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NUT116BLName: ___Yuchen Xie_____________Winter 2014Section: _________02_______________Mini Case Study #1Due 1/17/201420 pointsPlease be concise and use only the space provided. Please cite sources as necessary. You may use your textbook, the pocket resource, and Patient History: Miss R is a 12 year old Hispanic female referred to you by her PCP for “fatty liver”. Miss R. is accompanied by her mother who does most of the talking as the patient is embarrassed and withdrawn. Patient is an only child who enjoys watching movies and reading books. Patient has recently complained of being tired, falling asleep at school, and mild abdominal pain. She was born LGA at 10 lbs 2 oz. Mother states she has always been a ‘big girl’.PMH: LGA, Childhood ObesityMeds: noneFamily hx: mother and father have Type 2 DiabetesPhysical History:General Exam: obese female Vitals: Temp 98.6 F, BP 138/89 mm Hg, HR 84 BPM, RR 23Ht: 57” (25th %tile)Wt: 152lb (>95th %tile)BMI 32.9 (>95th %tile)Nutrition History:General: Reports adequate appetite. Miss R. will eat some vegetables and fruit but prefers starchy and high fat foods. She sneaks candy from her cousins after school. Mom cooks traditional Hispanic meals at home, but a couple times per week they will go to fast food and get a burger or pizza.Usual Dietary Intake:Breakfast: 2 breakfast burritos with cheese, eggs, sausage, beans, and homemade tortillas (made with lard), and a large glass of juiceSnack: granola barLunch: school lunch (pizza or burger, with fries, maybe a fruit, chocolate milk or juice, with a cookieSnack: she is offered fruit but prefers candy and dried cereal (Fruit Loops) with regular sodaDinner: 3-4 tortillas (made with lard), cheese, beef or chicken, maybe a vegetable (corn or peas), and a glass of whole milkSnack: microwavable popcorn with butter or ice creamFood allergy/intolerance: NKFATreatment PlanWeight Management: Reduce simple sugar intake Reduce portions at mealsAim for half plate fruits and vegetables at mealsChoose low fat foodsIncrease physical activity, 30 minutes dailyWeight loss of 5-10% over 3-6 month periodReassess labs in 3 monthsFasting Labs 12/20/2013LabValueInterpretationALT80 U/L?GGT28 U/LWNLGlucose115 mg/dL?Hemoglobin A1c6.8%?Total Cholesterol245 mg/dL?LDL Cholesterol148 mg/dL?HDL Cholesterol22 mg/dL?Triglycerides198 mg/dL?CT scan (12/20/2013) shows the presence of a hepatic steatosisIn the table of laboratory values above, for the column labeled “Interpretation”, indicate whether the values are high (?), low (?) or within normal limits (WNL). (4 points)Briefly explain how Insulin Resistance can lead to Non-Alcoholic Fatty Liver Disease (NAFLD). (6 points)In adipose tissue, insulin resistance lower inhibitory action of insulin on hormone sensitive lipase, higher TG lipolysis and higher FFA release.Which foods in Miss R’s diet are contributing most to: (2 points)Triglyceride level: Tortillas (made from lard), cheeseFasting blood glucose level: Juice, fruit, sodaExplain the rationale for the following interventions: (4 points)Reduce simple sugar intakeHer HbA1c is 6.8% which indicate she has diabetes, and she drinks juice and soda. Also both of her parents have T2DM, so she might have T1DM. Reduce portionSince her BMI is 32.8, which is obese I, weight loss the critical for her. Choose low fat foodsSince she eat tortillas that made from lard is not good the liver disease. Low fat and low-CHO can improve insulin resistance.Increase physical activitySince she spent most of her time in reading and watching movie, more physical activity can help weight loss. Write 2 PES statements using the Intake domain. (4 points)Excessive fat intake r/t food choices, fast foods AEB elevated Total and LDL Cholesterol, Triglycerides. Excessive sugar intake r/t juice, chocolate AEB elevated glucose level ................
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