CHO Choices - Kathryn Hughes



Meal Planning ProjectType II Diabetic with Crohn’s DiseaseKathryn HughesFall 2013Professor: Brenda O’ DayNutrition AssessmentDiagnosis: Type II Diabetic with Crohn’s DiseaseName: Steve WilsonAge: 38Gender: MaleDietary intake: PO intakeSymptoms: polydipsia, polyphagia, polyuria, weaknessMedications: Metformin twice daily Anthropometric measurementsHt: 5’10, 70”Wt: 195lbs, 76.77kgBMI= 27.9IBW= 150-182lbs%IBW= 117%Energy, protein and fluids neededGive a rageTotal Energy= 1900kcal, 25kcal/kg/body weightProtein= 60-76 PROFluid= 2.6L/dayIncludes basis for estimations For energy, used 25 cal per Kg weightFor protein used: .8-1.0g PRO/kgFor fluids needed, used 35 ml/kg/dayLab./Tests- can indicate high or low, normal or abnormalGlucose: 345 mg/dLHbA1c: 12%Triglycerides: 201 mg/dLCRP: 1.4 mg/dLASCA: positiveNutrition DiagnosisInconsistent carbohydrate intake R/T no utilizing actuate CHO counting to ensure p/t is not over consuming carbohydrates EVB p/t usual nutrient intake record of cinnamon rolls, french fry’s, juice, glucose levels of 345mg/dL, HbA1c 12%, Triglycerides of 201 mg/dL. Also p/t is incompliant with medication.Nutrition Intervention Meals and snacksFresh fruits and vegetablesEggsYogurt & cheeseNutrition RecommendationsRelated medication managementSmall Frequent Meals Eliminate problem foodsGoalsReduce glucose levels to 70-110 mg/dLReduce HbA1c <7%Monitoring and EvaluationFollow-up phone call with in one weekAsk patient keep a daily food record Re-assess lab valuesHbA1c- 3 monthsGlucose-1 weekCheck VitalsConsult MD if the patient proceeds to have high glucose levels.Part B: Meal Budget and Meal PlanMeal OneBreakfast2 slice of whole wheat toast 1 Large banana 2 eggs scrambled with cheeseGlass of almond milkLunchTurkey Sandwich:4 slices of Turkey1T MayoLettuce 2 slices Tomato2 Sliced of cheeseWaterSnackYogurtDinner7 oz Grilled Chicken 1 cup Cooked potato’s roasted with herbs no skinsSalad: Lettuce? cup Tomato’sDressing: olive oil (1teaspoon) and vinegarMeal TwoBreakfastOatmeal- 1 cupGlass of almond milk -2 cupsBanana -1 largeLunchCan of soup- chicken noodleGrilled cheese2 slices - whole wheat double fiber bread1 ? slics - cheeseGlass of almond milk -1 cupSnackApple Large WaterDinner8oz glass of milk Small side saladLettaceTomatoOil/vinegar dressingChicken Quesadilla2 (6 inch) tortillas whole wheat? cup shredded cheese 6 oz shredded chicken1 tbs Butter (for frying the tortillas in)Food ItemBrandAmountPriceCouponLocation PurchasedAlmons MilkO Organics 32oz$1.99MemberVonsEggsRalphs12 count0Yes (free)RalphsOatmealSafeway Kitchens Oats Quick18oz$2.00VonsChicken Boneless SkinlessO Organics 1lbs$4.99VonsBreadOroweat Double Fiber Bread24oz$2.99VonsApples1lb$0.89YesNorth Park ProduceBanana3eahc=1lbs$0.99YesNorth Park ProduceRoman LettuceEach$0.39YesNorth Park ProduceBlock of CheeseRalphs12oz$2.99MemberRalphsTomato’sRalphs1lbs$0.89MemberRalphsSoupCampbell’sEach$1.50Member (2 for $3)VonsYogurtO OrganicsEach$0.56MemberVonsTortillasMission6 count$2.56Wal-MartTurkeyOscar Mayer12oz$2.99AlbertsonsTOTAL =SUM(ABOVE) $25.73Part C: Assessment of Dietary Intake ReviewNutrients Report Meal OneYour plan is based on a default 2000 Calorie allowance.NutrientsTargetAverage EatenStatusTotal Calories2000 Calories1862 CaloriesOKProtein (g)***46 g118 gOKProtein (% Calories)***10 - 35% Calories25% CaloriesOKCarbohydrate (g)***130 g200 gOKCarbohydrate (% Calories)***45 - 65% Calories43% CaloriesUnderDietary Fiber25 g36 gOKTotal Fat20 - 35% Calories36% CaloriesOverSaturated Fat< 10% Calories12% CaloriesOverMonounsaturated FatNo Daily Target or Limit14% CaloriesNo Daily Target or LimitPolyunsaturated FatNo Daily Target or Limit7% CaloriesNo Daily Target or LimitLinoleic Acid (g)***12 g11 gUnderLinoleic Acid (% Calories)***5 - 10% Calories5% CaloriesOKα-Linolenic Acid (g)***1.1 g1.8 gOKα-Linolenic Acid (% Calories)***0.6 - 1.2% Calories0.9% CaloriesOKOmega 3 - EPANo Daily Target or Limit14 mgNo Daily Target or LimitOmega 3 - DHANo Daily Target or Limit69 mgNo Daily Target or LimitCholesterol< 300 mg649 mgOverMineralsTargetAverage EatenStatusCalcium1000 mg1444 mgOKPotassium4700 mg4441 mgUnderSodium**< 2300 mg2672 mgOverCopper900 ?g1612 ?gOKIron18 mg14 mgUnderMagnesium310 mg507 mgOKPhosphorus700 mg1951 mgOKSelenium55 ?g138 ?gOKZinc8 mg12 mgOKVitaminsTargetAverage EatenStatusVitamin A700 ?g RAE770 ?g RAEOKVitamin B61.3 mg3.4 mgOKVitamin B122.4 ?g3.1 ?gOKVitamin C75 mg96 mgOKVitamin D15 ?g5 ?gUnderVitamin E15 mg AT19 mg ATOKVitamin K90 ?g173 ?gOKFolate400 ?g DFE369 ?g DFEUnderThiamin1.1 mg1.3 mgOKRiboflavin1.1 mg2.5 mgOKNiacin14 mg34 mgOKCholine425 mg503 mgOKInformation about dietary supplements. ** If you are African American, hypertensive, diabetic, or have chronic kidney disease, reduce your sodium to 1500 mg a day. In addition, people who are age 51 and older need to reduce sodium to 1500 mg a day. All others need to reduce sodium to less than 2300 mg a day.*** Nutrients that appear twice (protein, carbohydrate, linoleic acid, and α-linolenic acid) have two separate recommendations: 1) Amount eaten (in grams) compared to your minimum recommended intake. 2) Percent of Calories eaten from that nutrient compared to the recommended range. You may see different messages in the status column for these 2 different recommendations.MEAL PLAN ASSIGNMENTMeal OneName: Steve WilsonDiet Rx:Diabetic Diet50% Kcals CHO= 950238 gm CHO20% Kcals Pro =38095 gm Pro30% Kcals Fat =57063 gm FatReminders: Think well-balanced meals! Snacks are optional if you would like to include themBSLSDSTotalCHO (g)Pro (g)Fat (g)KcalsStarches2226 90 (15g)18(3g)6(1g)360+72+54=486Fruit213 45(15g)180Milk2114 48(12g)32(8g)20(1,5,8g)192+128+180=500Vegetables123 15(5g)6(2g)60+24=84Meats/Substitutes22 2842(7g)30(3,5,8g)168+270=438Fats115(5g)45CHO Choices16198g63g61gKcals/gmTOTAL Kcals:1733%KcalsNutrients Report Meal TwoYour plan is based on a default 2000 Calorie allowance.Nutrients Target Average Eaten StatusTotal Calories 2000 Calories 1880 Calories OKProtein (g)*** 46 g 83 g OKProtein (% Calories)*** 10 - 35% Calories 18% Calories OKCarbohydrate (g)*** 130 g 198 g OKCarbohydrate (% Calories)*** 45 - 65% Calories 42% Calories UnderDietary Fiber 25 g 33 g OKTotal Fat 20 - 35% Calories 44% Calories OverSaturated Fat < 10% Calories 19% Calories OverMonounsaturated Fat No Daily Target or Limit 16% Calories No Daily Target or LimitPolyunsaturated Fat No Daily Target or Limit 4% Calories No Daily Target or LimitLinoleic Acid (g)*** 12 g 6 g UnderLinoleic Acid (% Calories)*** 5 - 10% Calories 3% Calories Under?? Linolenic Acid (g)*** 1.1 g 1.1 g OK?? Linolenic Acid (% Calories)*** 0.6 - 1.2% Calories 0.5% Calories UnderOmega 3 - EPA No Daily Target or Limit 10 mg No Daily Target or LimitOmega 3 - DHA No Daily Target or Limit 20 mg No Daily Target or LimitCholesterol < 300 mg 258 mg OKMinerals Target Average Eaten Status Calcium 1000 mg 2356 mg OKPotassium 4700 mg 2845 mg UnderSodium** < 2300 mg 1950 mg OKCopper 900 μg 1501 μg OKIron 18 mg 13 mg UnderMagnesium 310 mg 425 mg OKPhosphorus 700 mg 1685 mg OKSelenium 55 μg 121 μg OKZinc 8 mg 11 mg OKVitamins Target Average Eaten StatusVitamin A 700 μg RAE 1202 μg RAE OKVitamin B6 1.3 mg 1.9 mg OKVitamin B12 2.4 μg 1.3 μg UnderVitamin C 75 mg 42 mg UnderVitamin D 15 μg 11 μg UnderVitamin E 15 mg AT 52 mg AT OKVitamin K 90 μg 44 μg UnderFolate 400 μg DFE 266 μg DFE UnderThiamin 1.1 mg 1.2 mg OKRiboflavin 1.1 mg 3.1 mg OKNiacin 14 mg 26 mg OKCholine 425 mg 224 mg UnderInformation about dietary supplements.** If you are African American, hypertensive, diabetic, or have chronic kidney disease, reduce your sodium to 1500 mg a day. In addition, people who are age 51 andolder need to reduce sodium to 1500 mg a day. All others need to reduce sodium to less than 2300 mg a day.*** Nutrients that appear twice (protein, carbohydrate, linoleic acid, and ??linolenic acid) have two separate recommendations:1) Amount eaten (in grams) compared to your minimum recommended intake.2) Percent of Calories eaten from that nutrient compared to the recommended range.You may see different messages in the status column for these 2 different recommendations.Steve Wilson is a 37 year olds male who is in a remission state of Crohn’s disease and is currently struggling with regulating his type II Diabetes. He is slight over weight with a BMI of 27.9 and has been advised that by regulating his diet and increasing his exercise he would be able to get a better handle on his glucose levels. Steve’s Regular diet consists of high sugar and high fat foods such as cinnamon rolls, fast food burgers and fry’s, regular juices. He is not currently struggling with his Crohn’s disease but has been advised to stay away from foods that pose a problem with him.Because Steve has been struggling with his glucose control it has been advised that he takes his Metformin twice daily and begin to practice carbohydrate counting or utilize the exchange to help better manage his food intake. According to the CHO exchange method Steve is allotted 238g of CHO or 950 kcals. Due to his high glucose Steve has cut back him CHO intake to about 190-200 or about 42% to help maintain good glucose control. Due to his cute back in CHO he remain under the MyPlate recommendations of 45-65% of daily Kcal coming from CHO.In the past Steve has also struggled with a mild case of lactose intolerance due to his Crohn’s Disease. Therefore he shies away from drinking regular milk and opts to consume Almond milk. But because he can tolerate some lactose cheese does not seem to affect his gut and therefore he eats cheese and yogurt on a regular basis.I would also recommend a daily multi vitamin for Steve to help increase his intake of potassium, iron, folate, and vitamin D for which he is just slightly under the recommended intake levels.Part D: ReviewI very much enjoy this project. It was very time consuming but also very eye opening. Being a type one diabetic myself I deal with CHO counting on a day-to-day biases but I never had learned the exchange method. It was very interesting to learn a new tool that could potentially help me in the long run. This project could be very valuable for an aspiring dietitian. This is what they will be doing everyday with many patients. Also it allows them to understand how hard it is to obtain 2 days of food in such a tight budget. It was very difficult to obtain a well-balanced meal with two disease states and while also staying in a budget. Although it was fun, like a puzzle as times it got frustrating. I could not imagine having to do this on day-to-day biases and this is one reason I do not want to be clinical dietitian. I would recommend this project to future students. It will allow them to get a very good picture of what life will be like at a registered dietitian. This gives students great practice for meal planning, ADIME note and nutrient analysis. All of this is very important in the clinical setting.APENDEX ................
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