Optimizing Diabetes Management Using a Low-Calorie Diet in Saudi Arabia: A Cost-Benefit Analysis.

BACKGROUND: Low-calorie diets, high in protein and low in carbohydrates, are commonly recommended for patients with pre-diabetes and type 2 diabetes. The objective of this study was to carry out a cost-benefit analysis (CBA) of a low-calorie versus a standard diet from the perspective of the Saudi Arabian health system. METHODS: The CBA compares costs and benefits of the two diet strategies over a 1-year time horizon. Costs included diet and diabetes treatment-related resources while benefits were measured in terms of the costs of diabetes complications avoided. Data on costs and benefits were collected from published literature and subject matter experts. Incremental costs were estimated as the cost difference between low-calorie and standard diet. Incremental benefits were estimated as cost difference from medical complications when following a low-calorie or standard diet. The incremental absolute cost-benefit ratio was calculated to show the difference between the costs and benefits of the low-calorie diet. Incremental relative cost-benefit ratio was calculated to show the cost per dollar of benefit obtained. Monte Carlo simulation modeled variability in outcomes due to variation in costs and uncertainty of diabetes complications. RESULTS: The 1 year cost of standard diet was US$2515 ± 156 compared to US$2469 ± 107 per patient for a low-calorie diet. Incremental benefit is estimated at US$21,438 ± 7367 per patient. The estimated incremental absolute cost-benefit ratio was US$ - 21,360 establishing that benefits are greater than costs, while the estimated incremental relative cost-benefit ratio is 0.0037, establishing that benefits are 270 times greater than costs. CONCLUSION: The low-calorie diet was the dominant strategy compared to the standard diet in modeled scenarios. These findings highlight the importance of a low-calorie diet as part of diabetes management programs for outpatients with type 2 diabetes.

Morphofunctional Nutritional Assessment in Clinical Practice: A New Approach to Assessing Nutritional Status.

This Special Issue of Nutrients titled "Morphofunctional Nutritional Assessment in Clinical Practice" is oriented to the diagnosis of disease-related malnutrition (DRM) [...].

Prevalence of sarcopenia in patients older than 75 years admitted for hip fracture.

BACKGROUND: Hip fracture in the population aged 75 years and older is one of the most disabling pathologies. Likewise, disease related malnutrition (DRM) and sarcopenia are two frequent diagnoses in this age group, whose prevalence may be increased in patients with hip fracture. AIMS: To determine the prevalence of malnutrition and/or sarcopenia in patients admitted for hip fracture and evaluate the existence of malnutrition related to disease and sarcopenia, and the differences between the sarcopenic and non-sarcopenic group. METHODS: 186 patients aged 75 years or over, hospitalised for hip fracture from March 2018 to June 2019 were included. Demographic, nutritional and biochemical variables were collected. Nutritional screening was carried out with the Mini-Nutritional Assessment (MNA), the presence of DRM was established with The Global Leadership Initiative on Malnutrition (GLIM) criteria. For sarcopenia screening, the Strength, Assistance with walking, Rising from a chair, Climbing stairs and Falls (SARC-F) was used and the diagnosis of sarcopenia was made using the criteria from the European Working Group on Sarcopenia in Older People (EWGSOP) reviewed in 2019 (EWGSOP2). Muscle strength was determined by hand-grip strength, body composition by measurement of bioelectrical impedance. RESULTS: The mean age was 86.2 years, most of the patients were women (81.7%). 37.1% of patients were at nutritional risk (MNA 17-23.5) and 16.7% were malnourished (MNA < 17). 72.4% of women and 79.4% of men, were diagnosed with DRM. 77.6% of the women and 73.5% of the men had low muscle strength. The appendicular muscle mass index was below the cut-off points for sarcopenia in 72.4% of the women and 79.4% of the men. Patients with sarcopenia had a lower body mass index, older age, poorer previous functional status and higher disease burden. The relationship between weight loss and hand grip strength (HGS) was significant (p = 0.007). CONCLUSIONS: 53.8% of patients admitted for hip fracture present malnutrition or are at risk after screening with MNA. Sarcopenia and DRM affects at least three out of four patients older than 75 years admitted for hip fracture. Older age, worse functional status, lower body mass index and high number of comorbidities, are associated with these two entities. There is a relationship between DRM and sarcopenia.

Vitamin D Receptor (VDR) Gene Polymorphisms Modify the Response to Vitamin D Supplementation: A Systematic Review and Meta-Analysis.

The vitamin D receptor (VDR), a member of the nuclear receptor superfamily of transcriptional regulators, is crucial to calcitriol signalling. VDR is regulated by genetic and environmental factors and it is hypothesised that the response to vitamin D supplementation could be modulated by genetic variants in the VDR gene. The best studied polymorphisms in the VDR gene are Apal (rs7975232), BsmI (rs1544410), Taql (rs731236) and Fokl (rs10735810). We conducted a systematic review and meta-analysis to evaluate the response to vitamin D supplementation according to the BsmI, TaqI, ApaI and FokI polymorphisms. We included studies that analysed the relationship between the response to vitamin D supplementation and the genotypic distribution of these polymorphisms. We included eight studies that enrolled 1038 subjects. The results showed no significant association with the BsmI and ApaI polymorphisms (p = 0.081 and p = 0.63) and that the variant allele (Tt+tt) of the TaqI polymorphism and the FF genotype of the FokI variant were associated with a better response to vitamin D supplementation (p = 0.02 and p < 0.001). In conclusion, the TaqI and FokI polymorphisms could play a role in the modulation of the response to vitamin D supplementation, as they are associated with a better response to supplementation.

[The NADYA-SENPE Home Enteral Nutrition Registry in Spain: years 2018 and 2019]. / Registro del Grupo NADYA-SENPE de Nutrición Enteral Domiciliaria en España: años 2018 y 2019.

INTRODUCTION: Aim: to present the results of the Spanish home enteral nutrition (HEN) registry of the NADYA-SENPE group for the years 2018 and 2019. Material and methods: from January 1, 2018 to December 31, 2019 the home enteral nutrition registry was recorded, and afterwards a further descriptive and analytical analysis was done. Results: in 2018, 4756 active patients were registered and the prevalence was 101.79 patients per one million inhabitants; in 2019 there were 4633 patients with a prevalence of 98.51 patients per one million inhabitants. They originated in 46 hospitals: 51.3 % were male, and median age was 71.0 years in both periods. The most frequent diagnosis was a neurological disorder that presents with aphagia or severe dysphagia - 58.7 % and 58.2 %, respectively. The main cause of episode termination was death. A total of 116 pediatric patients were registered in 2018 and 115 in 2019. Females represented 57.8 % and 59.1 %, respectively, in each of the periods. Median age at the beginning of HEN was 5 and 7 months. The most commonly recordered diagnostic group (42.2 % and 42.6 %) was included within the other pathologies group, followed by neurological disorders that present with aphagia or severe dysphagia in 41.4 % and 41.7 % of children. The route of administration was gastrostomy in 46.6 % and 46.1 %, respectively, in each of the periods. Conclusions: the NED registry of the NADYA-SENPE group continues to operate uninterruptedly since its inception. The number of registered patients and the number of participating hospitals remained stable in the last biennium analyzed.

INTRODUCCIÓN: Objetivo: exponer los resultados del registro de nutrición enteral domiciliaria (NED) de los años 2018 y 2019 del Grupo NADYA-SENPE. Material y métodos: se recopilaron los pacientes introducidos en el registro desde el 1 de enero al 31 de diciembre de 2018 y en las mismas fechas para 2019, procediendo al análisis descriptivo y analítico de los datos. Resultados: en el año 2018 se registraron 4756 pacientes activos con una tasa de prevalencia de 101,79 pacientes/millón de habitantes; en 2019 fueron 4633 con una tasa de prevalencia de 98,51 pacientes/millón de habitantes. Procedían de 46 hospitales. Fueron el 51,3 % los varones registrados y la edad mediana fue de 71,0 años en ambos periodos. El diagnóstico más frecuente fue el de enfermedad neurológica que cursa con afagia o disfagia severa (58,7 % y 58,2 %), respectivamente. La causa principal de finalización de los episodios fue el fallecimiento. Los pacientes pediátricos registrados fueron 116 en 2018 y 115 en 2019. Las niñas representaron el 57,8 % y 59,1 %, respectivamente, en cada uno de los periodos. La edad mediana de inicio de la NED fue de 5 y 7 meses. El grupo diagnóstico más registrado (42,2 % y 42,6 %) se englobó dentro del grupo de otras patologías, seguido de la enfermedad neurológica que cursa con afagia o disfagia severa de los niños (41,4 % y 41,7 %). Se alimentaban a través de gastrostomía el 46,6 % y 46,1 %, respectivamente, en cada uno de los periodos. Conclusiones: el registro de NED del grupo NADYA-SENPE sigue operativo de forma ininterrumpida desde sus inicios. El número de pacientes registrados y el de hospitales participantes permanece estable en el último bienio analizado.

The risk variant of CDKAL1 (rs7756992) impairs fasting glucose levels and insulin resistance improvements after a partial meal-replacement hypocaloric diet.

BACKGROUND: The CDKAL1 (CDK5 Regulatory Subunit Associated Protein 1 Like 1) gene encodes cyclin-dependent kinase 5 (CDK5) regulatory subunit-associated proten1 like 1. This protein has been shown to contribute to the glucose-dependent regulation of insulin secretion in pancreatic islets. AIMS: The aim of our study was to analyze the effects of the rs7756992 genetic variant of CDKAL1 gene on fasting glucose and insulin resistance after weight loss secondary to partial meal replacement hypocaloric diet (pMRHD). METHODS: This was a non-randomized, single-treatment study with a formula-diet in 44 obese subjects. The patients received nutritional education and a modified diet with two intakes of a normocaloric hyperproteic formula for 3-months. Anthropometric parameter and biochemical profile were measured at basal time and after 3 months. The variant of CDKAL1 gene rs7756992 was assessed. RESULTS: The following genetic distribution was observed; [27AA (61.3%), 12 AG (27.3%) and 5 GG (11.4%)]. After the pMRHD, body weight, the body mass index (BMI), fat mass, waist circumference and blood pressure decreased in both genotypes. Non-G allele carriers showed a significant improvement in fasting glucose levels (AA vs. AG + GG) (-6.1 ±â€¯1.4 md/dl vs. -1.2 ±â€¯0.7 mg/dl; p = 0.01), fasting insulin levels (-3.6 ±â€¯0.2 mU/l vs. -1.3 ±â€¯0.6 mU/l; p = 0.02) and HOMA-IR (-1.2 ±â€¯0.2 units vs. -0.3 ±â€¯0.2 units; p = 0.01). Fasting plasma glucose levels were higher in G allele carriers than non G allele carriers. CONCLUSIONS: Our data suggest that the genetic variant (rs7756992) of CDKAL1 gene is associated with glycaemic status after a pMRHD, with greater improvements in fasting glucose, insulin and HOMA-IR in subjects without the G allele.

Adiponectin Gene Variant rs3774261, Effects on Lipid Profile and Adiponectin Levels after a High Polyunsaturated Fat Hypocaloric Diet with Mediterranean Pattern.

The role of ADIPOQ gene variants on metabolic improvements after weight change secondary to different hypocaloric diets remained unclear. We evaluate the effect of rs3774261 of ADIPOQ gene polymorphism on biochemical improvements and weight change after high polyunsaturated fat hypocaloric diet with a Mediterranean dietary pattern for 12 weeks. A population of 361 obese subjects was enrolled in an intervention trial with a calorie restriction of 500 calories over the usual intake and 45.7% of carbohydrates, 34.4% of fats, and 19.9% of proteins. The percentages of different fats was; 21.8% of monounsaturated fats, 55.5% of saturated fats, and 22.7% of polyunsaturated fats. Before and after intervention, an anthropometric study, an evaluation of nutritional intake and a biochemical evaluation were realized. All patients lost weight regardless of genotype and diet used. After 12 weeks with a similar improvement in weight loss (AA vs. AG vs. GG); total cholesterol (delta: -28.1 ± 2.1 mg/dL vs. -14.2 ± 4.1 mg/dL vs. -11.0 ± 3.9 mg/dL; p = 0.02), LDL cholesterol (delta: -17.1 ± 2.1 mg/dL vs. -6.1 ± 1.9 mg/dL vs. -6.0 ± 2.3 mg/dL; p = 0.01), triglyceride levels (delta: -35.0 ± 3.6 mg/dL vs. 10.1 ± 3.2 mg/dL vs. -9.7 ± 3.1 mg/dL; p = 0.02), C reactive protein (CRP) (delta: -2.3 ± 0.1 mg/dL vs. -0.2 ± 0.1 mg/dL vs. -0.2 ± 0.1 mg/dL; p = 0.02), serum adiponectin (delta: 11.6 ± 2.9 ng/dL vs. 2.1 ± 1.3 ng/dL vs. 3.3 ± 1.1 ng/dL; p = 0.02) and adiponectin/leptin ratio (delta: 1.5 ± 0.1 ng/dL vs. 0.3 ± 0.2 ng/dL vs. 0.4 ± 0.3 ng/dL; p = 0.03), improved only in AA group. AA genotype of ADIPOQ variant (rs3774261) is related with a significant increase in serum levels of adiponectin and ratio adiponectin/leptin and decrease on lipid profile and C-reactive protein (CRP).

The risk variant of CDKAL1 (rs7756992) impairs fasting glucose levels and insulin resistance improvements after a partial meal-replacement hypocaloric diet. / La presencia de la variante de riesgo de CDKAL1 (rs7756992) altera los niveles de glucosa en ayunas y la resistencia a la insulina después de una dieta hipocalórica con reemplazo parcial de comidas.

BACKGROUND: The CDKAL1 (CDK5 Regulatory Subunit Associated Protein 1 Like 1) gene encodes cyclin-dependent kinase 5 (CDK5) regulatory subunit-associated proten1 like 1. This protein has been shown to contribute to the glucose-dependent regulation of insulin secretion in pancreatic islets. AIMS: The aim of our study was to analyze the effects of the rs7756992 genetic variant of CDKAL1 gene on fasting glucose and insulin resistance after weight loss secondary to partial meal replacement hypocaloric diet (pMRHD). METHODS: This was a non-randomized, single-treatment study with a formula-diet in 44 obese subjects. The patients received nutritional education and a modified diet with two intakes of a normocaloric hyperproteic formula for 3-months. Anthropometric parameter and biochemical profile were measured at basal time and after 3 months. The variant of CDKAL1 gene rs7756992 was assessed. RESULTS: The following genetic distribution was observed; [27AA (61.3%), 12 AG (27.3%) and 5 GG (11.4%)]. After the pMRHD, body weight, the body mass index (BMI), fat mass, waist circumference and blood pressure decreased in both genotypes. Non-G allele carriers showed a significant improvement in fasting glucose levels (AA vs. AG + GG) (-6.1 ± 1.4 md/dL vs. -1.2 ± 0.7 mg/dl; p = 0.01), fasting insulin levels (-3.6 ± 0.2 mU/L vs. -1.3 ± 0.6 mU/L; p = 0.02) and HOMA-IR (-1.2 ± 0.2 units vs. -0.3 ± 0.2 units; p = 0.01). Fasting plasma glucose levels were higher in G allele carriers than non G allele carriers. CONCLUSIONS: Our data suggest that the genetic variant (rs7756992) of CDKAL1 gene is associated with glycaemic status after a pMRHD, with greater improvements in fasting glucose, insulin and HOMA-IR in subjects without the G allele.

Association of the rs10830963 polymorphism in MTNR1B with fasting glucose, serum adipokine levels and components of metabolic syndrome in adult obese subjects.

INTRODUCTION: Background and objectives: the aim of the present investigation was to describe the association of this single nucleotide polymorphism (SNP) with fasting glucose levels, serum adipokine levels and diabetes mellitus. Methods: the study involved a population of 1,002 adult obese subjects. Measurements of anthropometric parameters, blood pressure, fasting blood glucose, C-reactive protein (CRP), insulin concentration, insulin resistance (HOMA-IR), HOMA-B, lipid profi le and adipocytokines levels were performed. Genotype of MTNR1B gene polymorphism (rs10830963) was evaluated. Results: fasting glucose levels (GG: 101.5 ± 19.1 mg/dl vs GT: 103.5 ± 8.1 units vs TT: 107.2 ± 8.0 mg/dl; p = 0.01) and HOMA-IR (GG: 3.1 ± 1.6 units vs GT: 3.4 ± 1.1 units vs TT: 3.7 ± 1.0 units; p = 0.02) were higher in subjects with GG genotype than in other genotypes. Total adiponectin levels (CC: 20.5 ± 8.4 ng/dl vs CG: 21.8 ± 5.4 ng/dl vs GG: 15.4 ± 1.4 ng/dl; p = 0.02) and HOMA-B (CC: 2.3 ± 0.8 units vs CG: 2.2 ± 1.1 units vs GG: 1.9 ± 0.9 units; p = 0.01) were lower in subjects with GG genotype than GC or CC genotypes. Logistic regression analysis showed an increased risk of hyperglicemia (OR = 1.31, 95% CI = 1.12-2.78, p = 0.03) and diabetes mellitus (OR = 1.37, 95% CI = 1.14-2.86, p = 0.04). Conclusions: this study showed that the MTNR1B rs10830963 polymorphism was associated with increased fasting glucose levels, HOMA-IR, and risk of DM2. This SNP was associated with decreased adiponectin levels and HOMA-B.

INTRODUCCIÓN: Introducción y objetivos: el objetivo de la presente investigación fue describir la asociación del polimorfi smo del gen MTNR1B (rs10830963) con los niveles de glucosa en ayunas, los niveles séricos de adipocitoquinas y la diabetes mellitus. Métodos: el estudio incluyó una población de 1.002 adultos obesos. Se realizó la determinación de parámetros antropométricos, presión arterial, glucosa en sangre en ayunas, proteína C reactiva (CRP), concentración de insulina, resistencia a la insulina (HOMA-IR), HOMA-B, perfil lipídico y niveles de adipocitoquinas. Se evaluó el genotipo del polimorfi smo del gen MTNR1B (rs10830963). Resultados: los niveles de glucosa en ayunas (GG: 101,5 ± 19,1 mg/dl vs. GT: 103,5 ± 8,1 unidades vs. TT: 107,2 ± 8,0 mg/dl; p = 0,01) y HOMA-IR (GG: 3,1 ± 1,6 unidades vs. GT: 3,4 ± 1,1 unidades vs. TT: 3,7 ± 1,0 unidades, p = 0,02) fueron más altos en sujetos con genotipo GG que en otros genotipos. Los niveles totales de adiponectina (CC: 20,5 ± 8,4 ng/dl vs. CG: 21,8 ± 5,4 ng/dl vs. GG: 15,4 ± 1,4 ng/dl, p = 0,02) y HOMA-B (CC: 2,3 ± 0,8 unidades vs. CG: 2,2 ± 1,1 unidades frente a GG: 1,9 ± 0,9 unidades, p = 0,01) fueron menores en sujetos con genotipo GG que en genotipos GC o CC. El análisis de regresión logística mostró un mayor riesgo de hiperglicemia (OR = 1,31, IC 95% = 1,12-2,78, p = 0,03) y diabetes mellitus (OR = 1,37, IC 95% = 1,14-2,86, p = 0,04). Conclusiones: este estudio mostró que el polimorfi smo MTNR1B rs10830963 se asoció con un aumento de los niveles de glucosa en ayunas, HOMA-IR y riesgo de DM2. Este SNP se asoció con niveles de adiponectina disminuidos y HOMA-B.

[Spanish home enteral nutrition registry of the year 2016 and 2017 from the NADYA-SENPE Group]. / Registro del grupo nadya-senpe de nutrición enteral domiciliaria en españa; años 2016 y 2017.

INTRODUCTION: Objective: to present the results of the Spanish home enteral nutrition (HEN) registry of the NADYA-SENPE group for the year 2016 and 2017. Material and methods: from January 1st 2016 to December 31st 2017, the HEN registry was recorded and afterwards a further descriptive and analytical analysis was done. Results: in 2016, 4,578 active patients were recorded and prevalence was 98.33 patients per one million inhabitants; in 2017, 4,777 patients were recorded, with a prevalence of 102.57 per one million inhabitants; 50.8% were males in 2016 and 50.5% in 2017. During the period 2016-17, median age was 71.5 years (IIQ 57-83), 1,558 HEN episodes were finished and the main cause was death (793 patients, 50.89%). Adult males were younger than females (65.3 vs. 73.3 years, p-value < 0.001). The most frequent diagnosis was the neurological disorder that presents with aphagia or severe dysphagia (59%). Nasogastric tube was the most frequent administration route (48.3%) and it is the most widely used in elderly patients (p < 0.001). One hundred and twenty-six pediatric patients were registered (57.1% females). Median age at the beginning of HEN in children was four months. "Other disorders" was the most recorded diagnostic group (41.3%), followed by the group of neurological disorder that presents with aphagia or severe dysphagia. Regarding children, 57.6% were fed through gastrostomy and the younger ones were fed through nasogastric tube (p-value 0.001). Conclusions: the number of patients in the registry, as well as the number of participating centers, is progressively increasing. The main characteristics of the patients have not changed. Despite the increase in diagnostic possibilities in the pediatric population, the classification within the group of "Other pathologies" is quite significant.

INTRODUCCIÓN: Objetivo: exponer los resultados del registro de nutrición enteral domiciliaria (NED) de los años 2016 y 2017 del Grupo NADYA-SENPE. Material y métodos: se recopilaron los pacientes introducidos en el registro del 1 de enero al 31 de diciembre de 2016 y la mismas fechas de 2017 para proceder al análisis descriptivo y analítico de los datos. Resultados: en el año 2016 se obtuvieron 4.578 pacientes activos (prevalencia = 98,33 pacientes/millón de habitantes) y en 2017 fueron 4.777 (prevalencia = 102,57). Por sexos, hubo un 50,8% de varones en 2016 y un 50,5% en 2017. En el periodo 2016-17, la edad mediana fue de 71,5 años (IIQ 57-83); asimismo, finalizaron 1.558 episodios de NED y la causa principal fue el fallecimiento (793 pacientes, 50,89%). Los varones adultos fueron más jóvenes que las mujeres (65,3 vs. 73,3 años, p-valor < 0,001) y el diagnóstico más frecuente fue la enfermedad neurológica que cursa con afagia o disfagia severa (59%). La sonda nasogástrica (SNG) fue la vía de acceso más utilizada (48,3%) y se observa, además, que esta es la vía que se utiliza en los pacientes más ancianos (p < 0,001). Se registraron 126 pacientes pediátricos (57,1% niñas). La edad mediana de inicio de la NED fue de cuatro meses. Otras patologías fue el grupo diagnóstico más registrado (41,3%), seguido por la enfermedad neurológica que cursa con afagia o disfagia severa. Se alimentaban a través de gastrostomía en el 57,6% de los casos. Se observó que los niños más pequeños eran los que se alimentaban preferentemente por SNG (p-valor 0,001). Conclusiones: el número de pacientes del registro, así como el número de centros participantes, se va incrementando progresivamente. Las principales características de los pacientes no han variado. A pesar del aumento de posibilidades diagnósticas en la población pediátrica, llama la atención la clasificación dentro del grupo de Otras patologías.

[Home and Ambulatory Artificial Nutrition (NADYA) Report. Home Parenteral Nutrition in Spain, 2017]. / Nutrición parenteral domiciliaria en España 2017. Informe del Grupo de Nutrición Artificial Domiciliaria y Ambulatoria NADYA.

AIM: to communicate HPN data obtained from the HPN registry of the NADYA-SENPE group (www.nadya-senpe.com) for the year 2017. MATERIAL AND METHODS: descriptive analysis of the data collected from adult and pediatric patients with HPN in the NADYA-SENPE group registry from January 1st, 2017 to December 31st, 2017. RESULTS: there were 308 patients from 45 Spanish hospitals (54.5% women), 38 children and 270 adults, with 3,012 episodes, which represent a prevalence rate of 6.61 patients/million inhabitants/year 2017. The most frequent diagnosis in adults was "palliative cancer" (25.6%), followed by "others". In children, it was Hirschsprung's disease with six cases (15.8%). The first indication was short bowel syndrome in both children (55.3%) and adults (33.7%). The most frequently used type of catheter was tunneled in both children (73.4%) and adults (38.2%). Ending 81 episodes, the most frequent cause was death (62.9%) and transition to oral feeding (34.7%). CONCLUSIONS: the progressive increase of collaborating centers and professionals in the registry of patients receiving NPD is maintained. The main indications of HPN and the motive for ending have remained stable.

OBJETIVO: comunicar los datos de nutrición parenteral domiciliaria (NPD) obtenidos del registro del grupo NADYA-SENPE (www.nadya-senpe. com) del año 2017. 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 2017. RESULTADOS: se registraron 308 pacientes (54,5% mujeres), 38 niños y 270 adultos, procedentes de 45 hospitales españoles, en total 312 episodios, lo que representa una tasa de prevalencia de 6,61 pacientes/millón de habitantes/año 2017. El diagnóstico más frecuente en adultos fue "oncológico paliativo" (25,6%), seguido de "otros". En niños fue la enfermedad de Hirschsprung, con seis casos (15,8%). El primer motivo de indicación fue síndrome de intestino corto tanto en niños (55,3%) como en adultos (33,7%). El tipo de catéter más utilizado fue el tunelizado tanto en niños (74,3%) como en adultos (38,2%). Finalizaron 81 episodios; la causa más frecuente fue el fallecimiento (62,9%) y que pasaron a vía oral (34,7%). CONCLUSIONES: se mantiene el incremento progresivo de centros y profesionales colaboradores en el registro de pacientes que reciben NPD. Las principales indicaciones de NPD y de motivo de finalización se mantienen estables.

The 10-item eating assessment tool is associated with nutritional status, mortality and hospital stay in elderly individuals requiring hospitalization with acute diseases.

OBJECTIVE: the purpose of this investigation was to investigate the associations between nutritional status by Mini Nutritional Assessment (MNA) test and dysphagia by EAT-10 in elderly individuals requiring nutritional oral care in an acute hospital. PATIENTS: this was a cross-sectional survey covering a sample of 560 elderly individuals. As anthropometric parameters, weight and body mass index (BMI) have been included. Glucose, creatinine, sodium, potassium, albumin, prealbumin and transferrin serum levels were measured. The EAT-10 and MNA tests were carried out. The days of hospital stay and mortality were recorded. RESULTS: the mean EAT-10 was 11.2 ± 0.89, the median was 10 and the interquartile range, 6-15. A total of 465 (83.1%) elderly patients had EAT-10 scores between 3 and 40, indicating the presence of dysphagia. The mean MNA test was 15.2 ± 1.1, median was 15 and interquartile rage, 11-18.5. According to their MNA score, a total of 340 (60.7%) elderly patients had MNA scores under 17 (malnutrition) and 177 subjects (31.6%) had a MNA score of 17-23.5 (risk of malnutrition). The MNA score and EAT-10 score were independently associated with hospital stance Beta -0.111 (CI 95%: -0.031- -0.78) and Beta 0.122 (CI 95%: 0.038-0.43), respectively. MNA score was associated with EAT-10 score Beta -0.236 (CI 95%: -0.213-0.09). The MNA score and EAT-10 score were independently associated with mortality odds ratio 0.91 (CI 95%: 0.84-0.96) and 1.040 (CI 95%: 1.008-1.074), respectively. CONCLUSION: dysphagia assessed by the EAT-10 is associated with nutritional status in elderly subjects requiring acute hospitalization. Subsequently, malnutrition and dysphagia were associated with poor outcome such as hospital stay and mortality.

Influence of a meal-replacement diet on quality of life in women with obesity and knee osteoarthritis before orthopedic surgery.

BACKGROUND: Knee osteoarthritis is a disease with a high prevalence in our environment, especially in women. Weight loss can improve the quality of life of these patients before surgery. OBJECTIVES: To evaluate the effect of a meal-replacement diet on weight loss, body composition, and the improvement of the quality of life in obese women with knee osteoarthritis pending surgery. METHODS: One branch intervention study was performed over three months on 81 women with a body mass index greater than 30 kg/m2 with knee osteoarthritis before surgery. Patients received a hyperproteic meal-replacement diet with two bottles of an oral nutrition supplement in lunch and dinner (1,035 kcal). Anthropometric parameters, and body composition were measured. The quality of life was assessed by WOMAC and SF-36 test. RESULTS: The mean age of the patients was 62.23 (8.50) years. The percentage of weight loss was 8.23% (4.04). An improvement in the SF-36 total score was observed (basal: 49.35 [20.41], three months: 58.71 [17.07], p < 0.01). There was an improvement in WOMAC test (basal: 49.24% [25.53], three months: 40.59% [21.76], p < 0.01). It was observed that a 10% improvement in the SF-36 test was independently related to weight loss (OR: 1.2 [1.03-1.36], p < 0.02) adjusted by age and changes in body composition. CONCLUSIONS: In women with osteoarthritis of the knee treated with a meal-replacement diet, there is a significant decrease in weight and fat mass with a relative increase of the latter. There is an improvement in the quality of life according to SF-36 and WOMAC. There is an independent relationship between weight loss and SF-36 improvement.

Histopathological differences in patients with biopsy-proven non-alcoholic fatty liver disease with and without type 2 diabetes.

BACKGROUND AND AIMS: Prevalence of non-alcoholic fatty liver disease (NAFLD) in developed countries is 30% in the general population and 50% in patients with type 2 diabetes mellitus (T2DM). The aim of this study was to compare the severity of NAFLD, as assessed by liver biopsy and using the non-invasive index NAFLD Fibrosis Score (NFS), in subjects with and without T2DM. PATIENTS AND METHODS: The study sample consisted of 217 patients with biopsy-proven NAFLD. Anthropometric assessments, laboratory tests, histological criteria established by the Non-alcoholic Steatohepatitis Clinical Research Network (NASH CRN), and the NFS were recorded. RESULTS: Patients with T2DM (n=36; 16.5%) had higher HOMA-IR values (6.3±3.6 vs. 3.3±2.4; p<0.0001), GGT levels (125.2±102.3 vs. 82.5±70.6IU/l; p<005), and NFS index (-0.6±0.2 vs. -1.8±0.1; p<0.001) than subjects with no T2DM. Patients with T2DM were found higher rates of NASH (72.2% vs. 48.6%; p<0.05), advanced steatosis (80.6% vs. 63%; p<0.05), and liver fibrosis (75% vs. 43.1%, p<0.05) than patients with no T2DM. Patients with T2DM also had higher NFS values (-0.6±1.2 vs. -1.8±1.8: p=0.01). A logistic regression analysis adjusting for age, gender and BMI showed a significant independent association between NASH and presence of T2DM (OR=4.2: 95% CI: 1.4-12.1; p=0.007). A second model adjusting for the same covariates showed T2DM to be an independent factor associated to advanced fibrosis (OR=4.1; 95% CI: 1.7-9.7). CONCLUSION: Patients with T2DM have more advanced degrees of NAFLD and advanced fibrosis as assessed by liver biopsy and the NFS index. Particular attention should be paid to the study and monitoring of NASH in patients with T2DM.

Relation of Trp64Arg polymorphism of beta 3 adrenoreceptor gene with metabolic syndrome and insulin resistance in obese women.

BACKGROUND AND AIM: Trp64Arg variant in beta 3 adrenoreceptor has been reported to be associated with increased body weight and insulin resistance. These risk factors are the ones that make up the so-called metabolic syndrome. The aim of our study was to investigate the relationship between metabolic syndrome and Trp64Arg polymorphism in the beta3 adrenoreceptor gene in obese women. METHODS: A population of 531 obese women was analyzed in cross-sectional survey. A bioimpedance, blood pressure, a serial assessment of nutritional intake with 3 days written food records and biochemical analysis were performed. Genotype of beta 3 adrenoreceptor gene polymorphism (Trp64Arg) was studied. RESULTS: Prevalence of metabolic syndrome (MS) with ATP III definition was 47.1% (250 patients) and 52.9% patients without MS (n = 281 patients). Prevalence of beta 3 genotypes was similar in patients with metabolic syndrome (87.6% wild genotype and 12.4% mutant genotype) and without metabolic syndrome (87.9% wild genotype and 12.1% mutant genotype). Insulin and HOMA levels were higher in patients with mutant genotype than wild type, in patients with and without metabolic syndrome. CONCLUSION: In mutant group of beta3 adrenoreceptor gene patients have higher insulin and HOMA levels than wild type group, without relation with metabolic syndrome.

[ASSESSMENT OF THE GENETIC MODIFICATION INDUCING DIET THROUGH BLOOD MONONUCLEAR CELLS]. / EVALUACIÓN DE LAS MODIFICACIONES GENÉTICAS QUE INDUCE LA DIETA A TRAVÉS DE LAS CÉLULAS MONONUCLEARES SANGUÍNEAS.

The term nutrigenomics was created to describe how nutrition affects genes and the functions of the protein, at the transcriptional level, proteomic, and metabolic. Using changes in gene expression in blood mononuclear cells could be a model to assess the dietary intervention studies in order to understand the underlying mechanisms and impact of diet and nutrients in atherosclerosis, resistance insulin, obesity and diabetes mellitus. There are studies that have changed the dietary intake of cholesterol, polyunsaturated fat, monounsaturated, antioxidants and decreased caloric intake showing a variety of effects on the expression of mRNA in blood mononuclear cells related to inflammation, immunity, lipid metabolism genes, etc. These molecular findings entrench awareness of our body's response to diet and open up the possibility of rapid analysis of new diagnostic pathways in this area of knowledge and even new therapeutic tools.

El término nutrigenómica fue creado para describir cómo la nutrición afecta a los genes y a las funciones de la proteínas, a nivel transcripcional, proteómico y metabólico. El uso de las modificaciones en la expresión génica en las células mononucleares sanguíneas (CMNS) podría ser un modelo que permita evaluar los estudios de intervención dietética con el objetivo de comprender los mecanismos subyacentes y la influencia de la dieta y los nutrientes en la aterosclerosis, la resistencia a la insulina, la obesidad y la diabetes mellitus. Existen trabajos que han modificado el aporte dietético de colesterol, grasas poliinsaturadas, grasas monoinsaturadas y antioxidantes, y disminuido el aporte calórico, mostrando una gran variedad de efectos sobre la expresión de RNAm en CMNS de genes relacionados con la inflamación, la inmunidad, el metabolismo lípidico, etc. Estos hallazgos moleculares afianzan el conocimiento sobre la respuesta de nuestro organismo a la dieta y abren la posibilidad del análisis rápido de nuevas vías diagnósticas e incluso de nuevas herramientas terapéuticas.

MEDITERRANEAN DIET IS ASSOCIATED WITH LIVER HISTOLOGY IN PATIENTS WITH NON ALCOHOLIC FATTY LIVER DISEASE.

BACKGROUND: clinical data on impact of the Mediterranean diet on the the stage of non alcoholic fatty liver disease are limited and these studies have heterogeneous designs. AIM: we decide to explore any potential associations between adherence to the Mediterranean diet and histological characteristics of patients with NAFLD. METHODS: a sample of 82 patients was analyzed in a cross sectional study. To evaluate the level of adherence to the Mediterranean dietary pattern the 14-Item Mediterranean Diet Assessment Tool was used. RESULTS: thirty five patients (42.7%) had a low grade of steatosis (grade 1 of classification) and 47 patients (57.3%) had a high grade of steatosis (grade 2 and 3). Fifty-six patients (68.3%) had liver steatohepatitis and forty-two patients (51.2%) had liver fibrosis. In the logistic regresion analysis, one unit of the 14-Item Mediterranean Diet Assessment Tool was associated with a lower likehood of having steatohepatitis odds ratio 0.43 (CI:95%: 0.29-0.64) and steatosis 0.42 (CI:95%: 0.26- 0.70). Secondly, one unit of HOMA-IR was associated with higher likehood of having steatosis odds ratio 2.01 (CI:95%: 1.08-3.71) and liver fibrosis 1.38 (CI:95%: 1.10-1.80) . CONCLUSIONS: greater adherence to the Mediterranean diet was associated with lower likelihood of high grade of steatosis and presence of steatohepatitis.

Antecedentes: los datos clínicos sobre el impacto de la dieta mediterránea en el estadio de la enfermedad son limitados, y los estudios existentes tienen diseños heterogéneos. Objetivo: decidimos explorar las posibles asociaciones entre la adhesión a la dieta mediterránea y las características histológicas de los pacientes. Métodos: se analizó una muestra de 82 pacientes en un estudio de corte transversal. Para evaluar el nivel de adhesión al patrón de dieta mediterránea se utilizó la herramienta de evaluación de la dieta mediterránea de 14-ítem. Resultados: treinta y cinco pacientes (42,7%) tenían un bajo grado de esteatosis (grado 1 de la clasificación) y 47 pacientes (57,3%) tenían un alto grado de esteatosis (grados 2 y 3). Cincuenta y seis pacientes (68,3%) tenían esteatohepatitis y cuarenta y dos pacientes (51,2%) tenían fibrosis hepática. En el análisis de regresión logística, el aumento de una unidad de la Herramienta de Evaluación de Dieta Mediterránea de 14-ítems se asoció con un menor probabilidad de desarrollar esteatohepatitis 0,43 (IC del 95%: 0,29 hasta 0,64) y esteatosis 0,42 (IC: 95%: 0,26- 0,70). En segundo lugar, una unidad de HOMA- IR se asoció con mayor probabilidad de esteatosis 2,01 (IC del 95%: 1,08 a 3,71) y la fibrosis hepática 1,38 (IC: 95%: 1,10 a 1,80). Conclusiones: la mayor adhesión a la dieta mediterránea se asoció con una menor probabilidad de presentar esteatosis y esteatohepatitis.

[Factors associated with antiretroviral treatment and their influence on health related quality of life in HIV infected patients]. / Factores relacionados con el tratamiento antirretroviral y su influencia en la calidad de vida relacionada con la salud en personas infectadas por VIH.

OBJECTIVES: Access to antiretroviral treatment (ART) has become essential to delay HIV clinical progression and increase survival, so improving Health Related Quality of Life (HRQL). The aim of this investigation was to describe factors associated with ART and their impact on HRQL in HIV infected patients. METHODS: A cross-sectional study on 150 HIV-outpatients in a tertiary hospital was designed, and ART-related data collected. Adherence was assessed by the SMAQ questionnaire. HRQL data were collected by disease-specific questionnaire MOS-HIV (Medical Outcomes Study HIV Health Survey). RESULTS: A total of 84% of patients were on ART. Half of the treatment regimens were Protease inhibitor (PI) based, LPV/r being the most commonly used drug. The large majority of treatments used (89.7%) were second line or successive, and NNRTI-based combinations were the most used in first line. Lipodystrophy was the most frequently referred side-effect (61.1%). Almost all (94.5%) of our patients declared they were adapting well to treatment in their daily-life-activities, with 64.3% adhering to treatment according to the SMAQ (Simplified Medication Adherence Questionnaire) questionnaire. In the HRQL, patients with PI-based treatment got lower scores in 4 of 11 domains with the MOS-HIV questionnaire; while patients that adapted well to their ART had better scores in 4 of 11 domains and overall HRQL assessment in MOS-HIV. CONCLUSIONS: Most of our patients were on ART during our investigation. We have documented a negative association between PI-based treatment and HRQL domains, and a positive association between subjective ART adaptation and HRQL. The assessment of HRQL in this population has increasing interest as it is influenced by ART related factors as treatment improves life conditions of HIV infected people.

Relation of -55CT polymorphism of uncoupling protein 3 gene with fat mass and insulin resistance in morbidly obese patients.

Some studies have pointed to a role of uncoupling protein 3 (UCP3) in the regulation of whole-body energy homoeostasis and regulation of fat distribution. The aim of our study was to investigate the influence of -55CT polymorphism of UCP3 gene on fat mass and insulin resistance in morbidly obese patients. A population of 47 obese subjects (body mass index [BMI] >40 kg/m(2)) was selected randomly in a prospective way. A nutritional evaluation was performed. Dietary intake and exercise were recorded. The mean age was 48.2 +/- 15.4 years; and the BMI was 44.7 +/- 4.7 kg/m(2), with 10 men (21.3%) and 37 women (78.7%). Thirty-two (68.1%) had the genotype -55CC (wild-type group), and 15 patients (31.9%) had -55CT (mutant-type group). In the mutant-type group, insulin (20.6+/-10.8 vs 31.2 +/- 17.4 mIU/L, P < .05), homeostasis model assessment (5.3 +/- 2.7 vs 8.7 6.6, P < .05), weight (114.1 +/- 17.3 vs 122.8+/-19.1 kg, P < .05), BMI (44.1 +/- 4.6 vs 45.7 +/- 6.3 kg/m(2), P < .05), fat mass (56.3 +/- 11.4 vs 61.4 +/- 15.1 kg, P < .05), and waist circumference (124.8 +/- 12.5 vs 128.3 +/- 9.1 cm, P < .05) were higher than those in the wild-type group. Adiponectin levels were higher in wild-type group than mutant-type group (70.3 +/- 26.1 vs 30.5 +/- 32.5 ng/mL, P < .05). In conclusion, mutant-type group of -55CC UCP3 gene patients had higher weight, fat mass, and insulin resistance than wild-type group.