Assignment 1 - Module 1

NHM 365-901

Name: ___Rayzl Kahn________________________

CWID: _11665628_______________

LJ is a 37-year-old male who is 511 and weighs 235 lbs. During college, he played several intramural
sports and maintained a UBW of 185 lbs. However, after graduation, his weight increased to 200 lbs. Four
years ago, he transitioned from his job as a high school teacher to a new position of vice principal. The new job
requires longer hours and more desk work. Because his job requires so much time, LJ does not regularly
exercise.
LJs family hx is a concern. Both of his parents have type 2 diabetes. LJs doctor has told him he needs
to lose weight in order to reduce the risk of developing diabetes. His doctor referred him for a nutrition consult
for weight reduction.
The RD interviewed LJ and found that he was born in Mexico but immigrated to the United States when
he was 4-years-old. Growing up, LJs family owned a restaurant, and he learned to cook at an early age. He
often prepares traditional food from Mexico and fries these foods in lard. Since LJ began his job as vice
principal, his North American wife has assumed some of the cooking, but they frequently patronize fast food
restaurants and the all you can eat buffet restaurant near their home. He does not eat breakfast at home,
stating that he doesnt have time to do so. Instead he typically takes a large muffin and a 20 oz soda with him to
school. He drinks several cups of coffee with sugar and cream at his desk during the morning. He eats lunch in
the school cafeteria, often requesting large portions of meats and other foods he likes. After lunch, he usually
drinks at least one additional sweetened soda. After the students leave school in the afternoon, LJ commonly
purchases a snack from the convenience store near his school and returns to work for several hours. Analysis
of a 24-hour recall combined with a food frequency questionnaire reveals that LJs typical intake is
approximately 4200 kcals with ~200 grams per day of total fat, 100 grams of saturated fat, and ~20%kcals from
sugar or other concentrated sweets.
Additional assessment data:
DOB: 01/13/1977
Household members: Wife, age 34 in good health
Biochemical data:
Lab
Sodium (Na+)
Potassium (K+)
Blood urea nitrogen (BUN)
Creatinine
Glucose
Calcium
Thyroid stimulating
hormone (TSH)
Triiodothyronine (T3)

Result
141 mEq/L
4.0 mEq/L
18 mEq/L
1.1 mg/dL
98 mg/dL
9.5 mg/dL
2.1 mIU/L

Normal Range
135-145 mEq/L
3.5-5 mEq/L
5-20 mg/dL
0.6-1.2 mg/dL
70-99 mg/dL
8.6-10 mg/dL
0.5-5 mIU/L
(milli-international units per liter)

156 ng/dL

PMH: Unremarkable other than acid reflux

70-205 ng/dL

1. In addition to the information provided above, list 3 additional pieces of information you would collect
as part of your nutrition assessment. (3 pts)
1- Cholesterol (HDL & LDL)
2- Blood pressure
3- HbA1C
2. Calculate LJs BMI, and interpret according to the WHO categories. (2 pts)
Be sure to show your work, and report BMI to 1 decimal place.
Weight in kg = 106.6kg = 32.8- Class 1 Obesity
Height in m2
3.25m2
3. Calculate LJs %IBW, %UBW (using 200 lbs as UBW), and % wt change over the past 4 years. Be sure
to show your work. (3 pts)
IBW- 189.2lbs
%IBW: (235/189.2) x 100 = 124%
%UBW: (235/200) x 100 = 118%
% wt change: [(235-200)/235] x 100= 17.5%
4. Calculate LJs REE using the Mifflin St. Jeor Equation and the Harris Benedict Equation. Apply an
Activity Factor of 1.2 (sedentary) to approximate TEE. (Show your work. Remember, these equations
use weight in kg and height in cm). (4 pts)
Mifflin St. Jeor Equation (men):
REE = (9.99 X weight) + (6.25 X height) (4.92 X age) + 5
(9.99 x 106.6) + (6.25 x 180.34) (4.92 x 37) + 5
(1064.934) + (1127.125) (182.04) + 5 = 2020.019 x 1.2 = 2424 kcal
Harris Benedict Equation (men):
REE = 66.47 + (13.75 x weight in kg) + (5.003 x height in cm ) - (6.755 x age in years)
66.47 + (13.75 x 106.6) + (5.003 x 180.34) (6.755 x 37)
66.47 + (1465.75) + (902.24102) - (249.935) = 2184.52602 x 1.2 = 2621 kcal
5. Complete the chart of biochemical data with normal values for each lab test. Evaluate LJs lab results.
Why did his doctor order a thyroid panel? (4 pts)
His increased weight gain (and difficulty losing weight) may possibly be stemming from a thyroid
disorder. Likely the doctor wanted to find out if there is an issue while LJ begins his new
diet/lifestyle changes.
6. Based on this nutrition assessment, write two PES statements for this patient. (6 pts)
A) Excessive energy intake related to consistent consumption of large portions of high calorie, fat
and sugary foods as evidenced by 24-hr recall and FFQ.
B) Class I obesity related to high energy intake and low level of physical activity as evidenced by
BMI of 32.8.

7. Identify 2 goals for this pt. Identify 3 specific recommendations you would make for this patient to
facilitate his weight loss goals. (5 pts)
Does each recommendation address the etiology (or at least the s/s) of your PES statement?
a- Lower caloric intake to 3000 kcal/day
b- Limit sweetened drinks to 1 per day
c- do hour of moderate exercise every day
8. Monitoring and Evaluation:
When should the next outpatient visit with LJ be scheduled? Identify 3 things you plan to assess during
that follow-up visit? (3 pts)
Does your plan for monitoring relate back to s/s of PES statement?
The next visit should be in 4 weeks. We will: a- review his daily schedule (exercise, eating habits
etc.), b- we will see how much weight he has lost, c- we will conduct a 24-hr recall to see what the
caloric intake is.