Due Monday, March 7, 2016
HYPERTENSION 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. Rashamel’s 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 ½ cup
Lunch: Iced Tea (sweetened) 12 fl.oz.
Tuna fish w/ mayo ¾ 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

Rashamel’s Current Diet Analysis Results:
NUTRIENT INTAKE
Sodium 2466 mg
Potassium 2886 mg
Calcium 670 mg
Magnesium 281 mg

What is Rashamel’s %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 DRI’s 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. ½ cup of cereal……etc. 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 doesn’t gain weight? (i.e. What foods does he consume which are not nutrient dense?)

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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 Mia’s DRI (AI) for calcium? ____________

How does Mia’s 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 Hanna’s 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 don’t 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 neighbor’s child, friend’s child, niece, nephew, significant other, brother, sister, coworker’s 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 client’s 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. (DRI’s) 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 client’s 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 Client’s Average INTAKE for
3 days Client’s 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 AMDR’s (find the correct column and compare)
Macronutrient 1-3 years 4-18 years Adult > 19 yr Client’s 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 client’s 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 doesn’t mean they had “enough” if their total kcal are low. Also there are different % ranges for macronutrients for younger aged clients.)

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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)?

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Dietary fiber helps lower cholesterol, helps regulate blood sugars, and helps our body eliminate waste products and may reduce our risk of colon cancer. How was their total (%DRI) for dietary fiber compared to their recommendation?

To help prevent hypertension and cardiovascular disease, an Adequate Intake (AI) has been established of <1000 mg of sodium per day for ages 1-3 yrs, 1200 mg for ages 4-8 yrs, <1500 mg for ages 9-50 yrs, < 1300 mg for ages 51-70 yrs, <1200 mg for adults over 70 years of age.
The DRI upper limit for sodium is 2300 mg. per day for ages 14 and up. Remember we become much more sodium sensitive as we age. (The UL for children 1-3 years is 1500 mg, 1900 mg for 4-8 years of age, and 2200 mg for 9-13 year olds.) How much sodium did your client consume? Using both the AI and the UL value, did your client exceed these recommendations? Comment on results of both.

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A diet low in cholesterol and saturated fat is recommended to help prevent cardiovascular disease. The American Heart Association’s goal for cholesterol is less than 300 milligrams/day. The recommendation for saturated fat is to consume less than 10% or your total kcal. How did your client do in regards to these two recommendations?

Is your client considered overweight based on their BMI? ______________
(You may use: http://www.cdc.gov/healthyweight/assessing/index.html – options on left side)
Do you feel their BMI is accurate in categorizing them? Does their BMI put them at risk for chronic diseases associated with obesity? Underweight and osteoporosis?

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Looking at the results of this three day analysis, what chronic nutrition related diseases is your client putting themselves at risk for?
cardiovascular disease: overweight, high cholesterol, high sodium, high saturated fat, low fiber, low antioxidants – vitamins A and C;
diabetes: overweight, low fiber, low antioxidants, low magnesium, high fat, high saturated fat; stroke/hypertension: overweight, high sodium, low potassium, magnesium, and calcium;
some cancers: overweight, low fiber, low antioxidants;
osteoporosis: underweight, low calcium, low magnesium, potassium, low Vitamin D, K, and A.
List all chronic diseases your client may be at risk of and why you feel they are at risk .

Does your client meet the minimum recommendations for physical activity?
(Aerobic: at least 150 minutes per week, Flexibility: at least 2-3 days a week, and
Muscle strength and endurance: at least 2-3 nonconsecutive days a week) Yes? No? ________

Looking at all of this information, what are 2 specific suggestions you could recommend to your client to improve their diet and/or health based on these three days? You will need to talk to them about what would work for them. (i.e. Not just eat more fruit……what fruit? When?)
Talk to them (or their parent) about what they could and actually would do to meet the recommendations. You are the nutritionist in this role.
Remember….. diet is a way of life and it has to work for each unique individual.

These recommendations are a significant part of this assignment! BE SPECIFIC!
Consider what nutrients they might be low in? What foods do they like that would provide these nutrients? When could they add them that would fit in with their routine?
Consider if they need to lower saturated fat, cholesterol, or sodium? What changes to their diet would help to lower these? Remember small changes add up.
We don’t want to overwhelm them so just pick two reasonable dietary strategies.
When could they make these changes? At what meal?
What changes would really work for them?

Tell me what and when you are suggesting these changes.
1. __________________________________________________________________
2. __________________________________________________________________
What does your client think of your recommendations?! _____________________________

Please do not print any reports other than those requested.
Required Reports:
From MyPlate SuperTracker DA Program:
1) Print a “Meal Summary Report” of these three days – neatly handwrite your suggestions on report for what and when you are recommending your changes.