RISK FACTORS FOR HYPOGLYCEMIA IN INPATIENTS WITH TOTAL PARENTERAL NUTRITION AND TYPE 2 DIABETES: A POST HOC ANALYSIS OF THE INSUPAR STUDY.

Objective: Treatment of hyperglycemia with insulin is associated with increased risk of hypoglycemia in type 2 diabetes mellitus (T2DM) patients receiving total parenteral nutrition (TPN). The aim of this study was to determine the predictors of hypoglycemia in hospitalized T2DM patients receiving TPN. Methods: Post hoc analysis of the INSUPAR study, which is a prospective, open-label, multicenter clinical trial of adult inpatients with T2DM in a noncritical setting with indication for TPN. Results: The study included 161 patients; 31 patients (19.3%) had hypoglycemic events, but none of them was severe. In univariate analysis, hypoglycemia was significantly associated with the presence of diabetes with end-organ damage, duration of diabetes, use of insulin prior to admission, glycemic variability (GV), belonging to the glargine insulin group in the INSUPAR trial, mean daily grams of lipids in TPN, mean insulin per 10 grams of carbohydrates, duration of TPN, and increase in urea during TPN. Multiple logistic regression analysis showed that the presence of diabetes with end-organ damage, GV, use of glargine insulin, and TPN duration were risk factors for hypoglycemia. Conclusion: The presence of T2DM with end-organ damage complications, longer TPN duration, belonging to the glargine insulin group, and greater GV are factors associated with the risk of hypoglycemia in diabetic noncritically ill inpatients with parenteral nutrition. Abbreviations: ADA = American Diabetes Association; BMI = body mass index; CV% = coefficient of variation; DM = diabetes mellitus; GI = glargine insulin; GV = glycemic variability; ICU = intensive care unit; RI = regular insulin; T2DM = type 2 diabetes mellitus; TPN = total parenteral nutrition.

Appetite disorders in cancer patients: Impact on nutritional status and quality of life.

Cancer patients are at high risk of malnutrition due to several symptoms such as lack of appetite. The aim of this study was to determine the prevalence of different appetite disorders in cancer patients and their influence on dietary intake, nutritional status, and quality of life. We conducted a cross-sectional study of cancer patients at risk of malnutrition. Nutritional status was studied using Subjective Global Assessment, anthropometry, and grip strength. Dietary intake was evaluated with a 24-h recall, and patients were questioned about the presence of changes in appetite (none, anorexia, early satiety, or both). Quality of life was measured using EORTC-QLQ-C30. Multivariate analysis was performed using linear regression. 128 patients were evaluated. 61.7% experienced changes in appetite: 31% anorexia, 13.3% early satiety, and 17.2% both. Appetite disorders were more common in women and with the presence of cachexia. The combination of anorexia and satiety resulted in a lower weight and BMI. However, there were no significant effects on energy or macronutrient intake among different appetite alterations. Patients with a combination of anorexia and early satiety had worse overall health perception, role function, and fatigue. Appetite disorders are highly prevalent among cancer patients at risk of malnutrition. They have a significant impact on nutritional status and quality of life, especially when anorexia and early satiety are combined.

Prevalence of sarcopenic obesity according to different diagnostic methods and cut-off points in candidates for bariatric surgery.

BACKGROUND AND AIMS: Sarcopenic obesity (SO) is defined as a combination of low strength and muscle mass along with excess adiposity. Our study aimed to determine the prevalence of sarcopenic obesity in candidates for bariatric surgery, according to ESPEN/EASO criteria using bioimpedance analysis (BIA) and dual-energy X-ray absorptiometry (DXA). METHODS: Retrospective study of adult patients (18-60 years) candidates for bariatric surgery (BMI ≥40 kg/m2 or ≥35 kg/m2 with associated complications). Adiposity was assessed by the percentage of fat mass by DXA, according to Gallagher's cut-off points. Muscle strength was measured by hand grip according to Sánchez-Torralvo, Dodds, and <-2SD cut-off points of healthy reference population. Muscle mass was determined by DXA (ALM/weight according to Batsis) and by BIA (SMM/weight according to Janssen and according to reference population). In addition, the agreement of the different diagnostic methods of sarcopenic obesity was analyzed. RESULTS: A total of 124 subjects were included in the study, with 71.8 % being women. The overall mean age was 42.6 (SD 8.9) years. SO prevalence was found to be 13 %-22 % applying BIA with the SMM/weight equation according to Janssen, 14 %-23 % utilizing BIA with the SMM/weight equation according to the reference population, and 13 %-23 % employing DXA with the ALM/weight equation following Batsis criteria, depending on the specific hand grip strength cut-off points used. In general, we found good or very good concordances with the different diagnostic methods (with kappa values between 0.6 and 0.97). CONCLUSIONS: The prevalence of SO according to ESPEN/EASO criteria in candidates for bariatric surgery was 13 %-23 % based on the diagnostic method and cut-off points used.

Is Food Tolerance Different After Bariatric Surgery Depending on the Surgical Procedure?

BACKGROUND: Bariatric surgery (BS) is a very effective treatment regarding body weight loss but might affect food tolerance and energy and protein intake. The aim of this study was to compare three BS techniques (biliopancreactic diversion (BPD), gastric bypass (GB), and sleeve gastrectomy (SG)) and their effect on food tolerance. METHODS: Prospective study conducted between April 2016 and April 2019. Visits included were 1 before and 6, 12, and 24 months after BS. Food tolerance test (FTT), 24-h recall, and bioelectrical impedance (TANITA MC780) were performed at all visits. RESULTS: Sixty-six patients were included (74.2% women). FTT showed a better self-perception of the intake after surgery in BPD at 6 months (p = 0.013), and at 12 months (p = 0.006). BPD had a better tolerance of 8 food groups at 6 months (red meat p = 0.017, white meat p = 0.026, salad p = 0.017, bread p < 0.001, rice p = 0.047, pasta p = 0.014, fish p = 0.027) and at 12 months, but only red meat (p = 0.002), bread (p < 0.001), rice (p = 0.025), and pasta (p = 0.025) remained statistically different. Twenty-four months after surgery, only the red meat food group (p = 0.007) showed differences. BPD had the lowest incidence of vomiting at 6 months (p < 0.001), 12 months (p = 0.008), and 24 months (p = 0.002). The total score of FTT was better in BPD at 6 months [25.6 (SD 1.5), p < 0.001], 12 months [25.6 (SD 2.4), p < 0.001], and 24 months [25.7 (SD 1.3), p = 0.001]. BPD showed the best intake in energy and proteins at 6 months [1214.8 (SD 342.4) kcal and 67.1 (SD 18.4) g] and 12 months [1199.6 (SD 289.7) kcal and 73.5 (SD 24.3) g]. % FML was higher in GB both at 6 and 12 months being statistically different (p < 0.050). CONCLUSION: Biliopancreatic diversion appears to be the technique with a better food tolerance and protein and energy intake in the first year of follow-up after BS.

Analysis of psychometric questionnaires used in patient selection for bariatric surgery.

INTRODUCTION: In severe forms of obesity there is a high prevalence of psychopathological comorbidity. Psychiatric evaluation is an important component of comprehensive obesity care and contributes to optimizing therapeutic results after bariatric surgery. OBJECTIVE: To assess the effectiveness of psychometric tests used in the protocol for selecting patients for bariatric surgery. MATERIAL AND METHODS: Retrospective naturalistic observational study of 100 patients who were candidates for bariatric surgery. Patients who complete the psychometric protocol and the psychiatric interview between January 2019 and June 2021 are included. Two groups are formed: those considered unfit for any psychopathological reason and those considered fit. To evaluate the effectiveness of the tests used, ROC curves will be used. The sensitivity and specificity values of each test used will be obtained. RESULTS: 97 patients included, aged between 20 and 61 years, 64.9% women. 51.5% had a family history and 38.1% a personal history of any psychiatric disorder. Regarding the area under the curve, the scales that presented a value greater than 0.7 were the YFAS total score (0.771), HADS-D (0.757), the Edinburgh Bulimia total score (0.747), the severity score of YFAS (0.722) and Edinburgh Bulimia Severity Score (0.705). The most frequent diagnoses as a cause of exclusion were Food Addiction 8 (20.5%) and Generalized Anxiety Disorder (GAD) 6 (15.5%). CONCLUSIONS: The YFAS, BITE and HADS-A scales were useful to discriminate those patients considered unsuitable for bariatric surgery for any psychopathological cause.

Long-Term Effects of Bariatric Surgery on Gut Microbiota Composition and Faecal Metabolome Related to Obesity Remission.

Obesity is one of the main worldwide public health concerns whose clinical management demands new therapeutic approaches. Bariatric surgery is the most efficient treatment when other therapies have previously failed. Due to the role of gut microbiota in obesity development, the knowledge of the link between bariatric surgery and gut microbiota could elucidate new mechanistic approaches. This study aims to evaluate the long-term effects of bariatric surgery in the faecal metagenome and metabolome of patients with severe obesity. Faecal and blood samples were collected before and four years after the intervention from patients with severe obesity. Biochemical, metagenomic and metabolomic analyses were performed and faecal short-chain fatty acids were measured. Bariatric surgery improved the obesity-related status of patients and significantly reshaped gut microbiota composition. Moreover, this procedure was associated with a specific metabolome profile characterized by a reduction in energetic and amino acid metabolism. Acetate, butyrate and propionate showed a significant reduction with bariatric surgery. Finally, correlation analysis suggested the existence of a long-term compositional and functional gut microbiota profile associated with the intervention. In conclusion, bariatric surgery triggered long-lasting effects on gut microbiota composition and faecal metabolome that could be associated with the remission of obesity.

Bone metabolism and fracture risk after Biliopancreatic Diversion.

BACKGROUND: Bariatric surgery (BS) is an effective treatment. However, there have been concerns regarding the negative effect on the bone. The aim of this study was to assess changes in bone metabolism and the risk of fracture after biliopancreatic diversion (BPD). MATERIAL AND METHODS: A retrospective analysis of obese patients undergoing BPD between 1998 and 2017 was conducted, and patients with at least 1 year of follow-up were included. The incidence of fracture and of changes in bone metabolism was studied. RESULTS: In total, 216 patients were included (78.2% female), with a mean age of 42.5(10.6) years. The median follow-up was 6.8(IQR 10.2-3.2) years. The mean body mass index (BMI) was 49.7(6.3) kg/m2. 13.2% (n=29) suffered a bone fracture after surgery; the time until the first fracture was 7.9(3.8) years (55.2% secondary to a casual fall). The rate of fracture incidence was 19.6 per 1000 person-years (95%CI: 1.3-2.7), prevalence was 13.4% (95%CI: 8.9-18.0). The risk of bone fractures seems to increase with longer postoperative evolution time. PTH (pg/ml) levels were significantly higher in patients with fractures (1 year, 98.1 vs. 77.8; 5 years, 162.5 vs. 110.3 p<0.05, adjusted HR 1.10; 95%CI 1.01-1.11). Subjects with a higher %EWL had less risk of fractures after surgery (adjusted HR 0.97; 95%CI 0.94-0.99). Moreover, 25(OH)D levels were lower, and osteocalcin and ß-Crosslaps levels were slightly higher (not significant) in patients with fractures. CONCLUSION: BPD is related to important changes in bone metabolism, which can lead to an increased risk of bone fractures. Assessing the risk of fractures should be part of BS patient care.

Bone metabolism and fracture risk after Biliopancreatic Diversion.

BACKGROUND: Bariatric surgery (BS) is an effective treatment. However, there have been concerns regarding the negative effect on the bone. The aim of this study was to assess changes in bone metabolism and the risk of fracture after biliopancreatic diversion (BPD). MATERIAL AND METHODS: A retrospective analysis of obese patients undergoing BPD between 1998 and 2017 was conducted, and patients with at least 1 year of follow-up were included. The incidence of fracture and of changes in bone metabolism was studied. RESULTS: In total, 216 patients were included (78.2% female), with a mean age of 42.5(10.6) years. The median follow-up was 6.8(IQR 10.2-3.2) years. The mean body mass index (BMI) was 49.7(6.3) kg/m2. 13.2% (n=29) suffered a bone fracture after surgery; the time until the first fracture was 7.9(3.8) years (55.2% secondary to a casual fall). The rate of fracture incidence was 19.6 per 1000 person-years (95%CI: 1.3-2.7), prevalence was 13.4% (95%CI: 8.9-18.0). The risk of bone fractures seems to increase with longer postoperative evolution time. PTH (pg/ml) levels were significantly higher in patients with fractures (1 year, 98.1 vs. 77.8; 5 years, 162.5 vs. 110.3 p<0.05, adjusted HR 1.10; 95%CI 1.01-1.11). Subjects with a higher %EWL had less risk of fractures after surgery (adjusted HR 0.97; 95%CI 0.94-0.99). Moreover, 25(OH)D levels were lower, and osteocalcin and ß-Crosslaps levels were slightly higher (not significant) in patients with fractures. CONCLUSION: BPD is related to important changes in bone metabolism, which can lead to an increased risk of bone fractures. Assessing the risk of fractures should be part of BS patient care.

Diabetes remission after malabsorptive bariatric surgery.

Obesity and diabetes are two closely related disorders. Lifestyle changes and drug treatment do not achieve successful diabetes remission. A treatment option for these patients is bariatric surgery (BS). The partial and complete remission rates vary, depending on the type of technique used (restrictive or malabsorptive), with malabsorptive surgery being more effective in terms of both weight reduction and diabetes remission (DR). Different scales (DiaRem, Ad-DiaRem or 5y-Ad-DiaRem) predict the probability of DR after BS, particularly after gastric bypass surgery. Some studies report higher DR rates in surgery with a greater malabsorptive component. Our aim was to study the benefits of BS at one year and 5 years in terms of the weight and blood glucose profile in patients with obesity and type 2 diabetes mellitus; assess percentage DR according to ADA criteria; determine the DR predictive capacity of different scores; and examine which variables predict DR at one and five years after biliopancreatic diversion (BPD). Percentage overweight reduction and the decrease in both blood glucose and HbA1c were greater with BPD. Complete diabetes remission was approximately 80% at one and 5 years after BS. In general, the scores that determine the probability of DR show poor discriminative capacity in malabsorptive surgery. Presurgery HbA1c predicts DR at one and 5 years after BPD. The type of surgery performed should be individualized, based on the severity of diabetes and the specific characteristics of each patient.

Diabetes remission after malabsorptive bariatric surgery. / Remisión de diabetes tras cirugía bariátrica malabsortiva.

Obesity and diabetes are two closely related disorders. Lifestyle changes and drug treatment do not achieve successful diabetes remission. A treatment option for these patients is bariatric surgery (BS). The partial and complete remission rates vary, depending on the type of technique used (restrictive or malabsorptive), with malabsorptive surgery being more effective in terms of both weight reduction and diabetes remission (DR). Different scales (DiaRem, Ad-DiaRem or 5y-Ad-DiaRem) predict the probability of DR after BS, particularly after gastric bypass surgery. Some studies report higher DR rates in surgery with a greater malabsorptive component. Our aim was to study the benefits of BS at one year and 5 years in terms of the weight and blood glucose profile in patients with obesity and type 2 diabetes mellitus; assess percentage DR according to ADA criteria; determine the DR predictive capacity of different scores; and examine which variables predict DR at one and five years after biliopancreatic diversion (BPD). Percentage overweight reduction and the decrease in both blood glucose and HbA1c were greater with BPD. Complete diabetes remission was approximately 80% at one and 5 years after BS. In general, the scores that determine the probability of DR show poor discriminative capacity in malabsorptive surgery. Presurgery HbA1c predicts DR at one and 5 years after BPD. The type of surgery performed should be individualized, based on the severity of diabetes and the specific characteristics of each patient.

Effectiveness of energy-restricted diets with different protein:carbohydrate ratios: the relationship to insulin sensitivity.

OBJECTIVE: Insulin sensitivity could determine the effectiveness of weight-loss diets with different protein:carbohydrate ratios. Our aim was to evaluate whether or not energy-restricted diets with different protein:carbohydrate ratios in obese individuals with (IR) or without (IS) insulin resistance could lead to differences in weight loss or insulin sensitivity. DESIGN: Prospective, randomized, clinical intervention study. Thirty-six obese patients, allocated to the IR or IS group after a 75 g oral glucose tolerance test and calculation of the homeostasis model assessment of insulin resistance (HOMA) index, were assigned to follow an energy-restricted diet with either 40 % carbohydrate/30 % protein/30 % fat (diet A) or 55 % carbohydrate/15 % protein/30 % fat (diet B) and followed up to 16 weeks. RESULTS: Twenty-one IR and fifteen IS patients were randomized to diet A or B. After 16 weeks, there was no difference in weight loss between diets A and B in each group. Glucose and insulin levels and HOMA were significantly reduced at 16 weeks, but no differences related to the type of diet were detected either in the IR or the IS group. CONCLUSIONS: Varying the macronutrient composition of a hypoenergetic diet, regarding the percentage protein:carbohydrate ratio, did not produce different weight loss or result in an improvement in insulin sensitivity in people with or without insulin resistance.

Postoperative enteral immunonutrition in head and neck cancer patients: Impact on clinical outcomes.

BACKGROUND: Head and neck cancer patients have a high rate of complications during the postoperative period that could increase their morbidity rate. Arginine has been shown to improve healing and to modulate inflammation and immune response. The aim of our study was to assess whether use of arginine-enriched enteral formulas could decrease fistulas and length of stay (LoS). METHODS: A retrospective study was conducted in patients who had undergone head and neck cancer surgery and were receiving enteral nutrition through a nasogastric tube in the postoperative period between January 2012 and May 2018. The differences associated to use of immunoformula vs. standard formulas were analysed. Sociodemographic, anthropometric, and nutritional intervention variables, as well as nutritional parameters, were recorded during the early postoperative period. Occurrence of complications (fistulas), length of hospital stay, readmissions, and 90-day mortality were recorded. RESULTS: In a univariate analysis, patients who received nutritional support with immunonutrition had a lower fistula occurrence rate (17.91% vs. 32.84%; p=0.047) and a shorter mean LoS [28.25 (SD 16.11) vs. 35.50 (SD 25.73) days; p=0.030]. After adjusting for age, energy intake, aggressiveness of surgery and tumour stage, fistula occurrence rate and LoS were similar in both groups irrespective of the type of formula. CONCLUSIONS: Use of arginine-enriched enteral nutrition appears to decrease the occurrence of fistulas in the postoperative period in patients with head and neck cancer, with a resultant reduction in length of hospital stay. However, the differences disappeared after adjusting for age, tumour stage, or aggressiveness of the surgery.

Fish Oil Enriched Intravenous Lipid Emulsions Reduce Triglyceride Levels in Non-Critically Ill Patients with TPN and Type 2 Diabetes. A Post-Hoc Analysis of the INSUPAR Study.

There are no studies that have specifically assessed the role of intravenous lipid emulsions (ILE) enriched with fish oil in people with diabetes receiving total parenteral nutrition (TPN). The objective of this study was to assess the metabolic control (glycemic and lipid) and in-hospital complications that occurred in non-critically ill inpatients with TPN and type 2 diabetes with regard to the use of fish oil emulsions compared with other ILEs. We performed a post-hoc analysis of the Insulin in Parenteral Nutrition (INSUPAR) trial that included patients who started with TPN for any cause and that would predictably continue with TPN for at least five days. The study included 161 patients who started with TPN for any cause. There were 80 patients (49.7%) on fish oil enriched ILEs and 81 patients (50.3%) on other ILEs. We found significant decreases in triglyceride levels in the fish oil group compared to the other patients. We did not find any differences in glucose metabolic control: mean capillary glucose, glycemic variability, and insulin dose, except in the number of mild hypoglycemic events that was significantly higher in the fish oil group. We did not observe any differences in other metabolic, liver or infectious complications, in-hospital length of stay or mortality.

Secondary Hyperparathyroidism in Patients with Biliopancreatic Diversion After 10 Years of Follow-up, and Relationship with Vitamin D and Serum Calcium.

BACKGROUND: Secondary hyperparathyroidism (SHPT) is a matter of concern after biliopancreatic diversion (BPD). The aim of this study was to investigate the relationship between SHPT, 25(OH)D, and calcium after BPD. DESIGN: A retrospective analysis in obese patients after BPD performed between 1998 and 2016. METHODS: Patients with at least 1 year of follow-up were included. SHPT was considered when PTH > 65 pg/mL in the absence of an elevated corrected calcium. 25(OH)D (ng/mL) status was defined as: deficiency < 20, insufficiency 20-29.9, and sufficiency ≥ 30. RESULTS: In total, 321 patients were included (76.6% women), with mean age 43.0 (10.5) years. Median follow-up was 6.0 (IQR 3.0-9.0) years. Mean body mass index was 49.8 (7.0) kg/m2. SHPT increased to a maximum of 81.9% in the ninth year of follow-up (95% CI: 1.5-9.1). Two years after surgery, 33.9% of patients with 25(OH)D sufficiency had SHPT (p = 0.001). Corrected calcium levels were lower in patients with PTH > 65 pg/mL when compared with PTH < 65 pg/mL; 1 year: 8.96 vs 9.1 mg/dL and 5 years: 8.75 vs 9.12 mg/dL (p < 0.01). After surgery, patients with PTH > 65 pg/mL and 25(OH)D sufficiency had lower corrected calcium levels when compared with subjects with PTH and 25(OH)D in normal range. Two years: 9.0 vs 9.2 mg/dL (p < 0.05) and 4 years: 8.9 vs 9.2 mg/dL (p < 0.01). CONCLUSIONS: Once 25(OH)D is sufficient, the increase in PTH persists associated with a decrease in serum corrected calcium. It is important to ensure a sufficient calcium intake in these patients in order to avoid SHPT and osteomalacia in the future.

Comparison of two nutritional screening tools to detect nutritional risk in hematologic inpatients.

OBJECTIVE: The aim of the study was to compare two nutritional screening tools in oncohematologic inpatients. METHODS: A cross-sectional study was performed in a hematology ward from August to December 2015. Within the first 24 h of admission, the following nutritional screenings were performed: Malnutrition Universal Screening Tool (MUST), Malnutrition Screening Tool (MST), and Subjective Global Assessment (SGA). Patients who stayed in the hematologic ward were reevaluated with the three screening tools 1 and 2 wk after admission. The SGA was used as the gold standard in the detection of malnutrition. RESULTS: Sixty-three patients were included in the study. Of these, 61.9% were men, ages 64 y (SD = 17.9 y) with 90.5% having a diagnosis of cancer. The prevalence of patients with nutritional risk at admission was 17.5% with SGA, 16.7% at week 1, and 31.6% at week 2. According to MST, the prevalence was 41.3% at admission, 13.9% at week 1, and 15.8% at week 2. According to MUST, the prevalence was 36.5%, 25%, and 36.8%, respectively. The results of diagnostic tests on admission were an area under the curve receiver operating characteristic of 0.691 for MST and 0.830 for MUST at admission; at week 1, 0.717 for MST and 0.850 for MUST; and at week 2 of assessment, 0.506 for MST and 0.840 for MUST. CONCLUSION: MUST might be a better screening tool than MST for detecting the risk for malnutrition in oncohematological inpatients.

Efficacy of enteral nutritional support after hospital discharge in major gastrointestinal surgery patients: a systematic review

INTRODUCTION: Nutritional support for malnourished patients undergoing gastrointestinal surgery reduces the complication rate and shortens the length of stay. The efficacy of nutritional support after hospital discharge was analyzed in this systematic review. METHODS: The search strategy (nutrition OR "enteral nutrition" OR "nutritional supplements" OR "oral nutritional supplements" OR "sip feed" OR "sip feeding" OR "dietary counseling") AND ("patient discharge" OR discharge OR postdischarge) AND (surgery OR operation OR "surgical procedure") was followed in Medline, CENTRAL, and Trip databases. Inclusion criteria comprised: type of study (randomized controlled trial), language (English, Spanish), and subjects (patients undergoing gastrointestinal surgery). The risk of bias was assessed by using the Cochrane methodology. RESULTS: Five studies which were published in six different articles and recruited 446 patients were included. A high risk of bias was detected for most of them. Nutritional support improved energy intake and protein intake when high-protein oral supplements were provided. The intervention was associated with better weight prognosis, but the data about body composition were inconsistent. In most of the trials, nutritional intervention did not enhance functional capacity or quality of life. None of the studies analyzed the effects on complications after discharge. CONCLUSION: Nutritional support provided at discharge may increase dietary intake and improve body weight, but the low quality of studies can weaken the validity of results.

Biliopancreatic Diversion for Severe Obesity: Long-Term Effectiveness and Nutritional Complications.

BACKGROUND: Bariatric surgery is currently the treatment of choice for those patients with severe obesity, but the procedure of choice is not clearly established. We describe weight loss and nutritional parameters in severely obese patients after biliopancreatic diversion for 10 years of follow-up. METHODS: Patients were followed by the same multidisciplinary team, and data are shown for 10 years. Bariatric Analysis and Reporting Outcome System (BAROS) questionnaire, data regarding the evolution of obesity-related diseases, and nutritional parameters are reported. RESULTS: Two hundred ninety-nine patients underwent biliopancreatic diversion, 76.1 % women, initial BMI 50.1 kg/m(2) (7.2). Weight loss was maintained throughout 10 years with EWL% around 65 % and EBMIL% around 70 %. More than 80 % of the patients showed EWL higher than 50 %. Blood pressure, glucose metabolism, and lipid profile clearly improved after surgery. Mean nutritional parameters remained within the normal range during follow-up. Protein malnutrition affected less than 4 % and anemia up to 16 %. Fat-soluble vitamin levels decreased along the time, with vitamin D deficiency in 61.5 % of patients. No significant differences were found either in nutritional parameters or weight loss regarding gastrectomy or gastric preservation, or common limb length longer or shorter than 55 cm CONCLUSIONS: Biliopancreatic diversion is an effective surgical procedure in terms of weight loss, quality of life, and evolution of obesity-related diseases. Nutritional deficiencies are less frequent than feared for a malabsorptive procedure, but must be taken into account, especially for fat-soluble vitamins.

CHRONIC ENTERITIS IN PATIENTS UNDERGOING PELVIC RADIOTHERAPY: PREVALENCE, RISK FACTORS AND ASSOCIATED COMPLICATIONS.

INTRODUCTION: the radiation of tumours located in pelvic organs can cause mucositis in the bowel. The aim of this study was to determine the prevalence, risk factors, and complications of chronic radiation enteritis in patients who had received pelvic radiotherapy. PATIENTS AND METHODS: cross-sectional study recruiting 150 patients that had been treated with radiation therapy during the year 2008 because of a prostate, cervical, endometrial or rectal cancer. The patients were asked about symptoms related to enteritis, and about changes in body weight and in dietary patterns. Sex, age, treatment modalities, acute enteritis, and type of cancer were considered possible risk factors, and were analysed with univariate and multivariate methods. RESULTS: the study included 100 patients, 84% males, median age 72.3 years. Chronic radiation enteritis was found in 20% of the patients, most of them grade 1 (45%). Furthermore, 10% had lost ≥ 5 kg of weight, 3% had been hospitalized due to diarrhoea or bowel obstruction, and 11% had changed their diet, mainly by removing vegetables, legumes and pastry. Male gender, age, previous acute radiation enteritis, and chemotherapy were associated with chronic enteritis, but only chemotherapy remained independently related to bowel toxicity after multivariate analysis (OR = 3.59 [95% CI 1.20-10.73]). CONCLUSION: chronic enteritis is common among patients treated with pelvic radiotherapy, especially if chemotherapy is associated. The complication rate is low, but a significant number of patients change their usual diet in order to prevent symptoms.

Introducción: la radiacion de los tumores de la cavidad pelvica puede provocar mucositis a nivel intestinal. El objetivo de nuestro estudio fue determinar la prevalencia, los factores de riesgo y las complicaciones de la enteritis radica cronica en los pacientes tratados con radioterapia pelvica. Pacientes y métodos: estudio transversal sobre 150 pacientes tratados con radioterapia pelvica durante el ano 2008 debido a un cancer de prostata, cervix, endometrio o recto. Se interrogo a los pacientes sobre la presencia de sintomas sugestivos de enteritis y sobre cambios en el peso habitual y modificaciones en su dieta. Los parametros considerados como posibles factores de riesgo de enteritis cronica (sexo, edad, tratamiento antitumoral, enteritis aguda previa y tipo de tumor) se analizaron con metodos univariantes y multivariantes. Resultados: el estudio incluyo finalmente a 100 pacientes, el 84% varones, con una mediana de edad de 72,3 anos. Se encontro una prevalencia de enteritis radica cronica del 20%, en la mayoria de grado 1 (45%). Por otra parte, el 10% referian una perdida de peso ≥ 5 kg, el 3% habian requerido hospitalizacion debido a diarrea incoercible o a obstruccion intestinal, y el 11% habian modificado su patron de alimentacion habitual, reduciendo principalmente el consumo de verduras, legumbres y dulces. Se encontro asociacion entre la enteritis radica cronica y el sexo masculino, la edad, la enteritis radica aguda previa y la quimioterapia, pero solo esta resulto asociarse de forma independiente con el desarrollo de enteritis radica cronica despues del analisis multivariante (OR = 3,59 [95% CI 1,20­10,73]). Conclusión: la enteritis cronica es una entidad frecuente en los pacientes tratados con radioterapia pelvica, sobre todo cuando se asocia con quimioterapia. La tasa de complicaciones por esta patologia es baja, pero un numero importante de pacientes realiza modificaciones en su dieta habitual para aliviar o evitar la sintomatologia derivada de aquella.

Relationship Between Diet and Body Composition After Biliopancreatic Diversion.

BACKGROUND: Biliopancreatic diversion (BPD) has been shown to be one of the most effective techniques for losing weight, although the relationship between body composition and diet after the procedure is not well known. Our aim was to assess dietary changes and their effects on body composition. METHODOLOGY: This longitudinal study included all patients eligible for BPD who had undergone body composition analysis. Two assessments were performed: 6 weeks before and 1 year after surgery. Nutritional education was given after surgery by a registered dietitian, and dual energy X-ray absorptiometry was performed and a 3-day food record was collected for further analysis at both of the visits. RESULTS: Forty-six patients were included. The percentage of excess of weight loss was 61.03 % (SD 14.01 %), which was statistically different by gender (p = 0.045). The percentage of subjects reporting a low daily protein consumption of less than 60 g and 1.2 g/kg of ideal body weight (IBW)/day was 15.2 % before surgery and 19.6 % at 12 months (p = 0.006). The weight loss was mainly of fat mass (FM). There were differences of body composition by gender before and after surgery. A simple correlation analysis showed a significant association between daily energy intake and FM (g) only before surgery (p = 0.030), and also between daily protein intake (expressed as total g) and lean body mass (LBM) 12 months after surgery (p = 0.018), but no association was found with achieved protein goal. CONCLUSION: BPD enhanced by nutritional education seems to improve its results by achieving an adequate weight loss, preserving LBM, decreasing FM, and guaranteeing an appropriate protein intake.

SHORT-TERM CHANGES IN MACRONUTRIENT INTAKE IN MORBIDLY OBESE PATIENTS UNDERGOING BILIOPANCREATIC DIVERSION: A LONGITUDINAL STUDY.

INTRODUCTION: biliopancreatic diversion (BPD) has been shown to be one of the most effective techniques for losing weight, although nutritional education also might play an important role. Our aim was to determine the effect of the combination of a nutrition educational program (NEP) and BPD on changes in the intake of energy and macronutrients after the surgery. METHODOLOGY: this longitudinal study included all patients eligible for BPD who filled in a dietary record. Two assessments were performed: six weeks before and twelve months after surgery. The nutrition educational program was given two weeks after surgery by a registered dietitian and a 3-day food record was collected for further analysis at both of the assessments. RESULTS: 68 patients were included. The percentage of excess weight loss was 60.76% (SD 14.50%). A year after the surgery there was a reduction of energy (-602.27 kcal [SD 930.19 kcal], p < 0.001), fat (-41.70 g [SD 77.87 g], p < 0.001), percentage of fat (-4.79% [SD 11.38%], p = 0.001), and an increase in the percentage of protein (+ 2.72% [SD 7.10%], p = 0.002). A lower consumption of fat, especially of polyunsaturated fatty acids, was observed in the patients that achieved the nutritional recommendations and in the super-obese patients. CONCLUSION: The combination of NEP and BPD resulted in an improvement in the nutritional profile, with a reduction of fat and maintenance of the protein intake.

Introducción: la derivación biliopancreática (DBP) ha demostrado ser una de las técnicas más efectivas en la pérdida de peso, aunque la educación nutricional también puede jugar un papel importante. El objetivo del estudio fue determinar el efecto de la combinación de un programa de educación nutricional (PEN) y DBP en los cambios de ingesta energética y de macronutrientes después de la cirugía. Métodos: estudio transversal que incluyó a todos los pacientes subsidiarios de DBP que cumplimentaron la encuesta dietética. Se realizaron dos valoraciones: seis semanas antes y doce meses después de la cirugía. El PEN fue impartido dos semanas después de la cirugía por una dietista-nutricionista. Fue recogida una encuesta dietética de tres días en ambas visitas para realizar el análisis nutricional de la ingesta. Resultados: fueron incluidos 68 pacientes. El porcentaje de exceso de peso perdido fue de 60,76% (DE 14,50%). Un año después de la intervención se produjo una disminución de la ingesta calórica (−602,27 kcal [DE 930,19 kcal], p.