Estrategias de guía e ingredientes dietéticos de precisión para enfermedades crónicas en población pre-sénior y sénior / Precision dietary guidelines and ingredients for chronic diseases in pre-senior and senior populations

El envejecimiento de la población supone un importante reto, económico y cualitativo, para el sistema de salud orientándolo hacia una atención de tipo preventivo, en la que la nutrición de precisión (NP) y la prescripción de hábitos saludables adquieren relevancia capital. El fin de la NP es procurar una nutrición adaptada a cada individuo, entendiendo que la prevención o el tratamiento de trastornos crónicos (obesidad, diabetes, enfermedad cardiovascular, etc.) deben abordarse de un modo integral, considerando información personal y clínica relevante, edad y características feno- y genotípicas. La elaboración de la presente guía surge de la necesidad de desarrollar modelos nutricionales de precisión que permitan la individualización del tratamiento nutricional, con énfasis en el adulto mayor. Las necesidades nutricionales, las recomendaciones dietéticas y los ingredientes para una NP en las personas pre-sénior y sénior quedan resumidas en realizar al menos 3 comidas diarias, reducir las calorías totales, optar por una alimentación variada y equilibrada con alimentos frescos y de alta densidad nutricional, incorporar verduras, legumbres y pescado, consumir productos lácteos y fibra, preferir carnes blancas en lugar de rojas, evitar frituras, embutidos y alimentos procesados, moderar el consumo de sal, café y alcohol, e hidratarse adecuadamente

The aging of the population underlines an important challenge for the health system not only from sanitary and economic reasons but also by quality perspectives concerning preventive care, where precision nutrition (PN) and the prescription or advice on healthy habits becomes relevant. PN focuses on provide nutrition adapted to each individual, understanding that the prevention or treatment of chronic disorders (obesity, diabetes, cardiovascular disease, etc.) must be addressed in a comprehensive way, considering not only relevant personal and clinical information, but also healthy aging and phenotypical and genotypical features. This guide was prepared due to the need to develop precision nutritional models that allow individualized nutritional treatment for each subject and physiopathological particularities with emphasis on the elderly. Therefore, the requirements of the Spanish pre-senior and senior populations, dietary recommendations and precision foods are reviewed in this document: have at least three daily meals, reduce total calories, choose a varied and balanced diet with fresh foods and high nutritional density, add vegetables, legumes and fish, consume dairy products and fiber, prefer white meat instead of red, avoid fried foods, sausages and processed foods, moderate the consumption of salt, coffee and alcohol, and get hydrated

Resolution of control and monitoring instrument of nutritional therapy in the intensive care unit of a university hospital / Resolución del instrumento de control y monitorización de la terapia nutricional en la unidad de cuidados intensivos de un hospital universitario

Introduction: Patients in intensive care status are in nutritional threat and frequently present innutrition, therefore monitoring the nutritional offer becomes indispensable. Aim: To purpose a control and monitoring form of enteral nutritional therapy and to evaluate its resoluteness. Methods: Observational, analytical and retrospective study performed in intensive care patients receiving an enteral diet exclusively and/or associated with the oral/parenteral route, from January to April 2015 and from January to April 2016. An enteral nutritional therapy control form was purposed and applied in 2016 and the results were compared to those of the previous year. In both of these years, five quality indicators proposed by the task force of clinical nutrition from the International Life Sciences Institute (Brazil, 2008) were applied. Results: Ninety-four patients, mostly aged, were included (47 per year) in the study. There was an increase in the number of patients that presented diarrhea (p = 0.007) and hyperglycemia (p = 0.013) as well as an increase in the occurrence of these episodes among patients (p = 0.018, p = 0.032, respectively). The frequency of diarrhea, fasting of more than 24 hours and hypoglycemia did not correspond to the goal established by the indicators. Energy and protein estimations were reported, as well as their compliance with the literature. Conclusion: After using the form, a greater report of clinical intercurrences and information on caloric and protein estimates was observed, thus demonstrating its effectiveness with respect to data recording (AU)

Introducción: los pacientes en terapia intensiva presentan riesgo nutricional y frecuentemente se encuentran en estado de malnutrición, por lo que es fundamental la monitorización de la oferta nutricional. Objetivo: proponer una forma de control y seguimiento de la terapia nutricional enteral y evaluar su efectividad. Métodos: estudio de observación, analítico y retrospectivo, realizado en pacientes ingresados en una unidad de cuidados intensivos que reciben dieta por vía enteral exclusiva y/o asociada a vía oral/parenteral, en el periodo de enero a abril de 2015 y de enero a abril de 2016. En 2016 se propuso y aplico un instrumento de control y monitorización de la terapia nutricional enteral en la unidad de cuidados intensivos y los resultados fueron comparados con los del año anterior. En ambos periodos se aplicaron cinco indicadores de calidad propuestos por el grupo especial de nutrición clínica del International Life Sciences Institute, de Brasil (2008). Resultados: se incluyen 94 pacientes y se estudiaron 47 en cada ano, la mayoría de ellos ancianos. Hubo un aumento del número de pacientes que desarrollaron diarrea (p = 0,007) e hiperglucemia (p = 0,013) y también de la cantidad de episodios de estas complicaciones (p = 0,018 y p = 0,032, respectivamente). La frecuencia de diarrea, ayuno superior a 24h e hipoglucemia no correspondía a la meta fijada por los indicadores. Se recogieron datos del aporte energético y proteico, así como su comparación con lo publicado. Conclusión: después de la utilización del instrumento hubo un aumento en el registro de complicaciones clínicas y la información referente a la estimación calórica y proteica, lo que demuestra su efectividad en el registro de datos para el cual fue desarrollado (AU)

Effects of nutritional support on short-term clinical outcomes and immune response in unresectable locally advanced oesophageal squamous cell carcinoma.

This retrospective study investigated the efficiency of nutritional support in unresectable locally advanced oesophageal squamous cell carcinoma (LAOSCC) patients who received concurrent chemoradiotherapy (CCRT) based on 5-fluorouracil and cisplatin. In the routine care group, 63 patients served as historical controls and received nutrition support in a reactive manner. In addition, 57 patients in the nutritional support group received timely diet counselling, oral nutritional supplements, enteral nutrition and/or parenteral nutrition during CCRT. This support was based on scores from nutritional risk screening 2002 (NRS-2002) after June 2014. The nutritional support group had significant advantages over the routine care group with respect to the incidence of neutropenia, the objective response rate, the change in serum albumin and the lengths of hospital stay. In addition, the nutritional support group had significantly higher levels of IgG and IL-2, higher proportions of NK, CD3+ and CD4+ cells as well as a higher ratio of CD4+ /CD8+ cells than the routine care group (p < .05). In contrast, the nutritional support group had a significantly lower level of IL-6. In conclusion, the current nutritional care programme could bring benefits of improving treatment compliance, reducing toxicity and lengths of hospital stay and enhancing the immune response.

Estado Nutricional e indicadores de qualidade em terapia nutricional de pacientes hematológicos internados em Hospital Público Universitário do Brasil / Nutritional status ans quality indicators in nutritional therapy of hematological patients hospitalized in Public University Hospital of Brazil

Objetivo: Avaliar o estado nutricional e a prevalência de adequação dos indicadores de qualidade em terapia nutricional (IQTNs) de pacientes hospitalizados na unidade de hematologia. Métodos: Estudo de caráter transversal, retrospectivo e descritivo, realizado no período fevereiro a maio de 2017, no qual foi avaliado o estado nutricional e os IQTNs (1- realização de triagem nutricional até 48 horas de internação, 2- medida de Índice de Massa Corporal (IMC), 3- catabolismo proteico pela circunferência do braço) de 133 pacientes internados na unidade de hematologia do Hospital Universitário da rede pública de saúde em Fortaleza, por meio de informações contidas no banco de dados dos serviços de nutrição. Resultados: A amostra predominante era do sexo feminino (60,9%). A idade média geral foi em torno de 45±16,0 anos. Observou-se que a maioria dos pacientes avaliados foram classificados como eutróficos pelo IMC (41,6%) e circunferência do braço (43,6%); no entanto, de acordo com a triagem nutricional, a maioria dos pacientes internados encontrava- se em risco nutricional (55,3%). Com relação aos IQTNs, observou-se conformidade no indicador 1 e não conformidade nos indicadores 2 e 3. Conclusão: Conclui-se que a maioria dos pacientes eram eutróficos; no entanto, apresentavam risco nutricional. Além disso, O IMC foi o único indicador de qualidade que atingiu a meta proposta. Sendo assim, ressalta-se a importância da avaliação periódica dos outros IQTNs do serviço de nutrição, visto que os pacientes hematológicos merecem atenção especial por apresentarem elevado risco nutricional e necessitarem de cuidados rigorosos

Objective: To evaluate the nutritional status and the adequacy prevalence of quality indicators for nutrition therapy (QINTs) of hospitalized patients in the hematology unit. Methods: A cross-sectional, retrospective and descriptive study was carried out between February and May 2017, in which nutritional status and QINTs were evaluated (1- nutritional screening up to 48 hours of hospitalization, 2- body mass index (BMI), 3- protein catabolism by arm circumference) of 133 patients hospitalized at the University Hospital of the public health service in Fortaleza, through information contained in the database of the nutrition services. Results: The predominant sample was female (60.9%). Overall mean age was around 45 ± 16.0 years. It was observed that the majority of the evaluated patients were classified as eutrophic based on BMI (41.6%) and arm circumference (43.6%); however, according to nutritional screening, most hospitalized patients were at nutritional risk (55.3%). With regard to QINTs, compliance with indicator 1 and nonconformity in indicators 2 and 3 were observed. Conclusions: It is concluded that the majority of patients were eutrophic; however, presented nutritional risk. The BMI was the only quality indicator that met the proposed goal. Therefore, the importance of periodic evaluation of other indicators of quality of nutrition service is emphasized, since hematological patients deserve special attention because they present high nutritional risk and require rigorous care

Objetivo: Evaluar el estado nutricional y la prevalencia de adecuación de los indicadores de calidad en terapia nutricional (IQTNs) de pacientes hospitalizados en la unidad de hematología. Método: El estudio de carácter transversal, retrospectivo y descriptivo, realizado en el período febrero a mayo de 2017, en el cual se evaluó el estado nutricional y los IQTNs (1- realización de clasificación nutricional hasta 48 horas de internación, 2- medida de Índice de Masa Corporal (IMC), 3- catabolismo proteico por la circunferencia del brazo) de 133 pacientes internados en la unidad de hematología del Hospital Universitario de la red pública de salud en Fortaleza, por medio de informaciones contenidas en el banco de datos de los servicios de nutrición. Resultados: La muestra predominante era del sexo femenino (60,9%). La edad media general fue de alrededor de 45 ± 16,0 años. Se observó que la mayoría de los pacientes evaluados fueron clasificados como eutróficos por el IMC (41,6%) y circunferencia del brazo (43,6%); sin embargo, de acuerdo con la clasificación nutricional, la mayoría de los pacientes internados se encontraba en riesgo nutricional (55,3%). Con respecto a los IQTNs, se observó conformidad en el indicador 1 y no conformidad en los indicadores 2 y 3. Conclusiones: Se concluye que la mayoría de los pacientes eran eutróficos; sin embargo, presentaban riesgo nutricional. Además, el IMC fue el único indicador de calidad que alcanzó la meta propuesta. Por lo tanto, se resalta la importancia de la evaluación periódica de los otros IQTNs del servicio de nutrición, ya que los pacientes hematológicos merecen atención especial por presentar un alto riesgo nutricional y necesitan cuidados rigurosos

Long-term nutritional impact of sleeve gastrectomy.

BACKGROUND: Sleeve gastrectomy (SG) has become a predominant bariatric procedure throughout the world. However, the long-term nutritional impact of this procedure is unknown. OBJECTIVES: To describe the nutritional deficiencies before and after SG and to analyze the influence of baseline weight on nutritional status. SETTING: University-affiliated tertiary care center. METHODS: All patients who underwent SG as a standalone procedure between 2008 and 2012 were included in this study. Patients were given multivitamin supplementation. Data were obtained from our prospectively maintained electronic database and are reported as mean ± standard deviation and percentage. Bivariate analyses were conducted to evaluate the influence of selected variables on outcomes. RESULTS: The mean age of the 537 patients was 48.0 ± 11.3 years, with an initial body mass index of 48.1 ± 8.7 kg/m2. Excess weight loss and total weight loss were 56.2% and 28.0% at 1 year and 43.0% and 21.1% at 5 years, respectively (P<.0001). Percentage of follow-up was 74% at 5 years (n = 79). The mean follow-up time was 34.3 ± 17.2 months. Hypoalbuminemia was present in 1.1% preoperatively and 4.2% at 5 years (P = .0043), low ferritin levels in 8.6% and 37.8% (P<.0001), low vitamin B12 in 30.3% and 16.4% (P<.0001), low vitamin D 63.2% and 24.3% (P<.0001), and hyperparathyroidism in 23.4% and 20.8% (P<.0001). There was no significant difference in the prevalence of anemia over time (P = 0.4301). The prevalence of vitamin A insufficiency peaked from 7.9% preoperatively to 28.7% at 3 months (P<.0001) and returned to baseline thereafter. Baseline weight was negatively correlated with vitamin B12 and vitamin D. CONCLUSION: Nutritional deficiencies are common in patients with morbid obesity before and after surgery. Preoperative supplementation and long-term nutritional follow-up are required to prevent nutritional deficiencies.

Estado nutricional de pacientes renais crônicos submetidos a tratamento hemodiálitico em um hospital de referência de Pernambuco / Nutritional state of chronic renal patients submetid to hemodialysis in a hospital of Pernambuco reference

Introdução: As alterações do estado nutricional de pacientes submetidos à Hemodiálise (HD) estão associadas ao aumento da morbidade e da mortalidade nesta população. Objetivo: Avaliar o estado nutricional de pacientes submetidos à programa de Hemodiálise. Métodos: Trata-se de um estudo transversal que foi realizado em 62 pacientes com idade superior a 18 anos, em programa regular de HD, há mais de 3 meses, no período de outubro de 2013 à maio de 2014. O estado nutricional foi determinado através da avaliação de dados antropométricos, bioquímicos e Avaliação Subjetiva Global (ASG). As medidas antropométricas coletadas foram: índice de massa corporal (IMC), circunferência braquial (CB), dobra cutânea tricipital (DCT), circunferência muscular do braço (CMB) e circunferência abdominal (CC). Os dados bioquímicos como albumina sérica, cálcio, fósforo, potássio, ureia pré e pós-diálise, hemoglobina, colesterol sérico total, triglicerídeos, glicemia e contagem total de linfócitos também foram avaliados. Resultados: A alteração nutricional mais prevalente foi a desnutrição. Sua prevalência apresentou ampla variação, a depender do método utilizado, variando de 64,5%, 44,3%, 37,1% e 35,5% para as medidas de DCT, IMC, CMB e CB respectivamente. Discussão: A comparação entre os grupos desnutridos e bem nutridos pela ASG mostrou diferenças significativas entre parâmetros nutricionais, com menores valores de adequação de CB, DCT, CC e albumina no grupo dos desnutridos. Conclusão: Observou-se alta prevalência de desnutrição nesta população, com variações dependendo do parâmetro utilizado. A ASG demonstrou ser um bom parâmetro na determinação do estado nutricional de pacientes em hemodiálise (AU)

Introduction: Changes in the nutritional status of patients undergoing hemodialysis (HD) are associated with increased morbidity and mortality in this population. Objective: To evaluate the nutritional status of patients undergoing hemodialysis program. Methods: This is a cross-sectional study performed in 62 patients aged over 18 in the regular HD program for more than three months, from October 2013 to May 2014. The nutritional status was determined through the evaluation of anthropometric and biochemical data and Subjective Global Assessment (SGA). Anthropometric measurements were collected: body mass index (BMI), arm circumference (AC), triceps skinfold (TSF), arm muscle circumference (AMB) and waist circumference (WC). The biochemical data as serum albumin, calcium, phosphorus, potassium, pre and post-dialysis urea, hemoglobin, total serum cholesterol, triglycerides, blood glucose and total lymphocyte count was also assessed. Results: The most prevalent nutritional alteration was malnutrition. Its prevalence showed wide variation, depending on the method used, ranging from 64.5%, 44.3%, 37.1% and 35.5% for measures of TSF, BMI, AMB and WC, respectively. Discussion: The comparison between the undernourished and well-nourished groups by SGA showed significant differences between nutritional parameters, with lower fitness values of WC, TSF, AC and albumin in the group of malnourished patients. Conclusion: There was a high prevalence of malnutrition in this population, with variations depending on the parameter used. The SGA has proven to be a good parameter in determining the nutritional status of hemodialysis patients (AU)

¿Podemos integrar la atención nutricional en los distintos niveles asistenciales? Reflexiones desde la cronicidad y la complejidad clínica / Is the integration of nutritional care in the different assistance levels possible? Reflections from the perspective of chronicity and clinical complexity

En los tiempos actuales, en los que la cronicidad es el argumento casi hegemónico de los sistemas de salud, la multimorbilidad y la gestión asistencial de las necesidades complejas aparecen como retos prioritarios de las sociedades del bienestar. En un 5% de la población la dificultad de los profesionales y de los agentes para identificar y responder a lo que estos pacientes necesitan -en términos de salud- es especialmente significativa. Ello conlleva un impacto muy relevante no solo desde el punto de vista clínico, sino también en cuanto a la resiliencia de los sistemas públicos de atención a las personas. En este contexto, las condiciones nutricionales tienen un papel destacado como marcador del estado de salud y como vector determinante de la morbimortalidad. A pesar de ello, los márgenes de mejora en la generación de conocimiento epidemiológico y en la aplicación de modelos de atención centrados en la persona son aún magníficos. La gestión de la desnutrición relacionada con las condiciones de cronicidad compleja va más allá del simple perfil de las enfermedades que la persona padece. Así, los condicionantes sociales tienen un rol explicativo central y constituyen una palanca prioritaria de la gestión clínica. Por todas estas consideraciones, los enfoques de atención integral, integrada y centrada en la persona, son los que mejor van a permitir atender a los pacientes más vulnerables de nuestro entorno en los que, con frecuencia, el argumento nutricional tendrá un papel destacado. El trabajo colaborativo parece ser, pues, una de las principales claves del éxito (AU)

Nowadays, chronicity is the leitmotiv in all healthcare systems. Consequently, multimorbidity and the management of complex care needs become a critical challenge in modern welfare societies. Professionals and other agents’ difficulties to identify and satisfy healthcare related needs of these patients is especially significant in a 5% of the population. This has an enormous impact not only from a clinical perspective, but also in terms of the resilience of public health care systems. In this context, nutritional status plays an outstanding role as a health indicator and also as a determinant vector of morbidity and mortality. However, improvement possibilities regarding the evolution of epidemiological knowledge and the implementation of person-centered attention models are still vast. The management of malnutrition related to complex chronic conditions is not limited to the profile of the patient’s conditions, since the explanatory role of social factors, which become key to clinical management, is crucial. As a result of the above, integrated and person-centered approaches, where nutritional factors often play an important role, are required to provide care to the most vulnerable patients within our settings. Therefore, collaborative work appears as one of the keys to success (AU)

Formulas alimentares: influência no estado nutricional, condição clínica e complicações na terapia nutricional domiciliar / Nutrition formulas: influence on nutritional condition, clinical condition and complications in household nutrition therapy

Introdução: As transições demográfica, epidemiológica e nutricional contribuem para o aumento do nú- mero de indivíduos com necessidade de Terapia Nutricional Enteral Domiciliar (TNED). Objetivo: Analisar a influência da categoria de fórmula nutricional no estado nutricional, nas complica- ções relacionadas à TNED e na necessidade de hospitalização de indivíduos em TNED. Métodos: Estudo clínico transversal observacional analítico realizado em Curitiba, PR, Brasil, com adultos e idosos em TNED. A antropometria, a categoria de fórmula alimentar infundida, a presença de complica- ções relacionadas à TNED e a necessidade de admissão hospitalar foram avaliadas. O estado nutricional foi classificado por meio do Índice de Massa Corporal (IMC). A estatística foi descritiva e as análises dos dados foi realizada por teste de qui-quadrado ou teste exato de Fisher e teste de Kruskal Wallis. O nível de significância adotado foi de 5% (p0,05). Discussão: Estudos sugerem que estado nutricional, complicações relacionadas à TNED e necessidade de hospitalização dependem da categoria de fórmula utilizada. Os resultados do presente estudo demonstraram que a categoria de fórmula não influencia o estado nutricional e admissões hospitalares. Conclusão: A categoria de fórmula não influencia no estado nutricional, presença de complicações e readmissões hospitalares. O estado nutricional comprometido não aumentou a ocorrência de complicações relacionadas à TNED e a necessidade de hospitalização (AU)

Introduction: Demographic, epidemiologic and nutritional transitions have contributed to increase Home Enteral Nutrition (HEN). Objective: To analyze the influence of enteral nutrition type in nutritional status, outcome related with HEN and need of hospital care. Method: Clinical cross-sectional, observational and analytical study in Curitiba, PR, Brazil, with adults and elders in HEN. Anthropometric data, diet enteral nutrition type, outcomes related with HEN and need of hospital care were assessed. Body Mass Index (BMI) classified nutritional status. Data were analyzed in descriptive and statistic way (chi-square, Fischer test and Kruskal Wallis test). Results: The final sample was 42 patients. Most of the participants was older than 60 years (mean age: 65y; minimum: 21y; maximum: 94y), 50% (n=21) of each sex. Undernutrition was observed in 72.7% and 86.2%, to adults and elders, respectively. Hospital care was needed by 72.8% and, industrialized and food blended enteral nutrition used concomitantly was observed to 57.1% of the patients. Gastrointestinal system outcomes were the most frequent (40.5%) and tube obstruction frequency was higher in food blended HEN. There were no association between nutritional status with outcomes and diet enteral nutrition type (p>0.05). Discussion: Studies suggested that nutritional status, outcome related with HEN and need of hospital care depends on HEN formula type, and these results are different from ours. HEN formula type did not influence nutritional status and need of hospital care. Conclusion: HEN formula type did not influence nutritional status, outcomes, and in need of hospital care. Nutritional status did not influence outcomes related with HEN, and in need of hospital care (AU)

Cost-effectiveness of early nutritional therapy in malnourished adult patients in a high complexity hospital / Coste-efectividad de la terapia nutricional temprana en pacientes adultos malnutridos en un hospital de alta complejidad

Introduction: hospital malnutrition is a frequent worldwide problem and its potential issues related include increased complications, length of stay, mortality, and healthcare costs. Objectives: the aim of this study was to establish the cost-effectiveness of early nutritional therapy for malnourished patients in a high complexity hospital. Materials and methods: this analytical study with economic assessment included 227 adult hospitalised and malnourished according to the Subjective Global Assessment. The cohort prospective received Early Nutrition Therapy (ENT), whereas the cohort retrospective received Delayed Nutrition Therapy (DNT). The measures of cost-effectiveness included costs by: length of stay, complications and discharge condition. Results: the cohorts were similar in demographic and clinical characteristics, except that the median age, for the ENT was 61 years (interquartile range [IQR]: 48-71) and for the DNT was 55 years (IQR: 44-67) (p = 0.024). The median length of stay was lower in the ENT (11 days, IQR: 7-17) than in the DNT (18 days, IQR: 10-28) (p < 0.001). The cost per patient discharged alive was US $ 10,261.55 in the ENT and US $ 15,553.11 in the DNT (p=0.043); the cost per patient with complications was US $ 13,663.90 in the ENT and US $ 17,860.32 in the DNT (p= 0.058). ENT increased the likelihood of being discharged alive, RR adjusted=0.31; 95% confidence interval (CI): 0.1; 0.6; (p<0.001) and decreased the likelihood of complications RR crude=0.8; 95% CI: 0.6; 0.9; (p=0.006). Conclusion: early nutritional therapy for malnourished adult patients appears to be cost-effective because it can reduce the length of stay, complications, mortality and associated costs (AU)

Introducción: la malnutrición hospitalaria es un problema frecuente en el mundo que aumenta las complicaciones, los días de estancia, la mortalidad y los costes sanitarios. Objetivos: el objetivo de este estudio fue establecer el coste-efectividad de la terapia nutricional precoz en pacientes malnutridos en un hospital de alta complejidad. Materiales y métodos: este estudio analítico con valoración económica, incluyó 227 adultos hospitalizados y malnutridos según Valoración Global Subjetiva. La cohorte prospectiva recibió Terapia Nutricional Precoz (TNP), mientras que la cohorte retrospectiva recibió Terapia Nutricional Tardía (TNT). Las medidas del coste-efectividad incluyeron costes por: días de estancia, complicaciones y condición de egreso. Resultados: las cohortes fueron similares en cuanto a características clínicas y demográficas, excepto en la mediana de edad; para la TNP fue 61 años (rango intercuartil [RIQ]: 48-71) y para la TNT fue 55 años (RIQ: 44-67) (p=0,024). La TNP se encontró costo-efectiva en la reducción de los días de estancia hospitalaria (11 días, RIQ: 7-17) en comparación con la TNT (18 días, RIQ: 10-28) (p<0,001). La TNP registró costos de 10.261,55 $ US por paciente egresado vivo, inferiores a los obtenidos en la TNT 15.553,11 $ US (p=0,043); el coste por paciente con complicaciones fue 13.663,90 $ US en la TNP y 17.860,32 $ US en la TNT (p=0,058). La TNP incrementó la probabilidad de egresar vivo, RR ajustado=0,31; intervalo de confianza (IC) 95%: 0,1; 0,6; (p<0,001) y disminuyó la probabilidad de complicaciones RR crudo=0,8; IC 95%: 0,6; 0,9; (p=0,006). Conclusión: la terapia nutricional precoz en pacientes adultos malnutridos parece ser coste-efectiva porque puede reducir los días de estancia, las complicaciones, la mortalidad y los costes asociados (AU)

Nutrición enteral en síndrome de intestino corto / Short bowel syndrome and nutritional enteral

Lo más característico del presente caso es el manejo nutricional del paciente, que ha logrado evitar la utilización de nutrición parenteral total de forma prolongada y sus posibles complicaciones, mediante la administración de una nutrición enteral a través de una sonda yeyunal en el extremo distal de una ileostomía en un paciente con intestino corto severo. Se trata de un hombre de 34 años de edad, con antecedentes de colecistectomía complicada con peritonitis postquirúrgica y dehiscencia, que a los dos años desarrolló un cuadro de obstrucción de intestino delgado, por lo que se realizó devolvulación de intestino delgado que se complicó con dos fugas intestinales en diferentes tiempos; tras la segunda fuga se realizó yeyunostomía lateral en doble cañón de escopeta a nivel de la dehiscencia; presentó altos débitos por el asa aferente de la yeyunostomía terminal; durante el ingreso se insertó una sonda de poliuretano para alimentación enteral por asa eferente de la yeyunostomía. Recibió nutrición enteral por sonda yeyunal colada en el asa eferente con disminución del débito de yeyunostomía proximal terminal y ganancia de peso con posterior reconstrucción del tránsito intestinal (AU)

The particularity of this case is the nutritional management that has managed to avoid the use of prolonged parenteral nutrition and possible complications by placing jejunal tube at the distal end in patients with short bowel. It is a 34-year-old colecistectomizado complicated with postoperative peritonitis and dehiscence; two years he studied with small bowel obstruction, he was made de-volvulus and was complicated with two leak at different times after the second escape took place jejunostomy side double barreled shotgun level dehiscence, presented high debits by afferent loop of the terminal jejunostomy; during admission, polyurethane probe enteral feeding was inserted by the efferent loop jejunostomy. He received jejunal tube feeding laundry in the efferent loop terminal with decreased weight gain and subsequent reconstruction of intestinal transit debit proximal jejunostomy (AU)

Historia de la nutrición clínica española (1): Nutrición artificial y su incorporación al ámbito clínico español / The development of clinical nutrition in Spain (1): integrating artificial nutrition into the Spanish clinical setting

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Historia de la Nutrición Clínica Española (2): La contribución de SENPE y de la revista Nutrición Hospitalaria / The development of clinical nutrition in Spain (2): the contribution of SENPE and «Nutrición Hospitalaria» journal

Se aborda la aportación que ha realizado la Sociedad Española de Nutrición Parenteral y Enteral (SENPE) a la nutrición clínica, a través del análisis de los principales elementos que han configurado su proyecto de asociacionismo científico: los inicios y el contexto científico y asistencial que determinó su puesta en marcha, las características y la evolución de los socios y de las juntas directivas, los congresos y las reuniones científicas organizadas, la importancia que ha adquirido la revista Nutrición Hospitalaria como referente para la comunicación científica en el ámbito de las ciencias de la nutrición y las actividades encaminadas a promover la investigación y la formación continuada (grupos de trabajo, publicaciones, etc.) (AU)

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Hospital nutritional care: propositions endorsed by the scientific community / Atención nutricional hospitalaria: proposiciones aceptadas por la comunidad científica

Background/objectives: the incidence of hospital undernutrition and its consequences for both the patient and the hospital has demanded procedures that ensure the delivery of good-quality hospital nutritional care. On the basis of literature reports, this study aimed to build a hospital nutritional care propositions that the scientific community later evaluated and endorsed. Methods: forty-one propositions concerning patient clinical nutritional care and hospital food service management by the Hospital Nutrition and Food Service were designed. One hundred professionals, researchers, and professors evaluated the propositions. Agreement with the propositions was analyzed by means of a five-point Likert scale (I strongly disagree; I partially disagree; I have no opinion; I partially agree; I totally agree) associated with each proposition. Agreement was considered to occur when 70% or more of the interviewees agreed (partially or totally) with the proposition. The procedure Proc Corresp of the software SAS 10, version 8, aided descriptive statistics and correspondence analysis. Results: more than 90% of the interviewees completely or partially agreed with 85% (35) of the 41 propositions; between 80 and 90% of the interviewees totally or partially agreed with 15% (6) of the 41 propositions. All the proposed criteria had over 70% agreement (total and partial). The lowest value of total agreement was 70%, attributed to the proposition that suggested patient’s participation in nutritional intervention. Conclusions: the scientific community presented high level of agreement with the hospital nutritional care propositions, which suggested an important consensus about it (AU)

Antecedentes/objetivos: la incidencia de desnutrición hospitalaria y sus consecuencias tanto para el paciente como para el hospital ha exigido procedimientos que aseguren un servicio de atención nutricional hospitalaria de buena calidad. Basado en los informes de la literatura, este estudio tuvo como objetivo construir proposiciones sobre los cuidados nutricionales hospitalarios, que después fueran evaluados y aprobados por la comunidad científica. Métodos: fueron desarrolladas cuarenta y una proposiciones relativas a la atención nutricional clínica del paciente y a la gestión del servicio de alimentación por el Servicio de Alimentación y Nutrición Hospitalaria. Un total de cien profesionales, investigadores y profesores evaluaron las proposiciones. Para analizar si los evaluadores estaban de acuerdo con las proposiciones se utilizó una escala Likert de cinco puntos (estoy en total desacuerdo, estoy parcialmente en desacuerdo, no tengo opinión, estoy parcialmente de acuerdo, estoy totalmente de acuerdo) asociada a cada proposición. Fue considerada concordancia cuando el 70% o más de los evaluadores estaban de acuerdo (totalmente o parcialmente) con la proposición. Para el análisis estadístico fue utilizado el procedimiento Proc Corresp del software SAS 10, versión 8, estadística descriptiva y análisis de correspondencias. Resultados: más del 90% de los entrevistados estaban total o parcialmente de acuerdo con el 85% (35) de las 41 proposiciones; entre el 80 y 90% de los entrevistados estaban total o parcialmente de acuerdo con el 15% (6) de las 41 proposiciones. Todos los criterios propuestos tuvieron más del 70% de concordancia (total y parcial). El menor valor de concordancia total fue del 70%, atribuido a la proposición que sugiere la participación del paciente en la intervención nutricional. Conclusiones: la comunidad científica presentó alto nivel de concordancia con las proposiciones para la atención nutricional hospitalaria, lo que sugiere un importante consenso al respecto (AU)

Normas para la administración de fármacos por sonda: información adicional / Drugs administration rules through a feeding tube: additional information

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Role of eggs consumption in women at different life stages / Papel del huevo en la alimentación de la mujer en distintas etapas de su vida

Although women need less energy than men, their recommended dietary intakes for some nutrients are similar or even higher. Some physiological situations can highlight those differences, such as growth, pregnancy, lactation and menopause. Nutritional deficiencies may impact on growth, fertility, pregnancy and newborn health, so in this context eggs are a food of great interest because of its essential and highly bioavailable nutrients, while providing few calories. In addition, and bearing in mind that life expectancy for women is generally higher than that of men, the likelihood of suffering chronic diseases and for a longer time is high. In this sense, eggs are very nutritive food, inexpensive and easy to prepare, easy to chew and digest, and are especially suitable for women in old age or more fragile situations. Nutrients and bioactive substances provided by eggs can help prevent chronic diseases and improve the health of women in the last stages of their life (AU)

Las mujeres necesitan menos energía que los hombres, pero sus ingestas recomendadas de algunos nutrientes son iguales o incluso superiores. Algunas situaciones fisiológicas pueden aumentar aún más estas diferencias, como ocurre durante el crecimiento, el embarazo, la lactancia o la menopausia. Las deficiencias nutricionales pueden tener consecuencias adversas sobre el crecimiento y desarrollo, la fertilidad, el desarrollo del embarazo y la salud del recién nacido. En este contexto, el huevo es un alimento de gran interés debido a que contiene nutrientes esenciales y altamente biodisponibles, y bajo contenido calórico. Además, teniendo en cuenta que la esperanza de vida para la mujer es mayor que para el hombre, la probabilidad de padecer enfermedades crónicas y durante más tiempo aumenta. Los huevos son alimentos altamente nutritivos, baratos, fáciles de preparar y fáciles de masticar y digerir, y especialmente útiles para la mujer en la ancianidad y en situaciones de mayor fragilidad. Los nutrientes y las sustancias bioactivas del huevo ayudan a prevenir enfermedades crónicas y a mejorar la salud de las mujeres en las últimas etapas de su vida (AU)

Eficiencia, coste-efectividad y justificación de necesidad de inversión en terapia nutricional en un hospital de nivel III; papel conjunto del médico especialista en endocrinología y nutrición y la unidad de codificación / Efficiency, cost-effectiveness and justification of need for investment in nutrition therapy in a hospital of third level; the role of specialists in endocrinology and nutrition and the coding unit

La desnutrición relacionada con la enfermedad (DRE) es una entidad con alta prevalencia en el medio hospitalario español. Según la OMS, entre el 20 y el 40% del gasto sanitario se pierde por ineficiencia. Demostrar que la DRE es una fuente de ineficiencia y que la contratación de un médico especialista para su detección y tratamiento es coste-efectiva para el sistema. Material y métodos: Comparación de diagnósticos y procedimientos nutricionales detectados y codificados en informes de alta mediante test de McNemar. Recodificación de 55 informes de alta incluyendo diagnósticos y procesos nutricionales. Determinar variaciones en IC, coste proceso, coste proceso/punto GRD tras la recodificación. Comparación con test de Wilcoxon. Resultados: Sólo se codificaron 2 de 55 casos de desnutrición (p<0,001) Tras recodificación el IC aumentó 42,67 puntos (p<0,05), lo que se tradujo en disminución del índice coste proceso/punto GRD en 976,81€ (p<0,05). Conclusiones: La DRE no se detecta adecuadamente en el centro. Su detección y la de los procedimientos nutricionales adecuados en manos de un médico especialista en nutrición produjeron una disminución del índice coste proceso/punto GRD de un 20% respecto al coste oficial del sistema. Se produjo una pérdida de un 20% del gasto sanitario, estimado en 172.690€ exclusivamente por procesos nutricionales. Su adecuada codificación justificaría un reembolso de 154.581€ para la asistencia nutricional. Ambos costes, perdidos por ineficiencia, son superiores a los que implica la contratación de un especialista en endocrinología, por lo que no existe justificación económica para su no contratación (AU)

Disease Related Malnutrition (DRM) is highly prevalent in Spanish hospitals. WHO estimates that 20-40% of health-associated expenses are lost due to inefficiency. Demonstration that DRM is a component of inefficiency and hiring a specialist physician for its detection and treatment is cost-effective. Material and methods: Comparison between nutritional diagnosis and procedures detected and encoded at discharge using McNemar test. Recoding of 55 discharge reports including nutritional diagnoses and procedures. Determine changes on Case-Mix Index (IC), cost of procedure and cost procedure/GRD index. Comparison using Wilcoxon test. Results: Only 2 of 55 diagnoses of malnutrition were coded in delivery statements (p<0,001) After right codification, IC increased in 42,67 GRD points (p<0,05), Consequently, procedure cost/GRD index was reduced in 976,81€ (p<0,05). Conclusions: DRM is underdiagnosed in our hospital. DRM and nutritional procedures detection by a specialist on endocrinology and nutrition led to a reduction in cost procedure/GRD index of 20% of officially established by the Health System. Loss of 20% of health expenses, estimated in 172690€ was described. Proper codification would have justified 154581€ reimbursement just for nutritional diagnoses and processes. Both expenses were lost due to system’s inefficiency. Those amounts are much higher than cost associated of hiring a specialist, so there is no economic reason for denying it (AU)

Nutritional assessment and therapy in COPD: a European Respiratory Society statement.

Nutrition and metabolism have been the topic of extensive scientific research in chronic obstructive pulmonary disease (COPD) but clinical awareness of the impact dietary habits, nutritional status and nutritional interventions may have on COPD incidence, progression and outcome is limited. A multidisciplinary Task Force was created by the European Respiratory Society to deliver a summary of the evidence and description of current practice in nutritional assessment and therapy in COPD, and to provide directions for future research. Task Force members conducted focused reviews of the literature on relevant topics, advised by a methodologist. It is well established that nutritional status, and in particular abnormal body composition, is an important independent determinant of COPD outcome. The Task Force identified different metabolic phenotypes of COPD as a basis for nutritional risk profile assessment that is useful in clinical trial design and patient counselling. Nutritional intervention is probably effective in undernourished patients and probably most when combined with an exercise programme. Providing evidence of cost-effectiveness of nutritional intervention is required to support reimbursement and thus increase access to nutritional intervention. Overall, the evidence indicates that a well-balanced diet is beneficial to all COPD patients, not only for its potential pulmonary benefits, but also for its proven benefits in metabolic and cardiovascular risk.

Functional and metabolic disorders in celiac disease: new implications for nutritional treatment.

Celiac disease (CD) is a chronic disease causing the inflammation of the proximal small intestine, in genetically predisposed individuals. This is triggered by the consumption of the gluten protein and the side effects of the disease are mitigated by a lifelong gluten-free diet (GFD) treatment. The predominant consequence of CD is malnutrition due to malabsorption (with diarrhea, weight loss, nutritional deficiencies, and altered blood parameters), especially in patients who do not show strict adherence to GFD treatment. Recent evidence shows that, despite a lifelong GFD, some functional disorders persist, such as compromised gallbladder function and motility, exocrine pancreatic insufficiency, increased gut permeability, small-intestinal bowel overgrowth, nonalcoholic fatty liver disease (NAFLD), lactose intolerance, and milk allergy. These abnormalities may predispose to the occurrence of overweight and obesity even in CD patients. This review focuses on the principal functional and metabolic disorders in both treated and untreated CD, ranging from alterations of the gastrointestinal system to impaired glucose and lipid metabolism and insulin secretion with the aim of providing new implications beyond a GFD, for an ad hoc nutrition treatment in these patients.

Evaluación de una intervención nutricional en personas mayores: el proyecto Edumay / Evaluation of a nutritional intervention among elderly people: the edumay project

Introducción: La adhesión a un patrón de Dieta Mediterránea está asociado a una reducción de la morbi-mortalidad, y a una mejora de la calidad de vida. Objetivos: Evaluar una intervención nutricional en personas mayores independientes a través de un programa de educación que favorezca el conocimiento de los alimentos y la confección de dietas adecuadas, promocionando un patrón de dieta saludable. Métodos: Estudio cuasi-experimental realizado en un colectivo de personas mayores que residen en apartamentos tutelados del Ayuntamiento de Pamplona (n = 41). La intervención consistió en seis sesiones de educación grupal y una entrevista motivacional individual en un periodo de tres meses. Se evaluó la adhesión a la Dieta Mediterránea a través de un cuestionario de 14 puntos previamente validado. Resultados: El 80,5% de los participantes fueron mujeres, con una mediana de edad de 79 años, en gran proporción viudas (48,8%) y con estudios primarios (58,5%). Tras la intervención nutricional el porcentaje de participantes que consumió dos o más raciones de verduras u hortalizas aumentó significativamente con respecto al grupo control (p = 0,042). De forma similar en comparación con el grupo control hubo un mayor incremento en el porcentaje de individuos que consumían 3 raciones de legumbres a la semana (p = 0,042), 3 o más veces por semana frutos secos (p = 0,003) y que tomaban preferentemente carne de pollo, pavo o conejo en vez de ternera, cerdo, hamburguesas o salchichas (p = 0,011). Discusión: Una intervención basada en educación nutricional individual y grupal consiguió una mejora significativa en diversos parámetros de adhesión a un patrón de Dieta Mediterránea (AU)

Background: The adherence to a Mediterranean Dietary Pattern is associated with a morbi-mortality reduction, and with a better quality of life. Objectives: To evaluate a nutritional intervention among independent elderly people enrolled in an educational program to increase the knowledge of the food and daily diets, promoting a healthy dietary pattern. Methods: Quasi-experimental design conducted in elderly participants who lived in foster home apartments owned by the City Council of Pamplona (n = 41). The intervention was based on six group sessions and an individual motivational session in a period of three months. Adherence to Mediterranean diet was evaluated through a 14-point scale previously validated. Results: Eighty point five per cent of participants were women, with a median age of 79 years, the majority of them widowed (48.8%) and with primary education (58.5%). After the nutritional intervention the percentage of participants who consumed two or more servings of vegetables increased significantly versus the control group (p = 0.042). Similarly, in comparison with the control group, there was an increase in the percentage of participants who consumed three servings per week of legumes (p = 0.042), three or more servings per week of nuts (p = 0.003), and those who consumed preferably meat from chicken, turkey, or rabbit instead of veal, pork, hamburgers, or sausages (p = 0.011). Discussion: An intervention based on individual and group sessions improved significantly several parameters of a Mediterranean dietary pattern (AU)