(Note: CVD stands for cadiovascular disease. Also, I have cut out the numbers because they don't copy well from the program. I can retype those or send screen caps, if someone truly wants to know.)
The Project Instructions
Instructions: Read the case study, analyze the 24 hours recall, and answer the questions that follow.
Mr. Jones is a 55 year old retired school teacher. He is fairly sedentary, and estimates that he gets about 30 minutes of cardiovascular exercise per week. He has a family history of both Diabetes and CVD. His yearly physical showed the following:
Weight: 250 pounds
Blood Pressure: 175/100
Cholesterol: 295 mg/dL
HDL: 20 mg/dL
24 hour recall:
2 slices bacon
1 cut 2% milk
1 English muffin
1 tbsp margarine
1 tbsp jelly
1 cup unsweetened applesauce
1 coffee w/ cream and sugar
1 ham and cheese sandwich on white bread
1 cup canned tomato soup
8 baby carrots
3 Oreo cookies
1 can Root Beer
1 pork chop, broiled (six ounces)
1 baked potato, no skin
2 tbsp sour cream
1 tbsp margarine
1/2 cup canned corn
1 slice apple pie
1 cup vanilla ice cream
1 cup apple juice
3 cheese crackers
Questions and Answers:
1. Elements of Mr. Jones’ diet, physical characteristics and lifestyle may put him at risk for CVD. What are these risk factors?
Unfortunately, almost all of the information in Mr. Jones’ profile shows his risk of CVD. He is 55 years old, has an HDL of only 20 mg/dL (less then a third of the recommended >60 mg/dL), a systolic blood pressure of 175 (40 points higher than the upper edge of the healthy range), total cholesterol of 295 (deep in the high risk range), a family history of both CVD and diabetes, his weight (250 pounds), an atherogenic diet (high in meat, low in fruits and vegetables) and a sedentary lifestyle.This brings Mr. Jones’ risk to greater than 30%.
2. Calculate his BMI (body mass index) – see page 262. What does this number mean?
BMI is calculated by taking his weight in pounds (250) and multiplying it by 703. The total is then divided by his height in inches squared.
250 * 703 = 175750 = Mr. Jones’ BMI is 35.86
A person’s BMI is a ration of weight to height that is a quick determination of a person’s general health with regards to weight. It can also be a quick determination of a person’s risk for various health problems.
It’s important to note that it should not be a person’s sole determining factor of health. It makes no reference to body composition or cardio-vascular health, among other factors.
3. What are the recommended blood levels of HDL and total cholesterol? (You will have to research this answer.) What do his laboratory values for these blood lipid levels indicate?
The recommended blood levels of HDL are greater than or equal to 60 mg/dL. Total cholesterol should be below 200 to be at low risk for CVD.
HDL is the lipoprotein responsible for carrying fatty acids, cholesterol and phospholipids from the cells back to the liver for recycling or disposal.
Mr. Jones’ HDL score means that he has approximately a third of the cholesterol removing molecules in his body that he should, resulting in a very high LDL level. Using the Friedwald formula, we can see that the LDL in Mr. Jones’ blood stream is close to 220 mg/dL.
This is resulting in Mr. Jones having a very high level of cholesterol and triglycerides moving in his blood stream and cells, and a very slow removal of those substances from the body.
4. What does blood pressure mean? Is 175/100 something to be concerned about?
Blood pressure is ‘the pressure exerted by the blood on the walls of the blood vessels.’
In reading blood pressure, the first number is the systolic number and refers to point of highest pressure in a cardiac cycle, whereas diastolic pressure refers to the point of lowest pressure. Typical values of a healthy adult is approximately 120 mmHg systolic and 80 mmHg diastolic. This is written as 120/80.
Mr. Jones’ values mean that at any given moment, the walls of his blood vessels are having excess pressure being exerted on them, resulting in hypertension. Hypertension stresses the heart, and can result in health failure, an aneurysm or kidney disease.
5. Mr. Jones’ doctor has recommended that he increase his intake of folic acid and vitamin B6. Why is this? What foods would you recommend? (Provide specific sources of each nutrient.)
B6 is ‘used in amino acid and fatty acid metabolism; helps to convert tryptophan to niacin and to serotonin; helps to make red blood cells. Folic acid, or folate, is used in DNA synthesis, which is important in new cell formation.
While Mr. Jones’ diet does meet the recommended levels of both vitamin B6 and folic acid, increasing the levels of these vitamins and nutrients would give the body a boost in it’s ability fight against various health related concerns.
For instance, according to the National Institute of Health a vitamin B6 deficiency can result in an increase in homocysteine. There is evidence that excess homocysteine can increase a person’s risk for hearth disease and/or stroke.
To increase Mr. Jones’ intake of B6 I would recommend fortified cereals, broccoli, tomato juice, banana and watermelon. I would also recommend broiled or baked chicken, because it can be prepared or marinated a variety of ways. Because of chicken’s versatility, it’s easy to work into the diet.
To increase his intake of folic acid I would recommend broccoli, tomato juice, pinto beans, lentils and asparagus.
As a quick way to combine many of these foods together, I would recommend wraps or burritos. A flour tortilla, 3oz of chopped chicken, ½ cup of pinto beans, 1.5 ounces of cheddar cheese, and fresh salsa would provide in excess of 0.7mg of B6 and 250 micrograms of folic acid. Just in that one meal, he would be half way to his DRI.
6. What recommendations would you make for Mr. Jones in terms of his fat intake? Include discussion of saturated fatty acids, cholesterol, trans-fatty acids, and essential fatty acids. What foods would you recommend that he increase and/or decrease to achieve these recommendations?
The long and the short of his fat recommendation is this: “Reduce it.”
His fat intake, according to the assessment by the Diet Analysis program, puts his fat intake at 142.33g, well above the recommended upper amount of 113g. His saturated intake should have been below 10% of the total kcal intake, but was at 53.3g, which equals 14.83%. Doing the math also shows that his trans-fat levels are at 12.64g.
Saturated fat should be specifically limited because it has numerous negative effects on the body. Specifically, it raises LDL cholesterol (increasing the risk of heart disease). They are most often found in meat, and are solid at room temperature.
Trans-fatty acids have no positive health benefits. Research from the National Academy of Sciences has found that in additional to raising LDL levels, trans-fats also lower levels of HDL cholesterol. They find that “trans fatty acids are not essential and provide no known benefit to human health.” Because trans-fat is present in some animal fats, it’s totally elimination isn’t possible outside of a vegan diet, but the recommendations are to keep it as low as possible.
Dietary cholesterol seems to also have an affect on blood cholesterol, but it seems to have less of an impact that saturated fat and trans fat in that regard.
There also seems to be a very small amount of essential fatty acids such as mono- and poly-unsaturated fats. I would recommend increasing unsaturated fats in his diet, as some levels of fats are needed for the body to function properly.
My primary dietary recommendation would be to reduce his fatty meat intake, such as pork, and moving more towards leaner meats like poultry and fish. I would also alter it so that vanilla ice cream, Oreos, apple pie and other ‘splurge’ foods should be exactly that and not an everyday occurrence.
In a perfect world, I would also him stop drinking coffee, cut back on potatoes, eliminate margarine and not eat canned soups and vegetables.
7. Rewrite Mr. Jones’ diet (in the form of a 24-hour recall) to incorporate the recommendations for CVD prevention. Beside each menu item, write your reasoning for the food choice.
Step number one is to drastically increase his water consumption. I would recommend keeping either a water bottle or glass on hand to be constantly drinking throughout the day.
I specifically added some things to the diet for ‘flavor.’ I knew that to totally change Mr. Jones’ diet without keeping some of the things he likes would just set him up for failure and that defeats the purpose of eating healthy.
I also specifically added lycopene rich tomatoes to his diet. It’s an unfortunate thing that cancer risks increase as men get older, and lycopene can help prevent some forms of cancer, most noticeably prostate cancer.
In addition to an improved diet I would recommend Mr. Jones move from 30 minutes of exercise in a week to 30 minutes of exercise per day, provided his doctor agrees. That will help the heart to strengthen, which may also assist in lowering blood pressure and his weight.
Enriched corn flakes (vitamins and nutrients)
1% milk (slightly less milk fat than what he was drinking)
Whole wheat toast, two slices (fiber and to help replenish glucose stores)
1 tbsp unsalted butter (little healthier than margarine, less trans-fat)
1 tbsp jelly (for toast and for flavoring; some antioxidants depending on what it is made from)
8 ounces orange juice (vitamins and flavor)
8 baby carrots (vitamins)
8 fluid ounces apple juice (flavor, mostly; vitamins)
Peanut butter and jelly sandwich, 1 serving (unsaturated fats, protein, fiber to reduce cholesterol)
Tortilla chips, 1 ounce (side dish as a vehicle for the salsa)
Salsa, (lycopene in the tomatoes)
Root Beer, 1 can (‘splurge’ item and for flavor; mostly to prevent drinking of coffee or caffeinated beverages)
1 Fuji apple (vitamins, nutrients, energy stores, sweetness to help assuage junk food cravings)
0.5 cups cashews (‘good’ fats, protein, also take a while to digest so maintains satiety longer)
Broiled chicken breast, skinless (protein, B6 and folic acid as well as other nutrients, versatile)
Broccoli (nutrients and vitamins)
Sour dough bread (carbohydrates and flavoring)
1 tbsp butter (flavor)
1% milk (calcium, vitamins, flavor)
After-dinner snack, AKA dessert:
Peach (vitamins/nutrients; like a Fuji apple, it’s sweet and a good snack)
Extra Credit: Enter your new menu into Diet Analysis Plus and note any positive changes.
• The new diet has approximately 1,000 kcal fewer per day than the older diet, which will contribute to weight loss.
• Less than half the total fat grams.
• Less than halt the saturated fat grams.
• 160 mg less cholesterol.
• 8g more dietary fiber.
• Double folic acid intake to 526.5 micrograms.
• 300mg more calcium.
• 5mg more iron.
• Doubled magnesium intake.
• 500mg more potassium.
• 4.4mc more zinc.
• Sodium less than half of original values.
Areas that still can be improved:
• Omega-6 and Omega-3 values considerably below DRI.
• Dietary fiber still below DRI.
• Vitamins D and E are still below DRI
• Calcium and potassium are still below DRI.
• Sodium is still almost 800mg above the recommended level.
I'm the type of person that I would honestly welcome people punching holes in this. If I was truly on my game I would have finished this a week ago and posted it. It's too late to make any changes now, but I'll know for the next project.