Running head: NUTRITIONAL ASSESSMENTS 1

NUTRITIONAL ASSESSMENTS 57

Nutritional Assessments

Name of Author

Institutional Affiliation

Date

Abstract

Introduction

The client, (TJ), is a 52-year-old British woman working a giant IT firm as a corporate secretary. She got employed as a personal secretary to the CEO in 2008, and since then, her lifestyle changed because she started spending spends a lot of time at her workstation due to the additional parks including bonus, overtime, and salary increment. Over the last ten years, she has gained considerable weight from a mere 45kg (110.231lb) to 242.508 pounds. Her weight gain can be attributed to her sedentary lifestyles.

Method

The nutritional status of the patient is associated with several interrelated factors. For example, food intake, quality, and quantity of food, Physical health are all factors that influence the nutritional assessment of individuals. This study will employ the direct methods of nutritional assessment. The direct methods include methods such as Anthropometric methods, Biochemical, laboratory methods, Clinical methods, and Dietary evaluation methods. The focus was on bioelectrical impedance analysis. Comment by Grammarly: Deleted:is

Results

Data collection was mainly based on the nitritics.com assessment of the anthropometric body composition measured using the bioelectric impedance. Body fat percentage for the patient was 32; the visceral fat area in the client was 52. Born on 2nd January 1966, her weight increased over the years, and now she is weighing 110kg, and measures 170centimeters with a BMI of 38.1,

Waist circumference is 42cm, Hip circumference: 51cm, Body fat percentage: 32. Her physical activity level is 1.2., Resting metabolic rate: 1742, and Daily energy requirements: 1890. The researcher found that with the increase in BMI, the body fats percentages, as well as the visceral fat area, also increase. The researcher recommended that the client should focus on Class 2 obesity-related lifestyles to reduce weight, and prevent further weight gains. Menopause transition triggers extreme metabolic and cardiovascular processes that place women at risk of Class 2 obesity and obesity-related comorbidities. The researcher has recommended dietary and exercises intervention in addition to the hormonal invention.Comment by Grammarly: Deleted:,Comment by Grammarly: Deleted:,

Table of Contents

Abstract2

Section 1. Nutritional Assessment6

1.1 Introduction:6

1.2 Overweight/ Class 2 obesity overview:8

1.3 Cost of Obesity/ Burden of the Disease9

Section 2: Methods:10

2.1 Anthropometric, Biochemical, Clinical, and Dietary (ABCD) Methods10

2.2 Food Intake Assessment10

Strengths of food intake assessments11

Limitations of food intake assessment12

2.3 Physical Activity Measurement12

2.3.1Strengths of physical activity measurement12

2.3.2 Limitation of physical activity assessment13

2.4 Anthropometric Measurements14

2.4.1 Strengths of anthropometric Measurements14

2.4.2 Limitations of anthropometric Measurements15

2.5 Predictive Equations for Energy15

Section 3: Results16

3.1 Rationale for Sampling Meals on Monday, Wednesday, and Sunday16

3.2 The daily intake kcal:16

3.2.1 Monday meal plan16

3.2.2 Wednesday meal plan17

3.2.3 Weekend Sunday meal plan17

3.5 Food diary summary18

Section 4. Discussion22

4.1 Discussion of the daily meal plan components22

4.2 Leptin, Ghrelin, and weight loss Hormonal control of appetite, and body fat23

Section 5. Recommendations24

Section 6. Conclusion25

6.1 Risks26

Obesity, and overweight26

Breast cancer26

Alcohol26

Dietary fat27

Dietary energy, overweight, and obesity27

Phytoestrogens27

Cardiovascular disease27

6.2.1 Multi-Component Recommendations, and timeline28

6.2.2 Monitoring weight loss, and timeline28

7. References30

Appendix45

Appendix 1: Calculate BMR (Basal Metabolic Rate)45

Appendix 2: Calculate Total Daily Energy Expenditure (TDEE)45

Appendix 3: Macronutrient Analysis For Monday’s Meal Plan46

Appendix 4: Meal Plan for MRS TJ: Monday47

Appendix 5: Nutritional Analysis for Wednesday’s Meal Plan48

Appendix 6: Meal Plan for MRS TJ: Wednesday49

Appendix 7: Macro Nutrient Analysis for Sunday’s Meal50

Appendix 8: Meal Plan for MRS TJ: Weekend50

List of Tables, and Figures

Figure 1: In most age groups, men are more likely than women to be overweight or obese. Adapted from Obesity Statistics Baker (2018).8

Table 1: Food diary summary for weekdays, and weekend16

Table 2: Components of total daily energy expenditure, and measurement approaches. Adapted from Hills, Mokhtar, & Byrne, (2014).18

Table 3: Table of Energy Balance (Energy Intake- Average Energy Expenditure)19

Section 1. Nutritional Assessment

1.1 Introduction:

TJ is a 52-year-old British woman working for a leading IT firm as a secretary to the CEO in London England. She moved to London city from Groomsport, Northern Ireland over 20 years ago. She does not have any relative in England apart from her children. She has been working as a sectary for ten years and has since gained considerable weight due to the nature of her sedentary lifestyle, and work that involves staying seated for more than 10 hours per days at work. TJ had once been concerned about her weight gain in 2014 and even started dieting, doing cardio workouts, and going to work on an empty stomach only to relapse into binge eating from the company’s cafeteria. She started to gain weight rapidly two years ago when she lost interest in physical exercise when there was no motivation, no dietician approved meal plan, or proper weight monitoring, and the pressures at work forced her to carry work to do at home.Comment by Grammarly: Deleted:,Comment by Grammarly: Deleted:,

TJ was referred to a dietician by her general practitioner who was concerned about her weight gain. She is in menopause which means that she is experiencing night sweats, and hot flushes (Regestein, 2018). She is also overweight and spends most of her daytime in the office where she works as a secretary. Her lifestyles is mainly that of an upwardly mobile woman who spends most of the time seated at work, order her fast foods such as pizza, and have them delivered to her workstation since the company has no lunch program. Her reactivity levels are very low as she works seated, and only gets to exercise on the weekends when she visits the gym or at home doing the household chores. The fact that she led sedentary lifestyles places her at risk of overweight, and Class 2 obesity (Regestein, 2018). Comment by Grammarly: Deleted:,

Client Profiles:

· Name: Mrs. TJ, Gender: female.

Daily energy requirements: 1890 (nutritics.com).

· Ethnicity: English

BMI: 38.1 (see appendix1).

· Aged: 52 years (DOB: 2 Jan 1966).

Waist circumference is 42cm[footnoteRef:2] [2: Waist circumference is 42cm taken around the waist at the same level with the belly button. ]

· Weight: 110kg[footnoteRef:3] [3: Weight measurement taken without clothes or heavy jewellery.]

Hip circumference: 51cm;

Body fat percentage: 32;

Her physical activity level is 1.2;

Resting metabolic rate: 1742

Height 1.7m[footnoteRef:4] (see appendix 9 [4: from heat to toe with shoes but subtracting the depth of shoes sole (Jesus, Assis, Kupek & Dias, 2017);]

The Waist circumference (WC) is considered as an indicator of health risks that are associated with excess fat around the waist (Savino et al. 2007). For example, according to the (Canadian Diabetes Association, (2018), a waist circumference of 88 centimetres (35 inches) or more in women, is associated with health problems such as type 2 diabetes, heart disease, and high blood pressure (Popova & Strahilova, 2014). She sleeps on average of 5 hours a day as she goes to bed at 11.00pm, and wakes up at 4.00am. She drives to work, and only walk 10 minutes to her work station when she remains seated for 5 hours, and break for 30 minutes lunch then back to work till 5 pm, and drives her car back home (Bergmann et al. 1997). She watches television for 2 hours, and eats with the family before refreshing, and then goes to bed. She spends only one hour in a day walking without rigorous physical exercises and spends the remaining 23 hours either seated or sleeping which means she leads a sedentary lifestyle (Maher, 2016)Comment by Grammarly: Deleted:, Comment by Grammarly: Deleted:,

1.2 Overweight/ Class 2 obesity overview:

Based on the assessment information BMI (see appendix1), it is clear that the client is obese (Class 2 (moderate-risk) obesity as the BMI is between 35.0, and 39.9 (DelParigi, 2010). Naufel, Frange, Tufik, & Hachul, (2016, pp. 346–347) “women in menopause with BMI of higher than 32 are obese while those with BMI between 25- 31 are overweight". Obesity is a medical condition mostly associated with excess body fat, and excessive commotion of body fat (Freeman, Sammel, Lin & Gracia, 2010). Excessive body fat is one of the significant predictors of diabetes, and high blood pressure, cardiovascular debases, type 2 diabetes, abstractive sleep apnea, cancer, osteoarthritis as well as depressions (Yeah, 2017). Based on the patient-specific data, TJ needs to lose leats30% of her body weight to be free from the risks of other obesity-related health risks (Lemstra, 2016).Comment by Grammarly: Deleted:, Comment by Grammarly: Deleted:l

Class 2 obesity is caused by excessive food intake, and from the nutritional assessment, the patient's meal was found to have a higher proportion of carbohydrate hydrates (54% averages). The prevalence of obesity in the UK indicates that the UK is one of the countries with the leading percentages of obesity across all demographics (Carney, 2010). For example, in 2014, over 62% of the adults in England were overweight or obese (Shapiro, 2013). Additionally, at least two-thirds of the men were obese while six in every ten women were obese (Baker, 2018). As of 2018, the age group that is highly likely to be overweight or obese are those between the age of 55 and 64 years. However, the differences are only a small margin. Currently (2018) the prevalence of obesity and overweight is 70% for all age groups more than 45 years of age. In most age groups, men are more likely than women to be overweight or obese (Obesity Statistics Baker, 2018). According to Cancer.net (2018), “obesity highly increases the risk of patient developing cancer as obese people are three times most likely to develop colon cancer while obese people are 2.5 times more likely to develop high blood pressures and heart disease”. Comment by Grammarly: Deleted:,Comment by Grammarly: Deleted:,

1.3 Cost of Obesity/ Burden of the Disease

The costs of obesity have also increased significantly with the increase in the cost of living. For example, the GOV.UK (2018) reported that “the NHS in England spent more than £6.1 billion on overweight and obesity-related ill-health from 2014 to 2015”. On the other h, and, Dungan (2011) also stated that “the medical condition cost the whole UK society £27bilion per year, and has been estimated to cost more than other sectors such as fire service, the police, and the judicial systems”Comment by Grammarly: Deleted:,

Section 2: Methods:2.1 Anthropometric, Biochemical, Clinical, and Dietary (ABCD) Methods

Using the ABCD method of nutritional assessment, the researcher would examine the anthropometry which would involve systematic measurements of the human body, weight, height, and proportions (Naufel, et al, 2016). ABCD of nutritional assessment refers to the measurement of an individual’s nutritional intake using the anthropometric, biochemical, clinical, and dietary (ABCD) methods (Burns, Marsh & Bender, 1989). The Anthropometric Assessment involves assessing a client’s intake using height, and weight based on the ideal body weight (Tai, Goh, Mohd-Taib, Rampal & Mahadeva, 2010). The Ideal Body Weight (IBW) for males = 106 pounds for 5 feet plus 6 pounds per inch above 5 feet or IBW for females = 100 pounds for 5 feet plus 5 pounds per inch above 5 feet) as reported by Woteki et al(1988) on the National Health, and Nutrition Examination Survey (NHANES) . The Percent of IBW = (Current weight/Ideal weight) x 100 (Ward & Muller, 2013). Biochemical assessment involves static tests, and functional tests to detect marginal nutritional deficiencies in individuals, particularly when dietary histories are questionable or unavailable (Firkin, 1997).

Routine blood and urine lab test can be used to provide an objective measurement of the individuals' nutritional status (Burns, Marsh & Bender, 1989). The clinical assessment refers to the physical examination (P.E.) of a client for signs, and symptoms that can suggest nutritional health, and/or clinical pathology (Tai, Goh, Mohd-Taib, Rampal & Mahadeva, 2010). According to Wells (2005), and Davis et al (2010), the clinical examination is usually conducted by physicians by examining the anatomic changes in the superficial, epithelial tissues like skin, eyes, hair, or organ systems. Finally, the Dietary Assessment involves analysing data from food recalls food frequency (retrospective), and food records (prospective) (Pereira et al. 2018; Huerta-Ramirez et al. 2018).

2.2 Food Intake Assessment

The method of food intake assessment is the most appropriate for understanding the health condition of the lady. The food frequency questionnaires (FFQs) are the main dietary tool used in large epidemiological studies (Tai, Goh, Mohd-Taib, Rampal & Mahadeva, 2010). Other methods include duplicate diet approach, food consumption record, food diary method, the 24-hour dietary recall, dietary record, and dietary history method (Shim, Oh & Kim, 2014). The food diary method was chosen, and the Nutritics software for dietary analysis was used to assess food intake in clients because of the following strengths.

Strengths of food intake assessments (food diary)

1. A food diary is chosen because it is more effective in monitoring weight, and enhancing weight loss because keeping the food diary increase's an individual's awareness of they eat, the amount they eat, and what they are wearing the specific foods (Christofi & Hextall, 2008). The food diary is effective in helping individual’s cut down on their mindless eating (Yuan et al. 2013).

2. The client would benefit from the food dairy as she would identify the areas where they can make changes that would contribute towards losing weight (Christofi & Hextall, 2008). Finally, food diaries are effective in unveiling patterns of overeating as well as triggers that can be avoided (Gilsenan, and Gibney, 2004).

3. Apart from food dairy, other methods o that can be used to accurately assess dietary intake include 24 hours recall, and food frequency questionnaire (Woteki et al. 1988). The 24 hours recall is advantages because each food intake is quantified, and does not alter the eating behaviours (Christofi & Hextall, 2008). However, it is not preferred because it mainly relies on the ability of an individual to recall, and might require multiple recalls when examining the habitual intake over a long period of time (Yuan et al. 2013).

4. The food frequency questionnaire is advantageous because it does not alter the individual's eating behaviours but it captures the habitual intake (Krantzler et al. 1982)

5. Marcus, Foster, and El ghormli (2014) argued that the method is very easy to use for a health practitioner. The software used in this method contains a step-by-step guideline for a healthcare professional (Bindal, 2018). Roberts, Lowry, and Sayer (2014) noted that this is because every step leads to the other as long as one clicks some special buttons shown in every stage. On the same note, Sallis (2010) argued that an individual has the opportunity to confirm if he or she is satisfied with the dietary information added; there is an option to review to ensure that on the correct information is included (Stallings & Wolman, 1992).

6. Sylvia, Bernstein, Hubbard, Keating, and, Anderson (2014) observed that adding the specified number of days, and the respective meals for the given days are made easy since the diary is established in the form of an excel spreadsheet (Yuan et al. 2013). One does not have to necessarily search for a given item every time but rather click on the corresponding cell (Tankisheva, Bogaerts, Boonen, Delecluse, Jansen, & Verschueren, 2015). The method will be important as will be showing what type of food will be necessary for the nutrition management of the lady, and to which day of the week (Tucker, 2008). For this particular case, the software information will be applicable to the lady's food intake whereby 2 weekdays and 1 weekend day will be considered (Taylor, 2017).Comment by Grammarly: Deleted:isComment by Grammarly: Deleted:, Comment by Grammarly: Deleted:,

Limitations of food intake assessment

1. In spite of the effectiveness of the method, Thomas (2014) argued that it is associated with some limitations in the course of assessment of dietary issues (Bindal, 2018). For instance, apart from the clinical professional knowledge, a healthcare practitioner should have sufficient knowledge in working with the software in question (Yuan et al. 2013).

2. Furthermore, Goodpaster, DeLany, Otto, Kuller, Vockley, and South-Paul (2010) showed that to achieve all the qualities that it has the potential to deliver, it consumes a significant amount of time. Furthermore, it is one of the most expensive methods of nutritional assessment (Kruschitz, Wallner-Liebmann, Luger, Lothaller & Ludvik, 2016).

2.3 Physical Activity Measurement2.3.1Strengths of physical activity measurement

1. Burke (2013) argued that “physical activity, and exercise are associated with many health benefits”. However, adults record a considerable in the level of physical activity which has remained the potential cause of the increased in the body fats among the victims (Christofi & Hextall, 2008).Comment by Grammarly: Deleted:p

2. Chahal, Lee, and Luo (2014) added that “the knowledge on the need for physical activity in the management of one’s health can be used to ensure an active lifestyle”. Samat, Rahim & Barnett (2008) reported that assessing the physical activity will be a strategic way through which the management of the body fats would be understood.

3. The physical activity factor of SCAN (2011) will be used other than activity diary in this method (Yuan et al. 2013). This due to the level of the effectiveness of the approach in relation to the latter method. Foong, Chherawala, Aitken, Scott, Winzenberg, and Jones (2015) reacted that that, it is because it allows the use of self-reports which are generated at a low-cost with a significant level of accuracy (Kong & Jackson, 2008).

4. Besides, the method allows the implementation of objective monitors like accelerometers which are applicable in the generation of accurate information, but resources and expertise are needed to collect and manage the data (Yuan et al. 2013). Moreover, Furjanic, Cooney, and McCarthy (2016) indicated that the method comfortably accommodates the data collected through direct physical observation. The method will, therefore, be important in assessing the health condition of the lady (Christofi & Hextall, 2008).Comment by Grammarly: Deleted:,Comment by Grammarly: Deleted:,

2.3.2 Limitation of physical activity assessment

1. Accelerometers are expensive, and can mainly be used by the knowledgeable and skilled people (Christofi & Hextall, 2008).

2. The pedometers are less expensive but provide limited data as compared to accelerometers that provide information such as physical acuity intensity, and energy expenditure estimates (McNamara, Hudson, &, Taylor, 2010), Comment by Grammarly: Deleted:,

2.4 Anthropometric Measurements

The methods of anthropometric measurements (bioelectric impedance) will be applicable in the assessment are shape, size, and the composition of the lady’s body (Christofi & Hextall, 2008). There are many methods of measurement of the percentage of body fats including Dexa, bod pod, skinfold thickness (Gracia-Marco, 2016).

2.4.1 Strengths of Anthropometric Measurements

1. Bioelectric impedance is more practical, and reliable, therefore, would be the most appropriate for the assessment of the lady's body fat (Emmanuel Mbada et al. 2014). The method is undertaken by a clinical device which is relatively easy to use. Besides, the given assessment equipment is portable hence can be transferred from one point to another (Ahn, Jung, Yadav, Kim & Koh, 2017).

2. The assessment method will be important in the estimation of the total body water (TBW) by determining the extent to which the body parts tend to oppose the flow of electric current in the body (Emmanuel Mbada et al. 2014). As a result, the fat-free body mass would be easily determined with regard to the lady’s weight (Gracia-Marco, 2016).

3. The method can be used to provide further important information other than data on her weight (Emmanuel Mbada et al. 2014). The application of the method will be used to assess the general, and detailed status of her body. The overweight, composition, size as well the shape of her body (Pallas-Areny, and Webster, 1993).

4. This approach recognizes that individuals can be of the same weight record significant variation in the composition of their body (Samat, Rahim & Barnett, 2008). The idea of the use of the method draws from the argument that simply knowing one's weight would not be enough to reveal the overall health condition of the lady (Gracia-Marco, 2016).

5. The approach takes different dimension which will help to reveal the probable causes of the excess weight which subsequently lead to the serious health conditions (Christofi & Hextall, 2008). The method is also applicable to determining the health trends in a given group of people (Yuan, Wang, Shang & Sun, 2013). Therefore, the means of assessment of given measurements can be applied to a similar situation of the same body composition (Judy, Demeter, and Toth, 1986).

2.4.2 Limitations of Anthropometric Measurements

1. According to Kripke, et al. (2001), single anthropometric measurement, such as weight, does not normally in itself assess growth , and/or body composition, and, therefore, indicate nutritional status which means a combinations of measurements must be compared with the references groups by values, by age, and sex (Judy, Demeter, and Toth, 1986).

2.5 Predictive Equations for Energy

There are many predictive equations for energy with regard to the need to determine one’s resting energy expenditure (REE). According to Taylor (2017), the effectiveness of an equation depends on the validity, reliability, and practicality to assess this client's energy expenditure (Dunkelmann et al. 2012). For the case of the lady in question, the Mifflin equation for weight control will be implemented as the most applicable approach (Dixon, 2018). The method will be used to determine how active the lady is, and further show the amount, and type of activity that she should adopt (Gracia-Marco, 2016). The level of the level of activity is shown by different, and specific values which reveal what intervention procedures should follow (Bindal, 2018). The given equation will enable the production of more valid, practical, and reliable result hence might be important in this given setting. The researcher used the Mifflin-St. Jeor equation to determine the RMR kcal/day of the client. The Mifflin-St. Jeor equation is given by the formula: 9.99*weight (kg) +6.25*height (cm)-4.92*age (years)-161 (see appendix 2).

Section 3: Results 3.1 Rationale for Sampling Meals on Monday, Wednesday, and Sunday

The client’s nutrition assessment was done based on her normal daily intake. Because of the nature of her work, she spends 10 hours seated at work, and 2 hours of commuting to work on a bus. When not at work over the weekends, she spends time with her children, doing house chores, and preparing meals for the family (Dunkelmann et al. 2012). For the sake of this study, the researcher sampled meal plans for three days. One day over the weekend (Sunday) since Sunday’s is the only day she spends with the family and is free to prepare meals at home (Judy, Demeter, and Toth, 1986). Two weekdays were also sampled to help in understanding the type of meals, and the average amount of calories she consumes on a typical weekday. Therefore, the researcher sampled Monday, and Wednesday meals because the meal plans for the two weekdays fully represent the meals taken on all the weekdays.Comment by Grammarly: Deleted:,

3.2 The daily intake kcal:3.2.1 Monday meal plan

On Monday, the client’s food intake was mainly composed of 46% carbohydrates, 12.4% sugars, 35.9% fats, and protein was only 18.1%. The macronutrient analysis below indicates that a total of 3830kcal of which 1426kcal of carbohydrate was taken on that day while only 347kcal of Tran’s fat, and 1112 kilocalories of fats, and 560 kcal of protein was taken. It is quite interesting to note that the patient’s intake of fat is quite high at 1112kcal while fat was 347 kcal (see Appendix 3, and Appendix 4). The patient is mainly obese because of the carbohydrate, sugars, fat, and unsaturated fats that she consumed (Judy, Demeter, and Toth, 1986). According to the assessment of nutritional status in postmenopausal women by Nemati, and Baghi (2008), "sedentary women should limit their carbohydrates and fat intake". Therefore, the client should reduce her fat intake by half as a sedentary woman of 52 years old needs only 1800 calories per day based on the dietary guidelines for United Kingdoms in 2010. She does not exercise regularly as require thus should only need only 1890 calories to maintain healthy body weight. Because she also weights more than 165 pounds, the national heart, and lung, and blood institute recommendation is that she needs only 1890 calories a day (Kruschitz, Wallner-Liebmann, Luger, Lothaller & Ludvik, 2016).Comment by Grammarly: Deleted:, Comment by Grammarly: Deleted:'

3.2.2 Wednesday meal plan

The intake kcal on Wednesday was varied across meals. The morning breakfast was 2i90kcal, mid-morning snacks were 537kcal, lunch was 995kcal, 4 pm snacks was 175kcal, dinner was 460kcal, bedtime wine was 131kcal. On Wednesday, the total kcal was 2588kcal. The macronutrient analysis showed that the patient's meals on Wednesday were composed of 40.5% carbohydrates, 19.1% protein, 35.5% fat, and 4.9% alcohol (see appendix 5, and appendix 6). Ahn et al (2010) argue that "a good meal plan should be tailored according to the client's nutritional needs." Comment by Grammarly: Deleted:,

3.2.3 Weekend Sunday meal plan

The patient's meal plan on Sundays was balanced with low carbohydrates intakes at 28.1%, and high protein intake at 34.2 per cent. However, the patient still needs to reduce his fat intake because fat is converted to carbohydrates (Judy, Demeter, and Toth, 1986). The client's Sunday meal was mainly comprised of fat, and saturated fats (47%), while protein accounted for 33.9% and carbohydrates were only 21%. However, the kilocalories from carbohydrates was 767 kcal which is relatively good, but the number of calories from fat, and saturated fat was quite high 1608, and 300 consecutively (see appendix 7, and 8).

3.4 Information on daily activity for this client, and normal energy output:

Predict energy expenditure: this should be also predicted from formulae for BMR based on age/sex, and weight, and activity factor. The client’s BMR is 2261.4calories/ day (see appendix 1), and her total daily energy expenditures (TDEE) is 2091 (see appendix 2).

3.5 Food diary summary

The food dairy summary below shows the daily calories intake per meals for weekdays and weekend. The calories intake summary for each meal from breakfast, mid-morning snack, lunch, mid-afternoon snack, and dinner.Comment by Grammarly: Deleted:,

Table 1: Food diary summary for weekdays, and weekend

Meal Plan for MRS TJ

Week Day

Weekend

Monday

Wednesday

Sunday

Breakfast

567kcal

295kca

433kcal

Mid-morning snack

140kcal

947kcal

962kcal

Lunch

1042kcal

738kcal

1005kcal

Mid-afternoon snack

673kcal

306kcal

-

Dinner

1685 kcal

1119kcal

1196kcal

3098kcal

3405kcal

3596kcal

Based on the Scientific Advisory Committee on Nutrition (SACN) report, dietary carbohydrates intakes are related to cardio-metabolic- colorectal, and oral health outcomes. Carbohydrates specific risk factors in cardiovascular diseases, obesity, type 2 diabetes mellitus as well as colorectal cancer (Zoned et al. 2016). Cardiovascular diseases cause disability, and are associated with high costs of healthcare, Coronary diseases is the biggest killer in the Up since atherosclerosis progresses faster, and is influenced with another cardiovascular risk factor such as poor diet, lack of physical activity, hypotension, abnormal blood lipids (dyslipidaemia). According to SACN (2017) elevated blood glucose is also associated with high carbohydrates in the diet as blood pressures, fasting blood lipid concentration, coronary vascular factors, as well as other inflammatory mercers, are type 2 diabetes mellitus relate to risk factors (p.30). Some of the clinical manifestation associated with the medical condition such as type 2 diabetes mellitus, include angina, myocardial infarction, transient cerebral ischemic attack as well as stroke (Morey & Murray, 2012). Diabetes is a significant risk factor for cardiovascular disease, and they coexist because diabetes and cardiovascular diseases share commonly modifiable risk factors including obesity and high central adiposity. Losing body weight or control body weight is the main factors that should be considered in the prevention of the progression of impaired glycaemia control to the type 2 diabetes mellitus (Mewari, Feskanich, Hu, Willett & Field, 2010).Comment by Grammarly: Deleted:,

3.6 Assessment of Physical Activity, and Energy Expenditure

To assess the physical activity of the client, the researcher mainly relies on the data from the client observation. For example, physical activity from occupation, household task, and recreation would be quantified and documented. The researcher would also assess the frequency, duration as well as the intensity of the physical activity of the individual. Ndahimana, & Kim, (2017) recommended that the physical activity and energy expenditure during the physical activity would help in accurately predicting the energy balance, and the Total energy expenditure (TEE) based on the resting energy expenditure (REE), thermic effect of food (TEF), and activity energy expenditure (AEE). The researcher would use the doubly labelled water (DLW) for energy expenditure method because it is highly accurate, and can allow the clients the freedom of action as shown in figure 2 below:Comment by Grammarly: Deleted:,Comment by Grammarly: Deleted:,Comment by Grammarly: Deleted:,

Table 2: Components of total daily energy expenditure, and measurement approaches. Adapted from Hills, Mokhtar, & Byrne, (2014).

3.7 Discussion of energy balances, and relate to recommended requirements.

There is a significant relationship between emery intakes, and energy intake, and expenditure. If the energy expenditure is lower than the energy intakes then there is a positive energy balance, and storage in the form of body fat, increased fat storage is relatively inappropriate during menopause (Stallings & Wolman, 1992). Energy expenditure can be more than energy intake, and this negative energy balconies lead to weight loss. The patient should set negative energy balance by looking weight, and reduce the energy intakes (Jakubowicz, Froy, Weinstein & Boaz, 2012). The percentage of body fat continuously increases with the age because regular physical activity declines as one gets old. Those who lead sedentary lifestyles spend a lot of time seated at work or at home but still consume a lot of food mostly fast foods, snacks which are very salty and can be detrimental to health (Dungun, 2011). The sedentary lifestyles mean that she had more body fat as compared to her counterparts of the same age (SACN, 2000). The estimates of absolute energy intake of the patient indicate that the patient is obese considering the fact that at 52 years, her weight is 110 kg, and her height is only 170 cm (1.7m). Her BMI (see appendix1) is significantly higher than the recommended BMI so less than 25. A BMI of 38 indicates that one is very obese. With a body fat percentage of 32 and physical activity level of 1.2, it is important for the patient to take more regular physical exercises probably by walking to, and from work. Why her resting metabolic rate is average at 1742, her daily energy requirement is little on the higher side 1890 as opposed to 1600 (SACN, 2000).Comment by Grammarly: Deleted:, Comment by Grammarly: Deleted:,

Table 3: Table of Energy Balance (Energy Intake- Average Energy Expenditure)

Day

Energy intake(kcal)

Average energy expenditure

Energy balance

Weekend-Sunday

3098kcal

2091

1007

Monday

3405kcal

2091

1314

Wednesday

3596kcal

2091

1505

Total Energy Balance

3826

Section 4. Discussion4.1 Discussion of the daily meal plan components

On Monday, the client’s diet was laden with carbohydrates, Tran’s fat, saturated fats, and sugars. On Monday, a total of 3098kcal was consumed while on Wednesday, the client consumed 3405kcal, and on Sunday, the same client also consumed 3596kcal. The lunch, afternoon break, and dinners accounted for a larger percentage of the kilocalories consumed on Mondays. On Wednesday, then most of the calories were consumed in the midmorning snack, and dinner while on Sunday, the researcher consumed the larger portion of the calories in her lunch and dinner.Comment by Grammarly: Deleted:,

For a sedentary woman in menopause, a lot of fats, and carbohydrates is not healthy as the level of physical exercise is quite low, and physical engagement in other strenuous activity that requires a lot of energy is quite limited (Palacios, Joshipura, & Willett, 2009, pp. 369–381). Because most of these sugars are from carbohydrates, transfect, and saturated fat are not used during the day by nature of the client’s career, it is clear that excess. All these are in turn converted into energy, and if not used during the day through physical activity, these are converted to sugars and stored in the belly, hips, and buttocks.Comment by Grammarly: Deleted:,

Saturated fats increase the risk of type 2 diabetes (Palacios, Joshipura, & Willett, 2009). Saturated fats are mainly from red meat, poultry, and other range of full-fat dairy products including milk. Saturated fats can significantly raise the blood cholesterol levels as well as the low-density lipoprotein (LDL) cholesterol levels that also increase the risk of CVD, and type 2 diabetes (Moreno, 2017). On the other h, and, the high Trans fat levels are mainly from the oil added through food processing such as partial hydrogenation (Trailer, Reedier, Whitbread, Scherer & Schmidt, 2002). It is important to note that the partially hydrogenated Trans fat can significantly increase the unhealthy LDL (Everett, et al, 2006). Dietary Approaches that Delay Age-Related Diseases. Clinical Interventions in Aging, 1(1), 11–31. Carbohydrates from her Monday meal plans would be turned into glucose which the body would convert into glycogen for storage in the muscles, and lover between the meals (Trailer, Reedier, Whitbread, Scherer & Schmidt, 2002). However, as she eats more calories from the carbohydrates, fats, , and Tran’s fat, the body stores the execs as fat in the belly , and hips which would later increase her risks of types 2 diabetes mellitus, obesity, , and other forms of cancer (Mozaffarian, et al, 2014).

4.2 Leptin, Ghrelin, and weight loss Hormonal control of appetite, and body fat Comment by Grammarly: Deleted:,

Leptin and Ghrelin are the key players in the regulation of the appetite as they influence the general body weight, and fat (Otto-Buczkowska & Chobot, 2012). Both Leptin and Ghrelin affect the central nervous systems despite being secreted in the peripheral of the body (Savino et al, 2007). Leptin is a long-term regulator of body weight (Woliński, Słupecka & Romanowicz, 2013). While Leptin is secreted in the fat cells, stomach, heart, placenta, and skeletal muscles they are responsible for decreasing hunger (Mustonen, Nieminen & Hyvärinen, 2002). On the other h, and, ghrelin is secreted mainly in the stomach lining, and has the potential for increasing hunger (Savino et al, 2007). For obese people with more fat, the body produces more Leptin as they activate the hypothalamus (Traebert, Riediger, Whitebread, Scharrer & Schmid, 2002). The Leptin triggers the hypothalamus thereby reducing appetites, and increasing appetite allowing one to eat more (Woliński, Słupecka & Romanowicz, 2013). The obese women have more appetite as they have more Leptin in their body as the body produces allot of Leptin (Otto-Buczkowska & Chobot, 2012). Leptin increase metabolism making people more hungry, and crave for food most the fast foods, and snacks (Mustonen, Nieminen & Hyvärinen, 2002). The Leptin resistant people continue to eat more and gain more body fat that further produces more leptin (Savino et al, 2007). Ally of body fat produce Leptin but also disrupts the Leptin signalling leading to more hunger, and body weight. Menopause women have more fat under their skins thus the higher Leptin levels (Savino et al. 2007). Additionally, fructose associated with obesity also tend to induce and increase the Leptin resistance (Mustonen, Nieminen & Hyvärinen, 2002).Comment by Grammarly: Deleted:, Comment by Grammarly: Deleted:, Comment by Grammarly: Deleted:, Comment by Grammarly: Deleted:d ,

On the other h, and, Ghrelin also regulates appetite, hunger, and homeostasis (Savino et al. 2007). When losing weight the body responds by controlling the hormone levels making one feel hungry (Savino et al. 2007). In the process, the individuals losing weight goes back to eating especially after rigorous physical exercises (Crujeiras et al, 2010). Those who lose weight have lower Leptin and insulin than those who lost very little weight (Savino et al. 2007). Therefore, a dieter should focus on lowering the leptin, and Ghrelin level (Savino et al. 2007). Women with very low blood Leptin can maintain the new weightless (Karoutsos, Karoutsou, &, Karoutsos, 2017). The fact that in menopause the women's growth hormone is depleted means that Ghrelin is not affected as in menopause (Woliński, Słupecka & Romanowicz, 2013). In menopause, women produce more Leptin which makes them hungrier and fat meaning that they need to control their eating (Goumenou, Matalliotakis, Koumantakis & Panidis, 2003). Short term diets contribute to weight gain as the individual increasingly become hungrier, and the Leptin build-up (Otto-Buczkowska & Chobot, 2012). A good weight loss strategy should focus on reducing calories for at least eight weeks, then lose weight but the weight loss has to be maintained by reducing or taking low carbohydrates, and taking high protein diet (Mustonen, Nieminen & Hyvärinen, 2002). TJ should improve the Ghrelin , and Leptin levels by taking more fish oil (Omega 3 fatty acids reduces hunger) , and ensuring that she gets quality sleep (lack of sleep increases the Ghrelin, and reduces Leptin) while increasing daily physical activity, in addition to social support (Chou & Mentors, 2014). At least 9 hours of quality sleep is recommended for menopausal women (Jehan, et al, 2015). Comment by Grammarly: Deleted:, Comment by Grammarly: Deleted:, Comment by Grammarly: Deleted:inComment by Grammarly: Deleted:,

Section 5. Recommendations

Based on Monday's meal plan, it is recommended that she need to reduce carbohydrates intake on Mondays to 900kcal, sugars should be reduced to 200kcal, protein should also be maintained, and fat is reduced to 400kcal while saturated fat is reduced by 75%. Too many carbohydrates in a meal for sedentary women in her menopause have serious health consequences (Roberts, Butler, and Green, 2017; Krychman, 2015; Magliano, 2008). The Sunday's meal plan should also be reviewed as she is consuming a lot of carbohydrates. Rae, Jones, Handel, Blue horse-, Anderson, Frazier, and Maltrud (2016) argued that it is advisable for the patient to reduce fat intakes from 820kcal to 400-kilocal, and consume more water. Sugars should also be reduced by half as she risks b type 2 diabetes while protein should be maintained, fat, and saturated fats should be reduced by 400kcal, and 50kcal respectively. Never the less, the carbohydrates intake was adequate as she is usually busy with household chores, and physical activities during the weekends (Di Daniele, Noce, Vidiri, Moriconi, Marrone, Annicchiarico-Petruzzelli, &, De Lorenzo, 2017). Shapira, (2013) also reported that looking at the patient's diet on Wednesday, it is clear that the patient needed to reduce his fat, and carbohydrate hydrates intake, and implore her protein intake. Lane (2008) reported that fat, and carbohydrates when consumed in large proportion lead to Class 2 obesity as the excess fat are deposited in the body tissues, such as under the belly, in the hips region, and waist region. The patient is at high risk of overweight , and Class 2 obesity which are the main precursors of series health problems such as type 2 diabetes, some ulcers, and other forms of health problems including cardiovascular diseases as the fat get deposited in the blood vessels blocking the blood from reaching the important body parts (Everett, et al, 2006).

Section 6. Conclusion

There is no significant effect on the varying proportions of the proportion of fat on the systolic blood pressure, and carbohydrate to protein, and. The other trials carried out showed that there is a considerable decrease in the systolic blood pressure with the decrease in carbohydrate, fat, and the availability of a high unsaturated fat diet .this is different from the case of a controlled diet in which there is no significant difference. All the trials consider restricted weight loss varying with the percentage of energy associated with carbohydrate, fats, and proteins. It is important to note that the existence of a higher carbohydrate content with an average protein diet results in a lower rate of reduction in the concentration of fasting total cholesterol concentration. The difference in the weight between the included experimental groups can be demonstrated through the use of a forest graph; such a graph shows proportionality for each trial with the change in the fasting blood cholesterol. The analysis of the information presented should disregard the pooled estimate since the 75% measure of the pre-specified cut-off is much lower than the heterogeneity. This implies that it is impossible to exclude the confounding with the concomitant weight loss on the influence on the fasting total cholesterol. On this note, the trials show no significant difference even with the variation of the carbohydrate content in the diet. To a record an effect, carbohydrate should be kept high with lower fat; subsequently, the average diets of the protein will decrease the fasting HDL-cholesterol concentration. The result may be slightly different in the other trials which they could be a relatively lower increase in the cholesterol concentration with weight loss in two similar experiments. Based on her body weight, and sedentary lifestyles, and menopause stage in life, TJ is at risk of Class 2 obesity, and overweight, breast cancer, dietary fat, cardiovascular diseases.Comment by Grammarly: Deleted:,

6.1 Risks Obesity, and overweight

Obesity occurs when one’s BMI is greater than 30 kg/m2while overweight associated with the BMI that is greater than 25 kg/m2. Such conditions lead to the risk of cardiovascular disorders.

Breast cancer

The risk of the occurrence of which is traced with cumulative exposure to the ovarian hormones. The hormones are secreted by the ovaries of a woman in her lifetime.

Alcohol

Consumption of alcohol causes serious in the body of a female individual which increases the chances of breast cancer. Research shows there is a standard level of alcohol that increases the chances of breast cancer by 9%.

Dietary fat

There is enough evidence showing that intake of fat has no association with breast cancer risk. Further research shows that fat consumption has the potential to reduce the risk in the post-menopausal women.

Dietary energy, overweight, and obesity

Research shows that many of the women who follow the western diet risk gaining more than 25kg of weight which a major cause of Class 2 obesity among them, consequently they tend to suffer from breast cancer.

Phytoestrogens

Consuming foods rich in phytoestrogens has caused many breast cancer cases especially in countries like Japan where it is common, and easily available (Maddalozzo, Cardinal, Li & Snow, 2004). The hot flash frequency can be suppressed after eating as they are experienced when blood glucose falls between meals. Blood glucose stability should be given priority. The frequency of eating should be reduced to only breakfast, light lunch, and super with fruits, and a lot of water in between the meals (Dormire, & Howharn, 2007).Comment by Grammarly: Deleted:ly

Cardiovascular disease

The menopause is a tricky stage in the lives of the women since they easily gain unnecessary weight owing to the increased fat content in the body. The fats clog in the arteries, therefore, leading to the cardiovascular disorders (Mathura, Plank, Hill, Rice & Hill, 2007).

6.2 Recommendation for losing body fat

6.2.1 Multi-Component Recommendations, and timeline

Exercise helps to prevent the occurrence of the breast cancer as it reduces the amount and the effect of the estrogens produced by the ovaries of females. Physical activity or exercise is recommended. The client should start with less strenuous physical activities such as aerobic activity (brisk walking, jogging, biking, swimming or water aerobics) for ten minutes per day, and gradually increase the intensity , and duration), strength training (weight machines, h, hand-held weights or resistance tubing), Stretching, and Stability, and balance (standing on one leg). This physical exercise should take at least one hour per day can help improves flexibility balance, and physical function (Mendoza et al. 2016). 30% weight loss is recommended for the patient (Noël, & Pugh, 2002). The patient would lose 30% of the 248 pounds to attain the right weight of 173.6 pounds (Heymsfield et al. 2007). This will reduce the BMI to 28.1 which is considered overweight within the first 6 months, and later the BMI would decrease up to 24 which are healthy.Comment by Grammarly: Deleted:,

The practice also serves to burn calories hence promoting a healthy existence (Akers, Cornett, Savla, Davy & Davy, 2012). The patient should consider reducing the carbohydrate kilocalories from 1049kcal to 800kcal, and sugars should be reduced from 193kcal to 90kcal. Protein should be increased from 494 kilocals to 800kcal while saturated fats should be reduced from 433 kilocals to 200kcal. Kilocalories from alcohol are just fine (Lickteig & Reynolds, 1999).

For example, the patient was advised to reduce the portion of food intake especially carbohydrates, and focus more on the physical exercise by creating a timetable for a physical exercise regime that would be done on a daily basis. Registering with gyms, and physical fitness trainer or coaches was also advised.

6.2.2 Monitoring weight loss, and timeline

The researcher also recommended that the clients should work with a professional dietician to help in developing an appropriate meal plan aligned with the body weight loss goals are many but the most effective is the daily weight monitoring programs where weight loss maintenance (WTLM) involves self-monitoring of body weight, step counting fruits, and vegetables as well as water consumption (Thurston, Ewing, Low, Christie & Levine, 2015). The client should record the daily body weight, step count (physical exercises), and fruit, and vegetable intakes. The patient should be instructed to consume a lot of fresh green vegetables, and record their daily intakes. Any deviation from the recommended daily intake should be investigated and corrected (Lickteig & Reynolds, 1999).Comment by Grammarly: Deleted:,

Practical, and effective weight loss maintenances programs involve recording, and monitoring outcomes measures such as body weight changes, dietary behaviours as well as physical activities behaviours (Poehlman, 2002; Grossman, Arigo & Bachman, 2017)). The client should also be advised on how to achieve the theoretical constructs associated with menopausal body weight, and health behaviours (Thurston, Ewing, Low, Christie & Levine, 2015). The daily self-monitoring of the client’s body weight, their physical activity, fruit, and green vegetable consumption help the patient sustain weight body weight for the first six months. However, working with a peer with similar weight loss objectives can help in maintaining the weight loss regime (Noël, & Pugh, 2002).Comment by Grammarly: Deleted:s

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AppendixAppendix 1: Calculate BMR (Basal Metabolic Rate)

Gender: Female

Age: 52 years

Height : 5.57743

Height: 170 cm (5.57743ft)

Weight: 110 (151lbs.) or 242.508 pounds

BMI: = kg/m2Therefore,

BMI=38.1

BMR = Women BMR = 655 + (9.6 X weight in kg) + (1.8 x height in cm) – (4.7 x age in yrs)

BMR=655+ (9.6X110) + (1.8X170)-(4.7X52)

BMR=2261.4calories/ day 

Appendix 2: Calculate Total Daily Energy Expenditure (TDEE)

TDEE = BMR x Activity Factor

The Mifflin-St. Jeor equation is given by the formula: 9.99*weight (kg)+6.25*height (cm)-4.92*age (years)-161

The Mifflin-St Jeor=99*110+6.25*170-4.92*52-161

The Mifflin-St Jeor=1098.9+1062-255.84-161

The Resting Metabolic Rate (RMR)=1744.06

Amount of Exercise/Activity

Description

TDEE/ Maintenance

Sedentary

Little or no Exercise/ desk job

TDEE = 1.2 x BMR

Therefore,

TDEE = BMR x Activity FactorTDEE = 1520.9 x 1.375            = 2091

Appendix 3: Macronutrient Analysis For Monday’s Meal Plan

Appendix 4: Meal Plan for MRS TJ: Monday

Appendix 5: Nutritional Analysis for Wednesday’s Meal Plan

Appendix 6: Meal Plan for MRS TJ: Wednesday

Appendix 7: Macro Nutrient Analysis for Sunday’s Meal

Appendix 8: Meal Plan for MRS TJ: Weekend

Appendix 9

The height of patient with shoes= 1.73m

The height of high heel shoes= 3cm

The height of patient without shoes=1.7m