Parrish | Dietary Assessment Project

Dietary Assessment Project

Stephanie Parrish
Community Nutrition
Oregon State University
18 March 2015

Client Profile, Energy Balance and Macronutrient Balance

Parrish | Dietary Assessment Project

Client L. is a 22-year-old female, who is currently breast-feeding her 7month-old son. L. also has a 2-year-old daughter. The client is 4 feet 11 inches
tall and weighs 109 pounds, which corresponds to a normal range BMI of 22.02.
She leads a mostly sedentary lifestyle with occasional walks and a job that
requires a standing position. L. supplements about half of the infant's
nourishment through formula. As a breast-feeding mother it is important for L. to
get all necessary nutrients through a balanced, healthful diet and to ensure
staying well hydrated. This will ensure breast milk that is good in quality and
quantity. The client follows an ovo-lacto vegetarian diet, and should pay special
attention to an adequate intake of foods containing protein, iron, and vitamins C
and B12.
Based on this profile, L.'s recommended daily energy intake is estimated to
be 2000 kcal. Through a food frequency questionnaire (FFQ) L.'s actual daily
energy intake was estimated to be 3092 kcal, 150% of her daily need. A 24-hour
food recall yielded a similar result with 2980 kcal. The excess calories stem
largely from an intake of convenience foods high in refined carbohydrates and fat.
This is reflected in the client's AMDRs; both carbohydrate and fat intakes are at
the higher end of the recommended distribution range, at about 54% and 35%,
respectively. Saturated fat should be addressed, as the client's intake exceeds the
recommended maximum of 7% of calories by 5%. Her protein intake is adequate
both in absolute amount and as percentage of calories, making up about 11% of
her energy intake. The client's fiber intake is close to adequate, varying with food
intake from day to day. Her cholesterol level is well below the recommended

Parrish | Dietary Assessment Project

upper limit.
The FFQ and 24-hour diet recall captured the client's food intake very
differently, either more broadly, focused on variety, or more specifically, focused
on exact food types and amounts, respectively. Despite this difference in
approach, estimates for macronutrient intake and energy balance were similar for
both. Therefore, neither method is preferred over the other, but it is valuable to
use both in tandem.

Micronutrient Adequacy
The following evaluation of client L.'s micronutrient intake is based on the
24-hour recall. With the client's high energy intake, a number of her micronutrient
needs are met. She showed an adequate intake of the following nutrients:
calcium, copper, iron, magnesium, phosphorus, selenium, zinc, folate, thiamin,
riboflavin, niacin, and vitamins B12 and K. Significant sources for most of these
nutrients were fortified, processed foods such as macaroni and cheese, ramen
soup, and crackers. Intake of cheese provided calcium and vitamin B12. These
foods were also a major source of sodium, as reflected in L.'s sodium intake of
>240% of the daily recommended maximum amount.
The client's high intake of processed foods displaced more nutrient dense
food choices, resulting in a number of micronutrient intakes being well below
recommended amounts. These include potassium, and vitamins A and E being at
or below 50% of the recommendation. L.'s Vitamin C and choline intake were at or
below 33% of the recommendation. Her intake of vitamin D was only 13% of the

Parrish | Dietary Assessment Project

recommended amount.
The micronutrient intake results were quite different on the FFQ. The client
reported consumption of foods that provide a more adequate supply of
micronutrients than the foods reported in the 24 hour recall. The broad focus of
the FFQ can elicit an overestimation of some healthy foods, resulting in erroneous
micronutrient data. Therefore, data from the 24-hour recall was used for this
analysis.
Dietary Balance and Nutrient Adequacy With Respect to MyPlate
Client L.'s macronutrient distribution profile was about 54% carbohydrate,
35% fat, and 11% protein. While this is an acceptable distribution, the client
consumed about 1000 excess calories, which can be traced to a high intake of
refined carbohydrates and solid fats through processed foods. This is consistent
with her 24-recall data showing that 1026 kcal of the total 2980 kcal were empty
calories.
With regards to MyPlate, grains outweighed all other food groups with an
intake more than twice the recommended amount, most of which were refined.
More specifically, L. consumed three times the recommended amount of refined
grains, but only a third of the recommended whole grain amount. According to
the FFQ L. reported a food intake below the recommendation in the protein
category, which is consistent with a lack of any of these foods on the recorded
day. However, her intake of dairy foods and processed meals containing dairy
provided an adequate supply of protein. These foods also supplied an adequate
amount of calcium. The client did not consume any fruit on the recorded day. Her

Parrish | Dietary Assessment Project

vegetable intake surpassed the recommended amount but was not characterized
by a large variety. The lack of fruit, red and orange vegetables, and legumes is
reflected in the low intake of vitamins A, B6, C, E, and potassium. The client's lack
of nut and seed consumption is reflected in a need for more healthy fats and
vitamin E.
L.'s low vitamin D intake is of concern, because a deficiency of this nutrient
in breast milk puts her baby at risk for rickets. Since L. does supplement with
formula, this is of less concern, but it should be kept in mind, should she decide
not to feed her baby formula in the future.

Report Addressing the Client

As a vegetarian you can be assured that you are getting many of your
recommended nutrients in your diet. Your food choices provide adequate amounts
of the nutrients commonly underconsumed by vegetarians, including protein,
calcium, iron, and vitamin B12; but you were low on a few other vitamins. You are
eating enough vegetables and grains, and your calorie intake is sufficient to
produce enough breast milk for your baby. In fact, your calorie intake surpasses
the amount that is necessary for you. Some of the packaged meals and snacks
you recalled eating add extra calories, saturated fat, sodium, and added sugar.
You can lower these by tweaking your foods for healthier options. I would like to
discuss some foods you might be interested in, and some easy ways to prepare
them.

Parrish | Dietary Assessment Project

Regarding protein foods, if you feel like deviating from cheese but wonder if
you'd get your protein and calcium, there is good news; many more foods are
good sources of these nutrients. The vegetarian refried beans that you mentioned
are a great source of protein, as are whole beans like black, pinto, or kidney
beans, as well as peas. Other sources include eggs, nuts, nut butters, and seeds
like sunflower or pumpkin seeds. To get both protein and calcium, plain yogurt,
tofu, tempeh, and hummus are excellent choices.
The great thing about varying up what you eat is that you can get all of
your other vitamins and minerals too, without getting bored of eating same
things. The foods you recalled showed that you were a little low for some
nutrients. By adding a variety of the foods mentioned for the protein category
above, you can easily ensure to also include many vitamins and minerals that you
and your baby need. For example, consider these tasty snacks: apples with
peanut butter, your favorite veggies with hummus, plain yogurt with fruit and
chopped almonds. You can even have your daughter help you create your own
trail mix; buying different nuts, seeds, and dried fruit from your supermarket's
bulk section can not only be a lot of fun but also less expensive than buying
premade mixes.
When it comes to fruit and vegetables, you are on a good path. You said you
liked eating them; so definitely keep choosing your favorite kinds. Many busy
parents find it convenient to clean, chop, and store different fruit and veggies at
the beginning of the week, so that they are ready to go. Consider adding your
favorite fruits to your meals and snacks, in order to reach your total

Parrish | Dietary Assessment Project

recommended amount of 2 cups of fruit per day. With your love for salads you
have no problem eating your recommended 2 cups of vegetables each day. To
get the most nutrients from your salads, you can play with colorful vegetables like
dark green spinach, yellow peppers, white cauliflower, orange carrots, red
tomatoes, and purple cabbage. Having fun with food not only makes it more
appetizing for you, but might also convince your daughter to give these a try. Why
not have her help prepare family dinner one night?
The final food group is grains, which includes bread, cereals, pasta, tortillas,
and crackers. This group should make up about a quarter of your plate with a
daily total of six ounce equivalents. Your recall shows that you are getting more
grains than you need through snacks like cookies and crackers. Another important
thing to consider is choosing whole grains for at least half of this group. The
whole wheat bread with seeds you described would be a great option. Other ideas
are oatmeal for breakfast and sweet potato bean chili over rice for dinner. Whole
wheat, oats, rice and other whole grains will keep you full longer, postponing the
need for a snack.
All the foods discussed above are healthy options that you could give a try.
It usually helps to add new foods one at a time so not to be overwhelmed by too
much change. Trying these foods instead of some of the packaged meals, snacks,
and sweets will help you lower your sodium, added sugar, and saturated fat
intake; not to mention all the nutrients they will provide for your own health and
that of your baby's. Healthful eating and physical activity make you a healthy
mom and great role model.

Parrish | Dietary Assessment Project

To help you navigate the different food groups, recommendations, and
serving sizes, I recommend the USDA's MyPlate website. This site also features a
tool called Supertracker that could help you measure your intake. For help with
breastfeeding and for financial help, you can contact both WIC (1-800-723-3638)
and Headstart (541-996-3028). Can I answer any questions you may have?