Impact of Medical Nutrition Therapy on Neutrophil-Lymphocyte Ratio and Total Lymphocyte Count in Malnourished AMAN and Miller Fisher Syndrome variants GBS: A Case Series

Guillain-Barré syndrome (GBS) is an autoimmune disorder of the peripheral nervous system characterized by immune-inflammatory dysregulation. The neutrophil-to-lymphocyte ratio (NLR) reflects the severity of inflammation, while total lymphocyte count (TLC) indicates immune-nutritional status and prognosis. This study aimed to evaluate the impact of medical nutrition therapy (MNT) on GBS patients, particularly regarding NLR and TLC changes. A retrospective case series was conducted at Wahidin Sudirohusodo Hospital from 2024 to 2025, involving four GBS cases: three acute motor axonal neuropathy (AMAN) variants and one Miller-Fisher syndrome (MFS). AMAN with diabetes mellitus showed the highest NLR (30.7) and lowest TLC (427.89/μL), followed by obese AMAN (NLR 17, TLC 680/μL), AMAN without comorbidities (NLR 19.7, TLC 747/μL), and MFS (NLR 12.5, TLC 963.6/μL). MNT emphasizing anti-inflammatory macronutrients and micronutrients (vitamins A, B, C, D, zinc, and curcumin) improved inflammatory and nutritional parameters, supported by 98–100% monitored intake. Clinical recovery was faster with shorter hospital stays: AMAN with comorbidities (22–25 days) compared to AMAN without comorbidities and MFS (27 days). These findings suggest that GBS patients with diabetes have the most severe inflammatory and nutritional disturbances. MNT effectively modulated inflammation, improved clinical outcomes, and reduced hospitalization duration in both AMAN and MFS variants.