Disease And Nutrition
Diet and Nutrition: Atherosclerosis and hypertension are at the heart of developed countries’ most prevalent cardiovascular diseases. These two diseases are overwhelmingly influenced by diet and can be addressed with nutritional help and the rising obesity epidemic. The nutrients in the diet are a complex mixture with the potential for interaction. It can be challenging to comprehensively study diet essentials or nutrients and how they affect cardiovascular disease.
In various racial and environmental contexts, a number of dietary factors play a critical role in these illnesses. Early prevention must be practiced since these risks are frequently present in young people. Even though studies in developed countries provide the majority of the knowledge about cardiovascular disease and nutritional risk factors, the situation is quickly escalating to epidemic levels in developing countries, placing a heavy burden on health services and the economy.
Diet has a significant impact on a number of cardiovascular disease risk factors. Although studies in developed countries account for the majority of data about nutritional risk factors, the condition is hastily intensifying in developing countries to epidemic levels, putting a huge strain on the financial condition and the availability of healthcare services.
Part 1 – The Diet | Disease And Nutrition
Criterion 1 – Deficiency or excess of CHO, PRO, and Fat
To assess the nutritional requirements of an individual, especially if some kind of health disorder is also present, health professionals generally refer to the RDA as the base using which the diet is adjusted according to the patient’s individual case (Dudek, 2014). The patient is a 60-year-old, 6 ft tall, African American male weighing 230 lbs (104 kg approx). His diet consists of fast food, which is generally low in carbohydrates, with a single patty burger offering 34 grams of carbohydrates, equaling only 11% of an adult’s daily value percentage. Our patient should consume enough carbohydrates to offer 45% to 50% of his required calories.
For example, if the patient aims to consume 2,000 calories, 225 grams to 325 grams should come from the carbohydrates taken in the daily diet (Coleman, N.A). This is also necessary as the patient is overweight and aiming to lose weight. Also, since his diet is high in calories and low in nutrients, there is no doubt that calorie intake is coming from sources other than carbohydrates. The patient needs to enhance his intake of carbohydrates in his daily diet.
Disease And Nutrition
Regarding protein requirements, the patient consumes a diet offering excess protein, surpassing his daily requirements. The RDA suggests 0.8 grams of protein intake per kilogram weight of an individual, which allows our patient to consume 83.2 grams of protein daily, however since he leads a sedentary lifestyle, this consumption pattern is decreased even further, as active individuals require more protein compared to ones leading a sedentary lifestyle (Bragg, 2017), however, currently the patient is taking much higher than recommended protein intake, which is another reason of weight increase in the patient. It is also significant to indicate that weight increase will also adversely affect the diabetes condition of the patient.
Fat intake again is in excess as the patient follows a diet that includes a lot of high-calorie food. The daily fat consumption of the patient depends on the number of calories he is to take daily, which is around 20% to 35% of the daily calorie count. Assuming he is to take a 2,000 calories diet daily, this would total 44 to 78 grams of fat to be taken daily (St John, 2017). The patient currently is taking much more fat than required. Also, since he requires losing weight, the fat consumption should be reduced even more.
Disease And Nutrition
Criterion 2 – RDA Requirements for Micronutrients
RDA or Recommended Dietary Allowances are the daily average dietary intake levels that are required at sufficient levels to meet 97% to 98% of the daily nutrient requirement for healthy individuals based on gender group and life stage (Dudek, 2014).
The amount of intake varies from person to person, depending on the diet and quantity consumed. However, insufficiencies and dietary malnutrition can lead to the development of few chronic diseases, including obesity and type 2 diabetes (Azadbakht & Esmailzadeh, 2012).
The patient is already overweight and suffers from type 2 diabetes. Thus, his nutritional requirement is even more essential to maintain.
The patient follows a fast food diet that is high in calories and low in nutrients. Fast food offers very low micronutrient-related benefits and is a variety of essential nutrients such as zinc, fiber, vitamins, minerals, and, in some cases, healthy fat sources (El-Seweidy, et al., 2008). The bread wraps or similar items provided with fast food are often white bread, which offers little to no protein or fiber for the body, whereas vitamins and minerals are almost extinct in fast food (Dray, 2017).
Disease And Nutrition
Though salads, fruits, vegetables, and grains are a big source of nutrients; however, these things are seldom ever found in fast foods. Even in some cases where salads may offer some nutrients, more is needed to cover the dietary requirement of the person. Essential minerals such as calcium and iron can be found in some fast foods with cheese, but not in sufficient quantities. Other minerals like zinc, copper, and potassium are absent. Also, even though fast foods are a big source of fat; however, almost all of this fat is saturated fats, and no healthy fat in the form of mono-saturated or poly-saturated fats can be found in fast food (Dray, 2017).
While many essential micronutrients are deficient in the patient, others, such as Sodium, can be found in abundance. Fast food offers notoriously high levels of sodium, weighing down on your kidneys and heart, which perform the duty of ridding the body of excess sodium. It is a source of high blood pressure (which our patient suffers from) and increases the chances of heart disease, osteoporosis, and kidney stones. Fast food also offers an abundance of transfats and sugars, both of which are fatal for heart diseases and type 2 diabetes. Even though a lot of calories are offered from fast food; however, the nutrient count is very low, leading to weight gain (McDermott, 2014). Thus our patient’s diet is deficient in essential micronutrients such as vitamins, minerals, copper, zinc, calcium, etc, and very high in trans fats, sodium and sugar.
Part 2 – Disease And Nutrition
Criterion 1 – Nutrition and Pathophysiology
Salt or sodium content is the leading reason behind elevated blood pressure, though numerous other reasons can contribute to its rise. The patient is hypertensive and suffers from Type 2 diabetes, and continuing a fast food diet would increase the level of blood pressure and, to an extent, blood sugar also. However, sodium is largely considered as being a key contributor (Blood Pressure UK, 2008).
Blood pressure is referred to the force of blood that forces against the walls of the blood vessels. HTN or High Blood Pressure also referred to as hypertension, is when this pressure rises above the normal range in the arteries. An individual’s diet affects high blood pressure tremendously as some foods increase, while others can help decrease the blood pressure. Also, gain in weight contributes to high blood pressure and vice versa. It is suggested to high blood pressure patients that they eat foods low in fats, sodium, and calories. Since the patient is also suffering from Type 2 Diabetes, food rich in fats, sugar, and sodium also has adverse effects on the patient. Sugar contributes directly to the increase of glucose in the body, worsening its symptoms, whereas sodium and fats increase body weight, which also affects diabetic patients.
Disease And Nutrition
Fast food contains sodium in abundance, which increases the level of salt in the body. Excess salt puts stress on the kidneys, which have the duty of washing off excess salt from the body. The body retains water to wash off excess salt, and this, in many individuals, can lead to a rise in blood pressure. The extra retained water puts stress on the heart, kidney, arteries, and brain and requires them to work harder than usual. The kidneys remove the fluids from the body through urine, using the osmosis process that draws the extra fluid out of the body. This process takes place under a delicate balance of potassium and sodium. The more the amount of salt consumed, the more the delicate balance of osmosis is wrecked, affecting the capability of the kidneys.
The result of all this is high blood pressure which is a result of strain on the delicate blood vessels. Also, over time, this unbalance starts to affect the functioning of the kidneys, which loses its effectiveness in flushing out the toxins from the body that start accumulating (Blood Pressure UK, 2008a). Following a salt-free or low-sodium diet is one quick way to lower blood pressure.
A human requires a set amount of cholesterol to function normally; however, exceeding the amount of cholesterol means building it up in the arteries. This blocks or narrows them, increasing the chances of stroke or heart attack. Another thing is that fast food diets are rich in saturated fats. The body transforms saturated fats into cholesterol and enhances the risks mentioned above (Blood Pressure UK, 2008c). Fast food is the biggest source of saturated fats contributing to HTN conditions in the patient.
Disease And Nutrition
Eating high sodium and trans fat-loaded foods results directly in gaining weight, making it impossible for the patient’s body to regulate the amount of sugar present in it. Weight gain is one of the high risks associated with Type 2 diabetes, as when the body contains a lot of fat tissue, especially in the mid-section area, the body increasingly begins to resist insulin. Insulin helps for removing sugar from the blood and body cells (Hepler, 2016). Initially, when this starts to happen, the body does not prepare enough insulin to monitor sugar levels. The pancreas mistakes this as a need to produce more insulin, which wears the pancreas out over time, and the body stops producing insulin. The sugar level develops in the blood, causing the patient to become diabetic, characterized by high blood sugar in the body.
Fast foods are high in calories, are processed, and contain large amounts of sugar and saturated and trans fats, increasing sugar levels in the body. They also increase bad cholesterol that induces weight gain, again contributing to the elevation of diabetes conditions.
Disease And Nutrition
The patient must eat foods that are low in sodium and calories, such as fresh vegetables and salads without dressing or lean white meat (chicken, fish) broiled or boiled. Also, the use of herbs and lemon juice should be encouraged to season food instead of salt. Oily and bakery products should be avoided. To counter the diabetic symptoms, food rich in sugars should also be avoided along with foods that contribute to high blood pressure or weight gain, as it together contributes to worsening diabetic situations.
Foods that should be taken include Greek yogurt, or 1% skimmed milk, to balance calcium requirements, which also lowers blood pressure and aids diabetic patients. Lean meat, skinless chicken meat, cereals, grains, low fat, unsalted cheeses, fresh fruits (that are low in sugars), and vegetables, plain rice, and pasta, are all good foods for HTN, type 2 diabetic patients. Patients should refrain from using too many fruits and control their intake as fructose produces a higher postprandial glucose rise than sucrose (Dudek, 2014). Unsalted seeds such as squash, pumpkin, and sunflower seeds are also healthy food options as they are rich in minerals, lowers blood pressure, and do not harm diabetic patients.
Also, foods rich in dietary fibers are very good for the patient. The patient should ideally take 5 to 7 servings of vegetables per day. Though butter and margarine should be avoided, they can only be taken once a week in small quantities.
Disease And Nutrition
Criterion 2 – Medical and Nutrients Related Interventions and Dietary Needs
Metformin is a known medication often prescribed to people with diabetes. It lowers blood sugar levels, decreasing glucose in the blood. It also enhances the insulin capability of the body to push out excess sugar from the body. The patient takes 500mg of Metformin twice a day and Metoprolol 200 g daily with a multivitamin. Though there is no need to avoid any foods when on Metformin, however, consuming alcohol, along with the medication, is not recommended. Alcohol consumption is limited when on Metformin, as too much alcohol, including wine, beer, and hard liquor, breaks up Metformin, affecting its performance.
Metformin is having an antihyperglycemic agent that improves glucose tolerance levels in a patient suffering from Type 2 diabetes. It lowers both postprandial and basal glucose. Its pharmacologic mechanisms are very different from other oral antihyperglycemic agent classes. It decreases the production of hepatic glucose in the patient’s body and enhances the sensitivity towards insulin by increasing peripheral glucose utilization and uptake. Unlike other sulfonylureas, Metformin does not contribute to the production of hypoglycemia in either diabetes type 2 patients or normal patients alike.
Disease And Nutrition
Metformin therapy does not affect the body’s insulin secretion, and its levels remain the same as fasting insulin levels. In contrast, the day-long response of plasma insulin has been seen to decrease. A fast food diet disrupts this balance and adds excessive sugar to the patient, requiring him to take more medicine dosages to regulate blood sugar (Metformin Hydrochloride Tablets, N.A.). Moreover, the fatty and sodium-laden diet affects the patient’s blood pressure, which in turn increases blood glucose in the patient, requiring him to take two dosages of 500 mg of Metformin daily.
Metformin is also prescribed to be taken with multivitamins as Metformin interacts with some well-known nutrients such as calcium, Vitamin B12, folic acid, and chromium. Since patients taking Metformin are often seen to suffer from deficiencies of these nutrients, especially B12, which leads to deficiency of calcium as well, Metformin is often prescribed along with a multivitamin (Briggs, 2017). One side effect of Metformin is weight loss as it induces appetite loss in patients and a feeling of fullness. To overcome this, fiber-rich food should be taken that offer the feeling of fullness for a longer time and offer more nutrients to the body.
Disease And Nutrition
Metoprolol is a beta blocker that affects blood circulation in the veins and the heart. It is a medication used to monitor high blood pressure and angina. It is also used to treat patients that are at high risk of heart attack. This medicine, when taken by diabetic patients, makes it hard to identify low blood sugar; however, since that is rarely a case in Type 2 diabetes, it is safely prescribed to patients. There are no food reactions that occur with Metoprolol. However, the medication should be taken right after meals at a certain time every day, even if no symptoms occur as blood pressure medications continue for life (Drugs.com, 2017).
The patient also takes multivitamins regularly, which means either it should be supplemented with a diet that offers sufficient nutrients or foods that will overload certain vitamins in the body, causing harm should be avoided. For example, if iron supplements are being taken, foods rich in iron, like spinach and red meat, should be avoided or taken rarely. Similarly, Vitamin A overdose can also harm the human body; thus, if doses of Vitamin A are present in dosages enough for daily requirements, foods containing Vitamin A should be avoided, such as liver, sweet potato, carrots, spinach, etc.
Disease And Nutrition
Part 3 – Patient Education
Criterion 1 – Nutrient Calculations
The patient is a 60 years old male, weighing 230 lbs (104 kg approx) at 6” height.
After calculating BMI, the patient’s BMI rests at 31.2, which is way over the healthy weight BMI which should be between 18.5 to 24.9 (Dudek, 2014).
BMI = weight in pounds ÷ height in inches 2 X 703
= 230/ (72 X 72) (703) = 31.2
The patient’s BMI shows him as an obese individual, and thus, his caloric needs would be assessed for a sedentary old age male individual. The right amount of calories the patient can consume to stay healthy is 2005 calories a day; however, since he is leading a sedentary lifestyle, he is also aiming to lose weight; the calculations below depict the number of calories needed to maintain the current weight. Since each pound contains 3500 calories, aiming to lose one pound per week requires eating 500 fewer pounds every day. Calculations from further on will be calculated based on (2406 – 500) 1906 calories intake daily.
1- BMR = 66.47 + (6.23 X weight in pounds) + (12.7 X height in inches) – (6.8 X age in years)
2- BMR = 66.47 + (6.23 X 230) + (12.7 X 72) – (6.8 X 60) X (sedentary lifestyle 1.2)
3- BMR = 66.47 + (1432.9) + (914.4) – (408) X (1.2)
4- BMR = 2410.19 – 408 X (1.2)
5- BMR = 2005 X 1.2
6- BMR = 2406 calories per day
Intake of carbohydrates varies from person to person, and carbohydrates are not restricted for the patient however should be taken with precaution monitoring the glycemic effects and spreading those carbohydrates over the entire day’s meals.
Least amount of carbs/day = 1906 X 0.45 = 858/4 (calories/gram) 214 grams of carbohydrates/day
The maximum amount of carbs/day = 1906 X 0.65 = 1239/4 (calories/grams) 310 grams of carbohydrates/day
The daily range of CHO for the patient lies between 214 – 310 grams/day, indicating that around 858 to 1239 calories should come from carbohydrates on a daily basis.
The protein intake according to the Recommended Dietary Allowance (RDA) is calculated based on the weight of the individual 0.8 g per kg weight. According to Dudek (2014), the acceptable macronutrient distribution range for protein lies between 10% to 35% of the total calories required.
PRO = weight in kg X 0.8 = total grams of protein intake
PRO = 104.3 X 0.8 = 83.44 grams/day or 334 calories/day
According to Dudek (2014), the Acceptable Macronutrients Distribution Range (AMDR) for fats is estimated at 20% to 35% of the total calorie intake for adults. Based on the calculation below, the patient should take 42 grams to 74 grams of fat daily.
Least amount of FATS/day = 1906 X 20% = 381 calories/9 calories in 1gm fat = 42.3 gm/day
Maximum amount of FATS /day= 1906 X 35% = 667 calories/9 calories in 1gm fat = 74 gm/day
Disease And Nutrition
Criterion 2 – Patient Care Plan with SMART Goals
SMART Goal 1
The patient will make a two-day menu consisting of three meals a day, choosing protein and carbohydrates rich foods and white meat, legumes, whole grains, and fresh vegetables. A small amount of nuts and seeds (unsalted) will also be the part of diet on a weekly basis. Goal met.
SMART Goal 2
The patient will spread his diet in small portions spread over the entire day, focusing on eating a larger portion (75%) of the meal in the daytime. The patient will consume large amounts of vegetables 4 to 5 times a day, with fruit consumption restricted to a slice of low fructose fruit once daily, due to diabetic conditions. Whole grains in small portions can be consumed in 6 to 8 servings a day; for example, a piece of whole grain bread will suffice for one serving of the day.
SMART Goal 3
Low-fat and sugar-free dairy products, such as skimmed cheese or low-fat yogurt, can be consumed daily. Nuts, legumes, and seeds can be consumed 3 to 4 times a week. Two servings of unsaturated fat sources per day can be taken to cover the daily requirements of fats.
The patient is a 60-year-old, 6 feet tall, African American Male who is a type 2 diabetic patient, hypertensive, and dealing with obesity. He came in with increased sugar levels and enhanced blood pressure of 160/100, with a temperature of 98.8 degrees Fahrenheit.
The patient had been a diabetic patient for the past 12 years, with high blood pressure prevailing for an even longer period. This patient is a regular fast food eater, indicating continuously elevated blood pressure trends. The patient currently consumes Metformin 500 mg twice a day to control blood pressure, and a multivitamin is also being taken to overcome the nutrient deficiency. To control sugar levels, 200 mg of Metoprolol is also taken daily. The patient leads a sedentary lifestyle with no exercise at all. He travels moderately, has a family with kids, and consumes large amounts of calories, almost varying nutrients.
Initial attempts were made to normalize the patient’s blood pressure, and sugar levels were checked to offer medications. After Blood pressure normalization, the patient was offered a sugar-free, fiber-rich diet to offer him the energy he needed to stabilize, after which he was educated on the need for physical exercise and a healthy diet (George & Hazle, 2016). The food types he should take in abundance and the ones that should be avoided were also explained to him. The patient was also guided that medications are to be taken throughout their lifetime and the consequences that the patient will have to bear if he discontinues.
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Azadbakht, L., & Esmailzadeh, A. (2012) Macro and Micro-Nutrients Intake, Food Groups Consumption And Dietary Habits Among female Students In Asfahan University Of Medical Sciences. Iran red crescent Medical Journal. 14(4), pp. 204-209.
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Dudek, S. G. (2014). Nutrition essentials for nursing practice (7th ed.). Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins.
El-eidy, M. M., Hashem, R. M., Abo-El-Matty, D. M., & Mohamed, R. H. (2008) Frequent Inadequate Supply Of Micronutrients In Fast Food Induces Oxidative Stress And Inflammation In Testicular Tissues Of Weaning Rats. J Pharm Phamacol. 60(9), pp. 1237-1242.
George, C., & Hazle, L. (2016). Cystic fibrosis: Nurses act as a healthcare provider, advocate and educator for CF patients. Advance Healthcare Network for Nurses. Retrieved from http://nursing.advanceweb.com/Continuing-Education/CE-Articles/Cystic-Fibrosis.aspx
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Metformin Hydrochloride Tablets. (N.A.) Metformin Hydrochloride Tablets. Retrieved from https://www.fda.gov/ohrms/dockets/dailys/02/May02/053102/800471e6.pdf St John, T. M. (2017) How Many Fat Grams Per Day? Retrieved from http://healthyeating.sfgate.com/many-fat-grams-per-day-4137.html