Nutritional Therapy: Identifying Eating Habits and Malnutrition - Assignment Example

Nutritional Therapy Introduction: The practice of good nutrition habits is expected to eliminate many health problems caused by malnutrition. The dietary history is a fair clue to the subject's nutritional habits and is very important in the nutritional assessment of any patient. By verbal reports, it can be very difficult to obtain an accurate nutritional assessment. Although, the most common method is a 24-hour recall, where the patient is usually interviewed by the nutritional therapist and is asked to give the types, amounts, and preparation used for all food eaten in the 24 hours. In this assignment, where a dietary assessment would be undertaken of the micronutrients in my diet, and I will list all foods eaten in a three-day period in the second half of the week, where a weekend diet is also included. Although this provides a fair idea about the usual diet, this method has been criticized to be not totally accurate. This is because, the subjects either forget or are not totally truthful. They are also sometimes inclined to say they have eaten certain foods because they know they should have done so. However, in the absence of a more reliable method, this option is worth exploring. In this assignment, the collated data will be analyzed by a computer software programme to determine of the nutrient intake has been appropriate. It will accurately reveal any nutrient deficiencies from this dairy. The three day diary has been given below: Personal Food Diary Day 1 Meal Contents of the Meal Notes Breakfast Bread, wheat; Egg, Cheese and Bacon Griddle Cake Sandwich; Orange juice drink Lunch Rice, white, long-grain, parboiled, enriched, dry; Vegetables, mixed, frozen, cooked, boiled, drained, without salt; Soup, vegetable beef, dry, mix; Chicken, meatless, breaded, fried; Fruit punch drink, frozen concentrate Dinner Salami, cooked, turkey; Noodles, chinese, chow mein; Apples, raw, with skin, medium; Carrot, dehydrated Snacks Prunes, dehydrated (low-moisture), stewed Beverages None Food Groups Food Groups Milk and Dairy X X X X Meats X Grains X Fruits X Vegetables X Other X X The computer analysis provides the following data Personal Food Diary Day 2 Meal Contents of the Meal Notes Breakfast Cereals, ready-to-eat, ALPEN; Milk, indian buffalo, fluid; Egg, whole, cooked, scrambled; "Apples, canned, sweetened, sliced, drained, unheated Lunch BURGER KING, Chicken WHOPPER Sandwich; Hot Cocoa Mix Rich Chocolate With Marshmallows Dinner Rice, brown, medium-grain, cooked; Potato salad, home-prepared; Beef, corned beef hash, with potato, canned; Vegetarian stew; Desserts, apple crisp, prepared-from-recipe Snacks Candies, NESTLE, AFTER EIGHT Mints Beverages None Food Groups Food Groups Milk and Dairy X X Meats X X Grains X Fruits X X X Vegetables X X X Other X X X Computer Analysis Personal Food Diary Day3 Meal Contents of the Meal Notes Breakfast Bread, wheat; Papaya nectar, canned Lunch Rice, white, medium-grain, cooked; Vegetables, mixed, frozen, cooked, boiled, drained, without salt; Chicken breast tenders, cooked, microwaved; Soup, chicken broth cubes, dry; Desserts, flan, caramel custard, prepared-from-recipe Dinner Rice noodles, cooked; Veal, ground, cooked, broiled; Fish, haddock, smoked; Vegetarian stew; Fruit salad, (pineapple and papaya and banana and guava), tropical, canned, heavy syrup, solids and liquids Snacks Snacks, fruit leather, pieces Beverages Alcoholic beverage, wine, table, white Food Groups Food Groups Milk and Dairy X X X X X Meats X X X Grains X X Fruits X Vegetables X X X Other X X X X Computer Analysis When these steps are evaluated together, the dietician has the best possible opportunity to make an accurate nutritional assessment. This information can then be used by the dietician or the nutritional therapist to plan the patient's dietary management and counseling. This would also help to determine the risk from a possible deficiency if detected. Nutrition has a cumulative effect on the health and future health of the individual. The risk assessment, henceforth, is necessary to predict future health problems of the individuals, although presently, they are maintaining a perfect health status. This has significance. Based on the analysed data, appropriate preventative measures may be taken to prevent future health hazards. As is evident from the tables labeled day 1, day 2, and day 3, I have listed three days' food, drinks, and other elements in the tables, and at the same time, I have ticked the categories of the foods in the food groups. The collected data is analyzed by a software programme, Diet Organizer version 2, and depending on the data, the analysis has been made. The Daily Macronutrient Calculation and Their Averages Macronutrient Amount Day 1 Amount Day 2 Amount Day 3 Average Sodium 7466.5 mg 5297.8 mg 5304.7 mg 6023 mg Potassium 4093.3 mg 2923.3 mg 3764.2 mg 3593.6 mg Calcium 684.8 mg 726.9 mg 824.3 mg 745.33 mg Magnesium 442.2 622.2 998.3 687.5667 The Daily Micromineral Levels and Their Averages Micronutrient Amount Day 1 Amount Day 2 Amount Day 3 Average Copper 2.1 2.8 4.9 3.26667 Iron 29.3 28.3 24 27.2 Iodine 3.2 1.2 2.1 2.16667 Manganese 7.1 2.9 3.9 4.63333 Selenium 142.2 132.2 136.2 136.867 Zinc 10.1 12.5 17.5 13.3667 Chromium 1.3 2.1 1.6 1.66667 The Vitamin Levels and Their Averages Vitamin Day 1 Day 2 Day 3 Average Vitamin A 61089.7 3816.4 31025.5 31977.2 Vitamin D 0.2 0.5 0 0.23333 Vitamin E 11.4 4.3 7.6 7.76667 Vitamin C 248.6 45 150.8 148.133 Thiamine 4.7 3.6 5.2 4.5 Riboflavin 3.3 3.1 5.2 3.86667 Niacin 51.5 51.2 90.7 64.4667 Vitamin B6 4.2 4.4 7.6 5.4 Vitamin B12 7.3 6.6 14.5 9.46667 Folate 685.6 495.6 865.6 682.267 Pantothenate 6.3 4.1 6.2 5.53333 Analysis of the Tables: As evident from the dietary data, I had considerably higher intake of sodium, potassium, and magnesium, whereas, the calcium intake is considerably low. From these tables, the findings and their analyses are presented below item-wise. Sodium: The average intake of sodium 6023 mg. Sodium plays important parts in the body, but this amount of sodium is more than the recommended amount of 2300 mg of sodium. The Recommended Dietary Allowance defines the average daily amount of the nutrient needed to meet the health needs of 97-98% of the population. However, high dietary intake of salt can cause less visible health damage in the form of high blood pressure or hypertension. Hypertension silently damages the heart, blood vessels, and kidney and increases the risk of stroke, heart attack, and kidney damage. Most problems related to high blood pressure are chronic, slow to develop disorders that do not cause serious complications until the second half of an individual's lifetime. Kidney failure, heart attack, and stroke are all complications of high blood pressure and potentially of high sodium intake. The other ways to reduce the high intake are to eat more fresh fruits and vegetables, to look for processed foods that say ''no salt added'', to limit or eliminate salty snacks such as chips and pretzels, to restrict the amount processed meats such as hot dogs, pepperoni, and deli meats, to avoid high salt canned soups, to choose heart-healthy lower salt soups instead, and to use spices instead of salt to give foods flavor (Hawkins, 2006, 23-37). Potassium: There is no RDA for potassium but an intake deemed safe and adequate is 2000 mg/day. Potassium passes freely from the gastrointestinal system into the enterocyte and thence into the body. The minimum daily requirement for potassium in healthy adults is approximately 2g , and the average daily intake among the adult population is approximately 2-3g. However, recommended daily intakes to reduce risk of high blood pressure, stroke, and heart disease, are higher-in the range of 4-5g/day. My average intake is 3593.6 mg which is above 2 mg, but below 4 mg. Therefore, I have a chance of developing hypokalaemia in the long run. The symptoms of hypokalaemia include fatigue, lethargy, delayed gastric emptying, decreased blood pressure, muscle weakness, constipation, and cardiac arrhythmias. In this particular person due to antagonistic nature of sodium and potassium, the sodium imbalance may cause potassium imbalance. I need to take fruits that are rich in potassium, such as, banana, and addition of two bananas in the diet would suffice for this person. Other vegetables, such as, white lentils, white beans, orange juice, or spinach may be considered (Capuccio and Macgregor, 1991, 465). Calcium: Calcium is one of the most important elements in the diet because it is a structural component of bones, teeth, and soft tissues and is essential in many of the body's metabolic processes. Because of its biological importance, calcium levels are carefully controlled in various compartments of the body. Calcium is one of the most important macronutrients for the body's growth and function. The adequate intake my age group is 1000 mg; taking into consideration the fact that I am not on any supplements and I have vegetables in the diet that can reduce absorption, the average intake of 745.33 mg is below the required adequate intake. Therefore, I may suffer from hypocalcaemia. The bones then become less dense, weaker, and more likely to break. This condition is called osteoporosis and it is most noticeable in the elderly who have a high rate of broken bones resulting from falls. Osteoporosis is a part of aging, but eating a healthy diet high in calcium, getting adequate vitamin D, and doing weight-bearing exercises regularly can delay its onset. Calcium deficiency, called hypocalcaemia, can occur because of inadequate calcium intake, excess calcium excretion by the kidney, the inability to adequately absorb calcium, or because of interactions between calcium and some prescription drugs. Dairy products, meats, and some seafood such as sardines, oysters are excellent sources of calcium. Spinach, beet greens, beans, and peanuts are among the best plant-derived sources (Matkovic, 1992, 119). Magnesium: The recommended daily intake of magnesium is 270 to 300 mg. My intake on an average is 687.56 mg which is over the limit. Therefore, I may develop hypomagnesaemia. Toxicity from excessive dietary intake of major minerals rarely occurs in healthy individuals. Kidneys that are functioning normally can regulate mineral concentrations in the body by excreting the excess amounts in urine. Toxicity symptoms from excess intakes are more likely to appear with acute or chronic kidney failure. Magnesium intake from foods has no adverse effects, but a high intake from supplements when kidney function is limited increases the risk of toxicity. The most serious complication of magnesium toxicity is cardiac arrest. In healthy adults magnesium is nontoxic at doses up to 1g/day. High blood levels can produce symptoms of nausea, vomiting, low blood pressure, and arrhythmia (He et al., 2006, 1675-1682). Chromium: The adequate intake for prevention of deficiency as per UK standards is 25 mcg, and I on an average am taking only 1.66 mcg leading to immediate and long-term deficiencies. Modern diets in the industrialized countries that are high in fat and refined carbohydrates contain only low amounts of chromium. Refining grains reduces the chromium content dramatically: whole wheat contains 10 times the amount of chromium found in white flour. Increased stress from strenuous exercise, physical activity, infection, trauma, or illness, sharply increases chromium loss in the urine, elevates chromium requirements, and may exacerbate a deficiency. These will lead to impaired glucose tolerance and reduced insulin action, weight loss, elevated cholesterol and triglyceride levels in blood, and peripheral neuropathy. Diabetic peripheral neuropathy, a form of nerve damage that is a direct result of diabetes, is indirectly related to a lack of sufficient chromium. Chromium occurs naturally in meat, seafood, dairy products, eggs, whole grains, black pepper, and almonds. Stainless-steel cookware typically contains 11-30% chromium (Lamson and Plaza, 2002, 218-236). Iron: The availability of iron from food depends on its source. Soybean protein, for example, contains an inhibitor of iron uptake. Tannins, phytates, certain fibers, carbonates, phosphates, and low-protein diets also adversely affect the apparent absorption of iron. In contrast, ascorbic acid, fructose, citric acid, high-protein foods, lysine, histidine, cysteine, methionine, and natural chelates, i.e., heme, all enhance the apparent absorption of iron. The RDA for iron varies between 10 and 15 mg/day for different groups. The available iron in my diet is on an average 27.2 mg, and considering the fact that only 10% will be absorbed, the amount absorbed is 2.72 mg making a deficient intake of about 7 to 12 mg per day. This would lead to iron deficiency. Diets which contain whole grain cereals and legumes contain only nonheme iron which is poorly absorbed. Iron deficiency predominantly leads to iron deficiency anemia that occurs in stages. Clinical iron deficiency anemia occurs in three stages: the first involves depletion of iron stores as measured by a decrease in serum ferritin which reflects the ferritin supply in the body, without loss of essential iron compounds and without any evidence of anemia. The second stage is characterized by biochemical changes that reflect the lack of iron sufficient for the normal production of hemoglobin and other iron compounds. This is indicated by a decrease in transferring saturation levels and an increase in erythrocyte protophyrin - so-called iron deficiency without anemia. In the final stage, iron deficiency anemia occurs, with depressed hemoglobin production and a change in the mean corpuscular volume of the RBC to produce a microcytic hypochromic anemia. This is expressed clinically as pallor and weakness. There are also changes in the nails, which take on a spoon shape when the iron-deficient state is severe. Optimal iron intakes can protect against lead toxicity. Lead competes with iron for uptake by the enterocyte. If the transporter is fully saturated by its preferred mineral, iron, then the lead will be poorly absorbed and excreted in the feces. Well-nourished individuals with respect to iron nutrition are at less risk for lead toxicity than are those whose iron intake is marginal or deficient. Unfortunately, humans at risk for lead toxicity are frequently those whose diets are less than optimal. Lead intoxication has anemia as a characteristic because lead substitutes for iron in the hemoglobin molecule and kills the red cell. As the heme is being synthesized lead competes with iron for placement yet does not have the divalent characteristic of the iron so the heme is nonfunctional. Lead-induced anemia therefore is a direct effect of the lead, not a sign of iron deficiency per se. Nonetheless, lead toxicity and iron deficiency frequently coexist. Apart from these, iron deficiency may lead to anemia; pallor; dry skin; poorly-formed, upturned nails; brittle hair, quick fatigue, weakness, lack of energy; loss of appetite, inability to maintain body warmth when exposed to cold, learning difficulties, impaired memory and concentration, impaired mental and motor development during, childhood, inflammation of the oral mucosa, increased susceptibility to infection, increased uptake and vulnerability to environmental lead and cadmium, reduced performance, early fatigue, increased lactic acid production in muscles, and muscle cramping. The bioavailability of iron from foods varies greatly, ranging from less than 2% in certain plant foods, to 15-20% from meats, to nearly 50% from human-breast milk. Iron is poorly absorbed from foods high in phytates, such as, spinach and lentils. It is better absorbed from carrots, potatoes, soybeans and broccoli. Iron absorption is highest from meals including meat, poultry, or fish. Vitamin C is a strong promoter of iron absorption, and when vitamin C-rich foods are combined with iron-containing foods, bioavailability of the iron is substantially increased. Obviously necessary dietary adjustments and iron supplementation are necessary in this subject. The preferred way to treat mild iron deficiency is through changes in diet. If these changes are ineffective, iron supplements may be used (Iannotti et al., 2006, 1261-1276) Iodine: The only known function of iodine in the body is as an essential component of the thyroid hormones. The recommended daily intake of iodine is 140 mcg per day. In this case, the intake is 2.16 mcg, leading to an enormous dietary deficiency. The signs and symptoms of hypothyroidism include weight gain, edema, fatigue, lack of energy, slow heart rate, low blood pressure, hair loss, and dry skin, and in adults iodine deficiency of this magnitude would lead to hypothyroidism. Even in areas where iodized salt is available, iodine intake may be low. Mussels, clams, salmon, Shrimp, cod, Mackerel, tuna, herring, halibut, and iodized salt are rich sources, and they should be included in the diet (Delange, 1994, 107). Manganese: Manganese is acquired through diet. It is not evenly distributed in the body but is concentrated in the bones, liver, pancreas, and brain. Excess manganese is removed in bile, a digestive fluid made by the liver. The role of manganese in health is not well understood. Both manganese deficiency and manganese excess are rare. The recommended daily intake is 2.3 mg. I have an average intake of 4.6 mg demonstrating an excess intake. Side effects of high levels of manganese include loss of appetite, headaches, tremors, convulsions, and mental changes such as hallucinations, but still it remains within the upper limit of intake of 11 mg for adults. Thus, no adjustment is necessary for manganese (Higdon, 2001). Selenium: Selenium is an essential trace element that is a component of several enzyme systems. the recommended daily intake is 60 mcg, whereas I have an average intake of 136 mcg, indicating an excess intake, although selenium is trace element that is essential in small amounts, but is toxic in larger amounts. Excessive intake can result in symptoms that may include fatigue and irritability, with increased toxicity leading to loss of hair and nails, white blotchy nails, and garlic breath odor. If not corrected, it leads to a condition called chronic selenium toxicity, with symptoms of vomiting, nausea, nerve damage, skin rashes, and brittle bones. Daily intakes of up to 500 mcg/day appear to be safe in healthy adults, so no adjustment is necessary (Rayman, 2000, 233). Zinc: My average intake is 13.37 mg which is over the limit of recommended dietary intake in the UK. Zinc is nontoxic at moderate supplementation levels (less than 100mg /day). At doses higher than 150mg zinc may cause nausea and vomiting and may interfere with copper absorption. At very high doses (more than 300mg/day), zinc may impair immune function and decrease HDL cholesterol levels in the blood. In this subject no adjustment is necessary (Sandstead, 1995, S-87). Vitamin A: Recommendation of daily intake is 700 IU, and I am getting 31977.2 IU that is very high. High doses of vitamin A can produce severe toxicity. However, toxicity is not usually observed in adults at doses lower than 15000 IU of RE, even when taken for long periods. Because their conversion to retinol in the body is tightly regulated, carotenes do not produce vitamin A toxicity. If it causes toxicity that is very probable in such case, it may produce bone pain and joint swelling, nausea, vomiting, and diarrhea, dry skin and lips, hair loss, headache and blurred vision, enlargement of the liver and spleen, reduced thyroid activity, and high blood calcium. Urgent adjustment is necessary by reduction of beef, liver, egg, butter, whole milk, carrot, and sweet potato (Canfield et al., 1994, 1-300). Vitamin D: As opposed to daily requirement of upto 10 mcg, I am getting only 0.23 mcg from the diet. Because vitamin D is found only in animal foods, strict vegetarian diets sharply increase the risk of deficiency if sunlight exposure is inadequate, and this subject is at risk. Because of reduced sunlight intensity and duration, people living in northern latitudes, particularly in the winter season, are at risk for deficiency if dietary intake is low. This deficiency would lead to defects in calcium metabolism and would lead to loss of bone mineral from the skeleton with increased risk of osteoporosis and fractures in the long run, hearing loss and ringing in the ears, muscle weakness, particularly around the hip and pelvis, possible increased risk of colorectal and breast cancer, possible increased risk of high blood pressure, impaired immune response with increased risk of infection. Diets such as Salmon, Tuna, Eggs, Butter, and Cheese should be added to the diet (Fraser, 1995, 104). Vitamin E: The average daily intake of vitamin E in this patient is 7.77 mg, whereas the daily intake recommended is 15 mg. Thus, I am at risk of deficiency. This deficiency would lead to decreased membrane integrity of red blood cells that would produce hemolysis and anemia, degeneration of nerve cells in the spinal cord and peripheral nerves, atrophy and weakness in skeletal and smooth muscles, cardiomyopathy with breakdown and replacement of myocardial cells with scar tissue, atrophy of the reproductive organs and infertility, possible increased risk of cancer, atherosclerosis, arthritis, and cataract. Dietary adjustments that would include sunflower seeds, wheat germ, sweet potatoes, safflower oil, shrimp, salmon, and eggs can be added to the diet in the appropriate amount (Meydani, 1995, 170). Vitamin C: I am consuming on an average 148 mg of vitamin C when the dietary requirement is merely 40 mg per day. Due to this excess consumption, this subject would run the risk of hypervitaminosis C. In several large studies in which 5-10 g of vitamin C were given daily to healthy humans for several years, no adverse effects were demonstrated, other than occasional nausea, loose stools, and diarrhea. Although reports have warned of an increased risk of kidney stones with high intakes of vitamin C, large doses of vitamin C do not increase oxalate excretion into the urine and do not contribute to kidney stones in healthy people. High doses of vitamin C may decrease copper absorption, and chewable forms of vitamin C, because of their acidity, can cause erosion of dental enamel. Therefore, in this subject, practically, no adjustment is necessary in relation to vitamin C (Sauerberlich, 1994, 371). Thiamine: The recommended daily intake is 0.9 to 1.0 mg, and I am consuming 4.5 mg. Thiamin is virtually nontoxic. Doses greater than 200 mg may cause drowsiness in some people. No adjustment is necessary. Riboflavin has no known toxicity, no adjustment is necessary (Finglass, 1994, 270). Niacin: The recommended daily intake is 16 to 17 mg, and I am taking 64 mg on an average. This high amount of niacin would lead to problems. At doses of more than 2.5g/day, niacin can produce hypotension and dizziness, increased uric acid in the blood, liver dysfunction, increased risk of peptic ulcer, and increased blood sugar. Food elements such as calf liver, peanuts, tuna, chicken, breast, halibut, and mushrooms should be reduced from diet (Bendich, 1992, 300). Vitamin B6: Although the recommended daily intake is 1.3 mg, the safe upper limit is 100 mg. I am taking only 5.4 mg. Therefore, no adjustment is necessary although intake is high. Long-term intake in higher dosage produces neuropathy (Driskell, 1994, 293). Vitamin B12: The recommended daily intake for prevention of deficiency is 1 mcg per day. I am consuming 9.46 mcg that is higher than this value. No dietary adjustment is necessary since there are no reports of toxicity in healthy adults, even at very high oral intakes of greater than 10mg/day (Markle, 1996, 247). Folate: The recommended daily dietary intake for prevention of deficiency is 200 to 400 mcg. I am getting 682.2 mcg. Although over the limit, folic acid is nontoxic, even at very high doses. No adjustment is necessary (Bailey and Gregory, 1999, 779). Pantothenate: The recommended daily intake for prevention of deficiency is 3 to 7 mg. I am consuming 5.53 mg, which is perfectly alright (Tahiliani and Beinlich, 1991, 165). References Bailey LB, Gregory JF., 1999. Folate metabolism and requirements. J Nutr.;129:779 Bendich A., 1992. Safety issues regarding the use of vitamin supplements. Ann NY Acad Sci; 669:300. Canfield LM, et al., 1994. Carotenoids and human health. Ann NY Acad Sci.;691:1-300. Capuccio FP, Macgregor GA., 1991. Does potassium supplementation lower blood pressure A metaanalysis of published trials. J Hypertens.;9:465. Delange F., 1994. Disorders induced by iodine deficiency. Thyroid.;4:107. Driskell JA., 1994. Vitamin B6 requirements in humans. Nutr Res.;14:293. Finglass PM., 1994. Thiamin. Int J Vitam Nutr Res.;63:270. Fraser DR., 1995. Vitamin D. Lancet.;345:104. Hawkins, W. Rex., 2006. Eat Right-Electrolyte: A Nutritional Guide to Minerals in Our Daily Diet. Amherst, NY: Prometheus Books, P. 23-37. He, Ka, Liu Kiang, Martha L. Daviglus et al., 2006. Magnesium Intake and Incidence of Metabolic Syndrome Among Young Adults. Circulation 113, no. 13:1675-1682. Higdon, Jane, 2001. Manganese. Linus Pauling Institute-Oregon State University. Iannotti, Lora L, James M. Tielsch, Maureen M. Black, et al., 2006. Iron Supplementation in Early Childhood: Health Benefits and Risks.'' American Journal of Clinical Nutrition, 84:1261-76. Lamson, Davis W., and Steven M. Plaza., 2002. The Safety and Efficacy of High-Dose Chromium. Alternative Medicine Review: 218-236. Markle HV., 1996. Cobalamin. Crit Rev Clin Lab Sci.;33:247. Matkovic V., 1992. Calcium intake and peak bone mass. N Engl J Med.;327:119. Meydani M., 1995. Vitamin E. Lancet.;345:170. Rayman MP., 2000. The importance of selenium to human health. Lancet;356:233. Sandstead HH., 1995. Is zinc deficiency a public health problem Nutrition.;11:S87. Sauerberlich HE., 1994. Pharmacology of vitamin C. Annu Rev Nutr.;14:371. Tahiliani AG, Beinlich CJ., 1991. Pantothenic acid in health and disease. Vitam Hormon.;46:165. Read More