yasathribandara

A 35-year-old sedentary male patient weighing 120 kg was experiencing angina (chest pain) and other signs of coronary artery disease. His physician, in consultation with a registered dietician, conducted a 3-day dietary recall. The patient consumed an average of 585 g of car- bohydrate, 150 g of protein, and 95 g of fat each day. In addition, he drank 45 g of alcohol. The patient’s diet is best described by which one of the following?

A. He consumed between 2,500 and 3,000 kcal/day.

B. He had a fat intake within the range recommended in current dietary guidelines (i.e., year 2010).

C. He consumed 50% of his calories as alcohol.

D. He was deficient in protein intake.

E. He was in negative caloric balance.

The answer is B. However, I'm confused on the explanation of the answer D (how did they get the RMR value which is 24 kcal/daylkg and the 2880 kcal?).

Exaplanation: The recommended total fat intake is less than 30% of total calories. His total caloric consumption was 4,110 kcal/day (carbohydrate, 4x585=2,340 kcal; protein, 150x4=600 kcal; fat, 95x9=855 kcal; alcohol, 45x7=315 kcal) (thus, A is incorrect). His fat intake was 21% (855 4,110) of his total caloric intake. His alcohol intake was 7.7% (315/ 4,110) (thus, C is incorrect). His protein intake was well above the RDA of 0.8 g/kg body weight (thus, D is incorrect). His RMR is roughly 24 kcal/day/kg body weight or 2,880 kcal/day (it will actually be less because he is obese and has a greater proportion of metabolically less active tissue than the average 70-kg man). His daily energy expenditure is about 3,744 kcal/day (1.3x2,880) or less. Thus, his intake is greater than his expenditure, and he is in positive caloric balance and is gaining weight (thus, E is incorrect).

Thank you.

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