NEmecum: herramienta digital de ayuda a la prescripción y dispensación de fórmulas de nutrición enteral y preparados infantiles / NEmecum: digital tool for assisting in the prescription and dispensing of enteral nutrition formulas and infant preparations

Introducción: existe una amplia variedad de fórmulas o preparados de nutrición enteral y fórmulas o preparados infantiles. La consulta de información relacionada debe hacerse en las herramientas propias de cada laboratorio, lo que dificulta la visión crítica y la comparativa entre las mismas. Objetivo: describir el desarrollo de NEmecum como la primera web que permite realizar una búsqueda dirigida e independiente de fórmulas de nutrición o preparados infantiles, analizar el abanico nutricional actual en España y evaluar los datos de uso de la herramienta. Métodos: se desarrolló la estructura de una base de datos que unifica los parámetros de todas las fórmulas y se analizó el abanico nutricional español. Posteriormente, se seleccionaron los principales algoritmos de búsqueda dirigida y se codificó la herramienta digital. Se llevó a cabo una intensa difusión y se evaluó el impacto obtenido. Se analizaron el perfil de usuarios y centros registrados y los datos de uso de la herramienta y se evaluó su usabilidad mediante el cuestionario System Usability Scale (SUS). Resultados: se obtuvo una web responsive de acceso gratuito (http://nemecum.com) que permite realizar búsquedas dirigidas en base a unos filtros de búsqueda preestablecidos. La herramienta permitió analizar detalladamente el abanico nutricional en España, observándose la gran variedad de fórmulas disponibles de similares características. La campaña de difusión consiguió incrementar su uso de forma exponencial y cuenta actualmente con 1.370 usuarios y 79 centros registrados. La usabilidad fue valorada como excelente. Conclusión: el desarrollo de NEmecum supone una herramienta valiosa en la búsqueda y consulta de datos de fórmulas o preparados de nutrición enteral y fórmulas o preparados infantiles. (AU)

Introduction: there is a wide variety of enteral nutrition and infant formulas preparations. When there is a need to find infomation on a product,only the infomation from industy is available. Comparison amomg products becomes then ardous.Objective: to describe the development of NEmecum as the first website that allows a directed and independent search for enteral nutritionproducts and infant formulas, currently available in Spain, and to evaluate the initial use of NEmecum.Methods: the structure of a database that unifies the parameters of all formulas was developed, and the nutritional composition of all formulaswas analyzed. Subsequently, the main search algorithms were selected and the digital tool was codified. Intensive dissemination was performedand the impact was evaluated. The profile of users and registered centers and the use of the tool were analyzed, and its usability was evaluatedusing the System Usability Scale (SUS) questionnaire.Results: a free-access responsive website (http://nemecum.com) that allows searches based on pre-established search filters was obtained. Thistool allows for a detailed analysis available formulas in Spain by observing a wide variety of formulas with similar characteristics. The disseminationcampaign managed to increase its use exponentially, currently reaching 1,370 users and 79 registered centers. Usability was rated as excellent.Conclusion: the development of the NEmecum represents a valuable tool in the search and consultation of the characteristics of enteral nutritionformulas and infant preparations. (AU)

Terms, concepts and definitions in clinical artificial nutrition. The ConT-SEEN Project. / Términos, conceptos y definiciones en nutrición clínica artificial. Proyecto ConT-SEEN.

BACKGROUND: Imprecision in terms used in the field of clinical nutrition may lead to misinterpretations among professionals. OBJECTIVE: For this reason, the Spanish Society of Endocrinology and Nutrition (SEEN) promoted this document on the terms and definitions used in clinical artificial nutrition (enteral and parenteral), establishing an agreement between Spanish experts of this specialty. METHODS: Forty-seven specialists in endocrinology and nutrition, members of the Nutrition Area of the SEEN, participated between April and September 2016. After a systematic literature review, 52 concepts were proposed. The coordinators included two additional concepts, and 57were finally selected by the working group: 13 of a general nature, 30 referring to enteral nutrition and 14 to parenteral nutrition. The degree of agreement was subsequently determined using a two-round Delphi process. It was finally ratified by consistency and concordance analysis. RESULTS: Fifty-four of the 57 terms had a very consistent agreement and were concordant. Only three showed no concordance, of whom two were very consistent and one inconsistent. In conclusion, there was consensus in the definition of 54 basic terms in the practice of clinical nutrition.

Proposal for a new practicable categorization system for food for special medical purposes - Enteral nutritional products.

BACKGROUND & AIMS: Changes in the EU regulation on food for specific groups (FSG) [1] and within the German social law [2] combined with various definitions in the legal and the scientific background led to the need for development of a categorization system for "Food for special medical purposes" (FSMP) for enteral use [3]. METHODS: The system was developed by an interdisciplinary working group of two German industry associations, which represent the leading manufacturers and distributors of FSMP in Europe. It aims to minimize the misunderstandings surrounding the different definitions used in relation to enteral nutritional products and incorporate the latest scientific knowledge and medical guidelines [4]. RESULTS: The new proposal consists of a table which shows the product categories and briefly the definitions of the used terms. The text contains the relevant definitions of terms often used within the field of enteral nutrition. CONCLUSION: This provides health care professionals with support and the decision making process for the prescription and use of such products. Additionally it also benefits the responsible authorities to formulate new directives, which are user-friendly and reflect the latest knowledge in medical nutrition.

Transnasal endoscopic evaluation of swallowing: a bedside technique to evaluate ability to swallow pureed diets in elderly patients with dysphagia.

BACKGROUND: Endoscopic evaluation of swallowing (EES) is not commonly used by gastroenterologists to evaluate swallowing in patients with dysphagia. OBJECTIVE: To use transnasal endoscopy to identify factors predicting successful or failed swallowing of pureed foods in elderly patients with dysphagia. METHODS: EES of pureed foods was performed by a gastroenterologist using a small-calibre transnasal endoscope. Factors related to successful versus unsuccessful swallowing of pureed foods were analyzed with regard to age, comorbid diseases, swallowing activity, saliva pooling, vallecular residues, pharyngeal residues and airway penetration/aspiration. Unsuccessful swallowing was defined in patients who could not eat pureed foods at bedside during hospitalization. Logistic regression analysis was used to identify independent predictors of swallowing of pureed foods. RESULTS: During a six-year period, 458 consecutive patients (mean age 80 years [range 39 to 97 years]) were considered for the study, including 285 (62%) men. Saliva pooling, vallecular residues, pharyngeal residues and penetration/aspiration were found in 240 (52%), 73 (16%), 226 (49%) and 232 patients (51%), respectively. Overall, 247 patients (54%) failed to swallow pureed foods. Multivariate logistic regression analysis demonstrated that the presence of pharyngeal residues (OR 6.0) and saliva pooling (OR 4.6) occurred significantly more frequently in patients who failed to swallow pureed foods. CONCLUSIONS: Pharyngeal residues and saliva pooling predicted impaired swallowing of pureed foods. Transnasal EES performed by a gastroenterologist provided a unique bedside method of assessing the ability to swallow pureed foods in elderly patients with dysphagia.

Oficina culinária de receitas vegetarianas com baixo teor de açúcares simples e gordura saturada / Workshop or vegetarian recipes low in simple sugars and saturated fat

Introdução: A dieta vegetariana difere da dieta onívora em aspectos que vão além da simples supressão de produtos cárneos. Os vegetarianos fazem um consumo elevado de vegetais, como frutas, cereais, hortaliças, leguminosas e oleginosas, além de sua dieta conter menor quantidade de gordura saturada e , relativamente, maior quantidade de gordura insaturada, carboidratos e fibras. Objetivo: Este estudo tem por objetivo testar aceitação de receitas vegetarianas com baixo teor de açúcares simples e gordura saturada entre graduandos de um Centro Universitário da zona sul de São Paulo. Métodos: Trata-se de um estudo de intervenção, que permite verificar o efeito de uma ação educativa entre indibvíduos estudados. Participaram do estudo graduandos deste Centro Universitário. Foram programados três encontros para o desenvolvimento da oficina culinária vegetariana e todos os graduiandos foram convidados. Participaram 13 alunos no primeiro encontro, nove no segundo encontro e terceiro. Foram testadas quatro receitas em cada encontro, entre doces, salgados e sucos nutritivos. Resultados: A avaliação sensorial foi feita por meio da escala hedônica de intenção de consumo com sete pontos, na qual 7 pontos significam comeria sempre, 6 comeria muito frequente, 5 comeria frequentemente, 4 comeria ocasionalmente, 3 comeria raramente, 2 comeria muito raramente e 1 nunca comeria. Todas as preparações testadas tiveram aceitação entre comeria sempre e comeria frequentemente. Conclusão: Todas as receitas vegetarianas tiveram boa aceitação pelos graduandos.

Introduction: The omnivorous vegetarian diet differs in ways that go beyond the simple removal of meat products. Vegetarians have a high consuption of vegetables and fruits, grains, vegetables and oilseeds, as well as their diets contain less saturedf fat and relatively larger amounts of unsaturated fat, fibers and carbohydrates. Objective: This study aims to test the acceptance of vegetarian recipes low in saturated fat and simple sugars between undergraduates from a University Center of the south zone of São Paulo. Methods: It is an intervention study to verify the effect of an educational activity among individuals studied. Study participants were undergraduates of this University Center. In order to develop a vegetarian cooking workshop, three meetings were scheduled. All undergraduates of University Center were invited. Thirteen students attended. The first meeting was attended by 13 students, nine students in the second and third meeting, four students tested recipes in every meeting consisting of sweet, salty and nutrious juices. Results: The sensorial evaluation was performed using the hedonic scale consuption of intent with seven points, 7 points which means always eat, 6 points eat very often, 5 points eat often, 4 points eat occasionally, 3 points eat rarely, 2 points eat very rarely, and 1 point never eat at all. All recipe tested were accepted between 7 points always eat 6 points eat very often. Conclusion: All vegetarian recipes had a good acceptance by undergraduates.

Caries experience in individuals with cerebral palsy in relation to oromotor dysfunction and dietary consistency.

The aim of this study was to investigate caries experience in individuals with cerebral palsy (CP) who have oromotor dysfunction and relate it to age and dietary consistency. Noninstitutionalized individuals with CP (n = 108) aged 4-19 years (mean: 10 years, 1 month +/- SD 4 years, 5 months) were recruited for this study. Subjects who were severely impaired (35.2%) had orofacial motor dysfunction most frequently, followed by those who were slightly affected (27.7%), moderately affected (20.4%), and very slightly affected (16.7%). Age was a statistically significant factor for oromotor dysfunction (p= 0.007), with the youngest individuals having the most severe oromotor problems. Dietary consistency and oromotor function were statistically significant influence on the DMF index (p= 0.0352). The highest total DMF values were measured for individuals who were severely impaired and also the youngest, as well as for those receiving liquid diets. Early rehabilitation, intervention, and prevention are important for these individuals.

[Mixtures for enternal nutrition in Russia (literature review)].

The article provides a history of research in the field of enteral nutrition, history of the mixtures for tube alimentation. Also presented classification of the present mixtures for enteral introduction, as well as a characteristic of each of them.

Ingredientes funcionales en las fórmulas infantiles / Functional ingredients in the infant formulas

Los últimos avances realizados en la elaboración de las fórmulas infantiles responden al criterio de la ESPGHAN de acercarse al máximo a la composición de la leche materna y a la respuesta metabólica del lactante alimentado con leche materna. Entre los avances más significativos caben señalar los siguientes: Reducción del contenido de proteínas y fósforo (efecto bifidógeno): la conjunción del contenido reducido de proteínas y fósforo y la presencia de lactosa como hidrato de carbono mayoritario ha permitido conseguir que los lactantes alimentados con estas fórmulas infantiles tengan una flora predominante en bifidobacterias, similar a la de los alimentados con leche materna, con el consiguiente efecto positivo para el desarrollo del sistema inmunitario. Oligosacáridos: aunque se ha observado que una mezcla de dos oligosacáridos puede favorecer la flora bifidógena, la ESPGHAN señala que no se debe hacer una recomendación general sobre su utilización. Probióticos: entre las distintas cepas, se ha observado en ensayos clínicos que el Bifidobacterium lactis es efectivo en la prevención de diarreas y en el sistema inmunitario. Ácidos grasos poliinsaturados de cadena larga (LCPUFA’s): la adición de DHA y ARA con una relación 1/1potencia los efectos inmunomoduladores y permite conseguir unos niveles de DHA y ARA plasmáticos similares a los de los lactantes alimentados con leche materna. Nuceótidos: tienen un efecto positivo sobre la funcionalidad de los linfocitos intestinales y la inmunidad. Conclusión: es necesario efectuar ensayos clínicos aleatorizados a doble ciego placebo-controlado de cada una de las fórmulas funcionales (AU)

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Alimentación con fórmulas hidrolizadas para la prevención primaria de las alergias: ¿estamos seguros del beneficio?. Réplica / Feeding with hydrolysed formulas for the primary prevention of allergies: are we sure of the benefits? Reply

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Dysphagia dietary guidelines and the rheology of nutritional feeds and barium test feeds.

BACKGROUND: Dysphagia can lead to aspiration of oral feeds, thus causing pneumonia. Dysphagia is diagnosed by assessing the ability to swallow barium test feeds (BTF) of different viscosities. Dysphagia diet foods (DDF) are thickened as recommended by the National Dysphagia Diet (NDD) guidelines. To our knowledge, there are no published data evaluating if the viscosity of BTF or commercial DDF meet NDD guidelines. METHODS: A TA1000 rheometer (TA Instruments; New Castle, DE) measured dynamic viscosity of BTF and DDF using creep transformation under controlled stress. Thin DDF studied included Plus Energy Drink (Boost; Novartis/Nestle; Fremont, MI) and Instant Breakfast (Carnation; Wilkes-Barre, PA) and nectar- and honey-thick DDF from Hormel (Hormel Health Labs; Savannah, GA) and Novartis (Novartis/Nestle). The BTF studied were thin, nectar-, and honey-thick Polibar barium suspension or Varibar (E-Z-EM, Inc.; Lake Success, NY). We measured batch-to-batch variability in the viscosity of DDF, with and without shaking, and after 2 h at ambient temperature at a shear rate chosen to match natural swallowing. RESULTS: We observed the following: (1) DDF: the viscosity of honey-thick DDF was consistent with NDD guidelines, but other products were not. All products had minimal change in viscosity over 2 h. Boost thin liquid had > 300% increase in viscosity after shaking. (2) BTF: thin barium had a viscosity consistent with NDD guidelines. The nectar- and honey-thick Polibar BTFs were thixotropic and had unacceptably high viscosity. Varibar BTFs were not thixotropic but were more viscous than the NDD guidelines. CONCLUSIONS: There was a poor relationship between the viscosity of DDF and BTF. The viscosity of BFTs is much greater than the correspondingly named diet foods and the NDD guidelines. This can place patients at significant risk for oral aspiration.

Early enteral administration of immunonutrition in critically ill children: results of a blinded randomized controlled clinical trial.

OBJECTIVES: In a blinded, prospective, randomized, controlled clinical trial, we compared nitrogen balance (NB), nutritional indices, antioxidant catalysts, and outcome in critically ill children given an immune-enhancing formula (I) or conventional early enteral nutrition (C). METHODS: Fifty patients, 103 +/- 7 months old, with disorders prompting admission to the pediatric intensive care unit, including sepsis, respiratory failure, and severe head injury, were enrolled in the study. Within 12 h of admission, patients were randomized to receive I (n=25) or C (n=25). Caloric intake was aimed at meeting patient's predicted basal metabolic rate by day 2 and predicted energy expenditure by day 4, irrespective of group assignment. Outcome endpoints and complications were recorded; NB, transthyretin, retinol-binding protein, transferrin, zinc, copper, and metabolic indices were measured on days 1 and 5 and compared with clinical and nutritional characteristics within and between groups. RESULTS: Both diets achieved their initial targets of covering predicted basal metabolic rate by day 2 and predicted energy expenditure by day 4. Twenty four-hour NB became positive in 40% of patients in group C and occurred in 64% of patients in group I by day 5. Only in group I did the mean NB become positive by day 5 (0.07+/-0.07 g/kg versus -0.24+/-0.03 g/kg on day 1, P<0.001) compared with group C in which the mean NB remained negative (-0.06+/-0.04 g/kg versus -0.25+/-0.06 g/kg on day 1, P<0.001). By day 5, nutritional indices and antioxidant catalysts showed a higher increasing trend in group I compared with group C and higher osmolality (P<0.02), sodium (P<0.03), and urea (P<0.04). Diarrhea for group I (P<0.02) and gastric distention for group C (P<0.04) were the most frequently recorded complications. Mortality or length of stay did not differ between groups, but there was a trend for less gastric gram plus isolates (P<0.05) or for Candida species (P<0.04) and nosocomial infections in group I compared with group C. CONCLUSIONS: Although less well tolerated, immunonutrition is a feasible method of early enteral nutrition in the pediatric intensive care unit. It has a favorable effect on nutritional indices and antioxidant catalysts, but not on outcome hard endpoints. Although it poses a higher metabolic burden to the patient, it shows a trend to improve colonization and infection rates. Appropriate modifications for specific age populations might improve its tolerability and benefits among critically ill children.

Nutrición enteral y parenteral en pediatría / Enteral and parenteral nutrition in pediatrics

Estudios en niños hospitalizados muestran que existe una incidencia significativa de desnutrición, tanto aguda como crónica. Proporcionar un adecuado soporte nutricional es parte importante de los cuidados de cualquier niño hospitalizado, esté o no desnutrido. Para conseguir cubrir las necesidades energéticas y proteínicas de todo el arco de edades pediátricas, además de las fórmulas infantiles para lactantes sanos y de fórmulas infantiles especiales, disponemos de fórmulas enterales y de sistemas de alimentación intravenosa. La nutrición enteral es el método de elección en los niños que requieren soporte nutricional y que tienen un tracto gastrointestinal funcionante, y se reserva la nutrición parenteral para las situaciones en las que la función gastrointestinal está afectada de forma importante. Como el recién nacido, el lactante y el niño tienen unas necesidades especiales, las técnicas de soporte nutricional difieren en gran medida de las utilizadas en el paciente adulto. Así, se han desarrollado productos específicos para niños al tiempo que protocolos de actuación. En este artículo se resumen algunas de las características más relevantes de la nutrición artificial en el niño (AU)

Dietary fat, ketosis, and seizure resistance in rats on the ketogenic diet.

PURPOSE: Fat is the major component of the ketogenic diet (KD), yet no studies have examined whether the type of fat used in the diet can be optimized to provide additional benefits. The purpose of the present experiments was to compare the efficiency of different fats in inducing ketosis and affording seizure resistance. METHODS: The effects of KDs that incorporate lard, butter, medium-chain triglycerides (MCT), or flaxseed oil or a mixture of the latter three fats were examined in rats fed KD for up to 98 days. The maximal electroshock (MES) or pentylenetetrazole (PTZ) threshold tests were used to assess seizure susceptibility in two separate experiments. RESULTS: The rank order of induced ketosis was MCT > mixture > or = flaxseed oil > or = lard = butter > or = control. MES failed to reveal anticonvulsant effects, but the PTZ test indicated that up to 50% of rats fed the KD were seizure protected (p < 0.05). The measures of seizure protection, seizure incidence and score, did not correlate, however, with the level of ketosis in the range of 0. 7-5.2 mmol/L for beta-hydroxybutyrate. In the long-term study, flaxseed oil KD maintained stable ketosis throughout 98 days, whereas ketones declined with lard and butter KD to the control level. CONCLUSIONS: Seizure protection with the versions of the KD did not improve with the higher level of ketosis. The focus of the KD improvement, therefore, is not the achievement of higher ketosis per se but rather designing a diet that provides steady ketosis, exploits advantages of certain fats for neurological development or seizure protection via a nonketogenic mechanism, and is nutritionally balanced.

[Home enteral nutrition]. / Nutrición enteral domiciliaria.

Enteral nutrition in the home is applied to stabilized patients who do not require hospitalization or to chronically ill patients who can stay in their homes. However, ensuring the correct administration of this treatment requires a coordinated, expert multidisciplinary team. This article reviews the conditions for use of enteral nutrition in the home, the means of access, the nutritional formulas, the administrative technique, and the complications enteral nutrition in the home may present. Furthermore, the composition and characteristics of the multidisciplinary team which will be in charge of carrying out this treatment is discussed.

[Enteral nutrition: ways of access and formulas]. / Nutrición enteral. Vías de acceso y fórmulas.

Enteral nutrition is a very adequate method to feed those patients who can not receive food by oral means, to be used only when their gastrointestinal functions are preserved and carry out a proper assimilation of nutrients. Starting from these facts, this article analyzes the various access ways which can be used in enteral nutrition, and the most commonly used enteral nutrition formulas, noting their possible classifications. The nutritional modules and the material necessary to employ this form of feeding, as well as the administrative guidelines, are also presented in this article.

[Critical analysis of the evolution of commercial preparations for enteral nutrition during 1988-1996]. / Análisis crítico de la evolución de los preparados comerciales enterales en el período 1988-1996.

Enteral nutrition is a form of nutritional support that is continually growing and expanding, and within this area especially the enteral preparations or formulae. The object of the present is to analyze the evolution of the commercially available nutritionally complete enteral preparations between 1988 and 1997, illustrating the variations that have occurred both from the quantitative and form the qualitative points of view. A progressive increase is seen in the absolute number of available enteral formulae, with the increase in both polymeric formulae with dietary fiber, and that of formulae designed for specific diseases being significant (p < 0.05). The standard polymeric formulae and the oligomeric formulae decrease, but not in a significant manner. There is a special discussion or the characteristic and the usefulness of the polymeric formulae with dietary fiber ad the formulae designed especially for specific diseases. The clinical efficacy of most of these special formulae is controversial, with there not being sufficient objective clinical evidence at present that justifies their routine use.