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Case Study 1: Genetics and Hyperlipidemia

Last updated on 2021-08-24T03:01:09 by




Hannah is a 30-year-old single mother with two young children. She is of Chinese descent and moved to the United Kingdom 6 years ago; she has a good level of English. Recently, her mother suffered a heart attack, which prompted Hannah’s first visit to the general practitioner (GP). Meanwhile, Hannah performed a predictive genetic test independently through an online company, which showed an increased risk of developing cardiovascular disease (CVD); she has the ?4 variant of the APOE gene. The company has recommended a daily supplement as well as dietary changes. Blood tests showed raised blood lipids and her GP referred Hannah to a dietitian for lifestyle management. Hannah is very concerned and anxious about her health.
Weight 67.5 kg (stable for past year)
Height 1.65 m
Waist circumference 83 cm
Fasting glucose 5.2 mmol/L
Fasting lipids
Total cholesterol (TC) 6.9 mmol/L
Low density lipoproteins (LDL) cholesterol 5.4 mmol/L
High density lipoproteins (HDL) cholesterol 1.5 mmol/L
Triglycerides (TG) 2.2 mmol/L
Liver function tests
Albumin 36 g/L
Protein 82 g/L
Total bilirubin 5 ?mol/L
Gamma glutamyl transpeptidase (GGT) 60 U/L
Alkaline phosphatase (ALP) 160 U/L
Alanine aminotransferase (ALT) 60 U/L
Aspartate aminotransferase (AST) 40 U/L
Clinical and Dietary 
Past medical history – none
Medication/supplementation – none
Blood pressure (BP) 145/80 mmHg
Diet history
Chinese rice porridge made with soya milk (200 g)
Chinese bun (plain wheat flour) (40 g)
Pickled vegetables (75 g)
Ryvita crackers (2 × 20 g)
Kaya (coconut jam) (15 g)
Fruit juice (190 mL)
Lunch (at local café)
Meat pie (150 g) or pasty (145 g) or battered fish
(170 g)
Chips (200 g)
Strawberry milk shake (300 mL)
Afternoon snack
Biscuits (e.g. oat based or shortbread) (3 × 13 g) or
cake, for example, chocolate/cream éclair (65 g) or
cake slice (35 g)
Dinner – home cooked
White rice (180 g)
Stir-fry (may be vegetables/ meat/ combination), uses
oyster sauce and Chinese spices (360 g)
Soup (mainly stock-based with tomatoes and egg) 1
bowl (180 g)
Fruit (e.g. apple) – 1 piece (112 g)
Ice cream (95 g)
Evening snack
Chocolate biscuits (2 × 18 g)
Crisps (40 g)
Chinese cake (2 × 40 g)
Behaviour and Social Life
Chinese culture influences her cooking, shopping and food beliefs Her mother lives with her and helps in caring for her children. She attends Yum Cha once a week with her family. This is a popular Chinese style of eating brunch or morning/afternoon tea, which is composed of various small dishes of foods (similar to tapas or mezze) Yoga 3 times per week.
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  • What other potential risk factors or characteristics should you clarify in the assessment?
  • Describe the dietetic intervention ?
Credit: Judy Lawrence, Pauline Douglas, Joan Gandy
By NutriSoft Team
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