Elsie is an 85-year-old woman who was diagnosed with osteoporosis 15 years ago. In addition to her osteoporosis, she has arthritis and tooth loss secondary to periodontal disease. She also has a history of type 2 diabetes mellitus, hyperlipidemia, and hypertension, which are controlled with medications. Elsie has a complete upper denture and partial lower dentures that were made at her last dental appointment 5 years ago. Elsie is widowed and lives alone. She has two children who visit once every few weeks and help out with grocery shopping and meal preparation. The following clinical information was collected when she visited her primary care provider.
Anthropometric Data:
Height: 163 cm (64”) Weight: 47.7 kg (105 lbs) BMI: 18.1 kg/m2 Weight History Elsie reports a stable weight over the past 3 years.
Biochemical Data:
Hemoglobin A1C 6.8% (4.3-5.8%) Albumin 3.5 (3.5-5.0 g/dL) Prealbumin 16 (17-36 g/dL) Calcium 9 (8.5-10.5 mEq/L) 25-hydroxy vitamin D 20 ng/dL (20-100 ng/dL) Low-density lipoprotein (LDL-C) 125 (Desirable<100mg>
Clinical Data:
Past Medical History: Type 2 diabetes mellitus, hyperlipidemia, hypertension, osteoathritis Medications: Simvastatin, metoprolol, metformin, glipizide, Fosamax, aspirin, calcium carbonate 600 mg with breakfast and lunch, vitamin D3 800 IU daily Vital Signs: Blood pressure: 135/90 mm Hg, Temperature 98.4ºF, heart rate 77 beats/min Nutrition-focused Physical Exam: Appears frail with diminished fat stores and temporal muscle wasting. Skin feels cold to touch. Elsie has a complete upper denture and partial lower denture. Normal tongue noted. Gums appear red and swollen.
Dietary Data:
Dietary History: Elsie has been instructed to follow a carbohydrate-controlled, low–saturated fat, low-sodium diet. Compliance is questionable due to reliance on convenience foods for most meals.
1. How would you describe Elsie’s nutritional status?
2. What are Elsie’s nutritional risk factors?
3. What additional information might you need?