Prognostic value of bioelectrical impedance analysis in head and neck cancer patients undergoing radiotherapy: a VALOR® study.

Introduction: Bioelectrical impedance analysis (BIA) serves as a method to estimate body composition. Parameters such as phase angle (PA), standardized phase angle (SPA), body mass cell (BCM), BCM index (BCMI), and fat-free mass (FFM) might significantly impact the prognosis of head and neck cancer (HNC) patients. The present study aimed to investigate whether bioelectrical parameters can be used to predict survival in the HNC population and establish the optimal cutoff points for predictive accuracy. Methods: A multicenter observational study was performed across 12 tertiary hospitals in Andalusia (a region from the south of Spain). A total of 494 patients diagnosed with HNC between 2020 and 2022 at different stages were included in this study, with a minimum follow-up period of 12 months. The BIA assessment was carried out during the first 2 weeks of radical radiotherapy treatment with chemotherapy or other systemic treatments. A multivariate logistic regression analysis of overall survival, complications, hospital admission, and palliative care and its relationship with BIA nutritional assessment was performed. Results: Significant prognostic factors identified in the multivariable analysis encompassed phase angle (PA), standardized phase angle (SPA), body cell mass (BCM), and BCM index (BCMI). Lower PA and BCM values were significantly associated with adverse clinical outcomes. A BCM threshold above 17 kg/m2 was the most significant predictor for predicting survival within the overall HNC population. The PA values of <5.1° in male and <4.8° in female patients showed the best predictive potential for mortality. Increased PA (as a continuous variable) demonstrated a significantly reduced risk for mortality (OR, 0.64; 95% CI, 0.43-0.94; p < 0.05) and a decreased likelihood of hospital admission (OR, 0.75; 95% CI, 0.52-1.07; p < 0.05). Higher BCM correlated with a lower risk of mortality (OR, 0.88; 95% CI, 0.80-0.96; p < 0.01) and a diminished probability of hospital admission (OR, 0.91; 95% CI, 0.83-0.99; p < 0.05). Conclusion: BIA is a crucial tool in the nutritional assessment of HNC patients. BCM and PA are the main bioelectrical parameters used to predict clinical outcomes in this population. Future studies are needed to validate BIA variables in a large cohort to ensure whether early intensification of nutritional treatment would improve survival.

Efecto de dapagliflozina sobre la rigidez arterial en pacientes con diabetes mellitus tipo 2 / Effect of dapagliflozin on arterial stiffness in patients with type 2 diabetes mellitus

Introducción y objetivos: Los antidiabéticos orales inhibidores del cotransportador sodio-glucosa (iSGLT2) reducen la morbimortalidad cardiovascular en la DM2. El aumento de la rigidez arterial puede participar en esta morbimortalidad. El objetivo de este trabajo fue analizar el efecto de la administración de dapagliflozina en la rigidez arterial. Pacientes y métodos: Estudio observacional, prospectivo que incluyó a 32 pacientes con DM2. Antes del inicio de dapagliflozina y a los 6 y 12 meses, se analizaron parámetros bioquímicos en sangre y orina. Basalmente y a los 12 meses se determinó la velocidad de pulso carótida-femoral (VPc-f) mediante tonometría. El análisis de los cambios en las variables y su interrelación se hizo mediante ANOVA de datos repetidos, test de Wilcoxon y regresión múltiple. Resultados: Se objetivó un descenso significativo de la VPc-f. No se evidenció asociación entre descenso de VPc-f y cambios de la glucemia, la uricemia, la presión arterial ni del peso. Conclusiones: Dapagliflozina, en sujetos con DM2, produce, a medio-largo plazo, una disminución de la rigidez arterial

Introduction: Oral antidiabetic inhibitors of the sodium-glucose cotransporter (SGLT2i) reduce cardiovascular morbidity and mortality in DM2. The increase in arterial stiffness can participate in this morbidity and mortality. The aim of this study was to analyse the effect of the administration of dapagliflozin on arterial stiffness. Patients and methods: Prospective observational study that included 32 patients with DM2. Before starting dapagliflozin, and at 6 and 12 months, biochemical parameters in blood and urine were analysed. Before starting dapagliflozin and at 12 months the velocity of the carotid-femoral pulse (VPc-f) was determined by tonometry. Changes in the variables and their interrelation was analysed by repeated data ANOVA, Wilcoxon's test and multiple regression. Results: A significant decrease in the VPc-f was observed. There was no association between decreased VPc-f and changes in blood glucose, uric acid, blood pressure or weight. Conclusions: Dapagliflozin, in subjects with DM2, produces a medium to long-term decrease in arterial stiffness

Effect of dapagliflozin on arterial stiffness in patients with type 2 diabetes mellitus. / Efecto de dapagliflozina sobre la rigidez arterial en pacientes con diabetes mellitus tipo 2.

INTRODUCTION: Oral antidiabetic inhibitors of the sodium-glucose cotransporter (SGLT2i) reduce cardiovascular morbidity and mortality in DM2. The increase in arterial stiffness can participate in this morbidity and mortality. The aim of this study was to analyse the effect of the administration of dapagliflozin on arterial stiffness. PATIENTS AND METHODS: Prospective observational study that included 32 patients with DM2. Before starting dapagliflozin, and at 6 and 12 months, biochemical parameters in blood and urine were analysed. Before starting dapagliflozin and at 12 months the velocity of the carotid-femoral pulse (VPc-f) was determined by tonometry. Changes in the variables and their interrelation was analysed by repeated data ANOVA, Wilcoxon's test and multiple regression. RESULTS: A significant decrease in the VPc-f was observed. There was no association between decreased VPc-f and changes in blood glucose, uric acid, blood pressure or weight. CONCLUSIONS: Dapagliflozin, in subjects with DM2, produces a medium to long-term decrease in arterial stiffness.

Efectividad y seguridad de un modelo protocolizado de control glucémico en el medio hospitalario / Effectiveness and safety of a blood glucose control protocol in hospital

OBJETIVO: Evaluar la efectividad y seguridad de un protocolo de control glucémico para pacientes con diabetes mellitus (DM) en el medio hospitalario. MATERIAL Y MÉTODOS: Estudio de intervención, prospectivo y abierto realizado en pacientes con DM ingresados en planta de hospitalización convencional. Los pacientes fueron asignados a un grupo de intervención (protocolo de control glucémico), o a un grupo control (tratamiento para la diabetes según práctica habitual) con evaluaciones cada 48 h, estableciéndose como objetivo primario la obtención de glucemias preprandiales entre 80 y 180mg/dl, siendo el objetivo secundario la ausencia de hipoglucemias. RESULTADOS: Se incluyó a 104 pacientes de 67,8±9,2 años de edad, 13,7±10,2 años de evolución de diabetes y HbA1c media de 7,8±1,5%. En el grupo de intervención se observó una mejoría significativa en las glucemias capilares antes del desayuno, almuerzo, cena y media de 24 h tanto con respecto al día 0 como comparativamente con el grupo control, alcanzando el 7.° día de seguimiento una glucemia media de 148,2±30,3mg/dl. El porcentaje de pacientes con glucemia entre 80 y 180mg/dl superó el 50% desde el día 4 para la glucemia en ayunas, desde el día 5 para la glucemia antes del almuerzo y desde el día 7 para la glucemia antes de la cena. Siete pacientes (13,4%) presentaron hipoglucemias leves en el grupo de intervención y 9 (17,3%) en el grupo control (p = 0,817). CONCLUSIONES: La aplicación de un protocolo de control glucémico en el medio hospitalario es efectiva para mejorar el control metabólico y alcanzar los objetivos establecidos, con un bajo número de hipoglucemias asociadas

OBJECTIVE: To evaluate the effectiveness and safety of a glucose control protocol designed to manage patients with diabetes in hospital. MATERIAL AND METHODS: An interventional, prospective and open study was designed for patients with diabetes admitted in a conventional hospital setting. Patients were randomized to an intervention group (glucose control protocol) or to a control group (conventional treatment for diabetes). Blood glucose was performed every 48 hours. The primary endpoint was to obtain a pre-prandial blood glucose between 80 and 180 mg/dl, and the secondary endpoint was the absence of hypoglycemia. RESULTS: The study included a total of 104 patients (51.0% male), with a mean age of 67.8 ± 9.2 years old, 13.7 ± 10.2 years since onset of diabetes, and mean HbA1c of 7.8±1.5%. The patients in the intervention group showed a significant improvement in glucose control before all meals as well as in the 24 hour mean compared to day 0 and with the control group. In the first week, patients achieved a mean blood glucose of 148.2 ± 30.3 mg/dl. The percentage of patients with blood glucose between 80 and 180mg/dl gradually increased, exceeding 50% of patients from day 4 for fasting blood glucose, day 5 for blood glucose before lunch, and day 7 for blood glucose before dinner. Seven patients (13.4%) had mild hypoglycemia in the intervention group, and nine (17.3%) in the control group (P = 0.817). CONCLUSIONS: The use of a blood glucose control protocol in hospital settings is effective for improving metabolic control and to achieve the targets, with a low rate of associated hypoglycemia