Case study:Diabetic + Heart Patient
BY: MADHURA GURAV
Patient ProfileName Mrs. XYZAge 61 yearsSex FemaleEthnic background Hindu :
GujaratiOccupation
HousewifeActivity SedentarySocio economic status Upper
middle classFamily history Obesity
Anthropometric measurements
Height – 5’2” i.e. 157.4 cm
Weight – 90 kg
IBW – 52.4 kg ( Brocca’s Index)
% IBW – 69.8% overweight
BMI – 35.2kg/m2 (Grade II Obese)
Biochemical Parameters
Group I Ob Values Normal (mg/dL) (mg/dL)
Blood sugar fasting 336.5 70 - 110
Blood sugar ( PP) 349.4 70 – 130
BUN 15 4.5 - 21
Serum creatinine 1.2 0.5 – 1.4
Urine sugar fasting 2++
Group II Ob Values Normal (mg/dL) (mg/dL)
Serum t Cholesterol 175.1 130 - 199
Serum HDL 54.8 35 - 80
Serum TG 118.4 40 - 165
Serum VLDL 23.7 6 - 38
Serum LDL 96.9 < 130
Clinical Parameters
Chest painVomitingDyspneaGeneral weaknessPain in epigastriaAdvised to go for cardiac profile
test and ECG.
Medication
Dietary guidelines
As she is Grade II obese she need to be given
20 Kcal / kg IBW
Thus her daily calorie intake should be
20 * 52.4 = 1048 Kcal / day
Total calorie intake of 3 day recall of Mrs. Kusum was 2018 Kcal / day
As a drastic reduction of
970 kcal / day is not possible in her daily diet
Hence her calorie intake is reduced by 518 Kcal / day
Thus recommended total calorie intake / day is
1500 Kcal
Macronutrient Distribution
Improving the quality of CHO is the essence of this diet as patient is diabetic as well as heart patient. It can be improved by giving complex CHO with low GI.55 – 60 % calories should come from CHO.
Quality of protein should be maintained for better assimilation with 50 – 60 % from good BV. Vegetable proteins are preferred as they are high in fiber, low in fat and provide adequate micronutrients. 15 – 20 % of calories should come from proteins
Intake of good quality fat i.e. high intake of MUFA coupled with a low n-6 : n-3 ratio should be emphasized. Since it is weight loss diet we consider 22 % of energy from fats.
Sodium intake should be restricted as she has hypertension Food rich in antioxidants, hypocholesterolemic agents and phytochemicals protect from CHD. These include: vitamin E and vitamin C, selenium, garlic
Diet Plan
Counseling tips
Limit your intake of foods high in calories or low in nutrition, including foods like soft drinks and candy that have lots of sugars.
Eat enough amounts of grain products, including whole grains which provide large amounts of fiber, vitamins and complex carbohydrates.
Reduce total fat intake. Reduce or avoid saturated fat (ghee) when possible. Saturated fat raises your cholesterol level.
Limit the amount of salt (sodium chloride) you eat.
Maintain your ideal body weight by exercising regularly. For example, a brisk walk for at least 30 minutes a day, aerobic exercise or Yoga.
Get regular medical checkups.
Control your blood pressure.
Check your cholesterol.Don’t smoke.Exercise regularly.Maintain a healthy
weight.Eat a heart-healthy diet.Manage stress.
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