[Five-year comparison of two techniques of bariatric surgery in patients with morbid obesity followed up in a nurse consultation]. / Comparación a 5 años de dos técnicas de cirugía bariátrica en pacientes con obesidad mórbida seguidos en consulta enfermera.

AIMS: To compare the evolution of weight loss and complications in the patients subjected to two techniques of bariatric surgery (RVG: ring vertical gastroplasty and BP: gastric by pass type Capella) carried out in HospitalLa Paz during the years 2000 and 2001. MATERIAL AND METHODS: 51 patients (27 RVG and 24 BP) were operated, and 44 (22 RVG and 22 BP) completed the follow-up at 1 year, 43 (22 RVG and 21 BP) at 2 years, and 28 (10 RVG and 18 BP) at 5 years. The parameters analyzed at 6, 12, 18, 24 months and 5 years were BMI (body mass index), EI (effectiveness index), % LW (percentage of lost weight), % LEW (percentage of lost excess of weight), alimentary intolerances, digestive complications, surgical complications, physical activity and modification of alimentary habits. RESULTS: An important reduction of weight was observed at 6 months with both techniques (% LEW: 45.8% with RVG and 53.4% with BP). After 12 months the loss of weight was significantly higher with BP (% LEW at 2 years: 59.5% with RVG and 83% with BP). However, at 5 years a weight recovery was detected in both groups of patients. At 12 months the patients subjected to RVG tolerated worse the meat and at 18 months the group of BP tolerated worse the rice. There were not significant differences in other parameters. CONCLUSION: The long term results are better with BP than with RVG. There is a reduction of effectiveness at 5 years that could be related with the modification of alimentary habits and with giving up attendance to the nurse consultation.

[Life-style in eating behavior disorders]. / Estilo de vida en trastornos de conducta alimentaria.

GOAL: To identify the eating habits and lifestyles of patients with eating behaviour disorders (TCA in its Spanish acronym) who attended our out-patients' clinic at the "La Paz" Teaching Hospital for the first time. METHOD: A questionnaire was drafted to which patients responded freely and anthropometric data were assessed. RESULTS: The sample comprised 94 patients who were subsequently distributed into two groups: the first group contained 43 offspring of working mothers (HMTF) and the second 46 offspring of mothers who did not work outside the home (HMNTF in its Spanish acronym). In the case of the 5 remaining patients, their mothers had deceased. The results from the group as a whole showed the following lifestyles for Monday-Friday: 34.4% eat alone, 72% watch television while they eat and 68.1% use restrictive behaviour in their eating habits. When assessing the existence of a friend with TCA, the results were significantly higher among those under the age of 20 years (53.7%) versus those older than 20 (26.9%) (p < 0.05). No differences were found in the habits and nutritional status of HMTF and HMNTF since 8.2% of the first had severe caloric malnutrition versus 2.3% in the second group. While 12.2% of the HMTF group eat outside the home on weekdays and 44.9% of them eat alone, 20.5% of the HMNTF group eat outside the home on weekdays and 22.7% of them eat alone. The age of onset of TCA was significantly earlier among the HMTF group (16.6 years) than in the HMNTF group (19.0 years) (p < 0.05). CONCLUSION: A large number of subjects had a friend with TCA in their close environment and this situation was more frequent among the youngest ones in the group. Some mistaken ideas regarding food have favoured unhealthy eating: in our group a large majority of people eat while watching TV. The development of TCA occurs earlier in connection with a particular family structure: where the mother works outside the home.

[Results of educational intervention in obese patients]. / Resultados de la intervención educativa en pacientes con obesidad.

We have carried out an active longitudinal study to analyze the results obtained in the treatment of obesity by means of educational measures and a visit to a nurse for follow-up every 15-30 days. A total of 116 patients have been treated over the last two years, following referral from the medical clinic of the Nutrition and Dietetics Unit with a diagnosis of obesity. These patients received instruction in healthy eating and they were monitored in groups of 4-5 individuals with a similar level of obesity, age and cultural level, or else individually in special cases. At the cut-off point, 26.7% of the patients continued to attend the follow-up clinic, 5.1% had completed the therapy and achieved the goal set (weight reduction of at least 10%), whereas 44% had abandoned the monitoring process, 15.5% were referred back to the medical clinic and 8.6% requested a voluntary discharge. The largest percentage decrease in the BMI (Body Mass Index) can be found among those who requested a voluntary discharge (ddd 12.8) over the others. By analyzing the change in the BMI between the start and the end of the process, we have found a non-uniform significant decrease (p nnn 0.001) between the different degrees. We feel that education in healthy eating provides patients with the necessary information for them to be able to achieve balanced eating habits as the basis for the treatment of obesity. Regular follow-up and group sessions reinforce their continuity with treatment and the achievement of the goals set.

[Nutritional assessment for hospitalized patients]. / Valoración nutricional para pacientes hospitalizados.

A review of the following points was performed: Factors favouring the development and presence of malnutrition among hospitalized patients. Useful parameters in nutritional evaluation. Types of malnutrition. The Chang nutritional evaluation protocol is used in our Hospital, which is simple, inexpensive, reliable, specific and easily reproduced. This is based on five variables (three anthropometric and two biochemical), randomized and based on reference tables and values. A study was made on data corresponding to 70 patients, in whom a prevalence of malnutrition was observed in critical patients. The patients were classified based on three different definitive possibilities (Marasmo, Kwashiorkor and combined), and three grades of malnutrition (slight, moderate and severe).