title: Nutritional management of a patient with obesity and pulmonary embolism: a case report.
abstract: The aim of this case report is to discuss the issue of nutritional therapy in patients taking warfarin. Patients are often prescribed vitamin K free diets without nutritional counseling, leading to possible health consequences.
  
  
  
  A 52-year-old woman with obesity and hypertension was prescribed a low calorie diet by her family doctor in an effort to promote weight loss. After a pulmonary embolism, she was placed on anticoagulant therapy and on hospital discharge she was prescribed a vitamin K free diet to avoid interactions. Given poor control of her anticoagulant therapy, she was referred to our Nutritional Unit outpatients' service.
  
  
  
  This case illustrates the importance of a thorough medical nutrition assessment in the management of patients with obesity and the need for a change in the dietary approach of nutritional therapy in the management of vitamin K anticoagulant therapy. In patients taking warfarin, evidence suggest that the aim of nutritional therapy should be to keep dietary intake of vitamin K constant.
authors.affiliation: Department of Public Health, Experimental and Forensic Medicine, Unit of Human Nutrition, University of Pavia, Via Bassi, 21, 27100, Pavia, PV, Italy.
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Fonte
authors.affiliation: Department of Pediatrics, Division of Pediatrics GI and General Academic Pediatrics Mass General Hospital for Children, Boston, Massachussets, USA.
authors.forename: Lauren
authors.initials: L
authors.lastname: Fietchner
authors.affiliation: Department of Public Health, Experimental and Forensic Medicine, Unit of Human Nutrition, University of Pavia, Via Bassi, 21, 27100, Pavia, PV, Italy. matteo.manuelli@unimi.it.
authors.forename: Matteo
authors.identifier: 0000-0001-8645-4473
authors.initials: M
authors.lastname: Manuelli
authors.affiliation: Department of Public Health, Experimental and Forensic Medicine, Unit of Human Nutrition, University of Pavia, Via Bassi, 21, 27100, Pavia, PV, Italy.
authors.forename: Hellas
authors.initials: H
authors.lastname: Cena
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D031204:Caloric Restriction; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008875:Middle Aged; D015596:Nutrition Assessment; D009765:Obesity / Q000178:diet therapy*; D011655:Pulmonary Embolism / Q000188:drug therapy*; D014812:Vitamin K / Q000008:administration & dosage / Q000097:blood; D014859:Warfarin / Q000008:administration & dosage* / Q000009:adverse effects; D015431:Weight Loss
chemical_list: D000925:Anticoagulants; D014812:Vitamin K; D014859:Warfarin
keywords: Diet; Nutrition; Nutritional assessment; Obesity; Pulmonary embolism; Vitamin K