Effect of three different doses of arginine enhanced enteral nutrition on nutritional status and outcomes in well nourished postsurgical cancer patients: a randomized single blinded prospective trial.

OBJECTIVE: Patients with head and neck cancer undergoing surgery have a high occurrence of postoperative complications. The aim of our study was to investigate whether postoperative nutrition of head and neck cancer patients, using an enhanced enteral formula with three different doses of arginine could improve nutritional variables as well as clinical outcome, depending of arginine dose. PATIENTS AND METHODS: A population of 84 patients with oral and laryngeal cancer was enrolled. At surgery patients were randomly assigned to three different treatment groups, each one containing at less 28 patients. Group I (28 patients) received an enteral diet supplements with a low physiological dose of arginine (5.7 g per day), group II (28 patients) received an isocaloric, isonitrogenous enteral formula with a medium dose of arginine (12.3 g per day) and group III (28 patients) received an isocaloric, isonitrogenous enteral formula with a high dose of arginine (18.9 g per day). RESULTS: The length of postoperative stay had a trend to be better with high dose of arginine received (31.9 ± 17.2 days in group I vs 27.8 ± 15.2 days in group II vs 24.8 ± 18.3 days in group III: p = 0.034). No differences were detected in postoperative infections complications and diarrhea. Fistula was less frequent in groups II and III than I (10.7% group I vs 3.6% group II vs 3.6% group III: p = 0.033), The length of postoperative stay had a trend to be better with high dose of arginine received (31.9 ± 17.2 days in group I vs 27.8 ± 15.2 days in group II vs 24.8 ± 18.3 days in group III: p = 0.034). CONCLUSIONS: Our results suggest that these patients could benefit from a high dose of arginine enhanced enteral formula to decrease length of hospital stay and fistula wound complications.

Clinical effects of a hypercaloric and hyperproteic oral suplemment enhanced with W3 fatty acids and dietary fiber in postsurgical ambulatory head and neck cancer patients.

BACKGROUND: Patients with head and neck cancer undergoing surgery have a high risk of nutritional complications. OBJECTIVE: The aim of our study was to investigate the influence of a hypercaloric and hyperproteic oral supplement enriched with w3 FATTY ACIDS and fiber in clinical parameters in head and neck tumor postsurgical ambulatory patients with or without radiotherapy. DESIGN: A population of 37 ambulatory postsurgical patients with oral and laryngeal cancer was enrolled. At Hospital discharge postsurgical head and neck cancer patients were asked to consume two units per day of a hypercaloric and hyperproteic oral supplement for a twelve week period. RESULTS: The mean age was 63.8+/-7.1 years (16 female/ 21 males). Duration of supplementation was 98.1±19.1 days. A significant increase of albumin and transferrin levels was observed, in total group and in patients undergoing radiotherapy and without it. No differences were detected in weight and other anthropometric parameters in total group and in patients with radiotherapy during the protocol. Nevertheless, patients without radiotherapy showed a significant improvement of BMI; weight, fat free mass and fat mass. CONCLUSIONS: An omega 3 and fiber enriched formula improved seric protein levels in ambulatory postoperative head and neck cancer patients. Improvement of weight, fat mass and fat free mass was observed in patients whom not received radiotherapy during the follow up.

Antecedentes: Los pacientes con tumores de cabeza y cuello sometidos a cirugía presentan un alto riesgo de complicaciones nutricionales. Objetivo: El principal objetivo de nuestro trabajo fue evaluar la influencia de un suplemento hiperenergético e hiperproteico enriquecido en ácidos grasos w3 y fibra en pacientes postquirúrgicos ambulatorios con tumores de cabeza y cuello, con y sin radioterapia. Diseño: Una muestra de 37 pacientes postquirúrgicos ambulatorios con tumores de cabeza y cuello fue evaluada. Tras el alta hospitalaria, los pacientes recibieron dos envases al día de un suplemento hiperproteico e hipercalórico durante 12 semanas. Resultados: La edad media fue de 63.8+/-7.1 años (16 mujeres/21 varones). La duración media de la suplementación fue de 98.1±19.1 días. Se detectó un aumento significativo en los niveles de albúmina y transferrina en los pacientes del grupo global, en los que recibieron radioterapia y en los que no al recibieron. El peso y los parámetros antropométricos no mejoraron en el grupo global ni en los que recibieron radioterapia. Sin embargo los pacientes que no recibieron radioterapia tuvieron un aumento de la masa magra, peso y masa grasa Conclusiones: La formula enriquecida en omega 3 y fibra mejoró lo niveles de proteínas séricas. Por otra parte los pacientes que no recibieron radioterapia durante el seguimiento presentaron un aumento del peso, masa grasa y masa magra.

Clinical effects of a w3 enhanced powdered nutritional formula in postsurgical ambulatory head and neck cancer patients.

BACKGROUND: Patients with head and neck cancer undergoing surgery have a high risk of nutritional complications. OBJECTIVE: The aim of our study was to investigate the influence of an oral w3 enriched immunoenhanced powdered formula in nutritional and biochemical parameters in postsurgical ambulatory patients with head and neck tumor. DESIGN: A population of 33 ambulatory postsurgical patients with oral and laryngeal cancer was enrolled. At Hospital discharge postsurgical head and neck cancer patients were asked to consume two units per day of a w3 enriched immunoenhanced powdered formula for a twelve week period. RESULTS: The mean age was 61.3 ± 9.1 years (6 female/27 males). Duration of supplementation was 95.9 ± 21.1 days. A significant increase of albumin and transferrin levels was observed, in total group and in patients undergoing radiotherapy and without it. No differences were detected in weight and other anthropometric parameters in total group and in patients with radiotherapy during the protocol. Nevertheless, patients without radiotherapy showed a significant improvement of BMI; weight, fat free mass and fat mass. CONCLUSIONS: At dose used, an omega 3 enriched powdered formula improved seric protein levels in ambulatory postoperative head and neck cancer patients. Improvement of weight, fat mass and fat free mass was observed in patients whom not received radiotherapy during the follow up.

Antecedentes: Los pacientes con tumores de cabeza y cuello sometidos a cirugía presentan un alto riesgo de complicaciones nutricionales. Objetivo: El principal objetivo de nuestro trabajo fue evaluar la influencia de un suplemento oral en polvo inmunoenriquecido con ácidos grasos omega 3 en pacientes postquirúrgicos ambulatorios con tumores de cabeza y cuello. Diseño: Una muestra de 33 pacientes postquirúrgicos ambulatorios con tumores de cabeza y cuello fue evaluada. Tras el alta hospitalaria, los pacientes recibieron dos envases al día de un suplemento inmunoenriquecido con omega 3 en polvo durante 12 semanas. Resultados: La edad media fue de 61,3 ± 9,1 años (6 mujeres/27 varones). La duración media de la suplementación fue de 95,9 ± 21,1 días. Se detectó un aumento significativo en los niveles de albúmina y transferrina en los pacientes del grupo global, en los que recibieron radioterapia y en los que no al recibieron. El peso y los parámetros antropométricos no mejoraron en el grupo global ni en los que recibieron radioterapia. Sin embargo los pacientes que no recibieron radioterapia tuvieron un aumento de la masa magra, peso y masa grasa Conclusiones: A la dosis usada, la formula en polvo enriquecida en omega 3 mejoró lo niveles de proteínas séricas. Por otra parte los pacientes que no recibieron radioterapia durante el seguimiento presentaron un aumento del peso, masa grasa y masa magra.

A randomized clinical trial with two doses of an enteral diabetes-specific suplements in elderly patients with diabetes mellitus type 2.

OBJECTIVES: The aim of our study was to investigate whether two different daily doses of a high monounsaturated fatty acid (MUFA) specific diabetes enteral formula could improve nutritional variables as well as metabolic parameters. PATIENTS AND METHODS: We conducted a randomized, open-label, multicenter, parallel group study. 27 patients with diabetes mellitus type 2 with recent weight loss were randomized to one of two study groups: group 1 (two cans per day) and group 2 (three cans per day) for a ten week period. RESULTS: A significative decrease of HbA1c was detected in both groups. The decrease 0.98% (confidence interval 95% 0.19-1.88) was higher in group 2 than group 1 0.60% (confidence interval 95% 0.14-1.04). A significant increase of weight, body mass index, fat mass, albumin, prealbumin and transferrin was observed in both groups without statistical differences in this improvement between both groups. The increase of weight 4.59kg (confidence interval 95% 1.71-9.49) was higher in group 2 than group 1 1.46% (confidence interval 95% 0.39-2.54). Gastrointestinal tolerance (diarrhea episodes) with both formulas was good, without statistical differences (7.60% vs 7.14%: ns). CONCLUSIONS: A high monounsaturated fatty acid diabetes-specific supplement improved HbA1c and nutritional status. These improvements were higher with three supplements than with two per day.

Association of anthropometric and biochemical markers with length of stay and mortality in the hospital.

INTRODUCTION: Malnutrition is associated with patient outcome, hospital stay and costs. The objective of our study was evaluated the relationship of different anthropometric and biochemical nutritional markers with hospital stance (days) and mortality. PATIENTS AND METHODS: A sample of 3087 hospitalized patients in a Universitary Hospital was enrolled. Nutritional status was assessed from anthropometric variables; body mass index (BMI), weight, weight loss in previous three months, tricipital skin fold thickness, midarm muscle circumference and midarm muscle area. Biochemical evaluation was assessed with albumin, prealbumin, transferrin and lymphocytes. Length of hospital stance and mortality were recorded. RESULTS: A total of 3087 patients were enrolled, mean age was 67.7±18.3 years, weight 63.3±15,7 kg and BMI 23.7±6.8, with a weight loss (3 months) of 6.3±4.6 kg. Length of stay was 24.7±22.1 days. A total of 2583 patients were discharged. Hospital discharge data showed 87.8% of patients went home, and a 12.2% of patients were discharged to a secondary Hospital. A (n=504) 16.3% of patients died. In the multivariate analysis with a dependent variable [length of stay (days)], only albumin levels remained as an independent predictor in the model (F=2.9; p < 0.05), with an increase of 3.1 days in hospital stay (CI 95%: 0.4-5.8) with each decrease of 1 g/dl of albumin. In multivariate analysis, an independent factor that decrease mortality was high albumin levels (hazard ratio: 0.41; 95% CI: 0.22-0.80), adjusted by age and sex. CONCLUSIONS: Our study shows a significant association among serum albumin levels with length of stay in hospital and mortality.

A randomized clinical trial with two doses of a omega 3 fatty acids oral and arginine enhanced formula in clinical and biochemical parameters of head and neck cancer ambulatory patients.

INTRODUCTION: Postsurgical patients with head and neck cancer could have a high rate of ambulatory complications. The aim was to investigate whether oral ambulatory nutrition of head and neck cancer patients with recent weight loss, using two different doses of an omega 3 fatty acids and arginine enhanced diets could improve nutritional parameters. DESIGN: At Hospital discharge post surgical head and neck cancer patients (n=37) were asked to consume two or three cans per day of a designed omega 3 fatty acid and arginine enhanced supplement for a twelve week period. RESULTS: Albumin, prealbumin, transferrin and lymphocytes levels improved in both groups. Weight, fat mass and fat free mass improved during supplementation in group II (3 bricks per day). No differences were detected in anthropometric parameters in group I. Gastrointestinal tolerance with both formulas was good, no episodes were reported. There are no differences between both formulas on postsurgical complications rates. CONCLUSIONS: Omega 3 and arginine enhanced formulas improved blood protein concentrations and lymphocyte levels in ambulatory postoperative head and neck cancer patients. A high dose of arginine and omega 3 fatty acids formula improved weight, too.

Experience over 12 years with home enteral nutrition in a healthcare area of Spain.

BACKGROUND: The wide spread use of long-term enteral nutrition and the substantive costs dictate a need to study the outcome, as well as the clinical and epidemiological characteristics, of these patients. The present study aimed to analyse the incidence and characteristics of a cohort of patients on home enteral nutrition (HEN) over 12 years. MATERIALS AND METHODS: A prospective observational study was performed between January 1999 and December 2010. All adult patients living in Valladolid West area who were discharged from the hospital on HEN were prospectively studied and followed up. RESULTS: The incidence of HEN ranged between 9.52 per 100, 000 inhabitants in 2001 to 30.0 per 100,000 inhabitants in 2009. HEN was administered orally in 472 patients (68.28%) (group 1), and through a nasogastric tube in 168 patients (24.30%), a percutaneous enteral gastrostomy tube in 47 patients (6.80%) and a jejunostomy in four patients (0.60%) (group 2; 219 patients). During the course of HEN, 31 patients had diarrhoea (4.5%), 17 patients had constipation and 12 patients had nausea. The mean (SD) duration of HEN was 159.9 (97) days. In multivariable analysis, an independent factor associated with death was age (hazard ratio = 1.03; 95% confidence interval - 1.01-1.05), adjusted by sex, route and diagnosis. CONCLUSIONS: HEN has a high incidence in our area and it is a valid and safe technique for nutrition support.

Resistin levels in morbid obese patients following the biliopancreatic diversion surgery.

Previous studies addressing the changes of resistin concentrations in morbidly obese patients after bariatric surgery have yielded conflicting results. The purpose of the present study was to investigate the changes in serum resistin levels 1 year after biliopancreatic diversion in morbidly obese patients without diabetes mellitus. A cohort of 39 morbidly obese patients without diabetes mellitus was operated. Biochemical and anthropometric evaluation were realized at basal visit and at each visit. The frequency of patients with hypertension and hyperlipidemia was recorded at each visit. Overall the mean patient age was 44.8 ± 14.1, and the mean preoperative BMI was 47.3 ± 6.5 kg/m². After one year of surgery, a significant decrease was observed in BMI, weight, waist circumference, fat mass, blood pressure, total cholesterol, LDL cholesterol, and triglyceride levels. Resistin levels did not change after surgery (5.61 ± 1.93 ng/ml vs. 6.41 ± 3.58 ng/ml; ns). Correlation analysis showed a positive association between basal resistin and weight (r = 0.68, p < 0.01) and fat mass (r = 0.65, p < 0.05). Resistin concentrations did not change after massive weight loss with biliopancreatic diversion in morbid obese patients without diabetes mellitus.

Effects of C358A missense polymorphism of the endocannabinoid degrading enzyme fatty acid amide hydrolase on weight loss and cardiovascular risk factors 1 year after biliopancreatic diversion surgery.

BACKGROUND: Bariatric surgery is the most effective long-term treatment of morbid obesity and also results in a reduction of obesity-associated co-morbidities. We investigated the role of the polymorphism (C358A) of the fatty acid amide hydrolase gene on the clinical outcomes 1 year after biliopancreatic diversion in morbidly obese patients. METHODS: A total of 67 morbidly obese patients (body mass index >40 kg/m(2)) underwent biliopancreatic diversion. Their weight, blood pressure, basal glucose, triglycerides, total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol were measured at the baseline visit and at each follow-up visit. The frequency of the metabolic co-morbidities was recorded at each visit. RESULTS: Of the 67 patients, 46 (68.7%) had genotype C358C (wild-type group) and 21 (10.3%) had genotype C358A (mutant-type group). In the wild- and mutant-type groups, the body mass index, weight, waist circumference, systolic blood pressure, and glucose, total cholesterol, low-density lipoprotein cholesterol, and triglyceride concentrations decreased, without statistical significance between the 2 groups. The initial percentage of weight loss at 9 months and 1 year of follow-up was greater in the mutant-type group (9 months, 22.1% versus 28.8%, P <.05; and 1 year, 28.3% versus 36.4%, P <.05). CONCLUSION: The allele A358 of fatty acid amide hydrolase was associated with a better initial percentage of excess weight loss 9 and 12 months after biliopancreatic diversion.

G 1359A polymorphism of the cannabinoid receptor gene (CNR1) and clinical results of biliopancreatic diversion.

BACKGROUND: Bariatric surgery is the most effective long-term treatment for morbid obesity, reducing obesity-associated co-morbidities. We decide to investigate the role of the polymorphism (G1359A) of the cannabinoid (CB)1 receptor gene on clinical outcomes 1 year after biliopancreatic diversion in morbidly obese patients. DESIGN: A sample of 66 morbidly obese patients (BMI >40 kg/m2) were operated. Weight, fat mass, blood pressure, basal glucose, triacylglycerols, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol were measured at basal visit and at each visit. The frequency of metabolic comorbidities was recorded at each visit. RESULTS: Thirty-nine patients (59.1%) had genotype G1359G (wild type group) and 27 (40.9%) patients had genotype G1359A (mutant type group). In wild and mutant type groups, body mass index, weight, waist circumference, systolic blood pressure, glucose, total cholesterol, low-density lipoprotein cholesterol and triacylglycerols concentrations decreased, without statistical between genotype groups. Initial weight percent loss at 1 year of follow up was similar in both genotypes (33.1% vs 33.6%; ns). CONCLUSION: The present study demonstrates that polymorphism G1359A in the CB1 receptor did not have a significant effect on biochemical and anthropometric improvements after biliopancreatic diversion surgery.

A randomized double-blind clinical trial with two different doses of arginine enhanced enteral nutrition in postsurgical cancer patients.

OBJECTIVES: Patients with head and neck cancer undergoing surgery have a high incidence of postoperative complications. The aim of our study was to investigate whether postoperative nutrition of head and neck cancer patients, using an enteral high dose of arginine (20 g per day) vs a medium dose (12.3 g per day) could improve nutritional variables as well as clinical outcome. MATERIAL AND METHODS: A population of 115 patients with oral and laryngeal cancer was enrolled. At surgery patients were randomly allocated to two groups: group I (58 patients) received an enteral diet supplements with a high dose of arginine (20 g per day) and group II (57 patients) received an isocaloric, isonitrogenous enteral formula with a medium dose of arginine (12.3 g per day). RESULTS: Gastrointestinal tolerance (diarrhea) of both formulas was good (3.44% group I and 3.51% group II: ns). The postoperative infections complications were similar in both groups (8.6% group I and 12.2% group II: ns). Fistula was less frequent in enriched nutrition group (3.4% group I and 10.5% group II: p = 0.006). The length of postoperative stay was similar in both groups (27.2 +/- 17.8 days in group I vs 25.7 +/- 18.8 days in group II: ns). CONCLUSIONS: Enriched arginine formula improves fistula wound complications in postoperative head and neck cancer patients. Our results suggest that these patients could benefit from a high dose of arginine enhanced enteral formula.

Influence of an immuno-enhanced formula in postsurgical ambulatory patients with head and neck cancer.

BACKGROUND: Patients with head and neck cancer undergoing surgery have a high incidence of ambulatory postoperative complications. OBJECTIVE: The aim of our study was to investigate the influence of an oral immunoenhanced supplement (arginine and glutamine) on nutritional and biochemical parameters in postsurgical ambulatory patients with head and neck tumor. DESIGN: A population of 39 ambulatory postsurgical patients with oral and laryngeal cancer was enrolled. At Hospital discharge postsurgical head and neck cancer patients were asked to consume two units per day of a specially designed enhanced supplement for a twelve week period. RESULTS: The mean age was 60.2+/-13.1 years (9 female/30 males). Duration of supplementation was 90.8+20 days. A significant increase of albumin (3.1±0.6 g/dl vs 4.12+0.7 g /dl; p<0.05), prealbumin (21.4±6.3 mg/dl vs 22.4+5.9 mg/dl; p<0.05) and transferrin (198.8±45.2 mg/dl vs 253.8+60.7 mg/dl; p<0.05) levels were observed. No differences were detected in weight and other anthropometric parameters. Ten patients (41.3%) received radiotherapy along the enhanced supplementation period and only 5 (20% of patients with radiotherapy) developed a clinical oral mucositis. CONCLUSIONS: At dose used, arginine and glutamine enhanced formula improved seric protein levels in ambulatory postoperative head and neck cancer patients with a low rate of oral mucositis in the subgroup with radiotherapy.

Influence of -55CT polymorphism of UCP3 gene on surgical results of biliopancreatic diversion.

BACKGROUND: Bariatric surgery is the most effective long-term treatment for morbid obesity, reducing obesity-associated comorbidities. The purpose of the present study was to evaluate the UCP3 promotor (-55C-->T) polymorphism outcomes 1 year after biliopancreatic diversion in morbidly obese patients. METHODS: A sample of 40 morbidly obese patients (BMI >40 kg/m(2)) were operated. Weight, fat mass, blood pressure, basal glucose, triacylglycerols, total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol were measured at basal visit and at each visit. The frequency of patients with diabetes mellitus, hypertension, and hyperlipidemia was recorded at each visit. RESULTS: Twenty-eight patients (70%) had the genotype C/C (wild group) and 12 (30%) patients C/T (mutant group). In wild type group, body mass index, weight, fat mass, systolic blood pressure, glucose, total cholesterol, low-density lipoprotein cholesterol, and triacylglycerols concentrations decreased. In mutant type group, the same parameters improved, without statistical differences with wild group. Initial weight percent loss at 1 year of follow-up was similar in both genotypes (34.1% vs 28.6%; ns). CONCLUSION: Polymorphism -55C/T of the UCP3 promotor did not have an effect on weight loss or clinical outcomes after bariatric surgery.

Influence of G308A polymorphism of tumor necrosis factor alpha gene on surgical results of biliopancreatic diversion.

BACKGROUND: Bariatric surgery is the most effective long-term treatment for morbid obesity, reducing obesity-associated comorbidities. The purpose of the present study was to evaluate G308A polymorphism of the tumor necrosis factor (TNF) alpha gene on outcomes 1 year after biliopancreatic diversion. METHODS: A sample of 41 morbidly obese patients (body mass index > 40 kg/m(2)) were operated on. Weight, fat mass, blood pressure, creatinine, uric acid, basal glucose, triacylglycerols, total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol were measured at basal visit and at each visit. Adipocytokines were measured at basal time and 12 months after surgery. The frequency of patients with diabetes mellitus, hypertension, and hyperlipidemia was recorded at each visit. RESULTS: Thirty-two patients (78%) had genotype G308G [wild-type group and nine patients (22%) with G308A genotype (mutant-type group)]. Genotype A308A was not detected. In the wild group, body mass index, weight, uric acid, glucose, total cholesterol, low-density lipoprotein cholesterol, triacylglycerol, leptin, and systolic blood pressure decreased. In the mutant group, the same parameters improved. Adiponectin levels increased after surgery in both genotypes. Initial weight percent loss at 1 year of follow up was similar in both groups (32.2% vs 28.6%; ns). CONCLUSION: The present study demonstrates that the G308A polymorphism in the TNF-alpha gene is not related to clinical outcomes after bariatric surgery.

High dose of arginine enhanced enteral nutrition in postsurgical head and neck cancer patients. A randomized clinical trial.

OBJECTIVE: Patients with head and neck cancer undergoing surgery have a high incidence of postoperative complications. The aim of our study was to investigate whether postoperative nutrition of head and neck cancer patients, using a higher dose of arginine (20 g per day) could improve nutritional variables. MATERIALS AND METHODS: A population of 72 patients with oral and laryngeal cancer was enrolled. At surgery patients were randomly allocated to two groups: a) patients were receiving an enteral diet supplements with arginine and fiber (group I); b) patients were receiving an isocaloric, isonitrogenous enteral formula (group II). RESULTS: No significant intergroup differences in the trend of the three serum proteins and lymphocytes were detected. Gastrointestinal tolerance (diarrhea) of both formulas was good (7.89% group I and 5.88% group II: ns). The postoperative infections complications were similar in both groups (23.6% group I and 20.6% group II: ns). Fistula was less frequent in enriched nutrition group (5.2% group I and 17.6% group II: p = 0.026). The length of postoperative stay was better 24.3 +/- 14 days in the immunonutrition group than 36.1 +/- 27 days in the control group (p = 0.036). CONCLUSIONS: Enriched formula improves local wound complications in postoperative head and neck cancer patients and decreases length of stay.

Clinical results and nutritional consequences of biliopancreatic diversion: three years of follow-up.

BACKGROUND: Bariatric surgery is the most effective long-term treatment for morbid obesity, reducing obesity-associated comorbidities. The aim of our work was to describe clinical results and nutritional complications in morbidly obese patients with biliopancreatic diversion. METHODS: We have analyzed a consecutive series of 64 patients who have been followed up for 3 years after undergoing open biliopancreatic diversion by the Scopinaro technique. RESULTS: Initial excess weight loss was 29.3% at 6 months and 61.5% at 3 years. A significant improvement of body mass index, weight, waist circumference, fat mass, glucose level, total cholesterol, uric acid and triglycerides levels was detected. Ferritin, vitamin A, vitamin D, vitamin B(12), zinc and copper levels showed a low percentage of deficiency at basal time, but during the follow-up, the percentage of deficiency increased. Vitamin E and K did not show basal deficiency. However, after surgery, a moderate deficiency of both vitamins was detected (vitamin E 7.1% and vitamin K 8.3%). Folic acid deficiency was observed in 54.3% of the subjects at basal time, but decreased during the study. CONCLUSION: Biliopancreatic diversion is an effective method of sustainable weight loss. However, micronutrient deficiencies can occur.

A randomized clinical trial with two enteral diabetes-specific supplements in patients with diabetes mellitus type 2: metabolic effects.

The aim of this study was to investigate whether two specific diabetes enteral formulas could improve nutritional as well as metabolic parameters in elderly patients with diabetes mellitus type 2. A population of 30 elderly patients with diabetes mellitus type 2 with recent weight loss was recruited. At basal time diabetic patients were asked to consume randomly two cans per day of two different specially designed high monounsaturated fatty acid diabetes-specific supplement: one with 49.95% of calories provided by fats (I), the second with a 34% of calories provided by fats (II), for a ten week period. A significative decrease of glucose (119.8 +/- 42 vs 95.1 +/- 16.8 mg/dl: p < 0.05) and Hbalc (8.2 +/- 2.8 vs 5.8 +/- 0.7%: p < 0.05) levels was observed in group I with a significant increase in serum albumin levels (3.1 +/- 0.8 vs 3.5 +/- 0.5 g/dl: p < 0.05). A significant increase of serum albumin (3.1 +/- 0.4 vs 3.7 +/- 0.6 g/dl: p < 0.05) and total proteins (6.3 +/- 0.5 vs 6.9 +/- 0.3 g/dl: p < 0.05) was observed in group II. Patients of group II had a significant improvement in weight (56.5 +/- 16 vs 58.3 +/- 15 kg: p < 0.05), body mass index (21.8 +/- 5.6 vs 22.5 +/- 5.3 kg/m2: p < 0.05) and fat mass (15.7 +/- 6.4 vs 16.9 +/- 6.2 kg: p < 0.05). In conclusion, high monounsaturated fatty acid diabetes-specific enteral supplement improved glucose, HbAlc and albumin levels. A diabetes-specific supplement with lower fat percentage than the first improved weight and protein levels without significative metabolic effects.

A randomized clinical trial with two omega 3 fatty acid enhanced oral supplements in head and neck cancer ambulatory patients.

The aim of our study was to investigate whether oral ambulatory nutrition of post surgical head and neck cancer patients with recent weight loss, using two different omega 3 fatty acids enhanced diets could improve nutritional variables as well as clinical outcome. A sample of 65 ambulatory post surgical patients with oral and laryngeal cancer and recent weight loss was enrolled. At Hospital discharge post surgical head and neck cancer patients were asked to consume two cans per day of either a specially designed omega 3 fatty acid enhanced supplement with a high ratio of omega3/omega6 (I) or a omega 3 fatty acid enhanced supplement with a low ratio of omega3/omega6 (II). Serum albumin, prealbumin and transferrin concentrations improved with both enhanced formula. Weight stabilization was reached with both formulas. Gastrointestinal tolerance (diarrhea episodes) with both formulas was good (6.45 vs 5.88%: ns). The postoperative infectious complications were similar in both groups (29 group I vs 15.7% group II: ns). No local complications were detected in surgery wound. In conclusion, at dose taken, omega 3 enhanced formulas with different omega3/omega6 ratios improved serum protein concentrations in ambulatory postoperative head and neck cancer patients with good tolerance.

Influencia de una fórmula inmunoenriquecida en parámetros clínicos y bioquímicos en una población ambulatoria de pacientes intervenidos por cáncer de cabeza y cuello / Influence of a W3 fatty acids oral enhanced formula in clinical and biochemical parameters of head and neck cancer ambulatory patients

Fundamento y objetivo: Los pacientes con cáncer de cabeza y cuello sometidos a cirugía pueden presentar una alta tasa de complicaciones ambulatorias. El objetivo de nuestro estudio fue investigar la influcenia de una fórmula enteral enriquecida en ácidos grasos omega 3 y arginina en la situación nutricional asi como en la tasa de complicaciones clínicas (infecciones postoperatorias, complicaciones de la herida quirúrgica) de estos pacientes. Pacientes y métodos: Se realizó un estudio prospectivo de los pacientes con cáncer de cabeza y cuello intervenidos en nuestro centro (n= 30). Tras el alta hospitalaria se les administró 2 sobres día de un preparado enriquecido en ácidos grasos omega 3 y arginina durante 12 semanas. Realizandose una valoración nutricional en el tiempo basal (tras alta hospitalaria) y a las 12 semanas de tratamiento, así como una valoración de las complicaciones postoperatorias ambulatorias. Resultados: La edad media fue de 62,7 ± 11,1 años (3 mujer / 27 varones). La duración media de la suplementación fue de 90,8 ± 22 días. Se detectó una elevación significativa de las concentraciones séricas de albúmina, prealbúmina, transferrína y linfocitos. Los niveles séricos de PCR disminuyeron de una manera significativa (71,83 ± 19,7 md/dl vs 25,4 ± 10,1 mg/dl; p < 0,05). No se detectó ganancia de peso ni variación en otras variables antropométricas. Se detectó una correlación positiva entre la ratio w3/w6 de la ingesta de ácidos poliinsaturados y los kgs de masa grasa (r = 0,69; p < 0,05), así como la circunferencia muscular del brazo (r = 0,62; p < 0,05). Al dividir a los pacientes en grupo I (ingestaratio w3/w6 < 0,51) y grupo II (ingesta ratio w3/w6 > 0.51), el grupo II mostró mayor masa grasa final que el grupo I (17,52 ± 6,3 kg vs. 13,9 ±5,1 kg; p < 0,05). Conclusiones: A la dosis utilizada, esta fórmula inmunoenriquecida mejora los niveles séricos de albúmina, prealbúmina, transferrina y linfocitos, disminuyendo los niveles de proteína C reactiva en pacientes con cáncer de cabeza y cuello intervenidos. El incremento de masa grasa es superior en los pacientes con una ratio favorable en la ingesta de w3/w6

Introduction: Postsurgical patients with head and neck cancer could have a high rate of ambulatory complications. The aim of our study was to investigate whether oral ambulatory nutrition of post surgical head and neck cancer patients with recent weight loss, using an omega 3 fatty acids and arginine diet could improve nutritional status and complications. Design: A population of 30 ambulatory post surgical patients with oral and laryngeal cancer and recent weight loss was enrolled. At Hospital discharge post surgical head and neck cancer patients were asked to consume two cans per day of a specially designed omega 3 fatty acid and arginine enhanced supplement during 12 weeks. Results: The average age was 62.7 + 11.1 years (3 females / 27males). The average days of dietary suplementation was 90.8 + 22 days. Blood albumin, prealbumin, transferring and lymphocites concentrations improved. C reactive protein decreased. Neither weight improvement nor other anthropometric parameters improved. A positive correlation between ratio w3/w6 and kg of fat mass (r = 0.69; p < 0.05) and with midarm circumference (r = 0.62; p < 0.05) were detected. Patients were divided in two groups; group I (ratio dietary intake w3/w6 < 0,51) and group II (ratio dietary intake w3/w6 > 0,51). Group II had more final fatmass than group I (17.52 + 6.3 kg vs. 13.9 + 5.1 kg; p < 0.05). Conclusion: At dose taken, inmuno-enhanced formula increased blood proteins (albumin, prealbumin and transferrin) concentrations and decresed CRP. The increase of fat mass was higher in patients with better w3/w6 ratios

[Influence of a W3 fatty acids oral enhanced formula in clinical and biochemical parameters of head and neck cancer ambulatory patients]. / Influencia de una fórmula inmunoenriquecida en parámetros clínicos y bioquímicos en una población ambulatoria de pacientes intervenidos por cáncer de cabeza y cuello.

INTRODUCTION: Postsurgical patients with head and neck cancer could have a high rate of ambulatory complications. The aim of our study was to investigate whether oral ambulatory nutrition of post surgical head and neck cancer patients with recent weight loss, using an omega 3 fatty acids and arginine diet could improve nutritional status and complications. DESIGN: A population of 30 ambulatory post surgical patients with oral and laryngeal cancer and recent weight loss was enrolled. At Hospital discharge post surgical head and neck cancer patients were asked to consume two cans per day of a specially designed omega 3 fatty acid and arginine enhanced supplement during 12 weeks. RESULTS: The average age was 62.7 + 11.1 years (3 females/27 males). The average days of dietary suplementation was 90.8 + 22 days. Blood albumin, prealbumin, transferring and lymphocites concentrations improved. C reactive protein decreased. Neither weight improvement nor other anthropometric parameters improved. A positive correlation between ratio w3/w6and kg of fat mass (r = 0.69; p < 0.05) and with midarm circumference (r = 0.62; p < 0.05) were detected. Patients were divided in two groups; group I (ratio dietary intake w3/w6 < 0,51) and group II (ratio dietary intake w3/w6 > 0,51). Group II had more final fat mass than group I (17.52 + 6.3 kg vs. 13.9 + 5.1 kg; p < 0.05). CONCLUSION: At dose taken, inmuno-enhanced formula increased blood proteins (albumin, prealbumin and transferrin) concentrations and decresed CRP. The increase of fat mass was higher in patients with better w3/w6 ratios.