Effects of lipid-based nutrient supplements v. micronutrient powders on nutritional and developmental outcomes among Peruvian infants.

OBJECTIVE: To determine the effects of lipid-based nutrient supplements (LNS) on children's Hb, linear growth and development, compared with supplementation with micronutrient powder (MNP). DESIGN: The study was a two-arm parallel-group randomized controlled trial, where participants received either LNS or MNP for daily consumption during 6 months. Supplements were delivered by staff at government-run health centres. Hb, anthropometric, motor development, language development and problem-solving indicators were measured by trained research assistants when children were 12 months of age. SETTING: The study was conducted in five rural districts in the Province of Ambo in the Department of Huánuco, Peru. SUBJECTS: We enrolled 6-month-old children (n 422) at nineteen health centres. RESULTS: Children who received LNS had a higher mean Hb concentration and lower odds of anaemia than those who received MNP. No significant differences in height-for-age, weight-for-height or weight-for-age Z-score, or stunting and underweight prevalence, were observed. Provision of LNS was associated with a higher pre-verbal language (gestures) score, but such effect lost significance after adjustment for covariates. Children in the LNS group had higher problem-solving task scores and increased odds of achieving this cognitive task than children in the MNP group. No significant differences were observed on receptive language or gross motor development. CONCLUSIONS: LNS between 6 and 12 months of age increased Hb concentration, reduced anaemia and improved cognitive development in children, but showed no effects on anthropometric indicators, motor or language development.

Relevancia del soporte nutricional especializado en las declaraciones de voluntades anticipadas. Experiencia de un centro hospitalario de especialidades / Relevance of specialized nutritional support in the statements of advance directives. A specialty hospital experience

Introducción: la declaración de voluntades anticipadas (DVA) es un documento que contiene las preferencias sobre los cuidados y tratamientos sanitarios que se desea recibir cuando no se tenga capacidad para expresarlos. Objetivo: estudiar el contenido de las DVA inscritas en la sede del Registro de Voluntades Anticipadas del Hospital Universitario Puerta del Mar, respecto al soporte nutricional especializado (SNE) e hidratación en el periodo de noviembre 2013 a diciembre 2015. Método: estudio transversal realizado sobre el contenido de las DVA inscritas en el modelo del Decreto 59/2012. Se estudian 9 variables de relevancia relacionadas con el SNE e hidratación en las DVA. Resultados: se analizan 414 DVA de las que el 60% corresponden a mujeres. La edad media de los declarantes es 55,2 años. El 41,7% inscribieron su DVA por automotivación. El 84,78% no desea recibir nutrición parenteral, el 91,06% rechaza la alimentación mediante tubo de gastrostomía y el 89,37% no desea recibir la sonda nasogástrica. La hidratación es rechazada por el 71,26%. Las tres posibles opciones de SNE dependen significativamente de la edad del declarante (p < 0,001) pero no así la hidratación. Ambos, SNE e hidratación, sí se asociaron significativamente con los motivos para inscribir las voluntades anticipadas (p < 0,001). Conclusiones: la edad es el principal factor que condiciona la opción de aceptación o rechazo de SNE. Por el contrario, la elección de la hidratación no está condicionada por la edad. Los motivos por los que se inscriben los otorgantes son otro determinante en la elección de si desean recibir o no SNE e hidratación (AU)

Introduction: The Statement of Advance Directives (SAD) is a written document that contains the preferences for health care and treatments desired to receive when the capacity to express is lost. Objective: To study the content of SAD registered in the office of Register of Advance Directives of the Hospital Universitario Puerta del Mar regarding Specialized Nutritional Support (SNS) and hydration in the period from November 2013 to December 2015. Method: Cross-sectional study on the content of the SAD written in the form of Decree 59/2012. Nine relevant variables related with SNS-H are studied in the DVA. Results: 414 SAD are analysed, 60% of which belong to women. The average age is 55.2 years. 41.7% of the SAD was registered by self-motivation. 84.78% do not wish to receive parenteral nutrition, 91.06% reject feeding through gastrostomy intubation, and 89.37% do not want to receive the nasogastric intubation. Hydration is rejected by 71.25%. The three possible options of SNS depend on the age of the declarant with statistical significance (p < 0.001), but not so for hydration. Both SNE and hydration are significantly associated with the reasons for the registration of Advance Directives (p < 0.001). Conclusions: Age is the main factor that determines the choice of accepting or rejecting SNS. By contrast, the choice of hydration is not conditioned by age. The reasons that drive respondents to register DVA is another determinant in the choice of whether to receive or not SNE and hydration (AU)