CLINICAL CASE STUDY Amalia is a 32-year-old spanic female who was diagnosed with depression 3 years ago by her primary care physician and referred to

CLINICAL CASE STUDY
Amalia is a 32-year-old spanic female who was diagnosed with depression
3 years ago by her primary care physician and referred to the clinic’s psycholo-
gist. Multiple family members suffer from depression in Amalia’s family.
Amalia has been faithfully attending her monthly counseling sessions since
that time and, although her affect has improved somewhat, she feels like she’s
not getting better. In fact, has recently been getting worse. Her chief complaint
is exhaustion, to the extent that she has lost interest in her church work and
social activities that in the past have brought her pleasure. Increasingly she
feels too tired to manage self-care such as cooking. She has been eating fast-
food take out and snacking on ready-to-eat processed foods. Her physician
prescribed an antidepressant, but she stopped taking it some time ago be-
cause she says she does not want to take medication to feel better. Her com-
prehensive metabolic panel is unremarkable; however, a genetic panel reveals
she has a homozygous mutation in the MTHFR C677T gene. The psychologist
has referred her for nutrition and genetic counseling.
Nutrition Diagnostic Statements
Undesirable food choices related to fatigue and depression as evidenced by
consumption of highly processed, nutrient-poor fast foods.
. Altered nutrition-related laboratory value related to personal genetic varia-
tion as evidenced by a mutation in the MTHFR C677T and potential
increased need for B vitamins, especially folate.
Nutrition Care Questions
1. is the difference between a heterozygous and a homozygous muta-
tion in a gene?
2. are your thoughts about what might be causing Amalia’s symptoms
of depression and fatigue?
3. is the significance of having a MTHFR C677T mutation?
4. foods may improve Amalia’s nutrition status, especially foods
that would support her genetic aberration?

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