NTR 5101: Macronutrients New York Chiropractic College Case Study # 3
Directions: Please answer the questions below which pertain to the case study. When answering the questions, please use peer-‐ reviewed references. There is no page limit but please be concise. Quality is more important than quantity.
C.S. is a 45-‐year-‐ old Hispanic man with a 10-‐year history of type 2 diabetes. He has glycated hemoglobin of 7.0% and a blood pressure of 130/80 mmHg, treated with an angiotensin-‐ converting enzyme inhibitor for the past 2 years. He has stable background retinopathy and is a nonsmoker. His BMI has been 30 (height 5′10″, weight 210 lb) for the past year. However, lately, he has put himself on the latest high-‐ protein diet (i.e., the Atkins diet).
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His weight has dropped by 10 lb, his fasting serum triglyceride level has fallen from 185 to 130 mg/dl, and his blood pressure has decreased to 120/78 mmHg. His LDL cholesterol has remained stable at 102 mg/dl on a statin. His serum creatinine is 0.9 mg/dl, and his 24-‐ hour urine shows a significant increase in microalbuminuria from 100 mg/24 hours last year to the current 200 mg/24 hours. He has stage 1 chronic kidney disease indicating kidney damage, with a normal glomerular filtration rate (GFR) of 98 ml/min/1.73 m2.
1. Would the weight reduction, blood pressure, and lipid-‐ lowering accomplished by this high-‐protein, low-‐ carbohydrate diet be an acceptable choice for a patient who is at significant risk of cardiovascular disease?
2. What are the recommendations of the American Heart Association (AHA), the National Kidney Foundation (NKF), the National Academy of Sciences, and the American Diabetes Association (ADA) regarding this type of diet for diabetes and/or weight loss?
3. What has research revealed about appropriate levels of macronutrients for patients such as C.S.?
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