Question

Part 1: Michael is a 12 year old boy that you are seeing for the first time at a well-child visit. The mother reports his birth weight as 2.3 kg. (5064). He had diarrhea during the first year of life and gained slowly to 8.0 kg. (17.6 #) at one year. After that, she reports "He ate really well." Michael has no chronic medical conditions and has never had to be on medication for anything. His mother, age 35, is a single parent who works full time in a grocery store and was diagnosed several years ago with hypertension and type 2 diabetes mellitus. Additionally, she has hyperlipidemia with an LDL of 260. His father is not with the family but the mother is able to inform you that he is 42 years old and has hypertension and had a heart attack at age 39. Michael has three siblings by a different father, two younger sisters, ages 11 and 9, and a younger brother, age 4; they are all healthy Michael is currently in the sixth grade at a local public school and has a B average. He receives both free breakfast and lunch at school. Most days after school he and his sisters take the bus (even though they could walk) to a neighbor's house where they will usually eat some type of snack like chips or convenience foods, watch TV for a couple of hours, and occasiohally eat dinner. Michael's mother reports that he has a good appetite and eats meat, cereals and grains, but refuses to eat vegetables. He will occasionally drink orange juice in the morning but usually has soda with his meals On physical exam you find that Michael is 58" tall and weighs 130#. His BP was 12882 mmHg at this visit. At this visit, the physician also ordered a lipid profile and blood glucose tests for. Below are the results of non-fasting lab work. Reference Range 80-120 3.9-5.2 s170 55 F, >45 M <110 s150 Result 112 0 Glucose (mg/dL) HbA1c (%) 165 Cholesterol (mg/dL) HDL (mg/dL) LDL (mg/dL) Triglycerides (mg/dL) 34 114

Answer 1

Michael and his siblings are not consuming fibre rich diet . From the data provided, it is understood that he consumes more unhealthy food rich in LDL cholesterol. Also he is not doing any physical exercise or any activity .

1. 58 inches = 1.47 M(1 metre= 39.37 inches)

130 lb= 58.96 Kg ( 2.2 lb=1kg)

BMI=  weight (kg) / [height (m)]²

  = 58.96/ (1.47)²

=58.96/2.1609

= 27.28

Michael is overweight.

(Underweight = <18.5
Normal weight = 18.5–24.9
Overweight = 25–29.9
Obesity = BMI of 30 or greater)

According to Michael age he may be about 39.9 kgs and his weight for his height is also about 39 -40 kgs. Michael 's height is correct for his age but his weight is very high and not normal for his age. At birth and after that his weight was normal .Due to consumption of unhealthy diet and lack of exercises are the reasons for his overweight.

2. Hypertension is characterized by a blood pressure more than 140/90 mm of Hg . For a boy aged 12 years normal blood pressure may be 116/75 mm of Hg. For Michael 's height 1.47 metres his normal BP is about 116/75 mm Hg, but his BP is 128/82 mm Hg . According to US department of public and health sciences the systolic blood pressure ranges for predicting hypertension in children is given below.

For the height of 1.47 metres

• If systolic BP is 117 it indicates Prehypertension  
• If systolic BP is 121 it indicates Stage 1 HTN
• If systolic BP is 133 it indicates Stage 2 HTN

So Michael is having Stage 1 hypertension . So It should be rechecked again in 1 to 2 weeks and if BP remains at same level it is mandatory to begin evaluation and treatment which includes weight management , dietary and lifestyle management.

3. The risk factors of hypertension in 12 years are

• Hereditary
• Male
• being obese or overweight
• Increased intake of salt
• Sedentary lifestyle
• Having high cholesterol

Michael is a male , his father and mother has hypertension, his weight is high for his height, he consumes more sodium rich foods , he has a sedentary life style and cholesterol is also near to normal.

4. Cholesterol- 165 mg/dL

Glucose - 112 mg/dL

HDL - 34 mg/dL

LDL -110 mg/dL

HbA1C- 5.0

His cholesterol levels are at borderline . His LDL is at borderline which indicates he has a concern to get heart disease or heart disease risk factors.Michael consumes more trans fats and saturated fat food items high in sodium which has made his LDL at borderline.

HbA1C is at borderline which indicates he is at risk for Diabetes.