HNFE 2014/HNFE 2014H

Case Scenario #2: Adolescent through Adult

Fall 2014

Your Name:

Sandy Ma

Student ID Number:

Assignment Objectives:
Identify the physiological basis for nutritional requirements of adolescents and adults related to
health maintenance, disease prevention, and successful aging.
Describe general nutritional needs and discuss special nutritional concerns of adolescents.
Apply anthropometric and biochemical data to assessing and determining health status.
Discuss the importance of healthy eating practices and food relationships in adolescents and
adults.
This assignment is worth 75 possible points, but there are 8 additional points that you can earn as
extra credit so that a flawless assignment could earn you 83/75 points. This entire case study is due
at 9:05 am in class on Monday, December 8, 2014 (see posted syllabus). To complete this
assignment you will move through the case scenario below and answer the questions in the different
sections of this assignment. Each part of the case scenario may apply to following sections (i.e. what
was true in Part 1 is also true in Part 3 for the clients described in the case). This is an independent
assignment and must be completed entirely on your own. Any assistance received on this
assignment, other than from the course instructor or GTA, will be considered a Virginia Tech Honor
Code Violation.
The final assignment should be printed and includes a minimum of 6 pages. You MUST Show ALL
calculations to receive credit for your answers. Partial credit is possible for answers.

Part 1: Adolescent Nutrition (20 Points)

Part 2: Adolescent Dietary Assessment (35 Points + 7 EC Points)
Part 3: Adult Nutrition (20 Points + 1 EC Point)

Part 1: Adolescent Nutrition (20 Points)

Will, a 13 year old boy, has parents who are happily married and two older sisters. Will saw a
pediatric dietitian when he was 5 years old due to his pediatricians concerns with his weight gain
when he was a toddler. Since that time, Wills weight has been a source of interest for Wills
physician, his mother and his father. Wills parents dont agree on what is a healthy weight for Will.
His father, Dan, likes that Will is a bigger kid and has hopes of Will following in his footsteps on the
football field. Wills mother, Annie, is more concerned about Wills weight because his 16-year-old
sister was just diagnosed with type 2 diabetes. Wills favorite pastimes include playing football,
basketball, and video games with his friends. Will has football or basketball practice 3-4 days a week
(practice lasts for 1.5 hours) and the other days of the week Will often goes to his friends houses
where they eat snacks including potato chips, frozen pizzas, candy and soda. Wills weekends
include sports games, homework, and hanging out with his friends at their parents houses playing
hours of video games. Will would be considered to have an active physical activity level. Will
currently weighs 115 pounds and is 63 inches tall. (Recall that 1 kilogram = 2.2 pounds; 2.54 cm = 1
inch; 100 cm = 1 m. BMI = weight in kilograms divided by height in meters squared or BMI = kg/m2.)
Will is at SMR stage 3. Sexual Maturation Rating (SMR) and its stages are clearly defined in your text
on pages 362-363. This information is included in this case study description since we all know that
the onset and the velocity of puberty varies widely. That means that Wills chronological age (13 years
old) does not tell us very much unless we also know something about his degree of sexual maturity,
which is stage 3.

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HNFE 2014/HNFE 2014H

Case Scenario #2: Adolescent through Adult

Fall 2014

Use the information from your book and the formulas provided below to answer the following
questions. Partial credit is possible and you must show all calculations. Recall that PA stands for
Physical Activity which is an important variable when estimating a persons total energy requirement.
Estimated Energy Requirement (EER) for Boys 9 through 18 years:
EER = 88.5 (61.9 age [y]) + PA (26.7 weight [kg] + 903 height [m]) + 25 kcal
PA
PA
PA
PA

=
=
=
=

1.00
1.13
1.26
1.42

if
if
if
if

PAL
PAL
PAL
PAL

is
is
is
is

estimated
estimated
estimated
estimated

to
to
to
to

be
be
be
be

1.0
1.4
1.6
1.9

<
<
<
<

1.4
1.6
1.9
2.5

(sedentary)
(low active)
(active)
(very active)

Questions:
1. Using the appropriate growth chart, what percentile is Wills weight for his age? What percentile is
Wills height for his age? (You do not need to attach the plotted growth chart, but can if youd
like.) (2 Points)
Weight = 80%; Height = 70%

2. What is Wills BMI (show ALL calculations, including any unit conversions)? Using the appropriate
growth chart, what percentile is Wills BMI? Should his mother be concerned about his weight
status? Why or why not? (4 Points)
120lb / 2.2lb = 54.55kg
63in x 2.54cm = 160.02cm
160.02cm / 100 = 1.60m
54.55kg / (1.60cm)2 = 21.31
Wills BMI is 21.31 and it is in the 80th percentile. Adolescents BMI between 85th and
95th percentile shows no significant comorbidity, so his mother should not be concerned.
3. Calculate the daily estimated energy requirements for Will using the formula above. Show the
formula you are using and ALL calculations. (3 Points)
EER = 88.5 (61.9 x 13) + 1.26 x (26.7 x 54.55kg + 903 x 1.60m) + 25kcal
EER = 2964.42
4. Calculate the daily protein requirements for Will based on his current age. Recall that protein
requirements can be expressed in relation to height (g/cm), in relation to body weight (g/kg), and
as a general guideline in terms of daily amount (g/day). Show all three protein requirements (with
corresponding units) for Will. (3 Points)
0.95g/kg = 0.23g/cm = ~34g/day

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HNFE 2014/HNFE 2014H

Case Scenario #2: Adolescent through Adult

Fall 2014

5. If Will was at SMR Stage 4, what general statement could you make regarding his daily energy and
protein requirements? Why? [Think about what we addressed in class regarding peak growth
rate and how the textbook relates this peak growth rate to the SMR. (2 Points)
Peak velocity of linear growth among males occurs during the SMR Stage 4. According to
the textbook, males peak growth height is at 15-18 yo. and the DRI reflects that by
increasing the protein requirement for that age. Because Will is already at SMR Stage 4
even though he is only 13, he should follow the DRI with increased protein intake.

6. Describe three important influences on Wills eating behaviors. Propose how these influences
might be adjusted to improve his health? (6 Points)
1. Growing adolescent requires more energy, but Will should meet his calorie intake
through nutrient dense snacks such as fruits and vegetables rather than potato
chips and food high in sodium, sugar or saturated fat.
2. At the age of 13, Will has not become his own independent thinker and is highly
influenced by his peers who play a lot of video games and eat unhealthy snacks.
Alternately, he can still spend time with his friends by being active and do outdoor
activities.
3. The fathers attitude towards Wills unhealthy habit is another influence on his
lifestyle. Because his father supports him, Will may think that his own unhealthy
behavior is okay.

Part 2: Adolescent Dietary Assessment (30 Points + 7 EC Points)

Listed below is a 24-hour diet recall for Will. Will and his parents stated that this is Wills usual daily
intake and that he follows a similar dietary pattern on most days.
Questions:
1. Use the Whats In the Foods You Eat Search Tool, version 5.0, updated May 2013 to complete
this table (fill in all the blanks) for each of the following foods and nutrients. Be sure to provide the
totals for the day for each nutrient. Feel free to copy this table to an Excel document and do the
addition of the nutrients in Excel. Paste your Excel document back into this space or simply record
the daily totals at the bottom, based on your Excel calculation. Be sure to use the correct serving
sizes when determining the nutrients in each food/beverage. (20 Points)
Food or Beverage Item
Apple Cinnamon Cheerios
2% milk
Orange juice, Minute Maid
Pop-Tart

Serving Size
2 cups
1 cup
1 cup
1

Calories
(kcal)
310
122
122
208

Fat (g)

4.56
4.83
0.30
4.88

Calcium
(mg)
266
293
27
6

Iron
(mg)
12
0.05
0.32
2.33

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HNFE 2014/HNFE 2014H

Case Scenario #2: Adolescent through Adult

Fall 2014

Food or Beverage Item

Serving Size

Calories
(kcal)
372

Fat (g)

20.15

Calcium
(mg)
152

Iron
(mg)
2.79

Cheeseburger w/ mayo on a
bun
French fries, from frozen &
deep fried
Mountain Dew (regular)

1
1 large fast
food
16 ounces

515

24.3

30

1.34

171

0.09

0.51

100% Whole-wheat bread

Peanut butter
Jelly
2% milk

2
6
2
1

181
564
101
122

2.52
48.37
0.01
4.83

116
41
3
293

1.78
1.80
0.07
0.05

Spaghetti, cooked & oil added

to cooking
Spaghetti sauce w/ beef
Garlic toast
Mixed salad greens
French dressing
Mountain Dew (regular)

2 cups

440

2.58

20

3.56

1 cup
2 med. slices
1 cup
cup
12 ounces

219
562
9
286
171

10.73
26.71
0.13
28.01
0.09

65
43
26
15
9

2.74
4.91
0.64
0.5
0.51

Ice cream, chocolate

1 cups

480

24.42

242

2.06

Potato chips, regular

2 cups of
chips
Daily Totals:

271

18.2

12

0.8

5226

225.71

1668

38.76

slices
Tbs.
Tbs.
cup

2. Compare Wills daily calorie consumption with his energy needs you calculated in Part 1. Is Wills
calorie consumption appropriate? Why or why not? (2 Points)
No, his calorie consumption is inappropriate. Wills EER is only 2964.42kcal, but he
consumes a daily total of 5226kcal.
3. What percentage of Wills total calorie intake is provided by fat (show your calculation)? To convert
the grams of fat into calories coming from fat, recall how many calories of fat are in one gram. (2 Points)
1 gram = 9 calories
225.71g x 9 calories = 2031.39
(2031.39 / 5226) x 100 = 38.87%
4. Is Wills fat intake appropriate for his nutritional needs? Why or why not? (2 Points)
No, the fat intake should only be 25-35% of total calories, but Wills intake of 38.87%
exceeded the limit.

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HNFE 2014/HNFE 2014H

Case Scenario #2: Adolescent through Adult

Fall 2014

5. Is Wills fluid/beverage intake appropriate for his nutritional needs? Why or why not?

(2 Points)

1oz = 29.5735mL
1 cup = 236.588mL
3 x 236.588mL = 709.764mL
28 x 29.5735mL = 828.058mL
828.058mL + 709.764mL = 1537.822mL
No, Wills fluid/beverage intake should be 1mL per kcal. If he is consuming 5226kcal,
then he should at least consume 5226mL. However, he is only consuming 1537.822mL.
6. What is Wills calcium DRI? How does Wills intake of calcium compare with his needs? (2 Points)
Wills calcium DRI is 1300mg, but he over consumes at 1668mg.
7. What is Wills iron DRI? How does Wills intake of iron compare with his needs? (2 Points)
The iron DRI is 11 for Will since he is at SMR Stage 4. He also over consumes iron at
38.76mg.
8. Provide five (5) specific dietary recommendations for improving Wills nutritional intake.

(5 Points)

1. Consume more fluid, especially water instead of high in sugar juices that add onto the
empty calories.
2. Will needs to significantly reduce his caloric intake, especially the empty calories
from potato chips, soda and fast foods.
3. Cut back on processed food especially high in saturated fat and trans fat.
4. Eat more nutrient dense fruits and vegetables in place of sugary and fatty snacks.
5. Reduce the overconsumption of iron and calcium and choose a more balanced diet.

Part 3: Adult Nutrition (20 Points + 1 more EC Point)

Will, now 52 years old, weighs 79.5 kg and is 177.8 cm tall. Will is married and has two children, ages
15 and 13. He is moderately active and enjoys hiking and biking with his family when he has the time.
Will has a 40 minute commute by car in each direction every day to work as a physical therapist. He
does his own yard work and tries to walk at lunch at work but often has too many clients to get away
for a walk. Will spends much of his time after work driving his children to and from school and sports
activities. He wants to start exercising more but cant seem to find the time. Wills wife works as a
nurse at a local hospital three evenings a week. On those nights Will and the kids usually pick up
dinner from the drive-through window of a fast food restaurant on the way home from the kids
activities. Will just had his annual physical appointment with his physician and in addition to finding
out his weight, was told that his fasting blood glucose level is 114 mg/dL, his LDL cholesterol is 141
mg/dL, and his triglycerides are 173 mg/dL. (Refer to your note guide and Table 17.6 on page 438.)

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HNFE 2014/HNFE 2014H

Case Scenario #2: Adolescent through Adult

Fall 2014

Questions:
1. Calculate Wills weight in pounds, height in inches, and BMI. (Show ALL calculations.)

(3 Points)

79.5kg x 2.2lbs = 174.9lbs = weight

177.8cm / 2.54cm = 70in
177.8 / 100 = 1.78m = height
79.5kg / (1.78m)2 = 25.09 = BMI
2. Classify Wills BMI as underweight, normal weight, overweight, or obese. Is Wills weight a
concern based on his recent physical? Justify your response. (2 Points)
Wills BMI of 25.09 falls between the overweight range of 25th and 29.9th percentile. At
the physical, his weight is a concern in addition to high levels of blood glucose, LDL
cholesterol and triglycerides.
3. Did Will obtain the height you would have expected? Justify your response in reference to what
you know regarding his adolescence (Part 1). (2 Points)
Yes. Will weighed 120lb (54.55kg) at 13 yo, which put him at the 80th percentile of the
growth chart.
4. Based on the above information about Will, calculate his estimated energy needs using the
Mifflin-St. Jeor Energy Estimation Formula. Include the most appropriate Activity Factor based on
Wills lifestyle; select among the activity factors given in class. (Show all calculations.) (4 Points)
REE = (10 x 79.5kg) + (6.25 x 177.8cm) (5 x 52) + 5 = 1651.25
REE x activity factor = kcal/day
1651.25 x 1.55 (moderately active) = 2,559.44 kcal/day
5. Assuming Will is maintaining his weight, use the 1 mL water per calorie of food ingested method
to estimate his daily fluid needs. (Show all calculations.) (1 Point)
The fluid intake should be 1mL per kcal consumed. Since the daily energy needs is
2,559.44kcal, his fluid needs is also 2,559.44mL.
6. What beverages would you recommend Will consume to reach this fluid goal? (1 Point)
Water. He should not consume juice or soda with high sugar content due to his high
blood glucose level. He also over consumed calcium and has high level of cholesterol and
triglyceride, so he should not drink too much whole milk.

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HNFE 2014/HNFE 2014H

Case Scenario #2: Adolescent through Adult

Fall 2014

7. Based on Wills recent physical results, describe three (3) chronic diseases Will is at risk for and
explain why. (3 Points)
Will has 3 out of 6 characteristics of metabolic syndrome. His blood glucose level is
above 110mg/dL. His blood LDL is above 130mg/dL and his blood triglyceride is above 150mg/dL.
Will may be at risk for heart disease because of his high LDL cholesterol level at 141 mg/dL. He
could also be at risk for insulin resistance with the blood glucose level at 114 mg/dL.
8. Wills physician has recommended Will get to a BMI of 23.0 in the next 3 months. Will is agreeable
to this plan of action. To get to a BMI of 23.0, what would Will need to weigh in 3 months? How many
calories a day would Will need to not consume (or how many extra calories would he need to burn
daily) to achieve his weight goal? (Show all calculations.) (2 Points)
23.0 x (1.78m)2 = 72.91kg
79.5kg 72.91kg = 6.59kg
Wills current REE is 2,559.44 kcal/day. An adult needs to create a negative calorie
balance of 500 calories daily, either by burning more or consuming less, in order to lose
1lb each week. Will can lose the recommended 6.59kg in 7 weeks before his next check
up in 3 months.
9. Provide Will with three (3) specific recommendations for changing his current lifestyle so he can
effectively achieve his weight loss goal. (3 Points)
1. For weight loss, Will needs to do moderate to vigorous exercises for 60-90 minutes
on most days of the week.
2. Will needs to cut back on fast food with high levels of empty calories and saturate
fat and eat more healthy, nutrient dense food such as lean meat, vegetables and
whole grains.
3. Because will has the 3 out of 6 symptoms of metabolic syndrome, he should reduce his
carbohydrate intake by ~45% of calories and spread out meals.

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