Association of major depressive disorder (MDD) with zinc levels and handgrip muscle strength in a sample of Colombian adults / Asociación del trastorno depresivo mayor con los niveles séricos de zinc y la fuerza muscular

Introduction: Depression is related with poor musclestrength, and deficiencies of microelements such as Zinc (Zn).Otherwise, Zn is related with muscle strength, but there is noevidence of the relations between muscle strength and Znlevels in depression. Objective: To determine the association between serum Zn levels, handgrip muscle strength, and depression. Methods: An observational, analytical case-control study. 102 depressive patients hospitalized at the San Juan de DiosClinic in Manizales, and 36 controls with no personal historyof mental illness were evaluated for depression severity,serum Zn levels, and handgrip muscle strength. The groupswere matched by sex, age, educational level, and socioeco-nomic stratum. The severity of depression was assessed us-ing the Montgomery–Asberg Rating Scale (MADRS). Serum Znlevels were determined, and handgrip muscle strength wasassessed using dynamometer. Descriptive analysis, logistic reression and linear models were performed with depressionand severity of depression as dependent variables. Results: Lower Zn levels and reduced handgrip musclestrength were related to the presence of depression with thelogistic model. Lower handgrip muscle strength and severityof depression were associated with the linear model. Conclusion: An association was found between depressionand low Zn levels, and an inverse association between severityof depression and handgrip muscle strength. Future studiesshould investigate causality, and to evaluate the relationshipbetween depression, muscle strength and nutritional status.(AU)

Introducción: La depresión se encuentra relacionada con una disminución de la fuerza muscular y deficiencia de microelementos como el Zinc (Zn). De otra parte, el Zn está relacionado con la fuerza muscular, sin embargo, no hay evidencia si existe una asociación entre fuerza muscular y Zn en depresión. Objetivo: Determinar la asociación entre niveles séricos de Zn, fuerza muscular y depresión. Metodología: Se realizó un estudio observacional, analítico de casos y controles. Participaron 102 pacientes hospitalizados en la Clínica San Juan de Dios de Manizales y 36 controles sin historia personal de enfermedad mental. Fueron evaluados la severidad de la depresión, los niveles séricos de Zn y la fuerza de agarre manual. Los grupos fueron pareados por edad, sexo, escolaridad y estrato socioeconómico. La severidad de la depresión se evaluó con la escala de depresión Montgomery-Asberg (MADRS), se determinaron niveles séricos de Zn y la fuerza muscular fue evaluada con por dinamometría. Se realizo un análisis descriptivo, y modelos de regresión logística y regresión lineal con depresión y severidad de la depresión como variables dependientes.Resultados: El modelo de regresión logística encontró una asociación entre los niveles bajos de Zn y la fuerza muscular con la presencia de depresión. El modelo de regresión lineal encontró una relación entre menor fuerza de agarre y severidad de la depresión.Conclusión: Existe una asociación entre depresión y niveles bajos de Zn, y una relación inversamente proporcional entre severidad de la depresión y menor fuerza muscular. Estudios en el futuro deben investigar relaciones de causalidad y evaluar la relación entre depresión, fuerza muscular y estado nutricional.(AU)

Cut-off points to determine muscle mass reduction by electrical bioimpedance analysis for the diagnosis of sarcopenia in older adults: a systematic review

Introduction: Sarcopenia is considered a muscular disease known in older adults, characterized by the reduction of muscle mass and physical performance. In 2010, the European Working Group on Sarcopenia in Older People(EWGSOP) established criteria to define sarcopenia based on muscle mass, grip strength, and gait speed. Bioelectrical Impedance Analysis (BIA) has become popular for estimating body composition in various populations, particularly for assessing sarcopenia in geriatrics. Objective: To identify the cutoff points for Skeletal Muscle Mass Index (SMI) using BIA for the diagnosis of sarcopenia inmen and women aged over 60 years within the period between January 1, 2010, and July 19, 2020. Methodology: A literature search was conducted in the databases of PubMed, Science Direct, Springer, EBSCO, Scopus, OVID, and WOS. Studies in English and Spanish reporting cutoff points for skeletal muscle mass evaluated byBIA for the diagnosis of sarcopenia in adults > 60 years ofboth sexes were included. Results: Only 14 studies met the inclusion criteria. The cutoff points for the decrease in muscle mass varied in each study from 7 kg/m2 to ≤ 10.75 kg/m2 inmen and from <5.7 kg/m2 to <7.4 kg/m2 in women, adjusted for height. Conclusion: This systematic review enabled the recognition of distinct cutoff points for the diagnosis of sarcopenia in older adults world wide. Further more, it demonstrated that the cut off points for SMI vary from country to country. As a result, further studies encompassing diverse regions within each country are necessary to establish cutoff points that enhance the accurate diagnosis of sarcopenia in the elderly population (AU)

Potential Hypoglycemic and Antilipidemic Activity of Polyphenols from Passiflora ligularis (Granadilla).

The consumption of fruits or by-products from plants of the Passifloraceae family has been associated with multiple health and nutritional benefits, due to their phenolic compound content. Likewise, the effects of polyphenols from Camellia sinensis (green tea) have been explored and are considered a reference for different biological actions of these bioactive substances. This study compared the hypoglycemic and antilipemic activity of polyphenol-rich extracts of Passiflora ligularis Juss (passion fruit) and Camellia sinensis (green tea) given to a group of Wistar rats induced to be overweight. The individuals were subjected to three doses of supplementation of both sources of polyphenols in the drinking water. An additional group without polyphenol supplementation served as a control group. Water consumption, weight gain, glycemia, cholesterol, serum triglycerides and percentage of fecal ethereal extracts were analyzed. Although Passiflora ligularis Juss had five times less polyphenol content than Camellia sinensis, rats fed doses of 2.5 and 3.0 g/L Passiflora ligularis Juss showed reduced glycemia by 16%, suggesting an antiglycemic activity similar to that of Camellia sinensis. On the other hand, higher doses of polyphenols from Passiflora ligularis Juss and Camellia sinensis significantly reduced triglyceride levels (p = 0.05) by more than 17% compared to the unsupplemented control group. The polyphenol-rich extracts produced effective inhibitory activity of lipemic metabolites with a reduction in the percentage of fecal lipids (p < 0.05), with no side effects on liver tissue. The 3.0 g/L dose produced the best result on signs of metabolic syndrome associated with excess weight. Polyphenols extracted from fresh Colombian passion fruit showed the potential to decrease metabolic syndrome risk factors in a murine model.

Effect of 8-Week Consumption of a Dietary Pattern Based on Fruit, Avocado, Whole Grains, and Trout on Postprandial Inflammatory and Oxidative Stress Gene Expression in Obese People.

Overweight and obesity constitute a major global public health problem. Healthy dietary patterns induce changes at the molecular level. Currently, there are no studies evaluating the effect of a diet based on fruit, avocado, whole grains, and trout (FAWGT diet) on the expression of obesity-related genes. This randomized controlled crossover study included 44 obese Colombians with BMI ≥30 kg/m2 who followed either a FAWGT diet or a usual diet (UD) characterized by a high intake of saturated fat and foods rich in processed carbohydrates. After 8 weeks of intervention, a postprandial expression study of inflammation and oxidative stress-related genes was carried out with a real-time PCR. The intervention with a FAWGT diet decreased the expression of inflammatory (NFKB1, IL6, IL1ß) and oxidative stress (NFE2L2) genes compared with the intake of the UD. Finally, the postprandial expression of NFkB1 was positively correlated with triglyceride levels after a dietary intervention with the FAWGT diet and the IL1ß gene, and likewise with insulin levels after following the usual diet. The consumption of the FAWGT diet for 8 weeks reduced the inflammatory status; thus, it can be considered a valid alternative to other healthy diets, since it induces beneficial changes on the genes involved in inflammation and oxidative stress in obese people.

Factores que afectan la meta calórica en pacientes de cuidados intensivos con insuficiencia o falla intestinal. Revisión sistemática / Factors affecting caloric goal in intensive care patients with intestinalinsufficiency or failure. Systematic review

Introducción: La insuficiencia y falla intestinal hacenparte de la disfunción gastrointestinal y ocurren en cerca del60% de los pacientes hospitalizados en cuidado intensivo, locual afecta el cumplimiento de las metas nutricionales. Objetivo: Establecer los factores que afectan el cumpli-miento de la meta calórica del soporte nutricional en pa-cientes de cuidado intensivo con insuficiencia o falla intes-tinal. Métodos: Se consultó en las bases de datos de MEDLINE,SCOPUS y COCHRANE, desde enero del 2015 hasta septiem-bre del 2020, sobre meta calórica e insuficiencia y falla intes-tinal en pacientes críticos. Dos investigadores realizaron labúsqueda, aplicaron los criterios de selección, extrajeron losdatos, y evaluaron la calidad metodológica de los estudios. Sehizo una matriz de comparación para los artículos encontra-dos y se evaluó su validez. Resultados: Los artículos evaluados fueron heterogeneose incluyeron pacientes críticos con diferentes trastornos gas-trointestinales. Los determinantes identificados como factoresque afectan la meta calórica fueron: intolerancia gástrica, nutrición postpilórica, uso de opioides, uso de proquinéticos,diarrea y equipo multidisciplinario. Conclusiones: Esta revisión, resalta la ausencia de pará-metros validados para calificar la insuficiencia o falla intesti-nal en pacientes con enfermedades críticas. Los seis aspectosidentificados que afectan el cumplimiento de la meta calóricase deben evaluar prospectivamente en esta población.(AU)

Introduction: Insufficiency and intestinal failure are partof gastrointestinal dysfunction and the occurrence of some ofthese situations is frequent in about 60% of patients hospi-talized in intensive care, which affects the fulfillment of nutri-tional goals. Objective: To establish the factors that affect the fulfill-ment of the caloric goal of nutritional support in intensive carepatients with intestinal insufficiency or failure. Methods: The MEDLINE, SCOPUS and COCHRANE data-bases were consulted, from January 2015 to September2020, on caloric goal and intestinal insufficiency and failure incritically ill patients. Two investigators conducted the search,applied the selection criteria, extracted the data, and as-sessed the methodological quality of the studies. A comparison matrix was made for the articles found and its validity wasevaluated. Results: The articles evaluated included critical patients,but with different gastrointestinal disorders according to thecut-off points used in each one. The determinants identifiedas factors that affect caloric goal were: gastric intolerance,post-pyloric nutrition, use of opioids, use of prokinetics, diar-rhea, and multidisciplinary team. No unified parameters werefound to measure caloric goal and intestinal insufficiency orfailure in most of the studies. Discussion: The articles evaluated were heterogeneousand included critical patients with different gastrointestinaldisorders. The determinants identified as factors that affectcaloric goal were: gastric intolerance, post-pyloric nutrition,use of opioids, use of prokinetics, diarrhea, and multidiscipli-nary team. Conclusions: This review highlights the absence of vali-dated parameters to qualify intestinal insufficiency or failurein critically ill patients. The six identified aspects that affectthe fulfillment of the caloric goal should be evaluatedprospectively in this population.

Evaluación de un sistema experto para el soporte nutricional enteral en pacientes críticos con disfunción gastrointestinal / Evaluation of an expert system for enteral nutritional support in critically illpatients with gastrointestinal dysfunction

Antecedentes: La medicina y la nutrición han empleadoherramientas informáticas para apoyar la toma de decisionesque mejore la atención de los pacientes. Un sistema expertoes una de estas herramientas que puede guiar a los usuariosen el manejo de una problemática específica. La adhesión aguías de práctica clínica para el manejo nutricional de pacientes con disfunción gastrointestinal optimiza el tratamiento médico y nutricional de pacientes críticos, posibilitando su recuperación. El empleo de un sistema experto quefacilite esta adherencia, puede mejorar el desenlace clínicode los pacientes. Objetivo: Evaluar sí un sistema experto desarrollado comouna herramienta para mejorar la adhesión de los médicos alas guías internacionales y apoyar en la toma de decisiones,mejora el manejo del soporte nutricional en pacientes con disfunción gastrointestinal. Métodos: Entre junio de 2020 y enero de 2021 se recolectó la información médica de los pacientes críticos con disfunción gastrointestinal del Hospital Santa Sofía de Caldas. El estudio constó de dos tratamientos experimentales, uno el de pacientes tratados con la ayuda del sistema experto y el otro, de pacientes tratados sin la ayuda del sistema experto, considerado como grupo Control. Los datos fueron recolec-tados durante los primeros cuatro meses del estudio, sinayuda del sistema experto y en los cuatro meses posteriores, la atención nutricional fue apoyada con el empleo del sistemaexperto. Resultados: Hubo diferencia estadística significativa (p =0,0001) entre tratamientos en las variables metas calórica yproteica, e inicio de nutrición enteral. Los pacientes tratadoscon la ayuda del sistema experto presentaron mayor cumplimiento en metas calórica y proteica y, menor tiempo de iniciode la nutrición enteral. Conclusiones: el uso del sistema experto presenta asociación con una mejor adherencia a las recomendaciones delas guías internacionales, mejorando la tolerancia y el suministro del soporte nutricional enteral.(AU)

Background: Medicine and nutrition have used computertools to support decisionmaking that improves patient care.An expert system is one of these tools that can guide users inhandling a specific problem. Adherence to clinical practiceguidelines for the nutritional management of patients with gastrointestinal dysfunction optimizes the medical and nutritional treatment of critically ill patients, enabling their recovery. The use of an expert system that facilitates this adherence can improve the clinical outcome of patients. Objective: To evaluate whether an expert system developed as a tool to improve the adherence of physicians to international guidelines and to support decision making improves the management of nutritional support in patients withgastrointestinal dysfunction. Methods: Between June 2020 and January 2021, medical information was collected from critically ill patients withgastrointestinal dysfunction at Hospital Santa Sofía deCaldas. The study consisted of two experimental treatments, one of patients treated with the help of the expertsystem and the other of patients treated without the helpof the expert system, considered as a Control group. Datawere collected during the first four months of the study,without the help of the expert system, and in the four subsequent months, nutritional care was supported with theuse of the expert system. Results: There was a statistically significant difference(p = 0.0001) between treatments in the caloric and proteingoals variables, and start of enteral nutrition. The patientstreated with the help of the expert system presented highercompliance with caloric and protein goals and a shorterstart time for enteral nutrition. Conclusions: the use of the expert system is associatedwith better adherence to the recommendations of international guidelines, improving tolerance and the provision of enteral nutritional support.(AU)

Cut-off points for low skeletal muscle mass in older adults: Colombia versus other populations.

Background: The European Working Group on Sarcopenia in the Elderly defined sarcopenia as a geriatric syndrome with a diagnostic criteria of low skeletal muscle mass (LMM). Various sarcopenia consensuses recommend as cut-offs for LMM, the use of below 2 SDs from the mean skeletal muscle mass index (SMI) of a young reference group. Given the contrast between reported cut-offs, the objective of this study was to establish cut-offs for LMM from older adults in Manizales and compare them with those published in the literature. Methods: This was a prospective, cross-sectional analytical study in 237 healthy elderly patients from the city of Manizales, Colombia. Anthropometric measurements of weight, height and body mass index were estimated. The SMI was estimated with the Xitron Technologies bioimpedance meter using the Janssen formula. For the comparison of SMI cut-offs, studies that evaluated this parameter with bioelectrical impedance analysis (BIA) were taken into account, in addition to being obtained from the -2 SD from the sex-specific mean of a young reference group. Results: The cut-off points for SMI were 8.0 kg/m 2 for men and 6.1 kg/m 2 for women. There was a statistically significant difference when evaluating LMM from the cut-offs of the present study and those reported in Spain, Turkey, and Finland. The cut-off points of SMI derived from this sample of Colombian men and women may be adequate for the diagnosis in the Colombian geriatric population. However, we did not find significant differences when comparing the cut-offs for SMI from a population of older adults and young adults from the same city. Conclusions: The cut-off points of SMI by BIA derived from a sample of Colombian men and women may be adequate for the diagnosis of LMM in the Colombian geriatric population or populations with similar characteristics to those of the sample evaluated here.

Flavonoid/Polyphenol Ratio in Mauritia flexuosa and Theobroma grandiflorum as an Indicator of Effective Antioxidant Action.

Studies on polyphenols and flavonoids in natural products reveal benefits in the prevention of multiple diseases. Proper extraction, treatment of extracts, and quantification of polyphenols and flavonoids demand attention from the scientific community in order to report more specific biological action. Total polyphenol content (TPC) and total flavonoid content (TFC) (measured at three different times) of ethanol, methanol and acetone extracts of Mauritia flexuosa (aguaje) and Theobroma grandiflorum (copoazú) fresh pulp, from the Colombian Amazon region, were evaluated with the purpose of focusing in the polyphenol/flavonoid proportion and its effective antioxidant activity. This objective could help to explain specific flavonoid biological action based on higher flavonoid proportion rather than higher total polyphenol content. Differences in extracting solvents resulted in statistically significant different yields; the highest TPC was observed with acetone 70% in Mauritia flexuosa and ethanol 80% for T. grandiflorum. The best flavonoid/polyphenol ratio in M. flexuosa was about 1:2.4 and 1:12.8 in T. grandiflorum and the antioxidant efficacy was proportionally higher for flavonoids extracted from T. grandiflorum. HPLC analysis revealed 54 µg/g of the flavonoid kaempferol in M. Flexuosa and 29 µg/g in T. grandiflorum. Further studies evaluating this proportionality, in seeds or peel of fruits, as well as, other specific biological activities, could help to understand the detailed flavonoid action without focusing on the high total polyphenol content.

Alternative Foods in Cardio-Healthy Dietary Models That Improve Postprandial Lipemia and Insulinemia in Obese People.

Obesity is one of the major health problems worldwide. Following healthy dietary patterns can be difficult in some countries due to the lack of availability of certain foods; thus, alternative foods are needed. Our aim was to evaluate the effect of a dietary pattern consisting of fruit, avocado, whole grains, and trout (FAWGT) on postprandial insulinemia and lipemia in obese Colombian subjects. A randomized controlled crossover study was conducted, in which 44 subjects with BMI ≥ 30 kg/m2 followed either a FAWGT diet or a diet high in saturated fat and rich in processed carbohydrates. Levels of lipids and carbohydrates were measured during the postprandial state. The FAWGT diet reduced fasting insulin, VLDL, and HOMA-IR after 8 weeks (p < 0.05), while there was a lower postprandial increase in TG, VLDL, and insulin levels after both acute and chronic intake of FAWGT diet (p < 0.05). The intake of FAWGT-diet was characterized by high consumption of foods rich in fiber, MUFAs, and vitamins C and E (p < 0.05). The consumption of a diet composed of fruit, avocado, whole grains, and trout has emerged as a valid alternative to the foods included in other heart-healthy diets since it improves postprandial lipemia and insulinemia in obese people and has similar beneficial effects to these healthy models.

Polyphenols from Passiflora ligularis Regulate Inflammatory Markers and Weight Gain.

Weight-related disorders affect more than half of the adult population worldwide; they are also concomitant with a state of chronic low-grade inflammation manifesting in abnormal cytokine production. The present study evaluated the effect of polyphenol and flavonoid extract from Passiflora ligularis (granadilla) on low-grade inflammation and body weight in overweight Wistar rats. To induce weight-gain, rats were fed a chow diet with 30% sucrose water and supplemented with 2.0, 2.5, and 3.0 g/L polyphenol extracts (n = 16). The design was a 3 +1 factorial model performed for 42 days (granadilla polyphenols, 3 levels of supplementation, and 1 control group). In addition to total polyphenol and total flavonoid content, the major identified and quantified polyphenol, via UHPLC, was ferulic acid. Interleukin 6 (IL-6), and cytokine tumor necrosis factor-alpha (TNF-α) were evaluated in serum. A decline in the concentration of TNF-α and in weight-gain was found in P. ligularis (granadilla) groups treated with the 2.5 g/L dose. Consumption of polyphenol extracts from granadilla inhibits interleukin-activity as an indicator of inflammation and aids in body-weight control, considering similar food intake, in overweight Wistar rats.

Evaluación de un sistema experto en médicos residentes para el manejo nutricional de pacientes críticos con insuficiencia y falla intestinal / Evaluation of an expert system in resident physicians for the nutritional management of critically ill patients with intestinal insufficiency and failure

La informática ha aportado a la medicina y a la nutrición herramientas de apoyo en la toma de decisiones, que han permitido una atención más objetiva y oportuna a los pacientes. Un sistema experto es una de estas herramientas con el potencial de guiar a los usuarios en el manejo de una problemática específica. La adhesión a las guías de práctica clínica para el manejo nutricional en pacientes con insuficiencia y falla intestinal, por medio de un Sistema experto optimiza el tratamiento de pacientes críticos y aumenta sus posibilidades de supervivencia. Objetivo: Establecer sí un Sistema experto desarrollado como una herramienta para mejorar la adhesión de los médicos a las guías internacionales y como apoyo en la toma de decisiones, mejora el manejo del soporte nutricional en pacientes con insuficiencia y falla intestinal. Métodos: Se empleó un cuestionario elaborado por cinco expertos mediante un proceso Delphi modificado de tres ron-das, para generar consenso sobre las preguntas que debían responder los médicos residentes al evaluar el conocimiento de las guías internacionales de manejo nutricional en estos pacientes. el consenso se estableció mediante estadísticas descriptivas, cuando la concordancia alcanzó el 80% o más en cada una de las preguntas. El cuestionario se aplicó a 26 médicos residentes que rotaban por la unidad de cuidado intensivo en un hospital local, la mitad con apoyo del Sistema y la otra mitad sin este. Resultados: El empleo del Sistema mostró ser un apoyo para los médicos residentes que lo emplearon (P valor =0,044). Proporcionándoles asistencia para mejores resultados, y menos errores en la prueba escrita y mejor adherencia a las recomendaciones de guías internacionales. Conclusiones: los resultados encontrados sugieren que el uso del Sistema, puede mejorar la toma de decisiones frente al abordaje médico y nutricional en pacientes con insuficiencia y falla intestinal. (AU)

Information technology has provided medicine and nutrition with decision support tools, which have allowed a more objective and timely care to patients. An expert system is one of these tools with the potential to guide users in handling a specific problem. Adherence to clinical practice guidelines for nutritional management in patients with intestinal insufficiency and failure, through an expert system, optimizes the treatment of critically ill patients and increases their chances of survival. Objective: To establish an expert system developed as a tool to improve the adherence of physicians to international guidelines and as support in decision-making, improves the management of nutritional support in patients with intestinal insufficiency and failure. Methods: A questionnaire prepared by five experts through a modified three-round Delphi process was used to generate consensus on the questions that resident physicians had to answer when evaluating knowledge of international guidelines for nutritional management in these patients. Consensus was established through descriptive statistics, when agreement reached 80% or more in each of the questions. The questionnaire was applied to 26 resident physicians who rotated through the intensive care unit at a local hospital, half with support from the System and the other half without it. Results: The use of the System was shown to be a support for the resident physicians who used it (P value = 0.044). Providing assistance for better results, fewer errors in the written test and better adherence to the recommendations of international guidelines. Conclusions: the results found suggest that the use of the System can improve decision-making regarding the medical and nutritional approach in patients with intestinal insufficiency and failure. (AU)

Desgaste proteico energético en pacientes con enfermedad renal crónica en estadios III a IV en Caldas, Colombia / Protein Energy Wasting in Patients with Chronic Renal Disease in Stage III to IV Caldas (Colombia)

Resumen Introducción: la enfermedad renal crónica (ERC) es un problema de salud mundial con una prevalencia aproximada del 7,2 % en países desarrollados y del 10 % en todo el mundo; además, es un factor independiente de morbilidad y riesgo cardiovascular que se caracteriza por la pérdida progresiva de la función renal. Objetivo: evaluar la frecuencia de desgaste proteico energético (DPE) en pacientes con ERC en estadios III a IV. Materiales y métodos: estudio descriptivo y de corte transversal. Se realizó una evaluación de los registros de las base de datos de la Sociedad Internacional de Nutrición y Metabolismo Renal sobre pacientes con ERC que contaran con variables sociodemográficas, bioquímicas, valoración global subjetiva (VGS) y medidas antropométricas para el diagnóstico de DPE. Resultados: de 200 pacientes revisados en consulta externa de Nefrología, 60 cumplieron con los criterios de inclusión. El promedio de edad fue de 68,4 años, con una media de tasa de filtración glomerular (TFG) de 47,1 mL/min. Respecto a la ERC, el 61,66 % (n=37) de los participantes fue clasificado en estadio IIIa; el 31,6 % (n=19), en estadio IIIb, y el 6,66 % (n=4), en estadio IV. Ninguno de los pacientes cumplió con los criterios para el DPE. La evaluación de la VGS mostró que el 53,33 % (n=32) de los pacientes estaba en categoría VGS-A (bien nutridos), el 45 % (n=27) en VGS-B (malnutrición moderada) y solo un paciente en VGS-C (malnutrición grave). La mayor proporción de pacientes con bajos niveles de albúmina y colesterol estuvo en pacientes con ERC en estadio IIIb, y los pacientes con índice de masa corporal <23, en estadios IIIb y IV. Conclusión: según los criterios de la Sociedad Internacional de Nutrición y Metabolismo Renal, ningún paciente presentó DPE.

Abstract Introduction: Chronic kidney disease (CKD) is a condition that is recognized as a global health problem and has an approximate prevalence of 7.2% in developed countries, and 10% in the world population, it is also an independent factor of cardiovascular morbidity and risk characterized by progressive loss of kidney function. Objective: To evaluate the frequency of DPE in patients with CKD stages III to IV. Methods: Descriptive, cross-sectional study. Evaluation of a database of patients with CKD, which will have sociodemographic, biochemical variables, Subjective Global Assessment (VGS), and anthropometric measures, for the diagnosis of DPE of the International Society for Nutrition and Renal Metabolism. Results: Of 200 reviewed patients from the Nephrology outpatient clinic, 60 met the inclusion criteria. The average age was 68.4 years, with a mean glomerular filtration rate (GFR) of 47.1ml / min. Regarding CKD, 61.66% (37) of the patients classified in stage IIIa, 31.6% (19) in stage IIIb, and 6.66% (4) in stage IV. None of the patients met the criteria for DPE. The VGS evaluation showed that 53.33% (32) of the patients were in the VGS A category (well nourished), 45% (27) VGS B (moderate malnutrition) and only one patient was classified as VGS C (severe malnutrition). The highest proportion of patients with low levels of albumin and cholesterol was in patients with CKD stage IIIb, and patients with BMI less than 23 in stages IIIb and IV. Conclusion: According to the criteria of the International Society for Renal Nutrition and Metabolism, no patient had DPE. outpatient clinic in Caldas, with CKD stages III to IV-. METHODS: Descriptive, cross-sectional study. Evaluation of a database of patients with CKD, which will have sociodemographic, biochemical variables, Subjective Global Assessment (SGA), and anthropometric measures, for the diagnosis of PEW of the International Society for Nutrition and Renal Metabolism. RESULTS: Of200 reviewed patients from the Nephrology outpatient clinic, 60 met the inclusion criteria. The average age was 68.4 years, with a mean glomerular filtration rate (GFR) of 47.1ml / min. Regarding CKD, 61.66% (37) of the patients were classified in stage IIIa, 31.6% (19) in stage IIIb, and 6.66% (4) in stage IV. None of the patients met the criteria for PEW. The SGA evaluation showed that 53.33% (32) of the patients were in SGAA category (well nourished), 45% (27) SGA B (moderate malnutrition) and only one patient was classified as SGA C (severe malnutrition). The highest proportion of patients with low albumin and cholesterol levels was in patients with CKD in stage IIIb, and patients with BMI less than 23 in stages IIIb and IV. Conclusion: According to the criteria of the International Society for Nutrition and Renal Metabolism, no patient had PEW.

Bioelectrical impedance analysis and dual x-ray absorptiometry agreement for skeletal muscle mass index evaluation in sarcopenia diagnosis.

BACKGROUND: All definitions for diagnosing sarcopenia include the estimation of muscle mass. This can be made using bioelectrical impedance analysis (BIA) or dual x-ray absorptiometry (DXA). BIA is a portable and inexpensive method suitable for clinical settings, while DXA is cumbersome, more expensive and less available. OBJECTIVES: To evaluate the interchangeability of both techniques for skeletal muscle mass index (SMI) estimation, and assess whether the two methods are comparable for the diagnosis of sarcopenia. APPROACH: Prospective, cross-sectional study. SETTING: Faculty for Health Sciences, Universidad de Caldas, Colombia. PARTICIPANTS: Seventy-two subjects aged 65-80 years were recruited. MEASUREMENTS: BIA and DXA for SMI estimation and sarcopenia diagnoses using the definition of the European Working Group on Sarcopenia in Older People (EWGSOP). Of the 72 patients, 28 were diagnosed with sarcopenia by BIA and corroborated by DXA were included in the study. To establish the agreement between techniques, the intraclass correlation coefficient and the concordance correlation coefficient were calculated. A Bland-Altman plot evaluated the agreement. To evaluate agreement on the diagnosis of sarcopenia, a Cohen's kappa test was performed. MAIN RESULTS: Agreement between SMI by BIA and DXA was good according to the intraclass correlation coefficient (ICC 0.7 95% CI 0.5 to 0.8) but poor when the concordance correlation coefficient was used (CCC 0.4 was calculated 95% CI 0.3 to 0.5). The Bland-Altman analysis showed a clinically unacceptable discrepancy between the methods; the confidence intervals were too wide; the difference between methods tends to get larger as the average increases and the scatter around the bias line get larger as the average gets higher. Cohen's kappa test was 0.2 (SEE: 0.1). SIGNIFICANCE: The agreement between BIA and DXA was weak. We concluded that, in this studied population, the methods were not interchangeable. Results may improve if a specific formula in a greater sample size is used.

Polyphenol Extracts from Three Colombian Passifloras (Passion Fruits) Prevent Inflammation-Induced Barrier Dysfunction of Caco-2 Cells.

Chronic intestinal inflammation is associated with pathophysiology of obesity and inflammatory bowel diseases. Gastrointestinal inflammation increases barrier dysfunction exacerbating the immune response and perpetuating chronic inflammation. Anti-inflammatory flavonoids may prevent this intestinal barrier dysfunction. The purpose of this study was to evaluate the polyphenol composition of Colombian Passiflora edulis var. Flavicarpa (Maracuyá), Passiflora edulis var. Sims (Gulupa), and Passiflora ligularis var. Juss (Granadilla) (passion fruits) and to evaluate their ability to inhibit disruption of intestinal barrier dysfunction of Caco-2 (colorectal adenocarcinoma) cells by an inflammatory cocktail (IC). Polyphenols (flavan-3-ols, phenolic acids, flavonols), xanthenes, and a terpene were identified in passion fruits. Cyanidin 3-rutinoside, (+)-catechin and ferulic acid were the most abundant phenolics in P. edulis var. Flavicarpa, P. edulis var. Sims, and P. ligularis var. Juss, respectively. Fruit extracts prevented loss of transepithelial electrical resistance in Caco-2 cells treated with the IC. Among the extracts, P. ligularis var. Juss was most effective at maintaining Caco-2 transepithelial electrical resistance (TEER) with ~73% relative to the IC-treated cells with about 43% of initial TEER values. This fruit had cyanidin-3-rutinoside, (+)-catechin, (-)-epicatechin, and ferulic acid in its phenolic profile. Results of this work support the hypothesis that consumption of passion fruit extracts could benefit intestinal health.

Conocimiento y actitudes de médicos residentes en medicina interna y cirugía general con respecto a la nutrición clínica en 5 universidades del suroccidente colombiano y eje cafetero / Knowledge and Attitudes of resident physicians in internal medicine and general surgery with respect to clinical nutrition in 5 universities of colombian south western and coffee region

INTRODUCCIÓN: Un buen estado nutricional de los pacientes es de vital importancia para su evolución y pronóstico y los conocimientos y actitudes de los médicos son fundamentales en este proceso. OBJETIVO GENERAL: Caracterizar los conocimientos y actitudes de médicos residentes en Medicina Interna y Cirugía General con relación a la nutrición clínica en 5 Universidades del sur occidente y el eje cafetero colombianos y establecer si sus programas académicos influyen en los resultados. METODOLOGIA: Estudio observacional descriptivo de corte transversal con la aplicación de una encuesta de tres módulos: datos sociodemográficos, prueba de conocimientos nutricionales y prueba sobre actitudes en escala Likert. RESULTADOS: Se obtuvo una muestra por conveniencia de 70 participantes siendo la mayoría del género masculino, residentes de medicina interna de primer y segundo año. La media de respuestas acertadas fue de 8/20(IC 95%). El género femenino, los residentes de 1 y 2 año y participantes con menos de 1 año de experiencia clínica obtuvieron mejor promedio de respuestas acertadas. En términos cualitativos 50 participantes obtuvieron calificación "baja" y 20 calificación "regular". Las variables objeto de estudio no mostraron asociación estadísticamente significativa en el resultado final de la prueba de conocimientos. Las respuestas a las preguntas sobre actitudes mostraron una disposición positiva en el 55% de los casos con un grado de indiferencia que oscila alrededor del 20%. DISCUSIÓN Y CONCLUSIONES: Los conocimientos en nutrición clínica de residentes de medicina interna y cirugía general de las universidades del suroccidente colombiano y Eje cafetero son muy escasos. La actitud positiva frente a los temas nutricionales no concuerdan con los bajos resultados en las prueba de conocimientos. Los programas académicos no influyeron en los resultados obtenidos. Deben corregirse estas deficiencias en aras de mejorar la calidad de la atención de los pacientes hospitalizados

INTRODUCTION: The nutritional status of patients plays a fundamental role in the evolution and prognosis of different conditions, and the knowledge and attitudes of physicians are a fundamental part of this process. General objective: To characterize the knowledge and attitudes of resident physicians in internal medicine and general surgery in relation to clinical nutrition in 5 Universities of the southwest and the Colombian coffee axis and establish if their academic programs influence the results obtained. METHODOLOGY: Cross-sectional descriptive observational study with the application of a survey that contains three modules: socio-demographic data, knowledge test on nutritional assessment and artificial nutrition and test of attitudes on Likert scales. RESULTS: A convenience sample of 70 was obtained being the majority of the male gender, residents of internal medicine and first and second year. The average of correct answers was 8/20 (95% CI) the female gender, the residents of 1 and 2 years of residence and the participants with less than 1 year of clinical experience obtained the best average of correct answers. In qualitative terms 50 obtained "low" qualification and 20 "regular" qualification. The variables studied did not show a statistically significant association in the final result of the knowledge test. The answers to the questions on attitudes showed a positive disposition in 55% of the cases with a degree of indifference that oscillates around 20%. DISCUSSION AND CONCLUSIONS: The knowledge in clinical nutrition of residents of internal medicine and general surgery of the universities of southwestern Colombia and the coffee region are very scarce. The positive attitude towards nutritional issues does not agree with the low results in the knowledge test. The academic programs did not influence the results obtained. These deficiencies should be corrected in order to improve the quality of care for hospitalized patients

Postprandial lipid profile in young colombian people. A comparison of two breakfasts / Perfil lipídico posprandial en jóvenes colombianos. Una comparación de dos desayunos

El objetivo fue comparar el perfil lipídico posprandial de estudiantes universitarios que ingirieron un desayuno característico de la región andina colombiana, alto en grasas saturadas y bajo en carbohidratos complejos, en comparación con un desayuno experimental con bajo contenido de grasa y alto en carbohidratos complejos; y su relación con medidas antropométricas. 75 estudiantes universitarios consumieron uno de los dos desayunos después de un ayuno de 12 horas. Se realizó un perfil completo de lípidos en ayunas, tres y seis horas después de la ingestión del desayuno. De los 75 pacientes, 11 fueron excluidos, 28 personas consumieron el desayuno experimental y 36 el habitual. No hubo diferencias significativas entre los dos grupos; sin embargo, hubo una tendencia a disminuir los niveles de todos los componentes del perfil lipídico en el desayuno experimental, excepto las lipoproteínas de alta densidad (HDL). El área bajo la curva (AUC) no difirió entre los desayunos. El índice de masa corporal (IMC) y la relación cintura / cadera (WHR) obtuvo una relación inversa con el HDL y una relación directa con las lipoproteínas de baja densidad (LDL). En conclusión, no hubo diferencias en el efecto agudo de ambos desayunos, posiblemente debido a factores como: el tabaquismo, el ejercicio, el estilo de vida sedentario, el tipo de alimento utilizado en la dieta; variables que no fueron discriminadas en este estudio. La principal contribución de este estudio es la descripción del comportamiento a lo largo del tiempo de las variables del perfil lipídico y su relación con las variables antropométricas. Es posible que el efecto de estas dietas sea significativo a largo plazo

The aim was to compare the postprandial lipid profile of university students who ate a regular breakfast of the Colombian Andean region, high in saturated fats and low in complex carbohydrates, compared with an experimental breakfast with low fat content and high in complex carbohydrates and its relation with anthropometric measurements. 75 university students consumed one of the two breakfasts after a 12-hour fast. A complete lipid profile was performed in a fasted state, three and six hours after breakfast ingestion. Of the 75 patients, 11 were withdrawn, 28 people consumed the experimental breakfast and 36 the usual one. There was no significant difference between the two groups; however there was a tendency to decrease the levels of all the components of the lipid profile in the experimental breakfast, except for High density lipoprotein (HDL). The Area under the Curve (AUC) did not show differences between breakfasts. The body mass index (BMI) and the waist / hip ratio (WHR) showed an inverse relationship with HDL and a direct relationship with Low density lipoproteins (LDL). In conclusion, there were not differences in the acute effect of both breakfasts, possibly due to factors such as smoking, exercise, sedentary lifestyle, type of food used in the diet, variables that were not discriminated in this study. The main contribution of this study is the description of the behavior over time of the lipid profile variables and their relationship with the anthropometric variables. It is possible that the effect of these diets is likely to be significant in the long terms

Puntos de corte provisionales para el diagnóstico de sarcopenia en ancianos de Caldas, Colombia / Provisional cut-off points for the diagnosis of sarcopenia in elderly people from Caldas (Colombia)

Introducción. La sarcopenia es la disminución de masa muscular y la consecuente reducción del rendimiento y de la función física. Su aparición puede ser indicativa de riesgo de otras condiciones en los ancianos, y su diagnóstico requiere la comparación con los datos sobre la composición corporal de la población joven sana para establecer valores de referencia de la disminución de la masa muscular. Objetivo. Establecer puntos provisionales de corte recolectados mediante bioimpedancia eléctrica para el diagnóstico de sarcopenia en ancianos caldenses a partir de los datos de la composición muscular esquelética de jóvenes. Materiales y métodos. Se utilizaron las mediciones de la composición corporal de jóvenes sanos entre los 18 y los 35 años de edad tomadas mediante bioimpedancia eléctrica con base en las cuales se estableció el índice de masa muscular esquelética. Se aplicó la prueba de Kolmogorov-Smirnov para evaluar la normalidad de los datos y se estableció el promedio de dicho índice con sus desviaciones estándar tanto para hombres como para mujeres. Resultados. A partir de estos datos, se estableció como bajo un índice de masa muscular esquelética con un valor de dos desviaciones estándar por debajo de la media del índice en jóvenes. En las mujeres el valor fue de 6,42 kg/m2 y, en hombres, de 8,39 kg/m2. Conclusión. Estos valores son similares a los determinados por algunos autores en población asiática, lo que evidencia que esta tiene características de composición corporal similares a la población de estudio. Hasta donde se sabe, este es el primer estudio que ofrece una descripción de la composición corporal muscular esquelética en jóvenes colombianos y establece puntos de corte para el diagnóstico de sarcopenia en ancianos de esta región centro-andina del país.

Introduction: Sarcopenia is defined as a decrease in muscle mass associated with the reduction of performance and physical function. It is an indicator of adverse outcomes in elderly people. Its diagnosis requires body composition data of healthy young population to establish reference values of low muscle mass. Objective: To establish a provisional cut-off point for sarcopenia in the elderly population from Caldas based on the skeletal muscle composition data of young people using electric bioimpedance. Materials and methods: Body composition data from healthy young people (18 to 35 years old) were used to calculate the skeletal muscle mass index. The Kolmogorov-Smirnov test was applied to evaluate the normality of the data and then the average and standard deviation of muscle mass index were established for both men and women. Results: Based on these data, we established as low muscle mass a skeletal muscle mass index of two standard deviations below the mean of the muscular mass index in young people. The cut-off points were 6.42 kg/m2 and 8.39 kg/m2 for women and men, respectively. Conclusion: This is the first study that offers a description of skeletal muscle body composition in young Colombians and provides cut-off points for the diagnosis of sarcopenia in the elderly population from the Central-Andean region. The data gathered are similar to those proposed by some Asian authors, which shows that the population of this Colombian region has body composition characteristics similar to those from Asia.

Looking for optimum ECG electrodes for bioelectrical impedance analysis (BIA). The need for evaluation.

BACKGROUND: The accuracy and precision of the BIA method is affected by the electrode system. Failing to adjust for differences in it may result in systematic biases of up to 5.2%. METHODS: Forty females ranging from 18 to 24 years, with a body mass index (BMI) of 18.6 to 27.6 kg/m2, were measured by BIA in the frequency range 5 to 500 kHz using the manufacturers recommended electrodes and two types of commercial ECG electrodes (3M-2228 and 3M-2330). RESULTS: The two types of ECG electrodes performed well, but at high frequencies 2330 performed better. CONCLUSION: It was concluded that when electrodes recommended by the equipment manufacturer are not available, ECG electrodes with the best performance should be used. In this way, it will be possible to predict and prevent inadequate records of electrical signals.

Looking for optimum ECG electrodes for bioelectrical impedance analysis (BIA). The need for evaluation / En búsqueda de electrodos óptimos para el uso de la bioimpedancia eléctrica. Una evaluación necesaria

Background: The accuracy and precision of the BIA method is affected by the electrode system. Failing to adjust for differences in it may result in systematic biases of up to 5.2%. Methods: Forty females ranging from 18 to 24 years, with a body mass index (BMI) of 18.6 to 27.6 kg/m2, were measured by BIA in the frequency range 5 to 500 kHz using the manufacturers recommended electrodes and two types of commercial ECG electrodes (3M-2228 and 3M-2330). Results: The two types of ECG electrodes performed well, but at high frequencies 2330 performed better. Conclusion: It was concluded that when electrodes recommended by the equipment manufacturer are not available, ECG electrodes with the best performance should be used. In this way, it will be possible to predict and prevent inadequate records of electrical signals (AU)

Introducción: la exactitud y la precisión del método de análisis de bioimpedancia eléctrica (ABE) se ven afectadas por el sistema de electrodos. Cuando no se realizan los ajustes por las diferencias en este sistema se pueden producir errores en los resultados hasta en un 5,2%. Métodos: cuarenta mujeres de entre 18 y 24 años con un índice de masa corporal (IMC) entre 18,6 y 27,6 kg/m2 fueron medidas con el ABE en rangos de frecuencia de 5 a 500 kHz, usando los electrodos recomendados por el productor del dispositivo de bioimpedancia (Impedimed®), los cuales fueron tomados como referencia. Resultados: dos tipos de electrodos comerciales de electrocardiograma (3M-2228 and 3M-2330) fueron comparados con los de referencia. Ambos electrodos comerciales tuvieron un desempeño similar a los de referencia; sin embargo, a frecuencias altas los electrodos 2330 se comportaron mucho mejor. Conclusión: se concluyó que cuando los electrodos recomendados por el productor del equipo no estén disponibles, se usen los electrodos de ECG que tengan un mejor comportamiento. De esta forma, será posible predecir y prevenir registros inadecuados de las señales eléctricas (AU)

An anthropometric and physical condition assessment of university students attending a food assistance program in colombia / Evaluación antropométrica y de la condición física en estudiantes universitarios, beneficiarios de un programa de asistencia alimentaria en colombia

ABSTRACT The university life implies significant changes in the food habits and physical activities. The university students usually don't fulfill neither the recommended nutritional requirements nor the physical condition advises. The objective of this study was to evaluate the nutritional state and physical condition in Colombian university students attending to a food assistance program. It was a descriptive cross-sectional study with undergraduate students from the University of Caldas, Colombia. Anthropometric measurements (e.g. height, weight, biceps, triceps, subscapular and suprailiac skinfolds, arm and waist circumferences) were taken. Besides, functional manual pressure tests and the Harvard step test were performed. The correlation between anthropometrical and functional variables was calculated. According to the Body mass index (BMI), 22.4% from 420 students had malnutrition. The weight excess was 3.6 times bigger than undernourishment (17.9 compared to 4.5%). However, when the body fat was measured the situation got worse: the 46.4% of them had fat excess. The women were the most affected. The waist circumference showed a fat distribution with abdominal predominance in 14% of the population. The forearm strength and muscle mass were decreased in almost the 50% of men and 30% of women. The physical condition was inappropriate for the 38.1% of participants with a greater alteration in the men. Contradicting the assumptions, it has found out that around 50% of the public university students and beneficiaries of a food assistance program had body fat excess and an inappropriate physical condition. Efforts to improve the physical activity and food habits must be carried out. At the same time, the impact of the malnutrition in health and academic efficiency must be reduced.

RESUMEN La etapa universitaria conlleva cambios significativos en los hábitos de alimentación y en la actividad física. Los estudiantes universitarios usualmente no cumplen los requerimientos nutricionales ni de condición física recomendados. El objetivo del presente estudio fue evaluar el estado nutricional y la condición física de estudiantes de universidad pública, pertenecientes a un programa de asistencia alimentaria. Como método investigativo se empleó un estudio descriptivo de corte transversal en estudiantes de pregrado de la Universidad de Caldas, Colombia. Se realizaron mediciones antropométricas de estatura, peso, pliegue bicipital, tricipital, subescapular y suprailiaco, circunferencia de la cintura y del brazo. Además, se realizaron pruebas funcionales de fuerza de prensión manual y test de banco de Harvard. Se calcularon las correlaciones entre variables antropométricas y funcionales. De acuerdo al índice de masa corporal, de 420 estudiantes, 22,4% presentaban malnutrición. El exceso de peso fue 3,6 veces mayor que la desnutrición (17,9 vs. 4,5%). Sin embargo, al medir la grasa corporal la situación empeoró: el 46,4% de ellos tenían exceso de grasa, siendo las mujeres las más afectadas. La circunferencia de la cintura mostró una distribución de la grasa con un predominio abdominal en el 14% de la población. La fuerza y la masa muscular del antebrazo estuvieron disminuidas en casi el 50% de los hombres y el 30% de las mujeres. La condición física fue inadecuada en el 38,1% de los estudiantes y fue mayor en los hombres. Contrario a lo que podría suponerse en estudiantes de una universidad pública y beneficiarios de un programa de asistencia alimentaria, cerca del 50% presentaron exceso de grasa corporal y una inadecuada condición física. Deben hacerse esfuerzos para mejorar los hábitos de alimentación y actividad física, reduciendo el impacto que tiene la malnutrición en el rendimiento académico y en la salud.