Running head: CASE STUDY 11Lesson 11 Case Study Determine Basic Concepts of Medical Nutrition Therapy Angela Martin United States University 1 CASE STUDY 11 2 Lesson 11 Case Study- Al Introduction This case analysis is about Al who is a retired professional football player. He won many awards for his outstanding athletic ability. After he retired from football he spends his time speaking to high school athletes and managing his investments. While speaking at his son's school he feels light headed and has blurred vision. After a few minutes he feels better, but decides to call his doctor. His doctor diagnoses his problems over the phone as probably low blood sugar, but suggests Al come in the next day for some blood tests. 1. How old is Al? According to the information presented in the case study, Al was born in 1965 and as of today (2012) he is forty-seven years old. 2. What is Al’s IBW? What is his percentage of IBW? Al’s Ideal Body Weight is 91.4 kg based on the fact that he is currently weighing 131 kg and his height is 78 inches. Percentage of Ideal Body Weight = Original Weight/ Ideal Weight * 100 Percentage of Ideal Body Weight = 131kgs / 91.4 kg *100 Percentage of Ideal Body Weight = 143% 3. What does his lab report tell you about his iron status? What are normal iron status lab values for adult males? The problem of anaemia is the most intractable and common nutritional problems today. The main reasons of anaemia are: inherited conditions (thalassaemia), deficiencies of key micronutrients (Vitamin A, Vitamin B12 and flotae), schistosomiasis and hookworm infections, malaria and most importantly dietary iron deficiency (Pinkney, Johnson & Gale, 2010). The dietary iron deficiency is measured by evaluating patient’s iron status. Al’s iron status can be evaluated by his HCT and HGB stats. Al seems to have normal hemoglobin count as his Hgb is 17 g/dL. On the other hand, Al’s hermatocrit of 44% means that there are 44 milliliters of red CASE STUDY 11 3 blood cells in 100 milliliters of blood and it’s also normal. The normal value of Hgb in adult males is 13.8 to 17.2 grams per deciliter (g/dL) and for Hermatocrit its 45% to 52% for adult men. 4. What does his lab report tell you about his risk for diabetes? What is normal lab values reflecting blood glucose control? Al is at higher risk of diabetes because his Fasting Blood Sugar is very high (212) while the normal range is between 70 to 100 mg/dl. On the other hand, Al’s hemoglobin A1c (HgAlc) is also high as it should be 5.7% normally. Lastly Al has higher cholesterol of 299 mg/dl while the normal value should be 180 to 200 mg/dL or less. 5. What does his lab report tell you about his risk for heart disease? What is normal lab values reflecting cardiac status? The risk of heart disease depends on various risk factors such as, uncontrolled stress and anger; high C-reactive protein; uncontrolled diabetes; Obesity; Physical inactivity; Uncontrolled hypertension; High LDL; and smoking. According to the analysis of Al’s lab report, he has a high risk for heart disease. First of all Al has higher Fasting Blood Sugar indicating him to be a patient of diabetes. Al also has higher blood pressure that increases his risk for cardiovascular disease. Various researches have indicated a positive relationship between insulin resistance and hypertension that increases risk for heart disease. Moreover Al has highly elevated cholesterol level that is also a factor behind heart disease. 6. His doctor is not pleased with the initial blood tests and tells AI to "cut back on the sugar" and come back in one week for more blood work. Listed below is AI's diet for the next day. Using the AND (Academy of Nutrition and Dietetics, formerly known as the American Dietetic Association [ADA]) Exchange lists estimate about how many calories are CASE STUDY 11 4 in AI's 24 hour record. Estimate how many grams of carbohydrate and fat are in his 24hour record. Determine the percentage of calories from fat. FOOD ITEM Grams Carbohydrate 3 Scrambled Eggs 2 Slices Bacon 0.28 2 Biscuits with 2 tsp Butter 30 2 tsp Diet Jelly 0 1 Cup Orange Juice 30 1 Cup Black Coffee 0 6 Oz, Chicken Breast, Broiled 0 Grams Percentage of calories Fat from fat 9 8 10 0 0 0 18 49% 70% 40% 0% 0% 0% 36% no Skin 1 Cup White Rice, Fat-Free ½ Cup Green Beans 1 Cup Melon Cubes 1 Cup Frozen Yoghurt (Fat 45 5 13 35 0 0.1 0.3 0.65 0% 6% 6% 4% Free) 1 Cup Iced Tea, Unsweetened ½ of 10” Cheese Pizza 1 Light Beer (12 Oz) 1 Cup Tossed Salad 3 Brownies (2” sq) 3 Oz. Potato Chips 12 Oz Diet Soft Drink TOTALS 0.67 72 6 3 63 42 0.84 428 0 28 0 4 15 32 0.07 147 0% 38% 0% 51% 33% 62% 25% CASE STUDY 11 5 References Pinkney, J. H., Johnson, A. B., & Gale, E. A. M. (2010). The big fat bariatric bandwagon. Diabetologia, 53(9), 1815-1822.