1.

Diagnostico nutricional
Pacient: Pedro Sanchez Rodriguez
Sexo: Hombre
Edad: 42anos 1,78
Height: 178cm
Weight: 78kg
Profesion: Truck driver
Indice cintura cadera: 0,98
Complexion: delgada
Perimetro abdominal: 101cm
Porcentaje de grasa corporal: 15%

Tension: 155/95
Medicacion: ninguna
Enfermedades: Hypertension
Motivo de la consulta: Bad frame of mind during hot weather
Actividad fisica: no practica deporte
IMC: 95/(1,78*1,78) = 24,62kg/m2

Evaluacion subjectiva
The main problem with the way of feeding of this pacient is irregular eating during work. He
oftens smoke because of stressful work and doesn’t have a lot of opportunities to do
exercises. He eats often cheap prepared food from markets. Also every free weekends he is
going to pubs for beers with his best friends to see the football matches and drink beers. His
way of living is highly determined by his job and it lead him to health problems including
hypertension. Father of pacjent also has hypertension. The paramets of weight and IMC are
proper but on the limit.
A long time of staying in vechicle without moving and from time eating fast foods and salty
snacks during the way have consequences which can turn out to be very serious during high
temperatures when the effects od disease are exaggerated.

2. Requerimientos nutricionales
REE = 78*13,7516+178*5,0033-42*6,755+66,473= 1745,9752kcal
ETA=10%REE (because IMC is proper) = 174,5975kcal
TEE= 1745,9752 * 1,4 = 2444,36528kcal

We should analize meals which were eaten during the last two weeks by our pacient. Was it
regular eating during the same time everyday? We should also take into the consederation
to implement the limit of calories everyday. The pacient is on the limit of norm with his IMC
what can highly predispose him to became overweight, so loosing 4-5kilograms will help to
maintain the proper weight.

Lípidos, descienden hasta el 25%. 20 – 25 % energía:

0,2x2444,36528= 488.873056Kcal 0,25x2444,36528= 611.09132Kcal
AGS, menos del 10% de la energía: 0’1x2444,36528= 244.436528Kcal
Colesterol: menos de 300mg
 Proteínas, las proteínas aumentan ligeramente hasta el 17‐
20% 17 – 20 % energía: 0,17x2444,36528= 415.5420976Kcal 0,20x2444,36528= 488.873
056Kcal
Hidratos de carbono, el límite máximo disminuye a 60%. 50 – 60% energía:
0,5x2444,36528= 1222.18264Kcal 0,6x2444,36528= 1466.619168Kcal
Azúcares libres, menos del 10% de la energía: 0,1x2444,36528= 244.436528Kcal
Fibra (OMS/EFSA): 25g ‐ Agua: 3litres/día

That diet isnt below the level that insure all micro&macroelements but their requirement amounts
should be mostly delivered in products like fruit and vegetables. Reducing level of salty meals will be
another important factor to fing with hypertension.

3. Planificacion alimentaria

Important issue is planing meals on the same periods of times during every day. The meals
shouldn’t be quited and during the breaks between them any snacks shouldn’t be delievered.
In order to having possibilities to eat during work all products and meals should be
preapared before. Also if there will be opportunity is much better to use fresh products
especially fruit and vegetables than freezing one. It is good to put some seasonal products.

Desayuno (15%)= 366.654792Kcal

Almuerzo (10%)= 244.436528Kcal
Comida (30%)= 733.309584Kcal
Merienda (10%)= 244.436528Kcal
Cena (25%)= 611.09132Kcal
Recena (10%)= 244.436528Kcal

4. Modificaciones con respectos a la dieta normal

The aims of diet during hypertension are: reduce blood pressure, control coexisting risk
factors, and optimize the pharmacological treatment, when it is used. Health-promoting
habits should be promoted among patient, although as we know, their implementation, let
alone adherence to daily life requires a lot of effort and is often unrealized.

It is generally believed that both lowering blood pressure and cardiovascular risk can be
achieved through the following lifestyle modifications: stop smoking, increasing physical
activity, reduction in total fat intake, including saturated fat.

We should recommend with no doubt some exercises. For the begining that should be simple
ones like walking everyday or at least 5days per week around half an hour and slowly
increasing the level of activity. Running or swimming i salso desarible. It is worth to
implement every activity in everyday life like choosing going by foot to the shop insted of
driving a car. It should be implement to schedule in the way which will fit to the patient.
The products like fast food, fatty meals should be removed. Food should be served slowly
and the patient shouldn’t eat food that contains a lot of lipids and fatty hams and sasuages,
fried staff, and fat cheeses.

Products which ar totally prohibited in diet and should be replaced by better analogues are:
sweet milk and milk drinks with a fat content above 2%, condensed milk, scrambled eggs,
omelette, fried eggs, fried in fat, especially in lard, pork fat, bacon, greasy meat: pork,
mutton, geese, ducks, oily meats, canned meat, offal sausages, pates
the meat is strongly cured and strongly seasoned, herring and other salted fish, smoked fish,
canned fish, patties from homogenized fish, seafood in processed form, eg marinated, salted
butter, cream with a fat content above 12%, fried potatoes, chips, potato pancakes, crisps,
prunes, salads combined with mayonnaise or sour cream, compotes and high-sugar jams,
fruit juices with the addition of sugars, fruit syrups, salted nuts, peanuts in breadcrumbs
(crust), peanuts in caramel, sunflower seeds in caramel or honey, pancake deep fried, fried
deep dumplings, pies, fry dishes, groats fried with the addition of fat, pork chops, cakes and
biscuits baked with the addition of baking powder, shortbread cookies, cakes and French
pastries, faworki, donuts, cakes and cookies,ice cream,creams, whipped cream

Another requirement for the diet is to completely avoid eating sweets and eating smaller
amounts of simple carbonhydrates and if it is needed change sugar in tea ora coffe for some
noncaloric sweets. Hypocaloric fiber-rich foods will be included in the diet because they have
a more satisfying effect, such as vegetables, fruits and whole grains.
It is completely required from your pacjent to give up smoking to improve his condition
health.

The loosing some weight is highly recommended for your pacient. The relationship between
overweight and obesity and the prevalence of hypertension has long been known. Excess fat,
especially visceral fat, referred to as abdominal obesity, promotes the increase in pressure
and the occurrence of hypertension.

Quiting of drinking. There is a population dependence between blood pressure and the
prevalence of hypertension and alcohol consumption is linear. Men with hypertension who
drink alcohol, it is recommended to limit its consumption to less than 20-30 g ethanol per
day . The pacient should be encourge to give up drinking or at least limit it.

In the daily diet about 25-40% of sodium comes from table salt, about 25% from meat and
processed products, about 22% from bread, about 7% from milk and dairy products, and less
than 6% from vegetables and fruits. The more processed food, the more sodium is in it. That
is why Some authors report a 75% share of sodium in the diet of processed food should be
replaced by fresh fruits and vegetables. That is why diet DASH is highly recommended for
people with hipertension.

Diet with a predominance of vegetables and fruits not only contains not much sodium, but
because of the increased content of potassium is associated with a decrease in blood
pressure. This effect is partly inversely proportional to the sodium content in the diet. The
increase in potassium supply was associated with a decrease in systolic and diastolic pressure
in patients with hypertension.
5. Breakfast: Whole grain bread (70 g), margarine baja en calorias (10 g) –
36,2kcal,0,16gprotein,0,04g carbohydrates, 4g grasa, skinny curd cheese (50 g), radish (45 g),
chives Cereal coffee with milk

2nd breakfast: Rice wafers (30 g) with lean cheese cheese (50 g), tomatoes (70 g) Mineral
water with lemon

Lunch: bean soup (350 g) Rice balls with chickpeas (100g rice, 1 chickpea can), tomato and
cucumber salad (100g) Apple juice (250g)

Afternoon tea: Banana (100 g), almonds (30 g)

Supper: Pasta (100 g) with broccoli (100 g), olive oil (10 g), cherry tomatoes (80 g) Lemonade
(250 g)

During all day drinking at least 2 liters of water is required.

6. Como se formula una prescripcion

Hypertension is a cardiovascular disease in which the systolic pressure periodically or

continuously exceeds or equals 140 mmHg and / or the diastolic pressure exceeds or equals
90 mmHg. If the force with which the blood presses against the walls of blood vessels is too
big, it damages, which has a number of further health consequences.

One of your the most important resposibility is to consious the pacient about the
hypertension and how serious is that disease to encourage him to make affords to keep his
health. It is worth to underline that hypertension is incurable disease and has also to
development of distractive effects for the way of working of heart, kidneys, brain and eyes.

It accelerates the development of atherosclerosis: the blood thrown out of the heart with
greater force hits the walls of the arteries and causes them to harden. Increases the risk of a
heart attack: narrower arteries reach the heart less blood.

We should also underline the fact that following proper diet has as good as or even better
results in treatment that pharmacotherapy.