Liposomes as selenium nanocarriers for foliar application to wheat plants: A biofortification strategy.

In the present work, liposomes have been used as nanocarriers in the biofortification of wheat plants with selenium (Se) through foliar application. Liposomal formulations were prepared using 1,2-dipalmitoyl-sn-glycero-3-phosphocholine (DPPC) and Phospholipon®90H (P90H) (average size <100 nm), loaded with different concentrations of inorganic Se (selenite and selenate) and applied twice to the plants in the stage of vegetative growth. Liposomes enhanced Se uptake by wheat plants compared to direct application. The highest Se enrichment was achieved using the phospholipid DPPC and a concentration of 1000 µmol·L-1 of Se without affecting the biomass, chlorophylls, carotenoids, and the concentration of mineral nutrients of the plants. The chemical speciation of Se in the plants was further investigated by X-ray absorption spectroscopy (XAS). The results from XAS spectra revealed that most of the inorganic Se was transformed to organic Se and that the use of liposomes influenced the proportion of C-Se-C over C-Se-Se-C species.

Phytochemical Profile, Bioactive Properties, and Se Speciation of Se-Biofortified Red Radish (Raphanus sativus), Green Pea (Pisum sativum), and Alfalfa (Medicago sativa) Microgreens.

The impact of selenium (Se) enrichment on bioactive compounds and sugars and Se speciation was assessed on different microgreens (green pea, red radish, and alfalfa). Sodium selenite and sodium selenate at a total concentration of 20 µM (1:1) lead to a noticeable Se biofortification (40-90 mg Se kg-1 DW). In green pea and alfalfa, Se did not negatively impact phenolics and antioxidant capacity, while in red radish, a significant decrease was found. Regarding photosynthetic parameters, Se notably increased the level of chlorophylls and carotenoids in green pea, decreased chlorophyll levels in alfalfa, and had no effect on red radish. Se treatment significantly increased sugar levels in green pea and alfalfa but not in red radish. Red radish had the highest Se amino acid content (59%), followed by alfalfa (34%) and green pea (28%). These findings suggest that Se-biofortified microgreens have the potential as functional foods to improve Se intake in humans.

Effects of feeding with a protein liquid supplement on productivity, mortality and health of Apis mellifera hives in southwestern Spain.

Colony collapse disorder (CCD) has affected bees worldwide in recent decades, with southwestern Spain being no exception. This disorder is one of the main causes of Apis mellifera mortality and is believed to be caused by environmental, social and sanitary conditions. Dietary supplementation can help to improve some parameters of the general status and sanitary condition of bees, such as infestation by certain recurrent pathogens, including Varroa destructor and Nosema ceranae, by enhancing immune and social response. Thus, the aim of this study was to test a liquid hydrolysed protein supplement on the health and general status of the hive in several apiaries with access to the same natural food and under similar climatic conditions. We selected two groups of ten hives (supplemented by either placebo or protein) from five apiaries where the number of adult bees, amount of brood (open and operculated), honey and pollen reserves, infestation by V. destructor, N. ceranae, deformed wing virus (DWV) and chronic bee paralysis virus (CBPV) were measured. Additionally, we assess the expression of four immune system-related genes and a gene encoding vitellogenin. At the end of this work, treated hives showed a significant increase in open brood and a decrease in V. destructor infestation. Also, these hives showed a significant decrease in the mortality rate after the cold season. Therefore, supplementation with this product improved the health of the hive and could be a promising tool against bee colony loss.

Selenium biofortification of microgreens: Influence on phytochemicals, pigments and nutrients.

Kale (Brassica oleracea L. var. sabellica L.), kohlrabi (Brassica oleracea L. var. gongylodes L.) and wheat (Triticum aestivum L. cv. Bancal) microgreens were cultivated in presence of selenium 20 µmol L-1 as sodium selenite and sodium selenate mixture. The influence of this biofortification process was evaluated in terms of biomass production, total Se, macro- and micronutrients concentration, polyphenols, antioxidant activity, chlorophylls and carotenoids levels and total soluble proteins content. The results obtained have shown a significant concentration of total Se in the biofortified microgreens of kale (133 µg Se·g-1 DW) and kohlrabi (127 µg Se·g-1 DW) higher than that obtained for wheat (28 µg Se·g-1 DW). The Se uptake in all the species did not produce oxidative damage to the plants reflected in the bioactive compounds, antioxidant capacity or pigments concentration. These Se-enriched microgreens may contribute to the recommended intake of this nutrient in human diet as to overcome Se-deficiency.

Ammonium concentration in stream sediments resulting from decades of discharge from a wastewater treatment plant.

A study of ammonium pollution in the sediments of a stream that receives wastewater treatment plant (WWTP) discharge has been carried out. It is urgently necessary to find environmental indicators that can help prevent and detect potential contamination of water, as water is an increasingly scarce resource. To understand the behaviour of ammonium ions introduced by a historical (50-year) contamination process, vertical boreholes were drilled in the stream banks to depths between 30 and 120 cm. Moisture, pH, ammonium (soluble and exchangeable), and clay fraction content were analysed. The variation profile of these parameters was evaluated as a function of depth to determine factors related to the distribution of ammonium in several locations along the stream banks. The ammonium concentration was asymmetrically distributed among samples collected in near-surface locations, with ammonium concentrations between 0.3048 mmol/kg soil and 0.0007 mmol/kg soil. Ammonium was typically concentrated at sediment depths of 30-40 cm, which also exhibited the highest clay fraction content. High positive correlations were detected (r > 0.8; p < 0.0001) among the different ammonium variables (exchanged and dissolved species). No contamination effect was observed below 60-70 cm depth, which was due to ammonium retention in a natural barrier layer of clayey sediment. The clays in our study area (previously identified as smectite, a 2:1 sheet silicate) were able to control the contamination by retaining ammonium in the interlayers, which retarded nitrification. It is suggested that clay could serve as a geo-indicator of ammonium pollution evolution.

Optimization of iron oxide nanoparticles for MRI-guided magnetic hyperthermia tumor therapy: reassessing the role of shape in their magnetocaloric effect.

Superparamagnetic iron oxide nanoparticles have hogged the limelight in different fields of nanotechnology. Surprisingly, notwithstanding the prominent role played as agents in magnetic hyperthermia treatments, the effects of nanoparticle size and shape on the magnetic hyperthermia performance have not been entirely elucidated yet. Here, spherical or cubical magnetic nanoparticles synthesized by a thermal decomposition method with the same magnetic and hyperthermia properties are evaluated. Interestingly, spherical nanoparticles displayed significantly higher magnetic relaxivity than cubic nanoparticles; however, comparable differences were not observed in specific absorption rate (SAR), pointing out the need for additional research to better understand the connection between these two parameters. Additionally, the as-synthetized spherical nanoparticles showed negligible cytotoxicity and, therefore, were tested in vivo in tumor-bearing mice. Following intratumoral administration of these spherical nanoparticles and a single exposure to alternating magnetic fields (AMF) closely mimicking clinical conditions, a significant delay in tumor growth was observed. Although further in vivo experiments are warranted to optimize the magnetic hyperthermia conditions, our findings support the great potential of these nanoparticles as magnetic hyperthermia mediators for tumor therapy.

Combination of Soy Isoflavones, 8-Prenylnaringenin and Melatonin Improves Hot Flashes and Health-Related Quality of Life Outcomes in Postmenopausal Women: Flavie Study.

OBJECTIVES: This study aims to investigate the effects of a combination of soy isoflavones, 8-prenylnaringenin (8-PN), and melatonin in postmenopausal women suffering from moderate-to-severe hot flashes (HFs). METHODS: A multicenter, prospective, open-label study enrolled 44 postmenopausal women suffering from moderate-to-severe HFs (≥ 5 daily or ≥ 35 weekly) to receive 54.4 mg standardized soy isoflavones (including 24.5 mg genistein and 16.3 mg daidzein), 100 µg 8-PN, and 1 mg melatonin once daily for 12 weeks. The primary clinical outcomes included changes in health-related quality of life (HRQoL) scores (Menopause-Specific QoL questionnaire [MENQoL] and Cervantes Scale) and HFs following 4 and 12 weeks of treatment. Other analyses included treatment adherence, acceptability, tolerability, and safety. RESULTS: All of the four domains of MENQoL questionnaire significantly improved at 4 weeks (P < 0.05) and 12 weeks (P < 0.001), affecting significantly the vasomotor, psychosocial, and physical spheres (41.2%, 26.3%, and 25.0%; 12 weeks improvements, respectively). Similarly, in the menopause (39.3%) and psychic (51.7%) domains (both P < 0.05 at 12 weeks), the global score of the Cervantes Scale significantly increased at 4 weeks (18.6%) and 12 weeks (35.4%). Accordingly, moderate-to-severe HFs significantly decreased at 4 weeks compared to baseline (41.7% reduction) and further reduced at 12 weeks (76.5%), including the total number of episodes. CONCLUSIONS: Food supplements containing soy isoflavones, 8-PN, and melatonin showed an early and progressive benefit for reducing clinically significant HFs and for improving HRQoL across all domains, favorably affecting postmenopausal women's overall well-being.

Relato de caso de intoxicación con superwarfarinas: un desafío terapéutico / Managing Superwarfarin Poisoning: A Challenging Case

La intoxicación humana por rodenticidas anticoagulantes de acción prolongada, conocidos como superwarfarinas, provoca coagulopatía de prolongado manejo. Presentamos el caso de un hombre de 42 años que ingirió una dosis tóxica de rodenticida en un intento suicida, evolucionando con epistaxis, INR de 11,6 y necesidad de hospitalización. Durante 7 días se realizaron controles seriados de pruebas de coagulación, con optimización de diferentes dosis de suplementación de Vitamina K. El caso destaca la potencia y vida media prolongada (aproximadamente 6 semanas) de este tipo de anticoagulantes, hecho que requiere un control clínico regular y una adherencia al tratamiento satisfactoria.

Human intoxication by long-acting anticoagulant rodenticides, known as superwarfarins, causes coagulopathy that is difficult to manage. We present the case of a 42-year-old man who ingested a toxic dose of rodenticide in a suicide attempt, evolving with epistaxis, INR of 11.6, and needing hospitalization. For seven days, serial controls of coagulation tests were carried out, with optimization of different doses of Vitamin K supplementation. The case highlights this type of anticoagulant's potency and prolonged half-life (approximately six weeks), which requires regular clinical control and satisfactory treatment adherence.

Effect of feed supplementation with probiotics and postbiotics on strength and health status of honey bee (Apis mellifera) hives during late spring.

Currently, beekeeping faces many risks, such as deteriorating health of honeybees in hives, which results in high mortality rates, mainly during winter. An important consequence is the emergence/re-emergence of communicable diseases such as varroosis or nosemosis. These diseases jeopardize the continuity of the sector because of the absence of effective treatments and harmful residues that they can be retained on wax or honey. This study aimed to evaluate how feed supplementation with probiotic and postbiotic products derived from lactic acid bacteria affected the strength, dynamic population, and sanitary parameters of honey bees. Three groups of 30 hives were established and fed with feed supplemented with control, probiotic, or postbiotic products, with a total of nine applications over two months in late spring. Two monitoring tests were conducted to evaluate the strength and health status of hives. Hives that consumed postbiotic products enhanced their strength, increased bee population and egg laying of the queen, and maintained their reserves of pollen, whereas these parameters decreased in hives belonging to other groups. Furthermore, although the results suggested a favorable effect of postbiotic products on the trend of N. ceranae infection levels, probiotics showed intermediate results. While awaiting long-term results regarding V. destructor infestation, which showed similar trends in all groups, feed supplementation with postbiotics could be an important tool for beekeepers to enhance the strength and health status of their hives.

Implementation of the WHO integrated care for older people (ICOPE) programme in clinical practice: a prospective study.

BACKGROUND: The INSPIRE integrated care for older people (ICOPE)-CARE programme is a public health programme implementing the ICOPE health-care pathway in clinical practice. The primary objective of this study was to describe the large-scale implementation and feasibility of the INSPIRE ICOPE-CARE guidelines in clinical practice. The secondary aims were to describe the characteristics of patients who were identified as positive for abnormalities in intrinsic capacity (ie, locomotion, cognition, psychology, vitality, hearing, and vision) during step 1, and to describe the prevalence of these positive screenings. METHODS: In this prospective study, we evaluated a real-life population of users of primary care services in the Occitania region (France). Participants who were aged 60 years and older and lived in a community were eligible for inclusion in our study. Individuals aged ≥60 years were screened (step 1) by health-care providers or through self-assessments using digital tools (the ICOPE MONITOR app and the ICOPEBOT conversational robot). Our implementation strategy involved raising awareness among health-care professionals about the WHO ICOPE programme, training professionals in the ICOPE-CARE guidelines, and developing a digital infrastructure (ie, digital tools, a database, and a remote ICOPE monitoring platform). The feasibility of implementing the INSPIRE ICOPE-CARE guidelines was determined by the anticipated inclusion of ≥10 000 participants, and having a follow-up rate of over 50%. FINDINGS: Between Jan 1, 2020, and November 18, 2021, 10 903 older people (mean age 76·0, SD 10·5 years; 6627 [60·8%] of whom were women) had a baseline step 1 screening done, and 5185 (70·4%) of 7367 eligible participants had a 6-month follow-up of step 1 screening. 10 285 (94·3%) participants had a positive intrinsic capacity result during screening at baseline. 958 (9·3%) participants were evaluated with step 2 (in-depth assessments). Positive intrinsic capacity was confirmed in 865 (90·3%) participants. Most recommendations in step 3 (care plan) were related to locomotion, vitality, and cognition. INTERPRETATION: The high number of participants included in our study, as well as the high rates of follow-up, provides evidence to suggest that the large-scale implementation of ICOPE in clinical practice is feasible. The very high prevalence of positive screening for impaired intrinsic capacity during step 1, as well as the high rates of confirmed deficits in intrinsic capacity during step 2, suggest that the INSPIRE ICOPE-CARE programme is able to target individuals who are at increased risk for functional loss and disability. FUNDING: Occitania Regional Health Agency, Region Occitanie and Pyrénées-Méditerranée, European Regional Development Fund, and The Interreg Program V-A Spain-France-Andorra.

Differentiation of bee pollen samples according to the betaines and other quaternary ammonium related compounds content by using a canonical discriminant analysis.

In the last years, an increase has been observed in the adulteration of bee pollen. Consequently, different tools are required to authenticate the origin of this product, such as a study of the profile and composition of a specific family of compounds. The present study investigates the potential of betaines and related compounds as markers of the apiary of origin and harvest period of 71 bee pollen samples. These were collected from four apiaries (Pistacho, Tío Natalio, Monte and Fuentelahiguera), located in the same geographical area (Guadalajara, Spain) and sampled during three consecutive harvest periods in the same year (April-May, June, July-August). They were analyzed by means of a previously developed methodology, which involved solvent extraction, hydrophilic interaction liquid chromatography coupled to mass spectrometry, and a statistical analysis of the data (canonical discriminant analysis). Variable amounts of betaines and related compounds were found in the samples, with four of these being identified in all of them (betonicine, betaine, trigonelline and choline); betonicine was the predominant compound in a concentration range of 264 to 52384 mg/kg. It was possible to statistically assign over 50 % of the samples to the corresponding apiary of origin, the best results being obtained for the Tío Natalio apiary (75 %); this classification was even better in the case of the harvest period, as more than 75 % of the samples were correctly assigned, and in two periods (April-May and June) a 90 % rate was obtained.

Acyclic Diterpene Phytol from Hemp Seed Oil (Cannabis sativa L.) Exerts Anti-Inflammatory Activity on Primary Human Monocytes-Macrophages.

Seeds from non-drug varieties of hemp (Cannabis sativa L.) have been used for traditional medicine, food, and fiber production. Our study shows that phytol obtained from hemp seed oil (HSO) exerts anti-inflammatory activity in human monocyte-macrophages. Fresh human monocytes and human macrophages derived from circulating monocytes were used to evaluate both plasticity and anti-inflammatory effects of phytol from HSO at 10-100 mM using FACS analysis, ELISA, and RT-qPCR methods. The quantitative study of the acyclic alcohol fraction isolated from HSO shows that phytol is the most abundant component (167.59 ± 1.81 mg/Kg of HSO). Phytol was able to skew monocyte-macrophage plasticity toward the anti-inflammatory non-classical CD14+CD16++ monocyte phenotype and toward macrophage M2 (CD200Rhigh and MRC-1high), as well as to reduce the production of IL-1ß, IL-6, and TNF-α, diminishing the inflammatory competence of mature human macrophages after lipopolysaccharide (LPS) treatment. These findings point out for the first time the reprogramming and anti-inflammatory activity of phytol in human monocyte-macrophages. In addition, our study may help to understand the mechanisms by which phytol from HSO contributes to the constant and progressive plasticity of the human monocyte-macrophage linage.

Bilateral Adrenalectomy in a Patient With Refractory Primary Aldosteronism Due to Adrenal Hyperplasia.

Primary aldosteronism (PA) is a frequent cause of secondary hypertension. The main cause of PA is bilateral adrenal hyperplasia, and treatment is usually medical with mineralocorticoid receptor antagonists (MRAs) such as spironolactone or eplerenone. In this paper, we present a rare clinical case of a middle-aged female with refractory arterial hypertension and hypokalemia that complementary medical tests confirmed PA due to bilateral hyperplasia, and despite a maximum dose of spironolactone and oral potassium supplements, there was no clinical response. Because of this, finally, the patient needed surgical treatment based on bilateral adrenalectomy, which was effective. This is unusual and poorly described in the medical literature.

Early Life Nutrition and the Role of Complementary Feeding on Later Adherence to the Mediterranean Diet in Children up to 3 Years of Age.

The first years of life represent a window of opportunity to establish proper dietary patterns and to maintain them over time. Our aim was to describe the diet of a cohort of Spanish children, from 2 to 36 months, and to identify the components that could influence the quality of the diet at 24 and 36 months of age. This was a longitudinal prospective study analyzing information from administered questionnaires about general characteristics and food frequency consumption in 97 full-term babies. At 2-3 months of age, only 53.6% of infants were observed to be breastfed. The intake of animal foodstuffs from 12 to 36 months was higher than national recommendations, and the contrary was true for fruits and vegetables. The intake of vitamin D was below European Food Safety Authority recommendations. Moreover, energy intake at 6 months was inversely associated with Mediterranean Diet Score (MDS) at 24 months, whereas vegetables intake was positively associated with MDS at 36 months. These results could be useful in the creation of future guidelines focused on the promotion of breastfeeding and healthy early-life food habits.

Protein domain-based prediction of drug/compound-target interactions and experimental validation on LIM kinases.

Predictive approaches such as virtual screening have been used in drug discovery with the objective of reducing developmental time and costs. Current machine learning and network-based approaches have issues related to generalization, usability, or model interpretability, especially due to the complexity of target proteins' structure/function, and bias in system training datasets. Here, we propose a new method "DRUIDom" (DRUg Interacting Domain prediction) to identify bio-interactions between drug candidate compounds and targets by utilizing the domain modularity of proteins, to overcome problems associated with current approaches. DRUIDom is composed of two methodological steps. First, ligands/compounds are statistically mapped to structural domains of their target proteins, with the aim of identifying their interactions. As such, other proteins containing the same mapped domain or domain pair become new candidate targets for the corresponding compounds. Next, a million-scale dataset of small molecule compounds, including those mapped to domains in the previous step, are clustered based on their molecular similarities, and their domain associations are propagated to other compounds within the same clusters. Experimentally verified bioactivity data points, obtained from public databases, are meticulously filtered to construct datasets of active/interacting and inactive/non-interacting drug/compound-target pairs (~2.9M data points), and used as training data for calculating parameters of compound-domain mappings, which led to 27,032 high-confidence associations between 250 domains and 8,165 compounds, and a finalized output of ~5 million new compound-protein interactions. DRUIDom is experimentally validated by syntheses and bioactivity analyses of compounds predicted to target LIM-kinase proteins, which play critical roles in the regulation of cell motility, cell cycle progression, and differentiation through actin filament dynamics. We showed that LIMK-inhibitor-2 and its derivatives significantly block the cancer cell migration through inhibition of LIMK phosphorylation and the downstream protein cofilin. One of the derivative compounds (LIMKi-2d) was identified as a promising candidate due to its action on resistant Mahlavu liver cancer cells. The results demonstrated that DRUIDom can be exploited to identify drug candidate compounds for intended targets and to predict new target proteins based on the defined compound-domain relationships. Datasets, results, and the source code of DRUIDom are fully-available at: https://github.com/cansyl/DRUIDom.

The core microbiome is responsible for volatile silicon and organic compounds degradation during anoxic lab scale biotrickling filter performance.

Volatile silicon compounds present in the biogas of anaerobic digesters can cause severe problems in the energy recovery systems, inducing costly damages. Herein, the microbial community of a lab-scale biotrickling filter (BTF) was studied while testing its biodegradation capacity on octamethylcyclotetrasiloxane (D4) and decamethylcyclopentasiloxane (D5), in the presence of toluene, limonene and hexane. The reactor performance was tested at different empty bed residence times (EBRT) and packing materials. Community structure was analysed by bar-coded amplicon sequencing of the 16S rRNA gene. Microbial diversity and richness were higher in the inoculum and progressively decreased during BTF operation (Simpson's diversity index changing from 0.98-0.90 and Richness from 900 to 200 OTUs). Minimum diversity was found when reactor was operated at relatively low EBRT (7.3 min) using a multicomponent feed. The core community was composed of 36 OTUs (accounting for 55% of total sequences). Packing material played a key role in the community structure. Betaproteobacteriales were dominant in the presence of lava rock and were partially substituted by Corynebacteriales and Rhizobiales when activated carbon was added to the BTF. Despite these changes, a stable and resilient core microbiome was selected defining a set of potentially degrading bacteria for siloxane bioremoval as a complementary alternative to non-regenerative adsorption onto activated carbon.

Dry needling for treating spasticity in multiple sclerosis.

[Purpose] The aim of the study is to evaluate the efficacy of dry needling (DN) in the treatment of spasticity in patients with multiple sclerosis (MS). [Participants and Methods] Twelve participants (3 males and 9 females) with MS, with no evidence of a relapse in the last four weeks and with an EDSS (Expanded Disability Status Scale) greater than 2.5 points (related with pyramidal score) were recruited. DN was performed in lower limbs for 12 consecutive sessions and evaluated with: PSFS (Penn Spasm Frequency Scale), VAS (visual analogical scale) of spasticity, EDSS (Pyramidal item), Time up and go (TUG), 25 foot, 9hold peg test (9HPT) and the improvement or not in the quality of life (MSQol54) was verified before and after treatment. A follow up visit was carried out to assess improvement. [Results] All patients improved in: VAS scale, EDSS score, quality of life, 9HPT, 25 foot test and TUG and 90% of them showed a decrease in the number of spasms/hour (PSFS). [Conclusion] Dry needling produces positive changes in spasticity in patients with MS and their quality of life, as well as walking capacity and manual dexterity. Therefore, DN should be considered in the treatment of spasticity in patients with MS.

Bioavailability of magnesium food supplements: A systematic review.

OBJECTIVES: The market for food supplements is booming thanks to their increased consumption. European regulations include different ways in which vitamins and minerals are administered, without making it clear to the consumer whether one formulation has advantages over the other. The aim of this review was to compare the bioavailability of different forms of magnesium and analyze the differences between them. METHODS: Based on a PICO (population, intervention, comparison, outcome) research question, a search strategy was established for magnesium bioavailability studies comparing different forms in the PubMed, Cochrane, Web of Science, and Scopus databases. We found 433 studies, out of which 14 were finally selected. RESULTS: Inorganic formulations appear to be less bioavailable than organic ones, and the percentage of absorption is dose dependent. CONCLUSIONS: All magnesium dietary supplements can maintain physiological levels in healthy people without prior deficit, although this cannot be assured in older people or those with illnesses or previous subphysiological levels.

[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.