5/3/2013 1 Nutrition Therapy in Metabolic Syndrome Nicole Raimondo Sodexo Dietetic Internship Saint Joseph’s Medical Center INTRODUCTION • Increasing obesity has led to an increase in metabolic syndrome increase in metabolic syndrome • Affects ~32% of adults over the age of 20 and up to 45% over age 50 OUTLINE Diagnostic Criteria Overview Critical Comments Patient M MNT Medical Treatment • Also known as… METABOLIC SYNDROME –Syndrome X –Insulin resistance syndrome –Obesity syndrome • Group of risk factors that promote the de elo e t of WHAT IS IT? development of – Atherosclerotic Cardiovascular Disease – Type II Diabetes WHAT ARE THESE FACTORS? Abdominal obesity High triglycerides Low HDL High blood pressure High fasting blood sugar
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5/3/2013
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Nutrition Therapy inMetabolic Syndrome
Nicole RaimondoSodexo Dietetic Internship
Saint Joseph’s Medical Center
INTRODUCTION
• Increasing obesity has led to an increase in metabolic syndromeincrease in metabolic syndrome
• Affects ~32% of adults over the age of 20 and up to 45% over age 50
Food category Recommendation/dayLow GI vegetables (<55) ≥ 3 servings
Moderate GI vegetables (55-70) 1 servingModerate GI vegetables (55 70) 1 servingLegumes ≥1 servingsAnimal and vegetable proteins unlimitedNuts and seeds 1 servingLow GI fruits 2-3 servingsDairy 2-3 servings maxWhole grains 1 servingFats and oils 4 servings
DASH DIET
Food ServingsGrains 6-8 per dayFruits 4-5 per dayp yVegetables 4-5 per dayMeats, poultry, fish ≤ 6 per dayFat-free or low-fat dairy 2-3 per dayNuts, seeds, legumes 4-5 per weekFats and oils 2-3 per daySweets ≤5 per week
f ll hi t i t• full psychiatric assessment• OT for psychosocial functioning• group therapy• individual psychotherapy• psychopharmacotherapy• finger sticks BID• dietary consult
Zocor cholesterol and triglycerides
NovoLog regulate blood sugar levels
Levemir regulate blood sugar levels
Diovan blood pressure
MEDICATIONS
Diovan blood pressure
Clozaril schizophrenia
Prolixinpsychotic symptoms such as hallucinations and delusions
Depakote mania
Nicorette smoking cessation
Protonix gastroesophageal reflux
Zocor cholesterol and triglycerides
NovoLog regulate blood sugar levels
Levemir regulate blood sugar levels
Diovan blood pressure
MEDICATIONS
Diovan blood pressure
Clozaril schizophrenia
Prolixinpsychotic symptoms such as hallucinations and delusions
Depakote mania
Nicorette smoking cessation
Protonix gastroesophageal reflux
1. To provide safety and support to the patient
2. To encourage therapeutic relationships and assist the
INTERDISCIPLINARY PLAN FOR PATIENT M
patient in acclimating to the unit and psyc programs
3. To improve the patient’s symptoms of psychosis to a level that would allow her to be safely discharged back into the community
4. To improve the patient’s ability to care for herself so as to not neglect her health conditions
Excessive energy intake related to a caloric intake greater than her calculated needs to promote weight loss as evidenced by a BMI of 45/Obesity Grade IIIloss as evidenced by a BMI of 45/Obesity Grade III.
Inconsistent and inappropriate carbohydrate intake related to a deficit in nutrition knowledge as evidenced by high glucose of 291 mg/dL, high HgA1Cof 9.4%, and high finger sticks of 250-337.
MonitoringAssessment Diagnosis Intervention
Monitoring &
Evaluation
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• Food and nutrient delivery–Modify diet to 2000 kcal CHO-consistent, fat, sodium
NUTRITION INTERVENTION
• Nutrition education–Nutrition relationship to health and disease– Educate on diet changes– Encourage attendance to monthly nutrition
class & psyc unit walking club– Encourage fish consumption for anemia
M it iAssessment Diagnosis Intervention
Monitoring &
Evaluation
MONITORING AND EVALUATION
• Diet order• Energy intake• CHO intake and timing
Intake
• Attendance of classesAttendance of classes• Level of nutrition
• Previous diagnosis of excessive energy intake being resol ed on inpatient dietresolved on inpatient diet
• Finger sticks <300, but still >200s at times so diagnosis relating to carbohydrate intake was still in effect
• Weight: 266 lbs
• BMI: 40 kg/m2
FOLLOW-UP #2
Glucose 260 H, ↓ from admHgA1C 8 1 H ↓ from admBMI: 40 kg/m
• Revise calorie needs based on new wt– Modify calorie
restriction to 1800
HgA1C 8.1 H, ↓ from admTotal Cholesterol 187 H, ↓ from admTriglycerides 204 H, ↓ from adm
Finger Sticks 150 to < 300
Blood Pressure 129/74
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CRITICAL COMMENTS
• Patients on clozapine gain an average of 11.7-13.9 lbs during the 1st yr of use– Reduce REE estimates by ~280 calories/day
• Multivitamin and vitamin D
• Schizoaffective disorder different nutrition counseling
Saint Joseph’s Medical Center nutritional care team!
Gayanne, Christina, and fellow interns!
Thank you to
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