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Elements of Nutrition: Adult Male Case Study & Recommendations

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Brad is a 32-year-old male who is present in your office due to weight gain and high blood pressure. He recently had blood work done and he has borderline elevated cholesterol and his blood sugars are a little bit elevated, but his doctor only wants him to focus on losing weight. He thinks he does well with his diet and exercise, so cannot understand why he is gaining weight since when he was younger he could eat more and exercise less and still be thin. He is also quite upset he has developed a "beer gut" since he rarely drinks unless it is during the holidays then he will have a beer or two. He has a family history of prostate cancer. He is 5'9" tall and weighs 250 pounds. He weighed 235 pounds 1 year ago per his medical chart.

This is his typical diet and exercise:
Exercise: Works out Monday, Wednesday, and Friday for 30 minutes on an elliptical machine
Breakfast: 3oz of turkey bologna, 1 oz. of cheese, 2 slices of whole wheat bread, and 1 cup of coffee with 2 tablespoons 1% milk
Lunch (if there is time): cheeseburger and large fries with 12 oz. of diet soda
Dinner: 6oz of meat, 2 cups of rice, 1 bowl of salad with 4 tablespoons of ranch dressing, ½ cup of mixed vegetables, water
Late night snack: 1 cup of coffee with 2 tablespoons 1% milk and 4 chocolate sandwich cookies
1. Describe how the body weight and composition of Brad has changed from when he was a teen to his current age.
2. What nutrient needs change as he ages? Focus on carbohydrates, proteins, and fats.
3. What are two assessment tools you would use to determine Brad's nutritional status?
4. What dietary/supplement recommendations would you have for Brad to help him lose weight, reduce his blood pressure, reduce his total cholesterol, and reduce his blood sugars?
5. Since he has a family history of prostate cancer, what further recommendations would you provide to Brad in regards to his diet?

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Body composition changes are the result of many factors, but in this example age has a prominent role in such changes. Recall that body composition generally refers to the percentage of lean body mass (i.e., skeletal muscle tissue) and body fat mass (i.e., subcutaneous fat versus visceral fat); however, do not disregard that the composition of the body is technically made up of each constituent part and its specific makeup. The "beer gut" mentioned relates to visceral fat accumulation, which increases the likelihood of adverse health effects such as metabolic syndrome, diabetes mellitus, and inflammatory syndromes/disorders. This body composition change is multifactorial, meaning that many pathophysiologic mechanisms are responsible. To briefly mention what is discussed in greater detail below, chronic intake of refined sugar and trans fats is implicated in the accumulation of visceral fat. A genetic predisposition may exist here as well. Aside from dietary choices, age-related metabolic changes also are associated with body composition changes. For instance, when considering body composition, realize that lean body mass is the major determinant of resting metabolic rate - the rate at which the body runs - encompassing all the processes requiring energy to maintain homeostasis of the organism, the human body. Importantly, as we age, skeletal muscle is slowly replaced with non-functional tissue, thereby decreasing the metabolic rate. Thus, this exploits the importance of resistance training throughout middle and late adulthood. Lastly, body weight, like resting metabolic rate, is dependent on the body's composition, whereby fat is less dense than muscle. For example, five pounds of muscle would fit into a smaller volume than five pounds of fat. This is a common misconception when people use the scale to determine their progress with fitness and weight loss goals. Sometimes weight will go up as people increase their lean body mass due to the disproportionate decrease in body fat; however, their appearance and health should be the focus, especially early on in the training regimen.

As we age, our body composition gradually changes. Because of this our intake of macronutrients and micronutrients needs to change accordingly. The focus here is on carbohydrate, protein, and fat intake. Although there is much controversy as to which macronutrient grants the best overall health, maintaining a relatively low fat intake while consuming the majority of calories from carbohydrate and sufficient protein seems to be the commonest recommendation. However, increasing the percentage of fats in the diet has been currently proposed as having the most favorable effects on glycemic control (blood sugar stability), cardiovascular health, and weight loss. Increasing the amount of unsaturated fats is the goal, like poly- and mono-unsaturated fats from fish and nuts. The intake of carbohydrates continues to be obligate, meaning our bodies without a doubt require ...

Solution Summary

Nutritional recommendations for an obese male adult having a family history of prostate cancer are included in this case study review. A review of nutritional status, weight loss strategies, overall dietary recommendations, and insight on disease prevention is included throughout.

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