Home enteral nutrition in Spain; NADYA registry 2011-2012.

OBJECTIVE: To describe the results of the home enteral nutrition (HEN) registry of the NADYA-SENPE group in 2011 and 2012. MATERIAL AND METHODS: We retrieved the data of the patients recorded from January 1st 2011 to December 31st 2012. RESULTS: There were 3021 patients in the registry during the period from 29 hospitals, which gives 65.39 per million inhabitants. 97.95% were adults, 51.4% male. Mean age was 67.64 ± 19.1, median age was 72 years for adults and 7 months for children. Median duration with HEN was 351 days and for 97.5% was their first event with HEN. Most patients had HEN because of neurological disease (57.8%). Access route was nasogastric tube for 43.5% and gastrostomy for 33.5%. Most patients had limited activity level and, concerning autonomy, 54.8% needed total help. Nutritional formula was supplied from chemist's office to 73.8% of patients and disposables, when necessary, was supplied from hospitals to 53.8% of patients. HEN was finished for 1,031 patients (34.1%) during the period of study, 56.6% due to decease and 22.2% due to recovery of oral intake. CONCLUSIONS: Data from NADYA-SENPE registry must be explained cautiously because it is a non-compulsory registry. In spite of the change in the methodology of the registry in 2010, tendencies regarding HEN have been maintained, other than oral route.

Objetivos: Describir los resultados del registro de nutrición enteral domiciliaria (NED) del grupo NADYASENPE de los años 2011 y 12. Material y métodos: Se recopilaron los datos introducidos en el registro desde el 1 de enero de 2011 al 31 de diciembre de 2012. Resultados: Hubo 3021 pacientes en el registro durante el periodo, procedentes de 29 hospitales, lo que da una prevalencia de 65,39 casos por millón de habitantes. 97.95% fueron adultos, 51,4% varones. La edad media fue 67,64 ± 19,1 años y la mediana 72 años para los adultos y 7 meses para los niños. La duración media de la NED fue 351 días y para el 97,5% fue el primer episodio con NED. La mayoría de pacientes tenían NED por una enfermedad neurológica (57,8%). La vía de acceso fue sonda nasogástrica para el 43,5% y gastrostomía para el 33,5%. La mayoría de pacientes tuvieron un nivel de actividad física limitado y, respecto a la autonomía, 54,8% necesitaba ayuda total. La fórmula de nutrición se suministró desde las oficinas de farmacia para el 73,8% y los fungibles, cuando fueron necesarios, desde los hospitales para el 53,8%. La NED se suspendió en 1.031 pacientes (34,1%) durante el periodo de estudio, 56,6% debido a fallecimiento y 22,2% debido a recuperación de la vía oral. Conclusiones: Los datos del registro NADYA-SENPE deben ser interpretados con precaución ya que se trata de un registro voluntario. A pesar del cambio de metodología del registro en 2010, las tendencias en NED se han mantenido, salvo la importancia cuantitativa de la vía oral.

Metabolic effects of L-carnitine on type 2 diabetes mellitus: systematic review and meta-analysis.

INTRODUCTION: Carnitine is an endogenous metabolite and exogenous nutrient with a pivotal role in lipid metabolism. Plasma levels of carnitine are reduced in type 2 Diabetes Mellitus (T2DM). The aim was to evaluate the metabolic effects of the administration of L-carnitine in T2DM. METHOD: A systematic review was performed. Relevant randomized, controlled-trials trials were searched in Pubmed, Trip Database and Cochrane Library, and selected when they had enough methodological quality assessed with the Jadad scale. Article search strategy included "Carnitine" OR "L-carnitine" AND "Diabetes -Mellitus" OR "Diabetes mellitus, type 2" OR "Noninsulindependent-diabetes mellitus". Meta-analysis was performed, and the difference of means calculated with a 95% confidence interval. Heterogeneity was evaluated with the Q statistic. RESULTS: The systematic review included 4 trials with 284 patients. Oral L-carnitine lowered fasting plasma glucose [-14.3 mg/dl (CI95% - 23.2 to -5.4); p=0,002], total cholesterol [-7.8 mg/dL (95%CI -15.5 to -0.1); p=0.09], low density lipoprotein [-8.8 mg/dl (CI95% -12.2 to -8.5), p<0.0001], apolipoprotein-B100 [-7.6 mg/dl (CI95% -13.6 to -1.6); p=0.013] and apolipoprotein-A1 [-6.0 mg/dl (CI95% -10.5 a -1.5); p=0.523]. There was no significant heterogeneity. The changes in triglycerides, lipoprotein (a) or HbA(1c) were not significant. CONCLUSION: The administration of L-carnitine in type 2 diabetes mellitus is associated with an improvement in glycaemia and plasma lipids.

Nutritional intervention in oncohematological patient.

BACKGROUND: Oncohematological diseases such as lymphoma or leukaemia affect an increasing number of newly diagnosed patients in Spain and other countries. Both disease and treatment may have a negatively impact in the nutritional status of the patient. Malnutrition is not uncommon among oncohematological patients. This situation can compromised the course of the disease, the clinical response of the treatment and the patient's quality of life. METHOD: The implementation of a multidisciplinary approach and a systematic and protocolled nutritional assessment would be useful when dealing with haematological malignancies. RESULTS: We present a proposal of protocol for nutritional intervention in oncohematological patients. This proposal is been developed from the analysis of the published literature as well as clinical practice of a multi-disciplinary team specialized in the management of patients with haematological malignancies.

[Analysis of the relevance and feasibility of quality indicators in nutrition support]. / Análisis de la relevancia y factibilidad de indicadores de calidad en las unidades de nutrición.

INTRODUCTION: The quality assessment in health activities requires the choice of indicators in line with the results we want to measure. Of all possible, we should prioritize those that allow us to obtain the most relevant information without overloading the regular work of our units. OBJECTIVE: To determine the opinion of the members of SENPE regarding the relevance and feasibility of using a selection of quality indicators designed for use in clinical nutrition. METHODS: E-mail survey sent to members of SENPE asking them their views on 12 quality indicators, evaluating each in terms of their relevance and feasibility of implementation in their environment. RESULTS: 40 respondents answered from 40 centers in 12 different regions. In general, the indicators were considered more relevant than feasible. The indicators best rated were: "identification in artificial nutrition bags, "semi-recumbent position in patient with nasogastric tube feeding" and "basic clinical protocols". Considering the type of indicator: "patient identification in the bags of artificial nutrition (structure)," a semi-incorporated "and" basic clinical protocols (process), and "fulfillment of the caloric goal" (result). CONCLUSION: The results of the survey can make a selection of indicators that could be considered for first-line introduction in a Nutrition Unit.

[Global therapeutic approach to sarcopenia]. / Enfoque terapéutico global de la sarcopenia.

Sarcopenia is the loss of skeletal muscle mass that occurs with ageing, and is a major contributing factor to disability and loss of independence in the elderly. The etiopathogenesis involves a number of underlying mechanisms including intrinsic changes in the muscle and central nervous system, and hormonal and lifestyle factors. Many hormones and cytokines affect muscle mass and function. Reductions in testosterone and estrogens that accompany ageing appear to accelerate loss of muscle mass. Growth hormone has been hypothesised to contribute to loss of lean body mass. Although sarcopenia is not completely reversed with exercise, physical inactivity leads to accelerated muscle loss. The diagnosis of sarcopenia is difficult because the most reliable methods to measure muscle mass are not easily available. Various treatment strategies have been tested for combating the loss of muscle mass: testosterone replacement and other anabolic androgens for men, estrogen replacement in women, growth hormone replacement, nutritional treatment and physical training. Only high resistance exercise training has been effective in increasing muscle mass, with or without nutritional supplementation.

[Acromegaly and Graves-Basedow disease. Report of 3 cases]. / Acromegalia y enfermedad de Graves-Basedow. A propósito de 3 casos.

Acromegaly is associated to thyroidal disorders such as hyperthyroidism. The Graves-Basedow disease as a cause of thyroid hyperfunction is very infrequent, with only 8 cases having been reported up to 1993. The authors present 3 patients with acromegaly who developed hyperthyroidism due to Graves-Basedow disease in the course of their disease. Two of the patients had acromegaly of 30 years of evolution and the third patient underwent consultation for clinical symptoms of hyperthyroidism with acromegaly being simultaneously diagnosed. All the patients had weight loss prior to diagnosis and the possibility of neoplasia associated to acromegaly was excluded. The hyperthyroidism responded well to initial treatment with antithyroid drugs in the three cases. The authors conclude that hyperthyroidism should be taken into consideration in the diagnosis of a patient with acromegaly and weight loss.