DIET AND NUTRITION CASE STUDY
Introduction
Mary Browning is 54 year old part-time teaching assistant in a local primary school. She lives at home with her husband and two cats. She is premenopausal and consults her doctor about feeling tired recently. Clinically the doctor suspected that Mary is a little anemic and arranged some blood tests. Physical examination of Mary Browning revealed nutritional deficiencies and excesses in addition to weight changes. Premenopausal women are at risk of developing iron deficiency anemia. According to one report, 10% of women in their reproductive years have iron deficiencies, and between 2% and 5% have iron levels low enough to cause anemia.
The laboratory tests provide an objective data to the nutritional assessments, but because many factors can influence these tests, no single test specifically predicts nutritional risks or measures the presence or degree of nutritional problem. The tests most commonly used are serum proteins, urinary urea nitrogen and creatinine, and total lymphocyte count.
Problem Description
According to the diagnosis and results produced by the patient’s doctor, Mary Browning has been diagnosed with anemia, and test results show that she is suffering from iron deficiency anaemia. This patient is at risk of osteoporosis, due to lower intake of calcium. She really needs to increase potassium (K) and calcium (Ca) intake either by diet and nutrition or medication. The patient’s cholesterol was also high, suggesting glucose intolerance, as well as low density liver protein (LDL) and triglycerol (Trg). This means that she could be heading to Type II diabetes. Therefore, Mary Browning needs to change her diet to a very healthy one, and she needs to cut down on coffee a lot, as well as wine, chocolate and biscuits.
Iron deficiency is the most common cause of anaemia, and may be due to increased iron requirement, diminished iron absorption, or both. Iron is essential to the synthesis of hemoglobin. The iron balance in normal individuals is maintained by absorption of the amount of iron that is physiologically lost on a daily basis ( 2004). The first stage of iron deficiency anaemia is iron depletion, in which the loss of iron exceeds the gain and in which storage iron is progressively depleted but haemoglobin and plasma iron remain normal. As storage iron decreases, there is a compensatory increase in absorption of dietary iron and in the level of transferring ( 1998).
In the second stage, the stores are exhausted and the available iron is insufficient to meet the needs of the erythoid marrow. The plasma iron level drops progressively and the plasma transferring level continues to increase. The decreasing plasma iron level leads to a progressive decrease in marrow sideroblasts (1998).
In the third stage, anaemia begins to develop because of an insufficient supply of iron to the marrow, but there is no discernible change in the peripheral smear or RBC indices despite mild anaemia. In the fourth stage, hypochromic-microcytic changes appear. Microcytosis precedes hypochromia. Finally, in the fifth stage, symptoms and signs of tissue iron deficiency develop ( 1998).
Secondary Osteoporosis results from chronic conditions that contribute significantly to accelerated bone loss. These chronic conditions include endogenous and exogenous thyroxine excess, hyperparathyroidism, malignancies, gastrointestinal diseases, medications, renal failure and connective tissue diseases. Osteoporosis is a common complication of long-term glucocorticoid therapy and is responsive to bisphosphonates in this setting (2001).
Risk factors for osteoporosis includes advanced age, high caffeine intake, being female, low dietary intake of calcium, family history of osteoporosis, smoking, early menopause, estrogen deficiency and lack of exercise or sedentary lifestyle.
Possible Solutions
The best way to prevent iron deficiency is to educate oneself about their iron needs and the best iron sources, and to use this knowledge to make sure dietary intake keeps pace with their body's demands. Recommended dietary allowances (RDAs) for men over the age of 19 and women over the age of 51 are 8 mg per day; for women ages 19 to 50, the RDA is 18 mg per day.
Mary Browning should be provided the proper diet and support in order to best modify her anemic condition. This diet has to be in line with the nutrients that she needs to take and the ones that she needs to avoid. Along with the right diet, she also has to take medications that will help her fight iron deficiency anemia.
Health care personnel made Mary Browning a day to day normal meal schedule. This includes toast with butter, 2-5 cups of coffee in a day, chocolate biscuits, salad sandwich, a cup of tea, lasagne, salad, garlic bread, several glasses of red wine in a day, white wine, cake, digestive biscuits, steak, potatoes, carrots, peas, broccoli, pizza, prawn crackers and some others. The foods that are being ordered for Mary Browning are foods high in specific nutrients required such as iron, calcium, and potassium.
Foods that are rich in iron include brown rice, whole wheat bread, potatoes, broccoli, and pizza among others. Foods that are rich in calcium include broccoli, almonds, canned sardines, and cabbage among many others. Foods that are good sources of potassium include fish such as salmon, cod, flounder, and sardines. Various other meats also contain potassium.
Iron is provided by ferrous sulphate or ferrous gluconate. Oral iron is safer than parenteral iron; the rate of response is the same with either route. Parenteral iron should be reserved for patients who do not tolerate or will not take oral iron, or for patients who lose large amounts of blood steadily due to disorders. Mary Browning was advised to take ASA 75 mg od and Bendrofluazide 2.5 mg od as medications.
Increasing the milk intake of adolescents has been shown to improve bone mineralization. However, because other nutrients besides calcium are essential for bone health, calcium alone may be insufficient to combat osteoporosis. Unquestionably, adolescents must maintain a dietary balance among calcium, protein, other calorie sources and phosphorus. For example, phosphorus is a substantial component of carbonated drinks, and high phosphorus intake compromises calcium uptake by bone, thereby promoting decreased bone mass ( 2001).
Milk intake of Mary Browning has to be encouraged in order to help improve bone mineralization. As also stated in the previous paragraph, Mary Browning also must maintain a dietary balance among calcium, protein, other calorie sources and phosphorus. Uptake of coke, which is a carbonated drink, can somehow help combat osteoporosis.
Treatment for osteoporosis is actually supportive and specific. Specific treatment is empiric since the exact cause of the disease is unknown. Oral calcium supplements and sex hormones decrease bone resorption and arrest or decrease progression of the disease, but these effects may be partly negated by secondary decrease in bone formation after long term treatment.
Conclusion
Mary Browning’s condition is some sort of a normal response to her premenopause state. This is not a serious illness and can be modified and treated by proper education and eating the right foods. With constant monitoring and proper eating, Mary Browning can overcome her anemic state.
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