MNT
DFM 484
Polly Peru
Rachelle Sebastian
11/02/2014
Case Study 4
Hypertension and Cardiovascular Disease
Mrs. Cookie Sanders is a 54-year old housewife. For the past year, she has treated her newly
diagnosed hypertension with lifestyle changes including diet, smoking cessation, and exercise.
She is in to see her physician for further evaluation and treatment for essential hypertension.
Blood drawn two weeks prior to this appointment shows an abnormal lipid panel.
13. Briefly describe the DASH eating plan.
The Approaches to Stop Hypertension Diet plan (DASH) was developed to prevent and lower
high blood pressure. Studies indicate that the DASH Diet plan also reduces the risk of some
kinds of cancers, stroke, heart disease, kidney stones, diabetes, and aids in healthy weight loss
and improves overall health. The DASH plan emphasizes a diet rich in fruits, vegetables, whole
grains, lean meats, fish, poultry, nuts and beans. This diet plans is high in fiber and low to
moderate in fat; and follows the US guidelines for sodium intake (1500-2300 mg/day). The plan
includes all of the foods from the Mediterranean diet and was designed to be easy to follow and
flexible enough to meet the lifestyle and food preferences of most people (The DASH Diet Plan,
2014).
18. What nutrients in Mrs. Sanders’s diet are major concerns to you? Use Mrs. Sanders 24
hour recall:
*Calculate total kcal intake, total fat intake, total saturated fat, sodium intake using food values
at the back of the book and/or CalorieKing.com. What nutrients in Mrs. Sander’s diet are of
major concern to you?
Food Item
Breakfast
Coffee (black)
Oatmeal (Instant)
Margarine
Sugar
Low- fat (2%) milk
Orange juice
Snack
Coffee (black)
Glazed donut
Amount
Total
Calories
1 cup
1 packet
1 tsp
2 tsp
.5 cup
1 cup
2 kcal
120 kcals
33 kcals
32 kcals
61 kcals
112 kcals
2 cups
1
4
190 kcals
Total Fat
Intake
Total
Saturated Fat
Total Sodium
0
2.4 g
3.8 g
0
2.4 g
0.5
0
0.5 g
0.6 g
0
1.5 g
0
5 mg
87 mg
31 mg
0
50 mg
2 mg
0
11 g
0
5g
10 mg
90 mg
MNT
DFM 484
Polly Peru
Rachelle Sebastian
11/02/2014
Lunch
Campbell’s Tomato
Bisque/prepared with
milk
Saltines
Diet Coke
Dinner
Baked chicken/white
meat, no skin, salt
Seasoning
Baked potato, salt
Butter
Salt
Glazed carrots
Sugar
butter
Dinner salad
Ranch dressing
Croutons
Beer
HS Snack
Butter Pecan ice cream
Totals
1 can
198 kcals
6.6 g
3.1 g
1109 mg
10
1
120 kcals
1
3g
0
1g
0
190 mg
41 mg
6 oz.
284 kcals
6.2 g
1.8 g
128 mg
1 large
1 tbsp
.5 tsp
1 cup
1 tsp
1 tsp
2 cups
3 tbsp
0.5 oz
2
0
278 kcals
102 kcals
0
55 kcals
16 kcals
36 kcals
60
219 kcals
166 kcals
309 kcals
0
0
11.5 g
0
0
0
3.8 g
0
23.1 g
2.5 g
0
0
0
7.3 g
0
0
0
2.4 g
0
3.6 g
0.75 g
0
680 mg
30 mg
82 mg
380 mg
90 mg
0
27 mg
48 mg
366 mg
175 mg
30 mg
600 kcals
2998
Kcals
40 g
116.8 g
18 g
45 g
440 mg
4091 mg
2 cups
The Acceptable Macronutrient Distribution Ranges (AMDRs) for Fat is 20-35% of energy intake
per day for healthy adults.
116.8 g x 9 kcal/g = 1051.2 kcal
1051.2/2998 x 100 = 35%
The Acceptable Macronutrient Distribution Ranges (AMDRs) for Saturated Fat is < 7% of
energy intake per day for healthy adults.
45 g x 9 kcal/g = 405 kcal
405/2998 x 100 = 13.5%
The major nutrients that I am most concerned about in Mrs. Sanders’s diet are her high
consumption of total fat (35%) and saturated fat (13.5%); excessive intake of energy;
dangerously excessive intake of sodium: inadequate intake of fruits and vegetables; diet includes
very low intake of fiber; and low vitamin and mineral intake.
MNT
DFM 484
Polly Peru
Rachelle Sebastian
11/02/2014
21. Interpret Mrs. Sanders’s risk of CAD based on her lipid profile.
Lipid Profile Test
Normal Value
Cholesterol (mg/dL)
120-199
HDL-C (mg/dL)
>55 F
> 45 M
Mrs. Sanders’s
Value 6/25
270 ˄
30 ˅
Risk of Developing
CAD
More than twice the
risk of developing
CAD than someone
under 200mg/dL
A major risk factor for
CAD
Very Risk of
developing CAD
The American Heart
Association
recommends a ratio
for LDL/HDL
cholesterol below 5:1.
Decreased Apo A
levels consistently
associated with risk of
CAD
LDL (mg/dL)
< 130
210 ˄
LDL/HDL ratio
< 3.22 F < 3.55 M
7.0 ˄
Apo A (mg/dL)
101 – 199 F
94 – 178 M
75˅
Apo B (mg/dL)
60 – 126 F
63 – 133 M
140˄
Increased Apo B
levels consistently
associated with risk of
CAD
Triglycerides
(mg/dL)
35 – 135 F
40 – 160 M
150˄
Borderline High
(150 to 199 mg/dL)
When blood lipids in our body become too high and unbalanced, lipids can build up in the artery
walls to form plaque. This can obstruct blood flow through the arteries and increase CAD and
stroke risks. After reviewing Mrs. Sanders’s lipid panel there is an indication that she is severely
at risk for developing CAD.
MNT
DFM 484
Polly Peru
Rachelle Sebastian
11/02/2014
32. Select two nutrition problems and complete the PES statement for each.
1. Excess sodium intake related to not being in compliance with dietary reduction of sodium as
evidenced by excessive levels of sodium (4091 mg) in 24-Hour Dietary Recall.
2. Excessive intake of calorie dense foods related to excessive consumption of total fat and
saturated fat as evidenced by a BMI value of 25.8 and a 24-Hour Dietary Recall.
33. When you ask Mrs. Sanders how much weight she would like to lose, she tells you she
would like to weigh 125, which is what she weighed most of her adult life. Is this
reasonable? What would you suggest as a goal for weight loss for Mrs. Sanders?
Mrs. Sanders currently weighs 160 lbs. and her ideal body weight is 130 lbs. If she would like to
weigh 125 lbs. she would have to lose 35 lbs and at 125 lbs her BMI would be 20 which is in the
healthy range and would decrease her risk for hypertension, CAD and Type 2 diabetes. A 35 lb.
weight loss goal may be overwhelming and unrealistic for Mrs. Sanders. I would suggest that she
start attending a Heart Healthy class that emphasizes the DASH diet plan and that she start with a
more realistic weight loss goal of reducing energy intake by 500 kcals per day for a loss of
approximately 1 lb per week. I would explain that as she loses weight she can decide as she
approaches her ideal body weight where she feels comfortable and not to concentrate on losing
30 – 35 pounds in a certain amount of time. Setting unrealistic goals can cause a relapse and she
would have to start all over again or give up all together. This plan may be more reasonable,
attainable and not overwhelming for Mrs. Sanders and will also help decrease her risk for
hypertension, CAD, and Type 2 diabetes.
34. How quickly should Mrs. Sanders lose this weight?
I would encourage her to try and not rush the weight loss, but rather follow the DASH diet plan
and aim for a reduction of 500 kcals per day, which would assist her in losing weight at a safe
rate. If Mrs. Sanders follows the plan to reduce 500 kcals/day for a weight loss of 30 lbs at 1 lb
per week to reach her ideal body weight of 130 lbs it would take her approximately 30 weeks or
8 months. If she decided to lose 35 lbs to weigh 125 it would take her approximately 9 months.
MNT
DFM 484
Polly Peru
Rachelle Sebastian
11/02/2014
35. For each of the PES statements that you have written, establish an ideal goal (based on
the signs and symptoms) and an appropriate intervention (based on the etiology).
PES 1: Reduce sodium intake to less than 1500 mg/day to reduce risk of hypertension.
Method: Incorporate salt substitutes and spices to make food appealing and palatable.
PES 2: Reduce energy intake by 250 - 500 kcals per day.
Method: Choose lower calorie food items, increase fruit and vegetable consumption, incorporate
healthy whole grain carbohydrate choices, and include lower amounts and healthier fats in the
daily diet plan.