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status.
2. Discuss poor nutritional habits and relate them to two of the ten leading causes of death in the United States.
Answer: Students can select any of the following chronic diseases plus accidents: Heart disease, cancer, stroke,
chronic lung disease, accidents, diabetes mellitus, Alzheimer’s disease, pneumonia and influenza, kidney
diseases, and blood diseases. While many will pick the major disease states, some will select areas where a
family member has suffered, which can add to the flavor of the learning experience and discussion, if the
instructor chooses to provide time for discussion.
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Pneumonia and Influenza: Both of these significant disease states do involve a compromised immune system.
Many individuals that succumb to either of both of these diseases were generally immune compromised prior to
their acquiring the disease. That being said, their nutritional status was also in a compromised state. A healthy
body with a healthy immune system is less susceptible to infectious disease.
Kidney Disease: There are many types of kidney diseases; however, one co-morbidity of type 2 diabetes is
chronic renal disease. In this regard, obesity may be the link to this chronic disease.
Blood Infections: As noted above, a compromised immune system will result from poor nutritional status and
can lead to blood infections. Blood infections are very serious and demonstrate the significance of the
breakdown of the individual’s immune system.
3. Describe your risk for hypertension and cardiovascular disease, and explain how you might alter your risk.
Answer: This is a chance for the student to look at their health status and risk for a chronic disease. Students
should be expected to utilize Tables 18-4, 18-5 (p. 612), 18-6 (p. 615), and 18–7 (p. 619) and the How To’s on
4. Discuss the comorbidities of type 2 diabetes, and the role of the RD in preventing these health issues.
Answer: The chronic complications or comorbidities of type 2 diabetes are many. Due to the elevated blood
glucose levels in the body of a diabetic, both peripheral neuropathy, poor circulation, and resulting skin
infections are not uncommon. It is very important for individuals with diabetes to pay close attention to the
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flexible, and happy.
5. Review your health status and that of your family. Assess your health risk for cancer, given your medical
history. Then review your dietary habits. What changes do you need to make to optimize your health status and
help prevent cancer in your lifetime?
Answer: Again, the student is gaining a lifetime of education in this exercise by learning about themselves and
their family histories. They will also learn that multiple assessments gain more knowledge about a situation.
IM Worksheet Answer Key
Worksheet 18-1: Therapeutic Diets
Clinical Condition
Type of Diet
Indication
Adequate or
Transitional?
HIV/AIDS
RM & S
RM – neutropenic diet; S – improve
nutrient density
Adequate
DASH diet
Adequate
Adequate
transitional
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Worksheet 18-3: Fats Facts and Obesity Trends (Internet Exercise)
Canadian Information8
18.1 Leading Causes of Death in Canada
In 2004, the leading causes of death in Canadians of all ages and sexes differed slightly in rank order from those in
the United States (Table 18.1). Causes noted with an asterisk have relationships with diet.
Table 18.1 Leading Causes, Numbers, and Percentages of Death (2004) in Canada and United States9
Canada
United States
Cause of Death
Number
of Deaths
Percentage
of Deaths
Cause of Death
Number
of Deaths
Percentage
of Deaths
All causes of death
226,584
100.0
All causes of death
2,397,615
100.0
1. *Cancers
66,947
29.5
1. *Heart disease
652,486
27.2
2. *Heart disease
52,000
22.9
2. *Cancers
553,888
23.1
3. *Stroke
14,626
3. *Stroke
5. Accidents
5. Accidents
112,012
6. *Diabetes mellitus
6. *Diabetes mellitus
73,138
9. Suicide
9. Kidney disease
42,480
10. Kidney disease
10. Blood infections
33,373
All other causes
47,742
21.1
All other causes
532,548
22.2
As part of their Centre for Chronic Disease Prevention and Control, the Public Health Agency of Canada (PHAC)
has an interactive database, the Chronic Disease Infobase,10 which can be used to customize several output options
for data on common chronic diseases in Canada. Comparisons of data for a specific chronic disease can be made
across multiple regions of the country, morbidity and mortality time trends can be generated, and thematic maps can
be created; these are some of the output options.
Renal failure
18.2 Canadian Resources on Cancer
The Canadian Cancer Society (CCS) offers reliable online nutrition and lifestyle information and resources for the
prevention of cancer and for people living with cancer. The Eat well, be active: What you can do booklet provides
guidance for choosing a healthy diet and being active. This booklet and many CCS resources are provided in
18.3 Canadian Recommendations for Cardiovascular Disease
Under leadership of the Canadian Stroke Network and Heart and Stroke Foundation of Canada, Canadian Best
Practice Recommendations for Stroke Care: 2008 was published in the Canadian Medical Association Journal.12
This document outlines 28 evidence-based best practices for stroke prevention, care, rehabilitation, and
reintegration. The Heart and Stroke Foundation of Canada web site offers a confidential online tool, the Heart &
Stroke Blood Pressure Action Plan, that provides users with a personalized plan of action to improve lifestyle habits
as well as a variety of other resources to help reduce one’s risk for heart attack and stroke.13
PHAC released a report titled, Tracking Heart Disease and Stroke in Canada, 2009,14 as part of its Heart Health
Strategy.15 This report provides information on major risk factors for cardiovascular diseases (heart disease and
stroke), social and economic impacts, prevention, and current rates across the country. There has been a dramatic
decline in mortality from cardiovascular diseases from the late 1960s to 2004. However, as the population ages, and
obesity and diabetes rates continue to rise, there may be a reversal of this downward trend.14 Using the Chronic
Disease Infobase, PHAC provides current mortality statistics for cardiovascular disease across Canada.10
Customizable and downloadable maps and charts are available for cardiovascular mortality data, and are useful for
bringing national and provincial data into a classroom discussion on heart disease.
When Canadian students are using the same Framingham Risk Score method for assessing their ten-year risk of
coronary artery disease16 as found in, How to Assess Your Risk of Heart Disease, on page 616 of the textbook, they
will need to convert the units from mg/dL to mmol/L. Total cholesterol (TC) and high-density lipoprotein
cholesterol (HDL-C) values in mmol/L are listed in Tables 18.2 and 18.3. To convert cholesterol levels in mmol/L to
mg/dL, multiply mmol/L by 39.
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Table 18.2 Total Cholesterol Values for Assessing 10-year Risk of Coronary Artery Disease in Canada16
Risk Factors
Total
Cholesterol
(mmol/L)
Age 20-39 years
Age 40–49
years
Age 50-59 years
Age 60-69 years
Age 70-79 years
Men
Women
Men
Women
Men
Women
Men
Women
Men
Women
<4.14
0
0
0
0
0
0
0
0
0
0
Table 18.3 HDL Cholesterol Values for Assessing 10-year Risk of Coronary Artery Disease in Canada16
Risk Factors
HDL-C (mmol/L)
Men
Women
>1.55
1.30-1.54
0
0
1.04-1.29
1
1
<1.04
2
2
The Canadian Medical Association’s current position statement for the diagnosis and treatment of dyslipidemia and
prevention of cardiovascular disease17 suggests using more vigorous goals than had previously been recommended
for the management of dyslipidemia. Major changes found in the 2006 update include: (1) a lower low-density
lipoprotein cholesterol (LDL-C) treatment target (lower than 2.0 mmol/L) for high-risk patients, (2) a slightly higher
Table 18.4. 2003 Risk categories and target lipid levels16
Target level
Risk category
LDL-C level,
mmol/L
Total cholesterol:
HDL-C ratio
High
(10-year risk of coronary artery disease ≥ 20%, or history of
< 2.5 and
< 4.0
4.15-5.19
4
4
3
3
2
2
1
1
0
1
5.20-6.19
7
8
5
6
3
4
1
2
0
1
6.20-7.20
9
6
8
4
5
2
3
1
2
>7.21
8
5
7
3
4
1
2
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Table 18.5. 2006 Risk categories and treatment recommendations17
Risk Level
10-year
CAD risk
Recommendations
Grade, level of
evidence
High
20%
Treatment targets:
Primary: LDL-C <2.0 mmol/L
Secondary: TC/HDL-C <4.0
Class I, level A
Class IIa, level A
18.4 Canadian Recommendations for Hypertension
The Canadian Hypertension Society (CHS), Canadian Hypertension Education Program (CHEP), and Blood
Pressure Canada (BPC) are three key organizations that support hypertension awareness, prevention, and control in
CHS provides coordination of research on hypertension in Canada, a forum for presentation of research, and, among
other roles, dissemination of research to health professionals and the public.
CHEP annually updates recommendations for the prevention of hypertension and improving hypertension
management in Canada. With each yearly update, there is a focus on one aspect of managing hypertension. In 2007,
the focus was on the need to assess blood pressure in all Canadian adults and to regularly assess blood pressure in
those with high normal values; as well, the recommendations support reducing dietary sodium intake to help prevent
Depending on a patient’s global cardiovascular risk and recognizing factors other than hypertension, CHEP
recommends target blood pressure values be <140 SBP/90 DBP mmHg, and <130/80 mmHg for those with target
organ damage, diabetes mellitus, or chronic kidney disease.21 CHEP also recommends consumption of a Dietary
Approaches to Stop Hypertension (DASH) diet,22 a well-balanced diet that emphasizes low saturated fat and dietary
18 McAlister FA, Wooltorton E, & Campbell NRC for The Canadian Hypertension Education Program. 2005. The
Canadian Hypertension Education Program (CHEP) recommendations: launching a new series Canadian Medical
Association Journal, 173(5):508-509.
The Heart and Stroke Foundation of Canada (HSFC) offers a confidential online tool, the Blood Pressure Action
Plan, that provides a personalized assessment of one’s risk profile for hypertension.24 Users can obtain a
personalized action plan tailored to their risk profile, be informed of lifestyle changes that reduce risk for and
promote control of hypertension, learn how to properly monitor their blood pressure, and print reports to take to
their healthcare provider. In 2009, HSFC released a position statement on sodium titled, Dietary Sodium, Heart
Disease and Stroke.25 This position statement provides current facts, recommendations, and background information
on sodium, stroke, and heart disease.
18.5 Canadian Resources for Diabetes
Prevention of diabetes is a public health priority in Canada. In 2005-2006, more than 1.9 million Canadians, one in
17 people, had been diagnosed with diabetes, with almost 200,000 diagnosed in 2005-2006.26 In 1999, the Canadian
Diabetes Strategy (CDS) was formed to establish effective diabetes prevention and control strategies for the entire
population of Canada. This strategy continues today under leadership from PHAC, and has four components:
With funding provided by CDS, the Canadian Diabetes Association (CDA) collaborated with Dietitians of Canada
to create Healthy Eating is in Store for You: a nutrition labelling tool that helps teach consumers how to interpret
and apply the information provided on food labels to make better food choices.27
Beyond the Basics: Meal Planning for Diabetes Prevention and Management is a meal planning guide developed by
CDA in consultation with health care professionals representing a wide variety of expertise.28 Food lists from
Beyond the Basics… are found in Appendix I of the textbook. This meal planning guide is based on scientific
evidence found in the recently updated CDA 2008 Clinical Practice Guidelines for the Prevention and Management
of Diabetes in Canada, which calls for an aggressive approach to prevent, screen, diagnose, and manage diabetes in
Canada.29 Management of complications from diabetes as they interrelate with other chronic diseases is addressed in
the guidelines. A review of guidelines that are specifically focused on the management of cardiovascular disease in
people living with diabetes titled, Management of Cardiovascular Disease in Patients with Diabetes: the 2008
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Canadian Diabetes Association Guidelines was published in the Canadian Medical Association Journal in
September 2008.30
Highlight 18: Complementary and Alternative Medicines
The practice of health professionals is regulated on a provincial level, often through colleges of the various health
disciplines; thus the regulation of professional groups varies from province to province. Greater regulation of
mainstream and alternative health care practitioners makes them more accountable to the public. A list of regulatory
396
Worksheet 18-1: Therapeutic Diets
For each of the following clinical conditions, indicate the type of diet that is required (AC for altered consistency,
RM for restricted/modified, and/or S for supplemented), and whether it is nutritionally adequate or deemed a
transitional diet (a diet that is not considered to be nutritionally adequate but can be used for a limited amount of
time).
Clinical Condition
Type of Diet
Indication
Adequate1 or
Transitional2?
HIV/AIDS
Cancer
Postoperative surgical
client
Child with nausea &
vomiting
Renal failure
Coronary artery disease
Hypertension
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Worksheet 18-2: Chapter 18 Crossword Puzzle
Across:
Down:
1. white blood cells that have the ability to ingest and
destroy foreign substances
5. large proteins of the blood and body fluids,
produced by the immune system in response to the
invasion of the body by foreign molecules
6. factors that favor the development of cancer after it
2. the full complement of genetic material (DNA) in
the chromosomes of a cell
3. factors that cause mutations that give rise to cancer
4. white blood cells that participate in acquired
immunity; B-cells and T-cells
5. substances that elicit the formation of antibodies or
1 2 3
4 5
6
7 8
9
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Worksheet 18-3: Fats Facts and Obesity Trends (Internet Exercise)
Fad Diet and explore its three steps. Review the information in these 2 categories and then answer the following
questions. Do NOT close the window until you are done answering the questions.
1. Sat and Trans are considered to be the Better Fats Sisters.
a. True
b. False
2. What are the major dietary fats? Select ALL that apply.
3. As long as foods have 0 trans fat they are considered to be healthy.
4. One of the most effective ways to lose weight is to use planning in determining your dietary pattern.
5. Using the 75% solution can help you start to lose weight.
a. True
b. False
6. Obesity-related health care costs in 2005 totaled an estimated $117 billion.
7. Which of the following are considered to be health consequences of obesity?
8. According to the map for the year 2007, in the state of Florida the percentage of adults who are obese falls
between 20% and 24%.
a. True
b. False
9. According to the map for the year 2007, the highest percentages of obese adults were found in Tennessee,
10. According to the map for the year 2007, Georgia had the lowest percentage of obese adults.
a. True
b. False