Nutritional Ultrasonography, a Method to Evaluate Muscle Mass and Quality in Morphofunctional Assessment of Disease Related Malnutrition.

Nutritional ultrasonography is an emerging technique for measuring muscle mass and quality. The study aimed to evaluate the relationship between the parameters of body mass and quality of ultrasonography with other parameters of morphofunctional assessment in patients with disease-related malnutrition (DRM). METHODS: A cross-sectional study was developed on 144 patients diagnosed with DRM according to the Global Leadership Initiative on Malnutrition (GLIM) criteria. Morphofunctional evaluation was assessed with anthropometric variables, handgrip strength and bioelectrical impedanciometry (BIA). Nutritional ultrasonography of quadriceps rectus femoris (QRF) was made (muscle mass (Muscle Area of Rectus Femoris index (MARFI)), Y axis and muscle quality (X-Y index and echogenicity). RESULTS: The mean age of patients was 61.4 (17.34) years. The prevalence of sarcopenia in the sample was 33.3%. Patients with sarcopenia (S) had lower values of MARFI [(S: 1.09 (0.39) cm2/m2; NoS: 1.27 (0.45); p = 0.02), Y axis (S: 0.88 (0.27); NoS: 1.19 (0.60); p < 0.01) and X-Y index (S: 1.52 (0.61); NoS: 1.30 (0.53); p < 0.01)]. There was a correlation between BIA parameters (phase angle) and muscle mass ultrasonographic variables (MARFI) (r = 0.35; p < 0.01); there was an inverse correlation between muscle quality ultrasonographic variables (echogenicity) and handgrip strength (r = -0.36; p < 0.01). In the multivariate analysis adjusted by age, the highest quartile of the X-Y index had more risk of death OR: 4.54 CI95% (1.11-18.47). CONCLUSIONS: In patients with DRM and sarcopenia, standardized muscle mass and muscle quality parameters determined by ultrasonography of QRF are worse than in patients without sarcopenia. Muscle quality parameters had an inverse correlation with electric parameters from BIA and muscle strength. The highest quartile of the X-Y index determined by ultrasonography was associated with increased mortality risk.

Diagnosis of malnutrition and its relationship with prognosis in hospitalized patients with oncological pathology.

BACKGROUND AND AIMS: Medical oncology inpatients are at a very high risk of malnutrition, and the presence of complications associated with malnutrition is significant in their evolution. It is necessary to have adequate tools in the diagnosis of malnutrition. OBJECTIVES: This study is aimed to assess the nutritional status of cancer inpatients and compare the incidence of complications based on the nutritional diagnosis with different tools. METHODS: An observational, longitudinal, and retrospective study was designed on 149 patients admitted to the Oncology Service who were requested nutritional and medical treatment between January 2014 and June 2017. Epidemiological, clinical, anthropometric, and nutritional data were collected. Nutritional status was assessed using the Mini Nutritional Assessment (MNA), the Malnutrition Universal Screening Tool (MUST), and the Global Leadership Initiative on Malnutrition (GLIM) criteria. RESULTS: The age of the patients was 61.61 (15.96) years. 67.8% of the patients were men. Most of the patients were in advanced tumor stages (stage III (15.3%); stage IV (77.1%)). The median of the MUST was 2 (0-3) (High risk: 83 (55.7%)). The median MNA was 17 (14-20) (poor nutritional status: 65 (43.6%); risk of malnutrition 71 (47.7%)). According to the GLIM criteria, 115 (77.2%) had malnutrition, and 97 (65.1%) had severe malnutrition. According to MNA, an increase in mortality was observed (MNA <17: 24.6% vs. MNA >17: 7.9%; pvalue <0.01). Multivariate analysis showed that poor nutritional status measured with MNA is related to an increased probability of mortality regardless of the stage of the disease and the patient's age OR: 4.19 95% CI (1.41-12.47); p-value = 0.02. CONCLUSIONS: Malnutrition among cancer patients in whom a nutritional assessment is requested during admission is very high. In hospitalized patients with oncological pathology, it was observed that malnutrition measured by MNA acts as a mortality risk factor.

Metabolic control and satisfaction in a diabetes education programme in flash glucose monitoring through telemedicine in type 1 diabetes.

OBJECTIVE: To evaluate metabolic control and satisfaction with a telemedicine diabetes education programme for the initiation of flash glucose monitoring (FGM) in type 1 diabetes. MATERIAL AND METHODS: Prospective study in 48 patients (52.1% women, 22.9% on insulin pump) who started FGM. They were analysed at baseline and 3 months after the beginning of the FGM. The results were compared with an on-site learning cohort matched by age, sex and HbA1c. RESULTS: At the beginning and 3 months after the MFG, HbA1c improvement was observed (7.9±1.4 vs 7.3±1.1%), p<0.01; with a decrease in time below range - TBR - (4.7±4.9 vs 3.5±3.5%), p<0.05 and number of hypoglycaemic events (9.4±8.7 vs 6.9±5.7/15 days), p<0.05, associated with a worsening in time above range - TAR - (33.5±19.9 vs 37.0±20.9%), p<0.05. No significant differences were observed in the TIR 70-180mg/dl (61.7±18.6 vs 59.4±20.0%), glycemic variability or the use of FGM. Patient satisfaction with telemedicine training was 4.8±0.3 out of 5. No significant differences were observed in the follow-up, either in HbA1c or other glucometer parameters between on-site and online training. In a multivariate analysis adopting the HbA1c at follow-up as the dependent variable, only the TIR (ß=-0.034; p<0.001) and the initial HbA1c (ß=0.303; p<0.001) maintained statistical significance, unrelated to the on-site or online training (ß=0.136; p=ns). CONCLUSIONS: A telemedicine programme is an adequate tool for training in FGM, with results similar to on-site training, and it was associated with a high degree of satisfaction.

Prevalencia y factores asociados a la hiponatremia en pacientes con nutrición enteral / Hyponatremia among patients with total enteral tube feeding: prevalence and associated clinical factors

Introducción: la hiponatremia es el trastorno electrolítico más frecuente a nivel hospitalario. En pacientes con nutrición enteral (NE) puede influir en el abordaje terapéutico, así como en la selección del preparado nutricional. Objetivos: describir la prevalencia de la hiponatremia en pacientes con NE y factores asociados. Métodos: estudio retrospectivo de 1651 pacientes no críticos con NE, valorados por el Servicio de Endocrinología y Nutrición desde enero de 2014 hasta enero de 2020. Se recogieron la edad, el sexo, el índice de masa corporal (IMC) (kg/m2), el estado nutricional mediante el cuestionario Mini Nutritional Assessment (MNA), el diagnóstico principal y la presencia de hiponatremia al inicio y durante la NE. Resultados: del total, el 53,9 % fueron hombres, con una mediana de edad de 76,8 [65,7-85,3] años. El diagnóstico principal más frecuente fue la patología neurológica (37,3 %). El 26,1 % de los pacientes presentaron hiponatremia: un 11,0 % al inicio de la NE y el 16,7% durante su administración. La hiponatremia fue más frecuente en aquellos con patología digestiva (28,7 %) e infecciosa (27,65 %). Según el MNA, hasta el 41,1 % presentaron desnutrición y la frecuencia de esta fue estadísticamente superior en los pacientes con que en aquellos sin hiponatremia (76,3 % vs. 55,8 %; p < 0,001). En el análisis multivariante, únicamente la desnutrición se asoció de manera significativa con la presencia de hiponatremia, con una OR de 2,86 [IC 95 %: 1,5-4,88]. Conclusiones: la hiponatremia se detectó en un tercio de los pacientes con NE. Su presencia fue hasta 2 veces más frecuente en los pacientes desnutridos, independientemente de la edad, el sexo, el IMC y la patología basal (AU)

Introduction: hyponatremia is the most frequent disturbance in hospitalized patients. This situation may influence the therapeutic approach in patients with total enteral tube feeding (TEN). Objective: to study the prevalence of hyponatremia and the clinical factors that are associated with increased risk in a population with TEN. Methods: a retrospective study from January 2014 to January 2020; 1,651 non-critically ill patients receiving TEN were included who were assessed by the Department of Endocrinology and Nutrition. Data collected included sex, age, body mass index (BMI) (kg/m2), and nutritional status by Mini Nutritional Assessment (MNA); main disease diagnosis and development of hyponatremia at onset or during TEN were also included. Results: in all, 53.9 % of the total sample were males aged 76.8 [65.7-85.3] years. Neurological pathology was the most frequent primary diagnosis on admission (37.3 %). We found hyponatremia in 26.1 % —11.0 % at onset and 16.7 % during TEN—. Hyponatremia was more frequent in patients with digestive disease (28.7 %) and infectious disease (27.65 %). According to the MNA questionnaire 41.1 % were malnourished and nutritional status was worse in patients with hyponatremia (76.3 % vs. 55.8 %; p < 0.001). By multivariate analysis, malnutrition was only associated with hyponatremia status; OR, 2.86 [95 % CI: 1.5-4.88]. Conclusions: in this study, hyponatremia was detected in a third of patients. This was up to two more times as common in malnourished patients; however, age, sex, BMI, and baseline pathology were not related (AU)

[Hyponatremia among patients with total enteral tube feeding: prevalence and associated clinical factors]. / Prevalencia y factores asociados a la hiponatremia en pacientes con nutrición enteral.

Introduction: Introduction: hyponatremia is the most frequent disturbance in hospitalized patients. This situation may influence the therapeutic approach in patients with total enteral tube feeding (TEN). Objective: to study the prevalence of hyponatremia and the clinical factors that are associated with increased risk in a population with TEN. Methods: a retrospective study from January 2014 to January 2020; 1,651 non-critically ill patients receiving TEN were included who were assessed by the Department of Endocrinology and Nutrition. Data collected included sex, age, body mass index (BMI) (kg/m2), and nutritional status by Mini Nutritional Assessment (MNA); main disease diagnosis and development of hyponatremia at onset or during TEN were also included. Results: in all, 53.9 % of the total sample were males aged 76.8 [65.7-85.3] years. Neurological pathology was the most frequent primary diagnosis on admission (37.3 %). We found hyponatremia in 26.1 % -11.0 % at onset and 16.7 % during TEN-. Hyponatremia was more frequent in patients with digestive disease (28.7 %) and infectious disease (27.65 %). According to the MNA questionnaire 41.1 % were malnourished and nutritional status was worse in patients with hyponatremia (76.3 % vs. 55.8 %; p < 0.001). By multivariate analysis, malnutrition was only associated with hyponatremia status; OR, 2.86 [95 % CI: 1.5-4.88]. Conclusions: in this study, hyponatremia was detected in a third of patients. This was up to two more times as common in malnourished patients; however, age, sex, BMI, and baseline pathology were not related.

Introducción: Introducción: la hiponatremia es el trastorno electrolítico más frecuente a nivel hospitalario. En pacientes con nutrición enteral (NE) puede influir en el abordaje terapéutico, así como en la selección del preparado nutricional. Objetivos: describir la prevalencia de la hiponatremia en pacientes con NE y factores asociados. Métodos: estudio retrospectivo de 1651 pacientes no críticos con NE, valorados por el Servicio de Endocrinología y Nutrición desde enero de 2014 hasta enero de 2020. Se recogieron la edad, el sexo, el índice de masa corporal (IMC) (kg/m2), el estado nutricional mediante el cuestionario Mini Nutritional Assessment (MNA), el diagnóstico principal y la presencia de hiponatremia al inicio y durante la NE. Resultados: del total, el 53,9 % fueron hombres, con una mediana de edad de 76,8 [65,7-85,3] años. El diagnóstico principal más frecuente fue la patología neurológica (37,3 %). El 26,1 % de los pacientes presentaron hiponatremia: un 11,0 % al inicio de la NE y el 16,7% durante su administración. La hiponatremia fue más frecuente en aquellos con patología digestiva (28,7 %) e infecciosa (27,65 %). Según el MNA, hasta el 41,1 % presentaron desnutrición y la frecuencia de esta fue estadísticamente superior en los pacientes con que en aquellos sin hiponatremia (76,3 % vs. 55,8 %; p < 0,001). En el análisis multivariante, únicamente la desnutrición se asoció de manera significativa con la presencia de hiponatremia, con una OR de 2,86 [IC 95 %: 1,5-4,88]. Conclusiones: la hiponatremia se detectó en un tercio de los pacientes con NE. Su presencia fue hasta 2 veces más frecuente en los pacientes desnutridos, independientemente de la edad, el sexo, el IMC y la patología basal.

Impact of flash glucose monitoring on quality of life and glycaemic control parameters in adults with type 1 diabetes mellitus⋆.

INTRODUCTION: Flash glucose monitoring (FGM) improves some glycaemic control variables and quality of life parameters. OBJECTIVE: Our aim was to evaluate the quality of life and glycaemic control parameters after initiating FGM in patients with type 1 diabetes (DM1) in clinical practice. MATERIAL AND METHODS: A prospective observational study in DM1 patients that started using FGM between June 2019 and April 2020. We analysed their scores on the Diabetes Quality of Life (DQOL) questionnaire, Diabetes Distress Scale (DDS), Diabetes Treatment Satisfaction Questionnaire (DTSQ) and glycaemic control parameters at baseline and 3 months after the FGM onset. RESULTS: We recruited 114 patients, 56% male, mean age 37.2 (standard deviation, SD 12.4), with 18.7 (SD 11.5) years of DM1, 24.6% of which used continuous subcutaneous insulin infusion. Differences were observed (baseline vs. 3 months) in the DTSQ score (22 [15.5-27] vs. 25 [22-28], P < 0.001) and in the DQOL score (88 [74-104] vs. 84 [70-101], P = 0.017) but not in the DDS score. HbA1c was 7.8% (SD 1.3) vs. 7.4% (SD 1.1) (P < 0.001), without improvement in other glycaemic control variables, except for the mean number of hypoglycaemic events/14 days: 14 (SD 9) at baseline vs. 11.5 (SD 7) at 3 months (P < 0.001). CONCLUSIONS: The initiation of FGM, combined with a structured educational programme, was associated with improvement in quality of life and patient satisfaction in DM1 patients. An improvement in HbA1c and a reduction in the number of hypoglycaemia events was observed, but not in the rest of glycaemic control parameters.

Influence of Hyperglycemia Associated with Enteral Nutrition on Mortality in Patients with Stroke.

Objectives: To evaluate in patients admitted for stroke: (1) The frequency of hyperglycaemia associated with enteral nutrition (EN). (2) The risk of morbidity and mortality associated with the development of this type of hyperglycaemia. METHODS: A longitudinal observational study was conducted in 115 non-diabetic patients admitted for stroke with EN. Age, functional capacity (Rankin scale), and blood plasma glucose (BPG) were recorded. Hyperglycaemia was considered as: a value higher than 126 mg/dL before the EN and/or a value higher than 150 mg/dL after a week of enteral nutrition. According to this, three groups were differentiated: HyperES: Those who had hyperglycemia before the beginning of the EN (33% patients); NoHyper: those who did not have hyperglycemia before or after (47.8% patients); and HyperEN: Those who did not have hyperglycemia before but suffered it after the beginning of the EN (19.1% patients). RESULTS: The age was 72.72 (15.32) years. A higher rate of mortality was observed in the HyperEN group 45.50%, than HyperES 15.80% or NoHyper: 10.90%). A lower recovery of the oral feeding was observed in those patients of the HyperEN group 27.30%, than HyperES: 42.10% or NoHyper: 61.80%). In the multivariate analysis adjusting for age, sex, and Rankin scale the development of hyperglycemia in those who did not have it at the beginning (HyperEN) was an independent risk factor for non-recovery of the oral feeding (OR: 4.21 (1.20-14.79), p = 0.02); and mortality adjusted for age, sex and Rankin scale (OR: 6.83 (1.76-26.47), p < 0.01). CONCLUSIONS: In non-diabetic patients admitted for stroke with EN, the development of hyperglycaemia in relation to enteral nutrition supposes an independent risk factor for mortality and for the non-recovery of the oral feeding.