Peculiarities of the obese patient with cancer: a national consensus statement by the Spanish Society for the Study of Obesity and the Spanish Society of Medical Oncology

The relationship between obesity and cancer is clear and is present at all times during course of the disease. The importance of obesity in increasing the risk of developing cancer is well known, and some of the most prevalent tumours (breast, colorectal, and prostate) are directly related to this risk increase. However, there is less information available on the role that obesity plays when the patient has already been diagnosed with cancer. Certain data demonstrate that in some types of cancer, obese patients tolerate the treatments more poorly. Obesity is also known to have an impact on the prognosis, favouring lower survival rates or the appearance of secondary tumours. In this consensus statement, we will analyse the scientific evidence on the role that obesity plays in patients already diagnosed with cancer, and the available data on how obesity control can improve the quality of daily life for the cancer patient (AU)

No disponible

Peculiarities of the obese patient with cancer: a national consensus statement by the Spanish Society for the Study of Obesity and the Spanish Society of Medical Oncology.

The relationship between obesity and cancer is clear and is present at all times during course of the disease. The importance of obesity in increasing the risk of developing cancer is well known, and some of the most prevalent tumours (breast, colorectal, and prostate) are directly related to this risk increase. However, there is less information available on the role that obesity plays when the patient has already been diagnosed with cancer. Certain data demonstrate that in some types of cancer, obese patients tolerate the treatments more poorly. Obesity is also known to have an impact on the prognosis, favouring lower survival rates or the appearance of secondary tumours. In this consensus statement, we will analyse the scientific evidence on the role that obesity plays in patients already diagnosed with cancer, and the available data on how obesity control can improve the quality of daily life for the cancer patient.

Obesity as a risk factor in cancer: a national consensus of the Spanish Society for the study of obesity and the Spanish Society of Medical Oncology

In the last few years, many prospective studies have demonstrated a clear association between obesity and cancers of the colon and rectum, breast in post-menopausal women, endometrium, kidney, oesophagus and pancreas. Obesity is also associated with a high risk of recurrence and cancer-related death. The pathophysiology of obesity involves various changes that may be implicated in the relationship between obesity and cancer, such as excess inflammatory cytokines and chronic inflammation, hyperinsulinaemia, insulin resistance, and raised leptin and oestrogens. The Spanish Society for the Study of Obesity and the Spanish Society of Medical Oncology have signed a cooperation agreement to work together towards reducing the impact of obesity in cancer. Preventing obesity prevents cancer (AU)

No disponible

Obesity as a risk factor in cancer: A national consensus of the Spanish Society for the Study of Obesity and the Spanish Society of Medical Oncology.

In the last few years, many prospective studies have demonstrated a clear association between obesity and cancers of the colon and rectum, breast in post-menopausal women, endometrium, kidney, oesophagus and pancreas. Obesity is also associated with a high risk of recurrence and cancer-related death. The pathophysiology of obesity involves various changes that may be implicated in the relationship between obesity and cancer, such as excess inflammatory cytokines and chronic inflammation, hyperinsulinaemia, insulin resistance, and raised leptin and oestrogens. The Spanish Society for the Study of Obesity and the Spanish Society of Medical Oncology have signed a cooperation agreement to work together towards reducing the impact of obesity in cancer. Preventing obesity prevents cancer.

Clinical effectiveness of exenatide in diabetic patients waiting for bariatric surgery.

BACKGROUND: Bariatric surgery constitutes the most effective treatment for severely obese type 2 diabetic patients. Exenatide is a glucagon-like peptide 1 receptor agonist that can improve glycemic control and cause weight loss in patients with type 2 diabetes. Clinical experience with exenatide in obese patients with type 2 diabetes waiting for bariatric surgery has not been reported. The aim of the study was to evaluate, in clinical practice, weight and metabolic effects of exenatide (after 3 and 6 months) in patients with type 2 diabetes and obesity waiting for bariatric surgery. METHODS: A total of 100 diabetic adult subjects with a BMI ≥ 35 kg/m(2) were included. Primary endpoints were changes in weight and HbA1c after 6 months of treatment. Secondary endpoints were changes from baseline of a variety of clinical measures (triglycerides levels, blood pressure, and waist circumference). Data were analyzed at 3 and 6 months of follow-up. RESULTS: Treatment for 6 months with exenatide decreased significantly body weight (-12.5 kg) and waist circumference (-13 cm). Twenty percent of patients reduced their BMI under 35 kg/m(2) and significantly improved their metabolic profile (HbA1c <7 %). Significant and maintained decreases in HbA1c of 1 % were observed in the 3 and 6 months cohorts. Triglycerides levels and blood pressure also decreased from baseline to the end of the study. Treatment was discontinued in 19 % of patients mainly due to drug inefficacy (6 %) or adverse events (4 %). CONCLUSIONS: Exenatide twice daily (BID) leads to early, robust, and significant weight loss in a subset of patients with diabetes and severe obesity before bariatric surgery. Clinical trials are needed to confirm the benefits of GLP-1 agonists in type 2 diabetic obese patients or high-risk super-obese patients waiting for bariatric surgery.

Introducción, definición y medida del exceso de peso en adolescentes / No disponible

No disponible

Comorbilidades del exceso ponderal en el adolescente / No disponible

No disponible

Estrategia SEMERGEN, SEEDO y SEEN para la prevención y el tratamiento del sobrepeso y la obesidad en Atención Primaria / The strategy of the Spanish Society of Primary Care Physicians (SEMERGEN), the Spanish Society for the Study of Obesity (SEEDO) and the Spanish Society of Edocrinology and Nutrition (SEEN) for the prevention and treatment of excess weight and obesity in Primary Care

No disponible

No disponible

Evaluación de la función hipofisaria tras episodio neurológico grave / Evaluation of pituitary function after a severe neurological event

Objetivo: Estudiar la relación entre episodios neurológicos graves (traumatismo craneoencefálico, hemorragia subaracnoidea o accidente cerebrovascular) y déficit en la función hipofisaria, así como establecer parámetros en el momento agudo del episodio neurológico que permitan predecir la función hipofisaria posteriormente. Material y métodos: Estudio descriptivo y transversal, realizado en pacientes de la Unidad de Cuidados Intensivos del Hospital Universitario de Getafe (Madrid), durante los años 2001 y 2002, que habían sufrido traumatismo craneoencefálico grave, hemorragia subaracnoidea o accidente cerebrovascular. De 65 pacientes ingresados, se reclutó solamente a 11. Se contactó con ellos transcurridos de 3 a 24 meses del episodio neurológico para realización de historia clínica endocrinológica, exploración física y determinaciones hormonales. A 8 pacientes estudiados se les tomaron muestras basales de hormonas hipofisarias y se les realizaron pruebas de estimulación. En los 3 restantes se realizaron pruebas de estimulación cuando las basales extraídas hacían sospechar déficit. Retrospectivamente, se revisaron las historias para obtener parámetros del momento del ingreso que pudiesen predecir el déficit. Resultados: En los pacientes que sufrieron un episodio neurológico grave que precisó cuidados intensivos inicialmente, existe una prevalencia de déficit de un 36,4%. Se encuentra un 18,2% de déficit en los ejes gonadal y somatotropo. La presencia de hipertensión intracraneal en el momento agudo se relaciona con la aparición de déficit mediante una relación estadísticamente significativa. Conclusión: En este estudio preliminar aparece un alto porcentaje de afección hipofisaria en la evolución de pacientes que sufren un episodio neurológico grave. La hipertensión intracraneal se asocia a la aparición del déficit (AU)

Objective: To determine the relationship between severe neurological events [traumatic brain injury (TBI), subarachnoid hemorrhage (SAH) or stroke] and pituitary dysfunction, as well as to establish parameters at the acute moment of the neurological event that could help to predict subsequent pituitary function. Material and methods: We performed a descriptive, cross-sectional study in patients with a severe TBI, SAH or stroke in the Intensive Care Unit of the Getafe University Hospital in Madrid (Spain) between 2001 and 2002. Of the 65 patients who were admitted, only 11 were recruited. Contact was made with these patients between 3 and 24 months after the neurological event to take a medical history and perform a physical examination and hormone determinations. Basal samples of pituitary hormones and stimulation tests were performed in eight patients. In the remaining three patients, the stimulation tests were only performed when the basal samples were suspicious for pituitary deficiency. Medical records were retrospectively reviewed to obtain admission parameters that could predict deficiency. Results: In patients who experienced a severe neurological event that initially required intensive care, the prevalence of hormone deficiency was 36.4%; gonadal and somatotropic deficiency was found in 18.2%. The presence of intracranial hypertension in the acute phase was statistically significantly related to the development of hormone deficiency. Conclusion: In this preliminary study a high percentage of pituitary involvement was found in the follow-up of patients who experienced a severe neurological event. Intracranial hypertension was associated with the development of hormone deficiency (AU)

[Management in clinical nutrition]. / Gestión en nutrición clínica.

Terms such as management, costs, efficacy, efficiency, etc. that are so common in the discourse of managers are now beginning to appear in the vocabulary of clinicians. Management in Clinical Nutrition is an innovative aspect of interest among health-care professionals dealing with the needs of undernourished patients or those at risk of malnutrition. The basic goal of this paper is to show that the tools for clinical management of hospitals are applicable to such a multidisciplinary and complex speciality as clinical nutrition and also to propose the measures needed to improve our information systems and optimize management in this field. The very concept of hospitals has changed, as has their activity, over the years. Hospitals are nowadays no longer just a charitable institution but has become a service company, a public utility for the promotion of good health and they have to be managed in accordance with criteria of efficacy, efficiency, equity and quality. The concepts of Evidence-Based Medicine (EBM) and Cost-Effective Medicine (CEM) are of evident importance in the different ways of managing health-care services. Good clinical practice is the combination of EBM and CEM. This review defines the various cost studies of fundamental importance when taking decisions in hospital management and analyzes such clinical management tools as analytical accounting, Minimum Hospital Database Set (MHDS) and encoding systems, among others, thus facilitating an analysis of the usefulness of data in clinical nutrition management systems. Finally, after reviewing some specific examples, measures are proposed to optimize current information systems. The medical staff and those of us responsible for Nutrition Units operate in hospitals as part of a centralized service transferring information to the various departments where the patient is physically located (Surgery, Internal Medicine, Digestive, ICU, etc.). One of the priority goals in micro-management and middle management is to observe the quality improvement in the discharge reports for the patients admitted, including the nutritional diagnosis within the section for the main diagnosis, and also the administration of artificial nutrition (enteral or parenteral) in the section on procedures. With all of these measures we will improve the quality of the hospitals' information systems and contribute directly to ensuring that our activities in clinical nutrition have an impact on the overall results of the hospital when measured in terms of effectiveness, efficacy or quality.

Gestión en nutrición clínica / Management in clinical nutrition

Términos como gestión, costes, eficacia, eficiencia, etcétera, habituales en el discurso de los gestores, comienzan a ser integrados en el lenguaje de los clínicos. La Gestión en Nutrición Clínica es un aspecto novedoso y de interés entre los profesionales sanitarios que atienden las necesidades de los pacientes desnutridos o en riesgo de desnutrición. El objetivo fundamental de este trabajo es demostrar como las herramientas de gestión clínica hospitalaria, son aplicables a una disciplina tan multidisciplinar y compleja como la nutrición clínica y proponer las medidas necesarias para mejorar nuestros sistemas de información y optimizar la gestión en ese campo. El concepto de hospital ha ido cambiando, así como su actividad, a lo largo de los años. En la actualidad el hospital ya no es un centro de caridad sino que se ha convertido en una empresa de servicios, una empresa de utilidad pública para la promoción de la salud que debe ser gestionada con criterios de eficacia, eficiencia, equidad y calidad. Los conceptos de MBE (Medicina Basada en la Evidencia) y la MCE (Medicina Coste Efectiva) tienen un importante peso en las diferentes formas de hacer gestión sanitaria. La buena práctica clínica es aquella que combina la MBE con la MCE. En esta revisión se definen los diferentes estudios de costes, fundamentales en la toma de decisiones en la gestión sanitaria, y se analizan las herramientas de gestión clínica como la contabilidad analítica, el CMBDH (Conjunto Mínimo de Base de Datos Hospitalaria) y los sistemas de codificación entre otros, facilitando así el análisis de la utilidad de la información en los sistemas de gestión en nutrición clínica. Por último tras revisar algunos ejemplos concretos se proponen medidas para optimizar los actuales sistemas de información. Los facultativos y responsables de las Unidades de Nutrición funcionamos en los centros hospitalarios como parte de un servicio centralizado que traslada la información a los servicios finales en los que se encuentra físicamente localizado el paciente (Servicio de Cirugía, Medicina Interna, Digestivo, UCI, etc.). Un objetivo prioritario en la micro y mesogestión observará la mejora en la calidad de los informes de alta de los pacientes ingresados, incluyendo el diagnóstico de desnutrición dentro del apartado de diagnóstico principal, y la administración de nutrición artificial (enteral o parenteral) en el apartado de procedimientos. Con todo ello mejoraremos la calidad de los sistemas de información hospitalaria y contribuiremos de manera directa a que la actividad desarrollada desde el ámbito de la nutrición clínica repercuta en los resultados hospitalarios globales cuando estos se midan en términos de efectividad, eficacia o calidad (AU)

Terms such as management, costs, efficacy, efficiency, etc. that are so common in the discourse of managers are now beginning to appear in the vocabulary of clinicians. Management in Clinical Nutrition is an innovative aspect of interest among health-care professionals dealing with the needs of undernourished patients or those at risk of malnutrition. The basic goal of this paper is to show that the tools for clinical management of hospitals are applicable to such a multidisciplinary and complex speciality as clinical nutrition and also to propose the measures needed to improve our information systems and optimize management in this field. The very concept of hospitals has changed, as has their activity, over the years. Hospitals are nowadays no longer just a charitable institution but has become a service company, a public utility for the promotion of good health and they have to be managed in accordance with criteria of efficacy, efficiency, equity and quality. The concepts of Evidence-Based Medicine (EBM) and Cost-Effective Medicine (CEM) are of evident importance in the different ways of managing health-care services. Good clinical practice is the combination of EBM and CEM. This review defines the various cost studies of fundamental importance when taking decisions in hospital management and analyzes such clinical management tools as analytical accounting, Minimum Hospital Database Set (MHDS) and encoding systems, among others, thus facilitating an analysis of the usefulness of data in clinical nutrition management systems. Finally, after reviewing some specific examples, measures are proposed to optimize current information systems. The medical staff and those of us responsible for Nutrition Units operate in hospitals as part of a centralized service transferring information to the various departments where the patient is physically located (Surgery, Internal Medicine, Digestive, ICU, etc.). One of the priority goals in micro-management and middle management is to observe the quality improvement in the discharge reports for the patients admitted, including the nutritional diagnosis within the section for the main diagnosis, and also the administration of artificial nutrition (enteral or parenteral) in the section on procedures. With all of these measures we will improve the quality of the hospitals´ information systems and contribute directly to ensuring that our activities in clinical nutrition have an impact on the overall results of the hospital when measured in terms of effectiveness, efficacy or quality (AU)

Guía de Práctica Clínica para el Manejo del Sobrepeso y la Obesidad en Personas Adultas / Clinical Practice Guideline for the Management of Overweight and Obesity in Adults

La obesidad es una enfermedad crónica multifactorial de gran trascendencia sociosanitaria y económica y constituye un problema de salud pública. Causa o empeora un gran número de problemas relacionados con la salud: diabetes, enfermedad coronaria, hipertensión y determinados tumores. Se asocia con mayor riesgo de mortalidad cardiovascular, mayor prevalencia de alteraciones psicopatológicas, incremento del coste sanitario y disminución de la esperanza de vida. Actualmente en España, la prevalencia de exceso de peso afecta aproximadamente al 50% de la población. La Sociedad Española de Endocrinología y Nutrición (SEEN) ha elaborado una Guía de Práctica Clínica sobre el diagnóstico, la evaluación y el tratamiento del sobrepeso y de la obesidad en adultos estructurada en dos partes: 1) Definición y clasificación, epidemiología, etiopatogenia, complicaciones, beneficios de la reducción ponderal y evaluación del enfermo con sobrepeso u obesidad; 2) identificación de enfermos con riesgo de obesidad subsidiarios de tratamiento, objetivos de tratamiento y estrategias terapéuticas disponibles para conseguirlos, indicándose además, el grado de recomendación basado en la evidencia científica sobre cada uno de estos aspectos. Aun siendo la obesidad una enfermedad que debiera implicar no sólo a personal sanitario, sino también a autoridades políticas, agentes sociales, educadores e industria alimentaria entre otros, la SEEN ha querido desarrollar esta guía dados los evidentes aspectos endocrinológicos y metabólicos de este trastorno. Esta guía establece recomendaciones basadas en la evidencia científica para ayudar a tomar decisiones sobre el diagnóstico, la evaluación y el tratamiento del exceso ponderal en adultos y posibilitar una atención más homogénea y de calidad (AU)

Obesity is a chronic, multifactor disease with sizeable socio sanitary and economic consequences and is an issue in public health, mostly in developing countries. It causes or exacerbates a large number of health problems: diabetes, coronary heart disease, hypertension, and the incidence of certain cancers. It has been linked to a greater risk of cardiovascular mortality, a higher prevalence of psychopathology disorders and social maladjustment with a higher health care cost and shorter life-expectancy. In Spain, nowadays, the prevalence of overweight and obesity is nearly 50% of population. SEEN has developed a Clinical Practice Guide on diagnosis, evaluation and treatment of overweight and obesity in adult people with two sections: 1) Definition and classification of adult obesity, its epidemiology, etiopathogeny, complications, benefits of weight reduction and clinical evaluation of patients with overweight or obesity, and 2) Identification of patients with obesity risk subsidiary to weight reduction treatment, therapy goals and therapeutical strategies available to achieve them indicating as well the degree of recommendation based upon scientific evidence on each aspect. Although obesity is a disease which is supposed to involve not only medical but also political authorities, social agents, educators and food industry among others, SEEN decided to develop this Guide taking into account the evident endocrinological and metabolical aspects of this disorder. The Guide contains scientific evidencebased recommendations intended to help doctors making decisions on diagnose, evaluations and treatment of adult overweight so that a more homogeneous attendance with settled quality can be achieved (AU)

Protocolo unificado de utilización de la hormona del crecimiento en pacientes adultos deficitarios / Unified protocol for the use of growth hormone (GH) in GH deficient adults

En este artículo se especifica el protocolo unificado de utilización de hormona de crecimiento en pacientes adultos deficitarios: indicaciones para el inicio de tratamiento, diagnóstico bioquímico de la deficiencia de GH, contraindicaciones al tratamiento, dosis recomendadas y seguimiento (AU)