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Patient History: Miss R is an 11 year old Hispanic female referred to you by her PCP for a consult on
treatment for obesity & fatty liver. Miss R. is accompanied by her mother who does most of the talking
as the patient is embarrassed and withdrawn. Patient is an only child who enjoys watching movies and
reading books. Patient has recently complained of being tired, falling asleep at school, and mild
abdominal pain. She was born LGA (large for gestational age) at 10 lbs 2 oz. Mother states she has
always been a big girl.
Physical History:
General Exam: obese female
Vitals:
- Temp 98.6 F (WNL)
- BP 138/89 mm Hg (slightly above average of 120/ 80 mm Hg)
- HR 84 BPM (WNL)
- RR 23 (slightly above average of 12- 16 breaths/ min)
Ht: 57 (25th %tile) Wt: 152lb (>95th %tile) BMI 32.9 (>95th %tile)
CT scan (recent) shows the presence of a hepatic steatosis
Nutrition History:
General: Reports adequate appetite. Miss R. will eat some vegetables and fruit but prefers starchy and
high fat foods. She sneaks candy from her cousins after school. Mom cooks traditional Hispanic meals at
home, but a couple times per week they will go to fast food and get a burger or pizza.
Usual Dietary Intake:
Breakfast: 2 breakfast burritos with cheese, eggs, sausage, beans, and homemade tortillas (made
with lard), and a large glass of juice
Snack: granola bar
Lunch: school lunch (pizza or burger, with fries, maybe a fruit, chocolate milk or juice, with a
cookie
Snack: she is offered fruit but prefers candy and dried cereal (Fruit Loops) with regular soda
Dinner: 3-4 tortillas (made with lard), cheese, beef or chicken, maybe a vegetable (corn or peas),
and a glass of whole milk
Snack: microwavable popcorn with butter or ice cream
Food allergy/intolerance: NKFA
1. In the table of laboratory values below, place an X or a checkmark in the appropriate
Interpretation column l to indicate whether the values are high ( ), low ( ) or within normal
limits (WNL). (2 points) 0.25 each item
Fasting Labs 1/20/2017 Patient: Miss R.
Lab Value Interpretatio
n
WNL HIGH LOW
ALT 80 U/L X
(4-31 U/L)
AST 28 U/L X
(10-31 U/L)
Glucose 117 mg/dL X
(<110 mg/ dL)
Hemoglobi 6.9% X
n A1c (4-6%)
Total 245 mg/dL X
Cholestero (High > 240 mg/dL)
l
LDL 163 mg/dL X
Cholestero (<100 mg/ dL)
l
HDL 22 mg/dL X
Cholestero (40-60 mg/ dL)
l
Triglycerid 198 mg/dL
es (Borderline High: X
150-199 mg/dL)
a. Triglyceride level:
i. Nutrient: Fat, Carbohydrates
ii. Foods: cheese, sausage, homemade tortillas (lard), pizza or
burger, fries, cookie, butter, ice cream, juice and soda
(CHO turns to fat in liver)
4. Would you recommend that Miss R cut out the 5-6 tortillas she eats
each day? Why or why not? You must justify your answer & provide a
dietary suggestion. (2 points)
6. What type of dietary intervention plan has typically resulted in the best
outcomes and sustainability for adherence: (1 point)
Citation: NUT 116L Lecture #3, PowerPoint: Liver Disease Slide Number 16
c. Increase fruit and vegetable intake (and total fiber intake 20-30
g)
i. Increase fruit and vegetable intake, this can be done in
home meals and packing snacks for Miss R to consume
while at school or while at home.
9. List 3 items that you would Monitor and Evaluate at a 3-month follow-
up: (3 points)
b. Weight
Citation: NUT 116BL Lecture #3, PowerPoint: Liver Disease, Slide Number 16