Initial Dietetic Assessment

Initial Dietetic Assessment Date: 1 November 2024 Demographics: - Name: Sarah Johnson - DOB: 15 May 1985 - Age: 39 - Gender: Female Referral Details: - Referred by: Dr. Emily White, GP - Reason for referral: Elevated HbA1c and recent diagnosis of Type 2 Diabetes Mellitus, seeking dietary management and education. Medical History: - Relevant medical conditions: Type 2 Diabetes Mellitus (diagnosed 3 months ago), Hypertension (controlled with medication), Osteoarthritis. - Medications: Metformin 500mg BID, Amlodipine 5mg QD. - Allergies/intolerances: Penicillin (allergy), Lactose intolerance. Anthropometrics: - Height: 165 cm - Weight: 88 kg - BMI: 32.3 kg/m² (Obese Class I) - Waist circumference: 102 cm Biochemistry: - Recent pathology results: HbA1c 7.5% (previous 6.8%), Fasting Glucose 8.2 mmol/L, Total Cholesterol 5.8 mmol/L, LDL 3.5 mmol/L, HDL 1.1 mmol/L, Triglycerides 2.1 mmol/L. Nutrition-focused Physical Examination: - General appearance: Appears well-nourished, no overt signs of malnutrition. Central adiposity noted. - Oral health: Good dental hygiene, no current issues reported. Dentures present. - Skin integrity: No active lesions, rashes, or wounds observed. Skin appears well-hydrated. Diet History: - Usual eating pattern: Typically skips breakfast, large lunch (often takeaway), small dinner. Frequent snacking on biscuits and crisps throughout the day. Reports consuming sugary drinks daily. - Food preferences/aversions: Enjoys pasta, bread, and fried foods. Dislikes most green vegetables. Avoids dairy due to lactose intolerance. - Appetite: Good appetite, reports feeling hungry frequently between meals. - Fluid intake: Approximately 1-1.5 litres of sugary drinks (cola, fruit juice) and 500ml water daily. Nutrition-related Symptoms: - Gastrointestinal issues: Occasional bloating and flatulence, especially after consuming dairy products. - Other relevant symptoms: Reports feeling tired in the afternoons, attributes it to fluctuating blood sugar levels. Physical Activity: - Type and frequency: Sedentary lifestyle. Reports walking for approximately 20 minutes, 2-3 times per week, but no structured exercise. Psychosocial Factors: - Living situation: Lives with spouse and two adult children. - Support network: Spouse is supportive of dietary changes and willing to assist with meal preparation. Children are less involved. - Barriers to dietary changes: Limited cooking skills, time constraints due to work schedule, financial constraints impacting access to fresh produce, strong cultural preference for carbohydrate-rich meals. Nutrition Assessment: - Estimated energy requirements: 2000 kcal/day for weight management. - Estimated protein requirements: 70-80g/day. - Identified nutrition issues: High intake of refined carbohydrates and saturated fats, inadequate fibre intake, poor portion control, frequent consumption of sugary beverages, insufficient physical activity, lactose intolerance, elevated blood glucose and lipid levels. Nutrition Diagnosis: Impaired glucose utilisation related to insufficient physical activity and excessive carbohydrate intake as evidenced by HbA1c of 7.5% and patient report of frequent sugary drink consumption. Excessive energy intake related to frequent snacking and large portion sizes as evidenced by BMI 32.3 kg/m². Nutrition Intervention: - Goals: - Short-term: Reduce sugary drink intake to 1 glass/week within 2 weeks. Incorporate a balanced breakfast 5 days/week within 1 month. Increase vegetable intake to 3 portions/day within 1 month. - Long-term: Achieve HbA1c <7.0% within 6 months. Reduce weight by 5-7% within 6 months. Improve dietary quality to meet national guidelines for T2DM. - Nutrition education provided: Explained relationship between diet and blood glucose control, carbohydrate counting basics, benefits of fibre, label reading for sugar and fat content, importance of regular meal patterns, healthy snack alternatives, fluid recommendations. - Strategies discussed: Meal planning and preparation tips, incorporating lean proteins and non-starchy vegetables, portion control techniques, swapping sugary drinks for water or unsweetened alternatives, strategies for managing lactose intolerance, exploring local markets for affordable produce. Nutrition Monitoring and Evaluation: - Parameters to monitor: Weight, HbA1c, fasting glucose, dietary intake (food diary review), physical activity levels, subjective reports of energy and hunger. - Follow-up plan: Review in 4 weeks to assess progress on short-term goals and refine strategies. Coordinate with GP for ongoing medical management and blood work review. Sarah Davies, Registered Dietitian