Impact of nutritional and educational support on home enteral nutrition.

BACKGROUND: Home Enteral Nutrition (HEN) is used to prevent or correct malnutrition in outpatients. Due to the complexity of this process, the indication, follow-up, and results of an educational program of HEN patients was evaluated. METHODS: A prospective, observational, real-life, multicenter study was performed in 21 Spanish Hospital. Patients receiving HEN by nasogastric tube or ostomy were included. The following variables were collected: age, gender, HEN indication, type of formula, nutritional requirements, laboratory variables, complications, and quality standards of the educational program. To calculate the energy and protein requirements, the FAO/WHO/UNU formula was used considering the adjusted weight of the patients. All data were analyzed using SPSS.24. RESULTS: 414 patients were included. Most conditions diagnosed were neurodegenerative diseases (64.8%). 100 (25.3%) were diabetic. The mean weight was 59.3 ± 10.4 kg and BMI 22.6 ± 3.2. Moderate protein-calorie malnutrition was predominant at baseline (46.4%). Improvement in nutritional status at six months was recorded in more than 75% of patients (p < 0.05). Tolerance problems, diarrhea and abdominal distension fell between the 3- and 6-month visits (p < 0.05). Patients who received intermittent EN had fewer tolerance-related effects (OR 0.042; 95% CI 0.006-0.279) and less diarrhoea (OR 0.042; 95% CI 0.006-0.279). At the baseline and 6-month visits, compliance with the educational measures proposed by the prescriber was ≥ 99%. CONCLUSION: The nutritional assessment to prescribe individualized HEN to each patient, together with educational measures and training in the proper use of this treatment for both patients and trainers, improves nutritional status and reduces the onset of adverse events.

[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.

[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.