What Does the Patient Have Medical and Nutritional Status

The question "What does the patient have?" includes medical diagnosis and risk stratification, type of metabolic abnormality (dyslipi-demia, diabetes, overweight) and the associated risk factors which may have an influence on the dietary counseling (smoking, hypertension, sedentariness).

Dietary intake, as an index of atherogenic-ity and thrombogenicity, must be measured before counseling, as in most of western Europe more than 40% of energy derives from fat, far from the recommendations that only 20-30% of energy should be derived from lipid intakes. The major problem of dietary intake assessment is that no method is the universal "gold standard." Usually, three types of questionnaires are used:

• Recall methods based on the last 24 hours, or a 3-day period where subjects are asked to remember what they have eaten (this may be difficult because of problems of remembering or because certain days are not representative of usual daily intake).

• Prospective method based on exhaustive one week-record.

• Food frequency questionnaires, easy to use, inexpensive, valid and reliable, and less time-consuming than other methods, are increasingly being used.

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