Jared Mason

DIE 213
Michelle Alkadi
9/15/2015

1) Height = 67 inches = 170.18 cm = 1.7018 m = five feet seven inches.

Weight = 140 pounds. 140/2.2 = 63.6 kilograms.

IBW = 100 + 35 (5 pounds per inch over 5 feet) = 135 lbs.
% IBW = 135/140 = 96.4%
UBW = 160 lbs.
% UBW = 140/160 = 87.5%
BMI = Weight (kg) / height (m)2, so 63.6 kg / 2.89612324 = 21.9 or 22
A BMI of 22 is generally considered healthy, although a BMI of less than
23 puts a woman her age at risk of osteoporosis. At 140 pounds, she is
only five lbs. heavier than her IBW of 135 pounds. However, with a
UBW of 160 lbs. and a weight loss of 20 lbs. in the past six months, she
has lost 12.5% of her UBW, categorizing her weight loss as severe,
according to table 3.4 in our textbook. All calculations were done using
formulas found in our textbook and PowerPoint slides1.
2) REE = 655.1 + 9.6 (63.6) + 1.9 (170.18) 4.7 (76) = 1,232 calories.
Taking into consideration she has undergone skeletal trauma, we must
increase her caloric intake between 1.2 and 1.35. 1,232 (1.2) = 1,478
cal, and 1,232 (1.35) =1,663 cal. Therefore, our adjusted caloric range
can be set between 1,400 and 1,600 cal. REE was calculated using the
Harris Benedict Equation1.
Protein = 1.0 1.2 g / kg BW, so 1.0 (63.6) = 63.6 g protein. 1.2 (63.6)
= 76.32 g Therefore, protein requirements are between 64 and 76 g /
day. For a woman her age, fluid requirements are set between 30 and
35 mL / kg BW. 30 (63.6) = 1,908 mL and 35 (63.6) = 2,226 mL, giving
us a range of 1,900 to 2,200 mL a day. Currently she is consuming
around 963 calories a day, far fewer than the range where she needs
to be to meet her needs. She is also far below her protein
requirements, as she is consuming around 35g daily, substantially less
than the 64 and 76g she requires. She is consuming around 3.5 to 4
cups of fluid daily, which equates to between 830 and 946 mL,
severely lacking when compared to her target range of between 1,900
and 2,200 mL daily. Intake and nutrition status for the client was
determined using the SuperTracker from the USDA website.
3) She is lacking in many food groups and nutrients. She has excluded
eggs and milk from her diet and consumes virtually no dairy products
(excluding half and half), which can be a possible explanation for her
low levels of protein and very low very low levels of calcium. She is
severely lacking in fiber, which can be possibly attributed to her
infrequent consumption of fruits and vegetables, as well as her
tendency to consume much more refined grains as opposed to whole
grains. According to SuperTracker, she is currently getting no vitamin
D, which is a huge issue considering she is bedridden and unable to go

outside. Her levels of B6 and B12 are also low, most likely due to her
exclusion of dairy products and low meat consumption. A synopsis of
her nutrients report is below.
Nutrients

Target

Calories
Protein
Protein (%
calories)
Carbohydrates
Carbohydrates (%
calories)
Fiber
Total Sugar
Added Sugar
Total Fat
Saturated Fat
Polyunsaturated
Fat
Monounsaturated
Fat
Linoleic Acid
Linoleic Acid (%
Calories)
Alpha Linoleic
Acid (% Calories)
Alpha Linoleic
Acid
Omega 3 EPA
Omega 3 DHA
Cholesterol

Status

1600
46 g
10 35%

Average
Consumed
963
35 g
14%

130 g
45 65%

122 g
51%

Under
OK

21 g
None
None
20 35%
Calories
< 10% Calories
None

6g
60 g
38 g
37% Calories

Under
None
None
Over

9% Calories
10 Calories

OK
None

None

15 % Calories

None

11 g
5 10% Calories

10 g
9% Calories

Under
OK

0.6 1.2%
Calories
1.1 g

0.5% Calories

Under

0.5 g

Under

None
None
< 300 mg

7 mg
27 mg
74 mg

None
None
OK

Under
Under
OK

4) She is currently taking 20mg of Furosemide daily, a loop diuretic. Loop

diuretics are often used to treat hypertension, as they promote the
excretion of sodium and other electrolytes in the urine2. As sodium is
excreted, water follows, which decreases the amount of fluid in the

blood, which in turn lowers blood pressure and arterial resistance. This
being said, our client does have slightly low levels of Potassium, a
nutrient that tends to be excreted at a higher rate while using
diuretics. A very small amount of potassium supplementation could be
appropriate in order to maintain adequacy. Calcium is another nutrient
that tends to be excreted, and seeing that our client is extremely low in
calcium, supplementation may also be appropriate in this instance.
Also, our client is already under consuming fluids, and it is paramount
that she is meeting her fluid requirements while taking this drug, for
the increased urination that comes with the use of diuretics could be
problematic if she remains dehydrated.
5) Her serum albumin and prealbumin are both low. This can be explained
by two factors: her femoral neck fracture and her history of
hypertension. Both are negative acute phase proteins, meaning that
serum levels decease during inflammation, which is caused when
bones are fractured and / or broken. Both proteins are produced by the
liver, which is forced to make other proteins to fight inflammation,
leading to a decrease in serum concentrations. Secondly, hypertension
is known to put increase the stress on arteries and blood vessels,
which can lead to kidney damage3. If the kidney is damaged or not
functioning effectively, it is possible for albumin and prealbumin to leak
out into the urine, leading to low serum levels of these proteins. Serum
levels of these proteins may increase in response to dehydration, as
there is simply less water in the blood. A high protein diet may also
increase serum levels, as there is simply more protein in the blood
being metabolized.
6) Our client has a BMI of 22, with a height of five feet seven inches, a
usual body weight of 160 pounds, and a current body weight of 140
pounds. Generally a BMI of 22 is considered healthy, but in our clients
case a BMI between 25 and 27 is considered healthy in order to deter
osteoporosis. At her usual body weight of 160, her BMI is 25, falling in
the healthy range for her age. She has lost 12.5% of her UBW in the
past six months, categorized as severe weight loss. Her biochemical
data suggests that she is not getting adequate nutrition, as her serum
albumin and prealbumin levels are both lower than normal, in addition
to low potassium levels. She is also deficient in many other vitamins
and minerals, and her decreased skin turgor and dry oral mucosa are
classic symptoms of moderate dehydration. Her dietary report shows
us that not only is our client consuming far too few calories, but the
calories she is consuming are lacking adequate nutrition, as she has a

diet high in refined carbohydrates and added sugar and low in protein,
fruits, and vegetables. A synopsis of her vitamin and minerals is below.
Mineral

Target

Calcium
Potassium
Sodium
Copper
Iron
Magnesium
Phosphorus
Selenium
Zinc

1200 mg
4700 mg
1500 mg
900 mcg
8 mg
320 mg
700 mg
55 mcg
8 mg

Vitamin

Target

Vit. A
Vit. B6
Vit. B12
Vit. C
Vit. D
Vit. E
Vit. K
Folate
Thiamin
Riboflavin
Niacin
Choline

700 mcg RAE

1.5 mg
2.4 mcg
75 mg
15 mcg
15 mg AT
90 mcg
400 mcg DFE
1.1 mg
1.1 mg
14 mg
425 mg

Average
Consumed
173 mg
1097 mg
1339 mg
747 mcg
7 mg
154 mg
423 mg
41 mcg
4 mg

Status

Average
Consumed
245 mcg RAE
0. 9mg
1.4 mcg
49 mg
0 mcg
7 mg AT
89 mcg
266 mcg DFE
0.6 mg
0.6 mg
13 mg
113 mg

Status

Under
Under
OK
Under
Under
Under
Under
Under
Under

Under
Under
Under
Under
Under
Under
OK
Under
Under
Under
Under
Under

7) Inadequate energy intake and subsequent malnutrition, related to

under consumption of calories and healthful food, as evidenced by an
unintentional weight loss of 12.5% in a six month period.
8) I would first recommend our client to increase her consumption of
whole grains in order to cut back on her added sugar and increase her
fiber and thiamin. Including more legumes would be beneficial, as
legumes are a good source of zinc, magnesium, and iron4, all minerals
that our client is severely lacking in. I would highly recommend she
include milk and dairy products in her diet, for they are an excellent
source of calories and B vitamins, and would help offset many of her
nutritional deficiencies in that area. Including milk of any kind would
greatly increase her calcium, riboflavin, protein, and vitamin D, all of

which she is currently lacking in. Consuming more vegetables and fruit
would be beneficial, as they are excellent sources of nutrition and
phytochemicals, which act as antioxidants to help oxidize free radicals
in the body. This is exceedingly important considering she is recovering
from a fracture.
9) My nutrition goals for her are to meet her caloric requirements as
established by the Harris-Benedict equation, improve her blood serum
levels of albumin and prealbumin, and improve her overall nutrition
and improve he vitamin and nutrient profile by following the
aforementioned interventions, particularly including milk and dairy
products. I would monitor her progress by recommending she keep a
food diary to log all her food and liquid consumption, as well as
schedule visits once a month to assess her overall nutrition status.
10)
A: 76 year old woman with history of hypertension; five foot
seven inches, weight of 140 pounds with a UBW of 160 pounds with
unintentional weight loss of 20 pounds in six months; BMI is 22, activity
level is zero due to being bedridden due to fracture of femoral neck;
usual diet consists of refined carbohydrates and little fluid, fruit, and
vegetable consumption; diet low in calories, avoids eggs and milk;
takes 20mg of Furosemide daily; dry oral mucosa and decreased skin
turgor; husband passed away 6 months ago.
D: Inadequate energy intake and subsequent malnutrition, related to
under consumption of calories and healthful food, as evidenced by an
unintentional weight loss of 12.5% in a six month period.
I: Increase caloric intake to between 1,400 and 1,600 calories a day;
double fluid intake; incorporate milk / dairy products; incorporate more
fruits, vegetables, and legumes; nutritional supplement drink (Boost,
Ensure, Glucerna) once a day; supplement potassium and calcium as
needed to account for losses due to Furosemide.
ME: Evaluate weight, blood pressure, blood labs, and nutrient levels
once a month; log all food and liquids consumed two days a week to
observe calorie intake and changes being made to the diet.

References
1) Mahan K, Raymond J, Escott-Stump S. Krause's Food & the Nutrition
Care Process, 13th Edition. St. Louis, MO: Elsevier Inc.
2) Loop Diuretics. Bumetanide, Ethacrynic Acid, Furosemide,
Torsemide. National Institutes of Health Web site.
http://livertox.nih.gov/LoopDiuretics.htm. Accessed September 13,
2015.
3) Albumin blood (serum). U.S National Library of Medicine Web site.
https://www.nlm.nih.gov/medlineplus/ency/article/003480.htm.
Accessed September 14, 2015.
4) Messina M. Legumes and soybeans: overview of their nutritional
profiles and health effects. The American Journal of Clinical
Nutrition. 1999; 70(3): 439-450.
http://ajcn.nutrition.org/content/70/3/439s.full