Adult NutritionBy: Jessica Simmons

Case Study Life Stage

Adulthood: 20-64 years old

My Client

Gender = Male

Age = 48 years old

Weight = 178 lb.

Height = 6’0”

Adult Life Stage:Physiological changes During Midlife Male

Adulthood:

Careers are an influential component of one’s life

Responsibilities: blending families, paying college tuitions, focusing on paying off house notes and healthcare bills in preparation for future

Possible physical S/S of aging: muscle mass and size decreases; body fat increases; hearing and vision loss may become apparent; hormone levels of testosterone decrease; body fat is usually redistributed to central abdominal area of body; risks for certain adverse health conditions may being showing up at this point in an individual’s life

Ideal Body Weight Client is a male and is 6’0” / 72”. This

information is needed in order to determine his ideal body weight through the utilization of the….

Hamwi Equation - Males: Allow 106 pounds for 1st 60 inches (5 feet) Add 6 pounds for each additional inch

Client’s IBW = 106 (1st 60 in.) + 6 (12 for additional 12in./1ft.) = 178 lb.

Client’s actual weight is exactly that of the his reference, or ideal body weight

Body Mass Index

Calculation = Weight (lb.) x 703

Height (in. squared)

BMI = 178 lb. x 703

72” squared

BMI = 24.1

Patient is of a Normal/Healthy BMI (18.5 - 24.9).

Client’s Energy Needs

Mifflin-St. Jeor Equation:

Males: REE = (10 x wt in kg) + (6.25 x ht in cm) - (5 x age) +5 x AF X IF

Client’s wt. in kg = 80.9 kg; Client’s ht in cm = 182.88

Calculation = (10 x 80.9) + (6.25 x 182.88) - (5 x 48) + 5= 1,717 x activity factor of 1.2 (mostly sedentary) x injury factor of 1.0 (no injury)

Total Energy Needs = 2,060 kilocalories/day according to Mifflin-St. Jeor Equation

VERSES………..

MyPlate’s SuperTracker Diet Analysis:

Total Energy Needs = 2400 calories/day

Carbs, Fats, & Proteins

Carbs = 45-65% of calories (130 g (MyPlate rec) 2,060 kcal/day x 0.45 = 927 / 4 cal/g = 232 g CHO

2,060 kcal.day x 0.65 / 4 cal/g = 446 g CHO

MyPlate Analysis: actual average intake = 141 g (OK)/ 38% of cal (UNDER)

Fats = 20-35% of calories (MyPlate rec) 2,060 kcal/day x 0.20 = 412 / 9 cal/g = 46 g fat

2,060 kcal/day x 0.35 = 721 / 9 cal/g = 80 g fat

MyPlate Analysis: actual average intake = 41% of calories (OVER)

Protein = 10-35% of calories / 56 g (MyPlate rec) 2,060 kcal/day x 0.10 = 206 / 4 cal/g = 52 g PRO

2,060 kcal.day x 0.35 = 721 / 4 cal/g = 180 g PRO

MyPlate Analysis: actual average intake = 80 g/ 21% of cal (OK)

Client’s Current Intake

According to MyPlate.gov’s SuperTracker Nutrient Intake Report, he ate an average of 1490 calories/day compared to the recommended 2400 calories/day.

The Future RD’s Evaluations

Since the client noted that he is concerned with consuming a cardio-protective diet, I focused on a few dietary areas that could be improved.

The client is consuming protein in excess (mainly from seafood consumption); however, I suggest that he continues to eat fish twice a week, but replace some of his protein intake with the intake of more fruits and vegetables.

He is lacking dietary fiber in his diet and since 20-30 g/day is recommended by the guidelines of Therapeutic Lifestyle Changes (TLC’s), I suggest that he eat more fibrous foods like sweet potatoes, strawberries, beans, and peas, etc.

The client has consumed an average intake of 41% of calories from fat compared to the TLC’s recommendation of a total fat intake of 25-35% of total kcal and MyPlate’s recommendation of 20-35% intake.

Food Record : Day 2 On day 2, the

participant ate a total of 1,833 calories, in which 486 of those calories were empty calories (client has an empty calorie limit of 330 calories).

Research My research articles supported my client’s goal of eating a more cardio-protective diet. I chose articles that demonstrated heart healthy dietary options and compared these options to my client’s current food choices.

I researched an article obtained from the Harvard Heart Letter, which provides simple heart healthy dietary substitutions, some of which I included in my sample meal plan for my client. The article is focused on including whole grains, fruits, vegetables, low-sodium foods, and less sugary foods, foods with high saturated fats, and refined carbs in order to provide the body with more fiber and nutrients which reduces the individual’s risk for heart disease.

My client was low in his fruit, vegetable, and whole grain intake. He also consumed an empty calorie amount on average of 385 cal/day from high fat milk choices and from a night snack of brownies.

I also utilized a research article that portrays the benefits of the nonessential nutrient, dietary fiber. The article compares the intake of adequate dietary fiber to the decreased risk of type 2 diabetes and cardiovascular disease. The positive health benefits of fiber are outlined, which include its effect on laxation, its role in the decreased risk of heart disease, and its positive benefit on weight maintenance.

My client consumed an average dietary fiber intake of 12g/day compared to MyPlate’s recommended dietary fiber intake of 38g/day and the TLC’s recommendation of 20-30g of fiber/day.

Areas of Nutritional Concern

PES Statements:

1. Excessive protein intake related to frequent consumption of high protein foods such as seafood as evidenced by actual average protein intake of 80g/day that exceeds recommended intake of 56g/day.

2. Inadequate fiber intake related to infrequent consumption of fibrous fruits and vegetables such as beans, peas, strawberries, sweet potatoes, apples with skin, etc. as evidenced by actual average fiber intake of 12g/day as compared to recommended intake of 38g//day.

3. Excessive fat intake related to frequent consumption of fat calories and empty calories from fatty foods as evidenced by the average consumption of 385 empty cal/d compared to the recommended intake of < or = 330 empty cal/day from sources like a bedtime snack of a brownie and glass of 2% milk.

Vegetables: The participant is under his 3 cups per day recommendation for vegetables. He has on average eaten 1 1/4 cups of vegetables.

The client does not consume even half of the amount of recommended intakes for the subcategories of vegetables.

He consumed 0 cups of beans and peas over the three day period; therefore, my client is missing essential fibrous vegetables from his diet.

Recommendation: *The participant is recommended to add 2 3/4 + cups of vegetables to his diet each day. He could sauté these vegetables in olive oil and add them to the seafood that he adequately consumes each week. He can add vegetables to his diet by drinking 1 cup of 100% vegetable juice in place of one of the 8 oz. glasses of water he drinks each day. He could also eat a salad before meals or substitute a salad made with 2 cups of dark, leafy salad greens and an assortment of carrots, broccoli, red cabbage, and tomatoes for a brownie in order to help him choose a more nutrient dense food option rather than one providing empty calories.

Fruits: The participant is under his 2 cups per day recommendation for fruits. He has on average consumed 1/4 cup of fruits.

He averaged 0 cups of fruit juice and the 1/4 cup of the consumed cups were from whole fruit.

Recommendation: The client could eat 1 cup of canned or frozen pineapple, 1 cup of strawberries, 1 orange, 1 small banana for a nightly snack each day to increase his fruit intake. I previously recommended for the participant to eat breakfast and he could add a serving of fruit to his cereal or oatmeal each morning. I would recommend for him to eat an afternoon snack that is either a fruit or vegetable choice to avoid eating empty calories for the remainder of the day.

Protein: The participant is OVER his 6 1/2 ounces of recommended protein foods. The client on average consumed 8 1/2 ounces of protein. Although his food groups report shows that he is over his recommended protein food servings, his nutrient intake report shows that he has achieved an adequate percentage of calories from protein. On average, the client consumed 80g of the recommended 56 g or protein.

Of the 10 ounces/week of seafood recommendation, the participant is over his limit by 6 ounces. He consumed 3 ounces of meat, poultry, and eggs on average and 1/2 ounce of nuts, seeds, and soy on average.

Recommendation: He is obtaining adequate protein amounts; however, he maybe could decrease his protein intake by about 2 ounces per day and substitute these 2 ounces with 1+ ounces of fruit and 1+ ounces of vegetables to make up for these two areas where he is lacking.

Total Fat (& of calories)- He consumed a little over his recommended 20-35% calories from total fat allowance. Since the client is concerned with maintaining his weight and eating a more cardio-protective diet, I recommend that he stays within the recommended % of total calories from fat. I noticed in his 3 day food record that he did not obtain a great % of his fats from red meats or solid fats; therefore, I would advise him to continue to choose healthy fats, such as eating Omega-3 rich fatty fish. Since he likes fish and seafood, he could continue to eat seafood weekly as long as he stays close to his 10 ounce recommended range.

Saturated, Monounsaturated, and Polyunsaturated Fats- According to the MyPlate.gov recommendations, my client is OK in these fat categories. However, he is concerned with consuming a more heart healthy diet; therefore, I recommend that he obtains <7% of calories from saturated fat (actual intake = 9% of calories), up to 20% of calories from monounsaturated fat (actual intake of 15% of calories), and less than or equal to 10% of calories from polyunsaturated fat (14% of calories).

Protein (g)- The client is obtaining adequate protein amounts; however, he maybe could decrease his protein intake by about 2 ounces per day and substitute these 2 ounces with 1+ ounces of fruit and 1+ ounces of vegetables to make up for these two areas where he is lacking.

Focus on Fruits.

Vary your veggies.

Get your calcium-rich foods.

Make half your grains whole.

Go lean with protein.

Know the limits on fats, salt, and sugars.

To conclude my assessment, I left my client with a few simple dietary tips outlined in the MyPlate tool……

Breakfast1 packet oatmeal (instant, regular, 1.5 ounce packet) 1 tsp. honey½ cup strawberries½ cup mangoes½ cup skim/ 1% milk

Morning Snack¼ ounce almonds (lightly salted)2/3 cup of granola (2.5 ounces)¼ cup dried cranberries1 cup low-fat yogurt   LunchVegetable Stir Fry: 2 ounces cooked lean beef strips,½ cup cooked broccoli, and½ cup cooked carrots cooked with ½ ounce sesame seeds and 2 tsp. teriyaki sauce served on top of 2 ounces whole grain pasta½ cup canned pineapple chunks    

Dinner3 (1 ounce) fish fillets, grilled or sautéed 1 medium sweet potato (1/2 cup cooked)1 cup cauliflower, steamed with spices of choice½ cup cooked brown rice with ½ cup sautéed onion 1 slice of toasted bread (whole wheat if pasta at lunch wasn’t whole grain) topped with, 1 ounce cheddar cheese      

Evening Snack1 ounce dark chocolate1 cup skim / 1% milk  

Breakfast2 ounces whole wheat toast (2 slices bread)2 Tbsp. almond butter spread1 cup skim/ 1% milk 

Morning Snack1 small banana ½ cup strawberry yogurt  

Lunch1 turkey sandwich (2 oz. turkey) on whole wheat roll, and1 ounce American cheese 1 ½ Tbsp. olive oil based mayonnaise 1 cup raw baby carrots    Dinner1 cup potato chunks, cooked with 2 Tbsp. butter and…1.5 ounces natural mozzarella and Colby Jack cheese blend2.5 ounces chicken breast, grilled without skin2 ounces fettuccine with ½ cup fresh tomatoes and ½ cup tomato and olive oil based marinara sauce    Evening Snack1 cup mixed fruit½ large, blueberry bagel  

Sample Meal Plans: Based on a 2400 calorie diet

References