Robert is a 55-year-old truck driver with a long-standing history of tophaceous gout and several recurrent episodes of severe pain during the past 10 years. He has been taking allopurinol. His episodes worsen with beer and red meat consumption. Sometimes he tries taking NSAIDs without improvement. Medical examination revealed multiple tophi overlying the first and second metacarpophalangeal joints of his left hand and the interphalangeal joints of his right hand, wrist, elbow, both ankles and interphalangeal and metatarsophalangeal joints of the feet and heels. The affected joints are swollen, erythematous and exquisitely painful, with a limited range of motion related to pain. Robert has a history of hypertension and hyperlipidemia. He continues to gain weight.
Nutrition assessment Patient is a 55 year-old man with diagnosis of gout, hypertension and hyperlipidemia.
Anthropometric Data Ht 6´3” (1.90m) Wt 242 lb (110 kg) BMI 30 IBW 194 lb (88 kg) BP: 155/90 mm Hg
Biochemical data: Serum uric acid level is 10.2 mg/dL Lipid profile
• TC: 228 mg/dL
• TG: 160 mg/dL
• HDL-C: 39 mg/dL
• LDL-C: 136 mg/dL
• Non-HDL-C: 189 mg/dL
Food and Nutrition History
Due to his job, Robert is often away from home for extended periods of time, when he eats at truck stop diners, where he selects hamburgers, fried eggs with bacon and deep fried foods; he eats large quantities of chips and beef jerky as snacks. He drinks almost no water. On weekends, when Robert is at home, he enjoys drinking beer (8 to 10 12-oz cans) and making barbecues. Diet is high in red meat, processed foods and refined carbohydrates, and low in fiber and vitamins. EER: 2420 kcal (22 kcal/kg) and 110 g protein (1 g/kg BW)
Nutrition diagnostic statements
1. Obesity related to caloric intake higher to caloric expenditure as evidenced by elevated BMI. (NI-1.3)(NC-3.3)
2. Excessive alcohol and fat intake as evidenced from a diet history and flaring of gout symptoms. (NI- 4.3) (NI – 5.6.2)
Nutrition Interventions
Patient will include fruit and vegetables as frequently as possible in his diet, especially in substitution of high fat, high sugar snacks. Patient will reduce alcohol consumption and increase non-sweetened drinks. Education: Patient will be provided with guidelines for choosing meals and snacks with a low content of salt, processed sugars and saturated and trans fat. Goals: Patient will be able to identify sources of purines from list of foods and make food choices for a low purine daily intake. Patient will be physically active, taking 20-minute walks after dinner. A weight loss of 6 lbs is desired the first month.
Monitoring and Evaluation:
Follow up a month from date to evaluate goal achievement. Evaluate energy, water, alcohol, sugar, salt, fat and purine intake.