Question

Case Study

Assessment of the nutritional quality of Mrs. Anderson’s diet

Mrs. Anderson is 58 years old. She lives alone in her house in Orleans, Ontario. Her husband died six months ago. She worked as a manager for several big retail stores for about 20 years before retiring 1 years ago. She has two children, a 34-year-old daughter and a 32-year-old son and 3 grandchildren. They live in the Montreal and Toronto.

A few weeks ago, Mrs. Anderson fell and broke her wrist. Her attending physician referred her for a bone density assessment using bone densitometry. This test revealed that Mrs. Anderson suffers from osteoporosis. Her doctor used this visit as an opportunity to perform a complete routine examination. Laboratory results show that her blood cholesterol and blood pressure are marginally high.

Mrs. Anderson's doctor suggests that she consults a dietitian in private practice to obtain a nutritional evaluation of her diet but also to obtain specific nutritional advice related to her health problems. You are an intern (4th year) at Myriam Lavallée’s clinic. She decides to entrust you with Mrs. Anderson. Myriam has already had a first meeting with Mrs. Anderson for 60 minutes. During this first interview, she took her anthropometric measurements (height and weight) and did a dietary history to obtain an overall picture of her eating habits.

Myriam shares with you some of the information she has collected about Mrs. Anderson. The dietitian noted that some aspects of Mrs. Anderson's eating habits need to be improved. She prefers not to reveal her observations at this time as not to influence your own analysis! However, she shares with you that Mrs. Anderson's food pattern is very similar from one day to the next and that her eating habits have changed since her husband's death. Her main physical activity is limited to taking a walk with her small dog Nikko for about 15 minutes in the park near her home only when the weather is nice. During the winter, she walks to the neighbourhood shopping centre (1-2 times a week). She never smoked and she drinks alcohol only on occasions such as holidays and birthdays. It is then limited to 1-2 drinks. Mrs. Anderson feels lonely since she lives on her own. She does not really have any social activities and her children and grandchildren come to visit her about once a month in turn.

In order to analyze Mrs. Anderson's diet in more detail, you decide, first, to carry out a 24-hour recall since Mrs. Anderson's diet is not diversified. This analysis will be complementary to the dietary history already carried out by Myriam. The second meeting with Mrs. Anderson will take place next week. You are preparing well for this meeting by carefully reviewing the concepts surrounding the 24-hour recall method and by making sure you will bring different tools (food models, measuring cups, measuring spoons etc) that you need in order to help Mrs. Anderson to estimate the portion sizes of food she consumed.

Questions 1: What would be your concrete suggestions so that Mrs. Anderson can easily integrate your advice that will allow her to improve four (4) aspects of her diet/lifestyle. You must consider her health status, life cycle stage, and factors that influence her eating behaviour (psychosocial, economic, cultural context, etc.).

Q2: Include at the end of this section your thoughts on the benefits and limitations of analyzing the nutritional quality of a diet using a 24 hour recall.

Answer 1

Answer:

Osteoporosis is a bone disease in which bones become fragile and susceptible to fracture because of calcium depletion or vitamin D deficiency ( vitamin D has significant role in absorption of calcium).This can be improved by the following advices:

1) intake of green vegetables and fresh fruits.

2) milk and it's products should be raised in diet.

3)Change in lifestyle from sedentary to active state.

4)She should meet her children more frequently, it helps in coping with stress.It can improve her appetite.

5)regular exposure to sunlight ,as vitamin D is synthesized in our skin in it's presence and it makes bones more strong ( due to increased calcium absorption).

2)24hr recall method has advantages and limitations also, these are the following:

Advantages: This method tells us the whole caloric intake of the person per day. Amount of carbohydrates, fats ,proteins and dietary fibres is calculated and compared with normal daily requirements of that particular age group, by this any mineral or nutrient deficiency or excess can be calculated, and can be corrected accordingly

Limitation: This method has an associated problem that the person whose diet is being calculated has to recall all the food items which has been taken on the previous 24hrs and their quantity properly, none of the food item should be missed . For this , written record can be helpful.

It can not specifically tell the caloric requirements or intake of each day , as these may change on different days, for this recall method should be applied for 2 or 3 times at appropriate intervals, for getting original data.