Nutrition

407 project

Part A: Nutrition Assessment

Daniel Dueñas is a 28 year old Hispanic male who has been grieving the death of his grandmother for
the past year, as well as worrying for his uncle who was recently admitted to the hospital due to a gun
shot wound penetrating his skull. He has informed us that he has been depressed for awhile and that
fast food and excessive intake of food in general have been his coping mechanisms. Ever since Daniel
could remember, he states that he has always been on the heavier side. Growing up Hispanic in a poor
neighborhood with 5 other siblings, he consumed high fat and high processed meals without ever being
told the importance of proper nutrition from his family. Due to family problems, these last few years
have exacerbated his unhealthy choices of foods and increased his weight significantly. He has had no
motivation to exercise or choose healthier alternatives of his food and sweetened beverage
consumption. A year and a half ago he was diagnosed with Type 2 diabetes, but has showed no desire
and will to change. He has continued to consume excessive amounts of food, increase his soda intake,
and spends most of his day sedentary watching television. Earlier this year, he had an epiphany after he
was diagnosed with cardiovascular disease; the disease has motivated him to make immediate drastic
changes to his life. With a newly found motivation, drive, and willingness to thrive, he is determined to
improve his health, lose weight, and receive proper nutritional guidance from a professional. Daniel
recently visited his physician and asked to see a specialist. His physician then referred him to a
registered dietitian to assist Daniel is improving his overall well-being, and providing a sustainable
nutrition approach to support him in achieving his goal. Daniel is hopeful that the dietitian will help in
managing his type 2 DM and Cardiovascular Disease.

Client: Daniel Dueñas Date: 12/6/19

Nutrition Assessment
Diagnosis: Type 2 DM, hypertension, dyslipidemia
Age, gender: 28 y/o male
Dietary intake: PO intake; good appetite; eats breakfast, lunch, and dinner. Eats large meals
including processed foods, consumption of high fat and high sodium meals. Excessive
consumption of sweetened beverage. 3-4 can sodas a day.
Food preferences: fast food, ice cream, processed foods, soda
Exercise habits: none
Functional/behavioral factors: sedentary in his room most of the day and watches television.
Resources for obtaining, preparing food: self.
Symptoms: fatigue, polyuria, polydipsia, shortness of breath
Dietary order: 2000kcal diet for Type 2 DM; TLC diet
Anthropometric measurements
Ht/wt: Ht: 193.04cm. Wt:108.2kg/238#
BMI= 28.9kg/m2
IBW= 202#/91.8kg, %IBW:117% overweight.

Energy, protein and fluid needs

o Total Energy= 25kcal x 91.8kg = 2,295kcal, 30kcal x 91.8kg = 2,754kcal
o Protein= 0.8g x 91.8kg = 73g, 1.0 x 91.8kg = 92g
o Fluid= 1ml/kcal. 2,295-2,754 ml/day
 Medications/supplements: Metformin 1000mg/twice daily, Lasix 25mg/day, Lovastatin
60mg/day.

Lab Tests:
• Glucose: 220mg/dl; High (range:70-130mg/dl)
• HbA1c: 10%; High (<7%)
• TG: 190mg/dl High (<150mg/dl)
• HDL: 36mg/dl (low)
• LDL: 145(high)
• Cholesterol: 270mg/dl (high) (<200)

Nutrition Diagnosis

1. Overweight (NC-3.3.1) r/t consumption of large, high fat/processed meals, sedentary lifestyle
AEB BMI of 28.9kg/m^2.

2. Excessive fat intake (NI-5.6.2) r/t inadequate food and nutrition related knowledge AEB
altered nutrition related lab values.

Nutrition Intervention
1. Meals
• Increase consumption of high fiber foods(25-30g/d) (whole grains, legumes, leafy
greens)
• Avoid trans fat
• Increase consumption of mono-unsaturated fats (20% from MUFA; canola oil,
avocado, olive oil,)
• Limited saturated fat to <10% of total calories
• Small frequent meals
• Consume lean meats/substituting lean meats (tenderloin, pork loin, sirloin,
skinless chicken breast, tofu)
• Limited intake of sweets, especially sugar sweetened beverages
• Emphasize fish, poultry(white meat), legumes, whole grains, veggies, fruits, nuts,
vegetable oils, low-fat dairy.
• Consumption of omega-3s (fish, walnuts, chia seeds, flax seeds, safflower,
soybean oil)
2. Nutrition Education
a. Educate patient on Carbohydrate counting so CHO is being distributed evenly
throughout the day.
b. Educate patient on the importance of nutrition and explain how his health/weight
will improve if he follows the TLC and Type 2 DM diet accordingly.
c. Explain the importance of exercise and how it’s the best way to increase HDL.
3. Nutrition counseling
a. Social support
b. Motivation interviewing
 c. Setting goals
4. Coordination of care
a. Refer to certified Diabetes Educator
b. Refer to exercise physiologist

Goals
1. Maintain kcal diet within 2000kcal
2. Trend for weight loss, and lose 1Ib a week until normal BMI is reached
3. Normalize lab values
4. Take medications as prescribed and be consistent
5. Start incorporating regular exercise (40min, 3-4 times per week)
6. Increase consumption of fruits and vegetables

Nutrition Monitoring and Evaluation

• Monitor weight an evaluate BMI

• 3 day food log, bring to clinic to assess for correct choices
• Follow up phone call within 1 week
• Check blood lipids within 3 months
• Reassess glucose levels within 2 weeks

Signed: Pedro Guzman Date: 12/6/19

Part B: Meal Plan

MEAL PLAN ASSIGNMENT

Name:Daniel Dueñas

Diet Rx: Diabetic Diet 2000kcal

50% Kcals CHO= ___1000kcal______ 250gm CHO

20% Kcals Pro = ____400kcal_____ 100_gm Pro
30% Kcals Fat = ____600kcal_____ 67_gm Fat

B S L S D S Total CHO Pro Fat Kcals

(g) (g) (g)
Starches 2 3 2 7 (15g) (3g) (1g) 567kcal

Fruit 2 2 1 5 (15g) 300kcal

Milk 2 1 3 (12g) (8g) (1,5,8g) 456 kcal
Vegetables 1 2 2 5 (5g) (2g) 140kcal

Meats/Substitutes 1 2 2 5 (7g) (3,5,8g) 365kcal

Fats 1 1 1 3 (5g) 135kcal

CHO Choices 6 6 3 15 241 90 71

Kcals/gm TOTAL
964 360 639 Kcals:
%Kcals 1963
48% 18% 32%

Meal Plan
Day 1
Breakfast: Ingredients: Exchange:
Egg and Avocado Toast 1/8 Avocado 1 fat
1 slice Whole wheat bread 1 starch
¼ cup of egg white 1 meat substitute
½ cup of spinach 1 vegetable
1 whole wheat slice 1 starch
(toasted) w/ 2tsp sugar
free jelly
2 cup of whole milk 2 milk
½ mango 1 fruit
¾ cup of blueberries 1 fruit

Lunch:
Whole, grilled chicken
sandwich
2 slices of whole wheat 2 starch
toast
2oz of grilled chicken 2 meat
½ cup raw spinach 1 vegetable
1/8 avocado 1 fat
1 cup of whole milk 1 milk
1 cup of raw carrots 1 vegetable
1/2cup of oatmeal 1 starch
½ chopped banana 1 fruit
1 cup raw raspberries 1 fruit

Dinner:
Ground turkey w/brown
rice and cheese
 1 oz ground turkey 1 meat
1oz mozzarella 1 meat substitute
½ c of brown rice 1 starch
1 c green bellpepper 1 vegetable
chopped
1 cup of chopped onion 1 vegetable
1 cup raw raspberries 1 fruit
½ c mashed potato 1 starch
1tsp of butter 1 fat

Day 2

Breakfast: Ingredients: Exchange:

Egg and avocado bagel
sandwich
1 whole wheat bagel 2 starch
1 whole egg 1 meat
1/8 medium avocado 1 fat
½ c raw spinach 1 vegetable
2c of whole milk 2 milk
½ chopped banana 1 fruit
¾ c of blueberries 1 fruit

Lunch:
2oz grilled chicken 2 meat
1 cup of brown rice 2 starch
1 c of cooked broccoli 2 vegetables

½ c of cooked oatmeal 1 starch

1 c raw raspberries 1 fruit
¾ c blueberries 1 fruit
1 c whole milk 1 milk

2 whole walnuts 1 fat

Dinner:
2oz ground turkey 2 meat
1cup of brown rice 2 starch
½ c cooked asparagus 1 vegetable
½ c cooked green beans 1 vegetable
1 tsp olive oil 1 fat

½ mango 1 fruit
Part C: Budget of $30

Food item Quantity Total price Quantity utilized Utilized price

purchased
Mango 4 $4 1 mango $1
Chicken 40oz $6.99 4oz $0.70
Ground turkey 16oz $4.99 3oz $0.94
Whole wheat 1package $3.39 1 bagel $0.57
bagel (6bagels)
Brown rice 1 box $2.99 2 ½ servings $1.25
(3 pouches/2svg
per pouch)
Eggs 18ct large eggs $1.99 1 $0.11
Avocado 3 $1 3/8 avocado $0.12
Bell pepper 1 $.98 1 $.98
Whole wheat 1 loaf (21svg) $4.89 4 slices $.93
bread
Spinach 1 pack(10oz) $3.79 1½c $0.81
Onion 1 onion $0.99 1 $0.99
Green beans 12oz(1svg ¾ c) $3.49 ½c $0.58
Asparagus 8oz (2.5oz svg) $3.19 ½c $1.69
Egg white 16oz (10svg) $3.49 ¼ cup $0.46
Walnuts 8oz (8svg) $4.69 2 walnuts $.08
Blueberries 18oz $5 18oz $5
Raspberries 24oz $6.67 24oz $6.67
Whole milk 1 gallon (16svg) $3.19 6 cups $1.20
Banana 1 banana $.19 1 banana $0.19
Oatmeal 42oz(30svg) $2.59 1 cup $0.18
Carrots 12oz(4svg) $1.89 1 cup $1.25
Mozzarella 8oz(8svg) $2.49 1oz $0.16
Mashed potato 13.75oz(18svg) $1.99 ½ cup $0.17
Broccoli 12oz(4svg) $4.49 1 cup $1.12
Total $25.44

Food was purchased from: Ralphs, Sprouts, Trader Joe’s, and Target.
Part D: Nutritional Analysis
Diet analysis program: Cronometer

The two day menu that was utilized for Mr. Dueñas depicts majority of the macronutrients
and micronutrients being met. When comparing the two day menu with MyPlate and RDI, I
am pleased with the results yielded because mostly all his goals were spot on or slightly off.
The calories for day 1 was 1,917kcal, and 1,976kcal for day two which is not too off the
2,000kcal diet. Although both days were slightly under the 2000kcal goal, it shouldn’t be too
detrimental to his health since he’s overweight, and by having slightly lower calories it may
promote weight loss. For carbohydrates, both days depicted being under the pt goal of 50%
of calories coming from carbs. The DRI states that calories from carbs should be
approximately 45-65% of calories, and the TLC diet states 50-60kcal coming from carbs. I
am satisfied with day 1 carbohydrates being 44% and day 2 yielding 49% because even
though they both are under the DRI and TLC diet, the carbohydrate sources are from whole
grains, vegetables, and fruit that possess antioxidants and minerals that are beneficial for
fighting off free radicals/oxidative processes. Whole grains are a complex carb that have a
plethora of benefits, is nutrient dense and helps with feeling satiated. So, the more satiated
from whole grain carbs, the less consumption of refined carbohydrates that possess adverse
effects to health status. The DRI recommends that 20-35% of kcal coming from fat, 25-35%
from the TLC diet and my goal intake was 30%. When comparing both days, day 1 depicted
30% of kcal front fats which is the precise amount for goal intake, and within the range of the
DRI and TLC diet. Saturated fat however was slightly over the DRI and pt food goal, so
possibly modifying the menu plan and substituting the tbsp of butter for either a lower fat
content butter or removing it in general. Protein fell within the DRI but was 3-4% below the
pt food intake goal. The protein for both days is lower than what I expected, so possibly
increasing the portion sizes by 1oz will ensure that the goal intake is being met. I am
pleased that my omega-3 fell within the TLC diet since omega-3 does possess anti-
inflammatory processes as well as helps with regulating heart rhythm. Furthermore, omega-
3s have the capability of reducing hypertension, coronary heart disease, and lowering blood
pressure. Fiber intake surprisingly exceeded the DRI and pt food intake goal by a abundant
amount Fiber for day 1 was 54g and 49g for day 2 which spilled over the DRI of 38g per
day. High fiber diets are beneficial with lowering cholesterol but may display some adverse
effects in the GI tract. Recommendation for cholesterol by TLC is <200mg and day 1
consisted of almost being precise with a cholesterol level of 204mg, but day 2 consisted of
being 372mg. Although, cholesterol is high in the diet, dietary cholesterol has been
researched and it states that it doesn’t effect blood cholesterol levels, unless the patient has
genetic polymorphism; However, we can also stay in compliance with TLC guidelines by
removing the whole egg that was utilized or either suggesting egg whites to be used instead.
The electrolytes potassium and sodium were around the RDI. With the exception of
potassium being low on day 2 by 300mg and sodium being low on day 2 by 700mg was
probably caused by not allowing the patient to consume high processed foods. Day 1 was
high on potassium so this can possibly spill over to day 2 which will have more of a precise
intake. Sodium can be increased by possibly adding salt to the ground turkey or vegetables.
Calcium, magnesium and potassium are beneficial with regulating blood pressure because
these minerals are vasodilators. As previously stated, potassium was lower on day 2 but not
by much, calcium was over the RDI, and magnesium was under the RDI by a couple
hundred milligrams. To mitigate over consumption of calcium, we can add more whole
grains which consists of more magnesium in order to rectify the discrepancy.
 Vitamins such as vitamin D, E, A, and C were just about the RDI if not over, and vitamins
are essential in maintaining body processes such as collagen synthesis, regulating
hormones, or acting as antioxidants.

Nutrients Day 1 Day 2 DRI Pt food intake

goal
Calories 1,917kcal 1,976 2,000 2,000kcal
Carbohydrates 44% 49% 45-65% 50%
Fats 30% 27% 20-35% 30%
Protein 16% 17% 10-35% 20%
Saturated fat 12.7% 10% <10%kcal <7%;as low as
possible *TLC
diet*
Mono- 6.2g 7.8g No target 20%of kcal
unsaturated fat *TLC diet*
Polyunsaturated 3.3g 6.4g No target 10% of kcal
*TLC diet*
Omega-3 37% 0.8g 0.6-1.2g
Omega-6 16% 2.3g 5-10g
Fiber 54.1g 49.4g 38g
Cholesterol 204mg 372.5mg <200mg *TLC
diet*
Potassium 3623.8mg 3163.2mg 3,400mg
Calcium 1413.1mg 1177.7mg 1,000mg
Sodium 1567mg 808.0mg 1,500mg <1500mg *TLC
diet*
Iron 10.2mg 9.7mg 8mg
Vitamin D 303.4IU 345.9IU 15mcg
Vitamin E 6.7mg 10.3mg 15mg
Vitamin A 32282.0IU 8301.9IU 900mc
Vitamin C 164.7mg 256.1mg 90mg
Magnesium 316.4mg 168.6mg 400mg

Servings Day 1 Day 2 MyPlate
Vegetable 2 cups 2 ½ cups 2 ½ cups
 Fruit 3 ¾ cups 3 ½ cups 2 cups
Dairy 3 cups 3 cups 3 cups
Protein 3oz 4oz 5 ½ oz
Sodium 1567mg 808mg <2300
Saturated fat 12.7% 10% 22g a day;10%

Part E: Reflection

This project has taught me many things, with the budgeting portion of the project sticking out to me the
most. I did not anticipate how tedious and time-consuming the budget would be. Because I had a
budget, I was more inclined to find as many sales as possible to provide my plan with the proper amount
of nutrition and food without having to make any sacrifices or exchanges. Not only have a gained a new
skill in comparing and contrasting foods, but it has helped me realize how much time and effort it takes
to prepare a plan for a patient with comorbidity. It was interesting to watch how my original plan
formulated in my brain and then was translated onto the paper, considering the idea I had originally
completely changed once everything was being laid out on paper. It showed me that while we might
have an abundance of knowledge when we become a dietitian in the field, we also need to learn how to
utilize all of these pieces of the puzzle and correctly place them together to see a clear and concise
picture. It was interesting to see how much food you can put into a 2,000 calorie diet with low sodium; it
also makes me consider how easy it is to consume too much sodium with very little food depending on
the selection. This would be of high value to me as a dietitian as I have already been predisposed to the
process and will be better prepared when I experience it in the field. The meal plan, labs, and overall
project itself can show me as a dietitian what a patient needs and a detailed explanation of how I can
improve their quality of life. While I already knew that dietitians had a lot of work on their plate,
dietitians are required do construct these meal plans daily and this project was merely assigned to us
over the semester. This project provided a huge insight into what I will be seeing in the clinical field.






















 Appendices: