Nutritional Assessment, Individualized Therapeutic Dietary Plan, And Essay.

Learning Outcomes assessed:

1. Conduct anthropometric investigations to establish specific nutritional needs across the lifespan to optimise health.

2. Develop appropriate evidence-based individualised therapeutic dietary plans according to life stage.

3. Construct a therapeutic dietary plan using data obtained from dietary analysis software.

4. Evaluate client nutritional status and apply weight loss principles and strategies in nutritional management.

Target weight and Weight loss required

With aBMI of 30.12kg/m2and WHR of 0.91 Larissa is inthe obese-class1 category, with an increased high risk of chronic diseases like cardiovascular disease and type two diabetes (Oshaug et al. 1995; WHO, 2018). Furthermore obesity can lead to hormone imbalance and is also linked with poly-cystic ovary syndrome(Bhattacharya et al. 2010; Fertility Coalition, 2018).

Larissa’s physical assessment of her face, tongue and nails may indicate nutrient deficiencies(Branum et al., 2013; Rosewig, 2013). Nutrients to considerwould be zinc, calcium and iron would relate to Larissa’s weak and white spotted nails and the ridges would indicate low protein and vitamin A and B deficiency (Branum et al., 2013; Crouse & Reiley, 2008). A sluggish capillary return may be due to dehydration or reduced peripheral perfusion (Jarvis, 2016).

Her pale face and conjunctiva, dry lips and cracks in the corner of her mouth are strong indicators for lack of iron which could be one of the courses of fatigue (Branum et al., 2013; Crouse & Reiley, 1998; Rosewig, 2013; Stoltzfus, 2003).

Crack in the tongue may additionally indicate folate deficiency, as well as it could indicate low function of the pancreasthis may correlate to her digestive issues (Branum et al., 2013; Crouse & Reiley, 1998; Liu et al., 2017).

The quivering and scalloped edges of her tongue may indicate lack of energy in the body. Along with food allergies and decrease in liver vitality, which are indication of her presenting symptoms(Crouse & Reiley, 1998; Liu et al., 2017).

Target weight = BMI x Height

Weight = 24.0kg/m2 x 1.65m2 = 24 x 2.7225 = 65.34kg.

Target weight for Larissa is 65.34kg.

Weight to lose = current weight – target weight = 82kg – 65.34kg = 16.66 kg

Therefore, Larissa would have to lose 16.66kg to achieve a desired BMI of 24.0 kg/m2.

Larissa’s three day diet diary was analysed using a dietary analysis software program Foodzone (Appendices 1-7).The data suggests less than 50% on average for the recommended daily intake of iron (Appendix 2).This correlates with her physical appearance,of pale faceand conjunctiva as well as dry/cracked lips/mouth. Which may be one of her underlining deficiencies that is causing fatigue (Stoltzfus, 2003).

For the short-term and long-term health and weight loss goals for Candace, please refer to Table 1.  Justifications for each goal are included in this table.

Table 1. Short-term and Long-term goals for Larissa with justification
Treatment aims	1. To treat the underlying nutrient deficiencies for improved health and well-being.	2. To enhance overall energy levels for improved occupational as well as psychological functioning.
Short-term Goals	Goal	Justification
Dietary and Nutritional	1. Increase iron, calcium, Vitamin A  and iodine intake.	The eradication of deficiencies of the following nutrients is imperative for the improvement of Larissa’s present physiological symptoms. An enhanced folate and iron status will eradicate her depleted energy stores through improved oxygen transport (Holm et al., 2017). An individual’s energy metabolism is regulated via the thyroid gland, which requires iodine for optimum functioning. Hence and improved iodine status will enhance her energy levels (McAninch & Bianco, 2014). Vitamin A functions as a dietary antioxidant and hence, enhanced intake of the same will increase Larissa’s immunity and visual performance (Burke et al., 2018).
	2. Achieve an ideal body weight	As per her present anthropometric measurements, Larissa is categorised as class 1 obese. Prolonged adherence to increased body weight, paves the way for development of metabolic syndrome resulting in abnormal cardiovascular and hormonal functioning (Bovet, Chiolero & Gedeon, 2017).
	3. Increase water intake and decreased sugar consumption.	Adequate water intake is imperative to improve Larissa’s levels of dehydration and her decreased capillary refill (Weitzel et al., 2017). Observing Larissa’s present dietary recall, excessive consumption of sugary drinks is evident, which further leads to increased weight gain (Stinson et al., 2018).
Lifestyle	1. Reduce overall stress and improve immune functioning.	Larissa frequently complains about feelings of exhaustion and frequent illness, which not only aggravates her distorted dietary habits, but also reduces her overall performance (Geikar et al., 2018).
	2. Adhere to a structured routine.	Larissa believes herself to be sleep and leisure deprived due to occupational stress. Formulation and adherence to a planned routine will help her gain adequate rest and resultant improved dietary patterns, since lack of sleep results in a distorted appetite (Brianza-Padilla et al., 2015).
Long-term Goals	Goal	Justification
Dietary and Nutritional	1. Improved stamina, health and well-being.	Larissa’s wishes to regain her previous levels of energy, enthusiasm and vitality. The accomplishment of short term goals will lead to her achievement of the same.
	2. Optimum body weight and anthropometric measurements.	Larissa is overcome by nutritional deficiencies and future plans of pregnancy. Achievement and maintenance of healthy anthropometric measurements will disseminate positive implications in her physiological as well as psychological health, further preparing her for conception (Muktabhant et al., 2015).
	3. Improved physiological functioning	Improvement and eradication of Larissa’s inadequate diet and nutritional adequacies, will improve her immunity, energy levels and ability to function efficiently during stressful situations in the future.
Lifestyle	1. Improve response to occupational stress.	Larissa complains of feeling stressed and anxious frequently, the improvement of which will not only enhance her physiological health, but also keep her mentally sound.
	2. Increased dedication towards one’s welfare.	Assistance and the resultant adherence to an appropriate time plan, will allow Larissa to engage in appropriate leisure and sleep, while simultaneously performing occupational duties with ease.

For the meal suggestions and options for Candace, please refer to Table 2.  Justifications for each point are included in this table.

Nutritional Evaluation and Dietary Planning

(These should be specific, practical and in line with the Goals presented in Table 1).

Table 2. Suggestions and recommendations for Larissa with justification for their inclusion
Meal	Suggestion	Justification
Breakfast	1. Apple and Banana oatmeal porridge  and one egg (Boiled)	Oats are a source of soluble dietary fibre beta-glucan, which aids in the reduction of dietary cholesterol intake and resultant weight maintenance through high satiety levels (Clemens & van Klinken, 2014). Milk is a rich source of calcium, A and B vitamins, which will aid in reducing Larissa’s deficiencies (Marco et al., 2017). Apple is a rich source of the antioxidant quercetin, while bananas are loaded with dietary fibre aiding in Larissa’s energy levels and immune functions (Kusano Bucalen Ferrari et al., 2016). Eggs are a rich source of Vitamin A and a complete source of protein, which will aid in muscle repair and increased satiety (Zaheer 2015).
	2. Whole grain coleslaw sandwich with blueberry yogurt	Whole grain bread is a rich of fibre, vitamin B and iron, which will aid in improving Larissa’s deficiencies and weight maintenance goals through increased satiety (Seal & Brownlee, 2015). Blueberries are a rich source of antioxidants (Chang, Alasalvar & Shahidi, 2016). and yogurt aids in digestion, while possessing an impressive calcium profile (Clemens & van Klinken, 2014)., further aiding in healthy bones and improved immunity. Vegetables are a rich source of vitamins and trace minerals (Asaduzzaman & Asao, 2018).
Lunch	1. Quinoa and chickpea vegetable salad with lime.	Quinoa is a rich source of fibre and trace minerals (Gordillo-Bastidas et al., 2016). while chickpea is a good source of proteins and complex carbohydrates which will reduce Larissa’s untimely cravings, maintain her energy levels and aid in stress-induced tissue repair (Wallace, Murray & Zelman, 2016).
	2.  Roasted chicken and vegetable salad with lime and brown rice.	Lean meats like chicken are a good source of protein and fibre that will aid in recovery of her muscle damage as well as satiety levels, further preventing Larissa from indulging in untimely cravings (Zaheer 2015). Brown rice is a rich source of fibre, B vitamins and Iron, which will aid in recovery from her nutritional deficiencies. Adding a lime to her meals, will enhance her vitamin C status, as well as aid in iron absorption (Seal & Brownlee, 2015).
Dinner	1. Oats and lentils vegetable soup	Along with increased water intake, the fluid in the soup will replenish Larissa’s electrolyte and hydration levels, further improving her stamina. Lentils and Oats are an excellent source of fibre and protein, aiding in satiety, weight reduction and sustained energy levels due to low glycemic levels (Clemens & van Klinken, 2014).
	2. Baked lemon and garlic salmon with whole grain aglio-olio pasta	Whole grains, as compared to their refined counterparts, have lower glycaemic index, high fibre and exhibit improved satiety, hence aiding in weight loss and maintenance (Gordillo-Bastidas et al., 2016). Lemon is a rich source of vitamin C while salmon is an excellent source of iodine, antioxidants omega 3 fatty acids and protein, further aiding in improved immunity, reduced free radical formation and enhanced muscle repair (Sutili et al., 2018).
Snack: Morning Tea	1. Green tea with a handful of almonds and walnuts	Almonds and walnuts are rich in calcium, dietary fibre, iron, omega 3 fatty acids and Vitamin A and E, which will aid Larissa in recovery from her nutritional deficiencies and improve her antioxidant status (Chang et al., 2016). Green tea is rich in flavonoids known as catechins which will aid in increased energy metabolism and resultant weight loss (Lorenzo & Munekata, 2016).
Snack: Afternoon Tea	1. Chamomile tea and 2 crackers with peanut butter	Chamomile tea will aid in reduction of stress, which is frequently encountered by Larissa (habs et al., 2017). Crackers will aid in energy and peanut butter will provide satiety along with healthy monounsaturated fatty acids (Chang et al., 2016).

Conclusion

To conclude, with the incorporation of the above mentioned appropriate dietary and lifestyle modifications, Larissa can overcome her present nutritional inadequacies and enhance her overall health and well-being for the fulfilment of her future goals.

References

(American Psychological Association (APA) referencing style)

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