This report focuses on the case study of Douglas, discussing his major complaints of osteoporosis, hypertension, and dyslipidemia. It provides a nutritional analysis, treatment goals, and therapeutic recommendations.
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Running head: FOUNDATIONS OF HUMAN NUTRITION FOUNDATIONS OF HUMAN NUTRITION Name of the Student: Name of the University: Author note:
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1FOUNDATIONS OF HUMAN NUTRITION Table of Contents 1. Introduction......................................................................................................................2 2. Discussion........................................................................................................................2 2.1. Case Overview..........................................................................................................2 2.2. Nutrient Deficiencies and Excesses (See Appendices)............................................3 2.3. Treatment Goals........................................................................................................5 2.3.1. Short term Treatment Goals...............................................................................5 2.3.2. Long term Treatment Goals...............................................................................5 2.4. Therapeutic Recommendations................................................................................6 2.4.1. Dietary Recommendations.................................................................................6 2.4.2. Nutrient Corrections..........................................................................................7 2.4.3. Lifestyle Recommendations..............................................................................7 3. Conclusion.......................................................................................................................8 4. References........................................................................................................................9 5. Appendices....................................................................................................................13 5.1. Appendix 1: Nutritional Analysis using Food Works............................................13
2FOUNDATIONS OF HUMAN NUTRITION 1. Introduction The following report focuses on the case study of Douglas. The first section of this report will provide a brief case overview. The second part will focus on the nutritional analysis. Lastly, the report will focus on Douglas’s treatment goals and therapeutic recommendations. 2. Discussion 2.1. Case Overview Douglas’s major presenting complaints are osteoporosis, hypertension and dyslipidemia characterized by excessively high blood levels of LDL cholesterol. Osteoporosis is a chronic bone disease which results in stiffening of the joints, pain and swelling of bone (Khosla & Shane, 2016). Obesity is a major contributing factor underlying the occurrence of osteoporosis, due to the excessive pressure exerted by heavy body weight over one’s weight bearing joints, such as the knees (Greco et al., 2018). Douglas has a Body Mass Index of 32.5 kg/m2, which according to the Department of Health, falls under the category of ‘Obese’ and hence, poses as a key contributing factor for his osteoporotic symptoms (Australian Government, 2019). Douglas’s obesity is a key contributing factor to his hypertension and dyslipidemia. Obesity is associated with increased adiposity leading to endothelial fat deposition, plaque formation resulting in dyslipidemia and increased circulatory force by the heart resulting in hypertension. Douglas’s presentation of hypertensive and dyslipidemia symptoms are key risk factors for future disease acquisition of cardiovascular diseases (Ortega, Value & Blair, 2016). This is due to obesity induced endothelial adiposity resulting in increased inflammation, LDL oxidation, calcium deposition, plaque formation and myocardial infarction due to atherosclerotic cardiac muscle
3FOUNDATIONS OF HUMAN NUTRITION death (Mandviwala, Khalid & Deswal, 2016).As per calculations by the Food Works 9 Software, Douglas’s Estimated Energy Requirements (EER) and Basal Metabolic Rate as per Nutrient Reference Values (NRV) equations and Physical Activity Level (PAL) value of 1.70, are 12760 kJ and 7506 kJ. 2.2. Nutrient Deficiencies and Excesses (See Appendices) It can be observed that Douglas is consuming excesses of B complex Vitamins such as Vitamin B1 (Thiamin), Vitamin B2 (Riboflavin), Vitamin B3 (Niacin) by 146%, 151% and 300% and grossly deficient in vitamin B9 (Folate) by 64% respectively as per percentage values of Estimated Average Requirements (EAR). Douglas has also been found to exhibit nutrient deficiencies of calcium, magnesium and zinc with percentage intakes of 65%, 95% and 67% respectively. Nutrient Imbalances were also observed in terms of proteins (70%), energy (80%) and phosphorous (207%, respectively. Douglas’s nutritional analysis also recorded alarming excesses of sodium intake (189%) of upper intake (UI) percentage values and reduced intake of dietary fiber of 26gm as compared to the average intake (AI) values of 30 gm per day. Douglas has been found to suffer from excessive constipation and is heavily dependent on laxatives hence, indicating a deficient intake of dietary fiber (Wald, 2016). Douglas’s presentation of osteoporotic symptoms of knee pains is further indicative of his deficient intake of dietary calcium (Weaver et al., 2016). Douglas has also been found to face sleep difficulties and frequently has to urinate at night, which is indicative of the hyperglycemic symptoms of diabetes caused by excessive sugar consumption (Varni et al., 2016). His physical symptoms of brittle nails, inflamed tongue and cracks on his mouth corners is indicative of deficient intakes of micronutrients like Vitamin B12 (cobalamin) and Vitamin B9 (folate) (Moll & Davis, 2017). Further, Douglas’s acquisition of hypertension and excessive blood levels of LDL cholesterol are
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4FOUNDATIONS OF HUMAN NUTRITION indicative of his excessive dietary intake of sodium and saturated and trans fats (Gross et al., 2017). One of the first nutritional deficiencies which must be corrected as a first priority is his deficiency if dietary calcium intake since it has resulted in the acquisition of osteoporotic symptoms of joint pain and stiffness. Lack of management of dietary deficiencies of calcium can result in future health implications of bone diseases such as osteoporosis which will result in loss of bone mass and strength resulting in Douglas’s increased susceptibility to acquire fractures in case of future falls and accidents (Kopecky et al., 2016). The second nutritional priority which must be prioritized is his excessive sedum and fat intake since this has already resulted in his symptoms of hypertension and dyslipidemia. Hypertension and high LDL cholesterol will increase Douglas’s susceptibility of chronic cardiovascular diseases such as congestive heart failureandmyocardialinfarction(Estruchetal.,2018).Douglashasexhibiteddiabetic symptoms of nocturnal urination which indicates that his high dietary intake of sugar must be next prioritized. High dietary sugar consumption will further add to Douglas’s disease burden in the future since the resultant diabetes will lead to metabolic changes, altered lipid metabolism andincreaseddyslipidemiaandhypertensionfurtheraggravatingthefutureincidenceof cardiovascular diseases (Sánchez-Romero et al., 2016). Douglas’s folate and vitamin B12 deficiency must also be mitigated since lack of mitigation of the same has resulted in his acquisition of anemic symptoms associated with this micronutrient imbalances which will result in future symptoms of tiredness, fatigue and skin and tongue alterations (Achebe & Gafter-Gvili, 2017). His dietary deficiency of fiber must be corrected since it increases his future disease of constipation and possibility of colon cancer and gastrointestinal bleeding (Barichella et al., 2016).
5FOUNDATIONS OF HUMAN NUTRITION 2.3. Treatment Goals 2.3.1. Short term Treatment Goals 1.Improve fiber intake by increasing intake by 5grams and enhance regularization of bowel movements within the next 2 weeks. 2.Reduce diabetic symptoms and improve sleep duration by limiting sugar intake to no more than 1 teaspoon per day within the next 2 weeks. 3.Reduce joint pain and stiffening by increasing dietary calcium intake by 500 grams within the next 2 weeks. 4.Reduce high blood pressure and LDL cholesterol levels by reducing processed food consumption and limiting table salt consumption to no more than 2 grams per day and replacing saturated fat with unsaturated fat consumption within the next 2 weeks. 5.Reducing the symptoms of anemia by increasing the intake of vitamin B12 and Vitamin B9 to 7μg and 320 to 400μg per day within the next 2 weeks 2.3.2. Long term Treatment Goals 1.Reduce the risk of metabolic and cardiovascular diseases by encouraging a weight loss of 10% within the next 6 months. 2.Improve mobility and reduce the risk of fractures and falls through incorporation of resistance training and enhancing calcium and Vitamin D intake within the next 6 months. 3.Encourage the intake of a balanced diet through incorporation of core food groups and prevention of processed food consumption resulting in positive health outcomes and chronic disease risk prevention within the next 6 months.
6FOUNDATIONS OF HUMAN NUTRITION 2.4. Therapeutic Recommendations 2.4.1. Dietary Recommendations 1.It is recommended that Douglas reduce his high sodium intake which can be done by reducing his table salt intake to 2 grams per day and avoiding consumption of salty processed food products. Hypertensive symptoms associated with high sodium intake resulting in aggravation of Douglas’s genetic and physiological cardiovascular disease is the primary rationale (Gab et al., 2016). 2.Douglas must be recommended to replace his processed food and alcohol consumption with healthier, homemade choices. The former is rich in saturated and Trans fats and results lipid metabolism hindrances which will increase his existing high LDL levels. Dyslipidemia as a risk factor for cardiovascular risk is the rationale behind intervention (Li et al., 2016). 3.Douglas must be recommended to reduce his intake of sugar. High sugar results in diabetic symptoms as already observed in Douglas which further results in increased cardiovascular disease risk (Kumar et al., 2016). 4.Douglas must increase his consumption of Vitamin C foods such as citrus fruits since these will aid in the absorption of folate and iron and eradicate his anemia symptoms (Htet et al., 2016). 5.He must be recommended to increase his sunlight exposure and increase Vitamin D rich food consumption of eggs, fortified butter, mushroom and fatty fish since this will increasehisdietaryabsorptionofcalciumandreducehisosteoporoticsymptoms (Veldurthy et al., 2016).
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7FOUNDATIONS OF HUMAN NUTRITION 6.According to the Australian Dietary Guidelines, individuals must consume a balanced diet rich in core food groups of grain, dairy, legumes, lean meats, fruits and vegetables and unsaturated oils which will prevent deficiencies and result in positive life outcomes. Following this rationale Douglas must be recommended to consume a balanced diet adequate in all foods (Malek et al., 2016). 2.4.2. Nutrient Corrections 1.Douglas must correct his calcium deficiencies by consuming low fat dairy, green leafy vegetables, nuts and seeds to prevent his risk of osteoporosis (Rosen et al., 2017). 2.Douglas must increase his intake of foods rich in Vitamin B9 and B12 which include green leafy vegetables, legumes, beets, eggs, broccoli, Brussels sprouts, milk products and lean meats. This will correct his deficiencies and alleviate his symptoms of anemia as observed in the case study (Paul & Selhub, 2017). 3.Douglas must increase his consumption of dietary fiber rich foods such as whole grains, green leafy vegetable and whole fruits since this will improve his constipation and future risk of colon cancer and cardiovascular disease risk (Song et al., 2018). 4.Douglas must improve his protein intake my consuming vegetarian and lean protein sources since this will increase his satiety, improve his insulin sensitivity and aid in improving his lean body mass, metabolic rate and tissue repair due to obesity induced oxidative stress (Crujeiras et al., 2016). 2.4.3. Lifestyle Recommendations 1.It is recommended that Douglas modify his physical activity by incorporating mild resistance training which will reduce his knee pain and improve bone strength. This
8FOUNDATIONS OF HUMAN NUTRITION accompanied by balanced diet consumption will also result in weight reduction and chronic disease prevention (Pagnotti et al., 2019). 2.Douglas must also avoid or reduce his daily consumption of alcohol to no more than 6 pints per week since the same can increase levels of oxidative stress, induce obesity and increase cardiovascular disease risk (Bellis et al., 2016). 3. Conclusion To conclude, Douglas must aim to correct his B vitamin, calcium and fiber deficiencies, consume a balanced diet, reduce salt, sugar, fat and alcohol intake and incorporate lifestyle changes for better health outcomes.
9FOUNDATIONS OF HUMAN NUTRITION 4. References Achebe, M. M., & Gafter-Gvili, A. (2017). How I treat anemia in pregnancy: iron, cobalamin, and folate.Blood,129(8), 940-949. Australian Government. (2019). Body mass index (BMI) | Healthy Weight Guide. Retrieved fromhttp://healthyweight.health.gov.au/wps/portal/Home/get-started/are-you-a-healthy- weight/bmi/. Barichella, M., Pacchetti, C., Bolliri, C., Cassani, E., Iorio, L., Pusani, C., ... & Caccialanza, R. (2016). Probiotics and prebiotic fiber for constipation associated with Parkinson disease: An RCT.Neurology,87(12), 1274-1280. Bellis, M. A., Hughes, K., Nicholls, J., Sheron, N., Gilmore, I., & Jones, L. (2016). The alcohol harm paradox: using a national survey to explore how alcohol may disproportionately impact health in deprived individuals.BMC public health,16(1), 111. Crujeiras, A. B., Zulet, M. A., Abete, I., Amil, M., Carreira, M. C., Martínez, J. A., & Casanueva, F. F. (2016). Interplay of atherogenic factors, protein intake and betatrophin levels in obese–metabolic syndrome patients treated with hypocaloric diets.International Journal of Obesity,40(3), 403. Estruch, R., Ros, E., Salas-Salvadó, J., Covas, M. I., Corella, D., Arós, F., ... & Lamuela- Raventos,R.M.(2018).Primarypreventionofcardiovasculardiseasewitha Mediterraneandietsupplementedwith extra-virginolive oilor nuts.New England Journal of Medicine,378(25), e34.
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10FOUNDATIONS OF HUMAN NUTRITION Gabb, G. M., Mangoni, A. A., Anderson, C. S., Cowley, D., Dowden, J. S., Golledge, J., ... & Schlaich, M. (2016). Guideline for the diagnosis and management of hypertension in adults—2016.Medical Journal of Australia,205(2), 85-89. Greco, E. A., Fornari, R., Lenzi, A., & Migliaccio, S. (2018). Obesity and Osteoporosis: Is the ParadigmChanging?.InMultidisciplinaryApproachtoOsteoporosis(pp.143-152). Springer, Cham. Grosso, G., Marventano, S., Yang, J., Micek, A., Pajak, A., Scalfi, L., ... & Kales, S. N. (2017). A comprehensive meta-analysis on evidence of Mediterranean diet and cardiovascular disease:areindividualcomponentsequal?.Criticalreviewsinfoodscienceand nutrition,57(15), 3218-3232. Htet, M. K., Fahmida, U., Thurnham, D. I., Hlaing, L. M., Akib, A., Utomo, B., & Houghton, L. A. (2016). Folate and vitamin B 12 status and dietary intake of anaemic adolescent schoolgirls in the delta region of Myanmar.British Journal of Nutrition,116(S1), S36- S41. Khosla, S., & Shane, E. (2016). A crisis in the treatment of osteoporosis.Journal of Bone and Mineral Research,31(8), 1485-1487. Kopecky, S. L., Bauer, D. C., Gulati, M., Nieves, J. W., Singer, A. J., Toth, P. P., ... & Weaver, C.M.(2016).LackofevidencelinkingcalciumwithorwithoutvitaminD supplementation to cardiovascular disease in generally healthy adults: a clinical guideline from the National Osteoporosis Foundation and the American Society for Preventive Cardiology.Annals of internal medicine,165(12), 867-868.
11FOUNDATIONS OF HUMAN NUTRITION Kumar, K., Greenfield, S., Raza, K., Gill, P., & Stack, R. (2016). Understanding adherence- related beliefs about medicine amongst patients of South Asian origin with diabetes and cardiovascular disease patients: a qualitative synthesis.BMC endocrine disorders,16(1), 24. Li, Z., Bai, Y., Guo, X., Zheng, L., Sun, Y., & Roselle, A. M. (2016). Alcohol consumption and cardiovascular diseases in rural China.International journal of cardiology,215, 257-262. Malek, L., Umberger, W., Makrides, M., & Zhou, S. J. (2016). Adherence to the Australian dietary guidelines during pregnancy: evidence from a national study.Public health nutrition,19(7), 1155-1163. Mandviwala, T., Khalid, U., & Deswal, A. (2016). Obesity and cardiovascular disease: a risk factor or a risk marker?.Current atherosclerosis reports,18(5), 21. Moll, R., & Davis, B. (2017). Iron, vitamin B12 and folate.Medicine,45(4), 198-203. Ortega, F. B., Lavie, C. J., & Blair, S. N. (2016). Obesity and cardiovascular disease.Circulation research,118(11), 1752-1770. Pagnotti, G. M., Styner, M., Uzer, G., Patel, V. S., Wright, L. E., Ness, K. K., ... & Rubin, C. T. (2019).Combatingosteoporosisandobesitywithexercise:leveragingcell mechanosensitivity.Nature Reviews Endocrinology, 1. Paul,L.,&Selhub,J.(2017).InteractionbetweenexcessfolateandlowvitaminB12 status.Molecular aspects of medicine,53, 43-47. Rosen, H. N., Rosen, C. J., Schmader, K. E., & Mulder, J. E. (2017). Calcium and vitamin D supplementation in osteoporosis.
12FOUNDATIONS OF HUMAN NUTRITION Sánchez-Romero, L. M., Penko, J., Coxson, P. G., Fernández, A., Mason, A., Moran, A. E., ... & Bibbins-Domingo, K. (2016). Projected impact of Mexico’s sugar-sweetened beverage taxpolicyondiabetesandcardiovasculardisease:amodelingstudy.PLoS medicine,13(11), e1002158. Song, M., Wu, K., Meyerhardt, J. A., Ogino, S., Wang, M., Fuchs, C. S., ... & Chan, A. T. (2018). Fiber intake and survival after colorectal cancer diagnosis.JAMA oncology,4(1), 71-79. Varni, J. W., Delamater, A. M., Hood, K. K., Driscoll, K. A., Wong, J. C., Adi, S., ... & Kichler, J. C. (2018). Diabetes management mediating effects between diabetes symptoms and health‐relatedqualityoflifeinadolescentsandyoungadultswithtype1 diabetes.Pediatric diabetes,19(7), 1322-1330. Veldurthy, V., Wei, R., Oz, L., Dhawan, P., Jeon, Y. H., & Christakos, S. (2016). Vitamin D, calcium homeostasis and aging.Bone research,4, 16041. Wald, A. (2016). Constipation: advances in diagnosis and treatment.Jama,315(2), 185-191. Weaver, C. M., Alexander, D. D., Boushey, C. J., Dawson-Hughes, B., Lappe, J. M., LeBoff, M. S., ... & Wang, D. D. (2016). Calcium plus vitamin D supplementation and risk of fractures:anupdatedmeta-analysisfromtheNationalOsteoporosis Foundation.Osteoporosis International,27(1), 367-376.
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13FOUNDATIONS OF HUMAN NUTRITION 5. Appendices 5.1. Appendix 1: Nutritional Analysis using Food Works 24 hour Food Analysis for Douglas DESCRIPTION Douglas is a 73 year old man with a moderately active lifstyle of weekly cricket and Obese BMI of 32.5 FOODS 20-mar-19 Breakfast .Uncle Tobys Vita-brits [Breakfast cereal]3 biscuit Milk,Fluid,Skim/Nonfat(Fat<0.16%)200 mL Sugar,Raw2 tsp Banana,Common,Raw1 small (<12cm long) Tea,black,brewed from leaf/teabags,regular180 mL Sugar,Raw2 tsp Snack Coffee,instant,regular,dry powder15g Sugar,Raw2 tsp Milk,Fluid,Skim/Nonfat(Fat<0.16%)30 mL Biscuit,Anzac,Commercial2 round biscuit (6cm dia) Lunch Ham,Shoulder(No Separable Fat),Pre-Packed/Deli-Sliced2 medium slice (~7.5x5x0.6cm) Lettuce,Common,Raw50g Bread,White4 regular sandwich slice (crust left) Margarine Spread,Reduced Fat(~ 50%Fat),Poly,Red Salt2 tb Tomato,Raw2 thin slice Carrot,Raw1 cup (grated) Tea,black,brewed from leaf/teabags,regular180 mL Sugar,Raw2 tsp Snack Beer,Reduced Alcohol(1.15-3.5%V/V Alcohol)500 mL Peanut,Dry Roasted,Salted2 serve (10 nuts)
14FOUNDATIONS OF HUMAN NUTRITION Dinner Lasagne,Meat,Commercial1 unsp serve Wine,White,Dry2 wine glass(150ml) Ice Cream,Regular Fat,Vanilla,No Additions2 level scoops (5.7cm dia) Fruit Salad,Canned In Light Syrup2 tb ANALYSIS SUMMARY Avg/DayEAREAR(%)Alerts Weight (g)2305 Energy (kJ)7970 Protein (g)628970%<EAR, <RDI Total fat (g)57 - Saturated fat (g)18 - Polyunsaturated fat (g)15 - Monounsaturated fat (g)20 Cholesterol (mg)88 Carbohydrate (g)208 - Sugars (g)94 Starch (g)113 Water (g)1872<AI Alcohol (g)39 Dietary fibre (g)26<AI, <SDT Thiamin (mg)1.461.00146% Riboflavin (mg)1.961.30151% Niacin (mg)29.77 Niacin equivalents (mg)41.0512.00342% Vitamin C (mg)48.0030.00160%<SDT Total folate (ug)204.76320.0064%<EAR, <RDI, <SDT Total vitamin A equivalents (ug)2624.34625.00420% Retinol (ug)563.62 Beta carotene equivalents (ug)12361.50 Sodium (mg)2503.70>UL, >SDT Potassium (mg)2931.35<AI, <SDT Magnesium (mg)331.43350.0095%<EAR, <RDI Calcium (mg)713.091100.0065%<EAR, <RDI Phosphorus (mg)1203.14580.00207% Iron (mg)10.006.00167% Zinc (mg)8.0012.0067%<EAR, <RDI Kj from protein (%)13 Kj from fat (%)27 Kj from saturated fat (%)8 Kj from carbohydrate (%)43 Kj from alcohol (%)14 Kj from fibre (%)3
15FOUNDATIONS OF HUMAN NUTRITION Kj from others (%)0 Fat as mono (%)37 Fat as poly (%)28 Fat as saturated (%)34 NRVs based on: Male, 73years, 103kg, 178cm, Light-Moderate Activity
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16FOUNDATIONS OF HUMAN NUTRITION ESTIMATED AVERAGE REQUIREMENT (EAR) Avg/DayEAREAR(%) Protein (g)628970% Thiamin (mg)1.461.00146% Riboflavin (mg)1.961.30151% Niacin equivalents (mg)41.0512.00342% Vitamin C (mg)48.0030.00160% Total folate (ug)204.76320.0064% Total vitamin A equivalents (ug)2624.34625.00420% Magnesium (mg)331.43350.0095% Calcium (mg)713.091100.0065% Phosphorus (mg)1203.14580.00207% Iron (mg)10.006.00167% Zinc (mg)8.0012.0067% NRVs based on: Male, 73years, 103kg, 178cm, Light-Moderate Activity
17FOUNDATIONS OF HUMAN NUTRITION RECOMMENDED DIETARY INTAKES (RDI) Avg/DayRDIRDI(%) Protein (g)6211056% Thiamin (mg)1.461.20121% Riboflavin (mg)1.961.60123% Niacin equivalents (mg)41.0516.00257% Vitamin C (mg)48.0045.00107% Total folate (ug)204.76400.0051% Total vitamin A equivalents (ug)2624.34900.00292% Magnesium (mg)331.43420.0079% Calcium (mg)713.091300.0055% Phosphorus (mg)1203.141000.00120% Iron (mg)10.008.00125% Zinc (mg)8.0014.0057% NRVs based on: Male, 73years, 103kg, 178cm, Light-Moderate Activity
18FOUNDATIONS OF HUMAN NUTRITION ADEQUATE INTAKE (AI) Avg/DayAIAI(%) Water (g)1872340055% Dietary fibre (g)263088% Sodium (mg)2503.70460.00544% Potassium (mg)2931.353800.0077% NRVs based on: Male, 73years, 103kg, 178cm, Light-Moderate Activity UPPER LEVEL OF INTAKE (UL) Avg/DayULUL(%) Retinol (ug)563.623000.0019% Sodium (mg)2503.702300.00109% Calcium (mg)713.092500.0029% Phosphorus (mg)1203.143000.0040% Iron (mg)10.0045.0022% Zinc (mg)8.0040.0020% NRVs based on: Male, 73years, 103kg, 178cm, Light-Moderate Activity
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19FOUNDATIONS OF HUMAN NUTRITION SUGGESTED DIETARY TARGETS (MINIMUMS) Avg/DaySDT-Min(%) Dietary fibre (g)263869% Vitamin C (mg)48.00220.0022% Total folate (ug)204.76300.0068% Total vitamin A equivalents (ug)2624.341500.00175% Potassium (mg)2931.354700.0062% NRVs based on: Male, 73years, 103kg, 178cm, Light-Moderate Activity SUGGESTED DIETARY TARGETS (MAXIMUMS) Avg/DaySDT-Max(%) Sodium (mg)2503.701600.00156% NRVs based on: Male, 73years, 103kg, 178cm, Light-Moderate Activity GOALS (MINIMUMS) Unable to show graph - invalid values