IUCD'21 ABSTRACT BOOK

IN-PATIENT CATEGORY (IPD)

Name : Chong Koy Seong

Institution : International Medical University (IMU)

Title: Transitional feeding in a post-stroke patient

Background: Post-stroke patients often experience dysphagia and poor consciousness which impairs
their ability to consume adequate nutrition. Nutrition support is required to prevent deterioration in
nutritional status and improve clinical outcomes.

Nutrition Assessment: Mrs. S, a 60-year-old Indian woman was admitted on 3 rd March due to
recurrent cardiovascular accident (CVA) with right middle cerebral artery infarction, acute kidney injury
(AKI) secondary to dehydration and hypoglycemia secondary to poor oral intake. She has underlying
hypertension, diabetes, dyslipidemia, and CVA in 2019. She was presented with slurred speech and
poor consciousness upon admission and history of poor oral intake. Nasogastric (NG) feeding tube in
situ upon admission due to possibly compromised swallowing function. Bolus feeding was initiated
before dietitian visit with diabetes-specific formula and progressively increased from 50 ml to 120 ml
per feeding to optimise nutrition intake. All feedings were well-tolerated. Estimated intake on admission
day was 470.0 kcal (30% ER) with 20.9 g protein (32% PR). Dietitian visited a day after admission.

Nutrition Diagnosis: Inadequate enteral nutrition infusion RT feeding advancement in progress AEB
intake of 30% energy requirement and 32% protein requirement.

Nutrition Intervention: The goal of management was to meet the nutrient needs and preserve
nutritional status through provision of enteral feeding. The nutrient prescription was 1600 kcal/day and
65 g protein. NG feeding regime was maintained using diabetes-specific formula, achieving 250 ml per
feeding, 5 times daily, providing 1530 kcal (96% ER) 68 g protein (105% PR).

Nutrition Monitoring and Evaluation: The feeding advancement along with total energy, protein and
fluid intake was monitored, aiming to achieve at least 80% of prescription within two days. Feeding
tolerance was monitored through signs of aspiration, abdominal distention, and diarrhea. The progress
in functional status, swallowing function and biochemical parameters such as renal profile and glucose
value were monitored.

Follow up: Mrs. S achieved full feeding within 24 hours and progressed to oral intake after passing
swallowing test. She managed to consume soft diet although minimal due to poor appetite from the
recovery of CVA. Estimated intake was 525 kcal (33% ER) and 18 g protein (28% PR). Supervised meals of
soft diet and oral nutrition supplement (ONS) of diabetes-specific formula and modular protein was
prescribed 3 times daily to complement food intake.

Conclusion: Transitioning from enteral nutrition to oral feeding in post-stroke patients with recovering
swallowing function should be done using strategies such as texture-modified diet and ONS to optimise
nutrition intake.

Keywords: transitional feeding, stroke, enteral nutrition, oral nutrition supplement, swallowing function

51

IN-PATIENT CATEGORY (IPD)

Name : Nabihah Iman Binti Abdul Razak

Institution : Universiti Kebangsaan Malaysia (UKM)

Title: Nutrition management for cerebral toxoplasmosis and sacral sore grade II with underlying RVD
AIDS

Background: Cerebral toxoplasmosis is an infection caused by ubiquitous obligatory intracellular
apicomplexa parasite called Toxoplasma gondii. Cerebral toxoplasmosis is most common in HIV/AIDS
patients and extremely rare in immunocompetent individuals. Poor energy intake and increased
resting energy expenditure during bacterial and/or systemic opportunistic infections may contribute
to weight loss and malnutrition in person living with AIDS.

Nutrition Assessment: Patient is a 40 years-old, Malay male, admitted into ward due to cerebral
abscess presented with altered sensorium. Patient was treated with Bacterial abscess/TB Meningitis
initially and then was diagnosed with Cerebral Toxoplasmosis with focal seizures. Patient’s underlying
diseases included RVD with AIDS and history of smear +ve PTB. Patient previously was on RT feeding
for 4 days and has been off as patient need to go for OGDS procedure due to coffee ground aspirate
in RT (30cc). Patient then was diagnosed with esophageal tear 2° to traumatic RT insertion. Therefore,
CVL was inserted and patient was on TPN. Patient then was also diagnosed with MSSA Bacterimia 2° to
CVL. Hence, TPN was off and patient was scheduled for RT insertion via OGDS. He was referred to
dietitian for stepping up RT feeding due to re-initiation of tube feeding. During assessment, the BMI is
23.4 kg/m² and patient has grade II sacral sore due to long stay in hospital. He only receives 255 kcal
from IVD.

Nutrition Diagnosis: The nutrition diagnosis is inadequate protein-energy intake related to re-
initiation of tube feeding as evidenced by minimum calorie received from IVD (255 kcal) following
termination of TPN.

Nutrition Intervention: The objectives of the intervention are to optimize energy and protein
provision by RTF feeding and to promote wound healing.

Nutrition Monitoring and Evaluation: Feeding tolerance, renal profile, blood sugar level and I/O
chart monitoring were done on patient.

Conclusion: In conclusion, adequate energy and protein is crucial to improve an individual’s immune
function, prevent malnutrition, reduce disease complication and enhance quality of life in
immunocompromised patients.

Keywords: cerebral toxoplasmosis, AIDS, immunosuppressed, sacral sore, enteral nutrition

52

IN-PATIENT CATEGORY (IPD)

Name : Tri Hidayat, Olivia Anggraeny, Adji Hambali

Institution : Universitas Brawijaya

Title: Nutrition care process for patients with chronic kidney disease stage V, glomerulus disease,
suspected urinary tract infection, autoimmune hemolytic anemia on systemic lupus erythematosus,
short stature, renal anemia, and continuous ambulatory peritoneal dialysis at Saiful Anwar Hospital
Malang

Background: Chronic kidney disease’s (CKD) prevalence currently reaches 13% worldwide, and this
disease causes 12 deaths out of 100,000 people. Hemodialysis and continuous ambulatory peritoneal
dialysis (CAPD) are one way to remove waste products from the blood in very-low kidney function
conditions with a declining estimated Glomerular Filtration Rate or less than 15ml/minute. However,
inappropriate nutrition management can lead to the risk of malnutrition and complications, especially
in children.

Nutrition Assessment: In this case report, an 8-year-old girl had a history of twice- weekly
hemodialysis since December 2020. During observation, the patient appeared weak. Nutrition
screening was using STRONGkids with a score of 4 indicated a high malnutrition risk. The patient’s
nutritional status based on the weight for age (2000 CDC growth charts) was p50. Laboratory results
showed hemoglobin 11g/dl, erythrocytes 3.78x10 6 L, neutrophils 81.4%, lymphocytes 12.7%, urea
27.1mg/dl, creatinine 1.3 mg/dl, uric acid 0.9 mg/dl, potassium 2.42 mmol/L, and proteinuria (3+).
Blood pressure 100/170mmHg, respiratory rate 24x/minute, heart rate 91x/bpm, and fluid balance
-135 cc/24 hours were known.

Nutrition Diagnosis: The nutrition diagnosis problems based on ICD-10 found in this case were
increased nutritional requirements (protein), decreased fluid requirements, inadequate oral intake,
changes in nutritional-related laboratory values, and unexpected weight loss.

Nutrition Intervention: The nutrition intervention aimed to provide food without aggravating kidney
function, improve nutritional status, and regulate fluid and electrolyte balance. Basal energy
expenditure was based on ideal body weight (Recommended Dietary Allowance). The patient was
given the standard form of Hemodialysis II diet orally with a frequency of 3x main meals, 1x side dish
of milk from the hospital, and 2x150 g of Nephrisol. In addition, to motivate patients to achieve their
nutrition requirements, dietitians use toys and games as a tool in the approach process according to
the child's psychological condition.

Nutrition Monitoring and Evaluation: The monitoring and evaluation results for three days of
observation revealed that the patient's food intake had met the target of 80% of the
requirement.

Conclusion: Careful nutrition management coupled with food assistance according to the child's
psychological condition must be done thoroughly to avoid worsening nutrition status in children with
chronic kidney disease.

Keywords: chronic kidney disease, CAPD, nutrition care process

53

IN-PATIENT CATEGORY (IPD)

Name : Desty Ervira Puspaningtyas

Institution : Universitas Gadjah Mada (UGM)

Title: High-energy high-protein diet improve nutrient intake and symptoms in patients with post-
herpetic neuralgia

Background: Post-herpetic neuralgia is a complication that often occurs after Herpes Zoster infection.
It is a pain sensation in the head caused by nerve damage caused by Varicella Zoster. Poor intake and
poor nutritional status are triggers for recurrent herpes with neuralgia. Proper nutritional intervention
is needed in the management of post-herpetic neuralgia.

Nutrition Assessment: A 27-year-old man patient diagnosed with post-herpetic cephalic neuralgia
came with complaints of headache, persistent pain, vomiting, red spots on the abdomen and waist,
and chewing difficulty. Nutritional assessment indicated that patient was undernourished (MUAC of 22
cm), elevated neutrophils and decreased lymphocytes, inadequate intake (<80% of nutritional needs)
accompanied by poor dietary habit (consumption of instant noodles 3 times /day plus restriction of
animal protein with the aim of increasing body weight).

Nutrition Diagnosis: The nutrition diagnosis selected for the patient were NI-2.1 inadequate oral
intake, NI-5.1 increased energy and protein requirements, and NB-1.2 incorrect behaviour and beliefs
related to food and nutrients.

Nutrition Intervention: Patient was given soft high energy high protein containing 1987.1 kcal of
energy; 64.2 grams of protein; 44.2 grams of fat; and 333.27 grams of carbohydrate. Patient was also
given nutrition education and counselling on various topics including the role of energy and protein in
supporting healing, improving nutritional status and preventing herpes recurrence, which are aimed
at improving diet behaviour post discharge.

Nutrition Monitoring and Evaluation: During hospitalization, patient’s energy and macronutrient
intake increased significantly. In addition, the patient also stated that there was reduction in heat and
pain in the abdomen, waist area and less frequent headache.

Conclusion: In conclusion, high-energy high-protein diet improve nutrient intake and symptoms in
undernourished patient with recurrent herpes.

Keywords: post-herpetic neuralgia, high energy, high protein, headache, recurrent herpes

54

IN-PATIENT CATEGORY (IPD)

Name : Atiqah Najihah

Institution : Universiti Sains Malaysia (USM)

Title: Nutritional management of necrotizing fasciitis, diabetes mellitus and acute kidney injury

Background: National Health Morbidity and Survey 2019 has highlighted on 3.9 million Malaysian
aged 18 years above have diabetes, albeit 9.4% of them did not know that they have diabetes. Without
adequate awareness of diabetes implications and consequent poor dietary knowledge and practices,
some patients experience diabetic foot complications associated with poorly controlled glucose levels,
including necrotizing fasciitis and infections.

Nutritional Assessment: 54 years-old Malay male was admitted to orthopedic ward after being
diagnosed with type 2 diabetes mellitus, right foot necrotizing fasciitis, acute kidney injury, and
undergone below-knee amputation on the right side. He is 50.4 kg with a height of 162 cm and
significant weight loss, 3.7% in a week is reported. His white blood cell, urea, and capillary blood sugar
are high while his hemoglobin level is low. He is currently on insulin both Actrapid and Insulatard 8
units. He claims loss of appetite since last week, hence he has poor oral intake and currently tolerates
a minimal amount of diet. Previously at home, he had improper meal time patterns and carbohydrate
distribution, imbalanced meals, inadequate vegetable intake, excessive fruit intake, and frequent
sugary drink intake.

Nutrition Diagnosis: He is diagnosed with inadequate protein-energy intake and inconsistent
carbohydrate intake.

Nutrition Intervention: He has been educated on diabetic diet which emphasizes proper mealtime
and encourages taking orally as tolerated.

Nutrition Monitoring and Evaluation: His dietary compliances, biochemical and clinical updates are
monitored and evaluated.

Follow up: No recent weight loss is reported while his biochemical result of capillary blood sugar is
normal and improving. His appetite level is improving, and continues the current medication. He has
good compliance towards the recommendation given and his oral intake has improved. Thus, the
diagnosis of inadequate protein-energy intake is unresolved but improving while inconsistent
carbohydrate intake has resolved. As intervention, he has been educated on diabetic diet at home
which emphasizes on healthy balanced diet, proper carbohydrate distribution, and fruit intake, and
limits the sugary drink intake. His dietary compliances, biochemical and clinical updates will be
monitored and evaluated.

Conclusion: Clinically, this case report emphasizes both health professionals and patients to
understand the importance of diet which helps in diabetes management and better quality of life.

Keywords: endocrinology diabetes implication, diabetic diet

55

IN-PATIENT CATEGORY (IPD)

Name : Ratna Kusuma Ningrum

Institution : Universitas Gadjah Mada (UGM)

Title: Nutrition and dietetic therapy in patient with Covid-19 pneumonia, coagulopathy, acute renal
failure and acute respiratory distress syndrome

Background: COVID-19 is an emerging infectious disease which treatment options, particularly from
nutrition and dietetics perspectives are still limited. Thus, cautious steps in providing nutrition
intervention is essential to ensure the best outcome for the patients.

Nutrition Assessment: A 77 year old male admitted with frequent coughing, anorexia, and asthenia.
Medical diagnosis were COVID-19 Pneumonia, Coagulopathy, Acute Renal Failure and Acute
Respiratory Distress Syndrome. Patient had a history of poor water intake, but frequent consumption
of tea and coffee ranging up to 6 cups/day. Based on 24 recall during admission, patient had adequate
intake and were able to consume all prescribed diet. However, current nutritional status remain
suboptimal for elderly (BMI 19,3 kg/m2) and at risk of malnutrition. Lab tests indicated infection,
respiratory alkalosis, and altered kidney function.

Nutrition Diagnosis: Nutritional diagnosis were increased energy requirement due to
hypercatabolism and infection as evidenced by elevated leucocyte, CRP and COVID19 positive,
decreased protein need due to acute renal failure as indicated by elevated BUN and creatinine.

Nutrition Intervention: Patient was then prescribed 30 Kcal/Kg BW + 300 Kcal to cover for
malnutrition risk. Protein was given at 0.75g/kg BW due to kidney failure. Fat and carbohydrate were
given at a ratio of 35:65 percents to reduce endogenous CO2 production. Sodium and potassium were
limited at 1500mg and 40mg, respectively. Patient were able to consume >80% of the prescribed diet.

Nutrition Monitoring and Evaluation: Three days afterwards, patient showed consecutive negative
COVID19 test results, improved symptoms and lab results and was discharged from the hospital.

Conclusion: In conclusion, a relatively restrictive diet was well tolerated and effective in aiding the
recovery of patients with COVID19 pneumonia, Acute Renal Failure and Acute Respiratory Distress
Syndrome.

Keywords: covid-19, low protein diet, low potassium diet, low sodium diet, acute renal failure

56

OUT-PATIENT CATEGORY (OPD)

Name : Noor Fazlien Binti Nazri

Institution : Universiti Kebangsaan Malaysia (UKM)

Title: Nutrition management for high protein diet in patient with stoma double barrel

Background: Protein energy wasting (PEW) indicate poor protein intake with patient on hemodialysis
maintenance. Loss of nutrients and breakdown of muscle protein induced by metabolic acidosis
during dialysis require higher nutrient need. Low protein intake and energy causes of malnutrition
which increased morbidity and mortality.

Nutrition Assessment: A 66-years old married Indian lady was diagnosed with Appendiceal mucinous
neoplasm and undergone post right hemicolectomy with double barrel stoma on 30th November
2020. Patient had underlying end stage renal failure on Hemodialysis (2, 4, 6) at Sunway Medical
Centre with restriction of fluid 500 ml per day, diabetes mellitus on insulin, hypertension and
dyslipidemia on atorvastatin. She was refer for high protein diet as outpatient on 16th April 2021.
Patient is married blessed with 3 children, youngest daughter who responsible to prepare the food for
patient at home. Patient weight is 56.8 kg with height 153 cm, BMI is normal for elderly 24.4 kg/
kg/m2. Patient had weight loss 3.2 kg (5.3%) for last 4 months after surgery. Patient claimed of reduce
protein intake due to the taste. Estimated protein intake 44-58 g per day as patient complained of low
appetite, nausea when consumed fish and chicken. However patient report she frequent feel hungry
and took oat between mealtime 3-4 times in a day. Patient’s stoma located at the ride lower quadrant
and semisolid form stool been observed.

Nutrition Diagnosis: Inadequate energy and protein intake (NI-5.2) related to inability to consume
sufficient protein and energy also increases nutrient need for high protein intake as evidenced by
patient complain having low appetite to consumed sufficient protein and patient on hemodialysis
maintenance.

Nutrition Intervention: Nutrition intervention aimed to achieved more than 75% of energy and
protein requirement (1.2-1.4g/kg/day) prior to hemodialysis maintenance and prevent protein energy
wasting which prevalence for long term hemodialysis patient. Nutrition counselling and diet
modification was conducted by suggest ONS Novasources which contain 17.8 g protein, other protein
sources to increase protein intake and nutrient dense food to increase the calorie.

Nutrition Monitoring and Evaluation: To monitor weight changes and diet compliance in the next 2
weeks.

Follow-up: Patient achieved 113% of energy requirement. Protein intake improved from 44-58 g per
day to 78-84 per day which achieved 1.4g/kg body weight. Patient claimed she feel more energetic
compare to last visit. Patient was emphasize to maintain the current energy and protein intake and
also encourage to increase the fiber intake.

Conclusion: Adequate protein and energy is crucial for patient with undergo hemodialysis
maintenance to delay the nutritional impact of the patient. Lower energy at the start of hemodialysis
was a risk factor for 10 year mortality in end stage renal disease patient. Moreover, sufficient nutrient
need to be meet to sustain nutritional status for colostomy patient.

Keywords: Protein energy wasting, end stage renal failure, hemodialysis 57

OUT-PATIENT CATEGORY (OPD)

Name : Serene Neoh Minxin

Institution : International Medical University (IMU)

Title: Obesity management for pre-bariatric surgery

Background: Bariatric surgery is expanding rapidly in Asia along with the rise in prevalence of
obesity. Meal replacement is often introduced in preoperative weight loss management to reduce
calorie intake.

Nutrition Assessment: Patient MHM is a 28 years old Malay male, worked as a chef. He was referred
for weight loss pre-bariatric surgery. However, the surgery date was not confirmed. He claimed no
underlying disease but family history of hypertension and stroke. His measured BMI was 72.3kg/m2
(morbid obesity) with body fat 74%. His average intake was 2000kcal, he usually dined out and
consumed energy-dense food during the weekends. He had dieting attempt once previously with
exercising and taking weight loss medications simultaneously. He seemed to have food and nutrition-
related knowledge deficit as he was not aware that some of his food choices are energy-dense and
high in fat content. He was at contemplation stage as he was aware of the need to lose weight but has
no knowledge and motivation.

Nutrition Diagnosis: Excessive energy intake related to food and nutrition-related knowledge deficit
concerning appropriate energy intake as evidenced by diet recall whereby patient’s current intake of
2000kcal as compared to requirement of 1500kcal for weight loss.

Nutrition Intervention: The goal is to lose weight based on the calorie deficit. The energy
prescription was 1500kcal to help achieve weight loss. Nutrition education was given on dietary
modifications to reduce consumption of energy-dense food and meal replacement was introduced.
Health Belief Model was used in nutrition counselling.

Nutrition Monitoring and Evaluation: Weight loss of 0.5-1kg/week based on the calorie deficit of
500-1000kcal/day, body fat reduction, energy intake as per prescription, patient’s knowledge and
behaviour on healthy food choices, stage of readiness and motivation, as well as glucose and lipid
profile are to be monitored in follow-up visit. The time frame for these parameters would be in one
month time.

Conclusion: Weight loss management for pre-bariatric surgery differs from other non-surgery cases.
Preoperative weight loss is crucial as it helps reduce the risk of surgery complications and maximise
postoperative weight loss.

Keywords: obesity, weight loss, bariatric surgery, meal replacement

58

OUT-PATIENT CATEGORY (OPD)

Name : Miguel Moses A. Miguel

Institution : University of Santo Tomas (UST)

Title: A case of a 72 year old woman with hypertensive arteriosclerotic cardiovascular disease,
diabetes mellitus (type 2), hypertension (Stage 2), and chronic kidney disease (stage 3B)

Background: Uncontrolled hypertension and diabetes may lead to the development and progression
of chronic kidney disease. Proper dietary management that includes assessment of patient’s risk
factors and current nutritional status, identifying and prioritizing nutrition diagnoses, developing
dietary prescription and recommendations, and monitoring patient’s progress and evaluating
outcomes is crucial so patients may have improved quality of life.

Nutrition Assessment: Patient was assessed to be obese based on her current BMI (31.0 kg/m2) and
W:H ratio (0.9), which may have contributed to her diabetes and hypertension. No significant weight
loss noted. Moreover, the patient's laboratory values were all within normal range (fasting blood
sugar, creatinine, low density lipoprotein, triglycerides, sodium, potassium, etc.). Patient has normal
blood pressure, no signs of muscle wasting, edema and anemia. Dietary assessment shows adequate
energy intake, however excessive in sugar, saturated fatty acids and cholesterol.

Nutrition Diagnosis: 1. Excessive sugar intake (NI-53.3) RT excessive consumption of simple sugars,
such as fruits, and added sugars from processed foods and beverages AEB sugar intake of 71g (196%
of the recommended intake); 2. excessive fat intake (NI-51.2) RT food and nutrition-related knowledge
deficit AEB fat intake above the recommended (119%), 26 grams SFA intake (17% of her energy intake),
and 368 mg cholesterol intake.

Nutrition Intervention: Patient was prescribed with 25 kcal/kgbw/day to provide adequate energy;
60% CHO to maintain normal fasting blood sugar level with limited sources of simple sugars to avoid
hyperglycemia, <6 % SFA to avoid elevation of low density lipoproteins. Diet counseling focusing on
the quality and quantity of carbohydrates and fats to help patients adhere to her diet prescription.

Nutrition Monitoring and Evaluation: Total carbohydrate intake along with added sugar, total fat
including saturated fatty acids will be monitored and evaluated using a food record (to be assisted by
her primary caretaker).

Conclusion: Providing individualized nutrition care plans may help manage chronic diseases and help
slow down its progression. Moreover, this may help patients have improved quality of life.

Keywords: diabetes mellitus 2, chronic kidney disease, hypertension, diabetic nephropathy, nutrition
care plan

59

OUT-PATIENT CATEGORY (OPD)

Name : Johanna Marie C. dela Cruz

Institution : University of Santo Tomas (UST)

Title: A case of 57-year old woman with multi-morbidity of hypertension, diffuse non-toxic thyroid,
osteoarthritis, gout and pulmonary tuberculosis who recently underwent laparoscopic cholecystectomy

Background: The prevalence of both non communicable diseases and communicable diseases among
patients are increasing worldwide. Living with multimorbidity is associated with disability, poor quality
of life, increasing use of health care services and sudden hospital admissions. This case study aimed to
investigate the patterns between communicable and non- communicable diseases along with the risk
factors that contributed to the progression of the patient’s diseases.

Nutrition Assessment: A 57-year old woman demonstrated significant weight loss of 11% in 6 months
as a result of multimorbidity (hypertension, osteoarthritis, gout, pulmonary tuberculosis, s/p
cholecystectomy) with symptoms that affect dietary intake and increased energy needs. Nutrition
assessment showed that the patient has poor diet quality (high in SFA and refined carbohydrates) in
>10years, elevated blood pressure, and high uric acid levels which correlates with her occasional joint
pains. Additionally, the patient's current dietary intake is inadequate in protein (<75% of the RNI) and
fiber (<10 grams/day) but excessive SFA intake (>10% of total energy intake). Further, the patient is
physically inactive (<30 mins/day).

Nutrition Diagnosis: Patient was identified to have increased energy needs (NI-1.1) related to
increased metabolic rate due to infection, and metabolic stress as evidenced by frequent coughing,
fever and chills at night. Moreover, the patient is also diagnosed with protein-energy malnutrition (NI
5.2) related to altered nutrient needs due to infection (pulmonary tuberculosis) as evidenced by
significant weight loss of 11% in 6 months and inadequate intake of protein.

Nutrition Intervention: Based on these, patient was recommended to have modified energy and
protein requirements (ND-1.2): high energy (35kcal/kgbw/day) and high protein (1.75g/kgbw/day) to
avoid further weight loss, with adequate carbohydrates and fat to support the efficient utilization of
protein. Additionally, patient was recommended to have <6% of SFA and adequate fiber, and small
frequent feedings.

Nutrition Monitoring and Evaluation: Aligned with the intervention, indicators and outcomes will be
evaluated and monitored in order to address both short-term and long-term goals of the patient to
achieve optimal nutritional status. Monitoring and Evaluation parameters include weight change, blood
pressure, total energy intake, macronutrients intake and biochemical values of sodium, potassium, uric
acid, SGOT and SGPT.

Conclusion: Patients with multi-morbidity are at risk of malnutrition which may further result in
increased mortality and morbidity, and poor quality of life. Timely and individualized nutrition care may
help prevent and manage malnutrition thereby, reducing possible risk of further complications and help
patients have improved quality of life.

Keywords: hypertension, osteoarthritis, gout, pulmonary tuberculosis, cholelithiasis, cholecystectomy,
NCP, nutrition care

60

OUT-PATIENT CATEGORY (OPD)

Name : Chen Zi Xin

Institution : Universiti Putra Malaysia (UPM)

Title: Effectiveness of motivational interviewing on patient’s lifestyle modification: A case study in
obese patient with gouty arthritis

Background: Motivational interviewing has been incorporated into nutrition counselling to enhance
behavior change towards healthy lifestyle. It helps increase intrinsic motivation and confidence in
obese patients with gout to manage long-term lifestyle modification. Nutrition Assessment: A 32-year-
old obese gentleman with gouty arthritis was followed-up after two weeks for weight management
and low purine diet. Patient’s weight increased by 0.6kg in two weeks with BMI of 32.6 kg/m2. His uric
acid and triglycerides level was increasing in trend. He felt pricky sensations at big toe which markedly
affected activity of daily living and stopped him from doing half-marathon. After receiving nutrition
education on low purine, low fat diet as well as weight loss management, his dietary changes showed
intake reduction by ~1000kcal to 1700kcal/day, still exceeding 113% of his energy requirement (1500
kcal). He claimed reduced rice intake portion by half and replaced sweetened fruit juices with healthier
options. However, he claimed unable to control binge eating on fried foods during fasting month and
had recent episode of gout attack triggered by crab intake.

Nutrition Diagnosis: previous nutrition diagnosis of excessive energy intake related to failure to
adjust for lifestyle change as evidenced by food history and biochemical data remained active, with
new nutrition diagnosis of limited adherence to nutrition-related recommendations due to non-
compliance from patient.

Nutrition Intervention: The objectives are to achieve recommended energy and fat intake and to
improve triglycerides and uric acid level. Motivational interviewing (MI) was done with patient to
determine barriers perceived by patient. Patient is motivated with his strength and values then
encouraged on overcoming his barrier.

Nutrition Monitoring and Evaluation: Weight changes, biochemical data and dietary compliance
would be monitored in next follow-up.

Conclusion: This case demonstrated importance of motivational interviewing as effective approach to
elicit patient’s intrinsic motivation to change his lifestyle.

Keywords: gout, uric acid, low purine diet, weight management, motivational interview

61

OUT-PATIENT CATEGORY (OPD)

Name : Patricia Gail Monjes

Institution : University of Santo Tomas (UST)

Title: Hypertension and type 2 diabetes mellitus with possible chronic kidney disease stage 2

Background: Type 2 Diabetes Mellitus is known to increase the risk of developing other chronic
illnesses, including chronic kidney disease (CKD). About 40% of diabetic patients develop diabetic kidney
disease that results in albuminuria, decreased glomerular filtration rate (GFR), or both. Furthermore,
the presence of hypertension increases the risk for kidney disease progression. Thus, mismanaged
diabetes and hypertension may lead to the faster progression of chronic kidney disease.

Nutrition Assessment: The patient’s anthropometric assessment reveals an overweight Body Mass
Index (27.3 kg/m^2) and a waist-to-hip ratio (WHR) of 0.93 indicating substantially increased metabolic
complications after an intentional 6% weight loss in 3 months with moderate physical activity level.
Biochemical results show fluctuating levels of HbA1c, TSH and a normal fasting blood sugar. Triglyceride
and LDL-C levels are increasing, while HDL-C level decreased. Calcium and vitamin D levels are low; and
the GFR and albumin-to-creatinine ratio (ACR) results both suggest stage 2 CKD. Past medical history
includes kidney stones removal (2018). Dietary assessment revealed a usual diet with adequate total
carbohydrates and fat intake but excessive protein, saturated fat, added sugar, and sodium intake.
Fiber and calcium intakes were inadequate.

Nutrition Diagnosis: Overweight related to usual consumption of processed, empty-calorie food as
evidenced by a Body Mass Index of 27.3kg/m2.

Nutrition Intervention: A diet prescription of 1500 kcal, 210g carbohydrates, 50g proteins, 50g fats,
25g fiber, <35g added sugar, <12g SFA, <2300mg Na, 150μg I, 800-1000mg Ca, 15μg Vitamin D, DASH, 3
meals 3 snacks with Diabetasol (once a day).

Nutrition Monitoring and Evaluation: The monitoring would focus on daily total calorie intake and
blood pressure measurement, monthly checking of patient’s weight and WHR, and nutrition-related
biochemical tests every two months.

Conclusion: Hypertension with Type 2 Diabetes mellitus increases the risk for chronic kidney disease
progression. Improving food intake’s quality and monitoring the disease progression to diabetic
nephropathy at an early stage may help with disease management to attain glycemic control, and
prevent serious complications like recurrence of kidney stones, albuminuria, and uremia.

Keywords: hypertension, diabetes mellitus, overweight, diabetic nephropathy, chronic kidney disease

62

PPrreessenetnertse,rAsd,vAisdorvsi,sOorgrasn,isaenrsdaAnddmCo-iOnrgisatnrisaetrsion
Thank you for your time and participation as well as your help in
ensuring the seamless execution of the International Virtual
Undergraduates Symposium on Clinical Dietetics 2021.

To All Attendees
Thank you for joining us. We hope that the knowledge you have
gained has benefited you. Moreover, we wish you much success in
your future.

ORGANIZING COMMITTEE
INTERNATIONAL VIRTUAL UNDERGRADUATES SYMPOSIUM
ON CLINICAL DIETETICS 2021