Part B: Application to Case Study 1

DTN201
Riley Fletcher 19973656
Part B: Application to Case Study
1
Miss Smith is a 21 year old woman that weighs 74kg and measures 168cm. Miss Smith recorded her
food intake and physical activity level so that her health could be assessed, which included
calculations for her energy expenditure, consumption, physical activity level, body mass index, as
well as her daily intake of macronutrients and micronutrients – these were all compared to the NRV.
After using food choices and comparing her total caloric intake and energy expended from exercise it
is noted that Ms Smith could make some healthy changes to her diet.

Miss Smith’s recorded food intake appears to be accurate as for the three days, normal meals as well
as snacks and unhealthy food are included. It could also be possible that on the Saturday, Miss Smith
either skipped lunch or simply forgot to write her lunch in Saturday’s Food record. In some cases,
food intake records can be inaccurate due to the individual misreporting data – in cases of
measurements and calculations of portion sizes, as well as purposefully changing their results if they
feel embarrassment or to please the dietician or health professional who has required their food
intake record. Some individuals might record the everything of only the standard serving sizes on
the packaging or even under-report their food intakes. This also applies to activity patterns, while
most likely accurate, there could also be bias or errors apparent in the recording method used – for
example, if times were estimated rather than recorded with proper apparatus.

Miss Smith had recorded her daily physical activity, which were mostly general daily habits, and
included low intensity excersize, such as short 30 minute walks with almost no medium to high
intensity activity. While there could be errors here – it is usually more common for individuals to
report higher levels of physical activity than normal and due to the lack of any exercise at all, unless
errors were made on the clinician/dieticians part (Food-Choices / Calculations). The food intake
report appears very realistic.

Three days, however, appears to be long enough to obtain a reasonable picture of Miss Smith’s food
intake. Although multiple (3+) day records have been shown to reveal diet-disease relationships not
recorded in other versions of food records such as the food frequency questionnaire (FFQ), they
require very motivated participants and can be time consuming and can be prone to misreporting.
Therefore, three-day records are used in most settings (Yang, 2010).

Miss Smith’s diet appeared to show not only a portion of Miss Smith’s diet during the working week
(includes – Thursday – Friday) but also the weekend, where she consumed less meals and even
consumed some alcohol in the form of wine. The 3-day food record also appeared to be quite
reliable as Miss Smith’s food take showed many unhealthy food choices which was noted in further
analysis of her diet. If necessary a longer food record for up to a few more days would have been
useful to determine if the eating habits were caused by binge eating due to any possible temporary
stress and the effect it has on the insulin response (Yau, 2013). A more accurate food report could be
re-recorded if any doubts arise, as the time of year as well as emotional and temporal climate could
also greatly affect an individual’s food intake.

Due to the great amount of caloric restricti on on Saturday, the following calculati ons relati ng
to Miss Smith’s nutrient intake will only be from Thursday and Friday’s Food record.

While Miss Smith only consumed 67% of her EER on Saturday, her energy intake during the week
exceeded her recommended energy intake according to her EER calculations from BMI. For Day 1
and 2, Miss Smith averaged 10,814Kj which was a total of 115% of her recommended daily intake.
Miss Smith also exceeded protein, Thiamin, Riboflavin and Niacin’s EAR from 289% - 317%. While
lacking in Vitamin C and folate’s EAR. Thiamin and riboflavins toxicity is quite low, as most water-
soluble vitamins have a low risk of toxicity due to their low-absorption rates, and their ability to be
easily flushed out of the body. In regard to a lack of folate in the diet, - effects of deficiency can
cause DNA damage (Blount, 1995), lethargy, and anaemia (Khan, 2018). Vitamin C deficiency can
also cause weakness, and low RBC count, as well as bleeding (NRV, 2014).

If the post-lunch snack of cashews was replaced with navel oranges, averaging at around (10.6mg of
Vitamin C per serving), the average Vitamin C consumed would reach 119% of the EAR
(35mg/45mg). If another fruit such as strawberries was added to the morning snack or even with the
regular breakfast coffee, there would be an average of 60mg, further fulfilling Miss Smith’s RDI of
45mg. Replacing tinned food with fresh-alternatives could also possibly give Miss Smith a chance at
reducing her consumption of sodium from an average of around 828% of the EAR and 166% of the
UL.

While the NRV’s recommendations are helpful, it might not be good to recommend NRVs to patients
to avoid confusion, however, recommendations around usual eating patterns would be helpful. For
example, consuming more greens to increase folate intake, fruits to increase Vitamin C intake and
prevent scurvy and less tinned food and salty food such as curry to prevent hypertension.

The industry standard application ‘Food choices’ might be limiting as it does not have as many
recipes as other apps such as chronometer – or other diet-monitoring applications. If calculated
poorly or with an accidental excess of energy intake on a diet plan, Food Choices could be ‘limiting’
in preventing ‘intuitive eating’, which has shown to result in weight maintenance and possible
physical and physiological benefits other than from BMI (Dyke, 2014).

Miss Smith consumes 35.993 (saturated fat) and 64.006 (unsaturated fat) on average between
Thursday and Friday. However according to the NRV, saturated fat should be less than 10% and total
fat ranges between 20%-35%.

Miss Smith consumed 31.8% from carbs, 47.52% from fat, and 16% from protein, whereas the
acceptable AMDRs are 45-65% from carbs, 20%-35% from fat and 15%-25% from protein (NRV,
2014).

In regards to EER calculations, the general limitations of using equations for estimating energy
requirements and expenditure is that they can be affected by errors in the recording,
miscalculations, injury factors, as well as the thermal effect of food, or even a hypermetabolic state
caused by certain foods such as chilli peppers (Janssens, 2013).
EER calculations from the NRV tables are not always exact as it is based on an average height and
weight from a group of healthy subjects, and not exact reference heights or weights (e.g. 178,
164cm), while Schofields equations are. Miss Smith for example, is rather short compared to her
weight, with the NRV subject of her weight measuring only 160cm tall. (NRV, 2014).

Miss Smith’s EER according to the NRV for her height only (6624kJ), was slightly higher than the
Schofields equation (6462.4kJ) due to the difference in weight between her and her most similar
NRV example. If Miss Smith’s energy balance continues to be above the EER she could slowly gain
wait over a few months.

References
Janssens, P., Hursel, R., Martens, E., & Westerterp-Plantenga, M. (2013). Acute
Effects of Capsaicin on Energy Expenditure and Fat Oxidation in Negative
Energy Balance. Plos ONE, 8(7), e67786. doi: 10.1371/journal.pone.0067786
Macronutrient Balance | Nutrient Reference Values. (2014). Retrieved
from https://www.nrv.gov.au/chronic-disease/macronutrient-balance
nrv. (2014). Nutrients Energy Calc Result 1462608377 | Nutrient Reference
Values. Retrieved from https://www.nrv.gov.au/nutrients-energy-
calculation/nutrients-energy-calc-result-1462608377
Van Dyke, N., & Drinkwater, E. (2013). Review Article Relationships between
intuitive eating and health indicators: literature review. Public Health
Nutrition, 17(8), 1757-1766. doi: 10.1017/s1368980013002139
Yang, Y., Kim, M., Hwang, S., Ahn, Y., Shim, J., & Kim, D. (2010). Relative
validities of 3-day food records and the food frequency
questionnaire. Nutrition Research And Practice, 4(2), 142. doi:
10.4162/nrp.2010.4.2.142

Yau, Y. (2013). Stress and eating behaviours. Minerva Endocrinol, 1. Retrieved

from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4214609/

Khan KM, Jialal I. (2018). Folic Acid (Folate) Deficiency. StatPearls. Retrieved
from: https://www.ncbi.nlm.nih.gov/books/NBK535377/