Adherence and impact of an oral nutritional supplement enriched in leucine, EVOO, EPA and DHA, and beta-glucans on the coverage of energy and protein requirements in patients with cancer and malnutrition: Alisenoc study.

OBJECTIVE: The aim of this study was to evaluate the impact of an enhanced ONS (enriched in EPA, DHA, leucine, and beta-glucans) on the dietary intake of cancer patients. METHODS: A randomized, double-blind, parallel, controlled, and multicenter clinical trial was conducted in patients with cancer and malnutrition. The trial compared prescribed dietary advice and two packs per day, for 8 weeks, of a hypercaloric (400 kcal/pack) and hyperproteic ONS (20 g/pack) with fiber and specific ingredients (leucine, EPA and DHA, and beta-glucans) (enhanced-ONS) versus an isocaloric and isoproteic formula (standard-ONS) without specific ingredients. Food intake was assessed with a 3-day dietary survey, and adherence to the supplement with a patient self-completed diary. RESULTS: Thirty-seven patients completed the intervention period. The combined intervention of dietary advice and ONS managed to increase the energy intake of the overall cohort by 792.55 (378.57) kcal/day, protein by 40.72 (19.56) g/day. Increases in energy and nutrient intakes were observed in both groups, both in dietary intake and associated exclusively with the supplement. The group that received the enhanced-ONS ingested a greater volume of product when there was a greater severity of malnutrition; a tumor location in the head, neck, upper digestive area, liver, or pancreas; more advanced stages of the tumor; or the receipt of more than one antineoplastic treatment. CONCLUSION: The use of an enhanced-ONS helps meet the nutritional requirements of cancer patients, especially those who have a more compromised clinical condition, with high adherence, good tolerance, and acceptance.

Nutritional Ultrasonography, a Method to Evaluate Muscle Mass and Quality in Morphofunctional Assessment of Disease Related Malnutrition.

Nutritional ultrasonography is an emerging technique for measuring muscle mass and quality. The study aimed to evaluate the relationship between the parameters of body mass and quality of ultrasonography with other parameters of morphofunctional assessment in patients with disease-related malnutrition (DRM). METHODS: A cross-sectional study was developed on 144 patients diagnosed with DRM according to the Global Leadership Initiative on Malnutrition (GLIM) criteria. Morphofunctional evaluation was assessed with anthropometric variables, handgrip strength and bioelectrical impedanciometry (BIA). Nutritional ultrasonography of quadriceps rectus femoris (QRF) was made (muscle mass (Muscle Area of Rectus Femoris index (MARFI)), Y axis and muscle quality (X-Y index and echogenicity). RESULTS: The mean age of patients was 61.4 (17.34) years. The prevalence of sarcopenia in the sample was 33.3%. Patients with sarcopenia (S) had lower values of MARFI [(S: 1.09 (0.39) cm2/m2; NoS: 1.27 (0.45); p = 0.02), Y axis (S: 0.88 (0.27); NoS: 1.19 (0.60); p < 0.01) and X-Y index (S: 1.52 (0.61); NoS: 1.30 (0.53); p < 0.01)]. There was a correlation between BIA parameters (phase angle) and muscle mass ultrasonographic variables (MARFI) (r = 0.35; p < 0.01); there was an inverse correlation between muscle quality ultrasonographic variables (echogenicity) and handgrip strength (r = -0.36; p < 0.01). In the multivariate analysis adjusted by age, the highest quartile of the X-Y index had more risk of death OR: 4.54 CI95% (1.11-18.47). CONCLUSIONS: In patients with DRM and sarcopenia, standardized muscle mass and muscle quality parameters determined by ultrasonography of QRF are worse than in patients without sarcopenia. Muscle quality parameters had an inverse correlation with electric parameters from BIA and muscle strength. The highest quartile of the X-Y index determined by ultrasonography was associated with increased mortality risk.

Diagnosis of malnutrition and its relationship with prognosis in hospitalized patients with oncological pathology.

BACKGROUND AND AIMS: Medical oncology inpatients are at a very high risk of malnutrition, and the presence of complications associated with malnutrition is significant in their evolution. It is necessary to have adequate tools in the diagnosis of malnutrition. OBJECTIVES: This study is aimed to assess the nutritional status of cancer inpatients and compare the incidence of complications based on the nutritional diagnosis with different tools. METHODS: An observational, longitudinal, and retrospective study was designed on 149 patients admitted to the Oncology Service who were requested nutritional and medical treatment between January 2014 and June 2017. Epidemiological, clinical, anthropometric, and nutritional data were collected. Nutritional status was assessed using the Mini Nutritional Assessment (MNA), the Malnutrition Universal Screening Tool (MUST), and the Global Leadership Initiative on Malnutrition (GLIM) criteria. RESULTS: The age of the patients was 61.61 (15.96) years. 67.8% of the patients were men. Most of the patients were in advanced tumor stages (stage III (15.3%); stage IV (77.1%)). The median of the MUST was 2 (0-3) (High risk: 83 (55.7%)). The median MNA was 17 (14-20) (poor nutritional status: 65 (43.6%); risk of malnutrition 71 (47.7%)). According to the GLIM criteria, 115 (77.2%) had malnutrition, and 97 (65.1%) had severe malnutrition. According to MNA, an increase in mortality was observed (MNA <17: 24.6% vs. MNA >17: 7.9%; pvalue <0.01). Multivariate analysis showed that poor nutritional status measured with MNA is related to an increased probability of mortality regardless of the stage of the disease and the patient's age OR: 4.19 95% CI (1.41-12.47); p-value = 0.02. CONCLUSIONS: Malnutrition among cancer patients in whom a nutritional assessment is requested during admission is very high. In hospitalized patients with oncological pathology, it was observed that malnutrition measured by MNA acts as a mortality risk factor.

Nutritional ultrasound®: Conceptualisation, technical considerations and standardisation.

Nutritional ultrasound® is a new concept that uses ultrasound to assess body composition. It is composed of the evaluation of fat-free mass and fat mass. It is an emerging, economical, portable, non-invasive technique that evaluates the musculoskeletal area with linear, broadband, multifrequency probes, with a depth field of 20-100mm. It quantifies muscle modifications in malnutrition and provides information on functional changes (echogenicity). Although there are no validated specific cut-off points, the anterior rectum area of the quadriceps can be used as a criterion for malnutrition. The distribution of adipose tissue provides information on the energy reserve and the inflammatory pattern. It is important to integrate nutritional ultrasound® measures in clinical practice adapted to different settings and pathologies. It is necessary to establish training plans in nutritional ultrasound® for use by Endocrinology and Nutrition Specialists, with the aim of improving the diagnosis and treatment of their patients.

Effect on Body Composition of a Meal-Replacement Progression Diet in Patients 1 Month after Bariatric Surgery.

BACKGROUND: Progression diets after bariatric surgery (BS) are restricted in calories and protein, and they may induce a worsening of body composition. The aim of this study was to evaluate the effect of a modified diet with an oral nutritional supplement that is hyperproteic and normocaloric over the body composition. METHODS: A two-arm ambispective observational cohort study was designed. Forty-four patients who underwent sleeve gastrectomy were included in the study. Thirty patients received a progression diet with a normocaloric, hyperproteic oral nutritional supplement during the first two weeks after surgery (820 kcal, 65.5 g protein). They were compared with a historical cohort of 14 patients treated with a standard progression diet (220 kcal, 11.5 g protein). Anthropometric and body composition (using electrical bioimpedanciometry) data were analyzed before BS and 1 month after the surgery. RESULTS: The mean age was 47.35(10.22) years; 75% were women, and the average presurgical body mass index (BMI) was 45.98(6.13) kg/m2, with no differences between both arms of intervention. One month after surgery, no differences in the percentage of excess weight loss (%PEWL) were observed between patients in the high-protein-diet group (HP) and low-protein-diet group (LP) (HP: 21.86 (12.60)%; LP: 18.10 (13.49)%; p = 0.38). A lower loss of appendicular skeletal muscle mass index was observed in the HP (HP: -5.70 (8.79)%; LP: -10.54 (6.29)%; p < 0.05) and fat-free mass index (HP: 3.86 (8.50)%; LP:-9.44 (5.75)%; p = 0.03), while a higher loss of fat mass was observed in the HP (HP: -14.22 (10.09)%; LP: -5.26 (11.08)%; p < 0.01). CONCLUSIONS: In patients undergoing gastric sleeve surgery, the addition of a normocaloric, hyperproteic formula managed to slow down the loss of muscle mass and increase the loss of fat mass with no differences on total weight loss.

Evolution of nutrition support in patients with COVID-19 disease admitted in the Intensive Care Unit.

INTRODUCTION: Nutritional support in patients with COVID19 can influence the mean stay and complications in the patient in Intensive Care Unit (ICU). AIMS: To evaluate the selection of enteral nutritional treatment in the COVID-19 patient admitted to the ICU. To know the development of dysphagia and its treatment. To evaluate the adjustment to the requirements and its relationship with the patient's complications. MATERIAL AND METHODS: One-center longitudinal retrospective study in 71 patients admitted to the ICU with COVID19 infection and complete enteral nutrition between March and April 2020. Clinical variables were collected: length of stay in ICU, mean stay and rate of complications; and estimated anthropometric variables. RESULTS: The mean age was 61.84 (13.68) years. Among the patients analyzed, 33 (46.5%) died. The median stay in the ICU was 20 (15.75-32) days and the mean stay was 37 (26.75-63) days. The type of formula most prescribed was normoprotein 24 (35.3%) and diabetes-specific 23 (33.8%) depending on the prescribed formula. There was no difference in mean stay (p = 0.39) or death rate (p = 0.35). The percentage of achievement of the estimated protein requirements was 50 (34.38-68.76). At discharge, 8 (21%) of the patients had dysphagia. A relationship was observed between the mean ICU stay and the probability of developing dysphagia (OR: 1.035 (1.004-1.07); p = 0.02). CONCLUSIONS: In the patient with COVID19 disease admitted to the ICU, only half of the necessary protein requirements were reached. The presence of dysphagia at discharge was related to the length of time the patient was in the ICU.

Real World Practice Study of the Effect of a Specific Oral Nutritional Supplement for Diabetes Mellitus on the Morphofunctional Assessment and Protein Energy Requirements.

Introduction: The prevalence of malnutrition in patients with diabetes mellitus is high. In these patients, monitoring nutritional intervention is complex. Aims: To evaluate the evolution in the nutritional status in patients with diabetes/prediabetes and malnutrition with a diabetes-specific enteral formula. Methods: Real-life study of one arm in 60 patients with diabetes and prediabetes, performing a dietary adaptation with diabetes-specific oral nutritional supplementation. A morphofunctional assessment was performed, consisting of intake assessment, anthropometry, body composition (bioimpedance and muscle ultrasound), handgrip strength and biochemical markers. The diagnosis of malnutrition was made using the criteria of the Global Leadership Initiative on Malnutrition (GLIM). The variables were measured at baseline and 3 months after starting the intervention. Results: The mean age was 67.13 (14.9) years. In total, 30 (50%) of the patients were women. Of the total, 60% of the patients had diabetes mellitus and 40% of the patients had prediabetes. The initial body mass index was 24.65 (5.35) kg/m2. It was observed that 80% of the patients had malnutrition, whereas after the intervention, the prevalence was 51.7% (p < 0.01). At the beginning of the study, 20% of the patients suffered from sarcopenia and after the intervention it was 16.7% (p = 0.19). Conclusions: Medical Nutrition Therapy with an adapted oral diet associated with diabetes-specific oral nutritional supplementation reduces malnutrition in patients at nutritional risk and disturbances of carbohydrate metabolism.

Muscular Ultrasonography in Morphofunctional Assessment of Patients with Oncological Pathology at Risk of Malnutrition.

Background: Muscular ultrasonography is a technique that allows assessing the amount and quality of muscle in a specific body region. The aim of the study was to compare the value of muscle ultrasonography in diagnosis of malnutrition with techniques such as anthropometry, handgrip strength and impedanciometry in patients with oncological pathology. Methods: Cross-sectional study in 43 patients with oncological pathology and high nutritional risk. Classical anthropometry (body mass index (BMI), arm circumference (AC), calf circumference (CC) and estimated appendicular muscle mass index (ASMI)) was performed. Body composition was measured with impedanciometry (BIA), phase angle (PA) and fat-free mass index (FFMI) and muscle ultrasonography of quadriceps rectus femoris (muscle area (MARA) and circumference (MCR) in section transverse). Malnutrition was diagnosed using the GLIM criteria and sarcopenia was assessed using EWGSOP2 criteria. Results: The mean age was 68.26 years (±11.88 years). In total, 23/20 of the patients were men/women. The BMI was 23.51 (4.75) kg/m2. The ASMI was 6.40 (1.86) kg/m2. The MARA was 3.31 cm2 in ultrasonography. In impedanciometry, phase angle was 4.91 (0.75)°; the FFMI was 17.01 kg/m2 (±2.65 kg/m2). A positive correlation was observed between the MARA with anthropometric measurements (AC: r = 0.39, p = 0.009; CC: r = 0.44, p < 0.01; ASMI: r = 0.47, p < 0.001); and with BIA (FFMI: r = 0.48, p < 0.01 and PA: r = 0.45, p < 0.001). Differences were observed when comparing the MARA based on the diagnosis of sarcopenia (Sarcopenia: 2.47 cm2 (±0.54 cm2); no sarcopenia: 3.65 cm2 (±1.34 cm2); p = 0.02). Conclusions: Muscle ultrasonography correlates with body composition measurement techniques such as BIA and anthropometry in patients with cancer.

Influence of Obesity on Bone Turnover Markers and Fracture Risk in Postmenopausal Women.

Background and aims: The relationship between obesity and bone metabolism is controversial. In recent decades, the protective role of obesity in the development of osteoporosis is questioned. The aims of this study are the following: to evaluate the differences in bone turnover markers between postmenopausal women with and without obesity and to compare the risk of fracture at five years between these groups. Methods: An observational longitudinal prospective cohort study of postmenopausal women with obesity (O) (body mass index (BMI) > 30 kg/m2) and non-obesity (NoO) (BMI < 30 kg/m2) is designed. 250 postmenopausal women are included in the study (NoO: 124 (49.6%) and O: 126 (50.4%)). It measures epidemiological variables, dietary variables (calcium intake, vitamin D intake, smoking, alcohol consumption, and physical activity), biochemicals (ß-crosslap, type I procollagen amino-terminal peptide (P1NP), 25OH-vitamin D, and parathyroid hormone (PTH)), anthropometric variables, and fracture data five years after the start of the study. The mean age is 56.17 (3.91) years. Women with obesity showed lower levels of vitamin D (O: 17.27 (7.85) ng/mL, NoO: 24.51 (9.60) ng/mL; p < 0.01), and higher levels of PTH (O: 53.24 (38.44−65.96) pg/mL, NoO: 35.24 (25.36−42.40) pg/mL; p < 0.01). Regarding the bone formation marker (P1NP), it was found to be high in women without obesity, O: 45.46 (34.39−55.16) ng/mL, NoO: 56.74 (45.34−70.74) ng/mL; p < 0.01; the bone resorption marker (ß-crosslap) was found to be high in women with obesity, being significant in those older than 59 years (O: 0.39 (0.14) ng/mL, NoO 0.24 (0.09) ng/mL; p < 0.05). No differences are observed in the risk of fracture at 5 years based on BMI (OR = 0.90 (95%CI 0.30−2.72); p = 0.85). Conclusions: Postmenopausal women with obesity showed lower levels of bone formation markers; older women with obesity showed higher markers of bone resorption.

[Evolution of nutrition support in patients with COVID-19 disease admitted in the Intensive Care Unit]. / Evolución del soporte nutricional en el paciente con enfermedad COVID-19 ingresado en la Unidad de Cuidados Intensivos.

Introduction: Nutritional support in patients with COVID-19 can influence the mean stay and complications in the patient in Intensive Care Unit (ICU). Aims: To evaluate the selection of enteral nutritional treatment in the COVID-19 patient admitted to the ICU. To know the development of dysphagia and its treatment. To evaluate the adjustment to the requirements and its relationship with the patient's complications. Material and methods: One-center longitudinal retrospective study in 71 patients admitted to the ICU with COVID-19 infection and complete enteral nutrition between March and April 2020. Clinical variables were collected: length of stay in ICU, mean stay and rate of complications; and estimated anthropometric variables. Results: The mean age was 61.84 (13.68) years. Among the patients analyzed, 33 (46.5%) died. The median stay in the ICU was 20 (15.75-32) days and the mean stay was 37 (26.75-63) days.The type of formula most prescribed was normoprotein 24 (35.3%) and diabetes-specific 23 (33.8%). Depending on the prescribed formula, there was no difference in mean stay (p = 0.39) or death rate (p = 0.35). The percentage of achievement of the estimated protein requirements was 50% (34.38-68.76).At discharge, 8 (21%) of the patients had dysphagia. A relationship was observed between the mean ICU stay and the probability of developing dysphagia (OR: 1.035 (1.004-1.07); p = 0.02). Conclusions: In the patient with COVID-19 disease admitted to the ICU, only half of the necessary protein requirements were reached. The presence of dysphagia at discharge was related to the length of time the patient was in the ICU.

Effect of the type of specialized nutrition support on the course of the patient with amyotrophic lateral sclerosis (ALS). Interhospital registry SCLEDyN.

INTRODUCTION: Amyotrophic Lateral Sclerosis (ALS) is a neurodegenerative disease in which specialized nutritional support is essential. The objectives of our study were to describe nutritional support at the beginning of follow-up and its impact on anthropometry and survival. METHODS: An interhospital registry was created for the hospitals of Castilla-León through a web platform designed for this purpose. An anamnesis was carried out on the evolution and nutritional history of the disease; and classical anthropometry was determined. The prescribed nutritional treatment was recorded. The parameters were measured at the beginning, at six and twelve months of nutritional follow-up. RESULTS: A total of 93 patients [49 (52.7%) spinal; 44 (47.3%) bulbar)] were analyzed. The nutritional support route at the beginning was oral diet in 36 (38.7%) patients; oral nutritional supplementation (SON) in 46 (49.5%) patients; and in 11 (11.8%) patients percutaneous endoscopic gastrostomy (PEG). A decrease in the body mass index (BMI) was observed between the first and second visit [Start: 24.18 (3.29) kg/m2; 6 months: 23.69 (4.12) kg/m2; P < .05]. Less weight loss was observed at 6 months compared to the start of nutritional follow-up [Start: 8.09 (8.72)%; 6 months: 1.4 (6.29)%; P < .01]. 36 (38.7%) patients died but with no differences according to when nutritional support was started. Survival from the onset of symptoms was higher in the group of patients with artificial nutrition, although without reaching statistical significance [Oral: 28 (20.25) months; SON: 30 (16.75-48.25) months; PEG: 39 (27-52) months; P = .90]. CONCLUSIONS: Patients with ALS present a severe deterioration in nutritional status before the start of nutritional support. After the nutritional intervention, a slowdown in weight loss and nutritional deterioration was observed.

Impact of Percutaneous Endoscopic Gastrostomy (PEG) on the Evolution of Disease in Patients with Amyotrophic Lateral Sclerosis (ALS).

Dysphagia is a highly prevalent symptom in Amyotrophic Lateral Sclerosis (ALS), and the implantation of a percutaneous endoscopic gastrostomy (PEG) is a very frequent event. The aim of this study was to evaluate the influence of PEG implantation on survival and complications in ALS. An interhospital registry of patients with ALS of six hospitals in the Castilla-León region (Spain) was created between January 2015 and December 2017. The data were compared for those in whom a PEG was implanted and those who it was not. A total of 93 patients were analyzed. The mean age of the patients was 64.63 (17.67) years. A total of 38 patients (38.8%) had a PEG implantation. An improvement in the anthropometric parameters was observed among patients who had a PEG from the beginning of nutritional follow-up compared to those who did not, both in BMI (kg/m2) (PEG: 0 months, 22.06; 6 months, 23.04; p < 0.01; NoPEG: 0 months, 24.59-23.87; p > 0.05). Among the deceased patients, 38 (40.4%) those who had an implanted PEG (20 patients (52.6%) had a longer survival time (PEG: 23 (15-35.5) months; NoPEG 11 (4.75-18.5) months; p = 0.01). A PEG showed a survival benefit among ALS patients. Early implantation of a PEG produced a reduction in admissions associated with complications derived from it.

Effect of the type of specialized nutrition support on the course of the patient with amyotrophic lateral sclerosis (ALS). Interhospital registry SCLEDyN. / Efecto del tipo de soporte nutricional especializado sobre la evolución del paciente con esclerosis lateral amiotrófica (ELA). Registro interhospitalario SCLEDyN.

INTRODUCTION: Amyotrophic Lateral Sclerosis (ALS) is a neurodegenerative disease in which specialized nutritional support is essential. The objectives of our study were to describe nutritional support at the beginning of follow-up and its impact on anthropometry and survival. METHODS: An interhospital registry was created for the hospitals of Castilla-León through a web platform designed for this purpose. An anamnesis was carried out on the evolution and nutritional history of the disease; and classical anthropometry was determined. The prescribed nutritional treatment was recorded. The parameters were measured at the beginning, at six and twelve months of nutritional follow-up. RESULTS: A total of 93 patients [49 (52.7%) spinal; 44 (47.3%) bulbar)] were analyzed. The nutritional support route at the beginning was oral diet in 36 (38.7%) patients; oral nutritional supplementation (SON) in 46 (49.5%) patients; and in 11 (11.8%) patients percutaneous endoscopic gastrostomy (PEG). A decrease in the body mass index (BMI) was observed between the first and second visit [Start: 24.18 (3.29) kg/m2; 6 months: 23.69 (4.12) kg/m2; P<.05]. Less weight loss was observed at 6 months compared to the start of nutritional follow-up [Start: 8.09 (8.72)%; 6 months: 1.4 (6.29)%; P<.01]. 36 (38.7%) patients died but with no differences according to when nutritional support was started. Survival from the onset of symptoms was higher in the group of patients with artificial nutrition, although without reaching statistical significance [Oral: 28 (20.25) months; SON: 30 (16.75-48.25) months; PEG: 39 (27-52) months; P=.90]. CONCLUSIONS: Patients with ALS present a severe deterioration in nutritional status before the start of nutritional support. After the nutritional intervention, a slowdown in weight loss and nutritional deterioration was observed.

[Influence of prior ischemic events on the nutritional status of patients hospitalized for stroke]. / Influencia de la historia de isquemia sobre el estado nutricional en pacientes ingresados por accidente cerebrovascular.

INTRODUCTION: Background and aims: a poor nutritional status may worsen the prognosis of stroke. We assessed which factors were associated with a worse nutritional status in patients with stroke at the time of hospitalization. Methods: a cross-sectional study in patients with stroke needing enteral nutritional support, from January 2014 to September 2016. Nutritional status was evaluated by the Mini-Nutritional Assessment tool, and the Subjective Global Assessment. We performed a multivariate regression analysis including demographic, baseline disability (modified Rankin scale), and clinical and anthropometric variables, and we stratified the sample based on median age. Results: we included 226 patients, 58.3 % male, with a median age of 77 (66.7-83) years. Forty-four percent were at risk of malnutrition, and 24 % were malnourished. The factors that were associated with a worse nutritional status were age (odds ratio (OR): 1.03; 95 % CI: 1.01-1.08) and modified Rankin scale score (OR: 1.96; 95 % CI: 1.32-2.67). In the stratified analysis, associated factors were, in the subgroup of patients older than 77 years, the baseline degree of disability (OR: 1.88; 95 % CI: 1.26-2.80), whereas in the subgroup of patients younger than 77 years, it was a prior history of ischemic events (OR: 2.86; 95 % CI: 1.01-8.16). Conclusion: in patients hospitalized due to stroke, older age and worse functional status were associated with a worse nutritional status at the time of hospitalization. In elderly patients, the main factor was prior functional status, while in younger patients it was a prior history of ischemic events.

INTRODUCCIÓN: Introducción y objetivos: el mal estado nutricional empeora el pronóstico del ictus. El objetivo de este trabajo fue evaluar qué factores se asociaban a una mala situación nutricional en pacientes con ictus en el momento del ingreso. Material y método: estudio transversal de pacientes hospitalizados con ictus que precisaron soporte nutricional enteral, desde enero de 2014 hasta septiembre de 2016. Determinamos el estado nutricional mediante el Mini-Nutritional Assesment y la valoración global subjetiva. Se realizó un análisis de regresión multivariante, incluyendo variables demográficas, situación funcional (escala de Rankin) y variables clínicas y antropométricas, estratificándose por la edad mediana de la muestra. Resultados: se incluyeron 226 pacientes, el 58,3 % varones, con una edad mediana de 77 (66,7-83) años. El 44 % presentaban riesgo de malnutrición y el 24 % desnutrición. Los factores asociados a una mala situación nutricional fueron la edad (odds ratio (OR): 1,03, IC 95 %: 1,01-1,08) y la puntuación en la escala de Rankin (OR: 1,96; IC 95 %: 1,32-2,67). En el análisis estratificado, los factores asociados a una mala situación nutricional fueron, en el subgrupo de los mayores de 77 años, la capacidad funcional previa (OR: 1,88; IC 95 %: 1,26-2,80), y en el subgrupo de los menores de 77 años, la historia de eventos isquémicos previos (OR: 2,86; IC 95 %: 1,01-8,16). Conclusiones: en pacientes hospitalizados por ictus, la mayor edad y la peor situación funcional previa se asociaron a una peor situación nutricional. En los pacientes de mayor edad, el factor principal fue la situación funcional previa, mientras que en los pacientes más jóvenes, fue el antecedente de patología isquémica.

Malnutrition at diagnosis in amyotrophic lateral sclerosis (als) and its influence on survival: Using glim criteria.

BACKGROUND: Malnutrition is a prognostic factor in Amyotrophic Lateral Sclerosis (ALS). Sometimes, this condition is underdiagnosed, and it might influence on disease progression. AIMS: To evaluate a) nutritional status at the beginning of specialized nutritional treatment and b) the influence of initial nutritional status on disease evolution and survival in a group of patients with amyotrophic lateral sclerosis (ALS). METHODS: An interhospital registry of patients with motor neuron disease treated at the Clinical Nutrition Clinics of six hospitals in the region of Castilla y León in Spain was created. The study was developed from January 2015 to December 2017. An anamnesis, affiliation data, past medical history, disease evolution, nutritional history and an anthropometry and bioelectrical impedance analysis were performed at baseline. The mortality rate was compared among those patients with worse nutritional status at the beginning of the follow-up against those with a better nutritional situation using two tools: The Subjective Global Assessment (SGA) and the criteria of the Global Leadership Initiative for Malnutrition (GLIM). RESULTS: A total of 93 patients were analysed. The median age of the patients was 67 (57.5-75.5) years. The median Body Mass Index was 24.4 (21.7-25.9) kg/m2 and the median percentage of weight loss was 9.32 (2.7-17.6)% without differences between the onset type. According to the SGA, 27 (29%) patients were in grade A; 43 (46.3%) patients were in grade B and 23 (24.7%) were in grade C. According to the new GLIM malnutrition criteria, 45 patients (48.4%) had malnutrition. Patients with worse nutritional status had a lower survival median with both SGA (SGA A: 20.5 (10.2-35) months vs SGA B-C: 12 (5.2-23.7) months (p = 0.03)) or the new GLIM criteria according to severity (severe malnutrition: 18 (5-24) months vs. no severe malnutrition: 20 (12-33) months (p = 0.01)). In the multivariate analysis, malnutrition measured by SGA was an independent risk factor (HR: 4.6 (1.5-13.9) p = 0.007) for survival over 15 months when adjusted for age, sex and type of onset of ALS. CONCLUSIONS: Patients with ALS have a severe deterioration in nutritional status when analysed using a classical malnutrition test (SGA) or a new one (GLIM criteria). Patients with a better nutritional situation according to SGA and GLIM severity classification were associated with a longer survival time.

Effect of lockdown for COVID-19 on self-reported body weight gain in a sample of obese patients.

INTRODUCTION: Objective: the COVID-19 pandemic, by restricting population mobility, may exacerbate the risk factors for weight gain associated with physical inactivity and increased consumption of calorie-dense foods. The aim of this cross-sectional study was to evaluate the risk factors related to self-reported body weight gain among obese subjects. Methods: the study involved a population of 284 adult obese subjects. After a 7-week confinement period starting on March 17, a telephone interview (May 4 through 7) was conducted. In this phone call, self-reported body weight gain and a number of factors were recorded. In order to obtain the baseline data of this population, biochemical and anthropometric parameters were collected from electronic medical records. Results: mean age was 60.4 ± 10.8 years (range: 23-71) and mean body mass index (BMI) was 35.4 ± 4.7 kg/m2 (range: 30.6-41.2). Gender distribution was 211 females (74.3 %) and 73 males (25.7 %). Self-reported body weight gain was 1.62 ± 0.2 kg. Among patients who reported doing a lot of exercise self-reported body weight gain was lower (1.62 ± 0.2 vs 1.12 ± 0.3 kg; p = 0.02). Regarding eating habits, patients recognized snacking in 17 % of the sample. Patients who reported snacking had higher self-reported body weight gains (2.60 ± 0.36 vs 1.30 ± 0.17 kg; p = 0.001). The remaining variables did not influence self-reported body weight gain. In the multiple regression analysis with self-reported body weight gain as dependent variable, adjusted for age, sex, and physical activity, the snaking habit remained a risk factor: beta = 1.21 (95 % CI: 1.11-2.13; p = 0.01). Conclusions: the lockdown decreed during SARS-CoV-2 pandemic has produced an increase in self-reported body weight among obese subjects, which was related to the habit of taking snacks.

INTRODUCCIÓN: Objetivo: la pandemia de COVID-19, al restringir la movilidad de la población, podría exacerbar los factores de riesgo del aumento de peso asociados a la inactividad física y un mayor consumo de alimentos ricos en calorías. El objetivo de este estudio transversal fue evaluar los factores de riesgo relacionados con el aumento de peso corporal autoinformado entre sujetos obesos. Métodos: el estudio incluyó una muestra de 284 sujetos obesos adultos. Después de un período de reclusión de 7 semanas a partir del 17 de marzo, se realizó una entrevista telefónica (del 4 al 7 de mayo). En esta llamada telefónica se registraron el aumento de peso corporal autoinformado y diferentes factores asociados. Para obtener los datos basales de esta población, se registraron parámetros bioquímicos y antropométricos a partir de la historia clínica electrónica. Resultados: la edad media fue de 60,4 ± 10,8 años (rango: 23-71) y el índice de masa corporal (IMC) medio de 35,4 ± 4,7 kg /m2 (rango: 30,6-41,2). La distribución por géneros fue de 211 mujeres (74,3 %) y 73 hombres (25,7 %). El aumento de peso corporal autoinformado fue de 1,62 ± 0,2 kg. Los pacientes que reconocieron que hacían mucho ejercicio informaron de que la ganancia de peso corporal había sido menor (1,62 ± 0,2 vs 1,12 ± 0,3 kg; p = 0,02). En cuanto a los hábitos alimentarios, los pacientes reconocieron practicar el picoteo en el 17 % de la muestra. Los pacientes que reconocieron picar entre horas presentaron una mayor ganancia de peso corporal autoinformada (2,60 ± 0,36 vs 1,30 ± 0,17 kg; p = 0,001). Las demás variables no influyeron en el aumento de peso corporal autoinformado. En el análisis de regresión múltiple, con la ganancia de peso corporal autoinformada como variable dependiente y ajuste de edad, sexo y actividad física, el hábito del picoteo permaneció como factor de riesgo: beta = 1,21 (IC 95 %: 1,11-2,13; p = 0,01). Conclusiones: el encierro decretado durante la pandemia por el SARS-CoV-2 ha producido un aumento del peso corporal autoinformado en los sujetos obesos y este se ha relacionado con el hábito de picar entre horas.

A circadian rhythm-related MTNR1B genetic variant (rs10830963) modulates glucose metabolism and insulin resistance after body weight loss secondary to biliopancreatic diversion surgery.

INTRODUCTION: Objective: the rs10830963 SNP of the MTNR1B gene may be related with biochemical changes after weight loss induced by caloric restriction. We investigated the role of this SNP on biochemical parameters after biliopancreatic diversion (BPD) surgery in morbid obese subjects. Patients and methods: one hundred and fifty-four patients with morbid obesity, without diabetes mellitus type 2, were enrolled. Their biochemical and anthropometric parameters were recorded before the procedure and after one, two, and three years of follow-up. All subjects were genotyped (rs10830963) at baseline. Results: the decrease in fasting insulin levels seen after the first year (delta: -3.9 ± 1.2 mIU/L vs. -1.8 ± 1.1 mIU/L; p = 0.03), the second year (delta: -5.0 ± 0.3 mIU/L vs. -2.3 ± 0.2 mIU/L; p = 0.01) and the third year (delta: -5.1 ± 1.9 mIU/L vs. -2.8 ± 1.1 mIU/L; p = 0.02) was higher in non-G-allele carriers than in G-allele carriers. Additionally, the improvement of HOMA-IR levels at year one (delta: -0.7 ± 0.2 mIU/L vs. -0.2 ± 0.2 mIU/L; p = 0.03), year two (delta: -1.0 ± 0.3 mIU/L vs. -0.5 ± 0.2 mIU/L; p = 0.01) and year three (delta: -1.2 ± 0.3 mIU/L vs. -0.4 ± 0.2 mIU/L; p = 0.03) was also higher in non-G-allele carriers than in G-allele carriers. Finally, basal glucose levels after the first year (delta: -10.1 ± 2.4 mg/dL vs. -3.6 ± 1.8 mg/dL; p = 0.02), the second year (delta: -16.0 ± 2.3 mg/dL vs. -8.4 ± 2.2 mg/dL; p = 0.01) and the third year (delta: -17.4 ± 3.1 mg/dL vs. -8.8 ± 2.9 mg/dL; p = 0.03) were higher in non-G-allele carriers than in G-allele carriers, too. Improvements seen in comorbidities were similar in both genotype groups. Conclusion: our study showed an association of the rs10830963 MTNR1B polymorphism after massive weight loss with lower glucose response, insulin resistance, and fasting insulin levels in G-allele carriers.

INTRODUCCIÓN: Objetivo: la variante SNP rs10830963 del gen MTNR1B podría estar relacionada con cambios bioquímicos tras la pérdida de peso inducida por una restricción calórica. El objetivo de este trabajo es evaluar el papel de este SNP en los parámetros bioquímicos después de la cirugía de derivación biliopancreática (DBP). Pacientes y métodos: se reclutaron un total de 154 pacientes con obesidad mórbida sin diabetes mellitus de tipo 2. La valoración bioquímica y antropométrica se realizó antes de la intervención y tras 1, 2 y 3 años de seguimiento. Todos los sujetos fueron genotipados (rs10830963) en el momento basal. Resultados: la disminución de los niveles de insulina en ayunas después del primer año (delta: -3,9 ± 1,2 mUI/L vs. -1,8 ± 1,1 mUI/L; p = 0,03), el segundo año (delta: -5,0 ± 0,3 mUI/L vs. -2,3 ± 0,2 mUI/L; p = 0,01) y el tercer año (delta: -5,1 ± 1,9 mUI/L vs. -2,8 ± 1,1 mUI/L; p = 0,02) fueron mayores en los no portadores del alelo G que en los portadores. Además, la mejora de los niveles de HOMA-IR en el primer año (delta: -0,7 ± 0,2 mUI/L ± -0,2 ± 0,2 mUI/L; p = 0,03), segundo año (delta: -1,0 ± 0,3 mUI/L vs. -0,5 ± 0,2 mUI/L; p = 0,01) y en el tercer año (delta: -1,2 ± 0,3 mUI/L vs. -0,4 ± 0,2 mUI/L; p = 0,03) también fueron mayores en los no portadores del alelo G. Finalmente, los niveles basales de glucosa después del primer año (delta: -10,1 ± 2,4 mg/dL vs. -3,6 ± 1,8 mg/dL; p = 0,02), el segundo año (delta: -16,0 ± 2,3 mg/dL vs. ­ 8,4 ± 2,2 mg/dL; p = 0,01) y el tercer año (delta: -17,4 ± 3,1 mg/dL vs. -8,8 ± 2,9 mg/dL; p = 0.03) fueron mayores en los no portadores del alelo G. Las comorbilidades mejoraron en ambos genotipos de manera similar. Conclusión: nuestro estudio mostró una asociación del polimorfismo rs10830963 MTNR1B tras una pérdida de peso posquirúrgica con una menor respuesta de los niveles de glucosa, resistencia a la insulina e insulina en ayunas en portadores del alelo G.

[Effect of a Mediterranean-pattern diet on the metabolic response secondary to weight loss; role of the single nucleotide polymorphism (rs16147) of neuropeptide Y]. / Efecto de una dieta de patrón mediterráneo en la respuesta metabólica secundaria a la pérdida de peso; papel del polimorfismo de un único nucleótido (rs16147) del gen del neuropéptido Y.

INTRODUCTION: Background and aims: intervention studies that evaluate the effect of rs16147 on metabolic response and weight change after dietary intervention are scarce. We propose to evaluate the role of the rs16147 genetic variant in the metabolic effects produced by a hypocaloric Mediterranean-pattern diet with high content of omega-9. Material and methods: a sample of 363 obese subjects was recruited. At the baseline visit the patients were randomly assigned to one of two hypocaloric diets for 12 weeks (diet M, Mediterranean pattern; diet C, standard hypocaloric). All patients, at baseline and at 12 weeks, had biochemical and anthropometric variables measured, and genotyping performed for the rs16147 variant. Results: in all subjects, and with both diets, the parameters of adiposity, blood pressure, and circulating leptin improved. In obese subjects with allele (A) insulin levels (GG vs. GA + AA) (-0.9 ± 1.1 IU/L vs. -4.4 ± 1.0 IU/L; p = 0.01) and HOMA-IR (-0.3 ± 0.1 units vs. -1.2 ± 0.3 units; p = 0.02) decreased significantly with diet M. Subjects carrying the minor allele showed a significant decrease in basal insulin levels (GG vs. GA + AA) (0.7 ± 0.3 IU/L vs. -2.2 ± 0.9 IU/L: p = 0.02) and HOMA-IR (-0.3 ± 0.2 units vs. -0.7 ± 0.1 units: p = 0.01) after diet C. This decrease in circulating insulin and HOMA-IR levels in patients with allele A was significantly higher with diet M than with diet C. Conclusions: the A allele of the rs16147 variant produces a better metabolic response in terms of insulin resistance and basal insulin secondary to weight loss with two different hypocaloric diets in obese subjects, with improvement being higher with the Mediterranean diet.

INTRODUCCIÓN: Introducción y objetivos: los estudios de intervención que evalúan el efecto del rs16147 sobre la respuesta metabólica y el cambio de peso después de una intervención dietética son escasos. Evaluamos el papel de la variante genética rs16147 en los efectos metabólicos que produce una dieta hipocalórica de patrón mediterráneo y alto contenido en omega-9. Material y métodos: se reclutó una muestra de 363 sujetos obesos. En visita basal, los pacientes se asignaron aleatoriamente, durante 12 semanas, a recibir una de dos dietas: dieta M, de patrón mediterráneo, o dieta C, hipocalórica estándar. Se determinaron momento basal y a las 12 semanas, una serie de variables bioquímicas y antropométricas, realizándose el genotipado de la variante rs16147. Resultados: en todos los sujetos con ambas dietas mejoraron los parámetros de adiposidad, tensión arterial y leptina circulante. En sujetos obesos con el alelo menor (A), los niveles de insulina (GG vs. GA + AA) (-0,9 ± 1,1 UI/L vs. -4,4 ± 1,0 UI/L; p = 0,01) y HOMA-IR (-0,3 ± 0,1 unidades vs. -1,2 ± 0,3 unidades; p = 0,02) disminuyeron significativamente con dieta M. Los sujetos portadores del alelo menor tras dieta C mostraron disminución significativa de niveles de insulina basal (GG vs. GA + AA) (0,7 ± 0,3 UI/L vs. -2,2 ± 0,9 UI/L: p = 0,02) y HOMA-IR (-0,3 ± 0,2 unidades vs. -0,7 ± 0,1 unidades: p = 0,01). Esta disminución de los niveles de insulina circulante y HOMA-IR en los pacientes con alelo A fue significativamente superior con la dieta M que con la dieta S. Conclusiones: el alelo A de la variante rs16147 se relaciona con mejor respuesta metabólica, en términos de resistencia a insulina e insulina basal secundaria a pérdida de peso, a dos dietas hipocalóricas, siendo superior el efecto obtenido con una dieta de patrón mediterráneo.

ACYL-CoA synthetase long-chain 5 polymorphism is associated with weight loss and metabolic changes in response to a partial meal-replacement hypocaloric diet.

INTRODUCTION: Aims:to analyze the effects of the rs2419621 genetic variant of the ACSL5 gene on weight change and metabolic parameters after a partial meal-replacement hypocaloric diet. Methods: this was a non-randomized, single-treatment study with a formula-diet in 44 obese subjects with body mass index (BMI) greater than 35 kg/m2. Patients received nutritional education and a modified diet with two intakes of a normocaloric hyperproteic formula during 3 months. Anthropometric parameters and biochemical profile were measured at baseline and after 3 months. The rs2419621 variant of the ACSL5 gene was assessed using real-time polymerase chain reaction. Results: T-allele carriers showed greater improvement in body weight (CC vs. CT + TT; -7.4 ± 2.1 kg vs. -9.3 ± 1.8 kg; p = 0.01), body mass index (-3.1 ± 0.4 kg/m2 vs. -3.4 ± 0.5 kg/m2; p = 0.02), fat mass (-5.2 ± 1.4 kg vs. -6.4 ± 1.2 kg; p = 0.01) and waist circumference (-6.1 ± 1.1 cm vs. -8.6 ± 0.8 cm; p = 0.02) than non-T-allele carriers. Only subjects with the T allele showed significant improvement in triglyceride levels (-4.6 ± 2.4 md/dL vs. -14.4 ± 2.3 mg/dL; p = 0.01). Finally, improvements in insulin (-2.0 ± 0.3 mU/L vs. -4.5 ± 0.5 mU/L; p = 0.01) and HOMA-IR (-0.4 ± 0.2 units vs. -1.3 ± 0.3 units; p = 0.02) were higher in T-allele carriers than in non-T-allele carriers. Conclusions: our data suggest that the genetic variant (rs2419621) of the ACSL5 gene is associated with diet response after a partial-meal replacement intervention, with greater improvements in adiposity and biochemical parameters in subjects with the T allele.

INTRODUCCIÓN: Antecedentes: se hipotetiza que el genotipo de la acil-CoA-sintetasa 5 (ACSL5) podría influir en la pérdida de peso secundaria a la restricción de energía. Objetivos: el objetivo de nuestro estudio fue analizar los efectos de la variante genética rs2419621 del gen ACSL5 sobre el cambio de peso y los parámetros metabólicos después de una dieta hipocalórica parcial de reemplazo. Métodos: estudio no aleatorizado, de centro único, con una fórmula dietética, en 44 sujetos obesos con un índice de masa corporal (IMC) superior a 35 kg/m2. Los pacientes recibieron educación nutricional y una dieta modificada con dos tomas de una fórmula hiperproteica normocalórica durante 3 meses. Los parámetros antropométricos y el perfil bioquímico se determinaron en el tiempo basal y tras 3 meses. La variante rs2419621 del gen ACSL5 se evaluó mediante reacción en cadena de la polimerasa en tiempo real. Resultados: los portadores del alelo T mostraron mejorías de peso corporal (CC vs. CT + TT; -7,4 ± 2,1 kg vs. -9,3 ± 1,8 kg; p = 0,01), índice de masa corporal (-3,1 ± 0,4 kg/m2 vs. -3,4 ± 0,5 kg/m2; p = 0,02), masa grasa (-5,2 ± 1,4 kg vs. -6,4 ± 1,2 kg; p = 0,01) y circunferencia de la cintura (-6,1 ± 1,1 cm vs. -8,6 ± 0,8 cm; p = 0,02) superiores a las de los portadores de alelos distintos de T. Solo los sujetos con alelo T mostraron una mejoría significativa en los niveles de triglicéridos (-4,6 ± 2,4 md/dL vs. -14,4 ± 2,3 mg/dL; p = 0,01). Por último, la mejoría de la insulina (-2,0 ± 0,3 mU/L vs. -4.5 ± 0.5 mU/L; p = 0,01) y HOMA-IR (-0,4 ± 0,2 unidades vs. -1,3 ± 0,3 unidades; p = 0,02) fueron mayores en los portadores de alelos T que en los portadores de alelos no T. Conclusiones: nuestros resultados sugieren que la variante genética (rs2419621) del gen ACSL5 está asociada a la respuesta a la dieta después una dieta hipocalórica parcial de reemplazo, con una mejoría superior de los parámetros relacionados con la adiposidad y los parámetros bioquímicos en los sujetos con alelo T.

Effects of a snack enriched with carob and Undaria pinnatifida (wakame) on metabolic parameters in a double blind, randomized clinical trial in obese patients.

INTRODUCTION: Introduction: the composition of snack foods likely influences the overall effect that snacking has on metabolism and obesity. The objective of the current study was to assess the responses to two different snacks, one of them supplemented with wakame and carobs, on cardiovascular risk factors, satiety, and subsequent food intake in obese subjects with metabolic syndrome. Material and Methods: forty patients were randomized in a clinical trial (NCT03420989, clinicaltrial.gov) to group I (enriched snack, n = 16) or group II (control snack, n = 16). At baseline and after 8 weeks biochemical parameters, dietary intakes, and nutritional status were assessed. The subjects also rated their feelings of satiety/hunger with a test meal. Results: no differences were detected in anthropometric parameters between both snacks. Changes in other parameters were detected in patients with enriched snacks, with a significant decrease in LDL-cholesterol by 7.4 % (intervention snack, -8.9 ± 2.3 mg/dL vs control snack, -0.9 ± 3.3 mg/dL; p = 0.03), in total cholesterol by 5.8 % (intervention snack, -10.4 ± 2.9 mg/dL vs control snack, -1.4 ± 3.2 mg/dL; p = 0.02), and in resistin level by 15.9 % (intervention snack, -1.0 ± 0.2 mg/dL vs control snack, -0.1 ± 0.3 mg/dL: p = 0.03). After the test meal, satiety scores (after 20 min and 40 min) were higher than fasting levels in both groups. The same results were obtained with the 100-mm, 5-point visual satiety scale. Conclusion: our study indicates that a wakame- and carob-enriched snack induces a significant decrease in total cholesterol, LDL-cholesterol, and resistin levels when compared to a control snack, without effects on food consumption, other cardiovascular parameters, or anthropometric parameters.

INTRODUCCIÓN: Introducción: la composición de los "snacks" probablemente influya en el efecto que produce su consumo sobre los marcadores metabólicos y la obesidad. El objetivo fue evaluar respuestas a dos snacks, uno de ellos suplementado con wakame y algarroba, sobre factores de riesgo cardiovascular, saciedad y posterior ingesta de alimentos, en sujetos obesos con síndrome metabólico. Material y métodos: se aleatorizaron 40 pacientes en el ensayo clínico NCT03420989 (clinicaltrial.gov) para participar en el grupo I (snack enriquecido, n = 16) o el grupo II (snack de control, n = 16). Antes y después de 8 semanas se determinaron parámetros bioquímicos, ingestas dietéticas y estado nutricional. A los sujetos también se les evaluó saciedad y apetito con comida de prueba. Resultados: no se detectaron diferencias en parámetros antropométricos con ambos snacks. Se detectaron cambios en parámetros bioquímicos de pacientes que recibieron snacks enriquecidos, con disminución significativa del colesterol-LDL del 7,4 % (snack de intervención, -8,9 ± 2,3 mg/dl vs. snack de control, -0,9 ± 3,3 mg/dl; p = 0,03), del colesterol total del 5,8 % (snack de intervención, -10,4 ± 2,9 mg/dl vs. snack de control, -1,4 ± 3,2 mg/dl; p = 0,02) y de niveles de resistina del 15,9 % (snack de intervención, -1,0 ± 0,2 mg/dl vs. snack de control, -0,1 ± 0,3 mg/dl; p = 0,03). Después de la comida de prueba, las puntuaciones de saciedad (a los 20 min y 40 min) fueron más altas que nivel de ayuno en ambos grupos. Los resultados fueron similares con escala de saciedad visual de 5 puntos y 100 mm. Conclusión: nuestro estudio muestra que un snack enriquecido con wakame y algarroba produce disminución significativa de los niveles de colesterol total, colesterol-LDL y resistina frente a un snack de control, sin efectos sobre el consumo de alimentos, otros parámetros cardiovasculares y los parámetros antropométricos.