12ª Lección Jesús Culebras. La alimentación y la nutrición en los enfermos con cáncer de cabeza y cuello: un reto permanente / 12th "Jesús Culebras" Lesson. Feeding and nutrition in patients with head and neck cancer - A permanent challenge

Los enfermos con cáncer de cabeza y cuello son una población en riesgo nutricional permanente. El motivo es, además de la presencia del tumor, la localización del mismo, que afecta a todas las estructuras implicadas en la deglución. Los efectos secundarios de los tratamientos oncológicos que deben recibir en el transcurso de su enfermedad —cirugía, quimio-radioterapia, etc.— no hacen sino gravar más aun un estado nutricional ya de por sí precario. Por todo ello es imprescindible que, desde el diagnóstico de su enfermedad, estén supervisados por un equipo multidisciplinar con especialistas en dietética y nutrición (AU)

Head and neck cancer patients are a population at permanent nutritional risk. In addition to the presence of the tumour, the reason for this is the tumour's location, which affects all structures involved in the swallowing process. The side effects of the oncological treatments they must receive during the course of their illness—surgery, chemo-radiotherapy, etc.—only further burden an already precarious nutritional status. For all these reasons, it is essential that, from the diagnosis of their disease, a multidisciplinary team including specialists in dietetics and nutrition supervises them (AU)

Direct costs of a home parenteral nutrition programme.

BACKGROUND & AIMS: Home parenteral nutrition (HPN) is a lifesaving treatment for people with chronic intestinal failure and its cost has been reported to be very high. The purpose of the present paper was to study the direct healthcare and non-healthcare costs associated with the HPN programme managed by a tertiary hospital. METHODS: Observational, retrospective study of all adult patients on HPN from 11.1.2014 to 10.31.2015 treated at Gregorio Marañón University Hospital (Madrid, Spain). An economic evaluation was undertaken to calculate the direct healthcare (HPN provision, outpatient monitoring and management of complications) and non-healthcare costs (transportation process) of the HPN programme. The variables were collected from medical records, the dispensary and the hospital's financial services. The unit costs were taken from official price lists. RESULTS: Thirty-two patients met the inclusion criteria. Total direct healthcare and non-healthcare costs amounted to €13,363.53 per patient (€124.02 per patient per day). The direct healthcare costs accounted for 98.32% of overall costs, while the non-healthcare costs accounted for the remaining 1.68%. HPN provision accounted for the majority of the costs (74.25%), followed by management of complications (21.85%) and outpatient monitoring (2.23%). CONCLUSIONS: The direct healthcare costs accounted for the majority of HPN expenditure, specifically HPN provision was the category with the highest percentage.

Effect of inulin and fructo-oligosaccharide on the prevention of acute radiation enteritis in patients with gynecological cancer and impact on quality-of-life: a randomized, double-blind, placebo-controlled trial.

BACKGROUND/OBJECTIVES: The pathogenesis of enteritis after abdominal radiotherapy (RT) is unknown, although changes in fecal microbiota may be involved. Prebiotics stimulate the proliferation of Lactobacillus spp and Bifidobacterium spp, and this may have positive effects on the intestinal mucosa during abdominal RT. SUBJECTS/METHODS: We performed a randomized, double-blind, placebo-controlled trial involving patients with gynecological cancer who received abdominal RT after surgery. Patients were randomized to receive prebiotics or placebo. The prebiotic group received a mixture of fiber (50 inulin and 50% fructo-oligosaccharide), and the placebo group received 6 g of maltodextrin twice daily from 1 week before to 3 weeks after RT. The number of bowel movements and stool consistency was recorded daily. Diarrhea was evaluated according to the Common Toxicity Criteria of the National Cancer Institute. Stool consistency was assessed using the 7-point Bristol scale. Patients' quality-of-life was evaluated at baseline and at completion of RT using the EORTC-QLQ-C30 (European Organization for Research and Treatment of Cancer quality-of-life Questionnaire C30) test. RESULTS: Thirty-eight women with a mean age of 60.3±11.8 years participated in the study. Both groups (prebiotic (n=20) and placebo (n=18)) were comparable in their baseline characteristics. The number of bowel movements per month increased in both groups during RT. The number of bowel movements per day increased in both groups. The number of days with watery stool (Bristol score 7) was lower in the prebiotic group (3.3±4.4 to 2.2±1.6) than in the placebo group (P=0.08). With respect to quality-of-life, the symptoms with the highest score in the placebo group were insomnia at baseline and diarrhea toward the end of the treatment. In the prebiotic group, insomnia was the symptom with the highest score at both assessments, although the differences were not statistically significant. CONCLUSIONS: Prebiotics can improve the consistency of stools in gynecologic cancer patients on RT. This finding could have important implications in the quality-of-life of these patients during treatment.

[Nutritional support in chronic neurological diseases]. / Manejo nutricional en las enfermedades neurológicas crónicas.

Malnutrition is common in neurodegenerative disorders and is associated with a worse prognosis and an increased risk of complications. Factors leading to malnutrition in these patients are: diseased nutrient intake, due to anorexia, dysphagia and other factors, gastrointestinal symptoms, and energy expenditure alterations. Nutritional evaluation and monitoring is mandatory and should be part of regular clinical evaluation. It will help to identify those patients that need specialized nutritional support. In this paper, relevant aspects regarding nutritional evaluation and support in patients suffering from a neurodegenerative disorder are reviewed, including amyotrophic lateral sclerosis, multiple sclerosis, Parkinson's disease and dementia.

Manejo nutricional en las enfermedades neurológicas crónicas / Nutritional support in chronic neurological diseases

La desnutrición es frecuente en las enfermedades neurodegenerativas y condiciona un peor pronóstico y un aumento del riesgo de complicaciones. Las causas más frecuentes son la disminución de la ingesta, debido a anorexia, disfagia y otros factores, los síntomas digestivos y las alteraciones del gasto energético. La valoración y monitorización nutricional debe formar parte de la evaluación clínica de estos pacientes y permitirá identificar a los pacientes que puedan precisar un soporte nutricional específico. En este artículo se revisan los aspectos más importantes de la evaluación y el tratamiento nutricional de las enfermedades neurodegenerativas más prevalentes: esclerosis lateral amiotrófica, la esclerosis múltiple, la enfermedad de Parkinson y las demencias (AU)

Malnutrition is common in neurodegenerative disorders and is associated with a worse prognosis and an increased risk of complications. Factors leading to malnutrition in these patients are: diseased nutrient intake, due to anorexia, dysphagia and other factors, gastrointestinal symptoms, and energy expenditure alterations. Nutritional evaluation and monitoring is mandatory and should be part of regular clinical evaluation. It will help to identify those patients that need specialized nutritional support. In this paper, relevant aspects regarding nutritional evaluation and support in patients suffering from a neurodegenerative disorder are reviewed, including amyotrophic lateral sclerosis, multiple sclerosis, Parkinson’s disease and dementia (AU)

The effects of second-generation antipsychotics on food intake, resting energy expenditure and physical activity.

Second-generation antipsychotics (SGA) are associated with weight gain and metabolic alterations including hyperglycemia, dyslipidemia, hypertension and metabolic syndrome. These metabolic side effects increase cardiovascular risk and are related to medication non-compliance. Patients without previous exposure to these or other antipsychotic drugs (naive patients) seem to be more prone to develop these metabolic abnormalities. The mechanisms behind weight gain can be an increase in food intake and/or a decrease in energy expenditure. This review comprehensively examines the current knowledge on the impact of these drugs on food intake and energy expenditure. The influence of these drugs on appetite and food intake (total caloric intake and food sources) is reviewed as well as the evidence of abnormal eating behaviors. The studies evaluating the effect on resting energy expenditure are critically examined, taking into account the influence of body composition and previous exposure to antipsychotics (naive vs non-naive patients). Finally, the influence of these drugs on physical activity is also discussed. The knowledge of the mechanisms of weight gain in patients starting these drugs may be useful to further prompt research in this field and ameliorate the metabolic side effects associated with these treatments.

Nutrición en el paciente con ictus / Nutrition for stroke patients

La desnutrición es frecuente en los pacientes con ictus y se asocia con un aumento de la morbimortalidad y un mayor riesgo de discapacidad. La disminución de la ingesta es uno de los factores etiológicos más importantes de desnutrición en estos pacientes. La disfagia es especialmente frecuente y origina una alteración de la eficacia y la seguridad de la deglución, que da lugar a un mayor riesgo de desnutrición y deshidratación, aspiración, insuficiencia respiratoria y neumonía. La valoración del paciente con ictus requiere una evaluación del riesgo nutricional y de la presencia de disfagia. El soporte nutricional incluye la utilización de dieta oral adaptada, suplementos nutricionales orales o nutrición enteral, modalidad de elección en los pacientes con disfagia grave. En este trabajo se revisan los aspectos más relevantes sobre el riesgo nutricional de los pacientes con ictus, las pautas diagnósticas y las opciones terapéuticas, tanto en la fase aguda como en la rehabilitación (AU)

Malnutrition in common in patients with acute stroke and is associated with higher mortality, poor outcome and disability. Decreased intake is one of the most important factors leading to malnutrition in stroke patients. Dysphagia is especially common and is responsible of a decrease in safety and efficacy of swallowing that gives rise to an increased risk of malnutrition, dehydration, aspiration, pneumonia and respiratory failure. Clinical evaluation of stroke patients includes a nutritional risk and swallowing capacity assessment. Nutritional support may be necessary, with adapted oral diet, oral supplements. Enteral nutrition is needed in patients with severe dyaphagia. This article reviews the most relevant aspects regarding nutritional risk factors in stroke patients, evaluation and diagnosis and nutritional support, both in acute phase and during rehabilitation (AU)

Effect of a mixture of inulin and fructo-oligosaccharide on lactobacillus and bifidobacterium intestinal microbiota of patients receiving radiotherapy; a randomised, double-blind, placebo-controlled trial / Efecto de una mezcla de inulina y fructo-oligosacárido sobre la microflora intestinal de lactobacillus y bifidobacterium de pacientes que reciben radioterapia; un ensayo aleatorio, a doble ciego y controlado con placebo

Background & aims: The pathogenesis of enteritis after abdominal radiotherapy is unknown, although changes in faecal microbiota may be involved. In several studies, Lactobacillus and Bifidobacterium have proven beneficial for the host. Prebiotics stimulate the proliferation of Lactobacillus and Bifidobacterium, and this may have positive effects on the intestinal mucosa during abdominal radiotherapy. Methods: We performed a randomised double-blind, placebo-controlled trial including 31 patients with gynaecological cancer who received radiotherapy (29 sessions, 52.2 Gy) after surgery. Patients were randomised to two groups: prebiotic and placebo. The first group received a mixture of fibre (50% inulin and 50% fructo-oligosaccharide) and the second received 6 g of maltodextrin twice daily from one week before to three weeks after radiotherapy. Lactobacillus and Bifidobacterium counts were determined in faeces samples (day -7 before radiotherapy, day 15 of radiotherapy, at the end of treatment, and three weeks after radiotherapy) by culture in selective media and fluorescent in situ hybridization (FISH) using genus-specific probes. Bacterial counts by FISH were significantly higher than by culture method. Results: There were no differences in baseline microbiota between groups. At the end of radiotherapy, we observed a statistically significant decrease in Lactobacillus and Bifidobacterium counts in both groups. By cultural analysis, we observed higher numbers of Lactobacillus and Bifidobacterium three weeks after radiotherapy in the prebiotic group (5.6 vs. 6.3, p = 0.04 and 5.5 vs. 6 log cfu/g, p = 0.03). Conclusions: Abdominal radiotherapy negatively affects Lactobacillus and Bifidobacterium counts. The prebiotic mixture of inulin and fructoligosaccharide can improve the recovery of both genera after radiotherapy (AU)

Antecedentes y objetivos: Se desconoce la patogenia de la enteritis tras la radioterapia abdominal, si bien podrían estar implicados cambios en la microflora fecal. Diversos estudios han demostrado que los Lactobacillus y Bifidobacterium confieren beneficios al huésped. Los prebióticos estimulan la proliferación de Lactobacillus y Bifidobacterium y esto podría tener efectos positivos sobre la mucosa intestinal durante la radioterapia abdominal. Métodos: Realizamos un estudio de distribución aleatoria, a doble ciego y controlado con placebo que incluyó a 31 pacientes con cáncer ginecológico que recibieron radioterapia (29 sesiones, 52,2 Gy) tras la cirugía. Se distribuyó al azar a las pacientes en dos grupos: prebiótico y placebo. El primer grupo recibió una mezcla de fibra (50% de inulina y 50% de fructo-oligosacárido) y el segundo 6 g de maltodextrina dos veces al día desde una semana antes hasta 3 semanas después de la radioterapia. Se determinaron los recuentos de Lactobacillus y Bifidobacterium en muestras fecales (día 7 antes de la radioterapia, día 15 de radioterapia, al final del tratamiento y tres semanas después de la radioterapia) mediante un cultivo en medios seleccionados y con hibridación in situ fluorescente (FISH) con sondas específicas de la especie. Los recuentos bacterianos con FISH fueron significativamente superiores que por el método de cultivo. Resultados: No hubo diferencias en la microflora basal entre los grupos. Al final de la radioterapia, observamos un descenso estadísticamente significativo en los recuentos de Lactobacillus y Bifidobacterium en ambos grupos. Mediante el análisis de los cultivos, observamos un mayor recuento de Lactobacillus y Bifidobacterium a las tres semanas de finalizar la radioterapia en el grupo con prebiótico (5,6 frente a 6,3, p = 0,04 and 5,5 frente a 6 log ufc/g, p = 0,03). Conclusiones: La radioterapia abdominal afecta de forma negativa los recuentos de Lactobacillus y Bifidobacterium. La mezcla de prebióticos de inulina y fructo-oligo-sacárido puede mejorar la recuperación de ambas especies tras la radioterapia (AU)

[Persistent chylothorax in patient with lymphangioleiomyomatosis]. / Quilotórax persistente en paciente con linfangioleiomiomatosis.

Lymphangioleiomyomatosis (LAM) is a rare disease that affects women in fertile age and presents a systemic progressive evolution, being the lung and the mediastinic lymph nodes the most affected organs. The pulmonary disease is characterized by dyspnea, pleural effusion, hemoptysis and spontaneous pneumothorax, being the chylothorax a frequent complication in the course of this disease, appearing in up to 30% of cases. The treatment of chylothorax is not standardized and it is necessary a multidisciplinary approach: nutritional, pharmacological, respiratory and even surgery. These patients present high risk of malnutrition due to the constant loss of chyle, therefore a suitable nutritional management is essential to avoid more complications.

Quilotórax persistente en paciente con linfangioleiomiomatosis / Persistent chylothorax in patient with lymphangioleiomyomatosis

La linfangioleiomiomatosis (LAM) es una enfermedad poco frecuente que afecta a mujeres en edad fértil y presenta una evolución sistémica progresiva, siendo el pulmón y los ganglios mediastínicos los órganos más afectados. La afectación pulmonar se caracteriza por disnea, derrame pleural, hemoptisis y neumotórax espontáneo, siendo el quilotórax una complicación frecuente en el curso evolutivo de esta enfermedad, produciéndose hasta en el 30% de casos. El tratamiento del quilotórax no está estandarizado y precisa de un manejo multidisciplinar nutricional, farmacológico, respiratorio y en ocasiones quirúrgico. Estos pacientes presentan un alto riesgo de malnutrición debido a la pérdida continua de quilo, por lo que es fundamental un adecuado tratamiento (AU)

Lymphangioleiomyomatosis (LAM) is a rare disease that affects women in fertile age and presents a systemic progressive evolution, being the lung and the mediastinic lymph nodes the most affected organs. The pulmonary disease is characterized by dyspnea, pleural effusion, hemoptysis and spontaneous pneumothorax, being the chylothorax a frequent complication in the course of this disease, appearing in up to 30% of cases. The treatment of chylothorax is not standardized and it is necessary a multidisciplinary approach: nutritional, pharmacological, respiratory and even surgery. These patients present high risk of malnutrition due to the constant loss of chyle, therefore a suitable nutritional management is essential to avoid more complications (AU)

Manejo de los pacientes con disfagia / The management of patients with dysfhagia

La disfagia es un síntoma altamente prevalente, que puede ser debido a múltiples procesos patológicos, tanto estructurales como funcionales, y localizarse a nivel orofaríngeo o esofágico. La Disfagia Orofaríngea puede causar desnutrición hasta en 1/3 de los pacientes que la padecen, como consecuencia de alteraciones en la eficacia de la deglución, y ocasionar alteraciones en la seguridad de la misma (penetraciones y aspiraciones) en hasta 2/3 de los pacientes que la presentan, con elevado riesgo de neumonías por aspiración e infecciones respiratorias. En enfermos neurológicos, ancianos o personas institucionalizadas su prevalencia puede oscilar entre un 30-60%, con grados de severidad variables que pueden llegar a hacer necesaria una nutrición artificial. Se la relaciona además con mayor discapacidad, estancias hospitalarias prolongadas y mayor mortalidad. Por todo ello es fundamental un diagnóstico precoz de la misma y la instauración de un tratamiento eficaz que incluya maniobras posturales, soporte nutricional y rehabilitación (AU)

Dysphagia is a highly prevalent symptom, which may be due to multiple disease processes, both structural and functional, and located at the oropharyngeal or esophageal level. Oropharyngeal dysphagia can cause malnutrition even in 1/3 of patients as a result of alterations in the efficiency of swallowing and cause changes in the security of swallowing (penetration and aspiration) in up to 2/3 of the patients who present it, with high risk of aspiration pneumonia and respiratory infections. In neurological, elderly or institutionalized patients its prevalence may range from 30 to 60%, with different degrees of severity that may become necessary artificial nutrition. It is also related to greater disability, prolonged hospital stays and increased mortality. Therefore, early diagnosis and the establishment of an effective treatment that includes postural exercises, nutritional support and rehabilitation are critical (AU)

Effect of a mixture of inulin and fructo-oligosaccharide on Lactobacillus and Bifidobacterium intestinal microbiota of patients receiving radiotherapy: a randomised, double-blind, placebo-controlled trial.

BACKGROUND & AIMS: The pathogenesis of enteritis after abdominal radiotherapy is unknown, although changes in faecal microbiota may be involved. In several studies, Lactobacillus and Bifidobacterium have proven beneficial for the host. Prebiotics stimulate the proliferation of Lactobacillus and Bifidobacterium, and this may have positive effects on the intestinal mucosa during abdominal radiotherapy. METHODS: We performed a randomised double-blind, placebo-controlled trial including 31 patients with gynaecological cancer who received radiotherapy (29 sessions, 52.2 Gy) after surgery. Patients were randomised to two groups: prebiotic and placebo. The first group received a mixture of fibre (50% inulin and 50% fructo-oligosaccharide) and the second received 6 g of maltodextrin twice daily from one week before to three weeks after radiotherapy. Lactobacillus and Bifidobacterium counts were determined in faeces samples (day -7 before radiotherapy, day 15 of radiotherapy, at the end of treatment, and three weeks after radiotherapy) by culture in selective media and fluorescent in situ hybridization (FISH) using genus-specific probes. Bacterial counts by FISH were significantly higher than by culture method. RESULTS: There were no differences in baseline microbiota between groups. At the end of radiotherapy, we observed a statistically significant decrease in Lactobacillus and Bifidobacterium counts in both groups. By cultural analysis, we observed higher numbers of Lactobacillus and Bifidobacterium three weeks after radiotherapy in the prebiotic group (5.6 vs. 6.3, p = 0.04 and 5.5 vs. 6 log cfu/g, p = 0.03). CONCLUSIONS: Abdominal radiotherapy negatively affects Lactobacillus and Bifidobacterium counts. The prebiotic mixture of inulin and fructoligosaccharide can improve the recovery of both genera after radiotherapy. Registered under ClinicalTrials.gov Identifier no. NCT01549782.

[The Spanish Society of Parenteral and Enteral Nutrition (SENPE) and its relation with healthcare authorities]. / La Sociedad Española de Nutrición Parenteral y Enteral (SENPE) ante las administraciones públicas.

It has been well documented in medical literature that hyponutrition is a common issue at all healthcare levels, from primary to specialized health care, as well as geriatric healthcare facilities. This problem is not limited to countries with scarce economic resources or limited social development; it is also a universal issue in Europe. Hyponutrition increases the rates of morbidity, mortality, hospital admissions, and hospital stay. These higher figures also represent a higher use of healthcare resources. In spite of this, hyponutrition may often go undetected and the patient may not receive the necessary treatment. This problem requires the cooperation of multiple agents such as the Governments, the healthcare professionals, and the citizens themselves. The VIII Discussion Forum concludes on the need to establish a clear-cut plant for action (similar to the European Alliance for Health Nutrition) and the creation of a platform (coalition) encompassing the voices of healthcare professionals associations, institutions, professional colleges, patients associations, the pharmaceutical companies, and insurance companies. The goals of this platform will be to inform about the extent of this issue, to identity and promote leaders that will convey the aims of this initiative to regional and national healthcare authorities, to present solutions and to collaborate in their implementation, and finally to assess/control the actions taken.

Disfagia en el anciano / Dysphagia in elderly patients

La disfagia es un síntoma muy prevalente en la población anciana. En enfermos neurológicos, ancianos o personas institucionalizadas su prevalencia puede oscilar entre un 30-60%, con grados de gravedad variables que pueden llegar a hacer necesaria una nutrición artificial. Además, la disfagia está relacionada con mayor discapacidad, estancias hospitalarias prolongadas y mayor mortalidad. Las complicaciones de la disfagia derivan por un lado de una deglución ineficaz, motivo por el que el anciano puede presentar desnutrición y deshidratación y por otro lado de una deglución no segura, que conlleva la presencia de penetraciones, aspiraciones y en el 50% de los casos la aparición de neumonía por aspiración, ésta última con una mortalidad del 50%. Por todo ello es imprescindible un diagnóstico precoz de la misma, mediante métodos clínicos y/o instrumentales y que este diagnóstico lleve siempre implícito un tratamiento y una rehabilitación (AU)

Dysphagia is a prevalent symptom in the older people. The prevalence may range from 30-60% in neurological, elderly or institutionalized patients, with different degrees of gravity that can reach artificial nutritional support. Also, dysphagia is related to greater disability, longer hospital stay and higher mortality. Dysphagia may cause two types of complications in these patients: (a) a decrease in the efficacy of deglutition leading to malnutrition and dehydration, (b) a decrease in deglutition safety, leading to aspiration which results in pneumonia in the 50% of cases with an associated mortality of up to 50%. Therefore, it is essential an early diagnosis of it, using clinical and / or instrumental methods that always carry an implicit diagnosis treatment and rehabilitation (AU)

La Sociedad Española de Nutrición Parenteral y Enteral (SENPE) ante las administraciones públicas / The Spanish Society of Parenteral and Enteral Nutrition (SENPE) and its relation with healthcare authorities

Está muy bien documentado en la literatura médica que la desnutrición es un problema común en todos los niveles de atención sanitaria, desde atención primaria a especializada y en centros de atención geriátrica. Este problema no se limita a países con pocos recursos económicoso con limitado desarrollo social y económico. Tambiénes un problema universal en Europa. La desnutrición aumenta las cifras de morbilidad, mortalidad, ingresos hospitalarios y duración de la estancia. Estas cifras más elevadas suponen lógicamente un aumento deluso de recursos sanitarios. A pesar de esto, el problema de la desnutrición a menudo puede pasar desapercibido y el paciente no recibir el tratamiento necesario. Este problema requiere la cooperación de múltiples agentes tales como los Gobiernos de los Estados, los profesionales de la salud y los mismos ciudadanos. El VIII Foro de Debate concluye con la necesidad de establecer un claro plan de actuación (a semejanza de la European Alliance for Health Nutrition) y la creación de una plataforma (coalición) que reúna las voces de asociaciones de profesionales sanitarios, instituciones, colegios profesionales, asociaciones de pacientes, industria y entidades aseguradoras. Los fines de esta plataforma consistirán en informar de la extensión del problema, identificar y potenciar líderes que transmitan los fines de esta iniciativa ante las autoridades autonómicas y nacionales, propuesta de soluciones y colaboración en su puesta en marcha y finalmente, evaluación/control de las acciones desarrolladas (AU)

It has been well documented in medical literature that hyponutrition is a common issue at all healthcare levels,from primary to specialized health care, as well as geria -tric healthcare facilities. This problem is not limited to countries with scarce economic resources or limited social development; it is also a universal issue in Europe. Hyponutrition increases the rates of morbidity, mortality,hospital admissions, and hospital stay. These higherfigures also represent a higher use of healthcare resources. In spite of this, hyponutrition may often go undetected and the patient may not receive the necessary treatment. This problem requires the cooperation of multiple agents such as the Governments, the healthcare professionals, and the citizens themselves. The VIII Discussion Forum concludes on the need to establish a clear-cutplant for action (similar to the European Alliance forHealth Nutrition) and the creation of a platform (coalition)encompassing the voices of healthcare professionals associations, institutions, professional colleges, patients associations, the pharmaceutical companies, and insurance companies. The goals of this platform will be to inform about the extent of this issue, to identity and promote leaders that will convey the aims of this initiative to regional and national healthcare authorities, to present solutions and to collaborate in their implementation, and finally to assess/control the actions taken (AU)

Comparison of four nutritional screening tools to detect nutritional risk in hospitalized patients: a multicentre study.

BACKGROUND/OBJECTIVES: The prevalence of malnutrition in hospitals is high. No nutritional screening tool is considered the gold standard for identifying nutritional risk. The aims of this study were to evaluate nutritional risk in hospitalized patients using four nutritional screening tools. SUBJECTS/METHODS: Four nutritional screening tools were evaluated: nutritional risk screening (NRS-2002), the malnutrition universal screening tool (MUST), the subjective global assessment (SGA) and the mini nutritional assessment (MNA). Patients were assessed within the first 36 h after hospital admission. Date of admission, diagnosis, complications and date of discharge were collected. To compare the tools, the results were reorganized into: patients at risk and patients with a good nutritional status. The statistical analysis included the χ(2)-test to assess differences between the tests and the κ statistic to assess agreement between the tests. RESULTS: The study sample comprised 400 patients (159 women, 241 men), mean age 67.3 (16.1) years. The prevalence of patients at nutritional risk with the NRS-2002, MUST, SGA and MNA was 34.5, 31.5, 35.3 and 58.5%, respectively. Statistically significant differences were observed between the four nutritional screening tools (P<0.001). The agreement between the tools was quite good except for the MNA (MNA-SGA κ=0.491, NRS-2002-SGA κ=0.620 and MUST-SGA κ=0.635). Patients at nutritional risk developed more complications during admission and had an increased length of stay. CONCLUSIONS: The prevalence of nutritional risk in hospitalized patients was high with all the tools used. The best agreement between the tools was for NRS-2002 with SGA and MUST with SGA. At admission, NRS-2002 and MUST should be used to screen for nutritional status.

[Education on nutrition: from the university to specialized care]. / Formación en Nutrición: de la universidad a la especialidad.

The 7th Abbott-SENPE Forum is structured facing the new regulations of the European Space of High Education regarding the studies on Nutrition in the different degrees (Medicine, Pharmacology, Nutrition, Nursing) and post-doctoral education. A multi-professional and multidisciplinary discussion on the current situation of university education on nutrition, and its capabilities and limitations, is carried out. The value of the role of continuous medical education, the inhouse training programme, masters, and of scientific societies is also assessed. It is concluded that there is a need to urge academic authorities, the National Commission of Medical Specialties, the persons in charge of continuous medical education, and scientific societies of the importance of the studies relating to nutrition, feeding, and dietetics at both pre-graduate and post-graduate educational levels, and to implement and develop these studies in their areas of influence.

Formación en Nutrición: de la universidad a la especialidad / Education on Nutrition: Drom the university to specialized care

De cara a las nuevas normas del Espacio Europeo de Educación Superior en su relación con los estudios de nutrición tanto en los diferentes grados (medicina, farmacia, nutrición, enfermería) como en el postgrado, se estructura el VIIo FORO Abbott-SENPE. Se efectúa una reflexión multiprofesional y multidisciplinar sobre la actual situación de la formación universitaria en nutrición, sus posibilidades y límites. También se valora el papel de la formación continuada, del sistema de residencia, de los másteres y de las sociedades científicas. Se concluye en instar a las autoridades académicas, a la Comisión Nacional de Especialidades, a los responsables de formación continuada y a las sociedades científicas a reflexionar sobre la importancia de los estudios relacionados con la nutrición, alimentación y dietética tanto en el pregrado como en el postgrado y a implementarlos y desarrollarlos en sus áreas de influencia (AU)

The 7th Abbott-SENPE Forum is structured facing the new regulations of the European Space of High Education regarding the studies on Nutrition in the different degrees (Medicine, Pharmacology, Nutrition, Nursing) and post-doctoral education. A multi-professional and multidisciplinary discussion on the current situation of university education on nutrition, and its capabilities and limitations, is carried out. The value of the role of continuous medical education, the inhouse training programme, masters, and of scientific societies is also assessed. It is concluded that there is a need to urge academic authorities, the National Commission of Medical Specialties, the persons in charge of continuous medical education, and scientific societies of the importance of the studies relating to nutrition, feeding, and dietetics at both pre-graduate and post-graduate educational levels, and to implement and develop these studies in their areas of influence (AU)

Atrophy of the intestinal villi in a post-gastrectomy patient with severe iron deficiency anemia.

BACKGROUND & AIMS: Iron deficiency anemia is a common complication of gastric surgery that in certain patients can be refractory to treatment with oral iron and needs to be treated parenterally. METHODS: A 48-year woman underwent gastric surgery for a gastric ulcer. She was referred to the nutrition unit for the study and treatment of a 3-year iron deficiency anemia refractory to oral iron supplementation. Blood tests, endoscopy and jejunal biopsy were made to study the case. RESULTS: Intestinal villi atrophy in the absence of celiac disease was the result. She was treated with intravenous iron, resolving the villous atrophy and thus oral iron supplementation could be effective. CONCLUSION: This case illustrates that iron deficiency may cause villous atrophy. In this setting, parenteral iron administration is necessary to correct the haematological and non-hematological alterations associated with this deficiency.

Atrophy of the intestinal villi in a post-gastrectomy patient with severe iron deficiency anemia / Atrofia de las vellosidades intestinales en un paciente postgastrectomizado con anemia ferropénica grave

Background & aims: Iron deficiency anemia is a common complication of gastric surgery that in certain patients can be refractory to treatment with oral iron and needs to be treated parenterally. Methods: A 48-year woman underwent gastric surgery for a gastric ulcer. She was referred to the nutrition unit for the study and treatment of a 3-year iron deficiency anemia refractory to oral iron supplementation. Blood tests, endoscopy and jejunal biopsy were made to study the case. Results: Intestinal villi atrophy in the absence of celiac disease was the result. She was treated with intravenous iron, resolving the villous atrophy and thus oral iron supplementation could be effective. Conclusion: This case illustrates that iron deficiency may cause villous atrophy. In this setting, parenteral iron administration is necessary to correct the haematological and non-hematological alterations associated with this deficiency (AU)

Introducción y objetivos: La anemia ferropénica es una complicación frecuente tras la cirugía gástrica que en algunos pacientes puede ser refractaria al tratamiento con hierro oral, siendo necesaria su administración por vía parenteral. Métodos: Presentamos el caso de una mujer de 48 años intervenida de gastrectomía para tratamiento de una úlcera gástrica. Fue remitida a la unidad de nutrición para estudio y tratamiento de una anemia ferropénica de 3 años de evolución refractaria al tratamiento con hierro oral. Para el estudio del caso se realizó analítica y endoscopia digestiva alta con biopsia yeyunal. Resultados: En el estudio realizado la paciente presentaba atrofia de la mucosa yeyunal en ausencia de enfermedad celíaca. Fue tratada con hierro intravenoso desapareciendo la atrofia intestinal, tras lo cual continuamos con suplementos de hierro por vía oral. Conclusión: Este caso ilustra que la deficiencia de hierro puede producir atrofia intestinal. Si esto ocurre, es necesario la suplementación de este metal por vía parenteral para corregir las alteraciones hematológicas y no hematológicas asociadas a esta deficiencia (AU)