NMDF211 Nutritional Biochemistry
Investigate the major metabolic pathways of the given case including elaborate critical discussion on the role of nutrient cofactors, substrates, hormones and enzymes in succeeding/failing to maintain normal metabolic functions within the body. Explain integration of various biochemical pathways and their correlation with client’s symptoms.
Overview:
The assignment should be structured as a report. The purpose of writing a report is to present information which can be described or analysed. Your report can have headings and subheadings, can include tables, graphs and diagrams; and information can be presented in dot point form where appropriate.
Case Study
Susan is a 44 year old female who has gained 10 Kg over last two years. She is impressed with ‘detox diet’ that she read on an online blog and wants to try it. She loves perfumes. She watches her favourite web series till late night. Based on her biochemical report (see table below), her Nutritionist has suggested to address Gut dysbiosis and liver detox for her at an initial stage of intervention based on her GP’s diagnosis of non-alcoholic fatty liver disease (NAFLD) Her latest Ultrasound showed evidence of fatty infiltration (steatosis).
She experiences:
Fatigue and frequent urination, stress and anxiety, bloating, abdominal pain after foods.
She doesn’t have time to plan meals or cook and often buys take away foods.
When stressed, she drinks alcohol. She does not like fruits/salads.
Her stressful work does not allow her to have fix meal timings.
History: anxiety, food intolerance- shell fish.
Family history:
Father: Liver cancer, Mother: Diabetes Type II
One day Diet recall
(She likes to eat egg, meat and beef. She is trying to avoid processed foods for past one month)
Breakfast: oats with soy milk, orange juice
Mid-morning: black tea with biscuits
Lunch: beef curry with rice
Evening tea/Dinner: pasta Bolognese
Medications: Extensive anti-biotic use at 1 to 4 years (tonsillitis) and 13 to 15 years (mild acne)
Physical And Biochemical Tests:
| Test | Result | Reference Range |
| Blood pressure | 145/92 mm of Hg | Systolic: 110-120 mm/Hg |
| Diastolic: 70 – 80 mm/Hg | ||
| Heart rate | 76 beats per minute | 72-84 beats per minute |
| Respiratory rate | 18 per minute | 12-16 per minute |
| Waist Hip Ratio | 1.4 | <0.8 |
| Temperature | 37.8˚C | 35.8 – 37.3˚C |
| Body mass index (BMI) | 28 kg/m2 | Normal 18.5-24.9 kg/m2 |
| Blood glucose fasting | 7.0 mmol/L | Below 5.5mmol/L |
| Fasting insulin | 16mU/L | Fasting 2 – 12 mU/L |
| 2hr post prandial 5 – 30 mU/L | ||
| Liver tests: | ||
| Albumin | 37 g/L | 34–48 |
| Protein | 72 g/L | 65–85 |
| Total bilirubin | 13 µmol/L | 2–24 |
| GGT | 61 U/L | <60 |
| ALP | 112 U/L | 30–110 |
| ALT | 57 U/L | <55 |
| AST | 50U/L | <45 |
| Total Cholesterol | 5.7mmol/L | Below 4.0mmol/L |
Questions:
- Investigate relevant liver detox pathways in Susan’s case and demonstrate your understanding of the client’s biochemical reports, symptoms and relevant medical/family history. Explain integration/interplay of her gut dysbiosis/microbiome and liver health.
- Based on your research and biochemical analysis, provide two (2) key nutritional/dietary interventions that may benefit this client based on a scientific rationale.
- Suggest one (1) key lifestyle intervention that may benefit this client with a scientific rationale.
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