Name: _____Morgan Lindsay__________________
Instructions: This is not a group case study; it is an individual assignment! Complete the
following questions using the background information above. Use this as a template and
type in your answers.
Remember RD’s are experts in researching evidence-based practice for their patients so
you can use other credible sources. ***Be sure to reference your answers in-text and
provide a Work Cited page at the end.***
1. What factors found in the medical and social history are pertinent for determining Mr.
Watkins’ heart disease risk?
Medical
Social
Mild obesity for 10 years
Smoking 2ppd for 30 years
Hypertension
Alcohol use: 2 cans of beer per week
BP 160/100
Intake: ex: cheeseburgers/bacon/butter
BUN 20
Cuts salt intake
Bilirubin 1.1
Came to appointment because advised, but not willingly on
own terms
C-reative protein 1.0
HDL low (30)
LDL high (210
Ratio LDL:HDL (7)
Triglycerides (165)
Apo A/B 75/140
Cholesterol (250)
2. Briefly describe the DASH eating plan.
The DASH diet stands for Dietary Approaches to Stop Hypertension, which was discovered in
the 1990's. The DASH diet focuses on food choices that are low in sodium and reduce sodium, as
well as increase potassium, magnesium, calcium, and fiber. Along with other lifestyle
adaptations, the DASH diet is shown to lower blood pressure (Nelms et all, 293).
3. Using the EAL, describe the association between sodium intake and blood pressure in
hypertensive individuals.
Dietary sodium intake should be limited to no more than 2300 mg sodium (100 mmol)
per day. Reduction of dietary sodium to recommended levels lowers systolic blood pressure
by approximately 2 - 8 mmHg. If the patient demonstrates adherence to a 2300 mg sodium
diet but has not achieved the treatment goal, then the dietitian should recommend the DASH
dietary pattern and/or reduction in sodium to 1600 mg to further reduce blood pressure.
Optimal body weight should be achieved and maintained (BMI 18.5 - 24.9) to reduce
blood pressure. Weight reduction lowers systolic blood pressure by 5 - 20 mmHg per 22 lbs
(10 kg) body weight loss.
4. What are the Therapeutic Lifestyle Changes? Outline the components of the nutrition
therapy interventions.
The Therapeutic Lifestyle Change is included in the current recommendations or treatment of
hyperlipidemia. TLC focuses on reducing total fat intake and reducing saturated and trans fats
from the diet. Nutrition therapy is a major component of this treatment process to treat cardiac
disease, hyperlipidemia, and hypertension. The TLC diet requires the following:
“- Less than 7 percent of your daily calories from saturated fat
- Less than 200 mg a day of cholesterol
- 25–35 percent of daily calories from total fat (includes saturated fat calories)
- Diet options you can use for more LDL lowering
- 2 grams per day of plant stanols or sterols (see pages 27–28)
- 10–25 grams per day of soluble fiber (see pages 23, 27–29)
- Only enough calories to reach or maintain a healthy weight
- In addition, you should get at least 30 minutes of a moderate intensity physical activity, such as
brisk walking, on most, and preferably all, days of the week” (NCEP, et all. 22).
5. Calculate Mr. Watkins’ body mass index (BMI). What are the health implications of this
number?
BMI= wt (Kg)/ Ht (meters)^2 = 34.2. This puts Mr. Watkins in the Class 1 obesity category.
This indicates a risk for cardiovascular disease and hypertension.
6. Calculate Mr. Watkins’ total energy needs. Identify the formula/calculation method you
used and explain your rationale for using it.
The TEE equation used for Mr. Watkins is:
1086-10.1xAge + PAx (13.7xweight+416xheight)
PA = 1.0 – sedentary
1086 - (10.1) 53 + 1.0 x (13.7 x 102 + 416 x 1.7) = 2655 – 500kcal/day = 2155kcal/day
I used this calculation because I felt it would give an accurate energy requirement. I used 1.0
for the PA because the case study does not say that Mr. Watkins does any additional physical
activity in addition to daily activity. Also, since Mr. Watkins’ is in the obese category, it was
important to use the correct calculation for obese males. I subtracted 500 kcal per day from Mr.
Watkins daily energy needs to promote healthy weight loss.
7. Using a computer dietary analysis program or food composition table, compare Mr.
Watkins’ “usual” dietary intake to her prescribed diet (DASH/TLC diet).
NUTRIENT
kcal
PATIENT
Prescribed
DISEASE
Your diet
INTAKE
diet (per
IMPLICATIONS based recommendations
(per day)
day)
on diet comparison
3280
2000
Obesity, CVD
Decrease total caloric
intake levels by
eliminating high energy/
low nutritional content
items.
% kcal Pro
% kcalCHO
17%
43%
15%
55%
Protein levels are
Protein levels are within
within healthy range.
a healthy range.
Carbohydrates are
Increase fiber content of
essential in fat burn,
CHO.
therefore, fat storage
can occur if CHO
levels are too low.
% kcal Fat
49%
25-30%
High fat diets can result Decrease overall fat
in higher risk of
consumption and make
obesity, CVD, and high
sure “good” fats are
cholesterol.
being put into diet (low
saturated fat).
%SFA 48%
</= 7%
High cholesterol,
Decrease animal fat
obesity, CVD.
sources, eliminate sat.
fat products from diet.
%MUFA 13%
~20%
Adequate intake of
Use olive or canola oils
MUFA’s reduces the
in dressing and
risk of CVD, lower
preparation of foods.
LDL levels, have no
effect on HDL levels,
and lower apoliprotein
AII lipoprotein levels.
Protective of metabolic
syndrome and type 2
diabetes if correct
amounts are consumed.
%PUFA 6%
~10%
Adequate amounts of
Adding corn,
PUFA’s lead to a
cottonseed, soybean,
reduction of LDL and
safflower, and sunflower
are associated with
oils to diet.
decreased CVD risk
(Nelms,et all. 313).
Cholesterol
1634 mg
</= 200mg
Hypercholesterolemia,
Avoid high cholesterol
heart disease.
foods such as shrimp,
tilapia, and animal fats.
Fiber
16.6 g
20-30 g
Adequate amounts
Increase fruit &
reduce LDL levels,
vegetable consumption,
serum cholesterol
whole grains, and beans.
levels. Reduces risk for
CVD. Supports
healthy liver function
and the synthesis of
bile.
Na
4076.16 mg
< 1300 mg
High blood pressure,
Reduce sodium intake,
sodium modification
provide education on
reduces risk of
sodium content foods,
hypertension by as
DASH diet (Nelms,et
much as 17%,
all. 295).
cardiovascular disease,
renal disease, and
stroke.
Ca
966.29 mg
1200mg
Reduces BP and
Atleast 3 cups of dairy
treatment of
into diet (low fat or fat
hypertension if
free), get Ca from
adequate amounts are
whole foods not
reached. Low calcium
supplements.
intake can increase risk
for HBP
K
4173.68 mg 4700 mg
Reduces BP and
High potassium foods
treatment of
such as apricots, prunes
hypertension.
(or juice), avocado,
Potassium levels lower
cantaloupe, banana,
than recommended
black beans, artichokes,
levels is associated
bran, milk, legumes, etc.
with high blood
pressure
(Nelms, et all. 313-317)
8. From the information gathered within the intake domain, list possible nutrition problems
using the diagnostic term.
Less than optimal intake of types of fats, inadequate fiber intake, Predicted food-medication
interaction, overweight/obesity, hypertension, and hyperlipidemia.
9. Dr. Clemmer ordered the following labs: fasting glucose, cholesterol, triglycerides, and
creatinine. He also ordered an EKG. In the following table, outline the indication for these
tests (tests provide information related to a disease or condition).
Parameter
Normal
Patient’s
Value
Value
Reason for Abnormality
Your diet
recommendations
based on results
Glucose
70-110
110
Diet may affect his
Lower CHO content in
relatively high glucose
diet.
level. Also, stress and
illness can run high glucose
levels. Hyperglycemia
causes osmotic diuresis and
decreased blood volume
(Nelms, et all. 128)
Parameter
Normal
Patient’s
Value
Value
Reason for Abnormality
Your diet
recommendations
based on results
BUN
8-18
20
BUN and creatine levels
Add more water and
elevate during ARF.
fluids to the diet to see
Congestive heart failure can
if dehydration is the
be a reason or recent heart
problem. Also, monitor
attack. Dehydration can
kidney function.
also be a reason for elevated
BUN levels
Creatinine
0.6-1.2
0.9
Within normal limits
N/A
Total
120-199
250
Overweight, high
Reduced saturated fat/
cholesterol/saturated fat
trans fat content.
diets
Reduce overall total fat
cholesterol
consumption. Avoid
trans fats and refined
carbohydrates. Also,
instead of using butter
on toast, try a heart
healthy buttery spread
that will lower bad
cholesterol.
Parameter
Normal
Patient’s
Value
Value
Reason for Abnormality
Your diet
recommendations
based on results
HDL-
>45
30
cholesterol
Smoking, overweight, lack
Quit smoking; start
of physical activity, diet.
participating in some
physical activity if
possible. Reduced
saturated fat/ trans fat
content. Reduce overall
total fat consumption.
Avoid trans fats and
refined carbohydrates.
(TLC diet)
LDL-
<3.55
7.0
cholesterol
Unhealthy diet, overweight,
Adding more fiber to
inactivity, possibly genetics.
the diet. Lowering fat
and cholesterol in diet.
Apo A
94-178
75
HDL is low, which results
Adding more fiber to
in low Apo A because it is a
the diet. Lowering fat
major protein component of
and cholesterol in diet.
HDL.
Parameter
Normal
Patient’s
Value
Value
Reason for Abnormality
Your diet
recommendations
based on results
Apo B
63-133
140
Since Apo B is the major
Adding more fiber to
protein of LDL, it directly
the diet. Lowering fat
correlates with LDL levels.
and cholesterol in diet.
Meaning, since LDL levels
are high, Apo B levels will
be high.
Triglycerides 40-160
165
Reduce lipid intake
(lipid-free nutritional
formulas)
10. Calculate Mr. Watkins 10-Year Risk for a Heart Attack (using the pamphlet posted on
Angel; Box 5)?
6+ 4+ 3+2+2= 17= greater than or equal to 30%
11. Indicate the pharmacological differences among the antihypertensive agents listed below.
Medications
Mechanism of Action
Potential food-drug interactions
Medications
Diuretics
Mechanism of Action
Potential food-drug interactions
Decrease blood volume by
Hypokalemia, hyperlipidemia,
increasing urinary output; inhibit
hypertriglyceridemia, glucose
renal sodium and water
intolerance; N/V anorexia,
reabsorption.
hypercholesterolemia, dry mouth,
diarrhea, constipation, potassium
supplements may be necessary,
effect antagonized by NSAIDS,
avoid natural licorice.
Beta-blockers
Blocks B-receptors in heart to
Nausea, diarrhea, calcium may
decrease heart rate and cardiac
interfere with absorption, upset
output
stomach, dry mouth, stomach pain,
gas or bloating, heartburn.
Calcium-
Affect the movement of calcium,
Edema, nausea, heartburn,
channel
cause blood vessels to relax,
contraindications: heart failure or
blockers
therefore, reduce vasoconstriction
greater than first degree heart block,
avoid Alcohol, caffeine, and natural
licorice.
ACE inhibitors
Vasodilators that reduce BP by
Hypotension (especially in elderly
decreasing peripheral vascular
patients), can worsen renal
resistance by interfering with the
function, hyperkalemia, dysgeusia,
production of angiotensin II from
causes dry non-productive cough,
angiotensin I and inhibiting
contraindications: pregnancy, avoid
degradation of bradykinin.
Natural licorice and salt substitutes.
Medications
Mechanism of Action
Potential food-drug interactions
Angiotensin II
Interferes with renin-angiotensin
May increase serum potassium,
receptor
system without inhibiting
avoid salt substitutes, dysgeusia,
blockers
degradation of bradykinin
nausea.
Alpha-
Blocks the vascular muscle
Avoid natural licorice,
adrenergic
response to sympathetic
nausea/vomiting, diarrhea, mouth
blockers
stimulation; reduces stroke volume
dryness.
(Nelms,et all 291)
12. What are the most common nutritional implications of taking hydrochlorothiazide?
The reason for taking hydrochlorothiazide is to decrease blood volume by increasing
urinary output. Also, this drug inhibits renal sodium and water reabsorption.
13. Mr. Watkins’ physician has decided to prescribe an HMGCoA reductase inhibitor (Zocor).
What is its mechanism of action and what changes can be expected in his lipid profile as a
result of taking this medication?
Zocor is a lipid-lowering agent, it reduces levels of "bad" cholesterol (LDL) and
triglycerides in the blood, while increasing levels of "good" cholesterol (HDL). Mr.
Watkins’ can expect healthier cholesterol levels in terms of HDL and LDL.
14. What are some possible barriers to compliance?
The fact that Mr.Watkin’s came to the appointment because he was told to and not
willingly going because he was concerned with his own heath may show that he is not ready
for change. Also, removing many things from him lifestyle may be hard for him (such as fats
and smoking).
15. Select two KEY nutrition problems and complete the PES statement for each.
P- Less than optimal intake of types of fats: saturated & trans (NI-5.6.3)
E- Related to high levels of saturated fat
S- As evidenced by high LDL level (210), and low HDL level (30).
P- Excessive oral intake (NI-2.2)
E- Related to energy intake levels higher than recommended amount.
S- As evidence by food analysis software of a day’s intake, BMI of 34.2, class 1 obesity.
16. When you ask Mr. Watkins how much weight he would like to lose, he tells you he would
like to weigh 170, which is what he weighed most of his adult life. Is this reasonable? What
would you suggest as a goal for weight loss for Mr. Watkins?
I do not think losing ~55 lbs is reasonable, but rather a goal weight of 200 within the first
6 months is a little more reasonable. I would recommend Mr. Watkins to lose about 10% of
his weight over 6 months; this would be about a 22-pound weight loss, and then I would
recommend education on weight maintenance for the next 6 months. After the first year,
discussion of more weight loss can be brought up.
17. How quickly should Mr. Watkins lose this weight?
I recommend 10% weight loss over 6 months. Which would be about a 22pound weight loss.
18. Write Nutrition Prescription for patient. Include Diet type, kcal level, % kcal from CHO,
PRO, FAT, Saturated fat, cholesterol, Na.
The nutrition prescription for Mr.Watkins is a ~2155 kcal diet composed of 55% total
kcal from CHO, 15% total kcal from PRO, 25-30% total kcal from fat, </= 7% total kcal
from saturated fat, </= 200 mg cholesterol, and </=1300 mg Na daily.
19. 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). Use
IDNT manual to label Intervention domains and subclasses; and give details of exactly
what you are going to do.
PES #1
o
Goal: Decrease saturated fat in diet and incorporate healthy fats into diet to ultimately
decrease LDL levels and increase HDL levels.
o
Intervention: Eliminating as much saturated fat from the diet through diet
modification. Changing items in typical diet such as adding plant sterols/stenols to
the diet. Switch butter for BENECOL spread.
PES #2
o
Goal: Healthy weight loss to decrease BMI and prevent risk of CVD.
o
Intervention: proved patient with education on healthy ways to lose weight, educate
on weight maintenance, adjust diet for weight loss.
20. Write a concise ADIME note by pulling the key components from you answers. Handin a double-spaced typed version only
A- 53 y/o male. Ht:70’’, wt: 225# (102.27 kg), BMI: 34.2 kg/m2. Dx: grade 1
hypertensive retinopathy, hypertensive heart disease, and early COPD. Pulse88, resp
rate:18, temp: 96.4. Abnormal lipid profile, No prior therapy, mild obesity for past 10
yrs, mild hypertension, no diabetes history, thyroid indices are normal, TSH is normal.
Tobacco use: 1 ppd for 30 yrs, alcohol use: 2 cans of beer per week. Family istory: CAD
in 48yr old brother, s/p coronary artery surgery. General appearance: overweight AA
male in NAD. Good appetite, eats 3 meals per day and 1 evening snack. Labs: BUN 20,
Bilirubin, direct 1.1, C-reactive protein 1, cholesterol 250, HDL-L 30, LDL-C 210,
LDL/HDL ratio 7.0, Apo A 75, Apo B 140, triglycerides 165. Reflecting hypertension,
possible CVD, risk of stroke/heart attack.
D- Less than optimal intake of types of fats: saturated & trans (NI-5.6.3) related to high
levels of saturated fat as evidenced by high LDL level (210), and low HDL level (30).
Excessive oral intake (NI-2.2) related to energy intake levels higher than recommended
amount as evidence by food analysis software of a day’s intake, BMI of 34.2, class 1 obesity.
I- The nutrition Rx: ~2155 kcal diet composed of 55% total kcal from CHO, 15% total kcal
from PRO, 25-30% total kcal from fat, </= 7% total kcal from saturated fat, </= 200 mg
cholesterol, and </=1300 mg Na daily.
Goal: decrease kcal content and fat consumption for healthy weight loss and
cardiovascular problem prevention. Also eliminate saturated fats as much as possible.
Overall goal: healthy weight loss and prevention of CVD or other cardiac problems.
Food and/or nutrient delivery: decrease saturated fat consumption and increase healthy
fat consumption instead. Use plant sterol/stanols to decrease LDL and increase HDL
such as BENECOL.
M/E- Monitor Food and Nutrient Intake: Total kcal, sat, fat, total fat, and food and
supplement intake.
Outcome: pt will decrease sat. fat consumption and total energy intake to reach a
healthier weight and reduced risk of cardiovascular issues.
Monitor: Anthropometric Measurements: Weight
Outcome: Promote weight loss at a healthy stable pace of eliminating 500kcal per day
through diet or PA.
Monitor: biochemical data: Total cholesterol, HDL, LDL, triglycerides, ApoA/B
Outcome: decrease LDL levels and increase HDL levels. Decrease triglycerides as
well, all to reduce risk of CVD and other cardiac complications and return to closer to normal
status.
Follow up in 3 months.
Morgan Lindsay 10/27/13
1.
Mr. Watkins had a myocardial infarction. Explain what happened to his heart.
Myocardial infarction is commonly called a heart attack. This means that blood stopped
flowing properly to part of the heart, resulting in injured heart muscles from lack of oxygen.
Usually this is a result of a blockage in the coronary arteries.
2. Mr. Watkins was treated with an angioplasty and stent placement. Explain this medical
procedure and its purpose.
Angioplasty is done using a thin, soft tube called a catheter. A doctor inserts the catheter
into a blood vessel in the groin or wrist. The doctor carefully guides the catheter through
blood vessels until it reaches coronary arteries on the heart. A small amount of contrast
material is injected through the catheter and is photographed with an X-ray as it moves
through the heart's chambers, valves, and major vessels. From the digital pictures of the
contrast material, the doctors can tell whether the coronary arteries are narrowed and whether
the heart valves are working correctly. If the decision is made to perform angioplasty, the
doctor will move the catheter into the artery with the blockage. He or she will then perform
one of the interventional procedures described below.
A stent is a small metal mesh tube that acts as a scaffold to provide support inside your
coronary artery. A balloon catheter, placed over a guide wire, is used to insert the stent into
the narrowed coronary artery. Once in place, the balloon tip is inflated and the stent expands
to the size of the artery and holds it open. The balloon is then deflated and removed while the
stent stays in place permanently. Over a several-week period, your artery heals around the
stent. Stents are commonly placed during interventional procedures such as angioplasty to
help keep the coronary artery open. Some stents contain medicine and are designed to reduce
the risk of reblockage (restenosis).
3. What are the current recommendations for nutritional intake during a hospitalization
following a myocardial infarction?
Bed rest is usually recommended for the first 24-48 hours of hospitalization. Oral intake
may be decreased because of pain, anxiety, fatigue, and shortness of breath. Caffeine is
omitted from the diet and a clear liquid diet is adopted immediately after MI. Oral diets
progress from liquids to soft diets and eventually a regular textured diet once the patient is
stabilized. The TLC dietary recommendations should be followed and specified to the
patients’ individual situation (Nelms, et all 319).
4. Examine the chemistry results for Mr. Watkins. Which labs are diagnostic of the MI
diagnosis? Explain.
Troponin l, troponin T- proteins release from myocardial cells which are elevated after
cardiac injury (Nelms,et all. 320).
Total cholesterol: =240 or above can aide in MI, as well as HDL levels below 40 and LDL
levels above 190.
5. Mr. Watkins was prescribed the following medications on discharge. What are the foodmedication interactions for this list of medications?
Medication
Possible Food-Medication Interactions
Lopressor 50 mg daily
Nausea, diarrhea, calcium may interfere with absorption;
upset stomach, dry mouth, stomach pain, gas or bloating,
heartburn.
Lisinopril 10 mg daily
Hypotension, esp. in elderly patients; can worsen renal
function, hyperkalemia, dysgeusia; causes dry, nonproductive
cough, hyperkalemia; contraindications: pregnancy, avoid
natural licorice, avoid salt substitutes
Nitro-Bid 9.0 mg twice
Nausea, vomiting, abdominal pain, dryness of mouth
daily
NTG 0.4 mg sl prn chest
Nausea, vomiting, abdominal pain, dryness of mouth
pain
ASA 81 mg daily
Do not drink on ASA, nausea
6. You talk with Mr. Watkins and his wife, a teacher at the local high school. They are
friendly and seem cooperative. They are both anxious to learn what they can do to prevent
another heart attack. What questions will you ask them to assess how to best help them?
Are you willing to change your eating habits to a healthier and preventative lifestyle?
How willing is Mr. Watkins to quit smoking?
Will Mrs. Watkins change her eating habits to influence and help support Mr. Watkins?
7. What is the rationale for the use of plant stanols/sterols and list some products that you
may recommend?
Plant stanols and sterols help block the absorption of cholesterol from the digestive tract,
which helps to lower LDL—without affecting HDL or triglycerides. Studies show that a
daily intake of about 2 grams of either stanols or sterols reduces LDL cholesterol by about 5–
15 percent—often within weeks. Stanols and sterols are added to certain margarines and
some other foods, such as a special type of orange juice (NCEP,et all. 31).
8. Mr. Watkins and his wife ask about supplements. “My roommate here in the hospital told
me I should be taking fish oil pills.” What does the EAL say about fish oil supplementation
for this patient?
According to the EAL, “In studies of patients with high triglycerides, not following
specific dietary advice and not on concurrent statin therapy, fish oil was associated with a 844% increase in LDL-C. In studies of people taking fish oil capsules and statins, LDL-C
decreased 0-20%” (EAL, ref. 1).
Although fish oils are shown to lower LDL levels in patients and associated with reduced
cardiac mortality from CHD or sudden death in American men, fish oil pills are not the end
all, be all. I would recommend Mr. Watkins and his wife to incorporate fish into their diet 23 times per week to increase their EPA/DHA intake instead of rushing straight into
supplemental treatment.
Meal Pattern
# of exchanges
CHO (g)
PRO (g)
FAT (g)
Starches
10
150
30
10
Fruit
5
75
Vegetables
5
25
10
Skim or 1% 2
24
16
0-6
Lean 3
21
0-18
Med-fat 2
14
10
Milk
2%
4%
Sweets/Other
carbs
Meat/substitutes
Plant-based
proteins
High-fat
Fat group
5
25
TOTAL (g)
xxx
274
91
45-69
% kcal
xxx
54.8 %
18.2%
20.25-31%
# of exchanges
CHO (g)
PRO (g)
FAT (g)
Starches
4
60
12
4
Fruit
3
45
XXX
XXX
Vegetables
XXX
XXX
XXX
XXX
1
12
8
0-3
XXX
XXX
XXX
XXX
Meal Pattern for Breakfast
Milk
Skim or 1%
2%
4%
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
1
XXX
7
0-3
XXX
XXX
XXX
XXX
XXX
XXX
XXX
2
XXX
XXX
10
117
27
14-20
# of exchanges
CHO (g)
PRO (g)
FAT (g)
Starches
3
45
9
3
Fruit
1
15
XXX
XXX
Vegetables
2
10
4
XXX
1
12
8
0-3
2%
XXX
XXX
XXX
XXX
4%
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
2
XXX
14
0-6
Med-fat
XXX
XXX
XXX
XXX
High-fat
XXX
XXX
XXX
XXX
2
XXX
XXX
10
82
35
13-22
Other carbs
Meat/substitutes
Plant-based
Lean
Med-fat
High-fat
Fat group
TOTAL (g)
xxx
Meal Pattern for Lunch
Milk
Skim or 1%
Other carbs
Meat/substitutes
Plant-based
Lean
Fat group
TOTAL (g)
Meal Pattern for Dinner
xxx
# of exchanges
CHO (g)
PRO (g)
FAT (g)
Starches
3
45
9
3
Fruit
1
15
XXX
XXX
Vegetables
3
15
6
XXX
Skim or 1%
XXX
XXX
XXX
XXX
2%
XXX
XXX
XXX
XXX
4%
XXX
XXX
XXX
XXX
XXX
XXX
XXX
XXX
Plant-based
XXX
XXX
XXX
XXX
Lean
XXX
XXX
XXX
XXX
Med-fat
2
XXX
14
10
High-fat
XXX
XXX
XXX
XXX
2
XXX
XXX
10
75
29
18
Milk
Other carbs
Meat/substitutes
Fat group
TOTAL (g)
xxx
~ Menu ~
Breakfast:
Choose: 3 fruit, 4 starches, 1 milk, 1 lean meat (egg), 2 fat (condiments)
-
Fruits: (pick 3) 1 large apple/banana/orange , ½ cup fresh squeezed apple/orange/prune juice
-
Starch: (pick4) ¾ cup hot/cold cereal, 1 4’’ waffle, 1 whole large bagel (counts as all 4 starches),
1 slice toast, ½ English muffin
-
Entrée of the day: Western omelet (made with egg whites, peppers, onions, ham, and RF
cheddar cheese)
-
Lean Meat: (pick 1) - choice of scrambled or omelet – 2 egg whites, ¼ c egg substitute
-
Milk: (pick 1) 8 oz. fat free milk, ¾ C plain yogurt (with sugar substitute if wanted)
-
Condiments ( fats): (pick 2) 1 slice turkey bacon, 1 ½ tbsp. reduced fat cream cheese, 1 tsp.
margarine (BENECOL) , 1 ½ tsp. peanut butter, 2 tbsp. cream half& half
-
Free foods: coffee (black), Tea (unsweetened or sweetened with sugar substitute)
Lunch/Dinner:
Lunch choose: 3 starch, 2 vegetable, 1 fruit, 1 milk, 2 lean meats, 1 fats
Dinner choose: 3 starch, 3 vegetable, 1 fruit, 2 med-fat meat, 2 fats
-
Salads/soups: 1 Cup bean/lentil soup (1 starch+ 1 lean meat), 1 Cup low sodium Tomato soup (1
Starch), ½ Cup Coleslaw (1 starch, 1 ½ fat)
-
Entrees: ½ Cup Tuna/Chicken salad ( ½ starch, 2 lean meat, 1 fat), turkey, avocado & lettuce
sandwich on whole grain bread (2 starch, 1 fat, 2 lean meats), 1 Cup Beef and Vegetable stew ( 1
starch, 1 med-fat meat, 2 fats)
-
Starch: ½ cup wild rice, 1/3 cup couscous, 1/3 cup plain pasta, ½ hot dog bun
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Med-fat meats: corned beef (1 oz.), meatloaf (1 oz.), pork chop (1 oz)
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Lean meats: 1 oz. tuna, ¼ cup cottage cheese, 1 oz. grilled chicken
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Vegetable: ½ cup cooked broccoli/ cauliflower/ asparagus/squash
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Fruit: apple, pear, banana, orange, ½ cup fresh squeezed apple/orange/prune juice
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Beverages: diet cola (caffeine free), unsweetened black tea (10 oz.), 8 oz. skim or 1% milk, water
-
Condiments (fats): 2 tbs. avocado, 6 almonds/cashews, 10 green stuffed olives, 16 pistachios, 1
tsp. margarine (BENECOL)
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Dessert: 1 ¼ Cup strawberries, 1 slice watermelon, frozen fruit juice bar (1 starch), ½ cup light
ice-cream- chocolate, vanilla, strawberry (1 starch + 2 fat)
Evaluation of Nutritional Adequacy of Menu
After inputting a specific one day menu into the Food Processor, I will admit that there were a
few components that need slight improvement. According to the guidelines provided, I exceeded the
protein requirements very slightly as well as the carbohydrates. However, I do not find this to be an
alarming amount since it is very close to the range requested. For the total fat content, I was slightly
lower than I wanted but I made a conscious effort to incorporate healthy fats such as avocados and
pistachios. Swapping out butter for BENECOL margarine spread decreased total fat content as well
however, the BENECOL would be more beneficial to the client than high fat butter.
In terms of vitamins and minerals, I think nutritional goals were met for Mr. Watkins 1-day meal
plan. I found it very important to make sure sodium levels did not exceed recommended amounts
especially because of the cardiovascular complications Mr. Watkins has been experiencing. Also,
according to the TLC diet he should not exceed 1300 mg per day which I made sure did not happen.
Also, calcium levels were important to maintain. A recommended amount was 1,000 mg per day and
the menu I created delivered 1167mg per day which I found important and beneficial. For potassium
levels, the reports say that the levels for the menu created are low, however I do not think that is an
issue for multiple reasons. First off, I was unable to enter all items on the menu as USDA supplier
products with the Food Processor; therefore the potassium levels can be skewed. The potassium levels
were not alarmingly low, so I’m assuming if all products had potassium levels recorded, Mr. Watkins
would be meeting the recommended amount.
Overall, I think this menu plan is both beneficial and accurate for Mr. Watkins. It provides a
healthy number of kcal, macronutrients vitamins, and minerals. Although the numbers are not 100%
exact, I believe the nutritional benefits of this menu will not only benefit Mr. Watkins but teach him a
new way to eat for health.
References:
Academy of Nutrition and Dietetics. (n.d.). Academy of Nutrition and Dietetics. Retrieved
October 29, 2013, from http://www.eatright.org/
Nelms, M. N. (2011). Nutrition therapy and pathophysiology (2nd ed.). Belmont, CA:
Wadsworth, Cengage Learning.
U.S. Department of Health and Human Services(2005). Your Guide To Lowering Your Cholesterol
With TLC. National Institutes of Health, National Heart, Lung, and Blood Institute.