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BACKGROUND: Body composition assessment using computed tomography (CT) scans may be hampered by software costs. To facilitate its implementation in resource-limited settings, two open-source segmentation programs (Horos and CoreSlicer) were transversally validated in colorectal cancer patients. METHODS: Contrast-enhanced abdominal CT scans were analyzed following the Alberta protocol. The Cross-Sectional Area (CSA) and intensities of skeletal muscle tissue (MT), subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), and intramuscular adipose tissue (IMAT) were measured. The Skeletal Muscle Index (SMI) was calculated. Cutoff points were applied to the SMI, MT intensity, and VAT CSA to define muscle atrophy, myosteatosis, and abdominal obesity. The inter-software agreement was evaluated using different statistical tools. RESULTS: A total of 68 participants were measured. The MT CSA and SMI displayed no differences. The MT CSA agreement was excellent, and both programs provided equal muscle atrophy prevalences. CoreSlicer underestimated the MT intensity, with a non-significant myosteatosis prevalence increase (+5.88% and +8.82%) using two different operative definitions. CoreSlicer overestimated the CSA and intensity in both VAT and SAT, with a non-significant increase (+2.94%) in the abdominal obesity prevalence. CONCLUSIONS: Both software programs were feasible tools in the study group. The MT CSA showed great inter-software agreement and no muscle atrophy misdiagnosis. Segmentation differences in the MT intensity and VAT CSA caused limited diagnostic misclassification in the study sample.
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INTRODUCTION: malnutrition is a very frequent problem in oncology patients and can have serious repercussions. Adequate nutritional management is cost-effective in terms of health and survival in this population, but it requires multidisciplinary coordination, specific training, and continuous follow-up. OBJECTIVE: to validate the applicability and efficacy of a multidisciplinary nutritional support protocol in oncology patients. METHODS: a multidisciplinary nutritional protocol was developed for oncology patients, with guidelines for screening and assessment of malnutrition, treatment, re-evaluation, and management of side effects, as well as guidance on supplementation and eating patterns. The protocol would be implemented in various clinical centers, collecting data through a structured questionnaire, registering variables before and after implementation. RESULTS: the protocol and its impact were implemented and evaluated in 39 centers. An improvement in nutritional care was observed, evidenced by an earlier initiation of nutritional assessment and an increase in the number of patients receiving adequate care following the protocol implementation. Problems related to inadequate malnutrition coding in the centers, limited resources, and the need for greater interdepartmental collaboration were identified. CONCLUSIONS: the conduct of this study provides insights into how the implementation of a multidisciplinary nutritional support protocol can improve the nutritional care received by patients and informs about the main obstacles to adequate implementation.
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BACKGROUND: Reduced muscle strength (dynapenia) and mass (atrophy) are prognostic factors in oncology. Measuring maximal handgrip strength with dynamometers is feasible but limited by the cost of the reference device (JAMAR). METHODS: A cross-sectional study was conducted on colorectal cancer outpatients treated with chemotherapy or under active surveillance in our center from September 2022 to July 2023. Accuracy, reliability, and concordance were compared for two handheld dynamometers: the JAMAR Plus (the gold-standard device) and the Camry EH101 (a low-cost index device). A simultaneous nutritional diagnosis with GLIM criteria and bioelectrical impedance analysis (BIA) was carried out. RESULTS: A total of 134 participants were included. The median of maximal strength for the JAMAR Plus had a non-significant difference of 1.4 kg from the Camry EH101. The accuracy and reliability of the devices were high. Bland-Altman analysis showed a 0.8 kg bias and -4.1 to 5.6 kg limits of agreement (LoA); a 0.1 kg bias and -5.3 to 5.4 kg LoA in men; a 1.5 kg bias and -2.2 to 5.3 kg LoA in women. In total, 29.85% of the participants were malnourished. Prevalence of dynapenia increased from 3.67% with the JAMAR Plus to 5.14% with the Camry EH101. Both devices had a moderate and significant correlation with BIA-estimated muscle mass. CONCLUSIONS: The Camry EH101 was a cost-effective alternative to JAMAR Plus in our sample.
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Neoplasias Colorrectales , Impedancia Eléctrica , Estado Nutricional , Humanos , Neoplasias Colorrectales/diagnóstico , Masculino , Femenino , Estudios Transversales , Persona de Mediana Edad , Anciano , Reproducibilidad de los Resultados , Fuerza de la Mano , Dinamómetro de Fuerza Muscular , Evaluación Nutricional , AdultoRESUMEN
Objectives: To compare complications associated with percutaneous gastrostomies performed using PUSH and PULL techniques, whether endoscopic (PEG) or radiological (PRG), in a tertiary-level hospital. Methods: This was a prospective observational study. Adult patients who underwent percutaneous PULL or PUSH gastrostomy using PEG or PRG techniques at the Virgen del Rocio University Hospital and subsequently followed up in the Nutrition Unit between 2009-2020 were included. X2 tests or Fisher's test were used for the comparison of proportions when necessary. Univariate analysis was conducted to study risk factors for PRG-associated complications. Results: n = 423 (PULL = 181; PUSH = 242). The PULL technique was associated with a higher percentage of total complications (37.6% vs. 23.8%; p = 0.005), exudate (18.2% vs. 11.2%; p = 0.039), and irritation (3.3% vs. 0%; p = 0.006). In the total sample, there were 5 (1.1%) cases of peritonitis, 3 (0.7%) gastrocolic fistulas, and 1 (0.2%) death due to complications associated with gastrostomy. Gender, age, and different indications were not risk factors for a higher number of complications. The most common indications were neurological diseases (35.9%), head and neck cancer (29%), and amyotrophic lateral sclerosis (17.2%). Conclusions: The PULL technique was associated with more total complications than the PUSH technique, but both were shown to be safe techniques, as the majority of complications were minor.
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Introducción: la teleconsulta es una herramienta asistencial útil en el manejo multidisciplinar de pacientes con indicación de nutrición enteral domiciliaria (NED). El empleo de diferentes herramientas de teleconsulta de NED, como ocurre en el Sistema Andaluz de Salud (SAS), conlleva heterogeneidad en los procesos de derivación entre los servicios de Atención Primaria (AP) y hospitalaria en una misma región. Objetivos: consensuar perfiles de pacientes y conjunto de datos mínimos necesarios para garantizar una derivación adecuada a la teleconsulta de NED, independientemente de la herramienta existente. Estos aspectos consensuados en Andalucía pueden servir de referencia en otras regiones. Métodos: se siguieron tres pasos consecutivos: a) revisión no sistemática de la literatura indexada sobre la teleconsulta en nutrición clínica en España; b) encuesta para conocer la implementación y las necesidades no satisfechas de las herramientas de teleconsulta en los hospitales públicos andaluces; y c) reuniones de trabajo y consenso de 14 profesionales sanitarios de AP (n = 4) y endocrinología y nutrición clínica hospitalaria (n = 10). Resultados: se consensuaron tres formularios de derivación en los que se definieron tres perfiles de pacientes, con el correspondiente conjunto mínimo de datos necesario para solicitar la teleconsulta de NED. El equipo de AP debe proporcionar este conjunto mínimo de datos al especialista en nutrición clínica a través de una herramienta de teleconsulta, implementada en el SAS. Conclusiones: tres formularios consensuados entre profesionales sanitarios involucrados en el proceso de derivación sirven para estandarizar la solicitud de teleconsulta de NED entre equipos asistenciales en función de perfiles de pacientes.(AU)
Introduction: teleconsultation is a useful healthcare tool in the multidisciplinary management of patients with indications of home enteral nutrition (HEN). The use of different teleconsultation platforms, as it happens in the Andalusian Health System (SAS), results in heterogeneous referral processes between Primary Care and hospital services in the same region. Objectives: to establish a consensus on patient profiles and the minimum data set necessary to guarantee an adequate referral to NED teleconsultation regardless of the existing platform. These agreed aspects in Andalusia can serve as a reference in other regions. Methods: three consecutive steps were followed: a) non-systematic review of the indexed literature on teleconsultation in clinical nutrition in Spain; b) survey to know the implementation and unmet needs of teleconsultation platforms in Andalusian public hospitals; and c) working meetings and consensus of 14 health professionals of Primary Care (n = 4) and endocrinology and hospital clinical nutrition (n = 10). Results: three referral forms were agreed in which three patient profiles were defined, with the corresponding minimum set of data necessary to request NED teleconsultation. The Primary Care team should provide this set of data to the clinical nutrition specialist via a teleconsultation platform, implemented in the SAS. Conclusions: three agreed forms between healthcare professionals involved in the referral process serve to standardize the request for teleconsultation of NED between healthcare teams based on patient profiles.(AU)
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Humanos , Masculino , Femenino , Consulta Remota , Visita Domiciliaria , Nutrición Enteral , Derivación y Consulta , DesnutriciónRESUMEN
Introduction: Introduction: teleconsultation is a useful healthcare tool in the multidisciplinary management of patients with indications of home enteral nutrition (HEN). The use of different teleconsultation platforms, as it happens in the Andalusian Health System (SAS), results in heterogeneous referral processes between Primary Care and hospital services in the same region. Objectives: to establish a consensus on patient profiles and the minimum data set necessary to guarantee an adequate referral to NED teleconsultation regardless of the existing platform. These agreed aspects in Andalusia can serve as a reference in other regions. Methods: three consecutive steps were followed: a) non-systematic review of the indexed literature on teleconsultation in clinical nutrition in Spain; b) survey to know the implementation and unmet needs of teleconsultation platforms in Andalusian public hospitals; and c) working meetings and consensus of 14 health professionals of Primary Care (n = 4) and endocrinology and hospital clinical nutrition (n = 10). Results: three referral forms were agreed in which three patient profiles were defined, with the corresponding minimum set of data necessary to request NED teleconsultation. The Primary Care team should provide this set of data to the clinical nutrition specialist via a teleconsultation platform, implemented in the SAS. Conclusions: three agreed forms between healthcare professionals involved in the referral process serve to standardize the request for teleconsultation of NED between healthcare teams based on patient profiles.
Introducción: Introducción: la teleconsulta es una herramienta asistencial útil en el manejo multidisciplinar de pacientes con indicación de nutrición enteral domiciliaria (NED). El empleo de diferentes herramientas de teleconsulta de NED, como ocurre en el Sistema Andaluz de Salud (SAS), conlleva heterogeneidad en los procesos de derivación entre los servicios de Atención Primaria (AP) y hospitalaria en una misma región. Objetivos: consensuar perfiles de pacientes y conjunto de datos mínimos necesarios para garantizar una derivación adecuada a la teleconsulta de NED, independientemente de la herramienta existente. Estos aspectos consensuados en Andalucía pueden servir de referencia en otras regiones. Métodos: se siguieron tres pasos consecutivos: a) revisión no sistemática de la literatura indexada sobre la teleconsulta en nutrición clínica en España; b) encuesta para conocer la implementación y las necesidades no satisfechas de las herramientas de teleconsulta en los hospitales públicos andaluces; y c) reuniones de trabajo y consenso de 14 profesionales sanitarios de AP (n = 4) y endocrinología y nutrición clínica hospitalaria (n = 10). Resultados: se consensuaron tres formularios de derivación en los que se definieron tres perfiles de pacientes, con el correspondiente conjunto mínimo de datos necesario para solicitar la teleconsulta de NED. El equipo de AP debe proporcionar este conjunto mínimo de datos al especialista en nutrición clínica a través de una herramienta de teleconsulta, implementada en el SAS. Conclusiones: tres formularios consensuados entre profesionales sanitarios involucrados en el proceso de derivación sirven para estandarizar la solicitud de teleconsulta de NED entre equipos asistenciales en función de perfiles de pacientes.
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Nutrición Enteral , Servicios de Atención de Salud a Domicilio , Derivación y Consulta , Consulta Remota , Humanos , Consulta Remota/métodos , España , Nutrición Enteral/normas , Nutrición Enteral/métodos , Servicios de Atención de Salud a Domicilio/normas , Consenso , Atención Primaria de SaludRESUMEN
Objectives: To describe the complications associated with the different gastrostomy techniques [endoscopic (PEG), radiologic (PRG), and surgical (SG)] performed in the last 26 years in a terciary hospital. Methods: Retrospective observational study. Patients who underwent gastrostomy at the Virgen del Rocío University Hospital between 1995 and 2021 were included. For PEG, the PULL technique was performed until 2018 and subsequently the PUSH technique predominantly. For PRG, a pigtail catheter was used until 2003, a balloon catheter between 2003 and 2009, and a balloon catheter with gastropexy between 2015 and 2021. For SG, the conventional technique (CSG) was performed until 2009 and since then the laparoscopic assisted percutaneous gastrostomy (PLAG) technique. Descriptive analysis was performed obtaining the median and quartiles of the quantitative variables [P50 (P25-P75)] and the frequency for the qualitative variables [n (%)].The comparison of complications between patients who underwent different techniques was performed with Fisher's test. Results: n = 1,070 (PEG = 608, PRG = 344, SG = 118). The three most frequent indications were head and neck tumors, neurological diseases and gastroesophageal tumors. The percentage of patients who had any complication was 48.9% (PEG-PULL), 23.7% (PEG-PUSH), 38.5% (pigtail PRG), 39.2% (balloon PRG), 29.7% (balloon with gastropexy PRG), 87.3% (CSG), and 41.26% (PLAG). 2 (0.18%) patients died from gastrostomy-related complications. 18(1.68%) presented with peritonitis and 5 (0.4%) presented with gastrocolic fistula. The rest of the complications were minor. Conclusion: Gastrostomy in any of its modalities is currently a safe procedure with a low rate of complications, most of which are minor.
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Evidence of the pharmacological activity of oleanolic acid (OA) suggests its potential therapeutic application. However, its use in functional foods, dietary supplements, or nutraceuticals is hindered by limited human bioavailability studies. The BIO-OLTRAD trial is a double-blind, randomized controlled study with 22 participants that received a single dose of 30 mg OA formulated as a functional olive oil. The study revealed that the maximum serum concentration of OA ranged from 500 to 600 ng mL-1, with an AUC0-∞ value of 2862.50 ± 174.50 ng h mL-1. Furthermore, we discovered a physiological association of OA with serum albumin and triglyceride-rich lipoproteins (TRL). UV absorption spectra showed conformational changes in serum albumin due to the formation of an adduct with OA. Additionally, we demonstrated that TRL incorporate OA, reaching a maximum concentration of 140 ng mL-1 after 2-4 hours. We conjecture that both are efficient carriers to reach target tissues and to yield high bioavailability.
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Ácido Oleanólico , Humanos , Disponibilidad Biológica , Suplementos Dietéticos , Aceite de Oliva/farmacología , Albúmina Sérica , Interacción de Doble VínculoRESUMEN
OBJECTIVES: We aimed to describe and compare the complications associated with different percutaneous radiologic gastrostomy (PRG) techniques. METHODS: A retrospective and prospective observational study was conducted. Patients who underwent a PRG between 1995-2020 were included. TECHNIQUES: A pigtail catheter was used until 2003, a balloon catheter without pexy was used between 2003-2009 and a balloon catheter with gastropexy was used between 2015-2021. For the comparison of proportions, X2 tests or Fisher's test were used when necessary. Univariate analysis was performed to study the risk factors for PRG-associated complications. RESULTS: n = 330 (pigtail = 114, balloon-type without pexy = 28, balloon-type with pexy = 188). The most frequent indication was head and neck cancer. The number of patients with complications was 44 (38.5%), 11 (39.2%) and 54 (28,7%), respectively. There were seven (25%) cases of peritonitis in the balloon-type without-pexy group and 1 (0.5%) in the balloon-type with-pexy group, the latter being the only patient who died in the total number of patients (0.3%). Two (1%) patients of the balloon-type with-pexy group presented with gastrocolic fistula. The rest of the complications were minor. CONCLUSIONS: The most frequent complications associated with the administration of enteral nutrition through PRG were minor and the implementation of the balloon-type technique with pexy has led to a decrease in them.
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Gastrostomía , Radiología , Humanos , Gastrostomía/efectos adversos , Gastrostomía/métodos , Estudios Retrospectivos , Centros de Atención Terciaria , Radiografía Intervencional/métodosRESUMEN
Extra virgin olive oil (EVOO) is a cornerstone of the Mediterranean diet (MedD). In this narrative review, we synthesize and illustrate the various characteristics and clinical applications of EVOO and its components-such as oleic acid, hydroxytyrosol, and oleuropein-in the field of clinical nutrition and dietetics. The evidence is split into diet therapy, oleic acid-based enteral nutrition formulations and oral supplementation formulations, oleic acid-based parenteral nutrition, and nutraceutical supplementation of minor components of EVOO. EVOO has diverse beneficial health properties, and current evidence supports the use of whole EVOO in diet therapy and the supplementation of its minor components to improve cardiovascular health, lipoprotein metabolism, and diabetes mellitus in clinical nutrition. Nevertheless, more intervention studies in humans are needed to chisel specific recommendations for its therapeutic use through different formulations in other specific diseases and clinical populations.
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Dieta Mediterránea , Ácido Oléico , Antioxidantes/uso terapéutico , Suplementos Dietéticos , Humanos , Aceite de Oliva/uso terapéuticoRESUMEN
Since the beginning of the practice of surgery, the reduction of postoperative complications and early recovery have been two of the fundamental pillars that have driven the improvement of surgical techniques and perioperative management. Despite great advances in these fields, the rationalization of antibiotic prophylaxis, and other important innovations, postoperative recovery (especially in elderly patients, oncological pathology or digestive or head and neck surgery) is tortuous. This can be explained by several reasons, among which, malnutrition has a major role. Perioperative nutritional support, included within the ERAS (Enhanced Recovery After Surgery) protocol, has proven to be a main element and a critical step to achieve better surgical results. Starting with the preoperative nutritional assessment and treatment in elective surgery, we can improve nutritional status using oral supplements and immunomodulatory formulas. If we add early nutritional support in the postoperative scenario, we are able to significantly reduce infectious complications, need for intensive care unit (ICU) and hospital stay, costs, and mortality. Throughout this review, we will review the latest developments and the available literature.
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Desnutrición , Anciano , Humanos , Tiempo de Internación , Desnutrición/prevención & control , Evaluación Nutricional , Estado Nutricional , Apoyo Nutricional , Atención Perioperativa , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & controlRESUMEN
OBJECTIVE: To present our experience in the clinical follow-up of patients undergoing a gastric bypass. METHOD: Description of six cases under follow-up by our unit after undergoing a gastric bypass at another private centre. RESULTS: The 6 patients presented complications, the most notable being the death of one patient due to severe malnutrition and the need for revision surgery in another for the same reason, destabilisation of type 1 diabetes mellitus in another patient and fat-soluble vitamin deficiency in all of them. CONCLUSIONS: There are few publications that support the safety of gastric bypass as a treatment for obesity. In our experience, it is a technique associated with a high rate of serious complications. As it is a technique that is not yet standardised, we consider that these cases should be operated on in centres where there is a multidisciplinary team with expertise in the management of possible complications, with close follow-up by surgeons and endocrinologists.
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Derivación Gástrica , Endocrinólogos , Derivación Gástrica/efectos adversos , Humanos , Obesidad/etiología , Reoperación/métodosRESUMEN
Objetivo: comunicar los datos de nutrición parenteral domiciliaria (NPD) obtenidos del registro del grupo NADYA-SENPE (www.nadya-senpe.com) del año 2019. Material y métodos: análisis descriptivo de los datos recogidos de pacientes adultos y pediátricos con NPD en el registro NADYA-SENPE desde el 1 de enero al 31 de diciembre de 2019. Resultados: se registraron 283 pacientes (51,9 %, mujeres), 31 niños y 252 adultos procedentes de 47 hospitales españoles, lo que representa una tasa de prevalencia de 6,01 pacientes/millón de habitantes/año 2019. El diagnóstico más frecuente en los adultos fue oncológico paliativo y otros (21,0 %). En los niños fue la enfermedad de Hirschsprung junto a la enterocolitis necrotizante, las alteraciones de la motilidad intestinal y la pseudoobstrucción intestinal crónica, con 4 casos cada uno (12,9 %). El primer motivo de indicación fue el síndrome del intestino corto tanto en los niños (51,6 %) como en los adultos (37,3 %). El tipo de catéter más utilizado fue el tunelizado tanto en los niños (75,9 %) como en los adultos (40,8 %). Finalizaron 68 episodios, todos en adultos: la causa más frecuente fue el fallecimiento (54,4 %). Pasaron a la vía oral el 38,2 %. Conclusiones: el número de centros y profesionales colaboradores con el registro NADYA va incrementándose. Se mantienen estables las principales indicaciones y los motivos de finalización de la NPD. (AU)
Aim: to communicate the home parenteral nutrition (HPN) data obtained from the HPN registry of the NADYA-SENPE group (www.nadya-senpe.com) for the year 2019. Material and methods: a descriptive analysis of the data collected from adult and pediatric patients with HPN in the NADYA-SENPE group registry from January 1 to December 31, 2019. Results: a total of 283 patients (51.9 % women), 31 children, and 252 adults from 47 Spanish hospitals were registered, which represents a prevalence rate of 6.01 patients per million inhabitants for year 2019. The most frequent diagnosis in adults was palliative oncological and others (21.0 %). In children, it was Hirschsprung's disease together with necrotizing enterocolitis, alterations in intestinal motility, and chronic intestinal pseudo-obstruction, with 4 cases each (12.9 %). The first reason for the indication was short-bowel syndrome in both children (51.6 %) and adults (37.3 %). The most used type of catheter was tunnelled both in children (75.9 %) and in adults (40.8 %). Sixty-eight episodes ended, all in adults, and the most frequent cause was death (54.4 %); 38.2 % were switched to oral. Conclusions: the number of collaborating centers and professionals in the NADYA registry is increasing. The main indications and reasons for HPN termination remain stable. (AU)
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Humanos , Servicios de Atención de Salud a Domicilio/normas , Nutrición Parenteral/métodos , Epidemiología Descriptiva , Enfermedad de Hirschsprung/dietoterapia , Servicios de Atención de Salud a Domicilio/tendencias , Estado Nutricional , Registros/estadística & datos numéricos , Síndrome del Intestino Corto/dietoterapia , España/epidemiologíaRESUMEN
INTRODUCTION: Aim: to communicate the home parenteral nutrition (HPN) data obtained from the HPN registry of the NADYA-SENPE group (www.nadya-senpe.com) for the year 2019. Material and methods: a descriptive analysis of the data collected from adult and pediatric patients with HPN in the NADYA-SENPE group registry from January 1 to December 31, 2019. Results: a total of 283 patients (51.9 % women), 31 children, and 252 adults from 47 Spanish hospitals were registered, which represents a prevalence rate of 6.01 patients per million inhabitants for year 2019. The most frequent diagnosis in adults was "palliative oncological" and "others" (21.0 %). In children, it was Hirschsprung's disease together with necrotizing enterocolitis, alterations in intestinal motility, and chronic intestinal pseudo-obstruction, with 4 cases each (12.9 %). The first reason for the indication was short-bowel syndrome in both children (51.6 %) and adults (37.3 %). The most used type of catheter was tunnelled both in children (75.9 %) and in adults (40.8 %). Sixty-eight episodes ended, all in adults, and the most frequent cause was death (54.4 %); 38.2 % were switched to oral. Conclusions: the number of collaborating centers and professionals in the NADYA registry is increasing. The main indications and reasons for HPN termination remain stable.
INTRODUCCIÓN: Objetivo: comunicar los datos de nutrición parenteral domiciliaria (NPD) obtenidos del registro del grupo NADYA-SENPE (www.nadya-senpe.com) del año 2019. Material y métodos: análisis descriptivo de los datos recogidos de pacientes adultos y pediátricos con NPD en el registro NADYA-SENPE desde el 1 de enero al 31 de diciembre de 2019. Resultados: se registraron 283 pacientes (51,9 %, mujeres), 31 niños y 252 adultos procedentes de 47 hospitales españoles, lo que representa una tasa de prevalencia de 6,01 pacientes/millón de habitantes/año 2019. El diagnóstico más frecuente en los adultos fue "oncológico paliativo" y "otros" (21,0 %). En los niños fue la enfermedad de Hirschsprung junto a la enterocolitis necrotizante, las alteraciones de la motilidad intestinal y la pseudoobstrucción intestinal crónica, con 4 casos cada uno (12,9 %). El primer motivo de indicación fue el síndrome del intestino corto tanto en los niños (51,6 %) como en los adultos (37,3 %). El tipo de catéter más utilizado fue el tunelizado tanto en los niños (75,9 %) como en los adultos (40,8 %). Finalizaron 68 episodios, todos en adultos: la causa más frecuente fue el fallecimiento (54,4 %). Pasaron a la vía oral el 38,2 %. Conclusiones: el número de centros y profesionales colaboradores con el registro NADYA va incrementándose. Se mantienen estables las principales indicaciones y los motivos de finalización de la NPD.
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Servicios de Atención de Salud a Domicilio/normas , Nutrición Parenteral/métodos , Adolescente , Adulto , Niño , Femenino , Enfermedad de Hirschsprung/dietoterapia , Servicios de Atención de Salud a Domicilio/tendencias , Humanos , Masculino , Persona de Mediana Edad , Estado Nutricional , Sistema de Registros/estadística & datos numéricos , Síndrome del Intestino Corto/dietoterapia , España/epidemiologíaRESUMEN
OBJECTIVE: To present our experience in the clinical follow-up of patients undergoing a gastric bypass. METHOD: Description of six cases under follow-up by our unit after undergoing a gastric bypass at another private centre. RESULTS: The 6 patients presented complications, the most notable being the death of one patient due to severe malnutrition and the need for revision surgery in another for the same reason, destabilisation of type 1 diabetes mellitus in another patient and fat-soluble vitamin deficiency in all of them. CONCLUSIONS: There are few publications that support the safety of gastric bypass as a treatment for obesity. In our experience, it is a technique associated with a high rate of serious complications. As it is a technique that is not yet standardised, we consider that these cases should be operated on in centres where there is a multidisciplinary team with expertise in the management of possible complications, with close follow-up by surgeons and endocrinologists.
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INTRODUCTION: In order to develop evidence-based recommendations and expert consensus for the nutritional management of patients with short bowel syndrome (SBS), we conducted a systematic literature search using the PRISMA methodology plus a critical appraisal following the GRADE scale procedures. Pharmacological treatment with antisecretory drugs, antidiarrheal drugs, and somatostatin contributes to reducing intestinal losses. Nutritional support is based on parenteral nutrition; however, oral intake and/or enteral nutrition should be introduced as soon as possible. In the chronic phase, the diet should have as few restrictions as possible, and be adapted to the SBS type. Home parenteral nutrition (HPN) should be individualized. Single-lumen catheters are recommended and taurolidine should be used for locking the catheter. The HPN's lipid content must be greater than 1 g/kg per week but not exceed 1 g/kg per day, and omega-6 fatty acids (ω6 FAs) should be reduced. Trace element vials with low doses of manganese should be used. Patients with chronic SBS who require long-term HPN/fluid therapy despite optimized treatment should be considered for teduglutide treatment. All patients require a multidisciplinary approach and specialized follow-up. These recommendations and suggestions regarding nutritional management in SBS patients have direct clinical applicability.
INTRODUCCIÓN: Con el fin de desarrollar recomendaciones basadas en la evidencia y el consenso de expertos para el manejo nutricional de los pacientes con síndrome de intestino corto (SIC), realizamos una búsqueda bibliográfica sistemática utilizando la metodología PRISMA junto a una valoración crítica siguiendo los procedimientos de la escala GRADE. El tratamiento farmacológico con fármacos antisecretores, antidiarreicos y somatostatina contribuye a reducir las pérdidas intestinales. El apoyo nutricional se basa en la nutrición parenteral; sin embargo, la ingesta oral y/o la nutrición enteral deben introducirse lo antes posible. En la fase crónica, la dieta debe tener las menores restricciones posibles y adaptarse al tipo de SIC. La nutrición parenteral domiciliaria (NPD) debe individualizarse. Se recomiendan catéteres de un solo lumen y se debe utilizar taurolidina para bloquear el catéter. El contenido de lípidos de la HPN debe ser superior a 1 g/kg por semana, pero no debe exceder 1 g/kg por día, y debe reducirse el ácido graso omega-6 (AG ω6). Deben utilizarse viales de oligoelementos con dosis bajas de manganeso. Los pacientes con SIC crónico que requieren NPD/fluidoterapia a largo plazo a pesar del tratamiento optimizado deben considerarse para el tratamiento con teduglutida. Todos los pacientes requieren un abordaje multidisciplinar y un seguimiento especializado. Estas recomendaciones y sugerencias con respecto al manejo nutricional de los pacientes con SIC tienen aplicabilidad clínica directa.
Asunto(s)
Consenso , Nutrición Parenteral/normas , Síndrome del Intestino Corto/dietoterapia , Adulto , Práctica Clínica Basada en la Evidencia/métodos , Humanos , Nutrición Parenteral/métodos , Nutrición Parenteral/tendenciasRESUMEN
INTRODUCCIÓN: la nutrición parenteral domiciliaria (NPD) es una técnica que permite incrementar la supervivencia de los pacientes con fallo intestinal. OBJETIVOS: estudiar la evolución de la NPD en los últimos 8 años en nuestro centro. MÉTODOS: estudio retrospectivo de pacientes adultos con NPD entre 2011 y 2019. Las variables se expresan como frecuencias y media ± DE (rango). Se realizaron pruebas paramétricas, no paramétricas y análisis de la supervivencia (p < 0,05). RESULTADOS: el uso de NPD mostró un sustancial incremento (hasta un 154 %). Un total de 76 pacientes recibieron NPD, el 76,32 % tenían patología oncológica y, en consecuencia, la principal indicación fue la obstrucción intestinal (56,58 %). La duración media fue de 11,12 ± 23,38 meses (0,17-139,17). El 44,74 % experimentaron una o varias complicaciones, siendo las principales la bacteriemia relacionada con el catéter (BRC) (27,63 %) y las metabólicas (40,79 %), fundamentalmente de tipo hepático. La tasa de BRC fue de 2,25/1000 días de NPD. La principal causa de muerte fue la enfermedad de base. La supervivencia global en caso de patología benigna a los 1, 3 y 5 años fue del 65,5 %, 53,6 % y 40,2 %, respectivamente. En caso de patología maligna, la supervivencia global a los 3 meses fue del 55,1 %, a los 6 meses del 28,7 %, y al año del 19,1 %. CONCLUSIONES: la enfermedad oncológica fue la principal patología que motivó la indicación en nuestro centro. Es la patología de base la que determina el pronóstico, lo que debe tenerse en cuenta en la selección de pacientes. La tasa de BRC obtenida es susceptible de mejora, por lo que es fundamental reforzar la educación sanitaria y la técnica correcta
BACKGROUND: home parenteral nutrition (HPN) is a technique that allows increasing the survival of patients with intestinal failure. AIM: to study the evolution of home parenteral nutrition over the last 8 years in our center. METHODS: a retrospective study of adult patients receiving HPN between 2011 and 2019. Study variables are expressed as frequency and mean ± SD (range). Parametric, non-parametric tests, and a survival analysis (p < 0.05) were applied. RESULTS: the use of HPN showed a substantial increase (up to 154 %). A total of 76 patients received HPN, 76.32 % had an oncological pathology, and consequently the main indication was intestinal obstruction (56.58 %). Average duration was 11.12 ± 23.38 months (0.17-139.17). In all, 44.74 % experienced one or several complications, primarily catheter-related bacteremia (CRB) (27.63 %), and metabolic disorders (40.79 %), mainly of hepatic type. CRB rate was 2.25/1,000 days of HPN. The main cause of death was the underlying disease. Overall survival in case of benign conditions at 1, 3, and 5 years was 65.5 %, 53.6 %, and 40.2 %, respectively. In case of malignancy overall survival at 3 months was 55.1 %, at 6 months 28.7 %, and at 1 years 19.1 %. CONCLUSIONS: oncological disease was the primary condition that led to an indication in our center. It is the underlying pathology what determines prognosis, which must be taken into account at the time of selecting patients. The BRC rate obtained is susceptible to improvement, so it is essential that health education and a correct technique be encouraged
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Nutrición Parenteral en el Domicilio , Ileus/terapia , Ileus/etiología , Estimación de Kaplan-Meier , Análisis de Supervivencia , Estudios Retrospectivos , Estudios LongitudinalesRESUMEN
INTRODUCTION: Background: home parenteral nutrition (HPN) is a technique that allows increasing the survival of patients with intestinal failure. Aim: to study the evolution of home parenteral nutrition over the last 8 years in our center. Methods: a retrospective study of adult patients receiving HPN between 2011 and 2019. Study variables are expressed as frequency and mean ± SD (range). Parametric, non-parametric tests, and a survival analysis (p < 0.05) were applied. Results: the use of HPN showed a substantial increase (up to 154 %). A total of 76 patients received HPN, 76.32 % had an oncological pathology, and consequently the main indication was intestinal obstruction (56.58 %). Average duration was 11.12 ± 23.38 months (0.17-139.17). In all, 44.74 % experienced one or several complications, primarily catheter-related bacteremia (CRB) (27.63 %), and metabolic disorders (40.79 %), mainly of hepatic type. CRB rate was 2.25/1,000 days of HPN. The main cause of death was the underlying disease. Overall survival in case of benign conditions at 1, 3, and 5 years was 65.5 %, 53.6 %, and 40.2 %, respectively. In case of malignancy overall survival at 3 months was 55.1 %, at 6 months 28.7 %, and at 1 years 19.1 %. Conclusions: oncological disease was the primary condition that led to an indication in our center. It is the underlying pathology what determines prognosis, which must be taken into account at the time of selecting patients. The BRC rate obtained is susceptible to improvement, so it is essential that health education and a correct technique be encouraged.
INTRODUCCIÓN: Introducción: la nutrición parenteral domiciliaria (NPD) es una técnica que permite incrementar la supervivencia de los pacientes con fallo intestinal. Objetivos: estudiar la evolución de la NPD en los últimos 8 años en nuestro centro. Métodos: estudio retrospectivo de pacientes adultos con NPD entre 2011 y 2019. Las variables se expresan como frecuencias y media ± DE (rango). Se realizaron pruebas paramétricas, no paramétricas y análisis de la supervivencia (p < 0,05). Resultados: el uso de NPD mostró un sustancial incremento (hasta un 154 %). Un total de 76 pacientes recibieron NPD, el 76,32 % tenían patología oncológica y, en consecuencia, la principal indicación fue la obstrucción intestinal (56,58 %). La duración media fue de 11,12 ± 23,38 meses (0,17-139,17). El 44,74 % experimentaron una o varias complicaciones, siendo las principales la bacteriemia relacionada con el catéter (BRC) (27,63 %) y las metabólicas (40,79 %), fundamentalmente de tipo hepático. La tasa de BRC fue de 2,25/1000 días de NPD. La principal causa de muerte fue la enfermedad de base. La supervivencia global en caso de patología benigna a los 1, 3 y 5 años fue del 65,5 %, 53,6 % y 40,2 %, respectivamente. En caso de patología maligna, la supervivencia global a los 3 meses fue del 55,1 %, a los 6 meses del 28,7 %, y al año del 19,1 %. Conclusiones: la enfermedad oncológica fue la principal patología que motivó la indicación en nuestro centro. Es la patología de base la que determina el pronóstico, lo que debe tenerse en cuenta en la selección de pacientes. La tasa de BRC obtenida es susceptible de mejora, por lo que es fundamental reforzar la educación sanitaria y la técnica correcta.
Asunto(s)
Nutrición Parenteral en el Domicilio , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Tiempo , Resultado del TratamientoRESUMEN
INTRODUCCIÓN: la nutrición parenteral domiciliaria (NPD) constituye el tratamiento de elección para pacientes con fallo intestinal que no requieren ingreso hospitalario. En esta revisión sistemática, nuestro objetivo fue realizar un análisis epidemiológico y de práctica clínica en NPD. MÉTODOS: la revisión se realizó siguiendo la guía PRISMA. Para ello, se hizo una búsqueda bibliográfica en PubMed® y EMBASE® de los estudios publicados entre 2009 y 2019 en inglés o español que realizaran el seguimiento de pacientes con NPD durante al menos 5 años. Esta búsqueda se completó manualmente. Se excluyeron los artículos centrados únicamente en pacientes oncológicos, una patología específica o embarazadas o bien en complicaciones. RESULTADOS: se identificaron 267 artículos, de los que cumplieron los criterios 9 (3 de población pediátrica y 6 de adultos). En adultos, la principal diferencia entre los estudios fue la patología de base. La indicación mayoritaria fue el síndrome de intestino corto y la causa de exitus, la enfermedad primaria. La mayor parte de la población pediátrica recibió este apoyo en los primeros meses de vida. Además, destaca el mayor porcentaje de conversión a vía oral y el menor número de fallecimientos frente a población adulta. CONCLUSIONES: la utilización de la NPD en patología oncológica está sometida a una amplia variabilidad geográfica. Sería recomendable establecer directrices de uso en enfermos oncológicos y la realización de estudios de calidad que aporten información rigurosa y homogénea
INTRODUCTION: home parenteral nutrition (HPN) is a fundamental treatment for patients with intestinal failure who do not require hospitalization. We aimed to conduct an epidemiological and clinical practice analysis of HPN through a systematic review. METHODS: the systematic review was conducted according to the PRISMA guidelines. A search was performed using the Healthcare Databases Advanced Search of PubMed® and EMBASE®, to identify articles which followed patients treated with HPN for at least 5 years, published between 2009 and 2019 in English or Spanish language. In addition, we manually retrieved other publications of interest. We excluded articles about subgroups of patients with a specific pathology, cancer or pregnant patients. We excluded studies collecting exclusively HPN complications. RESULTS: a total of 267 references were identified, of which 9 met criteria (3 of pediatric population and 6 of adults). In adults, the main difference found between publications was the underlying pathologies. The most common indication was short bowel syndrome and the main cause of exitus was the underlying pathology. Most of the pediatric patients received this support in the first months of life. In addition, children showed a higher conversion rate to oral intake and a lower number of deaths when compared to adults. CONCLUSIONS: the use of HPN in cancer pathology is subject to wide geographic variability. It would be advisable to establish indication guidelines in patients with cancer and conduct quality studies, which provide rigorous and homogeneous information
Asunto(s)
Humanos , Masculino , Niño , Adulto , Nutrición Parenteral en el Domicilio/métodos , Enfermedades Intestinales/epidemiología , Análisis de Supervivencia , Nutrición Parenteral en el Domicilio/estadística & datos numéricosRESUMEN
INTRODUCTION: Introduction: home parenteral nutrition (HPN) is a fundamental treatment for patients with intestinal failure who do not require hospitalization. We aimed to conduct an epidemiological and clinical practice analysis of HPN through a systematic review. Methods: the systematic review was conducted according to the PRISMA guidelines. A search was performed using the Healthcare Databases Advanced Search of PubMed® and EMBASE®, to identify articles which followed patients treated with HPN for at least 5 years, published between 2009 and 2019 in English or Spanish language. In addition, we manually retrieved other publications of interest. We excluded articles about subgroups of patients with a specific pathology, cancer or pregnant patients. We excluded studies collecting exclusively HPN complications. Results: a total of 267 references were identified, of which 9 met criteria (3 of pediatric population and 6 of adults). In adults, the main difference found between publications was the underlying pathologies. The most common indication was short bowel syndrome and the main cause of exitus was the underlying pathology. Most of the pediatric patients received this support in the first months of life. In addition, children showed a higher conversion rate to oral intake and a lower number of deaths when compared to adults. Conclusions: the use of HPN in cancer pathology is subject to wide geographic variability. It would be advisable to establish indication guidelines in patients with cancer and conduct quality studies, which provide rigorous and homogeneous information.
INTRODUCCIÓN: Introducción: la nutrición parenteral domiciliaria (NPD) constituye el tratamiento de elección para pacientes con fallo intestinal que no requieren ingreso hospitalario. En esta revisión sistemática, nuestro objetivo fue realizar un análisis epidemiológico y de práctica clínica en NPD. Métodos: la revisión se realizó siguiendo la guía PRISMA. Para ello, se hizo una búsqueda bibliográfica en PubMed® y EMBASE® de los estudios publicados entre 2009 y 2019 en inglés o español que realizaran el seguimiento de pacientes con NPD durante al menos 5 años. Esta búsqueda se completó manualmente. Se excluyeron los artículos centrados únicamente en pacientes oncológicos, una patología específica o embarazadas o bien en complicaciones. Resultados: se identificaron 267 artículos, de los que cumplieron los criterios 9 (3 de población pediátrica y 6 de adultos). En adultos, la principal diferencia entre los estudios fue la patología de base. La indicación mayoritaria fue el síndrome de intestino corto y la causa de exitus, la enfermedad primaria. La mayor parte de la población pediátrica recibió este apoyo en los primeros meses de vida. Además, destaca el mayor porcentaje de conversión a vía oral y el menor número de fallecimientos frente a población adulta. Conclusiones: la utilización de la NPD en patología oncológica está sometida a una amplia variabilidad geográfica. Sería recomendable establecer directrices de uso en enfermos oncológicos y la realización de estudios de calidad que aporten información rigurosa y homogénea.