Problem Set in Nutritional Biochemistry

Planning a Healthy Diet

CASE STUDY. Answers must be submitted in hard copy format on (Sept. 5 for 4BBC and Sept. 6 for 4ABC
and 4CBC). (100pts.)

Background Story: Margaret was taken to her pediatrician because of her breathing problem when
sleeping. Her pediatrician diagnosed her w ith sleep apnea related to her weight and referred to the
registered dietitian for nutrition counselling.

Personal Information:
Name: Hufalar, Margaret G.
Gender: Female
Height: 5’7"
Weight: 115 lbs

Doctor’s Diagnosis: Obstructive sleep apnea (OSA) secondary to obesity and physical inactivity

Nutrition:
General: Very good appetite with consumption of a wide variety of foods. Margaret’s physical activity level
is generally low. Her elementary school discontinued physical education, art, and music classes due to
budget cuts five years ago. She likes playing video games and reading.

24-hour recall:
Breakfast: 4 servings of pancakes (4 inches across, 1/4 inch thick), 8 oz whole milk, 4 oz
apple juice
Lunch: 2 burrito and cheese sandwiches (2 slices of white bread, 1 oz. mozzarella, 1
tbsp mayonnaise each) 1-oz pkg potato chips, 8 oz whole milk
After school snack: Peanut butter and jelly sandw ich (2 slices white bread with 2
tbsp crunchy peanut butter and 2 tbsp fruit jelly), 12 oz whole milk
Dinner: Skinless lean chicken (10 oz.), 1 c mashed potatoes, 1 c blanched okra,
16 oz lemonade
Snack: 3 c microwave popcorn, 12 oz Coca-Cola

Vitamin intake: Flintstones vitamin daily

1. Dietary factors associated with increased risk of overweight are increased dietary fat intake and
increased calorie-dense beverages. Enumerate foods from Margaret’s diet recall that fit these criteria.
(10pts.)
2. Calculate the percent of kcal from each macronutrient for Margaret’s 24-hour recall. Does it fall under
the recommended range? (20pts.)
3. Increased f ruit and vegetable intake is associated with decreased risk of overweight. What foods in
Margaret’s diet fall into these categories? If none, do you think it is necessary for her to add these
nutrients in her pattern? Why or why not? Explain. (10pts.)
4. Using your know ledge on healthy diet, plan a 1-day menu for Margaret. Also, calculate the percent of
kcal from each macronutrient. Use the Exchange List below as your reference. (50pts.)
5. Does your menu meet macro- and micronutrient recommendations for Margaret? Explain why you
choose that meal plan for her. (10pts.)

Good luck. :)
How to use the Re ference Exchange List Values:

Examples:
1. A serving of pork hotdog sandw ich (with 3 oz of bun; 5 oz of chorizo sausage; 2tsp of mayonnaise; 2oz
of mozzarella cheese)

a. 3 oz. bun x

= 45 g carbohydrate

b. 1. 5 oz. chorizo x

= 35 g protein
2. 5 oz. chorizo x

= 40 g protein
c. 2 tbsp. mayonnaise x

= 10 g protein
d. 1. 2 oz. mozzarella cheese x

= 14 g protein
2. 2 oz. mozzarella cheese x

= 8 g fat

2. Three servings of small, unfrosted brow nies (1 ¼ inch square each)

A small, unf rosted brow nie is counted as1 carbohydrate + 1 fat; therefore:

3 servings x = 45 g carbohydrate

3 servings x = 15 g fat

Reference Exchange List:

STARCH
1 sta rch c hoice = 15 g carbohydrate
In gene ral, one starch exchange is 1/2 c cooke d ce real, gra in, or starc hy vegetable; 1/3 c
cooked rice or pasta; 1 oz of bread product; 3/4 oz to 1 oz of most snack foods.
Food Serving Size
Bread
Bagel, large (about 4 oz) ¼ (1oz)
Bread
  Reduced-kcal 2 slices (1 ½ oz)
 White, wholegra in, pumpernickel, rye 1 slice (1oz)
Hotdog Bun or Hamburger bun 1
1
Pancakes (4 inches across, 1/4 inch thick)
½
Pita, 6inches across
2
Taco shell, 5 inches across 1
Waffle, 4-inch square or 4-inch across
Cereals and G rains
Bran, dry
 Oat ¼ cup
 Wheat ¼ cup
Cereals
 Bran ½ cup
 Cooked (oats, oatmeal) ½ cup
 Sugar coated ½ cup
 unsweetened ¾ cup
Pasta, cooked 1/3 cup
Rice, white or brown, cooked 1/3 cup
Starchy vegetables
Corn ½ cup
 on cob, large ½ cob (5oz.)
Potato
 baked w ith skin ¼ large (3oz.)
 boiled, all kinds ½ cup
 mashed, with milk and fat ½ cup
 French fried 1 cup (2 oz.)
Yam, sweet potato, plain ½ cup
Crackers and Snacks
Graham cracker, 2 ½ inch square 3
Popcorn 3 cups
Rice cakes, 4 inches across 2
Snack chips
 Fat-free of baked (tortilla, potato), baked pita chips 3/4 oz
 Regular Chips (tortilla, potato) 3/4 oz
FRUITS
The Fruits list includes fresh, frozen, canned, and dried fruits and fruit juices.
1 fruit choice = 15 g carbohydrate
Note: In ge neral, one fruit exchange is 1/2 c canned or fresh fruit or unsweetene d fruit juice; 1
small fresh fruit (4 oz); 2 Tbsp dried fruit.
Food Serving Size
Apple, unpeeled small 1 (4oz.)
Banana 1 (4oz.)
Pineapple, fresh ¾ cup
Strawberries 1 ¼ cups
Watermelon 1 ¼ cup

Fruit juice
Apple Juice ½ cup
Orange juice ½ cup
Pineapple ½ cup
MILK
In gene ral, one milk c hoice is 1 cup (8 fluid ounces or 1/2 pint) milk or yogurt.
1 whole milk c hoice = 12 g carbohydrate, 8 g protein, 8 g fat
1 reduced-fat milk choice = 12 g carbohydrate, 8 g p rotein, 5 g fat
1 fat-free/low-fat milk c hoice = 12 g ca rbohydrate, 8 g protein, 3 g fat
Food Serving size
Whole 1 cup
 Milk, buttermilk, goat’s milk 8 oz
  Yogurt plain 1 cup
Re duced fat milk 1 cup
Fat free milk
COUNTED AS :
Other milk: 1 whole milk + 1 carbohydrat e
 Chocolate Milk, wholemilk choice
1 carbohydrate + 1 fat
 Soy milk choices
SWEETS, DESSERTS and OTHER CARBOHY DRATES
1 carbohydrate c hoice = 15 g carbohydrate, varia ble grams prote in, varia ble gra ms fat, and
variable kcalories
Food with Service Sizes COUNTED AS:
(Food:Service size)

Beverage, Soda, and Energy/Sports Drinks

 Fruit drink, lemonade: 1 cup (8 oz.) 2 carbohydrates
 Soft drink (soda): regular 1 can (12 oz) 2 1/2 carbohydrates
Brownies, Cake, Cookies, Gelatin, Pie, and Pudding
 Brownie, small, unf rosted: 1 ¼ inch square 1 carbohydrate + 1 fat
 Cake, unfrosted: 2 inch square 1 carbohydrate + 1 fat
 Doughnut: medium size 1 ½ oz 1 ½ carbohydrates + 2 fats
 Muffin: ¼ (1 oz.) 1 carbohydrate + ½ fat
 Sugar-free cookies: 3 small cookies 1 carbohydrate + 1 fat
 commercially prepared fruit, 2 crusts: 1/6 8 inch pie 3 carbohydrates + 2 fats
Candy, Spreads, Sweets, Sweete ners, Syrups, a nd Toppings
 Candy bar, chocolate/peanut: fun size bar (1 oz) 1 ½ carbohydrates + 1 ½ fat s
 Honey 1 carbohydrate
 Jam or Jelly: 1tbsp. 1 carbohydrate
NON-STARC HY VEGETABLES
1 non-starchy vegetable choice = 5 g ca rbohydrate, 2 g protein, 0 g fat
Note: In gene ral, one non-starchy vegetable c hoice is 1/2 cup cooked vegetables or vegetable
juice or 1 cup raw vegetables.
Food Serving Size

Amaranth/Chinese Spinach 1 cup

Broccoli 1 cup
1 cup
Carrots
1 cup
Chayote 1 cup
Coleslaw, no dressing 1 cup
Mixed Greens (collard, kale, mustard, turnip) 1 cup
Okra 1 cup
Onions 1 cup
Peppers 1 cup
Tomatoes 1 cup
MEAT and MEAT SUBSTITUTES
 1 lean meat choice = 0 g carbohydrate, 7 g protein, 0 g fat
 1 medium-fat meat choice = 0 g carbohydrate, 7 g prote in, 4 g fat
 1 high-fat meat choice = 0 g carbohydrate, 7 g protein, 8 g fat
Food Serving Size
Lean Meat choice
 Beef: Select or Choice grades trimmed of fat: ground round, roast 1oz
(chuck, rib,rump), round, sirloin, steak (cubed, flank, porterhouse,
T-bone), tenderloin
 Egg whites 2oz
 Fish, smoked: herring or salmon (lox) 1 oz
 Poultry, without skin: Cornish hen, chicken, domestic duck or goose 1oz
(well-drained of fat), turkey
 Processed sandwich meats with 3 grams of fat or less per oz 1oz
 (chipped beef, deli thin-sliced meats, turkey ham, turkey kielbasa,
turkey pastrami
 Shellfish: clams, crab, imitation shellf ish, lobster, scallops, shrimp 1oz
Medium-fat Meat Choice
 Beef: corned beef, ground beef, meatloaf, Prime grades trimmed of 1oz
fat (prime rib), short ribs, tongue
 Cheeses with 4–7 grams of fat per oz (feta, mozzarella, pasteurized 1oz
processed cheese spread, reduced-fat cheeses, string)
 Egg 1
 Fish, any fried product 1 oz
 Pork: cutlet, shoulder roast 1 oz
 Poultry: chicken with skin (dove, pheasant, wild duck, or goose; 1 oz
fried chicken; ground turkey)
High-fat Meat Choice
 Bacon 2 slices (16 slices per lb; or
1 oz each)
 Nut spreads (almond butter, cashew butter, peanut butter) 1tbsp
 Sausage with 8 grams fat or more per oz (bratwurst, chorizo, 1 oz
Italian, knockwurst, Polish, smoked, summer)
FATS
1 fat c hoice = 0 g carbohydrate, 0 g protein, a nd 5 g fat
Note: In gene ral, one fat exchange is 1 teaspoon of regula r ma rga rine, vegetable oil, or butter;
1 tablespoon of re gular salad dressing
Food Serving Size
Avocado medium 2 tbsp (1oz)
Mayonnaise, regular 1tbsp
Oil: corn, cottonseed, flaxseed, grape seed,safflower, soybean, sunf lower 1tsp
Salad dressing reduced fat 2tbsp
COMBINATION FOOD

Food with Service Sizes COUNTED AS

(Food:Service size)

Burrito (beef and bean): 1 serving 3 carbohydrates + 1 lean

meat + 2 fats choices
Bean, lentil, or split pea: 1 cup 1 carbohydrate + 1 lean
meat
Pizza, cheese/vegetarian, thin crust : 1/4 of a 12 inch (41/2–5 oz) 2 carbohydrates + 2
medium-fat meats
Rice (congee): 1 cup 1 carbohydrate
Stews (beef/other meats and vegetables):1 cup (8 oz.) 1 carbohydrate + 1 medium-
fat meat + 3 fats
Tuna salad or chicken salad: 1/2 cup (31/2 oz) 1/2 carbohydrate + 2 lean
meats + 1 fat
Vegetable beef, chicken noodle, or other broth-type Soup: 1 cup (8 oz.) 1 carbohydrate

NOTE: “Counted as” means that a food is equivalent to an amount of one nutrient choice added to t he
amount of another nutrient choice. Equivalent nutrient choices are provided in the headings of every
category.