Nutrition Assessment and Counseling Project Final Report

Emily Feivor

Medical Nutrition Therapy 1 Karen Lacey December 14th 2012

Table of Contents
Consent Form. 2 Part A- Summary of Assessment 3 Part B- Nutrition Diagnosis 6 Part C- Nutrition Intervention9 Part D- Nutrition Monitoring and Evaluation.. 11 Part E- Summary and Self Evaluation of Learning Issues. 12 Nutrition Diagnoses Focused Assessment and Care Plan Form..13

Subject Consent Form NUT SCI -485 Nutrition Assessment and Counseling

I, _______________________________ agree to be interviewed and participate as a client/subject as part of a nutrition counseling project for the above named course at the University of Wisconsin-Green Bay. I understand the nature and purpose of the project and am aware that I may withdraw at any time without penalty. I also understand that the information obtained will be used for the sole purpose of this project and will be treated with respect and confidentiality.

Client/subject ________________________

Date: ________________

Student: ___________________________

Date: ________________

A. Summary of assessment data that is relevant to the identification of nutrition diagnoses 1. To start out, I had the client recall what he had eaten in the past 24 hours in order to get a close estimate to how many calories he was ingesting each day, and determine where he stood in respects to his recommended calorie needs. According to his 24hour recall, I calculated that he was eating about 4400-4800 kcal daily. When I plugged his information in to the Mifflin-St Jeor equation: Male: BMR = 10weight + 6.25height - 5age + 5 , I got : (10x (106 kg)+ (195.58 cm)-5 (21 years old)+5= 2183 kcal))= 2183 kcals. However, when I took into consideration that he was an avid weight lifter and worked out at least 3-5 times a week which entailed a strenuous regiment, I multiplied his kcals by 1.725 which brought me to a grand total of 3766 kcal/day. With this I see that he is consuming roughly 600-1000kcal more than he is recommended, however taking into consideration that he wants to increase his muscle mass and doesnt appear to be overweight and looks to have high lean body mass, his caloric intake seems fine. 2. The past diet history of the client has been relatively constant besides in the last two years by adding more lean body mass, in return increasing caloric intake. His usual eating pattern consists of four meals and three snacks, with his meals being much larger than his snacks. With each meal and snack he always includes a glass of milk, and with each of his four meals, will try to include a vegetable and/or fruit. He usually eats by himself, and finds himself eating more frequently when food is readily available or just hungry. Seldom does he eat out of boredom, although it does happen in some cases. According to his 24-hour recall, his diet is very well balanced. His carbohydrates were 54% of his daily calorie intake, protein was 23% of his daily calorie intake, and fat was 31% of his calorie intake. All these percentages fell into the normal recommended range. However, after calculating his percent of saturated fat from the diet, it was above the recommended rate that states that 10% or less of the fats should be saturated. His recall showed that he consumed 59grams of saturated fat, when the recommended amount is 36g or below. Also, his sodium levels were extremely high- showing that he had consumed 5990mg: more than double of the recommended amount which is 2300mg. Finally his protein levels were shown to be high as well, with his consumption of 241 grams for the day. When I had calculated the amount of protein that he should be ingesting using the formula: 1.5(g/kg)x (weight in KG)= 1.5X(106.6)= 160g/day of protein was recommended with his amount of activity. The highest value of grams that can be multiplied to your weight is 1.7, and I used 1.5 since he isnt to the max amount of physical activity. In reference to the 160g/day he is still well above the recommended amount. Also, when putting his food intake into Food Tracker on
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myplate.gov, his phosphorous levels were extremely high- about 4400mg when the recommended amount in adults is 700mg. In conclusion, his percentages from calories coming from CHO, protein, and fat were within healthy range. His protein, sodium, saturated fats and phosphorous were quite high, and are to be focused on to get back to lower levels. Although his protein intake was high, he didnt appear to be overweight or have poor muscle mass. Instead was very lean, muscular and looked relatively healthy. (recommended allowances came from myplate.gov) 3. In order to put a conclusion on my findings, I based them off my clients height of 6ft 5 inches, and a weight of 233 pounds. His BMI, using the equation: weight (lbs) /height (in)2X703
= (233/(77in)(77in))X703= 27.6 BMI.

This result shows that he is

overweight, but not obese. However, this equation fails to take in lean body mass, and unfortunately he had not had a skin fold test done to make an adjustment to this result. However his waist measures 39 inches and hips are 37 .From observation it does not appear he is overweight and appears to be at a healthy weight, and his waist to hip ratio shows that as well. 4. Biochemical information was not available, but I recorded his 24-hour food intake into Food Tracker on myplate.gov and gave me a nutrients report about his diet, and showed that his sodium, phosphorus, cholesterol, and calcium levels were high for that day. These arent actual blood/biochemical tests so arent 100% accurate. 5. There has been no major health concerns with the client, only had minor surgeries such as tonsillectomy, and wisdom teeth extraction. Obesity runs on his paternal side, along with his dad being obese (only his later years 35+). His maternal grandmother had skin cancer and was a smoker. The client has had no other medical aliments and has been healthy his whole life. His skin, hair and oral cavity appear normal, and healthy: full head of hair, moist-healthy skin, and pink oral cavities with no abnormal characteristics. One slight problem that he has is TMJ (temporomandibular joint disorder) which is a genetic disorder where the jaw moves out of socket. He has not experienced any complications relating to nausea, vomiting, diarrhea, or constipation. He has had this since memory serves him, and doesnt inhibit him from eating any foods. Overall the patient appears very healthy and hygienic with no visible problems. 6. The client shows great readiness to progress more into his food behaviors. Since he is already pretty well educated, from his High School degree, and nutrition classes he had taken at University of Wisconsin Stevens Point. He has minimal changes that he should do to even better his diet. The client expressed that he eats out of boredom and sometimes because something looks good. A good start to curving those cravings is to become self-aware of those feelings to try and stop triggered eating which results in excess calorie intake. Also, because he is such an avid body builder,
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he is very concerned to what he puts into his body and therefore another reason why I feel the client is very ready to maintain his healthy diet. Overall with more knowledge about food choices his motivation will increase, wanting to make more changes to his diet. 7. The client has many great practices that he already includes in his life, such as doing a cardio workout 3x/week for about 15-20 minutes which he then does some highintensity weight-lifting for 2-3 hours 4x/week. This shows he already has some positive motivations to push towards a healthy lifestyle. He experiences no difficulties with any of his 5 senses, has no trouble with his mobility nor has any difficulty obtaining foods, besides his dislikes for seafood and tomatoes. He has previous nutrition education at the University, and it was a positive experience. There he learned how to properly read food labels, and learn about whole foodsand how foods in their whole state are much more beneficial and the why to that as well. He has educated his mom about these things, since she is the primary food buyer, and she can then take these things into consideration when purchasing the familys grocery items. Since the client has a positive mindset about his overall health and makes it to the gym 3-4 times /week, it seems that he indeed has the motivation to further healthy practices. However, since he is so eager to put on mass to increase muscle, he feels the need to consume high levels of protein- not only in the things that he eats, but beverages. You can see this in his 24-hour recall chart with his abnormally high milk consumption and added soy protein. This is causing him to have the high saturated fat, calcium, and phosphorus levels in his diet. In conclusion, educating him about the proper amount of nutrients and the amount of all of them in a balanced diet will help to become even better at living and eating healthy. The difficulty will come when he feels hesitant about limiting his protein amount and drinking less milk-substituting it with water. His mindset may be set on him keeping his regiment due to the prior results he had been getting. Summary In conclusion I found that my client has been ingesting a high number of calories and protein- both over the recommended amount. In result his saturated fat, sodium, calcium, and phosphorus levels are very high (in reference to the Nutrients Report sheet from MyPlate- last sheet attached). However, his body shape, waist to hip ratio, and overall physique are not showing that he is overweight, even though his BMI tells otherwise. He practices a healthy lifestyle by eating primarily whole foods, exercising 34 times a week, and has had no major medical history that is affecting his eating habits. His family history shows a prevalence of obesity but no other conditions apply that need to be taken into account. His appearance of skin, teeth/oral cavity, and hair all look
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healthy, and no measures need to be taken there. He is already self-motivated but may show hesitation when changing up his diet to meet the RDIs. B. Nutrition Diagnosis 1. Nutrition Diagnostic Label (P) Cause/ Etiology (E) Signs and Symptoms (S) Behavioral Goals (B) Intake Goals (I) Clinical Goals (C) Nutrition Interventions

Excessive Saturated Fat Intake NI 5.6.2

As the 24-hour recall suggests, his main beverage of choice is 2% milk with 10+ cups per day. Rarely drinks water, juice or soda. (NI)

Saturated fat ingestion is 13% of daily calories and should be less than 10%, which is the recommended daily allowance.

B- replace 2-4 cups of milk with water C- reduce saturated fat intake I- switch to fatfree milk

C- health believe model Self-monitoring (C 2.3)- Chart cups of milk Goal setting (C 2.2)- at least 30 fl oz/ day of water

Nutrition Diagnostic Label (P)

Cause/ Etiology (E)

Signs and Symptoms (S)

Behavioral Goals (B) Intake Goals (I) Clinical Goals (C)

Nutrition Interventions

Excessive Protein Intake NI 5.7.2

High consumption of protein in drinks, meat consumption and substitutions as indicated in 24-hour recall sheet. (NI)

Consumed 241g protein, physically looks lean-protein is not negatively effecting his weight

B- drink half amount of protein beverage instead before workout C- maintain protein levels I- eliminate soy protein intake

E- recommended modifications (E.2.2) Determine appropriate amount of protein E- Advanced or related topics (E.2.3)

Excessive calcium and phosphorus intake (minerals) 5.10.1 5.10.2

As the 24-hour recall suggests along with the nutrients report sheet, his main beverage of choice is 2% milk with 10+ cups per day. Rarely drinks water, juice or soda. (NI)

No signs and symptoms relevant now, but could pose potential kidney complications or imbalance of ions

B- replace 2-4 cups of milk with water C- reduce Calcium and phosphorus levels I- reduce calcium and phosphorus intake

C- Health Belief Model (C 1.2)Potential risks if consumption remains this high Goal Setting (C2.2)- reduce the number of high calcium and phosphorous foods

Nutrition Diagnostic Label (P)

Cause/ Etiology (E)

Signs and Symptoms (S)

Behavioral Goals (B) Intake Goals (I) Clinical Goals (C)

Nutrition Interventions

Excessive Sodium Intake 5.10.7

Increased sodium is related to seasoned meats, fatty milk consumption, and high-fat cheese consumption as indicated by 24 hour recall and nutrients report (RDI)

Nutrients Report shows more than double intake of sodium than the recommended amount

B-choose low sodium choices C-reduce sodium levels I- replace 2-4 cups of milk with water to decrease sodium consumption

Health Believe Model (c1.2) Possible risks with a highsodium diet Goal Setting(C 2.2)- Cut sodium intake by half (3000mg to start)

2. The problem that poses the highest risk is the high saturated fat and high sodium intake. Both can drastically affect the heart and lead to hypertension and/or heart disease. He may not see the effects now since he is very active and does heartstrengthening exercises. However, as he ages and leads a more sedentary lifestyle, this may lead to hypertension, heart disease or other severe ailments. Starting to make those changes now, such as lower saturated fat content and a low sodium diet can result in preventative measures for the future. The mineral levels could eventually pose a risk to upper tolerable levels being reached daily, and maybe even lead to toxicity. Like mentioned prior, he is active and this may not pose a threat now, but it is important that he is still educated about the potential risks such as damage to the kidneys. Summary: In conclusion, the most important topics to address and focus on are to reduce his sodium and saturated fat intake. Making choices such as low- fat milk, drinking more water, choosing low-fat/part skim cheese, and minimizing meat seasonings, these goals of lowering sodium and saturated fat levels can be reached. Also with making these changes, using the Health Belief Model, it will help to lower his Calcium and Phosphorous levels as well due to diet adjustments.
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C. Nutrition Intervention 1. Above in PES chart 2. Above in PES chart 3. Lesson Plan Collecting and Evaluating Nutritional Data Type: Food Tracker- myplate.gov I. Create username for personal Food Tracker account a. Help fill in physical activity information and show how to work food log b. Identify food group charts and how to read them c. Help understand where the values for Sodium, calcium, phosphorous, and saturated fats are found, and how to read the results II. Assignment a. Decrease sodium intake levels to at least 3000mg /day, saturated fats to under 30 grams, and phosphorous and calcium levels lowered b. Drink at least 30 fl oz of water a day (preferably replace 2-4 cups of milk with different beverage) c. Check back in two weeks Follow-Up a. Take a look at food tracker to see if any progress has been made b. Ask of ways he has tried to make changes c. Explore the MyPlate website to discover heart healthy options

III.

4. The Health Belief Model would be the most beneficial in this situation. Primarily because it helps to predict potential health risks and behaviors and my client is very concerned about his health and well-being due to wanting to increase his muscle mass. If it is addressed that he could potentially be putting his health at risk, and that by taking a recommended action he will avoid a negative health condition. Also, with his willingness to make changes he will believe that he can successfully take a recommended health action. However, it may be challenging to break out of old habits, as willing as the person may seem to change. It will be important to provide self-efficacy to the client by providing guidance, assistance, and education.
Concept Perceived Susceptibility Definition Chances of getting a condition Application If saturated fat and sodium levels maintain at this high of rate, heart disease may occur as well as hypertension.

Perceived Severity Perceived Benefits Perceived Barriers Cues to Action

Potential severity of a condition, and the symptoms that occur Action to reduce risk or seriousness of impact Potential cognitive, physiological and physical walls to prevent success Strategies to activate "readiness"

Specify consequences of the risk and the condition Cut sodium levels down to 2300mg per day, and make saturated fats less than 10% of total fat intake. If done, can reduce all heart-related risks. Reduce barriers by reassurance, education, and options of low sodium and fat foods Provide how-to information like Food Tracker, and give helpful reminds of what he is making the changes he is. Continue to provide training, as well as guidance in performing action in order to continue to make goals and healthy adjustments.

Self-Efficacy

Confidence to take action

Summary: The Health Belief Model is the best way to approach this situation and diet modification due to the fact that the client is ready to make these changes, and is self-motivated. Although, it can be hard at times to maintain changes in eating patters and that is why the self-efficacy portion of the model is so important. It will help the client reassure himself that this is the best thing for him, so that he doesnt run into perceived severity and will have the perceived benefits instead.

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D. Nutrition Monitoring and Evaluation 1. The Food Tracker used on myplate.gov can recall every day of food and physical activity log that you have done, and charts results on a table. I think this would be very beneficial to do since you can see the direct results and figure out if what you are doing truly works. I would also like to use a food journal to keep track of food consumption, and what (if applicable) he did to provide a change to meet his goal. There is also a link on eatright.org that gives heart healthy cooking tips, and gives recommendations to decrease fat and sodium content in foods and food choices. It says to increase Omega 3 intake, which could be another plausible option to keep the heart strong. (http://www.eatright.org/Public/content.aspx?id=4294967441#.UMLLYbbipFM) It would be beneficial to track sodium content as well as saturated fats in the food log that was recommended to be kept, and at the end of the day determine how much was consumed and take note at what he did and if it was beneficial. If not, how could it have been changed? Also, http://www.etoolsage.com/chart/Food_Diet.asp?Cate=0&Chk307=307&SN307= 17&SR307=%3C%3D&Amount307=140&pageNo=1 This link provides a chart that gives you options to click on a certain category (ie. Low-sodium foods) and allows you to see alternative options for foods that you love. Summary: Overall there are a lot of tools that can help achieve goals, and the ones found can help point out alternative food choices that help reach the diet goals that are set. With these sources, my client will have a easier time choosing without having to sit and read labels for a lengthy period of time.

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E. Summary and Self Evaluation of Learning Issues 1. This experience overall was a very rewarding and was an incredibly skill-enhancing activity. I learned that a nutrition analysis isnt about just writing down what a person ate, but looking into the how, why, what, and where. It took me longer than I had expected to find out information, as well as plan out the best way to approach an addressed issue. Making sure you have the most accurate information is what I found to be the most important out of this process, as well as dealing with a clients personal feelings and beliefs and taking that into consideration. Although some topics may not be relatively familiar or interesting to me, it was still important to the client that I was interviewing, and they trusted me to give them information that can better their lives. I also found that it was easier to give information then it was to have a client follow through on it. Some may be more perceptive to others, but overall it most likely will be difficult to work with someone unwilling to change or hesitant. I have learned that in order to be successful at what you do, you need to be a good listener to what the client is saying, be perceptive to their feelings and thoughts, as well as accurate on the information you are giving to them. Overall to improve my educational and counseling skills, I would take the time to research more topics to widen my horizons as well as look into weight lifting and the specific nutrients (both macro and micro) to give more accurate information.

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