Rashamel is a 43-year-old African-American man. His father died of a stroke at the age of 54 as a result of undiagnosed and untreated high blood pressure. Rashamel wants to live to see his grandchildren so he exercises as often as he can about three times a week quit smoking and watches his diet and weight.
Rashamel is a 43-year-old African-American man. His father died of a stroke at the age of 54 as a result of undiagnosed and untreated high blood pressure. Rashamel wants to live to see his grandchildren so he exercises as often as he can about three times a week quit smoking and watches his diet and weight. Despite these efforts at his recent physical his blood pressure was 138/87 in the prehypertension category. To try to reduce his blood pressure to a healthier level his doctor suggests a change in diet and refers him to a dietitian. A 24-hour recall reveals that Rashamel is maintaining a normal body weight of 175 lbs at 6 feet 2 inches height by consuming ~ 2600 kcalories per day. After evaluating his current diet the dietitian recommends he follow the DASH Eating Plan to reduce his blood pressure. Rashamels current diet is shown here.
Current Diet:
Breakfast: Dinner:
Orange Juice 1/2 cup Baked Chicken 5 ounces
1% Milk 1 cup Rice 1 cup
Wheaties 1 cup (1 oz) Lettuce 1 cup
Whole Wheat Toast 1 slice Salad dressing 1 Tb
Jelly and Margarine 1 tsp each Dinner Roll 1 small (1 slice equiv.)
Coffee black 2 cups Margarine 1 tsp
Cantaloupe cup
Lunch: Iced Tea (sweetened) 12 fl.oz.
Tuna fish w/ mayo cup (3 oz tuna)
Wheat Bread 2 slices Snacks:
Cola 20 ounces Cola 1 can
Dried apricots 5 halves (1/4 c)
Milky Way Candy Bar 1 fun size
Rashamels Current Diet Analysis Results:
NUTRIENT INTAKE
Sodium 2466 mg
Potassium 2886 mg
Calcium 670 mg
Magnesium 281 mg
What is Rashamels %DRI for:
Sodium______ %DRI Potassium ______ %DRI Calcium ______%DRI Magnesium______ %DRI
Hint: All DRI recommendations are listed in the front of your text. There are 1000 mg in 1 gm.
Vitamin D and Calcium DRIs have since been updated. Check the class slides for these or go to: http://www.nal.usda.gov/fnic/DRI/DRI_Tables/RDA_AI_vitamins_elements.pdf
These are all micronutrients directly linked to hypertension.
Go to www.choosemyplate.gov and go to SuperTracker program. Click on Food-A-Pedia and enter your suggested sources of dietary sources of nutrients of concern in the search box. Next to the bar labeled Food Info click on the Nutrient Info tab. Scroll down to check micronutrient contents. (Look for dietary sources for potassium on page 431 of your text. Calcium and Magnesium are listed in Ch 11 of your text.)
Can you get Rashamel to meet 100% of his DRI for potassium? (Remember the DASH Diet recommendations from previous page.)
Food (include volume/amount!) Amount of Potassium mg
i.e. cup of cerealetc. Current intake 2886 mg
Do the same as above for magnesium: (Also consider the DASH Diet recommendations from previous page here as well.)
Food (include volume/amount!) Amount of Magnesium mg
Current intake 281 mg
If Rashamel added the DASH diet servings of recommended foods what foods might he need to omit from his diet to keep his total kcal in line with his recommendations so that he doesnt gain weight? (i.e. What foods does he consume which are not nutrient dense?)
___________________________________________________________________________________
OSTEOPOROSIS
Mia is 55 years old. Although she has no symptoms she is worried about her risk for osteoporosis. Her mother is 75 and recently suffered a fractured hip due to reduced bone density caused by osteoporosis. Her previously independent mother is now living in a nursing home and struggling to return to her former life. Mia is frightened that she will face the same future.
Although Mia does not drink a lot of milk she knows that other dairy products and many other foods are good sources of calcium. She records what she eats and drinks for a day (shown below) to estimate her typical calcium intake.
TOTALS: 1989 kcal 695 mg Calcium
What is Mias DRI (AI) for calcium? ____________
How does Mias intake compare to her recommendations for calcium intake? _________ %DRI?
What non dairy foods could she add to improve her calcium intake?
List at least two other dietary strategies Mia could address (besides increasing calcium intake what other nutrients impact bone health?) and two lifestyle changes which Mia could consider (if necessary) which may affect her current osteoporosis risk?
Dietary Strategies:
1)
2)
Lifestyle Change:
1)
2)
ANEMIA
Hanna is a 23-year-old student from South Carolina. She has been feeling tired and run down all semester. She recently read an article about iron deficiency in young women and became concerned about her iron status. She decides to go to the health center where she has her blood drawn. The results of her tests indicate that she does not have iron deficiency anemia but her iron stores are very low. Hanna decides to try to increase the amount of iron she gets from her diet before considering iron supplements. She consumes a lacto-ovo vegetarian diet meaning she consumes dairy products and eggs but no meat. Her typical diet is shown on the right.
Diet Analysis Results for Hanna:
NUTRITENT INTAKE
Iron 11 mg
As a 23 year old female vegetarian what is Hannas DRI for iron? %DRI?
DRI: _________ mg Iron %DRI? __________
What non meat non fortified foods could Hanna add to increase the iron content in her diet?
What one other strategy could Hanna add or subtract to her diet above to increase the absorption of iron in her meals? (Do not suggest she take an iron supplement or for her to add meat!)
8.
Diet Analysis/nutritionist
Food Record. In this assignment you will play the nutritionist for a younger or older individual. You will need to obtain a food record from a younger person between the ages of 2 to 18 OR a pregnant or lactating woman OR a senior over the age of 60 years old. (If you dont know anyone in these categories at least use a different gender than yourself or talk to me about using someone else. I can create a hypothetical client if necessary.) You may use your own child a neighbors child friends child niece nephew significant other brother sister coworkers kid etc. OR you can work with your grandparent parent spouse aunt uncle neighbor coworker etc. (If it is someone you care about this will have more meaning!)
We will refer to the individual you are working with as your client.
Ask your client to keep track of their food intake for three days. Have them write down all meals (breakfast lunch dinner and snacks) the food eaten and the amount. Be sure they record everything that they eat and drink (except water and supplements). When you look over their food record think of probes or questions you could ask to obtain items they may have forgotten. For example you could ask if they had anything to drink with a meal? Did they have any condiments with that sandwich or that entree? Any snacks between meals? Beverages? Clarify amounts consumed. Etc. It is very difficult to remember all items and probes help to recall food items that can add up nutritionally.
Ask them to keep track of typical days. This is their opportunity to have you assess their diet! Ideally they should record one weekend day and two week days.
If your client is a child you can obtain information from their parent or caregiver (or yourself!). If your client is a senior you may interview their spouse or significant other if that helps. Just try to obtain as accurate of an account of your clients intake as you can.
You will also need to ask them their approximate height weight age and activity level so you can enter their profile to determine their individual dietary recommendations. (DRIs) You will need to create a new profile for your client in SuperTracker.
Enter their 3 day intake under their profile.
Please describe your Client: ___________________________________
(i.e. 6 year old boy 72 year old female etc.)
What is your clients BMI? _________
May use: http://www.cdc.gov/healthyweight/assessing/bmi/index.html
Brief Medical History: (any chronic diseases?)________________________
When using MyPlate (SuperTracker) DA Program:
After entering data go to the My reports tab. Choose Nutrients Reports option. In the section labeled View reports from are two calendars. Adjust the dates to include the 3 days you have entered. (Note: Do not enter other information between these dates!) This program will then average all three days for you.
Fill in the following table completely with your results.
NUTRIENT Clients Average INTAKE for
3 days Clients DRI or
Target %DRI
(Divide intake by DRI x 100)
Total Calories
Fiber (g)
Vit. A (mcg RAE)
Vitamin C (mg)
Calcium (mg)
Iron (mg)
Potassium (mg)
Magnesium (mg)
Other*
Next 3 stay below:
Saturated fat (%) Goal: Less than 10% total kcal.
Did you meet or exceed the goal?
(circle meet or exceed)
Cholesterol (mg) Goal: Less than 300 mg Did you meet or exceed the goal?
Sodium (mg) Goal: UL Values!
1-3 yrs: 1500 mg
4-8 yrs: 1900 mg
9-13 yrs: 2200 mg
14 and up: 2300 mg Did you meet or exceed the goal?
*You may enter a different nutrient of interest or leave blank.
COMPARING MACRONUTRIENT %s TO AMDRs (find the correct column and compare)
Macronutrient 1-3 years 4-18 years Adult > 19 yr Clients Value
Protein (% kcal) 5-20% 10-30% 10-35%
CHO (% kcal) 45-65% 45-65% 45-65%
Fat (% kcal) 30-40% 25-35% 20-35%
How did your clients macronutrient percentages compare to the AMDR recommendations?
(Remember these values just show you if the distribution of kcal from the macronutrients are in good proportion. It doesnt mean they had enough if their total kcal are low. Also there are different % ranges for macronutrients for younger aged clients.)
_______________________________________________________________________
Vitamins A and C function as antioxidants in our body and may prevent cardiovascular disease as well as certain cancers. Adequate iron prevents anemia.
Potassium magnesium and calcium may help prevent hypertension.
One out of every two women in the US will experience osteoporosis in her lifetime. Adequate calcium prevents osteoporosis and weak bones.
For which vitamins and minerals did your client consume less than their needs (%DRI)?
