1.Betty is 48 years old and her height is 167 cm, weight is 71 kg, waist circumference is 87 cm and hip circumference is 88 cm. The Basal Metabolic Rate is defined as “the energy required for performing vital body functions at rest and is the largest contributor of energy expenditure” (Sabounchi, Rahmandad & Ammerman, 2013, pp. 1364). Betty’s basal metabolic rate is 34 x 71 + 3538 = 5952kJ/day. Determination of physical activity level is based on activity levels as well as gender. Betty carries out very little activity. According to her activity levels, she can be considered to carry out a light activity level. Activity level is considered to be light when there is presence of some form of exercise with respect to work or tasks carried out at home or in the garden. Light activity level is associated with at least 2 hours of walking or some form of activity that involves the use of feet (Westerterp, 2013, pp. 90). Thus, the physical activity level or PAL for Betty is 1.6-1.7. Estimated energy requirement or EER is defined as the estimated daily energy requirement, which is needed to maintain weight. It can be calculated by multiplying basal metabolic rate or BMR with physical activity level or PAL (Reaburn, 2014). Thus, the estimated energy requirement or EER for Betty is 5952 x 1.6 – 1.7 = 9523.2 – 10118.4 kJ or 2276.1 – 2418.3calories. Her energy requirement in order to carry out weight loss is (2276.1 – 600) – (2418.3 – 600) = 1676.1 – 1818.3 cal. The recommended daily intake also called the recommended dietary intake is defined as the average of the daily intake of a particular nutrient, that helps to meet the energy requirements of the healthy individuals. The recommended daily intake or RDI for females is 0.75gms/kg/day. Therefore, the recommended daily intake for Betty is 0.75 x 71 kg = 53.25 gms/day. The acceptable macronutrient distribution range or AMDR is the range of intake with respect to a particular energy source (Wolfe, Cifelli, Kostas & Kim 2017, pp. 266-275). This helps to reduce daily intakes of nutrients in order to prevent the development of chronic diseases, while providing enough nutrients to garner energy for daily activities. Her energy intake is also significantly high, which is more than 2000 calories/day. Excess consumption of energy is associated with development of type 2 diabetes, obesity, fatty liver disease, cardiovascular diseases, hypercholesterolemia, hypertension, among others (Rippe & Angelopoulos, 2016, pp. 697; Noakes, 2013, pp. 826-830). According to the WHO, energy intake should be limited from total fats and should be shifted from saturated to unsaturated fatty acids and also reduce the consumption of trans fats. Increased intake of sugars is associated with the development of obesity and diabetes (Who.int, 2015). Moreover, increased sodium intake is associated with the onset of hypertension (Ha, 2014, pp. 7-18). According to the NHS, the upper limit for the daily dietary intake of sodium for adults is 2400mg (Nhs.uk, 2015). Moreover, her daily sodium intake is also high and increased sodium intake raises the chances of developing high blood pressure and also increases the risks for strokes. Moreover, she also drinks very little amount of water and drinking enough water is associated with managing body weight by reducing the intake of calorie containing beverages, prevents dehydration, prevents overheating, development of kidney stones and constipation.
|
Betty’s RDI |
Betty’s actual intake |
|
RDI – 53.25 gms/day Protein – 94.235 gms/day. |
Protein – 94-132.5gms/day, |
|
Fat – 64.94 gms/day |
Fat – 89.5 – 93gms/day |
|
Carbohydrate – 161.76 gms/day |
Carbohydrate – 208.6-215.6 gms/day |
2.According to WHO, physical activity is defined as the “bodily movement produced by skeletal muscles that requires energy expenditure”. Presence of physical inactivity is associated with increased global mortality rates. Physical inactivity is also associated with the development of 30% of heart disease cases in the World, 27% diabetes cases and 21-25% of colon and breast cancer cases. Moreover, physical inactivity is also associated with the development of hypertension, stroke, coronary heart disease, diabetes, depression, colon and breast cancer, among others (Who.int, 2018). Physical inactivity is associated with the development of the disuse syndrome, which involves cardiovascular vulnerability, obesity, premature ageing, increased fragility of muscles and bones as well as depression (Knight, 2012, pp. 320-337). Moreover, with the onset of chronic diseases, individuals become less physically active, which in turn generates a deconditioning cycle (Vogiatzis, Zakynthinos & Andrianopoulos, 2012, pp. 11). Cardiovascular diseases have modifiable and non-modifiable risk factors. Among the modifiable risk factors are high blood pressure, high cholesterol levels, increased levels of blood glucose, obesity, physical inactivity, among others. In the case of Betty, she also indulges herself in very little physical activity. She works in a hair dressing salon, which does not require much movement and as a result she has also gained 4 kgs of weight in 2 years. Moreover, 3 days a week, she does not have to work on her own and has an employee who works for her. She is also not involved in any form of house chores as her husband carries out shopping and also cooking. Moreover, her husband also packs her lunch, which she takes to work. She used to walk the dog every morning, but due to work pressure, she is unable to carry out the activity every day and it is restricted to only Sundays. Moreover, on the weekends, she does not cook her own breakfast and prefers to eat outside. Thus, in addition to her nutrient poor and high calorific diet, physical inactivity or very little physical activity could be associated with her developing obesity, diabetes, cardiovascular diseases, depression. She can also succumb to strokes, heart attacks, high blood pressure, hypercholesterolemia, among others. Along with unhealthy diet, lack of physical activity is associated with the increase of 80% of the prevalence of diabetes in the world (Who.int, 2018). Lack of physical activity is also associated with the development of depression and other mental illnesses. Exercise helps to regulate the levels of the chemicals like serotonin, endorphins and also the stress hormones. Exercise is therefore an effective intervention for the treatment of depression (Valim et al., 2013, pp. 538-541). Genetic risk factors is also an important contributing factor in the development of cardiovascular diseases. Inheritance of variants in DNA sequences play an important role in conferring the risk of developing diseases. A family history of premature atherosclerotic cardiovascular disease is associated with a 3-fold increase in the development of cardiovascular risks among the off springs (Dai, Wiernek, Evans & Runge, 2016, pp. 1). Mutations in the low-density lipoprotein receptor gene also called the LDL-R gene is associated with the development of familial hypercholesterolemia and in turn increases the risk of development of cardiovascular diseases (Akashi et al., 2017, pp. 127-136). Development of hypertrophic cardiomyopathy is associated with the presence of mutations in the genes such as MYH7, TNNT2, TPM1, among others (Marsiglia & Pereira, 2014, pp. 295-304). In the case of Betty, her parents as well as her brother has died of cardiovascular diseases and this indicates a genetic predisposition to development of cardiovascular disease in Betty.
3.Diet plays an essential role in the prevention of cardiovascular diseases. Consumption of low fat diet is generally associated with the prevention of heart diseases. Diet should consist of a total fat intake comprising 25-35% of calories, of which the percentage of saturated fat should not exceed 7 – 10%, percentage of trans fat should be less than 1% and the presence of unsaturated fatty acids like monounsaturated fatty acids and omega 3 polyunsaturated fatty acids should constitute the rest of the fat and cholesterol of about 300mg/day or less (Health.gov, 2018). Such optimum fat percentages can be obtained from consumption of lean meats, vegetables, low fat containing dairy products and very low amounts of trans fat containing foods. A diet consisting of low amounts of carbohydrate is associated with the consumption of 30-130gms of carbohydrates per day and involves the consumption of foods that contain low amounts of triglycerides and increased amounts of high-density lipoprotein cholesterol (HDL-C). In comparison to the low-fat diet, low carbohydrate diets lead to enhanced weight loss. Moreover, low carbohydrate diets increase the level of good cholesterol or HDL-C and decreases the levels of triglycerides in the body, which in turn has a positive influence with respect to long term health consequences. The Mediterranean diet is characterized by the presence of omega 3 fatty acids obtained from fish and various plan sources. It also involves the consumption of seasonal fruits and vegetables, whole wheat breads, legumes, eggs, chicken, fish, nuts, among others. Red meat consumption is avoided in the case of this diet. Consumption of small amounts of wine are encouraged in this diet. Mediterranean diet is associated with decline in the risk of developing coronary heart disease and also reduces the increased risk of mortality. Another diet called the DASH diet is associated with the prevention of hypertension, which is a risk factor for the development of heart diseases. The diet is associated with increased intake of calcium, magnesium, potassium, dietary fiber and low amount of fat obtained from fruits, vegetables, low fat dairy, chicken, fish, whole grains, nuts, among others (Eilat-Adar, Sinai, Yosefy & Henkin, 2013, pp. 3646-3683). Diet is associated with the development of cardiometabolic diseases like stroke, coronary heart disease, diabetes mellitus, obesity, among others. Diet related risk factors are also associated with the development of peripheral arterial disease, atrial fibrillation, heart failure, chronic kidney disease, among others. Betty has a hip to waist ratio of 0.97, which puts her at risk of developing various types of lifestyle diseases like cardiovascular diseases, diabetes, among others. In order for Betty to lead a healthy life without the occurrence of any diseases and also to maintain a healthy weight it is recommended that she consumes nutritious foods and drinks every day. These include vegetables, beans and legumes, fruits, cereals, wholegrains, breads, polenta, pasta, quinoa, barley, oats, among others. It is also necessary that she consumes lean meats, fish, eggs, as well as nuts, tofu, seeds. Moreover, consumption of dairy products is also essential like milk, cheese, yoghurt. Betty consumes very little water, so it is necessary that she consumes plenty of water. Moreover, she should limit her intake of foods containing saturated fats like added sugars, salt, among others. Such foods include biscuits, pastries, processed meats, chips, fries. High saturated fat containing foods can be replaced by foods that contain monounsaturated and polyunsaturated fats like avocado, oils, butter and pastes made from nuts, spreads, among others. It is also necessary to avoid consumption of sugar sweetened beverages. According to the Australian dietary guidelines, it is necessary to eat 5 servings of vegetables, 2 serves of fruits, 2 servings of dairy products, consume wholegrains, a small serving of lean meats and drink plenty of water every day (Eatforhealth.gov.au, 2013).
Reference List
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Dai, X., Wiernek, S., Evans, J. P., & Runge, M. S. (2016). Genetics of coronary artery disease and myocardial infarction. World journal of cardiology, vol. 8, no. 1, pp. 1, doi: 10.4330/wjc.v8.i1.1.
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Eilat-Adar, S., Sinai, T., Yosefy, C., & Henkin, Y. (2013). Nutritional recommendations for cardiovascular disease prevention. Nutrients, vol. 5, no. 9, pp. 3646-3683, doi: 10.3390/nu5093646.
Ha, S. K. (2014). Dietary salt intake and hypertension. Electrolytes & Blood Pressure, vol. 12, no. 1, pp. 7-18, doi: 10.5049/EBP.2014.12.1.7
Health.gov. (2018). Chapter 6 Fats. Health.gov. Retrieved 30 January 2018, from https://health.gov/dietaryguidelines/dga2005/document/html/chapter6.htm
Knight, J. A. (2012). Physical inactivity: associated diseases and disorders. Annals of Clinical & Laboratory Science, vol. 42, no. 3, pp. 320-337.
Marsiglia, JDC, & Pereira, AC (2014). Hypertrophic cardiomyopathy: how do mutations lead to disease? Brazilian Archives of Cardiology , vol. 102, no. 3, pp. 295-304.
Nhs.uk. (2015). How much salt or sodium is good for me? – Health questions – NHS Choices. Nhs.uk. Retrieved 30 January 2018, from https://www.nhs.uk/chq/pages/1138.aspx?CategoryID=51
Noakes, T. D. (2013). Low-carbohydrate and high-fat intake can manage obesity and associated conditions: Occasional survey. SAMJ: South African Medical Journal, vol. 103, no. 11, pp. 826-830.
Reaburn, P. R. (Ed.). (2014). Nutrition and performance in masters athletes. CRC Press.
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Valim, V., Natour, J., Xiao, Y., Pereira, AFA, Lopes, BBDC, Pollak, DF, … & Russell, IJ (2013). Effects of physical exercise on serum levels of serotonin and its metabolite in fibromyalgia: a randomized pilot study. Brazilian Journal of Rheumatology , vol. 53, no. 6, pp. 538-541, doi: 10.1016/j.rbr.2013.02.001.
Vogiatzis, I., Zakynthinos, G., & Andrianopoulos, V. (2012). Mechanisms of physical activity limitation in chronic lung diseases. Pulmonary medicine, vol. 2012, pp. 11, doi: 10.1155/2012/634761
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Wolfe, R. R., Cifelli, A. M., Kostas, G., & Kim, I. Y. (2017). Optimizing Protein Intake in Adults: Interpretation and Application of the Recommended Dietary Allowance Compared with the Acceptable Macronutrient Distribution Range–. Advances in Nutrition, vol. 8, no. 2, pp. 266-275, doi: 10.3945/an.116.013821
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