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Compliments to the nutritionist

Hospital offers healthy eating in tasty dishes

By Peggy Peck
MedPage Today Managing Editor

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Fatima Cabral talks to a nurse about a patient's care.

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University of Southern California

LOS ANGELES, California (MedPage Today) -- Hospital food, like airline food, rarely rates rave reviews, but the cuisine at USC's University Hospital is an exception. Here, patients regularly send their compliments to the chef, which makes Fatima Cabral's day.

Cabral, 30, is the clinical nutrition manager at this major teaching hospital for the University of Southern California's Keck School of Medicine. During an average week, 200 patients are fed from a menu of more than a dozen diets specially designed by Cabral and her team of five clinical dietitians and one nutrition assistant.

Those diets range from plans for patients who are nutritionally deficient to weight-loss diets for the obese. In between are diets designed for patients with specific conditions such as heart disease and diabetes, as well as soft, chopped, pureed, and liquid diets. From those general diet categories, Cabral and her staff conduct assessments of the protein and carbohydrate needs of each patient so that they can tweak the diets to fit each individual.

At USC, as at other hospitals, physicians routinely ask clinical dietitians to evaluate patients' nutritional needs and recommend specific diet plans. It was during one such consultation that Cabral had a life-changing experience -- only in that case she was the patient, not the dietitian.

She was 15 years old and was hospitalized with severe gastrointestinal problems.

"I was very scared by the experience, but then a dietitian came to see me," Cabral recalled. "She was very friendly and she eased a lot of my worries by explaining to me how I could ease my symptoms by changing my diet. That's when I decided that I wanted to be a clinical dietitian -- I wanted to help people in the same way."

At the time, Cabral was living with her family in Somerset, Massachusetts. With the help of high school counselors, she discovered that Framingham State College had a program in medical nutrition. After receiving her degree there, she interned for a year at Beth Israel Deaconess Hospital in Boston.

During her internship year, she had an experience with a cancer patient that convinced her that she made the right choice.

Looking good

Cancer patients, said Cabral, are always a challenge for clinical dietitians because they "often have extreme weight loss and difficulty regaining weight after treatment." To overcome this, dietitians design diets that are "very high in calories, very dense."

When she met the patient, he had been through a long course of treatment and could not gain weight. "I worked very closely with him and kept trying different foods, encouraging him on a regular basis. As with other cancer patients, this man was frequently in and out of the hospital for chemotherapy and radiation treatments, so I saw him very often. Finally, we had a breakthrough and he began to gain weight."

As soon as the patient began to gain weight his whole attitude changed. "He was really excited. He contacted me and told me that he really felt good when he looked in the mirror and could see that he was gaining weight. It was really important to him, and really important to me as well," she said.

California bound

After she completed her internship, a college friend suggested that they both look for jobs in Los Angeles. "So that is what we did! We didn't have any real job prospects, just some appointments lined up, but we just headed west," she said.

Within a few months, Cabral was hired by USC. She worked there for three years before leaving to take a management position at another Los Angeles hospital. "Then in March 2004, I was offered the position of clinical nutrition manager."

At USC, clinical nutrition is a major component of patient care, she said, with most patients recommended for a nutritional consultation by their physicians. But even if a physician doesn't request a consult "every patient who is hospitalized for at least five days will be visited by a clinical dietitian, who will discuss the importance of nutrition in maintaining a healthy lifestyle," she said.

Cabral speaks from experience regarding the importance of nutrition. Her hospitalization at age 15 was the first of many hospitalizations for gastrointestinal problems and at age 25 she was diagnosed with Crohn's disease. "Crohn's symptoms, of course, are very diet dependent," she said.

Cabral now lives in Redondo Beach, where she can pursue her favorite hobby: taking long walks on the beach.

What else does a dietitian do on her day off? "I love to bake -- chocolate cupcakes!"

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