FN-417/617 Fall 2017

Introductory NCP Case Study

Due by September 19th at 10am in the Dropbox

Read the following case carefully, then answer the questions that follow.
AR is a 52-year-old man who is married with three children ages 10, 13, and 16 years. AR is 5’11” tall and says
that he usually weighs about 200#, but today he weighs 220# on your office scale. About 4 years ago, he took a
job as a junior high school principal, when he started that job he weighed 190#. The principal’s job requires
much more desk work, and, despite walking the halls regularly between periods at the large urban school, MR
doesn’t get much exercise. He has verbalized the need to “get back in shape.”

AR’s family medical history is a concern. Both of his parents have Type 2 diabetes. AR’s father was forced into
retirement a year after his foot was amputated because of complications from the diabetes. Two of AR’s older
brothers have been told to lose weight in order to reduce their risk of developing Type 2 diabetes. His younger
sister recently gave birth to her third child and was diagnosed with gestational diabetes during the pregnancy.

Because his first son will enter college soon, AR is thinking about the future. He is thinking about how he will
prepare for his children’s college education and, eventually, their weddings. He would like to be healthy enough
to play baseball with his grandchildren when they arrive. He is becoming concerned about his health and
realizes that he needs to do something about his weight. A recent visit to his physician was a great relief because
no problems other than obesity were identified. The physician emphasized the importance of weight loss and
referred AR to a Registered Dietitian Nutritionists (RDN) for a weight reduction program.

The RD interviewed AR and found:

AR was born in Brazil, but immigrated to the United States at age four with his parents. His family owned a
restaurant, and he learned to cook at an early age. He often prepares traditional foods from Brazil and fries these
foods in lard. His North American-born wife does some of the cooking and prepares meals with meat, potatoes,
fruits and vegetables, and gravy.

AR does not eat breakfast at home, stating that with five people in the house getting ready for work and school
each morning, there is too much of a rush to stop for a meal. He frequently takes several cookies or a large
muffin with him to school. He drinks several cups of coffee with sugar and cream at his desk during the
morning. He eats lunch in the school cafeteria, often requesting large portions of meats and other foods he likes.
After lunch, he usually drinks at least one sweetened soda. He is usually at school until late afternoon, and may
return for evening activities.

On these evenings, he enjoys the “all you can eat buffet” at a family restaurant near his home. He eats a variety
of foods, including fruits, vegetables and salads. His weakness is flour tortillas slathered with butter or sour
cream, and he eats several with each evening meal taken at home. AR eats dessert only on special occasions.
Because the family is busy, there are plenty of “snack foods” available, and he usually has an “after dinner
snack” when he returns home from evening activities.

AR’s alcohol intake is moderate, limited to 2 or 3, 12 ounce (360 mL) cans of beer on a Friday or Saturday
night if he and his wife go out with friends. Analysis of a 24-hour diet recall combined with a food frequency
questionnaire reveals that AR’s typical intake is approximately 3700 calories/day with about 210 grams/day of
total fat, about 90 grams of saturated fat, and about 25% of calories from sugar or other concentrated sweets.
Because his job and family require so much of his time, AR does not regularly exercise.

Submit your responses to the following questions to the Dropbox:

1. What is AR’s BMI? What is his BMI classification (Normal? Overweight? Obese?)
2. If you classified AR as overweight or obese, would you use his current/actual weight or what he states is his
usual weight to calculate his energy needs? Or would you use another weight to calculate his energy needs?
Explain your answer.
FN-417/617 Fall 2017
3. Using the Mifflin-St. Jeor equation, what would you estimate as his daily energy demands?
4. What activity factor did you use, and why?
5. Now calculate AR’s energy needs using the appropriate kcal/kg body weight?
6. Do the two energy equations differ in recommended amount of kcals? Which one would you use?
7. Summarize your nutrition assessment, based on the 5 domains of nutrition assessment data (Nutrition
History, Biochemical Data, Anthropometric Data/Measurements, nutrition focused Physical Findings, and
Client History) using terminology (in the IDNT Reference Manual).
8. Write at least one (1) PES statement to identify a nutrition diagnosis for this case. Use the Nutrition
Diagnostic Reference Sheets (in the IDNT Reference Manual) to help formulate your PES statement
9. A Nutrition Prescription
10. Nutrition goals/expected outcomes for AR. Be sure to use the language for nutrition intervention, based
on the appropriate intervention domains and classes
11. Include strategies that you would suggest to achieve each of the goals/expected outcomes that you have
identified in #10 for AR.