[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.

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.

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.

[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.

[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.

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 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.

[Study of death with secondary diagnosis of malnutrition in a third level hospital]. / Estudio de los exitus con diagnóstico secundario de desnutrición en un hospital de tercer nivel.

BACKGROUND: Malnutrition is a major public health problems, according to WHO, is the leading cause of death, when it affects the group of hospitalized patients, making denominating separate entity "hospital malnutrition". OBJECTIVES: The overall objective is to quantify the main diagnoses frequently high, causing exitus, with secondary diagnosis of malnutrition. METHODS: This is a descriptive study, which included all hospital discharges in 2011 and first half of 2012, which have been exitus and whose secondary diagnosis of malnutrition, with the total of 33. We performed a descriptive analysis, effected the Mann-Whitney nonparametric test (p < 0.05). RESULTS: The most frequent main diagnoses among 33 analyzed are high sepsis (12.1%), liver metastases (9.1%), pneumonia (6.1%), acute respiratory failure (6.1%) and renal acute renal (6.1%). CONCLUSIONS: Although the most frequent primary diagnosis of sepsis, by grouping the diagnoses, the most frequent DRG is respiratory disease, so it has to make comprehensive and quality coding to adjust the relative weight of the same reality. It is essential to specify the source of clinical information used for coding, the degree of malnutrition, for greater specificity in the data.

Introducción: La desnutrición constituye uno de los principales problemas de Salud Pública, según datos de la OMS, es la primera causa de mortalidad, cuando la misma afecta al colectivo de los sujetos hospitalizados, toma entidad propia denominándose "desnutrición hospitalaria". Objetivos: El objetivo general es cuantificar los diagnósticos principales de alta más frecuentes, que causan exitus, con el diagnóstico secundario de desnutrición. Métodos: Se trata de un estudio transversal y descriptivo, en el que se han incluido todas las altas hospitalarias del año 2011 y primer semestre de 2012, que han sido exitus y que tienen como diagnóstico secundario la desnutrición, siendo el total de 33. Se ha realizado un análisis estadístico descriptivo, efectuándose el test de Mann-Whitney para pruebas no paramétricas (p < 0,05). Resultados: Los diagnósticos principales más frecuentes entre las 33 altas analizadas son la sepsis (12,1%), metástasis hepáticas (9,1%), neumonía (6,1%), insuficiencia respiratoria aguda (6,1%) e insuficiencia renal aguda (6,1%). Conclusiones: Aunque el diagnóstico principal más frecuente es la sepsis, al agrupar los diagnósticos, el GRD más frecuente es de patología respiratoria, por lo que se ha de hacer codificación exhaustiva y de calidad para ajustar el peso relativo de los mismos a la realidad. Es fundamental especificar en la fuente de información clínica utilizada para la codificación, el grado de desnutrición, para obtener mayor especificidad en los datos.

[Endocarditis caused by Trichoderma longibrachiatumin a patient receiving home parenteral nutrition]. / Endocarditis por Trichoderma longibrachiatum en paciente con nutrición parenteral domiciliaria.

Home parenteral nutrition (HPN) improves the quality of life of the patients although it has complications. Catheter-related infections and mechanical complications are the most frequent ones. We report the case of endocarditis over catheter in a man suffering from short bowel and receiving HPN. The special features of the case are firstly the catheter was a remaining fragment on the right atrial and secondly the infection was caused by Trichoderma longibrachiatum, an isolated fact regarding this pathology so far. Conventional surgery was applied to take the catheter out. Staphylococcus epidermidis, Ochrobactrum anthropi and Trichoderma longibrachiatum were isolated from the surgical specimen. The extraction of the infected catheter along with antibiotic therapy led to the complete recovery of the subject. Ochrobactrum anthropi and Trichoderma longibrachiatum are unusual microorganisms but they are acquiring more relevance. Although there is no agreement about intravascular retained catheter management, the most recommended approach consists on monitoring them and removing the device in case of complications.

La modalidad domiciliaria de la nutrición parenteral (NPD) mejora la calidad de vida de los pacientes, pero tiene complicaciones como infecciones asociadas a catéter (IAC) y complicaciones mecánicas. Presentamos el caso de un paciente con NPD por intestino corto que desarrolla una endocarditis sobre catéter con matices especiales: asentar sobre un catéter abandonado en aurícula derecha y tratarse de una infección con participación de un microorganismo no descrito hasta el momento en esta patología, Trichoderma longibrachiatum. El catéter se extrajo mediante cirugía convencional. En la pieza quirúrgica se aislaron Staphylococcus epidermidis, Ochrobactrum anthropi y Trichoderma longibrachiatum. Combinando el tratamiento antibiótico y la eliminación del foco infeccioso se consiguió la recuperación completa. Ochrobactrum anthropi y Trichoderma longibrachiatum son microorganismos poco habituales, pero que cada vez adquieren mayor relevancia. Aunque no existe acuerdo en el manejo de los catéteres intravasculares "abandonados", es recomendable el seguimiento y eliminarlos en caso de complicación.

Implementation of a nutrition education program in a handball team; consequences on nutritional status.

OBJECTIVE: To evaluate nutritional status and dietary habits after implementation of a nutritional education program in professional handball players. RESEARCH METHODS AND PROCEDURES: Longitudinal study of 14 handball players evaluated with 72-h recall, a questionnaire on food consumption and anthropometric measures during 4 months. The intervention consisted of a nutrition education program. RESULTS: Energy intake was consistently below the recommended allowances. Macronutrient intakes as a percentage of total energy intake were below the recommended allowances for carbohydrates, and above recommended allowances for fats. Nutritional education was followed by a significant increase (p < 0.01) in total energy and macronutrient intakes, with no significant changes in macronutrient or micronutrient intakes after adjustment for energy intake. DISCUSSION: The imbalance in nutrient intake in handball players suggests that detailed re-analysis is needed to determine specific recommendations for this population. Nutritional education with continuous follow-up to monitor athletes' dietary habits may lead them to adopt appropriate nutritional habits to optimize dietary intakes. The lack of specific recommendations for micronutrient intakes in athletes leads to confusion regarding appropriate intakes; biochemical tests that yield normal values (albeit approaching cut-off values for deficiency) may disguise deficient status for some nutrients when strenuous exercise is involved. CONCLUSION: In-depth studies with nutrition education programs that include long-term follow-up are advisable to avoid deficiencies that can lead to irreversible damage in competitive athletes.

Objetivos: Evaluar el estado nutricional y los hábitos dietéticos en respuesta a la aplicación de un programa de educación nutricional en jugadores profesionales de balonmano. Sujetos y metodología: Estudio longitudinal realizado a una muestra de 14 jugadores pertenecientes a un equipo de balonmano de alto rendimiento, a los que se les evaluó mediante recordatorio de 72 horas, un cuestionario de frecuencia de consumo, medidas antropométricas a lo largo de 4 meses, y a los que se les aplicó un programa de educación nutricional al inicio del estudio. Los valores de ingesta y de frecuencia de consumo fueron comparados con las recomendaciones de macronutrientes existentes para deportistas y micronutrientes para población sana, respectivamente, y con la pirámide de alimentos para población sana española. Resultados: La ingesta de energía de los deportistas se situó por debajo de las recomendaciones a lo largo de todo el estudio. La ingesta de macronutrientes respecto a la energía ingerida, se situó por debajo de las recomendaciones para la ingesta de carbohidratos y por encima de las recomendaciones para la ingesta de grasa, mostrada en los resultados obtenidos de frecuencia de consumo de alimentos. La educación nutricional produjo un incremento significativo (p < 0,01) en la ingesta de energía y macronutrientes tras su aplicación. A pesar de ello, no se produjeron cambios significativos en la ingesta de macronutrientes y micronutrientes al ajustar por energía ingerida. Los niveles bioquímicos se encontraron dentro de los rangos de normalidad durante todo el estudio. Discusión: El desequilibrio en la ingesta de nutrientes presente en los jugadores de balonmano hace necesario realizar un ajuste nutricional completo para poder establecer recomendaciones específicas para este tipo de población. La aplicación de un programa de educación nutricional monitorizada de manera continuada mediante seguimiento en los deportistas, puede tener como consecuencia la instauración de hábitos nutricionales adecuados que lleve a una optimización en la ingesta. La ausencia de recomendaciones específicas de micronutrientes en el deporte, provoca una cierta confusión a la hora de establecer una ingesta adecuada de micronutrientes, ya que en muchos casos demuestran normalidad en los niveles bioquímicos, aunque muy cercanos a la deficiencia, pudiendo comprometer el estatus de algún nutriente en situaciones de ejercicio extremo. Conclusión: Sería aconsejable realizar estudios exhaustivos de valoración del estatus nutricional que planteen la instauración de programas de educación nutricional a largo plazo, con el fin de evitar carencias que deriven en daños irreversibles en el deportista de competición.

Postprandial glucose, insulin and gastrointestinal hormones in healthy and diabetic subjects fed a fructose-free and resistant starch type IV-enriched enteral formula.

BACKGROUND: Reducing the dietary glycaemic response has been proposed as a means of reducing the risk of diabetes. AIM: To evaluate the effects of a new diabetes-specific formula (DSF) enriched with resistant starch type IV and fructose-free on postprandial glycaemia, insulinaemia and gastrointestinal hormones in healthy volunteers and in outpatient type 2 diabetics. METHODS: (1) Twenty-four healthy volunteers were divided into two groups: Group 1 ( n = 10) was provided 50 g of the carbohydrate (CHO) constituent of the new product and 50 g of glucose separated by 1 week; Group 2 ( n = 14) was provided 400 ml of the new DSF (T-Diet Plus(®) Diabet NP) and 400 ml of a control product separated by 1 week. (2) Ten type 2 diabetic patients received 400 ml of the new DSF and two other commercially available DSF (Glucerna(®) SR and Novasource(®) Diabet) on three occasions separated by 1 week. Venous blood samples were drawn at time 0 and at different times until 120 min. Glucose, insulin and gastrointestinal hormones were determined. Glycaemic and insulinaemic indices and glycaemic load were calculated. RESULTS: The CHO constituent and the new DSF showed low glycaemic index and glycaemic load. In healthy subjects, insulin and C-peptide release were lower after administration of the CHO constituent as well as after the new DSF (P < 0.001). Ghrelin, glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic peptide (GIP) production were lower after intake of the CHO constituent (P ranging from <0.001 to 0.019) compared with glucose, and GIP was lower after ingestion of the new DSF (P = 0.002) than after the control product. In type 2 diabetic patients, glucose AUC was lower after the administration of the new DSF (P = 0.037) compared with the others. CONCLUSIONS: Our results indicate that this new product could be beneficial for diabetic patients.

[Hospital malnutrition: relation between the hospital length of stay and the rate of early readmissions]. / Desnutrición hospitalaria: relación con la estancia media y la tasa de reingresos prematuros.

BACKGROUND AND OBJECTIVE: In hospitalized patients, malnutrition ranges between 30% and 55% and is associated with a higher rate of complications, prolonged hospitalization and increased cost of health services. Despite this, there is no awareness of the clinical and economic implications involving hospital malnutrition and its treatment. We analyzed the relationship between hospital malnutrition, average length of stay and early readmissions. MATERIAL AND METHODS: It is a prospective and dynamic cohort study, in which patients were observed from the time of their admission and throughout their hospitalization on a weekly basis. The selection was carried out using a systematic random method. Patients were all older than 18 and admitted to the services with an average stay 5 days. It was decided that a patient had malnutrition when some anthropometric (biceps circumference, tricipital, abdominal and subscapular skinfold thickness) or biochemical (albumin, prealbumin, and transferrin) parameter was below normal values. Early readmission was defined as a patient's return to hospital in a period < 31 days from the last date of discharge. Hospital entries were classified in relation to the average stay (hospital and services) and we analyzed the stays below and the stays above the average expected. Results have been expressed in average and standard deviation (X +/- SD) and frequency (%). Intergroup comparisons by Student's t test and chi(2), remain significant to P < .05. The risk and confidence intervals (CI) were applied to malnourished cohorts, with a significance level of 95%. RESULTS: The study included 817 patients (50.9 +/- 18.5 years), 62.9% men and 37.1% women. 45.9% (n = 375) of patients were malnourished, and malnutrition was most common in those with digestive diseases (22.5%), neoplasm (20.8%), circulatory (16.5%) and respiratory pathologies (11.6%). The average stay (hospital and services) and the premature readmission rate were higher in patients admitted to hospital with malnutrition. CONCLUSIONS: Nearly half of the patients presented some degree of malnutrition when they were admitted, increasing hospital stay and premature readmission rate. The high prevalence and incidence of malnutrition requires suggestions to develop mechanisms to determine its real scope and programs to solve it.

Glycemic and lipid control in hospitalized type 2 diabetic patients: evaluation of 2 enteral nutrition formulas (low carbohydrate-high monounsaturated fat vs high carbohydrate).

BACKGROUND: Type 2 diabetic patients may need enteral nutrition support as part of their treatment. The objective was to compare glycemic and lipid control in hospitalized patients with type 2 diabetes requiring feeding via nasogastric tube using enteral feedings with either a highcarbohydrate or a high-monounsaturated-fat content. METHODS: This trial included type 2 diabetes patients admitted to the hospital for neurologic disorders or head and neck cancer surgery who received either a low-carbohydrate-high-mono-unsaturated-fat (Glucerna) or a high-carbohydrate diet (Precitene Diabet). Glycemic and lipid control was determined weekly. Safety and gastrointestinal tolerance were also assessed. RESULTS: A total of 104 patients were randomized and 63 were evaluable according to preestablished protocol criteria. Median duration of therapy was 13 days in both groups. Mean glucose was significantly increased at 7 days of treatment (p = .006) in the Precitene arm, with no significant variations in the Glucerna arm. Mean weekly blood triglycerides levels in the Precitene arm were increased without reaching statistical significance, whereas patients in the Glucerna arm showed a stable trend. Patients in the Precitene arm showed a significantly higher incidence of diarrhea than patients in Glucerna arm (p = .008), whereas the incidence of nausea was smaller in the Precitene arm than in the Glucerna arm (p = .03). CONCLUSIONS: An enteral formula with lower carbohydrate and higher monounsaturated fat (Glucerna) has a neutral effect on glycemic control and lipid metabolism in type 2 diabetic patients compared with a high-carbohydrate and a lower-fat formula (Precitene Diabet).