Case Study: Implementing the Nutrition Care Process (NCP) in Clinical Practice

Case Background

Mrs Aisha, a 52-year-old Nigerian woman, was referred to a hospital nutrition clinic for poorly controlled type 2 diabetes and obesity. She had a BMI of 33 kg/m², high fasting blood glucose (190 mg/dL), and complained of constant fatigue, excessive thirst, and frequent urination. Her doctor suspected that her diet and lifestyle were contributing to her condition and requested a nutrition consultation.

Step 1: Nutrition Assessment

The nutritionist collected the following data:

1. Anthropometric Data:

• Height: 1.65m
• Weight: 90kg
• BMI: 33 kg/m² (Obese Class 1)
• Waist Circumference: 100 cm (Increased risk of metabolic syndrome)

2. Biochemical Data:

• Fasting Blood Glucose: 190 mg/dL (Normal: <100 mg/dL)
• HbA1c: 9.0% (Normal: <5.7%)
• Cholesterol Levels: Elevated LDL, low HDL

3. Clinical Data:

• History of type 2 diabetes for 5 years
• Complaints of fatigue, frequent urination, excessive thirst
• Medications: Metformin (500mg twice daily)
• No known food allergies

4. Dietary History:

• Breakfast: White bread with butter and tea with 3 teaspoons of sugar
• Lunch: Rice with stew, fried plantain, and soda
• Dinner: Garri with groundnut and fish
• Snacks: Meat pies, soft drinks, biscuits
• Water Intake: <4 glasses per day
• Physical Activity: Minimal (sedentary lifestyle)

💡 Key Findings: Mrs Aisha’s diet was high in refined carbohydrates, fats, and sugar, with low fibre intake and minimal physical activity.

Step 2: Nutrition Diagnosis

Using the PES (Problem, Etiology, Signs/Symptoms) statement, the nutritionist identified the primary nutrition problem:

🔹 Problem: Excessive carbohydrate intake leading to poor glycemic control
🔹 Etiology: Lack of nutrition knowledge, poor food choices, and sedentary lifestyle
🔹 Signs & Symptoms: High blood glucose (190 mg/dL), HbA1c (9.0%), excessive thirst, fatigue

📌 Nutrition Diagnosis Statement:
"Excessive carbohydrate intake related to poor dietary choices and sedentary lifestyle as evidenced by high fasting blood glucose, HbA1c, and symptoms of hyperglycemia."

Step 3: Nutrition Intervention

The nutritionist designed a personalized meal plan and lifestyle intervention to help Mrs Aisha manage her blood sugar levels.

1. Medical Nutrition Therapy (MNT):

✅ Reduce simple sugars (replace white bread with whole grains)
✅ Increase fibre intake (add vegetables, legumes, and whole grains)
✅ Control portion sizes (reduce rice and starchy foods, increase protein intake)
✅ Increase water intake (at least 8 glasses per day)
✅ Encourage physical activity (30 minutes of walking, 5 times a week)

💡 Sample Meal Plan:

2. Nutrition Education & Behavior Change:

• Taught carbohydrate counting for better glucose control
• Encouraged label reading to avoid high-sugar foods
• Provided a food diary to track eating habits
• Set SMART goals: Reduce sugar intake, exercise 3x per week, increase vegetable intake

Step 4: Nutrition Monitoring and Evaluation

Mrs Aisha had follow-up appointments every 2 weeks. Her progress was tracked using the following indicators:

Progress After 8 Weeks:

✅ Weight Loss: 85kg (5kg loss)
✅ Fasting Blood Sugar: Reduced to 130 mg/dL
✅ HbA1c: Dropped to 7.5%
✅ Energy Levels: Improved significantly
✅ Hydration & Physical Activity: Drinking 8 glasses of water daily and walking 4 days a week

📢 Final Outcome: Mrs Aisha successfully improved her diet, reduced blood sugar levels, and adopted healthier habits.

Key Takeaways for Nutritionists

✅ NCP helps structure patient care effectively
✅ Personalized interventions lead to better outcomes
✅ Regular follow-ups are essential for success
✅ Educating patients empowers them to take charge of their health