Effectiveness of High-Protein Energy-Dense Oral Supplements on Patients with Malnutrition Using Morphofunctional Assessment with AI-Assisted Muscle Ultrasonography: A Real-World One-Arm Study.

Background: User-friendly tools for assessing nutrition status and interventions in malnourished patients are crucial. This study evaluated the effectiveness of a personalised nutrition intervention using a novel oral nutritional supplement and AI-supported morphofunctional assessment to monitor clinical outcomes in patients with disease-related malnutrition (DRM). Methods: This prospective observational study involved patients receiving concentrated high-protein, high-calorie ONS (cHPHC-ONS), per usual clinical practice. Comprehensive assessments were performed at baseline (B0) and three months (M3) post-intervention. Results: 65 patients participated in the study. Significant decreases were observed in the percentage weight loss from B0 (-6.75 ± 7.5%) to M3 (0.5 ± 3.48%) (p < 0.01), in the prevalence of malnutrition (B0: 93.4%; M3: 78.9%; p < 0.01), severe malnutrition (B0: 60.7%; M3: 40.3%; p < 0.01), and sarcopenia (B0: 19.4%; M3: 15.5%; p < 0.04). Muscle area increased (p = 0.03), and there were changes in the echogenicity of the rectus femoris muscle (p = 0.03) from B0 to M3. In patients aged ≥60, an increase in muscle thickness (p = 0.04), pennation angle (p = 0.02), and handgrip strength (p = 0.04) was observed. There was a significant reduction in the prevalence of malnutrition (B0: 93.4%; M3: 78.9%; p < 0.01) and severe malnutrition (B0: 60.7%; M3: 40.3%; p < 0.01). Conclusions: In patients with DRM, a personalised intervention with cHPHC-ONS significantly reduces the prevalence of malnutrition, severe malnutrition, and sarcopenia and improves muscle mass and function.

Effect of a diabetes-specific formula in non-diabetic inpatients with stroke: a randomized controlled trial.

BACKGROUND/OBJECTIVES: In patients with acute stroke, the presence of hyperglycaemia has been associated with higher morbidity and less neurological recovery. The aim of the study was to evaluate the impact of a diabetes specific enteral nutrition (EN) formula on glycaemia, comorbidities and mortality in patients admitted with a first episode of stroke who received complete EN. METHODS: This was a prospective randomised controlled trial. Patients with acute stroke did not have diagnosis of diabetes mellitus and required nasogastric tube feeding. This study has been registered with code NCT03422900. The patients were randomised into two arms: an isocaloric isoprotein formula (control group (CG), 27 patients) vs a diabetes-specific formula (low glycaemic index carbohydrates, fibre (80% soluble) and higher lipid content) (experimental group (EG), 25 patients). Pre-EN blood glucose, hyperglycaemia during EN treatment, HbA1c, insulin use, oral route recovery, length of stay (LOS) and mortality at 30 days were collected. The complications of enteral nutrition during admission were collected as well. RESULTS: 52 patients were included, 50% females, with an age of 77.44(11.48) years; 34 (65.4%) had ischaemic stroke, with a Rankin score of 0(0-2), and a National Institute of Health Stroke Scale (NIHSS) of 19 (15-22). In CG, there were more cases of hyperglycaemia on the 5th day post-NE (13(65%) vs7(35%), p < 0.01). CG showed an OR of 7.58(1.49-39.16) (p = 0.02) for the development of hyperglycaemia. There were no differences in LOS between groups (12(8.5) days vs 14(23) days, p = 0.19) or in the death rate (10(37%) vs 10(40%), p = 0.8), although differences were found in terms of oral route recovery (EG: 11(44%) patients vs CG: 5(18.5%) patients, p = 0.04) (OR (EG): 5.53(1.25-24.47); p = 0.02). CONCLUSIONS: The use of a diabetes-specific enteral formula in non-diabetic patients admitted with acute stroke reduced the risk of developing hyperglycaemia and improved the rate of oral route recovery. Registered under ClinicalTrials.gov Identifier no. NCT03422900.

Adherence and impact of an oral nutritional supplement enriched in leucine, EVOO, EPA and DHA, and beta-glucans on the coverage of energy and protein requirements in patients with cancer and malnutrition: Alisenoc study.

OBJECTIVE: The aim of this study was to evaluate the impact of an enhanced ONS (enriched in EPA, DHA, leucine, and beta-glucans) on the dietary intake of cancer patients. METHODS: A randomized, double-blind, parallel, controlled, and multicenter clinical trial was conducted in patients with cancer and malnutrition. The trial compared prescribed dietary advice and two packs per day, for 8 weeks, of a hypercaloric (400 kcal/pack) and hyperproteic ONS (20 g/pack) with fiber and specific ingredients (leucine, EPA and DHA, and beta-glucans) (enhanced-ONS) versus an isocaloric and isoproteic formula (standard-ONS) without specific ingredients. Food intake was assessed with a 3-day dietary survey, and adherence to the supplement with a patient self-completed diary. RESULTS: Thirty-seven patients completed the intervention period. The combined intervention of dietary advice and ONS managed to increase the energy intake of the overall cohort by 792.55 (378.57) kcal/day, protein by 40.72 (19.56) g/day. Increases in energy and nutrient intakes were observed in both groups, both in dietary intake and associated exclusively with the supplement. The group that received the enhanced-ONS ingested a greater volume of product when there was a greater severity of malnutrition; a tumor location in the head, neck, upper digestive area, liver, or pancreas; more advanced stages of the tumor; or the receipt of more than one antineoplastic treatment. CONCLUSION: The use of an enhanced-ONS helps meet the nutritional requirements of cancer patients, especially those who have a more compromised clinical condition, with high adherence, good tolerance, and acceptance.

Nutritional Ultrasonography, a Method to Evaluate Muscle Mass and Quality in Morphofunctional Assessment of Disease Related Malnutrition.

Nutritional ultrasonography is an emerging technique for measuring muscle mass and quality. The study aimed to evaluate the relationship between the parameters of body mass and quality of ultrasonography with other parameters of morphofunctional assessment in patients with disease-related malnutrition (DRM). METHODS: A cross-sectional study was developed on 144 patients diagnosed with DRM according to the Global Leadership Initiative on Malnutrition (GLIM) criteria. Morphofunctional evaluation was assessed with anthropometric variables, handgrip strength and bioelectrical impedanciometry (BIA). Nutritional ultrasonography of quadriceps rectus femoris (QRF) was made (muscle mass (Muscle Area of Rectus Femoris index (MARFI)), Y axis and muscle quality (X-Y index and echogenicity). RESULTS: The mean age of patients was 61.4 (17.34) years. The prevalence of sarcopenia in the sample was 33.3%. Patients with sarcopenia (S) had lower values of MARFI [(S: 1.09 (0.39) cm2/m2; NoS: 1.27 (0.45); p = 0.02), Y axis (S: 0.88 (0.27); NoS: 1.19 (0.60); p < 0.01) and X-Y index (S: 1.52 (0.61); NoS: 1.30 (0.53); p < 0.01)]. There was a correlation between BIA parameters (phase angle) and muscle mass ultrasonographic variables (MARFI) (r = 0.35; p < 0.01); there was an inverse correlation between muscle quality ultrasonographic variables (echogenicity) and handgrip strength (r = -0.36; p < 0.01). In the multivariate analysis adjusted by age, the highest quartile of the X-Y index had more risk of death OR: 4.54 CI95% (1.11-18.47). CONCLUSIONS: In patients with DRM and sarcopenia, standardized muscle mass and muscle quality parameters determined by ultrasonography of QRF are worse than in patients without sarcopenia. Muscle quality parameters had an inverse correlation with electric parameters from BIA and muscle strength. The highest quartile of the X-Y index determined by ultrasonography was associated with increased mortality risk.

Nutritional ultrasound®: Conceptualisation, technical considerations and standardisation.

Nutritional ultrasound® is a new concept that uses ultrasound to assess body composition. It is composed of the evaluation of fat-free mass and fat mass. It is an emerging, economical, portable, non-invasive technique that evaluates the musculoskeletal area with linear, broadband, multifrequency probes, with a depth field of 20-100mm. It quantifies muscle modifications in malnutrition and provides information on functional changes (echogenicity). Although there are no validated specific cut-off points, the anterior rectum area of the quadriceps can be used as a criterion for malnutrition. The distribution of adipose tissue provides information on the energy reserve and the inflammatory pattern. It is important to integrate nutritional ultrasound® measures in clinical practice adapted to different settings and pathologies. It is necessary to establish training plans in nutritional ultrasound® for use by Endocrinology and Nutrition Specialists, with the aim of improving the diagnosis and treatment of their patients.

Diagnosis of malnutrition and its relationship with prognosis in hospitalized patients with oncological pathology.

BACKGROUND AND AIMS: Medical oncology inpatients are at a very high risk of malnutrition, and the presence of complications associated with malnutrition is significant in their evolution. It is necessary to have adequate tools in the diagnosis of malnutrition. OBJECTIVES: This study is aimed to assess the nutritional status of cancer inpatients and compare the incidence of complications based on the nutritional diagnosis with different tools. METHODS: An observational, longitudinal, and retrospective study was designed on 149 patients admitted to the Oncology Service who were requested nutritional and medical treatment between January 2014 and June 2017. Epidemiological, clinical, anthropometric, and nutritional data were collected. Nutritional status was assessed using the Mini Nutritional Assessment (MNA), the Malnutrition Universal Screening Tool (MUST), and the Global Leadership Initiative on Malnutrition (GLIM) criteria. RESULTS: The age of the patients was 61.61 (15.96) years. 67.8% of the patients were men. Most of the patients were in advanced tumor stages (stage III (15.3%); stage IV (77.1%)). The median of the MUST was 2 (0-3) (High risk: 83 (55.7%)). The median MNA was 17 (14-20) (poor nutritional status: 65 (43.6%); risk of malnutrition 71 (47.7%)). According to the GLIM criteria, 115 (77.2%) had malnutrition, and 97 (65.1%) had severe malnutrition. According to MNA, an increase in mortality was observed (MNA <17: 24.6% vs. MNA >17: 7.9%; pvalue <0.01). Multivariate analysis showed that poor nutritional status measured with MNA is related to an increased probability of mortality regardless of the stage of the disease and the patient's age OR: 4.19 95% CI (1.41-12.47); p-value = 0.02. CONCLUSIONS: Malnutrition among cancer patients in whom a nutritional assessment is requested during admission is very high. In hospitalized patients with oncological pathology, it was observed that malnutrition measured by MNA acts as a mortality risk factor.

Effect on Body Composition of a Meal-Replacement Progression Diet in Patients 1 Month after Bariatric Surgery.

BACKGROUND: Progression diets after bariatric surgery (BS) are restricted in calories and protein, and they may induce a worsening of body composition. The aim of this study was to evaluate the effect of a modified diet with an oral nutritional supplement that is hyperproteic and normocaloric over the body composition. METHODS: A two-arm ambispective observational cohort study was designed. Forty-four patients who underwent sleeve gastrectomy were included in the study. Thirty patients received a progression diet with a normocaloric, hyperproteic oral nutritional supplement during the first two weeks after surgery (820 kcal, 65.5 g protein). They were compared with a historical cohort of 14 patients treated with a standard progression diet (220 kcal, 11.5 g protein). Anthropometric and body composition (using electrical bioimpedanciometry) data were analyzed before BS and 1 month after the surgery. RESULTS: The mean age was 47.35(10.22) years; 75% were women, and the average presurgical body mass index (BMI) was 45.98(6.13) kg/m2, with no differences between both arms of intervention. One month after surgery, no differences in the percentage of excess weight loss (%PEWL) were observed between patients in the high-protein-diet group (HP) and low-protein-diet group (LP) (HP: 21.86 (12.60)%; LP: 18.10 (13.49)%; p = 0.38). A lower loss of appendicular skeletal muscle mass index was observed in the HP (HP: -5.70 (8.79)%; LP: -10.54 (6.29)%; p < 0.05) and fat-free mass index (HP: 3.86 (8.50)%; LP:-9.44 (5.75)%; p = 0.03), while a higher loss of fat mass was observed in the HP (HP: -14.22 (10.09)%; LP: -5.26 (11.08)%; p < 0.01). CONCLUSIONS: In patients undergoing gastric sleeve surgery, the addition of a normocaloric, hyperproteic formula managed to slow down the loss of muscle mass and increase the loss of fat mass with no differences on total weight loss.

Muscular Ultrasonography in Morphofunctional Assessment of Patients with Oncological Pathology at Risk of Malnutrition.

Background: Muscular ultrasonography is a technique that allows assessing the amount and quality of muscle in a specific body region. The aim of the study was to compare the value of muscle ultrasonography in diagnosis of malnutrition with techniques such as anthropometry, handgrip strength and impedanciometry in patients with oncological pathology. Methods: Cross-sectional study in 43 patients with oncological pathology and high nutritional risk. Classical anthropometry (body mass index (BMI), arm circumference (AC), calf circumference (CC) and estimated appendicular muscle mass index (ASMI)) was performed. Body composition was measured with impedanciometry (BIA), phase angle (PA) and fat-free mass index (FFMI) and muscle ultrasonography of quadriceps rectus femoris (muscle area (MARA) and circumference (MCR) in section transverse). Malnutrition was diagnosed using the GLIM criteria and sarcopenia was assessed using EWGSOP2 criteria. Results: The mean age was 68.26 years (±11.88 years). In total, 23/20 of the patients were men/women. The BMI was 23.51 (4.75) kg/m2. The ASMI was 6.40 (1.86) kg/m2. The MARA was 3.31 cm2 in ultrasonography. In impedanciometry, phase angle was 4.91 (0.75)°; the FFMI was 17.01 kg/m2 (±2.65 kg/m2). A positive correlation was observed between the MARA with anthropometric measurements (AC: r = 0.39, p = 0.009; CC: r = 0.44, p < 0.01; ASMI: r = 0.47, p < 0.001); and with BIA (FFMI: r = 0.48, p < 0.01 and PA: r = 0.45, p < 0.001). Differences were observed when comparing the MARA based on the diagnosis of sarcopenia (Sarcopenia: 2.47 cm2 (±0.54 cm2); no sarcopenia: 3.65 cm2 (±1.34 cm2); p = 0.02). Conclusions: Muscle ultrasonography correlates with body composition measurement techniques such as BIA and anthropometry in patients with cancer.

Influence of Obesity on Bone Turnover Markers and Fracture Risk in Postmenopausal Women.

Background and aims: The relationship between obesity and bone metabolism is controversial. In recent decades, the protective role of obesity in the development of osteoporosis is questioned. The aims of this study are the following: to evaluate the differences in bone turnover markers between postmenopausal women with and without obesity and to compare the risk of fracture at five years between these groups. Methods: An observational longitudinal prospective cohort study of postmenopausal women with obesity (O) (body mass index (BMI) > 30 kg/m2) and non-obesity (NoO) (BMI < 30 kg/m2) is designed. 250 postmenopausal women are included in the study (NoO: 124 (49.6%) and O: 126 (50.4%)). It measures epidemiological variables, dietary variables (calcium intake, vitamin D intake, smoking, alcohol consumption, and physical activity), biochemicals (ß-crosslap, type I procollagen amino-terminal peptide (P1NP), 25OH-vitamin D, and parathyroid hormone (PTH)), anthropometric variables, and fracture data five years after the start of the study. The mean age is 56.17 (3.91) years. Women with obesity showed lower levels of vitamin D (O: 17.27 (7.85) ng/mL, NoO: 24.51 (9.60) ng/mL; p < 0.01), and higher levels of PTH (O: 53.24 (38.44−65.96) pg/mL, NoO: 35.24 (25.36−42.40) pg/mL; p < 0.01). Regarding the bone formation marker (P1NP), it was found to be high in women without obesity, O: 45.46 (34.39−55.16) ng/mL, NoO: 56.74 (45.34−70.74) ng/mL; p < 0.01; the bone resorption marker (ß-crosslap) was found to be high in women with obesity, being significant in those older than 59 years (O: 0.39 (0.14) ng/mL, NoO 0.24 (0.09) ng/mL; p < 0.05). No differences are observed in the risk of fracture at 5 years based on BMI (OR = 0.90 (95%CI 0.30−2.72); p = 0.85). Conclusions: Postmenopausal women with obesity showed lower levels of bone formation markers; older women with obesity showed higher markers of bone resorption.

Evolution of nutrition support in patients with COVID-19 disease admitted in the Intensive Care Unit.

INTRODUCTION: Nutritional support in patients with COVID19 can influence the mean stay and complications in the patient in Intensive Care Unit (ICU). AIMS: To evaluate the selection of enteral nutritional treatment in the COVID-19 patient admitted to the ICU. To know the development of dysphagia and its treatment. To evaluate the adjustment to the requirements and its relationship with the patient's complications. MATERIAL AND METHODS: One-center longitudinal retrospective study in 71 patients admitted to the ICU with COVID19 infection and complete enteral nutrition between March and April 2020. Clinical variables were collected: length of stay in ICU, mean stay and rate of complications; and estimated anthropometric variables. RESULTS: The mean age was 61.84 (13.68) years. Among the patients analyzed, 33 (46.5%) died. The median stay in the ICU was 20 (15.75-32) days and the mean stay was 37 (26.75-63) days. The type of formula most prescribed was normoprotein 24 (35.3%) and diabetes-specific 23 (33.8%) depending on the prescribed formula. There was no difference in mean stay (p = 0.39) or death rate (p = 0.35). The percentage of achievement of the estimated protein requirements was 50 (34.38-68.76). At discharge, 8 (21%) of the patients had dysphagia. A relationship was observed between the mean ICU stay and the probability of developing dysphagia (OR: 1.035 (1.004-1.07); p = 0.02). CONCLUSIONS: In the patient with COVID19 disease admitted to the ICU, only half of the necessary protein requirements were reached. The presence of dysphagia at discharge was related to the length of time the patient was in the ICU.

Real World Practice Study of the Effect of a Specific Oral Nutritional Supplement for Diabetes Mellitus on the Morphofunctional Assessment and Protein Energy Requirements.

Introduction: The prevalence of malnutrition in patients with diabetes mellitus is high. In these patients, monitoring nutritional intervention is complex. Aims: To evaluate the evolution in the nutritional status in patients with diabetes/prediabetes and malnutrition with a diabetes-specific enteral formula. Methods: Real-life study of one arm in 60 patients with diabetes and prediabetes, performing a dietary adaptation with diabetes-specific oral nutritional supplementation. A morphofunctional assessment was performed, consisting of intake assessment, anthropometry, body composition (bioimpedance and muscle ultrasound), handgrip strength and biochemical markers. The diagnosis of malnutrition was made using the criteria of the Global Leadership Initiative on Malnutrition (GLIM). The variables were measured at baseline and 3 months after starting the intervention. Results: The mean age was 67.13 (14.9) years. In total, 30 (50%) of the patients were women. Of the total, 60% of the patients had diabetes mellitus and 40% of the patients had prediabetes. The initial body mass index was 24.65 (5.35) kg/m2. It was observed that 80% of the patients had malnutrition, whereas after the intervention, the prevalence was 51.7% (p < 0.01). At the beginning of the study, 20% of the patients suffered from sarcopenia and after the intervention it was 16.7% (p = 0.19). Conclusions: Medical Nutrition Therapy with an adapted oral diet associated with diabetes-specific oral nutritional supplementation reduces malnutrition in patients at nutritional risk and disturbances of carbohydrate metabolism.

[Evolution of nutrition support in patients with COVID-19 disease admitted in the Intensive Care Unit]. / Evolución del soporte nutricional en el paciente con enfermedad COVID-19 ingresado en la Unidad de Cuidados Intensivos.

Introduction: Nutritional support in patients with COVID-19 can influence the mean stay and complications in the patient in Intensive Care Unit (ICU). Aims: To evaluate the selection of enteral nutritional treatment in the COVID-19 patient admitted to the ICU. To know the development of dysphagia and its treatment. To evaluate the adjustment to the requirements and its relationship with the patient's complications. Material and methods: One-center longitudinal retrospective study in 71 patients admitted to the ICU with COVID-19 infection and complete enteral nutrition between March and April 2020. Clinical variables were collected: length of stay in ICU, mean stay and rate of complications; and estimated anthropometric variables. Results: The mean age was 61.84 (13.68) years. Among the patients analyzed, 33 (46.5%) died. The median stay in the ICU was 20 (15.75-32) days and the mean stay was 37 (26.75-63) days.The type of formula most prescribed was normoprotein 24 (35.3%) and diabetes-specific 23 (33.8%). Depending on the prescribed formula, there was no difference in mean stay (p = 0.39) or death rate (p = 0.35). The percentage of achievement of the estimated protein requirements was 50% (34.38-68.76).At discharge, 8 (21%) of the patients had dysphagia. A relationship was observed between the mean ICU stay and the probability of developing dysphagia (OR: 1.035 (1.004-1.07); p = 0.02). Conclusions: In the patient with COVID-19 disease admitted to the ICU, only half of the necessary protein requirements were reached. The presence of dysphagia at discharge was related to the length of time the patient was in the ICU.

[Influence of prior ischemic events on the nutritional status of patients hospitalized for stroke]. / Influencia de la historia de isquemia sobre el estado nutricional en pacientes ingresados por accidente cerebrovascular.

INTRODUCTION: Background and aims: a poor nutritional status may worsen the prognosis of stroke. We assessed which factors were associated with a worse nutritional status in patients with stroke at the time of hospitalization. Methods: a cross-sectional study in patients with stroke needing enteral nutritional support, from January 2014 to September 2016. Nutritional status was evaluated by the Mini-Nutritional Assessment tool, and the Subjective Global Assessment. We performed a multivariate regression analysis including demographic, baseline disability (modified Rankin scale), and clinical and anthropometric variables, and we stratified the sample based on median age. Results: we included 226 patients, 58.3 % male, with a median age of 77 (66.7-83) years. Forty-four percent were at risk of malnutrition, and 24 % were malnourished. The factors that were associated with a worse nutritional status were age (odds ratio (OR): 1.03; 95 % CI: 1.01-1.08) and modified Rankin scale score (OR: 1.96; 95 % CI: 1.32-2.67). In the stratified analysis, associated factors were, in the subgroup of patients older than 77 years, the baseline degree of disability (OR: 1.88; 95 % CI: 1.26-2.80), whereas in the subgroup of patients younger than 77 years, it was a prior history of ischemic events (OR: 2.86; 95 % CI: 1.01-8.16). Conclusion: in patients hospitalized due to stroke, older age and worse functional status were associated with a worse nutritional status at the time of hospitalization. In elderly patients, the main factor was prior functional status, while in younger patients it was a prior history of ischemic events.

INTRODUCCIÓN: Introducción y objetivos: el mal estado nutricional empeora el pronóstico del ictus. El objetivo de este trabajo fue evaluar qué factores se asociaban a una mala situación nutricional en pacientes con ictus en el momento del ingreso. Material y método: estudio transversal de pacientes hospitalizados con ictus que precisaron soporte nutricional enteral, desde enero de 2014 hasta septiembre de 2016. Determinamos el estado nutricional mediante el Mini-Nutritional Assesment y la valoración global subjetiva. Se realizó un análisis de regresión multivariante, incluyendo variables demográficas, situación funcional (escala de Rankin) y variables clínicas y antropométricas, estratificándose por la edad mediana de la muestra. Resultados: se incluyeron 226 pacientes, el 58,3 % varones, con una edad mediana de 77 (66,7-83) años. El 44 % presentaban riesgo de malnutrición y el 24 % desnutrición. Los factores asociados a una mala situación nutricional fueron la edad (odds ratio (OR): 1,03, IC 95 %: 1,01-1,08) y la puntuación en la escala de Rankin (OR: 1,96; IC 95 %: 1,32-2,67). En el análisis estratificado, los factores asociados a una mala situación nutricional fueron, en el subgrupo de los mayores de 77 años, la capacidad funcional previa (OR: 1,88; IC 95 %: 1,26-2,80), y en el subgrupo de los menores de 77 años, la historia de eventos isquémicos previos (OR: 2,86; IC 95 %: 1,01-8,16). Conclusiones: en pacientes hospitalizados por ictus, la mayor edad y la peor situación funcional previa se asociaron a una peor situación nutricional. En los pacientes de mayor edad, el factor principal fue la situación funcional previa, mientras que en los pacientes más jóvenes, fue el antecedente de patología isquémica.

Effect of the type of specialized nutrition support on the course of the patient with amyotrophic lateral sclerosis (ALS). Interhospital registry SCLEDyN.

INTRODUCTION: Amyotrophic Lateral Sclerosis (ALS) is a neurodegenerative disease in which specialized nutritional support is essential. The objectives of our study were to describe nutritional support at the beginning of follow-up and its impact on anthropometry and survival. METHODS: An interhospital registry was created for the hospitals of Castilla-León through a web platform designed for this purpose. An anamnesis was carried out on the evolution and nutritional history of the disease; and classical anthropometry was determined. The prescribed nutritional treatment was recorded. The parameters were measured at the beginning, at six and twelve months of nutritional follow-up. RESULTS: A total of 93 patients [49 (52.7%) spinal; 44 (47.3%) bulbar)] were analyzed. The nutritional support route at the beginning was oral diet in 36 (38.7%) patients; oral nutritional supplementation (SON) in 46 (49.5%) patients; and in 11 (11.8%) patients percutaneous endoscopic gastrostomy (PEG). A decrease in the body mass index (BMI) was observed between the first and second visit [Start: 24.18 (3.29) kg/m2; 6 months: 23.69 (4.12) kg/m2; P < .05]. Less weight loss was observed at 6 months compared to the start of nutritional follow-up [Start: 8.09 (8.72)%; 6 months: 1.4 (6.29)%; P < .01]. 36 (38.7%) patients died but with no differences according to when nutritional support was started. Survival from the onset of symptoms was higher in the group of patients with artificial nutrition, although without reaching statistical significance [Oral: 28 (20.25) months; SON: 30 (16.75-48.25) months; PEG: 39 (27-52) months; P = .90]. CONCLUSIONS: Patients with ALS present a severe deterioration in nutritional status before the start of nutritional support. After the nutritional intervention, a slowdown in weight loss and nutritional deterioration was observed.

Impact of Percutaneous Endoscopic Gastrostomy (PEG) on the Evolution of Disease in Patients with Amyotrophic Lateral Sclerosis (ALS).

Dysphagia is a highly prevalent symptom in Amyotrophic Lateral Sclerosis (ALS), and the implantation of a percutaneous endoscopic gastrostomy (PEG) is a very frequent event. The aim of this study was to evaluate the influence of PEG implantation on survival and complications in ALS. An interhospital registry of patients with ALS of six hospitals in the Castilla-León region (Spain) was created between January 2015 and December 2017. The data were compared for those in whom a PEG was implanted and those who it was not. A total of 93 patients were analyzed. The mean age of the patients was 64.63 (17.67) years. A total of 38 patients (38.8%) had a PEG implantation. An improvement in the anthropometric parameters was observed among patients who had a PEG from the beginning of nutritional follow-up compared to those who did not, both in BMI (kg/m2) (PEG: 0 months, 22.06; 6 months, 23.04; p < 0.01; NoPEG: 0 months, 24.59-23.87; p > 0.05). Among the deceased patients, 38 (40.4%) those who had an implanted PEG (20 patients (52.6%) had a longer survival time (PEG: 23 (15-35.5) months; NoPEG 11 (4.75-18.5) months; p = 0.01). A PEG showed a survival benefit among ALS patients. Early implantation of a PEG produced a reduction in admissions associated with complications derived from it.

Malnutrition at diagnosis in amyotrophic lateral sclerosis (als) and its influence on survival: Using glim criteria.

BACKGROUND: Malnutrition is a prognostic factor in Amyotrophic Lateral Sclerosis (ALS). Sometimes, this condition is underdiagnosed, and it might influence on disease progression. AIMS: To evaluate a) nutritional status at the beginning of specialized nutritional treatment and b) the influence of initial nutritional status on disease evolution and survival in a group of patients with amyotrophic lateral sclerosis (ALS). METHODS: An interhospital registry of patients with motor neuron disease treated at the Clinical Nutrition Clinics of six hospitals in the region of Castilla y León in Spain was created. The study was developed from January 2015 to December 2017. An anamnesis, affiliation data, past medical history, disease evolution, nutritional history and an anthropometry and bioelectrical impedance analysis were performed at baseline. The mortality rate was compared among those patients with worse nutritional status at the beginning of the follow-up against those with a better nutritional situation using two tools: The Subjective Global Assessment (SGA) and the criteria of the Global Leadership Initiative for Malnutrition (GLIM). RESULTS: A total of 93 patients were analysed. The median age of the patients was 67 (57.5-75.5) years. The median Body Mass Index was 24.4 (21.7-25.9) kg/m2 and the median percentage of weight loss was 9.32 (2.7-17.6)% without differences between the onset type. According to the SGA, 27 (29%) patients were in grade A; 43 (46.3%) patients were in grade B and 23 (24.7%) were in grade C. According to the new GLIM malnutrition criteria, 45 patients (48.4%) had malnutrition. Patients with worse nutritional status had a lower survival median with both SGA (SGA A: 20.5 (10.2-35) months vs SGA B-C: 12 (5.2-23.7) months (p = 0.03)) or the new GLIM criteria according to severity (severe malnutrition: 18 (5-24) months vs. no severe malnutrition: 20 (12-33) months (p = 0.01)). In the multivariate analysis, malnutrition measured by SGA was an independent risk factor (HR: 4.6 (1.5-13.9) p = 0.007) for survival over 15 months when adjusted for age, sex and type of onset of ALS. CONCLUSIONS: Patients with ALS have a severe deterioration in nutritional status when analysed using a classical malnutrition test (SGA) or a new one (GLIM criteria). Patients with a better nutritional situation according to SGA and GLIM severity classification were associated with a longer survival time.

Effect of the type of specialized nutrition support on the course of the patient with amyotrophic lateral sclerosis (ALS). Interhospital registry SCLEDyN. / Efecto del tipo de soporte nutricional especializado sobre la evolución del paciente con esclerosis lateral amiotrófica (ELA). Registro interhospitalario SCLEDyN.

INTRODUCTION: Amyotrophic Lateral Sclerosis (ALS) is a neurodegenerative disease in which specialized nutritional support is essential. The objectives of our study were to describe nutritional support at the beginning of follow-up and its impact on anthropometry and survival. METHODS: An interhospital registry was created for the hospitals of Castilla-León through a web platform designed for this purpose. An anamnesis was carried out on the evolution and nutritional history of the disease; and classical anthropometry was determined. The prescribed nutritional treatment was recorded. The parameters were measured at the beginning, at six and twelve months of nutritional follow-up. RESULTS: A total of 93 patients [49 (52.7%) spinal; 44 (47.3%) bulbar)] were analyzed. The nutritional support route at the beginning was oral diet in 36 (38.7%) patients; oral nutritional supplementation (SON) in 46 (49.5%) patients; and in 11 (11.8%) patients percutaneous endoscopic gastrostomy (PEG). A decrease in the body mass index (BMI) was observed between the first and second visit [Start: 24.18 (3.29) kg/m2; 6 months: 23.69 (4.12) kg/m2; P<.05]. Less weight loss was observed at 6 months compared to the start of nutritional follow-up [Start: 8.09 (8.72)%; 6 months: 1.4 (6.29)%; P<.01]. 36 (38.7%) patients died but with no differences according to when nutritional support was started. Survival from the onset of symptoms was higher in the group of patients with artificial nutrition, although without reaching statistical significance [Oral: 28 (20.25) months; SON: 30 (16.75-48.25) months; PEG: 39 (27-52) months; P=.90]. CONCLUSIONS: Patients with ALS present a severe deterioration in nutritional status before the start of nutritional support. After the nutritional intervention, a slowdown in weight loss and nutritional deterioration was observed.

A circadian rhythm-related MTNR1B genetic variant (rs10830963) modulates glucose metabolism and insulin resistance after body weight loss secondary to biliopancreatic diversion surgery.

INTRODUCTION: Objective: the rs10830963 SNP of the MTNR1B gene may be related with biochemical changes after weight loss induced by caloric restriction. We investigated the role of this SNP on biochemical parameters after biliopancreatic diversion (BPD) surgery in morbid obese subjects. Patients and methods: one hundred and fifty-four patients with morbid obesity, without diabetes mellitus type 2, were enrolled. Their biochemical and anthropometric parameters were recorded before the procedure and after one, two, and three years of follow-up. All subjects were genotyped (rs10830963) at baseline. Results: the decrease in fasting insulin levels seen after the first year (delta: -3.9 ± 1.2 mIU/L vs. -1.8 ± 1.1 mIU/L; p = 0.03), the second year (delta: -5.0 ± 0.3 mIU/L vs. -2.3 ± 0.2 mIU/L; p = 0.01) and the third year (delta: -5.1 ± 1.9 mIU/L vs. -2.8 ± 1.1 mIU/L; p = 0.02) was higher in non-G-allele carriers than in G-allele carriers. Additionally, the improvement of HOMA-IR levels at year one (delta: -0.7 ± 0.2 mIU/L vs. -0.2 ± 0.2 mIU/L; p = 0.03), year two (delta: -1.0 ± 0.3 mIU/L vs. -0.5 ± 0.2 mIU/L; p = 0.01) and year three (delta: -1.2 ± 0.3 mIU/L vs. -0.4 ± 0.2 mIU/L; p = 0.03) was also higher in non-G-allele carriers than in G-allele carriers. Finally, basal glucose levels after the first year (delta: -10.1 ± 2.4 mg/dL vs. -3.6 ± 1.8 mg/dL; p = 0.02), the second year (delta: -16.0 ± 2.3 mg/dL vs. -8.4 ± 2.2 mg/dL; p = 0.01) and the third year (delta: -17.4 ± 3.1 mg/dL vs. -8.8 ± 2.9 mg/dL; p = 0.03) were higher in non-G-allele carriers than in G-allele carriers, too. Improvements seen in comorbidities were similar in both genotype groups. Conclusion: our study showed an association of the rs10830963 MTNR1B polymorphism after massive weight loss with lower glucose response, insulin resistance, and fasting insulin levels in G-allele carriers.

INTRODUCCIÓN: Objetivo: la variante SNP rs10830963 del gen MTNR1B podría estar relacionada con cambios bioquímicos tras la pérdida de peso inducida por una restricción calórica. El objetivo de este trabajo es evaluar el papel de este SNP en los parámetros bioquímicos después de la cirugía de derivación biliopancreática (DBP). Pacientes y métodos: se reclutaron un total de 154 pacientes con obesidad mórbida sin diabetes mellitus de tipo 2. La valoración bioquímica y antropométrica se realizó antes de la intervención y tras 1, 2 y 3 años de seguimiento. Todos los sujetos fueron genotipados (rs10830963) en el momento basal. Resultados: la disminución de los niveles de insulina en ayunas después del primer año (delta: -3,9 ± 1,2 mUI/L vs. -1,8 ± 1,1 mUI/L; p = 0,03), el segundo año (delta: -5,0 ± 0,3 mUI/L vs. -2,3 ± 0,2 mUI/L; p = 0,01) y el tercer año (delta: -5,1 ± 1,9 mUI/L vs. -2,8 ± 1,1 mUI/L; p = 0,02) fueron mayores en los no portadores del alelo G que en los portadores. Además, la mejora de los niveles de HOMA-IR en el primer año (delta: -0,7 ± 0,2 mUI/L ± -0,2 ± 0,2 mUI/L; p = 0,03), segundo año (delta: -1,0 ± 0,3 mUI/L vs. -0,5 ± 0,2 mUI/L; p = 0,01) y en el tercer año (delta: -1,2 ± 0,3 mUI/L vs. -0,4 ± 0,2 mUI/L; p = 0,03) también fueron mayores en los no portadores del alelo G. Finalmente, los niveles basales de glucosa después del primer año (delta: -10,1 ± 2,4 mg/dL vs. -3,6 ± 1,8 mg/dL; p = 0,02), el segundo año (delta: -16,0 ± 2,3 mg/dL vs. ­ 8,4 ± 2,2 mg/dL; p = 0,01) y el tercer año (delta: -17,4 ± 3,1 mg/dL vs. -8,8 ± 2,9 mg/dL; p = 0.03) fueron mayores en los no portadores del alelo G. Las comorbilidades mejoraron en ambos genotipos de manera similar. Conclusión: nuestro estudio mostró una asociación del polimorfismo rs10830963 MTNR1B tras una pérdida de peso posquirúrgica con una menor respuesta de los niveles de glucosa, resistencia a la insulina e insulina en ayunas en portadores del alelo G.

Effects of a snack enriched with carob and Undaria pinnatifida (wakame) on metabolic parameters in a double blind, randomized clinical trial in obese patients.

INTRODUCTION: Introduction: the composition of snack foods likely influences the overall effect that snacking has on metabolism and obesity. The objective of the current study was to assess the responses to two different snacks, one of them supplemented with wakame and carobs, on cardiovascular risk factors, satiety, and subsequent food intake in obese subjects with metabolic syndrome. Material and Methods: forty patients were randomized in a clinical trial (NCT03420989, clinicaltrial.gov) to group I (enriched snack, n = 16) or group II (control snack, n = 16). At baseline and after 8 weeks biochemical parameters, dietary intakes, and nutritional status were assessed. The subjects also rated their feelings of satiety/hunger with a test meal. Results: no differences were detected in anthropometric parameters between both snacks. Changes in other parameters were detected in patients with enriched snacks, with a significant decrease in LDL-cholesterol by 7.4 % (intervention snack, -8.9 ± 2.3 mg/dL vs control snack, -0.9 ± 3.3 mg/dL; p = 0.03), in total cholesterol by 5.8 % (intervention snack, -10.4 ± 2.9 mg/dL vs control snack, -1.4 ± 3.2 mg/dL; p = 0.02), and in resistin level by 15.9 % (intervention snack, -1.0 ± 0.2 mg/dL vs control snack, -0.1 ± 0.3 mg/dL: p = 0.03). After the test meal, satiety scores (after 20 min and 40 min) were higher than fasting levels in both groups. The same results were obtained with the 100-mm, 5-point visual satiety scale. Conclusion: our study indicates that a wakame- and carob-enriched snack induces a significant decrease in total cholesterol, LDL-cholesterol, and resistin levels when compared to a control snack, without effects on food consumption, other cardiovascular parameters, or anthropometric parameters.

INTRODUCCIÓN: Introducción: la composición de los "snacks" probablemente influya en el efecto que produce su consumo sobre los marcadores metabólicos y la obesidad. El objetivo fue evaluar respuestas a dos snacks, uno de ellos suplementado con wakame y algarroba, sobre factores de riesgo cardiovascular, saciedad y posterior ingesta de alimentos, en sujetos obesos con síndrome metabólico. Material y métodos: se aleatorizaron 40 pacientes en el ensayo clínico NCT03420989 (clinicaltrial.gov) para participar en el grupo I (snack enriquecido, n = 16) o el grupo II (snack de control, n = 16). Antes y después de 8 semanas se determinaron parámetros bioquímicos, ingestas dietéticas y estado nutricional. A los sujetos también se les evaluó saciedad y apetito con comida de prueba. Resultados: no se detectaron diferencias en parámetros antropométricos con ambos snacks. Se detectaron cambios en parámetros bioquímicos de pacientes que recibieron snacks enriquecidos, con disminución significativa del colesterol-LDL del 7,4 % (snack de intervención, -8,9 ± 2,3 mg/dl vs. snack de control, -0,9 ± 3,3 mg/dl; p = 0,03), del colesterol total del 5,8 % (snack de intervención, -10,4 ± 2,9 mg/dl vs. snack de control, -1,4 ± 3,2 mg/dl; p = 0,02) y de niveles de resistina del 15,9 % (snack de intervención, -1,0 ± 0,2 mg/dl vs. snack de control, -0,1 ± 0,3 mg/dl; p = 0,03). Después de la comida de prueba, las puntuaciones de saciedad (a los 20 min y 40 min) fueron más altas que nivel de ayuno en ambos grupos. Los resultados fueron similares con escala de saciedad visual de 5 puntos y 100 mm. Conclusión: nuestro estudio muestra que un snack enriquecido con wakame y algarroba produce disminución significativa de los niveles de colesterol total, colesterol-LDL y resistina frente a un snack de control, sin efectos sobre el consumo de alimentos, otros parámetros cardiovasculares y los parámetros antropométricos.

[The rs10401670 variant of the resistin gene is related to circulating resistin levels, insulin resistance, and presence of type-2 diabetes mellitus in obese patients]. / La variante rs10401670 del gen de la resistina se relaciona con los niveles de resistina circulante, la resistencia a la insulina y la presencia de diabetes mellitus de tipo 2 en los pacientes obesos.

INTRODUCTION: Background: the SNP 3´UTR C/T (rs10401670) of the RETN gene is a polymorphism that has been associated with the presence of type-2 diabetes mellitus in a single work in the literature. Objective: the objective of our study was to evaluate the influence of this resistin gene SNP (rs10401670) on the serum levels of resistin, as well as on the presence of type-2 diabetes mellitus in obese subjects and on insulin resistance. Material and methods: a Caucasian population of 653 obese subjects was analyzed. All subjects underwent an anthropometric evaluation (weight, waist circumference, fat mass), an evaluation of their nutritional intake, a biochemical profile (glucose, insulin, C-reactive protein, lipid profile, insulin, HOMA-IR), and an assessment of the rs10401670 genotype. Determinations were made in the presence of type-2 diabetes mellitus (DM2). A univariate analysis was carried out and a logistic regression was performed with a dichotomy parameter (DM2: yes/no) (SPSS, 17.0, IL, EUA). Results: genotype distribution was as follows: CC, 212 subjects (32.4%); CT, 340 subjects (52.0%); and TT, 101 subjects (15.6%). There were no significant differences between both genotypes in lipid profile, basal glucose, C-reactive protein, anthropometric parameters, nutritional intake, and blood pressure levels. Serum resistin levels (delta: 1.0 ± 0.2 ng/mL; p = 0.02), insulin levels (delta: 1.3 ± 0.1 ng/mL; p = 0.02), and HOMA-IR (delta: 1.2 ± 0.2 ng/mL; p = 0.01) were higher in T-allele carriers than non-T-allele carriers. The overall prevalence of type-2 diabetes mellitus (DM2) in the sample was 21.8%. With respect to the rs10401670 polymorphism, 17.9% of subjects with the CC genotype had DM2, and 23.8% of T-allele carriers had DM2. In the logistic regression analysis the T-allele of the SNP rs10401670, adjusted by age, sex, resistin levels, and body weight showed an association with DM2 - OR: 2.27 (95% CI: 1.26-4.09). Conclusions: the T-allele of the rs10401670 genetic variant is associated with higher levels of resistin, basal insulin, and insulin resistance, and a higher prevalence of type-2 diabetes mellitus, in obese subjects.

INTRODUCCIÓN: Introducción: el SNP 3´UTR C/T (rs10401670) del gen RETN es un polimorfismo que se ha asociado con la presencia de diabetes mellitus de tipo 2 en un único trabajo en la literatura. Objetivo: el objetivo de diseñar este estudio fue evaluar la influencia del SNP rs10401670 del gen de la resistina sobre los niveles séricos de resistina, así como sobre la presencia de diabetes mellitus de tipo 2 en sujetos con obesidad y la resistencia a la insulina. Material y métodos: se analizó una población caucásica de 653 sujetos adultos con obesidad. A todos se les realizó una evaluación antropométrica (peso, circunferencia cintura, masa grasa), una evaluación de la ingesta nutricional y un análisis bioquímico (glucosa, insulina, proteína C-reactiva, perfil lipídico, insulina, HOMA-IR). La evaluación del genotipo rs10401670 se determinó en presencia de diabetes mellitus de tipo 2 (DM2). Se realizó un análisis univariante y posteriormente un análisis de regresión logística con la variable dependiente dicotómica "DM2 = Sí/No" (SPSS, 17.0, IL EUA). Resultados: la distribución del genotipo fue la siguiente: CC, 212 (32,4%); CT, 340 (52,0%), y TT, 101 (15,6%). No se hallaron diferencias significativas entre ambos genotipos en cuanto a perfil lipídico, glucosa basal, proteína C-reactiva, parámetros antropométricos, ingesta nutricional y tensión arterial, pero sí en los niveles de resistina (delta: 1,0 ± 0,2 ng/ml; p = 0,02), insulina (delta: 1,3 ± 0,1 ng/ml; p = 0,02) y HOMA-IR (delta: 1,2 ± 0,2 ng/ml; p = 0,01), que fueron superiores en los pacientes portadores del alelo mutado T. La prevalencia global de la diabetes mellitus de tipo 2 (DM2) en la muestra fue del 21,8%. Con respecto al SNP rs10401670, entre los sujetos con CC un 17,9% tenían DM2 y entre los portadores del alelo T, el 23,8% tenían DM2. En el análisis de regresión logística, al analizar el efecto del alelo T ajustado según la edad, el sexo, los niveles de resistina circulante y el peso corporal, continuó mostrándose como variable independiente la presencia del alelo T del SNP rs10401670 sobre la presencia de DM2: OR: 2,27 (IC 95%: 1,26-4,09). Conclusiones: el alelo T de la variante genética rs10401670 se asocia con mayores niveles de resistina, insulina basal, resistencia a la insulina y prevalencia de la diabetes mellitus de tipo 2 en los sujetos obesos.