La malnutrición como causa y consecuencia de distorsiones sensoriales / Malnutrition as cause and consequence of sensory distorsions

La malnutrición es una enfermedad provocada por un exceso o defecto en el consumo o aprovechamiento de los nutrientes. Habitualmente, se utiliza este término para referirse a la desnutrición, es decir, a un trastorno derivado del déficit de algún macro y/o micronutrientes. Las alteraciones quimiosensoriales pueden reducir de forma importante la alimentación en el individuo, por lo que es importante verificar que el aporte de nutrientes y, de forma concreta, de algunos micronutrientes, sea suficiente, ya que alguno de ellos, como el zinc, desempeñan un papel primordial en las alteraciones del gusto y del olfato. Además, el paciente malnutrido o con una alimentación que excluya gran número de alimentos, tiene mayor riesgo de presentar déficits de dichos micronutrientes. Diversas enfermedades, tanto agudas como crónicas, se asocian a alteraciones de la percepción sensorial, y pueden llegar a afectar a más del 50% de las personas mayores de 65 años. Los efectos provocados por los fármacos y algunos tratamientos como la quimioterapia y la radioterapia, juegan también un papel muy importante en la distorsión sensorial y en la incidencia de malnutrición (AU)

Malnutrition is a pathological condition caused by an excess or deficiency in the consumption or the use of the nutrients. Usually this term refers to a lack of adequate nourishment, a disorder resulting from a deficiency of some macro and/or micronutrients. Chemo-sensory alterations can significantly reduce food choice and intake, so it is very important to verify that the supply of nutrients and specifically of some micronutrients are sufficient. Some of them, such as «zinc», play a very important role in alterations in the sense of taste and smell. In addition malnutrition patients or a poorly-balanced diet or faulty utilization of foods have increased the risk of deficiencies in these micronutrients. Several types of diseases, both acute and chronic ones, are associated with sensory perception and can affect more than 50% of people over 65 years old. The effects caused by drugs and some treatments such as chemotherapy and radiation therapy play an important role in sensory distortion and the incidence of malnutrition (AU)

Comparación a 5 años de dos técnicas de cirugía bariátrica en pacientes con obesidad mórbida seguidos en consulta enfermera / Five-year comparison of two techniques of baritatric surgery in patients with morbid obesity followed up in a nurse consultation

Objetivo: Comparar la evolución de la pérdida ponderal y las complicaciones en los pacientes sometidos a dos técnicas de cirugía bariátrica (GVA: gastroplastia vertical anillada y BP: by pass gástrico tipo Capella) realizadas en el Hospital La Paz durante los años 2000 y 2001. Material y métodos: Se intervinieron 51 pacientes (27 GVA y 24 BP), de los que 44 (22 GVA y 22 BP) completaron 1 año de seguimiento, 43 (22 GVA y 21 BP) 2 años y 28 (10 GVA y 18 BP) 5 años. Los parámetros analizados a los 6, 12, 18, 24 meses y 5 años fueron IMC (índice de masa corporal), IE (índice de eficacia), % PP (porcentaje de peso perdido), % EPP (porcentaje de exceso de peso perdido), intolerancias alimentarias, complicaciones digestivas, complicaciones quirúrgicas, actividad física y modificación de hábitos alimentarios. Resultados: Con ambas técnicas se observa una importante reducción de peso a los 6 meses (% EPP: 45,8% con GVA y 53,4% con BP). A partir de los 12 meses la pérdida de peso era significativamente superior con BP (% EPP a 2 años: 59,5% con GVA y 83% con BP). Sin embargo, a los 5 años se detecta una recuperación ponderal en ambas técnicas. A los 12 meses los pacientes del grupo GVA toleraban peor la carne y a los 18 meses los del grupo de BP toleraban peor el arroz. No se encontraron diferencias significativas en otros parámetros. Conclusión: Los resultados a largo plazo son mejores con la técnica BP que con la GVA. Hay una reducción de la eficacia a los 5 años que podría estar relacionada con la modificación de hábitos alimentarios y con el abandono del refuerzo en consulta enfermera (AU)

Aims: To compare the evolution of weight loss and complications in the patients subjected to two techniques of bariatric surgery (RVG: ring vertical gastroplasty and BP: gastric by pass type Capella) carried out in HospitalLa Paz during the years 2000 and 2001. Material and methods: 51 patients (27 RVG and 24 BP) were operated, and 44 (22 RVG and 22 BP) completed the follow-up at 1 year, 43 (22 RVG and 21 BP) at 2 years, and 28 (10 RVG and 18 BP) at 5 years. The parameters analyzed at 6, 12, 18, 24 months and 5 years were BMI (body mass index), EI (effectiveness index), % LW (percentage of lost weight), % LEW (percentage of lost excess of weight), alimentary intolerances, digestive complications, surgical complications, physical activity and modification of alimentary habits. Results: An important reduction of weight was observed at 6 months with both techniques (% LEW: 45.8% with RVG and 53.4% with BP). After 12 months the loss of weight was significantly higher with BP (% LEW at 2 years: 59.5% with RVG and 83% with BP). However, at 5 years a weight recovery was detected in both groups of patients. At 12 months the patients subjected to RVG tolerated worse the meat and at 18 months the group of BP tolerated worse the rice. There were not significant differences in other parameters. Conclusion: The long term results are better with BP than with RVG. There is a reduction of effectiveness at 5 years that could be related with the modification of alimentary habits and with giving up attendance to the nurse consultation (AU)

[Five-year comparison of two techniques of bariatric surgery in patients with morbid obesity followed up in a nurse consultation]. / Comparación a 5 años de dos técnicas de cirugía bariátrica en pacientes con obesidad mórbida seguidos en consulta enfermera.

AIMS: To compare the evolution of weight loss and complications in the patients subjected to two techniques of bariatric surgery (RVG: ring vertical gastroplasty and BP: gastric by pass type Capella) carried out in HospitalLa Paz during the years 2000 and 2001. MATERIAL AND METHODS: 51 patients (27 RVG and 24 BP) were operated, and 44 (22 RVG and 22 BP) completed the follow-up at 1 year, 43 (22 RVG and 21 BP) at 2 years, and 28 (10 RVG and 18 BP) at 5 years. The parameters analyzed at 6, 12, 18, 24 months and 5 years were BMI (body mass index), EI (effectiveness index), % LW (percentage of lost weight), % LEW (percentage of lost excess of weight), alimentary intolerances, digestive complications, surgical complications, physical activity and modification of alimentary habits. RESULTS: An important reduction of weight was observed at 6 months with both techniques (% LEW: 45.8% with RVG and 53.4% with BP). After 12 months the loss of weight was significantly higher with BP (% LEW at 2 years: 59.5% with RVG and 83% with BP). However, at 5 years a weight recovery was detected in both groups of patients. At 12 months the patients subjected to RVG tolerated worse the meat and at 18 months the group of BP tolerated worse the rice. There were not significant differences in other parameters. CONCLUSION: The long term results are better with BP than with RVG. There is a reduction of effectiveness at 5 years that could be related with the modification of alimentary habits and with giving up attendance to the nurse consultation.

[Life-style in eating behavior disorders]. / Estilo de vida en trastornos de conducta alimentaria.

GOAL: To identify the eating habits and lifestyles of patients with eating behaviour disorders (TCA in its Spanish acronym) who attended our out-patients' clinic at the "La Paz" Teaching Hospital for the first time. METHOD: A questionnaire was drafted to which patients responded freely and anthropometric data were assessed. RESULTS: The sample comprised 94 patients who were subsequently distributed into two groups: the first group contained 43 offspring of working mothers (HMTF) and the second 46 offspring of mothers who did not work outside the home (HMNTF in its Spanish acronym). In the case of the 5 remaining patients, their mothers had deceased. The results from the group as a whole showed the following lifestyles for Monday-Friday: 34.4% eat alone, 72% watch television while they eat and 68.1% use restrictive behaviour in their eating habits. When assessing the existence of a friend with TCA, the results were significantly higher among those under the age of 20 years (53.7%) versus those older than 20 (26.9%) (p < 0.05). No differences were found in the habits and nutritional status of HMTF and HMNTF since 8.2% of the first had severe caloric malnutrition versus 2.3% in the second group. While 12.2% of the HMTF group eat outside the home on weekdays and 44.9% of them eat alone, 20.5% of the HMNTF group eat outside the home on weekdays and 22.7% of them eat alone. The age of onset of TCA was significantly earlier among the HMTF group (16.6 years) than in the HMNTF group (19.0 years) (p < 0.05). CONCLUSION: A large number of subjects had a friend with TCA in their close environment and this situation was more frequent among the youngest ones in the group. Some mistaken ideas regarding food have favoured unhealthy eating: in our group a large majority of people eat while watching TV. The development of TCA occurs earlier in connection with a particular family structure: where the mother works outside the home.

Estilo de vida en trastornos de conducta alimentaria / Lifestyle in eating behaviour disorders

Objetivo: Conocer las prácticas alimentarias y hábitos de vida en los pacientes con trastornos del comportamiento alimentario (TCA) que acudieron como primera vez a nuestra consulta externa del Hospital Universitario de La Paz. Método: Se elaboró un cuestionario que los pacientes respondían libremente y una valoración de datos antropométricos. Resultados: La muestra la constituían 94 pacientes que posteriormente fueron divididos en dos grupos: un primer grupo compuesto por 43 hijos de madres que trabajaban fuera del hogar (HMTF) y 46 hijos de madres que no trabajan fuera (HMNTF). En los 5 pacientes restantes sus madres habían fallecido. Como resultado del grupo total obtenemos en los hábitos de vida en días laborables: un 34,4 por ciento comen solas, un 72 por ciento ven la televisión (TV) mientras comen y un 68,1 por ciento utilizan conductas restrictivas en su alimentación. Al valorar la existencia de algún amigo/a con TCA, resultó significativamente mayor entre los más jóvenes 20 años (26,9 por ciento) (p<0,005). No encontramos diferencias en los hábitos y estado nutricional de las HMTF e HMNTF: dado que en el primer grupo un 8,2 por ciento tienen malnutrición calórica severa frente al 2,3 por ciento del segundo grupo. Mientras que un 12,2 por ciento de HMTF comen fuera de casa en los días laborables y un 44,9 por ciento lo hacen en soledad, un 20,5 por ciento del grupo HMNTF comen fuera de sus casas y 22,7 por ciento comen solas. La edad de inicio del TCA fue significativamente más precoz entre HMTF (16,6 años) frente a HMNTF (19,0 años) (p<0,05). Conclusión: Un elevado número de pacientes tiene en su entorno algún amigo con TCA y son los más jóvenes de edad, en las que esta situación es más frecuente. Algunas actitudes erróneas frente a la comida favorecen un comportamiento alimentario insano: en nuestro grupo una gran mayoría come viendo la televisión. El desarrollo del TCA es más precoz en relación con una estructura familiar determinada; que la madre trabaje fuera de casa (AU)

Goal: To identify the eating habits and lifestyles of patients with eating behaviour disorders (TCA in its Spanish acronym) who attended our out-patients’ clinic at the “La Paz” Teaching Hospital for the first time. Method: A questionnaire was drafted to which patients responded freely and anthropometric data were assessed. Results: The sample comprised 94 patients who were subsequently distributed into two groups: the first group contained 43 offspring of working mothers (HMTF) and the second 46 offspring of mothers who did not work outside the home (HMNTF in its Spanish acronym). In the case of the 5 remaining patients, their mothers had deceased. The results from the group as a whole showed the following lifestyles for Monday-Friday: 34.4% eat alone, 72% watch television while they eat and 68.1% use restrictive behaviour in their eating habits. When assessing the existence of a friend with TCA, the results were significantly higher among those under the age of 20 years (53.7%) versus those older than 20 (26.9%) (p < 0.05). No differences were found in the habits and nutritional status of HMTF and HMNTF since 8.2% of the first had severe caloric malnutrition versus 2.3% in the second group. While 12.2% of the HMTF group eat outside the home on weekdays and 44.9% of them eat alone, 20.5% of the HMNTF group eat outside the home on weekdays and 22.7% of them eat alone. The age of onset of TCA was significantly earlier among the HMTF group (16.6 years) than in the HMNTF group (19.0 years) (p < 0.05). Conclusion: A large number of subjects had a friend with TCA in their close environment and this situation was more frequent among the youngest ones in the group. Some mistaken ideas regarding food have favoured unhealthy eating: in our group a large majority of people eat while watching TV. The development of TCA occurs earlier in connection with a particular family structure: where the mother works outside the home (AU)

[Results of educational intervention in obese patients]. / Resultados de la intervención educativa en pacientes con obesidad.

We have carried out an active longitudinal study to analyze the results obtained in the treatment of obesity by means of educational measures and a visit to a nurse for follow-up every 15-30 days. A total of 116 patients have been treated over the last two years, following referral from the medical clinic of the Nutrition and Dietetics Unit with a diagnosis of obesity. These patients received instruction in healthy eating and they were monitored in groups of 4-5 individuals with a similar level of obesity, age and cultural level, or else individually in special cases. At the cut-off point, 26.7% of the patients continued to attend the follow-up clinic, 5.1% had completed the therapy and achieved the goal set (weight reduction of at least 10%), whereas 44% had abandoned the monitoring process, 15.5% were referred back to the medical clinic and 8.6% requested a voluntary discharge. The largest percentage decrease in the BMI (Body Mass Index) can be found among those who requested a voluntary discharge (ddd 12.8) over the others. By analyzing the change in the BMI between the start and the end of the process, we have found a non-uniform significant decrease (p nnn 0.001) between the different degrees. We feel that education in healthy eating provides patients with the necessary information for them to be able to achieve balanced eating habits as the basis for the treatment of obesity. Regular follow-up and group sessions reinforce their continuity with treatment and the achievement of the goals set.

Resultados de la intervención educativa en pacientes con obesidad / Results of educational action on obese patients

Hemos realizado un estudio longitudinal con intervención, analizando los resultados obtenidos en el tratamiento de la obesidad, mediante educación y seguimiento cada 15-30 días en consulta de enfermería. Durante dos años se han tratado un total de 116 pacientes, enviados de la consulta médica de la Unidad de Nutrición y Dietética con el diagnóstico de obesidad. Estos pacientes recibían educación alimentaria y se les realizaba el seguimiento, bien en grupos de 4-5 personas con similar grado de obesidad, edad y nivel cultural, o de forma individual en casos especiales. En el momento de corte continuaban en la consulta de enfermería el 26,7 por ciento de los pacientes, habían finalizado el tratamiento consiguiendo el objetivo marcado (reducción del peso al menos del 10 por ciento) el 5,1 por ciento, el 44 por ciento había abandonado el seguimiento, fueron derivados a consulta médica el 15,5 por ciento y solicitaron el alta voluntaria el 8,6 por ciento. El mayor descenso porcentual del IMC (índice de masa corporal) lo encontramos entre los que solicitan el alta voluntaria (-12,8) frente a los demás. Al analizar la modificación del IMC del inicio y final encontramos un descenso significativo (p < 0,001) no uniforme entre los diferentes grados. Pensamos que la educación alimentaria proporciona los conocimientos necesarios para poder realizar una alimentación equilibrada y saludable como base del tratamiento de la obesidad. El seguimiento periódico y la intervención en grupo refuerzan la adherencia al tratamiento y la consecución de los objetivos (AU)

We have carried out an active longitudinal study to analyze the results obtained in the treatment of obesity by means of educational measures and a visit to a nurse for follow-up every 15-30 days. A total of 116 patients have been treated over the last two years, following referral from the medical clinic of the Nutrition and Dietetics Unit with a diagnosis of obesity. These patients received instruction in healthy eating and they were monitored in groups of 4-5 individuals with a similar level of obesity, age and cultural level, or else individually in special cases. At the cut-off point, 26.7% of the patients continued to attend the follow-up clinic, 5.1% had completed the therapy and achieved the goal set (weight reduction of at least 10%), whereas 44% had abandoned the monitoring process, 15.5% were referred back to the medical clinic and 8.6% requested a voluntary discharge. The largest percentage decrease in the BMI (Body Mass Index) can be found among those who requested a voluntary discharge (ddd 12.8) over the others. By analyzing the change in the BMI between the start and the end of the process, we have found a non-uniform significant decrease (p nnn 0.001) between the different degrees. We feel that education in healthy eating provides patients with the necessary information for them to be able to achieve balanced eating habits as the basis for the treatment of obesity. Regular follow-up and group sessions reinforce their continuity with treatment and the achievement of the goals set (AU)