Olive oil-based lipid emulsion is noninferior to soybean oil-based lipid emulsion in the acute care setting: A double-blind randomized controlled trial.

OBJECTIVES: Olive oil (OO)-based intravenous lipid emulsion (IVLE) may have biological advantages for nutrition and inflammation status compared with soybean oil (SO)-based IVLE. We aimed to compare prealbumin levels during infusion of OO- or SO-based IVLE in patients receiving parenteral nutrition in the acute-care setting. METHODS: In this prospective, noninferiority, double blind randomized controlled efficacy trial, patients received either OO-based or SO-based IVLE after providing consent. Biochemical and nutrition parameters were collected at baseline and at 7 to 10 d after initiation of parenteral nutrition. Results are expressed as means (standard deviations). RESULTS: A total of 210 patients completed the study: 102 patients in the SO-based IVLE group and 108 patients in the OO-based IVLE group. Both groups had a significant increase in prealbumin levels from baseline (SO: 0.10 [0.06] versus 0.15 [0.08] g/L; P < 0.0001; OO: 0.11 [0.06] versus 0.16 [0.08] g/L; P < 0.0001), but mean changes between groups were not different (P = 0.53). OO-based IVLE was noninferior to SO-based IVLE in maintaining or increasing serum prealbumin levels, with 20% as the noninferiority margin at follow-up (least square geometric mean ratio [95% CI], 1.10 [0.83,1.47]; P = 0.50). There was a significant improvement in C-reactive protein levels from baseline within each group (SO: 83.24 [69.72] versus 53.4 [59.78] mg/dL; P < 0.0001; OO: 85.13 [68.14] versus 58.75 [60.11] mg/dL; P = 0.004), but mean changes between the groups were not different (P = 0.836). Mortality, length of stay, and infection rates were not different for both groups. CONCLUSIONS: In this study, OO-based IVLE was not inferior to SO-based IVLE in maintaining or increasing the prealbumin level. The improvement of C-reactive protein levels and other clinical outcomes were not different for both groups.

Assessment of parenteral nutrition prescription in Canadian acute care settings.

BACKGROUND: Parenteral nutrition (PN) prescription can be challenging in patients with complex conditions and has potential complications. OBJECTIVE: To assess PN prescription, monitoring, and PN-related complications in a Canadian acute care setting. METHODS: This was a prospective cohort study in which patients receiving PN were assessed by an auditor for nutritional status, PN-related prescription, monitoring, and complications. In addition, length of stay and mortality were recorded. RESULTS: 147 patients (mean ± SD 56.1 ± 16.4 y) with complex diseases (Charlson comorbidity index, median [p25-p75] 2 [1-4]) were enrolled. Before starting PN, 18.6%, 63.9%, and 17.5% of patients were classified as subjective global assessment A, B, and C, respectively. Body mass index remained unchanged during the period on PN. On average, 89% and 73% of patients received <90% of their energy and protein requirements, respectively, but 65% received oral or enteral nutrition at some point during PN. The average daily energy provided by PN increased and stabilized on day 10, reaching 87.2 ± 20.1% of the requirements. Line sepsis (6.8% of patients) and hyperglycemia (6.9%) were the most common complications. The overall mortality was 15.6%. For those alive, length of stay was 30 (range: 4-268) d. PN was discontinued because of transitioning to an oral diet (56.6%), enteral nutrition (17.6%), home PN (14.7%), palliative care (5.1%), death (4.4%), or other (1.5%). CONCLUSION: Most patients were malnourished at the start of PN. Energy and protein provided from PN were less than requirements, and the goals were reached with delay. Mortality was high, possibly as a result of complex diseases.

[Bone mineral density disminution post Roux-Y bypass surgery]. / Disminución de masa ósea post-cirugía bariátrica con by-pass en Y de Roux.

INTRODUCTION: Bariatric surgery has important metabolic complications such as bone mass loss. GOAL: To assess bone mineral density (BMD) after Roux-en-Y gastric by-pass (RYGB) in patients under standard calcium and vitamin D supplementation. METHOD: In patients with morbid obesity submitted to RYGB, 76 women and 22 men of diverse age, all with standard nutritional instruction including vitamin D and calcium, we measured BMD with a dual X-ray densitometer. They had lumbar spine and hips measurement 2-3 years post-surgery. Twenty females were followed up with BMD until of a mean of 54 months. Using World Health Organization (WHO) criteria's, values were compared with young controls and same age and sex population, evaluating osteopenia and osteoporosis. RESULTS: Inverse correlation was observed between BMD and age; positive between BMD and body mass index as well as with preoperative weight excess. In women younger than 45 years, we observed a diminished BMD in 26.8% of them, with no cases of osteoporosis. In older females, BMD was decreased in 65.7% (p = 0.0011); corresponding to 45.7% of osteopenia and 20% osteoporosis, more frequent in lumbar spine. In the female's subgroup followed longer, BMD diminished progressively mainly in left hip. In men, there was 36% of osteopenia and 14% of osteoporosis. CONCLUSION: Patients from both genders and diverse ages after BPYR presented osteopenia and osteoporosis, despite early supplement prescription of calcium and vitamin D. We consider important to perform serial BMD measurements and also to individualize therapy with risk factors control.

Introducción: La cirugía bariátrica tiene complicaciones metabólicas importantes como la pérdida de masa ósea. Objetivo: Evaluar la densidad mineral ósea (DMO) posterior a by-pass gástrico en Y de Roux (BPYR) en pacientes con indicación de suplemento estándar de calcio y vitamina D. Método: En pacientes con BPYR por obesidad mórbida, 76 mujeres y 22 hombres de diversa edad, con instrucción nutricional, suplemento de calcio y vitamina D, se midió la DMO en columna lumbar y caderas con densitómetro radiológico de doble haz 2 a 3 años post-cirugía. Veinte mujeres fueron seguidas con DMO hasta 54 meses en promedio. Según criterios de Organización Mundial de la Salud (OMS), se comparó con población control joven y de su edad según sexo, evaluando osteopenia y osteoporosis. Resultados: Hubo correlación negativa de DMO con edad; positiva de DMO con índice de masa corporal y con exceso de peso preoperatorio. En mujeres menores de 45 años, se observó disminución de DMO en 26,8%, sin casos de osteoporosis y en 65,7% en las mayores de 45 años (p = 0,0011), correspondiendo a 45,7% de osteopenia y 20% de osteoporosis, predominantemente en columna lumbar. El subgrupo de mujeres con mayor seguimiento, presentó disminución progresiva de DMO, especialmente en cadera izquierda. En hombres se observó 36% de osteopenia y 14% de osteoporosis. Conclusión: Pacientes de ambos sexos y diversa edad, despues de un BPYR, presentaron osteopenia y osteoporosis, a pesar de suplemento precoz de calcio y vitamina D. Consideramos importante medir DMO seriada, individualizando terapias y controlando factores de riesgo.

Disminución de masa ósea post-cirugía bariátrica con by-pass en Y de Roux / Bone mineral density disminution post y de roux by-pass surgery

Introducción: La cirugía bariátrica tiene complicaciones metabólicas importantes como la pérdida de masa ósea. Objetivo: Evaluar la densidad mineral ósea (DMO) posterior a by-pass gástrico en Y de Roux (BPYR) en pacientes con indicación de suplemento estándar de calcio y vitamina D. Método: En pacientes con BPYR por obesidad mórbida, 76 mujeres y 22 hombres de diversa edad, con instrucción nutricional, suplemento de calcio y vitamina D, se midió la DMO en columna lumbar y caderas con densitómetro radiológico de doble haz 2 a 3 años post-cirugía. Veinte mujeres fueron seguidas con DMO hasta 54 meses en promedio. Según criterios de Organización Mundial de la Salud (OMS), se comparó con población control joven y de su edad según sexo, evaluando osteopenia y osteoporosis. Resultados: Hubo correlación negativa de DMO con edad; positiva de DMO con índice de masa corporal y con exceso de peso preoperatorio. En mujeres menores de 45 años, se observó disminución de DMO en 26,8%, sin casos de osteoporosis y en 65,7% en las mayores de 45 años (p = 0,0011), correspondiendo a 45,7% de osteopenia y 20% de osteoporosis, predominantemente en columna lumbar. El subgrupo de mujeres con mayor seguimiento, presentó disminución progresiva de DMO, especialmente en cadera izquierda. En hombres se observó 36% de osteopenia y 14% de osteoporosis. Conclusión: Pacientes de ambos sexos y diversa edad, despues de un BPYR, presentaron osteopenia y osteoporosis, a pesar de suplemento precoz de calcio y vitamina D. Consideramos importante medir DMO seriada, individualizando terapias y controlando factores de riesgo (AU)

INTRODUCTION: Bariatric surgery has important metabolic complications such as bone mass loss. GOAL: To assess bone mineral density (BMD) after Roux-en-Y gastric by-pass (RYGB) in patients under standard calcium and vitamin D supplementation. METHOD: In patients with morbid obesity submitted to RYGB, 76 women and 22 men of diverse age, all with standard nutritional instruction including vitamin D and calcium, we measured BMD with a dual X-ray densitometer. They had lumbar spine and hips measurement 2-3 years post-surgery. Twenty females were followed up with BMD until of a mean of 54 months. Using World Health Organization (WHO) criteria's, values were compared with young controls and same age and sex population, evaluating osteopenia and osteoporosis. RESULTS: Inverse correlation was observed between BMD and age; positive between BMD and body mass index as well as with preoperative weight excess. In women younger than 45 years, we observed a diminished BMD in 26.8% of them, with no cases of osteoporosis. In older females, BMD was decreased in 65.7% (p = 0.0011); corresponding to 45.7% of osteopenia and 20% osteoporosis, more frequent in lumbar spine. In the female's subgroup followed longer, BMD diminished progressively mainly in left hip. In men, there was 36% of osteopenia and 14% of osteoporosis. CONCLUSION :Patients from both genders and diverse ages after BPYR presented osteopenia and osteoporosis, despite early supplement prescription of calcium and vitamin D. We consider important to perform serial BMD measurements and also to individualize therapy with risk factors control (AU)

Calidad de la alimentación de mujeres con obesidad severa y mórbida sometidas a bypass gastrico y gastrectomia vertical en manga

El objetivo de este estudio fue comparar la ingesta de energía y nutrientes y la calidad de la alimentación, en pacientes sometidos a bypass gástrico en Y de Roux y (BPGYR) y gastrectomía vertical en manga (GVM). En 36 mujeres con obesidad severa y mórbida se estudió la alimentación previa y a los 6 meses posteriores a la cirugía, mediante encuesta de registro de tres días, se analizó el grado de adecuación e índice de calidad nutricional (ICN). Se controló estrictamente el consumo de suplementos de vitaminas y minerales. El consumo de energía y nutrientes fue significativamente menor al sexto mes post cirugía comparado con el preoperatorio, sin diferencias significativas entre grupos, excepto calcio y vitamina C. El ICN fue similar entre grupos. La ingesta dietética de calcio, hierro, zinc, cobre, ácido fólico, vitamina C y E fue menor al 100% de adecuación al 6º mes. Sin embargo, al considerar en conjunto el aporte de la dieta como de los suplementos, la adecuación de prácticamente todos los nutrientes estudiados sobrepasa el 100% en ambos grupos, logrando una mayor adecuación el grupo sometido a BPGYR. Las excepciones las constituyen el calcio, el cual no alcanza a cubrir el 100% en ningún grupo y el ácido fólico en el grupo sometido a GVM. En conclusión, estos pacientes presentan reducciones importantes de la ingesta dietética de energía y micronutrientes, sin mayores diferencias dependientes del tipo de cirugía. Las características de los suplementos son críticos para lograr la cobertura de las necesidades.

The objective of this study was to evaluate the changes of dietary intake and quality of the diet in patients undergoing gastric bypass and sleeve surgery. In 36 women with severe and morbid obesity it was assessed their nutrient intakes and dietary quality before and 6 months after bariatric surgery through three-day food records. Vitamin and mineral intakes from supplements were strictly controlled. Energy and nutrient intakes were significantly decreased 6 months after surgery bypass compared to the pre-surgery period, with the exceptions of calcium and vitamin C. No differences were observed between groups. The Dietary quality index was also similar in both groups. Dietary intakes of calcium, iron, zinc, copper, folic acid, vitamin C, and vitamin E were below 100% of adequacy from at the 6th month after the surgery. Nevertheless, by considering both diet and supplements supply, nutrient adequacy of all but calcium and folic acid was above 100% in both groups. Gastric bypass patients presented greater values. In conclusion, these patients present an important reduction of their energy and nutrient intakes, with no major impact of the type of surgery. Supplement characteristics are crucial to cover nutritional needs.

[Socioeconomic level and nutritional status: a study in schoolchildren]. / Nivel socioeconómico y estado nutricional. Un estudio en escolares.

Obesity increased in recent years at different rates among socioeconomic levels (SEL). The purpose of this study was to analyze the association between SEL and nutritional status in schoolchildren attending elementary schools in the six counties that show the highest prevalence of obesity in Santiago, Chile. Within the counties schools were stratified according to obesity and children were randomly selected from each school. Anthropometric assessment was performed in children whilst a socio-demographic survey and a 24 hour recall of food intake were applied to their mothers. We classified the sample according to SEL in two categories (higher and a lower vulnerability). The prevalence of excess weight was 51.1% (24.7% overweight and 26,4% obese) without significant differences among SEL. The most vulnerable group had lower values of body mass index, skinfold thickness, arm circumference and food intake however, these differences were not statistically significant. At the same time, these children were physically more active, showing higher use of community places to play [OR 1.91; 95% CI 1.05-3.48] and walked larger distances from houses to schools OR 6.6; CI 2.5-16.7). Thus, albeit non significant association was detected between SEL and anthropometric indicators nor with food intake, the highest vulnerable group showed a tendency to have lower values and more physical activity.

Nivel socioeconómico y estado nutricional: un estudio en escolares / Socioeconomic level and Nutritional Status: a study in schoolchildren

La obesidad ha aumentado en años recientes en tasas que difieren según el nivel socioeconómico (NSE). El propósito de este estudio fue analizar la asociación entre NSE y estado nutricional de escolares de enseñanza básica en seis comunas con las mayores prevalencias de obesidad en Santiago, Chile. Se seleccionaron escuelas con diferentes prevalencias de obesidad en cada comuna y los escolares se escogieron aleatoriamente en cada escuela. Se evaluaron antropométricamente los escolares y a sus madres se les aplicó una encuesta sociodemográfica y del registro alimentario de 24 horas de sus hijos. Mediante la técnica de componentes principales se clasificó la muestra entre los que son de menor y mayor NSE. La prevalencia de exceso de peso fue de 51,1%, (24,7% tenía sobrepeso y 26,4% eran obesos) sin diferencias significativas entre NSE. Los de menor NSE presentaron menores valores de IMC, pliegues y circunferencia del brazo e ingesta alimentaria, sin embargo estas diferencias no fueron estadísticamente significativas. Hubo también una menor tendencia al sedentarismo en los de menor NSE, ya que usaban más lugares comunitarios [Odds Ratio (OR) 1,91; Intervalos de Confianza (IC) 1,05-3,48] y se iban y volvían al colegio caminando (OR 6,76; IC 2,75-16,67). En conclusión, aunque no hubo asociación significativa entre NSE e indicadores antropométricos e ingesta alimentaria, aunque los escolares de menor NSE tienen una tendencia a tener valores más bajos de estos índices y son más activos.

Socioeconomic level and Nutritional Status: A study in schoolchildren. Obesity increased in recent years at different rates among socioeconomic levels (SEL). The purpose of this study was to analyze the association between SEL and nutritional status in schoolchildren attending elementary schools in the six counties that show the highest prevalence of obesity in Santiago, Chile. Within the counties schools were stratified according to obesity and children were randomly selected from each school. Anthropometric assessment was performed in children whilst a socio-demographic survey and a 24 hour recall of food intake were applied to their mothers. We classified the sample according to SEL in two categories (higher and a lower vulnerability). The prevalence of excess weight was 51.1% (24.7% overweight and 26,4% obese) without significant differences among SEL. The most vulnerable group had lower values of body mass index, skinfold thickness, arm circumference and food intake however, these differences were not statistically significant. At the same time, these children were physically more active, showing higher use of community places to play [OR 1.91; 95% CI 1.05-3.48] and walked larger distances from houses to schools OR 6.6; CI 2.5-16.7). Thus, albeit non significant association was detected between SEL and anthropometric indicators nor with food intake, the highest vulnerable group showed a tendency to have lower values and more physical activity.