Carl is a 55-year-old male referred for medical nutrition
therapy (MNT) after being diagnosed with dyslipidemia. At his initial MNT visit
he discloses that he works over 60 hours per week as an accountant and relies
on fast food choices for meals during the day. His wife prepares family meals
for dinner, and he does not want to complain or change her cooking habits. He
admits that he does not exercise, but tries to play outside with his daughters
on the weekends.
Anthropometric Data:
Weight: 95 kg (210 lbs) Height: 178 cm (60”) BMI: 30 kg/m2
Waist circumference: 107 cm (42”) Biochemical Data: Total cholesterol (TC) 299
(Desirable: <><100mg>
Clinical Data:
Past Medical History: HTN, dyslipidemia (newly diagnosed)
Medications: metoprolol Vital Signs: Blood pressure 160/73 mm Hg, Temperature
98.6ºF, Heart rate 70 beats/min Nutrition-focused Physical Exam: Appears well
nourished, apple-shaped body type
Dietary Data:
24-hour Diet Recall Breakfast (6 am): 2 cups of coffee
(cream and sugar added) Lunch (12 pm): Large steak and cheese sandwich,
snack-sized chips, 12 ounces of soda Snack (3 pm): 2 cookies, or a donut, or a
fruit cup Snack (6 pm): Peanut butter and jelly sandwich or bologna (2 slices)
and cheese (1 slice) with a little mayonnaise on white bread Dinner (8 pm):
Large serving of spaghetti and meatballs (3 large homemade ricotta meatballs),
homemade marinara sauce, 2 dinner rolls with butter, garden side salad (lettuce,
cucumber, tomato) with ranch dressing, 8 ounces of water, sometimes wine (15
ounce glass) Snack (10 pm): Ice cream with fruit (large bowl)
1. What risk factors does Carl have for CVD at this point?
2. How would you interpret Carl’s biochemical data?
3. Assess Carl’s diet recall. Make notes regarding his
eating pattern and food/beverage choices. What recommendations can be made?
What goals can be set?
4. Plan a nutrition intervention to help Carl improve his
lipid panel.
5. Is it possible to encourage Carl to follow up? What is
the benefit of follow-up MNT visits?