Frances K.1, Teo SL.1
1Division of Nutrition and Dietetics, School of Health Sciences, International Medical University, Bukit Jalil, Kuala Lumpur.
RBK a 64-year-old Malay woman, was referred to Diet clinic for poor oral intake. She has underlying hyperlipidaemia and diabetes mellitus (DM) with multiple admissions for heart disease. Her current weight is 51.7kg with a BMI of 23kg/m2. She has increased her weight by 5.5% since discharge a month ago. No recent biochemical data was available since. Patient consumes 436 kcal and 19.6g protein over 3 meals. Her intake is supplemented with 1 scoop Nutren Diabetik. She is compliant to a low salt, low fat diet, in addition to her 500ml fluid restriction. RBK attributes her poor appetite to consuming multiple medications although caregiver claims her appetite is comparatively better since discharge. Patient has no oedema, uses a walker, is dependent for food preparation but is able to self-feed without any swallowing or chewing difficulties. She also has the nutrition knowledge to manage her comorbidities and is keen for self-blood glucose monitoring.
Inadequate oral intake RT decreased ability to consume sufficient energy due to decreased appetite caused by taking multiple medications AEB achievement of 34% energy requirement.
The goal consist of optimising oral intake and blood glucose control through the prescription of 1300kcal, 51.7g protein and 500ml fluid. RBK was educated on methods to meet her nutrition requirements by including nutrient-densed foods, increasing her Nutren Diabetik to 6 scoops/day with coffee powder as per her preference, plus incorporating of her favourite foods to stimulate appetite. Intake of sufficient carbohydrates and low sodium diet was emphasized to supply adequate nutrient besides preventing fluid retention recurrence. Continued compliance to fluid restriction was also advised.
Monitoring & Evaluation
Dietary intake, signs of oedema, blood pressure reading, appetite improvement, weight maintenance, blood glucose, renal and lipid profile will be monitored in 1 month. Future management would include managing comorbidities while balancing good quality of life.