Kennedy Lu Jian Hua1, Jazlina Syahrul2, Zuriati Ibrahim1
1Department of Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia.
2Department of Dietetics, Hospital Pengajar Universiti Putra Malaysia (HPUPM), Universiti Putra Malaysia.
Cancer patients with poor glycemic control have an increased risk of recurrent cancer events and a higher mortality rate. Nutritional management plays a crucial role in determining the survivability rate and outcomes in diabetic cancer patients.
A 59-year-old retired Malay lady presented with poorly controlled T2DM was referred to the dietetics outpatient clinic for nutrition management.
Upon assessment, patient's weight was 56kg, height 1.64m, normal BMI 21kg/m2 and low lean body mass 20.9kg. Self-monitoring blood glucose shows high reading (post-prandial: 14 mmol/L, which may be attributed to excessive fruit consumption. Patient was moderately malnourished (PG-SGA rating: B) and claimed of having LOA. Patient had low energy and protein intake with energy adequacy ranging between 5261%, with low protein intake (0.5g/kg BW/day, 37% adequacy).
Inadequate protein energy intake related to decreased ability to consume sufficient protein and energy as evidenced by recent lack of interest in food (loss of appetite), estimated energy intake of 730 ‚Äì 850 kcal, energy adequacy of 52-61% and low protein intake (0.5g/kg BW/day, 37% adequacy).
Nutritional intervention aim to achieve 70-75% from energy prescription (1400 kcal) and high protein prescription of 70g/day (20% from total energy; 1.3g/kg/ABW/day) to preserve lean body mass and to optimize blood glucose control. Current ONS (diabetes-specific formula) intake was increased from 2 scoops (1x/day) to 3 scoops, 2x/day. Education on diabetic diet, importance of adequate protein intake, tips to increase appetite and Ramadhan nutrition plan were provided to the patient in view of the upcoming Ramadhan.
Monitoring & Evaluation
After the first visit, patient was aware of her fruits intake and able to control the portion size of fruits. Patients shows an improvement on glycemic control (pre-prandial: 5 – 6 mmol, post-prandial: 9 – 12 mmol/L). Patient’s weight maintained within the range of 56 – 57kg.