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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