Is Food Tolerance Different After Bariatric Surgery Depending on the Surgical Procedure?

BACKGROUND: Bariatric surgery (BS) is a very effective treatment regarding body weight loss but might affect food tolerance and energy and protein intake. The aim of this study was to compare three BS techniques (biliopancreactic diversion (BPD), gastric bypass (GB), and sleeve gastrectomy (SG)) and their effect on food tolerance. METHODS: Prospective study conducted between April 2016 and April 2019. Visits included were 1 before and 6, 12, and 24 months after BS. Food tolerance test (FTT), 24-h recall, and bioelectrical impedance (TANITA MC780) were performed at all visits. RESULTS: Sixty-six patients were included (74.2% women). FTT showed a better self-perception of the intake after surgery in BPD at 6 months (p = 0.013), and at 12 months (p = 0.006). BPD had a better tolerance of 8 food groups at 6 months (red meat p = 0.017, white meat p = 0.026, salad p = 0.017, bread p < 0.001, rice p = 0.047, pasta p = 0.014, fish p = 0.027) and at 12 months, but only red meat (p = 0.002), bread (p < 0.001), rice (p = 0.025), and pasta (p = 0.025) remained statistically different. Twenty-four months after surgery, only the red meat food group (p = 0.007) showed differences. BPD had the lowest incidence of vomiting at 6 months (p < 0.001), 12 months (p = 0.008), and 24 months (p = 0.002). The total score of FTT was better in BPD at 6 months [25.6 (SD 1.5), p < 0.001], 12 months [25.6 (SD 2.4), p < 0.001], and 24 months [25.7 (SD 1.3), p = 0.001]. BPD showed the best intake in energy and proteins at 6 months [1214.8 (SD 342.4) kcal and 67.1 (SD 18.4) g] and 12 months [1199.6 (SD 289.7) kcal and 73.5 (SD 24.3) g]. % FML was higher in GB both at 6 and 12 months being statistically different (p < 0.050). CONCLUSION: Biliopancreatic diversion appears to be the technique with a better food tolerance and protein and energy intake in the first year of follow-up after BS.

Increased incidence of Graves' disease during the SARS-CoV2 pandemic.

INTRODUCTION: COVID-19 has a wide spectrum of clinical severity and there is evidence that SARS-Cov2 affects several organs and systems. Among the organs affected since the beginning of the pandemic, the relationship between SARS-CoV-2 infection and thyroid involvement has been demonstrated. Novel and highly effective messenger RNA and DNA-based vaccines have been rapidly developed to decrease SARS-CoV-2 morbidity and mortality. Early after mass vaccinations, cases of thyroid dysfunction mainly including episodes of subacute thyroiditis, began to be reported like adverse effects. The objective of this study is to determine the impact of the pandemic, both due to SARS-CoV2 infections and vaccinations, on the incidence of Graves' disease (GD). METHODS: Cross-sectional, observational study comparing incidence of GD in adult population (over 18 years) before (2017-2019) and after (2020-2021) Covid-19 pandemic. Only patients with new cases of GD, no relapsed diseases, were included. SARS-CoV-2 diagnosis was based on nucleic acid amplification tests on nasopharyngeal swabs or measurement of class M and class G antibodies to SARS-CoV-2 by highly specific assays. Data on incidence and vaccination related to SARS-CoV-2 infection were obtained from the public records from Castilla y León autonomous regional government. RESULTS: A total of 180 subjects were diagnosed and treated for GD during the study period. We observed a notable increase in expected GD cases in 2021 compared to 2017-19. The number of GD cases was higher in the second (Q2) quarter. Among 2021 GD cases, 42/66 patients (63.6%) had been vaccinated in the 90 days before symptom onset, but none of them in the first quarter of the year. A total of 97.7% were women with a mean age of 48.9 (SD 15.6) years. On average they were diagnosed 19.9 (SD 17.6) days after receiving the vaccine. A total of 7/42 (16.67%) had another previously diagnosed autoimmune disease and 11/42 (26.19%) were smokers. DISCUSSION: Our results show a notable increase in the incidence of GD during the year 2021, specially in women with a history of smoking. Hyper activation of the immune system induced by SARS-CoV2 and by the recently released SARS-COV-2 vaccines has been highlighted in recent months. To assess whether this observed increase in the incidence of GD is sustained in the coming years or has simply been a precipitous trigger for individuals who were already predisposed to develop the disease, future studies will be needed.

[Assessment of low muscle mass and strength in a control population]. / Valoración de la baja masa y fuerza muscular en una población de control.

Introduction: Background and aims: low muscle mass (LMM) conditions the nutritional status of an individual and has implications for quality of life and prognosis. The aim of this study was to evaluate body composition and determine normal values in the diagnosis of LMM in a control group of healthy individuals. Methods: a cross-sectional study of healthy volunteers aged 18 to 45 years with body mass index (BMI) < 30 kg/m2. A descriptive study was performed including demographic, clinical, anthropometric, and body composition variables (by bioimpedance, TANITA MC 780 MA; TANITA, Tokyo, Japan), stratified by age, sex and BMI. Values corresponding to -1/-2 standard deviations (SD) were determined to consider low muscle mass/function. Results: we included 67 patients, 71,60 % women, with a median age of 28.29 (IQR 4.05) years. Males presented higher weight, BMI, fat-free mass (FFM), muscle mass (MM), appendicular lean mass (ALM), appendicular lean mass index (ALMI), and dynamometry values when compared to females. The -1/-2 SD values of the various muscle parameters were determined according to sex. Conclusion: this study determined normal LMM values in healthy and young people, and the most commonly used indexes to express it, which will allow the diagnosis of LMM in disease-related situations using the corresponding -2 DS value.

Introducción: Introducción y objetivos: la baja masa muscular (BMM) condiciona el estado nutricional de un individuo y tiene implicaciones en la calidad y el pronóstico de vida. El objetivo de este trabajo fue evaluar la composición corporal y determinar los valores de normalidad en el diagnóstico de BMM en un grupo de control de individuos sanos. Material y método: estudio transversal de voluntarios sanos con edades entre 18 y 45 años, con un índice de masa corporal (IMC) < 30 kg/m2. Se realizó un estudio descriptivo incluyendo variables demográficas, clínicas, antropométricas y de composición corporal (mediante bioimpedancia, TANITA MC 780 MA; TANITA, Tokio, Japón), con estratificación por edad, sexo e IMC. Se determinaron los valores correspondientes a -1/-2 desviaciones estándar (DE) para considerar una baja masa/función muscular. Resultados: se incluyeron 67 pacientes, el 71,60 % mujeres, con una mediana de edad de 28,29 (RIC: 4,05) años. Los varones presentan mayor peso, IMC, masa libre de grasa (MLG), masa muscular (MM), masa muscular apendicular (MMA), índice de masa muscular apendicular (IMMA) y dinamometría con respecto a las mujeres. Se determinaron los valores de -1/-2 DE de los distintos parámetros musculares en función del sexo. Conclusiones: este estudio determina los valores normales de BMM en una población sana y joven de nuestro medio, y los índices más empleados para expresarla, lo que permitirá diagnosticar la BMM en situaciones patológicas empleando el valor correspondiente a -2 DE.

Bioelectrical impedance analysis as an alternative to dual-energy x-ray absorptiometry in the assessment of fat mass and appendicular lean mass in patients with obesity.

OBJECTIVE: Obesity is a challenge for bioelectrical impedance analysis (BIA) estimations of skeletal muscle and fat mass (FM), and none of the equations used for appendicular lean mass (ALM) have been developed for people with obesity. By using different equations and proposing a new equation, this study aimed to assess the estimation of FM and ALM using BIA compared with dual-energy x-ray absorptiometry (DXA) as a reference method in a cohort of people with severe obesity. METHODS: This cross-sectional study compared a multifrequency BIA (TANITA MC-780A) versus DXA for body composition assessment in adult patients with severe obesity (body mass index [BMI] of >35 kg/m2). Comparisons between measured (DXA) and predicted (BIA) data for FM and ALM were performed using the original proprietary equations of the device and the equations proposed by Kyle, Sergi, and Yamada. Bland-Altman plots were drawn to evaluate the agreement between DXA and BIA, calculating bias and limits of agreement (LOA). Reliability was analyzed using intraclass correlation coefficient (ICC). Stepwise multiple regression analysis was used to derive a new equation to predict ALM in patients with obesity and was validated in a subsample of our cohort. RESULTS: In this study, 115 patients (72.4% women) with severe obesity (mean BMI of 46.1 [5.2] kg/m2) were included (mean age 43.5 [8.6] y). FMDXA was 61.4 (10.1) kg, FMBIA was 57.9 (10.3) kg, and ICC was 0.925 (P < 0.001). Bias was -3.4 (4.4) kg (-5.2%), and LOA was -14.0, +7.3 kg. Using the proprietary equations, ALMDXA was 21.8 (4.7) kg and ALMBIA was 29.0 (6.8) kg with an ICC 0.868, bias +7.3 (4.0) kg (+34.1%) and LOA -0.5, +15.1. When applying other equations for ALM, the ICC for Sergi, et al. was 0.880, the ICC for Kyle, et al. was 0.891, and the best ICC estimation for Yamada, et al. was 0.914 (P < 0.001). Bias was +2.8 (2.8), +4.1 (2.9), and +2.7 (2.8) kg, respectively. The best-fitting regression equation to predict ALMDXA in our population derived from a development cohort (n = 77) was: ALM = 13.861 + (0.259 x H2/Z) - (0.085 x age) - (3.983 x sex [0 = men; 1 = women]). When applied to our validation cohort (n = 38), the ICC was 0.864, and the bias was the lowest compared with the rest of the equations +0.3 (+0.5) kg (+2.7%) LOA -5.4, +6.0 kg. CONCLUSION: BIA using multifrequency BIA in people with obesity is reliable enough for the estimation of FM, with good correlation and low bias to DXA. Regarding the estimation of ALM, BIA showed a good correlation with DXA, although it overestimated ALM, especially when proprietary equations were used. The use of equations developed using the same device improved the prediction, and our new equation showed a low bias for ALM.

Disease-Related Malnutrition and Sarcopenia Predict Worse Outcome in Medical Inpatients: A Cohort Study.

(1) Background: Both sarcopenia and disease-related malnutrition (DRM) are unfortunately underdiagnosed and undertreated in our Western hospitals, which could lead to worse clinical outcomes. Our objectives included to determine the impact of low muscle mass (MM) and strength, and also DRM and sarcopenia, on clinical outcomes (length of stay, death, readmissions at three months, and quality of life). (2) Methodology: Prospective cohort study in medical inpatients. On admission, MM and hand grip strength (HGS) were assessed. The Global Leadership Initiative on Malnutrition (GLIM) criteria were used to diagnose DRM and EWGSOP2 for sarcopenia. Assessment was repeated after one week and at discharge. Quality of life (EuroQoL-5D), length of stay (LoS), readmissions and mortality are reported. (3) Results: Two hundred medical inpatients, median 76.0 years-old and 68% with high comorbidity. 27.5% met GLIM criteria and 33% sarcopenia on admission, increasing to 38.1% and 52.3% on discharge. Both DRM and sarcopenia were associated with worse QoL. 6.5% died and 32% readmission in 3 months. The odds ratio (OR) of mortality for DRM was 4.36 and for sarcopenia 8.16. Readmissions were significantly associated with sarcopenia (OR = 2.25) but not with DRM. A higher HGS, but not MM, was related to better QoL, less readmissions (OR = 0.947) and lower mortality (OR = 0.848) after adjusting for age, sex, and comorbidity. (4) Conclusions: In medical inpatients, mostly polymorbid, both DRM but specially sarcopenia are associated with poorer quality of life, more readmissions, and higher mortality. Low HGS proved to be a stronger predictor of worse outcomes than MM.

Evaluation of Lipoprotein Profile and Residual Risk Three Years After Bariatric Surgery.

INTRODUCTION: Obesity is a chronic disease associated with other comorbidities, including atherogenic dyslipidemia (AD). Bariatric surgery (BS) has shown to reduce cardiovascular risk (CVR) by achieving a significant weight reduction and improving the lipid profile. Different surgical techniques may have a different effect on the lipoprotein profile. PURPOSE: To evaluate the lipid profile at 3 years after BS according to the surgical technique used and to determine which variables predict variation in the lipid profile at 3 years after BS. METHODS: Retrospective observational study of 206 patients who underwent BS between 2010 and 2019. We analyzed the variation of lipid parameters in the 3 years of follow-up according to the surgical technique, including a group analysis of patients according to whether they had dyslipidemia and whether they were treated or untreated and determined which variables predict variation in the lipid profile at 3 years after BS. RESULTS: There was a significant increase in high-density lipoprotein cholesterol (HDL-c) with sleeve gastrectomy (SG) and a significant decrease in total cholesterol (TC), LDL-cholesterol (LDL-c), non-HDL, and LDL/non-HDL with biliopancreatic diversion (BPD). Variables predicting lipid profile variation were surgical technique and pre-surgery lipoprotein level. CONCLUSIONS: Malabsorptive techniques achieve a greater decrease in TC and LDL-c throughout follow-up and could also improve residual cardiovascular risk (non-HDL and LDL/non-HDL). The type of surgical technique and the presurgery lipid profile predict variation after 3 years of BS.

Diabetes remission after malabsorptive bariatric surgery.

Obesity and diabetes are two closely related disorders. Lifestyle changes and drug treatment do not achieve successful diabetes remission. A treatment option for these patients is bariatric surgery (BS). The partial and complete remission rates vary, depending on the type of technique used (restrictive or malabsorptive), with malabsorptive surgery being more effective in terms of both weight reduction and diabetes remission (DR). Different scales (DiaRem, Ad-DiaRem or 5y-Ad-DiaRem) predict the probability of DR after BS, particularly after gastric bypass surgery. Some studies report higher DR rates in surgery with a greater malabsorptive component. Our aim was to study the benefits of BS at one year and 5 years in terms of the weight and blood glucose profile in patients with obesity and type 2 diabetes mellitus; assess percentage DR according to ADA criteria; determine the DR predictive capacity of different scores; and examine which variables predict DR at one and five years after biliopancreatic diversion (BPD). Percentage overweight reduction and the decrease in both blood glucose and HbA1c were greater with BPD. Complete diabetes remission was approximately 80% at one and 5 years after BS. In general, the scores that determine the probability of DR show poor discriminative capacity in malabsorptive surgery. Presurgery HbA1c predicts DR at one and 5 years after BPD. The type of surgery performed should be individualized, based on the severity of diabetes and the specific characteristics of each patient.

Bone metabolism and fracture risk after Biliopancreatic Diversion.

BACKGROUND: Bariatric surgery (BS) is an effective treatment. However, there have been concerns regarding the negative effect on the bone. The aim of this study was to assess changes in bone metabolism and the risk of fracture after biliopancreatic diversion (BPD). MATERIAL AND METHODS: A retrospective analysis of obese patients undergoing BPD between 1998 and 2017 was conducted, and patients with at least 1 year of follow-up were included. The incidence of fracture and of changes in bone metabolism was studied. RESULTS: In total, 216 patients were included (78.2% female), with a mean age of 42.5(10.6) years. The median follow-up was 6.8(IQR 10.2-3.2) years. The mean body mass index (BMI) was 49.7(6.3) kg/m2. 13.2% (n=29) suffered a bone fracture after surgery; the time until the first fracture was 7.9(3.8) years (55.2% secondary to a casual fall). The rate of fracture incidence was 19.6 per 1000 person-years (95%CI: 1.3-2.7), prevalence was 13.4% (95%CI: 8.9-18.0). The risk of bone fractures seems to increase with longer postoperative evolution time. PTH (pg/ml) levels were significantly higher in patients with fractures (1 year, 98.1 vs. 77.8; 5 years, 162.5 vs. 110.3 p<0.05, adjusted HR 1.10; 95%CI 1.01-1.11). Subjects with a higher %EWL had less risk of fractures after surgery (adjusted HR 0.97; 95%CI 0.94-0.99). Moreover, 25(OH)D levels were lower, and osteocalcin and ß-Crosslaps levels were slightly higher (not significant) in patients with fractures. CONCLUSION: BPD is related to important changes in bone metabolism, which can lead to an increased risk of bone fractures. Assessing the risk of fractures should be part of BS patient care.

Comparison of the performance of two grades of metformin hydrochloride elaboration by means of the SeDeM system, compressibility, compactability, and process capability indices.

Quality by design, applied to the development of a pharmaceutical drug, demands scientific methodologies, representing a source of information that will allow for a complete understanding the production process and the materials used for its manufacturing. Although the SeDeM system is a tool that enables a rational development of a product, result does not assure that an assessed material or mixture will be successful in terms of compression, hence, further research will be necessary on these features. The objective of this study was to assess and compare two grades of metformin hydrochloride elaboration: crystalline and direct compression using PXRD, the SeDeM expert system, the Heckel and Ryshkewitch-Duckworth models, as well as process control tools such as control charts and process capability indices to characterize and predict the performance of the materials in a direct compression process. The assessment identified that in spite of dealing with two different technical grades of a material with specific critical quality attributes for each one, PXRD analysis showed we dealt with the same crystalline structure, while the SeDeM system profiles obtained have very close values, and the main differences in materials were observed when subjecting them to conditions that simulate a compaction process with the Ryshkewitch-Duckworth model, in which a 46-times higher mechanical resistance was observed in the direct compression material compared with the crystalline one. The statistical control analysis revealed that only the direct compression material could be used to elaborate tablets whose weight variation was always maintained within the specification and control limits.

Bone metabolism and fracture risk after Biliopancreatic Diversion.

BACKGROUND: Bariatric surgery (BS) is an effective treatment. However, there have been concerns regarding the negative effect on the bone. The aim of this study was to assess changes in bone metabolism and the risk of fracture after biliopancreatic diversion (BPD). MATERIAL AND METHODS: A retrospective analysis of obese patients undergoing BPD between 1998 and 2017 was conducted, and patients with at least 1 year of follow-up were included. The incidence of fracture and of changes in bone metabolism was studied. RESULTS: In total, 216 patients were included (78.2% female), with a mean age of 42.5(10.6) years. The median follow-up was 6.8(IQR 10.2-3.2) years. The mean body mass index (BMI) was 49.7(6.3) kg/m2. 13.2% (n=29) suffered a bone fracture after surgery; the time until the first fracture was 7.9(3.8) years (55.2% secondary to a casual fall). The rate of fracture incidence was 19.6 per 1000 person-years (95%CI: 1.3-2.7), prevalence was 13.4% (95%CI: 8.9-18.0). The risk of bone fractures seems to increase with longer postoperative evolution time. PTH (pg/ml) levels were significantly higher in patients with fractures (1 year, 98.1 vs. 77.8; 5 years, 162.5 vs. 110.3 p<0.05, adjusted HR 1.10; 95%CI 1.01-1.11). Subjects with a higher %EWL had less risk of fractures after surgery (adjusted HR 0.97; 95%CI 0.94-0.99). Moreover, 25(OH)D levels were lower, and osteocalcin and ß-Crosslaps levels were slightly higher (not significant) in patients with fractures. CONCLUSION: BPD is related to important changes in bone metabolism, which can lead to an increased risk of bone fractures. Assessing the risk of fractures should be part of BS patient care.

Diabetes remission after malabsorptive bariatric surgery. / Remisión de diabetes tras cirugía bariátrica malabsortiva.

Obesity and diabetes are two closely related disorders. Lifestyle changes and drug treatment do not achieve successful diabetes remission. A treatment option for these patients is bariatric surgery (BS). The partial and complete remission rates vary, depending on the type of technique used (restrictive or malabsorptive), with malabsorptive surgery being more effective in terms of both weight reduction and diabetes remission (DR). Different scales (DiaRem, Ad-DiaRem or 5y-Ad-DiaRem) predict the probability of DR after BS, particularly after gastric bypass surgery. Some studies report higher DR rates in surgery with a greater malabsorptive component. Our aim was to study the benefits of BS at one year and 5 years in terms of the weight and blood glucose profile in patients with obesity and type 2 diabetes mellitus; assess percentage DR according to ADA criteria; determine the DR predictive capacity of different scores; and examine which variables predict DR at one and five years after biliopancreatic diversion (BPD). Percentage overweight reduction and the decrease in both blood glucose and HbA1c were greater with BPD. Complete diabetes remission was approximately 80% at one and 5 years after BS. In general, the scores that determine the probability of DR show poor discriminative capacity in malabsorptive surgery. Presurgery HbA1c predicts DR at one and 5 years after BPD. The type of surgery performed should be individualized, based on the severity of diabetes and the specific characteristics of each patient.

Searching for disease-related malnutrition using Big Data tools. / Persiguiendo la desnutrición relacionada con la enfermedad mediante herramientas de big data.

INTRODUCTION: Disease-related malnutrition (DRM) is underdiagnosed and underreported despite its well-known association with a worse prognosis. The emergence of Big Data and the application of artificial intelligence in Medicine have revolutionized the way knowledge is generated. The aim of this study is to assess whether a Big Data tool could help us detect the amount of DRM in our hospital. METHODOLOGY: This was a descriptive, retrospective study using the Savana Manager® tool, which allows for automatically analyzing and extracting the relevant clinical information contained in the free text of the electronic medical record. A search was performed using the term "malnutrition", comparing the characteristics of patients with DRM to the population of hospitalized patients between January 2012 and December 2017. RESULTS: Among the 180,279 hospitalization records with a discharge report in that period, only 4,446 episodes (2.47%) included the diagnosis of malnutrition. The mean age of patients with DRM was 75 years (SD 16), as compared to 59 years (SD 25) for the overall population. There were no sex differences (51% male). In-hospital death occurred in 7.08% of patients with DRM and 2.98% in the overall group. Mean stay was longer in patients with DRM (8 vs. 5 days, P<.0001) and there were no significant differences in the 72-hour readmission rate. The most common diagnoses associated with DRM were heart failure (35%), respiratory infection (23%), urinary infection (20%), and chronic kidney disease (15%). CONCLUSION: Underdiagnosis of DRM remains a problem. Savana Manager® helps us to better understand the profile of these patients.

Postoperative enteral immunonutrition in head and neck cancer patients: Impact on clinical outcomes.

BACKGROUND: Head and neck cancer patients have a high rate of complications during the postoperative period that could increase their morbidity rate. Arginine has been shown to improve healing and to modulate inflammation and immune response. The aim of our study was to assess whether use of arginine-enriched enteral formulas could decrease fistulas and length of stay (LoS). METHODS: A retrospective study was conducted in patients who had undergone head and neck cancer surgery and were receiving enteral nutrition through a nasogastric tube in the postoperative period between January 2012 and May 2018. The differences associated to use of immunoformula vs. standard formulas were analysed. Sociodemographic, anthropometric, and nutritional intervention variables, as well as nutritional parameters, were recorded during the early postoperative period. Occurrence of complications (fistulas), length of hospital stay, readmissions, and 90-day mortality were recorded. RESULTS: In a univariate analysis, patients who received nutritional support with immunonutrition had a lower fistula occurrence rate (17.91% vs. 32.84%; p=0.047) and a shorter mean LoS [28.25 (SD 16.11) vs. 35.50 (SD 25.73) days; p=0.030]. After adjusting for age, energy intake, aggressiveness of surgery and tumour stage, fistula occurrence rate and LoS were similar in both groups irrespective of the type of formula. CONCLUSIONS: Use of arginine-enriched enteral nutrition appears to decrease the occurrence of fistulas in the postoperative period in patients with head and neck cancer, with a resultant reduction in length of hospital stay. However, the differences disappeared after adjusting for age, tumour stage, or aggressiveness of the surgery.

The appearance of malnutrition in hematological inpatients prolongs hospital stay: the need for nutritional surveillance during hospitalization.

INTRODUCTION: Introduction: oncohematological diseases are associated with a high prevalence of malnutrition during hospitalization. Our aim was to analyze the appearance and repercussions of malnutrition in well-nourished hematological inpatients at admission. Method: a prospective one-year study conducted in hematology inpatients. The Malnutrition Screening Tool (MST) was used at admission and repeated weekly. Patients with a negative screening at admission who developed malnutrition during hospitalization constituted our study sample. A nutritional evaluation and intervention was performed. We also analyzed the effect of newly diagnosed malnutrition on patients' outcomes in comparison with the outcomes of patients that remained well-nourished during hospitalization. Results: twenty-one percent of hematological inpatients who were well nourished at admission developed malnutrition during hospitalization. Of the patients, 62.4% needed a nutritional intervention (100% oral supplements, 21.4% diet changes, 5.2% parenteral nutrition). After intervention, an increase in real intake was achieved (623 kcal and 27.3 g of protein/day). Weight loss was slowed and visceral protein was stabilized. Length of stay was 8.5 days longer for our sample than for well-nourished patients. Conclusions: newly diagnosed malnutrition appeared in one in five hematological well-nourished inpatients, leading to a longer length of stay. Nutritional intervention improved intake and nutritional status. Nutritional surveillance should be mandatory.

INTRODUCCIÓN: Introducción: las enfermedades oncohematológicas asocian una elevada prevalencia de malnutrición, especialmente durante la hospitalización. Objetivo: analizar la aparición de malnutrición y su repercusión en pacientes normonutridos al ingreso. Métodos: estudio prospectivo de un año en una cohorte de ingresados hematológicos. El Malnutrition Screening Tool (MST) se realizó al ingreso, repitiéndose semanalmente. Los pacientes con cribado negativo al ingreso que desarrollaron malnutrición durante la hospitalización constituyeron nuestra muestra. Se realizó evaluación e intervención nutricional, analizando el efecto de la aparición de malnutrición en el pronóstico, comparado con los pacientes que permanecieron normonutridos. Resultados: el 21% de los pacientes normonutridos al ingreso desarrolló malnutrición en la hospitalización. El 62.4% precisó intervención nutricional (100% suplementos orales, 21,4% cambios dietéticos, 5.2% nutrición parenteral). La intervención logró un aumento de ingesta real de 623 kcal y 27,3 g proteína/día, frenando la pérdida de peso y estabilizando las proteínas viscerales. La estancia fue 8,5 días mayor en nuestra muestra que en los pacientes que permanecieron normonutridos. Conclusiones: uno de cada cinco ingresados normonutridos al ingreso desarrolló malnutrición en la hospitalización, asociando mayor estancia. La intervención nutricional puede mejorar la ingesta y el estado nutricional, por tanto, la vigilancia nutricional debería ser obligatoria.

Secondary Hyperparathyroidism in Patients with Biliopancreatic Diversion After 10 Years of Follow-up, and Relationship with Vitamin D and Serum Calcium.

BACKGROUND: Secondary hyperparathyroidism (SHPT) is a matter of concern after biliopancreatic diversion (BPD). The aim of this study was to investigate the relationship between SHPT, 25(OH)D, and calcium after BPD. DESIGN: A retrospective analysis in obese patients after BPD performed between 1998 and 2016. METHODS: Patients with at least 1 year of follow-up were included. SHPT was considered when PTH > 65 pg/mL in the absence of an elevated corrected calcium. 25(OH)D (ng/mL) status was defined as: deficiency < 20, insufficiency 20-29.9, and sufficiency ≥ 30. RESULTS: In total, 321 patients were included (76.6% women), with mean age 43.0 (10.5) years. Median follow-up was 6.0 (IQR 3.0-9.0) years. Mean body mass index was 49.8 (7.0) kg/m2. SHPT increased to a maximum of 81.9% in the ninth year of follow-up (95% CI: 1.5-9.1). Two years after surgery, 33.9% of patients with 25(OH)D sufficiency had SHPT (p = 0.001). Corrected calcium levels were lower in patients with PTH > 65 pg/mL when compared with PTH < 65 pg/mL; 1 year: 8.96 vs 9.1 mg/dL and 5 years: 8.75 vs 9.12 mg/dL (p < 0.01). After surgery, patients with PTH > 65 pg/mL and 25(OH)D sufficiency had lower corrected calcium levels when compared with subjects with PTH and 25(OH)D in normal range. Two years: 9.0 vs 9.2 mg/dL (p < 0.05) and 4 years: 8.9 vs 9.2 mg/dL (p < 0.01). CONCLUSIONS: Once 25(OH)D is sufficient, the increase in PTH persists associated with a decrease in serum corrected calcium. It is important to ensure a sufficient calcium intake in these patients in order to avoid SHPT and osteomalacia in the future.