ABSTRACT
Protein calorie malnutrition is frequently a complication in the chronic liver disease patient and is considered to be a negative prognostic factor. Anorexia and several other endocrine metabolic complications produce an hypermetabolic state that needs more caloric intake. Hepatic encephalopathy is one of the developments possible in patients with descompensated cirrhosis. The wellknown role of ammonia in the pathogenesis of hepatic encephalopathy has determined a restriction in dietary protein along many decades. Nevertheless, there is no evidence about a low protein diet being better in the outcome of hepatic encephalopathy, it worsens, moreover, the nutritional status and helps in the development of many nutritional related complications. This article reviews the use of oral branched-chain amino acids and proteins of different sources, probiotics, synbiotics, antioxidants, oral L-Ornithine L-Aspartate and acetyl-L-carnitine in patients with hepatic encephalopathy.
Subject(s)
Hepatic Encephalopathy/therapy , Nutritional Support , Guidelines as Topic , Hepatic Encephalopathy/complications , Humans , Liver Cirrhosis/etiology , Liver Cirrhosis/therapy , Nutrition Assessment , Nutrition Policy , Protein-Energy Malnutrition/etiology , Protein-Energy Malnutrition/therapyABSTRACT
La desnutrición es una complicación frecuente que influye negativamente en el pronóstico del enfermo con cirrosis hepática. La disminución de la ingesta junto con la aparición de diversas alteraciones endocrino-metabólicas condicionan un estado hipercatabólico que precisa de un mayor aporte energético. Una de las complicaciones que puede aparecer en la fase de cirrosis descompensada es la encefalopatía hepática. El reconocido papel del amonio en la patogenia de la encefalopatía hepática ha condicionado durante muchos años una restricción en el aporte de proteínas de estos enfermos. Sin embargo, no existe evidencia de que una dieta baja en proteínas mejore el curso de la encefalopatía hepática y sí de que empeore el estado nutricional y favorezca la aparición de distintas complicaciones relacionadas con la desnutrición. En este trabajo, se revisa el uso de aminoácidos ramificados y de proteínas de diferente origen, probióticos y simbióticos, antioxidantes, L-Ornitina-L-Aspartato, acetil-L-carnitina en enfermos con encefalopatía hepática (AU)
Protein calorie malnutrition is frequently a complication in the chronic liver disease patient and is considered to be a negative prognostic factor. Anorexia and several other endocrine metabolic complications produce an hypermetabolic state that needs more caloric intake. Hepatic encephalopathy is one of the developments possible in patients with descompensated cirrhosis. The wellknown role of ammonia in the pathogenesis of hepatic encephalopathy has determined a restriction in dietary protein along many decades. Nevertheless, there is no evidence about a low protein diet being better in the outcome of hepatic encephalopathy, it worsens, moreover, the nutritional status and helps in the development of many nutritional related complications. This article reviews the use of oral branched-chain amino acids and proteins of different sources, probiotics, synbiotics, antioxidants, oral L-Ornithine L-Aspartate and acetyl-L-carnitine in patients with hepatic encephalopathy (AU)
Subject(s)
Humans , Nutritional Support/methods , Malnutrition/diet therapy , Hepatic Encephalopathy/diet therapy , Amino Acids/therapeutic use , Protein-Losing Enteropathies/diet therapy , Probiotics/therapeutic use , Antioxidants/therapeutic useABSTRACT
Percutaneous endoscopic gastrostomy (PEG) is the first choice method for long-term enteral feeding when the digestive tube is undamaged and the patients' survival is longer than 2 months. There are increasing series and indications reported and although it is a safe technique we should take into account an appropriate patient selection. The aim of this work was to analyze the follow-up of the patients undergoing percutaneous endoscopic gastrostomy (PEG) at a hospital with high assistance level and one of the referents for organ transplantation in our community, with the peculiarities that this may have on our series. We analyze a cohort of 73 patients submitted to PEG during the years 2000-2007 at the Reina Sofía Hospital of Córdoba. Neurological and ENT neoplasms and upper GI tract neoplasms are among the most frequent causes, with similar results to those reported in other series. We highlight the number of young patients with cystic fibrosis (CF) in our series with nutritional support through PEG complementing oral and nocturnal feeding, which has lead to improved nutritional parameters before lung transplant. In consequence, we therefore analyze patients' selection and their characteristics, the ethical and moral implications in some of these patients, such in neurological patients, their complications, mortality, and we mention as being of interest the transient and well tolerated indication in a subgroup of CF patients that deserves special mention.
Subject(s)
Endoscopy, Gastrointestinal , Enteral Nutrition , Gastrostomy , Adult , Aged , Cohort Studies , Cystic Fibrosis/complications , Cystic Fibrosis/therapy , Endoscopy, Gastrointestinal/adverse effects , Enteral Nutrition/adverse effects , Follow-Up Studies , Gastrointestinal Neoplasms/complications , Gastrointestinal Neoplasms/surgery , Gastrostomy/adverse effects , Humans , Lung Transplantation , Middle Aged , Minimally Invasive Surgical Procedures , Nervous System Diseases/complications , Nervous System Diseases/therapy , Organ TransplantationABSTRACT
La Gastrostomía Endoscópica Percutánea (PEG) es el método de elección para la alimentación enteral a largo plazo, cuando el tubo digestivo está indemne, y la supervivencia de los pacientes es superior a 2 meses. Son cada vez más, las series comunicadas e indicaciones, a pesar de ser una técnica segura, debemos tener en cuenta una adecuada selección de los pacientes. El propósito de este trabajo es analizar el seguimiento de los pacientes sometidos a Gastrostomía Endoscópica Percutánea (PEG), en un Hospital de gran nivel asistencial y uno de los referentes de Trasplante de órganos en nuestra comunidad, con las peculiaridades que esto tiene en nuestra serie. Analizamos una cohorte de 73 pacientes sometidos a PEG, durante los años 2000 a 2007 en el Hospital Reina Sofía de Córdoba. Las Enfermedades Neurológicas y Neoplásicas de la esfera ORL y Digestiva alta son las causas más frecuentes, con resultados similares a los publicados en otras series. Destacamos, el número de paciente jóvenes con Fibrosis Quística (FQ), en nuestra serie, con soporte nutricional a través de PEG complementaria a la alimentación oral y nocturna, lo cual, ha supuesto una mejora de los parámetros nutricionales de cara al trasplante pulmonar. En consecuencia, analizamos las características de los pacientes, las implicaciones éticas y morales de algunos de ellos, como son los enfermos neurológicos, sus complicaciones y mortalidad. Destacamos con interés, la indicación transitoria y bien tolerada en un subgrupo de pacientes con FQ, que en nuestra serie merece especial mención (AU)
Percutaneous endoscopic gastrostomy (PEG) is the first choice method for long-term enteral feeding when the digestive tube is undamaged and the patients survival is longer than 2 months. There are increasing series and indications reported and although it is a safe technique we should take into account an appropriate patient selection. The aim of this work was to analyze the followup of the patients undergoing percutaneous endoscopic gastrostomy (PEG) at a hospital with high assistance level and one of the referents for organ transplantation in our community, with the peculiarities that this may have on our series. We analyze a cohort of 73 patients submitted to PEG during the years 2000-2007 at the Reina Sofía Hospital of Córdoba. Neurological and ENT neoplasms and upper GI tract neoplasms are among the most frequent causes, with similar results to those reported in other series. We highlight the number of young patients with cystic fibrosis (CF) in our series with nutritional support through PEG complementing oral and nocturnal feeding, which has lead to improved nutritional parameters before lung transplant. In consequence, we therefore analyze patients selection and their characteristics, the ethical and moral implications in some of these patients,such in neurological patients, their complications, mortality,and we mention as being of interest the transient and well tolerated indication in a subgroup of CF patients that deserves especial mention (AU)
Subject(s)
Humans , Gastrostomy/methods , Endoscopy, Gastrointestinal/methods , Enteral Nutrition/methods , Nutrition Disorders/diet therapy , Cystic Fibrosis/diet therapy , Nutrition AssessmentABSTRACT
No disponible
Subject(s)
Humans , Male , Female , Adolescent , Weight Gain/physiology , Obesity/epidemiology , Body Composition/physiology , Anthropometry/methods , Body Weights and Measures/methods , Overweight/diagnosis , Overweight/epidemiology , Overweight/therapy , Body Mass Index , Absorptiometry, Photon/methods , Weight by Height/physiology , Spain/epidemiology , Body Composition , Body Weights and Measures/trends , European Union/statistics & numerical data , Overweight/physiopathology , Absorptiometry, Photon/trends , /methodsSubject(s)
Humans , Male , Female , Adolescent , Overweight/diagnosis , Overweight/etiology , Obesity/etiology , Body Weight/physiology , Obesity/genetics , Obesity, Morbid/epidemiology , Obesity, Morbid/genetics , Life Style , Longitudinal Studies , Risk Factors , Leptin/deficiency , Leptin/genetics , Fruit/physiology , Receptors, Leptin/biosynthesis , Pro-Opiomelanocortin/deficiency , Pro-Opiomelanocortin/genetics , Healthy Lifestyle , Micronutrients/therapeutic use , Nutrients , VegetablesABSTRACT
No disponible
Subject(s)
Humans , Male , Female , Adolescent , Comorbidity , Body Weight , Body Weight/physiology , Risk Factors , Quality of Life , Diagnosis, Differential , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/prevention & control , Apnea/complications , Apnea/etiology , Epiphyses, Slipped/epidemiology , Metabolic Syndrome/complications , Metabolic Syndrome/etiologySubject(s)
Humans , Male , Female , Adolescent , Overweight/complications , Overweight/diagnosis , Overweight/psychology , Family/psychology , Comorbidity , Micronutrients/therapeutic use , Exercise/physiology , Metformin/therapeutic use , Nutrients , Weight Loss , Risk Factors , Cardiovascular Diseases/complications , Cardiovascular Diseases/metabolism , Endocrine Surgical ProceduresABSTRACT
OBJECTIVE: To detect potential complications and interactions between drugs and enteral nutrition (EN) as to describe the interventions carried out by the pharmacist in those circumstances and to propose strategies of improvement. METHOD: Prospective assessment of patients admitted to hospital candidates to receive EN. The pharmacist worked as part of the team of Endocrinology and Nutrition for one month. A data collection form was designed for the study in which the following information had to be recorded: NE indications, nutrition characteristics (type, route of administration, infusion rate), pharmacological therapy, drug/EN interaction and complications. RESULTS: The study included 14 patients (mean age of 50 +/- 13 years) in which digestive (35.7%) and neurological (28.6%) complications were the most frequent indications for EN. Eleven patients (78.57%) reported complications associated to EN, mostly digestive (57.14%). The main cause for consultation was related to the administration of drugs via NGT (nasogastric tube). A total of 77 drugs were prescribed, 23 of which were administered in this way, so a guidelines for the administration of drugs via nasogastric tube was prepared. CONCLUSIONS: The hospital pharmacist can actively cooperate with nutritional support units, given the need to assess the nutritional support administered and to manage potential complications and interactions between nutritional status, drugs and artificial nutrition. The pharmacist also plays a significant role in the prevention and identification of problems related to the administration of drugs via NGT.
Subject(s)
Enteral Nutrition , Food-Drug Interactions , Enteral Nutrition/adverse effects , Female , Humans , Male , Middle Aged , Pharmacy Service, Hospital , Prospective StudiesABSTRACT
Objetivo: Detectar las posibles complicaciones e interaccionesentre medicamentos-nutrición enteral (NE) y describir lasintervenciones realizadas por el farmacéutico en este entorno,proponiendo estrategias de mejora.Método: Evaluación prospectiva en pacientes ingresados en elhospital candidatos a recibir NE. El farmacéutico se integra en elequipo de Endocrinología y Nutrición durante 1 mes. Para el estudiodiseña un impreso de recogida de datos donde se especifica:indicación de NE, características de la nutrición (tipo, vía de administración,velocidad de infusión), tratamiento farmacológico, interaccionesmedicamento/NE y complicaciones.Resultados: Se incluyeron 14 pacientes (edad media 50 ± 13años) en los que las alteraciones digestivas (35,7%) y las neurológicas(28,6%) fueron las indicaciones más frecuentes de NE. Seprodujeron complicaciones asociadas a NE en 11 pacientes(78,57%) siendo las digestivas (57,14%) las más frecuentes. Elprincipal motivo de consulta estuvo relacionado con la administraciónde medicamentos por sonda nasogástrica (SNG), se pautaronun total de 77 medicamentos de los que 23 se administraron porésta vía, por lo que se elaboró una guía de administración de fármacospor sonda.Conclusiones: El farmacéutico de hospital puede colaboraractivamente en las unidades de soporte nutricional ya que es necesarioevaluar el aporte nutricional administrado y manejar las posiblescomplicaciones e interacciones entre el estado nutricional,medicamentos y nutrición artificial. Del mismo modo juega unpapel importante en la prevención y detección de los problemasrelacionados con la administración de medicamentos por SNG
Objective: To detect potential complications and interactionsbetween drugs and enteral nutrition (EN) as to describe the interventionscarried out by the pharmacist in those circumstances andto propose strategies of improvement.Method: Prospective assessment of patients admitted to hospitalcandidates to receive EN. The pharmacist worked as part ofthe team of Endocrinology and Nutrition for one month. A datacollection form was designed for the study in which the followinginformation had to be recorded: NE indications, nutrition characteristics(type, route of administration, infusion rate), pharmacologicaltherapy, drug/EN interaction and complications.Results: The study included 14 patients (mean age of 50 ±13 years) in which digestive (35.7%) and neurological (28.6%)complications were the most frequent indications for EN. Elevenpatients (78.57%) reported complications associated to EN, mostlydigestive (57.14%). The main cause for consultation was relatedto the administration of drugs via NGT (nasogastric tube). Atotal of 77 drugs were prescribed, 23 of which were administeredin this way, so a guidelines for the administration of drugs vianasogastric tube was prepared.Conclusions: The hospital pharmacist can actively cooperatewith nutritional support units, given the need to assess the nutritionalsupport administered and to manage potential complicationsand interactions between nutritional status, drugs and artificialnutrition. The pharmacist also plays a significant role in theprevention and identification of problems related to the administrationof drugs via NGT
Subject(s)
Humans , Enteral Nutrition/methods , Drug Utilization , Intubation, Gastrointestinal , Pharmacy Service, Hospital/methods , Drug Administration RoutesABSTRACT
El hiperparatiroidismo primario (HPP) durante el embarazo puede llevar a graves complicaciones fetales y maternas, como la pancreatitis agua. Por ello, el tratamiento médico sólo se considera en gestantes asintomáticas con calcemias moderadas, y en el resto se opta por el abordaje quirúrgico. Presentamos a una gestante de 9 semanas con hiperemesis gravídica y pancreatitis aguda por hipercalcemia secundaria a un adenoma paratiroideo. La falta de respuesta al tratamiento médico conservador llevó a la intervención en el segundo trimestre de embarazo. La cirugía resultó exitosa, y la gestación, el parto y el recién nacido no presentaron más incidencias. Concluimos que la cirugía en el segundo trimestre de embarazo es una alternativa eficaz en el tratamiento del HPP cuando fracasa el abordaje conservador
Primary hyperparathyroidism (PHP) during pregnancy could conduce to seriously fetal and maternal complications as acute pancreatitis. Because of that, medical treatment can be consider only in asymptomatic pregnants with moderate calcium levels, in the rest of cases is prefer to use surgical management. We present a 9th week pregnant with hyperemesis gravidarum and acute pancreatitis due to hypercalcemia secondary to a parathyroid adenoma. The absence of response to medical treatment conduced to surgical intervention during second trimester of pregnancy. Surgery was successful, and not any incidence was detected in the rest of gestation, delivery and newborn. We conclude that surgery during second trimester is an efficacy alternative in HPP treatment when conserver management failed
Subject(s)
Female , Pregnancy , Humans , Pancreatitis/etiology , Hyperparathyroidism/complications , Hyperparathyroidism/surgery , Pregnancy Complications , Hyperemesis Gravidarum , Adenoma/surgery , Adenoma , Parathyroid Neoplasms/surgery , Parathyroid Neoplasms , Acute Disease , Treatment Outcome , Adenoma/complicationsABSTRACT
La alimentación es saludable cuando favorece el buen estado de salud y disminuye el riesgo de enfermedades crónicas relacionadas con ella. La investigación epidemiológica ha demostrado una estrecha relación entre la alimentación y el riesgo para desarrollar estas enfermedades crónicas caracterizadas por una elevada morbimortalidad, por lo que es necesario establecer normas de referencia que sirvan de guía para garantizar un estado nutricional adecuado. El modelo de alimentación mediterráneo es una tradición centenaria que contribuye a un excelente estado nutricional, proporciona una sensación placentera y forma parte de la cultura mundial. Se revisan algunos de los estudios más sólidos y recientes que sugieren esta relación tan estrecha entre estilo de vida no saludable y riesgo de enfermedad (AU)
A diet is healthy when it encourages good health and reduces the risk of diet-related chronic diseases. Epidemiological research has demonstrated a close relationship between diet and the risk of developing these chronic diseases, which are characterized by high morbidity and mortality. Consequently reference intakes that would serve as a guide to guarantee a healthy nutritional status should be established. The Mediterranean diet is a tradition that goes back for more than a hundred years and which contributes to excellent nutritional status; this diet is highly palatable and forms part of global culture. Some of the most rigorous and recent studies on the relationship between unhealthy lifestyle and the risk of disease are reviewed (AU)
Subject(s)
Humans , Male , Female , Evidence-Based Medicine/methods , Evidence-Based Medicine/trends , Health Behavior , Feeding Behavior/physiology , Nutritional Status , Cardiovascular Diseases/diet therapy , Cardiovascular Diseases/prevention & control , Evidence-Based Medicine/instrumentation , Nutrition Programs and Policies , Nutrition ProgramsABSTRACT
La obesidad es una enfermedad crónica multifactorial de gran trascendencia sociosanitaria y económica y constituye un problema de salud pública. Causa o empeora un gran número de problemas relacionados con la salud: diabetes, enfermedad coronaria, hipertensión y determinados tumores. Se asocia con mayor riesgo de mortalidad cardiovascular, mayor prevalencia de alteraciones psicopatológicas, incremento del coste sanitario y disminución de la esperanza de vida. Actualmente en España, la prevalencia de exceso de peso afecta aproximadamente al 50% de la población. La Sociedad Española de Endocrinología y Nutrición (SEEN) ha elaborado una Guía de Práctica Clínica sobre el diagnóstico, la evaluación y el tratamiento del sobrepeso y de la obesidad en adultos estructurada en dos partes: 1) Definición y clasificación, epidemiología, etiopatogenia, complicaciones, beneficios de la reducción ponderal y evaluación del enfermo con sobrepeso u obesidad; 2) identificación de enfermos con riesgo de obesidad subsidiarios de tratamiento, objetivos de tratamiento y estrategias terapéuticas disponibles para conseguirlos, indicándose además, el grado de recomendación basado en la evidencia científica sobre cada uno de estos aspectos. Aun siendo la obesidad una enfermedad que debiera implicar no sólo a personal sanitario, sino también a autoridades políticas, agentes sociales, educadores e industria alimentaria entre otros, la SEEN ha querido desarrollar esta guía dados los evidentes aspectos endocrinológicos y metabólicos de este trastorno. Esta guía establece recomendaciones basadas en la evidencia científica para ayudar a tomar decisiones sobre el diagnóstico, la evaluación y el tratamiento del exceso ponderal en adultos y posibilitar una atención más homogénea y de calidad (AU)
Obesity is a chronic, multifactor disease with sizeable socio sanitary and economic consequences and is an issue in public health, mostly in developing countries. It causes or exacerbates a large number of health problems: diabetes, coronary heart disease, hypertension, and the incidence of certain cancers. It has been linked to a greater risk of cardiovascular mortality, a higher prevalence of psychopathology disorders and social maladjustment with a higher health care cost and shorter life-expectancy. In Spain, nowadays, the prevalence of overweight and obesity is nearly 50% of population. SEEN has developed a Clinical Practice Guide on diagnosis, evaluation and treatment of overweight and obesity in adult people with two sections: 1) Definition and classification of adult obesity, its epidemiology, etiopathogeny, complications, benefits of weight reduction and clinical evaluation of patients with overweight or obesity, and 2) Identification of patients with obesity risk subsidiary to weight reduction treatment, therapy goals and therapeutical strategies available to achieve them indicating as well the degree of recommendation based upon scientific evidence on each aspect. Although obesity is a disease which is supposed to involve not only medical but also political authorities, social agents, educators and food industry among others, SEEN decided to develop this Guide taking into account the evident endocrinological and metabolical aspects of this disorder. The Guide contains scientific evidencebased recommendations intended to help doctors making decisions on diagnose, evaluations and treatment of adult overweight so that a more homogeneous attendance with settled quality can be achieved (AU)
Subject(s)
Humans , Obesity/epidemiology , Diabetes Mellitus/etiology , Hyperlipoproteinemias/etiology , Myocardial Ischemia/etiology , Obesity/therapy , Obesity/complications , Spain , Societies, MedicalABSTRACT
No disponible
Subject(s)
Humans , Neuroendocrine Tumors , Receptors, Somatostatin/analysis , Hypophosphatemia, FamilialABSTRACT
OBJECTIVES: To analyse the prevalence of malnutrition in candidates for lung transplantation and to establish if there are any differences in the prevalence of malnutrition among the different groups of patients regarding their illness. METHODS: We reviewed the nutritional evaluation of 163 consecutive transplant candidates referred to our hospital (1996-2001). The nutritional assessment included: clinical history, anthropometric measurements, bioelectrical impedance analysis, and biochemical measurements. The nutritional status diagnosis was determined following RWS Chang protocol. RESULTS: 163 patients (108 male/55 female; 42.9 +/- 14.7 yr.) agrupped into four main lung diseases groups: obstructive (chronic obstructive pulmonary disease): 60 (36.8%); interstitial (idiopathic pulmonary fibrosis): 45 (27.6%); septic (cystic fibrosis and bronchiectasis): 47 (28.8%); and vascular (primary pulmonary hypertension and miscellaneous etiology): 11 (6.7%). The prevalence of malnutrition is 60.9% (IC 95%; 53.4-68.4) and the most prevalent type is moderate caloric malnutrition (23.3%). Percentage of triceps skinfold thickness was lower in the septic group (65.1 +/- 43.0) than in the obstructive (94.8 +/- 53.9; p < 0.05) or in the interstitial one (130.3 +/- 61.5; p < 0.0001). Interstitial group had also the higher weight, BMI and percentage of ideal weight. Percentage of arm muscle circumference was only different between interstitial and septic groups (105.5 +/- 18.3 vs 95.9 +/- 11.1; p < 0.01). Resting energy expenditure was lower in septic patients. This group had lower levels of prealbumin than obstructive (17.6 +/- 4.7 vs 24.4 +/- 4.8 mg/dl; p < 0.0001) or interstitial groups (17.6 +/- 4.7 vs 27.3 +/- 7.7 mg/dl; p < 0.0001). CONCLUSIONS: Malnutrition in patients awaiting lung transplantation is highly prevalent, specially in septic and vascular lung diseases. Anthropometric measurements are a good and easy option to explore this problem. Nutritional rehabilitation of these patients could improve their postoperative course.
Subject(s)
Lung Diseases/complications , Lung Transplantation , Nutrition Disorders/epidemiology , Adolescent , Adult , Anthropometry , Body Composition , Diagnosis-Related Groups , Energy Metabolism , Female , Humans , Male , Middle Aged , Nutrition Assessment , Nutrition Disorders/complications , Nutrition Disorders/diagnosis , Obesity/complications , Prevalence , Pulmonary Disease, Chronic Obstructive/complications , Pulmonary Fibrosis/complications , Retrospective Studies , Sepsis/complications , Spain/epidemiology , Vascular Diseases/complicationsABSTRACT
Objetivos: Determinar la prevalencia de desnutrición en candidatos a trasplante pulmonar y establecer los grupos de patología pulmonar con mayor frecuencia de desnutrición. Metodología: Estudio de la evaluación nutricional de 163 candidatos a trasplante pulmonar remitidos a nuestro hospital entre 1996-2001. La evaluación incluyó: historia clínica, antropometría, impedanciometría y medidas bioquímicas. El diagnóstico nutricional se estableció según RWS Chang. Resultados: 163 enfermos (108 hombre/55 mujeres; 42,9+/- 14,7 años) clasificados según los siguientes grupos de enfermedad pulmonar: obstructivo (enfermedad pulmonar obstructiva crónica): 60 (36,8 por ciento); intersticial (fibrosis pulmonar idiopática): 45 (27,6 por ciento); séptico (fibrosis quística y bronquiectasias): 47 (28,8 por ciento) y vascular (hipertensión pulmonar primaria y miscelánea): 11 (6,7 por ciento). La prevalencia de desnutrición es del 60,9 por ciento (IC 95 por ciento: 53,4-68,4) siendo la más frecuente la calórica moderada (23,3 por ciento). El porcentaje de pliegue triccipital es menor en el grupo séptico ( 65,1+/- 43,0) que en el obstructivo ( 94,8 +/- 53,9; p<0,05) o en el intersticial (130,3+/- 61,5; p<0,0001). El grupo intersticial tiene mayores peso, IMC y porcentaje de peso ideal. El porcentaje de circunferencia muscular del brazo sólo resultó diferente entre los grupos intersticial y séptico (105,5 +/- 18,3 frente a 95,9 +/- 11,1; p<0,01). El gasto energético basal es menor en los enfermos sépticos. Este grupo tiene niveles de prealbúmina menores que el obstructivo (17,6 +/- 4,7 frente a 24,4 +/- 4,8 mg/dl; p<0,0001) o el intersticial (17,6 +/- 4,7 frente a 27,3 +/- 7,7 mg/dl; p<0,0001). Conclusiones: La desnutrición en candidatos a trasplante pulmonar es altamente prevalente, especialmente en enfermedades sépticas o vasculares. Las antropometría es una técnica adecuada para detectar precozmente este problema. La mejoría del estado nutricional de estos enfermos puede favorecer su evolución postrasplante (AU)
Objectives: To analyse the prevalence of malnutrition in candidates for lung transplantation and to establish if there are any differences in the prevalence of malnutrition among the different groups of patients regarding their illness. Methods: We reviewed the nutritional evaluation of 163 consecutive transplant candidates referred to our hospital (1996-2001). The nutritional assessment included: clinical history, anthropometric measurements, bioelectrical impedance analysis, and biochemical measurements. The nutritional status diagnosis was determined following RWS Chang protocol. Results: 163 patients (108 male/55 female; 42,9 ± 14,7 yr.) agrupped into four main lung diseases groups: obstructive (chronic obstructive pulmonary disease): 60 (36,8%); interstitial (idiopathic pulmonary fibrosis): 45 (27,6%); septic (cystic fibrosis and bronchiectasis): 47 (28,8%); and vascular (primary pulmonary hypertension and miscellaneous etiology): 11 (6,7%). The prevalence of malnutrition is 60,9% (IC 95%; 53,4-68,4) and the most prevalent type is moderate caloric malnutrition (23,3%). Percentaje of triceps skinfold trickness was lower in the septic group (65,1 ± 43,0) than in the obstructive (94,8 ± 53,9; p < 0,05) or in the interstitial one (130,3 ± 61,5; p < 0,0001). Interstitial group had also the higher weight, BMI and percentaje of ideal weight. Percentaje of arm muscle circumference was only different between interstitial and septic groups (105,5 ± 18,3 vs 95,9 ± 11,1; p < 0,01). Resting energy expenditure was lower in septic patients. This group had lower levels of prealbumin than obstructive (17,6 ± 4,7 vs 24,4 ± 4,8 mg/dl; p < 0,0001) or interstitial groups (17,6 ± 4,7 vs 27,3 ± 7,7 mg/dl; p < 0,0001). Conclusions: Malnutrition in patients awaiting lung transplantation is highly prevalent, specially in septic and vascular lung diseases. Anthropometric measurements are a good and easy option to explore this problem. Nutritional rehabilitation of these patients could improve their postoperative course (AU)
Subject(s)
Middle Aged , Adolescent , Adult , Male , Female , Humans , Lung Transplantation , Spain , Vascular Diseases , Nutrition Assessment , Prevalence , Sepsis , Nutrition Disorders , Obesity , Pulmonary Fibrosis , Retrospective Studies , Pulmonary Disease, Chronic Obstructive , Anthropometry , Body Composition , Diagnosis-Related Groups , Energy Metabolism , Lung DiseasesABSTRACT
An increase in transaminases may be due to multiple causes. We present a case of reversible hypertransaminasemia following specific dietary therapy. The various potential aetiopathogenies are reviewed to explain the raising of transaminase levels and the improvement in analytical results after the institution of this dietary treatment.
Subject(s)
Diet Therapy/adverse effects , Metabolic Diseases/blood , Metabolic Diseases/etiology , Transaminases/blood , Humans , Male , Middle AgedABSTRACT
The nutritional status of a patient determines to a great extent his/her susceptibility and capacity in responding to infections. Protein and caloric malnutrition as well as many selective mineral and vitamin deficiencies deteriorate the immune and inflammatory metabolic response, increasing the frequency of infections and worsening their evolution and prognosis. Furthermore, recurrent infections can deteriorate nutritional status, with both problems forming a vicious circle that needs to be recognized for adequate treatment. This problem is not as foreign to us as we might think, given that many hospitalized patients as well as those with chronic diseases suffer from serious nutritional deficiencies. If we also take into account the proposition that the nutritional status of a patient can affect his/her response to treatment with antibiotics and vaccines, we realize then that not enough attention has been paid to this important public health risk factor to date.
