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Answer to #1
To promote and support healthful eating patterns, emphasizing a variety of
nutrient dense foods in appropriate portion sizes, in order to improve overall
health and specifically to:
Attain individualized glycemic, blood pressure, and lipid goals. General
recommended goals from the American Diabetes Association for these markers are as follows:
A1C ,<7.
Blood pressure ,<140>LDL cholesterol ,<100 mg>40
mg/dL for men; HDL cholesterol >50 mg/dL for women.
Achieve and maintain body weight goals.
Delay or prevent complications of diabetes.
Evidence suggests that there is not an ideal percentage of calories from carbohydrate,
protein, and fat for all people with diabetes ; therefore, macronutrient distribution
should be based on individualized assessment of current eating patterns,
preferences, and metabolic goals.
A variety of eating patterns (combinations of different foods or food groups) are
acceptable for the management of diabetes. Personal preferences (e.g., tradition,
culture, religion, health beliefs and goals, economics) and metabolic goals should be
considered when recommending one eating pattern over another.
Evidence is inconclusive for an ideal amount of carbohydrate intake for people with
diabetes. Therefore, collaborative goals should be developed with the individual
with diabetes. The amount of carbohydrates and available insulin may be the most important factor
influencing glycemic response after eating and should be considered when
developing the eating plan.Monitoring carbohydrate intake, whether by carbohydrate counting or experiencebased
estimation remains a key strategy in achieving glycemic control.For good health, carbohydrate intake from vegetables, fruits, whole grains, legumes,and dairy products should be advised over intake from other carbohydrate sources,
especially those that contain added fats, sugars, or sodium.
(Evert AB et al. Nutrition Therapy Recommendations for the Management of Adults with Diabetes. Diabetes Care. 2014; 37S;S120-S143.)
Answer to #2
Obesity related to excessive consumption of energy-dense foods and large meals as evidenced by BMI of 31.2, frequent consumption of hamburgers, fries, cookies, desserts, etc, and reported high frequency of snacking on desserts between meals.
Undesirable food choices related to lack of prior nutrition education and disinterest as evidenced by acknowledgement of one's own sweet tooth, reported liking fruit but rarely consuming them, and high consumption of foods containing high calories, saturated fats, low fiber, and added sugar..
Inadequate fiber intake related to lack of food- and nutrition-related knowledge as evidenced by reported low consumption of fruits, vegetables, and whole-grain products.
Excessive saturated fat intake related to high-consumption of animal products and processed foods as evidenced by frequent consumption of doughnuts, cookies, soda, pastries, hamburger, and meat, elevated total cholesterol (285 mg/dL), and elevated LDL (189 mg/dL) levels.
Excessive simple sugars related to food- and nutrition-related knowledge deficit and new diagnosis of NAFLD as evidenced by lack of previous nutrition therapy, excessive snacking of sugary foods, and frequent consumption of soda, cookies, pastries, pie, and dessert.
Answer to #3
I would assess his level of physical activity by comparing it to the standards of the Dietary Guidelines (2.5 hours per week or about 30 min. of moderate physical activity on five days of the week)
Questions:
- Do you engage in any formal or recreational physical activities?
- How long do those activities last and how frequently do you engage in them?
- How much time do you spend walking/standing/sitting at your job?
- Does your job/daily life require frequent physical labor?
Answer to #4
Vitamin D supplementation may be recommended to meet normal serum levels
Answer to #5
General:
- Avoid sugary drinks
- Limit consumption of processed foods high in sugar and fat
- Eat more fruits, vegetables, whole grains, and legumes
- Limit red meat and processed-meat consumption
- Limit alcohol to no more than 1 or 2 drinks per day for women and men, respectively.
- Limit salt consumption
Breast Cancer:
- Vitamin D intake to meet normal serum vitamin D levels (not < 20 ng/mL)
- Avoid/limit red meat consumption
- Consumption of fish containing -3 fatty acids
- Minimize alcohol intake
- Increase fruits, vegetables, fiber, and polyphenol/phyto-estrogen-rich foods may help prevent breast cancer
Answer to #6
Mr. Kim's typical diet is about 2200 kcal, 14 protein, 57 carbohydrate, and 30 fat
This is about 200 kcal over the upper range needed for Mr. Kim to lose weight.
Important factors that may have contributed/impact his NAFLD include his low fiber (12 g), high saturated fat ( 8), and high sugar (116 g added/135 g total) consumption
Answer to #7
Provide interventions to maintain adequate protein and energy intake to prevent malnutrition/cancer cachexia
Provide interventions to treat the common side effects of cancer treatment:
- Nausea/vomiting
Small, low fat meals; avoid favorite foods when nauseous; avoid odorous foods; take antiemetic medication prior to meals
- Early satiety
Small frequent meals; consume nutrient-providing beverages between meals; avoid high-fiber foods
- Mucositis
Soft, non-fibrous, non-acidic foods; avoid hot foods; non-acidic juices/beverages to prevent dehydration; calorically-dense and protein-dense nutritional supplemental liquids may help meet intake requirements
- Diarrhea
Drink small amounts of fluids throughout the day to prevent dehydration; avoid excessive intake of fructose containing beverages (e.g. fruit juices); consume good sources of soluble fiber and choose low fat foods.
- Dysgeusia
Incorporate alternative high-protein foods (e.g. peanut butter, cheese, soy meat substitutes) due to problems associated with meats; encourage use of spices and marinades to flavor foods
- Xerostomia
Sugar-free gum or sour candy to stimulate saliva production; avoid alcohol based mouthwashes; use lozenges and mouth-moisturizing gels. Drink frequently use moist foods.
- Anorexia
Small, frequent meals; maximize consumption when appetite is highest; don't consume empty calorie liquids during meals that prevent consumption of adequate calories and protein; mild exercise to stimulate hunger; use of energy- and protein-dense nutritional supplements
Abstain from alcohol or limit to less than one drink per day.
Answer to #8
Lab Patient's value Normal value Relationship to diagnosis
Glucose 121 mg/dL 70-99 mg/dL Insulin resistance due to excessive body fat (adiposity) that may contribute to inflammation associated with insulin resistance.
ALT 54 U/L 4-36 U/L Damaged liver cells release enzymes when lysed (may be due to inflammation associated with NAFLD).
AST 42 U/L 0-35 U/L Damaged liver cells release enzymes when lysed (may be due to inflammation associated with NAFLD).
Cholesterol 285 mg/dL < 200 mg/dL Excessive saturated fat/inadequate fiber in the diet, which may be contributory to his NAFLD, too.
HDL-C 43 mg/dL > 50 mg/dL N/A
LDL 189 mg/dL < 130 mg/dL Excessive dietary saturated fat intake.
Triglycerides 350 mg/dL 40-160 mg/dL Increased triglyceride production related to NAFLD.
HbA1C 6.1 < 5.7 Insulin resistance and poor glycemic control related to elevated blood glucose value.
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