Andrea Myers KNH 411
Gracie Moore 34 Female 5’5” 180lbs Graduate Student Graduate teaching assistant Married One adopted child, infant
“I just keep gaining weight, no matter what I do! The more weight I gain, the more hair shows up on my body. And I just found out I have sleep apnea and I have to use a CPAP at night!”
Stopped menstruating in college Placed on oral contraceptives Controlled her weight during her undergraduate education through regular physical activity and eating a healthy diet. Maintained weight of 140lbs. Since graduating, she has gained an average of 4lbs per year PCOS symptoms grew worse as she gained weight
Has had two miscarriages Adopted infant girl one year ago Stress of school, job and family have exacerbated her symptoms further and caused her to seek further medical intervention Has had nutrition education 6 years prior to current admission
Diagnosed with Polycystic Ovary Syndrome (PCOS) six years ago PCOS is a health problem that can affect a woman’s menstrual cycle, fertility, hormones, insulin production, heart, blood vessels and physical appearance.
Only affects women Elevated level of androgens (male hormones) Irregular or no menstrual cycle May cause many small cysts to develop in the ovaries The most common hormonal reproductive problem in women of childbearing age
There is not a well-defined diagnostic criteria for PCOS Criteria according to the Androgen Excess Society (2006): hyperandrogenism (clinical or biochemical) ovarian dysfunction (oligomenorrhea or anovulation and/or polycystic ovarian morphology) exclusion of other androgen excess or related disorders
Cause of PCOS is unknown Several factors seem to be linked to PCOS Genetics Body’s ability to make insulin
Symptoms presented: Cessation of menstruation Weight gain Sleep apnea Hirsutism Thinning hair Dandruff Acne Skin tags Acanthosis Nigricans High blood pressure High cholesterol
Bilirubin: 0.41mg/dL ALT: 42U/L HDL-C: 51mg/dL TG:184 mg/dL LDL:132 mg/dL
Complete blood count with: Metabolic panel Lipid panel Thyroid panel with TSH Testosterone level 2 hour GTT
YAZ 1 tablet PO Glucophage 850mg PO Aldactone 100mg/d PO Vaniqua Nutrition consult requested
Gracie’s weight= 180lbs/2.2= 82kg Gracie’s height= 65” x 2.54= 165cm= 1.65m BMI: 82kg/1.65m^2 = 30 kg/m^2
TEE: (10 x 140lbs x 65” – 5 x 34) 1.3 = 2,127 kcal/day Range: 2,100-2,200 kcal/day
Those with PCOS are encouraged to follow a healthy, balanced diet in moderation. One with PCOS should take care to: Limit processed foods and foods containing processed sugars Add more whole grains to their diet Add more fruits and vegetables to their diet add more lean meats to their diet
Breakfast: 8oz. calcium-fortified orange juice, 6 oz. black coffee Snack: 1 cup mixed nuts (salted), 10 oz. unsweetened iced tea Lunch: Cheeseburger and small fries from fast food restaurant, 18 oz. Diet Coke Dinner: 1 ½ cup ham and beans, 2 corn muffins, 12 oz. Diet Coke Snack: Skinny Cow ice cream sandwich
Excessive energy intake related to frequent consumption of high-fat, high kilocalorie foods as evidenced by 24-hour dietary recall and obese BMI of 30 kh/m^2. Physical inactivity related to busy lifestyle and lack of access to facility as evidenced by undesired weight gain of 40 lbs over ten years.
Reduce weight and BMI to normal range by reducing daily kilocalorie intake from 2,500kcal to 2,100-2,200kcal/day and eating balanced meals containing 50% CHO, 20% protein and 30% fat Increase physical activity slowly, starting with 30 minutes 4 times/week and working up to recommended 1 hour/day. Encourage family physical activities, such as daily walks.
With treatment, women with PCOS are usually able to lead normal lives and can become pregnant. National Institute of Health
cle/ htm Nutrition Therapy and Pathophysiology; pg. 501 assistants.advanceweb.com r-publications/fact-sheet/ polycystic-ovary- syndrome.cfm . sue/2004/ / s.htm