Question

JJ is a 50 y.o. woman who works as an accountant. She presents to her family physician with elevated blood pressure and obesity. JJ has struggled with her weight since childhood and indicates that her weight problems worsened 5 years ago when she returned to work as an accountant.

Nutrition Assessment

Client History:

Age- 50 years old

Gender- Female

Married with three children-ages 20, 15, and 10

Medical/Health History- elevated blood pressure (145/90 mm Hg)

Family History: Mother history of hypertension and T2DM at age of 60

Medical Diagnosis: Metabolic Syndrome

Food/Nutrition-Related History:

Total energy intake- Diet history indicated estimated energy intake of 2800-3000 kcal/day from a usual meal pattern of three meals and two snacks

Physical Activity History- sedentary lifestyle

Biochemical Data, Medical Tests, and Procedures:

Glucose, fasting- 122 mg/dL

Cholesterol, serum- 236 mg/dL

Triglycerides, serum- 179 mg/dL

Cholesterol, HDL- 39 mg/dL

Cholesterol, LDL- 153 mg/dL

Anthropometric Measurements:

Height- 5' 5"

Weight- 220#

Body Mass Index- 36.6

Waist Circumference- 40

Weight History- Lowest weight of 150 pounds (age of 25). Highest weight is current weight of 220 pounds. Gained approximately 50 pounds since returning to work as an accountant.

Comparative Standards

MyPlate recommendations of 1800-2200 kcal/day

BMI 36.6- Obese Class II

case study about medical nutrition

case study about medical nutrition

Answer 1

CASE STUDY ABOUT MEDICAL NUTRITION

A female patient J.J of 50 years old came with complaints of elevated blood pressure and obesity , she was over weight since childhood which worsened since 5 years.

Social history includes desk job as accountant and she has family history, mother with hypertension and type 2 Diabetes mellitus at the age of 60 yrs and she has 3 children of age 20, 15 and 10 yrs old.

History of present illness include elevated B.P (blood pressure) 145/90 (mmHg) , were normal B.P is 120/80 mmHg and for her normal B.P. at this age is 129/85mmHg and metabolic syndrome.

Her dietary habits include estimated energy intake of 2800-3000Kcal/day from usual meal pattern of 3 meals and 2 snacks along with sedentary life style .

On systemic examination the Anthropometric Measurements were Height- 5' 5" ,Weight- 220pounds, Body Mass Index- 36.6 and Waist Circumference- 40. Body Mass Index (BMI) is one way to see if you're at a healthy weight and here its a case of obese, as BMI between 25 to 29.9 is considered overweight and BMI which is 30 or higher is considered obese . The normal BMI is 18.5-24.9.Her weight history was lowest of 150 pounds at age of 25 and highest is current which is 220 pounds ,gained 50 pounds since 5 yrs .

Her laboratory investigation includes glucose fasting -122mg/dL which shows that she is pre-diabetic as normal value is 100mg/dL and the range 100-125 mg/dL is considere as pre-diabetic.She has cholesterol seru level 236mg/dL were normal range is less than 200mg/dL ,triglycerids serum level is 179mg/dL and normal range is less than 150mg/dL , the cholesterol HDL is 39mg/dL and cholesterol LDL is 153mg/dL were healthy HDL cholesterol should be higher than 55mg/dL (in women ) and healthy LDL cholesterol should be less than 130mg/dL.

ASSESSMENT : Based on the subjective and objective evidence she was assessed with Hypertension and Obesity.

The dietary plans have to be adopted and medication should be taken for Hypertension and Hyperlipidemia.

• Comparative Standards

1. Hypertension : 145*90mmHg ( Normal Value :120/80mmHg )
2. Dietary habits :2800-3000Kcal/day ( Normal Value : 2000Kcal/day for women )
3. BMI :36.6 ( Normal Value :18.5-24.9)
4. Glucose, fasting- 122 mg/dL ( Normal Value : 100mg/dL)
5. Cholesterol, serum- 236 mg/dL ( Normal Value :less than 200mg/dL)
6. Triglycerides, serum- 179 mg/dL( Normal Value :less than 150mg/dL)
7. Cholesterol, HDL- 39 mg/dL ( Normal Value : higher than 55mg/dL)
8. Cholesterol, LDL- 153 mg/dL ( Normal Value :less than 130 mg/dL)

• My Plate recommendations of 1800-2200 kcal/day

Always choose foods and beverages wisely. Make sure your choices are limited in sodium, saturated fat, and added sugars. Start with small changes to make healthier choices you can enjoy and consistent dieting is also important.

1. Find your healthy eating style
   Creating a healthy style means regularly eating a variety of foods to get the nutrients and calories you need.
2. Make half your plate fruits and vegetables
   Eating colorful fruits and vegetables is important because they provide vitamins and minerals and most are low in calories.
   
3. Focus on whole fruits
   Choose whole fruits—fresh, frozen, dried,   or canned in 100% juice. Enjoy fruit with meals, as snacks, or as a dessert.
   
4. Vary your veggies
   Try adding fresh, frozen, or canned vegetables to salads, sides, and main dishes. Choose a variety of colorful vegetables prepared in healthful ways: steamed, sauteed, roasted, or raw.
   
5. Make half your grains whole grains
   Look for whole grains listed first or second on the ingredients list—try oatmeal, popcorn, whole-grain bread, and brown rice. Limit grain-based desserts and snacks, such as cakes, cookies, and pastries.
   
6. Move to low-fat or fat-free milk or yogurt
   Choose low-fat or fat-free milk, yogurt, and soy beverages (soymilk) to cut back on saturated fat. Replace sour cream, cream, and regular cheese with low-fat yogurt, milk, and cheese.
   
7. Vary your protein routine
   Mix up your protein foods to include seafood, beans and peas, unsalted nuts and seeds, soy products, eggs, and lean meats and poultry. Try main dishes made with beans or seafood like tuna salad or bean chili.
   
8. Drink and eat beverages and food with less sodium, saturated fat, and added sugars
   Use the Nutrition Facts label and ingredients list to limit items high in sodium, saturated fat, and added sugars. Choose vegetable oils instead of butter, and oil-based sauces and dips instead of ones with butter, cream, or cheese.
   
9. Drink water instead of sugary drinks
   Water is calorie-free. Non-diet soda, energy or sports drinks, and other sugar-sweetened drinks contain a lot of calories from added sugars and have few nutrients.
   
10. Everything you eat and drink matters
    The right mix of foods can help you be healthier now and into the future.

• BMI 36.6- Obese Class II

Body Mass Index (BMI)

It's one way to see if you're at a healthy weight.

Underweight: Your BMI is less than 18.5.

Healthy weight: Your BMI is 18.5 to 24.9.

Overweight: Your BMI is 25 to 29.9.

Obese: Your BMI is 30 or higher

OBESE CLASS II

These ranges of BMI are used to describe levels of risk

Overweight (not obese), if BMI is 25.0 to 29.9.

Class 1 (low-risk) obesity, if BMI is 30.0 to 34.9.

Class 2 (moderate-risk) obesity, if BMI is 35.0 to 39.9. Class 3 (high-risk)

obesity, if BMI is equal to or greater than 40.0

•