Josephine is a 20 year old female who is present for an eating disorder not otherwise specified. She currently teaches salsa lessons at the community college and is in her last semester of college. She reports she is living at home and the food her mom prepares is not the healthiest because her mom is from Honduras and her father is from Guatemala, so the food is prepared differently. She indicates she has been thin all her life, but as soon as puberty hit, she has struggled to maintain her weight and since she is a salsa instructor, she has to remain fit. She reports she feels very guilty if she has consumed fried foods during the day, but since that is the way her mom primarily cooks, she feels awful to tell her mom to stop cooking that way. She reports if she does consume too much fried foods or junk food, she will run at least 2-3 miles that day or else force herself to vomit, but all the food does not come out. She reports sometimes if she has a later class, she will not eat dinner or only eat 1 meal per day. She has tried counting calories, but then she gets so mad at herself for having more than 1200 calories it causes her to exercise more, which then leads her to feeling exhausted. She indicates she is on no medication, but does take a multivitamin when she remembers. She indicates she has gone from 110 pounds to 125 pounds over 5 years and wants to be back down to 110 or even less. She also had gone to the doctor and he was quite concerned with her lab values. She has provided you a 24 hour meal record:
Breakfast:
1-6” corn tortilla
½ cup fried beans cooked with peppers, onions and oil
½ cup rice
1 cup no sugar added orange juice
Lunch:
1 slice of whole wheat bread
2 slices turkey
1 small apple
Dinner:
2- 6” tortillas
Beef with onions, peppers cooked in oil
Tomato, onion, pepper salad (made with oil and lime juice)
2 cups of rice
Height: 5’2” Weight: 117 pounds (based on your scale in the office)
Labs:
Test Result Reference Units
Albumin (visceral protein stores) 3.3 g/dL 3.5-4.8 g/dL
Sodium 133 mEq/L 136-145 mEq/L
Potassium 3.8 mEq/L 3.5-5.2 mEq/L
Iron 0.4 mg/dL 0.6-1.1 mg/dL
Vitamin B12 185 pg/mL 200-835 pg/mL
Based on her above food record, what are some areas you can see that needs to be improved?
What lab values are elevated or decreased and what are some reasons for these high or low values?
Based on Josephine's 24-hour meal record, here are some areas that need improvement:
1. Breakfast: The breakfast is high in fried foods (corn tortilla, fried beans) and also includes a significant amount of rice. These foods contribute to a higher calorie and fat intake.
2. Lunch: The lunch consists of a single slice of whole wheat bread, turkey, and a small apple. This meal is low in variety and may not provide adequate nutrients or energy.
3. Dinner: The dinner includes two tortillas, beef cooked in oil, a salad with oil, and two cups of rice. This meal is also high in fried foods and has an excessive amount of rice, which can contribute to higher calorie intake.
Now, let's analyze the lab values:
1. Albumin (visceral protein stores): Josephine's albumin level is below the reference range. Albumin is an indicator of protein status and inadequate intake of protein-rich foods may lead to low levels.
2. Sodium: The sodium level is slightly lower than the reference range, but it is not significantly concerning. This could be due to various factors, including the types of foods consumed.
3. Potassium: Josephine's potassium level falls within the reference range. This indicates that her potassium intake is adequate.
4. Iron: Josephine's iron level is below the reference range. Iron deficiency can result from inadequate intake of iron-rich foods, such as red meat and leafy green vegetables.
5. Vitamin B12: The vitamin B12 level is within the reference range, but it is on the lower side. Low B12 levels could be indicative of poor dietary intake, especially for individuals who follow restrictive eating patterns.
In summary, the areas that need improvement in Josephine's diet include reducing the intake of fried foods, increasing the variety of foods, and ensuring adequate intake of protein, iron, and overall calorie needs. The low albumin and iron levels may be due to inadequate protein and iron intake, respectively. The slightly low sodium level is not significantly concerning. The lower side vitamin B12 level could be related to poor dietary intake.
To determine what areas need improvement in Josephine's diet and identify the elevated or decreased lab values, we can analyze the provided 24-hour meal record and compare it with the reference values for lab tests.
Areas needing improvement in Josephine's diet:
1. Breakfast:
- The meal consists of a corn tortilla, fried beans cooked with peppers, onions, and oil, rice, and orange juice. This meal is high in carbohydrates and fats, particularly fried foods. Josephine may consider reducing the amount of fried foods in her breakfast and incorporating more nutritious options like fruits, vegetables, and proteins.
2. Lunch:
- The meal includes one slice of whole wheat bread, two slices of turkey, and a small apple. This meal lacks vegetables and other essential nutrients. Josephine should add vegetables and whole grains to make it more balanced and nutritious.
3. Dinner:
- The dinner consists of two 6" tortillas, beef cooked in oil with onions and peppers, a tomato, onion, and pepper salad made with oil and lime juice, and two cups of rice. This meal is high in carbohydrates and fats, especially due to the fried beef and excessive rice consumption. Josephine can try reducing the amount of rice and incorporating more protein sources and vegetables in her dinner.
Elevated or decreased lab values and possible reasons:
1. Albumin (visceral protein stores):
- Josephine's albumin level is 3.3 g/dL, below the reference range of 3.5-4.8 g/dL. Albumin is a protein produced by the liver, and a low level can indicate malnutrition or inadequate protein intake. The inadequate protein intake in Josephine's diet may be contributing to this low value.
2. Sodium:
- Josephine's sodium level is 133 mEq/L, slightly below the reference range of 136-145 mEq/L. A low sodium level can be caused by inadequate dietary intake or excessive sweating. It is possible that Josephine's low sodium level is related to her intense exercise routine and lack of adequate nutrition to replenish electrolytes.
3. Potassium:
- Josephine's potassium level is within the normal range of 3.5-5.2 mEq/L.
4. Iron:
- Josephine's iron level is 0.4 mg/dL, below the reference range of 0.6-1.1 mg/dL. Low iron levels can indicate iron deficiency anemia, which can result from inadequate dietary intake of iron-rich foods. It seems Josephine's diet is lacking in iron sources, which may be contributing to her low iron level.
5. Vitamin B12:
- Josephine's vitamin B12 level is 185 pg/mL, below the reference range of 200-835 pg/mL. A low vitamin B12 level can indicate vitamin B12 deficiency, which can be caused by inadequate dietary intake or malabsorption. Josephine may need to incorporate more sources of vitamin B12, such as lean meats, fish, eggs, or fortified foods.
It is important for Josephine to consult with a healthcare provider or a registered dietitian to address her eating disorder, develop a balanced meal plan, and consider supplementation if necessary.