Question

Subject: 51 year Caucasian female                                     

Height: 5'5"                                                                              

Weight: 190 lbs                                                                            

Vitamin D Status: 12 ng/ml                                                    

Waist-to-Hip Ratio: 1.1

Body Fat %: 42% (via DXA)

Conditions Include:

type 2 Diabetic                                                                        

Hyperlipidemia                                                                       

Osteopenia (via DXA Scan)

Non-alcoholic Fatty Liver Disease (NAFLD)    

Vitamin D Status: 12 ng/ml                                                    

Hypertension

Sarcopenia

She states that she is essentially leading a sedentary lifestyle, but is motivated to make nutrition and exercise changes to improve health.

Dietary Recall:  Inadequate intake of Calcium, Vitamin D, Viscous-gel forming fiber, Omega-3 FAs.  Excess intake of Total FAT, Saturated FAT, and Trans FAT

Discuss:

1.      Calculate BMI and BMI category she calculates into.

2.      Dietary recall...discuss the recommended intake of nutrients listed above for this subject, and thus what levels of each she either did not meet or exceeded. Then list foods she could add or eliminate to improve dietary intake.

3.      For every condition listed above (Type 2 Diabetic, Hyperlipidemia etc.), discuss how each is diagnosed (test or technique used; cutoff values to determine

diagnosis).

4.      Discuss interrelationships between conditions listed above...how these conditions are linked and exacerbate entire overall health status.

5.      Discuss realistic dietary and exercise changes she could begin to implement in her routine to improve overall health...discuss mechanisms of improvement for

each condition where appropriate.

Vitamin D

1.      Discuss in detail the synthesis and activation of Vitamin D

2.      Discuss Vitamin D status...what is measured and cutoff values for different categories (sufficient, insufficient, deficient)

3.      Discuss food sources and lifestyle changes she could add to improve Vitamin D status.

4.      Discuss recommended Vitamin D intake (from food, supplementation, and sun exposure) for her to achieve sufficient Vitamin D status in a safe manner.

5.      Discuss in detail the mechanisms or potential/proposed mechanisms that Vitamin D could improve each condition listed above.

Answer 1

Answer 1: The female is having multiple health problems. These problems are common in old age.

BMI = 31.6; BMI category is ‘Obesity’.

Answer 2: The lady has Osteopenia. Osteopenia is a condition of weak bones. The major cause of this condition is the low calcium and vitamin D in the body. Vitamin D is required in a daily supplement of 10 µg. The patient has hyperlipidemia, that means the blood has higher concentrations of lipid, such as cholesterol. There is obesity as well. Viscous-gel forming fiber lowers the concentration of cholesterol in the blood. This also reduces appetite and cause weigh loss. Fish oil is generally rich in omega-3 fatty acids. This is important for health. It protects against a number of diseases. Omega-3 reduces heart risks. Even in small dose, Omega-3 reduces elevated blood pressure (hypertension).

She should eat sufficient green leafy vegetables, like cabbage and broccoli; soya beans and bread for calcium. Milk and cheese is not recommended in this case because of hyperlipidemia. Oily fish like salmon and sardines will provide the vitamin D and Omega-3 to the body. Other food source of vitamin D are red meat, egg yolks and liver. Viscous-gel forming fiber containing food are legumes, oats, and asparagus.

Answer 3:

Type 2 Diabetic – Fasting plasma glucose (FPG) level of 126 mg/dL or higher; Oral glucose tolerance test 200 mg/dl or higher.

Hyperlipidemia – Total cholesterol levels higher than 290mg/dL or low-density lipoproteins higher than 190 mg/dL in adults.

Osteopenia (via DXA Scan) – DXA scan T-score equal to or less than -2.5

Non-alcoholic Fatty Liver Disease – Non-alcoholic fatty liver disease (NAFLD) test score of 5 or more.

Hypertension – Blood pressure greater than 130/80

Sarcopenia -   Knee extension strength with 1.01Nm/kg as cutoff; gait speed with 0.8m/s as cutoff; appendicular skeletal muscle mass of less than 4.82 kg/m2 in women.