NCP Composite

GRADE: 90%
Nutrition 302 L
Paulina Delgado Cuenca
Experiment: blood Albumen
Date: 02.16.14
Recorder: Paulina Delgado
Nutrition Assessment
Diagnosis: Bladder cancer
Age: 55, female
Dietary intake: PO intake
Symptoms: decreased appetite since chemo. N/V when tries to eat
30g/d protein intake
Anthropometric measurements:
o ht/wt: 555/165.1cmand 112# /50.9kg
o BMI= 18.7kg/m2
o IBW= 125#/56.8kg, %IBW89.6%( mild mal nutrition
o UBW=123#/55.9kg %UBW= 91% (mild malnutrition
o %wt loss: 8.9% (mild degree of malnutrition)
Energy, protein and fluid needs
o Give a range
Total energy= 1998-2306 ml/d
Protein= 50.9-63.6 ml/d
Fluid=1782 ml/d
o Include basis of estimation (based on BW of 50.9kg)
For energy, used Harris-Benedict formula to determine REE then multiply
by activity (1.3)& injury factor (1.3-1.5)
For Protein, used stress factor for tumor. 1.0-1.25g PRO/kg
For fluid needs, used 35 ml/kg/d
o Labs/tests- can indicate high, low, normal or abnormal
Total PRO= 5.5 g/dL, low (<6.0g/dL)
Serum albumen= 2.8 g/dL low (<3.5-5 g/dL)
Nutrition Diagnosis- PES format
Inadequate protein intake ( or inadequate energy intake) R/T poor appetite and N/V
caused by chemotherapy AEB <90% IBW, 8.9% wt loss, low protein intake ( 30g/d), low
total protein and low serum albumen.
Nutrition Intervention
1) Meals and snacks
a. Nutrient-dense foods with meals
b. Supplemental protein drinks TID between meals
c. Examples of protein rich foods
2) Nutrition-related medication management
a. REC appetite stimulant
Goals
1)
2)
3)
4)
Dietary intake to meet >75% of estimated energy needs

Weight gain of 1#/wk until patient reaches UBW/IBW
Protein need: 50.9-63.6 g/d
Increase total protein and serum albumen to within normal ranges in 4 wk
Monitoring and evaluation

Follow up phone call within 1wk
Ask the patient to do 3-day food record and bring it to clinic to reassess BW,
protein, intake have increase from previous visit.
Re-assess total protein and serum albumen in 4 wks to determine if they are
within normal ranges.
Consult MD if the patient needs a TPN in case the patient has still low blood
albumen and loses body weight.
Grade 100%
GRADE: 88%
Nutrition 302 L
Experiment: blood hemoglobin/hematocrit
Delgado
Date: 02.20.14
Recorder: Paulina
Diagnosis: Anemia (not a medical diagnosis)
Age: 20, female
o Vegetarian diet and stopped taking vitamin supplement
Symptoms: she is breast-feeding, and feels worn down.
o ht/wt: 54/162.6cm //108# /49kg
o BMI= 18.7kg/m2 (normal)
o IBW= 120#/54.4 kg, %IBW= 90% (mild malnutrition)
o Give a range:
o Total energy= 2,019-2,940 kcal/d
Protein= 54-64 g/d
Fluid= 2,019-2,940 ml/d
o Include basis of estimation (based on BW of 49kg)
For energy, used Mifflin St. Jeor to determine REE then multiply by
activity (1.3)& injury factor (1.0) +500kcal for lactation
For Protein, used non stressed state: .8-1.00g PRO/kg + 15g/d lactation
For fluid needs, used 1ml/kcal
Hemoglobin levels= 9.5g/dL (low) (normal range: 11-16 g/dL)
Hematocrit = 30% (low) (normal range: 37-47%)
Inadequate Iron intake R/T lacto vegetarian diet, low %IBW suggestive of mild
malnutrition and stopped taking vitamin/mineral supplement during lactation AEB
feeling worn down, and low Hb levels (9.5g/dL) and low hematocrit (30%).
3) Meals and snacks
d. Iron rich vegetarian diet
e. Examples of iron rich foods: nuts, fish (if she is not strict vegetarian),
spinach, broccoli, soy products, soybeans, iron enriched cereals.
f. Increase protein intake to increase %IBW
g. Resume the vitamin/mineral supplement
2) Education intervention:
a. Educate about the importance of adequate iron intake specially during
lactation
b. Educate about what vegetarian foods are iron rich
c. Educate on the importance of consuming enough calories and protein
during lactation
3) Coordination of Nutrition care:
o Not necessary at this moment
Goals
1)
2)
3)
4)
Increase iron intake immediately

Start taking vitamin/mineral supplement immediately
Normalize Hb/Hct levels within 3 months
Increase protein intake to at least 90%

Re-assess Hb and Hct levels within 3 months
GRADE: 100%
Nutrition 302 L
Experiment: diet
Date: 03.18.14
Age: 27, female
o ht/wt: 52/157.5cm //106# /48kg
o BMI= 19.3kg/m2 (normal)
o IBW= 110#/50kg, %IBW= 96% (normal)
o Activity level: active
o Energy, protein Give a range:
o Total energy= 2,191(estimated by food intake software)
Protein= 38 g/d (estimated by food intake software)
(kcal)
CHO
(g)
Fiber
(g)
Fat
(g)
Sat
Fat
(g)
Pro
(g)
1791
low
207
low
42
high
66
17
right
2,191
301
37
68
82
69
137
97
energy
recall
right
VitA
(ug)
VitC VitD
(mg) (ug)
Iron
(mg)
Ca
(mg)
Na
(mg)
110 248
high low
241
high
2.83
low*
31
high
1996
high
2039
right
22
38
700
75
15
18
1000
2300
77
287
35
321
19
173
200
89
DRI
%DRI
* This value does not take into account the amount of vitamin D synthesized by sun exposure.
Most likely there is no vitamin D deficiency.
Excessive protein intake R/T regular high consumption protein rich foods AEB 24hr food
intake recall data provided (110g) vs. DRI (38g).
Inadequate carbohydrate intake R/T regular low consumption of carbohydrate rich foods
AEB 24hr food intake recall data provided (207g) vs. DRI (301g)
Inadequate vitamin A intake R/T low consumption of vitamin A rich foods AEB 24hr
food intake recall data provided (248ug) vs. DRI (700ug).
Excessive vitamin C intake R/T high consumption of vitamin C rich foods AEB 24hr
food intake recall data provided (241g) vs. DRI (75mg).
Excessive mineral Calcium, and Iron intake R/T high consumption of calcium and iron
rich foods AEB 24hr food intake recall data provided (1996mg) vs. DRI (1000mg) and
(31mg) vs. DRI (18mg) respectively.
4) Meals and snacks:
a. Reduce protein intake to at least 115% of recommended value (38-44g).
b. Increase CHO intake to at least 85% of recommended value (256g- 301g).
Example foods: pasta, rice, whole grains and fruits.
c. Increase vitamin A intake to at least 85% of recommended value (595ug
700ug). Example foods: carrots, sweet potato, and squash.
d. Reduce vitamin C intake to at least 115% of recommended value (86mg75mg).
e. Reduce calcium and iron intake to at least 115% of recommended values
(1,150mg-1000) and (21-18mg), respectively.
d. Educate about the importance of a balance diet when having an active
life with regular exercise routine.
e. Educate about foods rich in carbohydrates: pasta, rice, whole grains
and fruits.
f. Educate about foods rich in vitamin A like carrots, sweet potato, and
squash
g. Educate about foods rich in calcium and iron that should be consumed
in lower amounts. Example foods: dairy products, spinach, broccoli.
h. Educate about foods rich in vitamin C that should be consumed in
moderation. Example foods: citric fruits, berries, green leafy
vegetables.
Goals
5)
6)
7)
8)
9)
Reduce Protein intake to the recommended range (38g-44g)

Increase the CHO intake to recommended range (256g-301g)
Increase intake of Vitamin A to recommended range
Reduce vitamin C to recommended range
Reduce calcium and iron intake

3-4 day food record to have a better representation of nutrient intake and
see if in reality there is a regular lower Vitamin A consumption and regular
higher consumption of Vitamin C, Ca and iron.
Follow up visit in a month to reassess the patients vitamin, CHO, mineral
and protein levels and overall diet.
GRADE: 96%
Nutrition 302 L
Experiment: TG levels
Date: 03.18.14
Medical Diagnosis: Type II Diabetes Mellitus
Age: 37, female
o High fat diet
Symptoms: N/A
Physical activity: no exercise
o ht/wt: 51/155cm //152# /69kg
o BMI= 28.7kg/m2 (over weight)
o IBW= 105#/48kg, %IBW= 145% (obese, >125%)
o Adjusted BW= 107#/ 49kg
o Give a range:
o Total energy= 1,212 -1,455 kcal/d
Protein= 39g/d
Fluid= 1,212ml- 1,455 ml/d= 1.2 1.5 L/day
For energy used activity based formula: 25-30 kcal/ kg /day
For Protein used non stressed state: .8g Protein/kg
For fluid needs used 1ml/kcal
o Labs/tests:
TG levels= 250mg/dl (high, normal level is < 150 mg/dl)
Glucose= 145mg/dl (high, normal level <110 mg/dl)

Overweight/ obesity R/T high fat diet and lack of exercise AEB high BMI (28.7), high
TG levels (250mg/dL), and high %IBW (145%).
5) Meals and snacks
h. Reduce fat intake in diet
i. Reduce total Kcal consumption to the recommended range (1,2121455 kcal)
j. Increase vegetable and fruit intake
k. Increase whole grains intake
l. Reduce saturated fat and sodium intake
i. Educate about the importance of having a reduced fat diet and the
health risks of having a high fat diet
j. Educate on low fat foods like: vegetables, fruits, whole grains, lean
meats and cooking with less oil or butter
k. Educate on the importance of incorporating physical activity at least
30minutes most of the days in order to loose weight.
l. Educate on the positive effects of loosing weight on type II diabetes
patients.
o Refer patient to a physical trainer to incorporate an exercise routine
o Refer to diabetes educator
Goals
10)Work on loosing 1-2 #/week until a normal BMI is reached
11)Incorporate in at least 30min of physical activity most of the days
within 2 weeks
12)Normalize TG levels within 3-4 months
13)Consume the recommended daily kcal range immediately
14)Normalize Glucose levels immediately.

Request a 3day food log
Reassess TG and glucose in 3-4 months
Request a weight log. Measurements should be taken least 3 times a week
and at the same time.
GRADE: 100%
Nutrition 302 L
Experiment: HDL/ LDL
Date: 03.25.14
Medical Diagnosis: recovering from major surgery (coronary artery bypass graft)
Age: 54, female
o Diet high in fat
Habits: smokes 2 packs/day
Family history:
o Family history of heart disease
Symptoms: N/A
Physical activity: no exercise
o ht/wt: 54/163cm //148# /67kg
o BMI= 25.2kg/m2 (over weight)
o IBW= 120#/54kg, %IBW= 123% (over weight, over 100% but not greater than
125%)
o Give a range:
o Total energy= 1,717 - 2,126 kcal/d
Protein= 84 - 101g/d
Fluid= 1,717ml- 2,126 ml/d= 1.7 2.1 L/day
For energy used Mifflin-St. Jeor formula
For Protein used major surgery state: 1.25-1.5g Protein/kg
For fluid needs used 1ml/kcal
o Labs/tests:
AST= 76 U/L (high)
LDH= 322 U/L (high)
CPK= 268U/L (high)
TG levels= 250mg/dl (high, normal level is < 150 mg/dl)
TC= 240mg/dL (high)
HDL= 37mg/dL (low)
LDH= 153 mg/dL (high)
Undesirable food choices R/T preference of high fat foods and lack of exercise AEB high
BMI (28.7), high %IBW (123%), high TG levels (250mg/dL), high TC= 240 mg/dL, low
HDL (37mg/dL), high LDH (153 mg/dL, high AST (76 U/L), high LDH (320 U/L and
high CPK (268 U/L.
6) Meals and snacks
m. Reduce fat intake in diet
n. Meet the total Kcal recommended range (1,717 - 2,126 kcal)
o. Increase vegetable and fruit intake
p. Increase whole grains intake
q. Increase fiber intake
r. Reduce saturated fat
m. Educate about the importance of having a reduced fat diet and the
health risks of having a high fat diet
n. Educate on low fat foods like: vegetables, fruits, whole grains, lean
meats and cooking with less oil/ butter
o. Educate on the health risks of having high cholesterol levels
p. Educate on the importance of incorporating physical activity at least
30minutes most of the days in order to loose weight.
q. Educate on the health risk of family history of heart disease
r. Educate on severe health risks associated with smoking, especially
after surgery
o Refer patient to a physical trainer to incorporate an exercise routine as soon
as possible
o Refer to smoking cessation class as soon as possible
Goals
15)Work on modifying the diet and making better food choices reduced
in fat as soon as possible
16)Work on consume the DRI of kcal as soon as possible
17)Incorporate in at least 30min of physical activity most of the days
within 2 weeks
18)Normalize TG levels, TC and LDL within 3-4 months
19)Stop smoking as soon as possible
Follow up phone call within 1wk and make sure the patient has attended the
smoking cessation class
Request a 3day food log to keep track of kcal consumption
Reassess TG, TC and LDH, HDL levels within 3 months
GRADE: 99%
Nutrition 302 L
Experiment: Anthropometry
Date: 04.8.14
Subject gender: Female

Age: 23
1. Ideal body weight (IBW)
Weight: 122# 55.5 kg (122/2.2=55.5kg)
Height: 5 4 = 64 in = 163 cm (64x2.52=163cm)
Elbow breadth: 2.5in, 6.35 cm (table 6-3 p. 92-2 lab book)
Frame size: medium (table 6-3 p. 92-2 lab book)
Life insurance table weight range: 124-138#, 56-63 kg (table 6-1 pg. 92-1 lab book)
Hamwi IBW: 120# (5=100 +5(4)=120#)
%IBW: 102% normal (122/120= 1.0166 x100=102%)
* Her body weight is within the ideal range 120-138 # for a medium frame person.
2. Body Mass Index (BMI)
BMI: 20.9 (55.5/1.63^2= 20.9)
Category: Normal
3. Waist-to Hip Ratio
Waist: 69.9cm (27.5in x2.54=69.9cm) smallest number
Hip: 82.6cm (32.5 in x 2.54= 82.6cm) largest number
Waist to hip ratio: .85 (69.9/82.6cm= .85). The ratio is higher than normal. (normal
ratio< .8)
* Her waist to hip ratio was slightly higher than what is considered normal. It might
be because her frame is very athletic and her hips are not very pronounced.
4. Arm circumference and triceps skin fold comparison:
Triceps: 7mm, <5th percentile (used the chart on p. 88 in lab book)
Mid-arm circumference: 275mm or 27.5cm
Arm muscle area: 4500mm^2, 92% (90-95%ile). (Used the chart on p. 88)
Total arm area: 6000 mm^2 (used the chart on p. 89 lab book)
Arm Fat area: 1500 mm^2, 25th %ile (total arm area- total arm muscle area= 60004500= 1500mm^2)
5. Body Composition
A. Circumference: (used the table for female, 23 yr. p. 84-85)
Abdomen constant:
+
Thigh constant:
Subtotal
Constant
38
37
75
45
30
-20
10
Approximate body fat: 10%
B. Bioelectrical impedance Analysis (BIA)* used the machine that runs electrical
field through body
Body Fat: 20.3#(122# x .166= 20.3#), 16.6%
C. Three and seven site skinfolds
Three site skinfolds for women:
trials
mean
Triceps (mm): 5, 8, 8, 7
7
Suprailiac (mm): 7, 6, 7, 5
6.25
Thigh (mm):
10, 10, 11, 10 10.25
Sum of means: 23.5 mm (7+6.25+10.25=23.5 mm)
Seven site skinfolds
Chest (mm)
Midaxillary (mm)
Triceps (mm)
Subscapular(mm)
Abdomen (mm)
Suprailiac (mm)
Thigh (mm)
trials
mean
4, 4, 4, 4
4
8, 8, 7, 7
7.5
5, 8, 8, 7
7
9, 11, 9, 9
9.5
10, 10, 9, 10
9.75
7, 6, 7, 5
6.25
10, 10, 11, 10 10.25
Sum of mean: 54.25 mm
(4+7.5+7+9.5+9.75+6.25+10.25= 54.25)
Body Density (BD) from 3 skinfold sites: 1.077428175

1.0994921 0.0009929 (23.5) + 0.0000023 (23.5)^2 0.0001392 (23)=
1.0793596+.001270175-.0032016= 1.077428175
Body Density (BD) from 7 skinfold sites: 1.0702159075
1.09700000 0.00046971 (54.25) + 0.00000056 (54.25)^2 0.00012828 (23)=

1.0715182325+ .001648115 -.00295044=1.0702159075
Three site skinfold Body Composition Results:
Body Fat: 5.22kg, (55.5kg x .094=5.22kg)

9.4% (495/density (1.077428175)) 450= 9.4%)
Lean Body Mass: 50.28 kg (55.5kg 5.22kg= 50.28kg)
90.6% (100%- 9.4%= 90.6%)
Seven site skinfold Body Composition Results
Body Fat: 6.94kg (55.5kg x .125= 6.94kg)
12.5% (495/density (1.0702159075)) 450= 12.5%)
Lean Body Mass: 48.56kg (55.5kg 6.94kg= 48.56)
87.5% (100%- 12.5%= 87.5%)
D. Hydrostatic weighing (gold std. for body fat)
Residual Volume (RV): 1.22 L
Female, 23years old:
29.3 (163)+ 7.6 (23) -3730= 4,775.9 +174.8 3730= 1,221 *.001
Trial #1: 2.359kg, #2: 2.439kg, #3: 2.477kg. Average= 2.425kg =UWW
Body Density: 1.0665776
55.5/((55.5-2.475)/0.99567) 1220.7)= 1.0665776
Body Fat: 7.83 kg (55.5kg x .141= 7.83kg)
14.1% (7.83 x100 /55.5kg= 14.1%)
Lean body mass: 47.67kg (55.5kg 7.83= 47.67kg)
85.9% (100-14.1%= 85.9%
*All methods gave different results for %body fat. The BIA gave the highest value
(16.6%) and the three site skinfold method gave the lowest value (9.4%) Based
on the variation among the different methods, it is very important to measure
with more than one method for more accurate results. Since the hydrostatic
weighing is the golden standard, if possible it should be used along with one of
the other tree methods.
GRADE: 98%
Nutrition 302 L
Experiment: calcium levels
Date: 04.10.14
Diagnosis: lactose intolerance (not a medical diagnosis)
Age: 67, male
Currently in a very high protein diet 150g/day (normal value: 60-75g/ day)
o ht/wt: 58/173 cm//166# /75kg
o BMI= 25.2/m2 (borderline normal / over weight)
o IBW= 154#/70kg, %IBW= 107%
o Give a range:
Total energy= 1954- 2,050 kcal/d
Protein= 60- 75g/d
Fluid= 1954- 2050 ml/d
o Basis of estimation (based on BW of 75kg)
For energy, used Harris Benedict to determine REE then multiply by
activity (1.3)& injury factor (1.0)
For Protein, used non stressed state: .8-1.00g PRO/kg
For fluid needs, used 1ml/kcal
Fasting glucose level is slightly higher than normal, not critical (normal:
70-110 mg/dl
Blood calcium: 9.8 mg/dl (normal) (normal range: 9-10 mg/dl)
Urinary calcium: 300mg/day (high) normal range: 100-240mg/day)
Inadequate energy intake R/T high protein consumption and low calcium intake due to
lactose intolerance AEB high urinary Ca (300mg/day) and high protein consumption
(150g/day).
7) Meals and snacks
s. Decrease protein intake to recommended range (60-75g/day)
immediately.
t. Increase consumption of calcium rich non-dairy foods immediately
like: dark leafy greens (spinach, kale, collard greens), fish, fortified
cereals, fortified orange juice and soybeans.
s. Educate about the importance of adequate calcium intake for bone
and overall health (1000mg/day)
t. Educate about what non-dairy foods are rich in calcium: dark leafy
greens (spinach, kale, collard greens), fish, fortified cereals, fortified
orange juice and soybeans.
u. Educate on why excess consumption of protein can me harmful as it
causes an imbalance in the bodys system and weakens bones.
Goals
20)Increase calcium intake immediately (1000mg/day)
21)Meet the DRI of protein (60-75g/day) immediately
22)Normalize calcium urinary levels within 3 weeks
23)Perhaps take a Ca supplement of 500mg/day to ensure the DRI is met.
24)Drink plenty of fluids in order to regulate urinary and blood levels.

Re-assess urinary Ca levels within 3 weeks
3 day food log record to make sure the necessary diet modifications are
being done

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GRADE: 90%

Recorder: Paulina Delgado

Dietary intake to meet >75% of estimated energy needs

Monitoring and evaluation

Increase iron intake immediately

Monitoring and evaluation

Follow up phone call within 1wk

Recorder: Paulina Delgado

Reduce Protein intake to the recommended range (38g-44g)

Monitoring and evaluation

Follow up phone call within 1wk

Recorder: Paulina Delgado

Nutrition Diagnosis- PES format

Follow up phone call within 1wk

Recorder: Paulina Delgado

Recorder: Paulina Delgado

Subject gender: Female

Body Density (BD) from 3 skinfold sites: 1.077428175

1.09700000 0.00046971 (54.25) + 0.00000056 (54.25)^2 0.00012828 (23)=

Three site skinfold Body Composition Results:

Body Fat: 5.22kg, (55.5kg x .094=5.22kg)

Recorder: Paulina Delgado

Follow up phone call within 1wk

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