[Prevention of eating disorders in obesity]. / Prevención de los trastornos de laconducta alimentaria en la obesidad.

Introduction: Obesity is a public health problem due to its high prevalence, high morbidity, and high mortality. The relationship between eating disorders (ED) and obesity is widely established. A healthcare professional that cares for people with obesity must take into account a series of best practices to minimize the risk of developing an ED in the course of treatment for weight loss. Bariatric surgery (BS) is an effective, long-term treatment in selected patients with severe obesity. During the preoperative period, it is essential to detect any ED due to its high prevalence in this group. After surgery, the presence of a post-op ED and its possible relationship in terms of poorer outcomes make screening during follow-up after surgery essential. From a preventive perspective, cognitive-behavioral therapy before BS could positively influence postoperative results, and its use after BS could improve weight loss efficacy and reduce binge eating and grazing. From a more holistic preventive perspective, many believe in an integrative approach to both obesity and ED. In order to be successful, it is essential to identify any relevant risk and protective factors for both disorders.

Introducción: La obesidad constituye un problema de salud pública por su alta prevalencia y elevada morbimortalidad. La relación entre los trastornos de la conducta alimentaria (TCA) y la obesidad está ampliamente establecida. Es importante que el profesional que atiende a personas con obesidad tenga en cuenta una serie de premisas que minimicen el riesgo de aparición de un trastorno alimentario en el transcurso del tratamiento para perder peso. La cirugía bariátrica (CB) constituye un tratamiento efectivo a largo plazo en los pacientes adecuadamente seleccionados con obesidad grave. Por un lado, la elevada prevalencia de los TCA en este colectivo hace imprescindible la detección de estos trastornos en el preoperatorio. Por otro lado, la presencia de los TCA después de la cirugía y su posible relación en cuanto a peores resultados hace fundamental el cribado durante el seguimiento tras la intervención. Desde el punto de vista preventivo, la realización de una terapia cognitivo-conductual antes de la CB podría influir positivamente en los resultados posoperatorios y su empleo después podría mejorar la eficacia en cuanto a pérdida de peso y disminuir los atracones y el "grazing". Desde una perspectiva más global en relación a la prevención, son muchos quienes apuestan por un enfoque integrador para la obesidad y los TCA. Para ello es fundamental identificar los factores de riesgo y los protectores que tengan relevancia en ambos trastornos.

[Nutritional education protocol in the treatment of eating disorders in the clinical and care settings]. / Protocolo de educación nutricional en el tratamiento de los trastornos de la conducta alimentaria en el ámbito clínico y asistencial.

INTRODUCTION: Nutrition education (NE), as part of the treatment of eating disorders (EDs), plays a crucial role in helping patients to change their food attitudes and routines, lose fears, and recover a healthy eating pattern. All these changes may contribute to improving their nutritional status. However, there is a lack of consensus and standardization concerning the procedures to teach it. This work's objective was to elaborate a consensual protocol for NE implementation in the treatment of EDs to help in decision-making regarding which patients are appropriate candidates to receive NE, the agents (family, school community) and professionals involved, and the areas in the healthcare system that are best suited for implementation. Moreover, it would help in selecting the the topics to be imparted, and in following up treatment progression.

INTRODUCCIÓN: La educación nutricional (EN), dentro del tratamiento de los trastornos de la conducta alimentaria (TCA), juega un papel fundamental ya que contribuye a que el paciente modifique sus actitudes y rutinas en relación con la comida, pierda miedos y restablezca un patrón de alimentación saludable, favoreciendo de este modo su recuperación nutricional. Sin embargo, existe falta de consenso y estandarización acerca de los procedimientos para llevarla a cabo. El objetivo de este trabajo es elaborar un protocolo consensuado de EN en el contexto del tratamiento de los TCA que permita ayudar a la toma de decisiones sobre: los pacientes candidatos a recibirla, los agentes (familia, comunidad escolar) y profesionales implicados, los ámbitos de implementación de la intervención, la información sobre los pacientes que es necesario conocer, los temas, objetivos y contenidos a trabajar, y la necesidad de evaluación de la progresión del paciente y los programas desarrollados.

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.

[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.

Regular Consumption of Lipigo® Promotes the Reduction of Body Weight and Improves the Rebound Effect of Obese People Undergo a Comprehensive Weight Loss Program.

Obesity is a global public health problem. OBJECTIVE: To evaluate the effect of the regular consumption of the product Lipigo® on body weight and rebound effect on overweight/obese subjects undergoing a comprehensive weight loss program. METHODS: A randomized, parallel, double-blind, placebo-controlled clinical trial was conducted with male and female subjects presenting a BMI 25-39.9 kg/m2. All subjects underwent a comprehensive weight loss program (WLP) for 12 weeks, which included an individualized hypocaloric diet, physical activity recommendations, nutritional education seminars, and three times a day consumption of the product Lipigo® or Placebo. After-WLP, subjects continued the treatment for 9 months to assess rebound effect. Body weight (BW), BMI, and body composition were measured at the beginning and the end of the WLP, and in the follow-up. RESULTS: A total of 120 subjects (85% women) 49.0 ± 9.5 years old and with a BW of 81.57 ± 13.26 kg (BMI 31.19 ± 3.44 kg/m2) were randomized and 73 subjects finished the study. At the end of the WLP, there was a tendency toward reduced BW (p = 0.093), BMI (p = 0.063), and WC (p = 0.059) in the treated group. However, subjects with obesity type 1 (OB1) from the treated group significantly reduced body weight (-5.27 ± 2.75 vs. -3.08 ± 1.73 kg; p = 0.017) and BMI (-1.99 ± 1.08 vs. -1.09 ± 0.55 kg/m2; p = 0.01) compared with placebo. They also presented a minor rebound effect after 9 months with product consumption (-4.19 ± 3.61 vs. -1.44 ± 2.51 kg; p = 0.026), minor BMI (-1.61 ± 1.43 vs. -0.52 ± 0.96 kg/m2; p = 0.025) and tended to have less fat-mass (-3.44 ± 2.46 vs. -1.44 ± 3.29 kg; p = 0.080) compared with placebo. CONCLUSIONS: The regular consumption of the product Lipigo® promotes the reduction of body weight and reduces the rebound effect of obese people after 52 weeks (12 months), mainly in obesity type 1, who undergo a comprehensive weight loss program.

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.

Consumption of Goat Cheese Naturally Rich in Omega-3 and Conjugated Linoleic Acid Improves the Cardiovascular and Inflammatory Biomarkers of Overweight and Obese Subjects: A Randomized Controlled Trial.

This study examines the value of a goat cheese naturally enriched in polyunsaturated fatty acids (PUFA) (n-3 PUFA and conjugated linolenic acid (CLA)) as means of improving cardiovascular and inflammatory health. Sixty-eight overweight and obese subjects (BMI ≥ 27 and <40 kg/m2), with at least two risk factors for cardiovascular disease (CVD) in a lipid panel blood tests, participated in a randomized, placebo-controlled, double-blind, parallel designed study. The subjects consumed for 12 weeks: (1) 60 g/d control goat cheese and (2) 60 g/d goat cheese naturally enriched in n-3 PUFA and CLA. Diet and physical activity were assessed. Anthropometric and dual-energy X-ray absorptiometry (DXA) tests were performed. Blood samples were collected at the beginning and at the end of the study period. Changes in health status, lifestyle and dietary habits, and daily compliance were recorded. The consumption of a PUFA-enriched goat cheese significantly increased plasma high-density lipoprotein (HDL)-cholesterol, as well as in apolipoprotein B, and it significantly decreased high-sensitivity C-reactive protein concentrations compared to the control goat cheese (p < 0.05). The significant improvement of the plasma lipid profile and inflammatory status of people with risk for CVD due to the consumption of PUFA-enriched cheese suggests a potential role of this dairy product as an alternative to develop high nutritional value food in a balanced diet comprising regular exercise.

Diabetes-specific formulas high in monounsaturated fatty acids and metabolic outcomes in patients with diabetes or hyperglycaemia. A systematic review and meta-analysis.

OBJECTIVE: The aim of this study was to compare the metabolic benefits of diabetes-specific formulas (DSF) high in monounsaturated fatty acids (MUFA) with standard formulas (STDF) in adult patients with type 1, type 2 diabetes or stress-induced hyperglycaemia. RESEARCH DESIGN AND METHODS: A systematic review and meta-analysis were conducted through a literature search using different electronic databases from the index date to December 2018. We included randomised controlled trials that assessed the health benefits of high MUFA DSF vs STDF. Included outcomes were glycaemic control, lipid metabolism and tolerance. Effect sizes were calculated as standardised mean differences (SMDs) (<0.4 were considered small, 0.4-0.7 moderate and >0.7 large). This systematic review was registered as CRD42018108931 on Prospero. RESULTS: Of 385 references reviewed, 18 studies involving 845 adults met our inclusion criteria and contributed to the meta-analysis. Use of a high MUFA DSF compared with a STDF was associated with a statistically significant decrease in peak of postprandial glucose [SMD -1.53, 95% confidence interval (CI) -2.44 to -0.61], incremental glucose response (SMD -1.19, 95% CI -1.71 to -0.68), area under the curve of plasma insulin (SMD -0.65, 95% CI -1.03 to -0.26), mean blood glucose level (SMD -0.41, 95% CI -0.63 to -0.19), glycosylated haemoglobin (HbA1c) change (SMD -0.63, 95% CI -1.21 to -0.05), glucose variability (SMD -0.93, -1.55 to -0.31), mean administered insulin dose (SMD -0.49, 95% CI -0.85 to -0.14), mean blood triglycerides (SMD -0.34, 95% CI -0.65 to -0.03) and increase of mean blood high-density lipoproteins (SMD +0.42, 95% CI 0.08 to 0.76). Non-significant differences were found for tolerance [odds ratio (OR) 0.95, 95% CI 0.87 to 1.05]. CONCLUSIONS: This meta-analysis shows that a DSF (oral supplements and tube feeds) high in MUFAs can improve glucose control and metabolic risk factors among patients with diabetes or stress-induced hyperglycaemia compared with a STDF.

Supplementation with Hydroxytyrosol and Punicalagin Improves Early Atherosclerosis Markers Involved in the Asymptomatic Phase of Atherosclerosis in the Adult Population: A Randomized, Placebo-Controlled, Crossover Trial.

Hydroxytyrosol (HT) and Punicalagin (PC) exert cardioprotective and anti-atherosclerotic effects. This study evaluates the effect of oral supplementation with HT and PC (SAx) on early atherosclerosis markers in middle-aged, seemingly healthy adults. A randomized, double-blinded, placebo-controlled, crossover trial was performed for 20 weeks. There were two treatment sequences (Placebo/SAx, n = 41; SAx/Placebo, n = 43) for which the intervention periods (Placebo and SAx) were 8 weeks long, followed by a 4-week wash out period. The supplement was composed of 9.9 mg of HT and 195 mg of PC, and the placebo was composed of maltodextrin. SAx increased endothelial function (Flow-mediated dilatation [FMD]: 2.36%; p < 0.001) in the endothelial dysfunction subgroup compared to the placebo (2.36 ± 3.9 vs. 0.76 ± 3.5%, p < 0.05). SAx also reduced oxLDL by -28.74 ng/mL (p < 0.05) in subjects with higher levels of oxLDL, which was an improvement compared with the placebo (-28.74 ± 40.2 vs. 25.64 ± 93.8 ng/mL, p < 0.001). The prehypertension and hypertension subgroups exhibited decreased systolic (-15.75 ± 9.9 mmHg; p < 0.001) and diastolic (-6.36 ± 8.7 mmHg; p < 0.001) blood pressure after SAx consumption. Moreover, the systolic prehypertension and hypertension subgroups presented significant differences in systolic blood pressure compared to the placebo (-15.75 ± 9.9 vs. -2.67 ± 12.0 mmHg, p < 0.05). In conclusion, the supplement exerted anti-atherosclerotic effects by improving endothelial function, blood pressure, and levels of circulating oxLDL, especially for persons in whom these parameters were altered.

[Bioactive food compounds as adjuvants to breast cancer treatment: vitamin D and omega-3]. / Compuestos bioactivos de alimentos como coadyuvantes a los tratamientos de cáncer de mama: vitamina D y omega-3.

INTRODUCTION: breast cancer (BC) is the most commonly diagnosed tumor in women and it continues to be the leading cause of cancer death in women. Quality of life decreases significantly during treatment and in the survivors. There is growing evidence linking the intake of certain foods, or their bioactive compounds, with better prognosis of the disease or improvements in physiological parameters that can increase BC patients' quality of life. But there are hardly any reviews to clarify the scientific evidence. OBJECTIVES: gathering and summarizing the available evidence on the effectiveness of the dietary compounds use as coadjuvants for BC treatment. METHOD: literature search using Pubmed to identify and analyze bioactive compounds as coadjvants for BC treatment. RESULTS: all tested compounds showed antitumor effects in vitro. Vvitamin D decrease risk of bone fracture, and marine lipids may reduce bone resorption and inflammation. CONCLUSION: there are bioactive compounds with potential to improve the quality of life of women with BC. Vitamin D a marine lipids provide a solid quality scientific evidence. Despite this, more controlled clinical trials are required to establish a direct link between the use of these compounds and the tumor progression or patient survival.

INTRODUCCIÓN: el cáncer de mama (CM) es el tumor más diagnosticado en mujeres y la primera causa de muerte por cáncer en este grupo de población. La calidad de vida disminuye durante los tratamientos, así como a largo plazo en las supervivientes. Numerosos estudios relacionan la ingesta de algunos alimentos o sus compuestos bioactivos con un mejor pronóstico de la enfermedad o mejoras en la calidad de vida de pacientes con CM, pero apenas existen revisiones que permitan aclarar la evidencia científica. OBJETIVOS: agrupar y sintetizar la evidencia disponible sobre la efectividad del empleo de compuestos bioactivos de alimentos como coadyuvantes del tratamiento del CM. MÉTODOS: revisión bibliográfica mediante sistema de búsqueda PubMed para la identificación y estudio de compuestos bioactivos con posible efecto coadyuvantes en el tratamiento de CM. RESULTADOS: todos los compuestos analizados mostraron efectos antitumorales in vitro. La vitamina D contribuye a reducir las fracturas óseas. Los lípidos marinos disminuyen la resorción ósea y la inflamación. CONCLUSIÓN: existen compuestos bioactivos con potencial terapéutico para mejorar la calidad de vida de mujeres con CM. La vitamina D y los lípidos marinos son los que presentan mayor evidencia. Sin embargo, se necesitan más ensayos clínicos controlados para confirmar una relación directa entre el empleo de estos compuestos y la evolución tumoral o la supervivencia en CM.

[Costs associated to disease-related malnutrition and treatment: a literature review]. / Costes asociados a la desnutrición relacionada con la enfermedad y su tratamiento: revisión de la literatura.

INTRODUCTION: disease-related malnutrition has a high prevalence, with clinical consequences potentially severe for the patient, and of high economic impact for the healthcare system. OBJECTIVE: to perform a review of the literature regarding the economic burden of disease-related malnutrition, to assess complications, and to determine the usefulness of enteral or oral nutritional supplementation from a cost analysis perspective. METHODS: a review of the literature up to June 2016 was carried out regarding economic costs of disease-related malnutrition and cost analysis of nutritional treatment, with special focus on retrieval of systematic reviews, meta-analysis, and randomized clinical trials. RESULTS: a total of 31 publications were selected, 15 on costs of disease-related malnutrition and 16 on costs of treatment. Disease-related malnutrition increases health care costs in relation to a longer hospital stay, higher incidence of infectious and non-infectious complications, greater need of treatment, increase in readmissions, more prolonged stay in the intensive care unit and/or the need of referral to continuing care centers at discharge. Publications regarding treatment with oral nutritional supplements suggest that these oral supplements are cost-effective and cost-beneficial both in ambulatory and hospitalized patients. CONCLUSIONS: disease-related malnutrition causes an increase in health care costs that could be minimized, among other approaches, by an early diagnosis and treatment for which oral nutritional supplements are cost-effective and cost-beneficial.

Costes asociados a la desnutrición relacionada con la enfermedad y su tratamiento: revisión de la literatura / Costs associated to disease-related malnutrition and treatment: a literature review

Introducción: la desnutrición relacionada con la enfermedad tiene una elevada prevalencia, con consecuencias clínicas potencialmente graves para el paciente y de alto impacto económico para el sistema sanitario. Objetivos: realizar una revisión de la literatura sobre los costes económicos de la desnutrición asociada a la enfermedad, analizar sus complicaciones y evaluar la utilidad de la nutrición enteral u oral bajo la perspectiva del análisis de costes. Métodos: se llevó a cabo una revisión de la literatura hasta junio de 2016 sobre los costes económicos de la desnutrición y el análisis de costes del tratamiento nutricional, priorizando las revisiones sistemáticas, los metaanálisis y los ensayos clínicos aleatorizados. Resultados: se identificaron 31 publicaciones, 15 sobre los costes de la desnutrición relacionada con la enfermedad y 16 de análisis de costes del tratamiento. La desnutrición relacionada con la enfermedad incrementa los costes sanitarios por una mayor estancia hospitalaria, mayor incidencia de complicaciones infecciosas y no infecciosas, mayor necesidad de tratamientos, incremento de los reingresos, estancias más prolongadas en unidades de cuidados intensivos y/o la necesidad de derivación al alta a centros de continuación de cuidados. Las publicaciones evaluadas sobre el tratamiento mediante suplementos nutricionales orales sugieren que los suplementos nutricionales orales son coste-efectivos y coste-útiles tanto en pacientes ambulatorios como en pacientes hospitalizados. Conclusiones: la desnutrición relacionada con la enfermedad produce un incremento de los costes sanitarios que podría minimizarse, entre otras formas, mediante un diagnóstico y tratamiento precoz de la misma, para lo cual los suplementos nutricionales orales constituyen una herramienta coste-eficaz y coste-útil

Introduction: disease-related malnutrition has a high prevalence, with clinical consequences potentially severe for the patient, and of high economic impact for the healthcare system. Objective: to perform a review of the literature regarding the economic burden of disease-related malnutrition, to assess complications, and to determine the usefulness of enteral or oral nutritional supplementation from a cost analysis perspective. Methods: a review of the literature up to June 2016 was carried out regarding economic costs of disease-related malnutrition and cost analysis of nutritional treatment, with special focus on retrieval of systematic reviews, meta-analysis, and randomized clinical trials. Results: a total of 31 publications were selected, 15 on costs of disease-related malnutrition and 16 on costs of treatment. Disease-related malnutrition increases health care costs in relation to a longer hospital stay, higher incidence of infectious and non-infectious complications, greater need of treatment, increase in readmissions, more prolonged stay in the intensive care unit and/or the need of referral to continuing care centers at discharge. Publications regarding treatment with oral nutritional supplements suggest that these oral supplements are cost-effective and cost-beneficial both in ambulatory and hospitalized patients. Conclusions: disease-related malnutrition causes an increase in health care costs that could be minimized, among other approaches, by an early diagnosis and treatment for which oral nutritional supplements are cost-effective and cost-beneficial

[Consensus document about the nutritional evaluation and management of eating disorders: anorexia nervosa, bulimia nervosa, binge eating disorder, and others]. / Resumen ejecutivo "Consenso sobre la evaluación y el tratamiento nutricional de los trastornos de la conducta alimentaria: anorexia nerviosa, bulimia nerviosa, trastorno por atracón y otros".

Eating disorders (ED) are characterized by persistent changes in eating habits that negatively affect a person's health and psychosocial abilities. They are considered psychiatric disorders, highly variable in their presentation and severity, with a huge impact on nutrition, which conditions various therapeutic approaches within a key multidisciplinary context. A group of experts in nutrition, we decided to set up a task force adscribed to the "Sociedad Española de Nutrición Parenteral y Enteral" (SENPE), which has stated as one of its goals the development of a consensus document to generate a protocol based on the best scientific evidence and professional experience available in order to improve health care in this field.

[Consensus document about the nutritional evaluation and management of eating disorders: anorexia nervosa]. / Consenso sobre la evaluación y el tratamiento nutricional de los trastornos de la conducta alimentaria: anorexia nerviosa.

Anorexia nervosa is the most common psychiatric disease among young women and it is assumed to be of multifactorial origin. Diagnostic criteria have recently been modified; therefore amenorrhea has ceased to be a part of them. This disease shows a large variability in its presentation and severity which conditions different therapeutic approaches and the need to individualize the treatment, thus it is indispensable a multidisciplinary approach. The goals are to restore nutritional status (through an individualized diet plan based on a healthy consumption pattern), treat complications and comorbidities, nutritional education (based on healthy eating and nutritional patterns), correction of compensatory behaviors and relapse prevention. The treatment will vary according to the patient's clinical situation, and it may be performed in outpatient clinics (when there is clinical stability), in a day hospital or ambulatory clinic (intermediate mode between traditional outpatient treatment and hospitalization) or hospitalization (when there is outpatient management failure or presence of serious medical or psychiatric complications). Artificial nutrition using oral nutritional supplements, enteral nutrition and exceptionally parenteral nutrition may be necessary in certain clinical settings. In severely malnourished patients the refeeding syndrome should be avoided. Anorexia nervosa is associated with numerous medical complications which determines health status, life quality, and is closely related to mortality. There is little clinical evidence to assess the results of different treatments in anorexia nervosa, when most of the recommendations are being based on expert consensus.

[Consensus document about the nutritional evaluation and management of eating disorders: bulimia nervosa, binge eating disorder, and others]. / Consenso sobre la evaluación y el tratamiento nutricional de los trastornos de la conducta alimentaria: bulimia nerviosa, trastorno por atracón y otros.

Bulimia nervosa and binge eating disorder are unique nosological entities. Both show a large variability related to its presentation and severity which involves different therapeutic approaches and the need to individualize the treatment, thus it is indispensable a multidisciplinary approach. Patients with bulimia nervosa may suffer from malnutrition and deficiency states or even excess weight, while in binge eating disorders, it is common overweight or obesity, which determine other comorbidities. Many of the symptoms and complications are associated with compensatory behaviors. There are many therapeutic tools available for the treatment of these patients. The nutritional approach contemplates the individualized dietary advice which guarantees an adequate nutritional state and nutritional education. Its objective is to facilitate the voluntary adoption of eating behaviors that promote health and allow the long-term modification of eating habits and the cessation of purgatory and bingeing behaviors. Psychological support is a first-line treatment and it must address the frequent disorder of eating behavior and psychiatric comorbidities. Psychotropic drugs are effective and widely used although these drugs are not essential. The management is carried out mainly at an outpatient level, being the day hospital useful in selected patients. Hospitalization should be reserved to correct serious somatic or psychiatric complications or as a measure to contain non-treatable conflict situations. Most of the guidelines' recommendations are based on expert consensus, with little evidence which evaluates clinical results and cost-effectiveness.

Resumen ejecutivo "Consenso sobre la evaluación y el tratamiento nutricional de los trastornos de la conducta alimentaria: anorexia nerviosa, bulimia nerviosa, trastorno por atracón y otros" / No disponible

No disponible

Consenso sobre la evaluación y el tratamiento nutricional de los trastornos de la conducta alimentaria: anorexia nerviosa / No disponible

La anorexia nerviosa es la enfermedad psiquiátrica más frecuente entre las mujeres jóvenes y se asume de origen multifactorial. Los criterios diagnósticos han sido recientemente modificados de forma que la amenorrea deja de formar parte de ellos. Esta enfermedad muestra una gran variabilidad en su presentación y gravedad, lo que condiciona diferentes abordajes terapéuticos y la necesidad de individualizar el tratamiento, haciéndose indispensable un enfoque multidisciplinar. Los objetivos persiguen restaurar el estado nutricional (a través de un plan dietético individualizado y basado en un patrón de consumo saludable), tratar las complicaciones y comorbilidades, la educación nutricional (basada en patrones alimentarios y nutricionales sanos), corrección de las conductas compensatorias y la prevención de recaídas. El tratamiento variará según la situación clínica del paciente, pudiendo realizarse en consultas externas (cuando existe estabilidad clínica), en hospital de día (modalidad intermedia entre el tratamiento ambulatorio tradicional y la hospitalización) o en hospitalización (fracaso del manejo ambulatorio o presencia de complicaciones médicas o psiquiátricas graves). La nutrición artificial a través del empleo de suplementos nutricionales orales, nutrición enteral y excepcionalmente nutrición parenteral puede ser necesaria en determinados escenarios clínicos. En pacientes severamente desnutridos se debe evitar el síndrome de realimentación. La anorexia nerviosa está asociada a numerosas complicaciones médicas que condicionan el estado de salud, la calidad de vida y que se relacionan estrechamente con la mortalidad. Existe poca evidencia clínica para evaluar los resultados de los distintos tratamientos en la anorexia nerviosa, estando basados la mayoría de las recomendaciones en consenso de expertos

Anorexia nervosa is the most common psychiatric disease among young women and it is assumed to be of multifactorial origin. Diagnostic criteria have recently been modified; therefore amenorrhea has ceased to be a part of them. This disease shows a large variability in its presentation and severity which conditions different therapeutic approaches and the need to individualize the treatment, thus it is indispensable a multidisciplinary approach. The goals are to restore nutritional status (through an individualized diet plan based on a healthy consumption pattern), treat complications and comorbidities, nutritional education (based on healthy eating and nutritional patterns), correction of compensatory behaviors and relapse prevention. The treatment will vary according to the patient's clinical situation, and it may be performed in outpatient clinics (when there is clinical stability), in a day hospital or ambulatory clinic (intermediate mode between traditional outpatient treatment and hospitalization) or hospitalization (when there is outpatient management failure or presence of serious medical or psychiatric complications). Artificial nutrition using oral nutritional supplements, enteral nutrition and exceptionally parenteral nutrition may be necessary in certain clinical settings. In severely malnourished patients the refeeding syndrome should be avoided. Anorexia nervosa is associated with numerous medical complications which determines health status, life quality, and is closely related to mortality. There is little clinical evidence to assess the results of different treatments in anorexia nervosa, when most of the recommendations are being based on expert consensus

Consenso sobre la evaluación y el tratamiento nutricional de los trastornos de la conducta alimentaria: bulimia nerviosa, trastorno por atracón y otros / No disponible

La bulimia nerviosa y el trastorno por atracón constituyen entidades nosológicas propias. Ambas muestran una gran variabilidad en su presentación y gravedad, lo que implica la individualización del tratamiento y la necesidad de equipos multidisciplinares. Los pacientes con bulimia nerviosa pueden presentar desde desnutrición y estados carenciales a exceso de peso, mientras que en los trastornos por atracón es habitual el sobrepeso u obesidad, que condiciona a su vez otras comorbilidades. Muchos de los síntomas y complicaciones derivan de las conductas compensatorias. Se dispone de diversas herramientas terapéuticas para el tratamiento de estos pacientes. El abordaje nutricional contempla el consejo dietético individualizado que garantice un adecuado estado nutricional y la correcta educación nutricional. Su objetivo es facilitar la adopción voluntaria de comportamientos alimentarios que fomenten la salud y que permitan la modificación a largo plazo de los hábitos alimentarios y el cese de conductas purgantes y atracones. El soporte psicológico es el tratamiento de primera línea y debe abordar el trastorno de la conducta alimentaria y las comorbilidades psiquiátricas que frecuentemente presentan. Los psicofármacos, aunque eficaces y ampliamente utilizados, no son imprescindibles. El manejo se realiza principalmente a nivel ambulatorio, siendo el hospital de día útil en pacientes seleccionados. Se debe reservar la hospitalización para corregir aquellas complicaciones somáticas o psiquiátricas graves o como medida de contención de las situaciones conflictivas no tratables de forma ambulatoria. La mayoría de las recomendaciones de las guías se basan en consensos de expertos, existiendo poca evidencia que evalúe los resultados clínicos y de coste-eficacia

Bulimia nervosa and binge eating disorder are unique nosological entities. Both show a large variability related to its presentation and severity which involves different therapeutic approaches and the need to individualize the treatment, thus it is indispensable a multidisciplinary approach. Patients with bulimia nervosa may suffer from malnutrition and deficiency states or even excess weight, while in binge eating disorders, it is common overweight or obesity, which determine other comorbidities. Many of the symptoms and complications are associated with compensatory behaviors. There are many therapeutic tools available for the treatment of these patients. The nutritional approach contemplates the individualized dietary advice which guarantees an adequate nutritional state and nutritional education. Its objective is to facilitate the voluntary adoption of eating behaviors that promote health and allow the long-term modification of eating habits and the cessation of purgatory and bingeing behaviors. Psychological support is a first-line treatment and it must address the frequent disorder of eating behavior and psychiatric comorbidities. Psychotropic drugs are effective and widely used although these drugs are not essential. The management is carried out mainly at an outpatient level, being the day hospital useful in selected patients. Hospitalization should be reserved to correct serious somatic or psychiatric complications or as a measure to contain non-treatable conflict situations. Most of the guidelines' recommendations are based on expert consensus, with little evidence which evaluates clinical results and cost-effectiveness

Revisión de la evidencia científica sobre el papel de compuestos bioactivos de alimentos como coadyuvantes a los tratamientos antineoplásicos de cáncer de mama / A review of the scientific evidence on the role of bioactive food compounds as adjuvants to antineoplasic breast cancer treatment

Fundamentos: El cáncer de mama (CM) es el tumor más diagnosticado en mujeres y, a pesar de las altas tasas de curación, sigue siendo la primera causa de muerte por cáncer en este grupo de población. La calidad de vida disminuye significativamente durante los tratamientos, así como a largo plazo en el creciente número de supervivientes. Por lo que se necesita buscar nuevos tratamientos coadyuvantes que permitan aumentar la supervivencia y/o mejorar la calidad de vida en este colectivo. Numerosos estudios relacionan la ingesta de algunos alimentos, o compuestos bioactivos derivados de alimentos, con un mejor pronóstico de la enfermedad o con mejoras en la calidad de vida de pacientes con CM. El objetivo fue agrupar y sintetizar la evidencia disponible sobre la efectividad del empleo de compuestos bioactivos de alimentos como coadyuvantes en el tratamiento de CM. Métodos: Revisión bibliográfica mediante el sistema de búsqueda PubMed para la identificación y estudio de compuestos bioactivos con posible efecto coadyuvante en el tratamiento de CM. Resultados: Todos los compuestos analizados mostraron efectos antitumorales in vitro. Las catequinas del té verde tienen cierto potencial en la disminución del riesgo cardiovascular, la vitamina D participa en la reducción de fracturas óseas, la vitamina E podría disminuir los casos de linfedema y los lípidos marinos participan en la reducción de la resorción ósea y la inflamación. Conclusiones: Existen compuestos bioactivos con potencial terapéutico para mejorar la calidad de vida de mujeres con CM. Aun así, no existe suficiente evidencia que confirme una relación directa entre el empleo de estos compuestos y la evolución tumoral o la supervivencia en CM (AU)

Background: Breast cancer (BC) is the most commonly diagnosed tumor in women and, despite the high cure rates, it continues to be the leading cause of cancer death in this group. Life quality decreases significantly during the treatment of BC and at long term in the growing number of survivors. There is a need to find new adjuvant treatments to increase survival and/or improve the life quality in these women. There is growing evidence linking the intake of certain foods, or bioactive compounds derived from foods, with better prognosis of the disease or improvements in physiological parameters that can increase BC patients’ quality of life. The aim was gathering and summarizing the available evidence on the effectiveness of the use of dietary bioactive compounds as coadjuvants for the BC treatment. Methods: Literature search using Pubmed to identify and analyze bioactive compounds that could act as coadjvants for BC treatment. Results: All tested compounds showed antitumor effects in vitro. The catechins in green tea have the potential to reduce cardiovascular risk, vitamin D lowers risk of bone fracture, vitamin E could have some effect in the reduction of lymphedema and marine lipids may reduce bone resorption and inflammation. Conclusions: There are bioactive compounds with potential to improve the quality of life of women with BC. Despite this, there is no sufficient evidence to establish a direct link between the use of these compounds and the tumor progression or patient survival (AU)