Efficacy and Safety of Habitual Consumption of a Food Supplement Containing Miraculin in Malnourished Cancer Patients: The CLINMIR Pilot Study.

Taste disorders (TDs) are common among systemically treated cancer patients and negatively impact their nutritional status and quality of life. The novel food approved by the European Commission (EFSA), dried miracle berries (DMB), contains the natural taste-modifying protein miraculin. DMB, also available as a supplement, has emerged as a possible alternative treatment for TDs. The present study aimed to evaluate the efficacy and safety of habitual DMB consumption in malnourished cancer patients undergoing active treatment. An exploratory clinical trial was carried out in which 31 cancer patients were randomized into three arms [standard dose of DMB (150 mg DMB/tablet), high dose of DMB (300 mg DMB/tablet) or placebo (300 mg freeze-dried strawberry)] for three months. Patients consumed a DMB tablet or placebo daily before each main meal (breakfast, lunch, and dinner). Throughout the five main visits, electrochemical taste perception, nutritional status, dietary intake, quality of life and the fatty acid profile of erythrocytes were evaluated. Patients consuming a standard dose of DMB exhibited improved taste acuity over time (% change right/left side: -52.8 ± 38.5/-58.7 ± 69.2%) and salty taste perception (2.29 ± 1.25 vs. high dose: 2.17 ± 1.84 vs. placebo: 1.57 ± 1.51 points, p < 0.05). They also had higher energy intake (p = 0.075) and covered better energy expenditure (107 ± 19%). The quality of life evaluated by symptom scales improved in patients receiving the standard dose of DMB (constipation, p = 0.048). The levels of arachidonic (13.1 ± 1.8; 14.0 ± 2.8, 12.0 ± 2.0%; p = 0.004) and docosahexaenoic (4.4 ± 1.7; 4.1 ± 1.0; 3.9 ± 1.6%; p = 0.014) acids in erythrocytes increased over time after DMB intake. The standard dose of DMB increased fat-free mass vs. placebo (47.4 ± 9.3 vs. 44.1 ± 4.7 kg, p = 0.007). Importantly, habitual patients with DMB did not experience any adverse events, and metabolic parameters remained stable and within normal ranges. In conclusion, habitual consumption of a standard 150 mg dose of DMB improves electrochemical food perception, nutritional status (energy intake, fat quantity and quality, fat-free mass), and quality of life in malnourished cancer patients receiving antineoplastic treatment. Additionally, DMB consumption appears to be safe, with no changes in major biochemical parameters associated with health status. Clinical trial registered (NCT05486260).

Dietitian-nutritionist incorporation in a university hospital: position statement of the Commission on Nutrition, Hospital Universitario La Paz.

Introduction: The present document has the objective of justifying the incorporation of a dietician/nutritionist to the multidisciplinary teams of specialized care that provide education, food anamnesis, nutritional recommendations, treatment and follow up of those patients in risk of malnutrition in Madrid. The appropriate nutritional status of hospitalized patients bears a close relationship with the existence of dieticians at hospitals. Dieticians use nutrition therapy as a cost-effective means to achieve significant health benefits by preventing or altering the course of diabetes, obesity, hypertension, lipid metabolism disorders, heart failure, osteoporosis, celiac disease, and chronic kidney disease, among other diseases.

Introducción: El presente documento tiene como objetivo plantear y justificar la incorporación del dietista-nutricionista en los equipos multidisciplinares de atención integrada en la educación, el tratamiento y el seguimiento de aquellos pacientes con patologías que cursen con alteraciones del estado nutricional, tanto en su defecto como en su exceso, en el área sanitaria de la Comunidad Autónoma de Madrid. El estado nutricional de los pacientes hospitalizados se beneficiará de la incorporación del dietista-nutricionista al equipo multidisciplinar que, actualmente, se ocupa de la atención de estos. El manejo de la terapia nutricional por dietistas-nutricionistas ha demostrado ser costo-efectiva, habida cuenta de la repercusión sanitaria que tiene el estado nutricional en la evolución clínica y prevención de enfermedades como la diabetes, los trastornos de la conducta alimentaria, la obesidad, el cáncer, la insuficiencia cardiaca, la osteoporosis, la enfermedad celiaca y la enfermedad renal crónica, entre otras.

Effect of Regular Consumption of a Miraculin-Based Food Supplement on Taste Perception and Nutritional Status in Malnourished Cancer Patients: A Triple-Blind, Randomized, Placebo-Controlled Clinical Trial-CLINMIR Pilot Protocol.

Taste disorders are common among cancer patients undergoing chemotherapy, with a prevalence ranging from 20% to 86%, persisting throughout treatment. This condition leads to reduced food consumption, increasing the risk of malnutrition. Malnutrition is associated not only with worse treatment efficacy and poor disease prognosis but also with reduced functional status and quality of life. The fruit of Synsepalum dulcificum (Daniell), commonly known as miracle berry or miracle fruit, contains miraculin, a taste-modifying protein with profound effects on taste perception. The CLINMIR Protocol is a triple-blind, randomized, placebo-controlled clinical trial designed to evaluate the regular consumption of a food supplement containing a miraculin-based novel food, dried miracle berry (DMB), on the taste perception (measured through electrogustometry) and nutritional status (evaluated through the GLIM Criteria) of malnourished cancer patients under active antineoplastic treatment. To this end, a pilot study was designed with 30 randomized patients divided into three study arms (150 mg DMB + 150 mg freeze-dried strawberries, 300 mg DMB, or placebo) for three months. Throughout the five main visits, an exhaustive assessment of different parameters susceptible to improvement through regular consumption of the miraculin-based food supplement will be conducted, including electrical and chemical taste perception, smell perception, nutritional and morphofunctional assessment, diet, quality of life, the fatty acid profile of erythrocytes, levels of inflammatory and cancer-associated cytokines, oxidative stress, antioxidant defense system, plasma metabolomics, and saliva and stool microbiota. The primary anticipated result is that malnourished cancer patients with taste distortion who consume the miraculin-based food supplement will report an improvement in food taste perception. This improvement translates into increased food intake, thereby ameliorating their nutritional status and mitigating associated risks. Additionally, the study aims to pinpoint the optimal dosage that provides maximal benefits. The protocol adheres to the SPIRIT 2013 Statement, which provides evidence-based recommendations and is widely endorsed as an international standard for trial protocols. The clinical trial protocol has been registered at the platform for Clinical Trials (NCT05486260).

[Evaluation of the organoleptic characteristics of an oral nutritional supplement designed specifically for the cancer patient]. / Evaluación de las características organolépticas de un suplemento nutricional oral diseñado específicamente para el paciente oncológico.

Introduction: Introduction: oral nutritional supplements (ONS) are nutritional therapies used to treat malnutrition in cancer patients, therefore, innovation in these treatments, from nutrients to sensory quality, is essential to ensure their consumption. Objectives: to evaluate the organoleptic characteristic of different prototypes of oral nutritional supplements specifically designed for cancer patients. Method: cross-sectional, randomized, double-blind pilot clinical study in patients with any type of cancer, with or without oncological treatment, who tasted five ONS prototypes with different flavors (brownie, tropical, pineapple, tomato and ham) and different sensory qualities in order to evaluate their organoleptic characteristics (color, smell, taste, residual taste, texture and density) through a specific questionnaire. Results: thirty patients aged 67.5 ± 11.2 years and body mass index (BMI) of 22.3 ± 3.52 kg/m2 were evaluated. The most prevalent tumors were head and neck (30 %), pancreas (20 %) and colon (17 %); 65 % of the patients had lost ≥ 10 % of their body weight in six months. The best rated supplements by the cancer population were those with brownie flavor (23.67 ± 3.91 points) and tropical (20.33 ± 3.37 points), while the least valued were tomato (16.33 ± 5.44 points) and ham flavor (13.97 ± 4.64 points). Conclusions: cancer patients value the organoleptic characteristics of ONS with sweet flavors, such as brownie, and fruity flavors, such as tropical, much more positively. Less appreciated by these patients are those with a salty taste, such as ham and tomato flavor.

Introducción: Introducción: los suplementos nutricionales orales (SNO) son una de las terapias nutricionales más utilizadas para tratar la desnutrición en los pacientes oncológicos. Por ello, es de gran importancia contar con la innovación en estos tratamientos, desde los nutrientes hasta la calidad sensorial, para asegurar su consumo. Objetivos: evaluar las características organolépticas de diferentes prototipos de SNO diseñados específicamente para pacientes oncológicos. Métodos: estudio clínico piloto transversal, aleatorizado, cruzado y doble ciego en pacientes con cualquier tipo de cáncer, con o sin tratamiento oncológico, a los que se les realizó una cata de cinco prototipos de SNO con distintos sabores (brownie, tropical, piña, tomate y jamón) y distintas cualidades sensoriales para evaluar sus características organolépticas (color, olor, sabor, gusto residual, textura y densidad) a través de un cuestionario específico. Resultados: treinta pacientes de 67,5 ± 11,2 años y con un índice de masa corporal (IMC) de 22,3 ± 3,52 kg/m2 fueron evaluados. Los tumores más prevalentes fueron cabeza y cuello (30 %), páncreas (20 %) y colorrectal (17 %). El 65 % de los pacientes había perdido ≥ 10 % del peso corporal en seis meses. Los SNO mejor valorados fueron los sabores brownie (23,67 ± 3,91 puntos) y tropical (20,33 ± 3,37 puntos) mientras que los menos valorados fueron los SNO con sabor tomate (16,33 ± 5,44 puntos) y jamón (13,97 ± 4,64 puntos). Conclusión: los pacientes oncológicos valoran de forma mucho más positiva las características organolépticas de los SNO con sabores dulces, como el brownie, y los sabores afrutados, como el tropical. Menos apreciados por este colectivo son aquellos con un sabor salado, como el sabor jamón y tomate.

[Malnutrition management of hospitalized patients with diabetes/hyperglycemia and cancer cachexia]. / Abordaje de la desnutrición en pacientes hospitalizados con diabetes/hiperglucemia y caquexia tumoral.

Introduction: Diabetes is a frequent comorbidity in cancer patients, since they share common risk factors. In cancer, the concurrence of cachexia represents a poor prognostic factor, which is aggravated by poor nutritional status. Clinically, cancer cachexia manifests as a significant reduction in body weight, accompanied by changes in body composition and alterations in the balance of the biological system, and causes progressive dysfunction. This article describes the results of the expert consensus and the responses of the panelists on the nutritional management in routine clinical practice of patients with diabetes/hyperglycemia hospitalized (non-critically ill) with cancer cachexia.

Introducción: La diabetes es una comorbilidad frecuente en pacientes con cáncer, ya que comparten factores de riesgo comunes. En la enfermedad oncológica, la presencia de caquexia tumoral representa un factor de mal pronóstico, que se ve agravado por un estado nutricional deficiente. Clínicamente, la caquexia se manifiesta como una reducción significativa del peso corporal, acompañado de cambios en la composición corporal y alteraciones en el equilibrio del sistema biológico, y causa una disfunción progresiva. El presente artículo describe los resultados del consenso de expertos y las respuestas de los panelistas sobre el manejo nutricional en la práctica clínica habitual de los pacientes con diabetes/hiperglucemia hospitalizados en planta (no críticos) con caquexia tumoral concurrente.

[Malnutrition management of hospitalized patients with diabetes/hyperglycemia and liver cirrhosis]. / Abordaje de la desnutrición en pacientes hospitalizados con diabetes/hiperglucemia y cirrosis hepática.

Introduction: Liver cirrhosis is a progressive and chronic disease of the liver, of diverse etiology, which is frequently associated with glucose intolerance and in some cases concurs with type 2 diabetes (DM2). DM2 is associated with adverse outcomes in patients with cirrhosis, including a higher rate of hospitalizations, a higher prevalence of hepatocellular carcinoma, and an increased risk of mortality. Malnutrition is another frequent complication of cirrhosis, the prevalence of which increases with the degree of liver dysfunction, worsening the prognosis. This article describes the results of the expert consensus and the responses of the panelists on the nutritional management in routine clinical practice of patients with diabetes/hyperglycemia hospitalized (non-critically ill) with liver cirrhosis.

Introducción: La cirrosis hepática es una enfermedad progresiva y crónica del hígado, de etiología diversa, que se asocia frecuentemente con intolerancia a la glucosa y en algunos casos concurre con diabetes tipo 2 (DM2). La DM2 se asocia con resultados adversos en pacientes con cirrosis, incluyendo una mayor tasa de ingresos hospitalarios, una mayor prevalencia de carcinoma hepatocelular y un mayor riesgo de mortalidad. La desnutrición es otra complicación frecuente en la cirrosis, cuya prevalencia aumenta con el grado de disfunción hepática, empeorando el pronóstico. El presente artículo describe los resultados del consenso de expertos y las respuestas de los panelistas sobre el manejo nutricional en la práctica clínica habitual de los pacientes con diabetes/hiperglucemia hospitalizados en planta (no críticos) con cirrosis hepática.

[de la evidencia y algoritmo adaptado Immunonutrition in fast-track surgical patients - Evidence review and adapted algorithm]. / Inmunonutrición del paciente quirúrgico en los procedimientos fast-track: revisión de la evidencia y algoritmo adaptado.

INTRODUCTION: Surgical stress predisposes patients to have immune dysfunction and an increased risk of infection. Malnourished surgical patients have higher postoperative morbidity and mortality rates, higher readmission rates, and higher hospital costs. The use of an immunomodulatory formula is associated in the ESPEN guidelines with a reduction in wound healing problems, suture failure, and infectious and global complications. Several authors have suggested that, since most clinical trials evaluating the efficacy of immunonutrition have been carried out in a traditional perioperative setting, it would be interesting to investigate its efficacy in a more controlled setting, such as in the ERAS (Enhanced Recovery after Surgery) protocol. The objective of this work was: a) to define the role that immunonutrition should play in ERAS protocols based on the best scientific evidence available; b) to analyze the difficulties that continue to exist in real-life clinical practice to screen the nutritional risk of patients; c) to make a proposal of algorithms adapted to the characteristics of our environment regarding the screening, assessment, and nutritional treatment of surgical patients in fast-track surgery.

INTRODUCCIÓN: El estrés quirúrgico predispone a los pacientes a la disfunción inmune y a un mayor riesgo de infección. Los pacientes quirúrgicos desnutridos presentan una mayor morbimortalidad posoperatoria, mayores tasas de reingreso y costes hospitalarios más elevados. En las guías de la ESPEN se asocia el uso de una fórmula inmunomoduladora a una reducción significativa de los problemas de la cicatrización de heridas, de los fallos de la sutura y de las complicaciones infecciosas y globales. Varios autores han sugerido que, dado que la mayoría de los ensayos clínicos que evalúan la eficacia de la inmunonutrición se han realizado en un entorno perioperatorio tradicional, sería interesante investigar su eficacia en un entorno más controlado, como en el protocolo ERAS (Enhanced Recovery after Surgery). El objetivo de este trabajo es: a) definir el papel que debe jugar la inmunonutrición en los protocolos ERAS sobre la base de la mejor evidencia científica; b) analizar las dificultades que siguen existiendo en la práctica clínica real para realizar el cribado del riesgo nutricional del paciente; c) proponer unos algoritmos adaptados a las características de nuestro entorno sobre el cribado, la valoración y el tratamiento nutricional del paciente quirúrgico en modalidad fast-track.

A standardized, integral nutritional intervention and physical activity program reduces body weight in women newly diagnosed with breast cancer.

INTRODUCTION: Introduction: breast cancer is the most common invasive cancer among women in developed countries. At diagnosis, approximately 70 % of women are overweight, and the additional weight gain that can result from the ensuing treatments has been associated with cancer recurrence and progression. Objectives: the main objective was to compare the effect of only a nutritional intervention (CG) with a nutrition education program (nutritional intervention, nutrition education, and physical activity) (IG) for 1 year. Methods: a total of 65 women with breast cancer who had been evaluated at the Clinical Nutrition Department, La Paz University Hospital, Madrid, Spain were recruited into 2 groups: a control group (CG) and an intervention group (IG). Results: the IG showed a significant reduction in body weight (-1.87 ± 3.41 vs. 1.48 ± 2.01 kg, p < 0.05), BMI (-0.61 ± 1.40 vs. 0.65 ± 0.88 kg/m2, p < 0.05), total cholesterol (-32.92 ± 38.45 vs. -3.23 ± 39.73 mg/dl, p < 0.05), and low-density lipoprotein cholesterol (-35.29 ± 27.50 vs. 6.33 ± 40.70 mg/dl, p < 0.05). Both groups were shown to be more conscious of the importance of physical activity, with increased consumption of grains, fruits, oily fish, and dairy. Conclusions: dietary interventions and physical activity were shown to be important to achieving several physical and physiological benefits that could reduce some risk factors associated with breast cancer recurrence and progression.

INTRODUCCIÓN: Introducción: el cáncer de mama es el cáncer invasivo más común entre las mujeres de los países desarrollados. En el momento del diagnóstico, aproximadamente el 70 % de las mujeres tienen sobrepeso, y el aumento de peso adicional que puede resultar de los tratamientos subsiguientes se ha asociado con la recurrencia y progresión de la enfermedad. Objetivos: el objetivo principal del estudio fue comparar el efecto de solo una intervención nutricional (GC) con un programa integral de educación nutricional (intervención y educación nutricional y actividad física) (IG) durante 1 año. Métodos: un total de 65 mujeres con cáncer de mama previamente evaluadas en la Unidad de Nutrición Clínica y Dietética del Hospital Universitario La Paz, Madrid, España, fueron reclutadas y divididas en 2 grupos: grupo de control (GC) y grupo de intervención (GI). Resultados: el GI mostró una reducción significativa del peso corporal (-1,87 ± 3,41 vs. 1,48 ± 2,01 kg, p < 0,05), IMC (-0,61 ± 1,40 vs. 0,65 ± 0,88 kg/m2, p < 0,05), colesterol total (-32,92 ± 38,45 vs. -3,23 ± 39,73 mg/dl, p < 0,05) y colesterol unido a lipoproteínas de baja densidad (LDL) (-35,29 ± 27,50 vs. 6,33 ± 40,70 mg/dl, p < 0,05). Al finalizar el estudio, ambos grupos fueron más conscientes de la importancia de la actividad física y demostraron consumir una cantidad más elevada de cereales, frutas, pescado azul y lácteos. Conclusiones: las intervenciones dietéticas junto con la práctica de actividad física son importantes para lograr beneficios físicos y fisiológicos que podrían reducir algunos factores de riesgo asociados con la recurrencia y progresión del cáncer de mama.

Impact of SARS-CoV-2 infection in patients with cystic fibrosis in Spain: Incidence and results of the national CF-COVID19-Spain survey.

BACKGROUND: Given the high incidence of confirmed infection by SARS-CoV-2 and mortality by COVID-19 in the Spanish population, its impact was analysed among persons with Cystic Fibrosis (CF) as a group at risk of a worse evolution. The possible causes of the incidence observed in them are explained and how CF Units have faced this health challenge is detailed. METHODS: Retrospective descriptive observational study, for which a Spanish CF Patients with Confirmed COVID-19 Registry is created, requesting information on number of people affected between 8 March-16 May 2020 and their clinical-demographic characteristics from the CF Units participating in the European Cystic Fibrosis Society Patient Registry (ECFSPR). The accumulated incidence is calculated, compared with that of the general population. Additionally, a survey (CF-COVID19-Spain) is carried out on prevention of SARS-CoV-2 infection, workings of CF Units and possible reasons for the incidence observed. RESULTS: COVID-19 was diagnosed in eight CF patients, one of whom had received a lung transplant. The accumulated incidence was 32/10000 in CF patients and 49/10000 in the general population. General death rate was 5.85/10000 while no CF patients included in the ECFSPR died. The characteristics of those affected and the results of the survey are described. CONCLUSIONS: Despite being considered a disease at high risk of severe COVID-19, the low incidence and mortality in CF patients in Spain contrasts with the figures for the general population. The possible factors that would explain such findings are discussed, with the help of the results of the CF-COVID19-Spain survey.

[Comparison of the CONUT method with SGA and NSA for the prediction of complications, hospital stay, readmissions, and mortality]. / Comparación del método CONUT con la VGS y el VEN para la predicción de complicaciones, estancia hospitalaria, readmisiones y mortalidad.

INTRODUCTION: Introduction: disease-related malnutrition (DRM) is a specific type of malnutrition caused by the inflammatory response to the underlying disease. Its prevalence worldwide varies from 30 % to 50 %, being similar in Spanish hospitals. DRE is not commonly recognized but is usually misdiagnosed and generally not treated. It is associated with an increased risk of morbidity, mortality, and costs. Nutritional societies recommend that screening be performed within the first 24 to 48 hours after admission for the early detection of malnutrition. No screening tool is universally accepted. Objectives: to evaluate the predictive validity (hospital stay, complications, readmissions and mortality) of the CONUT method as compared to SGA and NSA. Material and method: a retrospective study included in a prospective observational study of 365 hospitalized patients from July to December 2012. Results: the most frequent admission services were Internal Medicine and Oncology (30.7 % and 29.3 %). Moderate and severe risk of malnutrition: CONUT, 42.2 % and 12.1 %, SGA 25.8 % and 10.1 %, and NSA 13.7 % and 14.5 %. Malnutrition evaluated using the CONUT method was significantly related to complications (p = 0.036), readmissions (p = 0.041) and mortality (p = 0.007). The ROC curves for mortality, for all the methods evaluated, showed that CONUT is the best tool. Conclusions: CONUT is an automatic detection tool that can be used as a first step in the diagnosis risk of malnutrition. CONUT offers the advantage of being a prognostic factor for complications, readmission, and mortality.

INTRODUCCIÓN: Introducción: la desnutrición relacionada con la enfermedad (DRE) es un tipo específico de desnutrición producida por la respuesta inflamatoria de la enfermedad de base. Su prevalencia en todo el mundo varía del 30 al 50 %, siendo similar en los hospitales españoles. La DRE no se reconoce comúnmente, se diagnostica inadecuadamente y generalmente no se trata. Se asocia a un mayor riesgo de morbilidad, mortalidad y costes. Las sociedades nutricionales recomiendan que el cribado se realice en las primeras 24 a 48 horas posteriores al ingreso para la detección temprana de la desnutrición. Ninguna herramienta de cribado se acepta universalmente. Objetivos: evaluar la validez predictiva (estancia hospitalaria, complicaciones, reingresos y mortalidad) del método CONUT en comparación con la VGS y el VEN. Material y método: estudio retrospectivo incluido en un prospectivo observacional de 365 pacientes hospitalizados de julio a diciembre de 2012. Resultados: los servicios de ingreso más frecuentes fueron Medicina Interna y Oncología (30,7 % y 29,3 %). Detección de los riesgos moderado y severo de desnutrición: CONUT, 42,2 y 12,1 %; VSG, 25,8 % y 10,1 %; VEN, 13,7 y 14,5 %. La desnutrición evaluada utilizando el método CONUT se relacionó significativamente con las complicaciones (p = 0,036), los reingresos (p = 0,041) y la mortalidad (p = 0,007). Las curvas ROC de la mortalidad, para todos los métodos evaluados, mostraron que CONUT es la mejor herramienta. Conclusiones: CONUT es una herramienta de detección automática que se puede utilizar como primer paso en el diagnóstico del riesgo de desnutrición. CONUT ofrece la ventaja de ser un factor pronóstico de complicaciones, reingreso y mortalidad.

A Dairy Product to Reconstitute Enriched with Bioactive Nutrients Stops Bone Loss in High-Risk Menopausal Women without Pharmacological Treatment.

Osteoporosis is a multifactorial disease characterized by the loss of bone mass and deterioration of the internal structure of the bone, increasing the risk of fractures, and is becoming an economic and social problem. The main treatment is pharmacological, however, the population demands other therapies, such as foods with nutrients beneficial to bone health. Seventy-eight healthy menopausal women at risk of osteoporosis or untreated osteopenia were recruited for a randomized, parallel, double-blind clinical trial with two intervention groups: one group consumed a serving a day of the experimental enriched product (experimental group (EG)) and the other group (control group (CG)) consumed the same product without enrichment. The main objective was to compare the effect of consuming a dairy preparation to reconstitute, similar to yogurt when prepared, enriched in calcium, vitamin D, vitamin K, vitamin C, zinc, magnesium, L-leucine and probiotic (Lactobacillus plantarum 3547) on bone metabolism markers for 24 weeks. The EG showed a significantly increased bone mass compared to the CG (0.01 ± 0.03 vs. -0.01 ± 0.03 kg; p < 0.05). In addition, the EG maintained their bone mineral density (BMD) compared to the CG, whose BMD significantly decreased at the end of the study. For biochemical markers, the EG significantly increased the serum levels of the N-terminal propeptide of type I collagen (P1NP) bone formation marker (13.19 ± 25.17 vs. -4.21 ± 15.62 ng/mL; p < 0.05), and decreased the carbo-terminal telopeptide of type I collagen (CTx) bone resorption marker compared to the CG (-0.05 ± 0.19 vs. 0.04 ± 0.14 ng/mL; p < 0.05). On the other hand, the EG exhibited a significantly decreased systolic and diastolic blood pressure compared to the start of the study. Finally, the EG significantly increased their dietary calcium and vitamin D intake compared to the CG. In conclusion, the regular consumption of a dairy product to reconstitute enriched with bioactive nutrients improves bone health markers in menopausal women at risk of osteoporosis without pharmacological treatment.

Nutritional Composition Assessment of 3000 Individualized Parenteral Nutrition Bags in a Tertiary Referral Hospital: Current Prescribing Patterns.

Individualized parenteral nutrition is the most specialized type of nutritional support in the hospital setting. The composition and prescribing patterns for parenteral nutrition have evolved due to new emerging scientific evidence. In the last few years, there has been a tendency to increase the nitrogen and lipid content and decrease the carbohydrate content. To assess the prescribing pattern in a tertiary referral hospital in Spain, the nutritional composition of individualized parenteral nutrition was evaluated retrospectively from January to December of 2016. A total of 3029 parenteral nutrition units were analysed, corresponding to 257 hospitalized adult patients. Medical specialists in General Surgery and Haematology were the most common petitioners. The three most frequently prescribed parenteral nutrition formulae contained 13.4 (28.8%), 15.7 (19.54%) and 17.9 (17.79%) g of nitrogen. The quantity of carbohydrates and lipids showed a mean non-protein calories-to-nitrogen ratio of approximately 78:1 and a carbohydrate-to-lipid ratio that was near 50:50 in most cases. These results suggest a trend towards the administration of parenteral nutrition with a high content of nitrogen and smaller proportion of the non-protein components.

New, Immunomodulatory, Oral Nutrition Formula for Use Prior to Surgery in Patients With Head and Neck Cancer: An Exploratory Study.

BACKGROUND: The perioperative use of immunomodulatory nutrition formulas in patients with head and neck cancer reduces the number of postoperative infections and the length of hospital stay. OBJECTIVE: An exploratory, randomized, controlled, blind, clinical trial was designed to examine the effect of the preoperative consumption of a new, immunomodulatory, oral nutrition formula in patients with head and neck cancer. METHODS: Thirty-eight patients were randomized to receive either 400 mL/d of either the new immunomodulatory formula (IF) or that commonly used in clinical practice (CF) over 10 days prior to surgery. Thirty-three patients completed the study. Compliance, tolerance, the length of hospital stay, the incidence of infections and noninfectious complications before discharge, and the same up to 15 and 30 days after discharge were recorded. RESULTS: The percentage of patients who developed infections before discharge was significantly lower in the IF than in the CF group (P = .013), as was the number of infections/100 patients/d (P = .035). The length of hospital stay was significantly shorter in the IF group (P = .001). Both formulas were safe and well tolerated. No other differences were detected. These results suggest preoperative consumption of the new formula to be beneficial for patients with neck and head cancer. Further trials are needed to confirm these results and to test the efficacy of the formula in patients with other conditions. CONCLUSION: The new formula can be safely prescribed as part of the preoperative treatment of patients with head and neck cancer and might reduce the problem of postoperative infection.

[Fiber-type indication among different pathologies]. / INDICACIONES DE DIFERENTES TIPOS DE FIBRA EN DISTINTAS PATOLOGÍAS.

INTRODUCTION: Fiber definition includes all those carbohydrates which are not digested nor absorbed in the upper gastrointestinal tract allowing them to reach the colon with no previous processing. Traditionally fiber has been classified according to their solubility into soluble and insoluble and different physiological properties have been defined for each type. The physiologic role of the fiber intake has been studied in diabetes, dyslipidemia or obesity. Fiber intake has also demonstrated to be beneficial in the prevention of many neoplastic diseases like colorectal cancer. It´s also known that fiber plays an important role in the faecal excretion of nitrogen. AIM: To evaluate the current evidence that fiber intake plays in the management and prevention of several different diseases, being able to determine, if possible, the most recommended fiber type for each clinical condition. METHODS: A non-systematic review by searching the Medline and Pubmed was made and studies which met the inclusion criteria were identified and selected for analysis. RESULTS: Different fiber types can be useful for the treatment of several gastrointestinal diseases like constipation, diarrhea, irritable bowel syndrome, ulcerative colitis remission or short bowel syndrome. Patients diagnosed with diabetes, obesity, hyperlipidemia, hypertension and other cardiometabolic diseases can get a clinical improvement with soluble fiber intake. Dietary fiber has demonstrated to play a role in the prevention of colorrectal cancer and other neoplastic diseases. Patients with hepatic encephalopathy or chronic kidney disease will also benefit from fermentable fiber intake. DISCUSSION: Fiber plays an important role in the prevention and treatment of many clinical conditions. However further investigations are needed to establish specific fiber intake recommendations.

Introducción: la fibra engloba los carbohidratos no digeridos ni absorbidos en el tubo digestivo, llegando intactos al colon. Se clasifica en soluble e insoluble, con propiedades fisiológicas distintas. La fibra se ha empleado frecuentemente para tratar y prevenir diversas patologías gastrointestinales. También se ha estudiado su papel en la fisiopatología de enfermedades como la diabetes, la dislipemia, la hipertensión arterial y la obesidad. Además se ha relacionado su consumo con la prevención de ciertos tumores, en especial del cáncer colorrectal, así como con el aumento de la excreción de nitrógeno en heces. Objetivos: analizar la evidencia del papel que la fibra puede tener en el tratamiento y prevención de distintas enfermedades, así como el tipo de fibra más adecuado en cada una. Métodos: revisión no sistemática en Medline y Pubmed, y posterior aplicación de los criterios de inclusión y exclusión. Resultados: diferentes tipos de fibra pueden ser útiles en el tratamiento de enfermedades gastrointestinales, como el estreñimiento, la diarrea, el síndrome de intestino irritable, la colitis ulcerosa en remisión o el síndrome de intestino corto. Los pacientes con diabetes, obesidad, hiperlipidemia, hipertensión y enfermedad cardiovascular también pueden beneficiarse del consumo principalmente de fibra soluble. La fibra alimentaria ha demostrado prevenir el cáncer de colon y otros tumores. En pacientes con encefalopatía hepática o insuficiencia renal, la fibra fermentable ha demostrado beneficios. Conclusiones: la fibra tiene un papel importante en la prevención y tratamiento de múltiples enfermedades; sin embargo, son necesarios más estudios de calidad para poder realizar recomendaciones más específicas.

Twenty-five years of home parenteral nutrition outsourcing: the experience at Hospital Universitario La Paz, Madrid.

INTRODUCTION: For the last 20 years, most adult patients following home parenteral nutrition (HPN) under the care of the Clinical Nutrition and Dietetics Dept. of the La Paz University Hospital (Unidad de Nutrición Clínica y Dietética del Hospital Universitario La Paz), Madrid, Spain, have received their nutrition formula via a catering system (Nutriservice) responsible for its preparation and home distribution. AIM: To assess the clinical characteristics, quality of life and degree of satisfaction with the care received, of patients undergoing HPN who received their nutrition formulae via the named catering service. MATERIALS AND METHODS: The characteristics of the patients who received HPN via this service between 1992 and 2013 were retrospectively collected. Those patients still undergoing treatment completed a quality of life questionnaire, plus a survey of their satisfaction with the catering system and the care provided by our department. RESULTS: Seventy eight patients were examined; 57.7% were men. The mean age of the patients was 53.1±14.3 years. The most common underlying disease was cancer, both in advanced stage (33.8% of all cases) and in stages in which active treatment was being provided (34%). The most common indication for HPN was intestinal obstruction (46%). The median duration of HPN treatment was 96 [1-5334] days. The most common complication was catheter infection (72%). For the analysis of the results, the patients were divided depending on disease type: those with advanced stage cancer, those with cancer under active treatment and with a better prognosis, and those with non-oncological disease. The patients undergoing active oncological treatment believed the quality of their lives to have been improved by the Nutriservice catering system, and rated the care received by our department positively. CONCLUSION: In our experience, patients with cancer are those who most commonly receive HPN, especially those with advanced disease. Given the seriousness of their conditions, and the complexity surrounding the use of HPN, catering systems appear to offer a means of improving their quality of life.

Introducción: La mayoría de los pacientes adultos con nutrición parenteral domiciliaria (NPD) que dependen de la Unidad de Nutrición Clínica y Dietética del Hospital Universitario La Paz, reciben desde hace más de 20 años la fórmula de nutrición a través de un sistema de catering que elabora y distribuye directamente al domicilio del paciente. Objetivo: Evaluar las características clínicas, calidad de vida y grado de satisfacción con la atención recibida de los pacientes con nutrición parenteral domiciliaria que recibieron las fórmulas de nutrición mediante el sistema de catering: Nutriservice. Material y métodos: Se recogen retrospectivamente las características de los pacientes que utilizaron fórmulas de nutrición parenteral en su domicilio a través de Nutriservice, desde el año 1992 hasta la actualidad. Los pacientes en tratamiento activo realizaron un cuestionario de calidad de vida y encuesta de satisfacción sobre el sistema de catering y la atención prestada por nuestra Unidad. Resultados: Se registraron 78 pacientes, el 57,7% eran hombres y la edad media 53,1±14,3 años. La patología de base más frecuente fue el cáncer, tanto en estadios avanzados (34%) como en tratamiento activo (34%). El motivo principal de indicación fue la obstrucción intestinal (46%).La duración del soporte nutricional tuvo una mediana de 96 días (1-5334). Las complicaciones más frecuentes fueron las infecciones relacionadas con el catéter (72%). Se analizaron los resultados, clasificando a los pacientes según la enfermedad de base: cáncer en estadio avanzado, cáncer en tratamiento activo y mejor pronóstico y patología no oncológica. Los pacientes en tratamiento activo consideraron afectada su calidad de vida y valoraron positivamente el servicio ofrecido por Nutriservice y la atención recibida de la Unidad de Nutrición. Conclusión: En nuestra experiencia, los pacientes oncológicos son los que con mayor frecuencia tienen nutrición parenteral domiciliaria, siendo muy frecuente su indicación en estadios avanzados de la enfermedad. A la gravedad de la patología de base se une la complejidad de la NPD. Los sistemas de catering podrían ser una alternativa eficaz para mejorar la calidad de vida en algunos de estos pacientes.

[Predictor variables for low adherence to a lifestyle modification program of overweight treatment in primary health care]. / Variables predictoras de baja adherencia a un programa de modificación de estilos de vida para el tratamiento del exceso de peso en atención primaria.

OBJECTIVES: To identify predictive variables of low adherence to a pilot Lifestyle Modification Program (LMP) for overweight and obesity treatment in primary health care (PC ). MATERIAL AND METHODS: Sixty subjects with BMI > 27 kg/m(2) were recruited. Health professionals directed the program in a group structure and biweekly, based on nutrition education with individualized dietary guidelines, promotion of physical activity and motivational support. A validated questionnaire on lifestyle habits for overweight and obesity subjects was used to identify variables related with program adherence and anthropometric variables were measured before and 6 months after intervention. Low adherence was considered when patients attended to less than 80% of visits. RESULTS: Twenty-seven subjects (45%) presented high adherence to the program. The variables associated to low adherence were related to baseline with IMC ≥ 35 kg/m(2) (p < 0.05); ex smoker period ≤ 4 months (p < 0.01); high caloric diet (p < 0.01) and scarce physical activity (p < 0.05). At 6 months the subjects who finalized the program presented a significant decrease of weight (86.0 ± 15.6 vs 79.2 ± 13.4 kg; p < 0,001); fat mass percentage (41,6 ± 4,6 vs 38.8 ± 5,4%; p < 0.001), blood glucose (108 ± 45.48 vs 94.38 ± 11.97 mg/dl; p < 0.01). It also improved caloric diet profile, above all decreasing the percentage of fat (39.6 ± 4.8 vs 35.5 ± 5.6%; p < 0.01). CONCLUSION: Have recently left smoking, obesity degree two or higher, a high caloric diet and scarce physical activity were basal variables identified as predictive of a low adhesion to a LMP for the treatment of overweight and obesity in primary health care. We do not consider this pilot experience as satisfactory and other new strategies are under development.

Objetivos: Identificar variables predictoras de baja adherencia a un programa piloto de Modificación de Estilos de Vida (MEV) para el tratamiento del exceso de peso en Atención Primaria (AP). Material y métodos: Se reclutaron 60 sujetos con IMC > 27 kg/m2. Profesionales sanitarios dirigieron el programa, en formato grupal y con una periodicidad quincenal, basado en educación nutricional, pautas dietéticas individualizadas, promoción de actividad física y apoyo motivacional. Para identificar las variables relacionadas con la adherencia al programa se utilizó un cuestionario validado sobre Hábitos de Vida de personas con Sobrepeso y Obesidad y se midieron variables antropométricas al inicio y a los seis meses del tratamiento. Una baja adherencia al programa fue considerada cuando los sujetos del estudio acudían a menos del 80% de las visitas quincenales. Resultados: Se adhirieron al programa 27 sujetos (45%). Las variables asociadas a baja adherencia estuvieron relacionadas al inicio del estudio con IMC ≥?35 kg/m2 (p < 0,05); período de exfumador =?4 meses (p < 0,01); mayor contenido calórico de la dieta (p < 0,01) y menor práctica de ejercicio físico (p < 0,05). A los 6 meses los sujetos que finalizaron el programa presentaron una disminución significativa de: peso (86,0 ± 15,6 vs 79,2 ± 13,4 kg; p < 0,001);% de masa grasa (41,6 ± 4,6 vs 38,8 ± 5,4%; p < 0,001) y glucemia (108 ± 45,48 vs 94,38 ± 11,97 mg/dl; p < 0,01). Además mejoró el perfil calórico de su dieta, disminuyendo sobretodo el porcentaje de grasa sobre el valor calórico total (39,6 ± 4,8 vs. 35,5 ± 5,6%; p < 0,01). Conclusión: Haber dejado de fumar recientemente, padecer obesidad de grado dos o superior, el alto contenido calórico de la dieta y la menor práctica de ejercicio físico fueron las variables basales identificadas como predictoras de una baja adherencia a un programa de MEV para el tratamiento de sobrepeso y obesidad en AP. Esta experiencia piloto una vez evaluada no la consideramos satisfactoria y otras nuevas estrategias están en fase de desarrollo.

[Obesity and sugar: allies or enemies]. / Obesidad y azúcar: aliados o enemigos.

In the last three decades, the prevalence of obesity in developed countries has reached epidemic proportions, and continues rising. Many factors have influence on the incidence of obesity, and with the decline of physical activity, overeating plays a role in the emergence of this public health problem. Although a clear relationship between fat intake and weight gain has been established, the role of carbohydrates and more specifically from sucrose and the development of obesity is more controversial. Much of this controversy is due to the growing demand for sweetened drinks and caloric increase posed by these in the diet. Despite multiple studies and communications on this subject in recent years, there are still many areas of uncertainty about the role played by diets rich in sugars over the increase in obesity in last years.

En las últimas tres décadas, la prevalencia de obesidad en los países desarrollados ha alcanzado dimensiones epidémicas y continua en aumento 1. Existen múltiples factores que influyen en la incidencia de obesidad, y junto con el descenso de actividad física ,el exceso de ingesta, juega un papel preponderante en la aparición de este problema de salud pública 2. Aunque existe una clara relación entre la ingesta de grasas y la ganancia de peso, el papel de los carbohidratos y más concretamente el de la sacarosa en el desarrollo de obesidad es más controvertido. Gran parte de esta controversia se debe a la creciente demanda de bebidas azucaradas y al posible incremento calórico en la dieta asociado a su consumo. A pesar de la publicación de múltiples estudios y comunicaciones a este respecto en los últimos años, siguen existiendo numerosas incógnitas acerca del papel que juegan las dietas ricas en azúcares en el incremento de incidencia y prevalencia de obesidad en los últimos años.

[Complete process of implantation of a nutritional risk screening system in the University Hospital La Paz, Madrid]. / Proceso completo de implantación de un sistema de cribado de riesgo nutricional en el hospital universitario La Paz de Madrid.

UNLABELLED: Disease-Related Malnutrition (DRM) is present in a high percentage of patients admitted to hospital and their impact is diverse and of great importance. OBJECTIVES: Nutrition Department of University Hospital La Paz, in collaboration with all members of the Nutrition Committee, we decided to implement some method of screening in our centre which allowed us to detect as many patients with malnutrition risk as possible. RESULTS: Due to the large size of our centre, with about 1,500 beds and the few human resources in our unit, we chose to use the CONUT system (Nutritional Control), a 100% automatic method based on analytical parameters, very easy to use, low cost and whose validity is confirmed, characteristics that fulfilled our needs. The method collects information from databases of Admission Service (affiliation, age, date) and Laboratory (albumin, cholesterol, total lymphocytes) and generates, in the report of analytical results, "alert" information about each patient''s nutritional risk and also nutritional recommendations based on the risk identified. Prior to its implantation several evaluations were performed in order to allow us to better know the extra workload, as it was the main factor that could limit our ability to assume that screening method and also many training activities for doctors and hospital health professionals who were increasingly assuming responsibilities in the nutritional treatment of their patients. This screening system has been working from June of 2010 and it has detected risk of malnutrition in 32% of the evaluated patients. In general, only in those cases where the alert corresponded to a high-risk nutritional situation, which represents approximately 10% of the total, specialized intervention by the Clinical Nutrition Unit was required. Later, as we have detected some possible causes that justify the system does not work properly; the screening system has undergone several changes . In this sense, we have made a retrospective evaluation of 233 patients admitted to the General Surgery plants and documented that those entering for scheduled surgery, having a alarm of malnutrition (50% of cases), its presence increases significantly the hospital stay and mortality. CONCLUSIONS: The implementation of this nutritional screening method has led to a change in the "nutritional" culture of our centre respect to DRM in most of our professionals: doctors and nurses and even in the management team, so all of them understand the importance of the process and know about the available tools and knowledge to indicate an adequate and early nutritional support.

La malnutrición asociada a la enfermedad (MAE) está presente en un porcentaje muy elevado de los pacientes que ingresan en los hospitales y su repercusión es diversa y de mucha trascendencia. Objetivo. Desde la Unidad de Nutrición del Hospital Universitario la Paz, en colaboración con todos los miembros de la Comisión de Nutrición, nos planteamos implantar algún método de cribado en nuestro centro, que permitiese abarcar al mayor número posible de pacientes. Resultados. Debido al gran tamaño de nuestro centro, con cerca de 1500 camas, unido a una escasez de recursos humanos en nuestra unidad, optamos por utilizar el sistema de cribado CONUT (Control Nutricional) 100 % automático y basado en parámetros analíticos, muy fácil de manejar, de bajo coste y cuya validez está confirmada, adaptándolo a nuestras necesidades. El método recoge información de las bases de datos del servicio de Admisión (filiación, edad, fecha) y del Laboratorio (albúmina, colesterol, linfocitos totales) y genera, en el informe de resultados de los análisis clínicos, la información sobre la alerta de riesgo nutricional de cada paciente, así como las recomendaciones nutricionales a seguir en función del riesgo detectado en cada caso. Para llegar su implantación se llevaron a cabo diferentes evaluaciones que nos permitieron conocer previamente la carga extra de trabajo que podría generar su implantación y nuestra capacidad para asumirlas, así como numerosas actividades formativas encaminadas a que los médicos y profesionales sanitarios del hospital asumieran cada vez más responsabilidades en el proceso del tratamiento nutricional de sus pacientes. Este sistema de cribado funciona desde Junio del año 2010 y detecta riesgo de desnutrición en el 32 % de los pacientes evaluados. En general, sólo en los casos en los que la alerta corresponde a una situación de Alto riesgo nutricional, hecho que se da aproximadamente en el 10 % del total, se requirió la intervención especializada por parte de la Unidad de Nutrición Clínica y Dietética. Posteriormente, conforme hemos ido detectando posibles causas que justificaran que el sistema no funcionase adecuadamente, el sistema de cribado ha sido objeto de diversas modificaciones. En este sentido, se ha realizado una evaluación retrospectiva en 233 pacientes ingresados en las plantas de Cirugía General y se ha documentado que aquellos que ingresan para cirugía programada y presentan una alarma alta o moderada de desnutrición (el 50 % de los casos), la presencia de la misma aumenta significativamente los días de ingreso y la mortalidad. Conclusiones. La implantación del cribado nutricional ha favorecido un cambio en la cultura de nuestro centro con respecto a la malnutrición asociada a la enfermedad y la mayoría de nuestros profesionales, tanto médicos como enfermeras e incluso el equipo directivo, comprenden la importancia del proceso y saben que disponemos de herramientas y de conocimiento suficiente para indicar un soporte nutricional adecuado y precoz.