[Home-Based Parenteral Nutrition (HBPN)-associated hepatobiliary complications]. / Complicaciones hepatobiliares asociadas a la Nutrición Parenteral Domiciliaria (NPD).

Home-based parenteral nutrition (HBPN) allows recovering or maintaining the nutritional status of patients with chronic intestinal failure that cannot afford their nutritional requirements through the digestive route. Frequently, liver function impairments develop along the treatment, which in the most severe cases, and especially in premature and low-weight infants, may lead to an irreversible liver failure. The proper composition of the parenteral nutrition bag, avoiding an excess of energy intake, together with the use of new types of lipid emulsions (with lower content in -6 fatty acids and voided of phytosterols) as well as the use, although being minimal, of the enteral route, may contribute to a decrease in the occurrence of HBPN-associated liver disease. It is necessary to perform monthly clinical and biochemical checks to early detect liver function impairments in order to perform the appropriate changes in the treatment and assess the indication of a potential bowel transplant before the liver damage becomes irreversible.

Complicaciones hepatobiliares asociadas a la Nutrición Parenteral Domiciliaria (NPD) / Home-based parenteral nutrition (hbpn)-associated hepatobiliary complications

La Nutrición Parenteral Domiciliaria (NPD) permite recuperar o mantener el estado nutricional de los pacientes con insuficiencia intestinal crónica que no pueden cubrir sus requerimientos nutricionales por vía digestiva. Es frecuente que a lo largo del tratamiento aparezcan alteraciones de la función hepática que, en los casos más graves y sobretodo en niños prematuros y debajo peso, pueden condicionar un fallo hepático irreversible. La correcta composición de la bolsa de nutrición parenteral, evitando un excesivo aporte de energía, junto con el uso de nuevos tipos de emulsiones lipídicas (con menor contenido en ácidos grasos de la serie ω-6 y exentas de fitosteroles) así como la utilización, aunque sea mínima, de la vía digestiva pueden contribuir a disminuirla aparición de la hepatopatía asociada a la NPD. Es imprescindible realizar controles periódicos clínicos y analíticos para detectar precozmente las alteraciones de la función hepática con objeto de realizar los cambios adecuados en el tratamiento y valorar la indicación de un posible trasplante intestinal antes de que el fallo hepático sea irreversible (AU)

Home-based parenteral nutrition (HBPN) allows recovering or maintaining the nutritional status of patients with chronic intestinal failure that cannot afford their nutritional requirements through the digestive route. Frequently, liver function impairments develop along the treatment, which in the most severe cases, and especially in premature and low-weight infants, may lead to an irreversible liver failure. The proper composition of the parenteral nutrition bag, avoiding an excess of energy intake, together with the use of new types of lipid emulsions(with lower content in -6 fatty acids and voided of phytosterols) as well as the use, although being minimal,of the enteral route, may contribute to a decrease in the occurrence of HBPN-associated liver disease. It is necessary to perform monthly clinical and biochemical checks to early detect liver function impairments in order to perform the appropriate changes in the treatment and assess the indication of a potential bowel transplant before the liver damage becomes irreversible (AU)

Preparación, métodos y pautas de administración de la nutrición parenteraldomiciliaria. Seguimiento de los pacientes. Educación a pacientes y cuidadores / No disponible

No disponible

[Spanish Registry of Home-based Parenteral Nutrition during 2006 (NADYA-SENPE Group)]. / Registro de la Nutrición Parenteral Domiciliaria (NPD) en España del año 2006 (Grupo NADYA-SENPE).

OBJECTIVE: To report the data of the Home Parenteral Nutrition (HPN) registry of the NADYA-SENPE working group for the year 2006. METHODOLOGY: We compiled the data from the on-line registry introduced by the responsible Units for the monitoring of HPN from January 1st to December 31st 2006. RESULTS: 103 patients with HPN were registered (47 males and 56 females), belonging to 19 hospitals. Average age for the 91 patients older than 14 years old was 53.3 +/- 14.9 years old, and that for the 12 patients under 14 years old was 2 +/- 0 years old. Most frequent pathology was neoplasm (29%), followed by intestinal motility disorders (13%). The reason for HPN provision was short bowel syndrome (40%), intestinal obstruction (22%), and malabsorption (21%). Tunneled catheters were mostly used (45%), followed by implanted port-catheters (32%). Catheter related infections were the most frequent complications, with a rate of 0.85 episodes / 10(3) days. HPD was provided for more than two years in 50% of the cases. By the end of 2006, 70.9% of the patients remained active; exitus was the most frequent reason to end HPN (53%). Complementary oral or enteral nutrition was provided to 52% of the patients. 48% of the patients had a normal activity level, and a 55% were autonomous. PN formula was supplied by the hospital in 82% of the cases, while this number was 78% for fungible materials. 27% of the patients were eligible for intestinal transplant. CONCLUSIONS: We observe an increase in registered patients with respect to previous years, with a very different prevalence among regions. Neoplasia remains as the main pathology since 2003. We observe a decrease in catheter-related infections with respect to the 2004-2005 period.

Cardiovascular disease in familial hypercholesterolaemia: influence of low-density lipoprotein receptor mutation type and classic risk factors.

AIM: To determine the effect of the type of mutation in low-density lipoprotein receptor gene and the risk factors associated with the development of premature cardiovascular disease (PCVD) in a large cohort of heterozygous familial hypercholesterolemia (hFH) subjects with genetic diagnosis in Spain. METHODS AND RESULTS: A cross-sectional study was conducted on 811 non-related FH patients (mean age 47.1+/-14 years, 383 males and 428 females) with a molecular defect in the low-density lipoprotein receptor (LDLR) gene from the Spanish National FH Register. Prevalence of PCVD was 21.9% (30.2% in males and 14.5% in women, P<0.001). Mean age of onset of cardiovascular event was 42.1 years in males and 50.8 years in females. Of those patients with PCVD, 59.5% of males and 27% of females suffered a second cardiovascular (CV) event. In multivariate analysis male gender, age, tobacco consumption (ever), and total cholesterol/HDL-cholesterol (TC/HDL-C) ratio were significantly associated with PCVD. Two hundred and twenty different mutations were found with a large heterogeneity. Patients carrying null-mutations had significantly higher frequency of PCVD and recurrence of CV events. No relationship with Lp(a) levels and genotype of Apo E were found. CONCLUSIONS: This study confirms the importance of identifying some classic risk factors such as smoking and TC/HDL-C ratio, and also the type of mutation in LDLR gene in order to implement early detection and intensive treatment for the prevention of cardiovascular disease in FH patients.

Registro de la nutrición parenteral domiciliaria en España de los años 2004 y 2005 (Grupo NADYA-SENPE) / Spanish Registry of home-based parenteral nutrition for the years 2004 and 2005 (NADYA-SENPE GROUP)

Objetivo: Comunicar los resultados obtenidos en el registro de Nutrición Parenteral Domiciliaria (NPD) del grupo NADYA-SENPE en los años 2004-2005. Material y métodos: Recopilación de los datos del nuevo registro "on-line" de NPD del grupo NADYA-SENPE en el período 2004-2005. Resultados: Durante el año 2004 se registraron 70 pacientes con NPD (23 hombres y 47 mujeres) pertenecientes a 14 centros hospitalarios. La edad media de los pacientes mayores de 14 años fue de 53,7 ± 14,87 años (m ± DS) y de 6 ± 2,83 años para los menores de 14 años. La enfermedad de base más frecuente fue la neoplasia (24%) seguida de la isquemia mesentérica (19%). Los catéteres más utilizados fueron los tunelizados (75%). Las complicaciones más frecuentes fueron las sépticas relacionadas con el catéter, con una tasa de 0,98 infecciones/ 103 días. El tiempo de soporte nutricional fue superior a dos años en el 69% de los casos. El suministro de las soluciones de NPD y del material fungible fue proporcionado por las farmacias hospitalarias en el 81% y el 83%, respectivamente. El 54% de los pacientes presentaban un nivel de actividad normal. En la mayoría de los pacientes la causa de finalización de la NPD fue la transición a la dieta oral (41%), o el fallecimiento (28%). Durante el año 2005 se registraron 79 pacientes con NPD (33 hombres y 46 mujeres), pertenecientes a 14 centros hospitalarios. La edad media de los mayores de 14 años fue de 52,39 ± 14,21 años y de 6,5 ± 5,21 años para los menores de 14 años. La enfermedad de base más frecuente fue la neoplasia (22%), seguida de la isquemia mesénterica (15%). El 63% de los pacientes utilizaron catéteres tunelizados. Las complicaciones más frecuentes fueron las sépticas relacionadas con el catéter (1,14 infecciones/ 103 días). El tiempo de soporte nutricional fue mayor a dos años en un 51% de los pacientes. El suministro de las soluciones de NPD y del fungible fue en el hospital en el 76% y 81%, respectivamente. El nivel de actividad de los pacientes con NPD fue normal en el 50%. Los motivos más frecuentes de finalización del tratamiento fueron la transición a dieta oral/ enteral (41%) y el fallecimiento (31%). Conclusiones: Hemos observado un ligero descenso en el número de pacientes registrados con NPD durante el período 2004-2005, posiblemente en relación con el cambio del registro. Las características generales de los pacientes son similares a las de años anteriores. Se aprecia un aumento en la tasa de complicaciones sépticas relacionadas con el catéter en el año 2005 (AU)

Objective: To report the results of the Home Parenteral Nutrition (HPN) registry of the NADYA-SENPE working group of the years 2004 and 2005. Material y methods: We summarized the data of the new on-line HPN registry of the NADYA-SENPE group for the period 2004-2005. Results: During the year 2004, 70 HPN-patients (23 males and 47 females) were registered from 14 hospitals. Mean age of adults was 53,7 ± 14,87 years (m ± SD) and 6 ± 2,83 years for those younger than 14 years. The most frequent etiologies of the intestinal failure were neoplasia (24%) and mesenteric ischaemia (19%). Tunneled catheters were used in 75% of the patients. The catheter related infections were the most frequent complications, with a rate of 0,98 episodes/103 days. In 69% of the cases the nutritional support was maintained for more than 2 years. HPN solutions and disposables were supplied by the hospital pharmacy in 81% and 83%, respectively. Up to 54% of the patients had a normal activity level. The most frequent reasons to end HPN treatment were the transition to oral intake (41%), or exitus (28%). During the year 2005, 79 patients (33 males and 46 females) were registered from 14 hospitals. Mean age of adults was 52,39 ± 14,21 years and 6,5 ± 5,21 years for those younger than 14 yrs. The most frequent etiologies of the intestinal failure were neoplasia (22%), and mesenteric ischaemia (15%). Tunneled catheters were used in 63% of the patients. The catheter-related infections were the most frequent complications, with a rate of 1,14 episodes/103 days. In 51% of the cases the nutritional support was maintained for more than 2 years. HPN solutions and disposables were supplied by the hospital pharmacy in 76% and 81%, respectively. Up to 50% of the patients had a normal activity level. The most frequent reasons to end HPN treatment were the transition to oral/enteral feeding (41%) and exitus (31%). Conclusions: We have observed a mild decrease in the number of HPN patients registered in the period 2004-2005, probably related to the change of the registry. The characteristics of the patients are similar to previous years. We have observed an increase in the septic catheter related complications in the year 2005 (AU)

Protocolo para el diagnóstico y tratamiento de la osteopatía metabólica en el enfermo con nutrición parenteral domiciliaria / A protocol for the diagnosis and treatment of metabolic osteopathy in patients with home-based parenteral nutrition

Los pacientes que presentan una insuficiencia intestinal severa sometidos a un programa de nutrición parenteral domiciliaria tienen un riesgo elevado de presentar alteraciones en el metabolismo óseo. Esta disminución de la calidad del hueso tiene un origen multifactorial y puede estar ya presente en el momento de instaurar el soporte nutricional. Es necesario disponer de protocolos que nos permitan realizar un diagnóstico precoz de la enfermedad osteometabólica e instaurar el tratamiento oportuno con objeto de evitar fracturas y mejorar la calidad de vida de estos enfermos

Patients presenting severe intestinal failure submitted to a home-based parenteral nutrition program have increased risk for bone metabolism impairments. This decrease in bone quality has a multifactorial origin and may be already present when implementing nutritional support. There is the need for having available protocols allowing early diagnosis of osteo-metabolic disease and implementing adequate therapy to prevent fractures and improving the quality of life of these patients

Diagnóstico y tratamiento de la hipercolesterolemia familiar / Diagnosis and treatment of familial hypercholesterolemia

La hipercolesterolemia familiar es la enfermedad hereditaria monogénica más frecuente. Se transmite de forma autosómica dominante y se caracteriza por cifras de colesterol unido a lipoproteínas de baja densidad (cLDL) muy elevadas, con posibilidad de presentar depósitos en distintos tejidos. Su presencia entraña un elevado riesgo vascular y un acortamiento de las expectativas de vida si no se trata adecuadamente. Es necesario, por tanto, diseñar estrategias de detección precoz en la población que nos permitan iniciar el tratamiento en edades tempranas de la vida. El riesgo vascular se estima por métodos distintos de los aceptados para la población general debido a las peculiaridades que presentan. El tratamiento con fármacos (fundamentalmente estatinas) es prácticamente obligado para la totalidad de personas afectadas, a causa de los valores de cLDL tan elevados que suelen presentar. El tratamiento farmacológico se ha mostrado seguro y eficaz para prevenir las complicaciones vasculares que amenazan a este colectivo (AU)

Familial hypercholesterolemia is the most frequent monogenetic disease. The mode of transmission is autosomal dominant. This disease is characterized by severe elevations of low-density lipoprotein cholesterol (LDLc), with the possibility of deposits in different tissues. Unless treated appropriately, this disorder carries a high risk of vascular complications and shortened life expectancy. Therefore, strategies for its early detection in the population should be designed to allow early treatment in affected individuals at young ages. Due to the peculiarities of this disease, vascular risk is estimated by methods that differ from those used in the general population. Drug treatment (mainly statins) is almost mandatory in all affected individuals due to their extremely high LDL-c levels. This type of treatment has been shown to be safe and effective in preventing the vascular complications for which this population is at risk (AU)

[Conclusions of the III SENPE Debate Forum on specialized nutritional support: ethical issues]. / Conclusiones del III Foro de Debate SENPE. Soporte nutricional especializado: aspectos eticos.

Conclusions of the III SENPE-Abbott Debate Forum on several ethical issues of specialized nutritional support in hospitalized patients and outpatients. An insight in the principle of equity is given depending on geographical location, in its indications both as a primary therapy and palliative care, and in informed consent.

[The year 2003 National Registry of Home-based Parenteral Nutrition]. / Registro Nacional de la Nutrición Parenteral Domiciliaria del año 2003.

OBJECTIVE: To report the results of the Home-based Parenteral Nutrition (HBPN) registry of the NADYA-SENPE working group, for the year 2003. MATERIAL AND METHODS: Gathering of registry data introduced by all units responsible of HBPN patient care. This an on-line registry available for authorized users of the working group web page (www.nadya-senpe.com). Epidemiological data, diagnosis, access route, complications, hospital admissions, disability degree, and course at December 31st, 2003 RESULTS: Data from 86 patients (62% female and 38% male) from 17 hospitals were gathered. Mean age of adult patients was 50.7 +/- 15.0 years, whereas for patients younger than 14 years was 2.4 +/- 1.5 years (n = 5 patients). Diseases that prone HBPN were neoplasm (21%), followed by mesenteric ischemia (20%), radiation enteritis (16.3%), motility impairments (10.5%), and Crohn's disease (4.6%). Tunneled catheters were used in 66.3% of the cases versus 29.1% of subcutaneous reservoirs. Mean treatment duration has been 8.5 +/- 4.6 months; 67.4% of patients had been on HBPN for a period of time longer than 6 months. Patient follow-up was mostly done from the reference area hospital (88.4%). In no case patient follow-up was done by the primary care team or by specialists other than those prescribing nutritional support. Nutritional support-related complications were seen in 98 occasions. The most frequent complications were infectious ones. They represented 1.60 hospital admissions per patient. The mean number of visits was 7.9 per patient (6.4 for scheduled visits and 1.5 for emergency visits). By the end of the year, we observed that 73.3% of the patients were still on the program, whereas in 23.3% HBPN had been withdrawn. The main reasons for withdrawal were decease (11 patients), and advancing to oral diet (9 patients). As for the disability degree, 13% were confined to a wheelchair or bed, and only 28% had no disability degree or only mild social disability. CONCLUSIONS: We observed a mild increase in HBPN prevalence rate in Spain (2.15 patients pmp). The main indication was cancer followed by short-bowel syndrome secondary to vascular pathology. Nutritional support-related complications were common, especially those of an infectious origin.

Conclusiones del III Foro de Debate SENPE. Soporte nutricional especializado: aspectos éticos / Conclusions of the III SENPE debate forum on specialized nutritional support: ethical issues

Conclusiones del III Foro de Debate SENPE-Abbott sobre diferentes aspectos éticos del soporte nutricional especializado en el paciente hospitalizado y en el domiciliario y ambulatorio. Se profundiza en el principio de equidad dependiendo de la localización geográfica, en las indicaciones tanto como terapia primaria y como cuidados paliativos y, en el consentimiento informado (AU)

Conclusions of the III SENPE-Abbott Debate Forum on several ethical issues of specialized nutritional support in hospitalized patients and outpatients. An insight in the principle of equity is given depending on geographical location, in its indications both as a primary therapy and palliative care, and in informed consent (AU)

[The year 2002 national register on home-based parenteral nutrition]. / Registro nacional de la nutrición parenteral domiciliaria del año 2002.

AIM: To report on the results of the Registry on Home-based Parenteral Nutrition (HPN) of the NADYA-SENPE working group, corresponding to the year 2002. MATERIALS AND METHOD: Compilation of the registry data loaded by the Units in charge of HPN patients care. It consists of an on-line registry available to the registered users of the group's web page (www.nadya-senpe.com). Epidemiological, diagnostic, access route, complications, hospital admissions, degree of disability, and course until December 31st of 2002. RESULTS: Data from 74 patients were gathered (56.8% women and 43.2% men), from 18 hospital centers. Mean age of adult patients was 49.4 +/- 15.5 years and 2.3-1.1 years for patients younger than 14 years (n=3 patients). Diseases that prompted the use of HPN were mesenteric ischemia (29.7%), followed by neoplasms (16.2%), radiation enteritis (12.2%), motility impairments (8.1%), and Crohn's disease (5.4%). Tunneled catheters were used in 52.7% of cases, as compared to 36.5% of subcutaneous reservoirs. Mean treatment duration was 8.7 +/- 4.4 months; 68.9% of patients remained on HPN for a duration longer than 6 months, and in 41.9% longer than one year. Patients' follow-up was mainly done from the reference hospital (87.8%), and the remaining patients (12.5%) by the home care team. In no case patients were followed by the primary care team or other specialists than the ones that prescribed nutritional support. In 94 cases there were complications related to nutritional therapy. The more frequent complications presented were infectious. These complications represented 1.84 admissions per patient. The mean number of visits was 12.9 per patient (10.2 routinary visits and 2.7 emergency visits). At the end of the year, we observed that 74.3% patients stayed in the program, whereas in the remaining 23.6% HPN had been discontinued. The main causes for discontinuation were death (52.9%), and switch to oral diet (23.5%) or enteral nutrition (11.8%). With regards to disability degree, 16.1% were confined to a wheelchair or bed, and 17.6% had no disability at all or only a mild social disability. CONCLUSIONS: We observed a sustained HPN prevalence rate in Spain (1.8 patient pmp). The main cause for its use was short bowel syndrome secondary to vascular disease, followed by cancer. Complications associated to nutritional therapy were common, especially of infectious origin.

[The year 2002 national registry on home-based enteral nutrition]. / Registro nacional de la nutrición enteral domiciliaria del año 2002.

GOAL: To communicate the information available by the NADYA-SENPE Working Group from patients on Home Enteral Nutrition (HEN) in our country during the year 2002. MATERIAL AND METHODS: The data were collected through a closed questionnaire included in the web site of the Working Group (www.nadya-senpe.com) available only by the authorized users. Variable included were: epidemiological information, the indication to prescribe this treatment, the access path, the specific nutritional formula used, the treatment duration, the complications and hospital readmission related to the nutritional treatment, the follow-up and the quality of life. RESULTS: We register 3967 patients that belong to twenty-one hospitals. Mean age from those adults 69.2 +/- 19.2 years, and from those younger than 14, 5.6 +/- 4.1 years. Neurological and neoplasic diseases were the diagnostics more frequents (39.2% and 34.6%, respectively). Oral nutrition was the preferential rout used for the enteral nutrition (53.6%) followed by naso-enteral tube (30.6%), and only in 15.8% we used ostomy tubes. Polymeric was the enteral formula mainly utilized (81.5%). The mean time on HEN was 5.8 +/- 4.4 months; the 35.7% of patients stayed in the treatment for less than 3 months, 22.4% between 3 and 6 months, and 41.6% more than 6 months. Patients were followed mainly by Nutritional Support Unit from the reference hospital (75.3%). While the reference hospital supplies the material (65.7%), reference hospital pharmacy (43%) and public pharmacies (37.3%) provides the enteral formula. Complications related to enteral nutrition included change of enteral tube (29.7%), mechanical complications (22.9%), gastrointestinal complications (22.9%), and the metabolic one (9.2%). These complications were followed by 0.02 hospitalizations/patient. At the end of the year, 49.3% of patients were in the HEN programme, and in 41.5% HEN was finish due to accept oral conventional alimentation (47.3%) or by deceased of patients. While 31.8% of the patients were confined to bed o armchair, 17.8% no o light discapacity degree was observed. CONCLUSIONS: We found a persistence of these treatment in our country (96.5 patients/million inhabitants. Neurological and neoplasic diseases were the more frequent diagnosis in patients analysed. The high prevalence of cancer patients could be the main cause of oral access for enteral nutrition. Change of enteral tube was the more frequent complication observed during this treatment.

Soporte nutricional basado en la evidencia / Evidence-based nutritional support

Cuando se plantea el inicio de un soporte nutricional artificial, la elección de la vía de acceso viene determinada por la posibilidad de utilizar, con seguridad y eficacia, el tracto digestivo. La decisión en muchos casos no presenta problemas. Sin embargo, hay situaciones en las que el concepto de "intestino utilizable" no está claro, y en estas circunstancias es cuando se plantea la controversia. Son numerosos los estudios clínicos realizados que comparan las 2 modalidades de nutrición artificial, pero desgraciadamente no existen grandes estudios prospectivos aleatorizados que aporten un nivel de evidencia adecuado. En un intento de obviar esta carencia y extraer conclusiones válidas de los datos aportados en estudios prospectivos aleatorizados previos se han realizado varios metaanálisis en que se compara el uso de la nutrición parenteral y la enteral. Con varias discrepancias, los diversos metaanálisis realizados concluyen que no existen diferencias en la mortalidad cuando se compara la nutrición parenteral y la enteral, mientras que la segunda se asocia con un menor riesgo de presentar complicaciones infecciosas, sobre todo si se inicia de manera temprana; los pacientes malnutridos son los que más se benefician de la intervención nutricional. Los resultados se deben interpretar con cautela debido a la baja calidad metodológica de muchos de los estudios incluidos y a la gran heterogeneidad existente. Se hace necesario disponer de estudios prospectivos aleatorizados con el suficiente número de pacientes con enfermedades concretas que permitan disponer en un futuro de un adecuado nivel de evidencia científica (AU)

When considering initiation of artificial nutritional support the choice of route of access is determined by the possibility of using the digestive tract safely and effectively. In many patients this decision is problem free. However, there are some situations in which the concept of "usable intestine" is not clear, leading to controversy. Numerous clinical trials have compared the two modalities of artificial nutrition, but unfortunately there are no large prospective randomized trials that provide an adequate level of evidence. In an attempt to meet this need and to extract valid conclusions from the data reported in previous prospective randomized trials, several meta-analyses comparing the use of enteral nutrition (EN) and parenteral nutrition (PN) have been performed. Although there are some discrepancies, the various meta-analyses performed tend to conclude that there are no differences in mortality between EN and PN while EN is associated with a lower risk of infectious complications, especially when initiated early, and that the patients who benefit most from nutritional intervention are those with malnutrition. Because of the poor methodological quality of many of the studies included and their wide heterogeneity, the results should be interpreted with caution. For a sufficient level of evidence to become available, prospective randomized trials with a sufficient number of patients should be performed in specific diseases (AU)

[National Registry of Home Parenteral Nutrition of the year 2001]. / Registro Nacional de la Nutrición Parenteral Domiciliaria (NPD) del año 2001.

AIM: We analyse the registered data of home parenteral nutrition (HPN) in our country during the year 2001. METHOD: The data were collected through a previously designed questionnaire. Apart from epidemiological information, the form includes the disease to prescribe this treatment, the specific nutritional treatment used and its duration, access path, complications and readmission rate in hospital, follow-up of the treatment, and progress. All data were processed and analysed by the co-ordinating team. RESULTS: Seventeen hospitals participated, and 66 patients were enrolled. Middle age was 5.5 +/- 4.9 years for patients < 14 years old, and 49.2 +/- 15.8 years for those > or = 14 years old. The more prevalent diagnosis were: ischemic bowel (28.9%), neoplasm (22.7%), radiation enteritis (12.1%), motility disorders (4.5%) and Crohn's disease (4.5%). The mean time on HPN was 8.4 +/- 4.5 months. Tunnelled catheter was the preferential route (62.1%), followed by the implantated one (33.3%). The intermittent method (nocturnal) was preferential (81.8%). Patients receive the formula, mainly from hospital pharmacy (75.7%). The complications related to nutrition (1.3/patient) included the infections (0.46 sepsis/patient, and 0.19 catheter contamination/patients), mechanic (0.15/patient), metabolic (0.1/patient) and electrolytic disorders (0.07/patient). The readmission rate, for nutritional problems, was 1.34/patient. At the end of the year, 74.2% of the patients remained in the HPN program, and 25.8% abandoned the treatment (due to death: 52.9%, and to progress to oral feeding (25.3%). CONCLUSIONS: This review illustrates that the registration of HPN patients in our country is standing (1.65 patients/10(6) habitants), that vascular pathology is the more frequent diagnoses in HPN patients, and the rate of readmission and complications and the behaviour is similar to other series making this as a safe treatment in our place.

[Home Enteral Nutrition: National Registry 2001]. / Nutrición Enteral Domiciliaria (NED): registro nacional 2001.

GOAL: The NADYA-SENPE Working Group analyzed the registered data of patients on Home Enteral Nutrition (HEN) in our country, during year 2001. MATERIAL AND METHODS: The data were collected through a closed questionnaire included on our web site (www.nadya-senpe.com). Apart from epidemiological information, the form includes the indication to prescribe this treatment, the specific nutritional treatment used and its duration, access path, complications and readmission rate in hospital, follow-up of the treatment, patient's quality of life and progress. All data were processed and analyzed by the coordinating team. RESULTS: Twenty two hospitals participated and 3,458 patients, aged 5.6 +/- 4.0 y for those younger than 14 y, and 67.1 +/- 19.5 y for those older than 14 y, were enrolled. Of these patients, 43.4% were diagnosed with neurological diseases and 33.5% with cancer. The mean time on HEN was 6.5 +/- 4.5 months. Oral nutrition was the preferential route (54.5%), followed by nasoenteral tube (32.3%), and in 13.3% ostomy tubes were placed. Polymeric was the formula composition mainly used (85.9%). Patients were followed (71.1%) by the hospital reference Nutritional Support Unit. The complications related to nutrition included mainly the gastrointestinal (0.16 complications/patient), and the mechanical one (0.15 complications/patient). At the end for the year, 48.3% of the patients were in the HEN program, and in 33.3% HEN was finish due to different reasons. In 22.9% of the patients no, o light, discapacity degree was found. CONCLUSIONS: Neurological diseases and cancer were the more frequent diagnoses in HEN patients. Oral access was the higher feeding route due, probably, to the high prevalence of cancer patients. In spite of the elevated prevalence of neurological diseases, a few number of patients, as previous years, were feed with ostomy tube. Due to the few complications observed, HEN is a safe treatment in our country.

Registro Nacional de la Nutrición Parenteral Domiciliaria (NPD) del año 2001 / Registered data of home parenteral nutrition (HPN) in our country during the year 2001

Objetivo: El objetivo de este estudio es analizar los datos registrados por el Grupo de Trabajo NADYA-SENPE de pacientes que han recibido Nutrición Parenteral Domiciliaria (NPD) en nuestro país durante el año 2001. Material y métodos: A partir de un cuestionario previamente diseñado, los médicos del grupo NADYA introducen en la página web (www.nadya-senpe.com), para su ulterior análisis, datos epidemiológicos, diagnóstico, vía de acceso, complicaciones, ingresos hospitalarios, duración del tratamiento, evolución y calidad de vida de los pacientes con NPD. Resultados: Los datos correspondían a 66 pacientes (edad media de 5,5 ñ 4,9 años para pacientes < 14 años y 49,2 ñ 15,8 años para 14 años) controlados por 17 centros hospitalarios. Las patologías que con más frecuencia han comportado este tratamiento fueron: isquemia mesentérica (28,9 por ciento), seguida de enfermedad neoplásica (22,7 por ciento), enteritis rádica (12,13 por ciento), alteraciones de la motilidad (4,5 por ciento) y enfermedad de Crohn (4,5 por ciento), entre otras. Se observó un predominio de los catéteres tunelizados (62,1 por ciento) sobre los implantados (33,3 por ciento) y de la administración cíclica (nocturna) de la nutrición parenteral (NP) (81,8 por ciento). Las farmacias hospitalarias suministraron las fórmulas de NPD con más frecuencia que el Nutriservice (75,7 por ciento versus 24,3 por ciento). La duración media del tratamiento fue de 8,43 ñ 4,52 meses. Se presentaron 86 complicaciones relacionadas con el tratamiento nutritivo (1,3 / paciente), con predominio de las infecciosas (0,67 / paciente) (sepsis: 0,46 / paciente y contaminación de catéter: 0,19 / paciente), seguidas de las mecánicas (0,15 / paciente), de las metabólicas (0,1 / paciente) y de las hidroelectrolíticas (0,07 / paciente). Estas complicaciones comportaron 1,34 hospitalizaciones / paciente. Al finalizar el año, seguían en activo 74,2 por ciento de los pacientes; mientras que en el resto (25,8 por ciento) se había retirado este tratamiento. Las principales causas de retirada fueron por éxitus (52,9 por ciento) y por pasar a depender de dieta oral (25,3 por ciento). El 10,6 por ciento estaban confinados en silla o cama y el 10,6 por ciento no presentaba ningún grado de incapacidad. Conclusiones: Aunque inferior a otros países europeos, se mantiene el número de pacientes con NPD registrados en nuestro país (1,65 pacientes / 106 habitantes). Si bien predomina la patología vascular, sigue creciendo el peso de las neoplasias. Predominio de las complicaciones infecciosas que generan la mayoría de los ingresos hospitalarios (AU)

Aim: We analyse the registered data of home parenteral nutrition (HPN) in our country during the year 2001. Method: The data were collected through a previously designed questionnaire. Apart from epidemiological information, the form includes the disease to prescribe this treatment, the specific nutritional treatment used and its duration, access path, complications and readmission rate in hospital, follow-up of the treatment, and progress. All data were processed and analysed by the co-ordinating team. Results: Seventeen hospitals participated, and 66 patients were enrolled. Middle age was 5.5 ± 4.9 years for patients < 14 years old, and 49,2 ± 15.8 years for those ≥ 14 years old. The more prevalent diagnosis were: ischemic bowel (28.9%), neoplasm (22.7%), radiation enteritis (12.1%), motility disorders (4.5%) and Crohn's disease (4.5%). The mean time on HPN was 8.4 ± 4.5 months. Tunnelled catheter was the preferential route (62.1%), followed by the implantated one (33.3%). The intermittent method (nocturnal) was preferential (81.8%). Patients receive the formula, mainly from hospital pharmacy (75.7%). The complications related to nutrition (1.3/patient) included the infections (0.46 sepsis/patient, and 0,19 catheter contamination/patients), mechanic (0.15/patient), metabolic (0.1/patient) and electrolytic disorders (0.07/patient). The readmission rate, for nutritional problems, was 1.34/patient. At the end of the year, 74.2% of the patients remained in the HPN program, and 25.8% abandoned the treatment (due to death: 52.9%, and to progress to oral feeding (25.3%). Conclusions: This review illustrates that the registration of HPN patients in our country is standing (1.65 patients/106 habitants), that vascular pathology is the more frequent diagnoses in HPN patients, and the rate of re-admission and complications and the behaviour is similar to other series making this as a safe treatment in our place (AU)

Nutrición enteral domiciliaria (NED): registro nacional 2001 / Home enteral nutrition (HEN) in our country, during the year 2001

Introducción y objetivos: Análisis del registro de los pacientes en programa de Nutrición Enteral Domiciliaria (NED) en nuestro país durante el año 2001. Material y métodos: Estudio analítico realizado mediante una base de datos incluida en la web del Grupo NADYA (www.nadya-senpe.com) con los pacientes en NED el año 2001. Han participado 22 hospitales. Se aportan datos epidemiológicos, diagnósticos, vía de acceso, pautas de administración, fórmulas, duración, complicaciones, evolución y grado de incapacidad. Resultados: Incidencia: Se han comunicado 3.458 pacientes, 1.818 varones (53,7 por ciento) y 1.567 hembras (46,3 por ciento). Edad media 5,6 ñ 4,0 años en los menores de 14 años, y 67,1 ñ 19,5 en los mayores de 14 años. Patologías: Predominio de la patología neurológica (43,4 por ciento), seguida de la neoplásica (33,5 por ciento) sobre las demás. Duración: Tiempo medio en NED de 6,5 ñ 4,5 meses. Vías de administración: La vía oral es la más frecuente (54,5 por ciento), seguida de la sonda naso gástrica (SNG) (32,2 por ciento) y de las ostomías (13,3 por ciento). Formas de administración: Predominio de la forma discontinua (66,1 por ciento), mediante goteo (43,4 por ciento) o bolus (22,7 por ciento). Fórmula: La fórmula polimérica fue la más utilizada (85,9 por ciento). Seguimiento: Los pacientes fueron mayoritariamente controlados por la unidad de nutrición de su hospital de referencia (69,3 por ciento). Hospitalizaciones: Se han registrado 7,3 por ciento hospitalizaciones asociadas a la nutrición [0,02 hospitalizaciones / paciente (c / p)]. Complicaciones: Las más frecuentes relacionadas con la nutrición fueron las gastrointestinales (25,9 por ciento; 0,16 c / p) y las mecánicas (24,2 por ciento, 0,15 c / p). Las diarreas han sido las complicaciones gastrointestinales más frecuentes (11,5 por ciento, 0,07 c / p). Evolución: Al finalizar el año el 48,3 por ciento de los pacientes continuaban en activo, mientras que en un 33,3 por ciento se suspendió la NE y en 18,4 por ciento no hubo continuidad de seguimiento. La causa más común de suspensión fue el paso a nutrición oral convencional (47,3 por ciento), seguido de la muerte relacionada con la enfermedad de base (43,5 por ciento). Un 29,7 por ciento de los pacientes estaban confinados en cama o silla, mientras que un 22,9 por ciento no presentaba prácticamente ningún grado de incapacidad. Conclusiones: Persiste la vía de administración oral como la más prevalente frente a la sonda y ostomía. Predominio de la patología neurológica. El bajo número de complicaciones e ingresos comportan que la NED sea un tratamiento seguro en nuestro medio (AU)

Goal: The NADYA-SENPE Working Group analyzed the registered data of patients on Home Enteral Nutrition (HEN) in our country, during year 2001. Material and methods: The data were collected through a closed questionnaire included on our web site (www.nadya-senpe.com). Apart from epidemiological information, the form includes the indication to prescribe this treatment, the specific nutritional treatment used and its duration, access path, complications and read-mission rate in hospital, follow-up of the treatment, patient's quality of life and progress. All data were precessed and analyzed by the coordinating team. Results: Twenty two hospitals participated and 3,458 patients, aged 5.6 ± 4.0 y for those younger than 14 y, and 67.1 ± 19.5 y for those older than 14 y, were enrolled. Of these patients, 43.4% were diagnosed with neurological diseases and 33.5% with cancer. The mean time on HEN was 6.5 ± 4.5 months. Oral nutrition was the preferential route (54.5%), followed by nasoenteral tube (32.3%), and in 13.3% ostomy tubes were placed. Polymeric was the formula composition mainly used(85.9%). Patients were followed (71.1%) by the hospital reference Nutritional Support Unit. The complications related to nutrition included mainly the gastrointestinal (0.16 complications/patient), and the mechanical one (0.15 complications/patient). At the end for the year, 48.3% of the patients were in the HEN program, and in 33.3% HEN was finish due to different reasons. In 22.9% of the patients no, o light, discapacity degree was found. Conclusions: Neurological diseases and cancer were the more frequent diagnoses in HEN patients. Oral access was the higher feeding route due, probably, to the high prevalence of cancer patients. In spite of the elevated prevalence of neurological diseases, a few number of patients, as previous years, were feed with ostomy tube. Due to the few complications observed, HEN is a safe treatment in our country (AU)

[Parenteral nutrition at home: NADYA register for the year 2000]. / Nutrición parenteral domiciliaria (NPD): registro NADYA. Año 2000.

AIM: We analyze the registered data of home parenteral nutrition (HPN) in our country during the year 2000. METHOD: The data were collected through a previously designed questionnaire. Apart from epidemiological information, the form includes the disease to prescribe this treatment, the specific nutritional treatment used and its duration, access path, complications and readmission rate in hospital, follow-up of the treatment, and progress. All data were processed and analysed by the co-ordinating team. RESULTS: Fourteen hospitals participated, and 67 patients were enrolled. Middle age was 5 +/- 4 years for patients < 14 years old, and 48 +/- 15 years for those > or = 14 years old. The more prevalent diagnosis were: ischemic bowel (28.4%), neoplasm (16.4%), radiation enteritis (13.4%), motility disorders (7.5%), Crohn's disease (2.9%), and other. The mean time on HPN was 7.5 +/- 4.4 months. Tunelized catheter was the preferential route (77.6%), followed by the implantated one (20.9%). The intermittent method (nocturnal) was preferential (91.0%). Patients receive the formula from hospital pharmacy more frequently than from Nutriservice (71.5% versus 19.4%). The complications related to nutrition (0.32/100 days of HPN) included the infections (0.12 catheter sepsis/100 d of HPN), metabolic (0.06/100 d of HPN), mechanic (0.03/100 d of HPN) and electrolitic disorders (0.03/100 d of HPN). The readmission rate, for nutritional problems, was 0.3 hospitalizations/100 d of HPN. At the end of the year, 61.2% of the patients remained in the HPN program, 37.3% abandoned the treatment (due to death (40%), to progress to oral feeding (48%), and to progress to enteral nutrition (4%); and 1.5% of the patients were not follow up. CONCLUSIONS: This review illustrates that there is an increment in the registration of HPN patients in our country (1997: 0.7 patients/10(6) habitants, 2000: 1.9 patients/10(6) habitants), that vascular pathology is the more frequent diagnoses in HPN patients, and the rate of readmission and complications and the behaviour is similar to other series making this as a safe treatment in our place.

[Enteral nutrition at home: National register for the year 2000]. / Nutrición enteral domiciliaria (NED): Registro Nacional del año 2000.

GOAL: Once again, the NADYA-SENPE Working Group analysed the registered data of Home Enteral Nutrition (HEN) in our country, during the year 2000. MATERIAL AND METHODS: The data were collected through a closed questionnaire included on our web site (www.nadya-senpe.com). Apart from epidemiological information, the form includes the indication to prescribe this treatment, the specific nutritional treatment used and its duration, access path, complications and readmission rate in hospital, follow-up of the treatment, patient's quality of life and progress. All data were processed and analysed by the co-ordinating team. RESULTS: Twenty two hospital participated and 2,986 patients, aged 65.1 +/- 19.7 years, were enrolled. Of these patients, 41.2% were diagnosed with neurological diseases and 33.3% with cancer. The mean time on HEN was 6.3 +/- 4.4 months. Oral nutrition was the preferential route (50.8%), followed by nasoenteral tube (30.5%), and in 17.4% ostomy tubes were placed. Polymeric was the formula composition mainly used (83.2%). Patients were followed (70.1%) by the hospital reference Nutritional Support Unit. The complications related to nutrition included the gastrointestinal (0.25 complications/patient), the mechanical one (0.19 complications/patient), and the metabolic (0.007 complications/patient). Feeding tube need to be replaced 0.3 times/patient/year. The readmission rate, for nutritional problems, was observed in 0.03 patients. At the end of the year, 54.9% of the patients were in the HEN program, and in 30.3% HEN was finish due to different reasons. In 21.9% of the patients no, o light, discapacity degree was found. CONCLUSIONS: Related to previous years, there is an increment in the number of enrolled patients. Neurological diseases and cancer were the more frequent diagnoses in HEN patients. Oral access was the higher feeding route due, probably, to the high prevalence of cancer patients. In spite of the elevated prevalence of neurological diseases, a few number of patients were feed with ostomy tube. Finally, due to the few readmission rate and complications, HEN is a safe treatment in our country.