Kerry Linne

11/29/17
Nutr 407
Independent Project

Part A: ADIME Note

Nutrition Assessment

 Patient: Mike Wazowski

 Diagnosis: Type II diabetes and cardiovascular disease
 Nutrition-related PMH, treatments, surgeries:
 Age, Gender: 27, male
 Dietary intake: PO intake
 Food preferences, allergies, intolerances: None
 Exercise habits: Walks cat
 Knowledge, readiness for change: Wants to change
 Functional/behavioral factors: Works long hours
 Resources for obtaining, preparing food: lives with girlfriend
 Symptoms: dehydrated, fatigue, weakness
 Anthropometric measurements
o Ht/wt: 71 in/ 180.3 cm and 205 lbs/ 93 kg
o BMI: 28.6 kg/m2 (overweight)
o IBW= 172 lbs/ 78.2 kg
 5’=106#, 11’ x 6#= 66#, 106+66= 172 lbs
 205#/172#=1.19x100= 119 % (overweight)

Energy, protein and fluid needs

 Total Energy: 1,564-1955 kcal/d

o 20-25 kcal/kg of IBW
o 20 x 78.2 = 1564, 25 x 78.2 = 1955
 Protein: 93-117 g protein/d
o 1.2-1.5 g protein/kg of IBW
o 1.2 x 78.2 = 1564, 1.5 x 78.2 = 117
 Fluid: 2,346-2,737 mL/d
o 30-35 mL/kg of IBW
o 30 x 78.2 = 2346, 35 x 78.2 = 2737

Lab/test- can indicate high or low, normal or abnormal

 Total cholesterol: 240 mg/dl (high)

 Glycosylated hemoglobin= 9.4% (high)
 LDL: 156 mg/dl (high)
 HDL= 32 mg/dL (low)
 Total Cholesterol: 240 mg/dl (high)
 Triglycerides: 250 mg/dl (high)
  Glucose: 145 mg/dl (high)

Medications/supplements: Metformin and Eplernone (Inspra)

Nutrition Diagnosis- PES format

a) Diabetes food-nutrition knowledge deficit related to lack of previous

nutrition education as evidenced by unregulated carbohydrate intake in
infrequent intervals through the day and consumption of high glycemic foods
choices during meals.
b) Altered nutrition-related laboratory values (NC-2.1) RT Type II Diabetes
Mellitus and Cardiovascular Disease AEB elevated blood glucose (145
mg/dL), triglycerides (250 mg/dL), cholesterol (240 mg/dL), LDL (156
mg/dL), and low HDL
(32 mg/dL).

Nutrition Intervention

1) Reduce refined carbohydrates (cakes, cookies, candy, added sugar)

2) Consume 16 servings of carbohydrates per day spread consistently
between all meals and snacks
3) Consume a more plant based diet
4) Decrease consumption of saturated fats (red meat, cheese)
5) Consume whole grain carbohydrates every couple hours
6) Consume nutrient dense foods

Goals

1) Learn how to manage Type 2 Diabetes with the help of nutrition education.
Take diabetic medication as prescribed, and stabilize CHO intake by
consuming 4-5 smaller meals throughout duration of the day.
2) Increase physical activity to 30-45 min/day of moderate to intense activity 3-
5 days a week.

Nutrition Monitoring and evaluation

1) Follow-up phone call in 2-3 days

2) Ask patient to keep food log for at least 3 days
3) Follow-up appointment in 3-4 weeks to re-asses blood work
4) Check in weekly to see how exercise routine is going
5) Meet with a registered dietitian to discuss diabetic nutritional needs
6) Meet with a personal trainer to discuss a workout routine

Part B: 2-Day Meal Plan

 Diet Rx: Diabetic Diet 2000 kcals

50% Kcals CHO= 1000 250gm CHO

20% Kcals Pro = 400 100gm Pro
30% Kcals Fat = 600 67gm Fat

B S L S D S Total CHO Pro Fat (g) Kcals

(g) (g)

Starches 3 3 3 1 10 (15g) (3g) (1g) 810

Fruit 1 1 1 3 (15g) 180

Milk 1 1 1 3 (12g) (8g) (1,5,8g) 274

Vegetables     4 (5g) (2g) 112

Meats/Substitutes 3 3 6 (7g) (3,5,8g) 330

Fats 1 2 1 2 6 (5g) 270

CHO Choices 5 5 0 5 1 16 240 96 63

Kcals/ 960 384 567 TOTAL
gm Kcals:1976

%Kcal 49% 20% 29%

s

Day 1:
Breakfast
 3 starches: ½ cup of cooked whole oats, 2 piece of whole wheat
toast
 1 fruit: 1 small orange
  1 milk: 1 cup 1% milk
 1 fat: 1/8 of medium avocado
Lunch
 3 starches: 1 cup cooked brown rice, ½ cup black beans
 1 fruit: 1 raw apple (2 inches across)
 1 vegetables: ½ cup cooked broccoli
 3 meats/substitutes: 1 cup of tofu, 2 ounces of chicken (white meat
no skin)
 2 fats: 2 teaspoon margarine
 1 milk: 1 cup 1% milk
Snack
 1 vegetable: 1 cup of raw carrots
 1 fat: 6 almonds
Dinner
 3 starches: 1 medium cooked sweet potato, 1 whole wheat roll
 1 fruit: 1 cup of fresh berries
 1 vegetable: ½ cup of cooked asparagus
 1 milk: 1 cup 1% milk
 3 meats/substitutes: 3 ounces of salmon (skin on)
 2 fats: 2 table spoons of peanut butter
Snack
 1 starch: 2 rice cakes (4 inches across)
 1 vegetable: 1 cup vegetable salad

Day 2:

Breakfast

 2 starches: 1 whole wheat bagel

 1 fruit: 1 medium kiwi
 1 milk: ¾ cup non-fat yogurt
 1 starch and 1 fat: ¼ cup granola

Lunch

 3 starches: 2 whole wheat tortillas, ½ cup black beans

 1 fruit: ½ medium mango
 1 vegetable: ½ cup spinach and ½ cup chopped tomatoes
 3 meats/substitutes: 3 oz grilled mahi-mahi
 2 fats: ¼ medium avocado
 1 milk: 1 cup 1% milk

Snack
  1 vegetable: 1 cup sliced cucumbers
 1 fat: 2 tbsp roasted garlic hummus

Dinner

 3 starches: 1 cup brown rice

 1 fruit: ¼ cup fresh pineapple
 1 vegetable: 1 cup diced bell peppers
 1 milk: ½ cup non-fat sour cream
 3 meat/substitutes: 3 oz grilled shrimp
 2 fats: ¼ medium avocado

Snack

 1 starch: 1 slice whole wheat toast

 1 vegetable: ½ cup of spinach and ½ cup sliced tomatoes

Part C: $30 Budget

Budget: $30.00 for 2 days

*Refer to Appendix A for sale items

Items Amount Price per Sale Price Cost Store

Purchased Pound
Whole Wheat 1 loaf $1.24 $1.99 ea. $0.37 Food 4 Less
Bread
Whole Oats 18 oz. pkg. $1.04 $1.67 $0.37 Food 4 Less
Orange 1 ea. $0.99 $0.50 ea. $0.50 Food 4 Less
1% Milk 1 gallon --- $2.29 $0.57 Food 4 Less
Medium 1 ea. /0.33# $2.64 $0.99 ea. $0.99 Food 4 Less
Avocado
Brown Rice 16 oz. pk. $0.89 $0.89 $0.89 Food 4 Less
Black Beans 15.5 oz. can $0.69 $0.69 $0.34 Food 4 Less
Apple 1 ea. --- $0.50 ea. $0.50 Food 4 Less
Broccoli 32 oz. $1.99 $3.99 $0.49 Food 4 Less
Tofu 1 pkg. $1.70 $1.49 $0.74 Food 4 Less
Chicken 1 pkg. $3.49 $5.72 $0.43 Food 4 Less
Margarine 1 pkg. $0.99 $0.99 $0.02 Food 4 Less
Carrots 10 oz. bag $2.06 $1.29 $1.03 Food 4 Less
Almonds 6.3 oz. bag $14.40 $3.49 $0.37 Food 4 Less
Sweet Potato 1 ea. $1.49 $1.30 $1.30 Food 4 Less
Whole Wheat 16 oz. pkg. $2.99 $2.99 $0.37 Food 4 Less
Roll
Blueberries 4.4 oz, pkg. $10.87 $2.99 $1.49 Food 4 Less
Asparagus 14.5 oz. can $1.97 $1.79 $0.51 Food 4 Less
Salmon 2 lb. $6.50 $12.99 $0.41 Food 4 Less
Peanut Butter 16 oz. pkg. $1.79 $1.79 $0.07 Food 4 Less
Rice cakes 1 pkg. $8.89 $2.50 $0.40 Food 4 Less
Spring Mix 5 oz. pkg. $8.93 $2.79 $0.46 Food 4 Less
Whole Wheat 1 pkg. $1.59 $1.79 $0.35 Food 4 Less
Bagel
Kiwi 1 ea. --- $0.98 $0.14 Food 4 Less
Non-fat Yogurt 1 ea. $1.87 $0.70 $0.70 Food 4 Less
Granola 13.5 oz. pkg. $2.96 $2.50 $0.74 Food 4 Less
Mango 1 ea. --- $0.98 $0.12 Food 4 Less
Spinach 1 pkg. $6.10 $2.29 $1.50 Food 4 Less
Tomato 1 ea. $0.99 $0.19 $0.18 Food 4 Less
Mahi-Mahi 1 lb. $4.33 $4.33 $0.81 Food 4 Less
Cucumber 1 ea. --- $0.59 $0.59 Food 4 Less
Roasted Garlic 1 pkg. $4.78 $2.99 $0.29 Food 4 Less
Hummus
Pineapple 20 oz. can $0.79 $0.99 $0.11 Food 4 Less
Red Bell Pepper 1 ea. --- $0.99 $0.99 Food 4 Less
Non-fat Sour 8 oz. pkg. $2.58 $1.29 $0.64 Food 4 Less
Cream
Shrimp 1.25 lb. $7.99 $9.99 $0.18 Food 4 Less
Whole Wheat 10 ct. pk. $1.79 $1.79 $0.53 Food For Less
Tortilla
Total Price: $20.49

Part D: Nutritional Analysis

Diet Analysis Program: www.supertracker.usda.gov

*Refer to Appendix B for full Nutrient Report

Mr. Wazowski luckily has an amazing inspiring dietitian who was able to
provide a delicious two-day menu that fit his dietary and financial needs. With the
help of the supertracker nutrient analyzer provided by the USDA, the micro and
macronutrient content was provided for each day’s intake. Mr. Wazowski was
provided a diet that consisted of consuming 2000 kcal and 16 starch items spread
out throughout the day as a target goal. The day one menu consisted of 1860 kcal
and day two contained 2207 which came out to an average of 2033 kcal average for
the two days. Overall, both meal plans met the majority of the DRI, MyPlate, and diet
prescription guidelines.

In regards to protein, Mr. Wazowksi consumed 100 grams on day one and
133 grams on day 2, which comes out to 21% and 24% respectively of total kcals
from protein for each day. These results both fall within the DRI range of 10-35%,
but the protein intake on day 2 was a little higher then the diet prescription
recommendation of 100 grams.

The carbohydrate evaluation for Day 1 shows that is equates to 238 grams
and 51% of total kcals from carbohydrates. This amount lies within the range of the
DRI (45-65%), but it is a little below the meal exchange plan of 250 grams. Day 2
equates to 298 grams and 54% of total kcals from carbohydrates. This amount lies
within the range of the DRI (45-65%), however it is above the meal exchange plan of
250 grams by almond fifty grams.

The fat content for day 1 came out to 29% (60 grams) and for day 2 it was
26% (63 grams) of total kcals. Both of the two-day menus fat content fell within the
range of the DRI (20-35%), but were slightly under the diet prescription guidelines
of being 30% (67 grams) that were recommended. The good news is that both days
menu contained less then 10% of calories from saturated fat that is recommended,
which is extremely important considering the patients cardiovascular disease. Also,
day 1 consisted of 267mg of cholesterol and day 2 contained only 146mg with the
DRI recommendations being less than 300mg in a day. Unfortunately, the DRI for
Linoleic Acid (8 and 14 grams) and Linolenic Acid (.8 and 1.2 grams) were not met
on either day with the recommended levels being 17 grams and 1.6 grams
respectively.

In regards to micronutrients, almost every vitamin and mineral met the DRI
for each day with the exception of Potassium (4201mg), Vitamin A (853ug RAE), and
Vitamin E (14mg AT) on day 1, and just Vitamin E (14 mg AT) on day 2. I was very
please to see that in regards to sodium each day was way under the recommended
levels of less than 2300mg with day 1 resulting in 2032mg and day 2 came in at
1688mg!

Overall, I am very please with the nutrient report of these two-days of meals
and snacks. After analyzing the nutrient content, the food items provided a well-
rounded meal that met the needs for a patient with type II diabetes and
cardiovascular disease. If Mr. Wazowski is able to still with this type of meal plan he
will hopefully be able to start transforming his health for the better.

Part E: Conclusion

At the conclusion of this assignment, I had a greater understanding of the

various nutritional needs for patients with type II diabetes and cardiovascular
disease. When caring for a sick patient it is critical for dietitians to properly
proscribe diets that match each patient’s different nutritional needs. When
composing diet orders there are a vast number of necessary factors that play a role
in assessing nutritional needs to then be able to recommend the most beneficial
interventions to improve a patient’s wellbeing. I believe I achieved my goal of
composing a diet that not only met the patient’s needs, but also was appealing and
delicious as well. However, attempting to create a two-day menu consisting of 2000
kcal each day on a budget of $30 was extremely challenging. It is extremely
frustrating when you realize you have to choose between money and eating healthy
foods. However, understanding this dilemma and being passionate about it will help
me in my future as a dietitian as many patients with diabetes and/or cardiac disease
come from a lower economic status. In conclusion, this experience completing this
project gave a more vast understanding of the process dietitians go through when
proscribing a diet for their patients.

Appendices

Appendix A:
Appendix B:

Day 1 Menu
Nutr407's Nutrients Report 12/05/17 -
12/05/17
Your personal Calorie goal is 2000. Your plan amounts are based on meeting
your nutrient needs.

Nutrients Target Average Eaten Status

Total Calories 2000 Calories 1860 Calories OK

Protein (g)*** 56 g 100 g OK

Protein (% Calories)*** 10 - 35% 21% Calories OK

Calories

Carbohydrate (g)*** 130 g 238 g OK

Carbohydrate (% 45 - 65% 51% Calories OK

Calories)*** Calories

Dietary Fiber 38 g 35 g Under

Total Sugars No Daily 79 g No Daily

Target or Limit Target or
Limit

Added Sugars < 50 g 8g OK

Total Fat 20 - 35% 29% Calories OK
Calories

Saturated Fat < 10% Calories 10% Calories Over

Polyunsaturated Fat No Daily 5% Calories No Daily

Target or Limit Target or
Limit

Monounsaturated Fat No Daily 11% Calories No Daily

Target or Limit Target or
Limit

Linoleic Acid (g)*** 17 g 8g Under

Linoleic Acid (% 5 - 10% 4% Calories Under

Calories)*** Calories

α-Linolenic Acid (% 0.6 - 1.2% 0.4% Calories Under

Calories)*** Calories

α-Linolenic Acid (g)*** 1.6 g 0.8 g Under

Omega 3 - EPA No Daily 453 mg No Daily

Target or Limit Target or
Limit

Omega 3 - DHA No Daily 644 mg No Daily

Target or Limit Target or
Limit

Cholesterol < 300 mg 267 mg OK

Minerals

Calcium 1000 mg 1324 mg OK

Potassium 4700 mg 4201 mg Under

Sodium < 2300 mg 2032 mg OK

Copper 900 µg 1856 µg OK

Iron 8 mg 14 mg OK

Magnesium 400 mg 526 mg OK

Phosphorus 700 mg 1955 mg OK

Selenium 55 µg 179 µg OK

Zinc 11 mg 12 mg OK

Vitamins

Vitamin A 900 µg RAE 853 µg RAE Under

Vitamin B6 1.3 mg 2.4 mg OK

Vitamin B12 2.4 µg 4.9 µg OK

Vitamin C 90 mg 371 mg OK

Vitamin D 15 µg 15 µg OK

Vitamin E 15 mg AT 14 mg AT Under

Vitamin K 120 µg 237 µg OK

Folate 400 µg DFE 565 µg DFE OK

Thiamin 1.2 mg 2.4 mg OK

Riboflavin 1.3 mg 2.1 mg OK

Niacin 16 mg 22 mg OK

Choline 550 mg 359 mg Under

Day 2 Menu
Nutr407's Nutrients Report 12/06/17 -
12/06/17
Your personal Calorie goal is 2000. Your plan amounts are based on meeting
your nutrient needs.

Nutrients Target Average Eaten Status

Total Calories 2000 Calories 2207 Calories Over

Protein (g)*** 56 g 133 g OK

Protein (% Calories)*** 10 - 35% 24% Calories OK

Calories

Carbohydrate (g)*** 130 g 298 g OK

Carbohydrate (% 45 - 65% 54% Calories OK

Calories)*** Calories

Dietary Fiber 38 g 47 g OK

Total Sugars No Daily 103 g No Daily

Target or Limit Target or
Limit

Added Sugars < 50 g 6g OK

Total Fat 20 - 35% 26% Calories OK

 Calories

Saturated Fat < 10% Calories 5% Calories OK

Polyunsaturated Fat No Daily 6% Calories No Daily

Target or Limit Target or
Limit

Monounsaturated Fat No Daily 13% Calories No Daily

Target or Limit Target or
Limit

Linoleic Acid (g)*** 17 g 14 g Under

Linoleic Acid (% 5 - 10% 6% Calories OK

Calories)*** Calories

α-Linolenic Acid (% 0.6 - 1.2% 0.5% Calories Under

Calories)*** Calories

α-Linolenic Acid (g)*** 1.6 g 1.2 g Under

Omega 3 - EPA No Daily 449 mg No Daily

Target or Limit Target or
Limit

Omega 3 - DHA No Daily 628 mg No Daily

Target or Limit Target or
Limit

Cholesterol < 300 mg 146 mg OK

Minerals

Calcium 1000 mg 1768 mg OK

Potassium 4700 mg 5200 mg OK

Sodium < 2300 mg 1688 mg OK

Copper 900 µg 2605 µg OK

Iron 8 mg 17 mg OK
Magnesium 400 mg 693 mg OK

Phosphorus 700 mg 2437 mg OK

Selenium 55 µg 180 µg OK

Zinc 11 mg 15 mg OK

Vitamins

Vitamin A 900 µg RAE 2826 µg RAE OK

Vitamin B6 1.3 mg 3.0 mg OK

Vitamin B12 2.4 µg 5.9 µg OK

Vitamin C 90 mg 169 mg OK

Vitamin D 15 µg 17 µg OK

Vitamin E 15 mg AT 14 mg AT Under

Vitamin K 120 µg 237 µg OK

Folate 400 µg DFE 549 µg DFE OK

Thiamin 1.2 mg 1.9 mg OK

Riboflavin 1.3 mg 2.6 mg OK

Niacin 16 mg 35 mg OK

Choline 550 mg 547 mg Under