Nutritional Assessment and Diet Plan for an Overweight Client with Coronary Artery

Disease

Introduction
Nutritional assessment is an essential component of medical practice, particularly for patients
with chronic conditions such as coronary artery disease (CAD). While body mass index
(BMI) and other traditional techniques provide a rapid evaluation, they might not capture
subtleties in body composition. An increasingly useful technique is bioelectrical impedance
analysis (BIA), which offers information on phase angle (PA), body impedance, fat mass
(FM) and fat-free mass (FFM) (Qin et al, 2021). In particular, PA is known to be a measure
of nutritional status; lower readings are thought to indicate malnutrition. Furthermore, total
body water (TBW), which indicates hydration status and is essential for controlling CAD and
other disorders, may be evaluated using BIA (Popiolek-Kalisz & Blaszczak, 2023). BIA
stands out as a thorough approach for nutritional assessment in CAD patients, providing
insights beyond BMI alone, given the complex effects of malnutrition on disease progression
and treatment success.
Another facet because of which the nutritional assessment is crucial is the incidence of a high
rate of malnutrition in hospitalized cardiovascular patients i.e. 20–30% cases out of the major
admissions (Boban et al., 2019). Longer hospital stays, greater rates of readmissions and
hospitalizations, a higher frequency of treatment-related infections and complications, and
higher death rates are all linked to malnutrition. It is crucial to recognize and manage
nutritional risk in cardiovascular patients in order to decrease its incidence rate and improve
quality of life of such patients (Arikawa et al., 2021).
The European Society for Enteral and Parenteral Nutrition (ESPEN) created the Nutritional
Risk Screening tool (NRS-2002), which is extensively used in hospital environments to
identify malnutrition (Kondrup et al., 2003). A score of three or above indicates greater
nutritional risk. Points are awarded for age over 70, accidental weight loss, and the severity of
the condition (Rasmussen et al., 2010). Additional screening instruments like the Subjective
Global Assessment (SGA) and the Malnutrition Universal Screening Tool (MUST) are also
accessible. Body mass index and the waist-to-hip ratio are two popular anthropometric
techniques that have a strong connection to clinical goals (Boban et al., 2014). Skinfold
calipers offer a quick and precise way to measure body composition. More accurate
techniques, such as dual-energy X-ray absorptiometry (DEXA) scans, provide comprehensive
data on the distribution of adipose tissue and lean body mass (González-Torres et al., 2023).
Together, these implements create a thorough method for evaluating nutritional status in
clinical settings.
Diet is an integral part of the treatment of cardiovascular diseases are a major worldwide
health problem. Dietary hazards have a major role in the development and prevention of
CVD. Current developments in nutrition research place more emphasis on examining whole
dietary patterns than on examining specific nutrients or foods. Certain dietary patterns
increase the risk of CAD where saturated fats are the part of the diet while others, having a
balance of major nutrients, reduce it. Therefore, precise diet quality evaluation and
improvement based on thorough pattern analysis are essential to the management of CAD
(Kohli et al., 2022).
Main Findings
A nutritional assessment is necessary for a holistic approach to managing health issues,
including CAD. This evaluation contributes to our understanding of the connection between
diet control, body composition, and nutrition (Boban et al., 2019). For the prevention and
treatment of CAD, it is essential to keep a nutritionally balanced diet, reduce high-fat and salt
intake, and increase fiber intake (NIH, 2021). This method can enhance the client's quality of
life while delaying the course of the illness (de Oliveira Laterza Ribeiro et al., 2023).
Comprehending the fundamental hazards linked to CAD is crucial for tailoring the dietary
suggestions. Obesity, high blood pressure, raised cholesterol, and the development of type II
diabetes mellitus are among the major factors that contribute to the initiation and progression
of CAD. Tobacco use and unhealthy eating patterns also make the problem worse (Tutor et
al., 2022). Therefore, to properly address the intricacies of CAD, a comprehensive nutritional
evaluation looks into the individual's daily eating habits, living environment, and general
lifestyle.
A key component of the evaluation is body composition, which includes measurements like
body fat percentage, waist circumference, and body mass index (BMI). These measures are
important markers of health issues associated with CAD and provide insightful information
about how body fat is distributed. Furthermore, knowing how these data affect the client's
general health offers a thorough basis for creating a customized diet that not only addresses
the unique needs of CAD but also enhances general wellbeing.
The findings from the evaluation of our 45-year-old overweight patient with a diagnosis of
coronary artery disease (CAD) reveal a significant correlation between health and nutrition.
First, the patient's body composition shows a high BMI of 26.4, signifying that they fall into
the overweight category. Furthermore, a 95 cm waist circumference indicates abdominal
obesity, which is a recognized risk factor for cardiovascular disease. These results are
consistent with previous studies showing a link between obesity and CAD, underscoring the
significance of helping CAD patients maintain their weight (Kozieł et al., 2021).
In terms of nutritional details, the patient's meal plan (Annex I) follows the guidelines of the
nutritional Approaches to Stop Hypertension (DASH) diet (Heart and Stroke Foundation of
Canada, n.d.), which is intended to reduce cardiovascular disease risk factors including
dyslipidemia and high blood pressure. While lowering salt, cholesterol, and saturated fats, the
DASH diet promotes the intake of whole grains, fruits, vegetables, lean meats, and low-fat
dairy products. It has been demonstrated that following this food pattern can lower the risk of
coronary heart disease and improve blood lipid profiles (Heart and Stroke Foundation of
Canada, n.d.).
The patient's diet plan underwent nutritional analysis, which provides various important
insights. The energy intake seems to be in line with the objective of maintaining body weight
in order to lessen the burden on the cardiovascular system, which is weight maintenance. A
balanced approach to nutrition is reflected in the distribution of macronutrients, which
includes reasonable amounts of fat, protein, and carbs. Notably, the meal plan includes
enough fiber, which is important for maintaining gastrointestinal health, increasing satiety,
and controlling blood sugar levels. These results imply that the patient follows dietary
recommendations for the treatment of coronary artery disease (Soltani et al., 2020)).

In addition, the patient's diet is full of vitamins that are vital for heart health. It offers
substantial levels of minerals and vitamins, such as potassium, magnesium, folate, and
vitamin C, all of which are essential for controlling blood pressure, promoting heart health,
and lowering inflammation. The diet plan also has a low cholesterol and saturated fat content,
which improves lipid profiles and lowers the risk of cardiovascular disease. These
micronutrient profiles highlight the significance of a nutrient-rich diet in controlling the
illness and are in line with guidelines for individuals with CAD (Yalcin, Ozsoy and Karabag,
2020).

Discussion and Implications

According to the results of the evaluation of the patient's dietary strategy, they now appear to
be in good compliance with guidelines for the treatment of coronary artery disease (CAD).
Their meal plan incorporates the DASH diet concepts since they have a thorough grasp of
how dietary changes may address cardiovascular risk factors. For example, although the
present meal plan promotes whole foods and nutrient-dense options, it could be advantageous
to further lower salt intake because high sodium intake might worsen hypertension, a
prevalent comorbidity in people with coronary artery disease. As a result, cutting less on salt
in recipes or switching to low-sodium substitutes can help lower blood pressure and enhance
cardiovascular health.

Recognizing the potential advantages and any potential drawbacks is crucial when assessing
the long-term effects of adhering to the DASH diet plan. Over time, following this eating
pattern can result in notable enhancements to lipid profiles, blood pressure regulation, and
general cardiovascular health. The patient can lessen the risk of unfavorable cardiovascular
events and slow the evolution of coronary artery disease by keeping a balanced diet and
reaching weight stability (Campos et al., 2019). However, because dietary habits are strongly
established and may need continual assistance and supervision from healthcare experts to
maintain, long-term sustainability of dietary modifications may provide issues.

Although dietary treatments are essential for controlling CAD, it's critical to recognize that
they are only one facet of a whole treatment plan. To maximize their cardiovascular health,
the patient could benefit from extra interventions including medication management, stress-
reduction strategies, and frequent exercise. Referrals to other medical specialists, including
physiotherapists or general practitioners, could be required to meet a patient's unique medical
needs and offer them with comprehensive treatment.

Notwithstanding the encouraging data that suggests the DASH diet is effective in treating
CAD, it is crucial to assess the literature thoroughly and take into account any contradicting
findings or limitations. Even though a large number of studies have shown how the DASH
diet might improve cardiovascular outcomes, some may have limitations or contradicting
results depending on the size of the sample, length of the study, or demographics of the
participants. As a result, to improve patient outcomes in the management of CAD, further
research and evidence-based practice are crucial.

Conclusion

In summary, the evaluation of the CAD patient demonstrated a well-aligned dietary strategy,
highlighting the DASH diet's tenets to successfully manage cardiovascular risk factors. The
patient's meal plan, which included a balanced distribution of macronutrients and an
appropriate intake of vital vitamins and minerals, showed that she understood the value of
whole foods and nutrient-rich selections in supporting heart health. All things considered, the
results indicate that the patient's present diet plan has potential for slowing down the
advancement of CAD and enhancing long-term cardiovascular outcomes.

The patient's therapy should then rationally proceed to continuous monitoring and
improvement of dietary interventions, taking into account areas that might be improved, such
lowering salt intake, and guaranteeing long-term adherence to the DASH diet guidelines. The
patient's cardiovascular health can also be further optimized by combining regular physical
exercise and treating other cardiovascular risk factors with holistic care approaches, such as
medication management and stress reduction strategies. To offer complete treatment and
support catered to each patient's unique requirements, collaboration is vital amongst
healthcare providers, including general practitioners, nutritionists, and physiotherapists.
Healthcare professionals can improve the patient's overall quality of life and lessen the long-
term burden of issues connected to CAD by continuously assessing and improving the
patient's dietary and lifestyle changes.
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Annex I