United Arab Emirates University

College of Medicine and Health Sciences

Department of Nutrition and Health

PART 1 - ANTHROPOMETRY:
The client X is a 22-year-old female.
Measurement First time Second time Third time Average
Weight (kg) 98.4 kg 98.3 kg 98.4 kg 98.37 kg
Height (cm) 154.9 cm 155 cm 155.1 cm 155 cm-
1.55 m2
Waist circumference (cm) 104 cm 104 cm 104.2 cm 104.1 cm
Hip circumference (cm) 123 cm 123.1 cm 123.3 cm 123.1 cm
Wrist circumference (cm) 16.5 cm 16.4 16.5 16.46 cm

The challenges experienced:

1. The client did not adhere to the appointed time.

2. The patient was wearing heavy clothes that were difficult
to take off.
3. The patient's hairstyle was up with accessories.

factors that could have affected the measurements recorded:

1. When measuring height, the client shoulders couldn't reach the stadiometer we had
only three touching points (buttock, heel, head).
2. The clinic was crowded.

Weight:
I started by weighing my client on a weighing scale in the clinic, pressing the tare button to reset
and zero out the scale before taking her weight. I asked my client to take off her shoes and any
thick clothing before asking her to step onto the scale with both of her legs at the same length
straight at an angle of----. I also checked to make sure her head was correctly positioned in the
Frankfort position. After waiting for the scale to settle, I took the first measurement, repeating it
three times for accuracy.

Height:
I measured the height of my client using a stadiometer. I requested her to take off any hair
accessories and her shoes before taking the measurement. I then asked her to stand with her back
toward the stadiometer, making sure that her head was pointed straight ahead at the Frankfort
position and that all four checkpoints—her heels, buttocks, shoulders, and head—touched the
stadiometer. I measured my client after asking her to take a deep breath to straighten her spine.

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Wrist circumference:
I used a measuring tape to find the size of my client's right wrist. I requested her to stretch her
hand at a 90-degree angle with her palm facing up. I placed the measuring tape 1 cm above the
styloid process and made sure it was flat against the client's wrist before taking the measurement.

Waist circumference:
I took a measurement of my client's waist using a measuring tape. To take the measurement
directly on the skin, I first asked my client to expose her waist, raising her hands to avoid any
mistakes. I then had to locate the ileum bone, position the measuring tape just above it, and take
a measurement while making sure the tape was flat on the skin.

Hip circumference:
I used a measuring tape to take my client's hip circumference; I made sure my client wasn’t
wearing anything heavy at hip area and started by kneeling down at eye level and wrapping the
tape around my client at the point of greatest protrusion. Her arms were raised as I instructed my
client to stand up straight.

Calculations:

BMI:
weight (kg ) 98.37 kg
BMI (Quetlets index)= 2
= 2
=40.94 kg /m2 , We need to do to an IBW
height (m) 1.55 m
and Adj BW because her BMI status is (Obese type III).

Frame size:
height (cm) 155 cm
frame ¿ R ¿= = =9.42 cm , The client frame size is large
wrist circumference(cm) 16.46 cm Frame size r value
because its less then 9.9 for women.
Women Men

Small >10.9 >10.4

Medium 10.9-9.9 10.4-9.6

Large <9.9 <9.6

Waist circumference:
Her waist circumference is 60.43cm which is healthy (female, < 88 cm)
not healthy because its more than 88 cm

Waist-hip ratio:

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 waist ( cm ) 104.1 cm
waist −hip ratio= = =0.85 cm ,The client waist circumference is The
hip ( cm ) 123.1 cm
waist- hip ration is also not healthy because its more than 0.85, so the client risk at having
degenerative diseases is high.

PART 2 - CLINICAL:

Medical history:
My client has Asthma since childhood which is a hereditary disease from the family, except that
the client don’t have any other chronic diseases or allergies. She had iron and vitamin D
deficiency and used to take (325 mg Ferrous sulfate) and vitamin D supplements for one mouth,
but she did not complete the intravenous iron injection prescribed for her 3 months ago. The
client face and eyes are pale (Pale conjunctiva), she may still have iron deficiency. Har nails
looks weak she also complains about extreme tiredness and lack of energy in addition to vison
problems, she may be having B-12 deficiency. She suffers from hair loss that can be a sign for
protein deficient.

Past surgical history:

The client has not done any type of surgery before.

Family medical history:

Some of the client family members suffer from High blood pressure. The client mother and
grandparents have diabetes so her risk at having diabetes increases. She had experienced a
significant increase in sugar levels during her high school studying period.

Social history:
The client currently lives with her big family, containing eight siblings and she is the youngest,
she is a third-year university student. The client is very social and has many friends she thinks
that spending time with her friends increase her food intake.

PART 3 - DIETARY:
24-hour recall video:
https://files.fm/f/nn2e47jq8

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Water intake during 24-hour recall:
Breakfast: 300 ml
Morning snack: 200 ml
Lunch: 500ml
Afternoon snack: 200ml
Dinner: 300 ml

Other fluid intake: Non

Total fluid intake: 1500 ml

Total calorie: (189.26 + 15.60 + 776.03 + 87.27 + 617.16) = 1685.32 kcal

Total protein: (6.21 + 0.68 + 50.77 + 0.73 + 32.43) = 90.82 g/d

Calculations:

Weight: 98.37 kg Height: 155 cm Age: 22 years

weight (kg) 98.37 kg
BMI = 2
= 2
=40.94 kg/m2 , Obese type III, so I must find adjusted body
height (m) 1.55 m
weight and Ideal body weight.

Ideal body weight:

Find IBW in order to find adjusted body weight:
Women: 45.5 kg for the first 152 cm + 2.3kg for each 2.54 cm
155-152= 3 cm
2.3 kg, 2.54 cm
?kg, 3cm
2.3 x 3 /2.54 = 2.72 kg

2.72kg + 45.5 = 48.2 kg

IBW= 48.2 kg

Adjusted body weight:

Adj.BW= [(ABW-IBW x 0.25)] + IBW
Adj.BW=[(98.37kg-48.2kg x 0.25)]+ 48.2kg
Adj.BW= 60.74kg

Calories:
Harris Benedict Equation:
Women- for obese use adjusted Body weight
= 655.1 + (9.56 x weight in kg) + (1.85 x height in cm) – (4.68 x age)
= 655.1 + (9.56 x 60.74kg) + (1.85 x 155cm) – (4.68 x 22)

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= 655.1 + (580.6744) + (286.75) – (102.96)
= 1419.5644 kcal
the patient is low active, by applying the physical activity, PA=1.16:
1419.5644 x 1.16 = 1646.694704 kcal
1647 kcal

Mifflin:
Female (REE):
= 10 x weight (kg) + 6.25 x height (cm) – 5 x age (years) - 161
= (10 x 60.74kg) + (6.25 x 155cm) – (5 x 22) - 161
= 607.4 + 968.75 – 110 – 161
= 1305.15 kcal
the patient is low active, by applying the physical activity, PA=1.16:
1305.15x 1.16 = 1513.974 kcal
1514 kcal

Protein:
Normal and healthy people should take 0.8 g/kg/d
Protein intake = 60.74kg x 0.8 = 48.592 g/d
Protein intake for IBW: 48.2 kg x 0.8 = 38.56 g/d

Fluids:
Fluids need, using method1: 30-35 ml/kg/ d
98.37 kg x 30 ml/kg/d = 2951.1 ml/d 98.37 kg x 35 ml/kg/d = 3442.95 ml/d
The range of fluids need for my patient.
Range : (2951.1- 3442.95) ml/d

Following ESHA evaluation of my client's 24-hour recall. The total calories consumed were
1685.32 kcal, which is slightly over the recommended amount based on the estimated calorie
intake, Harris formula = 1647 kcal and 171.32 kcal more than required when using Mifflin
formula = 1514 kcal. My client's calorie intake is higher than normal, but the difference was in
significant she still near to the normal required intake. Her daily protein intake was 90.82 grams,
which is nearly twice the recommended amount and 42.228 grams more than the recommended
daily protein intake of 48.592 grams. Her daily water consumption was 1500 ml, which is
inadequately below the advised range. Her estimated daily water intake is between 2951.1 and
3442.95 ml. Lastly, according to my plate recommendation it has shown that my client intake for
all food groups are inadequate fruits, vegetables, grain, and dairy. For example, her fruit intake is
0.21 cup not 2 cups as recommended. Except for protein which was more than the recommended
amount.

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PART 4 – SUMMARY OF FINDINGS AND RECOMMENDATIONS

After completing three assessments that include: anthropometry, clinical, and dietary. By using
measurements and calculations, my client’s nutritional status was found to be unhealthy
(overweight). I faced some challenges with the client being late and taking off her heavy clothes
and hair accessories took a lot of time. Measurements were taken without difficulty because the
clinic had everything we required and we could simply get the tools we needed. measurements
were done and everything went smoothly. However, there were some factors that might have
affected the records, such as not removing all the clothes which may affect weight measurement
accuracy and the hip circumference measurements since it is the only area that measurement
done with clothes on. The clinic being crowded reduced my attention and caused us to rush
while taking the measurements. When measuring height, the client shoulders couldn't reach the
stadiometer we had only three touching points (buttock, heel, head) this also could affect the
accuracy of measurements recorded. My client informed me during the clinical examination that
she had previously taken supplements but had stopped doing so three months ago due to iron and
vitamin D deficiencies. When I interviewed my client, the symptoms of B-12 deficiency were
clearly obvious, I noted that she might be having B-12 deficiency. A 24-hour recall provides the
intake of calories and protein some all food groups and many other nutrients needed. my client
consumed 1685.32 kcal which is more than the recommended amount, my client also consumed
90.82g/d of protein which is 42.228g more than the recommended daily amount. Water intake
was also inadequate. after doing some calculations to estimate her calorie, protein, and fluid
intake. It has shown that My client was eating more than the amount needed which shows her
nutritional status to be unhealthy also according to her BMI which was 40.94 kg /m2. Because the
24-hour recall only covers one day of a person's life, it is important to remember that it is not
accurate and does not represent her typical intake. The client might have a healthier intake of
food and fluid on other days. And Her intake over the weekdays might differ from weekends. In
the future, obtaining multiple 24-hour recalls or food diaries may give a better idea of the client
intake.