Question

Steve is a 39-year-old male who has been HIV positive for 6 years. His waistline is expanding, and he blames that for his recent onset of heartburn. Based on a physical examination and insulin resistance, his doctor diagnosed lipodystrophy syndrome. Steve is 6 ft tall and weighs 190 pounds. His weight has been stable for the last several years, although he “feels fatter”. He is on ART but is thinking of discontinuing the medication because of the change in his shape. He is willing to exercise but wants maximum benefit from minimum effort. He is also willing to change his eating habits but relies heavily on eating out. See chart for Steve’s typical day intake:

Breakfast
Fast food egg, bacon and cheese sandwich on English muffin
Hash browns
Large black coffee

lunch
Double hamburger
French fries
Cola

dinner
Grilled steak
Baked potato with sour cream
water

snack
Chips from vending machine
Question
2. How does Steve’s weight impact heartburn and insulin resistance? Reference s in APA format

3. How does his usual intake impact lipodystrophy, insulin resistance, and heartburn? Reference s in APA format

4.What are Steve’s nutrition related problems? What nutrition therapy recommendations would you make?  Reference s in APA format

5. What would you tell Steve about exercise? Reference s in APA format

6. What criteria would you monitor to evaluate effectivenesse of nutrition therapy?
Reference s in APA format

Steve is a 39-year-old male who has been HIV positive for 6 years. His waistline is expanding, and he blames that for his recent onset of heartburn. Based on a physical examination and insulin resistance, his doctor diagnosed lipodystrophy syndrome. Steve is 6 ft tall and weighs 190 pounds. His weight has been stable for the last several years, although he “feels fatter”. He is on ART but is thinking of discontinuing the medication because of the change in his shape. He is willing to exercise but wants maximum benefit from minimum effort. He is also willing to change his eating habits but relies heavily on eating out. See chart for Steve’s typical day intake:
Breakfast
Lunch
Dinner
snacks
Fast food egg, bacon and cheese sandwich on English muffin
Hash browns
Large black coffee
Double hamburger
French fries
Cola
Grilled steak
Baked potato with sour cream
water
Chips from vending machine
Questions:
Evaluate Steve’s current weight. Would you recommend weight loss?
How does Steve’s weight impact heartburn and insulin resistance?
How does his usual intake impact lipodystrophy, insulin resistance, and heartburn?
What are Steve’s nutrition related problems? What nutrition therapy recommendations would you make?  
What would you tell Steve about exercise?
What criteria would you monitor to evaluate the effective ness of nutrition therapy?
Reference your sources in APA format

Answer 1

2) Studies show that the heart burn or G.E.R.D is more common in over weight/obese individuals .

• This is because of the abdominal fat that pressurizes the stomach leading to acid reflux into the esophagus causing heart burn.
• So, in this case steve being overweight and his increasing waistline could be associated with intra abdominal pressure causing heart burn by increasing intra gastric pressure.
• Insulin resistance is also linked with abdominal fat (visceral adiposity) causes excess accumulation of fat in the liver that results in cell autonomous impairment in insulin signalling. abdominal fat is also prone to inflammation and inflammatory cytokine production which also contributes to impairment in insulin signalling.
• references- Article- body weight, lifestyle, dietary habits and GERD from ncbi resources.
• Article- what causes the insulin resistance underlying obesity? from ncbi resources.

3)  Steve's diet mostly contains fried, processed food, beverages and the studies says these foods are refluxo-genic and needs to be avoided in patients having heart burn.

studies show that these fatty and high carbohydrate foods, beverages causes blood sugar spikes. In this case he has insulin resistance. so the blood sugar in blood remains high posing him to risk of prediabetes, diabetes mellitus and cardio and renal complications. Also, insulin resistance and lipodystrophy worsens if he continues to have same diet mentioned above.

• references- Article body weight, lifestyle, dietary habits and GERD from ncbi resources.
• Article -what is insulin resistance?