Is adductor pollicis skinfold an accurate tool when checking local muscle improvement in malnourished patients with anorexia nervosa?

OBJECTIVES: Anorexia nervosa (AN) is a complex disease that involves malnutrition and a profound depletion in muscle mass. The thickness of the adductor pollicis muscle (APM) has been proposed as a new anthropometric technique to estimate muscle mass, check early changes, and assess its evaluation. This study aimed to evaluate the accuracy and validity of the APM thickness in a cohort of malnourished patients with AN when checking local mass gain. The Doppler ultrasound maybe an affordable and useful method to discriminate all tissues around the APM area. METHODS: A prospective cohort study was conducted of 31 malnourished patients with AN who were admitted to the Regional Eating Disorders Unit for treatment, including re-alimentation. Anthropometric measurements were taken, including arm circumference, triceps skinfold thickness, arm muscle circumference, body mass index, and APM thickness of both hands. Simultaneously, a Doppler ultrasound was performed in the same area, measuring and discriminating fat, skin, and muscle tissues around the APM. RESULTS: Nutritional improvement is accompanied by fat, but not muscle gain in the hand in the adductor pollicis area of patients with AN. A Doppler ultrasound can accurately discriminate between tissues around the APM. CONCLUSIONS: APM thickness reflects the addition of two different muscles plus fat and skin; therefore, this tool is not reliable to assess APM mass.

Consenso sobre la evaluación y el tratamiento nutricional de los trastornos de la conducta alimentaria: anorexia nerviosa, bulimia nerviosa, trastorno por atracón y otros. Resumen ejecutivo / Consensus document about the nutritional evaluation and management of eating disorders: anorexia nervosa, bulimia nervosa, binge eating disorder, and others. Executive abstract

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[Consensus document about the nutritional evaluation and management of eating disorders: anorexia nervosa, bulimia nervosa, binge eating disorder, and others]. / Resumen ejecutivo "Consenso sobre la evaluación y el tratamiento nutricional de los trastornos de la conducta alimentaria: anorexia nerviosa, bulimia nerviosa, trastorno por atracón y otros".

Eating disorders (ED) are characterized by persistent changes in eating habits that negatively affect a person's health and psychosocial abilities. They are considered psychiatric disorders, highly variable in their presentation and severity, with a huge impact on nutrition, which conditions various therapeutic approaches within a key multidisciplinary context. A group of experts in nutrition, we decided to set up a task force adscribed to the "Sociedad Española de Nutrición Parenteral y Enteral" (SENPE), which has stated as one of its goals the development of a consensus document to generate a protocol based on the best scientific evidence and professional experience available in order to improve health care in this field.

[Consensus document about the nutritional evaluation and management of eating disorders: anorexia nervosa]. / Consenso sobre la evaluación y el tratamiento nutricional de los trastornos de la conducta alimentaria: anorexia nerviosa.

Anorexia nervosa is the most common psychiatric disease among young women and it is assumed to be of multifactorial origin. Diagnostic criteria have recently been modified; therefore amenorrhea has ceased to be a part of them. This disease shows a large variability in its presentation and severity which conditions different therapeutic approaches and the need to individualize the treatment, thus it is indispensable a multidisciplinary approach. The goals are to restore nutritional status (through an individualized diet plan based on a healthy consumption pattern), treat complications and comorbidities, nutritional education (based on healthy eating and nutritional patterns), correction of compensatory behaviors and relapse prevention. The treatment will vary according to the patient's clinical situation, and it may be performed in outpatient clinics (when there is clinical stability), in a day hospital or ambulatory clinic (intermediate mode between traditional outpatient treatment and hospitalization) or hospitalization (when there is outpatient management failure or presence of serious medical or psychiatric complications). Artificial nutrition using oral nutritional supplements, enteral nutrition and exceptionally parenteral nutrition may be necessary in certain clinical settings. In severely malnourished patients the refeeding syndrome should be avoided. Anorexia nervosa is associated with numerous medical complications which determines health status, life quality, and is closely related to mortality. There is little clinical evidence to assess the results of different treatments in anorexia nervosa, when most of the recommendations are being based on expert consensus.

[Consensus document about the nutritional evaluation and management of eating disorders: bulimia nervosa, binge eating disorder, and others]. / Consenso sobre la evaluación y el tratamiento nutricional de los trastornos de la conducta alimentaria: bulimia nerviosa, trastorno por atracón y otros.

Bulimia nervosa and binge eating disorder are unique nosological entities. Both show a large variability related to its presentation and severity which involves different therapeutic approaches and the need to individualize the treatment, thus it is indispensable a multidisciplinary approach. Patients with bulimia nervosa may suffer from malnutrition and deficiency states or even excess weight, while in binge eating disorders, it is common overweight or obesity, which determine other comorbidities. Many of the symptoms and complications are associated with compensatory behaviors. There are many therapeutic tools available for the treatment of these patients. The nutritional approach contemplates the individualized dietary advice which guarantees an adequate nutritional state and nutritional education. Its objective is to facilitate the voluntary adoption of eating behaviors that promote health and allow the long-term modification of eating habits and the cessation of purgatory and bingeing behaviors. Psychological support is a first-line treatment and it must address the frequent disorder of eating behavior and psychiatric comorbidities. Psychotropic drugs are effective and widely used although these drugs are not essential. The management is carried out mainly at an outpatient level, being the day hospital useful in selected patients. Hospitalization should be reserved to correct serious somatic or psychiatric complications or as a measure to contain non-treatable conflict situations. Most of the guidelines' recommendations are based on expert consensus, with little evidence which evaluates clinical results and cost-effectiveness.

Resumen ejecutivo "Consenso sobre la evaluación y el tratamiento nutricional de los trastornos de la conducta alimentaria: anorexia nerviosa, bulimia nerviosa, trastorno por atracón y otros" / No disponible

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Consenso sobre la evaluación y el tratamiento nutricional de los trastornos de la conducta alimentaria: anorexia nerviosa / No disponible

La anorexia nerviosa es la enfermedad psiquiátrica más frecuente entre las mujeres jóvenes y se asume de origen multifactorial. Los criterios diagnósticos han sido recientemente modificados de forma que la amenorrea deja de formar parte de ellos. Esta enfermedad muestra una gran variabilidad en su presentación y gravedad, lo que condiciona diferentes abordajes terapéuticos y la necesidad de individualizar el tratamiento, haciéndose indispensable un enfoque multidisciplinar. Los objetivos persiguen restaurar el estado nutricional (a través de un plan dietético individualizado y basado en un patrón de consumo saludable), tratar las complicaciones y comorbilidades, la educación nutricional (basada en patrones alimentarios y nutricionales sanos), corrección de las conductas compensatorias y la prevención de recaídas. El tratamiento variará según la situación clínica del paciente, pudiendo realizarse en consultas externas (cuando existe estabilidad clínica), en hospital de día (modalidad intermedia entre el tratamiento ambulatorio tradicional y la hospitalización) o en hospitalización (fracaso del manejo ambulatorio o presencia de complicaciones médicas o psiquiátricas graves). La nutrición artificial a través del empleo de suplementos nutricionales orales, nutrición enteral y excepcionalmente nutrición parenteral puede ser necesaria en determinados escenarios clínicos. En pacientes severamente desnutridos se debe evitar el síndrome de realimentación. La anorexia nerviosa está asociada a numerosas complicaciones médicas que condicionan el estado de salud, la calidad de vida y que se relacionan estrechamente con la mortalidad. Existe poca evidencia clínica para evaluar los resultados de los distintos tratamientos en la anorexia nerviosa, estando basados la mayoría de las recomendaciones en consenso de expertos

Anorexia nervosa is the most common psychiatric disease among young women and it is assumed to be of multifactorial origin. Diagnostic criteria have recently been modified; therefore amenorrhea has ceased to be a part of them. This disease shows a large variability in its presentation and severity which conditions different therapeutic approaches and the need to individualize the treatment, thus it is indispensable a multidisciplinary approach. The goals are to restore nutritional status (through an individualized diet plan based on a healthy consumption pattern), treat complications and comorbidities, nutritional education (based on healthy eating and nutritional patterns), correction of compensatory behaviors and relapse prevention. The treatment will vary according to the patient's clinical situation, and it may be performed in outpatient clinics (when there is clinical stability), in a day hospital or ambulatory clinic (intermediate mode between traditional outpatient treatment and hospitalization) or hospitalization (when there is outpatient management failure or presence of serious medical or psychiatric complications). Artificial nutrition using oral nutritional supplements, enteral nutrition and exceptionally parenteral nutrition may be necessary in certain clinical settings. In severely malnourished patients the refeeding syndrome should be avoided. Anorexia nervosa is associated with numerous medical complications which determines health status, life quality, and is closely related to mortality. There is little clinical evidence to assess the results of different treatments in anorexia nervosa, when most of the recommendations are being based on expert consensus

Consenso sobre la evaluación y el tratamiento nutricional de los trastornos de la conducta alimentaria: bulimia nerviosa, trastorno por atracón y otros / No disponible

La bulimia nerviosa y el trastorno por atracón constituyen entidades nosológicas propias. Ambas muestran una gran variabilidad en su presentación y gravedad, lo que implica la individualización del tratamiento y la necesidad de equipos multidisciplinares. Los pacientes con bulimia nerviosa pueden presentar desde desnutrición y estados carenciales a exceso de peso, mientras que en los trastornos por atracón es habitual el sobrepeso u obesidad, que condiciona a su vez otras comorbilidades. Muchos de los síntomas y complicaciones derivan de las conductas compensatorias. Se dispone de diversas herramientas terapéuticas para el tratamiento de estos pacientes. El abordaje nutricional contempla el consejo dietético individualizado que garantice un adecuado estado nutricional y la correcta educación nutricional. Su objetivo es facilitar la adopción voluntaria de comportamientos alimentarios que fomenten la salud y que permitan la modificación a largo plazo de los hábitos alimentarios y el cese de conductas purgantes y atracones. El soporte psicológico es el tratamiento de primera línea y debe abordar el trastorno de la conducta alimentaria y las comorbilidades psiquiátricas que frecuentemente presentan. Los psicofármacos, aunque eficaces y ampliamente utilizados, no son imprescindibles. El manejo se realiza principalmente a nivel ambulatorio, siendo el hospital de día útil en pacientes seleccionados. Se debe reservar la hospitalización para corregir aquellas complicaciones somáticas o psiquiátricas graves o como medida de contención de las situaciones conflictivas no tratables de forma ambulatoria. La mayoría de las recomendaciones de las guías se basan en consensos de expertos, existiendo poca evidencia que evalúe los resultados clínicos y de coste-eficacia

Bulimia nervosa and binge eating disorder are unique nosological entities. Both show a large variability related to its presentation and severity which involves different therapeutic approaches and the need to individualize the treatment, thus it is indispensable a multidisciplinary approach. Patients with bulimia nervosa may suffer from malnutrition and deficiency states or even excess weight, while in binge eating disorders, it is common overweight or obesity, which determine other comorbidities. Many of the symptoms and complications are associated with compensatory behaviors. There are many therapeutic tools available for the treatment of these patients. The nutritional approach contemplates the individualized dietary advice which guarantees an adequate nutritional state and nutritional education. Its objective is to facilitate the voluntary adoption of eating behaviors that promote health and allow the long-term modification of eating habits and the cessation of purgatory and bingeing behaviors. Psychological support is a first-line treatment and it must address the frequent disorder of eating behavior and psychiatric comorbidities. Psychotropic drugs are effective and widely used although these drugs are not essential. The management is carried out mainly at an outpatient level, being the day hospital useful in selected patients. Hospitalization should be reserved to correct serious somatic or psychiatric complications or as a measure to contain non-treatable conflict situations. Most of the guidelines' recommendations are based on expert consensus, with little evidence which evaluates clinical results and cost-effectiveness

[Not Available]. / Nutritional assessment of hospitalized patients in Latin America: association with prognostic variables. The ENHOLA study.

BACKGROUND AND AIM: The prevalence of hospital malnutrition (HM) is variable, explained by the variability of patients, the nutritional evaluation method used among others. The aim is to determine the frequency of malnutrition in hospitals in Latin America, and estimate its association with mortality and length of hospital stay. METHODS: This is an analytical, observational cohort study that included 7,973 patients of both genders, 18 and older, who provided their consent. The survey was administered during the first three days of admission. The nutritional status was estimated using Subjective Global Assessment (SGA) and the Nutrition Risk Screening (NRS), body mass index (BMI), percentage of change of weight (PCW) and co-morbidities. Serum albumin was obtained from the clinical chart. Length of stay (LOS) and the survival status at discharge (dead or alive) were also recorded. RESULTS: By SGA: 10.9% had severe malnutrition and 34% moderate malnutrition. By NRS: 36.9% had nutritional risk. Univariate analysis showed that NRS score and serum albumin were prognostic factors for mortality: NRS 3-4 (OR: 2.3, 95% CI: 1.9-2.8), NRS 5-7 (OR: 5.8, 95% CI: 4.9-6.9), serum albumin < 2.5 g/dl, (OR: 2.9, 95% CI: 2.2-3.8). These results were consistent and similar to a multivariate analysis. Both NRS and serum albumin were also independently and clinically associated to LOS. CONCLUSIONS: The prevalence of hospital malnutrition in Latin America is high. Our results show that screening with NRS and serum albumin can identify hospital malnutrition as well as providing clinically relevant prognostic value.

[Not Available]. / El músculo, elemento clave para la supervivencia en el enfermo neoplásico.

El síndrome de caquexia cancerosa es responsable de la muerte de un número significativo de pacientes con cáncer. Se caracteriza por la presencia de una ingesta reducida, con inflamación sistémica y un metabolismo alterado. Los enfermos presentan característicamente una progresiva pérdida de peso y de masa muscular, junto a deterioro funcional. La pérdida muscular se debe a la combinación de reducción de la síntesis proteica con aumento de su degradación. Ello conduce tanto a un acortamiento como a una reducción en el área de la fibra muscular. Asimismo, existen datos que apoyan que selectivamente algunos de los tipos de fibra muscular se ven más afectados. Es necesario definir bien los valores de corte de sarcopenia para diagnosticar la pérdida muscular y existen diferentes métodos. El sistema de la ubiquitina-proteasoma parece desempeñar un papel predominante en la degradación de la proteína miofibrilar. La tendencia a perder masa muscular en los pacientes con caquexia cancerosa parece estar asociada a la activación de señales catabólicas por citoquinas proinflamatorias, así como por productos tumorales del tipo factor inductor de proteólisis. En referencia a los factores pronósticos, el riesgo de muerte está bien documentado en pacientes con sarcopenia y, especialmente, en aquellos con obesidad asociada a la sarcopenia. Asimismo, se ha establecido una relación directa entre la pérdida intensa de masa muscular y la supervivencia en pacientes con diferentes tipos de tumores del tipo de cáncer de páncreas, pulmón, tracto biliar o cáncer colorrectal. Respecto de la terapia en el síndrome de caquexia cancerosa, es factible que requiera tratamiento con varios grupos combinados que incluyan, junto al soporte nutricional, fármacos orexígenos, con efecto anabólico y antinflamatorio, asociados a intervenciones que estimulen el ejercicio físico.

Nutritional assessment of hospitalized patients in Latin America: association with prognostic variables. The ENHOLA study / Valoración nutricional en pacientes hospitalizados en hospitales latinoamericanos: asociación con factores pronóstico. El estudio ENHOLA

Background and aim: The prevalence of hospital malnutrition (HM) is variable, explained by the variability of patients, the nutritional evaluation method used among others. The aim is to determine the frequency of malnutrition in hospitals in Latin America, and estimate its association with mortality and length of hospital stay. Methods: This is an analytical, observational cohort study that included 7,973 patients of both genders, 18 and older, who provided their consent. The survey was administered during the first three days of admission. The nutritional status was estimated using Subjective Global Assessment (SGA) and the Nutrition Risk Screening (NRS), body mass index (BMI), percentage of change of weight (PCW) and co-morbidities. Serum albumin was obtained from the clinical chart. Length of stay (LOS) and the survival status at discharge (dead or alive) were also recorded. Results: By SGA: 10.9% had severe malnutrition and 34% moderate malnutrition. By NRS: 36.9% had nutritional risk. Univariate analysis showed that NRS score and serum albumin were prognostic factors for mortality: NRS 3-4 (OR: 2.3, 95% CI: 1.9-2.8), NRS 5-7 (OR: 5.8, 95% CI: 4.9- 6.9), serum albumin < 2.5 g/dl, (OR: 2.9, 95% CI: 2.2-3.8). These results were consistent and similar to a multivariate analysis. Both NRS and serum albumin were also independently and clinically associated to LOS. Conclusions: The prevalence of hospital malnutrition in Latin America is high. Our results show that screening with NRS and serum albumin can identify hospital malnutrition as well as providing clinically relevant prognostic value (AU)

Introducción y objetivo: la prevalencia de la malnutrición hospitalaria (MH) es variable y puede explicarse por la variabilidad de los pacientes, el método de evaluación nutricional entre otros. El propósito de esta investigación es determinar la frecuencia de malnutrición en hospitales de Latinoamérica y estimar su asociación con mortalidad y estancia hospitalaria. Métodos: es un estudio analítico, observacional de cohorte que incluyó a 7.973 pacientes de ambos géneros, mayores de 18 años y que estuvieron de acuerdo en participar en el estudio. La evaluación fue aplicada durante los primeros tres días de admisión al hospital. El estado nutricional fue estimado usando la evaluación global subjetiva (SGA) y el score de riesgo nutricional (NRS-2002). Se evaluó el índice de masa corporal (IMC), el porcentaje de cambio de peso (PCW) y las comorbilidades. La albúmina sérica se obtuvo del expediente clínico. La estancia hospitalaria (LOS) y las condiciones del egreso (vivo o muerto) fueron también registrados. Resultados: por SGA: 10,9% tuvieron malnutrición severa y 34% malnutrición moderada. Por NRS: 36,9% tuvieron riesgo nutricional. El análisis univariado mostró que el NRS y la albúmina sérica fueron factores pronósticos de mortalidad: NRS 3-4 (OR: 2,3, 95%CI: 1,9-2,8), NRS 5-7 (OR: 5,8, 95% CI: 4,9-6,9), albúmina sérica < 2,5 g/dl, (OR: 2,9, 95% CI: 2,2-3,8); estos resultados fueron coherentes y similares al análisis multivariado. Tanto el NRS y como la albúmina sérica fueron también independientemente y clínicamente asociados a la estancia hospitalaria prolongada. Conclusión: la prevalencia de malnutrición hospitalaria en Latinoamérica es alta. Nuestros resultados muestran que el tamizaje con NRS y la albúmina sérica inicial pueden identificar la malnutrición hospitalaria, así como proporcionar un valor clínico relevante (AU)

Body mass index and waist circumference are not good surrogate indicators of adiposity in psychogeriatric patients.

OBJECTIVE: to assess the utility of body mass index (BMI) and waist circumference (WC) as surrogate indicators of adiposity with respect to the total body fat estimated with bioimpedance analysis in psychogeriatric patients. METHODS: Anthropometric and hand-to-foot bioimpedance measurements were performed according to standard procedures in a sample of 128 psychogeriatric patients (87 males, 41 females). WC cutoffs proposed by the International Diabetes Federation were used to define abdominal obesity. Z-scores of fat and fat-free mass indices (Z-FMI and Z-FFMI) were calculated. RESULTS: Males with WC values below the cutoff were normal weight, and showed normal levels of FM and low FFM (Z-FFMI below 1.5 SD). Males with WC values above the cutoff were overweight, showed high levels of FM (Z-FMI: 1.34 SD) and a slight depletion of FFM (Z-FFMI: -0.59 SD). In females with WC values below the cutoff, BMI was close to 20 kg/m(2) and both FM and FFM were depleted (Z-FMI: -0.7 SD; Z-FFMI: -1.76 SD). In females with WC above the cutoff, the average BMI was 25.6 kg/m(2) , Z-FMI was 0.48 SD, and Z-FFMI was -0.56 SD. CONCLUSIONS: Our results indicate that it is necessary to establish age and sex-specific BMI and WC cutoffs, and also highlight the importance of focusing on body composition analysis to ensure an accurate nutritional diagnosis in older-adults and in psychogeriatric patients.

El músculo, elemento clave para la supervivencia en el enfermo neoplásico / Muscle wasting as a key predictor of survival in cancer patients

El síndrome de caquexia cancerosa es responsable de la muerte de un número significativo de pacientes con cáncer. Se caracteriza por la presencia de una ingesta reducida, con inflamación sistémica y un metabolismo alterado. Los enfermos presentan característicamente una progresiva pérdida de peso y de masa muscular, junto a deterioro funcional. La pérdida muscular se debe a la combinación de reducción de la síntesis proteica con aumento de su degradación. Ello conduce tanto a un acortamiento como a una reducción en el área de la fibra muscular. Asimismo, existen datos que apoyan que selectivamente algunos de los tipos de fibra muscular se ven más afectados. Es necesario definir bien los valores de corte de sarcopenia para diagnosticar la pérdida muscular y existen diferentes métodos. El sistema de la ubiquitina-proteasoma parece desempeñar un papel predominante en la degradación de la proteína miofibrilar. La tendencia a perder masa muscular en los pacientes con caquexia cancerosa parece estar asociada a la activación de señales catabólicas por citoquinas proinflamatorias, así como por productos tumorales del tipo factor inductor de proteólisis. En referencia a los factores pronósticos, el riesgo de muerte está bien documentado en pacientes con sarcopenia y, especialmente, en aquellos con obesidad asociada a la sarcopenia. Asimismo, se ha establecido una relación directa entre la pérdida intensa de masa muscular y la supervivencia en pacientes con diferentes tipos de tumores del tipo de cáncer de páncreas, pulmón, tracto biliar o cáncer colorrectal. Respecto de la terapia en el síndrome de caquexia cancerosa, es factible que requiera tratamiento con varios grupos combinados que incluyan, junto al soporte nutricional, fármacos orexígenos, con efecto anabólico y antinflamatorio, asociados a intervenciones que estimulen el ejercicio físico (AU)

Cachexia syndrome has been estimated to be responsible for the death of a significant amount of cancer patients. It is characterized mainly by reduced intake, systemic inflammation and anomalous metabolism. Progressive loss of body weight, muscle wasting and functional impairment are remarkable features of the entity. Muscle wasting is due to a combination of both a diminution of protein synthesis and an increase in protein degradation. Progressive reduction of muscle protein drives to muscle fibre lessening and a reduction in its cross sectional area. Likewise, there is some evidence that a specific type of fiber is targeted in this setting. Defined cut points for sarcopenia are essential to diagnose skeletal muscle depletion and various methods have been carried out. The ubiquitin-proteasome pathway seems to play the main role in the breakdown of myofibrillar proteins. The trend to lose muscle in cancer cachexia patients may be associated to the triggering of catabolic signals by pro-inflammatory cytokines or tumour-specific agents such as proteolysis-inducing factor. Regarding prognostication, mortality risk is documented in sarcopenic cancer patients but is particularly accentuated in sarcopenic obese ones. A relationship between severe muscle depletion and survival has been shown in patients with different types of cancer such us pancreas, lung, biliary tract and colorrectal cancer. Therapeutic interventions for cancer cachexia syndrome are likely to require treatments from various groups including a combination of nutritional support, drugs with orexigenic, anabolic, anti-inflammatory effects and also non-pharmacologic interventions such as exercise (AU)

[PROPOSAL FOR A NEW FORMULA FOR ESTIMATING RESTING ENERGY EXPENDITURE FOR HEALTHY SPANISH POPULATION]. / PROPUESTA DE UNA NUEVA FÓRMULA DE ESTIMACIÓN DEL GASTO ENERGÉTICO EN REPOSO PARA POBLACIÓN SANA ESPAÑOLA.

INTRODUCTION: although there are precise and accurate techniques for estimating resting energy expenditure, like the indirect calorimetry (IC), daily practice needs faster, easier and cheaper methods as the predictive equations. OBJECTIVE: the aim of the study was to develop a new predictive equation for estimating resting energy expenditure (REE) for healthy Spanish population. Méthods: the REE of 95 healthy normal weighted volunteers was determined by indirect calorimetry (IC). The new equation was obtained by multiple lineal regression by using the analytical criteria of the Cp of Mallows and the adjusted R2. Then, the behavior of the new formula was studied in a group of overweight volunteers through the intraclass correlation coefficient (ICC) and Bland-Almand plots. The level of signification was reached at p < 0,05. RESULTS: the average age was 42 years (range: 2.0-63.2). Mean REE determined by IC was 1 589.1 kcal/d (312.0). The selected equation was: [y = 1 376.4 - 308 Sex (M = 0; W = 1) + 11.1 Weigh (kg) - 8 Age (years)] (R2: 0.68; EE: 175.95). The ICC between the new equation and the IC in normal weighted subjects was 0.901 (95%CI: 0.851 - 0.934). The new formula showed a good level of agreement in the overweight group (ICC: 0.880; 95%IC: 0.772 - 0.937). CONCLUSIONS: we propose a new predictive equation for estimating the REE for healthy Spanish population which has an easy application and includes sex, age and weigh. The selected equation shows an adequate behavior in overweight subjects too.

Introducción: aunque se dispone de técnicas precisas y exactas para la estimación del GER, como la calorimetría indirecta (CI), en la práctica diaria se precisan métodos rápidos, fáciles de aplicar y económicos, como los modelos predictivos. Objetivo: desarrollar una nueva ecuación predictiva del gasto energético en reposo (GER) para población española adulta sana. Métodos: se determinó el GER en 95 sujetos sanos con normopeso mediante CI. Se utilizó la regresión lineal múltiple para la obtención del modelo, empleando como criterios analíticos la Cp de Mallows y el R2 ajustado. Se estudió el comportamiento del modelo generado en una muestra de 39 sujetos con IMC ≥ 25 kg/m2 mediante el coeficiente de correlación intraclase (ICC) y la prueba de Bland-Altman. La significación se alcanzó con p < 0,05. Resultados: la edad media fue de 42 años (rango: 23,0­ 63,2). El valor medio del GER estimado fue de 1.589,1 kcal/d (312,0). La ecuación seleccionada fue: [GER (kcal/d) = 1.376,4 ­ 308 Sexo (V = 0; M = 1) + 11,1 Peso (kg) ­ 8 Edad (años)] (R2: 0,68; EE: 175,95). El CCI entre el nuevo modelo predictivo y la CI fue de 0,901 (IC del 95%: 0,851 ­ 0,934) en la muestra con normopeso. La aplicación del modelo en la muestra de sujetos con IMC ≥ 25 kg/m2 alcanzó una buena concordancia (CCI de 0,880; IC del 95%: 0,772 ­ 0,937). Conclusiones: se presenta un nuevo modelo de estimación del GER para población sana española fácilmente aplicable en la práctica diaria, que incluye las variables sexo, edad y peso. La ecuación propuesta presenta un comportamiento adecuado en sujetos con IMC ≥ 25 kg/m2.

Propuesta de una nueva fórmula de estimación del gasto energético en reposo para población sana española / Proposal for a new formula for estimating resting energy expenditure for healthy Spanish population

Introducción: aunque se dispone de técnicas precisas y exactas para la estimación del GER, como la calorimetría indirecta (CI), en la práctica diaria se precisan métodos rápidos, fáciles de aplicar y económicos, como los modelos predictivos. Objetivo: desarrollar una nueva ecuación predictiva del gasto energético en reposo (GER) para población española adulta sana. Métodos: se determinó el GER en 95 sujetos sanos con normopeso mediante CI. Se utilizó la regresión lineal múltiple para la obtención del modelo, empleando como criterios analíticos la Cp de Mallows y el R2 ajustado. Se estudió el comportamiento del modelo generado en una muestra de 39 sujetos con IMC más o menos 25 kg/m2 mediante el coeficiente de correlación intraclase (ICC) y la prueba de Bland-Altman. La significación se alcanzó con p < 0,05. Resultados: la edad media fue de 42 años (rango: 23,0- 63,2). El valor medio del GER estimado fue de 1.589,1 kcal/d (312,0). La ecuación seleccionada fue: [GER (kcal/d) = 1.376,4 - 308 Sexo (V = 0; M = 1) + 11,1 Peso (kg) - 8 Edad (años)] (R2 : 0,68; EE: 175,95). El CCI entre el nuevo modelo predictivo y la CI fue de 0,901 (IC del 95%: 0,851 - 0,934) en la muestra con normopeso. La aplicación del modelo en la muestra de sujetos con IMC más o menos 25 kg/m2 alcanzó una buena concordancia (CCI de 0,880; IC del 95%: 0,772 - 0,937). Conclusiones: se presenta un nuevo modelo de estimación del GER para población sana española fácilmente aplicable en la práctica diaria, que incluye las variables sexo, edad y peso. La ecuación propuesta presenta un comportamiento adecuado en sujetos con IMC más o menos 25 kg/m2 (AU)

Introduction: although there are precise and accurate techniques for estimating resting energy expenditure, like the indirect calorimetry (IC), daily practice needs faster, easier and cheaper methods as the predictive equations. Objective: the aim of the study was to develop a new predictive equation for estimating resting energy expenditure (REE) for healthy Spanish population. Méthods: the REE of 95 healthy normal weighted volunteers was determined by indirect calorimetry (IC). The new equation was obtained by multiple lineal regression by using the analytical criteria of the Cp of Mallows and the adjusted R2. Then, the behavior of the new formula was studied in a group of overweight volunteers through the intraclass correlation coefficient (ICC) and Bland-Almand plots. The level of signification was reached at p < 0,05. Results: the average age was 42 years (range: 2.0-63.2). Mean REE determined by IC was 1 589.1 kcal/d (312.0). The selected equation was: [y = 1376.4 - 308 Sex (M = 0; W = 1) + 11.1 Weigh (kg) - 8 Age (years)] (R2: 0.68; EE: 175.95). The ICC between the new equation and the IC in normal weighted subjects was 0.901 (95%CI: 0.851 - 0.934). The new formula showed a good level of agreement in the overweight group (ICC: 0.880; 95%IC: 0.772 - 0.937). Conclusions: we propose a new predictive equation for estimating the REE for healthy Spanish population which has an easy application and includes sex, age and weigh. The selected equation shows an adequate behavior in overweight subjects too (AU)

[AGREEMENT BETWEEN INDIRECT CALORIMETRY AND PREDICTIVE EQUATIONS IN A SAMPLE OF SPANISH HEALTHY ADULTS]. / CONCORDANCIA ENTRE CALORIMETRÍA INDIRECTA Y MODELOS PREDICTIVOS EN UNA POBLACIÓN SANA ESPAÑOLA.

OBJECTIVE: the aim of this study was to analyze the agreement between the resting energy expenditure (REE) obtained by indirect calorimetry (IC) and that obtained by prediction equations in a sample of healthy adults from Spain. Méthods: a descriptive cross-sectional study was conducted in 95 healthy, normal-weight adults. REE was determined by IC and 45 population-specific prediction equations which were based on weight, height, sex and/or body composition (BC). The Intraclass Correlation Coefficient (ICC) and Bland-Alman plots were used to analyze the agreement between the REE obtained by IC and that obtained by prediction equations. The level of signification was reached at p < 0,05. RESULTS: mean age was 42 years (range: 23.0-63.2). Mean REE determined by CI was 1589 (312) kcal/d [1822.3 (224.3) kcal/d in men and 1379.3 (216.1) kcal/d in women; p < 0.05]. The De-Lorenzo, Harris-Benedict, Schofield, and especially the Korth equations showed the greatest level of agreement with respect to IC. CONCLUSIONS: there is high variability in the estimates of REE depending on the prediction equation used. The De Lorenzo, Harris-Benedict, and the Schofield equations showed a good level of agreement in our sample; however, the Korth equation was the most appropriate. Equations based on weight and/or height were more accurate than those which included body composition variables.

Objetivo: estudiar la concordancia entre el gasto energético en reposo (GER) obtenido mediante calorimetría indirecta (CI), y las ecuaciones de estimación más utilizadas en población adulta sana española. Métodos: estudio transversal en el que se determinó el GER en 95 sujetos sanos con normopeso mediante calorimetría indirecta y modelos predictivos (se seleccionaron 45 fórmulas desarrolladas en adultos de características similares a la muestra estudiada que incluían peso, talla, sexo y/o composición corporal). La concordancia entre ambos métodos se analizó mediante el Coeficiente de Correlación Intraclase (CCI) y la prueba de Bland-Altman. La significación se alcanzó con p < 0,05. Resultados: la edad media fue de 42 años (rango: 23,0­ 63,2). El GER medio estimado por CI en la muestra fue de 1589 (312) kcal/día [1822,3 (224,3) kcal/día en varones y 1379,3 (216,1) kcal/día en mujeres; p < 0,05]. Las fórmulas que mejor se ajustaron a la muestra fueron las de De-Lorenzo, Harris-Benedict, Schofield y, especialmente, Korth. Conclusiones: existen grandes variaciones en la estimación del gasto energético en reposo en función de la ecuación predictiva utilizada. Las fórmulas de De-Lorenzo, Harris-Benedic y Schofield se comportan adecuadamente en la muestra evaluada; sin embargo, la de Korth demostró ser la más apta. Los modelos que incluyen peso y/o talla obtuvieron mejores resultados que los que contienen variables de composición corporal.

Concordancia entre calorimetría indirecta y modelos predictivos en una población sana española / Agreement between indirect calorimetry and predictive equations in a sample of Spanish healthy adults

Objetivo: estudiar la concordancia entre el gasto energético en reposo (GER) obtenido mediante calorimetría indirecta (CI), y las ecuaciones de estimación más utilizadas en población adulta sana española. Métodos: estudio transversal en el que se determinó el GER en 95 sujetos sanos con normopeso mediante calorimetría indirecta y modelos predictivos (se seleccionaron 45 fórmulas desarrolladas en adultos de características similares a la muestra estudiada que incluían peso, talla, sexo y/o composición corporal). La concordancia entre ambos métodos se analizó mediante el Coeficiente de Correlación Intraclase (CCI) y la prueba de Bland-Altman. La significación se alcanzó con p< 0,05. Resultados: la edad media fue de 42 años (rango: 23,0– 63,2). El GER medio estimado por CI en la muestra fue de 1589 (312) kcal/día [1822,3 (224,3) kcal/día en varones y 1379,3 (216,1) kcal/día en mujeres; p< 0,05]. Las fórmulas que mejor se ajustaron a la muestra fueron las de De-Lorenzo, Harris-Benedict, Schofield y, especialmente, Korth. Conclusiones: existen grandes variaciones en la estimación del gasto energético en reposo en función de la ecuación predictiva utilizada. Las fórmulas de De-Lorenzo, Harris-Benedic y Schofield se comportan adecuadamente en la muestra evaluada; sin embargo, la de Korth demostró ser la más apta. Los modelos que incluyen peso y/o talla obtuvieron mejores resultados que los que contienen variables de composición corporal (AU)

Objective: the aim of this study was to analyze the agreement between the resting energy expenditure (REE) obtained by indirect calorimetry (IC) and that obtained by prediction equations in a sample of healthy adults from Spain. Méthods: a descriptive cross-sectional study was conducted in 95 healthy, normal-weight adults. REE was determined by IC and 45 population-specific prediction equations which were based on weight, height, sex and/or body composition (BC). The Intraclass Correlation Coefficient (ICC) and Bland-Alman plots were used to analyze the agreement between the REE obtained by IC and that obtained by prediction equations. The level of signification was reached at p< 0,05. Results: mean age was 42 years (range: 23.0–63.2). Mean REE determined by CI was 1589 (312) kcal/d [1822.3 (224.3) kcal/d in men and 1379.3 (216.1) kcal/d in women; p< 0.05]. The De-Lorenzo, Harris-Benedict, Schofield, and especially the Korth equations showed the greatest level of agreement with respect to IC. Conclusions: there is high variability in the estimates of REE depending on the prediction equation used. The De Lorenzo, Harris-Benedict, and the Schofield equations showed a good level of agreement in our sample; however, the Korth equation was the most appropriate. Equations based on weight and/or height were more accurate than those which included body composition variables (AU)