Determining Chronic Disease Risk

Katherine Silva
NFS 443
Lab section: Wednesday 1:00 PM
November 2014

1.
BP = 130/79 = Prehypertension At risk for high blood pressure.
Prehypertension is a systolic pressure from 120 to 139 or a diastolic
pressure from 80 to 89.
Total Cholesterol = 245 mg/dL (High)
High cholesterol over 240 mg/dL
LDL = 145 mg/dL (Borderline High)
Borderline High Between 130-159 mg/dL
HDL = 42 mg/dL (Low)
Low = <40 High >60
TG = 290 mg/dL (High)
High = 200-499
Fasting Glucose =110mg/dL (High- Impaired fasting glucose /
Prediabetes)
IFG: 100 -125
2.
BMI = 30 (Obesity Class I) Waist Circumference: 34 inches
With a BMI of 30 and a waist circumference of 34in, this places CG in the
high risk category for disease risk (type 2 diabetes, HTN, and CVD) according to
the NIH guidelines.
Weight loss is appropriate for CG. An appropriate weight loss goal would
be approximately 10% from baseline at a rate of about 1-2lbs/week over a period
of 6 months. 10% of her weight is 17.5 lbs.
The dietitian chose a 10% weight loss from the recommended 5-10%
since CG was already intent on losing weight through a weight loss program on
her own. She should be able to do well at a higher-end goal 10% because she
has the motivation and desire to lose weight already.
Losing between 5-10% of her weight comes with many health benefits for
those who are obese with poor blood pressure and lipid profile. Losing the weight
will result in improved glycemic control, reduced blood pressure, and an
improved lipid profile. These improvements will greatly reduce her risk for chronic
diseases and prevent the need for medication.

3.

10 Year Risk for ASCVD Pooled Cohort equation

Risk as a smoker: 8.2%

Risk as a non-smoker: 3.5%
CGs 10 year risk with her current smoking habits is 8.2% according to the
Pooled Cohort equation. If she quit smoking, her 10 year risk would drop
dramatically to 3.5%.
4.
According to the NIH guidelines, CG fall under the following risk categories that
modify LDL goals:
Cigarette smoking
Age: female over 55
5. Estimated energy needs
Mifflin St. Jeor
(10 x 80) + (6.25 x 162.5) (5 x 56) -161
800 + 1015.6 - 280 161
1,375 x 1.2 activity = 1,650

6.
Diet
2 Fried Eggs- (2 med fat
protein)
Salt (1tsp)
White Toast - 2 Slices (2
starch)
Butter- 2 tsp (2 fat)
Coffee (12 oz)
Coffee (12 oz)
Doughnut - 1 (1 1/2 starch +
2 Fat)
White Bread -2 Slices (2
starch)
Swiss Cheese - 2 oz (2 high
fat protein)
Ham - 2 oz (2 lean protein)
Mayonnaise - 1 Tbsp (3
fats)
Potato Chips -2oz (2 starch,
4 fat)
Meatloaf - 6oz (6 med fat)
Mashed Potatoes 1/2 c (1
starch, 1 fat)
Canned Corn -1/2 c (1
starch)
White Roll - 1, small
Butter - 1 Tbsp (3 fat)
Oatmeal Cookies - 1 Lrg (4
Cho + 3 Fat)
Milk, 2%- 12 fl.oz. (1 milk)

Carbs
0

Protein
14

Fat
10

Kcals
150

0
30

0
6

0
2

0
160

0
0
0
22.5

0
0
0
0

10
0
0
10

90
0
0
195

30

160

14

16

200

0
0

14
0

4
15

90
135

30

20

340

0
15

42
2

30
5

450
125

15

80

15
0
60

3
0
0

1
15
15

80
135
415

18

12

7.5

180

Total:

235.5

115

163.5

2,985

Total kcalories 2,985

% kcals from CHO 30%
% kcals from protein 18%
% kcals from fat 52%

CGs diet is not within the current guidelines for lowering the risk of CVD
and diabetes. After analyzing her dietary intake, approximately 32% of her
calories are coming from carbohydrates, 15% from protein and 50% from fat.
These values are not within the AMDR for carbohydrates (45-65%), protein (1035%), or fat (20-35%).
Her carbohydrates should increase from 33% to about 50% in order to
help balance out her macronutrient percentages. Increasing her whole grains and
vegetables consumption while decreasing her high fat, starchy snack foods will
be the best way to do this. Increasing fiber content of her meals and snacks will
increase satiety for longer periods and aid in her weight loss.
Protein should also increase from 15% to about 20% of her calories.
Choosing lean meats such as fish, chicken, and plant proteins will reduce her
saturated fat intake and aid in improving her lipid profile. Her dairy sources
should be low fat milk, and cheese instead of full fat. Paying attention to her
cooking methods, such as not frying her eggs, will also keep her protein sources
leaner. She could hard boil them instead of using frying oils.
Fat intake should be limited to about 30% of her calories. Snacking was a
big part of this macronutrient range in her 24-hr recall so increasing her fruits and
vegetables in place of her sugary, high fat doughnuts and cookies will greatly
decrease her fat intake. Also, using fat free or low fat condiments will help
decrease any additional empty calories to her meals.

7.

CGs lifestyle intervention will start with consulting her husband about

eating meals outside the home less. Once he has a full understanding of the
risks in not changing diet and eating habits, he should be supportive of his wifes
health. By cooking more at home, it will reduce portion sizes compared to
restaurant sizes, and most likely help in reducing sodium and fat content due to
the cooking methods in a lot of restaurant dishes compared to home cooked
meals. Decreasing the total fat, saturated fat, and sodium will improve blood
pressure and improve her lipid profile.
Her meals should increase in whole grains, fruits, vegetables, and low fat
dairy. Her protein should come from lean meats, and plant-based sources. She
should also cut down the alcohol consumption from 2 to 3 beverages per week,
to 1 or 2 per week if possible, although 2 to 3 beverages is still within the
recommendations.
Weight loss will also increase her HDL and lower the LDL and TG and
lower her risk for chronic disease. Increasing exercise from her sedentary
lifestyle will help her lose the weight and increase HDL. Smoking cigarettes is a
major risk factor, and if she stops, will lower her 10 year risk percentage from
11% to 4%.

8. SOAP note:
S: Pt lives with husband with no children. Reports of 45 pound weight gain within
15 years. Pt has a sedentary lifestyle and is working as teacher. FH of mothers
pancreatic cancer, diabetic father, and obesity in sibling. Cigarette smoking of 1/2
ppd.
O: 56 yo female, Ht 64 inches, Wt 175 pounds, BMI 30, BP 130/79, waist circ. 34
in. Total cholesterol 245 mg/dL, LDL 145 mg/dL, HDL 42 mg/dL, TG 290mg/dL,
FBG 110 mg/dL. 24-hr diet recall reveals intake of 2,985 kcals, 235.5 g. CHO,
115 g. pro, 163.5 g. fat.
A:
BMI and %IBW indicate client is obesity, class I. Diet recall indicates a calorie
intake of 2985 kcals compared to the 1650 kcals recommended, 52% of calories
from fat compared to recommended 25-25%, little to no fruit and vegetable
intake, and diet rich in simple carbohydrates. Clients TG, TC, and FG are high,
her LDL is boarderline high, her HDL is fairly low, and her BP is prehypertensive,
all indicating increased risk status for chronic disease.
Overweight/Obesity R/T excessive energy intake, high saturated fat intake,
sedentary lifestyle AEB BMI of 30, and 146% IBW.
P: Energy intake reduction to 1,650/d and adequate protein of 64 g/d. Exercise of
moderate intensity 3 days per week. Decrease sat fat and sodium, and increase
fruit and vegetable consumption. Limit take out and restaurant meals to 2 times
per month. Follow up in 1 month for diet tolerance, weight loss progress, lipid
profile labs, and BP. Referral to smoking cessation program.