Susan is a 67-year-old white female who works part-time at thelibrary and volunteers at least 10 hours per week. She and herhusband live in a two-story home; her children and grandchildrenvisit every 6 months. She and her husband travel at least twice peryear. She participates in water aerobics and yoga 4 days per weekfor 1 hour each. She will eat lunch at casual dining restaurants atleast four times per week. She consumes three meals per day but isnot eating as much due to recovering from a wrist fracture from afall that happened 2 months ago. For breakfast, she will have ¾ cupof high-fiber cereal with ½ cup skim milk. For lunch, a heavy salad(chicken, cheese, romaine lettuce, vegetables) with light dressing,1 slice of bread or a roll, and 4 ounces of wine. At dinner, shewill have a big bowl of thickened soup/stew with bread or 2–3ounces of fatty fish or meat, 1 cup of salad with light dressing,vegetables, and 4 ounces of wine. She tries to avoid milk-basedfoods due to the gas and bloating it causes and also tries to eatlow-fat/low-salt to avoid gaining weight and increasing her bloodpressure. She has no issues with chewing/swallowing or bowels asidefrom when eating milk-based foods. From her fall, the doctorsperformed a bone mineral density exam, in which her T-scores are asfollows: for the hip: 1.7 (normal is > –1.0); for a vertebra:–2.6 (normal is > –2.5). Susan’s serum vitamin D level is 23nmol/L. Her doctor has placed her on an over-the-counter 500-mgcalcium with vitamin D supplement. She has prehypertension (averageblood pressure of 128/92) and refuses to take any hypertensionmedications. She has lost 5 pounds over the past 2 months.

Height: 5’6”, weight: 122 pounds, weight history: 127 pounds (2months ago)

Questions

1. What do her lab values lead you to believe about her bonestatus?
2. What is her BMI? What is her BMI classification?
3. Is her weight loss a concern to you? Why or why not?
4. What additional questions would you ask Susan regarding hernutritional intake?
5. What are Susan’s calorie, macronutrient, and micronutrientneeds?
6. What are your diet recommendations for Susan?
7. What are your nutritional goals for Susan?