Clinical Cases

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Clinical Cases
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CLINICAL CASE NUTRITION AND CARDIOVASCULAR
DISEASES CASE 1 A 49-year-old man is found to
have a total cholesterol of 8.1 mmol/L. His
family history is negative, he smokes 1 pack of
cigarettes per day, and states that he once
tried to quit but gained 20 lbs in 1
month. History Weight history 65 Kg at 20
years of age, 70 Kg at 35 years of age, 84 Kg
presently Height 1.72m Blood pressure
135/85 Xanthomas, Xanthelasmas none Fasting
lipid profile Total Cholesterol 8.1
mmol/l HDL Cholesterol 1.12 mmol/l Triglyceride
s 2.20 mmol/l Urinalysis and thyroid
function tests normal
Risk Factors
BMI 84 / (1.72)2 ____
Calculate VLDL and LDL Cholesterol
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Diet History (2 days)
 Worst Offenders 
DAY 1 DAY 2
Breakfast 2 toasts with butter, apple jelly, orange juice 1 fried egg, bacon, 1 toast and butter, coffee
Lunch Ham and cheese sandwich, yogurt, 1 glass whole milk, doughnut Chicken sandwich, soft drink, 2 chocolate cookies
Supper Salmon, brocoli, rice, mayonnaise, tomato juice, coffee, chocolate cake 2 Hot Dogs, French fries, soft drink, pastry
Evening Chips, soft drink, jello Pop corn, soft drink
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Dietitians Assessment CALORIES 3328 2306 PR
OTEIN 121 g 69 g CARBOHYDRATE 414 g 248
g TOTAL FAT 131 g 115 g Saturated 52
g 44 g Monounsaturated 45 g 51
g Polyunsaturated 34 g 20 g CHOLESTEROL 395
mg 416 mg FIBER 20 g 13 g What is your
assessment of his diet? Calculate the of total
calories for protein, carbohydrate and each type
of fat.
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What are your recommendations to the patient?
List Diet ? diet substitutions Exercise Smoking
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When do you want to see the patient again? At
that time, the following results are
found Total cholesterol 6.4 mmol/L HDL
Cholesterol 1.08 mmol/L Triglycerides 1.95
mmol/L LDL Cholesterol 4.43 mmol/L What are
your recommendations at this point?

• How much weight was lost?
• Quit smoking
• Change in exercise
• ? Encourage to continue, but need to consider a
  more
• agressive approach

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CASE 2 A 37-year-old woman comes for screening
for cholesterol. Her brother suffered from a
myocardial infarct last week at the age of 43.
She is a non smoker, and works as an
accountant. History Her weight is 57 Kg, and
has been stable for the last 10 years (Height
1.65 m) Blood pressure 150/90 Tendinous
xanthomas and xanthelasmas present Lipid
profile Total cholesterol 11.96 mmol/L HDL
cholesterol 1.45 mmol/L Triglycerides 1.25
mmol/L Urinalysis, thyroid tests and fasting
glucose normal
Risk Factors
BMI 57 / (1.65)2
Calculate VLDL and LDL cholesterol
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Diet History (2 days)
 Worst Offenders 
DAY 1 DAY 2
Breakfast 2 toasts with peanut butter, orange juice 2 toasts with peanut butter, 2 milk
Lunch Vegetarian lasagna, brocoli, fruit salad, grape juice Salmon-stuffed tuna in lettuce leaves, orange sherbet, 1 glass of white wine
Supper Chicken, vegetables, rice, tomato juice Italian spaghetti, soft drink, blueberry muffin
Evening 2 toasts with apple sauce, 2 milk Nothing
None!
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Dietitians Assessment CALORIES 1624 1823 PR
OTEIN 83 g 91 g CARBOHYDRATE 224 g
232 g TOTAL FAT 44 g 59 g
Saturated 16 g 18 g Monounsaturated 17
g 24 g Polyunsaturated 11 g 17 g
CHOLESTEROL 124 g 274 mg FIBER 24 g 13 g
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What is your assessment of her diet? What is the
expected evolution? What else should be done?