Early versus conventional nutritional intervention in head and neck cancer patients before radiotherapy: benefits of a fast-track circuit.

BACKGROUND/OBJECTIVES: Radiotherapy (RT) is a component of therapy for head and neck cancer (HNC) with a negative nutritional impact. Our aim was to compare an early versus a conventional nutritional intervention. SUBJECTS AND METHODS: Retrospective study of HNC patients undergoing RT. Evolution before and after the establishment of a fast-track circuit was evaluated. A conventional group (CG) made up of patients submitted to the nutrition unit during RT after nutritional deterioration, was compared to an early group (EG) represented by patients included in a fast-track circuit, starting nutritional follow-up before the beginning of RT. Only patients with preserved oral intake were involved. Demographic, nutritional and clinical variables were analyzed. Data of hospitalizations and deaths were collected up to three months after RT. RESULTS: 135 subjects constituted the EG and 39 the CG. At baseline, the prevalence of malnutrition was lower in the EG (31.9% vs 69.5%, p = 0.0001), as was the need for nutritional supplements (40% vs 79.5%, p = 0.0001) or nasogastric tube (0% vs 12.8%, p = 0.0001) in comparison to the CG. Three months after RT, there were less patients with oral nutritional support in the EG (79.1% vs 96.9%, p = 0.018), and the number of emergency visits (0.75 vs 1.1 episodes per patient, p = 0.021) and hospitalizations was also lower in this group (29% vs 59%, p = 0.044). CONCLUSIONS: The fast-track approach made early intervention possible. Therefore, patients maintained a better nutritional status, needed less nutritional support and their evolution improved, with a significant decrease in hospitalizations.

Burden assessment in caregivers of patients with home artificial nutrition: a need and a challenge.

BACKGROUND/OBJECTIVES: Caregiving can be a stressful task with severe consequences on caregivers' health. Our aim was to evaluate the profile and the burden of caregivers of patients with home artificial nutrition (HAN) in our area. SUBJECTS/METHODS: We conducted a prospective observational study of patients who had started HAN over a period of a year (n=573) and their home caregivers (n=103). Epidemiological characteristics of the patients and the type of HAN were registered. Caregivers' profile data (gender, age and degree of kinship) and Zarit Burden Assessments were recorded. RESULTS: Care recipients had a median age of 79.0 (IQR 87) years, neurological and oncological diseases in 50% and a high rate of mobility limitations (80%). Oral supplements with high-calorie formulas were predominant (60%). The usual caregiver profile was a patient's daughter with a mean age of 53.1 (s.d. 13.4) years acting as the primary caregiver. Burden was absent in 49.5%, light in 18.4% and intense in 32% of caregivers. Intense burden was more frequent in oral over enteral nutrition (42% versus 22.6%; P=0.036). Supplementary nutrition was also associated with higher caregiver burden scores compared with complete diets. In patients with functional limitations, a tendency toward a slightly higher burden was observed. No differences in caregiver burden were detected according to other patient or caregiver characteristics. CONCLUSIONS: HAN type appears to be a factor influencing caregiver burden and therefore, evaluation of caregiver burden should be part of HAN programs.

Home enteral nutrition in Spain; NADYA registry 2011-2012.

OBJECTIVE: To describe the results of the home enteral nutrition (HEN) registry of the NADYA-SENPE group in 2011 and 2012. MATERIAL AND METHODS: We retrieved the data of the patients recorded from January 1st 2011 to December 31st 2012. RESULTS: There were 3021 patients in the registry during the period from 29 hospitals, which gives 65.39 per million inhabitants. 97.95% were adults, 51.4% male. Mean age was 67.64 ± 19.1, median age was 72 years for adults and 7 months for children. Median duration with HEN was 351 days and for 97.5% was their first event with HEN. Most patients had HEN because of neurological disease (57.8%). Access route was nasogastric tube for 43.5% and gastrostomy for 33.5%. Most patients had limited activity level and, concerning autonomy, 54.8% needed total help. Nutritional formula was supplied from chemist's office to 73.8% of patients and disposables, when necessary, was supplied from hospitals to 53.8% of patients. HEN was finished for 1,031 patients (34.1%) during the period of study, 56.6% due to decease and 22.2% due to recovery of oral intake. CONCLUSIONS: Data from NADYA-SENPE registry must be explained cautiously because it is a non-compulsory registry. In spite of the change in the methodology of the registry in 2010, tendencies regarding HEN have been maintained, other than oral route.

Objetivos: Describir los resultados del registro de nutrición enteral domiciliaria (NED) del grupo NADYASENPE de los años 2011 y 12. Material y métodos: Se recopilaron los datos introducidos en el registro desde el 1 de enero de 2011 al 31 de diciembre de 2012. Resultados: Hubo 3021 pacientes en el registro durante el periodo, procedentes de 29 hospitales, lo que da una prevalencia de 65,39 casos por millón de habitantes. 97.95% fueron adultos, 51,4% varones. La edad media fue 67,64 ± 19,1 años y la mediana 72 años para los adultos y 7 meses para los niños. La duración media de la NED fue 351 días y para el 97,5% fue el primer episodio con NED. La mayoría de pacientes tenían NED por una enfermedad neurológica (57,8%). La vía de acceso fue sonda nasogástrica para el 43,5% y gastrostomía para el 33,5%. La mayoría de pacientes tuvieron un nivel de actividad física limitado y, respecto a la autonomía, 54,8% necesitaba ayuda total. La fórmula de nutrición se suministró desde las oficinas de farmacia para el 73,8% y los fungibles, cuando fueron necesarios, desde los hospitales para el 53,8%. La NED se suspendió en 1.031 pacientes (34,1%) durante el periodo de estudio, 56,6% debido a fallecimiento y 22,2% debido a recuperación de la vía oral. Conclusiones: Los datos del registro NADYA-SENPE deben ser interpretados con precaución ya que se trata de un registro voluntario. A pesar del cambio de metodología del registro en 2010, las tendencias en NED se han mantenido, salvo la importancia cuantitativa de la vía oral.

[Adherence and fidelity in patients treated with intragastric balloon]. / Adherencia y fidelidad en el paciente tratado con balon intragastrico.

A correct treatment of obesity needs a program of habits modification regardless of the selected technique, especially if it is minimally invasive as the intragastric balloon (BIG). The adherence of the obese patients with regard to recommended drugs measures to medium- and long-term is less than 50%. Given that the results obtained using the technique of gastric balloon must be seen influenced by adherence to the modification of habits program and its fulfillment, we reviewed series published in attention to the program proposed with the BIG. The series published to date provide few details about the used Therapeutic Programs as well as the adherence of patients to them, and even less concerning the Monitoring Plan and the loyalty of the patient can be seen. We conclude the convenience to agree on a follow-up strategy, at least the 6 months during which the BIG remain in the stomach.

[Minimally invasive emergent techniques in obesity treatment]. / Técnicas mínimamente invasivas emergentes en el tratamiento de la obesidad.

INTRODUCTION: Obesity is a chronic disease for which several modalities of treatment are investigated today. One of them is the set of minimally aggressive techniques that have been added to the intragastric balloon. OBJECTIVE: To review the minimally invasive techniques described in the last years for the treatment of obesity. MATERIAL AND METHOD: It consisted in reviewing the bibliography through the habitual finders, in addition to the obtained data of the companies. They are classified in restrictive and malabsortive, and the restrictive are divides in mechanical or functional restriction. RESULT: Between mechanical restrictive the classified as we included in the restrictive emergent techniques the adjustable intragastric balloon, the intragastric prosthesis, the vertical endoluminal gastroplasty and the transoral gastroplasty. In order to obtain a functional restriction, we have the gastric pacemaker and the botulinic toxin. And finally, the endoluminal duodenojejunal bypass is described as a malabsortive technique. DISCUSSION: With less than 10 years of existence, it seems that the described techniques compensate their smaller effectiveness compared to the surgical techniques, with the absence of substantial modifications in the anatomy of the alimentary tract. None of these techniques is free of risks and complications.

[The registry of home artificial nutrition and ambulatory of the Spanish Society of Parenteral and Enteral Nutrition; SWOT analysis]. / El registro de Nutrición Artificial Domiciliaria y Ambulatoria de la Sociedad Española de Nutrición Parenteral y Enteral; análisis DAFO.

OBJECTIVE: To evidence by means of a SWOT-R analysis performed by an expert consensus the most worrying characteristics of the register on Home-based and Outpatient Artificial Nutrition. MATERIAL AND METHODS: SWOT-R analysis with expert consensus. We requested the participation of the active members of the NADYA group within the last 5 years with the premise of structuring the SWOT-R based on the characteristics of the NADYA registry from its beginning. RESULTS: 18 experts from hospitals all over Spain have participated. The internal analysis seems to be positive, presenting the registry as having important resources. The external analysis did not show a great number of threats, there are very potent factors, "the voluntariness" of the registry and the "dependence on external financing". The opportunities identified are important. The recommendations are aimed at stabilizing the system by decreasing the threats as one of the main focus of the strategies to develop as well as promoting the items identified as opportunities and strengths. CONCLUSIONS: The analysis shows that the NADYA register shows a big potentiality for improvement. The proposed recommendations should be structured in order to stay on the track of development and quality improvement that has characterized the NADYA register from the beginning.

[Informed consent in the intragastric balloon supported by SENPE, SEEDO, SEN and SECO: legal aspects]. / Consentimiento informado en el balón intragástrico avalado por SENPE, SEEDO, SEN y SECO: aspectos médico-legales.

INTRODUCTION: Intra-gastric balloon (IGB) is an invasive, temporary, non-surgical technique for the treatment of obesity. Its outcomes mainly depend on the patient's collaboration. OBJECTIVE: The aim was to adapt the informed consent used for bariatric surgery to a method that has especial characteristics. MATERIALS AND METHODS: We used the informed consent proposed by ASAC for bariatric surgery and 8 statements related to IGB included in the WESTLAW ES database. RESULTS: The review of the statements defines the IGB treatment as a curative-intended and non-satisfactive therapy with an obligation of the means used, but not the outcomes, by the treating physician. Moreover, the obligations of providing a correct and complete information -which includes the dietary regime- should be observed, as well as the possible therapeutic alternatives and finally, the proceeding used should be in written. CONCLUSIONS: The informed consent is a medico-legal document which content should consider the latest jurisprudence on the minimally invasive techniques for the treatment of obesity.

[Home enteral nutrition in Spain: NADYA registry in 2010]. / Nutrición enteral domiciliaria en España: registro NADYA del año 2010.

OBJECTIVE: To describe the results of the home enteral nutrition (HEN) registry of the NADYA-SENPE group in 2010. MATERIAL AND METHODS: We retrieved the data of the patients recorded from January 1st to December 31st 2010. RESULTS: We registered 6,591 patients (51% males) with 6,688 episodes of HEN, from 32 hospitals. Mean age in those younger than 14 yr (4%) was 1 ± 2 yrs (m ± SD) and 69,9 ± 17,8 yrs in those older than 14 yr. The length of HEN was longer than 2 yrs in 76% of the patients. The most frequent underlying disease was neurological disorders 42%, followed by cancer 28% (mostly head and neck cancer 18%). We had information related to the enteral access route in only 626 cases (9,4%), 51% of them used nasogastric tubes, 27% gastrostomies, 10% oral route and 3% jejunostomies. Only 251 episodes were closed during the year, mostly due to patient death 57% and progress to oral diet 14%. The activity level was limited in 29% of the patients and 39% of them were bed- or chairridden. Total or partial help was needed by 68% of the patients. The hospitals and the private pharmacies delivered the enteral formula in 63% and 34% of the cases, respectively. The hospitals and the primary care centres delivered the disposables in 83% and 16% of the cases, respectively. CONCLUSIONS: The results of the 2010 HEN registry are similar to those published in previous years regarding the number and characteristics of the patients. We continue finding problems in the entrance of data referred to the enteral access route and the closing of the episodes.

[Home Parenteral Nutrition (HPN) registry in Spain for the years 2007, 2008 and 2009 (NADYA-SENPE Group)]. / Registro de la Nutrición Parenteral Domiciliaria (NPD) en España de los años 2007, 2008 y 2009 (Grupo NADYA-SENPE).

OBJECTIVE: To report the data of the Home Parenteral Nutrition (HPN) registry of the NADYA-SENPE working group for the years 2007, 2008 and 2009. METHODOLOGY: We compiled the data from the on-line registry introduced by the responsible Units for the monitoring of HPN from January 1st 2007 to December 31st 2009. Included fields were: age, sex, diagnosis and reason for HPN, access path, complications, beginning and end dates, complementary oral or enteral nutrition, activity level, autonomy degree, product and fungible material supply, withdrawal reason and intestinal transplant indication. RESULTS: 2007: 133 patients with HPN were registered (61 males and 72 females), belonging to 21 hospitals. Average age for the 119 patients older than 13 years old was 53.7 ± 14.9 years, and 3.6 ± 3.6 y. for the 14 patients under 14 years old. Most frequent pathology was neoplasm (24%), followed by intestinal motility disorders and actinic enteritis (14% both). The reason for HPN provision was short bowel syndrome (43%), malabsorption (27%), and intestinal obstruction (23%). Tunnelled catheters were mostly used (69%), followed by implanted port-catheters (27%). Catheter related infections were the most frequent complications, with a rate of 0.92 episodes/103 HPN days. HPN was provided for more than two years in 50% of the cases. By the end of 2007, 71.4% of the patients remained active; exitus was the most frequent reason to end HPN (57.5%). 26% of the patients were eligible for intestinal transplant. 2008: 143 patients with HPN were registered (62 males and 81 females), belonging to 24 hospitals. Average age for the 133 patients older than 13 years old was 54.7 ± 13.9 years, and 3.7 ± 0.6 y. for the 10 patients under 14 years old. Most frequent pathology was neoplasm (20%), followed by actinic enteritis (14%) and intestinal motility disorders (13% ). The reason for HPN provision was short bowel syndrome (44%), malabsorption (28%), and intestinal obstruction (20%). Tunnelled catheters were mostly used (60%), followed by implanted port-catheters (29%). Catheter related infections were the most frequent complications, with a rate of 0.50 episodes/10³ HPN days. HPN was provided for more than two years in 67% of the cases. By the end of 2008, 71.6% of the patients remained active; exitus was the most frequent reason to end HPN (52.4%). 29% of the patients were eligible for intestinal transplant. 2009: 158 patients with HPN were registered (62 males and 96 females), belonging to 24 hospitals. Average age for the 149 patients older than 13 years old was 55.2 ± 13.0 years. Most frequent pathology was neoplasm (25%), followed by actinic enteritis (12%) and intestinal motility disorders (11%). The reason for HPN provision was short bowel syndrome (42%), malabsorption, and intestinal obstruction (23% both). Tunnelled catheters were mostly used (60%), followed by implanted port-catheters (36%). Catheter related infections were the most frequent complications, with a rate of 0.67 episodes/10³ HPN days. HPN was provided for more than two years in 58% of the cases. By the end of 2009, 79.2% of the patients remained active; full oral nutrition was the most frequent reason to end HPN (48%). 23% 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 in the last two years, being the 2008 rate the smallest since the register's beginning.

[The Spanish Home Enteral Nutrition registry of the year 2009: from the NADYA-SENPE group]. / Registro español de Nutrición Enteral Domiciliaria del año 2009: Grupo NADYA-SENPE.

OBJECTIVE: To describe the Home Enteral Nutrition Characteristics (HEN) recorded by the group NADYA-SENPE during 2009. MATERIAL AND METHOD: collection and analysis of the data voluntary recorded in the HEN registry from the NADYA-SENPE group from January 1st to December 31st. RESULTS: 6.540 HEN patients were registered, 5.11% more than the previous year and 6,649 episodes (3,135 in women, 47,93%) from 32 different hospitals. 6,238 of them (95,38%) were over 14 years. The mean age of the patients under 14 yr was 3,67 ± 2,86 and it was 72,10 ± 16,89 in those over 14 yr group. The base illness registered more frequently was the neurological disorders in 2,732 (41,77%) patients, followed by cancer patients in 1,838; 28,10%. The enteral access route was registered in 1,123 (17,17%) of the episodes, being more frequent the administration by nasogastric tube 562 (50,04%). The mean length of nutritional treatment by episode was 323 days (10,77 months). 606 episodes of HEN ended, being the principal reasons for discontinuing treatment the patient death in 295 (48,68%) occasions. The transition to oral feeding occurred in 219 (36,14%) cases. Patients maintained normal activity in 2162 (32,55%) HEN episodes and 2,468 (37,13%) cases were living "bed-couch". The level of dependence was "total" in 2,598 (39,07%) of the episodes recorded. The nutritional formula was provided by the hospital in 4,183 (62,91%) cases and by the reference pharmacy in 2,262 (el 34,02%). Consumables were provided by the hospital in 3,531 (53,11%) cases. CONCLUSIONS: The number of HEN patients recorded increased from the year 2008, continuing the gradual growth increase since the start of registration. The characteristics of the patients remain in the same profile as in previous years.

[Spanish home enteral nutrition (HEN) registry of the year 2008 from the NADYA-SENPE group]. / Registro del Grupo NADYA-SENPE de Nutrición Enteral Domiciliaria en España en el año 2008.

AIM: To present the results of the Spanish home enteral nutrition (HEN) registry of the year 2008 from the NADYA-SENPE group. MATERIAL AND METHODS: We recorded the HEN registry data from January 1st to December 31st 2008. RESULTS: The number of patients registered in this period was 6206 (51% male) with up to 6,279 episodes of HEN, from 31 Spanish hospitals. Most of the patients (95%) were older than 14 yr. Mean age was 4.83±3.29 yr in the children group, and 70.75±18.14 yr in the adult group (older than 14 yr). Neurological disorders (39%) and cancer (27%) were the two most prevalent diagnoses. The oral route was the most frequently used (43,4%), followed by nasogastric tube (40,4%), and gastrostomy tube (14,7%). Mean length of treatment was 305,36 days (10 months). The principal reasons for discontinuing treatment were death (43%) and progress to oral diet (40%). Only 33% of the patients had a normal activity level, being limited in different grades in the rest of the patients. Most of the patients required partial (25%) or total help (38%). The enteral formula was provided by the hospital in 65% of the cases and by private pharmacies in 32%. The disposables were provided by the hospital (82,4%) and primary care services (17,2%). CONCLUSIONS: The number and the age of the patients registered have increased comparing to previous years, with little variations in the rest of analyzed variables. The increase in the length of treatment could reflect misreporting of the weaning process in the registry.

[Adult celiac disease: endocrinological and nutritional issues]. / Enfermedad celíaca del adulto: aspectos endocrinológicos y nutricionales.

Celiac disease is an autoimmune enterophaty induced by the ingestion of gluten in genetically susceptible individuals. Although historically it was thought that it was an infrequent pediatric disease, now it is know that its prevalence is close to 1% in the general population. It is even higher between patients with some endocrine disorders and nutritional deficits. The use of antitransglutaminase and antiendomisium antibodies and the endoscopical duodenal biopsy are the cornerstones for its diagnosis. The introduction of a gluten-free diet will achieve the normalization of the intestinal mucosa. It will avoid the risk of long term complications and an it will achieve an improvement in quality of life. Medical and dietitian long term follow-up will be important to improve the compliance to the treatment.

[National registry of home enteral nutrition in Spain 2007]. / Registro de Nutrición Enteral Domiciliaria en España en el año 2007.

OBJECTIVE: To communicate the results from the registry of Home-Based Enteral Nutrition of the NADYASENPE group in 2007. MATERIAL AND METHODS: We included every patient in the registry with home enteral nutrition any time from January 1st to December 31st of 2007. RESULTS: The number of patients with home enteral nutrition in 2007 was 5,107 (52% male) from 28 different hospitals. 95.4% of them were 15 yr or older, with a mean age of 67.96 +/- 18.12, and 4.2 +/- 3.38 among patients aged 14 yr or less. The most common underlying diseases were neurological (37.8%) and neoplastic diseases (29.3%). Enteral nutrition was administered p.o. in most patients (63.5%), followed by nasogastric tube (25.9%), while gastrostomy was only used in 9.2%. The mean time in enteral nutrition support was 9.4 months and the most common reasons for withdrawal were death (58.7%) and switching to oral intake (32%). Activity was limited in 31.4% of patients and 36.01% were house-bound. Most patients needed partial (26.51%) or total (37.68%) care assistance. Enteral formula was provided by hospitals to 69.14% of patients and by pharmacies to 30.17% of them, while disposable material was provided by hospitals to 81.63% and by Primary Care to the remaining patients. CONCLUSIONS: In 2007, there has been an increase of more than 30% of patients registered with home enteral nutrition comparing with 2006, without any big difference in other data, but a higher proportion of patients with enteral nutrition p.o.

[Registry of home-based enteral nutrition in Spain for the year 2006 (NADYA-SENPE Group)]. / Registro de la Nutrición Enteral Domiciliaria en España en el año 2006 (Grupo NADYA-SENPE).

OBJECTIVE: To communicate the results obtained from the registry of Home-Based Enteral Nutrition (HBEN) of the NADYA-SENPE group for the year 2006. MATERIAL AND METHODS: Recompilation of the data from the HBEN registry of the NADYA-SENPE group from January 1st to December 31st of 2006. RESULTS: During the year 2006, 3,921 patients (51% men) from 27 hospital centers were registered. Ninety-seven percent were older than 14 years. The mean age for those < 14 years was 4.9 +/- 3.9 (m +/- SD) and in those > or = 14 years, it was 68.5 +/- 18.2 years. The most common underlying disease was neurological pathology (42%), followed by cancer (28%). Enteral nutrition was administered p.o. in 44% of the patients, through nasogastric tube in 40%, gastrostomy in 14%, and jejunostomy in 1%. The average time of nutritional support was 8.8 months. The most common reasons for ending the therapy were patient's death (54%) and switching to oral feeding (32%). Thirty-one percent of the patients presented a limited activity and 40% were confined to bed/coach. Most of the patients required partial (25%) or total (43%) care assistance. The nutritional formula was provided by the hospital in 62% of the cases and from the reference pharmacy in 27%. The fungible material was provided by the hospital in 80% of the cases and by primary care in the remaining patients. CONCLUSIONS: Although the number of registered patients is slightly higher than that from the last years, there are no important changes in the patients characteristics, or way of administration and duration of enteral nutrition.

Home artificial nutrition in a sanitary area of Galicia (Spain): descriptive study and proposals for the future.

OBJECTIVES: Home artificial nutrition (HAN) is a technique in increasing use, but the available data about it is limited because record-keeping in most countries is voluntary. Our objective is to describe the characteristics of HAN in our setting and to design a future proposal that improves its coordination. SUBJECTS: Retrospective review of 237 clinical histories of the patients who began with HAN in 2006 in our unit. VARIABLES: epidemiological information, indications, type of HAN, duration, complications and costs. RESULTS: Mean age: 75.4 years. Neurological and neoplasic diseases were the most frequent diagnoses (39.7% and 32.1%, respectively). Main indications were: reduction of ingestion (41.8%) and neurological dysphagia (27.8%). 48.1% presented an important functional impairment and 63.7% needed a caregiver. HAN duration was < 3 months in 43.9% and the principal cause of suspension was the lack of follow-up. Oral nutrition was the preferred route (70.9%), gastrostomy was found in only 3.4%. High-energy formulas were mostly used in patients with supplements (53.3%) and standard formulas in those with complete diets (32.4%). Complications related to this therapy were low, mainly in the oral route. The most frequent were gastrointestinal (19.3%). Mean monthly cost: 159.3 euros/patient and an average travel distance of 26 km to pick up supplies. CONCLUSION: HAN is a safe, short-term therapy, indicated in patients with diminished ingestion due to an acute situation. Our future proposal tries to improve the selection of patients, to facilitate the provision of materials and to customize follow-up to patient needs.

[Assessment of activity of care of a nutritional support multidisciplinary team in the follow-up of total parenteral nutrition]. / Evaluación de la actividad asistencial de un equipo multidisciplinario de soporte nutricional en el seguimiento de la nutrición parenteral total.

INTRODUCTION: In total parenteral nutrition (TPN) nutritional support multidisciplinary teams (NSMT) must provide a high quality nutritional assistance based on evidence and daily follow-up of patients with TPN. OBJECTIVES: To assess the degree of adherence to quality standards of care provided to patients on TPN by the NSMT in two consecutive annual periods, according to structure, procedure, and outcomes indicators, previously defined in the team working protocol. PATIENTS AND METHODS: Prospective study of all patients that received TPN at our Center (421-bed general teaching hospital) during the years 2002 and 2003, using the data introduced in NUTRIDATA by daily follow-up of clinical and analytical conditions, and nutritional and non-nutritional complications, comparing both periods and considering an statistical significance level of p < 0.05. RESULTS: One hundred and sixty-three patients and 145 patients received TPN during 2002 and 2003(65.9% male), respectively, with similar parameters of gender, age, indications for TPN, baseline nutritional status, mean nutritional supply, and non-nutritional complications. As to the different quality indicators established in the comparative study, we found a significant improvement in 2003 vs. 2002 in relation to initial anthropometrical assessment (71.03% vs 51.53%; p < 0.001), initial biochemical assessment (97.93% vs. 92.63%; p < 0.04), performance of systematic monitoring analysis (84.83% vs. 71.78%; p < 0.01), hypernatremia incidence (8.27% vs. 15.34%; p = 0.05) and moderate hyperphosphatemia (26.89% vs. 40.49%; p < 0.02), TPN ending for clinical improve- ment (76.60% vs. 64.40%; p = 0.04), and reduction of days on TPN (15.74 +/- 20.43 vs. 11.88 +/- 8.34; p < 0.02), the impaired electrolyte levels significantly improving as a whole. We also observed a non-significant trend towards an improvement of adequacy of TPN indications, hyperphosphatemia, severe hypophosphatemia, total stay, and post-surgical stay, in 2003 vs. 2002. CONCLUSIONS: The NSMT experience shows that analysis of indicators based on quality standards, in two successive annual periods allows assessing the improvement of efficiency of nutritional intervention in hospital-admitted patients with TPN with regards to indication, assessment, follow-up, and course.

Nutritional status study of inpatients in hospitals of Galicia.

OBJECTIVE: To know the prevalence of malnutrition and to validate a nutritional screening protocol (SP) in patients hospitalised in Hospitals representative of inpatients admitted for acute illnesses in Galicia. DESIGN: Cross-sectional study of 376 randomised patients (189 female, 210 > or =65 y old) from 12 public hospitals admitted to hospital for acute medical, surgical or trauma illnesses. The patients elicited were evaluated by a simple SP, including variables relative to recent weight changes, serum albumin, lymphocytes, food ingestion and diagnosis at admission (Cardona's Protocol), and with a diagnostic protocol (DP, Subjective Global Assessment). Both SP and DP were performed by personnel trained in nutritional evaluation. Results of SP and DP were compared; principal factors related to malnutrition were also analysed; statistical significance was considered at P<0.05. RESULTS: From patients studied, according to DP 169/360 (46.94%), patients presented malnutrition (134 B category and 35C category). SP rate was significantly related to severity of malnutrition detected by DP (P<0.001). The principal factors related to the presence of malnutrition were older age and degree of metabolic stress. CONCLUSIONS: In adult patients admitted for acute illnesses, the prevalence of protein-energy malnutrition is high. The risk was related to age and to metabolic stress. The risk of malnutrition in a hospital setting is evaluated appropriately by a simple screening procedure that may contribute to detecting and correcting malnutrition risk.

Recomendaciones nutricionales en las distintas etapas de la vida basadas en la evidencia / Evidence-based nutritional recommendations in the distinct stages of life

Se analiza la evidencia científica disponible sobre las recomendaciones nutricionales en las distintas etapas de la vida a través de 10 preguntas clave que se cuestionan alguno de los hechos más relevantes en cuanto a las modificaciones dietéticas a lo largo del ciclo vital: ¿cuál debe ser la duración de la lactancia materna?, ¿cuáles son los mejores métodos para promocionar la lactancia materna?, ¿deben utilizarse fórmulas con proteínas de soja para prevenir enfermedades alérgicas en lactantes de alto riesgo?, ¿está indicada la suplementación con micronutrientes en el lactante?, ¿cómo prevenir la obesidad infantil?, ¿existen estrategias válidas de prevención de los trastornos alimentarios en adolescentes?, ¿qué alimentación debemos recomendar para la embarazada y la mujer lactante?, ¿deben utilizarse suplementos nutricionales en los ancianos con riesgo de desnutrición?, ¿deben utilizarse suplementos de micronutrientes en los ancianos para prevenir o tratar las enfermedades degenerativas? (AU)

We review the scientific evidence available on nutritional recommendations in the distinct stages of life through 10 key questions relating to dietary modifications throughout the life cycle, namely: how long should breast-feeding last? What are the best methods for promoting breast-feeding? Should soya infant formulas be used to prevent allergic diseases in infants at high risk? Is micronutrient supplementation indicated in infants? How should childhood obesity be prevented? Are there any valid strategies for preventing eating disorders in adolescents? Which type of diet should be recommended in pregnant and breast-feeding women? Should nutritional supplements be used in elderly individuals at risk of malnutrition? Should micronutrient supplements be used in the elderly to prevent or treat degenerative diseases? (AU)

Nutrición y disfagia / Nutrition and dysphagia

Se conoce como disfagia la dificultad o incapacidad para tragar alimentos líquidos o sólidos desde la cavidad oral hasta el estómago. La disfagia puede provocar malnutrición al interferir con la ingesta, y también puede dar lugar a deshidratación, aspiración hacia la vía respiratoria o incluso la muerte. La disfagia es un síntoma de alguna patología subyacente y su manejo adecuado es fundamental para el mantenimiento del estado nutricional de los pacientes. Al mismo tiempo, las modificaciones nutricionales forman parte de las estrategias de rehabilitación de la deglución. En este trabajo se resumen las principales causas de disfagia en nuestro medio, se comentan las consecuencias nutricionales de esta situación y se proponen modificaciones dietéticas que pueden resultar útiles para mantener un adecuado estado nutricional y rehabilitar a los pacientes con disfagia (AU)

[Detection of malnutrition risk in hospitalized elderly patients]. / Detección del riesgo de malnutrición en ancianos hospitalizados.

UNLABELLED: OBJECTIVE AND SCOPE: To validate a protocol for the detection of malnutrition risk in a population of elderly patients admitted to a general hospital for non-surgical reasons. MATERIALS AND METHOD: The study involved 95 patients (34 of them male) over the age of 65 who were assessed on the third and fifth day after admission by means of a simple screening protocol (PC in its Spanish acronym) that considered recent changes in weight, serum albumin, lymphocyte concentration, food intake and diagnosis on admission, together with a more complex diagnostic protocol (PD in its Spanish acronym) including anthropometric, biochemical and immunological parameters. The PC was applied by personnel not expert in nutrition, while the PD was carried out by persons trained in nutritional assessment. The results of the PC and PD were compared, with statistical significance being considered at levels of p < 0.05. RESULTS: According to the PD, 75 patients (78.9%) suffered protein-energy malnutrition (39 slight, 31 moderate, 5 severe). The score obtained in the PC had a significant relationship with the severity of the malnutrition diagnosed using PD (p < 0.001). Furthermore, the absence or presence of nutritional risk assessed using the PC had a significant correlation with the diagnosis of malnutrition and its degree according to the PD (p < 0.01), thus indicating the validity of the PC as a method for screening of malnutrition. CONCLUSIONS: 1. In our population of geriatric patients admitted for reasons other than surgery, there was a high prevalence of protein-energy malnutrition. 2. The risk of malnutrition in an elderly population in hospital settings is appropriately assessed by means of a simple screening test effected by non-specialized personnel. 3. The score obtained in the PC is linked with the presence of malnutrition and with its severity. 4. The use of simple screening techniques in populations with a high prevalence of malnutrition may contribute to the detection and correction of this problem.