INHE 2320 Week 11 Final Nutrition Case Example

One Subject, Eleven Weeks of Figures, One Recommendation: A Final Nutrition Case Assembling Dana's Record, Energy Estimate, Macronutrient Shares, Micronutrient Gaps, Diet Quality and Revision

Student Name

Walden University

INHE 2320: Nutritional Science

Instructor Name

Month Day, Year

One Subject, Eleven Weeks of Figures, One Recommendation: A Final Nutrition Case Assembling Dana's Record, Energy Estimate, Macronutrient Shares, Micronutrient Gaps, Diet Quality and Revision

The Subject

Dana is the composite subject used throughout this course: a 34-year-old dental hygienist, 165 cm and 68 kg, with a body mass index of 25.0 and light daily activity. This case brings together every calculation made about her and checks that each figure is the same everywhere it appears. A single table of figures, built from the database matches in Weeks 1 and 10, is the source for every number below (U.S. Department of Agriculture, Agricultural Research Service [USDA ARS], 2019).

Part 1: The Record

Dana recorded 36 food and drink items across a Tuesday, a Thursday and a Saturday. Twenty-six amounts were weighed and ten estimated, with the restaurant hamburger, bottled ranch and a handful of almonds the least certain. Daily energy from the database came to 1,393 kcal on Tuesday, 1,388 on Thursday and 1,716 on Saturday, a mean of 1,499 kcal.

Part 2: Energy Needs

Using the Mifflin-St Jeor equation, Dana's predicted resting expenditure is 1,380 kcal, and with a light activity factor of 1.375 her total need is about 1,898 kcal (Mifflin et al., 1990). Allowing for the equation's usual error and uncertainty about her activity, the plausible range runs from about 1,490 to 2,350 kcal. Her recorded mean of 1,499 kcal sits near the bottom of that range, roughly 400 kcal below the point estimate. Underreporting, lighter-than-usual days and an estimate that is simply too high for her could each explain the gap, and the case does not choose among them.

Part 3: Macronutrient Distribution

On average Dana took in roughly 171 g of carbohydrate, 76 g of protein and 58 g of fat a day. By general energy factors these supply 45.4%, 20.2% and 34.4% of energy, all inside the Acceptable Macronutrient Distribution Ranges but with carbohydrate at the floor and fat at the ceiling (Institute of Medicine, 2005). Thursday and Saturday each broke the fat ceiling on their own. Protein, at 1.12 g per kilogram, is above the adult allowance of 0.8 g/kg on every day.

Part 4: Micronutrient Gaps

Table 1

Nutrients below their reference on the three-day mean, original and revised

Revised means come from the Week 10 menu; references apply to Dana's age and sex group.

Calcium, vitamin D and vitamin E fell below their average requirements in the original record, so if these days were typical, the chance of inadequate intake for each would exceed one in two. Potassium and fiber fell below adequate intakes, which means adequacy cannot be judged rather than that it is lacking (Institute of Medicine, 2000). Vitamin D was the most variable: Saturday's salmon supplied almost all of it.

Part 5: Diet Quality

A hand-estimated Healthy Eating Index score came to about 89 of 100, with full marks for whole fruits, greens and beans, both protein components, sodium and added sugars, and half marks for dairy (Shams-White et al., 2023). The score agrees with the gap analysis on one point, dairy, and is silent on vitamin D and vitamin E. Because the index scores density, it is unaffected by the possibility that Dana's energy was underreported.

Part 6: The Revision

Nine changes to the three days raised calcium by 155 mg, vitamin D by 2.0 µg, vitamin E by 1.1 mg, potassium by 336 mg and fiber by 2.7 g on the daily mean, while lowering sodium by about 250 mg and energy by 60 kcal. Iron fell by 1.3 mg, to 9.9 mg, still above its average requirement. Potassium moved above its adequate intake; the other four remained short.

Consistency Check

Every figure above was checked against the source table. One inconsistency was found and corrected while assembling the case: the Week 5 paper reported mean energy as 1,508 kcal, computed from general energy factors, while every other week used the database's 1,499 kcal. Both are correct for their methods, and the case now states which is which, using 1,499 kcal wherever energy is reported and 1,508 kcal only as the denominator for macronutrient shares.

What the Six Parts Say Together

Read separately, each part could suggest a different conclusion. The energy comparison alone might suggest Dana eats too little; the diet quality score alone might suggest her diet needs no change; the macronutrient shares alone might suggest too much fat. Read together, they point in one direction. Her food choices are mostly sound, as the high quality score and adequate protein show, but two weekday patterns, little dairy and almost no fatty fish, leave calcium and vitamin D short, and two weekend and restaurant meals push fat above its range. The revision showed that small trades address most of this without changing the shape of her days. What no part of the case can settle is whether her recorded energy reflects her usual intake, and that uncertainty runs underneath every per-day figure.

Recommendation

The recommendation is traced to specific numbers. First, add one more serving of calcium-rich food on weekdays, such as a second glass of milk or tofu made with calcium sulfate, because the revised calcium mean of 716 mg remains 84 mg short of the average requirement and Tuesday and Thursday contribute the least. Second, raise vitamin D through fatty fish more than once a week or through fortified foods, because the 8.3 µg revised mean depends heavily on a single Saturday meal; whether Dana's vitamin D status is actually low is a question for a clinician and a blood test, not for this record. Third, keep the trades that cost nothing, such as nuts for cookies and vinegar dressing for ranch, which improved four targets at once. Finally, record a longer stretch of days before drawing firm conclusions, since three days describe a snapshot and dietary assessment research cautions against reading usual intake from short records (Subar et al., 2015).

References

Institute of Medicine. (2000). Dietary reference intakes: Applications in dietary assessment. National Academies Press. https://doi.org/10.17226/9956

Institute of Medicine. (2005). Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids. National Academies Press. https://doi.org/10.17226/10490

Mifflin, M. D., St Jeor, S. T., Hill, L. A., Scott, B. J., Daugherty, S. A., & Koh, Y. O. (1990). A new predictive equation for resting energy expenditure in healthy individuals. The American Journal of Clinical Nutrition, 51(2), 241-247. https://doi.org/10.1093/ajcn/51.2.241

Shams-White, M. M., Pannucci, T. E., Lerman, J. L., Herrick, K. A., Zimmer, M., Meyers Mathieu, K., Stoody, E. E., & Reedy, J. (2023). Healthy Eating Index-2020: Review and update process to reflect the Dietary Guidelines for Americans, 2020-2025. Journal of the Academy of Nutrition and Dietetics, 123(9), 1280-1288. https://doi.org/10.1016/j.jand.2023.05.015

Subar, A. F., Freedman, L. S., Tooze, J. A., Kirkpatrick, S. I., Boushey, C., Neuhouser, M. L., Thompson, F. E., Potischman, N., Guenther, P. M., Tarasuk, V., Reedy, J., & Krebs-Smith, S. M. (2015). Addressing current criticism regarding the value of self-report dietary data. The Journal of Nutrition, 145(12), 2639-2645. https://doi.org/10.3945/jn.115.219634

U.S. Department of Agriculture, Agricultural Research Service. (2019). FoodData Central: SR Legacy. https://fdc.nal.usda.gov/