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This 6 page Class Notes was uploaded by Katherine Wilson on Wednesday August 17, 2016. The Class Notes belongs to at Ohio State University taught by in Winter 2016. Since its upload, it has received 7 views.
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Date Created: 08/17/16
Revised 6/7/2015 Katherine Wilson Case Study #1: Hypertension and CHD [25 points] Herman is a 35-year old accountant. He leads a fairly sedentary life – mostly sitting at his desk at work or watching TV when he’s at home. He is 5 feet, 8 inches tall and weighs 220 lbs; his pant size is 42 inches. He has never been diagnosed with any medical problems, and he does not currently take any medications. At his yearly check-up, his physician measured his blood pressure and found it to be borderline high at 130/85 mmHg. Herman tells his doctor that he tries to eat healthy. His physician tells him that he is probably salt-sensitive and needs to reduce the amount of sodium in his diet. Here is an example of Herman’s diet before he started to make changes. Old diet plan Breakfast: 3 slices of bacon (pan fried) 2 fried eggs 16 oz. black coffee Lunch: 2 beef tacos with cheese, lettuce, tomato, & salsa ½ cup refried beans 1 oz. tortilla chips with ¼ cup salsa 16 oz unsweetened iced tea Snack: ¼ cup mixed nuts (dry roasted and salted) Supper: 3 oz ham ½ cup canned peas 1 cup mashed potatoes (made with whole milk and butter) ½ cup turkey gravy (canned) 8 oz tomato juice (canned) Dessert: ½ cup canned peaches (in light syrup) 2 chocolate chip cookies (1 serving of Chewy Chips Ahoy!) His physician gives him very little guidance about his diet. Herman thinks he knows where the sodium is and makes some changes in his food selection. He also stops using the salt shaker. Herman’s new diet Breakfast: 1.5 cups of corn flakes ¾ cup of low-fat milk 16 oz. black coffee Lunch: 1 sandwich (made with 2 slices of whole wheat bread, 2 slices of American cheese, 2 slices of oven-roasted, deli-sliced chicken breast, 1 tsp mayonnaise, 1 tsp of yellow mustard and 3 bread-n-butter pickle chips) Salad (1.5 cups - lettuce, tomatoes and carrots) with 2 tbsp of Italian dressing 16 oz. unsweetened iced tea Revised 6/7/2015 Snack: 1 oz. of whole wheat pita chips 1 medium apple Supper: 3 oz. baked tilapia, seasoned with ½ tsp lemon pepper (Mrs. Dash) ½ cup canned peas 1 cup mashed potatoes (made with whole milk and butter) ½ cup turkey gravy 8 oz. low-sodium tomato juice Dessert: ½ cup canned peaches (in light syrup) Answer the following questions based on the info provided above. 1. What is Herman’s BMI? What BMI category does he fall into? (Hint: I know we haven’t really covered BMI yet, so please refer to the “Helpful Resources” at the bottom for some guidance.) Show your work/calculations below. [2 points] 220/(68)^2=.048 .048*703=33.45 Herman’s BMI is 33.45%. Herman falls into BMI category 1. 2. How would you characterize his fat distribution? (Hint: what does his pant size tell you?) [1 point] I would characterize his fat distribution as being highly distributed around the waist. 3. Herman’s physician told him that his blood pressure is “borderline high.” What are the blood pressure cut-offs for each of the following categories: a. Desirable b. Borderline/prehypertension c. High risk/hypertension The desirable blood pressure cut-off is <120/<80. The borderline/prehypertension cut-off for blood pressure is 120-139/80-89. The high risk cut-off for blood pressure is ≥140/≥90. [1.5 points] 4. What does it mean when Herman’s physician told him that he is “salt-sensitive”? [1 point] Salt sensitivity is a measure of how ones blood pressure responds to salt intake. Those who are salt sensitive are more likely to have high blood pressure when taking in salt. These people also have the greatest reduction in blood pressure when cutting back on their salt intake. Revised 6/7/2015 Herman returns to the doctor two months later and there is no change in his blood pressure. Use the diet analysis posted at the bottom of this document to answer the following questions. 5. Critique Herman’s old diet plan. Using the analysis provided below, identify FIVE specific foods that he was consuming that are the highest in sodium. Are there any foods that surprised you? [2.5 points] Herman’s old diet consisted of over 6,000 mg of while the daily recommendation is 2,300 mg. Five specific foods that he was consuming that were the highest in sodium were 1)3 oz. of ham 2).1 cup mashed potatoes 3). ½ cup turkey gravy 4). 8 oz. tomato juice and 5). ½ cup refried beans. One of the foods that surprised me was the tomato juice. Normally I don’t associate high sodium levels with juice. 6. Now using the analysis for his new diet, list at least THREE good changes that Herman made in his diet to lower sodium. How did these changes impact the amount of sodium Herman was consuming? [2 points] One good change that Herman made in his diet to lower sodium was changing the heat used in his supper from ham to tilapia. A second change that Herman made that lowered his sodium was switching from tomato juice to low sodium tomato juice. A third change that Herman made that lowered his sodium was switching from eating a side of refried beans at lunch to eating a salad. These changes significantly decreased his overall sodium he was taking in at each meal and as a whole. 7. List changes that he made that had little impact on his sodium intake. Cite at least THREE specific examples from the analysis. Are there any foods on his new diet for which the sodium content surprised you? [2 points] Three specific examples that had little impact on his diet was switching from taco beef to deli meat, switching from eating bacon and eggs for breakfast to corn flakes cereal, and switching from salsa to Italian dressing as a condiment used for lunch. One food that surprised me was the corn flake cereal. I wouldn’t have thought cereal as having such a high sodium concentration. 8. Why do you think Herman’s blood pressure did not change at his 2 month follow up? [1 point] The recommended lifestyle change should last for at least 3-6 months before seeing major results. I think Herman’s blood pressure did not change also due to the fact that he didn’t cut out some of the foods with the highest sodium content such as the mashed potatoes and gravy and some of the switches in foods had similar sodium levels. 9. Describe at least 4 lifestyle modifications Herman could make to reduce his blood pressure. [2 points] Four lifestyle modifications that Herman could make to reduce his blood pressure would be to increase his physical activity, increase his intake of potassium, magnesium, and calcium, avoid smoking and decrease alcohol levels. Revised 6/7/2015 10.What is the name of the diet that Herman could follow that may help to lower his blood pressure? What foods should be emphasized and what foods should be limited in this diet? [2 points] Herman could follow the DASH diet to help lower his blood pressure. Nutrient dense foods are emphasized in this diet such as lean protein, fruits and vegetables, and whole grains. Saturated and total fat should be limited while on this diet. 11.Help Herman prepare a sample one-day menu that follows the pattern of the diet listed in #10. Your sample menu should include 3 meals and 2 snacks. [4 points] Meal 1: 1 cup whole grain oats 1 cup fat free fruit yogurt 1 cup orange juice 1 cup low-fat milk 1 medium banana Snack 1:1/3 cup almonds unsalted 1 cup apple juice Meal 2: Turkey breast sandwich with: 2 slices whole wheat bread Romaine lettuce Low-fat mayonnaise 1 cup steamed asparagus 1 clementine Snack 2: 3 apple and peanut butter sandwiches (size of the width of an apple) 1/3 cup dried fruit Meal 3: 3 oz tilapia with: 1 tbsp lemon juice 1 small baked potato 1 cup of steamed broccoli Herman’s doctor has decided to have Herman do fasting blood work to further assess his CHD risk. The results of his blood work are as follows: total cholesterol = 250 mg/dL, LDL cholesterol = 165 mg/dL, HDL cholesterol = 35 mg/dL, triglycerides = 160 mg/dL, glucose = 110 mg/dL. 12.Assess Herman’s CHD risk, using the American Heart Association, Heart Attack Risk Calculator: https://www.heart.org/gglRisk/main_en_US.html. [1 point] Herman’s is at borderline high risk for total cholesterol, high risk for HDL cholesterol, moderate risk for blood pressure(systolic), and a low risk (4%) for a heart attack. Revised 6/7/2015 13.Does Herman meet the criteria for Metabolic Syndrome? If yes, how so? [1 point] Yes, Herman meets the criteria for Metabolic Syndrome because he had all five of the metabolic risk factors. You need to have three of more to meet the criteria. The risk factors are abdominal obesity, high blood pressure, high blood triglycerides, low HDL, and high blood sugar. 14.What, if any, additional recommendations would you suggest to Herman to help him improve his heart health and decrease his CHD risk? [2 points] Some additional recommendations I would suggest to Herman would be to lower his total cholesterol as well as increase his HDL cholesterol. Helpful Resources OR Remember: 2.2 lbs per kg, 2.54 cm in 1 inch Online Medical Dictionary: http://www.nlm.nih.gov/medlineplus/mplusdictionary.html Herman’s Old Diet Plan – Sodium Analysis Item Name Amount Sodium Eggs, Fried 2 item 190.44 mg 3% Bacon, Pork, Cured, Bro3 sl. 554.4 mg 9% Pan Fried or Roasted Coffee, Brewed 16 fl. oz. 9.48 mg 0% Taco or Tostada, Beef, 2 item 398.4 mg 7% Cheese, Lettuce, Tomato and Revised 6/7/2015 Item Name Amount Sodium Eggs, Fried 2 item 190.44 mg 3% Bacon, Pork, Cured, Broiled,3 sl. 554.4 mg 9% Pan Fried or Roasted Salsa Salsa 0.25 c. 384 mg 6% LIPTON PURELEAF Iced Tea, 16 fl. oz. 0 mg 0% Unsweetened Beans, Refried, Canned 0.5 c. 534.31 mg 9% Chips, Tortilla, Plain 1 oz. 119.35 mg 2% Ham, Cured, Boneless, 11% 3 oz. 1275 mg 21% Fat, Roasted Peas, Green, Canned, Drained0.5 c. 238.88 mg 4% Potatoes, Mashed, Prepared 1 c. 662.39 mg 11% with Whole Milk and Butter Gravy, Turkey, Canned 0.5 c. 686.63 mg 11% Juice, Tomato, Canned 8 fl. oz. 653.67 mg 11% CHIPS AHOY! Cookies, 1 svg. 80 mg 1% Chocolate Chip, Chewy Nuts, Mixed, with Peanuts, Dry 0.25 c. 229.13 mg 4% Roasted, with Salt Added S&W Sun Peaches, Canned in 0.5 c. 20 mg 0% Light Syrup Totals: 6036.08 mg *A gold star marks foods containing more than 20% of the DV. A silver star marks foods containing 10% to 20% of the DV. Herman’s New Diet Plan – Sodium Analysis Item Name Amount Sodium KELLOGG'S CORN FLAKES 1.5 c. 300 mg 7% Cereal Milk, Low Fat, 1% 0.75 c. 80.52 mg 2% Coffee, Brewed 16 fl. oz. 9.48 mg 0% Salad Dressing, Italian 2 T. 299.29 mg 7% Deli Meat, Chicken Breast, 2 sl. 456.54 mg 10% Oven Roasted, Fat Free, Sliced Bread, Whole Wheat, Prepared 2 sl. 318.32 mg 7% Cheese, American, Processed 2 sl. 701.83 mg 16% Mayonnaise, with Soybean Oil 1 t. 26.13 mg 1% Mustard, Yellow 1 t. 56.75 mg 1% CLAUSSEN Pickles, Bread 'N 3 sl. 135 mg 3% Butter, Pickle Chips Salad, Lettuce with Tomatoes 1.5 c. 20.81 mg 0% and Carrots, No Dressing LIPTON PURELEAF Iced Tea, 16 fl. oz. 0 mg 0% Unsweetened Tilapia, Cooked, Dry Heat 3 oz. 47.6 mg 1% MRS. DASH Seasoning, Lemon0.5 t. 0 mg 0% Pepper Juice, Tomato and Vegetable, 1 c. 169.4 mg 4% Low Sodium Peas, Green, Canned, Drained0.5 c. 238.88 mg 5% Potatoes, Mashed, Prepared 1 c. 662.39 mg 15% with Whole Milk and Butter Gravy, Turkey, Canned 0.5 c. 686.63 mg 15% ATHENOS Chips, Pita, Whole 1 oz. 270 mg 6% Wheat Apple, Medium 1 item 2.23 mg 0% S&W Sun Peaches, Canned in 0.5 c. 20 mg 0% Light Syrup Totals: 4501.79 mg *A gold star marks foods containing more than 20% of the DV. A silver star marks foods containing 10% to 20% of the DV.
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