[Home and Ambulatory Artificial Nutrition (NADYA) Report. Home Parenteral Nutrition in Spain, 2017]. / Nutrición parenteral domiciliaria en España 2017. Informe del Grupo de Nutrición Artificial Domiciliaria y Ambulatoria NADYA.

AIM: to communicate HPN data obtained from the HPN registry of the NADYA-SENPE group (www.nadya-senpe.com) for the year 2017. MATERIAL AND METHODS: descriptive analysis of the data collected from adult and pediatric patients with HPN in the NADYA-SENPE group registry from January 1st, 2017 to December 31st, 2017. RESULTS: there were 308 patients from 45 Spanish hospitals (54.5% women), 38 children and 270 adults, with 3,012 episodes, which represent a prevalence rate of 6.61 patients/million inhabitants/year 2017. The most frequent diagnosis in adults was "palliative cancer" (25.6%), followed by "others". In children, it was Hirschsprung's disease with six cases (15.8%). The first indication was short bowel syndrome in both children (55.3%) and adults (33.7%). The most frequently used type of catheter was tunneled in both children (73.4%) and adults (38.2%). Ending 81 episodes, the most frequent cause was death (62.9%) and transition to oral feeding (34.7%). CONCLUSIONS: the progressive increase of collaborating centers and professionals in the registry of patients receiving NPD is maintained. The main indications of HPN and the motive for ending have remained stable.

OBJETIVO: comunicar los datos de nutrición parenteral domiciliaria (NPD) obtenidos del registro del grupo NADYA-SENPE (www.nadya-senpe. com) del año 2017. MATERIAL Y MÉTODOS: análisis descriptivo de los datos recogidos de pacientes adultos y pediátricos con NPD en el registro NADYA-SENPE desde el 1 de enero al 31 de diciembre de 2017. RESULTADOS: se registraron 308 pacientes (54,5% mujeres), 38 niños y 270 adultos, procedentes de 45 hospitales españoles, en total 312 episodios, lo que representa una tasa de prevalencia de 6,61 pacientes/millón de habitantes/año 2017. El diagnóstico más frecuente en adultos fue "oncológico paliativo" (25,6%), seguido de "otros". En niños fue la enfermedad de Hirschsprung, con seis casos (15,8%). El primer motivo de indicación fue síndrome de intestino corto tanto en niños (55,3%) como en adultos (33,7%). El tipo de catéter más utilizado fue el tunelizado tanto en niños (74,3%) como en adultos (38,2%). Finalizaron 81 episodios; la causa más frecuente fue el fallecimiento (62,9%) y que pasaron a vía oral (34,7%). CONCLUSIONES: se mantiene el incremento progresivo de centros y profesionales colaboradores en el registro de pacientes que reciben NPD. Las principales indicaciones de NPD y de motivo de finalización se mantienen estables.

[Prevalence of malnutrition to income in a basic general hospital]. / Prevalencia de desnutrición al ingreso en un hospital general básico.

OBJECTIVE: The main objective has been to evaluate and quantify the prevalence of malnutrition at admission, the degree of severity and the correlation with the nutritional parameters in a basic general hospital of the first level. METHODS: Observational, transverse, and randomized study of 244 patients (59.8% male and 40.2% female) performed during the first 24 hours of hospital admission and with a nutritional assessment including nutritional screening (CONUT®), anthropometric parameters, other analytical parameters and a quantification of hospital stay. RESULTS: In this study, 60.7% of the sample has at least one criterion of malnutrition (anthropometric and/or analytical). When considering at least two altered nutritional parameters (one of them analytical type), the prevalence was 29.1%. Prealbumin and transferrin have been shown to be particularly sensitive to moderate to severe and mild malnutrition, respectively. CONUT® has detected nutritional risk of a mild nature in 39.8%. Malnourished patients have a longer stay, and are statistically significant in oncological versusnon-oncological patients. CONCLUSIONS: Anthropometric parameters, on their own, can generate some degree of controversy over the prevalence of malnutrition, so it is considered as appropriate to use two parameters, at least one of an analytical type. Prealbumin is the most sensitive and specific indicator, and CONUT® is an easy, quick and economical tool for nutritional screening. In order to greatly alleviate malnutrition at hospital admission, the objective of the study, it would be wise to strengthen its screening and treatment from Primary Health Care.

[Home and Ambulatory Artificial Nutrition (NADYA) Group Report - Home parenteral nutrition in Spain, 2016]. / Nutrición parenteral domiciliaria en España 2016; informe del Grupo de Nutrición Artificial Domiciliaria y Ambulatoria NADYA.

OBJECTIVE: To communicate HPN data obtained from the HPN registry of the NADYA-SENPE group (www.nadya-senpe.com) for the year 2016. MATERIAL AND METHODS: Descriptive analysis of the data collected from adult and pediatric patients with HPN in the NADYA-SENPE group registry from January 1st, 2016 to December 31st, 2016. RESULTS: There were 286 patients from 42 Spanish hospitals (54.2% women), 34 children and 252 adults, with 294 episodes, which represent a prevalence rate of 6.16 patients / million inhabitants / year 2016. The most frequent diagnosis in adults was "palliative cancer" (25.8%), followed by "others". In children it was "motility alterations" with 6 cases (17.6%), Hirschsprung's disease and necrotising enterocolitis, both with 5 children (14.7%). The first indication was short bowel syndrome in both children (64.7%) and adults (37.3%), followed by intestinal obstruction in 28.6% adults and 14.7% in children. The most frequently used type of catheter was tunnelled in both children (70.6%) and adults (37.9%). The most frequent complication in adults was infection related to the catheter, which presented a rate of 0.48 infections / 1,000 days of NPD. During this period, 71 episodes ended in adults and the main cause was death (57.7%) followed by resuming the oral route (31%). CONCLUSIONS: There is a progressive increase of centers and professional collaborators in the registry who report patients receiving parenteral nutrition at home. The main indications of HPN and the motive for ending have remained stable.

[Home parenteral nutrition: a consensus document of experts from Andalucia and Extremadura]. / Documento de consenso de expertos de Andalucía y Extremadura sobre la nutrición parenteral domiciliaria.

Home parenteral nutrition (HPN) is a technique that has allowed the survival in the community of those patients with serious diseases resulting in an intestinal failure that made their nutrition impossible by other methods. It is indicated if there is a documented intestinal failure (understood by the reduction of the intestinal function to the minimum to the point that intravenous supplementation is required to maintain health and/or growth) with impossibility for oral or enteral exclusive nutrition, provided that there is the possibility of managing the patient at home and that there is no short-term survival expectancy. It requires taking into account the patient's quality of life, family environment and the capacity of the patient and/or their caregivers to be trained for HPN therapy. In low prevalence health topics, as intestinal failure, where the available scientific evidence is of poor quality, consensus documents add value in decision-making. Furthermore, HPN is a complex process and, although there is extensive experience in its application and even clinical practice guidelines, in daily practice there are uncertainties about its suitability, usefulness, rational use and associated costs. For this reason, this document of consensus has been carried out, using the GRADE method. With this document we intend to define our position with regard to the current use of HPN in our country and answer several controversial questions related to this treatment.

La nutrición parenteral en domicilio (NPD) es una técnica que ha permitido la supervivencia en la comunidad de aquellos pacientes con enfermedades graves resultantes en un fallo intestinal que hacía imposible su nutrición por otros métodos. Esta está indicada si existe un fallo intestinal documentado (entendido como la reducción de la función intestinal al mínimo hasta el punto de que se requiere suplementación intravenosa para mantener la salud y/o el crecimiento) con imposibilidad para la nutrición exclusiva por vía oral/enteral, posibilidad de manejo del enfermo en el domicilio y que no exista una expectativa corta de supervivencia, teniendo en cuenta la calidad de vida del paciente, el entorno familiar y la capacidad del paciente y/o de sus cuidadores de entrenamiento para la terapia de NPD.En los problemas de salud poco prevalentes, como es el fallo intestinal, en los cuales la evidencia científica disponible es de baja calidad, los documentos de consenso/expertos aportan valor en la toma de decisiones. Se suma a ello que la NPD es un proceso muy complejo y, a pesar de que existe una amplia experiencia en su aplicación e incluso guías de práctica clínica, en la práctica diaria se plantean incertidumbres acerca de su conveniencia, utilidad, uso racional y costes asociados. Por este motivo se ha realizado este documento de consenso, utilizando el método GRADE, con el que pretendemos definir nuestra posición con respecto al uso actual de la NPD en nuestro país y dar respuesta a una serie de preguntas que generan controversia en relación a este tratamiento.

Spanish home enteral nutrition registry of the year 2014 and 2015 from the NADYA-SENPE Group / Registro del Grupo NADYA-SENPE de nutrición enteral domiciliaria en España, años 2014 y 2015.

Objective: To present the results of the Spanish home enteral nutrition (HEN) registry of the NADYA-SENPE group for the years 2014 and 2015. Methods: From January 1st 2014 to December 31st 2015 the HEN registry was recorded and afterwards a further descriptive and analytical analysis was done. Results: In 2014, 3749 patients were recorded, and 4202 in 2015; prevalence was 80.58 patients/one million inhabitants in Spain in 2014 and 90.51 in 2015. There were 49.9% females in 2014 and 50.3% in 2015. Median age was 73 years (IQI 59-83) in 2014 as well as in 2015. 684 episodes finished in 2014 and 631 in 2015, with death as the main cause, in 54.9% and 50.4%, respectively. The ones who were fed through nasogastric tube had a mean age higher than the ones fed by any other route (p-value < 0.001). Sisty-seven paediatric patients were recorded in 2014 (56.7% females) and 77 in 2015 (55.8% females). Median age at the beginning of HEN among children was 5 months in 2014 and 5 months in 2015. The main route of administration was gastrostomy, in 52.5% in 2014 and nasogastric tube in 50.8% in 2015. 7 episodes finished in 2014 and 13 in 2015, having death as the main cause (57.1% in 2014 and 38.5% in 2015). It was found that were younger children the ones who were mainly fed by nasogastric tubes (p-value 0.004 vs. 0.002). Among paediatric patients as well as adults, the main diagnosis leading to HEN was neurological disease which gives aphagia or severe dysphagia. Conclusions: There has been an increase in the number of patients in the registry as well as the participating centers and the number of patients per center, without any significant change in the characteristics of the patients other than longer duration of the episodes.

Objetivo: exponer los resultados del registro de nutrición enteral domiciliaria (NED) del año 2014 y 2015 del Grupo NADYA-SENPE. Métodos: se recopilaron los pacientes introducidos en el registro desde el 1 de enero al 31 de diciembre de 2014 y la mismas fechas de 2015, y se procedió al análisis descriptivo y analítico de los datos. Resultados: en el año 2014, se registraron 3.749 pacientes y en 2015, 4.202; la prevalencia fue de 80,58 pacientes/millón de habitantes en el año 2014 y de 90,51 en 2015. Por sexos, hubo un 49,9% de mujeres en 2014 y un 50,3% en 2015. La edad media fue de 73 años (IIQ 59-83) en ambos años. Finalizaron 684 episodios de NED en 2014 y 631 en 2015, la causa principal fue el fallecimiento en el 54,9% y 50,4% de los casos, respectivamente. Los portadores de sonda nasogástrica presentan una edad media superior a los pacientes con cualquier otra vía (p < 0,001). Se registraron 67 pacientes pediátricos en 2014 (56,7% niñas) y 77 en 2015 (55,8% niñas). La vía principal de administración fue la gastrostomía en el 52,0% de los casos de 2014 y sonda nasogástrica en el 50,8% de los casos de 2015. La causa principal de finalización de la nutrición fue el fallecimiento (57,1% en 2014 y 38,5% en 2015). Se observó que los niños más pequeños eran los que se alimentaban preferentemente por SNG (p 0,004 vs.0,002).Tanto en pacientes pediátricos como en adultos el diagnóstico principal que motivó la necesidad de NED fue la enfermedad neurológica que cursa con afagia o disfagia severa. Conclusiones: se ha incrementado el número de pacientes del registro, así como el número de centros participantes y el número medio de pacientes comunicados por cada centro respecto a años anteriores, sin que se hayan modificado sustancialmente las características de los pacientes, salvo mayor duración de los episodios.

A new fructose-free, resistant-starch type IV-enriched enteral formula improves glycaemic control and cardiovascular risk biomarkers when administered for six weeks to elderly diabetic patients.

BACKGROUND: Reducing the dietary glycaemic response has been proposed as a way to reduce the risk of diabetes complications. OBJECTIVE: The aim of the present study was to evaluate the glycaemic control and cardiovascular risk biomarkers in fragile, elderly type 2 diabetes patients after the intake of a new fructose-free diabetes-specific formula enriched with resistant-starch type IV and high in monounsaturated fatty acids. METHODS: Forty-one type 2 diabetes patients aged 78.9 ± 2.8 years were fed exclusively with an enteral diabetes-specific formula for 6 weeks. Data were collected at baseline and after 6 weeks of feeding. Carbohydrate and lipid metabolism and inflammatory and cardiovascular risk biomarkers were measured to evaluated the course of diabetes complications. RESULTS: Blood glycated haemoglobin significantly decreased after the intervention (6.1 ± 0.1 vs. 5.8 ± 0.1 %; p< 0,045), as well as monocyte chemotactic protein-1 and soluble E-selectin (p < 0.05), while soluble vascular cell adhesion molecule and plasminogen activator inhibitor-1 tended to decrease from baseline to 6 weeks (p = 0.084 and p = 0.05, respectively). CONCLUSION: The new product improves glycaemic control and cardiovascular risk without altering lipid metabolism, which is useful for the prevention of diabetic complications. Longer intervention studies are needed in order to validate these results in a larger population.

A serum metabolomics-driven approach predicts orange juice consumption and its impact on oxidative stress and inflammation in subjects from the BIONAOS study.

SCOPE: To identify biomarkers of orange juice (OJ) consumption containing different doses of polyphenols and to determine its impact on oxidative stress and inflammation using an untargeted metabolomics analysis. METHODS AND RESULTS: Thirty subjects aged 22-63 years from the BIONAOS study consumed a normal-polyphenol OJ (NPJ) or a high-polyphenol OJ (HPJ) (299 or 745 mg/L, respectively) for 12 weeks in a randomized, parallel, double-blind study. UHPLC-MS, univariate and multivariate statistical analysis and ROC curves were used to design biomarkers of consumption in serum. We propose betonicine, stachydrine, methyl glucopyranoside (alpha+beta), dihydroferulic acid and galactonate as a new metabolic signature to distinguish the intake of OJ with a different polyphenol content. Changes in metabolites related to OJ, oxidative stress and inflammation were observed. After HPJ consumption, the serum levels of hydroxyoctadecadienoic acid (9-HODE+13-HODE) and dihydroxyoctadecanoic acid (12,13-DiHOME and 9,10-DiHOME) decreased, whereas levels of 12-hydroxyeicosatetraenoic acid (12-HETE) increased. 5-HETE increased after the NPJ intervention exclusively. CONCLUSION: We designed a new panel of biomarkers to differentiate the intake of OJs containing different doses of polyphenols. On the other hand, the consumption of an OJ with a high content of flavanones improved oxidative stress and inflammatory biomarkers.

Prognostic value of severity by various visceral proteins in critically ill patients with SIRS during 7 days of stay.

INTRODUCTION: Critically ill patients typically develop a catabolic stress state as a result of a systemic inflammatory response (SIRS) that alters clinical-nutritional biomarkers, increasing energy demands and nutritional requirements. OBJECTIVE: To evaluate the status of albumin, prealbumin and transferrin in critically ill patients and the association between these clinical-nutritional parameters with the severity during a seven day stay in intensive care unit (ICU). METHOD: Multicenter, prospective, observational and analytical follow-up study. A total of 115 subjects in critical condition were included in this study. Clinical and nutritional parameters and severity were monitored at admission and at the seventh day of the ICU stay. RESULTS: A significant decrease in APACHE II and SOFA (p < 0.05) throughout the evolution of critically ill patients in ICU. In general, patients showed an alteration of most of the parameters analyzed. The status of albumin, prealbumin and transferrin were below reference levels both at admission and the 7th day in ICU. A high percentage of patients presented an unbalanced status of albumin (71.3%), prealbumin (84.3%) and transferrin (69.0%). At admission, 27% to 47% of patients with altered protein parameters had APACHE II above 18. The number of patients with altered protein parameters and APACHE II below 18 were significantly higher than severe ones throughout the ICU stay (p < 0.01). Regarding the multivariate analysis, low prealbumin status was the best predictor of severity critical (p < 0.05) both at admission and 7th day of the ICU stay. CONCLUSION: The results of the present study support the idea of including low prealbumin status as a severity predictor in APACHE II scale, due to the association found between severity and poor status of prealbumin.

Nutrición Parenteral Domiciliaria en España durante 2015; informe del Grupo de Nutrición Artificial Domiciliaria y Ambulatoria NADYA.

Objetivo: Comunicar los datos del registro de Nutrición Parenteral Domiciliaria (NPD) del grupo de trabajo NADYA-SENPE del años 2015.Material y métodos: Recopilación de los datos de NPD del registro "on-line" del grupo de Nutrición Artificial Domiciliaria y Ambulatoria (NADYA) desde el 1 de enero de 2015 al 31 de diciembre de 2015.Resultados: Se registraron 236 pacientes, con 243 episodios de NPD procedentes de 40 hospitales. Lo que representa una tasa de 5,08 pacientes/millón de habitantes/ año 2015. La patología más frecuente en los adultos fue "otros" (26,3%) seguido por "oncológico paliativo" (21,6%).  La complicación más frecuente fue la séptica relacionada con el catéter que presentó una tasa de 0,53 infecciones/1000 días de NPD. Finalizaron 64 episodios, la principal causa fue el fallecimiento (43,7%) y el 'paso a la vía oral' (32,8%).Conclusiones: constatamos el aumento de los centros y profesionales colaboradores, dando respuesta a la cantidad progresivamente mayor de pacientes con soporte nutricional parenteral en domicilio. Se mantienen estables las principales indicaciones para el establecimiento de NPD y las causas de finalización del tratamiento.

[Not Available]. / La desnutrición hospitalaria: un viejo problema sin resolver.

La detección de la desnutrición hospitalaria continúa de plena actualidad en la literatura médica y, a pesar de que desde hace dos décadas dejó de ser un tema novedoso, constituye un elemento recurrente en la bibliografía y motivo de abordajes monográficos en congresos y reuniones científicas.

[HOME AND AMBULATORY ARTIFICIAL NUTRITION (NADYA) GROUP REPORT, HOME PARENTERAL NUTRITION IN SPAIN, 2014]. / NUTRICIÓN PARENTERAL DOMICILIARIA EN ESPAÑA DURANTE 2014; INFORME DEL GRUPO DE NUTRICIÓN ARTIFICIAL DOMICILIARIA Y AMBULATORIA NADYA.

AIM: to communicate the results of the Spanish Home Parenteral Nutrition (HEN) registry of the NADYASENPE group for the year 2014. MATERIAL AND METHODS: data was recorded online by NADYA group collaborators that were responsible of the HPN follow-up from 1st January to 31st December 2014. RESULTS: a total of 220 patients and 229 episodes of HPN were registered from 37 hospitals that represents a rate of 4.7 patients/million habitants/year 2014. The most frequent disease in adults was other diseases (23.3%), neoplasm (20.4%) followed by radical active neoplasm (11.8%) and mesenteric ischemia (10.9%). The most frequent diagnosis for children were the congenital intestinal disorders (33.3%) followed by traumatic short bowel and other diagnosis. CONCLUSIONS: the number of participating centers and registered patients increased progressively respect to preceding years. We consider that the HPN should be regulated by the Sanitary Administration within the framework of the National Health Service Interregional Council. And its inclusion in the portfolio of health services of the different Autonomous Comunities would be beneficial for patients and professionals.

Objetivo: comunicar los datos del registro de Nutrición Parenteral Domiciliaria (NPD) del grupo de trabajo NADYA-SENPE del año 2014. Material y métodos: recopilación de los datos de NPD del registro "on-line" del grupo de Nutrición Artificial Domiciliaria y Ambulatoria (NADYA) desde el 1 de enero de 2014 al 31 de diciembre de 2014. Resultados: se registraron 220 pacientes, con 229 episodios de NPD, procedentes de 37 hospitales; lo que representa una tasa de 4,73 pacientes/millón de habitantes/ año 2014. Las patologías más frecuentes en los adultos fueron: 'otros diagnósticos' (22,3%), la neoplasia paliativa (20,4%), seguida por la neoplasia activa radical (11,8%) y la isquemia mesentérica (10,9%). En los niños las patologías más frecuentes fueron: 'alteraciones congénitas intestinales' (33,3%), seguidas por 'intestino corto traumático' y 'otro diagnóstico'. Conclusiones: se observa un aumento del número de pacientes que reciben nutrición parenteral domiciliaria y de los centros colaboradores. Consideramos que la NPD debería ser regulada por la Administración Sanitaria en el marco del Consejo Interterritorial del Sistema Nacional de Salud, y que su inclusión en la Cartera de Servicios de los diferentes Servicios de Salud de las diferentes comunidades autónomas redundaría en un beneficio para el paciente y los profesionales.

IMBALANCES IN PROTEIN METABOLISM IN CRITICAL CARE PATIENT WITH SYSTEMIC INFLAMMATORY RESPONSE SYNDROME AT ADMISSION IN INTENSIVE CARE UNIT.

BACKGROUND: trauma and severe infections cause remarkable metabolic changes in patient with SIRS from an adaptive response aimed to control the underlying disease, repairing damaged tissue, and to synthesize substrates. If the attack is intense and sustained and the patient has a compromised nutritional status, can evolve into multiple organ failure and death. OBJECTIVE: assessment of nutritional proteic status and the involvement of proteins and inflammatory factors in critically ill patients. METHOD: multicenter observational analytical study in critical ill patients at the admission in ICU. RESULTS AND DISCUSSION: patients showed disturbances in clinical nutritional parameters which confirm their hypercatabolic situation, showing malnutrition state at admission, where 42.9% had plasma levels below the reference prealbumin. Amino acid profile was situated below the reference values and 99% of patients had low plasma transferrin. Significant differences were observed in total protein, ferritin and transferrin parameters adjusted by CRP levels, being higher when patients presented high inflammation in the case of ferritin and the opposite for the rest of parameters. Adjusting APACHE and SOFA scores according to low, medium and high severity, results showed significant differences in creatinine, urea, and transferrin, being lower at high severity grade for the last one. CONCLUSION: critical illness is characterized by a high degree of stress and accelerated degradation of proteins that cause malnutrition, systemic inflammation and organ dysfunction, with a significant association between albumin, ferritin and transferrin.

Antecedentes: el trauma y las infecciones severas causan cambios metabólicos notables en los pacientes con SRIS como una respuesta adaptativa dirigida a controlar la enfermedad subyacente, la reparación del tejido dañado y para sintetizar sustratos. Si el ataque es intenso y sostenido y el paciente tiene un estado nutricional comprometido puede evolucionar a insuficiencia orgánica múltiple y muerte. Objetivo: evaluación del estado nutricional proteico y la participación de las proteínas y los factores inflamatorios en pacientes críticamente enfermos. Método: estudio analítico observacional multicéntrico en pacientes enfermos críticos en la admisión en la UCI. Resultados y discusión: los pacientes mostraron alteraciones en los parámetros nutricionales clínicos que confirman su situación hipercatabólica, mostrando malnutrición a la admisión en UCI, donde el 42,9% tenían niveles plasmáticos de prealbúmina por debajo de la referencia. Los aminoácidos se encuentran por debajo de los valores de referencia y el 99% de los pacientes presentaron bajos niveles plasmáticos de transferrina. Se observaron diferencias significativas en los niveles de proteína total, ferritina y transferrina ajustados por los niveles de PCR, siendo mayor cuando los pacientes presentaron altos valores de inflamación, en el caso de la ferritina, y lo opuesto para el resto de parámetros. Al estratificar por las puntuaciones APACHE y SOFA de acuerdo a la gravedad baja, media y alta, los resultados mostraron diferencias significativas en creatinina, urea y transferrina, siendo menor cuanto mayor era el grado de severidad para la transferrina. Conclusión: la enfermedad crítica se caracteriza por un alto grado de estrés y la degradación acelerada de proteínas que causan malnutrición, inflamación sistémica y la disfunción de órganos, con una asociación significativa entre albúmina, ferritina y transferrina.

Changes in Oxidative Stress and Inflammatory Biomarkers in Fragile Adults over Fifty Years of Age and in Elderly People Exclusively Fed Enteral Nutrition.

We aim to evaluate whether exclusive feeding of an enteral formula enriched with n-3 long chain polyunsaturated fatty acids (n-3 LC-PUFA) affects oxidative stress and the antioxidant defence system and may improve the levels of some relevant inflammatory, and cardiovascular biomarkers in frail adults over fifty years of age and in elderly subjects. Fifty-five patients were divided into two groups and were exclusively fed a newly designed normoproteic and isocaloric enteral formula enriched with eicosapentaenoic (98 mg/d) and docosahexaenoic acids (46 mg/d) (n = 26) or a reference enteral diet (n = 29). Oxidative, inflammatory and cardiovascular risk biomarkers and red blood cell fatty acid profiles were determined at the beginning and after 90 and 180 days of feeding. The n-3 LC-PUFA percentage tended to be higher (P = 0.053) in the experimental group than in the reference group. Administration of the n-3 LC-PUFA diet did not increase oxidative stress or modify plasma antioxidant capacity but decreased antioxidant enzymatic activities. MMP-9 plasma concentration decreased with both formulae, whereas tPAI-1 tended to decrease (P = 0.116) with the administration of the experimental formula. In conclusion, administration of the new n-3 LC-PUFA-enriched product for 6 months did not negatively alter the oxidative status and improved some cardiovascular risk biomarkers.

[PHARMACONUTRITION IN SEVERELY ILL PATIENT]. / FARMACONUTRICIÓN EN EL PACIENTE GRAVE.

"Pharmaconutrient" is a term applicable to those compounds which. in addition to their nutritional function, play a role as aids in the treatment of patients with severe pathologies, including sepsis, trauma, burns and major surgery, In general, enrichment of enteral an parenteral formulas with pharmaconutrients contribute to positively modulate the inflammatory response, infection and controlling the internal milieu, which in turn can be evaluated through lower mortality, hospital and intensive care units stay, days of mechanical ventilation and other parameters allowing to asses their effects. Arginine, glutamine, nucleotides, omega-3 fatty acids and antioxidant micronutrients, make up the nucleus of pharmaconutrients used with that aim, usually as mixtures of them. In the present review current evidence about the effects, indications, limitations, doses, potential adverse risks and even counter-indications is analysed.

El término farmaconutriente se aplica a aquellos compuestos que poseen un efecto añadido al meramente nutricional y que se utilizan como terapia coadyuvante en pacientes con patologías graves que incluyen sepsis, traumatismos, grandes quemados y enfermos quirúrgicos. En general, con su enriquecimiento en las fórmulas enterales o parenterales se pretende modular positivamente la respuesta inflamatoria, la infección y el control del medio interno, valorables a través de mortalidad, tiempo de estancia en hospital y en UCI, días de ventilación mecánica y otros parámetros que permiten dimensionar los efectos de su utilización. Arginina, glutamina, nucleótidos, ácidos grasos omega-3 y micronutrientes antioxidantes constituyen el núcleo de los farmaconutrientes utilizados con la finalidad antedicha, habitualmente en forma de mezclas. En la presente revisión se analiza la evidencia actual acerca de sus efectos, indicaciones, limitaciones, cantidades a aportar, peligros potenciales e incluso contraindicaciones.

[VALIDATION OF A COMPUTER PROGRAM FOR DETECTION OF MALNUTRITION HOSPITAL AND ANALYSIS OF HOSPITAL COSTS]. / VALIDACIÓN DE UN PROGRAMA INFORMÁTICO PARA DETECCIÓN DE LA DESNUTRICIÓN HOSPITALARIA Y ANÁLISIS DEL COSTE HOSPITALARIO.

BACKGROUND: one of the methods of diagnosis of malnutrition is serum albumin, for the simplicity of its determination and low cost. OBJECTIVES: the main objective is to validate and implement a computer program based on the determination of serum albumin, allowing early detection and treatment to malnourished or at risk of malnutrition patients, still another objective evaluation of costs by diagnosis-related groups. METHODS: the study design is cohort, dynamic and prospective, which are included hospital discharge from november 2012 until march 2014, being the study population of patients over age 14 who enter the various services of a Medical Surgical Hospital of the Granada's Hospital Complex Univesity, whose numbers are lower serum albumin 3.5 g/dL, for a total of 307 patients. RESULTS: of the 307 patients, 141 are malnourished (program sensitivity: 45.9%). 54.7% of patients were male and 45.3% female. The mean age of 65.68 years. The median length of stay is 16 days. 13.4% of patients have died. The average cost of GRD is € 5 958.30 and said average cost after detecting malnutrition is € 11 376.48. CONCLUSIONS: the algorithm that implements the software identifies nearly half of patients hospitalized malnourished. It is essential to record the diagnosis of malnutrition.

Introducción: uno de los métodos de diagnóstico de la desnutrición es la albúmina sérica, por la sencillez de su determinación y bajo coste. Objetivos: el objetivo principal es validar e implementar un programa informático, basado en la determinación de albúmina sérica, que permita detectar y tratar precozmente a los pacientes desnutridos o en riesgo de desnutrición, siendo otro objetivo la evaluación de costes por grupos relacionados por el diagnóstico. Métodos: el diseño del estudio es de tipo cohorte, dinámico y prospectivo, en el que se han incluido las altas hospitalarias desde noviembre del año 2012 hasta marzo del año 2014, siendo la población de estudio los pacientes mayores de 14 años que ingresen en los diversos servicios de un Hospital Médico Quirúrgico del Complejo Hospitalario Universitario de Granada, cuyas cifras de albúmina sérica sean menores de 3,5 g/dL, siendo el total de 307 pacientes. Resultados: de los 307 pacientes, 141 presentan desnutrición (sensibilidad del programa: 45,9%). El 54,7% de los pacientes son hombres y el 45,3% mujeres. La edad media es de 65,68 años. La mediana de la estancia es de 16 días. El 13,4% de los pacientes han fallecido. El coste medio de los GRD es de 5.958,30 € y dicho coste medio después de detectar la desnutrición es de 11.376,48 €. Conclusiones: el algoritmo que implementa el programa informático identifica a casi la mitad de los pacientes hospitalizados desnutridos. Es fundamental registrar el diagnóstico de desnutrición.

Normal or High Polyphenol Concentration in Orange Juice Affects Antioxidant Activity, Blood Pressure, and Body Weight in Obese or Overweight Adults.

BACKGROUND: The consumption of orange juice may lead to reduced oxidative stress and may enhance the antioxidant defense system. OBJECTIVE: The aim was to evaluate the effects of the intake of orange juice containing either normal (NPJ) or high (HPJ) concentrations of polyphenols (299 and 745 mg/d, respectively) on the antioxidant defense system, oxidative stress biomarkers, and clinical signs of metabolic syndrome in 100 nonsmoking subjects who were either overweight or obese. METHODS: A randomized, double-blind crossover study was conducted over two 12-wk periods with a 7-wk washout period. The effects on enzymatic and nonenzymatic blood antioxidant defense systems, urinary and plasma oxidative stress biomarkers, and clinical signs of metabolic syndrome were evaluated before and after an intervention with both of the orange juices. Paired t tests and linear mixed-effects models were used to evaluate the effects of juice, time, and interactions. RESULTS: The intake of either NPJ or HPJ led to a decrease in urinary 8-hydroxy-2'-deoxyguanosine (NPJ: 935 ± 134 to 298 ± 19 ng/mg creatinine; HPJ: 749 ± 84 to 285 ± 17 ng/mg creatinine), 8-iso-prostaglandin F2α (NPJ: 437 ± 68 to 156 ± 14 ng/mg creatinine; HPJ: 347 ± 43 to 154 ± 13 ng/mg creatinine), erythrocyte catalase, and glutathione reductase activities. A decrease was also observed in body mass index, waist circumference, and leptin (all P < 0.05). The NPJ intervention decreased systolic and diastolic blood pressures (systolic blood pressure: 128 ± 1 to 124 ± 2 mm Hg; diastolic blood pressure: 79 ± 1 to 76 ± 1 mm Hg), whereas the HPJ intervention increased erythrocyte superoxide dismutase (SOD) activity (17.7 ± 1.5 to 23.1 ± 1.7 U/mg hemoglobin). CONCLUSIONS: Our results show that the consumption of either NPJ or HPJ protected against DNA damage and lipid peroxidation, modified several antioxidant enzymes, and reduced body weight in overweight or obese nonsmoking adults. Only blood pressure and SOD activity were influenced differently by the different flavanone supplementations. This trial was registered at clinicaltrials.gov as NCT01290250.

A home enteral nutrition (HEN); spanish registry of NADYA-SENPE group; for the year 2013.

AIM: To present the results of the Spanish home enteral nutrition (HEN) registry of the NADYA-SENPE group for the year 2013. MATERIAL AND METHODS: From January 1st to December 31st 2013 data was recorded for the HEN registry and further descriptive and analytical analysis was done. RESULTS: In this period 3 223 patients (50.6% men) and a total of 3 272 episodes of HEN were registered in 33 Spanish hospitals. The rate of prevalence was of 67,11 patients/million habitants/ year 2013. A high percentage of patients (98,24%) were older than 14 years. Adult's mean age was 69,14 years (sd 17,64) and men were younger than women p-value <0,001. Children mean age was 2,38 years (sd 4,35). The most frequent indication for HEN was neurological disease for children (49,1%). and for adults (60,6%). Gastrostomy was the most used administration route for children (51%) while younger ones were fed with NGT (p-value 0,003) also older adults (48%) were fed with this type of tube (p-value <0,001). The most frequent reasons for cessation of treatment was death, 44,4% were children and 54,7% were adults. CONCLUSIONS: The number of patients and hospitals registered increased in the last years while the other variables maintain steady. The registry developed allowing contrasted analysis of data in order to get more information.

Objetivo: exponer los resultados del registro de nutrición enteral domiciliaria (NED) del año 2013 del Grupo NADYA-SENPE. Material y métodos: se recopilaron los pacientes introducidos en el registro desde el 1 de enero al 31 de diciembre de 2013, procediendo al análisis descriptivo y analítico de los datos. Resultados: durante este periodo se registraron 3.223 pacientes, (50,6% varones) y un total de 3.272 episodios de NED en 33 hospitales españoles. La tasa de prevalencia fue de 67,11pacientes/millón de habitantes/año 2013. El 98,24% de los enfermos tenía más de 14 años. La media de edad de los adultos fue de 69,14 años (dt 17,64) y la mediana se situó en 73 años (IIQ 58-83), siendo los varones más jóvenes que las mujeres; p-valor < 0,001. Los niños tuvieron una edad media de 2,38 años (dt 4,35). La enfermedad que con más frecuencia motivó el uso de la NED fue la patología neurológica en niños (49,1%) y en adultos (60,6%). La vía de administración más utilizada en los niños fue la gastrostomía (51%), siendo los niños más pequeños los que se alimentaban por SNG (p-valor 0,003) y en los adultos (48%), siendo estos pacientes los de mayor edad (p-valor.

A Home and Ambulatory Artificial Nutrition (NADYA) group report, Home Parenteral Nutrition in Spain, 2013.

AIM: To communicate the results of the Spanish Home Parenteral Nutrition (HPN) registry of the NADYA-SENPE group for the year 2013. MATERIAL AND METHODS: Data was recorded online by NADYA group collaborators that were responsible of the HPN follow-up from 1st January to 31st December 2013. RESULTS: A total of 197 patients and 202 episodes of HPN were registered from 35 hospitals that represents a rate of 4,22 patients/million habitants/year 2013. The median age was 53 years (IQR 40-64) for 189 adult patients and 7 months (IQR 6-35,5) for children. The most frequent disease in adults was neoplasm (30,7%) followed by other diseases (20,1%) and mesenteric ischemia (12,7%). Short bowel syndrome and intestinal obstruction (25,9%) were in 35.7% cases the indications for HPN. The most frequent diagnosis for children were the congenital intestinal disorders and other diagnosis, both with a (37,5%) and short bowel syndrome and intestinal obstruction were the indication for treatment, each was present in 50% of the sample. Tunneled catheters (50%) and subcutaneous reservoirs (27,7%) were frequently used. The septic complications related with catheter were commonly frequent with a rate of 0.74 infections/1000 HPN days. HPN duration presented a median of 1,69 days. A total of 86 episodes finalized during the year, death was the principal reason (45%), followed by "resumed oral via" (43,75%) while it happened inversely for children, 66,7% of them resumed oral via and 16,7% deceased. Fifteen per cent were considered for intestinal transplant, children were proportionally candidates, p-value 0.002. CONCLUSIONS: The number of participating centers and registered patients increased progressively respect to preceding years. Since 2003 Neoplasm is still being the principal pathological group. Death is adult's principal reason for finalizing HPN and "resuming oral via" for children. Despite that NADYA registry is consolidate as a essential source of relevant information about the advances in Home Artificial Nutrition in our country, currently is in an improvement process of the available information about patients characteristics with a special emphasis on children even though they still being a minority group.

Objetivo: comunicar los datos del registro de Nutrición Parenteral Domiciliaria (NPD) del grupo de trabajo NADYA-SENPE del años 2013. Material y métodos: recopilación de los datos del registro "on-line" introducidos por los colaboradores del grupo NADYA responsables del seguimiento de la NPD desde el 1 de enero de 2013 al 31 de diciembre de 2013. Resultados: se registraron 197 pacientes, procedentes de 35 hospitales, lo que representa una tasa de 4,22 pacientes/ millón habitantes/año 2013, con 202 episodios de NPD. La edad media de los 189 pacientes mayores de 14 años fue de 53 años (IIQ 40 ­ 64), y en los niños de 7 meses (IIQ 6 ­ 35,5). La patología más frecuente en los adultos fue la neoplasia (30,7%) seguida por otras patologías (20,1%) y la isquemia mesentérica (12,7%). En el 35,4% de los casos el motivo de indicación fue el síndrome de intestino corto, seguido de la obstrucción intestinal (25,9%). En los niños el diagnóstico más frecuente fueron las alteraciones congénitas intestinales y 'otros diagnósticos', ambas con un 37,5 %, y la causa de la indicación el síndrome de intestino corto y la obstrucción intestinal, que se repartieron el 50% de la muestra. Los catéteres más utilizados fueron los tunelizados (50%) y los reservorios subcutáneos (27,7%). Las complicaciones más frecuentes fueron las sépticas, relacionadas con el catéter, con una tasa de 0,74 infecciones/1.000 días de NPD. La duración de la NPD presentó una mediana de 1,69 años. Durante el año finalizaron 86 episodios, la principal causa de la finalización en adultos fue el fallecimiento (45%) seguido del 'paso a la vía oral' (43,75%) y en los niños a la inversa 66,7% pasan a vía oral y 16,7% fallecen. Se consideraron candidatos para trasplante intestinal el 15% de los pacientes, siendo proporcionalmente los candidatos niños, p-valor 0,002. Conclusiones: se observa un aumento progresivo de los centros participantes y de los pacientes registrados respecto a años anteriores. El principal grupo patológico sigue siendo oncológico, ocupando el primer lugar desde 2003. La principal causa de finalización de la NPD es en los adultos el fallecimiento y en los niños el 'paso a vía oral'. Aunque el registro NADYA es un registro consolidado y ha sido y es fuente imprescindible de información relevante para el conocimiento de los avances de la Nutrición Artificial Domiciliaria en nuestro país, se encuentra en proceso de mejorar la información que ofrece sobre las características de los pacientes, con especial atención en el grupo de niños, aunque estos siguen siendo un número reducido.

Association between magnesium-deficient status and anthropometric and clinical-nutritional parameters in posmenopausal women.

BACKGROUND: During menopause occurs weight gain and bone loss occurs due to the hormone decline during this period and other factors such as nutrition. Magnesium deficiency suggests a risk factor for obesity and osteoporosis. OBJECTIVE: To evaluate the clinical and nutritional magnesium status in a population of postmenopausal women, assessing intake and serum levels of magnesium in the study population and correlation with anthropometric parameters such as body mass index (BMI) and body fat, and biochemical parameters associated. SUBJECTS AND METHOD: The study involved 78 healthy women aged 44-76, with postmenopausal status, from the province of Grenade, Spain. The sample was divided into two age groups: group 1, aged < 58, and group 2 aged ≥ 58. Anthropometric parameters were recorded and nutritional intake was assessed by 72-hour recall, getting the RDAs through Nutriber® program. To assess the biochemical parameters was performed a blood sample was taken. Magnesium was analyzed by flame atomic absorption spectrophotometry (FAAS) in erythrocyte and plasma wet-mineralized samples. RESULTS: Our results show that 37.85% of the total subjects have an overweight status. Magnesium intake found in our population is insufficient in 36% of women, while plasma magnesium deficiency corresponds to 23% of the population and 72% of women have deficient levels of magnesium in erythrocyte. Positive correlations were found between magnesium intake and dietary intake of calcium, of phosphorus, and with prealbumin plasma levels, as well as with a lower waist / hip ratio. Magnesium levels in erythrocyte were correlated with lower triglycerides and urea values. CONCLUSION: It is important to control and monitor the nutritional status of magnesium in postmenopausal women to prevent nutritional alterations and possible clinical and chronic degenerative diseases associated with magnesium deficiency and with menopause.

Introducción: Durante la menopausia se produce un aumento de peso y de pérdida de masa ósea debido a la disminución hormonal producida durante este periodo y a otros factores como la nutrición. La deficiencia de magnesio podría ser un factor de riesgo para la obesidad y la osteoporosis. Objetivo: Evaluar el estado clínico-nutricional en una población de mujeres postmenopáusicas, evaluando la ingesta y los niveles séricos de magnesio, y su correlación con parámetros antropométricos, como el índice de masa corporal (IMC) y la grasa corporal, así como con parámetros bioquímicos asociados. Sujetos y Metodología: En el estudio participaron 78 mujeres sanas en situación de postmenopausia de la provincia a de Granada, con edades comprendidas entre los 44-76 años. La muestra se dividió en dos grupos de edad: grupo 1, mujeres postmenopáusicas con edad menor de 58 años y grupo 2, de edad mayor o igual a 58 años. Se registraron parámetros antropométricos y se valoró la ingesta nutricional mediante recordatorio de 72 horas, obteniendo las RDAs a través del programa Nutriber®. Para valorar los parámetros bioquímicos se realizó una extracción de sangre y el magnesio se analizó mediante espectrofotometría de absorción atómica de llama (FAAS) en muestras de eritrocitos y plasma previamente mineralizadas por vía húmeda. Resultados: Nuestros resultados muestran que el 37.8% de las mujeres presentan sobrepeso. La ingesta de magnesio encontrada en nuestra población es insuficiente en el 36% de las mujeres, mientras que la deficiencia de magnesio plasmático y eritrocitario corresponde al 23% y el 72% de las mujeres, respectivamente. Se observaron correlaciones significativas positivas entre el aporte de magnesio en la dieta y el aporte de calcio, de fósforo, y los niveles plasmáticos de prealbúmina, además de con una menor relación cintura/cadera. Los niveles de magnesio en eritrocito se correlacionaron con los niveles de triglicéridos y con menores valores de urea. Conclusión: Es importante un control y seguimiento de la situación nutricional en magnesio d la mujer postme nopáusica para prevenir alteraciones clínico-nutricionales y posibles enfermedades crónico-degenerativas relacionadas con la deficiencia del magnesio y la menopausia.

Safety and immunomodulatory effects of three probiotic strains isolated from the feces of breast-fed infants in healthy adults: SETOPROB study.

UNLABELLED: We previously described the isolation and characterization of three probiotic strains from the feces of exclusively breast-fed newborn infants: Lactobacillus paracasei CNCM I-4034, Bifidobacterium breve CNCM I-4035 and Lactobacillus rhamnosus CNCM I-4036. These strains were shown to adhere to intestinal mucus in vitro, to be sensitive to antibiotics and to resist biliary salts and low pH. In the present study, a multicenter, randomized, double-blind, placebo-controlled trial with 100 healthy volunteers in three Spanish cities was carried out to evaluate the tolerance, safety, gut colonization and immunomodulatory effects of these three probiotics. Volunteers underwent a 15-day washout period, after which they were randomly divided into 5 groups that received daily a placebo, a capsule containing one of the 3 strains or a capsule containing a mixture of two strains for 30 days. The intervention was followed by another 15-day washout period. Patients did not consume fermented milk for the entire duration of the study. Gastrointestinal symptoms, defecation frequency and stool consistency were not altered by probiotic intake. No relevant changes in blood and serum, as well as no adverse events occurred during or after treatment. Probiotic administration slightly modified bacterial populations in the volunteers' feces. Intestinal persistence occurred in volunteers who received L. rhamnosus CNCM I-4036. Administration of B. breve CNCM I-4035 resulted in a significant increase in fecal secretory IgA content. IL-4 and IL-10 increased, whereas IL-12 decreased in the serum of volunteers treated with any of the three strains. These results demonstrate that the consumption of these three bacterial strains was safe and exerted varying degrees of immunomodulatory effects. TRIAL REGISTRATION: ClinicalTrials.gov NCT01479543.