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Nutrition Case study paperwork

Client profile

Learner’s name: Date:

Please note it is essential the above details are completed as the assessor may need

to contact the learner should further clarification be required.

Client profile

Gender: Age: Height: Weight:

Male 27 1.80m 83.5kg

BMI Health status

25.6 Apparently healthy

Description of lifestyle, to include: family, occupation, hobbies etc.

Currently works as a Mortgage Valuation Surveyor which involves a lot of driving every day (approx

4 hours) so his activity level at work is very little. He does, however, go to the gym several times each

week to do weight training (details below). He plays the occasional game of golf and football but this

is infrequent given his responsibilities as a married man and a father. Because he spends much of his

time driving, he inds that his eating patterns are very hit and miss. This is evident upon reviewing his

7-day food diary. He often feels very tired after his working day and has little energy left to do other

things.

Description of present exercise and physical

activity levels (apply FITT where appropriate).

Description of past exercise and physical

activity levels (apply FITT where

appropriate).

Weight training three times per week

Low reps, high weights

3-4 reps per exercise for 5 sets

He trains with friends so that they can encourage and

spot each other, also assisting with concentric and

eccentric reps. As the number of friends training will

vary, the rest period between sets varies too so there

is no consistency in this regard.

He plays golf and football occasionally but this

usually only occurs about 6-8 times per year.

He used to play football 2-3 times per week

and golf about once or twice a month in the

spring/summer months.

This tailed off significantly because of his

family and work responsibilities, plus the

occasional injury caused him to re-evaluate the

implications that further injury would have on

his his own health and on his family, social and

work life.

He also did some weight training but this was

very sporadic and had little or no structure. He

also found it difficult to motivate himself as he

doesn’t particularly enjoy training alone.

Exercise and physical activity likes and dislikes:

Likes: Dislikes:

He now enjoys weight training and, as he has

started trying to get stronger, and the idea of

engaging in some powerlifting appeals to him.

He also enjoys golf and football and will play

occasionally in a social sense rather than a

competitive one as this will reduce the risk of

further injury.

Anything dance or choreography based

BMR calculation (please show the whole calculation):

Age 27 therefore BMR = 15.1 x W + 692

Therefore 15.1 x 83 = 1253.3 + 692 = 1945.3

Therefore BMR = 1945

Approximate daily kcal requirement:

(based on current activity levels, by calculating BMR and adding physical activity factor)

Moderately active therefore daily kcal requirement = 1945 x 1.7 = 3306.5

Therefore Daily kcal requirement = 3307

Any other comments:

No special considerations.

Client Food Diary

Client Food Diary

The following food diary needs to be completed by the client for a minimum of 7

days.

The boxes will expand as you complete them, and may run on to another page.

Day and

time

Food and drink consumed Portion size or

weight

1

11.00am

3.00pm

7.00pm

1 Baby Bel, 1 carrot, 30g humous

50g Maltesers, 1 bag Skips

4 sausages, mash, gravy

3 white coffees, 3 water, 1 Fanta

See attached food

diary and nutritional

analysis

2

7.30am

12.00pm

3.00pm

7.00pm

8.00pm

Oats, Whey Protein, banana, milk

1 Baby Bel, Handful spinach, .5 mozarrela ball,

50g coleslaw, 1 boiled egg

1 bag Skips

30g Whey Protein, 25g dextrose

1 can of tuna, pasta, sweetcorn, mayo

1 coffee

See attached food


analysis

3

7.30am

12.30pm

3.00pm

4.00pm

7.00pm

9.00pm

Oats, Whey Protein, Strawberries, milk, .5

banana

Double cheeseburger, med fries (McD)

2 bags of Skips

15g whey protein, 25 dextrose

Chicken, 1 mozarrela ball, .5 avocado, handful

spinach, 50g coleslaw

30g casein, milk

1 Dr Pepper, 2 white coffees, 2 white tea, 3

waters

See attached food


analysis

4

7.15am

8.30am

2.00pm

4.00pm

1 banana

100g oats, 30g whey protein, 1 banana, milk

Double cheeseburger

12 Hobnobs, 1 Wispa

2 white coffee, 2 white tea, 3 water

See attached food


analysis

5

1.00pm

5.30pm

7.00pm

Ham sandwich (granary bread), butter, mayo

Chicken Korma, white rice (homemade)

Handful cashews

4 white coffee, 1 glass semi-skimmed milk, 3

water

See attached food


analysis

6

10.00am

2.30pm

4.30pm

7.00pm

Sausage & egg McMuffin, 1 hash brown

Handful cashews, 3 Baby Bels, 2 Skips

25g dextrose, 15g whey protein

30g whey protein, 25g dextrose, 4 sausages,

mash, onions, gravy

4 white coffee, 1 glass semi-skimmed milk, 3

water

See attached food


analysis

7

1.30pm

3.45pm

6.00pm

150g pulled pork burger, fries, 8 onion rings, 1

slice choc fudge cake

Handful cashews

Macaroni cheese (homemade) - large

3 white coffee, 2 pints Guinness, 2 pints Fosters

See attached food


analysis

Clients’ Signature: Date:

Nutritional profile and analysis

Based on the client’s food diary (a blank food diary template can be found at the

back of this LAR or you can devise your own version) and other information

gathered from the client, complete the nutritional profile and analysis. Please

include a copy of the client’s foods diary with this analysis.

Clients nutritional likes and dislikes

Likes: Dislikes:

Chocolate

Biscuits

Skips

Macaroni cheese

Roast dinner

Indian meals

Chinese meals

Brussel Sprouts

Mushrooms

Analysis of the client’s eating habits

Client eats on a very irregular basis and much of the time it is ‘on the go’. Meal times vary

considerably as a result and the balance of nutritional intake is very random. He often skips

meals and on some days his calorific intake is very low. In fact, his intake on two of the seven

days was below his BMR*.

Much of his food intake is processed food and his protein intake is largely from

supplementation rather than from natural food sources. This can be seen from the attached

detailed food diary and also the diary above.

When everything is taken into consideration, it is evident that his food intake is detrimental to

his health and needs to be addressed as soon as possible (further details below)

*I subsequently questioned him on this and he realised he had forgotten to include some

things. Unfortunately, it was a marzipan chocolate bar each day!

Analysis of the client’s current nutritional intake in relation to quantity (number of portions

eaten daily and portion size) and nutritional quality of their diet compared to healthy eating

guidelines. Provide a rationale for your analysis in terms of health status.

His breakdown of macronutrients over the course of the week was as follows:

• Carbohydrates - 41% (33% of this is from refined sugars)

• Fats - 40%

• Protein - 19%

This is out of line with current UK national food guidelines by quite a bit. Although the protein

intake percentage is close to the guidelines, much of it is obtained from supplementation

(whey protein powder) where large amounts are consumed at one time rather than

spreading the intake over the course of the day.

Looking at portions consumed for each food group, again it is greatly out of line with

healthy eating guidelines. Only seven portions of fruit were consumed over the whole week

and just three portions of vegetables. As a result, the client is missing out on a great deal of

essential vitamins and minerals that will contribute to good health.

His intake of starchy foods, whilst better than the fruit and veg consumption, is still much

lower than it needs to be. He is only averaging 13g of fibre each day as a result.

His fluid intake is also less than it needs to be which will cause dehydration.

It is clear that the nutritional quality of his diet is poor and, if it continues in this manner, there

is a risk that he will suffer from serious health issues.

One further point is that he is not eating a sufficient amount of calories for his activity level

and, in particular, for him to be successful in meeting his fitness goals.

A structured nutritional programme will help to improve all of the above areas of concern.

Food Group Rec

Portions

Actual Portions

Quality of Foods

How will affect health status

Bread, rice, potatoes, pasta (carbs)

11 2.3

Mainly low GI except when eating out. Very little fibre being consumed

He will not be getting sufficient energy to support his activities (or bodily function at times)

Meat, fish, eggs and beans (protein) etc

4-5 3.1

Mostly from high fat sausages and burgers

Risk of some cancers, CHD, stroke, diabetes etc

Milk and dairy foods

3-4 2.9

Largely from whey protein supplements, and cheeses which have a high fat content

The high fat content is going to contribute to the risk of diseases stated above

Fruit

4+ 0.6

Quality is fine; just very little consumed

He is missing out on essential vitamins and minerals plus anti-oxidants. His energy levels will suffer as well due to such a low consumption

Vegetables

5+ 0.9

Very little eaten and, when he does, it’s usually surrounded with fat e.g. coleslaw, onion rings etc

As for Fruit plus he is also getting very little fibre which will adversely affect gut function

High fat and/or sugar

0-3 7.3

He eats an awful lot of chocolate, biscuits, skips and occasional fizzy drinks which provide very little good nutritional value

Risk of some cancers, CHD, stroke, diabetes etc. The highs and lows associated with sugar spikes will also affect his energy and mood. This, and everything else mentioned above, explains why he often feels tired and lacking in motivation

Goal Setting

Based on the information gathered from the client and the analysis of this

information agree short, medium and long-term SMART (nutritional and

exercise/activity) goals with the client.

SMART goals

Short-term

• Make healthier eating choices based on UK Healthy Eating Guidelines (included in client pack).

Aim to make small changes initially with the goal of increasing the changes in the longer term. In

short, this means:

• Increase consumption of fruit and vegetables. Try to eat some of each daily

• Increase carbohydrate intake

• Reduce intake of refined sugar by choosing low GI carbs over high GI

• Reduce fat intake by 10%

• Increase water consumption to six to eight glasses per day

• Reduce the amount of skipped meals (preferably to zero)

• Spread food intake more evenly over the day rather than loading the end of the day

• Changes will be measure by completion of a weekly food diary

• Avoid as far as possible or limit CRAP foods (Carbonated, Refined, Additives, Processed)

• Two to three days per week resistance training for muscle hypertrophy and strength

• CV training for 20 minutes three days per week at 70-80% MHR (Performance Zone)

• Introduce more activities of daily living that will contribute e.g. walk instead of driving, using stairs

instead of lifts etc

*More comprehensive details of the client’s exercise goals are contained in the PT Programme (same

client)

Agreed review points:

• Complete a 24 hour recall food diary in week 3

• Re-test press-ups and Cooper Run Test

• Re-test body measurements e.g. BMI, body fat etc

• Client feedback on how they are feeling e.g. more energy, feeling stronger and fitter, less tired etc

(ongoing)

Medium-term

• Increase consumption of food portions to a minimum of half the guideline amounts (portions) for

each category

• No skipped meals

• Spread food intake more evenly over the day rather than loading the end of the day (a combination

of 5-6 meals/snacks per day)

• Reduce supplement intake and aim to get as much of the nutrients from food

• Changes will be measured by completion of a weekly food diary

• An improvement in body composition results e.g. more muscle weight, less fat

• CV training for 20 minutes three days per week at 75-85% MHR


• Complete a a 24 hour recall food diary


• Re-test body measurements (BMI, body fat etc)


Long-term

• Food intake to more closely match the Healthy Eating guidelines i.e. eating the minimum number in

the range for all portions (e.g. 5-9 portions of fruit and veg etc)

• Add a further training day each week (home, outdoor or gym) for 30 mins


• Complete a 7 day food diary


• Re-test body measurements (BMI, body fat etc)


I (the client) agree with the above goals and review points and understand the advice I

have been given

Client’s

signature Date:

Nutritional and exercise/activity plan

Based on the information you have gathered from your client, your analysis and

agreed goals provide a nutritional and exercise/activity plan that will help your

client achieve their goals.

Identify 2 sources of educational information that you will access and make use of with your

client and describe how these will help your client achieve their goals

Source of information How it will help the client achieve their goals

a)

Public Health Eatwell Plate document

2015 from the NHS website

This provides all the details of what constitutes a

balanced diet in terms of portions to be eaten from

each food group. It will educate the client in this

and also what a food portion is in terms of weight.

b)

The British diabetes website

https://www.diabetes.org.uk

A very thorough resource on the subject. As

diabetes runs in the family, this will help Dan to

see if he is at risk. Also, seeing exactly what

diabetes is and what’s involved in managing the

condition along with details of the complications

and impact on health will hopefully make him

understand the need to improve his diet.

Outline of nutritional changes required Why these changes will help your client

achieve their goals

https://www.diabetes.org.uk/

1. Make healthier eating choices based on UK

Healthy Eating Guidelines (included in client

pack).

2. Increase consumption of fruit and vegetables.

Try to eat some of each daily

3. Increase carbohydrate intake and reduce intake

of refined sugar by choosing low GI carbs over

high GI and avoiding processed foods as far as

possible

4. Reduce fat intake

5. Increase water consumption

6. Reduce the amount of skipped meals and spread

food intake more evenly over the day rather than

loading the end of the day

1. His diet is poorly balanced and he is not getting

the nutrients he needs for good health. By

making changes in line with the NHS

recommendations, he will have more energy and

a healthier body and mind

2. He only had several portions of fruit and

vegetables over the whole 7 day food diary

period. By increasing this, he will obtain vital

nutrients and fibre that he was missing out on

3. Only 41% of his diet was carbohydrate and a

third of this was from refined sugar. By

increasing his carbohydrate intake and making it

primarily from low GI sources (3-5 portions of

vegetables and 6-11 portions bread, rice, pasta

etc) he will have more energy for longer without

the spikes and troughs of high GI carbs. This

will also reduce the risk of diabetes.

4. 40% of his diet is currently made up of fat, most

of it being saturated fat. Reducing his intake and

having that largely from unsaturated sources

will improve his health and reduce risks

associated with his current intake. For example,

replace foods high in saturated fat (e.g.

sausages) with lower fat or unsaturated fat

choices such as fish and nuts. Eat more fruit

instead of cakes which contain hydrogenated

fats. 3-5 portions a day should be consumed.

5. He drinks very little fluids. By increasing his

water intake, he will avoid the effects of

dehydration that can affect performance but,

more importantly, the many potential dangers

associated with dehydration such as, nausea,

vomitting, cramps, headaches, dizziness, heat

stroke and other life threatening conditions

6. This will help improve the function of the body

and mind as he will be getting a regular and

steady intake of food that he will need to

provide for his energy needs avoiding the

negative effects that volatile fluctuations can

have on his bodily systems. It will also help him

towards his fitness goals.

Proposed exercise and physical activity plan aligned to the agreed nutritional changes and

goals (applying FITT where appropriate)

• Two to three days per week resistance training for muscle hypertrophy and strength

• CV training for 20 minutes three days per week

• Introduce more activities of daily living that will contribute e.g. walk instead of driving, using stairs

instead of lifts etc

• Introduce a range of core stability exercises

• Introduce mobility exercises and a combination of static and dynamic pre-exercise stretches

appropriate to the exercise being performed in the session

• Post exercise maintenance and developmental stretches

• PNF stretches for major muscles to improve ROM and help correct minor kyphosis

Full details are contained in the client’s PT Programme

Short-term goal review

Review the short-term goals (see the goal setting section for review timescale) and

evaluate your client’s understanding of the nutritional advice and how it links to the

exercise/physical activity plan. Evaluate their progress and suggest any changes

that might be needed as a result of this review.6

Review of client’s understanding and feedback from the client about the plan

Client fully understands the reasons for the recommendations and how it will support him in achieving

his goals. He has implemented some of the recommendations e.g.. he spreads his intake more even

over the day and has cut out sausages due to their high fat content. However, he still eats more fat than

he should and snacks on the wrong type of food. He is happy with this though because he feels that he

has made positive changes but still eating ‘treats’ that he enjoys. His vegetable intake is still low

coming mainly through eating salad as an accompaniment to a meal so the portions are quite small.

Negotiated changes to the nutritional goals and/or exercise/physical activity plan

The plan remains the same for the medium term and he has said that he will try to make more of an

effort to add more vegetables to his diet as he understands the need to get the nutrients from this. I will

speak to him frequently to see how he is doing and encourage him to improve. Knowing Dan as I do,

getting him to make more changes will be difficult at this point in time because he is making good

progress with his training. I’ve told him that this will slow down and likely stop at some point unless

he makes the required changes but it may not be until this happens that he will have the increased

motivation to change. Having said that, he is eating more healthily than he ever has so it’s a step in the

right direction.

I can confirm that I have worked with a client and that the information given in this case

study is authentic.

Learner’s signature Date:

Assessor’s signature Date:

IQA’s signature Date:

Nutrition Case Study Evidence Index

Learner’s name:

No Description of Evidence

N1 24 hour Food Recall Diary

N2 Eatwell Plate PDF

N3 Body measurements

N4 Follow up 7 day Food Diary

N5

N6

N7

N8

N9

N10

N11

N12

N13

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