[Fiber and enteral nutrition]. / Fibra y nutrición enteral.

Dietary fibre is a mixture of various substances and is essential for maintaining appropriate intestinal functionality and it is currently considered to be a necessary part of a healthy diet. Current recommendations for fibre consumption by adults range from 20 to 35 g/day. Enteral nutrition is an emerging therapeutic variation in both hospital and domestic settings. To a great extent, this development has been made possible thanks to the design of new formulas that adapt better and better to the clinicla conditions or our patients. The type of fibre used in these preparations varies greatly. Some have only one source of fibre while others use differnet combinations. There are currently 32 formulas available on the Spanish market, without counting the modules or specific preparations of individual types of fibre. Despite the enormous advances in the knowledge of the beneficial effects of fibre, the fact of the matter is that enteral nutrition that we routinely prescribe in normal clinical practice does not contain fibre. The are several explanations for this, perhaps the most plausible is that these formulas may lead to problems in their administration and tolerance. It is necessary to choose the correct calibre of catheter and define the best infusion method and timing. Another difficulty may be the gastrointestinal tolerance of the formulas containing fibre. No large-scale problems of intolerance have however been described in healthy volunteers nor in patients with acute or chronic pathologies, although it is of fundamental importance to monitor the rhythm of depositions in all patients with enteral nutrition (EN) and ensure proper intake of liquids, which would also be useful to prevent occlusion of the catheter. The theoretical benefits of EN with fibre with a view to maintaining or improving normal intestinal structure and function are very varied. Nonetheless, it has noit yet been possible to prove many of these effects in controlled clinical trials. At the present time, there are sufficient reasons of a physiological nature for using EN with fibre in many patients, particularly in those predisposed to constipation or suffering from diarrhoea, in those requiring long-term EN and in some intestinal pathologies. In the near future, fibre can be expected to form part of EN as standard component and we should define its optimal composition for different pathologies. In the meantime, we need to continue working intensely in this highly promising area of knowledge.

[Evaluation of the cost of home enteral nutrition in relation to different access routes]. / Evaluación del coste de la nutrición enteral domiciliaria con relación a diferentes vías de acceso.

UNLABELLED: When home enteral nutrition is needed, there is still, despite the undisputed increase in the quality of life that can be achieved with a Percutaneous Endoscopic Gastrostomy (PEG), a reservation in its use because this technique and its maintenance is considered to be very costly. We aim to assess the true cost of home enteral nutrition using the oral route, a nasogastric tube, and PEG. PATIENTS AND METHODS: The data of 65 patients who required home enteral nutrition during 1996, were analyzed retrospectively. The access route was a nasogastric tube in 20 cases, 18 patients had PEG, and 27 candidates used an oral route. The average age was 56 years. 50% were men and 50% were women. The most common diagnoses that led to the indication were oropharyngeal-maxillofacial neoplasms and neurological disorders. In all cases the material and formula used was assessed, as were the associated complications and the cost of the at home enteral nutrition. RESULTS: The average duration of the treatment was 175 +/- 128 days, and this was similar in all three groups. The average formula/day cost was slightly higher in the patients using the oral access route. The average total day cost and the average material/day cost was slightly higher in patients with a PEG. Patients with a PEG presented fewer complications than those with a nasogastric tube. The cost derived from possible complications must be higher in the nasogastric tube group, especially considering the repeated tube changes due to obstruction or loss. CONCLUSIONS: The cost of home enteral nutrition is slightly lower if one uses a nasogastric tube. The greater incidence of complications that were mild but required a tube change, in this case a nasogastric tube, suggests higher indirect costs. The oral route is associated with the need for special formulae that are more expensive.

[Nutritional evaluation in patients with total gastrectomy]. / Evaluación nutricional en pacientes con gastrectomía total.

Gastric cancer continues to be the second cause of cancer-related mortality in the world. Surgery is the only potentially curative therapy, although the adverse effects of surgery are considerable and include digestive symptoms, loss of appetite and malnutrition. Our study included 45 patients subjected to gastrectomy who were under treatment at our unit during 2000. The data given here refer to their first visit following surgery. The most frequent complications were diarrhoea (31%), pain (29%) and early dumping (24%). Other complications found were late dumping, nausea/vomiting and dysphagia. Anorexia appeared in 49% and 29% presented a negative attitude towards food. These complications give rise to insufficient food intake, leading to malnutrition, mainly marasmic in nature. Only 7% of the patients were normonourished, with 86% presenting slight or moderate malnutrition and 7% severe malnutrition. The mean Body Mass Index (BMI) of these patients was 20 +/- 3 kg/m2. The most frequent analytical alterations were anaemia with ferropenia and b12 deficit, and a reduction in the levels of zinc and retinol transporting protein. Many patients had impaired quality of life; 43% did not leave home and only 13% were able to work. Three groups were established depending on the time that had passed since the gastrectomy was performed before the first nutritional assessment (less than 3 months, from three months to a year, and over one year), without significant differences being found in any of the parameters studied. In this article we include recommendations for the nutritional handling and treatment of patients following gastrectomy.

[Complications of enteral nutrition at home. Results of a multicentre trial]. / Complicaciones de la nutrición enteral domiciliaria. Resultados de un estudio multicéntrico.

AIM: In spite of the increasing number of home enteral nutrition (HEN) patients, only few articles had reported the frequency of complications related to this treatment. Our multicentric study analyzes the HEN complications in relation to access device and time of treatment. METHOD: 92 HEN patients from 8 hospitals were randomly selected. Patients were distributed in relation to the time of treatment and access device (nasogastric tube and percutaneous or surgical gastrostomies). After an educational program, they were filled in an initial questionnaire and repeated it the days 15 and 30. They received a mean of 1650 Kcal of enteral solution. A total of 2760 HEN prospective days were analyzed. RESULTS: In prospective study 42% of patients had some complication (112 episodes). The most frequent were gastrointestinal (55%) and mechanical (29%); 0.16 complications of patient-year were registered. The most common complications were: extraction (15%), constipation (13%), vomiting (12%) and diarrhoea (10%). The gastrostomy group had more gastrointestinal complications. In retrospective evaluation, percutaneous gastrostomy group had the lowest ratio of complications and nasogastric tube group required more tube replacements (4 vs 2) and had 1.96 episodes/patient (percutaneous group 1.85 and surgical gastrostomy 3.1 episodes/patient). CONCLUSION: HEN is safe with low incidence of complications. An adequate educational program is very important and we expect, in the future, to establish an proper National Home Care System.

[Home enteral nutrition. Annual report 1999. NADYA-SENPE Group]. / Nutrición enteral domiciliaria. Informe anual 1999. Grupo NADYA-SENPE.

GOAL: During 1999, as in previous years, the NADYA-SENPE Group has maintained an annual register of patients with Artificial Nutrition at Home in order to keep up to date our available knowledge of this therapy. The present paper analyzes the results of the sixth National Register of patients under treatment with Enteral Nutrition at Home corresponding to 1999, produced with the co-operation of twenty-three centres in the Spanish national health network. MATERIAL AND METHODS: The data were collected through a closed questionnaire included on our web site (www.nadya-senpe.com). Apart from epidemiological information, the form includes the indication that led to the prescription of nutrition, nutritional treatment, access path, complications and admissions to hospital, follow-up of the treatment, patients' quality of life and progress. All of the data are processed by the co-ordinating team. The Nutrition Unit at La Paz Teaching Hospital in Madrid has acted as the group co-ordinator. RESULTS: During 1999, a total of 2,262 patients at the twenty-three collaborating centres followed treatment with Home Enteral Nutrition (NED in its Spanish acronym). The mean age was 63.6 (19.67 years (males: 57.6%; females: 42.3%). The mean time with nutritional treatment is 5.89 (4.25 months. The neurological alterations (37.5%) and neoplasias (36.8%) were the most frequent indications for NED. Most patients used oral administration (50.7%), the use of artificial routes is less frequent, with 5NG being used on 27.9% and PEG on 12.7%. The polymeric formulas are the ones most commonly used (87.7%). The number of complications recorded amounted to 1,403 episodes, representing 0.62 complications per patient per year, of which 40.8% were gastro-intestinal (0.26 complications per patient per year) and 18.7% were mechanical complications, with only 9 recorded cases of bronchoaspiration. It was necessary to admit patients to hospital on 836 occasions (0.38 admissions per patient), albeit generally for causes not associated with nutrition (86.1%). At year-end, 51.4% of patients continued to receive nutritional support. CONCLUSIONS: Enteral nutrition at home is a safe technique whose use is growing in Spain. It requires the existence of appropriately equipped nutrition teams as well as the collaboration of the Primary Health Care services and the suitable training of patients and relatives. It is essential to progress more deeply into the development and application of clinical routes that provide a clear and concise methodology covering all nutrition-related aspects. In itself, nutrition is a therapeutic alternative regardless of whether access is obtained through a natural or an artificial route. It is necessary for the persons responsible for health-care administration to realize that the appropriate nutrition of patients leads to an improvement in their general health, a shorter course for their illness and, therefore, a reduction in costs.

[Importance of water in the hydration of the Spanish population: FESNAD 2010 document]. / Importancia del agua en la hidratación de la población española: documento FESNAD 2010.

For any healthy individual, thirst is an appropriate sign to drink water, except for babies, sportsmen, and most of ill and elderly people. In these instances, it is convenient to schedule appropriate times to drink water since great demands and the physiological mechanisms that determine thirst in these situations may condition water unbalances with important consequences for health and the physical and intellectual performance. The human body has a number of mechanisms that allow keeping constant the water content by adjusting intakes and wastes. Water balance is determined by intake (consumed water, beverages, and water contained in foods) and wastes (urine, stools, the skin, and expired air from the lungs). Failure of these mechanisms and subsequent impairments in water balance may produce severe disarrangements that may threaten somebody's life. In the present document, we analyze the evidences regarding the factors conditioning water needs in the different life stages and physiological situations, as well as the consequences of water unbalance under different situations. A proper hydration may be achieved by feeding and the use of water and other liquids. Although water is the beverage by excellence and represents the ideal way of restoring the losses and get hydrated, we should be aware that, from the very beginning, we have sought other liquid sources with hydration properties. In the last decades we have increased the consumption of different beverages, with a proliferation of sugar-containing beverages. Since excessive sugar consumption has been related to obesity and other chronic conditions, it is evident that the use of these caloric beverages should be rationalized, especially in children. In this document all the considerations regarding hydration are presented and different recommendations are exposed.

Recomendaciones de alimentación para la población española / Food recommendations for the spanish population

Todos los datos disponibles revelan en los últimos años un deterioro paulatino de la calidad de la dieta ingerida en toda Europa así como una insuficiente práctica de la actividad física con el consiguiente incremento del sobrepeso y la obesidad en la población de la Unión Europea. Científicamente, se ha podido demostrar la relación existente entre la dieta, la actividad fí- sica y la salud, en particular en lo que respecta a su papel en la aparición de ciertas patologías crónicas. En un futuro cercano, cabe esperar su aumento y la reducción de la esperanza y calidad de vida. Los determinantes fundamentales de los factores de riesgo son los cambios producidos en la dieta, conducentes a una mayor densidad energética, el incremento de la ingestión de grasa saturada y de grasa hidrogenada, la reducción del consumo de carbohidratos complejos y de fibra así como una reducción de la ingestión de frutas y verduras. La prevención podría ser muy eficaz si toda la población adaptara sus estilos de vida (dieta, tabaquismo, actividad física) a las recomendaciones. En España destaca la evolución de las personas con sobrepeso y obesidad: el 45,4% en 1995 y el 53,3% en 2006, de modo que en una década la prevalencia de personas con índice de masa corporal superior al aconsejado aumentó cerca del 8%. El seguimiento de dietas variadas y equilibradas así como el fomento de la actividad física son herramientas imprescindibles para la mejora de la calidad y la esperanza de vida de la población. Los contenidos de las directrices alimentarias deben ser trasladados a la población mediante diferentes modelos o patrones basados en alimentos, siendo también necesario potenciar y perfeccionar los programas de información y educación nutricional de la población. Con este fin, se han elaborado unas Recomendaciones para una alimentación equilibrada por parte de la Sociedad española de dietética y ciencias de la alimentación (AU)

All data available in the last years reveal a gradual deterioration of the quality diet ingested in all Europe as well as an insufficient practice of physical activity with the consequent increase of overweight and obesity in the population. Scientifically, it has been possible to demonstrate the relationship between diet, physical activity and health, in regard to its role in the appearance of certain chronic pathologies. In the near future, it is possible to wait for its increase and the reduction of quality of life. The fundamental determinants of risk factors are the changes produced in the diet, leading to a greater energy density, the increase of hydrogenated fat and saturated fat ingestion, the reduction of fiber and some carbohydrates as well as a reduction of the ingestion of fruits and vegetables. The prevention could be very effective if all the population adapts its lifestyles (diet, tobacco, physical activity) to the recommendations. In Spain, stresses the evolution of the people who are overweight and obesity: 45.4 per cent in 1995 and 53.3 per cent in 2006, so that in a decade the prevalence of persons with body mass index higher than the advised rose almost 8 per cent. The follow-up of balanced as well as the promotion of physical activity are essential tools for improving expectancy life of the population. The contents of the dietary guidelines should be transferred to the population through different models or patterns based on food, being also necessary to harness and to perfect the programs of information and nutricional education of the population. With this aim, Dietetic Recommendations for a balanced diet have been elaborated from the Spanish Dietetic Society (AU)

Complicaciones de la nutrición enteral domiciliaria. Resultados de un estudio multicéntrico / Complications of enteral nutrition at home. Results of a multi-centre trial

Objetivo: A pesar del número creciente de nutrición enteral domiciliaria (NED), sólo algunos artículos recogen la frecuencia de sus complicaciones. Este estudio multicéntrico analiza estas complicaciones en relación a la vía de acceso y la duración del soporte nutricional. Método: Seleccionamos aleatoriamente 92 pacientes con NED de 8 hospitales y se distribuyeron en relación a la duración del soporte y a la vía de acceso: sonda nasogástrica (SNG) y gastrostomías percutánea o quirúrgica. Tras un programa educativo, los pacientes completaron un cuestionario inicial que se repitió en los días 15 y 30.Recibieron una media de 1.650 kcal de fórmula enteral. Se analizaron un total de 2.760 días prospectivos de NED. Resultados: En la fase prospectiva, el 42 por ciento de los pacientes tuvo alguna complicación (112 episodios). Los más frecuentes fueron digestivos (55 por ciento) y mecánicos (29 por ciento); se registraron 0,16 complicaciones por paciente-año. Las complicaciones más comunes fueron: extracción (15 por ciento), estreñimiento (13 por ciento), vómitos (12 por ciento) y diarrea (10 por ciento). El grupo de gastrostomía tuvo más complicaciones digestivas. En el análisis retrospectivo, el grupo de gastrostomía percutánea tuvo menos complicaciones y el de SNG requirió más recambios de sondas (4 frente a 2) y tuvieron 1,96 complicaciones/paciente (grupo de gastrostomía percutánea 1,85 y quirúrgica 3,1). Conclusión: La NED es segura y presenta una baja incidencia de complicaciones. Un programa educativo adecuado es muy útil y esperamos, en el futuro, contribuir a un mejor sistema de atención domiciliaria (AU)

Aim: In spite of the increasing number of home enteral nutrition (HEN) patients, only few articles had reported the frequency of complications related to this treatment. Our multicentric study analyzes the HEN complications in relation to access device and time of treatment. Method: 92 HEN patients from 8 hospitals were randomly selected. Patients were distributed in relation to the time of treatment and access device (nasogastric tube and percutaneous or surgical gastrostomies). After an educational program, they were filled in an initial questionnaire and repeated it the days 15 and 30. They received a mean of 1650 Kcal of enteral solution. A total of 2760 HEN prospective days were analyzed. Results: In prospective study 42% of patients had some complication (112 episodes). The most frequent were gastrointestinal (55%) and mechanical (29%); 0.16 complications of patient-year were registered. The most common complications were: extraction (15%), constipation (13%), vomiting (12%) and diarrhoea (10%). The gastrostomy group had more gastrointestinal complications. In retrospective evaluation, percutaneous gastrostomy group had the lowest ratio of complications and nasogastric tube group required more tube replacements (4 vs 2) and had 1.96 episodes/patient (percutaneous group 1.85 and surgical gastrostomy 3.1 episodes/patient). Conclusion: HEN is safe with low incidence of complications. An adequate educational program is very important and we expect, in the future, to establish an proper National Home Care System (AU)

Recomendaciones de bebida e hidrataciónpara la población española / Spanish guidelines for hydration

El agua contenida en los alimentos junto con la que bebemos y el resto de los líquidos que ingerimos, tienen que garantizar nuestra correcta hidratación en todas las edades y circunstancias vitales. En consecuencia, es muy importante que su consumo tenga asegurada la calidad y la cantidad. La ingestión adecuada de agua total se ha establecido para prevenir los efectos deletéreos de la deshidratación que incluyen trastornos funcionales y metabólicos. Es conocido como el grado de hidratación puede influir sobre la salud y el bienestar de las personas. En la mujer embarazada, una parte importante del aumento de su peso se produce a expensas del incremento del volumen plasmático. En el caso de la lactancia, resulta obvia la importancia de mantener una ingesta hídrica adecuada si queremos preservar localidad y cantidad de la leche y, por lo tanto, el estado nutricional del niño y de la madre. En el caso del niño, su balance hídrico tiene que estar equilibrado a través de aportaciones cotidianas suficientes. Las necesidades basales de líquidos en los mayores se cifran en torno a 30-35 mL por Kilogramo de peso y día. Hay circunstancias que incrementan las necesidades de líquidos del organismo como el estrés, la actividad y el ejercicio físico, el aumento de la temperatura ambiental ,la fiebre, las pérdidas de líquidos por vómitos y/o diarreas, la diabetes descompensada, las quemaduras, etc. Los factores que condicionan el ejercicio en relación con la hidratación son: las características del ejercicio, las condiciones ambientales, las características individuales, el acostumbramiento a las condiciones climáticas externas, el entrenamiento, el umbral y la capacidad de sudoración. Todo ello hace que resulte muy conveniente instaurar unas Guías directrices que puedan orientar a los consumidores, así como a los distintos profesionales dela salud, sobre lo que resulta más adecuado beber o aconsejar beber en cada momento (AU)

Water is a natural resource essential to life and essential in our daily food. The water contained in food which along with liquids we drink and the rest we eat, we have to ensure proper hydration in all ages and life circumstances. It is very important that its consumption has ensured the quality and quantity. The adequate intake of total water has been established to prevent the deleterious effects of dehydration (especially acute effects) that include functional and metabolic disorders. It is known that the degree of hydration can influence the health and welfare of people, including his mental concentration and other cognitive aspects, their physical performance and heat tolerance. In pregnant women, an important part of its increasing weight occurs at the expense of the volume plasma increase. In the case of breastfeeding, if we consider that approximately 87-90% the composition of milk is water, it is obvious the importance of maintaining an adequate water intake if we want to preserve the quality and quantity of milk and, hence, the nutritional status of children and mothers. In the case of children, their water balance has to be balanced through sufficient contributions every day, especially in the early stages of life where they are most vulnerable to fluids and electrolytes imbalances. Children -especially infants and those who start walking-are at increased risk, even deadly, dehydration than adults. The factors that determine the exercise in relation to the hydration are the characteristics of the exercise, environmental conditions, individual characteristics, accustomed to external weather conditions, training, and capacity threshold of sweating. In recent years, besides the traditional beverages, a wide range of new drinks that often have a significant caloric value, have proliferated in the marketplace for. This makes it highly desirable to establish some guidelines (AU)

La nueva "rueda de los alimentos": su papel como recurso didáctico en la promoción de una alimentación saludable / No disponible

La rueda de los alimentos es un recurso didáctico que fue muy utilizado en los años 70 - 80, habiendo sido promovida en España por el programa EDALNU del Ministerio de Sanidad. Los cambios surgidos en la alimentación de los españoles en las últimas décadas, hacen necesaria la actualización de sus contenidos. Intervenciones. Con este motivo, se ha procedido a estudiar los materiales didácticos existentes que hacen referencia a la composición de una alimentación saludable y equilibrada. Se ha procedido a diseñar un material didáctico específico que dará lugar a una serie de recursos educativos en materia de alimentación y nutrición. Actualmente, ya está disponible la “Nueva rueda de los alimentos” para aquellos profesionales y entidades de carácter no lucrativo interesados en su utilización como recurso didáctico (AU)

The "wheel of foods" is a didactic resource that was used, having promoted in Spain by program EDALNU of the Ministry of Health. The changes arisen in the feeding of the Spaniards in the last decades, make the update necessary of their contents. With this reason, it has been come to study the existing didactic materials that make reference to the composition of a healthful and balanced feeding. At the moment, already the "New wheel of foods" (for those professionals and organizations of nonlucrative character) is available for people interested in its use as didactic resource (AU)

Trastorno de la conducta alimentaria. Anorexia nerviosa / No disponible

No disponible

Fisiopatología de la obesidad / Physiopathology of obesity

No disponible

Evaluación nutricional en pacientes con gastrectomía total / Nutritional assessment in patients with total gastrectomy

El cáncer gástrico continúa siendo la segunda causa más frecuente de mortalidad por cáncer en el mundo. La cirugía es el único tratamiento potencialmente curativo, aunque los efectos adversos de la cirugía son importantes e incluyen síntomas digestivos, pérdida de apetito y desnutrición. En nuestro estudio se incluyeron 45 pacientes gastrectomizados que estaban en tratamiento en nuestra unidad en el año 2000. Los datos aquí expuestos se refieren a la primera visita poscirugía. Las complicaciones más frecuentes fueron diarrea (31 por ciento), dolor (29 por ciento) y dumping precoz (24 por ciento). Otras complicaciones fueron dumping tardío, nauseas, vómitos y disfagia. El 49 por ciento presentaban anorexia, el 29 por ciento actitud negativa ante la comida. Estas complicaciones dan lugar a una alimentación insuficiente, generando malnutrición, principamente de tipo marasmática. Sólo el 7 por ciento de los pacientes estaban normonutridos, el 86 por ciento presentaban desnutrición leve o moderada y el 7 por ciento malnutrición severa. El índice de masa corporal (IMC) medio de estos pacientes fue de 20 +/- 3kg/m2. Las alteraciones analíticas más frecuentes fueron anemia con ferropenia y déficit de B12 y disminución de los niveles de zinc y proteína transportadora de retinol. Muchos pacientes veían afectada su calidad de vida; el 43 por ciento no salen de casa y sólo pueden trabajar el 13 por ciento. Se establecieron tres grupos en función del tiempo transcurrido desde la gastrectomía hasta la primera valoración nutricional (menos de 3 meses, entre los tres meses y el año y más de un año) no encontrándose diferencias significativas en ninguno de los parámetros estudiados. En este trabajo incluimos recomendaciones para el manejo y tratamiento nutricional del paciente gastrectomizado (AU)

Gastric cancer continues to be the second cause of cancer-related mortality in the world. Surgery is the only potentially curative therapy, although the adverse effects of surgery are considerable and include digestive symptoms, loss of appetite and malnutrition. Our study included 45 patients subjected to gastrectomy who were under treatment at our unit during 2000. The data given here refer to their first visit following surgery. The most frequent complications were diarrhoea (31%), pain (29%) and early dumping (24%). Other complications found were late dumping, nausea/vomiting and dysphagia. Anorexia appeared in 49% and 29% presented a negative attitude towards food. These complications give rise to insufficient food intake, leading to malnutrition, mainly marasmic in nature. Only 7% of the patients were normonourished, with 86% presenting slight or moderate malnutrition and 7% severe malnutrition. The mean Body Mass Index (BMI) of these patients was 20 ± 3 kg/m2. The most frequent analytical alterations were anaemia with ferropenia and b12 deficit, and a reduction in the levels of zinc and retinol transporting protein. Many patients had impaired quality of life; 43% did not leave home and only 13% were able to work. Three groups were established depending on the time that had passed since the gastrectomy was performed before the first nutritional assessment (less than 3 months, from three months to a year, and over one year), without significant differences being found in any of the parameters studied. In this article we include recommendations for the nutritional handling and treatment of patients following gastrectomy (AU)

Nutrición enteral domiciliaria. informe anual 1999. Grupo NADYA-SENPE / Enteral nutrition at home. annual report 1999. NADYA-SENPE group

Objetivo: Durante 1999, como en años anteriores, el Grupo NADYA-SENPE ha realizado el registro anual de pacientes con Nutrición Artificial Domiciliaria, con el objetivo de mantener actualizados los conocimientos que sobre esta terapéutica tenemos. En el presente trabajo analizamos los resultados del sexto Registro Nacional de pacientes en tratamiento con Nutrición Enteral Domiciliaria correspondiente al año 1999, en el que han colaborado veintitrés centros de la red sanitaria nacional.Material y Métodos: La información se ha recogido en un cuestionario cerrado incluido en nuestra pagina web (www.nadya-senpe.com). El formulario incluye, además de los datos epidemiológicos, la indicación que motivó la nutrición, tratamiento nutricional, vía de acceso, complicaciones y hospitalizaciones, seguimiento del tratamiento, calidad de vida y evolución de los pacientes. La información total es procesada por el equipo coordinador. La Unidad de Nutrición del Hospital Universitario La Paz de Madrid, ha actuado como coordinador del grupo.Resultados: Durante el año 1999 han seguido tratamiento con Nutrición Enteral Domiciliaria (NED) 2262 pacientes en los veintitrés centros colaboradores. La edad media ha sido de 63,6 ñ 19,67 (H: 57,6 por ciento; M: 42,3 por ciento). El tiempo medio con tratamiento nutricional es de 5,89 ñ 4,25 meses. Las alteraciones neurológicas (37,5 por ciento) y las neoplasias (36,8 por ciento) han sido las indicaciones de NED más frecuentes. La mayoría de los pacientes utilizan la vía oral (50,7 por ciento), la utilización de vías artificiales es menos frecuente, la SNG es utilizada en el 27,9 por ciento y la PEG en un 12,7 por ciento. Las formulas polimericas son las mas empleadas (87,7 por ciento). Se contabilizaron 1403 episodios de complicaciones, lo que representa 0,62 complicac./paciente/año, el 40,8 por ciento gastrointestinales (0,26 complicaciones/paciente/año), el 18,7 por ciento complicaciones mecánicas, solo se contabilizaron 9 casos de broncoaspiración. En 836 ocasiones (0,38 hospitaliz./paciente) fue necesario hospitalizar al paciente, aunque debido generalmente a causas no asociadas con la nutrición (86,1 por ciento).Al finalizar el año el 51,4 por ciento de los pacientes continuaban con el soporte nutricional Conclusiones: La nutrición enteral domiciliaria es una técnica segura en pleno desarrollo en nuestro país.Requiere la existencia de equipos de nutrición adecuadamente dotados así como la colaboración de los servicios de atención primaria y la adecuada formación de familiares y pacientes. Es indispensable profundizar en el desarrollo y aplicación de vías clínicas que contemplen una metodología clara y concisa que abarque todos los aspectos relativos a la nutrición. La nutrición es, en si misma, una alternativa terapéutica independientemente de si el acceso se realiza por una vía natural o artificial. Es necesario que los responsables administrativos se den cuenta de que una nutrición adecuada de los pacientes redunda en una mejoría de su estado general, un tiempo de evolución mas corto y, por lo tanto, en una disminución de los costes (AU)

Goal: During 1999, as in previous years, the NADYA-SENPE Group has maintained an annual register of patients with Artificial Nutrition at Home in order to keep up to date our available knowledge of this therapy. The present paper analyzes the results of the sixth National Register of patients under treatment with Enteral Nutrition at Home corresponding to 1999, produced with the co-operation of twenty-three centres in the Spanish national health network. Material and Methods: The data were collected through a closed questionnaire included on our web site (www.nadya-senpe.com). Apart from epidemiological information, the form includes the indication that led to the prescription of nutrition, nutritional treatment, access path, complications and admissions to hospital, follow-up of the treatment, patients’ quality of life and progress. All of the data are processed by the coordinating team. The Nutrition Unit at La Paz Teaching Hospital in Madrid has acted as the group co-ordinator. Results: During 1999, a total of 2,262 patients at the twenty-three collaborating centres followed treatment with Home Enteral Nutrition (NED in its Spanish acronym). The mean age was 63.6 ( 19.67 years (males: 57.6%; females: 42.3%). The mean time with nutritional treatment is 5.89 ( 4.25 months. The neurological alterations (37.5%) and neoplasias (36.8%) were the most frequent indications for NED. Most patients used oral administration (50.7%), the use of artificial routes is less frequent, with 5NG being used on 27.9% and PEG on 12.7%. The polymeric formulas are the ones most commonly used (87.7%). The number of complications recorded amounted to 1,403 episodes, representing 0.62 complications per patient per year, of which 40.8% were gastro-intestinal (0.26 complications per patient per year) and 18.7% were mechanical complications, with only 9 recorded cases of bronchoaspiration. It was necessary to admit patients to hospital on 836 occasions (0.38 admissions per patient), albeit generally for causes not associated with nutrition (86.1%). At year-end, 51.4% of patients continued to receive nutritional support Conclusions: Enteral nutrition at home is a safe technique whose use is growing in Spain. It requires the existence of appropriately equipped nutrition teams as well as the collaboration of the Primary Health Care services and the suitable training of patients and relatives. It is essential to progress more deeply into the development and application of clinical routes that provide a clear and concise methodology covering all nutrition-related aspects. In itself, nutrition is a therapeutic alternative regardless of whether access is obtained through a natural or an artificial route. It is necessary for the persons responsible for health-care administration to realize that the appropriate nutrition of patients leads to an improvement in their general health, a shorter course for their illness and, therefore, a reduction in costs (AU)