Factores de riesgo para las anormalidades de enzimas hepáticas de la nutrición parenteral en un hospital de referencia de México / Risk factors for abnormal liver function tests of parenteral nutrition in a referral hospital in Mexico

Introducción: Las anormalidades en las pruebas de funcionamiento hepático (APFH) y las complicaciones Hepáticas (CH) de la Nutrición Parenteral (NP) son frecuentes y a menudo multifactoriales. Aún no han sido evaluados dichos factores de riesgo en población mexicana adulta. Objetivo: Determinar si la dosis de lípidos prescrita de mayor a 1 g/kg es factor de riesgo para las anormalidades en pruebas de función hepática (APFH) de la NP. Material y métodos: Cohorte que incluyo pacientes mayores de 15 años de edad y excluyó aquellos que fueron manejados en la unidad de cuidados intensivos o con anormalidades en las enzimas hepáticas previo al inicio de NP. Los grupos expuesto (GE) y no expuesto (GNE) fueron aquellos que recibieron más de un gramo y un gramo o menos por kilo de peso de lípidos respectivamente. Las APFH fueron definidas como un incremento mayor al 50% de lo normal de AST, ALT, FA o Bilirubina Total. Resultados: La incidencia de APFH fue de 20 (47,6%) y15 (41,6%), en los GE y GNE respectivamente (RR 1,14IC 95% 0,69-1,88; p = 0,59). El patrón de daño hepático más común fue el colestásico, seguido del mixto y finalmente el hepatocelular. La dosis de lípidos prescrita de más de 1 g/kg, no se asoció con el desarrollo de CH de la APFH. A mayor dosis de proteínas menor frecuencia de APFH Conclusión: La dosis de lípidos prescrita de más de 1g/kg, no se asoció con el desarrollo de APFH de la NP en nuestra población. Estos hallazgos requieren ser confirmados en Ensayos clínicos (AU)

Introduction: the abnormalities in liver function tests (LFTs) and liver complications (LC) from parenteral nutrition (PN) are common and usually multi-factorial. These factors have not yet been assessed in the adult Mexican population. Objective: To determine whether the dose prescribed >1 g/kg is a risk factor for the abnormalities in liver function tests (LFTs) from PN. Material and methods: Cohort study including patients older than 15 years and excluding those managed at the intensive care unit or with abnormalities in liver enzymes before the start of PN. The exposed and non-exposed groups were those receiving > 1 g of lipids per kg of bodyweight or < 1 g/kg, respectively. LFTs were defined as an increase higher than 50% of the normal range for AST,ALT, AF or total bilirrubin. Results: the incidence of LFTs abnormalities was 20(47.6%) and 15 (41.6%) in the exposed and non-exposed groups, respectively (RR 1.14 95% IC: 0.69-1.88; p =0.59). The most frequent liver damage pattern was cholestatic, followed by the mixed pattern and then hepatocellular. The dose of prescribed lipids > 1 g/kg was not associated with the development of LC from LFTs abnormalities. The higher the dose of proteins the lower the frequency of LFTs abnormalities. Conclusion: The dose of lipids prescribed >1 g/kg was not associated with the development of LFTs abnormalities from PN in our sample population. These findings should be confirmed in clinical trials (AU)

[Risk factors for abnormal liver function tests of parenteral nutrition in a referral hospital in Mexico]. / Factores de riesgo para las anormalidades de enzimas hepáticas de la nutrición parenteral en un hospital de referencia de México.

INTRODUCTION: the abnormalities in liver function tests (LFTs) and liver complications (LC) from parenteral nutrition (PN) are common and usually multifactorial. These factors have not yet been assessed in the adult Mexican population. OBJECTIVE: To determine whether the dose prescribed > 1 g/kg is a risk factor for the abnormalities in liver function tests (LFTs) from PN. MATERIAL AND METHODS: Cohort study including patients older than 15 years and excluding those managed at the intensive car unit or with abnormalities in liver enzymes before the start of PN. The exposed and non-exposed groups were those receiving > 1 g of lipids per kg of body weight or < 1 g/kg, respectively. LFTs were defined as an increase higher than 50% of the normal range for AST, ALT, AF or total bilirrubin. RESULTS: the incidence of LFTs abnormalities was 20 (47.6%) and 15 (41.6%) in the exposed and non-exposed groups, respectively (RR 1.14 95% IC: 0.69-1.88; p = 0.59). The most frequent liver damage pattern was cholestatic, followed by the mixed pattern and then hepatocellular. The dose of prescribed lipids > 1 g/kg was not associated with the development of LC from LFTs abnormalities. The higher the dose of proteins the lower the frequency of LFTs abnormalities. CONCLUSION: The dose of lipids prescribed >1 g/kg was not associated with the development of LFTs abnormalities from PN in our sample population. These findings should be confirmed in clinical trials.

[C-peptide measurement in patients with type II diabetes mellitus: its possible use in the insulin therapy decision]. / La medición del péptido C en los pacientes con diabetes mellitus (DM) Tipo II: su posible utilidad en la decisión de terapia insulínica.

Considering pancreatic reserve recognition a more rational basis for starting insulin therapy in NIDDM, during 1988 we studied fasting and post-breakfast plasma C-peptide levels in 31 patients (21 w, 10 m, mean age 48.2 +/- 17.7 yr), referred to our department for insulin therapy evaluation because of primary or secondary failure to other measures. Major features were obesity and chronically uncontrolled illness. Our patients were categorized as follows: group A, considered non responders which included four patients; group B, taken as responders consisting in seven; and a remaining of 20 hyperresponsive patients which formed group C; these with patients of group B, embodied an 87.1% of patients. Among nonresponders there was no any case of total B cell loss of function, and plasma C-peptide activity surpassed through those limits considered for ketoacidosis. We believe that these patients should be eligible candidates for insulin therapy. We failed to found out correlation of plasma C-peptide activity with either age or duration of illness. Our observation supports that fasting plasma C-peptide evaluation would suffice for pancreatic reserve evaluation. We conclude that our patients mainly presented an insulin resistant state associated with obesity thus enhancing the commonplace call for reinforcing nonpharmacologic treatment modalities such as caloric restriction, weight loss and exertion to achieve a better control in NIDDM patients.