A Prospective, Observational Study of the Effect of a High-Calorie, High-Protein Oral Nutritional Supplement with HMB in an Old and Malnourished or at-Risk-of-Malnutrition Population with Hip Fractures: A FracNut Study.

BACKGROUND: Hip fractures are prevalent among older people, often leading to reduced mobility, muscle loss, and bone density decline. Malnutrition exacerbates the prognosis post surgery. This study aimed to evaluate the impact of a 12-week regimen of a high-calorie, high-protein oral supplement with ß-hydroxy-ß-methylbutyrate (HC-HP-HMB-ONS) on nutritional status, daily activities, and compliance in malnourished or at-risk older patients with hip fractures receiving standard care. SUBJECTS AND METHODS: A total of 270 subjects ≥75 years of age, residing at home or in nursing homes, malnourished or at risk of malnutrition, and post hip fracture surgery, received HC-HP-HMB-ONS for 12 weeks. Various scales and questionnaires assessed outcomes. RESULTS: During the 12 weeks of follow-up, 82.8% consumed ≥75% of HC-HP-HMB-ONS. By week 12, 62.4% gained or maintained weight (+0.3 kg), 29.2% achieved normal nutritional status (mean MNA score +2.8), and 46.8% improved nutritional status. Biochemical parameters improved significantly. Subjects reported good tolerability (mean score 8.5/10), with 87.1% of healthcare providers concurring. CONCLUSIONS: The administration of HC-HP-HMB-ONS markedly enhanced nutritional status and biochemical parameters in older hip-fracture patients, with high compliance and tolerability. Both patients and healthcare professionals expressed satisfaction with HC-HP-HMB-ONS.

[Recommendations on the use of telemedicine as applied to nutritional pathology]. / Recomendaciones sobre el uso de la telemedicina aplicada a la patología nutricional.

Introduction: Introduction: telemedicine can improve the standards of clinical care and use of resources. The COVID-19 pandemic has required its implementation in routine practice. For this reason, a group of endocrinologists from Valencia, Murcia and the Balearic Islands created a committee for its development. Objectives: to establish recommendations in order to improve the quality of consultation in nutritional disorders, and to create indicators for its management. Methodology: the Delphi methodology was followed with the participation of 13 professionals in order to reach the widest consensus. A 16-item questionnaire was distributed within 3 rounds: in the first round, the degree of consensus was established; in the second round, the participants responded to the posed questions after having access to the first-round results. Agreement was considered if ≥ 75 % participants reached consensus, while strong agreement was considered if consensus was reached by ≥ 90 %. In addition, quality indicators were established. In a third round, these indicators were developed. Results: after 3 rounds and a revision 5 recommendations with strong agreement were established based on organizational aspects. Regarding administrative aspects, 6 recommendations with strong agreement were established while 4 recommendations reached the level of agreement. Eight quality indicators were selected and developed. Conclusions: this document compiles a list of recommendations about needs and requirements to be taken into account for a quality telematic consultation in patients with nutritional disorders. In addition, health care quality indicators have been created and developed.

Introducción: Introducción: la telemedicina puede mejorar la calidad asistencial y el uso de recursos. La pandemia de COVID-19 ha hecho necesaria su implementación en la práctica habitual. Por ello, un grupo de endocrinólogos de la Comunidad Valenciana, Murcia y Baleares creó un comité para su desarrollo. Objetivos: establecer unas recomendaciones para mejorar la calidad de la consulta de patología nutricional y diseñar unos indicadores para su gestión. Metodología: se siguió la metodología Delphi con participación de 13 profesionales con el fin de alcanzar el mayor consenso. Para ello se circuló un cuestionario de 16 puntos en 3 rondas: en la primera se estableció el grado de consenso; en la segunda, los participantes tuvieron acceso a los resultados de la primera y respondieron a las cuestiones planteadas. Se consideró que había acuerdo si el consenso era ≥ 75 % de los participantes, y que existía acuerdo fuerte si este era ≥ 90 %. Además, se estableció la temática de los indicadores de calidad. En la tercera se desarrollaron dichos indicadores. Resultados: tras 3 rondas y una reunión de revisión se establecieron los sobre aspectos organizativos 5 recomendaciones con acuerdo fuerte; sobre los aspectos administrativos, 6 recomendaciones con acuerdo fuerte y 4 con acuerdo. Se seleccionaron 8 indicadores de calidad que se desarrollaron en formato de fichas. Conclusiones: este documento recopila una serie de recomendaciones sobre cuestiones, necesidades y requisitos a tener en cuenta para una consulta telemática de calidad al paciente con patología nutricional. Así mismo, se han desarrollado unos indicadores para mejorar la calidad asistencial.

[Validation of nutritional screening Malnutrition Screening Tool compared to other screening tools and the nutritional assessment in different social and health areas]. / Validación del cribado nutricional Malnutrition Screening Tool comparado con la valoración nutricional completa y otros cribados en distintos ámbitos sociosanitarios.

INTRODUCTION: nutritional screenings are used to detect nutritional risk, allow early intervention and influence the prognosis. The Malnutrition Screening Tool (MST) is only validated in hospitalized patients and oncology outpatients. OBJECTIVES: to analyze the nutritional screening MST, Malnutrition Universal Screening Tool (MUST) and Mini Nutritional Assessment-Short Form (MNA-sf) compared to the nutritional assessment gold standard according to socio-sanitary areas and age groups; and to assess the utility of the MST in those areas where it has not been validated. MATERIAL AND METHODS: a total of 815 outpatient, hospitalized and institutionalized subjects were included in this study. MUST and MST screenings, and nutritional assessment were performed in all subjects. MNA-sf was also performed in subjects ≥ 65 years of age. Nutritional diagnosis was performed according to the SENPE-SEDOM consensus. RESULTS: in the outpatient cohort, three screenings have a validity (AUC ROC) greater than 0.8 compared to nutritional assessment. In the institutionalized, the MNA-sf generates false positives and the MUST is more valid than MST (AUC ROC = 0.815 and 0.763, respectively). In hospitalized patients, there are excellent results with MUST and MST. In all socio-sanitary areas the MST obtains a better positive predictive value. By age groups, MUST and MST are valid tools. CONCLUSIONS: in our study, the MST correctly diagnoses more than 80% of the patients (S = 69.4%, E = 94.2%), and has a good reliability and validity with respect to nutritional assessment not only in hospitalized patients and oncology outpatients, where it has already been validated. In our population, the MST was found to be valid in outpatient, institutionalized and hospitalized subjects.

Validity, efficacy and reliability of 3 nutritional screening tools regarding the nutritional assessment in different social and health areas. / Validez, comportamiento y concordancia de 3 herramientas de cribado nutricional respecto a la valoración nutricional completa en distintos ámbitos sociosanitarios.

INTRODUCTION AND OBJECTIVE: Nutritional screening allows for the detection of nutritional risk. Validated tools should be implemented, and their usefulness should be contrasted with a gold standard. The aim of this study is to discover the validity, efficacy and reliability of 3 nutritional screening tools in relation to complete nutritional assessment. MATERIAL AND METHODOLOGY: A sub-analysis of a cross-sectional and descriptive study on the prevalence of disease-related malnutrition. The sample was selected from outpatients, hospitalized and institutionalized patients. MUST, MNAsf and MST screening were employed. A nutritional assessment of all the patients was undertaken. The SENPE-SEDOM consensus was used for the diagnosis. RESULTS: In the outpatients, both MUST and MNAsf have a similar validity in relation to the nutritional assessment (AUC 0.871 and 0.883, respectively). In the institutionalized patients, the MUST screening method is the one that shows the greatest validity (AUC 0.815), whereas in the hospitalized patients, the most valid methods are both MUST and MST (AUC 0.868 and 0.853, respectively). CONCLUSIONS: It is essential to use nutritional screening to invest the available resources wisely. Based on our results, MUST is the most suitable screening method in hospitalized and institutionalized patients.

[Prevalence of nutritional risk and malnutrition established in outpatient, institutionalized and hospitalized populations in a health department]. / Prevalencia de riesgo de desnutrición y desnutrición establecida en población ambulatoria, institucionalizada y hospitalizada en un departamento de salud.

INTRODUCTION: The prevalence of disease-related malnutrition depends on the population studied and the methods used for screening, for nutritional assessment and the diagnostic criteria employed. OBJECTIVES: To determine the prevalence of nutritional risk and malnutrition, and the type and degree of malnutrition in outpatient, hospitalized and institutionalized populations in a health department. MATERIAL AND METHODS: Cross-sectional and descriptive study with a randomly selected sample. Malnutrition Universal Screening Tool (MUST) was performed as a screening test to assess nutritional risk, and a complete nutritional assessment was carried out according to the American Society for Parenteral and Enteral Nutrition (ASPEN) criteria. The type and degree of malnutrition was determined according to the SENPE-SEDOM consensus criteria. RESULTS: MUST revealed a prevalence of nutritional risk of 28% (215) (outpatients n = 106: 15.1% [16]; institutionalized patients n = 375: 31.2% [117]; hospitalized patients n = 285: 28.8% [82]). The overall prevalence of disease-related malnutrition was 26.4% (202) (outpatients n = 106: 2.8% [3]; institutionalized patients n = 375: 30.13% [113]; hospitalized patients n = 285: 30.2% [86]). Prevalence was highest amongst patients older than 75 years (74.3%). Malnutrition of a caloric type and a mild degree was the most common in the whole sample (18% and 12.9%, respectively). CONCLUSIONS: One in four patients in the analyzed sample is malnourished. Disease-related malnutrition is especially prevalent in inpatients and in the elderly, affecting one in three patients. In light of this prevalence, it is essential to put in place nutritional screening procedures associated with therapeutic action plans.

INTRODUCCIÓN: la prevalencia de desnutrición relacionada con la enfermedad (DRE) varía según la población estudiada y los métodos empleados para el cribado, para la valoración nutricional y los criterios diagnósticos. OBJETIVOS: determinar la prevalencia de riesgo nutricional y de desnutrición establecida, tipo y grado de la misma en población ambulatoria, hospitalizada e institucionalizada, en un departamento de salud. Material y métodos: estudio transversal y descriptivo con selección aleatoria de la muestra. A la población reclutada se le realizó el Malnutrition Universal Screening Tool (MUST) como cribado para evaluar el riesgo nutricional y una valoración nutricional completa según los criterios de la American Society for Parenteral and Enteral Nutrition (ASPEN). El tipo y grado de desnutrición se estableció interpretando los criterios del consenso SENPE-SEDOM. RESULTADOS: la prevalencia de riesgo nutricional encontrada con el MUST es del 28% (215) (ambulatorios n = 106: 15,1% [16]; institucionalizados n = 375: 31,2% [117]; hospitalizados n = 285: 28,8% [82]). La prevalencia global de DRE encontrada es del 26,4% (202) (ambulatorios n = 106: 2,8% [3]; institucionalizados n = 375: 30,13% [113]; hospitalizados n = 285: 30,2% [86]). La mayor prevalencia de DRE se da en pacientes mayores de 75 años (74,3%). La desnutrición de tipo calórico y grado leve es la más frecuente en nuestra muestra (18% y 12,9%, respectivamente). CONCLUSIONES: uno de cada cuatro pacientes de la muestra estudiada está desnutrido. La DRE es especialmente prevalente en el medio hospitalario y en los ancianos afecta a uno de cada tres pacientes. Dada la prevalencia de desnutrición encontrada, es imprescindible la implementación sistemática de cribados nutricionales asociados a planes de acción terapéuticos.