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Capstone Project: An Analysis of Jessica Vachon


Jennifer Vachon
Amanda Sylvie
Nutrition 352
18 August 2016

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Introduction
The test subject I chose is my younger sister Jessica. I conducted the main interview on the 1st of
August 2016 at our dining room table. I followed up with Jessica for several days following the
initial interview in order to collect a 3-day food record from her.
Data
Demographics:
Jessica is a 14 year old female about to enter into the 8th grade at our local middle school. Her
date of birth is July 7, 2002. She is Caucasian and has lived in Massachusetts, United States her
entire life. She belongs to a middle class family consisting of her mother, father, two older
sisters, and one older brother. Jessica does not have any particular religious affiliation and does
not engage in any specific cultural practices.
Medical History:
After reviewing Table 14.1 detailing the various sexual maturation rates or Tanner Stages
regarding secondary sexual characteristics, Jessica put herself at stage 4 in her pubertal
maturation (Brown 362-3). She began menses at age 13. At age 7, Jessica experienced low levels
of iron in her blood and was characterized as anemic. She took Flintstone vitamins during this
time. She is not currently on any medications. She experiences no food allergies but does not
consume seafood because she does not like the taste or texture of it. She also does not like the
taste of white bread and therefore only consumes whole wheat bread. Her father suffers from
high blood pressure and high cholesterol and is on medication for both conditions. There is also a
familial medical history of cancer in three of her four grandparents including liver cancer, breast
cancer, and lung cancer.
Personal Information:
Jessica does not consume alcohol or have any drug use. She does not smoke and neither does
anyone in her household. She estimated that she sleeps from 6-7 hours per night on average over
the course of a year. Jessica spends approximately one hour per day engaged in physical activity
and one hour per day outdoors but says she tires easily.
Anthropometrics:
Jessica is 55 tall. She weighs 116 pounds. This calculates to a 19.3 BMI according to the
National Centers for Disease Control and Preventions Division of Nutrition, Physical Activity,

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and Obesitys BMI calculator for children and teens. A 19.3 BMI places Jessica at the 48th BMIfor-age percentile.
Food Intake Data:
I asked Jessica to complete a 3-day food intake recall from August 4-6. The 4th and 5th were
weekdays and the 6th was a weekend. For the complete 3-day report see Appendix 1.
Food Intake Analysis:
Jessica consumed a large number of foods high in fat, calories, salt, and sugars. This includes
honey barbeque Fritos, apple Snapple drinks, a lime rickey, a Ben and Jerrys ice cream pint, a
small Oreo McFlurry, Ramen noodles, a fruit roll up, and a Dunkin Donuts Boston Crme
Donut.1 In these three days the majority of her daily calories came directly from these low
nutritionally valued and highly processed food products. Jessica consumed an average of 1765
calories daily. Of the total calories consumed, 25% came directly from ice cream.2 In this
snapshot of her diet it is evident that she does more snacking than consuming of complete meals.
During the first day her first consumption of food occurred at 1pm. The second day she first had
food at 9:30AM. On the third day she first ate at 11AM. Figures 1-3 below show the percentage
of calories coming from protein sources, carbohydrate sources, and fat sources during each of the
3 days. The % of calories from protein remains consistent at 12%. The % of calories from
carbohydrates is very similar during the two weekdays at 53% and 52% collectively. This jumps
up for 68% during the final day of the food intake. Similarly the calorie percentages from fat
remain similar for the first two days before dropping from 35% and 36% to 21% on the last day.
The overall percentages are shown in Figure 4 below and depict the average of all three recorded
days.

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August 4: Percent of total calories

12

% Protein

35

% Carbohydrate
% Fat

53

Figure 1. Aug. 4th percent of total calorie intake

August 5: Percent of total calories

12

% Protein

36

% Carbohydrate
% Fat

52

Figure 2. Aug 5th percent of total calorie intake

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August 6: Percent of total calories

21

12

% Protein
% Carbohydrate
% Fat

68

Figure 3. Aug 6th percent of total calorie intake

August 4-6: Percent of total calories

12
32

% Protein
% Carbohydrate
% Fat

56

Figure 4. Average percent of total calorie intake

On average she consumed 12% of her calories from protein, 56% from carbohydrates, and 32%
from fat.2 Her average carbohydrate daily intakes were 138 grams of total sugar, 114 grams of
added sugar, 7 g dietary fiber, 0.5 ounces of whole grains, and 4.5 ounces of refined grains.2,6 She

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consumed an average of 1 cup of vegetables, 0.25 cup of fruit, 1.75 cup of dairy, 3 ounces of
protein, and 2 tsp of oils during the three day food intake.6 Added sugars contributed 455 calories
on average to Jessicas daily diet while saturated fats contributed 267 calories on average of
Jessicas daily diet.6
FFQ:
I gathered data using the Harvard T.H. Chan School of Public Health Nutrition Departments
2012 Youth Adolescent Food Frequency Questionnaire. This asked Jessica a variety of questions
relating to her relative intake of different food groups over the past year.
Drinks: Jessica does not consume diet soda, energy drinks of any kind, tea, alcohol of any
type, or caffeine of any type. She rarely consumes milkshakes or sport drinks including
PowerAde, Gatorade, and Vitamin Water which she has 1-3 times per month. She
frequently consumes soda and fruit drinks (not juice) at a rate of 4-8 bottles per week.
Jessica consumes 5-6 glasses per week of water.
Dairy: Jessica does not consume instant breakfast drinks, protein shakes, or light, low
calorie yogurts. She rarely consumes cottage cheese, ricotta cheese, cream cheese, butter,
whipped cream, and regular yogurt. She only has these dairy products 1-3 times per
month. Her household primarily uses Blue Bonnet stick margarine instead of butter which
she estimates she consumed 1 serving of per week. Her family also cooks with canola oil,
olive oil, and vegetable oil. Jessica eats 2-3 slices of nonfat or low-fat cheese in a typical
day. She drinks skim milk primarily at a rate of 1 glass of white milk per week and 2-6
glasses of chocolate milk per week.
Grains: Jessica does not consume oatmeal, cooked breakfast cereal, white bread, or
biscuits. From 1-3 times per month she consumes Cinnamon Toast Crunch, English
muffins, bagels, muffins, croissants, white rice, brown rice, flour tortillas, pancakes,
French fries, and potatoes. She consumes 2-4 slices of whole wheat bread each week.
Once per week Jessica consumes French toast.
Fruits: Less than once per month Jessica consumes raisins, apples, and pears. From 1-3
times per month she consumes grapes, bananas, applesauce, watermelon, cantaloupe,
grapefruit, strawberries, blueberries, peaches, pineapple, orange juice, and apple juice or
other 100% fruit juices.

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Vegetables: Jessica does not consume tomato juice, V8 Fusion, cauliflower, beans, peas,
collard greens, kale, yams, sweet potatoes, okra, or onions. Less than once per month she
consumes mixed vegetables, celery, zucchini, summer squash, eggplant, and pasta salad.
From 1-3 times per month she consumes tomatoes, green beans, broccoli, corn, spinach,
peppers, carrots, lettuce, potato salad, and coleslaw.
Main Dishes: Jessica does not consume tofu, soy dishes, veggieburgers, fish sticks, dark
meat fish, shellfish, or liver. Less than once per month she consumes chicken nuggets,
bacon, and sausage. From 1-3 times per month she consumes hamburgers, sloppy Joe,
pizza, turkey tacos, turkey burritos, beef in a mixed or main dish, pork in a mixed or main
dish, beef meatballs, turkey meatloaf, lasagna, and eggs either scrambled, fried, or in a
breakfast sandwich. About once per week she consumes a chicken hot dog and macaroni
and cheese. From 2-4 times per week she has a cheese turkey burger, a pork hot dog, and
spaghetti with tomato sauce. She consumes chicken or turkey as a main dish more than 4
times in a typical week but never with the skin. She also has noodles or pasta without
sauce more than 4 times per week.
Sandwiches: Very rarely does Jessica consume peanut butter sandwiches, roast beef
sandwiches, or tuna sandwiches. From 1-3 times per month she has a ham sandwich.
From 2-4 times per week she has a grilled cheese sandwich. More than 4 times per week
Jessica has a chicken or turkey sandwich.
Snack Foods: Jessica rarely consumes popcorn, peanuts, nuts, energy bars, pudding, or
Hersheys chocolate. From 1-3 times per month she has potato chips, pretzels, trail mix,
graham crackers, crackers, Poptarts, cake, cinnamon rolls, pie, candy bars, Jell-o, frozen
yogurt, sunflower or pumpkin seeds, or jams. About once per week Jessica consumes
Doritos, donuts, brownies, and ice cream. From 2-4 times per week she consumes granola
bars, candy without chocolate, cookies, and Little Debby snack cakes. She has ice pops
more than 4 times per week.
Other: Jessica does not add any sugar to her cereal or beverages. She rarely consumes
cream soups, chowder, mayonnaise, low fat salad dressings, or salsa. From 1-3 times per
month she has clear soup and salad dressing. About once per week she consumes
ketchup.
Evaluation

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Jessicas food intake data reveals are eaten at irregular intervals and represent more snacking
than complete meals. It is important to consider that she is on summer vacation and was having a
friend sleepover during the 3-days I was able to record her intake. Even the timing of her meals
was considerably unusual. When she is in school, as she is for 10 months out of the year, Jessica
typically has a more regular pattern of meals consisting of breakfast before her 7:00AM bus,
lunch at 11:30AM, a snack at 3:00PM, and dinner around 5:30PM. During most of the summer,
Jessica does not have any obligations so she is able to stay up as late as she likes and sleep in as
late as she likes. Her meals therefore are not consumed at consistent times. This evaluation was
simply a snapshot of her overall diet and in my opinion does not reflect a typical intake when
considered annually as the FFQ does. This being said, even the FFQ cannot be entirely relied
upon. The subject cannot be completely accurate in remembering the frequency of each food she
consumed over the course of the past year. I think this is evident in some of the responses. For
example, Jessica stated that she consumes ice pops and popsicles more than 4 times per week.7
The ice pops that are available in the household are only in stores for purchase during the early
spring and summer months. In reality, Jessica only is consuming 4 or more pops per week during
the summer vacation months from June to August. Since I conducted the FFQ in August while
she is consuming pops very regularly she may have overestimated her actual pop intake. Still, the
overall assessment is an excellent tool at evaluating the subjects diet without having access to a
daily food log.
At a strictly anthropometric glance, Jessicas BMI of 19.3 places her in the healthy weight
category. She is in the 48th percentile meaning she weighs more than 48% of other 14 year old
females (BMI Percentile Calculator for Child and Teen). She is at stage 4 in her sexual
maturation rate and has been menstruating normally since the age of 13. This is all very normal
according to the average age of female puberty from 10.5-14 and the average age of menarche
from 10.5-16.5 (Brown 362-3). She does not experience any physical symptoms other than tiring
easily but remains active for at least one hour per day on average. There are some concerns in
regards to Jessicas diet. Based on the three day food intake analysis she does not consume
enough Linoleic Acid, calcium, potassium, copper, iron, magnesium, phosphorous, zinc, Vitamin
A, Vitamin C, Vitamin D, Vitamin E, Vitamin K, Folate, or Choline.2 Jessica also averages an
under consumption of whole grains, vegetables, fruit, dairy, protein, and oils.6 Her intakes of

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added sugar, saturated fat, and refined grain are considerably over her recommended limits as
outlined in Figure 5 below.2,6
500
450
400
350
300

Recommended calories

250

Average calories
consumed

200
150
100
50
0
Added sugar

Saturated fat

Figure 5. Recommended vs. Actual intake of added sugar and saturated fat

The data from the 3-day food intake suggest Jessica does not consume enough Linoleic Acid,
calcium, zinc, or vitamin D. Keeping in mind that the food intake is a snapshot of an entire diet, I
disagree that Jessica is at risk of developing deficiencies to these vitamins and minerals based on
the responses she gave in her food frequency questionnaire. Jessica regularly consumes
vegetable oil, canola oil, and olive oil with her familys meals. She also has a pasta dish as a
main meal more than 4 times per week.7 Plant oils and pasta dishes are excellent sources of
Linoleic Acid (Brown 9). During the 3-day intake she did not have a pasta dish using these plant
oils as she normally does. Jessica consumes 2-3 slices of cheese per day and 2-6 total glasses of
milk per week according to her FFQ. Dairy is an excellent source of calcium (Brown 11). It is
therefore unlikely that Jessica would be deficient in this mineral. Jessica consumes poultry more
than 4 times per week.7 Poultry is a great source of zinc (Brown 11). It is unlikely she is deficient
in zinc. During the 3 days she only consumed chicken once in a main dish. Jessicas household
purchases milk fortified with Vitamin D. She also spends at least 60 minutes outdoors per day.
Since the body is able to produce Vitamin D when exposed to the sun, it is likely that Jessica has
sufficient levels of vitamin D overall.
Jessica does not consume seafood of any sort and even in the course of a year only consumes
nuts less than once per month.7 Fish and nuts are excellent sources of phosphorus, copper, and
Vitamin A (Brown 10). Jessicas RDA for phosphorous, copper and Vitamin A are 1250 mg, 890
ug, and 700 ug respectively per day (Brown A1). In her 3 day record she consumed 852 mg

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phosphorous, 536 ug copper, and 381 ug Vitamin A on average.2 From her 3-day food intake
reports Jessica exhibits deficiencies in Vitamin E, Vitamin K, folate, magnesium, potassium, and
iron.2 All of these nutrients are abundant in green leafy vegetables (Brown 9). Jessicas overall
vegetable consumption in her food intake is about half of her recommended intake. She
consumed an average of 1 cup of vegetables per day out of a recommended 2.5 cups per day. Of
that 1 cup, none came from the dark green leafy vegetables containing the aforementioned
vitamins and minerals.6 These results from the food intake are in line with the FFQ which show
Jessica consuming all listed vegetables at a rate of 1-3 times per month.7 Similar results are
found with Jessicas fruit intake. She consumed only 19 of a recommended 65 mg of Vitamin C
in her food intake report.2 Vitamin C is most abundant in fruit and fruit juices. Jessica reported
consuming the listed fruits in her FFQ at a rate of 1-3 times per month.7 It is likely that she does
not consume enough Vitamin C to meet her bodys needs. The final deficiency Jessica has is in
choline. Choline is most prominently found in eggs. Jessicas RDA for choline is 400 mg (Brown
A1). In her intake report Jessica consumed an average of 147 mg of choline.2 According to her
FFQ, Jessica has eggs 1-3 times per month.7 Fish is another source of choline as is liver and nuts
(Brown 9). Jessica does not consume liver or fish and rarely eats nuts, a choline deficiency is
likely.7
Recommendations
Jessica is at the prime of her pubertal maturation. This is a period of intense growth and
development both physically as well as physiologically. For many, this transition from
adolescents to adulthood marks a trying time. Eating behaviors are easily influenced and
suggestive changes to dietary habits could have potential for detrimental effects as many females
begin to feel uncomfortable in with their bodys changes. They are at high risk of developing an
eating disorder or experiencing intense self-esteem psychological struggles. For these reasons I
would be extremely cautious and contentious in the approach of suggesting dietary changes for
Jessica.
It is clear that she would benefit from decreasing her overall consumption of snack food
items. A decrease in snacking would help eliminate some of the added sugar and saturated fat she
consumes. A reasonable suggestion would be for Jessica to swap out one sugar snack for a
serving of fruit. There is still a sweetness factor but she would also be consuming the Vitamin C
she needs. Another suggestion I would make would be to try eating vegetable pastas in place of
one of the 4 pasta dishes she consumes weekly. Vegetable pastas are becoming more and more
popular and when mixed with a light sauce can closely resemble the texture and taste of normal
pasta! Shredding vegetables into pasta would also be providing potassium, iron, magnesium,
phosphorous, folate, Vitamin A, and Vitamin K she tends to be lacking. It is especially important

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that Jessica increase her iron intake. She already has a medical history of low iron and tires
easily. Her need for iron has increased as a result of her linear growth, increase in blood volume,
and onset of menarche (Brown 372). I would also recommend consuming a side salad of spinach
which is an excellent source of iron with fruit and nut topping at least twice per week. The nuts
would provide Vitamin E and the fruit and vegetables would provide the aforementioned
nutrients. Jessica may want to speak to her pediatrician and parent about the possibility of taking
the Flintstone supplement once again. Although she is not currently anemic the fact that she tires
easily and has begun menstruating as well as her low iron consumption puts her at high risk of
redeveloping iron deficient anemia. Although dietary changes may help to combat this, I think a
supplement would be the most effective way of ensuring a proper iron intake particularly during
this period of intense physiological change. Jessicas low intake of folate is also of concern. Her
body is in need of folate in order to synthesis new DNA, RNA, and proteins during her growth
(Brown 374). The Flintstone supplement could also combat this and ensure Jessica is consuming
the 400 ug RDA for folate daily.
A final change I would suggest is to try consuming one serving of yogurt with fruit and
nuts or granola at least twice per week. This would provide potassium especially if she chose a
banana yogurt. The nuts would provide Vitamin E as well as copper. Allowing Jessica to food
shop and to choose the products she consumes or potentially to even grow the vegetables she
consumes may encourage the dietary changes. Since she is still living at home, incorporating
these vegetables into the familys main dishes would help her to feel like she is less alone and
may deter some negative feelings about her health. As the book suggest, one or two goals is ideal
for a nutritional counseling session (Brown 377). I think Jessicas two goals should be first to
reduce consumption of high sugar, high fat snacks and sodas. Her second goal should be to
consume more plant based foods such as fruits, vegetables, and nuts. I think these are very
attainable and would enhance her overall nutritional health.
References
Brown, Judith E. Nutrition Through the Life Cycle. 5th ed. Stamford: Cengage Learning, 2014.
Print.
"2012 Youth Adolescent Food Frequency Questionnaire." Harvard T.H. Chan School of Public
Health. Nutrition Department, 2012. Web. 6 Aug. 2016.
<https://regepi.bwh.harvard.edu/health/KIDS/files>.

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"BMI Percentile Calculator for Child and Teen." Body Mass Index BMI (BMI) Percentile
Calculator for Child and Teen: Results| DNPAO. National Center for Disease Control and
Prevention, n.d. Web. 18 Aug. 2016. <https://nccd.cdc.gov/dnpabmi/Result.aspx?
&dob=7%2F7%2F2002&dom=8%2F16%2F2016&age=169&ht=65&wt=116&gender=2&meth
od=0&inchtext=0&wttext=0#mean>.
Appendices
See attached.

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