[Adverse effects of parenteral nutrition in cancer patients: systematic review]. / Efectos adversos de la nutrición parenteral en pacientes oncológicos: revisión sistemática.

Malnutrition in hospitals is of great concern in patients with cancer. This malnutrition in cancer leads to higher risk of complications, and worse response to treatments and outcomes. Parenteral nutrition (PN) in cancer is controversial due to the heterogeneous results found in scientific literature. This is the reason why the evaluation of adverse events of PN, its incidence and severity, is crucial when prescribing PN in cancer patients. This evaluation of adverse events of PN is the aim of the present systematic review of the randomized clinical trials (RCT) written in any language found in several databases. From the 74 articles found in our search, only 13 RCT (18 different types of cancer) met the criteria to be selected for the systematic review. These RCT included 669 patients receiving central PN in whom 225 adverse events (33.63%) of PN were described, and 92 patients with peripheral PN, with 54 adverse events (58.70%). There were no adverse events in a control group of 47 patients receiving parenteral fluids. We conclude that scientific literature is very heterogeneous and evaluate complications of parenteral nutrition only as a secondary aim. We think necessary that further research do define complications of parenteral nutrition homogeneously and study them as a main objective.

[Peripheral parenteral nutrition]. / Nutrición periférica.

The Target of this review is to provide an up-to-date overview of the advantages and disadvantages of Peripheral Parenteral Nutrition (PPN), including techniques, indications and results. The new generation catheters, together with a better knowledge of the intermediary metabolism, give us the opportunity to use PPN in many clinical situations for short periods of time. PPN is an alternative to Total Parenteral Nutrition (TPN) and is also a complement to enteral nutrition and to the oral route. Progress in the design of catheters and their materials, in infusion techniques and better knowledge of optimal nutrients has made PPN into an effective, safe and useful therapy in the treatment of patients for certain periods of time.

[Home enteral nutrition. Annual report 1999. NADYA-SENPE Group]. / Nutrición enteral domiciliaria. Informe anual 1999. Grupo NADYA-SENPE.

GOAL: During 1999, as in previous years, the NADYA-SENPE Group has maintained an annual register of patients with Artificial Nutrition at Home in order to keep up to date our available knowledge of this therapy. The present paper analyzes the results of the sixth National Register of patients under treatment with Enteral Nutrition at Home corresponding to 1999, produced with the co-operation of twenty-three centres in the Spanish national health network. MATERIAL AND METHODS: The data were collected through a closed questionnaire included on our web site (www.nadya-senpe.com). Apart from epidemiological information, the form includes the indication that led to the prescription of nutrition, nutritional treatment, access path, complications and admissions to hospital, follow-up of the treatment, patients' quality of life and progress. All of the data are processed by the co-ordinating team. The Nutrition Unit at La Paz Teaching Hospital in Madrid has acted as the group co-ordinator. RESULTS: During 1999, a total of 2,262 patients at the twenty-three collaborating centres followed treatment with Home Enteral Nutrition (NED in its Spanish acronym). The mean age was 63.6 (19.67 years (males: 57.6%; females: 42.3%). The mean time with nutritional treatment is 5.89 (4.25 months. The neurological alterations (37.5%) and neoplasias (36.8%) were the most frequent indications for NED. Most patients used oral administration (50.7%), the use of artificial routes is less frequent, with 5NG being used on 27.9% and PEG on 12.7%. The polymeric formulas are the ones most commonly used (87.7%). The number of complications recorded amounted to 1,403 episodes, representing 0.62 complications per patient per year, of which 40.8% were gastro-intestinal (0.26 complications per patient per year) and 18.7% were mechanical complications, with only 9 recorded cases of bronchoaspiration. It was necessary to admit patients to hospital on 836 occasions (0.38 admissions per patient), albeit generally for causes not associated with nutrition (86.1%). At year-end, 51.4% of patients continued to receive nutritional support. CONCLUSIONS: Enteral nutrition at home is a safe technique whose use is growing in Spain. It requires the existence of appropriately equipped nutrition teams as well as the collaboration of the Primary Health Care services and the suitable training of patients and relatives. It is essential to progress more deeply into the development and application of clinical routes that provide a clear and concise methodology covering all nutrition-related aspects. In itself, nutrition is a therapeutic alternative regardless of whether access is obtained through a natural or an artificial route. It is necessary for the persons responsible for health-care administration to realize that the appropriate nutrition of patients leads to an improvement in their general health, a shorter course for their illness and, therefore, a reduction in costs.

Effects of 2 lipid emulsions (LCT versus MCT/LCT) on the fatty acid composition of plasma phospholipid: a double-blind randomized trial.

BACKGROUND: Fatty acids from the diet or from IV fat emulsions are incorporated into the plasma and cell membrane phospholipids and act as substrates in the synthesis of eicosanoids. This study reports the effect of 2 parenteral lipid emulsions in plasma phospholipids fatty acids. METHODS: A total of 83 patients aged 18 to 75 years were randomized to receive long-chain triglycerides (LCT) or 50/50 mix of long- and medium-chain triglyceride emulsion (LCT/MCT). Blood samples were collected at baseline and at weekly intervals for 28 days. Plasma phospholipid fatty acids were measured by gas chromatography. RESULTS: Patients receiving LCT versus MCT/LCT emulsion have an increase in 18:2n6 and a decrease in 20:4n6 and 22:4n6 after 7, 14, and 21 days of treatment with parenteral nutrition. Phospholipid fatty acids at 15 days of treatment with parenteral nutrition with LCT versus MCT/LCT for 18:2n6 were 17.30% versus 22,90% (p < .05), for 20:4n6 10.44% versus 8.38% (p < .05), and for 22:4n6 0.51% versus 0.40% (p < .05). The 20:4n6 percentage inversely correlated with the percentage of 18:2n6 on days 7, 14, and 21: regression coefficients: -7.40 (p < .001), -7.39 (p < .001), and 5.70 (p < .001), respectively. CONCLUSIONS: Parenteral lipid emulsions modify fatty acid profiles in plasma phospholipids. MCT/LCT emulsions produce in phospholipids a fatty-acid profile that is closer to normality than that achieved with LCT emulsions. These changes in phospholipid fatty acids are suggestive of an inhibition of A-5-desaturase in patients who received LCT emulsions.

Plasma status of retinol, alpha- and gamma-tocopherols, and main carotenoids to first myocardial infarction: case control and follow-up study.

OBJECTIVE: Epidemiologic studies have suggested that dietary intake and plasma concentrations of antioxidants have an inverse relation with coronary heart disease. To test whether fat-soluble antioxidants can play a role against the occurrence of myocardial infarction (MI), we measured plasma levels of retinol, tocopherols, and individual carotenoids in MI patients. METHODS: A case-control and follow-up study of patients in the Móstoles area (Madrid, Spain). One hundred six patients (62 after 1 y) and 104 control subjects participated in the study. Blood samples were collected after overnight fast or during the first 24 h of MI onset for biochemical profiles of retinol, alpha- and gamma-tocopherols, and carotenoid by means of a quality-controlled high-performance liquid chromatography. RESULTS: During the acute phase after MI onset, plasma levels of retinol, gamma-tocopherol, and xanthophylls (lutein/zeaxanthin and beta-cryptoxanthin) decreased, whereas alpha-tocopherol, alpha-carotene, beta-carotene, and lycopene showed levels similar to those of control subjects. Logistic regression analysis showed low concentrations of gamma-tocopherol (and retinol) in plasma as the only statistically significant factor associated with MI, after adjusting for traditional risk factors. However, 1 y later, the MI patients showed a general improvement in plasma lipids and fat-soluble antioxidant status, and none of the analytes was associated with MI. CONCLUSIONS: The decreased plasma status of retinol, gamma-tocopherol, and xanthophylls during the acute phase of MI normalized the year after the MI event, suggesting that most subjects had followed an overall healthier lifestyle and dietary pattern. The results also raise concerns on the usefulness of these plasma compounds as specific, relevant, and predictive markers in relation to coronary heart disease.

[Manufacturing a double-lumen tube with simple and inexpensive materials]. / Fabricación de sonda de doble luz con materiales simples y baratos.

Twin-channel enteral feeding catheters allow the administration of early enteral nutrition in various pathologies while avoiding the use of total parenteral nutrition. We describe how to manufacture one simply using cheap and easy-to-find materials whenever a commercial catheter of this type is unavailable.

[Estimate of osteoporosis fracture risk with ultrasound bone assessment]. / Estimación del riesgo de fracturas osteoporóticas mediante medición ultrasónica del hueso.

BACKGROUND: Multiple studies suggest that ultrasound measurement of the bone can be a rapid, cheap, and radiation-free alternative to determine the fracture risk. In this paper the ultrasound measurement of the bone was performed among 288 postmenopausal women, and the influence of gynecologic history and factors related to lifestyle on the obtained values was examined. PATIENTS AND METHODS: One hundred nineteen healthy postmenopausal women and 169 women with previous osteoporotic fractures were included in the study. Both weight and height were determined and a clinical questionnaire was administered to assess factors related to bone mineral density. The values of broadband ultrasound attenuation (BUA) and speed of sound (SOS) were obtained with a contact ultrasound analyzer. RESULTS: Among women without fractures the mean BUA and SOS values (64.1 [14.9] and 1,601.1 [34.5], respectively) were significantly higher than mean BUA (48.8 [17.3]) and SOS (1,573 [57.8]) values among women with fractures (p < 0.001). Using the logistic regression analysis for predicting fracture risk, the model that suited best was that including BUA (OR = 0.668 [0.544-0.818]), age (OR = 1.102 [1.055-1.151]), age at postmenopause (OR = 0.794 [0.731-0.862]) and height (OR = 0.932 [0.883-0.983]). The area under the curve for this model was 0.871. CONCLUSIONS: BUA and SOS values are lower among women with osteoporotic fractures. The fracture risk can be predicted by means of a model including the variables BUA, age, postmenopausal age, and height.

[Backache as the initial symptom of adrenomyeloneuropathy]. / Lumbalgia como síntoma inicial de una adrenomieloneuropatía.

INTRODUCTION: Adrenoleukodystrophy is a paroxysmal disorder, with recessive linking to the X chromosome, characterized biochemically by the accumulation of extra-long-chain fatty acids. Six phenotypes are distinguished: pre-symptomatic, infantile, adolescent and adult cerebral forms, adrenomyeloneuropathy and isolated Addison's disease. We describe a patient with adrenomyeloneuropathy in whom the presenting symptom was lumbago. CLINICAL CASE: A 23 year old man with no significant previous clinical history complained of having lumbago for over two years. On examination he had pyramidal signs and reduced epicritic sensitivity of the legs. Laboratory investigations showed adrenal failure, increased plasma extra-long-chain fatty acids concentration, mononuclear cells and fibroblasts. On MR there was a hyperintense lesion of the genu of the corpus callosum. SSEP were pathological while the electroneurogram showed bilateral increase in latency of the F wave. The patient was diagnosed as having adrenomyeloneuropathy and treatment started with hydrocortisone, a diet low in extra-long-chain fatty acids and 'Lorenzo's oil'. The lumbago gradually disappeared while the plasma extra-long-chain fatty acids concentration dropped. The oil was stopped because of moderate thrombocytopenia, and treatment was started with lovastatin 40 mg/day. Two years later the patient has no lumbago and is neurologically stable. CONCLUSIONS: The lumbago associated with adrenomyeloneuropathy is probably due to demyelination of the spinal tracts. Although lumbago is usually a benign condition, a careful history and examination is necessary in all such cases.

[Artificial nutrition in the home. Annual information 1996.Group NADYA-SENPE]. / Nutrición artificial domiciliaria. Informe Anual 1996. Grupo NADYA-SENPE.

Using a simplified questionnaire from the NADYA group, data referring to age, sex, diagnosis, access route, duration, form of administration, complications, and quality of life have been gathered from 1,400 patients (57% male, 43% female) who receive home enteral nutrition, and from 38 patients (20% male and 18% female) who receive home parenteral nutrition. All of these patients come from the 1996 national registry. The most common indication for home enteral nutrition are neoplasias (39%) followed by neurological alterations (33%). The most common access route is oral (48%), followed by a nasogastric tube in 34%, PEG in 10% and surgical ostomies in 7%. The average treatment duration is 6 months. There is an index of 0.74 complications/patient-year (gastrointestinal 0.28 and mechanical alterations 0.19). At the end of the year 58% of the patients continued to use at home enteral nutrition, with a death rate of 17%. The majority of the treated patients presented a severe social disability (28%) or was bed-ridden (22%). The most common indications for home parenteral nutrition are: neoplasia (42%), Crohn_s disease (10%), and mesenteric ischemia (10%). AIDS (8%), radical enteritis (5%), and motility disorders (5%) are less common. In 42% of the cases tunneled catheters are used, and port-a-cath are used in 53%. The average treatment duration is 6.9 months. 1.06 hospitalizations/patient-year have been registered in relation to the nutritional treatment (mainly catheter sepsis). A mortality of 29% is registered, and there is recovery of the oral route in 7.9% of the cases. 50% of the patients present a severe social disability.

[Formulating a non-fat diet to induce essential fatty acid deficiency in rats]. / Formulación de una dieta sin grasa para producir deficiencia de ácidos grasos esenciales en ratas.

OBJECTIVE: To describe the manufacture of an experimental diet to cause essential fatty acids deficiencies in rats. MATERIAL AND METHODS: Rats. We used Wistar rats that were given a diet consisting of skimmed milk, starch, and dextrino maltose. The fatty acids were measured by means of gas chromatography. RESULTS: The prepared diet is considerably cheaper than laboratory animal feed and it is effective in causing a fatty acid deficiency.

[Plasma levels of vitamins A and E and the risk of acute myocardial infarct]. / Niveles plasmáticos de vitaminas A y E y riesgo de infarto agudo de miocardio.

INTRODUCTION AND OBJECTIVE: The incidence of myocardial infarction in Spain is low in spite of the high prevalence of smoking and hypertension. Natural antioxidants as vitamin E from a diet rich in fruit, oils and vegetables may protect against the development of this disease. In this study we have examine plasma levels of vitamin A and E as risk factors in the development of myocardial infarction. STUDY DESIGN: 62 cases were selected among patients 30-70 years old admitted to the hospital with a first episode of myocardial infarction, or diagnosed by arteriography of coronary heart disease. 62 controls were selected among patients with minor surgical conditions, and free of coronary heart disease according to the Rose questionnaire and ECG. LABORATORY ANALYSIS: Plasma samples for vitamin assays were taken in the first 24 hours after admission (62 cases) Plasma was separated by centrifugation and stored at -80 degrees C until plasma vitamins were determined by HPLC. RESULTS: Lipid adjusted blood levels of vitamin E were lower in cases, mean: 1092.0 +/- standard deviation 165.8 micrograms/dl (mean +/- SD) than in controls (1220.1 +/- 274.8 micrograms/dl p = 0.002). The multivariate adjusted odds ratio between extreme quintiles of blood vitamin E were 0.06 (95% confidence intervals (CI): 0.01-0.5; p for trend 0.0027. Adjusted blood levels of vitamins A were also lower in cases 44.0 +/- 15.1 micrograms/dl than in controls: (57.5 +/- 15.2 micrograms/dl; p < 0.001). Adjusted odds ratio between extreme quintiles of blood vitamin A adjusted for confounding factors were 0.06 (95% CI: 0.01-0.36; p for trend < 0.00001). CONCLUSIONS: There is an association between acute of myocardial infarction and reduce blood levels of vitamin A and E, that is not explained by the decrement in blood lipids levels. Therefore low blood levels of fat soluble vitamins may be a risk factor for the development of this disease.

[A catalogue of fatty acids]. / Un catálogo de ácidos grasos.

Fatty acids structure and function is an area of renewed interest because of its effects on plasma lipids, biosynthesis of prostaglandins, leucotrienes and thromboxanes, and the obligatory demands of some fatty acids, especially for the newborn. Fatty acids are identified in three different ways: by the classical nomenclature, by its trivial name, and by the new methods also known as the omega system. These three different methods have created some confusion. The aim of this article is to revise fatty acids chemical structure and to compile a list of nutritional important fatty acids with the three different terminologies.

[The effects of frying and grilling on the fat content of common foods (salmon, hake and beefsteak)]. / Los efectos de freír y asar a la plancha en el contenido graso de alimentos comunes (salmón, pescadilla y filete de vaca).

The effects of pan frying and deep frying in olive oil on the fat content in very lean meat (fat = 4.0%), salmon (fat = 26.0%) and hake (fat = 1.8%) have been studied. Both techniques produced fat loss in the meat: pan fried 0.5% (p = 0.07), deep fried 1.3% (p = 0.00036); and salmon: pan fried 11.7% (p = 0.0000026), deep fried 7.9% (p = 0.00012). Hake increased fat content with pan fried 2.4% (p = 0.002) and with deep fried 5% (p = 0.00001). Deep frying or pan frying of meat induce fat loss without dietetic relevance. Fat loss in salmon is nutritionally important specially when pan fried. Fat gain in hake is too small to be considered biologically relevant. This results can not be applied to frying with others fats than olive oil or to frying others food with the same oil.

[Difficulties and problems associated with the implantation of a catheter in the subclavian (II)]. / Dificultades y problemas asociados con la implantación de catéter en subclavia (II).

They are analyzed the problems which are present during placement of multiple-lumen subclavian catheters using the Seldinger technique, such as: the difficulty in anesthesia of the puncture area; failure in location of the vein; difficulties in advancement of the guide wire, the dilator or the catheter; catheter malposition; and accidental puncture of the subclavian artery, the pleura or the trachea; and also some potential solutions.

[The subclavian catheter in parenteral nutrition (I)]. / El catéter de subclavia en nutrición parenteral (I).

A meticulous review is made of the subclavian multiple-lumen catheter placement method by the Seldinger technique, which is based on the experience collected over the last five years. The details concerning to the material and field preparation, the anesthesia in the puncture site, the vein puncture, and the catheter insertion and fixing, are discussed.

[The automation of the calculations in surveys of food consumption frequency]. / Automatización de los cálculos en las encuestas de frecuencia de consumo de alimentos.

With the aim of facilitating and reducing the cost of food consumption frequency surveys, an automated reading, codification and nutrient calculation survey has been developed. Graphite mark optical reader sheet were used, with an XR-5 Datascan reader, and C and Dbase IV programming languages to create the programs and routines for the process. Data on food composition were obtained from the main tables currently published. Reading time for 220 surveys was 130 minutes and the time for calculation of the dietary composition was 175 minutes. This system facilitates the reading and codification of surveys, reducing the time required and cutting costs.

[The application of impedance analysis to the study of body composition]. / La aplicación del análisis de impedancia al estudio de la composición corporal.

We have reviewed the physical theory of body composition assessment using bioelectrical impedance analysis. We discuss the measurement reproducibility, the application to the estimation of total body water, extracellular water, nutritional assessment and the measurement of total body fat. We also comment the application to the study of body composition in children, other physiological and pathological situations and the utility in epidemiological studies.