[Home parenteral nutrition in Spain 2011 and 2012; a report of the home and ambulatory artificial nutrition group NADYA]. / Nutrición Parenteral Domiciliaria en España 2011 y 2012: informe del grupo de nutrición artificial domiciliaria y ambulatoria NADYA.

OBJECTIVE: To report the data of the Home Parenteral Nutrition (HPN) registry of the NADYA-SENPE working group for the years 2011 and 2012. METHODOLOGY: We compiled the data from the on-line registry introduced by reviewers of NADYA group responsible for monitoring of NPD introduced by since January 1, 2011 to december 31, 2012. Included fields were: age, sex, diagnosis and reason for HPN, access path, complications, beginning and end dates, complementary oral or enteral nutrition, activity level, autonomy degree, product and fungible material supply, withdrawal reason and intestinal transplant indication. RESULTS: Year 2010: 184 patients from 29 hospitals , representing a rate of 3.98 patients/million inhabitants/ year 2011, with 186 episodes were recorded NPD . During 2012, 203 patients from 29 hospitals , representing a rate of 4.39 patients/million inhabitants/year 2012 , a total of 211 episodes were recorded NPD . CONCLUSIONS: We observe an increase in registered patients with respect to previous years.Neoplasia remains as the main pathology since 2003. Although NADYA is consolidated registry and has been indispensable source of information relevant to the understanding of the progress of Home Artificial Nutrition in our country, there is ample room for improvement. Especially that refers to the registration of pediatric patients and the registration of complications.

Objetivo: Comunicar los datos del registro de Nutrición Parenteral Domiciliaria (NPD) del grupo de trabajo NADYA-SENPE de los años 2011 y 2012. Material y métodos: Recopilación de los datos del registro "on-line" introducidos por los colaboradores del grupo NADYA responsables del seguimiento de la NPD desde el 1 de enero de 2011 al 31 de diciembre de 2012 dividido por años naturales. Resultados: Año 2010: Se registraron 184 pacientes, procedentes de 29 hospitales, lo que representa una tasa de 3,98 pacientes/millón habitantes/año 2011, con 186 episodios de NPD. Durante el año 2012 se registraron 203 pacientes, procedentes de 29 hospitales, lo que representa una tasa de 4,39 pacientes/millón habitantes/año 2012, con un total de 211 episodios de NPD. Conclusiones: Se observa un aumento progresivo de los pacientes registrados respecto a años anteriores. El principal grupo patológico sigue siendo oncológico ocupando el primer lugar desde 2003. Aunque el registro NADYA es un registro consolidado y ha sido y es fuente imprescindible de información relevante para el conocimiento de los avances de la Nutrición Artificial Domiciliaria en nuestro país, queda un amplio margen para la mejora. En especial lo que hace referencia al registro de pacientes pediátricos y al registro de las complicaciones.

Nutrición Parenteral Domiciliaria en España 2011 y 2012; informe del grupo de nutrición artificial domiciliaria y ambulatoria NADYA / Home parenteral nutrition in Spain 2011 and 2012; a report of the home and ambulatory artificial nutrition group NADYA

Objetivo: Comunicar los datos del registro de Nutrición Parenteral Domiciliaria (NPD) del grupo de trabajo NADYA-SENPE de los años 2011 y 2012. Material y métodos: Recopilación de los datos del registro "on-line" introducidos por los colaboradores del grupo NADYA responsables del seguimiento de la NPD desde el 1 de enero de 2011 al 31 de diciembre de 2012 dividido por años naturales. Resultados: Año 2010: Se registraron 184 pacientes, procedentes de 29 hospitales, lo que representa una tasa de 3,98 pacientes/millón habitantes/año 2011, con 186 episodios de NPD. Durante el año 2012 se registraron 203 pacientes, procedentes de 29 hospitales, lo que representa una tasa de 4,39 pacientes/millón habitantes/año 2012, con un total de 211 episodios de NPD. Conclusiones: Se observa un aumento progresivo de los pacientes registrados respecto a años anteriores. El principal grupo patológico sigue siendo oncológico ocupando el primer lugar desde 2003. Aunque el registro NADYA es un registro consolidado y ha sido y es fuente imprescindible de información relevante para el conocimiento de los avances de la Nutrición Artificial Domiciliaria en nuestro país, queda un amplio margen para la mejora. En especial lo que hace referencia al registro de pacientes pediátricos y al registro de las complicaciones (AU)

Objective: To report the data of the Home Parenteral Nutrition (HPN) registry of the NADYA-SENPE working group for the years 2011 and 2012. Methodology: We compiled the data from the on-line registry introduced by reviewers of NADYA group responsible for monitoring of NPD introduced by since January 1, 2011 to december 31, 2012. Included fields were: age, sex, diagnosis and reason for HPN, access path, complications, beginning and end dates, complementary oral or enteral nutrition, activity level, autonomy degree, product and fungible material supply, withdrawal reason and intestinal transplant indication. Results: Year 2010: 184 patients from 29 hospitals, representing a rate of 3.98 patients/million inhabitants/ year 2011, with 186 episodes were recorded NPD. During 2012, 203 patients from 29 hospitals, representing a rate of 4.39 patients/million inhabitants/year 2012, a total of 211 episodes were recorded NPD. Conclusions: We observe an increase in registered patients with respect to previous years. Neoplasia remains as the main pathology since 2003. Although NADYA is consolidated registry and has been indispensable source of information relevant to the understanding of the progress of Home Artificial Nutrition in our country, there is ample room for improvement. Especially that refers to the registration of pediatric patients and the registration of complications (AU)

[Adverse effects of parenteral nutrition in cancer patients: systematic review]. / Efectos adversos de la nutrición parenteral en pacientes oncológicos: revisión sistemática.

Malnutrition in hospitals is of great concern in patients with cancer. This malnutrition in cancer leads to higher risk of complications, and worse response to treatments and outcomes. Parenteral nutrition (PN) in cancer is controversial due to the heterogeneous results found in scientific literature. This is the reason why the evaluation of adverse events of PN, its incidence and severity, is crucial when prescribing PN in cancer patients. This evaluation of adverse events of PN is the aim of the present systematic review of the randomized clinical trials (RCT) written in any language found in several databases. From the 74 articles found in our search, only 13 RCT (18 different types of cancer) met the criteria to be selected for the systematic review. These RCT included 669 patients receiving central PN in whom 225 adverse events (33.63%) of PN were described, and 92 patients with peripheral PN, with 54 adverse events (58.70%). There were no adverse events in a control group of 47 patients receiving parenteral fluids. We conclude that scientific literature is very heterogeneous and evaluate complications of parenteral nutrition only as a secondary aim. We think necessary that further research do define complications of parenteral nutrition homogeneously and study them as a main objective.

[Diagnostic and psychopathologic evaluation of binge eating disorder in gastric bypass patients]. / Valoración diagnóstica y psicopatológica del trastorno por atracón en obesos mórbidos intervenidos de bypass gástrico.

INTRODUCTION: The presence of binge eating disorder (BED) can influence the outcomes of laparoscopic gastric bypass (BPGL) in the treatment of morbid obesity. In English population, BED is assessed usually through the Eating Disorder Examination-Questionnaire (EDE-Q) and Questionnaire on Eating and Weight Patterns-Revised (QEWP-R). OBJECTIVES: To study validity and concordance of EDEQ and QEWP-R for diagnosis and psychopathologic assessment of BED in Spanish gastric bypass patients. METHODS: In a cross sectional study 27 recent gastric bypass patients completed Spanish version of EDE-Q and QEWP-R. Then patients were classified in BED or no BED. We evaluated possible differences between these groups in the items with psychometric relevance and we measure concordance between the questionnaires. RESULTS: The QEWP-R and EDE-Q identified respectively 25,9% and 18,5% patients with BED. These achieved higher scores in the items related to importance of weight or shape in self-assessment, interference in concentration because of thinking about food, shape or weight, and frequency of guilty feeling after eating. Diagnostic concordance was poor between questionnaires, but we found a strong relation between items with psychometric relevance. CONCLUSIONS: BED is frequent in gastric bypass patients and constitute a distinct subgroup of patients with more severe psychopathology. Spanish version of QEWP-R and EDE-Q are suitable questionnaires for assessment of BED.

Efectos adversos de la nutrición parenteral en pacientes oncológicos; revisión sistemática / Adverse effects of parenteral nutrition in cancer patients; systematic review

La malnutrición hospitalaria tiene gran importancia en los pacientes con cáncer y lleva a mayor riesgo de complicaciones, menor respuesta al tratamiento y peor evolución de los mismos. El empleo de nutrición parenteral (NP) en estos pacientes es controvertida por los resultados heterogéneos publicados en la literatura científica. Éste es el motivo por el que la evaluación de los efectos adversos de la NP, de su incidencia y gravedad, es muy importante a la hora de prescribir una NP en estos pacientes. Esta evaluación de los efectos adversos de la NP es el objetivo de la presente revisión sistemática de los ensayos clínicos aleatorizados (ECA) encontrados en diversas bases de datos y publicados en cualquier idioma. De los 74 artículos encontrados en nuestra búsqueda, sólo 13 ECA (18 tipos diferentes de neoplasias) cumplían los criterios de inclusión para ser seleccionados para la revisión sistemática. Estos ECA incluyeron 669 pacientes con NP central en los que se describieron 225 efectos adversos (33,63%) de la NP, y 92 pacientes con NP periférica, con 54 efectos adversos (58,70%). No hubo efectos adversos en los 47 pacientes del grupo control que recibió fluidoterapia intravenosa. Podemos concluir que los estudios publicados son muy heterogéneos y evalúan las complicaciones de la nutrición parenteral únicamente de forma secundaria. Creemos necesario que futuros ensayos clínicos definan las complicaciones de la nutrición parenteral de forma homogénea y los estudien como objetivo primario (AU)

Malnutrition in hospitals is of great concern in patients with cancer. This malnutrition in cancer leads to higher risk of complications, and worse response to treatments and outcomes. Parenteral nutrition (PN) in cancer is controversial due to the heterogeneous results found in scientific literature. This is the reason why the evaluation of adverse events of PN, its incidence and severity, is crucial when prescribing PN in cancer patients. This evaluation of adverse events of PN is the aim of the present systematic review of the randomized clinical trials (RCT) written in any language found in several databases. From the 74 articles found in our search, only 13 RCT (18 different types of cancer) met the criteria to be selected for the systematic review. These RCT included 669 patients receiving central PN in whom 225 adverse events (33.63%) of PN were described, and 92 patients with peripheral PN, with 54 adverse events (58.70%). There were no adverse events in a control group of 47 patients receiving parenteral fluids. We conclude that scientific literature is very heterogeneous and evaluate complications of parenteral nutrition only as a secondary aim. We think necessary that further research do define complications of parenteral nutrition homogeneously and study them as a main objective (AU)

Valoración diagnóstica y psicopatológica del trastorno por atracón en obesos mórbidos intervenidos de bypass gástrico / Diagnostic and psychopathologic evaluation of binge eating disorder in gastric bypass patients

Introducción: La presencia de trastorno por atracón (TA) podría influir en los resultados del bypass gástrico laparoscópico (BPGL) en el tratamiento de la obesidad mórbida. En población anglosajona, el TA suele valorarse mediante los cuestionarios Eating Disorder Examination-Questionnaire (EDE-Q) y Questionnaire on Eating and Weight Patterns-Revised (QEWP-R). Objetivos: Estudiar la validez y concordancia del EDEQ y QEWP-R para el diagnóstico y valoración psicopatológica del TA en población española con obesidad mórbida intervenida mediante BPGL. Métodos: En un estudio transversal se le ha solicitado a 27 obesos mórbidos recién intervenidos mediante BPGL que cumplimentaran el EDE-Q y QEWP-R traducidos al español. Según las respuestas se han identificado los pacientes con y sin TA, evaluando posibles diferencias entre estos grupos en los ítems con interés psicométrico y midiendo la concordancia entre ambos cuestionarios. Resultados: El QEWP-R permitió diagnosticar un 25,9% de TA y el EDE-Q un 18,5%. Los pacientes con TA tuvieron mayores puntuaciones en los ítems sobre la importancia del peso o figura en la autovaloración, la interferencia en la capacidad de concentración por pensar en la comida, silueta o peso y la frecuencia del sentimiento de culpa después de comer. Entre ambos cuestionarios la concordancia diagnóstica fue escasa, pero se encontró una asociación fuerte entre los ítems con interés psicométrico. Conclusiones: El TA es frecuente en obesos mórbidos intervenidos mediante BPGL y forma un subgrupo de pacientes con más alteraciones psicopatológicas. El QEWP-R y el EDE-Q en español son cuestionarios adecuados para su valoración (AU)

Introduction: The presence of binge eating disorder (BED) can influence the outcomes of laparoscopic gastric bypass (BPGL) in the treatment of morbid obesity. In English population, BED is assessed usually through the Eating Disorder Examination-Questionnaire (EDE-Q) and Questionnaire on Eating and Weight Patterns-Revised (QEWP-R). Objectives: To study validity and concordance of EDEQ and QEWP-R for diagnosis and psychopathologic assessment of BED in Spanish gastric bypass patients. Methods: In a cross sectional study 27 recent gastric bypass patients completed Spanish version of EDE-Q and QEWP-R. Then patients were classified in BED or no BED. We evaluated possible differences between these groups in the items with psychometric relevance and we measure concordance between the questionnaires. Results: The QEWP-R and EDE-Q identified respectively 25,9% and 18,5% patients with BED. These achieved higher scores in the items related to importance of weight or shape in self-assessment, interference in concentration because of thinking about food, shape or weight, and frequency of guilty feeling after eating. Diagnostic concordance was poor between questionnaires, but we found a strong relation between items with psychometric relevance. Conclusions: BED is frequent in gastric bypass patients and constitute a distinct subgroup of patients with more severe psychopathology. Spanish version of QEWP-R and EDE-Q are suitable questionnaires for assessment of BE (AU)

Systematic review of the clinical efficacy of sibutramine and orlistat in weigth loss, quality of life and its adverse effects in obese adolescents.

INTRODUCTION: The prevalence of obesity, a serious public health problem, is increasing among teenagers and thus also increases cardiovascular morbidity and mortality in adulthood. OBJECTIVE: To provide a systematic review of the best evidence about the effect of sibutramine and orlistat in weight loss, quality of life and its adverse effects in adolescents diagnosed with obesity. METHODS: We searched electronic databases and bibliographies of selected articles were inspected for any further reference. We included only randomized controlled trials that met a set of predefined criteria. The studies were reviewed by a narrative synthesis. RESULTS: We included 6 randomized controlled trials of sibutramine and 3 of orlistat. The majority reached a moderate to high methodological quality. Sibutramine and orlistat showed a reduction in body mass index (BMI) that was significantly higher compared with the placebo group. We also found a variation of weight with these drugs significantly better than placebo. Only one trial evaluated the quality of life. The incidence of adverse effects was similar for sibutramine and placebo, except for tachycardia. The most common adverse reactions associated with orlistat were gastrointestinal, mild to moderate. CONCLUSIONS: Sibutramine and orlistat in combination with a hypocaloric diet and changes in lifestyle in obese adolescents achieve a short-term loss of weight greater than that achieved through the dietary-behavioral therapy alone.

Preoperative determinants of outcomes of laparoscopic gastric bypass in the treatment of morbid obesity / Determinantes preoperatorios de resultados del bypass gástrico laparoscópico en el tratamiento de la obesidad mórbida

Introduction: Laparoscopic gastric bypass (LGBP) is the predominant technique in surgical treatment of morbidobesity. Objectives: To evaluate the results of LGBP and measure the validity of some hypothetical variables as predictors of these outcomes. Methods: We carried out a historical cohort study which included 50 morbidly obese patients operated with L GBP. The results were assessed by the Bariatric Analysis and Reporting Outcome System (BAROS), which measures the following parameters: the percentage of excess weight loss (EWL), changes in co-morbidities, quality of life and complications. The independent variables were age, body mass index (BMI), sex, history of depression and presence of more than one cardiovascular risk factor (CVRF).Results: Following LGBP, 11% of the results was classified as excellent, 54% as very good, 25% as good and9% as fair (median follow-up period: 17 months, 7-37).The best scores were found among younger patients. The EWL (mean: 55.4 ± 16.6%) was higher in patients with lower BMI and with no more than one cardiovascular risk factor. We obtained rates of resolution of CVRF of43.7 to 68.7%, complication rates < 10% and improvement of quality of life. Conclusions: We believe that, following LGBP in morbidly obese patients, when EWL, improvement in comorbidities and quality of life as well as complications are jointly assessed, the best results are obtained in younger patients (AU)

Introducción: El bypass gástrico la paroscópico (BPGL)es la técnica predominante en el tratamiento quirúrgico de la obesidad mórbida. Objetivos: Evaluar los resultados del BPGL y medir la capacidad de algunas variables como hipotéticas predictoras de estos resultados. Métodos: En un estudio de cohorte histórico se han incluido 50 obesos mórbidos intervenidos mediante BPGL, valorando los resultados según el sistema BAROS; este considera el porcentaje de sobrepeso perdido (PSP), evolución de comorbilidades, calidad de vida y complicaciones. Las variables independientes han sido la edad, índice de masa corporal (IMC), sexo, presencia o no de historia depresiva y de más de un factor de riesgo cardiovascular (FRCV).Resultados: La clasificación de los resultados del BPGL fue: 11% resultado excelente, 54% resultado muy bueno,25% resultado bueno y 9% resultado regular (mediana de seguimiento postoperatorio: 17 meses, 7-37); las mejores puntuaciones correspondieron a enfermos con menor edad. El PSP (media: 55,4 ± 16,6%) fue mayor en pacientes con menor IMC y con no más de un FRCV. Se obtuvieron unas tasas de resolución de los FRCV del 43,7-68,7%,unos índices de complicaciones < 10% y mejoró la calidad de vida. Conclusiones: Cuando se valora de forma conjunta PSP, evolución de comorbilidades, calidad de vida y complicaciones de los obesos mórbidos intervenidos mediante BPGL, los mejores resultados se obtienen en los pacientes más jóvenes (AU)

Systematic review of the clinical efficacy of sibutramine and orlistatin weigth loss, quality of life and its adverse effects in obese adolescents / Revisión sistemática sobre la eficacia clínica de la sibutramina y el orlistat en la pérdida de peso, calidad de vida y sus efectos adversos en obesos adolescentes

Introduction: The prevalence of obesity, a serious public health problem, is increasing among teenagers and thus also increases cardiovascular morbidity and mortality in adult hood. Objective: To provide a systematic review of the best evidence about the effect of sibutramine and orlist at in weight loss, quality of life and its adverse effects in adolescents diagnosed with obesity. Methods: We searched electronic data bases and bibliographies of selected articles were inspected for any further reference. We included only randomized controlled trials that met a set of predefined criteria. The studies were reviewed by a narrative synthesis. Results: We included 6 randomized controlled trials of sibutramine and 3 of orlistat. The majority reached a moderate to high methodological quality. Sibutramine and or listat showed a reduction in body mass index (BMI) that was significantly higher compared with the placebo group. We also found a variation of weight with these drugs significantly better than placebo. Only one trial evaluated the quality of life. The incidence of adverse effects was similar for sibutramine and placebo, except for tachycardia. The most common adverse reactions associated with orlistat were gastrointestinal, mild tomoderate. Conclusions: Sibutramine and orlistat in combination with a hypocaloric diet and changes in lifestyle in obese adolescents achieve a short-term loss of weight greater than that achieved through the dietary-behavioral therapy alone (AU)

Introducción: La prevalencia de la obesidad, un grave problema de salud pública, está aumentando entre los adolescentes y con ello también se incrementa la morbimortalidad cardiovascular en la edad adulta. Objetivo: Proporcionar una revisión sistemática de la mejor evidencia posible sobre el efecto de sibutramina y orlistat en la pérdida de peso, calidad de vida y sus efectos adversos en adolescentes diagnosticados de obesidad. Método: Se ha buscado en bases de datos electrónicas, las bibliografías de los artículos seleccionados se han inspeccionado en busca de alguna referencia adicional. Sólo se incluyeron ensayos clínicos aleatorizados y controlados que cumplieran una serie de criterios predefinidos. Los estudios se han revisado mediante una síntesis narrativa. Resultados: Se incluyeron 6 ensayos clínicos aleatorizados y controlados sobre la sibutramina y 3 sobre el orlistat. En su mayoría alcanzaron una calidad metodológica moderada-alta. Sibutramina y orlistat demostraron una reducción en el índice de masa corporal (IMC) significativamente mayor en comparación con el grupo placebo. También se encontró una variación del peso significativamente mejor con estos fármacos que con placebo. Únicamente un ensayo evaluó la calidad de vida. La incidencia de efectos adversos resultó similar para sibutramina y placebo, salvo la taquicardia. Las reacciones adversas más comunes asociadas con el orlistat fueron las gastrointestinales, de intensidad leve a moderada. Conclusiones: La sibutramina o el orlistat en combinación con una dieta hipocalórica y modificaciones en el estilo de vida propician en adolescentes obesos una pérdida de peso a corto plazo mayor que la que se conseguiría con el tratamiento dietético-conductual solo (AU)

Preoperative determinants of outcomes of laparoscopic gastric bypass in the treatment of morbid obesity.

INTRODUCTION: Laparoscopic gastric bypass (LGBP) is the predominant technique in surgical treatment of morbid obesity. OBJECTIVES: To evaluate the results of LGBP and measure the validity of some hypothetical variables as predictors of these outcomes. METHODS: We carried out a historical cohort study which included 50 morbidly obese patients operated with LGBP. The results were assessed by the Bariatric Analysis and Reporting Outcome System (BAROS), which measures the following parameters: the percentage of excess weight loss (EWL), changes in co-morbidities, quality of life and complications. The independent variables were age, body mass index (BMI), sex, history of depression and presence of more than one cardiovascular risk factor (CVRF). RESULTS: Following LGBP, 11% of the results was classified as excellent, 54% as very good, 25% as good and 9% as fair (median follow-up period: 17 months, 7-37). The best scores were found among younger patients. The EWL (mean: 55.4 ± 16.6%) was higher in patients with lower BMI and with no more than one cardiovascular risk factor. We obtained rates of resolution of CVRF of 43.7 to 68.7%, complication rates < 10% and improvement of quality of life. CONCLUSIONS: We believe that, following LGBP in morbidly obese patients, when EWL, improvement in comorbidities and quality of life as well as complications are jointly assessed, the best results are obtained in younger patients.

Cardiovascular risk factor management is poorer in diabetic patients with undiagnosed peripheral arterial disease than in those with known coronary heart disease or cerebrovascular disease. Results of a nationwide study in tertiary diabetes centres.

AIMS: To assess whether patients with Type 2 diabetes mellitus and unrecognized peripheral arterial disease (PAD), detected by the ankle-brachial index (ABI), have poorer cardiovascular risk factor management (CVRFs) and receive fewer medications than patients previously diagnosed with coronary heart disease (CHD) or cerebrovascular disease (CVD). METHODS: In 31 diabetes centres throughout Spain, 1303 patients with Type 2 diabetes mellitus were screened for PAD using the ABI. Patient history of CHD and CVD and treatment and control of CVRFs were recorded. RESULTS: Forty-one patients had an ABI > 1.30 and were excluded, leaving 1262 patients (age 65.3 +/- 7.7 years) for the study. Of those screened, 790 patients had a normal ABI (ABI > 0.9) and no known history of CHD or CVD (no CHD/CVD/PAD group), 194 had unrecognized PAD (ABI < or = 0.9) with no known history of CHD or CVD (undiagnosed PAD group) and 278 had a known history of CHD and/or CVD (CHD/CVD group). The undiagnosed PAD group had higher low-density lipoprotein (LDL) cholesterol (2.9 +/- 0.83 vs. 2.4 +/- 0.84 mmol/l; P < 0.001) and systolic blood pressure (150 +/- 20 vs. 145 +/- 21 mmHg; P < 0.001) compared with the CHD/CVD group. They were less likely to take statins (56.9 vs. 71.6%; P < 0.001), anti-hypertensive agents (75.9 vs. 90.1%, P = 0.001), and anti-platelet agents (aspirin, 28.7 vs. 57.2%; P < 0.001; clopidogrel, 5.6 vs. 20.9%; P < 0.001) and more likely to smoke (21.0 vs. 9.2%; P < 0.001). Higher LDL in the undiagnosed PAD group was associated with the underutilization of statins. CONCLUSIONS: Measurement of ABI detected a significant number of patients with PAD, who did not have CHD or CVD, but whose CVRFs were under treated and poorly controlled compared with subjects with CHD and/or CVD.