[Evaluation of perioperative nutritional therapy in patients with gastrointestinal tract neoplasms]. / Evaluación de la terapia nutricional perioperatoria en pacientes con neoplasia del tracto gastrointestinal superior.

OBJECTIVES: Cancer is usually associated to an important level of desnutrition together with a postoperative morbidity and mortality increase. The purpose of this study was evaluating its efficacy perioperative nutritional support to reduce surgical complications, stances and mortality significantly in patients undergoing higher digestive tract procedures. METHOD: A prospective, randomized trial was done among a sample of neoplasic patients undergoing higher intestinal tract resective surgery during a period of 4 years. After a nutritional assessment, a perioperative immune-enhancing formula was randomly assigned to a group of patients who presented malnourished preoperatively (DS) while well-nourished and the rest of malnourished patients (DNS) received pre-surgical dietetic guidance and intravenous fluids after surgery until the reintroduction of normal diet. The variables studied were: age, sex, tumor stage and length of hospital stay. Nutritional status at admission and discharge, mortality, outcome from surgery and gastrointestinal side effects (tolerability, diarrhoea, vomits or distension) were also collected. Statistical analyses were performed with the with the chi2 for qualitative variables, ANOVA and the Turkey post-hoc tests for the quantitative ones, with a significance of 95%. RESULTS: Sample conformed by 50 patients in 3 groups that were compared for all baseline and surgical characteristics. Significant differences were observed in the incidence of gastrointestinal and infectius complications with better progress in DS group. It was obtained a reduction in the length of hospital stay in 12.29 days in DS group in contrast to DNS group (P=0.224). CONCLUSIONS: Significant benefit from perioperative nutritional support has been demonstrated in severely malnourished patients undergoing major surgery. A statistically significant decrease in the incidence of postoperative gastrointestinal symptoms, a reduction in the length of hospital stay and less morbidity occurred on the group that received perioperative nutrition.

Evaluación de la terapia nutricional perioperatoria en pacientes con neoplasia del tracto gastrointestinal superior / Evaluation of perioperative nutritional therapy in patients with gastrointestinal tract neoplasms

Objetivos: La enfermedad oncológica se acompaña de un grado importante de desnutrición que se asocia con elevadas tasas de morbi-mortalidad postoperatoria. El propósito de este estudio fue evaluar la efectividad de un programa de apoyo nutricional perioperatorio de cara a reducir complicaciones postoperatorias, estancias hospitalarias y mortalidad entre pacientes sometidos a cirugía oncológica del tracto digestivo superior. Métodos: Estudio prospectivo aleatorizado sobre una muestra de pacientes intervenidos por cáncer gastrointestinal alto (esófago, estómago, cardias y duodeno/páncreas) durante un periodo de 4 años. Se realizó una valoración nutricional y se administró de forma perioperatoria una formula enteral inmunomoduladora a un grupo de pacientes malnutridos (DS), mientras que otro grupo de pacientes malnutridos (DNS) y los normonutridos (NN) recibieron consejo dietético antes de la cirugía y después de esta sueros por vía intravenosa hasta la reintroducción de la dieta normal. Las variables estudiadas fueron edad, sexo, estadio tumoral, tipo de neoplasia y estancia hospitalaria. También se recogieron la situación nutricional, mortalidad, complicaciones postoperatorias y alteraciones gastrointestinales. Para el análisis estadístico realizamos un estudio de frecuencias y aplicamos el test de Chi-cuadrado en las variables cualitativas. Para las cuantitativas usamos la ANOVA y el test Post-hoc de Tukey. Se consideraron significativos aquellos valores de p < 0,05. Resultados: Estudio sobre 50 pacientes divididos en 3 grupos. Se encontraron diferencias estadísticamente significativas en la incidencia de complicaciones gastrointestinales e infecciosas con mejores avances en el grupo DS. Se obtuvo una reducción de la duración de la estancia hospitalaria de 12,29 días en el grupo de DS en contraste con el grupo DNS (P = 0,224). Conclusiones: Se ha demostrado un beneficio significativo del apoyo nutricional perioperatorio en los pacientes severamente desnutridos sometidos a cirugía que recibieron suplementación. Se observaron en estos pacientes una menor incidencia de complicaciones gastrointestinales e infecciosas así como acortamiento de la estancia hospitalaria con respecto a los pacientes desnutridos que no recibieron suplementación perioperatoria (AU)

Objectives: Cancer is usually associated to an important level of desnutrition together with a postoperative morbidity and mortality increase. The purpose of this study was evaluating its efficacy perioperative nutritional support to reduce surgical complications, stances and mortality significantly in patients undergoing higher digestive tract procedures. Method: A prospective, randomized trial was done among a sample of neoplasic patients undergoing higher intestinal tract resective surgery during a period of 4 years. After a nutritional assessment, a perioperative immune-enhancing formula was randomly assigned to a group of patients who presented malnourished preoperatively (DS) while well-nourished and the rest of malnourished patients (DNS) received pre-surgical dietetic guidance and intravenous fluids after surgery until the reintroduction of normal diet. The variables studied were: age, sex, tumor stage and length of hospital stay. Nutritional status at admission and discharge, mortality, outcome from surgery and gastrointestinal side effects (tolerability, diarrhoea, vomits or distension) were also collected. Statistical analyses were performed with the with the chi(2) for qualitative variables, ANOVA and the Turkey post-hoc tests for the quantitative ones, with a significance of 95%. Results: Sample conformed by 50 patients in 3 groups that were compared for all baseline and surgical characteristics. Significant differences were observed in the incidence of gastrointestinal and infectius complications with better progress in DS group. It was obtained a reduction in the length of hospital stay in 12.29 days in DS group in contrast to DNS group (P = 0,224). Conclusions: Significant benefit from perioperative nutritional support has been demonstrated in severely malnourished patients undergoing major surgery. A statistically significant decrease in the incidence of postoperative gastrointestinal symptoms, a reduction in the length of hospital stay and less morbidity occurred on the group that received perioperative nutrition(AU)

Apoyo nutricional perioperatorio en pacientes con neoplasia colorrectal / Perioperative nutritional support in patients with colorectal neoplasms

Objetivos: La desnutrición se asocia con elevadas tasas de morbi-mortalidad postoperatoria. Nos proponemos evaluar la efectividad de un programa de apoyo nutricional perioperatorio entre pacientes sometidos a cirugía mayor oncológica. Métodos: Estudio prospectivo aleatorizado sobre una muestra de pacientes intervenidos por neoplasia del tubo digestivo bajo durante un periodo de 3 años. Se realizó una valoración nutricional y se administró de forma perioperatoria una formula enteral inmuno moduladora a un grupo de pacientes malnutridos (DS),mientras que otro grupo de pacientes malnutridos (DNS) y los normonutridos recibieron sólo consejo dietético antes de la cirugía. Las variables estudiadas fueron edad, sexo, tipo de neoplasia y estancia hospitalaria. También se recogieron la situación nutricional, mortalidad, complicaciones postoperatorias y alteraciones gastrointestinales. Para el análisis estadístico realizamos un estudio de frecuencias y aplicamos el test de Chi-cuadrado en las variables cualitativas. Para las cuantitativas usamos la ANOVA y el test Post-hoc de Tukey. Se consideraron significativos aquellos valores de p < 0.05. Resultados: Estudio sobre 82 pacientes divididos en 3 grupos estadísticamente comparables entre sí. Se encontraron diferencias estadísticamente significativas en la incidencia de complicaciones gastrointestinales, estancia hospitalaria (p:0,001) y mortalidad (p:0,004) entre los dos grupos de pacientes malnutridos. Conclusiones: Se ha demostrado una mejor evolución tras la cirugía en el grupo de pacientes normonutridos y el de DS. Se observaron en estos pacientes una (..) (AU)

Objectives: Malnutrition is clearly associated with increased morbidity and mortality after elective abdominal surgery. The purpose of this study was to compare perioperative nutritional support with traditional postoperative dietary management, evaluating its efficacy to reduce surgical complications, stances and mortality significantly in patients undergoing major colorectal procedures, Method: A prospective, randomized trial was done among a sample of neoplasic patients undergoing intestinal resective surgery during a period of near 3 years. A perioperative immune-enhancing formula was randomly assigned to a group of patients who presented malnourished preoperatively (DS) while well-nourished and the rest of malnourished patients (DNS) received conventional postoperative intravenous fluids until the reintroduction of normal diet. The variables studied were: age, sex, tumor stage and length of hospital stay. Nutritional status at admission and discharge, mortality, outcome from surgery and gastrointestinal side effects (tolerability, diarrhoea, vomits or distension) were also collected. Statistical analyses were performed with the with the chi(2),ANOVA and the Turkey post-hoc tests, with a significance of 95%. Results: Sample conformed by 82 patients. The 3groups were comparable for all baseline and surgical characteristics. Significant differences were observed in the incidence of gastrointestinal complications, length of hospital stay(DS: 13.15±5.26; DNS: 19.34±9.6; p=0,001) and mortality(DS: 13.8%, DNS:30%, p=0,004).Conclusions: Significant benefit from perioperative nutritional support has been demonstrated in severely malnourished patients undergoing major surgery. A statistically significant decrease in the incidence of postoperative gastrointestinal symptoms, a reduction in the length of hospital stay and less morbidity (..) (AU)

[Comparative study of two enteral feeding formulas in hospitalized elders: casein versus soybean protein]. / Estudio comparativo de dos dietas enterales en ancianos hospitalizados: proteína de soja frente a proteína caseína.

OBJECTIVES: To compare the incidence of gastrointestinal side effects of two enteral feeding formulas with changes in the origin of protein (casein and isolated soy protein) in hospitalised elderly patients. METHOD: A cross sectional survey was done among a sample of elderly patients carrying nasogastric tube admitted to the Reina Sofia General Hospital (Murcia) during a period of 6 months. A formula based on casein or soybean protein was randomly assigned. The variables studied were: age, sex, cause for indication of EN, duration of the EN and maximum amount of EN administered per day. Nutritional status at admission and discharge, mortality and gastrointestinal side effects (diarrhoea, constipation, vomits or regurgitation) were also collected. Statistical analyses were performed with the Student's T and chi 2 tests, with a significance of 95%. RESULTS: Sample conformed by 50 patients over 65 years (48% casein, 52% soybean) without statistically significant differences in age nor cause of indication of the EN. Either there were no differences in the nutritional status at the admission and discharge in both groups. Significant differences were observed in the incidence of diarrhoea (C: 45.83%, S: 7.69%, p = 0.009) and vomits (C: 41.66%, S: 15.38%, p = 0.05). CONCLUSIONS: A significant reduction in the incidence of gastrointestinal complications, a reduction in the incidence of ulcers by pressure and less mortality occurred on the group that took formula based on the soybean protein. The individualized nutritional evaluation must be performed routinely when the patient is admitted to the hospital for detection and treatment of early signs of malnutrition.

Estudio comparativo de dos dietas enterales en ancianos hospitalizados: proteína de soja frente a proteína caseína / Comparative study of two enteral feeding formulas in hospitalized elders: casein versus soybean protein

Objetivos: Comparar la incidencia de complicaciones gastrointestinales de dos fórmulas de nutrición enteral (NE) con distinta fuente proteica (caseína y proteína aislada de soja) en ancianos hospitalizados. Métodos: Estudio transversal sobre pacientes portadores de SNG a los que se asignó aleatoriamente una fórmula basada en caseína o en proteína de soja. Las variables recogidas fueron: edad, sexo, motivo de indicación y duración de la NE, cantidad máxima diaria de NE administrada, situación nutricional al ingreso y al alta, mortalidad y complicaciones gastrointestinales. Se compararon ambos grupos mediante la Chi Cuadrado de Pearson y la T de Student, fijando en ambas el grado de significación en el 95%. Resultados: Muestra de 50 pacientes mayores de 65 años (48% caseína, 52% soja) sin diferencias estadísticamente significativas en edad ni indicación de la NE . Tampoco hubo diferencias en el estado nutricional al inicio o al alta en ambos grupos. El grupo que recibió una fórmula basada en soja presentó menor incidencia de diarrea (C: 45,83%, S: 7,69%, p = 0,009) y vómitos (C: 41,66%, S: 15,38%, p = 0,05), mayor porcentaje de mejora del estado nutricional y menos mortalidad con diferencias estadísticamente significativas. Conclusiones: En el grupo que tomó proteína de soja se produjeron menos complicaciones gastrointestinales y de úlceras por presión al tiempo que la situación nutricional mejoraba. Se puede afirmar que esta NE es bien tolerada por el paciente y aporta importantes beneficios clínicos. Por otro lado, la valoración nutricional debe realizarse como rutina al ingreso de los ancianos en el hospital para detectar y tratar precozmente cualquier signo de malnutrición (AU)

Objectives: To compare the incidence of gastrointestinal side effects of two enteral feeding formulas with changes in the origin of protein (casein and isolated soy protein) in hospitalised elderly patients. Method: A cross sectional survey was done among a sample of elderly patients carrying nasogastric tube admitted to the Reina Sofia General Hospital (Murcia) during a period of 6 months. A formula based on casein or soybean protein was randomly assigned. The variables studied were: age, sex, cause for indication of EN, duration of the EN and maximum amount of EN administered per day. Nutritional status at admission and discharge, mortality and gastrointestinal side effects (diarrhoea, constipation, vomits or regurgitation) were also collected. Statistical analyses were performed with the Student's T and chi 2 tests, with a significance of 95%. Results: Sample conformed by 50 patients over 65 years (48% casein, 52% soybean) without statistically significant differences in age nor cause of indication of the EN. Either there were no differences in the nutritional status at the admission and discharge in both groups. Significant differences were observed in the incidence of diarrhoea (C: 45.83%, S: 7.69%, p = 0,009) and vomits (C: 41.66%, S: 15.38%, p = 0,05). Conclusions: A significant reduction in the incidence of gastrointestinal complications, a reduction in the incidence of ulcers by pressure and less mortality occurred on the group that took formula based on the soybean protein. The individualized nutritional evaluation must be performed routinely when the patient is admitted to the hospital for detection and treatment of early signs of malnutrition (AU)

[Evolution of the nutritional status of patients with HIV-AIDS. Effects of socioeconomic situation and dietetic counseling]. / Evolución del estado nutricional de pacientes VIH-SIDA. Efecto de su situación socio-económica y del consejo dietético.

OBJECTIVES: To know HIV-AIDS patient's nutritional status in different infection's condition and their relation with the socioeconomic situation and, in that case, the nutritional condition improvement through the dietetic advice appropriated for each patient. METHODS: Prospective study of 79 patients with HIV-AIDS diagnostic in any illness's condition and recopilation of anthropometrics and biochemical variables. At the beginning of the study we got data about socioeconomic situation of patient with a scale of 1 to 5 points each variable and an score top of 35. In the survivors we checked, after dietetic advice, the variables at 6 and 12 months by sanitary personal (physician and nurse) who weren't implicated in direct assistance. The study was analyzed by Student "T" for matched data and the simple correlation test. RESULTS: We have objectivated a lost of initial weight over their habitual's with a progressive impairment in different stage of evolution that weren't modified by dietetic advice. We didn't observed significant variations in the biochemical variables included in advances states and in parameters which are usually affected in malnutrition. In the analysis of relation between nutritional condition and socioeconomic factors, it was estimated a lesser score, that was statistically significative, in patients who had a work, family situation and an affective upset positive. CONCLUSIONS: The results obtained induce to think that the nutritional advices appropriated for each patient are not related, in our series, with progressive deterioration of anthropometrics variables, neither biochemical parameters fluctuations at 6, 12 months of follow-up. The patient's socioeconomic situation is not influenced by nutritional condition except for the work, affectivity and family environment.