Question

Case Study – The Davis Family

Preconception

Nutrition through the Life Cycle

Brianna and Kevin Davis met in college in Southeast Texas where they were both majoring in chemical engineering. After college Kevin went to work for a major oil refinery and Brianna was recruited by a local engineering consulting firm. They got married when they were both 23 years old. By the time they were 26 years old, they had bought a spacious house, adopted two Springer Spaniels, and gained 40 pounds each. They wanted to have a baby.

The couple discontinued using birth control and thought they would be announcing the happy news within a few months. However, after 18 months had passed, there was still no pregnancy. The problem could have been with Kevin, but Brianna had some health issues she suspected might be related to infertility, so she made an appointment with her gynecologist.

Brianna’s data:

                          Age – 28 years old

                          Race/ethnicity – African American

Weight – 198 pounds; gained 40 pounds since she graduated from college

                          Height – 67 inches

                          Waist circumference – 42 inches

Pertinent family history – Parents both living; mother is obese and has high blood pressure, type 2 diabetes, and hyperlipidemia.

Brianna’s signs/symptoms – irregular menstrual cycle for 6 years; mild acne; hirsutism; abdominal obesity; slight acanthosis nigricans.

Lifestyle habits – sedentary job, works 10-12 hours per day; no planned physical activity; does not smoke cigarettes; drinks alcohol and smokes marijuana occasionally (it’s legal now).

Pertinent medical findings: hyperinsulinemia, elevated testosterone levels, slightly elevated cholesterol and triglycerides; blood pressure is slightly above normal range; ultrasound showed enlarged ovaries, outer layer of ovaries thick and hard with multiple abnormal sacs with membranous linings.

Result of medical visit: MD prescribed Metformin and recommended weight loss. She provided a referral to a RDN (that’s you).

You see Brianna for her initial visit and she provides you with the following information:

Dietary intake – takes multiple vitamin-mineral supplement (contains 4 mg folic acid); does not drink milk (lactose intolerant), but enjoys cheese and yogurt.

      Typical day’s intake:

              Morning:       Coffee with cream/sugar

                                    Egg McMuffin from drive-thru

Lunch:           Eats out with colleague or friend. Usually has a cheeseburger or a ham and cheese sandwich with chips or fries. Sometimes pasta and salad. Drinks regular Dr. Pepper or sweet tea.

Afternoon snack:

                       Keeps a variety of cracker packages at her desk. Usually eats one package, such as cheese/peanut butter crackers, and drinks a Dr. Pepper. Drinks more coffee with cream/sugar in the afternoon to boost her energy level.

Dinner:           Either meets Kevin for supper at a restaurant or one of them picks up a take-out meal. Typical choices: fried seafood with rice and salad, Chinese meal, fried chicken from Popeye’s with mashed potatoes/gravy and Cajun rice; barbeque plate; barbeque baked potato; deluxe thin-crust pizza. Drinks Dr. Pepper or sweet tea.

Evening snack:

                       Brianna and Kevin enjoy a bowl of their favorite ice cream while they watch TV.

Weekends:    For breakfast, Kevin cooks pancakes with bacon or sausage. For the other meals, the couple eats at one of their parents’ houses. Brianna’s family enjoys typical Southern cooking. Kevin is of Polish descent. His family moved to the South from the Chicago suburbs. Polish food includes lots of meat, noodles, and potatoes. Polish cuisine is hearty and uses a lot of cream and eggs

Answer 1

As Brianna is trying to conceive and is already diagnosed with problems associated with obesity, its important her to reduce her weight and increase activity like exercises as she is a sedentary worker.She should work on her diet and hence referred to Registered Dietician.With her Kevin also should work on diet which would encouragement to Brianna.

The Menu what she can follow is

8am : 1 glass of slim milk, 3 slices of whole wheat bread with egg omlet

10 am: Nuts or a fruit

12:30 pm: Vegetable Whole wheat pasta, a cup of cooked chicken or seafood, cucumber and carrot salads, a cup of yogurt.

4:30 pm : Cooked cereals or sprouts or cup of salads with sugar free tea.

7:30pm: whole wheat vegetable noodles, a fruit, and cup of boiled chicken.

This diet will help her to cut down their weight with physical activity like scheduling walking, playing shuttle .This schedule will help Brianna is lowering fat and to control glucose level and can increase the chances of conceiving.