Displaying publications 1 - 20 of 33 in total

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  1. Kistler B, Avesani CM, Burrowes JD, Chan M, Cuppari L, Hensley MK, et al.
    J Ren Nutr, 2024 Mar;34(2):91-94.
    PMID: 38373524 DOI: 10.1053/j.jrn.2024.02.001
    Matched MeSH terms: Nutritionists*
  2. Yang WY, Fu Y
    Nutr Diet, 2018 09;75(4):411-417.
    PMID: 29633503 DOI: 10.1111/1747-0080.12421
    AIM: The health-care providers' empathy has been linked to better patient outcomes. The increased demand for dietetics services has called for dietitians to examine their clinical practices and encounters with patients. To date, there are limited studies published on empathy among dietitians. Hence, this study aimed to determine the clinical dietitians' empathy level in Malaysia.

    METHODS: Using a purposive sampling method, this study was conducted on dietitians practising in the Malaysian hospitals (government and private). The Toronto Empathy Questionnaire (TEQ), a validated 16-item questionnaire was self-administered, either by online survey method or face-to-face method. Additional information on gender, ethnicity, years of experience and percentage of working time spent on clinical, administrative and other areas were collected.

    RESULTS: A total of 69 dietitians participated in the study (private (n = 36) and government (n = 33)). The dietitians' mean total TEQ scores were 49.72 ± 5.62 (score ranged between 35 and 63). Significant difference of mean total TEQ scores was found between dietitians from private (51.06 ± 5.26) and government hospitals (48.27 ± 5.72). There was no significant difference in the level of empathy by gender, ethnicity, years of experience and percentage of time spent on clinical consultations, administration or others while at work.

    CONCLUSIONS: Results from this study showed that there were differences in empathy level of Malaysian dietitians by work setting. This preliminary finding serves as a baseline for future studies and could facilitate the development of dietetics education in Malaysia.

    Matched MeSH terms: Nutritionists/education; Nutritionists/psychology*
  3. Mohd Yusof BN, Ruzita AT, Norimah AK, Kamaruddin NA
    Med J Malaysia, 2013;68(1):18-23.
    PMID: 23466761 MyJurnal
    AIM: This prospective, single-group, pre-post design trial was conducted to evaluate the effect of individualised Medical Nutrition Therapy intervention administered by a dietitian in individuals with type 2 diabetes mellitus on glycaemic control, metabolic parameters and dietary intake.
    METHODS: Subjects (n=104; age=56.4 ±9.9 years; 37% male; years of diagnosis = 6.3 ±4.9 years) treated with diet and on a stabile dose of oral anti-diabetic agents were given dietary advice by a dietitian for a 12 week period. Individualised dietary advice was based on Malaysian Medical Nutrition Therapy for adults with type 2 diabetes mellitus. The primary outcome measure was glycaemic control (fructosamine and HbA1c level) and the secondary outcome included measures of anthropometry, blood pressure, lipid profile, insulin levels dietary intake and knowledge on nutrition.
    RESULTS: At week 12, 100 subjects completed the study with a dropout rate of 3.8%. The post-Medical Nutrition Therapy results showed a significant reduction of fructosamine (311.5 ±50 to 297 ±44 umol/L; P< 0.001) and HbA1c (7.6 ±1.2 to 7.2 +1.1%, p<0.001) with pronounced reduction for subjects who had very high HbA1c levels of >9.3% at baseline. Waist circumference (90.7 ±10.2 to 89.1 ±9.8 cm, p<0.05), HDL-cholesterol (1.1 ±0.3 to 1.2 ±0.3 mmol/L, p<0.05), dietary intake and nutrition knowledge score (42 ±19 vs. 75 ±17%; p< 0.001) were significantly improved from the baseline.
    CONCLUSIONS: Individualised Medical Nutrition Therapy administered by a dietitian resulted in favourable diabetes outcomes, which were more apparent for individuals with higher than optimal HbA1c levels at the start of the study.
    Matched MeSH terms: Nutritionists*
  4. Er YT, Chan YM, Mohd Shariff Z, Abdul Hamid H, Mat Daud Z', Yong HY
    BMJ Open, 2023 Nov 20;13(11):e075937.
    PMID: 37989361 DOI: 10.1136/bmjopen-2023-075937
    INTRODUCTION: Nutrition education is the cornerstone to maintain optimal pregnancy outcomes including gestational weight gain (GWG). Nevertheless, default for appointments is common and often lead to suboptimal achievement of GWG, accompanied with unfavourable maternal and child health outcomes. While mobile health (mHealth) usage is increasing and helps minimising barriers to clinic appointments among pregnant mothers, its effectiveness on health outcomes has been inconclusive. Therefore, this study aimed to address the gap between current knowledge and clinical care, by exploring the effectiveness of mHealth on GWG as the primary outcome, hoping to serve as a fundamental work to achieve optimal health outcomes with the improvement of secondary outcomes such as physical activity, psychosocial well-being, dietary intake, quality of life and sleep quality among pregnant mothers.

    METHODS AND ANALYSIS: A total of 294 eligible participants will be recruited and allocated into 3 groups comprising of mHealth intervention alone, mHealth intervention integrated with personal medical nutrition therapy and a control group. Pretested structured questionnaires are used to obtain the respondents' personal information, anthropometry data, prenatal knowledge, physical activity, psychosocial well-being, dietary intake, quality of life, sleep quality and GWG. There will be at least three time points of data collection, with all participants recruited during their first or second trimester will be followed up prospectively (after 3 months or/and after 6 months) until delivery. Generalised linear mixed models will be used to compare the mean changes of outcome measures over the entire study period between the three groups.

    ETHICS AND DISSEMINATION: Ethical approvals were obtained from the ethics committee of human subjects research of Universiti Putra Malaysia (JKEUPM-2022-072) and medical research & ethics committee, Ministry of Health Malaysia: NMRR ID-22-00622-EPU(IIR). The results will be disseminated through journals and conferences targeting stakeholders involved in nutrition research.

    TRIAL REGISTRATION NUMBER: Clinicaltrial.gov ID: NCT05377151.

    Matched MeSH terms: Nutritionists*
  5. Ke TJ, Sameeha MJ, Siah KTH, Jeffri PBQB, Idrus NAB, Krishnasamy S
    Nutrients, 2024 Oct 23;16(21).
    PMID: 39519430 DOI: 10.3390/nu16213596
    The low fermentable oligo-, di-, mono-saccharides and polyols (FODMAP) diet (LFD) is a second-line dietary intervention for irritable bowel syndrome (IBS) patients, involving FODMAP restriction, reintroduction, and personalization, and it needs to be delivered by dietitians. However, the application of this diet among Malaysian IBS patients is not well understood. This study aimed to explore the practices and barriers in delivering the LFD among Malaysia dietitians. Semi-structured qualitative interviews were conducted online with practicing dietitians until the data reached saturation. All the interview sessions were audio recorded and transcribed verbatim. Thematic analysis was used to analyze the data. Eleven dietitians were interviewed, with 36.4% (n = 4) having more than 10 years of experience. The following four themes regarding their practices emerged: 1. dietary advice on FODMAP restriction; 2. duration of FODMAP restriction phase; 3. references used to get information about FODMAPs, and 4. strategies on reintroduction. Meanwhile, the following seven barriers were identified: 1. lack of culturally relevant educational materials; 2. limited knowledge about the LFD; 3. inadequate formal training among dietitians; 4. lack of integration in multi-disciplinary care; 5. low health literacy of patients; 6. low compliance rate among patients, and 7. restrictions for certain populations. LFD implementation in Malaysia is not standardized as only experienced dietitians can provide dietary evidence-based advice. Lack of training and culturally specific resources are some of the main barriers that were identified to be limiting the implementation of the diet. Therefore, there is a need for training programs and resource development to support Malaysian dietitians in managing IBS patients.
    Matched MeSH terms: Nutritionists*
  6. Tah PC, Kee CC, Majid HA
    Nutr Clin Pract, 2020 Oct;35(5):942-950.
    PMID: 31556167 DOI: 10.1002/ncp.10416
    BACKGROUND: Malnutrition among hospitalized patients is closely associated with various medical complications. This study aimed to determine the validity and reliability of a 3-Minute Nutrition Screening (3-MinNS) tool in identifying the risk of malnutrition among hospitalized patients that can be administered by healthcare professionals.

    METHODS: A cross-sectional study was conducted between January and December 2012. A total of 350 adult patients in a teaching hospital were screened for risk of malnutrition using 3-MinNS and Subjective Global Assessment (SGA). To assess interrater reliability, each patient was screened for risk of malnutrition using 3-MinNS by 2 different nurses on 2 different occasions within 24 hours after admission. To assess the validity of 3-MinNS, the level of risk of malnutrition identified by the nurses using 3-MinNS was compared with the risk of malnutrition as assessed by a dietitian using SGA within 48 hours after the patients' enrolment into the study. The sensitivity, specificity, and predictive values were calculated in detecting patients at risk of malnutrition. Interrater reliability was determined using κ statistics.

    RESULTS: Using SGA, the estimated prevalence of moderate to severe malnutrition was 36.3% (127/350). There was 94% proportional agreement between 2 nurses using 3-MinNS, and interrater reliability was substantial (κ = 0.79, P < .001). The analysis showed that 3-MinNS had moderate sensitivity (61.4%-68.5%) but high specificity (95.1%).

    CONCLUSIONS: The 3-MinNS is a reliable and valid screening tool for use by healthcare professionals for identifying newly admitted medical and surgical patients who are at risk of malnutrition.

    Matched MeSH terms: Nutritionists
  7. Maisalihah Zamzuri, Aliza Haslinda Hamirudin, Norain Zainudin, Suriati Sidek, Nor Azlina A. Rahman
    MyJurnal
    Introduction: Dietary calcium intake is important in body system regulation. Inadequate intake
    among elderly may lead to various health issues such as osteoporosis and hip fracture. In order to counter the problem, this study was carried out to identify dietary calcium intake among elderly in Kuantan, Pahang. Methods: A face to face interviewer-administered session was done individually with seventy-nine (n=79) subjects aged ≥60 years to collect data on sociodemographic background, health status and dietary intake. Diet history method was used to obtain information related to dietary intake and analyzed using Nutritionist Pro Software. P-value was set at p
    Matched MeSH terms: Nutritionists
  8. Nor ‘Afifah Zahari, Aliza Haslinda Hamirudin, Noor Ezailina Badarudin
    MyJurnal
    Malaysian is one of the highest sugar consumers in the Asia Pacific region. There has been no available report quantifying sugar intake among Malaysian until Malaysian Adult Nutrition Survey
    (MANS) 2003 study was done. However, data concerning sugar consumption among university students is scarce. This study was conducted to assess sugar sweetened beverages intake among International Islamic University Malaysia (IIUM) Kuantan students. A total of 42 of IIUM Kuantan students was recruited by convenience sampling method. A questionnaire consisting of 3 days
    food record was distributed to all participants as a tool for data collection. Food record was analyzed using the Nutritionist Pro software prior to statistical analysis with SPSS version 12.0. P value was set as p
    Matched MeSH terms: Nutritionists
  9. Nurul Athirah Mohd Azhari, Norazmir Md Nor, Haidzir Manaf
    Movement Health & Exercise, 2018;7(2):145-150.
    MyJurnal
    Disability sport is becoming more popular worldwide as shown by increased participation from athletes. The increase participation exerted pressure on the athletes to achieve better sports performance. One of the factors in enhancing sports performances is nutrition. A proper diet is needed for athletes, as it is an essential component in optimizing physical development and sports performance. Identifying the nutritional knowledge and supplement habits among disabled athletes will help maximize the benefits of nutrition. Despite the importance of nutrition, there is no validated questionnaire for identifying nutritional knowledge and supplement habits among disabled athletes in Malaysia. Thus, this study aims to develop and validate a questionnaire on nutritional knowledge and supplement habits among Malaysian disabled athletes and to examine the reliability of the questionnaire. This paper intends to discuss the validation of the developed questionnaire specifically on expert validation. The target population of this study is Malaysian disabled athletes. Firstly, the questionnaire is developed and adapted from previous literature on both nutritional knowledge and supplement habits for disabled athletes. Then, the developed questionnaire undergoes translation process before proceeding with validation and reliability process. Expert validation requires a panel of experts in sports nutrition, nutrition and dietitian fields. The questionnaire will be analyzed in terms of content validity ratio (CVR). The expected result of this study is a questionnaire validated by an expert panel on nutritional knowledge and supplement habits among Malaysian disabled athletes. In future research, the reliability of the questionnaire will be tested on 23 Malaysian disabled athletes, and their nutritional status will be identified. Hence, this study will help to promote the growth of disability sports in Malaysia and enhance the sports performance of disabled athletes in Malaysia through nutrition.
    Matched MeSH terms: Nutritionists
  10. Mai CW, Tan JSH, Koay GWL, Lim LYX
    Pharmacy (Basel), 2020 Sep 13;8(3).
    PMID: 32933158 DOI: 10.3390/pharmacy8030170
    Dietary supplementation is increasingly sought after by consumers looking to meet the demands of a modern lifestyle. Effective supplementation requires knowledge of the purpose and proper use of nutritional supplements. Unverified or inadequate guidance on supplementation can propagate misconceptions and increase undue fears of side effects. Community pharmacists are best placed to guide consumers on nutritional supplement use. In this review, a panel comprised of community pharmacists, pharmacy academia, and dietitians (n = 6) convened to provide an experience- and evidence-based guidance on rational drug use, patient education, and integrated and personalized nutrition care in both community and hospital pharmacy settings. A novel framework to guide community pharmacist-led consultations on supplementation is proposed. The four-step CARE (Categorize, Assess, Recommend, Empower) guide was developed to facilitate and optimize outcomes of pharmacist-led nutritional supplement consultation. Telehealth advancements in the form of digital health applications and personalized nutrigenomic DNA testing support Integrative Nutrition Care, and will further promote appropriate supplementation use to improve overall well-being in the community. Practical implementation of the CARE guide is necessary to ascertain its applicability for optimizing outcomes of pharmacist-led consultation and the recommendation of nutritional supplements.
    Matched MeSH terms: Nutritionists
  11. Chin Yit Siew, Tee E Siong, Zawiah Hashim, Rasyedah Ahmad Raqi, Norimah A Karim
    MyJurnal
    Introduction: This paper discussed the effectiveness of “Healthy Kids Programme (HKP)”, specifically in improving the body weight status as well as knowledge, attitude and practice (KAP) of the children. Methods: In this longi- tudinal intervention study, a total of 12 primary schools in Klang Valley were randomly selected and divided into intervention and control groups. There were 386 standard three children participated at baseline. All children in the intervention group participated in the HKP that was conducted by nutritionists. The evaluations included the pre- and post-Immediate Impact survey (IIS) (every topic), and changes in nutrition KAP survey and anthropometric assess- ment of the children at the beginning and end of every year for three years. Results: School children in intervention group reported with an increased in the IIS score for each topic and achieved a significantly higher mean nutrition knowledge score than those in the control group over time. There were no significant differences in mean attitude and practice scores between two groups after the intervention. Children in the intervention group had lower rates of overweight and obesity (pre-test: 27.3%; post-test: 32.5%) than their counterpart (pre-test: 26.6%; post-test: 44.0%). Conclusions: The HKP is effective in improving nutrition knowledge of the children. A lower rate of overweight and obesity was observed in intervention group than control group. This approach will contribute towards inculcating healthy eating and active lifestyle habits among Malaysian children that bring about long-term health benefits.
    Matched MeSH terms: Nutritionists
  12. Roszanadia Rusali, Rosita Jamaluddin, Nor Baizura Md Yusop, Hazrina Ghazali
    MyJurnal
    The role of dietitians involves not solely on clinical responsibilities. Additionally, operation management responsibil- ities such as managing human labor, financial resources, and problem solver are the tasks that a dietitian look after. It is reported to be challenging and stressful and could affect job satisfaction levels in the working environment. This scoping review aimed to explore the job satisfaction level and skills needed among dietitians to assume management responsibilities at their workplace. This study was completed using PRISMA guidelines. Online databases (Scopus and Science Direct) were used to identify papers published from 2000 to 2019. We selected English publications from the United States, Australia, South Africa, Korea, and the United Kingdom that used job satisfaction as a pri- mary or secondary outcome. Studies were included if they addressed dietitians who were involved in clinical work, food service, and management in their dietetic practices. Findings on existing skills, including managerial skills, communication, teamwork, and time management among dietitians with management responsibilities, have helped to enhance the job satisfaction and work quality of the dietetic profession. The findings would be useful for human resource management in the organisation, preserving the professional identity of a dietitian.
    Matched MeSH terms: Nutritionists
  13. Mohd Yusof BN, Abdul Talib R, Abdul Karim N
    Malays J Nutr, 2005;11(2):151-163.
    MyJurnal
    This experimental study was carried out to investigate the effect of eight types of commercial rice in Malaysia on blood glucose response and to determine their glycaemic index (GI) values. Ten healthy Malay volunteers (7 males, 3 females, BMI=23.6kgm-2, age=25.1years) participated in this study. The eight types of rice tested were three high fibre rice (HFR A, HFR B & HFR C), three white rice (WR D, WR E and WR F) and two fragrant rice (FR G and FR H). The subjects were required to go through the study protocol on eleven separate occasions (eight tests for the test rice samples and three repeated tests for the reference food) after an overnight fasting. Capillary blood samples were taken immediately before (0min) and 15, 30, 45, 60, 90 and 120min after consumption of the test foods. The blood glucose response was obtained by calculating the incremental area under the curve (iAUC). The GI was determined according to the standardised methodology. This study showed that out of eight types of rice tested, three (HFR B, WR E and WR F) could be categorised as having intermediate GI while the remaining five were considered high GI foods (HFR A, HFR C, WR D, FR G and FR H). The GI of HFR B (60 ± 5.8) and WR E (61 ± 5.8) were significantly lower than the reference food (glucose; GI=100) (p0.05). The GI value of the rice tested in descending order were HFR C, 87 ± 9.0 followed by HFR A (81 ± 6.7), FR G (80 ± 5.5), FR H (79 ± 7.6), WR D (72 ± 8.5), WR F (69 ± 8.3), WR E (61 ± 5.8) and HFR B (60 ± 5.8). There was no relationship between the dietary fibre content of the rice with the iAUC (r= -0.05, p=0.63) and GI values (r= -0.08, p=0.46). This shows that the GI values of the test rice were independent of the dietary fibre content of the rice. Other factors that may influence the GI value of rice include amylose content, gelatinisation process and botanical sources. The results of this study will provide useful information for dietitians and nutritionists in selecting the appropriate type of rice for the daily diet of diabetics.
    Matched MeSH terms: Nutritionists
  14. Karupaiah T, Chee SS
    Malays J Nutr, 1997;3(2):117-130.
    MyJurnal
    Coronary Heart Disease (CHD) is recognised as an important public health problem in Malaysia. Hyperlipidaemia is one of the main risk factors related to CHD. The mainstay of treatment is diet therapy which should be maintained even if drug treatment is indicated. Since dietitians are the primary providers of dietary treatment to hyperlipidaemic patients, this retrospective study attempts to report the dietary approaches and methodologies adopted by Malaysian dietitians in managing their patients. A postal questionnaire covering various aspects of dietary management of hyperlipidaemia were sent to 47 dietitians practicing in private and government hospitals. A response rate of 53 % was elicited. The survey found that there was a disparity amongst the respondents in the approach to the dietary management of hyperlipidaemia in Malaysia. This was largely due to the absence of a standardised dietary protocol for general lipid lowering in patients with hyperlipidaemia.
    Study site: Private and public hospitals in Malaysia
    Matched MeSH terms: Nutritionists
  15. Balaravi, B., Chin, M.Q., Samantha Quah, L.W., Ramadas, A., Karppaya, H., Chai, W.J.
    Malays J Nutr, 2017;23(3):409-423.
    MyJurnal
    Introduction: Often considered a legitimate strategy to enhance health and
    performance, the consumption of nutritional supplements (NS) has become
    a common practice which frequently results in unintentional doping among
    athletes. Despite a probable association between NS and doping, there are limited
    studies on this topic in developing countries such as Malaysia. Thus, this study
    aimed to identify the prevalence of NS usage among national elite athletes and
    assess their knowledge and attitude regarding its use and doping.

    Methods:
    This was a cross-sectional study conducted at the Malaysian National Sports
    Institute among national elite athletes (n=50) recruited via convenience sampling.
    The athletes completed a self-administered questionnaire documenting their
    demographic characteristics, training information, NS consumption, knowledge
    and attitude related to supplement-doping. The total knowledge and attitude
    scores were compared according to demography, training information, and NS
    consumption.

    Results: The prevalence of NS use among the athletes was 72%.
    NS usage was significantly associated with training duration (p=0.029), source of
    nutrition information (p=0.047) and self-exploration on supplements (p=0.045).
    Supplement-doping knowledge was significantly higher among athletes with
    tertiary level education (p=0.027), NS users (p=0.044), those obtaining information
    from nutritionists (p=0.048) and those who had attended nutrition workshops
    (p
    Matched MeSH terms: Nutritionists
  16. Yashna Harjani, Siong Tee, E., Garcia, Jimena
    Malays J Nutr, 2016;22(1):91-102.
    MyJurnal
    A seminar titled "Sugar Substitutes: Understanding the Basics, Global Regulatory Approvals, Safety Assessment Protocols and Benefits" organised by the Nutrition Society of Malaysia was held on 1.5th Apri12015 for nutritionists and other health care professionals, to review and discuss the latest evidence on safety and efficacy of sugar substitutes. Highlights from lectures by local and international speakers about this topical subject are presented in this report. Sugar substitutes have been extensively evaluated for decades and regulatory agencies world-wide continue to review and confirm their safety. Furthermore, the effects of sugar substitutes on human health continue to be the subject of research studies. Many studies have shown that replacement of sugar with sugar substitutes may help in weight management, glucose control for people with diabetes, and in the prevention of tooth decay. It is important for health professionals to discern whether the available evidence is based on good science and adequate protocols in order to guide consumers with the responsible use of sugar substitutes following national and international dietary guidelines. The use of sugar substitutes for certain health outcomes was discussed, specifically in regard to appetite, energy balance, body weight and other cardio-metabolic risk factors. Overall, the seminar provided an understanding of the different types of commercially available sugar substitutes, their use in a range of food and beverages, and calorie contribution to the diet. The seminar also covered the approvals of different sugar substitutes and the protocols for assessing the safety of these sugar substitutes, especially in the case of children and pregnant women.
    Matched MeSH terms: Nutritionists
  17. Mohalijah, M.A., Boo, H.C., Muhammad Shahrim, A.K., Ainul Zakiah, A.B.
    MyJurnal
    Athletes are a special group of consumers whose specific diet requirement is important during training and competition to ensure their success. As commercial foodservice establishments are increasing involved in providing foods to this group of consumers on one hand and the lack of research investigating the athletes’ dining satisfaction, especially meeting their diet requirement on the other hand, this study was conducted to investigate the influence of nutritional factors in athletes’ dining satisfaction and the acceptance of various foods provided in an international sporting event. Following a stratified random sampling, 700 athletes were selected from the entire population of 1330 participants. The final usable sample size was 450 (64.3% response rate). Regression analysis revealed that overall service, overall food quality, grooming of server, and nutritional information tag significantly influence the overall dining satisfaction among athletes. In addition, nutritional value, menu variety, fat content, freshness, and taste were found as the most important determinant in almost all food categories. It is intriguing that meeting diet requirement is not a significant factor but nutritional information tag is. Important implications were discussed. Nutrition education is recommended for foodservice operators especially when they are involved in providing food for sporting events. It is advisable that an appointed specialized sport dietitian or nutritionist to a sporting event works together with the foodservice operators to ensure that the menu meets the nutritional requirement of athletes.
    Matched MeSH terms: Nutritionists
  18. Khairani O, Majmin SH, Saharuddin A, Loh SF, Noor Azimah M, Hizlinda T
    Malays Fam Physician, 2011;6(2):79-81.
    PMID: 25606230 MyJurnal
    This case report illustrates an adolescent with clinical presentation of moderate anorexia nervosa with no significant co-morbidities. It highlights the management of anorexia nervosa in the outpatient setting by a multi-disciplinary health care team which includes a family physician, a dietician, a psychologist and a child psychiatrist.
    Matched MeSH terms: Nutritionists
  19. Thalha AM, Mahadeva S, Boon Tan AT, Mun KS
    JGH Open, 2018 Oct;2(5):242-245.
    PMID: 30483596 DOI: 10.1002/jgh3.12083
    A 33-year-old man was referred with hyperosmotic symptoms of 4 weeks. Clinical examination showed palpable hepatomegaly and no stigmata of liver disease. Findings were random glucose 16.6 mmol/L, HbA1c 12.4%, triglyceride 6.2 mmol/L, normal LFTs and ultrasound liver: increased echogenicity. Management consisted of dietician referral and commencement of metformin 500 mg bd, diamicron MR 60 mg od, and fenofibrate 145 mg od. He was non-compliant, complaining of "heaviness of head" after consuming oral diabetic agents, without symptoms of hypoglycemia. Treatment was switched to Kombiglyze XR (saxaglipitin 5 mg + metformin 1000 mg) and empagliflozin 25 mg od. He presented 1 week later with generalised pruritus with ALT 307 IU/L and serum GGT 808 IU/L. Following this, a percutaneous liver biopsy was performed, revealing steatohepatitis and marked intra-hepatic cholestasis. Kombiglyze XR was withheld, with resolution of LFTs to baseline. Phenotypes of liver injury are categorised according to R value, defined as ratio ALT/ULN:ALP/ULN. R value of ≥5:hepatocellular injury, ≤2:cholestatic injury, 2-5:mixed-type injury. Here, R value points toward mixed type (R = 3.203). Hepatotoxicity in patients with NASH is difficult to diagnose, based on laboratory parameters. Liver histology was useful in indicating additional changes apart from NASH, causing liver derangement. The Rousal Uclaf Causality Assessment Method is a scoring method to determine the probability of drug induced liver injury. RUCAM score for this case was 6 (probable adverse drug reaction). Hepatotoxicity from saxagliptin not been reported prior. Clinicians need to be more vigilant, particularly in patients with NASH.
    Matched MeSH terms: Nutritionists
  20. Talib R, Ali O, Arshad F, Kadir KA
    Asia Pac J Clin Nutr, 1997 Jun;6(2):84-7.
    PMID: 24394705
    A study was undertaken in FELDA (Federal Land Development Authority) resettlement scheme areas in Pahang, Malaysia, to determine the effectiveness of group dietary counselling in motivating diabetic patients to achieve good dietary habits, and weight and diabetes control. Sixty-one non-insulin dependent diabetes mellitus (NIDDM) patients were randomly assigned to either the experimental or control group. The experimental group received six sessions of group dietary counselling over 5 months and the control group received mass media diabetes-educational program during the same period. The one hour group dietary counselling sessions discussed general knowledge of diabetes, food groups for meal planning, the importance of dietary fibre-rich foods, types of fat in food, exercise and weight control. The experimental group met monthly with a dietitian as a counsellor. Effectiveness was assessed by improvement in food choice, and decline in percentage glycated haemoglobin (total HbA1) or body mass index (BMI). Measurements were made at a baseline visit, every two months during the six month program, and six months afterwards. Patients in the experimental group improved their food choices, resulting in a healthier diet high in unrefined carbohydrates and dietary fibre rich foods, and low in fat. There were significant reductions of their percentage total HbA1 levels and BMI following the counselling sessions, which decreased further six months after the program compared with patients in the control group. Thus group dietary counselling is effective in motivating NIDDM patients to achieve better food choice, and related weight and glycaemic control in a Malaysian setting.
    Matched MeSH terms: Nutritionists
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