Burden assessment in caregivers of patients with home artificial nutrition: a need and a challenge.

BACKGROUND/OBJECTIVES: Caregiving can be a stressful task with severe consequences on caregivers' health. Our aim was to evaluate the profile and the burden of caregivers of patients with home artificial nutrition (HAN) in our area. SUBJECTS/METHODS: We conducted a prospective observational study of patients who had started HAN over a period of a year (n=573) and their home caregivers (n=103). Epidemiological characteristics of the patients and the type of HAN were registered. Caregivers' profile data (gender, age and degree of kinship) and Zarit Burden Assessments were recorded. RESULTS: Care recipients had a median age of 79.0 (IQR 87) years, neurological and oncological diseases in 50% and a high rate of mobility limitations (80%). Oral supplements with high-calorie formulas were predominant (60%). The usual caregiver profile was a patient's daughter with a mean age of 53.1 (s.d. 13.4) years acting as the primary caregiver. Burden was absent in 49.5%, light in 18.4% and intense in 32% of caregivers. Intense burden was more frequent in oral over enteral nutrition (42% versus 22.6%; P=0.036). Supplementary nutrition was also associated with higher caregiver burden scores compared with complete diets. In patients with functional limitations, a tendency toward a slightly higher burden was observed. No differences in caregiver burden were detected according to other patient or caregiver characteristics. CONCLUSIONS: HAN type appears to be a factor influencing caregiver burden and therefore, evaluation of caregiver burden should be part of HAN programs.

[Patient with Crohn's disease and seizures due to hypomagnesemia]. / Paciente con enfermedad de Crohn y convulsiones por hipomagnesemia.

We report a patient with Crohn's disease who suffered several generalized convulsions. He was studied with cerebral image techniques and neurophysiologic tests without getting the aetiology of the convulsions. A severe depletion in magnesium levels was suspected at the time of the initial evaluation by the Nutritional Team Group. Low serum magnesium levels were confirmed in the first blood test. Convulsions disappeared when magnesium was normalised by intravenous infusion. It is necessary for specialist physicians to be on the alert of severe complications of nutrients deficiency and that this kind of patients should be checked by the Nutrition Team.

[Protein-energy malnutrition: its effects on 4 metabolic parameters]. / Malnutrición energético proteica: repercusión sobre cuatro parámetros metabólicos.

The usefulness of cholinesterase (CS) and cholesterol (CO) in evaluating the nutritional state has been studied, comparing them to two classic parameters: albumin (ALB) and transferrin (TF). The study was done on 73 patients between the ages of 17 and 93, suffering from different afflictions, all of whom were suffering from energy-protein malnutrition (EPM). The patients were divided according to whether the EPM was predominantly visceral (V) or non-visceral (NV), based on the following parameters: ALB, TF, total lymphocytes (TL), cellular immunity test (CIT), triceps skin fold (TSF) and muscular circumference (MC). Our results show significant differences between the V and NV groups for the 4 studied parameters, obtaining lower values for each in the V group. There were significant differences between the ages of both groups, while these did not have any influence on any of the parameters. We found a positive and significant correlation when comparing TF and ALB, TF and CO, TF and CS, CS and ALB, and lastly, CS and CO. There was no correlation between ALB and COO. From our data we concluded that serum cholinesterase is a useful parameter for evaluating the nutritional state of the hospitalized patients.

[An analysis of an enteral nutrition guideline in patients with cancer of the ORL area]. / Análisis de una pauta de nutrición enteral en pacientes con cáncer del área ORL.

AIMS: The result was assessed of the enteral nutrition guideline prescribed in 50 patients using internationally accepted parameters as indicators of the nutritional state. METHODS: Fifty patients were selected at random with an ORL zone neoplasm, they were prescribed enteral nutrition according to our Section's procedure, involving the administration of a commercialized enteral diet whose composition is a homogenization of natural foods administered in 6 sessions at three-hour intervals during the day, begun with 100 cc of diet per session up to a total of 400 (2400 kcal/day), and with the addition of 100 cm of water in each administration. The average age was 59.58 +/- 11.2 years (range 30-81), the average duration of nutrition was 34.02 +/- 32.1 days (range, 3-201 days). The following were taken in all cases: Weight (W), Size (S), Tricipital fold (TF), brachial circumference, urinary creatinin, seric albumin (A), seric transferrin (T), total lymphocytes (Lt) and retarded cutaneous sensitivity, using Multitest IMC (M), and these data were used to calculate muscular circumference (MC) and the creatinin size index (CSI). Two nutritional valuations (NV) were analyzed, the first one taken (NV1) and the one prior to discharge (V2). Analytical calculations were done by our Center's Analytical Laboratory. We used Wilcoxon's test included in the SX statistical package for statistical analysis. RESULTS: On the fifty patients selected, only thirty had a second NV. Comparison of the two calculations gave the following results: A statistically significant rise of A (A1: 3.6 +/- 0.8, vs A: 3.8 +/- 0.7; p < 0.0001) and of T (T1: 208.2 +/- 52.0, vs T2: 237.5 +/- 44.39; p < 0.0001). There was also a statistically significant reduction of P (P1: 63.93 +/- 12.32 vs P2: 62.88 +/- 11.28; p < 0.04). Comparison of the remaining variables did not provide statistically significant differences: PT (PT1: 11.46 +/- 4.9 vs PT2: 12.07 +/- 4.6; p > 0.05). MC (MC1: 23.93 +/- 2.5 vs MC2: 23.58 +/- 1.9; P > 0.05). CSI (CSI1: 8.5 +/- 8 vs CSI2: 6.9 +/- 2.9; p > 0.05). L (L1: 1855 +/- 760.5 vs L2: 1808 +/- 769.1; p > 0.05). M (M1: 12.58 +/- 7.8 vs M2: 14.01 +/- 8.5; p > 0.05). CONCLUSIONS: It is deduced from the results that the guideline used is useful in maintaining the nutritional state of patients prior to their treatment, despite weight-loss, since the ratio of weight-loss to the time between NV1 and NV2 is not significant.