The idea of forming a medical Society in India specifically for the rapidly advancing new field of parenteral and enteral nutrition started in the mid-1980s. By this time, the American Society for Parenteral Enteral Nutrition (ASPEN) was already in existence for a decade and from an initial meeting of 5 visionary physicians it had already grown to several 100 members. Dr Krishnan Sriram, founding president had the privilege of working with several of these doyens in critical care, sepsis and especially nutrition. During his periodic visits to India from USA, several educational sessions were conducted. The increase in interest in this novel therapy brought together a group of physicians, dieticians, pharmacists, nurses, and hospital administrators to form ISPEN. Although the formal registration was in 1994, activities of the Society had started many months earlier. At a soft launch in Mumbai (still called Bombay) in 1993, several dietitians and doctors participated, especially from Chennai (still called Madras) and Delhi, most of whom are still involved with ISPEN! Mr Praful Naigoankar, pharmacist, and Dr Pravin Amin, intensivist, were part of our initial board and contributed to our success to a great extent.

ISPEN’s first registered office was located in the erstwhile Tamilnad Hospital, in a suburb of Madras, combined with the space allotted for India’s first organized nutrition support team and certified nutrition support dietitian (CNSD) training program. Dietitians Jayanthi, Chitra, and Geethalakshmi assisted in the organization, publicizing educational programs, recruitment of new members, record keeping, and communications (via old- fashioned “snail mail”, as email and other forms of digital communication were unavailable, and cell phones were non-existent!). Incidentally, the first time parenteral nutrition was administered and supervised by a dietitian-oriented nutrition support
team showcased ISPEN’s importance to our periodic visitors from all over India and abroad. These efforts were facilitated by the late Dr Shanmuga Bhaskar, surgeon at Madras, whose untimely demise is a great loss to I SPEN.

The first official ISPEN conference held at AIIMS under the leadership of the late Dr Rakesh Tandon was a huge success, with several faculty from USA and other countries that had already established PEN Societies. It was indeed a proud moment. In the early 1990s there was only one scientific enteral formula available in India. Parenteral
nutrition was in its infancy. There was no “3 in 1” admixture. Individual components, namely hypertonic dextrose and aminoacids had to be mixed under sterile conditions, and electrolytes including Mg & P needed to be added. Subsequently, with advice from ISPEN, many aminoacid formulations with electrolytes were made available. Trace elements were imported individually.

These parenteral admixtures were often prepared by the physicians themselves for both adult and pediatric use with assistance from dieticians except in a few hospitals privileged to have trained pharmacists. ISPEN is the first truly multidisciplinary society in India. Health care providers of all disciplines sat together at the same conference. This was unusual for our country where physicians were always considered “captains of the ship”. Younger physicians and even medical students were encouraged
to respect the important role of dietitians in the nutritional care of patients. Likewise, dietitians were encouraged to be assertive in their recommendations.

Confidence building among members was made easier by providing easy access to current literature by ISPEN’s leadership. Those were the days before internet and emails. The newly formed Society for Medical Learning Resources Transfer, and individual connections of members with authors in Europe and north America, helped us to keep up with the literature to be able to rapidly adopt new guidelines and discard old patterns.

ISPEN was also instrumental in teaching clinicians that international guidelines need to be modified for use in India. For example, the literature emphasized that pumps were always needed for enteral tube feeding, by authors who had no idea of the unreliability of electricity supply and the additional costs involved. ISPEN published a handbook on home enteral nutritional, widely distributed benefitting hundreds of patients. The handbook provided instructions about cleaning, sterilizing and reusing enteral delivery equipment (bags, bottles, and tubes), many of which suggestions have been ratified by other major societies. Publications on the use of pancreatic enzymes to prevent blockage of soft bore nasoenteral tubes, popularized by ISPEN, was accepted as a standard of care. Long before “prehabilitation” and “Enhanced Recovery after Surgery” or
“ERAS” became buzz words, ISPEN had popularized these concepts way back in the 2000s. Drug-nutrient interactions were often not recognized. Publications regarding this ensued and dietitians were taught to include this in their assessment. ISPEN thus recognized the importance of a comprehensive nutritional assessment long before other societies included this in their guidelines. Health care as an industry was still in its infancy and concentrated in major metropolitan areas, and the concept of branches of the parent company did not exist. Smaller towns and urban areas were neglected and clinicians in these areas were desperate for updating their knowledge. ISPEN
stepped in and conducted several Total Nutrition Therapy (TNT) programs all over India, with participation by dieticians who impressed their more senior colleagues with their knowledge and practical skills.

Decades ago, before “Open Access” became a regulatory requirement, many nutrition Societies used to charge large fees for access to their Guidelines. ISPEN successfully lobbied to stop this unfair practice affecting developing countries. International recognition ensued rapidly. We had an India Editor for prestigious journals such as Nutrition, and Journal of Parenteral and Enteral Nutrition. Publications from our own members followed many of which are still referenced. ISPEN received full support from Dr Michael Meguid, the editor-in-chief of Nutrition, a truly international journal created for encouraging publications from all over the world. Dr Meguid in 1994 advised us on several aspects of forming and running a society, especially limiting the duration of the terms of office bearers, and including dieticians, nurses and pharmacists in all aspects of the Society’s goals. 

ISPEN became an early member of the Parenteral & Enteral Nutrition Society of Asia (PENSA) and it was a national pride to be given the honor to host their meeting in conjunction with ISPEN, in 2003 at Goa. ISPEN was at least partly responsible for approval to manufacture and market parenteral additives such as trace elements, and phosphate. This took several years of negotiations to convince authorities about the safety of these products, already in use in other countries, and the absolute need of the same to ensure safe delivery of parenteral nutrition. Dignitaries from other countries recognized our strengths. Enteral products, feeding devices and parenteral nutrition formulations became readily available. An important difference between ISPEN and other medical societies was the inclusion ofphysicians dealing with both adult and pediatric patients. Sessions on pediatric nutrition were always included in our educational programs. Leaders who helped us include Dr TK Ramanujam, pediatric surgeon, and accepted to be the first in India to provide parenteral nutrition in India. Dr Sarath Gopalan, pediatric gastroenterologist, continues to be part of ISPEN’s activities.

We were fortunate to have support from Dr Georgi Abraham, a pioneer nephrologist, and the first person in India to start peritoneal dialysis. We also provided evidence that trace elements are not lost in peritoneal dialysis. With his assistance, ISPEN conducted courses on renal nutrition emphasizing the importance of adequate macro-and especially micronutrients to compensate for losses during renal replacement therapy. Clinicians began to accept the concept of diseasespecific nutrition therapy. The relationship between the Indian Society for Critical Care Medicine (ISCCM) and ISPEN goes back to over 25 years. In 1997, when Dr Ram Rajagopalan was the president of ISCCM, we conducted a combined conference. Internationally recognized faculty included Dr Tashiro and Dr Okamura from Japan, Dr Dennis Maki of infectious diseases fame who highlighted prevention of catheter sepsis, and Dr Harry Max Weil, the father of critical care medicine in USA.

ISPEN popularized concepts of “diversity and inclusion” long before the current political climate where this is a requirement. At least 50% of office bearers were women, and so was an equal distribution of speakers, the majority of whom had to be from Asian countries, preferably India. Efforts by ISPEN’s leadership to initiate postgraduate degree courses in clinical nutrition for physicians, especially artificial nutrition therapy, were (and still are) unsuccessful. However we were able to establish a department of clinical nutrition at Sri Ramachandra Medical College, in a suburb of Chennai, under the able leadership of Dr Varsha, initially with just 4 postgraduate certificate course candidates, and now with over 100 students and faculty, with numerous publications to their credit. In many ways, it is to ISPEN’s credit that dieticians (after receiving BSc, MSc or PhD degrees) realized that private practice with flexible hours is more suitable for many rather than depending on hospital-based jobs.

This brief writeup is about the initial years of ISPEN and does not diminish the work done in more recent years by numerous members, not necessarily office bearers. The Society continues to grow with their support.