Case Study 1: Reducing Disease Risk
Mary P. is a 57-year-old operating room nurse who works full-time at a local hospital. She is 65 inches tall and weighs 160 pounds. She has a family history of diabetes and heart disease and was recently diagnosed with high blood cholesterol. She has declined the cholesterol-lowering medication her doctor prescribed, and says she would like to explore other methods for lowering her cholesterol first. For the past few weeks, Mary has been taking a tablespoon of coconut oil every day after reading on the Internet that this will lower her cholesterol. She admits she has little time or energy to exercise. Her diet history reveals she often skips breakfast or has a donut or bagel with cream cheese at work. She drinks several cups of coffee each morning with cream and sugar. Lunch is a salad with crackers and iced tea with sugar in the hospital cafeteria. She occasionally drinks one or two glasses of wine in the evening, especially after a stressful day at work. She lives alone and relies on frozen dinners or other convenience foods in the evening. An analysis of her diet reveals an average daily intake of 200 grams carbohydrate, 50 grams protein, and 80 grams of fat.
1. Taking into account her current lifestyle and personal food preferences, what food habits might be difficult for Mary to change?
2. How might her emotions contribute to her food and drink choices?
3. Using Table 1-2, calculate Mary’s average daily kcalorie intake from carbohydrates, protein, and fat. Add these figures to together to arrive at her total daily caloric intake.
4. What percentage of her daily calories is provided by carbohydrates? Protein? Fat?
5. Compare the composition of Mary’s diet with the Acceptable Macronutrient Distribution Ranges (AMDR).
6. How would you use the information above to make dietary recommendations for Mary?
7. What are some credible sources of nutrition information from Table H1-1 that could provide information to help Mary lower her blood cholesterol?
 Contributed by Barbara Quinn.