RESUMO
INTRODUCTION: Bariatric surgery is an efficient approach to rapidly reduce morbid obesity and associated comorbidities. However, approximately one-fourth of patients experience weight and comorbidity recurrence, and both obesity and bariatric surgery can lead to micronutrient deficiencies. Implementing a structured program of lifestyle modification (PLM) might enhance weight loss and improve micronutrient status. METHODOLOGY: A total of 121 severely obese patients underwent Roux-en-Y gastric bypass (RYGB). Among them, 71 adhered to a PLM involving dietary changes (low- and very-low-calorie Mediterranean diets) and physical exercises (aerobic and resistance training) both before and after surgery, while 50 patients followed a conventional protocol. Anthropometric measurements and serological parameter quantifications were conducted throughout the procedures. RESULTS: The obese study population, primarily female (76.9%), with an average age of 47.11 ± 9.68, and a body mass index (BMI) of 44.68 ± 5.08 kg/m2, underwent either RYGB with a PLM or a conventional procedure. Before surgery, the PLM group exhibited significant reductions in body weight (6.3%) and phosphoremia compared to the conventional protocol (0.78%). Post-RYGB, the PLM group demonstrated shortened in-hospital stays and further BMI reductions (-16.12 kg/m2) that persisted for up to 2 years. Furthermore, the PLM group experienced increased plasma vitamin D levels (14.79 ng/mL vs. 1.2 ng/mL) for up to 2 years, as well as elevated folic acid (1.52 vs. -0.29 ng/mL) and phosphorus (0.48 vs. 0.06 mg/dL) levels at 1 month and 1 year after intervention, respectively. Notably, these effects were independent of weight loss. CONCLUSIONS: Initiating a structured PLM from the early stages of patients' preparation for RYGB could enhance and extend the benefits of weight loss and positively impact micronutrient (vitamin D, phosphorus, and folic acid) status in obese patients.
Assuntos
Cirurgia Bariátrica , Obesidade Mórbida , Oligoelementos , Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Micronutrientes , Estilo de Vida , Fósforo , Ácido Fólico , Obesidade Mórbida/cirurgiaRESUMO
INTRODUCTION: There is a large body of evidence about immunonutrition formulas; however, there are still doubts about their usefulness in routine clinical practice as compared with standard formulas. In the age of personalized medicine, new studies appear every year regarding several types of patients; therefore, an updated point of view on these formulas is necessary. METHODS: The Embase database was searched from 2016 to 14 March 2022. Our criteria were articles published in English and Spanish. The evidence quality was evaluated using GRADEpro, and the review was developed according to the PRISMA statement. RESULTS: In this review, a total of 65 unique records were retrieved; however, 36 articles did not meet the inclusion criteria and were thus excluded. In total, 29 articles were included in the final analysis. In the last few years, many meta-analyses have attempted to identify additional existing studies of surgical patients with certain pathologies, mainly oncological patients. Immunonutrition prior to oncological surgery was shown to cause a decrease in inflammatory markers in most of the studies, and the main clinical events that changed were the infectious complications after surgery. The length of stay and mortality data are controversial due to the specific risk factors associated with these events. CONCLUSIONS: The use of immunonutrition in patients who have undergone oncological surgery decreases the levels of inflammatory markers and infectious postoperative complications in almost all localizations. However, more studies are needed to assess the use of immunonutrition based on Enhanced Recovery After Surgery (ERAS) protocols.
Assuntos
Neoplasias , Complicações Pós-Operatórias , Humanos , Complicações Pós-Operatórias/prevenção & controle , Dieta de Imunonutrição , Alimentos Formulados , Fatores de Risco , Neoplasias/cirurgia , Tempo de InternaçãoRESUMO
OBJECTIVE: The prevalence of carbohydrate metabolism disorders in patients who receive total parenteral nutrition (TPN) is not well known. These disorders can affect the treatment, metabolic control, and prognosis of affected patients. The aims of this study were to determine the prevalence in noncritically ill patients on TPN of diabetes, prediabetes, and stress hyperglycemia; the factors affecting hyperglycemia during TPN; and the insulin therapy provided and the metabolic control achieved. METHODS: We undertook a prospective multicenter study involving 19 Spanish hospitals. Noncritically ill patients who were prescribed TPN were included, and data were collected on demographic, clinical, and laboratory variables (glycated hemoglobin, C-reactive protein [CRP], capillary blood glucose) as well as insulin treatment. RESULTS: The study included 605 patients. Before initiation of TPN, the prevalence of known diabetes was 17.4%, unknown diabetes 4.3%, stress hyperglycemia 7.1%, and prediabetes 27.8%. During TPN therapy, 50.9% of patients had at least one capillary blood glucose of >180 mg/dL. Predisposing factors were age, levels of CRP and glycated hemoglobin, the presence of diabetes, infectious complications, the number of grams of carbohydrates infused, and the administration of glucose-elevating drugs. Most (71.6%) patients were treated with insulin. The mean capillary blood glucose levels during TPN were: known diabetes (178.6 ± 46.5 mg/dL), unknown diabetes (173.9 ± 51.9), prediabetes (136.0 ± 25.4), stress hyperglycemia (146.0 ± 29.3), and normal (123.2 ± 19.9) (P<.001). CONCLUSION: The prevalence of carbohydrate metabolism disorders is very high in noncritically ill patients on TPN. These disorders affect insulin treatment and the degree of metabolic control achieved.
Assuntos
Diabetes Mellitus/epidemiologia , Hiperglicemia/epidemiologia , Insulina/uso terapêutico , Nutrição Parenteral Total/efeitos adversos , Estado Pré-Diabético/epidemiologia , Adulto , Idoso , Glicemia/análise , Diabetes Mellitus/metabolismo , Feminino , Humanos , Hiperglicemia/metabolismo , Masculino , Pessoa de Meia-Idade , Estado Pré-Diabético/metabolismo , Prevalência , Estudos ProspectivosRESUMO
OBJECTIVE: Hypoglycemia is a common problem among hospitalized patients. Treatment of hyperglycemia with insulin is potentially associated with an increased risk for hypoglycemia. The aim of this study was to determine the prevalence and predictors of hypoglycemia (capillary blood glucose <70 mg/dL) in hospitalized patients receiving total parenteral nutrition (TPN). METHODS: This prospective multicenter study involved 19 Spanish hospitals. Noncritically ill adults who were prescribed TPN were included, thus enabling us to collect data on capillary blood glucose and insulin dosage. RESULTS: The study included 605 patients of whom 6.8% (n = 41) had at least one capillary blood glucose <70 mg/dL and 2.6% (n = 16) had symptomatic hypoglycemia. The total number of hypoglycemic episodes per 100 d of TPN was 0.82. In univariate analysis, hypoglycemia was significantly associated with the presence of diabetes, a lower body mass index (BMI), and treatment with intravenous (IV) insulin. Patients with hypoglycemia also had a significantly longer hospital length of stay, PN duration, higher blood glucose variability, and a higher insulin dose. Multiple logistic regression analysis showed that a lower BMI, high blood glucose variability, and TPN duration were risk factors for hypoglycemia. Use of IV insulin and blood glucose variability were predictors of symptomatic hypoglycemia. CONCLUSIONS: The occurrence of hypoglycemia in noncritically ill patients receiving PN is low. A lower BMI and a greater blood glucose variability and TPN duration are factors associated with the risk for hypoglycemia. IV insulin and glucose variability were predictors of symptomatic hypoglycemia.
Assuntos
Hipoglicemia/epidemiologia , Nutrição Parenteral Total/efeitos adversos , Administração Intravenosa , Idoso , Glicemia/metabolismo , Índice de Massa Corporal , Estado Terminal , Relação Dose-Resposta a Droga , Feminino , Hospitalização , Humanos , Hipoglicemia/etiologia , Insulina/administração & dosagem , Insulina/efeitos adversos , Tempo de Internação , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Prevalência , Estudos Prospectivos , Fatores de Risco , Espanha/epidemiologiaRESUMO
BACKGROUND: Malnutrition in hospitalized patients is associated with an increased risk of death, in both the short and the long term. AIMS: The purpose of this study was to determine which nutrition-related risk index predicts long-term mortality better (three years) in patients who receive total parenteral nutrition (TPN). METHODS: This prospective, multicenter study involved noncritically ill patients who were prescribed TPN during hospitalization. Data were collected on Subjective Global Assessment (SGA), Nutritional Risk Index (NRI), Geriatric Nutritional Risk Index (GNRI), body mass index, albumin and prealbumin, as well as long-term mortality. RESULTS: Over the 1- and 3-year follow-up periods, 174 and 244 study subjects (28.8% and 40.3%) respectively, died. Based on the Cox proportional hazards survival model, the nutrition-related risk indexes most strongly associated with mortality were SGA and albumin (<2.5 g/dL) (after adjustment for age, gender, C-reactive protein levels, prior comorbidity, mean capillary blood glucose during TPN infusion, diabetes status prior to TPN, diagnosis, and infectious complications during hospitalization). CONCLUSIONS: The SGA and very low albumin levels are simple tools that predict the risk of long-term mortality better than other tools in noncritically ill patients who receive TPN during hospitalization.
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Desnutrição/epidemiologia , Nutrição Parenteral Total , Adulto , Idoso , Glicemia/metabolismo , Índice de Massa Corporal , Peso Corporal , Proteína C-Reativa/metabolismo , Comorbidade , Estado Terminal , Ingestão de Energia , Seguimentos , Avaliação Geriátrica , Hospitalização , Humanos , Pacientes Internados , Tempo de Internação , Desnutrição/diagnóstico , Pessoa de Meia-Idade , Avaliação Nutricional , Estado Nutricional , Modelos de Riscos Proporcionais , Estudos Prospectivos , Medição de Risco , Albumina Sérica/metabolismo , Adulto JovemRESUMO
No disponible
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Humanos , Feminino , Pessoa de Meia-Idade , Carcinoma Papilar/complicações , Neoplasias da Glândula Tireoide/complicações , Carcinoma de Células Escamosas/complicações , Tireoidectomia , LaringectomiaAssuntos
Carcinoma de Células Escamosas , Carcinoma , Neoplasias Primárias Múltiplas , Neoplasias da Glândula Tireoide , Carcinoma/patologia , Carcinoma Papilar , Carcinoma de Células Escamosas/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias Primárias Múltiplas/patologia , Câncer Papilífero da Tireoide , Neoplasias da Glândula Tireoide/patologiaRESUMO
OBJECTIVE: Hyperglycemia may increase mortality in patients who receive total parenteral nutrition (TPN). However, this has not been well studied in noncritically ill patients (i.e., patients in the nonintensive care unit setting). The aim of this study was to determine whether mean blood glucose level during TPN infusion is associated with increased mortality in noncritically ill hospitalized patients. RESEARCH DESIGN AND METHODS: This prospective multicenter study involved 19 Spanish hospitals. Noncritically ill patients who were prescribed TPN were included prospectively, and data were collected on demographic, clinical, and laboratory variables as well as on in-hospital mortality. RESULTS: The study included 605 patients (mean age 63.2 ± 15.7 years). The daily mean TPN values were 1.630 ± 323 kcal, 3.2 ± 0.7 g carbohydrates/kg, 1.26 ± 0.3 g amino acids/kg, and 0.9 ± 0.2 g lipids/kg. Multiple logistic regression analysis showed that the patients who had mean blood glucose levels >180 mg/dL during the TPN infusion had a risk of mortality that was 5.6 times greater than those with mean blood glucose levels <140 mg/dL (95% CI 1.47-21.4 mg/dL) after adjusting for age, sex, nutritional state, presence of diabetes or hyperglycemia before starting TPN, diagnosis, prior comorbidity, carbohydrates infused, use of steroid therapy, SD of blood glucose level, insulin units supplied, infectious complications, albumin, C-reactive protein, and HbA1c levels. CONCLUSIONS: Hyperglycemia (mean blood glucose level >180 mg/dL) in noncritically ill patients who receive TPN is associated with a higher risk of in-hospital mortality.
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Estado Terminal/mortalidade , Mortalidade Hospitalar , Hiperglicemia/etiologia , Hiperglicemia/mortalidade , Nutrição Parenteral Total/efeitos adversos , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosAssuntos
Cetoacidose Diabética/complicações , Pericardite/etiologia , Doença Aguda , Adulto , Colchicina/uso terapêutico , Cetoacidose Diabética/sangue , Cetoacidose Diabética/diagnóstico , Cetoacidose Diabética/tratamento farmacológico , Quimioterapia Combinada , Eletrocardiografia , Hemoglobinas Glicadas/análise , Humanos , Ibuprofeno/uso terapêutico , Insulina de Ação Curta/uso terapêutico , Masculino , Pericardite/sangue , Pericardite/tratamento farmacológico , Potássio/sangueAssuntos
Hipertrigliceridemia/terapia , Plasmaferese , Adamantano/análogos & derivados , Adamantano/uso terapêutico , Adulto , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Dieta com Restrição de Gorduras , Quimioterapia Combinada , Emergências , Humanos , Hiperglicemia/sangue , Hiperglicemia/tratamento farmacológico , Hiperglicemia/etiologia , Hipertrigliceridemia/sangue , Hipertrigliceridemia/complicações , Hipertrigliceridemia/dietoterapia , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Masculino , Metformina/uso terapêutico , Nitrilas/uso terapêutico , Pirrolidinas/uso terapêutico , VildagliptinaAssuntos
Bócio Subesternal/complicações , Síndrome da Veia Cava Superior/etiologia , Idoso , Albuminas/uso terapêutico , Fibrilação Atrial/complicações , Implante de Prótese Vascular , Terapia Combinada , Diabetes Mellitus Tipo 2/complicações , Dopamina/uso terapêutico , Evolução Fatal , Feminino , Furosemida/uso terapêutico , Bócio Subesternal/diagnóstico por imagem , Bócio Subesternal/cirurgia , Parada Cardíaca/etiologia , Humanos , Hipertensão/complicações , Obesidade Mórbida/complicações , Derrame Pleural/etiologia , Apneia Obstrutiva do Sono/complicações , Stents , Síndrome da Veia Cava Superior/diagnóstico por imagem , Síndrome da Veia Cava Superior/cirurgia , Tireoidectomia , Tomografia Computadorizada por Raios XRESUMO
La fístula linfática es una complicación poco frecuente tras mastectomía. A continuación se presenta el caso clínico de una paciente con dicha complicación y se discuten las diferentes alternativas terapéuticas (AU)
Chylous leak is a rare complication after breast cancer surgery. We present the case of a patient with a chylous leak and discuss the management options (AU)
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Humanos , Feminino , Idoso de 80 Anos ou mais , Fístula/etiologia , Doenças Linfáticas/etiologia , Mastectomia/efeitos adversosRESUMO
Primary hyperparathyroidism is a common endocrinological disease and most cases are asymptomatic. We report the case of a patient with primary hyperparathyroidism and symptomatic bone lesions. The possibility of different etiologies (adenoma vs carcinoma) according to the clinical manifestations and treatment are also discussed.