CASE STUDY-1

Given below is a case with detailed genetic parameters. Study the parameters and write
the interpretation, PES statement, and other dietary tips to relieve the symptoms.
Mrs. JKL is a 36 year old female with height of 157cm and weight 87kg. Her physical
activity is nil. Her only complaint is weight gain inspite of trying and controlling her
diet. She is also feeling very tired and stressed out and complains of chronic fatigue. Her
dietary data suggests that she is a vegetarian.

Area of Activity Gene Name Variant Gene Impact

Insulin sensitivity and PPARG CC High

energy regulation

Oxidative stress ENOS GG High

Fat absorption and ADRB2-1 GG High
metabolism
  APQA5 TT High
Exercise responsiveness ADRB3 CC High

Circadian rhythm CLOCK TT Beneficial

Fat storage PLIN GG Beneficial
Fat absorption and ADRB2-2 CC Beneficial
metabolism

Interpretation: Mrs. JKL is a 36 years old female. Her ideal body weight is significantly
lower than her existing body weight. She falls in the category of obesity as per her BMI.

PES statement:

1. Obesity due to no physical activities as suggested by the case and CC variant of

ADRB3 gene for exercise responsiveness.
2. Chronic fatigue due to imbalanced circadian rhythm as evidenced by TT variant of
CLOCK gene
3. Chronic fatigue due to improper fat metabolism and storage as evidenced by the GG
variant of PLIN gene and GG variant of ADRB2-1 gene and TT variant of APOA5
gene.

Short term goals:

1. Control the increasing weight

2. Switch the patient to moderate physical exercise
3. Reduce the levels of fatigue in the body of patient
4. Reducing fat storage in patient’s body by providing a low fat and high fiber as well as
protein diet

Long term goals:

 1. Focusing on high exercise responsiveness and relying more on physical activity for
weight reduction.
2. Bringing the patient’s weight nearer to the Ideal body weight
3. Bringing the patient’s BMI to normal (between 18.5-23.5) by reducing the weight
4. Setting the circadian rhythm of the patient to a proper level, so that the metabolism is
regulated well.

Calculation of nutritional management

1. Ideal Body Weight: 54.2 kg

2. BMI: Weight (kg)/ Height (m)*Height (m)= 87/1.57*1.57 =35 (obese)
3. Energy requirement (by Harris Benedict’s Equation):
BMR= 655.1 + (9.563*weight(kg)) + (1.850*Height in cm) – (4.676*age in years)
= 655.1 + (9.563*87) + (1.850*157) – (4.676*36)
= 655.1 + 831.981 + 290.45 – 168.336
= 1609.195
Multiplying the BMI with stress factor for sedentary life, the energy requirement is
=1609.195*1.53
= 2462.068 kCal/day
Now, as the lady is obese and has no physical activity the calories given per day needs
to be reduced. Here, i am reducing it by 500kCal/ day
Thus, total energy requirement = 1962 kCal/day
4. Carbohydrates: 60% of total daily energy
= 0.6*1962 = 1177.2 kCal
Now, 1 gm carbohydrates give 4kCal energy
Thus, CHO requirement = 1177.2/4 = 294.3 gms
5. Proteins: 16% of total daily energy
= 0.16*1962 = 313.92 kCal
Now, 1 gm proteins give 4kCal energy
Thus, Protein requirement = 313.92/4 = 78.48 gms
6. Fats: 24% of total daily energy
= 0.24*1962 = 470.88 kCal
Now, 1 gm fat give 9kCal energy
Thus, fat requirement = 470.88/9 = 52.32 gms

Dietary guidelines:

1. Reduce the fat intake to avoid high amount of fat storage. Take beneficial PUFAs like
omega-3 fatty acids as per the dietary recommendations
2. Avoid processed or refined foods (even maida) to reduce chronic fatigue
3. Increase the intake of proteins in the diet
4. Increase the intake of antioxidants. Eat the colours

Patient counselling tips:

1. The importance of exercise must be conveyed to the patient. She must be convinced
that exercise is playing a major role in her weight loss.
2. The patient must be made aware of the risk of T2DM and hypertension due to obesity
and the importance of weight reduction.
3. Exercising 150 minutes per week and including cardio exercises and resistance
training must be suggested.