Nutritional support and parenteral nutrition in cancer patients: an expert consensus report.

BACKGROUND: Malnutrition is a frequent medical problem of cancer patients that negatively impacts their quality of life. METHODS: A multidisciplinary group of experts in Medical Oncology, Pharmacy, and Nutrition convened to discuss the management of the nutritional support in cancer patients. RESULTS: Of the 18 questions addressed, 9 focused on nutritional support, 5 were related to parenteral nutrition (PN) and 4 about home PN (HPN). The panel of experts recommends using nutritional screening routinely, at diagnosis and throughout the disease course, for detecting the risk of malnutrition and, if it is positive, to perform a complete nutritional assessment, to diagnose malnutrition. Currently, there are different screening tools and methods that allow us to detect nutritional risk. Based on the evidence and experience, the panel stated that PN is indicated mainly when it is not possible to use the digestive tract and/or oral feeding and/or enteral nutrition is not sufficient or possible. The nutritional needs of the cancer patients, except in those cases where individualized measures are required, should be considered similar to healthy individuals (25-30 kcal/kg/day). The panel considers that the nutritional monitoring of the cancer patient should be multidisciplinary and adapted to the characteristics of each center. Additionally, the objective of the HPN is to improve or maintain the nutritional status of a patient at home. CONCLUSIONS: This document seeks to lay down a set of recommendations and to identify key issues that may be useful for the nutritional management of cancer patients.

[Satisfaction with weight and characteristics of eating disorders in high school]. / Satisfacción con el peso y rasgos de trastorno del comportamiento alimentario en secundaria.

INTRODUCTION: The prevalence of diseases related to eating behaviour disorders has increased among adolescents. The objective of this study is to analyse the satisfaction with body weight of schoolchildren as regards their body mass index and the strategies used to control the diet. METHOD: A total of 1197 students from secondary education (12-18 years) answered a questionnaire on eating habits and body weight control. Their weight and height was measured and body mass index was calculated. RESULTS: More than two-thirds (68.1%) of students who had an adequate BMI were satisfied with their weight. Greater dissatisfaction with the weight is associated with overweight (OR=10.23) and obesity (OR=16.60). Students with overweight are on a diet consulting an expert such as a physician or even the family, whereas among schoolchildren with normal weight there is a large percentage on a diet on their own. A 13.87% of the schoolchildren have been undertaken Compensatory activities before excessive eating has been undertaken by 13.87% of the schoolchildren. An overweight BMI is associated, with more than twice the risk (OR>2.00), with the use of measures such as physical activity, vomiting, or fasting to compensate an excessive intake. CONCLUSIONS: Overweight and obese schoolchildren are more likely to be dissatisfied with their body, and are more likely to use ploys such as vomiting, in order to compensate for the excess intake.

[Efficacy, cost-effectiveness, and effects on quality of life of nutritional supplementation]. / Eficacia, coste-efectividad y efectos sobre la calidad de vida de la suplementación nutricional.

This article summarizes the main results and conclusions presented in the Symposium "Nutritional supplementation: evidences and experiences" that took place in the XXIIIrd SENPE Congress (2008). Protein energy malnutrition, that can affect 30-50% of hospitalized patients, increases both time of hospitalization and costs of medical care of this kind of patients. There is a lot of scientific evidences demonstrating that the use of nutritional supplementation improves nutritional status or prevents malnutrition in those patients who do not meet their nutritional needs with a conventional diet or an adapted one with no replacing intake from normal food. This is strengthened by the results that demonstrate the rol of nutritional supplements improving nutritional and functional parameters. Current bibliographic reviews focused on certain clinical frameworks (i.g. geriatrics, oncology), prove that nutritional supplements reduce complications related to pathology and to nutritional status, and also reduce length of hospitalization and mortality. More studies regarding to efficacy of oral nutritional supplements are needed. These studies should be carried out with a period of follow-up longer than the current published studies have. As well as effective, nutritional supplements become a save therapeutic intervention with no important adverse events that, according to bibliography, improve patient's functionality and quality of life. It is worth mentioning that nutritional supplements can be effective on certain kind of patients, for instance, malnourished elderly or elderly in risk of malnourishment, and hospitalized surgical patients. Scientific literature refers that it is necessary to carry out more studies, with an accurate methodology, which assess the effect of nutritional supplements on quality of life and its cost-effectiveness on malnourished patients regarding specific clinical situations. That would allow physicians to make clinical decisions based on evidences and cost analysis.

[National registry of home enteral nutrition in Spain 2007]. / Registro de Nutrición Enteral Domiciliaria en España en el año 2007.

OBJECTIVE: To communicate the results from the registry of Home-Based Enteral Nutrition of the NADYASENPE group in 2007. MATERIAL AND METHODS: We included every patient in the registry with home enteral nutrition any time from January 1st to December 31st of 2007. RESULTS: The number of patients with home enteral nutrition in 2007 was 5,107 (52% male) from 28 different hospitals. 95.4% of them were 15 yr or older, with a mean age of 67.96 +/- 18.12, and 4.2 +/- 3.38 among patients aged 14 yr or less. The most common underlying diseases were neurological (37.8%) and neoplastic diseases (29.3%). Enteral nutrition was administered p.o. in most patients (63.5%), followed by nasogastric tube (25.9%), while gastrostomy was only used in 9.2%. The mean time in enteral nutrition support was 9.4 months and the most common reasons for withdrawal were death (58.7%) and switching to oral intake (32%). Activity was limited in 31.4% of patients and 36.01% were house-bound. Most patients needed partial (26.51%) or total (37.68%) care assistance. Enteral formula was provided by hospitals to 69.14% of patients and by pharmacies to 30.17% of them, while disposable material was provided by hospitals to 81.63% and by Primary Care to the remaining patients. CONCLUSIONS: In 2007, there has been an increase of more than 30% of patients registered with home enteral nutrition comparing with 2006, without any big difference in other data, but a higher proportion of patients with enteral nutrition p.o.

[Value of nutritional support in patients with pharingocutaneous fistula]. / Utilidad del soporte nutricional en pacientes con fistula faringocutánea.

INTRODUCTION: A prospective and statistic study is presented to evaluate the efficacy of nutritional support in the postoperative care of patients with pharyngocutaneous fistula after laryngectomy. PATIENTS AND METHODS: All patients who developed pharyngocutaneous fistula after total o partial laryngectomy between 2001 and 2004 were included and assigned to the study group if a supplementary and enteral nutrition was started through the nasogastric tube, and to the control group if a conventional liquid diet was given. Nutrition of patients in the study group was controlled by an Endocrinologist. RESULTS: 32 patients were included (14 in the study group and 18 in the control group). Both groups were similar for all variables measured except for the length of hospital stay (mean difference 31.02 days) and the need for surgical closure (33% in the control group and 0% in the study group). These differences were found statistically significant. DISCUSSION AND CONCLUSIONS: Postoperative supplementary enteral nutrition controlled by the Endocrinologist reduced the need for surgical treatment of pharyngocutaneous fistula and shortened the stay in hospital of these patients. More studies are needed to prove the efficacy of preoperative nutrition in reducing the incidence of fistula after laryngectomy.

[99m-Tc sestamibi scintigraphy in primary hyperparathyroidism. Importance of lateral projections using a pin-hole collimator]. / Gammagrafía con sestamibi-Tc99m en el hiperparatiroidismo primario. Importancia de las proyecciones laterales con colimador pin-hole.

UNLABELLED: 99mTc-Sestamibi double-phase scintigraphy has been improved with digital and tomographic procedures as well as additional projections. Since two years ago, we have introduced additional early lateral views of neck to the conventional double-phase scintigraphy. We have tried to give anatomic data about the depth of the adenomas and to evaluate the possibility of obviating the late images of the double-phase study. METHOD: Two observers reviewed 50 studies performed for primary hyperparathyroidism in two different ways. The first one reviewed only conventional double-phase studies and the second one, with the additional report of the lateral views. RESULTS: in 32/50 patients (64 %) the report of the additional lateral views and the conventional early views was enough to diagnose parathyroid adenomas. No additional lesions were observed in the late views. These views did not provide any additional useful data and could have been obviated. Four ectopic adenomas were found, 1 mediastinal and 3 in paraesophagic area; three intrathyroidal focus; all of these atypical lesions were identified by lateral pinhole views. CONCLUSION: The performance of additional lateral projections of the parathyroids supplies additional information to the surgeon on the depth of the lesion in atypical sites and would have made it possible to obviate the late phase in more than half of the patients since this did not supply additional information to that of the early images that had reached a diagnosis.