Lisa Mays
Kelsey Fenton
Allison Hofmann
Elizabeth West
NTR 421/521- Life Cycle Nutrition
Case Study Assignment 6:
Parenting and Early Childhood
1. Jackie, a 12-year-old female, is unhappy because she
believes she is getting fat. She asks you for help designing a
diet. Upon further investigation you learn the following:
Age
Height
8
9
10
11
12
52"
54”
56"
60”
62"
Weight
61.5 lb
68.5 lb
76 lb
92 lb
100 lb
Both of Jackie's parents are tall and slender.
Hct 38% (within normal limits)
Tanner SMR stage 2, appears in good health
24-hour recall
Time
7:30 am
noon
Food and amount consumed
¾ cup Life cereal
½ cup 2% milk
6 fluid oz orange juice
6 Chicken McNuggets
Small order of fries
12 fluid oz Coke
apple pie
(all at McDonalds)
3:30 pm
12 fluid oz diet iced tea
1 apple or orange
5:30 p.m.
3 oz. lean beef
1 dinner roll with 1 tsp margarine
½ cup rice with 1 tsp margarine
½ cup cooked green beans
12 fluid oz. root beer
7:00 pm
4 graham crackers
6 fluid oz. 2% milk
Exercise: Jackie does not exercise regularly.
Please write the question before each answer provided.
1. Evaluate Jackie’s growth. (30 points total)
a. Plot Jackie’s growth on the appropriate growth chart.
Complete the chart below providing the Growth Chart percentiles
for each age. Provide the completed growth chart for full credit.
To receive partial credit for wrong answers, you must show
your work and provide the growth chart plots. (15 points)
Age
BMI
BMI-for-Age
Percentile
8 Years
9 Years
10
Years
(43234.5)/(2704) = 16
(48155.5)/2916 = 16.5
(53428)/3136 = 17
50th - 75th
50th - 75th
50th 75th
11 Years
12 Year
(64676)/3600 = 18
(70300)/3844 = 18.3
50th - 75th
50th - 75th
b. Explain Jackie’s current weight status. Is she overweight,
underweight, normal, or obese? What information/data are you
using to draw this conclusion? (5 points)
Jackie’s current weight status is normal. This is determined by her
BMI falling within the 50th – 75th percentiles, which is within the
5th – 85th percentile range for normal weight.
c. Explain Jackie’s growth pattern. Is it a “normal” growth
pattern? Is there anything to be concern about? If yes, what are
you concerned about? What information/data are you using to
draw your conclusions for all questions? (5 points)
Jackie’s growth pattern is normal. This is determined by her
growth following a trajectory which falls reasonably within the
parameters of a normal growth pattern as illustrated on the BMIfor-age and gender percentile chart. There is cause for concern for
the fact that her rate of growth has declined slightly between years
eleven and twelve. This concern is due to the chart illustration of a
high rate of growth expected during this age, which is also
consistent for expectations of age for entering a linear growth
spurt in females. Questions should be asked about any changes in
her eating habits and behavior, as well as growth patterns
experienced during these ages by family members, an stature of
additional family members.
d. In 3 sentences or less, provide your overall interpretation and
evaluation of Jackie’s weight and growth pattern. Hint: You may
be repeating some of what you said in your previous answers. (5
points)
Jackie is within the 50th – 75th percentiles of BMI-for-age and
gender, which places her at normal weight status of between the
5th and 85th percentiles. Her growth pattern currently follows a
normal trajectory as illustrated by this growth chart, though her
rate of growth between years 11 and 12 has not increased as
rapidly as may be expected with this age. Should her growth
pattern continue to level, Jackie may need nutritional intervention.
2. Evaluate Jackie’s diet and make recommendations. (34
points total)
a. Enter Jackie’s usual intake into MyPyramid.gov for
using the MyPyramid tracker
device.
b. Provide a print out of: (8 points)
i. Your diet entry
ii. The analysis for Jackie’s diet based on the
Dietary Guidelines (assume she is
wanting to
maintain his weight—even though we know this is not
true)
iii. Nutrient Intakes
iv. The MyPyramid Recommendations.
c. Based on the print-outs and the general description of
Jackie’s diet, identify 3 key areas of concern in Jackie’s
diet. (18 points)
i. For each key area of concern, explain what
information from Jackie’s diet you
used to make
your decision.
ii. For each area of concern, explain why this is a
concern/ what are the
implications for
Jackie’s growth, development, and/or health status.
Areas of concern: 320, 369, 16/17, 371
1. Concern #1: Calcium
a. What information used: Jackie is only
consuming 697 mg of calcium on average per day when
she should be consuming about 1300 mg. Most of this is
coming from her 10 oz. of milk per day at breakfast and
before bed. Jackie also drinks 2 sodas on average per
day, which takes the place of nutrient-dense beverages
such as milk and fortified juices.
b. Why a concern? Implications for
growth/development/health status? Adequate calcium
intake during adolescence is crucial to physical growth
and development. Calcium is the main constituent of
bone mass and about half of a person’s peak bone mass
is accrued during adolescence and puberty. Calcium is
mandatory for the development of dense bone mass and
adequate consumption of this nutrient, especially during
adolescence, reduces the lifetime risk of fractures and
osteoporosis. Calcium absorption rates are higher during
adolescence than during any other time, except for
infancy. Adolescent females appear to have the greatest
calcium absorption rates around the time of the first
menstruation, with rates decreasing after that.
2. Concern #2: Low intake of fruits and vegetables
a. What information used: According to her 24hour food log, Jackie is consuming half of her
recommended intake for fiber at 13 g/day. She eats few
vegetables, only one piece of fresh fruit per day, and
consumes white rice instead of brown rice. Her dinner roll
is most likely not whole grain or whole wheat. On this
dayJackie is consuming 293 mcg of vitamin A daily when
optimum range is around 600 mcg. Jackie is consuming
an average of 4.4 mg of vitamin E per day when the
recommendations are that she consume at least 11 mg
per day.
b. Why a concern? Implications for
growth/development/health status? The low intake of
fruits, vegetables, and milk/dairy products by adolescents
contributes to a less-than-ideal intake of fiber, vitamin A
and vitamin E. Dietary fiber is important for normal bowel
function and may play a role in the prevention of chronic
diseases such as certain cancers, coronary artery
disease, and type II diabetes. Adequate fiber intake is
also thought to reduce serum cholesterol levels, to
moderate blood sugar, and to reduce the risk of obesity.
Low intake of fruits and vegetables, combined with an
average intake of less than one serving of whole grains
per day among adolescents, are contributing factors
affecting low fiber intake among adolescents. Vitamin A is
a fat-soluble vitamin needed for the formation and
maintenance of mucous membranes, skin, and bone. It is
especially important during adolescence when the body
undergoes rapid growth and development. Vitamin E
(alpha-tocopherol) acts as an antioxidant to prevent
damage to cell membranes, blood cells, lungs, and other
tissues. It repairs damage caused by free radicals in the
body. The role of this vitamin is increasingly important as
body mass expands during adolescence. Vitamin E also
reduces the oxidation of LDL cholesterol. By increasing
her intake of fruits and vegetables, she will be increasing
her fiber, vitamin A and vitamin E. To specifically increase
vitamin E, she would need to consume such foods as
leafy greens and tomatoes.
3. Concern #3: Calorie intake in the form of
energy-dense but nutrient-poor liquids
a. What information used: Jackie is consuming an
average of 2340 calories per day when the acceptable
range for an inactive adolescent is around 1712 calories
per day. Much of these calories comes from sodas.
Jackie is consuming an average of 2460 mg per day
when the acceptable range is 1500-2200 mg/day.
b. Why a concern? Implications for
growth/development/health status? Soft drinks can
contribute a significantly to a child’s overall calorie and
sodium intake, while contributing little nutrients in the
form of protein, calcium, and other vitamins and minerals.
These nutrient poor beverages take the place of nutrient
rich beverages such as fortified fruit juices and milk.
Studies have shown that BMI and frequency of high BMI
greater than the 95th percentile is directly proportional to
the intake of sugar-sweetened beverages; therefore,
nondiet soft drink consumption is related to an increased
risk for obesity. Additionally, high levels of sodium intake
may increase the risk for hypertension, kidney disease,
cardiovascular complications. In addition, higher calorie
2% milks take the place of lower calorie/higher calcium
skim milks.
d. List at least 2 other pieces of information that would be
helpful for assessing her
dietary intake. Be specific.
Explain how and why this data would be helpful. (8
points)
1. It would be beneficial to know whether or not Jackie
has started menstruation yet (menarche). SMR does not take
this into account as it only rates secondary sexual
characteristics. This would be beneficial to know because energy
and nutrient requirements are higher in girls that have started
menstruation. Onset of menarche during adolescence especially
increases a girl’s need for iron as it decreases the risk for irondeficiency anemia during heavy menstrual bleeding. Jackie’s
weight gain should also slow around the time of menarche, so
this can be used to assess her growth and weight patterns if her
weight gain continues to increase rather than stagnate or
decrease.
2. It would be beneficial to know if this is a typical day’s
intake for Jackie. We would like to know if she eats a piece of
fruit every day, or if she eats fast food every day. Knowing if this
food consumption is normal for Jackie would help us better
asses her nutritional status and risk for overweight or disease
development.
It would be beneficial to know Jackie’s ethnicity and
socio-economic status. Lower socioeconomic status and a black
or Hispanic ethnicity would increase Jackie’s risk for overweight
or obesity. Adolescents of a lower socioeconomic status or from
minority backgrounds are more likely to engage in less healthy
eating behaviors.
it would be beneficial to know any history of chronic
disease or eating disorders in Jackies family
Does Jackie exhibit any behaviors that would indicate an
eating disorder?
3. Evaluate Jackie's ABCDs of nutrition assessment. (15 points
total)
a. Identify each type/ piece of data provided for each
ABCD in the case study.
Anthropometrics: height, weight, BMI
Biochemical: Hematocrit
Clinical: Tanner SMR
Diet and Other History: Exercise level, 24-hour
recall, parental stature and weight
b. What does each of these measures suggest about her
weight gain? Is she growing
well or is there something
to be concerned about?
1. Height, weight, and BMI: Jackie’s BMI and growth
pattern are both in the middle of the normal range, which does
not cause concern. Her weight gain is consistent,
anthropometrically, with the growth of a healthy adolescent. Her
BMI does not indicate adiposity rebound.
2. Hematocrit: At 38 percent, the percentage of red
blood cells in Jackie’s whole blood is normal for her age (12).
Hematocrit levels under 35.7% are diagnostic of iron-deficiency
anemia in females ages 12 to 14.9. Although there is no concern
with Jackie’s hematocrit level, several tests are usually used in
determining iron status and the presence of anemia to assess
whether she is growing well.
3. Tanner SMR: At Tanner stage 2, Jackie’s physical
development appears normal and she has entered puberty.
Although more information was not given, knowing that she
“appears in good health” indicates that Jackie’s development is
not late, does not indicate discordance (her development occurs
in specific order), and does not indicate clues to disorders.
4. Diet and other history: Jackie does not have a
family history of obesity, at least in the parental generation,
which decreases the risk of excessive weight gain due to genetic
and environmental factors. However, Jackie is not physically
active which causes concern for controlling preventing obesity
and excessive weight gain long-term. In addition, Jackie’s diet
raises some concern about weight gain. Although her diet
contains adequate calories, macronutrients, and micronutrients
for proper growth in adolescence, some areas may indicate
future risk for obesity.
c. Explain how each value leads you to your conclusion.
1. Height, weight, and BMI: Jackie’s age and BMI
were charted on the BMI-for-age growth chart, and her resulting
percentiles were in the normal range. Although her BMI is
increasing, the increase in body fat in preadolescent girls is part
of normal growth and development
2. Hematocrit: More tests to ensure iron-deficiency
anemia is not an issue is advised, especially as Jackie begins to
enter puberty. A more sensitive and direct indicator of anemia
than hematocrit is the concentration of hemoglobin, an ironcontaining protein, in red blood cells. Also, low serum ferritin
levels, in addition to a low hemoglobin or hematocrit, confirms
the diagnosis of iron deficiency anemia. Serum ferritin reflects
iron reserves as opposed to just amount in the blood.
3. Tanner SMR: Developmental changes during
puberty in girls occur over a period of 3 – 5 years, usually
between 10 and 15 years of age. To be sure, bone maturation is
a good indicator of overall physical maturation, and an x-ray of
the hand to assess bone age can indicate whether Jackie has
reached a stage of physical maturation at which puberty should
be occurring.
4. Diet and other history: Because both of Jackie’s
parents are tall and slender, it can be assumed that they are not
obese. However, a slender physical appearance is not always an
indicator of healthy eating and living practices. Risk for abnormal
weight gain should not be determined solely by parental obesity
status. Regarding activity, it is recommended that children and
adolescents engage in at least 60 minutes of physical activity
every day to control childhood overweight and promote other
health benefits. Jackie, self-reportedly, does not exercise
regularly. Last, a 24-hour-recall, though limited in scope, can
give diet indications of concerns and risk of weight gain. Jackie
consumes calories in the form of soft drinks and fast food that
provide energy for growth, but not a proportionate amount of
nutrients. Studies have shown that frequency of high BMI
greater than the 95th percentile increased along with the
increased consumption of sugar-sweetened beverages.
4. Respond to Jackie's request for a weight loss diet. What
would you tell Jackie and why? Write in this in a conversational
language to Jackie (not Dr. G). (9 points)
“Jackie I would like for you to feel that you can talk to me about any
reasons which may make you think to lose weight. There are a lot
of young women that feel that need, and I welcome that
conversation. That being said, you are not a young woman that
needs to worry about losing weight right now. (Show her growth
chart) I use this chart and your BMI, essentially your height and
weight, to tell me if you are somebody who could benefit from
dropping pounds. You are, and have been, in a very healthy range.
I am going to say that again, okay? Losing weight is not something
you need to do right now.
I doubt you need me to tell you that your body is going through a
lot of changes, and it is going to keep right on changing. And you
know you may not like every one of those changes when you first
notice them, but I can tell you that the changes are normal and you
are not the only girl who feels like she is not super gorgeous, or
super fit, or super anything-you-want-to-be every day. I am going
to say the awful thing that I’m sure every adult is telling you and
that is give it time and be patient with yourself.
What I would like us to do is come up with a plan to maximize what
you eat, and come up with some ways to get in some exercise, so
you can be as healthy as possible. Because that’s the focus here,
making sure that the food you put into your body is giving you
enough nutrition, like calcium for your bones, so that you can keep
growing into the strong, smart, and overall awesome woman I
know you can be.”
Why: I would want to be quite firm with Jackie that she does not
need to worry about losing weight. She may benefit from seeing
the tool, the growth chart, that a professional uses to evaluate her
growth in order to both demystify the process and help her
understand the evaluation, and to give her a form of visual proof
that she is a normal weight. This may also open up an opportunity
for her to ask questions about what may be in store for her in the
future, so that she can be prepared for oncoming growth and
maturation. I think it is beneficial to remind young people that
they are not alone in both physical changes and not feeling
“perfect.” This is a good opportunity to use some humor and
comfortable language to break down adult-preteen communication
barriers and hopefully encourage her to talk. Finally, Jackie may
benefit from a shift of focus on her eating from that of having a
perfect figure to that of being as healthy as possible so that she can
reach her full potential. If she can adopt this attitude early in life,
she may be able to understand the importance of healthy eating
throughout her life.
5. Based on everything you know about Jackie and childhood
and adolescence, list 3 simple recommendations for improving
Jackie’s health and nutritional status. These recommendations
do not just need to be dietary changes. (12 points total)
i. For each recommendation, explain why you would
make this recommendation.
ii. For each recommendation, list at least 1 question that
you would ask Jackie to
appropriately adapt your
recommendation to their needs. Explain why you would ask this
question.
1. We recommend that Jackie try to incorporate atleast 30 to 60
min of physical activity into daily routine, aerobic exercise
(cardio) is highly encouraged. Engaging in some form of exercise
will be essential for Jackie’s overall health. Consistent exercise
will help reduce several health risks associated with obesity,
including diabetes. Regular Physical activity is necessary for
maintaining normal muscle strength, joint structure, joint
structure and joint function. Lack of physical exercise will cause
the calories consumed to be stored as fat, and could contribute
to excessive weight gain and obesity. Exercise will also benefit
Jackie’s psychological and emotional health by increasing her
self-esteem, and improving her overall quality of life. Exercise
could also provide a stress relief for Jackie, and could help her
develop new friendships. Exercise is especially important in the
case of Jackie’s age. With all of this said, Jackie’s’ parents can
also play a part in this task. Studies show that if the parent
engages in physical activity then this encourages the child to do
the same. Jackie’s parents can also bolster exercise by limiting
TV viewing to depress a sedentary lifestyle, and overeating. One
question we would ask Jackie is about any potential health
problems which may have been neglected before which would
hinder her from physical activity. We would ask this questions
because we would be concerned about any health condition that
would limit the amount of exercise she incorporates day to day.
2. We recommend that Jackie replace calorie dense foods in her
diet with higher nutrient dense foods. This would involve
Increasing fruit and vegetable intake, and decreasing high
calorie, fatty food consumption. We recommend this change
because excessive calorie consumption could lead to higher
weight status. In addition to weight gain, High calorie food often
leads to overeating whereas high nutrient foods such as fiber
rich foods can increase feelings of satiety.Portioning also plays a
part in this task as Jackie is accustomed to bigger dishes and
lots of snacking. Larger Portions cause us to eat more, leading to
increased calorie consumption, ultimately causing weight gain.
We recommend that Jackie’s snacks and meals be monitored by
a set time to implement more routine and structure within her
diet. Studies have shown that children who are allowed to graze
and who do not have set snack and meal times tend to have a
less nutritionally diet and consume more calories. Jackie’s junk
food intake needs to be monitored but not restricted. Jackie’s
parents should stock the kitchen with healthier options for
snacking to support Jackie’s weight loss goals. Furthermore,
Jackie’s parents can also encourage healthier eating by eating
healthy foods with her which will support Jackie. One question
we would ask Jackie would involve understanding when she
feels full. We would ask this question to better facilitate her in
proper portioning, for instance, is she able to refrain from eating
once she becomes full. We believe this is important in order to
accommodate Jackie’s needs regarding proper portioning and
learning how to listen to her body once shes full.
3. We also recommend that Jackie adjust her liquid consumption
choices. The current liquids Jackie drinks include soda and some
fruit juices both of which are very high in sugar, as well as empty
calories, and offer no nutritional value to Jackie. We would
suggest that Jackie replace these liquids with a healthier
alternative like skim milk, or for hydration purposes, water.
Research suggests that regular consumption of sodas
contribute to higher weight status and increased rates of obesity.
Studies also show that regular consumption of soda can result in
dehydration. Jackie’s regular soda consumption could be a
contributor to her high sodium intake. One question we would
ask Jackie would involve the types of beverages she enjoys
drinking. We would ask this question to see if she has any issues
with drinking water itself as an alternative for the other liquids in
her present diet.