Research Articles Base: Diet And Nutrition Assignment

Diet and nutrition – assignment case study Mary Browning is 54 year old part-time teaching assistant in a local primary school. She lives at home with her husband john and two cats. She is perimenopausal and consults her GP about feeling tired recently. Clinically the GP suspects that Mary is a little anaemic and arranges some blood tests. Her blood pressure is somewhat elevated but without any clinical signs of hypertension so the GP also arranges a 24 hour BP recording and some fasting biochemistry. On examination the following observations were noted: Weight                         84 kg Height                          162 cm Hearth rate                   84 regular Blood pressure             156 / 88 mmHg Venous pressure           not raised Cardiac apex                not displaced Heart sounds                Audible with a soft ejection systolic murmur & no added sounds Peripheral pulses           papable at the ankles with no peripheral oedema The results of relevant blood tests are shown below: FBC                             Hb                   9.8       (11.5 – 16.0) g/dl                                     MCV               62        (76 – 96) fl Biochem                       Na                   139      (135 – 145) mmol/l                                     K                     3.3       (3.5 – 5.0) mmol/l                                     Creatinine         110      (70 – 150) μmol/l                                     Urea                 4.0       (2.5 – 6.7) mmol/l                                     Calcium            1.9       (2.12 – 2.65) mmol/l   Fasting plasma chem                 Glucose            6.41 mmol/l                                                 Cholesterol       6.32 mmol/l                                                 LDL                 5.62 mmol/l                                                 HDL                1.0 mmol/l                                                 Trg                   1.1 mmol/l   The 24 hour BP recording showed mild to moderate systolic and diastolic hypertension throughout the day with an average pressure of 146/82 during the waking hours. Diurnal variation and nocturnal dip were preserved. The GP started Mary on the following tables and referred her to you for some nutrition advice. She arrives having completed a three day diet diary (attached). To her knowledge she has no allergies to foods or any medications. Mediations                   ASA                            75 mg od                                     Bendrofluazide 2.5 mg od   Question Describe (in 2000 words) the dietary measures that you would suggest for Mary and the rationale for their introduction with reference to the appropriate literature. Consider what further information/tests may be helpful, include a review of nutritional risk factors and make suggestions for concomittent pharmacological management of nutritional disorders where you think they may be necessary. Write your paper in the form of a case report and be sure to include a reference list (and bibliography if necessary).     I have also attached some information that will help you write this case study. In the medication, I think you should add  β – blocker to her medication as well as stampin.  Talk about anemia, the risk factors, osteoporosis, as a result of calcium, potassium, cholesterol, diabetes type II, interpret the results very well, recommend therapy, focus on main problems, especially her diet.           Below is Mary Browning day to day normal meal. Name: Mary Browning                                  Day: Thursday     Time Food and drink Portions Where Activity Circumstances 0700 1 slice toast with butter, 2 cups of coffee 1 Kitchen Getting ready for work   1040 Cup of coffee & chocolate biscuits   Staff room     1230 Salad sandwich, 2 cups of coffee 1 Staff room Preparing pm’s teaching   1410 Cup of tea   Staff room   Feeling tired 1915 Lasagne Salad Garlic bread 2 glasses red wine ½ sainsbury’s fruit trifle 2 1 1 2   2 Dining room With john   2030-2200 2 glasses red wine 2 Living room Watching TV John working upstairs                                                           Name: Mary Browning                                              Day: Friday   Time Food and drink Portions Where Activity Circumstances 0730 2 cups coffee   Kitchen Getting ready for work Browning late 1030 Cup of coffee 1 cream cake   1 Staff room Reading     1340 Chicken  fujita Chips 1 glass white wine 1 1 1 Restaurant   Lunch with maggle and joan   1600 Cup of tea 2 digestive biscuits   Kitchen Doing house work   2015 Steak (about 60z) New potatoes Carrots Peas Broccoliu 3 glasses red wine large slice black ferrest suteaux 1 1 1 1 1   3 2 Dining room Doing house work With John and Tim       Name: Mary Browning                                  Day: Saturday   Time Food and Drink Portion Where Activity circumstances 0820 2 slices of toast with butter 2 cups coffee 2 Kitchen     1040 Cup of coffee Chelsea bun 1 Café shopping   1320 9’’ pizza (beef, chillier, onion) 1 glass coke (large)   Pizza express   With John   1530 Cup of tea 4 chocolate biscuits   Maggies kitchen Chatting   1940 Chinese take away 1 spring roll 2 spare ribs 4 prawn crackers special fried rice pork with cashew nuts 4 glasses white wine   1 2 4 1 1   4 Living room Watching film           Case study In order to discuss our patient Mary Browning, it will be best to interpret the results from the examination or diagnosis made by her GP (doctor). According to the diagnosis and results produced by the patients doctor, the patient has been diagnose with anemia, (due to her Hb 9.8 g/dl is quite low, as well as her MCV 62 fl). Which definitely shows that she is suffering iron deficiency.  The patient’s potassium (3.3 mmol/l) and calcium (1.9mmol/l) level was lower than what the WHO or the government considers normal, normal potassium (K) level  is between 3.5-5.0 mmol/l and normal calcium (Ca) level is between 2.12-2.65 mmol/l. This patient is at risk of osteoporosis, due to lower intake of calcium. She really needs to increase K and Ca intake either by diet and nutrition or medication. The patients cholesterol was also high, glucose intoalence, as well as low density liver protein (LDL) and triglycerol (Trg). Meaning she could be heading to a type II diabetes. Therefore, needs to change her diet to a very healthy one, needs to cut down on coffee a lot, wine, chocolate and biscuits. While, the patients high desity liver protein (HDL) is low, creatinine is normal, urea is normal, and sodium (Na) is also normal. The patient is over weight (84kg) according to WHO, for her height (162) she should be weighing between 50-59kg, at least her heart rate is regular, blood pressure is little bit high. Therefore, we need to focus on changing this patients diet and get her to eat more healthy food as well as to take up some physical activities. Since the patient has been diagnose with anemia, lets talk about that first.     Iron is an essential building block used by the body to synthesize haemoglobin and red blood cells. Thus, if iron levels in the body are low, which makes us tired and apathetic the result is anemia (low haemoglobin (Hb) / hematocrit). Anemia is characterised by low levels of haemoglobin causing oxygen starvation in your tissues. There are other types of anemia that are not related to low iron, so accurate diagnosis is important. Haemoglobin is the chemical substance in red blood cells that captures and holds oxygen by circulating throughout the lining of our lungs, and carries this oxygen throughout our entire bodies to every tissue. This fresh oxygen is then used to burn our internal fuel for energy, which is needed for proper cell growth and development and to provide fuel other important metabolic processes. Normal Hb (complete blood count, CBC) 14.0g/dl to 17.4 for adult men and 12.3g/dl to 15.3g/dl for non pregnant women. The WHO defines anemia as less than 12g/dl for nonpregnant women and less than 13g/dl for men. Iron is also nedded to produce myoglobin, the oxygen reservoir in the muscle cells and cytochromes, a class of iron-containing proteins important in cell respiration as catalysts of oxidation-reduction reactions. Low levels of iron in the body can be associated with lack of iron in the diet, excess loss of iron from the body (especially menstruating females), pregnancy, and poor absorption of iron from the diet (rare). Iron deficiency anemia is the most common form of anemia. Approximately 20% of women, 50% of pregnant women, and 3% of men are iron deficient. Iron is normally obtained through the food in your diet and by recycling iron from old red blood cells. Without effectively and oxygen is needed for the normal functioning of every cell in the body. Anemia develops slowly after the normal stores of iron have been depleted in the body and in the bone marrow. Women, in general, have smaller stores of iron than men and have increased loss through menstruation, placing them at higher risk for anemia than men. In men and postmenopausal women, anemia is usually caused by gastrointestinal blood loss associated with ulcers, the use of aspirin or nonsteroidal anti-inflammatory mediations (NSAIDS), or certain types of cancer (Grund, 2004).    Signs and symptoms of iron deficiency:   Often, mild iron deficiency anemia has no symptoms, more severe iron deficiency anemia can cause fatigue, weakness, and pale coloured skin or mucous membranes. More shortness of breath during exercise, fast heartbeat, symptoms usually come on slowly so that you feel no sudden change in your energy level.     Reason for mineral treatment is to prevent the development of a possible or expected deficiency. Here, minerals are Administered when tests for possible mineral deficiency are not given. Ther is reason to believe that the purchase and consumption of most of these minerals is benefical to health for some, but not all, of the minerals. Potassium supplements are useful for reducing blood pressure, in cases of persons with high blood pressure. The effect of potassium varies from person to person. The consumption of calcium supplements is likely to have some effect on reducing the risk for osteoporosis. Calcium supplements, along with estrogen and calcitonin therapy, are commonly used in the prevention and treatment of osteoporosis. Bone loss occurs with diets supplying under 400mg Ca/day. Bone loss can be minimised with the consumption of the RDA for calcium. During emergency treatment of potassium deficiency (hypokalemia) and calcium deficiency (hypocalcemia) with intravenous injections, extreme caution must be taken to avoid producing toxic levels of each of these minerals, as minerals toxicity can be life-threatening in some instances. Osteoporosis is a disorder in which bones gradually become thinner and weaker until they can break easily. Most commonly, people with advanced osteoporosis will have fractures of the hip, spine or wrist. Osteoporosis is a major threat for 44 million Americans. More than half of people older than 50 have the condition. One in two women and one in four men older than 50 get fracture as a result of osteoporosis. Bone is a living tissue, giving  you the support for muscles, protecting your organs and storing the calcium for storing the calcium for strong bones. Your diet and exercise habits have a major impact on your constantly changing bones. Bone loss is worsened in women when their bodies stop producing estrogen, a hormone that helps protect bones. Although osteoporosis is a progressive disease without a cure, medications and hormones are used to slow down bone loss and even help rebuild bone strength. Eating calcium – rich foods, vitamin D and doing more weight-bearing exercise also helps slow bone loss and helps prevent the disease, and if you smoke quite (McFarland, 2005). Cholesterol is a soft wax-life substance in your blood stream and in your cells. Eating too much of foods with high cholesterol can hurt you. These foods are animal products such a smeats, poultry, fish, eggs, butter and whole milk. Plant foods such as fruit vegetables and cereal don’t have cholesterol. Cholesterol can’t dissolve in the blood and is carried from cell to cell by lipoproteins. You have two types of these lipoproteins. Low desity lipoprotein (LDL), is known as the bad cholesterol. Too much can cause your arteries to clog. High – density lipoprotein (HDL) is known as the good cholesterol. You want to have this in your body because it protects you by carrying cholesterol away from your arteries and may even help reduce your risk of heart attack.   Your Triglycerides level is also important in your cholesterol picture. Triglycerides are the chemical form in which most fat exists in foods and are also made in the body. Calories not used right away are change to triglycerides and stored in fat cells. Between, your hormones regulate the release of triglycerides to give you energy. High levels of triglycerides are associated with a high risk of heart attack and strock. People who have high triglycerides levels also have high total cholesterol and low HDL. People with diabetes or who are obese tend to have a high triglyceride level as well.   You can reduce unhealthy cholesterol levels by eating foods low in saturated fats, cholesterol and trans fats. Exercise and weight loss can also help.   General risk factors of anemia or iron deficiency:   Young children and premenopausal women are at highest risk, with those in lower socioeconomic groups having double the risk of those who are middle or upper class. Pregnant or lactating women who have an increased requirement for iron Adolescent and adult men and postmenopausal women have the lowest risk. Men, in fact, are at risk for iron overload, probably because of their higher meat intake. People with a poor dietary intake of iron Iron deficiency occurs in elderly, it is most likely to be due to causes other than diet, particularly gastrointestinal bleeding or from blood loss during surgery. Risk factors related to blood loss are peptic ulcer disease, long term aspirin use, and colon cancer (Grund, 2004).   Risk factors for permenopausal women   According to one report, 10% of women in their reproductive years have iron deficiencies, and between 2% and 5% have iron levels low enough to cause anemia. The risk for anemia (usually mild) in women occurs with one or more of the following conditions.   Heavy menstruation for longer than five days Abnormal uterine bleeding, such as from fibroids Pregnancy. About 20% of women in industrialised countries have iron deficiency during pregnancy. Multiple pregnancies and births significantly increase the risk.   Hence, in Mary Browning case, her anemia could also be due to she is a premenopausal women and also due to poor iron diet intake etc.   Iron rich foods can fortify your blood, in a properly balanced diet, which can become weakened by a lack of foods rich in iron. Iron, the metal, is an element that is also a trace nutrient mineral that we all need to consume as a part of our everyday diet. Iron, in some form, is essential for good health.   Risk factors for osteoporosis   Advanced age, – High caffeine intake Being female Low dietary intake of calcium Family history of osteoporosis Smoking Early menopause Estrogen deficiency as a result of menopause, especially early or surgically induced. Lack of exercise, etc.     Optimal Daily Dietary Iron Intake:   Children – from birth to age 6 months: 10mg daily Children – from ages 6 months to 4 years: 15mg daily Females – ages 11 to 50: 18mg Females – over age 50: 10mg Pregnant women : 30 to 60mg Males – ages 10 to 18: 18mg Males over age 19: 10mg    Two different types of digestible iron in food   Hemo iron, found in red meat seafood and poultry, and non-hemo iron found in breads, fruits, breakfast cereals, vegetable, legumes (example, baked beans, nuts and eggs).   Hemo iron foods are rich in iron and contain iron in a form that is easily absorbed by the body. Red meat also has a special effect on iron absorption. Red meat, when eaten together with the vegetables, can boost the absorption of non-hemo iron by up to 40%. Vitamin C has a  similar positive effect on the absorption of iron. Normally, there is no graet danger in ingesting a toxic amount of iron from food. Intakes of 25 to 75mg. A day are not going to cause a problem in healthy and active adult. Too much iron supplements. However, can be lethal and the younger the person who ingests the extreme dose of iron supplements, the higher the possibility of a lethal dose.   Foods (including, fruits and vegetable) rich in iron, calcium and potassium   Eat more food containing vitamin C. Vitamin C enhances the absorption of iron into your body. You can also counter act this being eating foods high in cacium with it (calcium binds the chemicals making iron more easily absorbed into the blood). This is a very good dietary source for this patient, considering she has a lower intake of calcium as well as needing iron in her diet. You can still obtain iron from vegetables. Food such as beans, whole grains, spinach and dried fruits have a significant amount of iron. Red meat contains a significant amounts of iron. Liver is an excellent source of iron try eating extra lean meat. Eat a lot of iron rich cereal. Many cereals are fortified with iron. Check the food label on the box and look for iron under the daily values. But in this patient case tea will be a good idea, because she drinks a lot of coffee, so now she can cut down on coffee and start drinking tea instead. However, should also avoid drinking tea with meals that are high in iron. Tea contains tannin that could inhibit the absorption of iron. A good policy is to monitor what you eat. You must know exactly what your diet is, having a brief written food intake list, if you wish to enhance or improve it.  Again, if all else fails, take an iron supplement or a multivitamin with iron. Though vitamins could cause side effects such as constipation and nausea, the proper balance of iron is easily achieved, and the rewards for your efforts are great. Recommendation of foods high in fibre is also good as an iron booster, drinking plenty of fluids and eat plenty of fibre rich vegetable is a good source of iron booster.   LIST OF GRAINS RICH IN IRON                                        iron (mg)   Brown rice, 1 cup cooked                                                        0.8 Whole wheat bread, 1 slice                                                       0.9 Wheat germ, 2 tablespoons                                                       1.1 Total cereal, 1 ounce                                                                1.8   List of iron rich legumes, seed and soy:   Sunflower seeds, 1 ounce                                                         1.4 Soy milk, 1 cup                                                                        1.4 Kidney beans, ½ cup canned                                                    1.6 Soy burger, 1 average                                                   1.6 Chickpeas, ½ cup, canned                                                        1.6   List of vegetables rich in iron:   Broccoli ½ cup, boiled                                                  0.7 Green beans, ½ cup, boiled                                                      0.8 Lima beans, baby, frozen, ½ cup boiled                                    1.8 Beets, 1 cup                                                                             1.8 Potato, fresh baked, cooked with skin on                                  4.0 Watermelon, 6 inch x ½ inch slice                                             3.0 (Brody, 2002)     A sample list of foods rich in iron:   Blackstrap molasses, one tablespoon                                        3.0 Dates or prunes, ½ cup                                                             2.4 Beef, pork, lamb, three ounces                                      2.3 to 3.0 Liver (beef, chicken), three ounces                                            8.0 to 25.0 Claims, oysters ¾ cup                                                   3.0 Dark meat turkey ¾ cup                                                           2.6 Pizza, cheese or pepperoni, ½ of 10 inch pie                             4.5 to 5.5 (Brody, 2002)   A list of food rich in calcium                                                      calcium (mg)   Baked beans, canned, 1 cup                                                     128 Black beans, 1 cup, boiled                                                        47 Butter beans, canned, 1 cup                                                      40 Cranberry beans, 1 cup, boiled                                                 89 Soy beans, 1 cup, boiled                                                           175 White beans, 1 cup, boiled                                                        161 Yellow beans, 1 cup, boiled                                                      110 Refried beans, canned,1 cup                                                     188   Grains rich in calcium   Almonds, 24 (dried)                                                                 75 Brazil nuts, 8 (dried)                                                                 50 Carob flour, 1 cup                                                                    359 Pistachios, 38 (dried)                                                                38 Sesame seeds, 1 tablespoon                                                     10 Sunflower seeds, 1 ounce (dried)                                              33   Seafoods rich in calcium   Canned salmon, 3 ounce                                                           150 Canned sardines, 6                                                                   250 (with bones) oysters, 1 cup                                                                           195   Vegetables and green rich in calcium   Acorn squash, ½ cup, baked                                                    45 Butter nut squash, ½ cup                                                           42 Beet greens, ½ cup                                                                   82 Black eyed peas, 1 cup                                                             42 Broccoli, raw, ½ cup                                                                21 Cabbage, green, raw, ½ cup boiled                                           15 Carrots, ½ cup, boiled                                                  24 Chickpeas, 1 cup, boiled                                                          80 Garlic, raw, three cloves,                                                          16 Spinach, raw, ½ cup boiled                                                       138   Other non-diary sources   Agar, dried, 3.5 ounces                                                            625 Papaya, raw, 1 medium                                                            72 Orange juice (fortified), 12 ounces                                            40 Natto, ½ cup                                                                            191 Kelp, raw, 3.5 ounces                                                              168 Cassava, raw, 3.5 ounces                                                         91 Amaranth, 1 cup, boiled                                                            138 (McFarland, 2005)   Potassium in diet: food sources:   Fish such as salmon, cod, flounder, and sardines are good sources of potassium. Various other meats also contain potassium.   Vegetables including broccoli, peas, lima beans, tomatoes, potatoes (especially their skins), and leafy green vegetables such as spinach, lettuce, and parsley contain potassium.   Fruits that contain significant sources of potassium are citrus fruits, apples, bananas, and apricots. Dried apricots contain more potassium than fresh apricots.                                                       References:   Grund. S. (2004) Iron Deficiency Anemia: Medline Plus Medical Encyclopedia. (Online). New Britain General Hospital,  Healthcare Network. Available from: http://www.nlm.nih.gov/medlineplus/ency/article/000584.htm. [Accessed on 26 April 2006].   Brody. T. (2002) Minerals (Online) Gale Encyclopedia of Medicine, Health A to Z. Available from: http://www.healthatoz.com/healthatoz/AtoZ/ency/minerals.jsp. [Accessed on 26 April 2006]. Credit:ivythesis.typepad.com

Diet and nutrition – assignment case study

Diet and nutrition – assignment case study Mary Browning is 54 year old part-time teaching assistant in a local primary school. She live...