[Vitamin B12 and iron deficiencies: from diagnostic to follow-up]. / Carences en vitamine B12 et fer: du diagnostic au suivi.

Vitamin B12 and iron deficiencies are common problems in consultations of general internal medicine. They cause different symptoms that can be non-specific. This article makes it possible, from a clinical frame of reference, to answer the following questions: What value of vitamin B12 should we consider a "deficiency", and what is the role of methylmalonate? What is the role of vitamin B12 oral supplements? How should we interpret values of ferritine? How should iron deficiency be investigated? What is the place of intravenous iron administration?

[Aneamia secondary to geophagia in a rich country? A case report]. / Anémie ferriprive sur géophagie dans un pays riche?

Geophagia, eating of earth, is a relative frequent practice in several countries and especially in the African and South American mainlands. In some cases, migrant people continue this practice in the host country. Geophagia has some positive effects, presumed or real, and several harmful effects with significant health impacts. We relate the history of young patient of Cameroonian origin who consults for chonic fatigue, abdominal pain and menorrhagia. Laboratory tests show a severe aneamia with iron deficiency.

[Prevalence of undernutrition in 143 patients before liver transplantation. The Lausanne experience between 1997 and 2005]. / Prévalence de la dénutrition chez 143 adultes en bilan prétransplantation hépatique. Experience lausannoise de 1997 a 2005.

The prevalence of undernutrition was prospectively studied in 143 patients before liver transplantation between 1997 and 2005. Nutritional assessment is a particularly tricky problem in cirrhosis and mid-arm muscle circumference is considered as the best reliable anthropometric tool. In this prospective study, prevalence rate is very high (61%) and undernutrition is more frequent in alcoholic cirrhotic patients. In conclusion, these patients should benefit from an early dietician intervention before liver transplantation.

[Short bowel syndrome: nutritional guidelines for the adult patient]. / Approche nutritionnelle pratique d'un patient adulte avec intestin court.

The short bowel is defined by the extended resection of the small intestine, leaving a maximum of 100 cm of healthy organ beyond the ligament of Treitz, with or without preservation of the colon. Nutritional management must be quick in order to optimize adaptation of the remaining intestine, therefore avoiding intestinal insufficiency. Consequent nutrition support such as long term enteral or parental nutrition is some times indispensable. Home enteral nutrition is relatively comfortable. Home parental nutrition somewhat complex, necessitates the creation of a strong home support group. This article addresses practitioners unfamiliar with clinical nutrition, directly faced with problems due to the short bowel in hospital (short and mean term phases) and in home settings (mean and long term phases).

[Chronic renal failure: what diet?]. / Insuffisance rénale chronique: quel régime?

A low protein diet has been traditionally advocated in patients with chronic renal failure (CRF), in order to slow its progression. However, CRF is often associated with malnutrition, aggravating its prognosis, especially in elderly patients. In severe CRF, the spontaneous reduction of appetite coupled with additional restrictions regarding sodium, potassium and phophates may further impact on nutrition status. The potential benefit of a low protein diet is therefore questionable. We only recommend a moderately restricted protein diet (0,8 g/kg/day) in selected patients with no sign of malnutrition. This strategy, if applied, must be supported by a multidisciplinary approach involving a nephrologist and a specialised dietician. Additional dietary restrictions are not justified, except in particular situations.

[Malnutrition on dialysis: the end of a fatality]. / Dénutrition en diatlyse: vers la fin d'une fatalité.

Protein-energy malnutrition in patients treated with haemodialysis (HD) is a complex, multifactorial and prevalent problem, starting well ahead of the dialysis program. It is associated with an increased morbidity and mortality. Uraemic patients are relatively resistant to nutrients because of metabolism abnormalities. Prevention of malnutrition is therefore more efficient than treatment per se. Classical supplementation including oral nutritional supplements, intradialytic parenteral nutrition and enteral nutrition remain efficient, if applied for a sufficient time. A global approach coupling supplementation and strategies designed to optimise metabolism abnormalities should increase treatment efficacy and improve the outcome and quality of life of these patients.