diet and nutrition case study examples

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Climbing Nutrition

Case study #1: simon (20-year-old athletic male).

by Brian Rigby, MS, CISSN

March 31, 2016 10 Replies

Case Studies

Since I started this blog almost a year ago, I’ve written many articles on good practices in sports nutrition, eating for climbing performance, and also on popular myths that ought to be debunked. I hope that through these articles you have been able to make healthy changes to your diet, and as a result have seen your climbing improve.

This is all good, but there’s still something missing—sometimes it’s hard to bridge the gap between theory and practice. For this reason, I’m debuting a new type of feature I’ll be running every now and again on Climbing Nutrition: Case Studies . Basically, I’m going to show you some of the process I would go through were I to see a particular individual as a client.

Though each case study is by nature individual (and therefore not necessarily cut to fit your own physiology), the basic work remains similar—so you should be able to go through the process yourself to come up with your own results.

Alright, let’s begin:

Client Information

Name: Simon Age: 20 Sex: Male Height: 5′ 10″ (178 cm) Weight: 145 lbs (66 kg)

Client’s Reason for Inquiry

I climb 3-4 days each week and ski (teaching and touring) another 2. For a long time, I’ve tried to keep my weight low in order to have the best strength-to-weight ratio, but whenever I make gains on the strength side from my training it doesn’t seem to transfer to my climbing. I’ve been stuck at v5-v6 for about a year now.

Simon’s weight and height gives him a BMI (body mass index) of 20.8, well within the healthy range of 18.5 to 24.9. A flaw in the design of the BMI, however, is that it cannot accurately measure fat mass vs. lean mass. Athletes tend to have greater amounts of lean mass (and less fat) than the average individual whom the BMI was designed for, and so in reality Simon is likely even leaner than the BMI indicates (in extreme cases, large athletes can appear to be “overweight” according to their BMI due to muscle mass). Without a body fat reading we cannot know for certain, but it’s probable that Simon has no more than 10-12 lbs of (perfectly healthy) fat he could lose before dropping into an unhealthy range. Thus, as far as strength-to-weight ratio is concerned, losing weight is not likely to yield a major benefit, especially for the amount of work it would require to lose fat below this already low level.

In our correspondence, Simon says he eats around 2,400 calories each day. Since Simon exercises 5-6 days each week, it’s unlikely this is enough calories to support his strength goals. Instead, this amount of energy is likely to be on the lower end of weight maintenance—a sort of metabolic limbo where the body attempts to preserve muscle tissue but doesn’t have enough energy to support muscle growth. Chances are good that Simon could eat significantly more calories each day and still maintain weight, or gain only minimal weight through muscle gain. He will also have more energy to train harder (or longer at a higher intensity), which will have even more significant effects on his strength.

Client Caloric Goal

Using the Harris-Benedict Energy Equation , we can calculate that Simon has a basal metabolic rate (BMR) of roughly 1,675 kcal/day.

Harris-Benedict Energy Equation

• Imperial: (4.55 * weight in lbs) + (15.88 * height in inches) – (5 * age in years) = BMR
• Men: Add 5 calories to the calculated BMR
• Women: Subtract 161 calories from the calculated BMR

A BMR only covers the essential functions necessary for sustaining life at its most basic level, though; unless Simon is literally lying in bed all day—eating nothing, drinking nothing, doing nothing—we need to multiply it by the appropriate modifier. There are two ways of doing this: the simple, averaged approach; or the more complex, individualized approach. Since Simon has given me a breakdown of his weekly activities, I will ultimately use the individualized approach. First, however, I’ll show you the generalized approach in case you choose to use this method instead.

Harris-Benedict Activity Modifiers

• Sedentary:  BMR * 1.2
• Light (1-3 days/week):  BMR * 1.375
• Moderate (3-5 days/week):  BMR * 1.55
• Vigorous (6-7 days/week):  BMR * 1.725
• Extreme (6-7 days/week, multiple workouts per day):  BMR * 1.9

Since Simon exercises an average of 5-6 days per week (3-4 days climbing, 2 days skiing), he falls into the “Moderate” to “Vigorous” category of physical activity level. “Moderate” has a modifier of 1.55, while “Vigorous” has a modifier of 1.725. Thus, for a more moderate week, Simon will need roughly 2,600 kcal per day (1,675 kcal/day * 1.55), while a more vigorous week calls for roughly 2,900 kcal per day (1,675 kcal/day * 1.725).

Based on this information, Simon’s daily intake appears to be 200-500 calories shy of the recommended amount for maintainance—and low enough to have a noticeable negative impact on his climbing and training. By increasing calories to the recommended amount, he would have more energy, gain strength easier (and transfer that strength to climbing), and still maintain weight.

Really, though, it’s better to individualize your plan whenever you can. The problem with modifiers is that they’re very broad, subject to interpretation, and error-prone. For example, it would appear based on the above list that exercising for one hour three days a week and exercising for two hours five days a week are equivalent, when it’s instantly apparent that they’re not—but two people might still calculate their metabolic rates as equivalent based on the above modifiers, despite having wildly different lifestyles! Furthermore, there’s no concern with intensity. An hour of walking is equivalent to an hour of race-pace running, even though there is a huge difference in the calories burned by each activity. An individual approach overcomes these limitations.

To individualize your plan, you just need to know approximately how many calories your chosen exercises burn, and approximately how long you engage in them each day. There is still room for error (overestimation of intensity or time, for example), but these errors will likely be much smaller in magnitude—only a 25-100 calorie difference across a day, rather than a 200+ calories difference.

The first step in an individualized plan is to calculate your  sedentary metabolic rate —your BMR multiplied by the sedentary modifier of 1.2. This sedentary rate accounts for all the little things we do everyday that are  not included in your BMR, such as eating, sitting upright, walking around, standing, etc. Simon’s sedentary rate is roughly 2,000 calories per day (1,675 * 1.2 = 2,010).

Next, we determine the average caloric cost of the activities Simon engages in. The easiest way to go about this is to just use an online calculator such as this on e and plug in your weight and the activity you’re interested in.

For Simon (weight 145 lbs), ski touring will burn between 400 (for an easy pace on gentle terrain) to 525 (for vigorous effort) per hour, with higher rates possible for certain conditions. Teaching skiing is a little harder to quantify because it’s variable, but light downhill skiing burns roughly 264 calories per hour (this would only include the time actually  skiing , not chairlifts, etc.) and it’ll likely be at least that.

According to the exercise calculator, climbing burns about 660 calories per hour, but we can be more specific here based on intensity. Based on this research , climbing burns roughly 17 kcal/minute for easy routes, 19 kcal/minute for moderate routes, and 22 kcal/minute for difficult routes (for an experienced climber). For a new climber, a difficult route—“difficult” is relative to skill, by the way, not absolute based on grades—burns 23 kcal/minute. Bouldering is of higher intensity, so it’s possible that it burns even more calories, but given the lack of data we’ll just assume it burns 22 kcal/minute. This is “on the wall” time only, which varies from person to person, but is likely to average 10-20 minutes per hour for bouldering. That means that each hour of bouldering will burn an average of 220-440 kcal.

Now, all we have to do is multiply each activity’s caloric cost by the time spent doing it and add that to Simon’s daily total. If we assume he climbs two hours per day with an average amount of “on the wall” time, he would burn 660 calories doing so. That means he should consume about 2,660 calories on a day he climbs (2,000 from his sedentary metabolic rate and 660 from his activities) to maintain weight. Or, on a day of ski touring that lasts six hours, he should consume 4,400 calories to maintain weight.

Macronutrient Breakdown

The final step is to determine the macronutrient breakdown of any given day. This is perhaps a little more complicated just because protein needs remain static  (roughly 100-160 grams per day) while carbohydrate and fat needs will vary based on total daily activity. Normally when I work with clients, I provide a “base goal” for each macronutrient (in addition to calories) and then a “per hour of exercise” goal as well (with variations according to intensity), but here I’m going to show a slightly easier variation.

First, based on Simon’s BMR of 2,000 calories per day, protein should account for roughly 24% of the calories in his diet (120 grams of protein at 4 calories per gram equals 480 calories, divided into 2,000 calories equals 24%—the 120 grams is the important part). Since this is a sedentary day, we’ll leave carbohydrates towards the lower end at 50%, which leaves fat at 26%. Even though 50% isn’t ideal for aerobic activities such as ski touring , the actual percentage will wind up being significantly  higher on ski touring days because protein doesn’t increase. If this isn’t clear right now, don’t worry, you’ll see the math in just a bit.

Simon’s Macronutrients on a Sedentary Day

• Protein:  120 g (480 kcal; 24%)
• Carbs:  250 g (1,000 kcal; 50%)
• Fat:  58 g (520 kcal; 26%)

To determine what his needs will be on non-sedentary days, we’ll figure out the ratio of carbohydrate-to-fat calories. In Simon’s case, it’s roughly 2-to-1 (50% carbs to 26% fat, or 50:26 –> 1.92:1), and he should try to keep this ratio approximately the same on active days as well. That means getting two calories of carbohydrate-based energy for every single calorie of fat-based energy.

For those interested in the gram-to-gram breakdown, carbohydrates weigh in at 4 calories per gram and fat weighs in at 9 calories per gram, which makes the gram of carbohydrate to gram of fat ratio about 4.5:1 (1/2 gram of carbohydrates for every 1/9 gram of fat). This isn’t necessary to figure out the rest of Simon’s macronutrient schedule, though, so don’t worry too much about it.

On days when Simon climbs, he should consume an estimated 2,660 calories (or more or less depending on the total amount of climbing). When the 480 calories from protein are subtracted, we are left with 2,180 calories—66.6% of which should come from carbohydrates, and 33.3% of which should come from fat (that 2-to-1 ratio). That comes out to roughly 1,440 carbohydrate calories (55% of his total caloric intake) and 720 fat calories (27% of his total caloric intake), which is about 360 grams of carbs and 80 grams of fat. So Simon’s climbing day macronutrients look more like this:

Simon’s Macronutrients on a Climbing Day

• Protein:  120g (480 kcal; 18%)
• Carbs:  360 g (1,440 kcal; 55%)
• Fat:  80 g (720 kcal; 27%)

Already you can see that carbohydrates are playing a much more significant role!

Now let’s do the same operation for the ski touring day. Removing the 480 calories of protein from the assumed 4,400 he will burn throughout the day, we are left with 3,920 total calories. At a 2:1 carb/fat ratio, about 2,600 of those calories should come from carbs while 1,300 should come from fat—this is equivalent to 650 grams of carbs and 144 grams of fat. Now, carbohydrates make up about 59% of his diet, fat is about 30%, and protein is only 11%!

Simon’s Macronutrients on a Ski Touring Day

• Protein: 120 g (480 kcal; 18%)
• Carbs: 650 g (2,600 kcal; 59%)
• Fat: 144 g (1,300 kcal; 30%)

The greater Simon’s caloric need, the greater role carbohydrates will play in his day, according to our specified ratio. Moving from a sedentary day to a moderately active climbing day to a significantly active ski touring day, Simon’s carbohydrate goal moves from 50% to 55% to almost 60% while fat only moves from 26% to 30% (and protein dwindles in relative “importance”).

For most people, starting with a similar caloric ratio (roughly 1:2:1 protein/carbs/fat) as the one demonstrated here is probably adequate, especially if you do a combination of anaerobic (bouldering, single-pitch sport climbing, campus training, fingerboarding, etc.) and aerobic (low-intensity multi-pitch climbing, hiking, cycling, etc.) activities. If you’re much more on the anaerobic side of spectrum, you can safely alter the carb-to-fat ratio to be 1.5:1 (45% carbohydrates, 30% fat on a sedentary day) without affecting performance. If you engage in a lot of aerobic activity, you may wish to increase it to 2.75:1 (55% carbohydrates, 20% fat on a sedentary day) or even 4:1 (60% carbohydrates, 15% fat on a sedentary day).

Test in the Real World

Determining theoritical ratios is only the first step for any nutrition plan. After we have a target to aim for, we need to gauge it against real world results, which means implementing the plan and monitoring Simon’s weight. If Simon continues to maintain weight with the increased caloric load, then we know we’ve hit about the right area, and we might even increase calories slightly until we find the point at which he starts to gain weight (so we can be certain he is doing the most for muscle recovery and strength gain). If Simon gains weight, then we’ll back calories off slowly until he starts to maintain again. He shouldn’t lose weight since we’re increasing calories.

Aside from monitoring progress in a concrete way such as through weight maintenance (or body fat readings, if he had a way to do it), Simon should also subjectively feel stronger and more able to translate his training strength gains to his climbing. He should have more energy, recover faster, and stay strong longer. If all of this is true, and his weight is stable, then we would consider Simon’s plan to be successful and he would follow it until his goals changed. If there are problems that persist longer than a week or two (the amount of time it can sometimes take to “break in” a diet), then we’ll make some changes depending on the specifics of the problems.

Wrapping Up

Simon is a great example of an average, active male climber. His focus on staying lean no matter the cost was inhibiting his strength gains on the wall and providing no discernible benefit since he was already quite lean. By increasing his daily calories to a more appropriate level, he should be able to continue to maintain weight while improving his ability to gain strength. If followed accurately for an extended period of time, he may even gain small amounts of muscle and lose equal amounts of fat (AKA “body recomposition”), thereby dramatically improving his strength-to-weight ratio.

If Simon does not resemble you or your goals, don’t fret! This is just our first case study, and I’ll more than likely cover someone with a similar goal or physique to your own in the future. In the meantime, you should hopefully be able to apply the lessons learned from this first case study to yourself (provided your goal is weight maintenance) and get positive results.

If you have questions about this case study, please ask them in the comments below so I can answer publicly on this page and clarify the confusion for everyone! If you think you’d be a great example for a case study, fill out the form on this page and  please be patient. I will do my best to answer your needs via email (at the least), or possibly use you as another example in the months to come.

Until next time!

10 comments

Very interesting from a theoretical point of view. But it seems almost impossible to implement in the real world. How does numbers and ratios translate to real food. It must take a lot of planning just to figure out what to actually eat. Also, how can you time your food intake on a normal workday that leaves little or no room for frequent food breaks and prepping.

Also, I have been a hardgainer my whole life and I can testify to eating enough calories is no way as easy as stated in post. Seems like you need to eat tons of food in very frequent intervals. Again the macro breakdown leads to a more practical issue: How does numbers translate to real food?

There are logistical issues, to be sure—issues that are probably better tackled in a separate post—but let me try to provide a little hope here. Let’s assume Simon will have the chance to eat 5 meals/snacks on a given climbing day. With his base carb requirement of 250 grams, that means he should eat approximately 50 grams of carbohydrate per meal, or just over a single cup of most cooked starchy carbs. A cup is not a lot, so this shouldn’t be infeasible. The remaining 110 grams of carbs that he needs from climbing can come from preloading before exercise (slow-digesting carbs to buoy blood glucose during his climb), intraexercise replenishment (such as a sports drink, or fruit), or afterwards in the form of extra food (over the next few hours, about an extra 2.5 cups of starchy carbs). In this case, I’m only focusing on carbohydrates because they are the most challenging to get enough of for most people, at least without resorting to highly concentrated forms like refined sugars.

A ski touring day would be more challenging, but since he will presumably be exercising with little break we can rely more on the above-mentioned concentrated sources, which will also be easier to digest during exercise. Dried fruit, sports drink mixed into his water, and granola bars all make it easier to get the necessary number of calories.

In all cases, it does take planning, but the end result is worth it, I think. Energy will be higher, recovery faster, and training gains will be increased. This isn’t to say everyone must plan like this, but rather than there’s value in doing it if you care to, just as there’s value in putting together a training schedule and sticking with it despite the logistical and motivational problems associated with putting together a weeks-long exercise schedule in advance. But, as I said, I think another post will ultimately do your question/comment more justice, so I’ll try to get one out soon!

you have a great blog here! would you like to make some invite posts on my blog?

Thanks! Send me an email here if you’re interested in guest posts .

Thank you for this post. It is very helpful. Because I don’t want to pay the $39.95 to read the article at https://link.springer.com/article/10.1007%2Fs00421-007-0501-0 , could you help me in determining the number of calories burned per minute for a 115# female for easy, moderate, and difficult bouldering ? I assume the numbers in the case study, 17 kcal/minute for easy routes, 19 kcal/minute for moderate routes, and 22 kcal/minute for difficult routes, are specific to Simon’s weight.

The numbers provided were based on the averages in the article itself, which were themselves based on an average weight of 64 kg (141 lb). It’s an imperfect approximation, but we just really don’t have any good data on the caloric cost of climbing so it’s the best I could offer! Based on weight, we could estimate up or down by the same factor as the weight change and get in the same ballpark, so a heavier 160 lb climber might burn 19 kcal/min while a lighter 120 lb climber might burn 15 kcal/min. But, these are only estimates because it’s tough to know precisely how the caloric costs associated with climbing relate to weight compared to how they do for running or other more well-studied sports. Sorry I couldn’t give a more precise answer!

I have a question with regard to carbohydrates. Do they include fibre or not? I used the formula kcal from all carbohydrates equals 4*gramms of carbohydrates + 2*gramms of fibre. And then I took the ratio 2:1 for all carbohydrates to fat. Is that correct in your opinion? The fibre should somehow be included since it contributes to the calorie intake.

Thank you very much and best regards, Chris

Fiber doesn’t have a significant effect on our caloric intake since it’s indigestible. Some fibers are fermentable by our gut bacteria and those bacteria will release short-chain fatty acids as a by product that will be absorbed and used by the cells lining our intestine and thereby technically add to our caloric intake, but overall the net calories from fiber will be negligible.

Since Simon is active on most days of the week, there are days when he is not. Compute for his TER on his sedentary days.??

Since Simon is active on most days of the week, there are days when he is not. Compute for his TER on his sedentary days.

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• CVD and risk factors
• Diet and dyslipidemia
• Lifestyle and dyslipidemia
• Motivating patients
• Case Studies

Case Study 1: A 55-year old female

• Case Study 2: A 44-year old male
• Case Study 3: A 50-year old female with low CVD risk, primary prevention

CVD AND RISK FACTORS

DIET AND DYSLIPIDEMIA

LIFESTYLE AND DYSLIPIDEMIA

MOTIVATING PATIENTS

Case Study 1: A-55 year old female patient,  normal weight

Cardiovascular disease risk factors identified:

• Hypercholesterolaemia (serum total cholesterol 228 mg/dl (5.9 mmol/l), elevated, LDL-cholesterol 174 mg/dl (4.5 mmol/l), elevated)
• Age 55 years
• Elevated blood pressure, despite medication (145/95 mmHg)
• Father died of an acute myocardial infarction at the age of 45 years

TREATMENT APPROACH:

According to the EAS and ESC guidelines for the management of dyslipidaemia, lifestyle changes together with statin treatment should be considered. Patient was reluctant to start medication, so a three step approach was undertaken.

Patient was referred to clinical nutritionist to start dietary changes. The clinical nutritionist evaluated her diet, using a 3-day dietary recall of her eating habits. Results indicated that total amount of cholesterol and fat intake were according to recommendations, but patient was consuming:

• Too much saturated fatty acids/day, mainly from butter and fatty cheese
• Too little fibre/day

Otherwise the dietary habits were according to the general recommendations. Changes recommended by the clinical nutritionist included:

• Replacing butter with vegetable oil- based margarine

40% on bread, and using vegetable oils in cooking / adding them to salad dressing

• Replacing white bread with wholemeal bread

After 2 months’ follow up, the patient’s serum and LDL-cholesterol values had lowered as demonstrated below, and HDL-cholesterol and serum triglyceride concentrations remained within the reference values.

• Serum total cholesterol 216 mg/dl (5.9 mmol/l), a 5% reduction
• LDL-cholesterol 154 mg/dl (4.2 mmol/l) , an 11% reduction

However, the patient’s serum total and LDL-cholesterol concentrations were still too high, since an LDL-cholesterol goal of less than 100 mg/dl (2.7 mmol/l) should be considered, in respect of the patient’s moderate risk for developing of cardiovascular disease. The patient still refused to consider drug therapy.

The patient was advised to change their vegetable-oil based margarine to plant sterol or plant stanol containing margarine so that 2 g of plant sterols or stanols were consumed daily. Otherwise, the patient continued the diet recommended by the clinical nutritionist.

After 2 months’ follow up, the patient’s serum total cholesterol concentration was 194 mg/dl (5.3 mmol/l), and LDL-cholesterol concentration was 135 mg/dl (3.7 mmol/l), so that the total reduction from baseline with dietary changes including daily consumption of plant sterol or plant stanol products were as follows:

• Serum total cholesterol : -34 mg/dl (0.9 mmol/l), a 15% reduction
• LDL-cholesterol: -39 mg/dl (1.0 mmol/l), a 22% reduction

Despite impressive results via dietary intervention, the patient was still not reaching their lipid target, so combining statin therapy with her new dietary habits was considered.

Statin treatment is added to dietary changes. Since LDL-cholesterol levels are now lower than they were previously at baseline, a smaller statin dose is needed. This compares to the higher statin dose that would have been required starting with high baseline values (before dietary changes).

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Medical Nutrition Therapy: A Case Based Approach

• Kathryn M. Kolasa, PhD, RDN, LDN Kathryn M. Kolasa Affiliations Brody School of Medicine at East Carolina University, 3080 Dartmouth Dr, Greenville, NC 27858 Search for articles by this author

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Use Case Studies to Bring Life Into Your Nutrition Course

NutritionCalc Case studies are a helpful way for students to bring life to the information in their textbook and Connect offers a variety of different topics to be used in your class.

Case Studies are great as a stand-alone project but they can also be built into assignments or even expanded upon in a variety of ways.  No matter how you use the case studies your students will gain a deeper understanding of the topic while increasing their critical thinking skills.

Here are a couple of ways you can use the auto-graded Case Study assignment in your classroom, whether virtual or in seated class.

Alternative to a personal 3-day record

A case study can be an alternative assignment for students who feel uncomfortable analyzing their diet and/or have a history of an eating disorder. The case study takes the focus off analyzing a personal record.

If needed, you can adjust the questions to focus more on the quality of the diet versus analyzing numbers like calories or grams of protein etc. You could also add more open-ended questions that include students looking for recipes that are suitable for that case study scenario.

Delve deeper to spark conversation into the topic

Use the case studies as an opportunity to have your students delve deeper into the topic with a discussion. If your students are in person, you can have them work in small groups and then discuss the case study. Alternatively, an online class may use discussion boards.

For example, the case study “Staying Energized When Stressed” could be a great case study to have at the beginning of the semester. This case study is a good starting point for students to bring self-awareness and begin to make connections with how college life can impact their eating habits.

Combine with another assignment

Each case study has 10 auto-graded questions that can be an excellent addition to an assignment you already have.

A nutrition article review assignment where students analyze the credibility of the article’s information can be a nice complement to many of the different case studies in Connect. By having an article review at the start of the assignment and then ending with a case study students can better demonstrate understanding and comprehension of the topic.

Add an AI menu planning feature

Take the case study one step further by incorporating a meal plan that is created using AI. Artificial intelligence will not always be accurate but one of the cool things about it is that it can create sample meal plans.

AI platforms can quickly create meal plans for various concerns or medical conditions; the accuracy of these plans is another story. Use an AI meal plan as a learning moment for students.

For example, assign the Polycystic Ovary Syndrome case study and then add an open-ended question where you instruct students to create an AI-generated meal plan. You can have the students write in their thoughts on the accuracy and feasibility of the meal plan. For your in-seat classes, you could have them bring their laptops and discuss in a small group.

Available Case Studies in NutritionCalc Plus: Nutrient Density, Keto Diet, Dietary Guidelines, Whole vs. Refined Grains, Diabetes, Mediterranean Diet, High Protein Diet, Vegan Dietary Pattern, DASH Diet, Weight Management, 5,000-calorie Diet, Breastfeeding Diet, School-Age Dietary Pattern, Okinawan Diet, WIC, Bone Health, Female Athlete Triad RED-S, Constipation.

New Cases coming Summer 2024: Celiac Disease, Elderly, Irritable Bowel Syndrome, Polycystic Ovary Syndrome, Fermented/Probiotic Foods, Heart Health, Anemia, Supporting Detox, Staying Energized when Stressed, Metabolic Support.

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Creative Steps to Write a Nutrition Case Study

Table of Contents

Nutrition plays a vital role in improving a patient’s health. However, each patient has unique nutritional needs requiring a personalized healthcare approach. That’s where nutrition case studies come in. These case studies comprehensively assess a patient’s nutritional status and help develop an individualized nutrition plan. They also help to monitor and evaluate the patient’s progress toward their health goals over time. In this article, we will provide a step-by-step guide on  how to write a nutrition case study . This post will help you understand the importance of nutrition case studies, whether you are a healthcare professional or a student.

What Is a Nutrition Case Study?

A nutrition case study comprehensively reports an individual’s nutritional status, dietary habits, and health outcomes . Healthcare professionals typically use these case studies to evaluate and treat patients. This is with various nutritional concerns, such as obesity, malnutrition, or chronic diseases. If you are a nutrition student or practitioner, learning how to write a nutrition case study is an essential skill to have. 

Importance of Nutrition Case Study

Nutrition case studies are a crucial tool for healthcare professionals in nutrition and dietetics. Here are some of the reasons why nutrition case studies are essential:

Provides a Comprehensive Assessment of a Patient’s Nutritional Status

 Nutrition case studies involve a detailed analysis of a patient’s dietary intake, medical history, and lifestyle factors that may impact their nutritional status. This information is used to develop a personalized nutrition plan tailored to the patient’s needs.

Develops an Individualized Nutrition Plan

A nutrition case study’s personalized approach to healthcare leads to an individualized nutrition plan. This approach can lead to better patient outcomes, improved health outcomes, and a higher quality of life for the patient.

Monitors and Evaluates Progress Over Time

Nutrition case studies track a patient’s food intake, weight, body composition, and other health outcomes over time. This enables healthcare professionals to monitor and evaluate the patient’s progress toward their health goals and adjust the nutrition plan as needed.

Provides Education About Healthy Eating Habits and Lifestyle Changes

Nutrition case studies can help educate patients about healthy eating habits and lifestyle changes. By providing a detailed assessment of a patient’s nutritional status, healthcare professionals can help patients make sustainable changes to their diet and lifestyle.

Supports Evidence-Based Practice

Nutrition case studies are based on evidence-based practice, meaning the nutrition plan is grounded in scientific research and clinical expertise. This approach ensures that the patient receives the best care based on the latest research and clinical knowledge.

Steps on How to Write a Nutrition Case Study

Selecting the patient.

The first step in writing a nutrition case study is selecting the patient. Typically, the patient has sought out nutritional counseling or treatment for a specific reason. These reasons include weight management, a chronic disease, or a food allergy. The patient should be willing to participate in the case study and provide detailed information about their diet, health history, and lifestyle habits. When selecting a patient, obtaining their written consent to participate in the case study is essential. This should include an explanation of the purpose of the case study and how their information will be used. It should also add any potential risks or benefits of participating. The patient should know that they can stop participating in the research at any moment if they don’t want to.

Gathering Information

The next step in writing a nutrition case study is gathering information about the patient. This includes a comprehensive assessment of their dietary habits, health status, medical history, and lifestyle factors that may impact their nutrition. To gather this information, you may need to conduct a nutrition assessment, which typically includes the following components:

Anthropometric Measurements

This involves measuring the patient’s height, weight, body mass index (BMI), and other body composition measures.

Dietary Intake Assessment

This involves collecting information about the patient’s dietary habits, including food preferences, allergies, and cultural or religious dietary restrictions.

Biochemical Assessment

This involves analyzing the patient’s blood, urine, or other biological samples to assess their nutritional status.

Medical History

This involves collecting information about the patient’s past and current medical conditions, medications, and surgeries.

Lifestyle Assessment

This involves collecting information about the patient’s physical activity, stress, and other lifestyle factors that may impact their nutrition status. Gathering as much information as possible is essential to create a comprehensive nutrition case study. This information will help you develop an individualized nutrition plan addressing the patient’s needs and concerns.

Developing a Nutrition Plan

Once you have gathered all the necessary information, the next step is to develop a nutrition plan for the patient. The nutrition plan should be based on the patient’s dietary needs, health goals, and lifestyle factors. It should also consider any medical conditions or medications that may impact the patient’s nutritional status. The nutrition plan should include the following components:

Macronutrient and Micronutrient Recommendations

This involves recommending specific amounts of carbohydrates, protein, fat, and other essential nutrients the patient should consume daily.

Food Group Recommendations

This involves recommending specific food groups for the patient, such as fruits, vegetables, whole grains, and lean proteins.

Meal and Snack Recommendations

This involves recommending specific meals and snacks for the patient to meet their nutritional needs throughout the day.

Nutritional Supplements

This involves recommending specific nutritional supplements, such as vitamins, minerals, or protein powders, that may help patients meet their nutritional needs.

Behavioral Recommendations

This involves recommending specific behavioral changes that may impact the patient’s nutrition status, such as increasing physical activity or reducing stress. The nutrition plan should be individualized to the patient’s needs and preferences. It should also be realistic and achievable, considering any barriers the patient may face in following the plan.

Implementing the Nutrition Plan

Once the nutrition plan has been developed, the next step is implementing it with the patient. This may involve educating the patient about healthy eating habits and strategies for making dietary changes. The patient should also be encouraged to track their food intake and monitor their progress toward their health goals. Working collaboratively with the patient throughout the implementation process is essential, as ongoing support and guidance are needed. This may involve regular follow-up appointments or communication via phone or email. The patient should be encouraged to ask questions and share any concerns or challenges they may be experiencing.

Monitoring and Evaluating Progress

The final step in writing a nutrition case study is monitoring and evaluating the patient’s progress. This involves tracking the patient’s food intake, weight, body composition, and other health outcomes. The patient’s progress should be regularly assessed, and adjustments made to the nutrition plan as needed. Objective measures such as laboratory values or body composition assessments are essential to evaluate the patient’s progress. This can help ensure that the nutrition plan is effective and that the patient is progressing toward their health goals.

How to Write a Nutrition Case Study

Once the nutrition plan has been implemented and the patient’s progress has been evaluated, it is time to write the case study. The case study should be organized in a logical and easy-to-read format, and should include the following sections:

Introduction

This should provide an overview of the patient’s case and outline the purpose of the case study.

Patient History

You should provide a comprehensive overview of the patient’s medical history, dietary habits, and lifestyle factors that may impact their nutritional status.

Nutrition Assessment

This should provide a detailed assessment of the patient’s nutritional status, including anthropometric measurements, dietary intake, biochemical markers, and medical history.

Nutrition Plan

This should provide a comprehensive overview of the patient’s individualized nutrition plan. They include macronutrient and micronutrient recommendations, food group recommendations, meal and snack recommendations, nutritional supplement recommendations, and behavioral recommendations.

Implementation and Follow-Up

This should provide an overview of the patient’s progress in implementing the nutrition plan, including any challenges or barriers encountered. It should also outline the follow-up appointments or communication that took place between the patient and healthcare provider.

This should provide an overview of the patient’s progress towards their health goals, including any changes in weight, body composition, or laboratory values.

This should provide an interpretation of the patient’s results, including any limitations or strengths of the case study. It should also provide a summary of the key takeaways and implications for future practice.

Writing a nutrition case study may not be the most exciting task in the world, but it is a crucial one. By following these steps and using a bit of wit and creativity, healthcare professionals can effectively communicate their patient’s nutritional needs . This shows progress toward their health goals. Who knows, maybe writing a nutrition case study will be more fun than you thought!

Abir Ghenaiet

Abir is a data analyst and researcher. Among her interests are artificial intelligence, machine learning, and natural language processing. As a humanitarian and educator, she actively supports women in tech and promotes diversity.

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Case studies

Your back catalogue to previously published case study-based articles from CN Magazine. Click on the case study below to download the PDF.

Dietetic Management of a Preterm Infant with Nephrogenic Diabetes Insipidus

Emily Quek & Sarah Khweir (2019). Complete Nutrition; Vol 19, No. 5

Click here to download the full PDF

The Positive Impact of a Dietitian Improving Outcomes in Frail Elderly Patients in the Community

Nick Bergin & Riddhi Desai (2019). CN Focus; Vol 11, No. 3

The Use of a Liquid High Protein Supplement in a Patient with Pressure Ulcers

Alka Pandey (2019). Complete Nutrition; Vol 19, No. 4

Nutritional Issues of Hyperemesis Gravidarum

Alison Carr (2018). Complete Nutrition; Vol 18, No. 5

Managing an Inpatient with Severe Obsessive Compulsive Disorder, Anxiety and Malnutrition

Nick Bergin (2018). Complete Nutrition; Vol 18, No. 4

Mental Health versus Physical Health: Managing a patient with schizophrenia within secure mental health services

Nicola Wolfe and Andrew Simmons (2018). Complete Nutrition; Vol 18, No. 1

Managing a Neuro-Rehab Patient using a High Protein Supplement

Kirsty-Anna McLaughlin (2012). Complete Nutrition; Vol 12, No. 3

Refeeding Syndrome and the Cancer Patient

Jennifer McCracken (2012). Complete Nutrition; Vol 12, No. 2

Nutritional Care of Patients with Dementia in the Acute Setting

Susan Merrick and Dr Daryl Leung (2012). Complete Nutrition; Vol 12, No. 2

The successful transition of a paediatric patient reliant on nasogastric tube feeding to oral feeding

Caroline Smith (2011). Complete Nutrition; Vol 11, No. 3

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The human body is the most complex machine on the face of the Earth. Like any machine, it requires an input of fuel to function along with a variety of chemicals for proper maintenance. In this case, those requirements are met by food. But food is incredibly complex, even a simple meal is composed of hundreds of compounds. It is folly to think that simple predictions can be made about what may happen when something as complex as food is introduced into an organism as complex as a living body, especially given that the living bodies concerned can differ in genetics, gender, age and health status. Yet simple nutritional advice is routinely given!

For example, to reduce the risk of heart disease, we are told to replace saturated fats, as found in red meat, dairy products and tropical oils such as coconut with unsaturated ones found in seed oils. Unfortunately, the story is much more complicated. (A quick chemistry lesson here: saturated fats contain no carbon-carbon double bonds in their molecular structure, while unsaturated fats contain one or more double bonds.)

This discussion was prompted by a study I came across in which researchers in Nigeria determined the fat composition of insects, specifically bees, winged termites, soldier termites and mopane worms. Since such insects are eaten in some parts of Africa, their nutritional content is of interest. What caught my attention in this report was the following statement: “The higher the polyunsaturated fatty acid (PUFA) to saturated fatty acid (SFA) ratio, the more the nutritional usefulness of a dietary oil and the PUFA/SFA ratios in the present study are good enough to discourage atherosclerotic tendency.” Atherosclerosis is the buildup of plaque in arteries that can lead to cardiovascular disease. The implied message in this study is that eating insects is “heart healthy.”

This study really has no practical relevance for us since insects are not an option in the western diet. But portraying polyunsaturated fats as angelic and saturated fats as demons is way too simplistic. For example, a large study across nine European countries found no strong association between dietary saturated fats and heart disease. Neither was the incidence of heart disease decreased by substituting unsaturated fats for saturated ones. However, the situation turned out to be different when sources of the saturated fats were considered. Saturated fat in red meat or butter increased heart disease risk, but saturated fat in yogurt or cheese actually decreased it.

The standard advice for years has been to replace saturated fats with unsaturated vegetable fats. That seems to be justified when we consider the “heart healthy” Mediterranean diet in which unsaturated fats come mostly from olives, nuts and fish. But the story is different when saturated fats are replaced by seed oils such as soy, sunflower, cottonseed or corn, as is common in the western diet. The prominent fatty acid in these oils is linoleic acid (a so-called omega-6 fatty acid due to the presence of a double bond on the sixth carbon from the end of the molecule).

Uncomfortably, studies have shown that replacing saturated fats with vegetable oils that contain linoleic acid actually increases heart disease risk. This despite total cholesterol and LDL cholesterol being decreased! That is surprising since reducing blood cholesterol is generally thought to be desirable. Indeed, numerous studies have shown that decreasing elevated cholesterol with the use of drugs such as the statins reduces the risk of heart disease, but studies that have focused on reducing cholesterol via diet have been inconclusive. This may be because statins also have an antioxidant effect that can mitigate the risk of heart disease.

The problem with linoleic acid is its susceptibility to attack by oxygen, in other words to be oxidized. When linoleic acid gets incorporated into LDL particles, as happens with fatty acids, it undergoes reaction with oxygen and breaks down to form “oxidation products” such as malondialdehyde and 4-hydroxynonenal. When LDL containing these oxidation products deposits in the walls of arteries to form plaque, it causes inflammation that in turn makes the plaque prone to rupture. When that happens, a blood clot can form, precipitating a heart attack or stroke. By contrast, omega-3 fats, as found in fish, are also polyunsaturated fats but are not prone to oxidation and replacing saturated fats with these appears to be protective.

Now back to the insects. Their fat content is mostly linoleic acid. So, the suggestion that eating insects may reduce the risk of heart disease because of a “favourable PUFA/SFA profile” is wrong. If the polyunsaturated fatty acids are mostly linoleic acid, the profile is not favourable.

Obviously, the link between diet and heart disease is frustratingly complex, but labeling polyunsaturated seed oils, increasingly found in processed foods, as “healthy,” is misguided. So is labelling all saturated fats as “unhealthy.” While in general they do raise cholesterol, the extent to which they do this depends on their molecular structure. The ones that contain 14 or 16 carbon atoms, namely myristic and palmitic acids, raise cholesterol, while lauric and stearic acids with their 12 and 18 carbon chains are relatively innocuous.

To complicate the picture further, saturated fats also raise HDL cholesterol, the so-called “good cholesterol.” Actually, the best measure of risk is not LDL, but the ratio of total cholesterol to HDL. To insert some practical numbers here, total cholesterol should be less than 5.2 mmol/L and HDL should be above 1.5mmol/L meaning that the ratio should ideally be less than 3.5. However, a diet in which saturated fats are substituted by seed oils high in linoleic acid can decrease this ratio but still increase the risk of heart disease!

If that isn’t complicated enough, determining the number of LDL particles in the blood is a better measure of risk than just measuring LDL cholesterol levels. Apolipoprotein B, or ApoB, is a protein found in LDL particles and the extent of its presence is indicative of the number of LDL particles. Levels above 1.2 grams/L are deemed to be elevated.

Now let’s try to uncomplicate things. Talking about total intake of saturated and unsaturated fats is not meaningful because fatty acids differ in their effects, and the effects are also dependent on the matrix of the food in which they are present. Therefore, it is much more meaningful to speak in terms of food rather than specific nutrients. Here goes. Limit red meat, white flour, sugar, salt, soft drinks and be wary of anything that comes in a box. Use oils such as canola, olive, safflower or avocado that are low in linoleic acid and in saturated fats. Eat 5-7 servings of fruits and vegetables a day with at least one of berries. Cheese and yogurt are fine. Emphasize fish and whole grains. Exercise 30 minutes at least five times a week. Not so complicated. And oh yes, select your parents carefully.

@JoeSchwarcz

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