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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.

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Clinical Cases

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  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?

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