Relationship of endogenous plasma concentrations of ß-hydroxy ß-methyl butyrate (HMB) with frailty in community dwelling older adults with type-2 diabetes mellitus.

BACKGROUND: Supplementation with ß-hydroxy ß-methyl butyrate (HMB) appears to be effective in preserving muscle in older adults. However, the association between endogenously produced HMB with frailty has not been studied in people with chronic disease. OBJECTIVES: The purpose of this study is to explore whether an association exists between endogenous HMB levels and frailty status in older adults with type-2 diabetes mellitus (T2DM). METHODS: Data were taken from the Toledo Study of Healthy Ageing, a community-dwelling aged (65 years+) cohort. Frailty was assessed at baseline and at 2.99 median years according to the Frailty Phenotype (FP) standardized to our population and the Frailty Trait Scale 12 (FTS12). The associations between HMB levels and frailty were assessed using three nested multivariate logistic regressions and segmented by sex. Glucose, HMB and glucose interaction, age and body composition were used as covariables. RESULTS: 255 participants (mean age 75.3 years, 52.94% men) were included. HMB levels showed an inverse cross-sectional association with frailty, which was modified when the interaction term HMB*glucose was included, remaining significant only for FTS12 [OR (95% CI): 0.436 (0.253, 0.751), p-value 0.003]. The association between HMB endogenous levels and FTS12 appears to be independent of sex, in which the association was maintained after adjusting for the covariates. However, there appears to be threshold points for glucose levels, above which the protective effect of HMB is lost: 145.4 mg/dl adjusted by gender for the whole sample and 149.6 mg/dl and 138.9 mg/dl for men and women, respectively. Endogenous HMB levels were not found to be associated with incident frailty. CONCLUSIONS: Cross-sectional analysis revealed that endogenous HMB levels were inversely associated with frailty as assessed by the FTS12 in older people with T2DM. This association was found to be dependent on circulating fasted glucose levels.

Association between endogenous plasma beta-hydroxy-beta-methylbutyrate levels and frailty in community-dwelling older people.

BACKGROUND: Frailty is a key element in healthy ageing in which muscle performance plays a main role. Beta-hydroxy-beta-methylbutyrate (HMB) supplementation has shown favourable effects in modulating protein synthesis, improving muscle mass and function in interventional studies. Decreased age-related endogenous HMB levels have been shown in previous studies. The aim of the present study is to assess whether there is an association between endogenous plasma HMB levels and frailty. METHODS: Data from 1290 subjects (56.98% women; mean ± standard deviation age 74.6 ± 5.95 years) from the Toledo Study for Healthy Aging were obtained. Participants had their frailty status qualified according to Fried's Frailty Phenotype (FFP) score and the Frailty Trait Scale in its 12-domain version (FTS-12). Plasma HMB levels were analysed by an ultrahigh-performance liquid chromatography tandem mass spectrometry. Differences between groups (frail vs. non-frail) were tested using Mann-Whitney U test, Kruskal-Wallis test and chi-squared test. The association between HMB and frailty was assessed by multivariate linear and logistic regressions when frailty was analysed as continuous and binary, respectively. Models were adjusted by age, gender, comorbidity, body composition and protein intake. RESULTS: HMB levels were lower in those aged ≥75 years than in those aged 65-74 years, with an inverse linear relationship between age and HMB levels (ß = -0.031; P = 0.018), mainly accounted by males (ß = -0.062; P = 0.002). HMB levels were higher in men (0.238 ± 0.065 vs. 0.193 ± 0.051 ng/mL; P ≤ 0.001). HMB levels were significantly lower in frail than in non-frail individuals: 0.204 ± 0.058 versus 0.217 ± 0.063 ng/dL (P = 0.001) according to the FFP and 0.203 ± 0.059 versus 0.219 ± 0.063 ng/mL (P < 0.001) according to FTS-12. These differences showed a dose-dependent profile when we compared them by quintiles of HMB (P for trend: 0.022; 0.012 and 0.0004, respectively, for FFP, FTS-12 binary and FTS-12 continuous). Variables associated with low HMB levels were body mass index, strength, exhaustion and weight loss. Frailty was associated with HMB levels in all the adjusted models, including the fully adjusted ones, no matter the tool used (odds ratio: 0.45 [0.26, 0.77] for FFP and 0.36 [0.20, 0.63] for FTS-12 binary; ß = -4.76 [-7.29, -2.23] for FTS-12 score). This association was also observed when the analyses were done by quintiles, showing such association since Q4 (FFP), Q2 (FTS-12 binary) and Q3 (FTS-12 score). The associations were observed in the whole sample and in each gender. CONCLUSIONS: There is an inverse association between HMB levels and frailty status. These findings support the design of targeted clinical trials to evaluate the effect of HMB supplementation in older frail people with low HMB levels.

Oligomeric Formulas in Surgery: A Delphi and Consensus Study.

Nutritional management of patients with intestinal failure often includes the use of oligomeric formulas. Implementing the use of oligomeric formulas in surgical patients with maldigestion or malabsorption could be a nutritional strategy to be included in clinical protocols. We aim to generate knowledge from a survey focused on the effectiveness of nutritional therapy with oligomeric formulas with Delphi methodology. Each statement that reached an agreement consensus among participants was defined as a median consensus score ≥7 and as an interquartile range ≤3. The use of oligomeric formulas in surgical patients, starting enteral nutrition in the post-operative phase in short bowel syndrome and in nonspecific diarrhea after surgical procedures, could improve nutritional therapy implementation. Stakeholders agreed that early jejunal enteral nutrition with oligomeric formula is more effective compared to intravenous fluid therapy and it is useful in patients undergoing upper gastro-intestinal tract major surgery when malabsorption or maldigestion is suspected. Finally, oligomeric formulas may be useful when a feeding tube is placed distally to the duodenum. This study shows a practical approach to the use of oligomeric formulas in surgical patients with intestinal disorders and malabsorption, and it helps clinicians in the decision-making process.

[Implementation of an ERAS program in liver surgery]. / Implantación de un programa ERAS en cirugía hepática.

The perioperative management of patients undergoing abdominal surgery has been based on traditional concepts and often not supported by scientific evidence. Recently there have been several scientific studies showing that some traditional procedures for the perioperative management of patients as preoperative fasting, bowel preparation, use of naso-gastric tubes, placement of intra-abdominal drainage, postoperative fasting etc. They are unnecessary and sometimes counterproductive. Perioperative management protocols ERAS or Fast-Track (Enhanced Recovery After Surgery) are based on the use in the perioperative period of measures that are supported by current scientific evidence. Since 2000 appear in the scientific literature several works that reflect the application of protocols ERAS or Fast- Track in surgery of the digestive system where it's shown uniformly, not only the security of your application but also, decreased complications and hospital stay. Although initially these protocols were described in colorectal surgery, due to the good results obtained, the application of these protocols has rapidly expanded to other surgical specialties such as thoracic surgery, Urology, Gynaecology, etc. In all these specialties has unanimously showing improved postoperative recovery with ERAS application protocols. The purpose of this paper is twofold. On the one hand examine the scientific evidence that exists today on the most important elements of an ERAS program and present preliminary results of the implementation of a program ERAS in our hospital.

Implantación de un programa ERAS en cirugía hepática / Implementation of an ERAS program in liver surgery

El manejo perioperatorio de los pacientes sometidos a cirugía abdominal se ha basado en conceptos tradicionales y frecuentemente no avalados por la evidencia científica. Recientemente han aparecido varios estudios científicos que demuestran que algunos procedimientos tradicionales para el manejo perioperatororio de los pacientes como, el ayuno preoperatorio, la preparación intestinal, el uso de sondas naso-gástricas, la colocación de drenajes intraabdominales, el ayuno en el postoperatorio etc., son innecesarios e incluso a veces contraproducentes. Los protocolos de manejo perioperatorio de ERAS o Fast-Track (Enhanced Recovery After Surgery) se basan en la utilización de medidas en el periodo perioperatorio que están avaladas por la evidencia científica actual. A partir del año 2000 empiezan a aparecer en la bibliografía científica varios trabajos que recogen la aplicación de protocolos ERAS o Fast- Track en la cirugía del aparato digestivo en los que se nuestra de manera uniforme, no solo la seguridad de su aplicación sino también, la disminución de las complicaciones y de la estancia postoperatoria. Aunque inicialmente estos protocolos fueron descritos en la cirugía colo-rectal, debido a los buenos resultados obtenidos, la aplicación de estos protocolos se ha expandido rápidamente a otras especialidades quirúrgicas como la cirugía torácica, la Urología, la Ginecología, etc. En todos estas especialidades se ha mostrando de forma unánime la mejoría de la recuperación postoperatoria con la aplicación de protocolos ERAS. El motivo de este artículo es doble. Por un lado examinar la evidencia científica que existe en la actualidad sobre los elementos mas importantes de un programa ERAS y presentar los resultados preliminares de la implantación (AU)

The perioperative management of patients undergoing abdominal surgery has been based on traditional concepts and often not supported by scientific evidence. Recently there have been several scientific studies showing that some traditional procedures for the perioperative management of patients as preoperative fasting, bowel preparation, use of naso-gastric tubes, placement of intra-abdominal drainage, postoperative fasting etc. They are unnecessary and sometimes counterproductive. Perioperative management protocols ERAS or FastTrack (Enhanced Recovery After Surgery) are based on the use in the perioperative period of measures that are supported by current scientific evidence. Since 2000 appear in the scientific literature several works that reflect the application of protocols ERAS or Fast- Track in surgery of the digestive system where it´s shown uniformly, not only the security of your application but also, decreased complications and hospital stay. Although initially these protocols were described in colorectal surgery, due to the good results obtained, the application of these protocols has rapidly expanded to other surgical specialties such as thoracic surgery, Urology, Gynaecology, etc. In all these specialties has unanimously showing improved postoperative recovery with ERAS application protocols. The purpose of this paper is twofold. On the one hand examine the scientific evidence that exists today on the most important elements of an ERAS program and present preliminary results of the implementation of a program ERAS in our hospital (AU)

Mielolipoma adrenal gigante: revisión a propósito de un caso / Giant adrenal myelolipoma: case report and literature review

El mielolipoma adrenal es un tumor benigno, poco frecuente, compuesto por tejido adiposo maduro y elementos hematopoyéticos diversos. Su hallazgo suele ser incidental, aunque en ocasiones pueden alcanzar gran tamaño y causar dolor abdominal y otros síntomas clínicos. La ecografía y la tomografía computarizada son herramientas útiles en su diagnóstico. Los tumores pequeños (< 6 cm) y asintomáticos pueden tratarse de forma conservadora con vigilancia periódica y los > 6 cm o con síntomas pueden precisar tratamiento quirúrgico. Presentamos un caso de mielolipoma adrenal gigante y a continuación se realiza una revisión de la literatura (AU)

Adrenal myelolipomas are rare benign tumors comprising mature adipose tissue and diverse hematopoietic elements. These neoplasms are usually incidental findings, although bulky masses can generate abdominal pain as well as other symptoms related to compression of adjacent organs. Diagnosis is usually provided by ultrasonography or computed tomography. Asymptomatic patients with tumors with a maximum diameter of less than 6 cm can benefit from periodic surveillance, whereas local compression symptoms and size larger than 6 cm are indications for surgical treatment. We present a case of giant adrenal myelolipoma (..) (AU)

Giant adrenal myelolipoma: case report and literature review.

Adrenal myelolipomas are rare benign tumors comprising mature adipose tissue and diverse hematopoietic elements. These neoplasms are usually incidental findings, although bulky masses can generate abdominal pain as well as other symptoms related to compression of adjacent organs. Diagnosis is usually provided by ultrasonography or computed tomography. Asymptomatic patients with tumors with a maximum diameter of less than 6cm can benefit from periodic surveillance, whereas local compression symptoms and size larger than 6cm are indications for surgical treatment. We present a case of giant adrenal myelolipoma and provide a review of the literature.

Seudoquiste adrenal gigante: a propósito de un caso / Giant adrenal pseudocyst: a case report

Los seudoquistes adrenales son las lesiones quísticas más frecuentes de la glándula suprarrenal, si bien constituyen una entidad rara. Suelen ser asintomáticas, pero pueden producir clínica inespecífica como dolor abdominal o lumbar. Se recomienda tratamiento quirúrgico si son sintomáticos o se sospecha malignidad. Presentamos un caso de un seudoquiste adrenal hemorrágico gigante con un antecedente de traumatismo como posible etiología (AU)

Although rare, adrenal pseudocysts are the most common cystic masses occurring in the adrenal gland. These lesions are usually asymptomatic, although they can produce nonspecific symptoms such as abdominal or lumbar pain. Surgical treatment is warranted only when adrenal pseudocysts are symptomatic or show imaging features suspicious for malignancy. We present a case of a giant hemorrhagic adrenal pseudocyst, possibly related to previous local trauma (AU)

[Functional nutrition and optimal nutrition. Near or far?]. / Alimentos funcionales y nutrición óptima. Cerca o lejos?

The concept of functional food, about which scientific agreement is still lacking, springs from the field of Optimum Nutrition, aimed at modifying genetic and physiological aspects of human life and at the prevention and treatment of a growing number of diseases, far beyond merely covering nutritional requirements. From the European Union perspective, functional foods can be natural as well as industrially processed foods. The leading functional foods regarding which the soundest scientific evidence exists are probiotics, live microbial food ingredients represented mainly by fermented dairy products. Prebiotics, such as inulin-type fructans, are the trophic substrate of probiotics and potential intestinal microflora selectors. The combination of prebiotics and probiotics is termed synbiotic. Innumerable substances are known to have functional effects: soluble and insoluble fiber, phytosterols, phytoestrogens, monounsaturated and polyunsaturated fatty acids, phenol derivatives, vitamins and other phytochemicals. Functional foods exert their actions on different systems, especially the gastrointestinal, cardiovascular and immunological ones, acting too as enhancers of development and differentiation and positively modulating nutrient metabolism, gene expression, oxidative stress and the psychic sphere. The establishment of Health Claims must be firmly based upon scientific knowledge and legal regulation. Efficient biomarkers related to biological response must be found. Furthermore, it is essential to analyze possible diet or drug interactions as well as it is indispensable to conduct valid studies on humans. The prime objective must be the diet as a whole. Thus, the future challenge of a functional diet emerges.

Alimentos funcionales y nutrición óptima.¿Cerca o lejos? / Functional Foods and Optimum Nutrition: A Way or Away?

El concepto de alimento funcional, aún no consensuado científicamente, surge en el seno de la Nutrición Óptima, encaminada a modificar aspectos genéticos y fisiológicos y a la prevención y tratamiento de enfermedades, más allá de la mera cobertura de las necesidades de nutrientes. Bajo la perspectiva de la Unión Europea, pueden ser tanto alimentos naturales como procesados industrialmente. Los alimentos funcionales más relevantes y sobre los que recae la más sólida evidencia científica son los probióticos, microorganismos vivos representados fundamentalmente por los derivados lácteos fermentados. Los prebióticos, como los fructanos tipo inulina, son el sustrato trófico de los probióticos y potenciales selectores de la flora colónica. La asociación de un prebiótico y un probiótico se denomina simbiótico. Se conocen innumerables sustancias con actividad funcional: fibra soluble e insoluble, fitosteroles, fitoestrógenos, ácidos grasos monoinsaturados y poliinsaturados, derivados fenólicos, vitaminas y otros fitoquímicos. Los alimentos funcionales ejercen su actividad en múltiples sistemas, especialmente el gastrointestinal, cardiovascular e inmunológico. Se comportan como potenciadores del desarrollo y la diferenciación, moduladores del metabolismo de nutrientes, la expresión génica, el estrés oxidativo y la esfera psíquica. La construcción de alegaciones sanitarias dirigidas al consumidor debe cimentarse en el conocimiento científico y la regulación legal. Es preciso encontrar biomarcadores eficientes del efecto biológico, analizar las posibles interacciones y realizar estudios válidos en humanos. El objetivo prioritario, sin embargo, debe ser la dieta en su conjunto. Emerge así el futuro reto de una dieta funcional (AU)

The concept of functional food, about which scientific agreement is still lacking, springs from the field of Optimum Nutrition, aimed at modifying genetic and physiological aspects of human life and at the prevention and treatment of a growing number of diseases, far beyond merely covering nutritional requirements. From the European Union perspective, functional foods can be natural as well as industrially processed foods. The leading functional foods regarding which the soundest scientific evidence exists are probiotics, live microbial food ingredients represented mainly by fermented dairy products. Prebiotics, such as inulin-type fructans, are the trophic substrate of probiotics and potential intestinal microflora selectors. The combination of prebiotics and probiotics is termed synbiotic. Innumerable substances are known to have functional effects: soluble and insoluble fiber, phytosterols, phytoestrogens, monounsaturated and polyunsaturated fatty acids, phenol derivatives, vitamins and other phytochemicals. Functional foods exert their actions on different systems, especially the gastrointestinal, cardiovascular and immunological ones, acting too as enhancers of development and differentiation and positively modulating nutrient metabolism, gene expression, oxidative stress and the psychic sphere. The establishment of Health Claims must be firmly based upon scientific knowledge and legal regulation. Efficient biomarkers related to biological response must be found. Furthermore, it is essential to analyze possible diet or drug interactions as well as it is indispensable to conduct valid studies on humans. The prime objective must be the diet as a whole. Thus, the future challenge of a functional diet emerges (AU)