Asna Urooj

ABSTRACT Nutritional status of pancreatitis patients varies among new cases and recurrent patients. Under nutrition is one of the major risk factors in the mortality and morbidity of patients with pancreatitis. Severe malnutrition will adversely affect outcomes, as occurs in other critical diseases. Malnutrition is known to occur in 50-80% of chronic alcoholics and alcohol is a major etiological factor. Excess body fat, lack of lean body mass, muscle wasting and poor immune status are some of the indicators of malnutrition associated with poor prognosis in patients. This study was an observational prospective study conducted on 22 subjects in two multi-specialty hospitals of Mysore city in the period of 2 months. Patients admitted to the hospital with diagnosis of pancreatitis and who were above 17 years of age were recruited for the study. Questionnaire was designed and data such as demographic profile, anthropometric, biochemical, clinical symptoms, medications, 24 hr dietary recall of hospital and home were collected. Results were expressed as Mean ± Standard deviation. Statistical analysis was conducted using student t test and chi square test by means of SPPS 16.0 software. Among 22 subjects, 17 were diagnosed with acute pancreatitis and 5 with chronic pancreatitis, 19 subjects had a history of chronic alcoholism. The serum protein levels was in the lower end of normal (6.73±0.93 g/dl) while liver enzymes and pancreatic enzymes were high(AST-75±81.28 U/L, ALT-47.11±48.44 U/L, P.lipase-485.18±431.65, P.amylase-667.45±824.53). The mean weight on admission was 62.2±9.59 kg, a weight loss of 2-4 kg was seen among majority of the patients at discharge, which could be attributed to the low-calorie intake (mean 367±488 kcal) during hospital stay. Even though the mean BMI was 23.41±4.17, the weight was attributed to empty calories acquired by daily alcohol consumption rather than diet. The mean intake of home recall was 1507 ±288 and that of hospital recall was 367±488. Malnutrition was found to be present among subjects and significant difference (p value-0.000) was seen in patients’ calorie intake. Nutritional status plays a major role in prognosis of patients and early nutrition support must be practiced for better recovery, reduction in length of stay and improvement in nutritional status of the patient. Keywords: Pancreatitis, Nutritional status, dietary recall, Malnutrition, Acute Pancreatitis, Chronic Pancreatitis

Evidence suggests that free radicals are the central pathogenic factor in the atherosclerotic process. Biochemical marker of oxidative stress malondialdehyde and antioxidants viz., serum vitamin E, glutathione (GSH) and magnesium were measured in MI patients (n=47) on admission and monitored over 96 h and compared with healthy controls (n=28). MI subjects were grouped according to the treatment – thrombolyzed (T) and non-thrombolyzed (NT). Mean age of MI onset was 40y, majority of the subjects had a lower protein status and higher waist-hip ratio. An atherogenic lipid profile was observed in >50% of the subjects. Serum Malondialdehyde (MDA) were significantly (p<0.05) elevated on day one of admission (T -10.6 + 0.49, NT-11.83 + 0.18 nmol/l), which decreased at 96h in both MI groups, however the levels were higher in the thrombolyzed group. Serum vitamin E, GSH and magnesium levels were also markedly lower (p<0.05) compared to normal subjects. Serum vitamin E levels increased after 24 h, as result of vitamin supplementation. Antioxidant rich foods were used less frequently. The observations suggest that increased generation of free radicals in the MI event maybe mediated through the oxidation of LDL as majority had markedly elevated LDL levels (> 140mg%). The findings indicate a persistent oxidative stress that might be associated with intravascular inflammation.

Malnutrition is one of the most important nutritional issues that can arise during cancer treatment and it is common among patients with head and neck cancer (HNC). The anatomic site of tumor can significantly affect deglutition and mastication which are the major causes of malnutrition apart from cachexia. The objective of this research work was to study the socio-demographic and nutritional status of patients with HNC. A pilot study was undertaken in patients diagnosed with HNC (n=50), attending cancer care specialty hospital, Mysuru, India. From the results, it was observed that the mean BMI of the patients (18.63±3.56 kg/cm2 in men, 21.06±4.69 kg/cm2 in women) was normal. The subjects had MUAC values lower than the standard value indicating a nutritional risk if not given attention (Men-25.12±2.47, Women-24.21±4.24). The TSF values were lower (Men – 7.27±4.19, Women – 14.3±7.64) compared to the standard value (10 in men and 13.25 in women). Hence, BMI is not an accurate tool to reflect the nutritional status. Biochemical data revealed that the haemoglobin (12.53±2.24 g/dL in men, 11±1.73g/dL in women) and platelet count was lower than the normal values. The PG-SGA score revealed that 42% of the study population were in the SGA B and C category implying moderate to severe malnutrition and 54% of the patients complained of deglutition. Cancer cachexia along with lower values of anthropometric measurements and biochemical parameters reflect poor nutritional status among HNC patients undergoing chemotherapy or radiotherapy or both. Therefore, nutritional screening and assessment of the HNC patients are of utmost importance before starting the treatment regimen.

Chronic obstructive pulmonary disease (COPD) is a disease of the respiratory system characterised by extra pulmonary manifestations that includes nutritional depletion, which is known to have negative consequences on morbidity and mortality. Chronic malnutrition results in reduced lung and respiratory muscle function secondary to loss of lean body mass, multiple nutrient deficiencies and cachexia when chronic in nature. A literature review was performed on the prevalence and trend of malnutrition, reported in COPD patients. Increased resting energy expenditure, thermic response to food, early satiety, increased pro inflammatory cytokines are known to lead to loss of appetite, weight loss and cachexia on a long term. Under nutrition among various study populations is reported between 20-70% and cachexia in 27-33% of subjects with COPD. Malnourished individuals are exposed to higher risk of mortality, morbidity and poor prognosis by the reduced pulmonary function and risk of infections due to the loss of fat free mass, skeletal muscle strength, lower immune function secondary to malnutrition. Pre-existing oxidative stress can be further worsened by deficits in micronutrient intakes. Anthropometric assessment including fat free mass is important in evaluating nutritional depletion as some COPD patients may lose fat free mass without any alterations in fat mass. Thus, COPD patients can suffer from malnutrition, further aggravated by the severity of symptoms, biochemical alterations and severity of disease. Further, undernutrition can negatively affect the prognosis necessitating a thorough assessment of body composition along with somatic status among patients losing weight and those with a history of weight loss.

Background & Objectives: Gestational diabetes is a metabolic disorder characterised by carbohydrate intolerance first during pregnancy associated with foetal and maternal complications. Objectives: To assess the pregnancy outcome as influenced by dietary versus insulin management among GDM mothers Methods: A total of 102 pregnant women, visiting the antenatal clinic of Apollo Hospitals, Bangalore were recruited for the study, classified as control and GDM groups based on the blood glucose levels using IADPSG guidelines, each group consisted of 51subjects. GDM group was further classified as diet managed group (n=23) and insulin managed group (n=28) depending on the modes of management. Biochemical profile was analysed and recorded in both groups Results: Non-significantly higher term weight and a lower gestation week of delivery (37 ±1.51 weeks) and significantly higher HbA1c (6.5±1.02%) was observed in the insulin managed group when compared to the diet managed group, while, total cholesterol and triglyceride levels were significantly higher in the diet managed group (p<0.03 and 0.007) respectively. Caesarean section was common in both groups. The mean birth weight of the infants in both groups was comparable (2.9±0.3 and 2.8±0.52 kg). Whereas, significantly higher serum bilirubin levels were observed in infants born to insulin managed women (9 ±4.78 mg/dl), indicating a poor morbidity status in these infants. Interpretation & Conclusion: Medical nutrition therapy and insulin initiation are the two modes of blood glucose management in GDMs which aids in preventing complications and influencing near to normal pregnancy outcome.