Solution Manual for Nutrition and Diet Therapy 12th

Edition Roth Wehrle 1305945821 9781305945821

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Instructor’s Manual to Accompany Nutrition & Diet Therapy,

12th Edition, by Ruth A. Roth and Kathy L. Wehrle

CHAPTER 5
LIPIDS (FATS)

Key Terms

cholesterol lecithin plaque

chylomicrons linoleic acid polyunsaturated fats
fatty acids linolenic acid satiety
glycerol lipids saturated fats
high-density lipoproteins lipoproteins trans-fatty acids (TFAs)
(HDLs) low-density lipoproteins triglycerides
hydrogenation (LDLs) very-low-density
hypercholesterolemia monounsaturated fats lipoproteins (VLDLs)
invisible fats omega-3 fatty acids visible fats

Objectives

After studying this chapter, you should be able to:

• State the functions of fats in the body

• Identify sources of dietary fats
• Explain common classifications of fats
• Describe disease conditions with which excessive use of fats is associated

Learning and Teaching Strategies

1. Evaluate the diet of a teenager, a middle-aged adult, and an elderly person to determine the
amount of cholesterol taken in over a 24-hour period. Compare the totals of each age group,

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Chapter 5 Lipids (Fats) 43

as well as each with the recommended dietary intake of cholesterol. Survey the subjects for
their understanding of the effects of excess cholesterol.

2. Bring a 1-pound block of meat fat to class. Initiate discussion of the correlation of the fat to
adipose tissue and dietary sources of the three different types of fat.

3. Have students evaluate the fat content of their favorite snack foods. Facilitate group learning
by having each student do an oral presentation with a poster depicting his or her favorite
snacks. Have them rank the snacks on the poster in order of fat content from lowest to
highest.

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44 Chapter 5 Lipids (Fats)

Additional Discussion Questions

Discussion Question 1

Discuss the various biochemical tests used to evaluate fats or fat consumption in the body.

Discussion Question 2

Using the 5-day food diary, have students calculate fat and cholesterol content.

Discussion Question 3

Fats metabolize to 9 calories per fat gram. Have students determine the caloric intake from fats
in their 5-day food diary.

Answers to Review Questions

1. d
2. a
3. c
4. d
5. a
6. b
7. c
8. d
9. b
10. a
11. c
12. a
13. d
14. a
15. b
16. a
17. d

CASE IN POINT—MURALI: FAMILY HISTORY AND ELEVATED CHOLESTEROL

Murali is from Sri Lanka. He moved to the United States when he was 19 years old. His family has
a history of heart disease and high cholesterol. Murali’s father and brother both died of heart
attacks in their 40s. Murali is now 52 years old. His wife Annika is worried about his health.
Annika has tried to be careful in preparing his meals. For many years, Murali’s cholesterol has
been in the high-normal range and he has not needed medication. He has recently landed a new
contract with a Fortune 500 company at work. He has been very busy with luncheons and dinner
meetings. He has been taking clients to many of the classy restaurants in town for four-course
meals that always include dessert. He has been working on this contract for several months. Due to
the added stress of this new lifestyle, he is rarely taking time to eat healthy. He also has resumed
his old habit of smoking. He is so busy that rarely has time for any exercise. Annika is worried and

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Chapter 5 Lipids (Fats) 45

convinces Murali to see his physician. His physician orders blood work that reveals a total
cholesterol of 428 mg/dL, an LDL of 263 mg/dL, and an HDL of 28 mg/dL. Due to his family
history his physician orders a cholesterol-lowering medication. However, he stresses to Murali that
this is no replacement for good nutrition and exercise. He refers Murali to a cardiac education class
for both nutrition and fitness information. He also refers Murali to a smoking cessation program.

ASSESSMENT
1. What data do you have about Murali?
a. Not paying attention to diet
b. Family history of heart disease
c. New stress in his life
d. Eating out frequently
e. Smokes

2. As a nurse, what conclusion can you draw from Murali’s lab results?
a. Murali is eating foods high in bad cholesterol.
b. He may also have elevated cholesterol related to family history.
c. He may not be getting much physical activity. His HDL is very low and would
normally be higher with routine exercise.

3. What do you need to know about his current eating habits? Could foods with unknown fat
content have a bearing on his current diet? How could a 24-hour food diary help?
a. You need to know what types of food Murali is consuming.
b. Murali is eating foods prepared in restaurants, so he may not know the total fat
content.
c. His food diary will help him identify the foods that are higher in fat and calories.

4. Should his health habits, like smoking and alcohol use, be of concern?
a. Smoking and excessive drinking add negatively to his health issues.

5. What is Murali doing that is healthy for his heart?

a. Seeking help from his physician and following the recommendations to exercise and
eat right
b. Taking the prescribed medication as directed

DIAGNOSIS
6. What is the cause of Murali’s imbalanced nutrition, more than body requirements?
a. Murali’s busy lifestyle makes it difficult to follow a specific diet.
b. Murali has a lack of knowledge about nutrition and is not making healthy choices.
c. Murali is not getting regular physical activity.

7. Complete this statement: Murali’s change of lifestyle is related to a new career and the
change in work hours and habits because of it.

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46 Chapter 5 Lipids (Fats)

PLAN/GOAL
8. What are two possible goals you have for Murali?
a. Implement his exercise regime at least five times a week for 30–45 minutes.
b. Keep a food diary and begin to look at the sources of high-fat and high-calorie
content in the foods he is consuming.
c. Enroll in a smoking cessation program.

IMPLEMENTATION
9. What topics do you need to cover related to dietary fats?
a. Cover saturated and unsaturated fats and why this is important
b. Cover the amount of cholesterol Murali is consuming as well as how that compares
to the recommended guidelines

10. Name three things Murali can do to help him recognize hidden fats in fast-food restaurants.
a. Ask how foods are prepared; identify key words that could indicate a higher fat
content
b. Request foods to be prepared with less fat and for condiments to be on the side so
Murali can use them more sparingly
c. Eliminate fried foods

11. Who else should be in class with Murali?

a. His wife

12. What agencies or resources could you provide to support Murali at home?
a. American Heart Association

13. How could the information on the American Heart Association website
(http://www.americanheart.org) be helpful to Murali?
a. Introduce information in a nonthreatening manner

EVALUATION/OUTCOME CRITERIA
14. What can the physician measure to determine the effectiveness of the plan?
a. Cholesterol levels
b. Murali’s weight
c. Murali’s BMI

15. What can Murali provide to demonstrate his compliance with the plan?
a. His food diary and exercise log

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Chapter 5 Lipids (Fats) 47

THINKING FURTHER
16. What is the worst consequence if Murali does not reduce his cholesterol?
a. Death

17. What does family history have to do with Murali’s results?

a. Family history plays a big part in how our bodies respond to lifestyle changes as
well as how much cholesterol our own bodies produce.

18. What are the challenges of maintaining a diet and exercise plan for life?
a. Boredom
b. Illness
c. Fatigue
d. Stressors
e. Busy schedule

RATE THIS PLATE

Murali attended the nutrition class to learn how to choose healthy foods while eating out. He
attended a dinner meeting with his clients and ordered the following meal. Rate this plate for
foods that contain large amounts of cholesterol and fat.

4 oz shrimp cocktail appetizer

2 cups chicken Caesar salad with 2 Tbsp light vinaigrette dressing
2 hot dinner rolls with creamy butter
1 slice of cheesecake with strawberries
20 oz iced tea

ANSWERS TO RATE THIS PLATE FOR MURALI

Shrimp is very high in fat, but low in cholesterol. The fat is not as detrimental in shrimp as
it is in prime cuts of beef or meat. The chicken Caesar salad is not high in fat or cholesterol.
The chicken does contain some cholesterol, but is considered a lean protein choice. The
dinner rolls are fine, but it is the butter that will add additional calories and fat. The
cheesecake is high in fat. Murali could ask for fresh fruit instead of eating a calorie- and
fat-laden dessert. The iced tea is a good choice.

CASE IN POINT—CECELIA: ELEVATED CHOLESTEROL AND TRANS FATS

Cecelia moved to New York City from Italy with her mother and father when she was a young
girl. Her parents opened an Italian bakery and Cecelia spent much of her time there growing up.
Her parents are now ready to hand the bakery over to Cecelia so they can retire. At 42 years old,
she is very excited about taking charge of the bakery. She has always enjoyed baking and has
learned so much through the years about running a business. Her parents recently had physicals
and they both had elevated cholesterol. They were concerned for Cecelia and asked her to see her
doctor and have her cholesterol tested as well. Cecelia has always been in pretty good health, but
decides this wouldn’t be a bad idea. When Cecelia sees her doctor, he informs her that she, too,

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48 Chapter 5 Lipids (Fats)

has elevated cholesterol. Her total cholesterol is 282. Her LDL is 186 and her HDL is 27. He
discusses with her the importance of weight loss. She is currently 5-ft 4-in tall and 173 lb. He
also refers her to a dietitian for an assessment of her diet. The dietitian discusses with her the
foods that can affect her cholesterol level. In addition to saturated fats, she mentions trans fats.
Cecelia has heard this term before, but never understood its meaning. The dietitian explains that
trans fats are created from hydrogenating (solidifying) vegetable oils. The dietitian tells Cecelia
that trans fats are usually present in baked goods. She also discusses with Cecelia that New York
City passed a law banning trans fats in restaurants. She educates Cecelia on the importance of
not just eliminating the trans fats from her diet, but making sure that her parents adjusted the
recipes for their bakery items to remove all trans fats as well.

ASSESSMENT
1. Why were Cecelia’s parents concerned about her cholesterol levels?
a. When Cecelia’s parents learned they both had elevated cholesterol, they were
concerned that she may also have elevated cholesterol due to genetics.

2. Cecelia’s doctor shares with her the results of her lipid panel. What are the recommendations
for total cholesterol, LDL, and HDL levels for Cecelia?
a. Total cholesterol less than 200
b. LDL less than 100
c. HDL greater than 40

3. What is Cecelia’s ideal body weight range? Is her current weight within her ideal range?
a. 108–132 pounds
b. Her current body weight of 173 pounds is above her ideal range.

4. What is trans fat and what are the impacts of trans fats on the body?
a. Trans fats are produced when hydrogen atoms are added to unsaturated fats to
produce a semisolid product such as margarine.
b. They are dangerous and will cause elevations in LDL and total cholesterol.

DIAGNOSIS
5. Write a nursing diagnosis for Cecelia.
a. Nursing Diagnosis: Risk for ineffective therapeutic regimen management, risk
factors include knowledge deficit of nutritional requirements to decrease LDL and
total cholesterol.

PLAN/GOAL
6. Cecilia should be educated on what foods will elevate her cholesterol. What are some of
these foods?
a. Saturated fats such as the fats in any animal source products such as meats, milk,
butter, and egg yolks.
b. Palm oil and coconut/coconut oil

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Chapter 5 Lipids (Fats) 49

7. Cecilia should understand that cholesterol comes not only from foods but also from what
other source?
a. The body. The liver manufactures 800–1,000 mg of cholesterol daily.

8. What goals would you set for Cecelia?

a. Decrease the fat in her diet to no more than 30% and the saturated fats to less than
10% of total calories.
b. Reduce consumption of high-fat meat.
c. Begin consuming low-fat and fat-free dairy products.

IMPLEMENTATION
9. What is important for Cecelia to understand about trans fats?
a. Trans fats can be just as harmful as saturated fats in cholesterol control.
b. How to read food labels to find any trans fats the food contains.
c. She also needs to know the laws in New York City regarding trans fats in
restaurants and bakeries, so that she can run a successful business.

10. How often should Cecelia have her cholesterol assessed?

a. Every 6 months. If her doctor puts her on cholesterol medication, her liver function
needs to be assessed as well.

EVALUATION/OUTCOME CRITERIA
11. How will Cecelia and her doctor know if she has been successful with her goals?
a. Total cholesterol will be under 200
b. LDL under 100
c. HDL over 40
d. Adhering to her low-fat, low-cholesterol diet
e. Weight loss

THINKING FURTHER
12. Search guidelines on the National Cholesterol Education Program website
(http://www.nhlbi.nih.gov) for cholesterol levels and take the 10-year risk assessment at the
bottom of the page. Are you at risk for a cardiac event in the next 10 years? Are there
changes in your diet that could help to decrease your risk?

RATE THIS PLATE

Cecelia would like to modify the following recipe for dark chocolate cake in order to make it
healthier for her family and customers. What ingredient could be adjusted to make it more
healthful?

2 cups boiling water

1 cup unsweetened cocoa powder

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50 Chapter 5 Lipids (Fats)

2 ¾ cups all-purpose flour

2 teaspoons baking soda
½ teaspoon baking powder
½ teaspoon salt
1 cup butter, softened
2 ¼ cups white sugar
4 eggs
1 ½ teaspoons vanilla extract

ANSWERS TO RATE THIS PLATE FOR CECELIA

One cup of applesauce can be used to replace the 1 cup of softened butter (which is a
saturated fat) to yield a tasty product with less fat. Mashed bananas or ½ cup of fruit puree
may also be used to replace the butter. Canola oil can replace butter in many baking
recipes such as pie crusts, cakes, and muffins, yielding a moister and softer product with no
cholesterol and less saturated fat. She could experiment with ground flax seeds and
almond flour, in place of the all-purpose flour to increase fiber content.

Resource Guide

1. http://health.gov

The U.S. Department of Agriculture and the Department of Health and Human Services
publish jointly the Dietary Guidelines for Americans 2015.

2. http://www.nutrition.gov

This is a U.S. Department of Agriculture website, Food and Nutrition Information Center, a
leader in providing food and human nutrition information since 1971.

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