Health Care Assignment: Evidence-based Nutritional & Lifestyle Intervention
Health Care Assignment Instructions: Select “any two short answer case vignettes “For each of your chosen case vignettes produce:
- An evidence-based nutritional and lifestyle intervention that briefly considers aetiology, progression of the health issue or condition and includes two or three evidence based Nutritional Therapy recommendations.
- Then provide a rationale to justify of your recommendations that critically evaluate underpinning evidence and illustrates and understanding of the role of the Nutritional therapy practitioner and recognition of boundaries and scope of practice.
Case Vignette 1: Kai
Kai is an active six years old who enjoys school and playing outside. He has eczema, affecting his hands, wrists, knees, neck and face as well as other parts of his body which is treated with aqueous creams from the GP. When it flares the GP has advised his parents apply a hydrocortisone steroid cream sparingly. Kai was born by C section and he was quite poorly as a baby with suspected sepsis and treated with an antibiotic called gentamicin. His mum tried to breast feed him for six months, but found it very difficult and did use some formula milk as well, in a combined feeding pattern. As a baby, before weaning Kai suffered from reflux which was treated with Omeprazole and Gaviscon powder for infants. This improved once Kai started on solid foods, but the eczema started around this time. Kai has normal height and weight and is an active boy but he found his eczema itchy and sore. He has been a fussy eater since he was a toddler, and is not keen on vegetables apart from broccoli and vegetable soup that his mum makes (this contains celery, onion, carrot, cauliflower, courgette, garlic and potato).His mum has tried other variations but he will not eat it and particularly doesn’t like it if it is too green or too orange. He will eat fish fingers, sausages, ham and eggs but is not keen on poultry or other red meat. His favourite fruit is banana; generally refuses all other fruits but will drink smoothies and juice.
Case Vignette 2: Jill
Jill is 47 and suffering from frequent insomnia where she wakes around 4am and can’t get back to sleep and also experiencing low mood and some anxiety. For the last six months she has had irregular, scant periods. Her BMI is 26.5 and she is concerned she is gaining more weight loss around the middle but principally wants to support her main symptoms listed above. Jill has been vegetarian for twenty years and wishes to remain so but feels she eats a balanced diet as she has her 5 fruits and vegetables a day. She doesn’t smoke and only drinks a few glasses of red wine weekly. She walks her dog twice a day but can work long hours meaning often in winter she doesn’t see much daylight.
Case Vignette 3: Charlie
Charlie is 35 years old and he and his partner have been trying for a baby for 2 years. His partner has had two early miscarriages before 12 weeks of pregnancy. Tests have revealed he has a lower than normal sperm count and problems with his sperm morphology, whilst his partner’s results are all normal. Charlie doesn’t drink more than ten units of alcohol a week and tries to eat a healthy diet including poultry and fish (but he avoids all red meat), he doesn’t like fruit very much. His BMI is now 24 (he has lost 6kg over the last six months). He is a lorry driver so spends long periods sitting behind the steering wheel, and he can be away from home for a few days at a time and has to eat out in service stations etc. He tries to get out for a game of football at the weekend and he doesn’t smoke.
Case Vignette 2: Jill
From the assessment of the case study of Jill undertaken in this health care assignment, it has been found that she has been suffering from difficulties such as insomnia, weight loss, and scant and irregular period which has been one of the reasons for her health condition and worries. As it is also known that she wants to remain vegetarian and avoid meats and fishes, it will be necessary to provide her diet which will meet all her requirements to sustain better health.
Intervention and nutritional therapy recommendation with rationale:
In order to treat her condition of insomnia, it will be necessary for Jill to intake food such as hummus which is a high fiber food and helps in retaining healthy sleep. Often low fiber diet induces the state of insomnia, thus Jill needs to avoid food with low fiber (Chesney & Minich, 2019). Tryptophan is one of the essential amino acids found in both hummus and almonds that help in inducing sleep as they are known to be sleep-promotingamino acids. almonds are a good source of magnesium which is necessary for maintaining a healthy diet (Nedopil et al., 2019). Apart from helping with sleep, magnesium has also its effective influence on menstrualcramps and irregularperiods. It helps in muscle relaxation, sleep and minimizes period crams which will be helpful for Jill against her health worries. Intake of Vitamin B6 and B1 is also necessaryagainst the condition of the scant period and sleep asthey serve as mood stabilize and helps cure stress and depression which often leads to less sleep and irregularperiod (Y?lmaz & Eskici, 2020). Also, spinach and kiwi have high antioxidant factors that help in stabilizing mood, restore depression and stress and induce healthy sleep and regular period (Nimrouzi et al., 2019).
Apart from a healthy diet, Jill needs to ensure regular exercise in order to manage her weight as well as help her with her mood swings, insomnia, and menstrual pain, and abnormality. It is known that exercise helps in maintaining the release of hormones in a normal and adequate manner which regulates the healthy metabolism of the body. thus, it is necessary that Jill gets self-involved in regular exercise and a healthy diet (Lim et al., 2018).
Lack of vitamin D in Jill's body is also one of the causes of her irregular period and insomnia, as vitamin D serves as an essential factor for stabilizing mood, inducing healthy sleep, minimize period pain, and promote a healthy menstrual cycle. Thus, it is necessary that Jill take a regular walk outside her home to promote exercise and sustain vitamin D in a natural manner and if necessary, can also use vitamin d tablets for increasing the balance of vitamin d in the body (de Oliveira et al., 2017). Nutritional therapy practitioner in case of Jill will help in providing effective diet focusing on her priority of having only vegetarian food, to help her with her scant and irregular period and condition of insomnia.
Case Vignettes 3: Charlie
After assessing the case study of Charlie, it was found that Charlie and his wife have been suffered from two early miscarriages. On analysis, it has been evaluated that the reason behind these miscarriages is low sperm count and abnormal sperm morphology in Charlie. The lifestyle and dietary habits of Charlie help in predicting the cause of the complication. It has been found that occupation of Charlie being a lorry driver is one of the main reasons behind the heath condition. It has been found that jobs that include prolonged sitting often cause a decrease in sperm count and impact the morphology of the sperm.
Intervention and nutritional therapy recommendation with rationale:
Thus, in order to sustain and increase sperm count and healthy conception, it will be necessary for Charlie to change his lifestyle and diet. It is necessary for Charlie to primarily initiate physical activity in order to keep the body healthy and fit and if possible, he needs to change his occupation as a lorry driver. It is necessary that Charlie indulges himself in regular exercise,but it will besignificant to consider avoiding excessive or healthyexcises routine as it may then impose a negativeimpact on the sperms (Jó?ków & Rossato, 2017). Though the main change that needs to be initiated in his lifestyle is a healthy diet. It is necessary that a patient with low sperm count and abnormal sperm structure intakes nutrients and food as below mentioned:
1. Zinc: low zinc level in the body may cause low and abnormal sperm quantity and quality. Thus, it is necessary that Charlie intake high zinc-containing foods such as red meat and poultry which Charlie avoided in his regular diet. Crabs, lobsters, dairy foods, nuts, beans, whole grains as well as oysters are some of the healthy foods that Charlie must intake in order to regulate the healthy level of zinc in his body (Fallah, Mohammad-Hasani & Colagar, 2018).
2. Vitamin B-12 and vitamin C: it has been found that vitamin B-12 has its effectiveness towards the sperm's mobility, reduction of sperm DNA damage, and increased sperm count in men. Thus, Charlie needs to intake fish, kinds of seafood, meats, dairy, egg, and nutritional yeast which also helps in increasing zinc count in the body (Banihani, 2017)S.
Though in order to increase sperm mobility and improve morphology, Charlie needs to intake vitamin c rich foods such as juices and fruits, vegetables, cereal, daily and sweet peppers (Terai et al., 2020).
It is necessary that Charlie eliminates alcohol and sugar from his diet in order to help his body sustain a healthy phase, as often it has been found that excessive alcohol has a negative impact on the sperm morphology which inhibits the mobility of the sperm. Alcohol has been known to reduce the level of testosterone and minimize the normal production of sperm in the body which may be one of the resound in the case of Charlie (Salas-Huetos et al., 2019). Thus, it will be necessary for Charlie to follow the nutritional therapy recommendation in order to sustain a healthy conception and pregnancy for Charlie and his wife. Nutritional therapy practitioner in the case study of Charlie will ensure effective treatment for his low sperm count and abnormal morphology of sperm by providing effective nutritional intervention which are effective for enhancement of sperm count and structure. ?
Banihani, S. A. (2017). Vitamin B12 and semen quality. Biomolecules, 7(2), 42.
Chesney, K., & Minich, D. M. (2019). Challenging Case in Clinical Practice: Use of the Elimination Diet as a Broad-Spectrum Approach for the First-Line Treatment of a Multi-Symptomatic Client. Alternative and Complementary Therapies, 25(2), 72-76.
de Oliveira, D. L., Hirotsu, C., Tufik, S., & Andersen, M. L. (2017). The interfaces between vitamin D, sleep and pain. Journal of Endocrinology, 234(1), R23-R36.
Fallah, A., Mohammad-Hasani, A., & Colagar, A. H. (2018). Zinc is an essential element for male fertility: a review of Zn roles in men’s health, germination, sperm quality, and fertilization. Journal of reproduction & infertility, 19(2), 69.
Jó?ków, P., & Rossato, M. (2017). The impact of intense exercise on semen quality. American journal of men's health, 11(3), 654-662.
Lim, H. S., Kim, T. H., Lee, H. H., Park, Y. H., Lee, B. R., Park, Y. J., & Kim, Y. S. (2018). Fast food consumption alongside socioeconomic status, stress, exercise, and sleep duration are associated with menstrual irregularities in Korean adolescents: Korea National Health and Nutrition Examination Survey 2009-2013. Asia Pacific journal of clinical nutrition, 27(5), 1146.
Nedopil, N., Einhäupl, K., Rüther, E., & Steinberg, R. (2019). L-Tryptophan in chronic insomnia. Schlossberger, Kochen, Linzen, Steinhart, Progress in tryptophan and serotonin re-search, 305-309.
Nimrouzi, M., Daneshfard, B., Tafazoli, V., & Akrami, R. (2019). Insomnia in traditional Persian medicine. Acta medico-historica Adriatica: AMHA, 17(1), 45-54. Salas-Huetos, A., James, E. R., Aston, K. I., Jenkins, T. G., & Carrell, D. T. (2019). Diet and sperm quality: Nutrients, foods and dietary patterns. Reproductive biology, 19(3), 219-224.
Terai, K., Horie, S., Fukuhara, S., Miyagawa, Y., Kobayashi, K., & Tsujimura, A. (2020). Combination therapy with antioxidants improves total motile sperm counts: A Preliminary Study. Reproductive medicine and biology, 19(1), 89-94.
Y?lmaz, S. K., & Eskici, G (2020). Evaluation of emotional (depression) and behavioural (nutritional, physical activity and sleep) status of Turkish adults during the COVID-19 pandemic period. Public Health Nutrition, 1-8.