Nutrición Parenteral Domiciliaria en España 2011 y 2012; informe del grupo de nutrición artificial domiciliaria y ambulatoria NADYA / Home parenteral nutrition in Spain 2011 and 2012; a report of the home and ambulatory artificial nutrition group NADYA

Objetivo: Comunicar los datos del registro de Nutrición Parenteral Domiciliaria (NPD) del grupo de trabajo NADYA-SENPE de los años 2011 y 2012. Material y métodos: Recopilación de los datos del registro "on-line" introducidos por los colaboradores del grupo NADYA responsables del seguimiento de la NPD desde el 1 de enero de 2011 al 31 de diciembre de 2012 dividido por años naturales. Resultados: Año 2010: Se registraron 184 pacientes, procedentes de 29 hospitales, lo que representa una tasa de 3,98 pacientes/millón habitantes/año 2011, con 186 episodios de NPD. Durante el año 2012 se registraron 203 pacientes, procedentes de 29 hospitales, lo que representa una tasa de 4,39 pacientes/millón habitantes/año 2012, con un total de 211 episodios de NPD. Conclusiones: Se observa un aumento progresivo de los pacientes registrados respecto a años anteriores. El principal grupo patológico sigue siendo oncológico ocupando el primer lugar desde 2003. Aunque el registro NADYA es un registro consolidado y ha sido y es fuente imprescindible de información relevante para el conocimiento de los avances de la Nutrición Artificial Domiciliaria en nuestro país, queda un amplio margen para la mejora. En especial lo que hace referencia al registro de pacientes pediátricos y al registro de las complicaciones (AU)

Objective: To report the data of the Home Parenteral Nutrition (HPN) registry of the NADYA-SENPE working group for the years 2011 and 2012. Methodology: We compiled the data from the on-line registry introduced by reviewers of NADYA group responsible for monitoring of NPD introduced by since January 1, 2011 to december 31, 2012. Included fields were: age, sex, diagnosis and reason for HPN, access path, complications, beginning and end dates, complementary oral or enteral nutrition, activity level, autonomy degree, product and fungible material supply, withdrawal reason and intestinal transplant indication. Results: Year 2010: 184 patients from 29 hospitals, representing a rate of 3.98 patients/million inhabitants/ year 2011, with 186 episodes were recorded NPD. During 2012, 203 patients from 29 hospitals, representing a rate of 4.39 patients/million inhabitants/year 2012, a total of 211 episodes were recorded NPD. Conclusions: We observe an increase in registered patients with respect to previous years. Neoplasia remains as the main pathology since 2003. Although NADYA is consolidated registry and has been indispensable source of information relevant to the understanding of the progress of Home Artificial Nutrition in our country, there is ample room for improvement. Especially that refers to the registration of pediatric patients and the registration of complications (AU)

Deficient selenium status of a healthy adult Spanish population.

INTRODUCTION: Selenium is an essential micronutrient for human health, being a cofactor for enzymes with antioxidant activity that protect the organism from oxidative damage. An inadequate intake of this mineral has been associated with the onset and progression of chronic diseases such as hypertension, diabetes, coronary diseases, asthma, and cancer. For this reason, knowledge of the plasma and erythrocyte selenium levels of a population makes a relevant contribution to assessment of its nutritional status. OBJECTIVE: The objective of the present study was to determine the nutritional status of selenium and risk of selenium deficiency in a healthy adult population in Spain by examining food and nutrient intake and analyzing biochemical parameters related to selenium metabolism, including plasma and erythrocyte levels and selenium-dependent glutathione peroxidase (GPx) enzymatic activity. MATERIAL AND METHODS: We studied 84 healthy adults (31 males and 53 females) from the province of Granada, determining their plasma and erythrocyte selenium concentrations and the association of these levels with the enzymatic activity of glutathione peroxidase (GPx) and with life style factors. We also gathered data on their food and nutrient intake and the results of biochemical analyses. Correlations were studied among all of these variables. RESULTS: The mean plasma selenium concentration was 76.6 ± 17.3 µg/L (87.3 ± 17.4 µg/L in males, 67.3 ± 10.7 µg/L in females), whereas the mean erythrocyte selenium concentration was 104.6 µg/L (107.9 ± 26.1 µg/L in males and 101.7 ± 21.7 µg/L in females). The nutritional status of selenium was defined by the plasma concentration required to reach maximum GPx activity, establishing 90 µg/L as reference value. According to this criterion, 50% of the men and 53% of the women were selenium deficient. CONCLUSIONS: Selenium is subjected to multiple regulation mechanisms. Erythrocyte selenium is a good marker of longer term selenium status, while plasma selenium appears to be a marker of short-term nutritional status. The present findings indicate a positive correlation between plasma selenium concentration and the practice of physical activity. Bioavailability studies are required to establish appropriate reference levels of this mineral for the Spanish population.

Deficient selenium status of a healthy adult Spanish population / Deficiencia de selenio en una población adulta sana española

Introduction: Selenium is an essential micronutrient for human health, being a cofactor for enzymes with antioxidant activity that protect the organism from oxidative damage. An inadequate intake of this mineral has been associated with the onset and progression of chronic diseases such as hypertension, diabetes, coronary diseases, asthma, and cancer. For this reason, knowledge of the plasma and erythrocyte selenium levels of a population makes a relevant contribution to assessment of its nutritional status. Objetive: The objective of the present study was to determine the nutritional status of selenium and risk of selenium deficiency in a healthy adult population in Spain by examining food and nutrient intake and analyzing biochemical parameters related to selenium metabolism, including plasma and erythrocyte levels and selenium-dependent glutathione peroxidase (GPx) enzymatic activity. Material and methods: We studied 84 healthy adults (31 males and 53 females) from the province of Granada, determining their plasma and erythrocyte selenium concentrations and the association of these levels with the enzymatic activity of glutathione peroxidase (GPx) and with life style factors. We also gathered data on their food and nutrient intake and the results of biochemical analyses. Correlations were studied among all of these variables. Results: The mean plasma selenium concentration was 76.6 ± 17.3 μg/L (87.3 ± 17.4 μg/L in males, 67.3 ± 10.7 μg/L in females), whereas the mean erythrocyte selenium concentration was 104.6 μg/L (107.9 ± 26.1 μg/L in males and 101.7 ± 21.7 μg/L in females). The nutritional status of selenium was defined by the plasma concentration required to reach maximum GPx activity, establishing 90 μg/L as reference value. According to this criterion, 50% of the men and 53% of the women were selenium deficient. Conclusions: Selenium is subjected to multiple regulation mechanisms. Erythrocyte selenium is a good marker of longer term selenium status, while plasma selenium appears to be a marker of short-term nutritional status. The present findings indicate a positive correlation between plasma selenium concentration and the practice of physical activity. Bioavailability studies are required to establish appropriate reference levels of this mineral for the Spanish population (AU)

Introducción: El selenio es un micronutriente esencial para la salud del ser humano, debido fundamentalmente a su implicación como cofactor de enzimas con actividad antioxidante que protegen al organismo del daño oxidativo, de modo que una ingesta inadecuada de este mineral está asociada con la aparición y desarrollo de enfermedades crónicas tales como hipertensión, diabetes, enfermedades coronarias, asma y cáncer. Por esta razón, la determinación de selenio plasmático y eritrocitario contribuirá a la valoración del estado nutricional de la población estudiada. Objetivo: El objetivo de estudio fue valorar el estado nutricional de selenio en una población adulta sana en riesgo de deficiencia, a través de una evaluación de la ingesta, así como de los niveles de selenio en plasma y eritrocito, y la actividad de la enzima selenio-dependiente Glutation Peroxidasa (GPx) en eritrocito. Material y métodos: El estudio se realizó en un grupo de población de 84 adultos sanos pertenecientes a la provincia de Granada (31 hombres y 53 mujeres) en los que se determinó la ingesta de nutrientes y selenio, sus niveles plasmáticos y eritrocitarios, así como su asociación con la actividad de la enzima Glutation Peroxidasa y con diversos factores del estilo de vida. Resultados: Las concentraciones medias de selenio en plasma fueron de 76,6 ± 17,3 μg/L (87,3 ± 17,4 μg/L en los hombres, y de 67,3 ± 10,7 μg/L para las mujeres), mientras que los valores eritrocitarios de selenio de la poblacion total del estudio fue de 104,6 μg/L (107,9 ± 26,1 μg/L en hombres y 101,7 ± 21,7 μg/L en mujeres). La evaluacion del estado nutricional de selenio, se realizo en funcion de la concentracion en plasma necesaria para alcanzar la maxima actividad de GPx, estableciendo como valor de referencia 90 μg/L, observamos que el 50% de los hombres y el 53% de las mujeres se encuentran en situacion de deficiencia. Conclusiones: El selenio es un mineral sujeto a múltiples mecanismos de regulación. El selenio eritrocitario es un buen indicador del estatus mineral de selenio a largo plazo, mientras que el selenio plasmático es un indicador de estatus nutricional de selenio a corto plazo. Los resultados obtenidos mostraron una correlación positiva entre los niveles de selenio en plasma y la realización de actividad física. Es necesario disponer de más estudios de biodisponibilidad de selenio con el fin de poder establecer niveles de referencia de este mineral para la población española (AU)

Efectos de la suplementación con glutamina sobre el sistema antioxidante y la peroxidación lipídica en pacientes críticos con nutrición parenteral / Effects of supply with glutamine on antioxidant system and lipid peroxidation in patients with parenteral nutrition

Introducción: En el paciente crítico hay una continua producción de especies reactivas de oxígeno (ERO) que necesitan se neutralizadas para evitar el estrés oxidativo (EO). Entre las defensas antioxidantes endógenas, el sistema glutatión (GSH) es cuantitativamente el más importante, pero en situaciones de estrés severo se encuentra disminuido. Para incrementarlo, la suplementación con glutamina ha demostrado ser efectiva, ejerciendo protección contra el daño oxidativo y reduciendo la morbi-mortalidad. Objetivo: Valorar el efecto de la adición de un dipéptidoal anyl-glutamina a la NP sobre la peroxidación lipídica y el metabolismo del glutatión y su relación con la morbilidad de los pacientes críticos. Métodos: Determinación, mediante técnicas espectrofo-tométricas, de glutatión peroxidasa, glutatión reductasa, glutatión total y malonil aldehído al ingreso y tras siete días de estancia en la Unidad de Cuidados Intensivos (UCI) de 20 pacientes mayores de 18 años con tratamiento nutricional parenteral. Resultados: El grupo de pacientes que recibió nutrición parenteral con adición de glutamina experimentó aumentos significativos a la semana de tratamiento nutricional en la concentración del glutatión total (42,35 ± 13 vs 55,29 ± 12 μmol/l; p < 0,05), junto a un incremento de la actividad de la enzima glutatión peroxidasa (470 ± 195 vs 705 ± 214 μmol/l; p < 0,05). En cambio, el grupo con nutrición parenteral convencional no presentó modificaciones significativas en ninguno de los parámetros estudiados (p > 0,05). Sin embargo, tanto la mortalidad como la estancia en UCI no fue diferente para los grupos estudiados, mientras que si se observó una menor gravedad, valorada por e SOFA score, en el grupo de pacientes que recibieron glutamina (SOFA 5 ± 2 vs 8 ± 1,8; p < 0,05).Conclusiones: El aporte de glutamina en pacientes críticos mejora las defensas antioxidantes, lo que repercute en una menor peroxidación lipídica y menor morbilidad durante la estancia en UCI

Introduction: In the critically ill patient, there is a continuous production of reactive oxygen species (ROS) that need to be neutralized to prevent oxidative stress (OS). Quantitatively speaking, the glutathionesystem (GSH) is the most important anti-oxidant endogenous defense. To increase it, glutamine supplementation has been shown to be effective by protecting against the oxidative damage and reducing the morbimortality. Objective: To assess the effect of adding an alanylglutamine dipeptide to PN on lipid peroxidation lipidica and glutathione metabolism, as well as its relationship with morbidity in critically ill patients. Methods: Determination through spectrophotometry techniques of glutathione peroxidase, glutathione reductase, total glutathione, and maloniladdehyde at admission and after seven days of hospitalization at the Intensive Care Unit (ICU) in 20 patients older than 18 years on parenteral nutrition therapy. Results: The group of patients receiving parenteral nutrition with glutamine supplementation had significant increases in total glutathione (42.35 ± 13 vs 55.29 ±12 μmol/l; p < 0.05) and the enzymatic activity of glutathione peroxidasa (470 ± 195 vs 705 ± 214 μmol/l; p < 0.05) within one week of nutritional therapy, where as the group on conventional parenteral nutrition did not show significant changes of any of the parameters studied(p > 0.05). However, both mortality and ICU stay were not different between the study group, whereas the severity (assessed by the SOFA score) was lower in the group of patients receiving glutamine (SOFA 5 ± 2 vs 8 ±1.8; p < 0.05).Conclusions: Glutamine intake in critically ill patients improves the antioxidant defenses, which leads to lower lipid peroxidation and lower morbidity during admission at the ICU

[Effects of supply with glutamine on antioxidant system and lipid peroxidation in patients with parenteral nutrition]. / Efectos de la suplementación con glutamina sobre el sistema antioxidante y la peroxidación lipídica en pacientes críticos con nutrición parenteral.

INTRODUCTION: In the critically ill patient, there is a continuous production of reactive oxygen species (ROS) that need to be neutralized to prevent oxidative stress (OS). Quantitatively speaking, the glutathione system (GSH) is the most important anti-oxidant endogenous defense. To increase it, glutamine supplementation has been shown to be effective by protecting against the oxidative damage and reducing the morbimortality. OBJECTIVE: To assess the effect of adding an alanylglutamine dipeptide to PN on lipid peroxidation lipidica and glutathione metabolism, as well as its relationship with morbidity in critically ill patients. METHODS: Determination through spectrophotometry techniques of glutathione peroxidase, glutathione reductase, total glutathione, and maloniladdehyde at admission adn after seven days of hospitalization at the Intensive Care Unit (ICU) in 20 patients older than 18 years on parenteral nutrition therapy. RESULTS: The group of patients receiving parenteral nutrition with glutamine supplementation had significant increases in total glutathione (42.35+/-13 vs 55.29+/-12 micromol/l; p<0.05) and the enzymatic activity of glutathione peroxidasa (470+/-195 vs 705+/-214 micromol/l; p<0.05) within one week of nutritional therapy, whereas the group on conventional parenteral nutrition did not show significant changes of any of the parameters studied (p>0.05). However, both mortality and ICU stay were not different between the study group, whereas the severity (assessed by the SOFA score) was lower in the group of patients receiving glutamine (SOFA 5+/-2 vs 8+/-1.8; p<0.05). CONCLUSIONS: Glutamine intake in critically ill patients improves the antioxidant defenses, which leads to lower lipid peroxidation and lower morbidity during admission at the ICU.

Perspectives in the design and development of new products for enteral nutrition.

Enteral nutrition is a technique that even though it was used in times immemorial, in the last 25 years has suffered a considerable development, from being considered a secondary therapeutic weapon destined only to feed the patient, to occupying an important status that goes beyond the single act of nourishing. The quantitative composition but overall the qualitative one, is object of an interesting argument in which a profile allowing the modulation of certain aspects of the organism response through the supplementation with different nutrients is searched. That includes from the keeping of the intestinal trophism and of the anti-bacteria intestinal barrier, so important to avoid the frightening multiple organ dysfunction, up to the lessening of the Systemic Response Inflammatory Syndrome (SRIS), going through the immuno-modulative feeding concepts, specific-feeding, pharmaco-nutrient or eco-nutrition. In this new dynamic not only certain nutrients such as glutamine, arginine, nucleotides, omega-3 fatty acids and many antioxidants have acquired importance, but also the manipulation of other molecules of a non- nutritional nature, such as hormones, cytokines and blockers. These aspects that imply passionate ways of investigation for the future are born from the better knowledge that is being acquired from such a severe pathophysiology processes such as sepsis and the organism response before fast and severe aggression; therefore, the modulation of that response through changes in the quantitative and qualitative formulas composition is being attempted.

[Nutrients and energy intake assessment in the critically ill patient on enteral nutritional therapy]. / Valoración de la ingesta de nutrientes y energía en paciente crítico bajo terapia nutricional enteral.

INTRODUCTION AND OBJECTIVES: The critically ill patient is especially susceptible to malnutrition due to his/her hypermetabolic state that leads to an increase in the nutritional requirementes, which many times are not compensated with the administered enteral formulas. The assessment of nutritional intake is essential in this kind of patients to know to what level their energetic and nutritional requirements are fulfilled, improving and monitoring in the most individualized possible way to indicated clinical and nutritional therapu. METHODOLOGY: This is a retrospective study in which all patients admitted to the Intensive Care Unit of Virgen de las Nieves Hospital were studied from January to December of 2003, aged more than 18 years, and on enteral nutrition. A total of 90 patients (52 men and 38 women) were studied, 81% of which were older than 50 years, and 57% had hospital stays longer than 8 days, with a 21% mortality rate. Intake was assessed from time of admission and throughout the whole hospitalization period. Energetic requirements were calculated according to the modified Long's formula and micronutrients intakes were compared to existing general recommendations for the Spanish, European and American populations, and to vitaminic requirements in critically ill patients. RESULTS: Percentages of mean energy and nutrients intakes in relation to theoretical calculated requirements for both genders are presented in figure 1. Mean energy intake was 1,326 cal in men and 917 cal in women. With regards to micronutrients intake, the values found for proteins, falts, and carbohydrates were lower than 50% of the requirements for both genders. The percentage of adequacy as referred to requirements for vitamins and minerals intake is shown in figure 2. Reference recommendations used correspond to sufficient intakes to cover the healthy individual requirements, therefore, the values obtained in our study show and adequacy greater than 75%, with the exception of particular elements such as vitamin A and magnesium. However, by taking a look at figure 3, which shows the adequacy of vitamins intake at recommended does for sick patients, the intake is lower than 25% of the requirements in all cases, and these deficiencies significantly interfere with wound healing, the immune, cardiovascular and nervous systems, as well as with metabolism of the remaining macronutrients leading to an unbalanced situation of the antioxidant system, worsening the patient's clinical status. CONCLUSIONS: The present study confirms the need for monitoring individually the nutritional requirements in the critically ill patient and adapting recommendations to his/her metabolic changes, since currently these recommendations are not clearly defined for these situations. It is necessary to provide micronutrients doses closer to the patient's demands, so that the nutritional status and the balance of the antioxidant system may be preserved or improved, making the adopted clinical treatment more effective.

Valoración de la ingesta de nutrientes y energía en paciente crítico bajo terapia nutricional enteral / Nutrients and energy intake assessment in the critically ill patient on enteral nutritional therapy

Introducción y objetivos: El enfermo crítico es especialmente susceptible a la desnutrición debido a que su situación hipermetabólica conlleva a un aumento de los requerimientos nutricionales, que muchas veces no se cubren con el aporte de las fórmulas enterales suministradas. El estudio de la ingesta nutricional resulta imprescindible en este tipo de paciente para conocer en qué medida se cubren sus necesidades energético-nutricionales, mejorando y monitorizando la terapia clínico-nutricional a seguir de la manera más personalizada posible. Metodología: Es un estudio retrospectivo en el que se evaluaron todos los pacientes ingresados en la Unidad de Cuidados Intensivos del Hospital Virgen de las Nieves desde enero a diciembre de 2003, mayores de 18 años bajo tratamiento nutricional enteral. Se estudiaron un total de 90 pacientes (52 hombres y 38 mujeres), el 81% de los mismos eran mayores de 50 años de edad, el 57% tuvieron estancias superiores a 8 días con una mortalidad del 21%. Se valoró la ingesta desde el ingreso y durante todo el período de hospitalización. Los requerimientos energéticos se calcularon a partir de la fórmula de Long modificada y se compararon las ingestas de micronutrientes con las recomendaciones generales existentes tanto para la población española como la europea la americana, y los requerimientos vitamínicos para pacientes en estado grave. Resultados: En la figura 1 se presentan los porcentajes de ingestas medias de energía y nutrientes con relación a los requerimientos teóricos calculados para ambos sexos. El aporte energético medio fue para los hombres de 1.326 cal y de 917 cal para las mujeres. Con respecto a la ingesta de macronutrientes, los valores encontrados tanto para las proteínas como para las grasas y los carbohidratos fueron inferiores al 50% de los requerimientos en ambos sexos. En la figura 2 se observa el porcentaje de adecuación a los requerimientos en el consumo de vitaminas y minerales. Las recomendaciones utilizadas como referencia corresponden a ingestas suficientes para cubrir requerimientos de individuos sanos, por lo tanto, los valores obtenidos en nuestro estudio muestran una adecuación superior al 75%, salvo casos particulares como la vitamina A y el magnesio. Sin embargo al observar la figura 3, el cual nos muestra la adecuación de las ingestas vitamínicas a las dosis recomendadas para pacientes enfermos, la ingesta es inferior al 25% de lo requerido en todos los casos, estas deficiencias repercuten de manera significativa en la cicatrización, el sistema inmune, el cardiovascular y el nervioso así como en el metabolismo del resto de macronutrientes, provocando un desequilibrio en el sistema antioxidante y empeorando la situación clínica del paciente. Conclusiones: El presente estudio nos confirma la necesidad de monitorizar de una manera personalizada las necesidades nutricionales en el paciente crítico y adaptar las recomendaciones a sus cambios metabólicos, ya que las mismas no están claramente definidas para estas situaciones en la actualidad. Es necesario aportar dosis de micronutrientes que se acerquen más a sus necesidades y así preservar o mejorar el estado nutricional y el equilibrio del sistema antioxidante, haciendo más eficaz el tratamiento clínico aplicado

Introduction and objectives: The critically ill patient is especially susceptible to malnutrition due to his/her hypermetabolic state that leads to an increase in the nutritional requirementes, which many times are not compensated with the administered enteral formulas. The assessment of nutritional intake is essential in this kind of patients to know to what level their energetic and nutritional requirements are fulfilled, improving and monitoring in the most individualized possible way to indicated clinical and nutritional therapu. Methodology: This is a retrospective study in which all patients admitted to the Intensive Care Unit of Virgen de las Nieves Hospital were studied from January to December of 2003, aged more than 18 years, and on enteral nutrition. A total of 90 patients (52 men and 38 women) were studied, 81% of which were older than 50 years, and 57% had hospital stays longer than 8 days, with a 21% mortality rate. Intake was assessed from time of admission and throughout the whole hospitalization period. Energetic requirements were calculated according to the modified Long's formula and micronutrients intakes were compared to existing general recommendations for the Spanish, European and American populations, and to vitaminic requirements in critically ill patients. Results: Percentages of mean energy and nutrients intakes in relation to theoretical calculated requirements for both genders are presented in figure 1. Mean energy intake was 1,326 cal in men and 917 cal in women. With regards to micronutrients intake, the values found for proteins, falts, and carbohydrates were lower than 50% of the requirements for both genders. The percentage of adequacy as referred to requirements for vitamins and minerals intake is shown in figure 2. Reference recommendations used correspond to sufficient intakes to cover the healthy individual requirements, therefore, the values obtained in our study show and adequacy greater than 75%, with the exception of particular elements such as vitamin A and magnesium. However, by taking a look at figure 3, which shows the adequacy of vitamins intake at recommended does for sick patients, the intake is lower than 25% of the requirements in all cases, and these deficiencies significantly interfere with wound healing, the immune, cardiovascular and nervous systems, as well as with metabolism of the remaining macronutrients leading to an unbalanced situation of the antioxidant system, worsening the patient's clinical status. Conclusions: the present study confirms the need for monitoring individually the nutritional requirements in the critically ill patient and adapting recommendations to his/her metabolic changes, since currently these recommendations are not clearly defined for these situations. It is necessary to provide micronutrients doses closer to the patient's demands, so that the nutritional status and the balance of the antioxidant system may be preserved or improved, making the adopted clinical treatment more effective

Gentamicin therapy monitoring in seriously compromised patients.

Gentamicin therapy was monitored in 30 patients with severe infection and other concomitant disease states. The application of the nomogram of Hull and Sarubbi [6] produced good plasma levels and disappearance of the infective agent without evidence of drug toxicity in 70% of patients. The remaining 30% did not respond satisfactorily to the treatment and showed low drug serum concentrations; and them had heavy fluid losses; when we modified their treatment, outside of the nomogram guidelines, we observed a better response. Since gentamicin distributes essentially in extracellular water, subjects who have alterations of body fluids regulation should be carefully controlled.