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Metabolic Syndrome

Metabolic Syndrome. Outpatient Case Study Elizabeth Olivares March 17, 2014. Purpose Explain Medical Nutrition Therapy (MNT) provided to patient. MNT: Assessed patients nutrition needs. Provided Interventions Carbohydrate Counting Menu planning Set goals.

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Metabolic Syndrome

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  1. Metabolic Syndrome Outpatient Case Study Elizabeth Olivares March 17, 2014

  2. Purpose • Explain Medical Nutrition Therapy (MNT) provided to patient. • MNT: • Assessed patients nutrition needs. • Provided Interventions • Carbohydrate Counting • Menu planning • Set goals • Patient referred from Primary Care Physician (PCP) to St. Josephs Outpatient Nutrition Services. • PCP diagnosed patient w/ Metabolic Syndrome (METS). • Patients Goals • Diabetes prevention • Improving lipid panel • Weight loss Introduction

  3. What are the 5 components of Metabolic Syndrome? • How many component does a patient need to possess to be diagnosed w/ METS? Test Your Knowledge

  4. Diagnosis requires the patient to possess 3 out of the 5 above. Metabolic Syndrome

  5. Risk factors Facts • Insulin resistance • Obesity • Especially abdominal obesity • Unhealthy lifestyle • Diet high in fat • Physical inactivity • Hormonal imbalance • Polycystic ovary syndrome (PCOS) • According to the American Heart Association, 47 million Americans have METS(1). • ~ 1 out of 6 people (1). • More common among: • African-Americans • Hispanics • Asians • Native Americans (1). • Risk of developing METS increases w/ age (1).

  6. Metabolic Syndrome increases risks of developing what disease conditions? Increases risk for diabetes, cardiovascular disease (CVD), and stroke. Test your knowledge

  7. Demographics Background • 37 year old • Asian • Female • Occupation: • Middle School Teacher • Marital Status • Married • Mother to 1 child • In 2005 • Patient lost 40 pounds prior to marriage. • UBW 200 lbs to 160 lbs. • Exercising 2x/day. • Restricting calories. • Gradual weight gain though out the years. • Especially after having baby • History of Gestational Diabetes. • Met w/ a Registered Dietitian. • Received nutrition education on carbohydrate counting. • Recently experiencing: • Situational stress d/t job • Anxiety • Insomnia • Sleep apnea Patient

  8. What information from patients background relates to an increased risk for developing type 2 diabetes? Prior history of Gestational Diabetes. Test your knowledge

  9. Labs

  10. Ht: 5’0” • Wt: 219.5 lbs • IBW: 100 lbs • % IBW: 219% • IBW per RD: 130 lbs • % IBW per RD: 168% • BMI: 43 kg/m2:Morbidly obese • BMR (Tanita Body Composition Analyzer Scale): 1720 kcal/day • Calories (MSJ x 1.1 AF): 1936 kcal/day • Protein (0.8 grams/kg): 78 grams • Fluids (30 ml/kg ABW): 1770 ml/day (~ 60 oz/day) Anthropometrics

  11. How many calories should the patient consume to promote a 1 lb weight loss per week? 1400 calories: 500 calorie deficit from calculated needs Test your knowledge

  12. Current Diet Barriers/Struggles • High in fat • High in sodium • Moderate in cholesterol • Low in fiber • Limited in the amounts of fruits and vegetables • Eats out often. • Favorite cuisine: • Mexican and Sushi. • Loves salty crunchy snacks. • Struggles w/ portion control. • Drinks Starbucks Latte occasionally. • Struggles w/ cooking separate meals for self and family. 3 Day Food Record

  13. Consume only 10-12 g of saturated fat per day. • Eliminate high fat deli meals and choose lower fat cheeses. • Consume a total of 45 grams of fat per day. • Consume 1400 calories per day. • Promote 1 lb weight loss per week. • 3 meals (300-350 calories/meal) . • 2 snacks (150 calories/snack). • Count Carbohydrates: • 30 grams of carbohydrates at meals. • 15 grams of carbohydrates at snacks. • Maintain a food log on myfitnesspal.com Interventions

  14. Breakfast: • 1 piece of whole wheat toast • 1 egg • 1 slice of turkey bacon • 1 orange AM Snack : • 6 (4inch) celery sticks • 1 cup of raw carrots • 1 tbsp peanut butter Lunch: • 3 cups spinach salad • 1/2 black beans • 3 oz broiled chicken • low fat balsamic vinaigrette • 3/4 cup of pineapple or papaya Dinner: • 3 oz grilled salmon • 1/3 cup brown rice • 1 cup steamed vegetables PM Snack : • 1 low fat mozzarella stick • 12 almonds • 8 wheat thin crackers • Analysis from myfitnesspal.com Sample One Day Menu

  15. Patient initially referred for metabolic syndrome. • MNT goals: • weight loss • maintaining food records • carbohydrate counting • Patient had a 3 lb weight loss after 2 weeks. • Patient continues motivated. • Provided List of healthy lunch and dinner ideas. New goals: • Maintain weight loss and continue to lose weight gradually. • Continue consuming small portions. • Continue visits with dietitian for accountability and evaluation of compliance to nutrition interventions. • Continue follow up visits until weight loss goal is reached and improved nutritional status is achieved. Dietitian will monitor lab values and weight to evaluate progress. Conclusion

  16. Lost weight even while vacationing in Hawaii. • Getting ready to start exercising.  • Still struggles with wanting to eat snacks at night. • Provided list of low calorie snacks to help her stay on track. Follow up:

  17. WebMD. What Is Metabolic Syndrome. Web MD Website. Available at: http://www.webmd.com/heart/metabolic-syndrome/metabolic-syndrome-what-is-it. Acessed November 26, 2013. • Mayo Clinic. Metabolic Syndrome. Mayo Clinic Website. Available at: http://www.mayoclinic.com/health/metabolic%20syndrome/DS00522. Accessed November 26, 2013. • Miller M. Metabolic Meltdown. Nutrition Action Healthletter. Published ed. July/August 2012:3-6. Assessed November 26, 2013. • Odegaard AO, Jacobs DR, Steffen LM, Van Horn L, Ludwig DS, Pereira MA. Breakfast Frequency and Development of Metabolic Risk. Diabetes Care Journal. Volume 36. Published October 2013: 3100-3106. Accessed November 26, 2013. • DeFronzo RA, Tripathy D, Schwenke DC, Banerji M, Bray GA, Buchanan TA, Lement SC, Henry RR, Kitabchi AE, Mudaliar S, Ratner RE, Stentz FB, Musi N, Reaven PD, Gastaldelli A. Prediction of Diabetes Based on Baseline Metabolic Characteristics in Individuals at High Risk. Diabetes Care Journal. Volume 36. Published November 2013: 3607-3612. Accessed November 26, 2013. References

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