Use of Tirzepatide in Adults with Type 2 Diabetes Mellitus: Scientific Evidence and Practical Aspects.

Tirzepatide is a novel antidiabetic medication a single-molecule, agonist to the glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptors. It is approved in the USA and EU for the treatment of type 2 diabetes mellitus (T2DM) and obesity. Due to the potential novelty represented by incorporating tirzepatide to clinical practice, we aim to review practical aspects of tirzepatide use in T2DM and the supporting scientific evidence. A group of ten endocrinologists involved as investigators in the phase 3 SURPASS clinical trial program followed a nominal group technique, a qualitative research methodology designed as a semi-structured group discussion to reach a consensus on the selection of a set of practical aspects. The scientific evidence for tirzepatide has been reviewed with respect to a number of patients' clinical profiles and care goals. Information of interest related to adverse events, special warnings and precautions, and other considerations for tirzepatide use has been included. Finally, information provided to the patients has been summarized. The practical aspects reported herein may be helpful in guiding physicians in the use of tirzepatide and contribute to optimizing the management of T2DM.

Evaluación sensorial de un suplemento nutricional oral específico para diabetescon aceite de oliva virgen extra en pacientes en riesgo nutricional y diabetes mellitustipo 2: ensayo clínico doble ciego, aleatorizado, cruzado y multicéntrico (DIACARE) / Organoleptic evaluation of a diabetes-specific oral nutritional supplement with extra virgin olive oil in patients at nutritional risk and type 2 diabetes mellitus: double-blind, randomized, crossover and multicenter clinical trial (DIACARE)

Introducción: las fórmulas nutricionales específicas para diabetes (FED) suelen presentar una composición que favorece simultáneamente su palatabilidad y el control glucémico y metabólico.Objetivo: comparar la aceptación sensorial de un FED respecto a un suplemento nutricional oral estándar (FE) en pacientes en riesgo de desnutrición con diabetes mellitus tipo 2.Método: ensayo clínico, aleatorizado, doble ciego, cruzado, multicéntrico y controlado. Se evaluó, a través de una escala del 1 al 4, el olor, el sabor y la textura percibida de un FED y de un FE.Resultados: se reclutaron a 29 pacientes y 58 evaluaciones sensoriales de los suplementos. Se observó una mejor valoración de la FED respecto a la FE, aunque no se alcanzaron diferencias estadísticamente significativas: olor, 0,04 (IC 95 %), de -0,49 a 0,56 (p = 0,092); sabor, 0,14 (IC 95 %), de -0,35 a 0,63 (p = 0,561); textura, 0,14, (IC 95 %), de -0,43 a 0,72 (p = 0,619). No se encontraron diferencias cuando se analizaron por orden de aleatorización, sexo, grado de desnutrición, mayor o menor grado de complejidad, mayor o menor tiempo de evolución de la diabetes, ni por ser más o menos mayores. Conclusiones: el suplemento nutricional específico para paciente con diabetes, formulado con aceite de oliva virgen extra, EPA y DHA, una mezcla específica en hidratos de carbono, fibra soluble e insoluble, presentó una adecuada aceptación sensorial del paciente desnutrido con diabetes mellitus tipo 2.(AU)

Introduction: oral nutritional supplements specific for diabetes (DSF) usually have a composition that favors their palatability and simultaneous glycemic and metabolic control. Objective: to compare the sensory acceptability of a DSF with respect to a standard oral nutritional supplement (STF) in patients at risk of malnutrition with type 2 diabetes mellitus. Method: randomized, double-blind, crossover, multicenter, controlled, double-blind clinical trial. Odor, taste and perceived texture of a DSF and a STD were evaluated using a scale of 1 to 4. Results: twenty-nine patients were recruited and 58 organoleptic evaluations of the supplements were registered. A better evaluation of DSF was observed with respect to STD, although no statistically significant differences were reached: odor, 0.04 (CI 95 %) -0.49 to 0.56 (p = 0.092); taste, 0.14 (CI 95 %), -0.35 to 0.63 (p = 0.561); texture, 0.14 (CI 95 %), -0.43 to 0.72 (p = 0.619). No differences were found when analyzed by order of randomization, sex, degree of malnutrition, greater or lesser degree of complexity, greater or lesser time of evolution of diabetes, or by being older or younger. Conclusions: the specific nutritional supplement for diabetic patients formulated with extra virgin olive oil, EPA and DHA, a specific mixture of carbohydrates, and fiber, presented an adequate sensory acceptance by malnourished patients with type 2 diabetes mellitus.(AU)

Glycaemic and insulinaemic impact of a diabetes-specific oral nutritional supplement with extra-virgin olive oil in patients with type 2 diabetes mellitus at nutritional risk: a randomized, double-blind, crossover, multicentre clinical trial (DiACARE) / Impacto glucémico e insulinémico de un suplemento nutricional oral con AOVE específico para diabetes en pacientes en riesgo nutricional y con diabetes mellitus tipo 2: ensayo clínico, aleatorizado, doble ciego, cruzado y multicéntrico (DIACARE)

Introduction: there is controversy about the usefulness of specific enteral nutrition formulas in malnourished patients with diabetes. The effects on blood glucose and other aspects of metabolic control are not fully understood in the scientific literature. Objective: the aim of the study was to compare the glycaemic and insulinaemic response of patients with type 2 diabetes at risk of malnutrition after oral feed between a diabetes-specific formula with AOVE (DSF) and a standard one (STF). Methods: A randomized, double-blind, crossover, multicentre clinical trial was conducted in patients with type 2 diabetes at risk of malnutrition (SGA). The patients were randomized to receive either DSF or STF, a week apart. A glycaemia and insulinaemia curve was made at times 0 minutes, 30 min, 60 min, 90 min, 120 min, and 180 min after the patients drank 200 ml of the oral nutritional supplement (ONS). The principal variables were the area under the curve (AUC0-t) of glucose and insulin. Results: 29 patients (51 % women) were included, who were on average 68.84 (SD 11.37) years old. Regarding the degree of malnutrition, 86.2 % presented moderate malnutrition (B) and 13.8 % severe (C). When the patients received the DSF, they had a lower mean of glucose AUC0-t (-3,325.34 mg/min/dl [95 % CI: -4,3608.34 to -2,290.07]; p = 0.016) and also a lower mean of insulin AUC0-t (-451.14 uU/min/ml [95 % CI: -875,10 to -27.17]; p = 0.038). There were no differences in the degree of malnutrition. Conclusion: compared with STF, DSF with AOVE showed a better glycaemic and insulinaemic response in patients with type 2 diabetes at risk of malnutrition.(AU)

Introducción: la utilidad de las fórmulas específicas de nutrición enteral en el paciente desnutrido con diabetes resulta controvertida. Sus efectossobre la glucosa en sangre y otros aspectos del control metabólico no se conocen del todo en la literatura científica.Objetivo: el objetivo del estudio fue comparar la respuesta glucémica e insulinémica de los pacientes con diabetes de tipo 2 (DM2) en riesgode desnutrición tras la ingesta oral de una fórmula específica para diabetes (DSF) con aceite de oliva virgen extra (AOVE) y una estándar (STF).Métodos: ensayo clínico aleatorizado, doble ciego, cruzado y multicéntrico enpacientes con DM2 en riesgo de desnutrición (SGA). Los pacientes seasignaron aleatoriamente para recibir DSF o STF con una semana de diferencia. Se realizó una curva de glucemia e insulinemia en los siguientestiempos: 0 minutos, 30 min, 60 min, 90 min, 120 min y 180 min tras la ingesta de 200 ml del suplemento nutricional oral (SNO). Las variablesprincipales fueron el área bajo la curva (AUC0-t) de glucosa e insulina.Resultados: se incluyeron 29 pacientes (51 % mujeres), con una edad media de 68,84 años (DE 11,37). En cuanto al grado de desnutrición,el 86,2 % presentaba desnutrición moderada (B) y el 13,8 %, severa (C). Cuando los pacientes recibieron DSF tuvieron una media más bajade AUC0-t de glucosa (-3325,34 mg/min/dl [IC 95 %: de -4.3608,34 a -2.290,07]; p = 0,016) y también una media más baja de AUC0-t deinsulina (-451,14 μU/min/ml [IC 95 %: de -875,10 a -27,17]; p = 0,038) respecto a cuando recibieron STF. No hubo diferencias por el gradode desnutrición.Conclusión: la fórmula con AOVE específica para diabetes mostró una mejor respuesta glucémica e insulinémica en pacientes con diabetes detipo 2 en riesgo de desnutrición respecto a una fórmula estándar.(AU)

[Organoleptic evaluation of a diabetes-specific oral nutritional supplement with extra virgin olive oil in patients at nutritional risk and type 2 diabetes mellitus: Double-blind, randomized, crossover and multicenter clinical trial (DIACARE)]. / Evaluación sensorial de un suplemento nutricional oral específico para diabetes con aceite de oliva virgen extra en pacientes en riesgo nutricional y diabetes mellitus tipo 2: ensayo clínico doble ciego, aleatorizado, cruzado y multicéntrico (DIACARE.

Introduction: Introduction: oral nutritional supplements specific for diabetes (DSF) usually have a composition that favors their palatability and simultaneous glycemic and metabolic control. Objetive: to compare the sensory acceptability of a DSF with respect to a standard oral nutritional supplement (STF) in patients at risk of malnutrition with type 2 diabetes mellitus. Method: randomized, double-blind, crossover, multicenter, controlled, double-blind clinical trial. Odor, taste and perceived texture of a DSF and a STD were evaluated using a scale of 1 to 4. Results: twenty-nine patients were recruited and 58 organoleptic evaluations of the supplements were registered. A better evaluation of DSF was observed with respect to STD, although no statistically significant differences were reached: odor, 0.04 (CI 95 %) -0.49 to 0.56 (p = 0.092); taste, 0.14 (CI 95 %), -0.35 to 0.63 (p = 0.561); texture, 0.14 (CI 95 %), -0.43 to 0.72 (p = 0.619). No differences were found when analyzed by order of randomization, sex, degree of malnutrition, greater or lesser degree of complexity, greater or lesser time of evolution of diabetes, or by being older or younger. Conclusions: the specific nutritional supplement for diabetic patients formulated with extra virgin olive oil, EPA and DHA, a specific mixture of carbohydrates, and fiber, presented an adequate sensory acceptance by malnourished patients with type 2 diabetes mellitus.

Introducción: Introducción: las fórmulas nutricionales específicas para diabetes (FED) suelen presentar una composición que favorece simultáneamente su palatabilidad y el control glucémico y metabólico. Objetivo: comparar la aceptación sensorial de un FED respecto a un suplemento nutricional oral estándar (FE) en pacientes en riesgo de desnutrición con diabetes mellitus tipo 2. Método: ensayo clínico, aleatorizado, doble ciego, cruzado, multicéntrico y controlado. Se evaluó, a través de una escala del 1 al 4, el olor, el sabor y la textura percibida de un FED y de un FE. Resultados: se reclutaron a 29 pacientes y 58 evaluaciones sensoriales de los suplementos. Se observó una mejor valoración de la FED respecto a la FE, aunque no se alcanzaron diferencias estadísticamente significativas: olor, 0,04 (IC 95 %), de -0,49 a 0,56 (p = 0,092); sabor, 0,14 (IC 95 %), de -0,35 a 0,63 (p = 0,561); textura, 0,14, (IC 95 %), de -0,43 a 0,72 (p = 0,619). No se encontraron diferencias cuando se analizaron por orden de aleatorización, sexo, grado de desnutrición, mayor o menor grado de complejidad, mayor o menor tiempo de evolución de la diabetes, ni por ser más o menos mayores. Conclusiones: el suplemento nutricional específico para paciente con diabetes, formulado con aceite de oliva virgen extra, EPA y DHA, una mezcla específica en hidratos de carbono, fibra soluble e insoluble, presentó una adecuada aceptación sensorial del paciente desnutrido con diabetes mellitus tipo 2.

Glycaemic and insulinaemic impact of a diabetes-specific oral nutritional supplement with extra-virgin olive oil in patients with type 2 diabetes mellitus at nutritional risk: a randomized, double-blind, crossover, multicentre clinical trial (DIACARE).

Introduction: Introduction: there is controversy about the usefulness of specific enteral nutrition formulas in malnourished patients with diabetes. The effects on blood glucose and other aspects of metabolic control are not fully understood in the scientific literature. Objective: the aim of the study was to compare the glycaemic and insulinaemic response of patients with type 2 diabetes at risk of malnutrition after oral feed between a diabetes-specific formula with AOVE (DSF) and a standard one (STF). Methods: A randomized, double-blind, crossover, multicentre clinical trial was conducted in patients with type 2 diabetes at risk of malnutrition (SGA). The patients were randomized to receive either DSF or STF, a week apart. A glycaemia and insulinaemia curve was made at times 0 minutes, 30 min, 60 min, 90 min, 120 min, and 180 min after the patients drank 200 ml of the oral nutritional supplement (ONS). The principal variables were the area under the curve (AUC0-t) of glucose and insulin. Results: 29 patients (51 % women) were included, who were on average 68.84 (SD 11.37) years old. Regarding the degree of malnutrition, 86.2 % presented moderate malnutrition (B) and 13.8 % severe (C). When the patients received the DSF, they had a lower mean of glucose AUC0-t (-3,325.34 mg/min/dl [95 % CI: -4,3608.34 to -2,290.07]; p = 0.016) and also a lower mean of insulin AUC0-t (-451.14 uU/min/ml [95 % CI: -875,10 to -27.17]; p = 0.038). There were no differences in the degree of malnutrition. Conclusion: compared with STF, DSF with AOVE showed a better glycaemic and insulinaemic response in patients with type 2 diabetes at risk of malnutrition.

Introducción: Introducción: la utilidad de las fórmulas específicas de nutrición enteral en el paciente desnutrido con diabetes resulta controvertida. Sus efectos sobre la glucosa en sangre y otros aspectos del control metabólico no se conocen del todo en la literatura científica. Objetivo: el objetivo del estudio fue comparar la respuesta glucémica e insulinémica de los pacientes con diabetes tipo 2 (DM2) en riesgo de desnutrición tras la ingesta oral de una fórmula específica para diabetes (DSF) con aceite de oliva virgen extra (AOVE) y una estándar (STF). Métodos: ensayo clínico aleatorizado, doble ciego, cruzado y multicéntrico enpacientes con DM2 en riesgo de desnutrición (SGA). Los pacientes se asignaron aleatoriamente para recibir DSF o STF con una semana de diferencia. Se realizó una curva de glucemia e insulinemia en los siguientes tiempos: 0 minutos, 30 min, 60 min, 90 min, 120 min y 180 min tras la ingesta de 200 ml del suplemento nutricional oral (SNO). Las variables principales fueron el área bajo la curva (AUC0-t) de glucosa e insulina. Resultados: se incluyeron 29 pacientes (51 % mujeres), con una edad media de 68,84 años (DE 11,37). En cuanto al grado de desnutrición, el 86,2 % presentaba desnutrición moderada (B) y el 13,8 %, severa (C). Cuando los pacientes recibieron DSF tuvieron una media más baja de AUC0-t de glucosa (-3325,34 mg/min/dl [IC 95 %: de -4.3608,34 a -2.290,07]; p = 0,016) y también una media más baja de AUC0-t de insulina (-451,14 uU/min/ml [IC 95 %: de -875,10 a -27,17]; p = 0,038) respecto a cuando recibieron STF. No hubo diferencias por el grado de desnutrición. Conclusión: la fórmula con AOVE específica para diabetes mostró una mejor respuesta glucémica e insulinémica en pacientes con diabetes tipo 2 en riesgo de desnutrición respecto a una fórmula estándar.

Phase angle as a marker of outcome in hospitalized pediatric patients. A systematic review of the evidence (GRADE) with meta-analysis.

Phase angle (PhA) is a valuable tool for evaluating the nutritional and inflammatory status, which can accompany acute and severe disorders. PhA is a cellular health biomarker, whose value is particularly substantial due to the negative consequences of these situations in the pediatric population. Relevant literature was collected with the aim of comprehensively analysing the evidence on the association between an altered PhA can serve as a predictive-marker for mortality and poor-outcomes in at-risk-pediatric patients. Understanding this relationship could have significant implications for identifying high-risk individuals and implementing timely interventions. A systematic review with meta-analysis was conducted in the primary electronic databases from inception until January 2023. Overall, four studies with a total of 740 patients were eligible for our analysis. Evidence demonstrates that PhA is associated with nutritional status, reflecting undernutrition and changes in body composition related to illness. This review suggests that PhA can indeed be used as an indicator of nutritional status and a tool for predicting prognosis, including mortality and poor-outcomes, in hospitalized pediatric patients. A low PhA was associated with a significant mortality risk [RR:1.51;95%CI (1.22-1.88),p = 0.0002;I2 = 0%,(p = 0.99)] and an increased complications risk [OR:8.17;95%CI (2.44-27.4),p = 0.0007;I2 = 44%,(p = 0.18)]. These findings highlight the importance of taking a comprehensive approach to clinical nutrition, integrating multiple evaluation aspects to establish an accurate diagnosis and personalized therapeutic plans. While PhA emerges as a valuable tool for assessing the risk of malnutrition and as a prognostic-indicator for poor-outcomes in pediatric patients. Further future studies are needed to focus on investigating this relationship in larger and diverse population to strengthen the evidence base.

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.

Phase angle and COVID-19: A systematic review with meta-analysis.

Phase angle (PhA) has been identified as a poor prognostic factor in patients with COVID-19. This study aimed to achieve a systematic review, where we discussed the potential role of PhA value as a prognostic marker of adverse clinical outcomes such as mortality and complication in hospitalized with SARS-CoV2 infection and established the strength of recommendations for use. A systematic literature review with meta-analysis was done in the main electronic databases from 2020 to January 2023. The selected articles had to investigate adverse consequences of the COVID-19 population and raw bioimpedance parameters such as PhA and published in peer-reviewed journals. GRADE tools regarded the quality of the methodology. The review protocol was registered in PROSPERO. Only eight studies, 483 studies, were eligible for the analysis. In general, differences in PhA were seen between the comparative study groups. Patients with a low PhA experienced poor outcomes. A low PhA was associated with a significantly increased mortality risk [RR: 2.44; 95% CI (1.20-4.99), p = 0.01; I2 = 79% (p = 0.0008)] and higher complications risk [OR: 3.47, 95% CI (1.16 - 10.37), p = 0.03; I2 = 82% (p = 0.004)] in COVID-19 patients. Our analysis showed four evidence-based recommendations on the prognostic value of PhA with two strong recommendations, one of moderate and another of low-moderate quality, for predicting mortality and complications, respectively. We recommend using PhA as a prognostic marker for mortality and complications in this population. Although the results are promising, future studies must identify the PhA cut-off to guide therapeutic decisions more precisely.Registration code in PROSPERO: CRD42023391044.

Overhydration Assessed Using Bioelectrical Impedance Vector Analysis Adversely Affects 90-Day Clinical Outcome among SARS-CoV2 Patients: A New Approach.

Background: COVID-19 has taken on pandemic proportions with growing interest in prognostic factors. Overhydration is a risk factor for mortality in several medical conditions with its role in COVID-19, assessed with bioelectrical impedance (BI), gaining research interest. COVID-19 affects hydration status. The aim was to determine the hydration predictive role on 90 d survival COVID-19 and to compare BI assessments with traditional measures of hydration. Methods: We studied 127 consecutive COVID-19 patients. Hydration status was estimated using a 50 kHz phase-sensitive BI and estimated, compared with clinical scores and laboratory markers to predict mortality. Results: Non-surviving COVID-19 patients had significantly higher hydration 85.2% (76.9−89.3) vs. 73.7% (73.2−82.1) and extracellular water/total body water (ECW/TBW) 0.67 (0.59−0.75) vs. 0.54 (0.48−0.61) (p = 0.001, respectively), compared to surviving. Patients in the highest hydration tertile had increased mortality (p = 0.012), Intensive Care Unit (ICU) admission (p = 0.027), COVID-19 SEIMC score (p = 0.003), and inflammation biomarkers [CRP/prealbumin (p = 0.011)]. Multivariate analysis revealed that hydration status was associated with increased mortality. HR was 2.967 (95%CI, 1.459−6.032, p < 0.001) for hydration and 2.528 (95%CI, 1.664−3.843, p < 0.001) for ECW/TBW, which were significantly greater than traditional measures: CRP/prealbumin 3.057(95%CI, 0.906−10.308, p = 0.072) or BUN/creatinine 1.861 (95%CI, 1.375−2.520, p < 0.001). Hydration > 76.15% or ECW/TBW > 0.58 were the cut-off values predicting COVID-19 mortality with 81.3% and 93.8% sensitivity and 64 and 67.6% specificity, respectively. Hydration status offers a sensitive and specific prognostic test at admission, compared to established poor prognosis parameters. Conclusions and Relevance: Overhydration, indicated as high hydration (>76.15%) and ECW/TBW (>0.58), were significant predictors of COVID-19 mortality. These findings suggest that hydration evaluation with 50 kHz phase-sensitive BI measurements should be routinely included in the clinical assessment of COVID-19 patients at hospital admission, to identify increased mortality risk patients and assist medical care.

Transcriptomic analysis of patients with clinical suspicion of maturity-onset diabetes of the young (MODY) with a negative genetic diagnosis.

BACKGROUND: Diagnosis of mature-onset diabetes of the young (MODY), a non-autoimmune monogenic form of diabetes mellitus, is confirmed by genetic testing. However, a positive genetic diagnosis is achieved in only around 50% of patients with clinical characteristics of this disease. RESULTS: We evaluated the diagnostic utility of transcriptomic analysis in patients with clinical suspicion of MODY but a negative genetic diagnosis. Using Nanostring nCounter technology, we conducted transcriptomic analysis of 19 MODY-associated genes in peripheral blood samples from 19 patients and 8 healthy controls. Normalized gene expression was compared between patients and controls and correlated with each patient's biochemical and clinical variables. Z-scores were calculated to identify significant changes in gene expression in patients versus controls. Only 7 of the genes analyzed were detected in peripheral blood. HADH expression was significantly lower in patients versus controls. Among patients with suspected MODY, GLIS3 expression was higher in obese versus normal-weight patients, and in patients aged < 25 versus > 25 years at diabetes onset. Significant alteration with respect to controls of any gene was observed in 57.9% of patients. CONCLUSIONS: Although blood does not seem to be a suitable sample for transcriptomic analysis of patients with suspected MODY, in our study, we detected expression alterations in some of the genes studied in almost 58% of patients. That opens the door for future studies that can clarify the molecular cause of the clinic of these patients and thus be able to maintain a more specific follow-up and treatment in each case.

Phase angle and standardized phase angle from bioelectrical impedance measurements as a prognostic factor for mortality at 90 days in patients with COVID-19: A longitudinal cohort study.

BACKGROUND & AIMS: Severe acute COVID-19 has taken on pandemic proportions with growing interest in identification of prognostic factors for mortality. Standardized bioelectrical impedance (BI) phase angle (SPhA), which is PhA adjusted by age and sex, has been related to mortality in patients with several diseases but never investigated in COVID-19. Inflammation, a consequence of COVID-19 infection, affects fluid status (hydration) and can be identified with PhA. The aim of this study was to determine the predictive role of PhA on 90 days survival of adults with COVID-19. METHODS: We studied 127 consecutive patients diagnosed with COVID-19. BI measurements determined with a 50 kHz phase-sensitive BI device, body composition parameters and laboratory markers were evaluated as predictors of mortality. RESULTS: Non-surviving COVID-19 patients had significantly lower PhA and SPhA values (p < 0.001) and increased hydration (p < 0.001) compared to surviving patients. Patients in the lowest SPhA quartile had increased (p < 0.001) mortality and hospital stay, hyperhydration (p < 0.001), increased inflammation biomarkers [CRP (p < 0.001)], decreased nutritional parameters: body mass cell index [BCMI (p < 0.001) albumin (p < 0.001)], and reduced other biomarkers [D-dimer (p = 0.002)]. Multivariate analysis (Cox regression) revealed that PhA and hydration status, adjusted for age, sex, BMI, diabetes, hypertension, dyslipidaemia or heart disease, were associated (p < 0.001) with increased mortality. The hazard ratio was 2.48 (95% CI, 1.60-3.84, p < 0.001) for PhA and 1.12 (95% CI, 1.04-1.20, p = 0.003) for hydration percentage. PhA <3.95° was the cut-off for predicting mortality in acute COVID-19 with 93.8% sensitivity and 66.7% specificity. PhA offers greater sensitivity as a predictive prognostic test at admission, compared to the established analytical parameters of poor prognosis (CRP, lymphocytes, prealbumin). CONCLUSIONS: Low PhA (<3.95°), independent of age, sex, BMI, and comorbidities, is a significant predictor of mortality risk in COVID-19. These findings suggest that the evaluation of body composition with single-frequency phase-sensitive BI measurements should be included in the routine clinical assessment of COVID-19 patients at hospital admission to identify patients at increased mortality risk.

Executive summary: Position document: Evaluation and management of hypoglycemia in the patient with diabetes mellitus 2020. Diabetes Mellitus Working Group of the Spanish Society of Endocrinology and Nutrition.

OBJECTIVE: To provide practical recommendations for the evaluation and management of hypoglycemia in patients with diabetes mellitus. PARTICIPANTS: Members of the Diabetes Mellitus Working Group of the Spanish Society of Endocrinology and Nutrition (SEEN). METHODS: The recommendations were made based on the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system to establish both the strength of the recommendations and the level of evidence. A systematic search was made in MEDLINE (PubMed) for the available evidence on each subject, and articles written in English and Spanish with an inclusion date up to 30 November 2019 were reviewed. This executive summary takes account of the evidence incorporated since 2013. CONCLUSIONS: The document establishes practical evidence-based recommendations regarding the evaluation and management of hypoglycemia in patients with diabetes mellitus.

Morphofunctional assessment of patient's nutritional status: a global approach / Evaluación morfofuncional del estado nutricional de los pacientes: un nuevo enfoque

Disease-related malnutrition represents an imbalance between the intake and the requirements of energy and nutrients. It produces a series of metabolic and functional changes in the body. There are multiple limitations in the classic parameters for nutrition assessment including body mass index, weight loss, food intake, or standard laboratory parameters such as albumin or lymphocytes. We can establish some points of interest in this new approach to nutrition focused on the assessment of nutritional status by evaluating changes in composition and function using parameters such as PhA and other electrical measurements of bioimpedance, dynamometry, functional tests, muscle ultrasound, or laboratory parameters such as CRP/prealbumin.Each of these parameters has a number of uses and limitations that should be understood when evaluating its ability to diagnose malnutrition as related to disease, its concordance with other tests, and its prognostic value. Emerging nutritional param­eters for future use should be sensitive, specific, and interrelated to allow a better understanding of each patient's status at different time points during their disease. (AU)

La malnutrición relacionada con la enfermedad representa un disbalance entre el aporte y los requerimientos de energía y nutrientes, que produce una serie de cambios metabólicos y funcionales a nivel corporal. Existen múltiples limitaciones de los parámetros clásicos de valoración nutricional, como el índice de masa corporal, la pérdida de peso, la ingesta o los parámetros analíticos clásicos, como es el caso de la albúmina o los linfocitos. Sugerimos un nuevo enfoque de la nutrición clínica centrado en la valoración del estado nutricional del paciente evaluando los cambios de composición y función con nuevos parámetros como el ángulo de fase y otras medidas eléctricas de la bioimpedanciometría, la ecografía nutricional©, los nuevos parámetros analíticos como el cociente PCR/prealbúmina, la dinamometría o los test funcionales.Cada uno de estos parámetros tiene una serie de utilidades y limitaciones que es importante conocer a la hora de evaluar su capacidad de diagnosticar la desnutrición relacionada con la enfermedad, la concordancia con otros tests y su valor pronóstico. La nueva visión global de la nutrición clínica debería integrar diferentes aspectos de composición y función del organismo para poder establecer un diagnóstico más preciso de la situación nutricional y un plan terapéutico individualizado. Los parámetros nutricionales emergentes deben ser sensibles y específicos, y estar relacionados entre sí, de forma que permitan un mejor conocimiento de la situación particular de cada paciente en los diferentes momentos evolutivos de su proceso patológico. (AU)

Morphofunctional assessment of patient´s nutritional status: a global approach.

INTRODUCTION: Disease-related malnutrition represents an imbalance between the intake and the requirements of energy and nutrients. It produces a series of metabolic and functional changes in the body. There are multiple limitations in the classic parameters for nutrition assessment including body mass index, weight loss, food intake, or standard laboratory parameters such as albumin or lymphocytes. We can establish some points of interest in this new approach to nutrition focused on the assessment of nutritional status by evaluating changes in composition and function using parameters such as PhA and other electrical measurements of bioimpedance, dynamometry, functional tests, muscle ultrasound, or laboratory parameters such as CRP/prealbumin. Each of these parameters has a number of uses and limitations that should be understood when evaluating its ability to diagnose malnutrition as related to disease, its concordance with other tests, and its prognostic value. Emerging nutritional parameters for future use should be sensitive, specific, and interrelated to allow a better understanding of each patient's status at different time points during their disease.

INTRODUCCIÓN: La malnutrición relacionada con la enfermedad representa un disbalance entre el aporte y los requerimientos de energía y nutrientes, que produce una serie de cambios metabólicos y funcionales a nivel corporal. Existen múltiples limitaciones de los parámetros clásicos de valoración nutricional, como el índice de masa corporal, la pérdida de peso, la ingesta o los parámetros analíticos clásicos, como es el caso de la albúmina o los linfocitos. Sugerimos un nuevo enfoque de la nutrición clínica centrado en la valoración del estado nutricional del paciente evaluando los cambios de composición y función con nuevos parámetros como el ángulo de fase y otras medidas eléctricas de la bioimpedanciometría, la ecografía nutricional©, los nuevos parámetros analíticos como el cociente PCR/prealbúmina, la dinamometría o los test funcionales. Cada uno de estos parámetros tiene una serie de utilidades y limitaciones que es importante conocer a la hora de evaluar su capacidad de diagnosticar la desnutrición relacionada con la enfermedad, la concordancia con otros tests y su valor pronóstico. La nueva visión global de la nutrición clínica debería integrar diferentes aspectos de composición y función del organismo para poder establecer un diagnóstico más preciso de la situación nutricional y un plan terapéutico individualizado. Los parámetros nutricionales emergentes deben ser sensibles y específicos, y estar relacionados entre sí, de forma que permitan un mejor conocimiento de la situación particular de cada paciente en los diferentes momentos evolutivos de su proceso patológico.

Executive summary: Position document: Evaluation and management of hypoglycemia in the patient with diabetes mellitus 2020. Diabetes Mellitus Working Group of the Spanish Society of Endocrinology and Nutrition. / Resumen ejecutivo: Documento de posicionamiento: evaluación y manejo de la hipoglucemia en el paciente con diabetes mellitus 2020. Grupo de Trabajo de Diabetes Mellitus de la Sociedad Española de Endocrinología y Nutrición.

OBJECTIVE: To provide practical recommendations for the evaluation and management of hypoglycemia in patients with diabetes mellitus. PARTICIPANTS: Members of the Diabetes Mellitus Working Group of the Spanish Society of Endocrinology and Nutrition (SEEN). METHODS: The recommendations were made based on the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system to establish both the strength of the recommendations and the level of evidence. A systematic search was made in MEDLINE (PubMed) for the available evidence on each subject, and articles written in English and Spanish with an inclusion date up to 28 February 2020 were reviewed. This executive summary takes account of the evidence incorporated since 2013. CONCLUSIONS: The document establishes practical evidence-based recommendations regarding the evaluation and management of hypoglycemia in patients with diabetes mellitus.

The Southern European Atlantic diet.

The Southern Europe Atlantic Diet (SEAD) is the traditional diet consumed in the Northwestern region of the Iberian Peninsula: Galicia (Spain) and North of Portugal. These regions have geographical, climatic and cultural characteristics that had led them to develop their own dietary pattern. This dietary pattern integrated into its environment is based on fresh, local and seasonal products intake. In this diet there is a high intake of fish, seafood, cereals, potatoes, legumes, fruits, dairy products and vegetables. Meat, preferably lean meat, is consume moderately as well as eggs and wine. SEAD is more than a diet, it is a lifestyle where exercise, simples cooking techniques, respect for the traditions and pleasure of eating accompanied are constants. Although this pattern has been known for centuries, it did not begin to be define as such until the signing of "Baione Declaration" in 2006. Some bioactive compounds of SEAD had showed health benefits and protect against acute myocardial infarction. Data supports that SEAD is a sustainable diet. In the presented review, results of studies on the SEAD are presented and discussed. Also, a recent proposal of SEAD Index is reported. Therefore, SEAD should be considered as an excellent dietary pattern and lifestyle.

The challenge of diabetes home control in COVID-19 times: Proof is in the pudding.

SARS-CoV-2 pandemic had changed self-care in diabetes. The aim of this work is to analyze the effect of lockdown on glycemic control in people with type 1 diabetes on multiple daily insulin injections using FGM. During lockdown no deleterious effect on glycemic control measured by FGM.