Case study

Presentation by Laxmi Govekar

Date: 27th October 2017

Held at Madhavbaug
 Case study No.1 (DM Prefailure)
o Patients profile
Name: XYZ
Age: 58 years
Present complaints:
DOE Grade 1
ICD Implant
Diagnosis: DM,CHF, Obesity
Anthropometric details:
Height: 164 cm
Weight: 81 kg
BMI: 30.12 kg/m2 (Obese)
IBW: 64 kg
Biochemical parameters:
FBS: 106 mg/dl (less than 110 mg/dL)
HbA1C: 7.3% (between 4% and 5.6%)
Total cholesterol: 224 mg/dl (<200)
Total triglycerides: 133 mg/dl (less than 150)
HDL: 61 mg/dl (more than 45)
LDL: 137 mg/dl (less than 100)
Sr. Creatinine: 0.31 mg/dl
Thyroid profile: T3: 87 (80-180 ng/dl); T4: 6.7(4.6-12 ug/dl) ; TSH:2.56 (0.35-4.94 uIU/dl)
*values in green indicate normal/desirable levels
24 hour Diet recall
Time Meal Menu House hold measures
8:30 am Breakfast Tea (black) 1 cup
Chapati(without oil) 2 nos.
10:30 am Mid morning Idli (big) 2 nos
Tea 1 cup
1:00 pm Lunch Chapati (without oil) 3-4 nos.
Bhaji (pulses/other vegeta 1 katori
bles/ leafy vegetables)

4:00-5:00 pm Snacks Fruit(apple or orange) 1nos

Or
Sheera ( ghee added) 1 katori
9:00 pm Dinner Chapati 3 nos.
Or
Jowar bhakri 2 nos.
Bhaji (pulses/other vegeta 1 katori
bles/ leafy vegetables)

10:30 pm Bedtime Milk 1 cup

GOALS OF NUTRITIONAL MANAGEMENT:

To maintain optimal nutritional status.

To improve HbA1C levels.
To achieve and maintain desirable body weight.
To reduce cholesterol levels.
To prevent and postpone complications related to diabetes.
Diet
A study demonstrated that 30%-carbohydrate diet led to greater reduction in hemoglobin A1c
(HbA1c).In this study, 33 outpatients (15 males, 18 females, mean age: 59 yrs) with HbA1c
levels of 9.0% or above were instructed to follow a low-carbohydrate diet (1852 kcal;
%CHO:fat:protein = 30:44:20) for 6 months, HbA1c levels decreased sharply from a baseline
of 10.9 1.6% to 7.8 1.5% at 3 months and to 7.4 1.4% at 6 months)
Carbohydrate-rich foods instructed to remove in the carbohydrate-reduced diet
Staple foods: rice, bread, corn, spaghetti, noodle made of wheat or buckwheat, potato, sweet
potato, taro and yam.
Fruits: pear, apple, persimmon, mikan, orange, grapefruit, peach, grape, melon, water melon,
banana, pine apple and Japanese chestnut, etc.
Vegetables: carrot, Indian lotus, pumpkin and autumn squash
Confectioneries Drink: beverages containing sugar, glucose and fructose, and milk
Alcohol brew: sake, beer and wine (Distilled liquor was not restricted.
Ref: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2690585/pdf/1743-7075-6-21.pdf
Diet (..contd)
Oils containing linoleic acid (n-6) only such as ground nut, sesame, cottonseed, rice
bran and safflower should be used along with oils containing alpha-linoleic acid (n-3)
such as soyabean, mustard, canola etc.
Fiber rich: whole grains, whole pulses, soybean, GLV, fruits and fenugreek seeds.
Soluble fiber such as pectins, gums,mucilages, hemicellulose in legumes, oats, fruits
lower serum cholesterol that is LDL and TG concentration.
1-2 servings of whole fruits.
Avoid alcohol and tobacco
Ref: http://icmr.nic.in/guidelines_diabetes/section6.pdf
Functional foods: Vit E, carotenoids, Vit C, selenium, soy proteins and garlic
consumption for extended period of time have found to be modest in reduction of
LDL cholesterol.
Exercise

For individuals with DM, exercise is useful for lowering plasma glucose
(during and following exercise) and increasing insulin sensitivity. In patients
with diabetes, moderate aerobic physical activity of 150 min/week
(distributed over at least 3 days) is recommended by ADA.
Several benefits: Improvement in insulin sensitivity, lipid profile,
cardiovascular function and sense of physical and mental well being;
reduction of hypertension and reduction in weight.
Ref: http://icmr.nic.in/guidelines_diabetes/section6.pdf
Case study No.2
o Patients profile
Name: XYZ
Age: 61 years
Present complaints:
DOE Grade 1(3 month)
Acidity
Swelling over body
Past History: DM, CAD
Diagnosis: CAD,DM,DYS, CHF
Anthropometric details:
Height: 157 cm
Weight: 69 kg
BMI: 27.99 kg/m2 (Overweight)
IBW: 52 kg
Biochemical parameters:
RBS: 141 mg/dl
Total triglycerides: 260 mg/dl
Hb: 10.3 g/dl (12-15.5 g/dl)
Sr. Creatinine: 0.31 mg/dl
*values in green indicate normal levels

GOALS OF NUTRITIONAL MANAGEMENT:

o To maintain optimal nutritional status.

o To achieve and maintain desirable body weight.
o To reduce triglyceride levels.
o To maintain blood glucose levels.
o To improve hemoglobin levels
24 hour Diet recall
Time Meal Menu House hold measures
9:30 am Breakfast Tea (black) 1 cup
Bread 2 nos.
1:30 pm Lunch Chapati (without oil) 1 nos.
Rice bowl
Dal katori
Bhaji (pulses/other vegeta katori
bles/ leafy vegetables)

4:00-5:00 pm Snacks Tea (black) 1cup

Biscuit (marie) 4 nos.

9:30 pm Dinner Chapati (without oil) 1 nos.

Dal katori

Walk: 15-20 mins

Fried food consumption: 2/week
Water intake: 2.5 liter
Ref: Cardiac Failure
Review, 2015; 1
(2):905

*The diastolic press

ure is specifically the
minimum arterial
pressure during
relaxation and
dilatation of the
ventricles of the
heart when the
ventricles fill with
blood.
Diet
According to the National Institutes of Health, coronary artery disease (CAD), also
called coronary heart disease, is a condition in which plaque builds up inside the
coronary arteries. These arteries supply your heart muscle with oxygen-rich blood.
Diet aims to reduce cholesterol intake, lower blood pressure and lower body weight.
A study demonstrated that 30%-carbohydrate diet led to greater reduction in
hemoglobin A1c (HbA1c).In this study, 33 outpatients (15 males, 18 females, mean
age: 59 yrs) with HbA1c levels of 9.0% or above were instructed to follow a low-
carbohydrate diet (1852 kcal; %CHO:fat:protein = 30:44:20) for 6 months, HbA1c
levels decreased sharply from a baseline of 10.9 1.6% to 7.8 1.5% at 3 months
and to 7.4 1.4% at 6 months)

Ref: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2690585/pdf/1743-7075-6-
21.pdf
Diet (..contd)

Carbohydrate-rich foods instructed to remove in the carbohydrate-

reduced diet
Staple foods: rice, bread, corn, spaghetti, noodle made of wheat or buckwheat,
potato, sweet potato, taro and yam.
Fruits: pear, apple, persimmon, mikan, orange, grapefruit, peach, grape, melon,
water melon, banana, pine apple and Japanese chestnut, etc.
Vegetables: carrot, Indian lotus, pumpkin and autumn squash
Confectioneries Drink: beverages containing sugar, glucose and fructose, and
milk
Alcohol brew: sake, beer and wine (Distilled liquor was not restricted.
Ref: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2690585/pdf/1743-7075-6-21.pdf
Diet (..contd)
To reduce acidity: Avoid Caffeinated drinks, carbonated drinks, greasy or
fatty foods, spicy food, citrus fruits and juices, tomatoes or anything
tomato based, onions, peppermint, chocolate, alcohol, nicotine
(cigarettes, cigars, chewing tobacco).
https://www.rexhealth.com/app/files/public/7576/pdf-rex-digestive-
anti_refluxdiet.pdf
To improve Hb levels: Include green leafy vegetables like spinach, tofu,
asparagus, chicken liver, whole egg, oysters, apple, pomegranate, apricot,
watermelon, prunes, pumpkin seeds, dates, almonds, raisins, amla
Water intake - upto 2 litre can be recommended.