ADIME -CVD/HTN

A
Client History 52 YOAAF
Married and unemployed
Walks 4-5x/wk for 30 min
Has maintained 10 lb wt loss for 1 year
History of heavy smoking
Medical Dx: Stage 2 HTN, hypertensive
heart disease, early COPD.
Dr. Rx: Hydrochorothiazide to reduce
BP, requires potassium intake be
monitored
Anthropometric Wt: 72.7 kg
Ht: 167.6 cm
WC: 38 (android adiposity)
BMI: 25.8 (overweight)
IBW: 59.1 kg
%IBW: 123% (moderately overweight)
UBW: 77.3 kg
%UBW: 94% (losing wt)
Biochemical FBG: 92 mg/dL (high end of nml)
BUN: 20 mg/dL (moderately high)
TG: 155 mg/dL (moderately high)
HDL: 30 mg/dL (low)
LDL: 210 mg/dL (high)
Total CH: 270 mg/dL (high)
Apo A: 75 mg/dL (low)
Apo B: 140 mg/dL (high)
Clinical No NFPE

Diet Total Energy: 2600 Kcal/d, 36 Kcal/kg

of body weight
Total Protein: 68g, 10.5% Kcal/d, 0.94
g/kg of body weight
Total
Carbohydrate: 320g, 50% of Kcal/

d
Total Fat: 118g, 41% of Kcal
High Na foods
Client motivation: moderate due to
family history of MI and desire to lose
wt.
NKA
No food related knowledge reported by
patient
Nutrient Needs EER 2100 Kcal/d, 29 Kcal/kg of body
weight, AF=1.55
Protein: 68g, 13% Kcal/d, 0.9g/kg of
body weight
Carbohydrate: 320g, 55% Kcal/d
Fiber: 20-30g/d
Fat: 75g, 32% Kcal/d
Saturated: 16g, 7% Kcal/d
Cholesterol: <200mg/d
MUFA: 35g, 15% Kcal/d
PUFA: 23g, 10% Kcal/d
Stanol Esters: 3.4g/d
Fluid: 2400ml/d
Sodium: 4g/d and working towards
less than 2.4g/d

Excessive energy intake related to high fat diet, combined with sedentary lifestyle and
poor food choices as evidenced by 24 hour diet recall, overweight BMI, 123% IBW,
and android adiposity.

I
Decrease Energy intake by 500 Kcal/d in the next two weeks

1. Incorporate 4 or more servings of vegetables daily.

2. Decrease fat intake by 50% or to 68g/d and choose unsaturated fats

3. Education on portion sizes adhering to MyPlate suggestions

ADIME -CVD/HTN
Diet Prescription:

Patient to begin TLC diet with initial 2100 kcal/d and a gradual 500kcal/d deficit until
IBW is reached

1. Diet should decrease sodium intake to 4g a day with an ultimate goal of less than
2400mg/d

2. Diet should increase stanol esters to 3.4g/d through substitution of butter with
Benecol

3. Diet should increase fiber intake to 30g a day to increase satiety and decrease CH
levels

Diet should incorporate smaller portions as well as moderate PA for slow wt loss.
Patient could benefit from education materials from heart.org i.e. What Can I Do to
Improve My Blood Pressure?, High Blood Pressure in African Americans, Losing Weight
the Right Way, and Why Should I Limit Sodium?

M/E
Indicator

Current Level of Indicator

Criteria for success

Apo A

75 mg/dL

99-101 mg/dL

Apo B

140 mg/dL

60-126 mg/dL

TG

155 mg/dL

less than 150 mg/dL

LDL

210 mg/dL

less than 130 mg/dL

Total CH

270 mg/dL

less than 200 mg/dL

HDL

30 mg/dL

greater than 55 mg/dL

Follow up:

3 weeks:

Measure blood pressure

reassess energy requirements based on wt, if loss

evaluate pt food record

evaluate food and drug interactions

3 months:

order lipid labs to R/O metabolic syndrome

Signed: ________________________________________ Date:_________ Time: _________