MALNUTRITION

• It refers to deficiencies, excesses or imbalances in a

person’s intake of energy and/or nutrients.
- WHO

Undernutrition: stunting, wasting, underweight and

micronutrient deficiencies or insufficiencies

Overnutrition: Overweight, obesity and diet-related

noncommunicable diseases
 MALNUTRITION

• Deficit, excess or imbalance of the essential

components of a balanced diet.

Undernutrition Overnutrition
A state of poor nourishment Ingestion of more
food than is
As a result of inadequate diet required for body
or diseases that interfere needs.
with normal appetite &
assimilation of ingested food
 EPIDEMIOLOGY
• Globally in 2022, 149 million children under 5 were
estimated to be stunted (too short for age), 45
million were estimated to be wasted (too thin for
height), and 37 million were overweight or obese.

• Nearly half of deaths among children under 5

years of age are linked to undernutrition.

• 1.9 billion adults are overweight or obese, while

462 million are underweight.
According to National Family Health Survey 5

Prevalence of Malnutrition :-
– 35.5% of children under age five years are stunted
– 19.3% are wasted
– 32.1% are underweight
– 3% are overweight
– Malnutrition among women aged 15-49 years is
18.7%
CONSEQUENSES OF MALNUTRITION IN INDIA

• Health Implications
• Educational consequences
• Economic Impact
• Intergenerational impact
• Social consequences
• National development
CONSEQUENCES OF MALNUTRITION IN INDIA

Health Implications

– Stunted Growth: impacts physical and cognitive

development

– Weakened Immune System: Malnourished individuals are

more susceptible to infections due to a weakened immune
system, leading to increased morbidity and mortality.

– Micronutrient Deficiencies: Consistent intake of

micronutrient-lacking food can lead to deficiencies in iron,
Vitamin A, and zinc, impairing immunity.
Educational Consequences:-

– Cognitive Impairment: Malnutrition during early

childhood can affect cognitive function, hindering
learning abilities and academic performance.

– School Dropout Rates: Malnourished children

may face challenges in attending school
regularly and are more likely to drop out,
impacting their overall education.
Economic Impact :-

– Productivity Loss: Malnutrition can lead to

decreased work productivity, both in childhood and
adulthood, affecting the nation's overall economic
output.

– Increased Healthcare Costs: The prevalence of

malnutrition contributes to a higher burden on the
healthcare system, leading to increased healthcare
costs for the government and individuals.
Inter-generational Impact

• Maternal and child health: anaemic mothers

are more likely to give birth to anaemic babies,
perpetuating the cycle of nutritional deficiencies.

• Long-term health effects: malnourished

children are more likely to face health
challenges in adulthood, further impacting the
overall health and well-being of the population.
• Social Consequences:
– Stigma and Discrimination: Individuals
experiencing malnutrition may face societal
stigma and discrimination, impacting their
mental health and well-being.
• National Development:-
Reduced Human Capital: Malnutrition hampers
the development of human capital, limiting the
potential for economic and social progress.

Increased Healthcare Burden: The prevalence

of malnutrition contributes to an increased
burden on healthcare resources, diverting
attention and resources from other essential
health initiatives.
PROTEIN- CALORIE MALNUTRITION
 PCM
A type of undernutrition which results when the
body’s need for protein or energy is not supplied
in adequate quantity.

Primary PCM Secondary PCM

It is the result of poor It is the result of an
eating habits as nutritional alternation of defect in
needs are not met. ingestion, digestion,
absorption, or metabolism.
 Marasmus Kwashiorkar
Concomitant deficiency of both Deficiency of protein intake which
caloric and protein intake leading is superimposed on a stress event
to generalised loss of body fat such as
and muscle GI obstruction
Surgery
Cancer
Malabsorption syndrome
Infectious disease

“wasted or emaciated” patient Well nourished patient

May have normal serum protein May have a very low protein level
levels.
 Increases risk for Malnutrition
• Dementia

• Depression

• Chronic alcoholism

• Excessive dieting to lose weight

• Swallowing disorders
Increases risk for Malnutrition
• Nutrient loss from Malabsorption, Dialysis,
Fistulas, Wounds

• Extreme need for nutrients because of

hypermetabolism or stress such as infection,
burns, trauma, fever

• NPO status
 CAUSES of Malnutrition

Malabsorption
Physical Illnesses
Syndrome

Incomplete Food-drug
Diets Interactions
PHYSICAL ILLNESS
 FOOD-DRUG INTERACTIONS
Drug Food Drug-food effects
Anticoagulants Dietary Decrease or loss of
vitamin K anticoagulant effect
Anti-seizure Folate Increase folic acid requirement
agents (folic acid)
Antidepressants Food It slows drug absorption
Riboflavin requirement
increase with amitryptline or
imipramine
Beta-adrenergic Food Bioavailability is enhanced
blockers when taken with food
Barbiturates Folate Increase folic acid requirement
(folic acid) Long term therapy may require
vitamin D supplementation for
osteomalacia
FOOD-DRUG INTERACTIONS
DRUG FOOD EFFECTS
Bronchodilators High carbohydrate, Decrease drug
low protein diet elimination

Zinc Foods (Milk) Fiber impair zinc

supplements absorption

Isoniazid Cheese or fish Redness or itching, HR

changes, sweating,
chills, clammy feelings,
headache or
lightheadedness
CLINICAL MANIFESTATIONS
Body system Subclinical Clinical manifestations
manifestations
Integumentary Slowed tissue Hair: Easy loss of hair, colour
turnover rate changes, lack of luster
Surface Nails : Brittle
temperature Skin : Decrease tone and elasticity
1-20 F cooler of skin, xeroderma, brown-gray
pigment changes, erythematous
seborrheic dermatitis, scrotal
dermatitis
Visual Nightblindness Bitot’s spots
Dryness of conjunctiva
Pale to red conjunctiva
CLINICAL MANIFESTATIONS
Mouth & lips Reduction in Cheilosis
saliva production

Tongue Mucous more Raw & beefy red, edematous and

permeable to smooth, atrophy or hypetrophy of
bacteria papillae

Teeth Improper Cavities, loose teeth, discoloured

development enamel
Delayed eruption
Gingivae Periodontal disease, tendency to
bleed easily, receding pale and soft
CLINICAL MANIFESTATIONS
Stomach Decreased gastric Constant hunger,
secretion, delayed increased
gastric emptying incidence of ulcer

Intestines Decreased motility Diarrhoea &

& absorption flatulence,
Normal flora cause protruding
infection from abdomen, increased
increasing incidence of
permeability of parasitic infection
mucosa
Liver-biliary Fatty liver, Hepatomegaly
Decreased
absorption of fat-
soluble vitamins
 CLINICAL MANIFESTATIONS
CV Decreased CO Decreased pulse, BP
Decreased Hb Slight cyanosis
Anaemia
Body edema

Endocrine Decrease insulin Thyroid enlargement

production Polydipsia, polyuria
Decreased sensitivity to cold
Musculo- Decrease growth rate Prominence of bony structures such
skeletal Decrease body stature as face, clavicle, scapula, ribs, iliac
with chronic PCM crests and spinal vertebrae
Decrease muscle mass Weak and spindly arms & legs, flat
buttocks, weak and flabby muscles
Decreased physical activity & ability
to work
Severe weight loss
CLINICAL MANIFESTATIONS
Neurologic Loss of ambition Depression
Feeling of being tired Confusion
Decreased reflexes in
legs, ankles
Decrease position
Paresthesia of hands,
feet
Syncope
Motor weakness
Renal Negative nitrogen balance Nocturia
Decreased BUN, creatinine Decreased urinary output
levels
CLINICAL MANIFESTATIONS
Reproductive Decreased Amenorrhoea
Gonado- Impotence
trophins Atrophied breasts
levels
Respiratory Pulmonary Increased
edema suspectibility of
Decreased infection
strength of Bradypnea
respiratory Decreased vital
muscles capacity
 DIAGNOSIS
• History

• Physical Examination

• Laboratory Studies
Hb
RBC
TLC
Liver enzymes
Serum vitamin levels
Serum albumin, globulin and total protein
Serum electrolyte levels
 LABORATORY STUDIES
Albumin

Normal value 3.8-4.5 g/dl

Mild depletion 3.0-3.7 g/dl

Moderate depletion 2.5-2.9 g/dl

Severe depletion < 2.5 g/dl

 LABORATORY STUDIES
Pre-albumin

Normal value 20mg/dl

Mild depletion 10-15 mg/dl

Moderate depletion 5-10 mg/dl

Severe depletion < 5 mg/dl

 MANAGEMENT
• Determine energy requirement (Basal Energy
Expenditure)

BEE (men): 66 + (13.7 x wt + (5 x ht in cm) –

(6.8 x age)

BEE (Women): 655 + (9.6 x weight in kg) +

(1.7 x ht in cm) – (4.7 x age)
 MANAGEMENT
• Weight maintenance: 25 kcal/kg body weight

• Weight gain : 35kcal/kg or an additional 500

kcal/day
 MANAGEMENT
• Determine protein requirement
1.5 g of protein/kg to as much as 2 g of
protein/kg body weight
 MANAGEMENT
• High calorie, high protein diet
Breads and cereals Hot cereals (oatmeal)
prepared with milk
added fat (butter) and
sugar

Potatoes prepared
with added fat (butter)

Dried fruits,
Buttermilk biscuits,
muffins
Vegetables Hot cereals (oatmeals) prepared
with added fat (butter)

Fruits Canned fruit in heavy syrup

Dried fruit

Meats Fried meats

Meats covered in cream sauces or
gravy

Milk & milk products Milk shakes

Whole milk and milk products

(yogurt, ice cream, cheese)

Whole milk with added nutritional

supplements
 MANAGEMENT
• Determine the route of feeding
 MANAGEMENT
• Nutritional Supplements

Ensure powder (250 ml)

• 8 grams of high-quality protein

• 24 essential vitamins and minerals, including
antioxidants
• 240 nutritious calories
 MANAGEMENT
• Peptan powder

18 amino acids

Glycine, proline & hydroxyproline

(50% of Peptan’s total amino acid content)

10 to 20 times higher Glycine & proline

 NURSING MANAGEMENT
• Imbalanced nutrition less than body requirements related
to decreased access, ingestion, digestion, or absorption
of food or related to anorexia

• Activity intolerance related to weakness, fatigue, and

inadequate calorie intake or iron stores.

• Self-care deficit (feeding) related to decreased strength

and endurance, fatigue, and apathy.

• Fluid volume deficit related to factors affecting access to

or absorption of fluids.
 NURSING MANAGEMENT
• Nutritional history (Family & friends)
• Physical Examination
• Client’s perspective & feeling toward eating &
food
• Etiological factor
• Plan diet according to the nutritional requirement
• Pleasant environment
• Good oral hygiene
• Proper positioning
OBESITY
 DEFINITION
• Characterised by an excess accumulation of fat
and reflect, on the most basic level, an overall
possible balance between energy intake and
expenditure.
 EPIDEMIOLOGY
• Around 2 billion adults are overweight, of
those 650 million are considered to be
affected by obesity (BMI ≥30 kg/m²)

• That equates to 39% (39% of men and 40% of

women) of adults aged 18 or over who were
overweight, with 13% obese.

• The worldwide prevalence of obesity nearly tripled

between 1975 and 2016.
 EPIDEMIOLOGY
• Morbid obesity affects 5% of the
country's population.

• In Northern India, obesity was most prevalent in

urban populations (male = 5.5%, female =
12.6%)
 EPIDEMIOLOGY
• Obesity rates were the lowest in rural
populations (male = 1.6%, female = 3.8%)

• Women of high socioeconomic class had rates of 10.4%

as opposed to 0.9% in women of low socioeconomic
class.

• It is estimated by 2025
2.7 billion adults will be overweight
Over 1 billion affected by obesity
177 million adults severely affected by obesity
 EPIDEMIOLOGY

• Globally, in 2016 the number of overweight

children under the age of five, is estimated to be
over 41 million.

• Almost half of all overweight children under 5

lived in Asia and one quarter lived in Africa.
 CLASSIFICATION
Primary obesity Secondary obesity

Intake of excess This results from various

calories for the body’s congenital anomalies,
metabolic demands. metabolic problems, CNS
lesions and disorders.
 Gynoid obesity Android obesity
1. Individuals whose fat is located 1. Individuals whose fat is distributed over
primarily in the upper legs (Pear the abdomen and upper body (neck,
shaped body) arms, and shoulders) (apple shaped
body)

2. People carry over more 2. People carry more visceral fat

subcutaneous fat
3. Health risks are 3. Health risks are
 Osteoporosis  Heart disease
 Varicose veins  Diabetes mellitus
 Cellulites  Breast cancer
 Endometrial cancer

Visceral fat is more active causing

 Decrease insulin sensitivity
 Increase triglycerides
 Decrease HDL cholesterol
 Increase BP
 Increase free fatty acid release into
blood
According to BMI
BMI Classification

≥ 35 Severe obesity

≥ 40 Morbid obesity

≥ 50 Super obesity
 CHILDHOOD OBESITY
• BMI greater than or equal to the 95th percentile
(CDC)
 CHILDHOOD OBESITY
• Experience emotional and psychological
problem.

• Risk factors: Obese Parents, increase in use of

technology, snacks and portion size of meals, &
decrease in the physical activity.
 CHILDHOOD OBESITY
Obesity is a major feature of –

• Prader-Willi syndrome (deletion of chromosome 15)

• Bardet-Biedl syndrome (Autosomal recessive,

Mutation in BBS1,2, BBS3, 4, 5,7, ARL6)

• MOMO syndrome

• Leptin receptor mutations (Mutations in the LEPR

gene)
 CHILDHOOD OBESITY
• Congenital leptin deficiency
Autosomal recessive trait
Homozygous frameshift or missense mutations
in the ob gene (7q31.3)

• Treatment : Lifestyle modification

 CAUSES
•
Genetic Psychosocial
Factors Factors

Environmental
Factors
GENETIC FACTORS
Harmone Normal Function Alteration in obesity
Leptin Suppresses appetite High levels
Regulates eating Leptin resistance develops
behaviour Lose the effect of appetite
suppression

Insulin Decreases appetite High levels

Ghrelin Stimulates appetite Increased appetite and
Increase after food overeating
deprivation
Decrease in response
to the presence of food
in stomach

Peptide YY Inhibits appetite by Decreased

slowing GI motility &
Gastric emptying
Cholecystokinin Inhibits gastric Unknown role
emptying
 ENVIRONMENTAL FACTORS
• Great access to pre-packaged fast foods, cold-
drinks

• Lack of physical exercise

• Increased time spent playing video games, TV

• Socio-economic status
 PSYCHOSOCIAL FACTORS
• For comfort

• For reward

• Specific foods and continue to eat beyond

satiety.
 DIAGNOSIS
• Body Mass Index (BMI) - WHO

BMI Classification

< 18.5 Underweight

18.5–24.9 Normal weight

25.0–29.9 Overweight

30.0–34.9 Class I obesity

35.0–39.9 Class II obesity

≥ 40.0 Class III obesity

 DIAGNOSIS
BMI Classification

≥ 35 Severe obesity

≥ 40 Morbid obesity

≥ 50 Super obesity
 BMI – Asian Criteria
BMI Classification
< 18.5 Underweight
18.5 - 22.9 Normal weight
23.0 - 24.9 Overweight
25.0 - 29.9 Pre-obese
≥ 30 Obese
30.0 - 40.0 Class 1 obesity
40.1 - 50 Class II obesity
>50 Class III obesity
 Waist circumference
• Men >102 cm (~40")
• Women >88 cm (~34.5")

• Waist–hip ratio
Men > 0.9
Women > 0.85

• WHR < 0.80 – optimal

A WHR > 0.8 indicates - greater risk for health
complications
 BODY FAT PERCENTAGE
• Total body fat expressed as a percentage of total
body weight.

• Body fat percentage = 1.39 x BMI + 0.16 x age –

10.34 x gender - 9
Gender 0 if female
Gender 1 if male

• Men > 25 %
• Women > 30 %
 HEALTH RISKS
CV disorders • CAD
• HTN
• Right sided Heart failure
• Left-ventricular
Hypertrophy
• DVT
• Atrial fibrillation
• Cardiomyopathy
• Cardiac arrest

Respiratory Problem • Reduced chest wall

compliance
• Decreased lung capacity,
functional residual capacity
• Sleep apnea
Metabolic Problems • Hyperinsulinemia
• Insulin resistance
• Metabolic syndrome
• Polycystic ovary
syndrome

Musculoskeletal problems:. • Osteoarthritis

• Lumber disc problems

GI & liver problems • GERD

• NASH diseases

Reproductive • Gynaecomastia
• Menstrual irregularities
Genitourinary • Stress incontinence
• ESRD secondary to
diabetes & hypertension

Cancer • Breast
• Endometrial
• Ovarian
• Cervical cancer
• Colorectal
• Prostrate
 MANAGEMENT

Nutritional Behaviour
Exercise
Therapy Modification

Drug Surgical
therapy therapy
NUTRITIONAL
THERAPY
• Low calorie : 800-1200 calories
per day

• Very low calorie : less than 800 calories per day

General Principles
• Small & frequent meals
• Maintain diet diary
• Eat regularly. Do not skip meals
• Appropriate fluid intake
 NUTRITIONAL THERAPY
• Avoid alcoholic beverages

• Avoid concentrated sweets such as sugar,

candy, honey, pies, cakes, cookies, sodas.

• Avoid baking, broiling or steaming foods.

• Fad diet
 FAD DIET
• Weight loss : quickly, easily and inexpensively.

• Diet low in fat or low in carbohydrates.

• Good effects on blood lipid concentrations, BP,

Glucose control.

• Effects are short-lived and not superior to

standard approaches over the longer term.
 FAD DIET
• The degree of weight loss strongly depends on
the ability of patients to adhere to their diets.
Food specific diet Cabbage soup diet
Low carb diet Atkins diet
protein- 27 %,
Carbohydrates - 54 %
Fat - 68 %
(Saturated fat – 26 %)

High-fiber, low-calorie diets

Liquid diet
Fasting
 FAD DIET
FAD DIET
Phase 1 Protein
(2 weeks)
Monounsaturated fats

Carbohydrates with the low glycemic index

Chocolate powder (no added sugar), hard

candy, sugar substitute)

Phase 2 Carbohydrates with low GI

Apples, berries, grapefruits, high-fiber cereal,

whole- grain breads.
 EXERCISE
Psychological benefits
• Reduce in stress and tension
• Better quality sleep and rest
• Increase stamina and energy
• Improve self-concept, self-confidence better
attitude towards work and play
• Increase optimism about future
BEHAVIOUR
MODIFICATION

Self- Stimulus
monitoring control

Weight
Reward reduction
centres
DRUG THERAPY
• Appetite - suppressing agents

Noradrenergic agents such as phentermine,

diethylproprion, phendimetrazine, &
benzaphetamine (< 12 weeks)

Adverse effects
palpitations, tachycardia, restlessness, dizziness,
insomnia, weakness and fatigue.
DRUG THERAPY
• Mixed noradrenergic-serotonergic
agents ; Sibutramine
 BARIATRIC SURGERY
Criteria

• BMI ≥40 kg/m2 or BMI ≥ 35 kg/m2 with one or more

severe obesity related medical complications (Type-2
DM, HTN, heart failure, sleep apnea)

• Age: ≥18

• Has been obese since 5 years

• Other methods tried and failed

 BARIATRIC SURGERY
• No serious endocrine problem causing the
obesity

• Psychiatric and social stability, willingness to

cooperate with long term follow up.

• Surgery would lessen or eradicate the risks of a

condition
 TYPES
Restrictive Surgery Vertical banded gastroplasty

Adjustable gastric banding

Malabsorptive surgeries Biliopancreatic diversion (BPD)

Biliopancreatic diversion with

duodenal switch (Roux-en-Y
surgical procedure)
Combination Lipectomy

Liposuction
 RESTRICTIVE SURGERY
• Reduce the size of a stomach to 30 ml or less
and causes patient to feel full quicker.

• Types
VBG
LapBand Beta
 VERTICAL
BANDED GASTROPLASTY (VBG)
 ADJUSTABLE
GASTRIC BANDING
(LapBand Beta)
MALABSORPTIVE SURGERY
• Bypass various length of small intestine to
reduce food absorption.

Types
• BPD
• Roux-en-Y surgical procedure
BILIOPANCREATIC DIVERSION
BILIOPANCREATIC DIVERSION WITH
DUODENAL SWITCH
 Lipectomy (adipectomy) Liposuction
Removal of unslightly flabby Suction out the excess fat under
folds of adipose tissue from the chin, along the jawline, in the
breasts, abdomen, lumber and nasolabial folds, over the
femoral areas. abdomen, or around the waist and
upper thighs after patient has
achieved weight reduction.

Generally used in an attempt to

change the body’s shape.
 NURSING MANAGEMENT
• Imbalanced nutrition more than body requirement related to
excessive intake in relationship to metabolic needs.

• Risk for impaired skin integrity related to alterations in

nutritional state (obesity), immobility, excess moisture, and
multiple skin folds.

• Ineffective breathing pattern related to decreased lung

expansion from obesity.

• Chronic low self-esteem related to body size, inability to lose

weight and perceived unattractiveness
 NURSING MANGEMENT
• Body image disturbances/ low self-esteem may be
related to biophysical/psychosocial factors such as
patient’s view of self as evidenced by verbalization of
negative feelings about body, fear of rejection /reaction
about others, feelings of hopelessness/powerlessness.

• Impaired social interaction related to verbalised or

observed discomfort in social situations as evidenced by
reluctance to participate in social gatherings.
 NURSING MANAGEMENT
• Determine patient’s view of being fat and what it does for the
individual.

• Provide privacy during care activities as individual remain

sensitive/self-conscious about body.

• Promote open communication avoiding criticism/ judgement about

patient’s behaviour

• Graph weight on weekly basis

• Encourage patient to use imagery to visualize self at desired weight

and to practice handling of new behaviours.

• Provide information about the use of makeup, hairstyles, and ways

of dressing to maximize figure assets.
 NURSING MANAGEMENT
• Review family patterns of relating and social behaviours as it is
primarily learned within the family origin.

• Encourage client to express feelings and perceptions of problems. It

helps in identifying and clarifying reasons for difficulties in
interacting with others.

• Assess client’s use of coping skills and defense mechanisms.

• Have client list behaviours that cause discomfort.

• Involve client in role playing new ways to deal with identified

behaviours/situations.

• Discuss negative self-concepts and self-talk with client “No one

wants to be a fat person, who would be interested in talking to me?”
 MALNUTRITION (VITAMINS)

Fat soluble vitamin Manifestations of deficiencies

A Dry, scaly scale, increased susceptibility to
infection, night blindness, anorexia, eye irritation,
xerosis, keratinization of respiratory and GI
mucosa, bladder stones, anaemia, retarded
growth

D Muscular weakness, excessive sweating,

diarrhoea, GI disturbances, bone pain, rickets,
osteomalacia

E Neurologic deficit
K Defective blood coagulation
Fat soluble vitamin Manifestations of overdose
A Hair loss, dry skin, headache, dry
mucous membrane, liver damage, bone
and joint pain, blurred vision, nausea
and vomiting

D Deposits of calcium and phosphorus in

soft tissue
Kidney and heart damage

E Relatively non-toxic

K Anaemia
 Water-soluble vitamins Manifestations of deficiencies
B1 Loss of appetite, fatigue, nervous irritability,
constipation, paresthesia, insomnia

B6 Seizures, dermatitis, anaemia, neuropathy with

motor weakness, anorexia

B12 Megaloblastic anaemia, inadequate myelin

synthesis, anorexia, glossitis, sore tongue,
pallor, neurologic problems such as depression,
dizziness, weight loss, nausea, constipation

C Bleeding gums, loose teeth, easy bruising, poor

wound healing, scurvy, dry and itchy skin

Folic acid Impaired cell division, protein synthesis,

megaloblastic anaemia, anorexia, fatigue, sore
tongue, diarrhoea, forgetfulness
NUTRITIONAL THERAPY
 MEDICATIONS
Optineuron injection (3 ml injection)

Composition -
• Cyanocobalamin (1000mcg)
• D-Panthenol (50mg)
• Niacinamide (100mg)
• Pyridoxine (100mg)
• Riboflavin (5mg)
 MEDICATIONS
• Ascorbic acid
500 mg

• Vitamin K
Oral tablets:
5 mg, 100 mcg

Injection:
10 mg/ml, 1 mg/0.5 ml
 MEDICATIONS
• Evion 200/400 mg

• Vitamin A (Retinol)
Tablet: 50000 IU
Capsule: 25000 IU, 50000 IU
 MEDICATIONS
Becosule Z

• Vitamin B1 (Thiamine) - 10 mg
• Vitamin B2 (Riboflavin) - 10 mg
• Vitamin B3 (Niacin)- 100 mg
• Vitamin B6 (Pyridoxine) - 3 mg
• Vitamin B7 (Biotin) - 100 mcg
• Vitamin B9 (folic acid, folate) - 1.5 mg
• Vitamin B12 (Cobalamin) - 15 mcg
• Ascorbic Acid - 150 mg
• Calcium Pantothenate - 50 mg
• Zinc Sulphate - 41.4 mg
 RESEARCH ARTICLE
Malnutrition predicts long-term survival in
hospitalized patients with gastroenterological and
hepatological diseases.

European Society for Clinical Nutrition & metabolism

Knappe-Drzikova B, Maasberg S, Vonderbeck D,

Krafft TA, Knüppel S, Sturm A, Müller-Nordhorn J,
Wiedenmann B, Pape UF
 RESEARCH ARTICEL
AIM : To assess the association between
nutritional status parameters & long-term overall
survival in hospitalized gastroenterological-
hepatological patients.

• Gastroenterological-hepatological patients : 644

• Follow up for 67 months.

 RESEARCH ARTICLE
Nutritional status Parameters

• Nutritional Risk Screening (NRS)

• Anthropometry (BMI, MUAC, TST)
• Serum transferrin
• Bioelectrical Impedance analysis (BIA)
 RESEARCH ARTICLE
Results
• Sufficiently nourished (NRS, 0-2): 475 (73.8%)

• Increased risk of malnutrition (NRS≤3): 169

(26.2%)

• Overall 5-YSR) were much shorter in

malnourished patients whether with (43.9%) or
without (73.6%) malignancy.
FMT
• Obesity is a/s with low bacterial richness/diversity.

• Leaness is a/s with greater microbial diversity.

• Probiotics enrich the intestinal flora

• Many studies show anti-obesity properties of probiotics.

• 90 % GI flora belong to two main phyla

Firmicutes
Bacteriodetes
FMT
• Probiotics for weight loss

Saccharomycetes boulardii
Lactobacillus rhamnosus
Enterococcus halli
Akkermansia muciniphilia
Lactobacillus gas
 RESEARCH ARTICLE
Patient perception and approval of faecal microbiota
transplantation (FMT) as an alternative treatment option for
obesity.

Obesity research and Clinical practice

Gundling F, Roggenbrod S, Schleifer S, Sohn M, Schepp W.

• Obese people : 100

• Survey using a questionnaire containing 21 both multiple

choice and open questions
 RESEARCH ARTICLE
• Response rate - 30.1 % (n = 31).

• Mean BMI - 40.5 kg/m2. Vast majority already tried out treatment
modalities to lose weight before.

• 25.8 % were aware of FMT.

• 62.1 % were willing to undergo FMT if the donor was healthy and
anonymous while only 6.9 % clearly refused this option.

• Sixty preferred an anonymous donor or a person proposed by their

doctor while colonoscopy was the preferred application by 76.7 %.

• Insufficient testing of the faeces concerning infections raised the

most concerns (in 61.6 %).
 RESEARCH ARTICLE
• The absence of risks of the procedure (47.8%) formed
the principal motivation while reduction of medication
was considered as least important reason (in 26.1).

Conclusion
• Approximately 2/3 of the questionees consider FMT as
an alternative treatment option, even in spite of a
satisfactory disease response to current standard
therapies.

• Unsurprisingly there are concerns in regard to the

transmission of possible infectious agents as well as to
the hygienic implementation of FMT itself.
SUMMARY
 BIBLIOGRAPHY
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