionary.org; health.harvard.com and merriam-webster.com) 7. Using the NCM, calculate Mr. G’s REE and Total energy requirement with Activity Factor (Note which equation was used within NCM). Show work. Using the NCM, we entered his height a 6’2’’ and his weight as 250lbs, his age as 50 years old, male not in the ICU. The calculator used the Mifflin-St. Jeor equation and is REE was 2069 kcal. 6 From our Krause text Chapter 22 Nutritional Requirements of exercise, we chose the activity factor of 1.2 since Mr. G is sedentary except for light activity at work. 2069 x 1.2 = 2483 kcal needed. 8. Mr. G has decided he is motivated to lose weight and would like help determining his kcal intake goal per day. How many kcals would you recommend daily to meet this goal? If Mr. G wants to safely lose weight without feeling deprived, he could deficit 3500 calories from his diet each week by cutting 500 calories from his daily intake. This would give him 1980 calories daily for his intake. This would allow a 1-pound weight loss weekly which would be slow and steady. He could also increase his activity which would likely deficit more calories to give him a slightly faster weight loss. Ideally, he could eat approximately 2000 calories a day with activity and see steady weight loss. Unless he began a weightlifting regimen which would build more active tissue and may give him slower weight loss at first (since muscle is more dense), but much better metabolism and active tissue in the long term. (we did not reference this since it came from our long term knowledge of 3500 calories = 1 pound). 9. Using the NCM, review the TLC patient diet materials. Make a customized plan using the template provided and account for his recommended daily calorie needs. Save and download a copy to submit with this assignment. Attached via Canvas ************************************************************************ The RD went in to visit Mr. G to discuss his diet with him. She did a 24-hour recall for a typical day and obtained the following information. For breakfast at home, Mr. G enjoys scrambled eggs with hash browns, one slice of toast with margarine, juice, and coffee with sugar . At work, his only snack is coffee with one tsp. sugar. For lunch, he usually eats a sandwich. This is usually a dressed hamburger with French fries and coffee with sugar . Sometimes he has a piece of pie or cake for dessert, depending on what is available. At home, he has what he described as a typical dinner consisting of meat at every evening meal (chicken, beef, pork, sometimes fish), potatoes, and usually a boiled vegetable (carrots, green beans, and cabbage are some of his favorites). A salad is seldom eaten at night. Sometimes he has dessert, such as pudding, ice cream, or jello (something soft and sweet). Before bedtime, he frequently has a large snack consisting of cheese and crackers, ice cream, or a sandwich of any meat that was left over from dinner. He 7 usually has a regular soft drink with his snack. fe FOOD %q EXERCISE LOMETRIC fo NOTE Scrambled Egg, with Satt Hashed Brown Potatoes. Prepared From Frozen Toast, Wheat. Plain Margarine, Salted Orange Juice, Fresh Coffee, Prepared From Grounds Sugars, Granulated McDonald's, Hamburger Kerenup Mustard Apple Pie, Bottom Crust Only McDonald's, French Fries Chicken Marsala Wegmans, Roasted Baby Potatoes Beans. Snap, Green, Cooked. Boiled, Drained, without Salt Chocolate Pudding, Store Bought Haagen-Dazs ice Cream. Vanilla Coca-Cola Classic Energy Summary © 2678 1722 956 kcal keal keal Consumed Burned Over @o FAST @g WATER eee n 1 cup 232.43 kcal O5 cup 260.57 kcal 1 sco 7812 kcal 1 tbsp 99.03 kcal 1 cup 1116 kcal 1 ftoz 03° kcal 1 tbsp 48.58 kcal 1 each (248.6 kcal 1 tsp 1815 kcal 1 tbsp 934 kcal 1 piece - single crust - 1/8 of 9° pie 270.07 kcal 1 medium - order 320.02 kcal 6 oz 283.5 kcal 1 cup 100 kcal 1 cup.cutpieces 4375 kcal OS cup 184.6 kcal 05 cup 238.92 kcal 1 can-each 12flaz 13631 kcal Macronutrient Targets @ (2678 keal / 1722 keal 155% Energy © — EEE 80.6 9/1076. 75% Protein a 305.3g/ 193.7 158% Net Carbs ©) quasi 120.491 57.4 210% Fat © tTacieat} 10 11 Recommended fat intake is between 25-35% of kcal according to the AND (Vannice & Rasmussen, 2014). A high-fat diet is considered one that has 35% of kcals from fat or greater. 12 Vannice, G., & Rasmussen, H. (2014). Position of the academy of nutrition and dietetics: dietary fatty acids for healthy adults. Journal of the Academy of Nutrition and Dietetics, 114(1), 136-153. https://www.andeal.org/vault/2440/web/DietaryFatty_JADA.pdf Choose foods with less than 120 milligrams of sodium per serving. https://www.eatright.org/health/essential-nutrients/minerals/is-sodium- the-same-t hing-as-salt Fewer than 2300 milligrams of sodium per day. https://www.eatrightpro.org/about-us/for-media/press-releases/nnm- 2022-healthf ul-eating Consume less than 10% of kcal from added sugar. Eating right with less added sugar. Nutrition Care Manual. Accessed February 13, 2024. https://www.nutritioncaremanual.org/vault/2440/web/files/Client-Ed/Eatright %20Handouts%20202 3/English/Eating%20Right%20with%20Less%20Added %20Sugar.pdf 11. Explain the relationship of each of the three types of fat and cholesterol intake to cardiovascular disease. The fats that we consume in food are a heterogeneous set of substances composed mainly of triglycerides, but also of cholesterol, sterols and phospholipids. All of them fulfill important functions in the body (Wang & Hu, 2017). Saturated Fats: are triglycerides that contain "simple" fatty acids that have unfavorable effects on health by increasing blood levels of LDL, raising blood pressure levels, increasing the risk of thrombosis, and increasing the risk of suffering from cardiovascular disease (Wang & Hu, 2017). Trans Fats: These are fats not present in nature, they originate from unsaturated fatty acids through a hydrogenation process. Trans fats have harmful effects on blood fats, increasing LDL cholesterol values and reducing HDL cholesterol values, they have the effect of enhancing inflammation on the arterial wall, increasing the risk of developing diabetes mellitus. type 2 and increases the risk of suffering from cardiovascular diseases (Ganguly & Pierce, 2012). Dietary Cholesterol: Cholesterol from foods does not have great effects on blood cholesterol. But studies have shown that there is a relationship between dietary cholesterol and the risk of cardiovascular disease. Cholesterol is only found in foods of animal origin, but since many of these foods also contain saturated fats in their composition, it is not advisable to consume them in excess (Carson et al., 2020). 15 15. Define: Antioxidant: a substance (such as beta carotene or Vitamin C) that inhibits oxidation or reactions promoted by oxygen, peroxides or free radicals. Coenzyme Q: ubiquinone – any of a group of lipid soluble quinones, found in mitochondria that function in oxidative phosphorylation as electron carrying coenzymes in electron transport. (Merriam-webster.com) 16. Describe the effect of antioxidants on free radicals and show how this relates to atherosclerosis. Free radicals oxidize LDL, turning it into OxLDL. OxLDL contributes to the formation of the plaque responsible for atherosclerosis, such as triggering foam cell formation and causing damage to the endothelial wall inside arteries. Antioxidants neutralize free radicals. Fat-soluble antioxidants, such as, beta-carotene and vitamin E, have been observed to both deoxidize OxLDL and prevent the oxidation of more LDL. Vitamin E has been observed to have the most significant impact on LDL oxidation. (Najafpour, et al.) Moreover, the consumption of antioxidant-rich foods (especially those high in fat-soluble antioxidants, has been associated with a dampening of atherosclerosis symptoms. 17. What relationship do folate and vitamins B12 and B6, have with atherosclerosis? The most observed association that B vitamins have with atherosclerosis is that they lower the plasma concentration of homocysteine. High doses MONITORING/EVALUATION: ·Fruits, vegetables, lean meat, plant based protein, whole food intake. ·2-3 portions per day of fruits and vegetables. ·Incorporate lean meat into every meal. ·Incorporate whole foods into at least 2 meals per day. NUTRITION INTERVENTION: ·Intake of 2483 Kcal/day ·Weight reduction diet, low in saturated fat, high in fiber · No more than 2 grams of sodium ·Provided patient with written and verbal instructions on benefits of a weight reduction diet, low in saturated fat, high in fiber and low in sodium. 16 of supplemented B vitamins have been observed to reverse symptoms of atherosclerosis. The exact mechanism of action is still foggy, but we are positive that high plasma concentrations of homocysteine are associated with atherosclerosis (and all CVD), and we also know that high intake levels of B vitamins are associated with reduced levels of homocysteine. (Hodis, et al) 18. What is the purpose of taking baby aspirin every day? Aspirin is an anticoagulant and can help prevent blood clotting. This would help reduce clotting in the small vessels where plaque can build up. A baby aspirin is a lower dose of aspirin (81mg) than a regular aspirin dose (325mg) (American Heart Association, 2023 and ACC.org). 19. Describe the possible relationship between garlic and atherosclerosis. Aged garlic extract has been observed to be associated with an improvement in atherosclerosis symptoms. The dose observed to have the greatest therapeutic effect is around 2400mg. Consistent consumption of 2400mg of aged garlic extract over the course of 12 months was observed to decrease coronary arterial calcification and improve vascular elasticity (improving peripheral tissue perfusion). (Wlosinska, et al) (Lindstedt, et al) A combination of aged garlic extract and vitamin B supplements (most commonly b12 and folic acid) has been observed in several RTC’s to improve atherosclerosis symptoms, namely coronary arterial calcification. (Budoff, et al) The exact mechanism of action is unclear and requires further study, but many believe that there is enough evidence of association to merit further study. 20. Have all preparations and forms of garlic been found to produce a favorable effect? The only form of garlic that has been observed to have a noticeable therapeutic effect in people with atherosclerosis is aged garlic extract. There have been studies with pressed garlic powder (in the form of pressed pills), but the effects were not as significant as aged garlic extract. 17 21. Can you describe a potential problem with taking aspirin, garlic, fish oil and vitamin E? They all have anticoagulant/ blood thinning properties which would likely make his blood too thin and cause risk of bleeding. Garlic can interact with blood thinners and blood pressure medications. Vitamin E can also interact with blood thinners. Aspirin is an anticoagulant and can thin blood. Fish oil is high in omega 3 fatty acids. Omega 3s in high doses can cause bleeding problems when taken with anticoagulant medications. If someone was injured or had surgery, they could bleed out and not be able to clot when needed. Too much anticoagulant can be dangerous just as too much coagulant. (National Institutes of Health Office of Dietary Supplements, ods.od.nih.gov) 22. How would you address Mr. G’s willingness to take supplements recommended by a person without professional training in nutrition or medicine? We would kindly make a joke about how everyone has some kind of old wives’ tale on health. We’d then offer literature and websites for him to access to do some of his own research. Like the National Institutes of Health Office of Dietary Supplements since they have consumer fact sheets. We’d explain that a lot of information can be found on the internet but that it’s not all reputable. We’d encourage him to discuss any medical recommendations with his doctor and nutritional recommendations with his dietitian. 20 https://doi.org/10.1002/14651858.CD012345.pub2 Tips 21 Fiber handout for Clients from NCM Fiber is the structural part of plant foods that is not digested. There are two types of fiber in food: soluble (viscous) and insoluble. Because soluble fiber is not absorbed in the intestine, it can bind cholesterol and remove it from the body. Fiber’s Benefits Soluble (viscous) fiber is especially helpful in lowering LDL (low-density lipoprotein, or “bad”) cholesterol. Insoluble fiber aids in laxation and prevents constipation. Try to eat 25 to 30 grams of total fiber each day, and 5 to 10 grams of soluble fiber each day. Eating 5 to 10 grams of soluble fiber every day can help lower your LDL cholesterol by 5 to 11 points—sometimes more. By reading nutrition fact labels on products, you can compare the fiber content of foods. Work toward achieving these fiber goals gradually, and be sure to drink plenty of water when you increase your fiber intake. This will help you avoid problems with gas. Ways to Add Fiber to Your Eating Plan ● Add fiber to foods you already eat: o Sprinkle oat bran or rice bran on cereal. o Add almonds to salad. o Include dried beans in soup o Mix ground flaxseed into muffins. ● Eat whole fruit rather than drinking juice. Pears and prunes are especially rich in fiber. Other fruits high in fiber: 1 medium apple, banana, guava, orange, or peach 2 apricots or plums ½ mango ¼ cup figs or dried apricots 3 prunes 1 cup raspberries, blackberries, or strawberries ● Select vegetables with lots of soluble fiber, such as Brussels sprouts, acorn squash, lima beans, broccoli, cabbage, green beans, onions, parsnips, turnips, carrots, okra, and eggplant. ● Look for whole grain products, especially those with oats and barley. ● Add vegetables to sandwiches, or eat a peanut butter sandwich on whole grain bread. ● Have bean dip or hummus for snacks. ● Healthy fats with 1 or more grams of soluble fiber are 2 tablespoons avocado, 1 tablespoons whole chia seeds, and 2 tablespoons ground flax seeds. 22 ● Eat lean protein foods that have fiber like beans (black beans, navy beans, kidney beans, lima beans, pinto beans), chickpeas, black-eyed peas, and soybeans. ● A natural fiber supplement like psyllium, a plant seed powder, can also be taken. Start with a small dose mixed with water then slowly increase the dose, taking as directed. Drink extra water as you increase your daily fiber intake. Fluid needs vary, but 9 to 12 cups of fluid a day are recommended for most healthy people. Fiber-Rich Foods Include many foods with 1 to 3 grams of soluble fiber in your daily diet plan. This chart shows how much total and soluble fiber is in one serving of some foods. Legumes Total Fiber (grams) Soluble Fiber (grams) ½ cup cooked lentils 8 1 ½ cup lima beans 7 3 ½ cup baked beans 6 3 ½ cup kidney beans 6 3 ½ cup green peas 4 1 Grains ½ cup oatmeal, regular, before cooking 4 2 ½ cup cooked barley 4 1 ½ cup raisin bran 4 1 1 slice whole wheat bread 2 Trace Fruits 1 large pear 5 3