Alfred's Bma Case Study Answers

1 Body Mass Index

Height:

Weight:

BMI:

Alfred has a BMI of 25.9 which classifies him as Overweight and puts him at an elevated risk of developing health problems (1). It is recommended Alfred lose at least 3.4 kg (7.5 lbs). This weight loss will lower his BMI to 24.9, placing him in the Normal Weight category and reducing his risk of developing health problems (1). However, it is not recommended that Alfred lose more than 26 kg (57 lbs) as that places his BMI below 18.5 and puts him in the Underweight category (1).

To achieve this recommended weight loss, Alfred should focus on eating healthier foods and engaging in physical activity. As he works 12 hour days on weekdays, it is recommended Alfred make a simple meal plan for the week and partially
prepare the low-work meals on the weekend to ensure he eats properly throughout the week. Due to his ease of access to convenience food, it is especially important that Alfred prepares meals during the weekend to avoid reliance on convenience foods during the weekday. Likewise, it is highly recommended that Alfred engages in moderate physical activity at least two and a half hours a week as recommended by the Eating Well with Canada’s Food Guide (2).

2 DRI Estimated Energy Requirement

Based on his gender, age, weight, height and activity level, Alfred’s Estimated Energy Requirement (EER) is 2701.77 kcal a day. This is 59.51 kcal above his current daily intake value of 2642.26 kcal. Therefore, Alfred is at an energy deficit and is not meeting the energy requirements needed to maintain his current weight. However, maintaining this energy deficiency will allow Alfred to achieve the suggested weight loss of at least 3.4 kg. As a result, it is recommended Alfred maintain this slight energy deficiency.

The general recommendation is to make up this energy deficit in his diet by eating low-fat, carbohydrates, which is based on the diet that he currently has.

3 Acceptable Macronutrient Distribution Ranges

Nutrient
Calories
Percentage of Calorie Intake
AMDR (3)
Protein

Carbohydrates

Fat

Alfred is not currently meeting the DRI Acceptable Macronutrient Distribution Ranges (AMDRs). Calculating the percentage of calorie intake from each macronutrient reveals he is consuming an excess of fat and an insufficient amount of carbohydrates. It is recommended that Alfred limits his intake of fat by eating low fat carbohydrates such as fruit. By implementing this recommendation, Alfred will increase his intake of carbohydrates while simultaneously reducing his fat consumption which allows him to meet his AMDRs requirements.

4 Dietary Fibre

Daily Intake Value
Adequate Intake (3)
Tolerable Upper Intake Level (3)
16.98 g/d
38 g/d
N/A

Alfred is currently consuming 16.98 g of fibre a day which is below the Adequate Intake (AI) of 38 g/day (3). Therefore, it is advised Alfred eat less processed foods, as they are low in fibre, and instead, eat more vegetables, such as lettuce, which are high in fibre. By implementing this change, Alfred will meet his daily fibre recommendations while improving his overall diet. Additionally, as foods rich in fibre are also high in carbohydrates, this recommendation will also increase Alfred’s carbohydrate intake while simultaneously limiting his fat intake, which allows him to meet his AMDRs requirements.

5 Calcium and Iron

Nutrient
Daily Intake Value
Recommended Daily Allowance (3)
Tolerable Upper Intake Level (3)
Calcium
1065.65 mg/d
1000 mg/d
2500 mg/d
Iron
17.95 mg/d
8 mg/d
45 mg/d

The DRI Recommended Daily Allowance (RDA) for calcium for a male between the ages of 19 and 70 is 1000 mg/day (3). Therefore, Alfred’s current daily calcium intake of 1065.65 mg meets the RDA.

The RDA for iron for a male over the age of 19 is 8 mg/day (3). Alfred’s current daily iron intake of 17.95 mg is well above the RDA. However, it is still below the Tolerable Upper Intake of 45 mg/day (3). Therefore, Alfred is meeting his recommendations for iron.

The general recommendation is that Alfred continues consuming the same amount of calcium and iron. However, as his current diet is very high in fat and sodium, it is suggested he instead consume more nutrient-dense foods that are lower in fat and sodium, such as 1% milk and leafy green vegetables, to maintain his intake level of calcium and iron.

6 Sodium

Daily Intake Value
Adequate Intake (3)
Tolerable Upper Intake Level (3)
6453.45 mg/d
1500 mg/d
2300 mg/d

Alfred’s daily intake of sodium is 6453.45 mg, which is nearly three times the UL of 2300 mg and well above the AI of 1500 mg. Alfred is therefore consuming an excessive amount of sodium. This excessive intake is the result of Alfred’s consumption of processed foods that are high in sodium. Consequently, by limiting his consumption of processed cheeses, such as parmesan cheese and cream cheese, Alfred can decrease his sodium intake.

7 Saturated Fat and Cholesterol

Nutrient
Daily Intake Value
Recommendation (3)
Saturated Fat
49.69 g/d
As low as possible while consuming a nutritionally adequate diet
Cholesterol
247.01 mg/d
As low as possible while consuming a nutritionally adequate diet

Alfred is consuming a large quantity of saturated fat and cholesterol. It is highly recommended Alfred replace the foods that are high in saturated fat and cholesterol, such as pizza and creamy salad dressings, with alternatives that are lower in saturated fat and cholesterol. Alfred can replace pizza with a stir-fry as well as the creamy caesar and ranch dressings with oil-based dressings.
8 Fluid

Daily Intake Value
Adequate Intake (3)
Tolerable Upper Intake Level (3)
2194.79 mL/d
3700 mL/d
N/A

Although his food record indicates he is trying to drink water during meals, Alfred is not currently meeting his recommendations for fluid. This is likely the result of a general inaccessibility to water in between meals. Therefore, it is recommended Alfred drink more water throughout the day by keeping a water bottle in his office to ensure continued water consumption between meals. 9 Meal Tracking

Servings by Food Group
Veg & Fruits
Grain Prod
Milk & Alt
Meat & Alt
Current # of Servings
3
8.75
3.75
1
List of Foods
1 apple = 1 serving

2 cups of romaine lettuce = 2 servings

1 New York style bagel = 2.5 servings

2 slices of pizza = 6 servings

2 tbsp of croutons = 0.25 servings
2 tbsp of cream = 0.25 servings

2 tbsp of cream cheese = 0.5 servings

2 tbsp parmesan cheese = 0.5 servings

2 slices of pizza = 2 serving

3 tbsp of Ceaser dressing = 0.25 servings

2 tbsp ranch dressing = 0.25 servings
3 ounces of chicken strips = 1 serving
Food Guide Recommendations (2)
8-10
8
2
3

Alfred is not currently meeting the specific recommendations outlined in the Eating Well with Canada’s Food Guide (CFG) for his age and gender.
He is consuming an excess of dairy products and grain products while consuming insufficient amounts of meat and alternatives and fruits and vegetables.

To ensure Alfred meets his CFG recommendations, it is advised that he limit his intake of fast food items, such as pizza, which will make room in his diet for healthier grain products and vegetables. Likewise, it is suggested Alfred consume more lean protein, like chicken, during meals to reach the appropriate number of meat and alternatives serving that he needs.
Although there are no age-specific recommendations for Alfred, it is advised that he follow some of the general recommendations set out by the CFG. These recommendations include being physically active for at least 2.5 hours per week. Additionally, as he lives in an area with an abundance of convenience foods, which are often high in trans fat, it is highly recommended that Alfred makes a conscience effort to limit his consumption of trans fats.

10 Meal Plan

Servings by Food Group
Veg & Fruit
Grain Prod
Milk &
Alt
Meat & Alt
# of Servings from Sample Menu
9.5
8
2
3
Sample Menu Foods
1 cup of orange juice = 2 servings

½ a cup of cubed apples = 0.5 servings

1 apple or nectarine = 1 serving

4 cups of romaine lettuce = 4 servings

1 cup of cucumber and shredded carrots = 2 servings
¾ cup of oatmeal = 1 serving

2 slices of whole grain bread = 2 servings

1 ½ cup of rice = 3 servings

1 whole grain bagel = 2 servings
2 tbsp. of light cream cheese = 0.5 servings

½ cup of milk = 0.5 serving

150g honey flavoured Greek yogurt = 1 serving
3 ounces of chicken strips = 1 serving

¼ cup of almonds = 1 serving

3 ounce chicken breast = 1 serving
Food Guide Recommendations (2)
8-10
8
2
3

Sample Menu Breakfast:
- 1 cup of coffee with 1 tbsp. of cream and 1 tbsp. of sugar
- 1 cup of orange juice
- ¾ of a cup of oatmeal with ½ of a cup of cubed apples

Morning Snack:
- 2 cups of water
- 1 apple or nectarine

Lunch:
- 2 cups of romaine lettuce with a ¼ cup of almonds
- 3 ounces of chicken strips
- 2 tbsp. of balsamic or raspberry vinaigrette
- 2 cups of tap water
- 2 slices of whole grain bread with 2 tbsp. of butter

Afternoon Snack:
- 1 whole grain bagel with 2 tbsp. of light cream cheese
- 1 cup of tap water

Supper:
- 3 ounce chicken breast
- 2 cups of romaine lettuce with 1 a cup of cucumber and shredded carrots
- 2 tbsp. of light Italian dressing
- 1.5 cups of rice with 2 tbsp. of soy sauce
- I cup of milk

Evening Snack:
- 150g of honey flavoured Greek yogurt
- 2 cups of tap water