Adherence and impact of an oral nutritional supplement enriched in leucine, EVOO, EPA and DHA, and beta-glucans on the coverage of energy and protein requirements in patients with cancer and malnutrition: Alisenoc study.

OBJECTIVE: The aim of this study was to evaluate the impact of an enhanced ONS (enriched in EPA, DHA, leucine, and beta-glucans) on the dietary intake of cancer patients. METHODS: A randomized, double-blind, parallel, controlled, and multicenter clinical trial was conducted in patients with cancer and malnutrition. The trial compared prescribed dietary advice and two packs per day, for 8 weeks, of a hypercaloric (400 kcal/pack) and hyperproteic ONS (20 g/pack) with fiber and specific ingredients (leucine, EPA and DHA, and beta-glucans) (enhanced-ONS) versus an isocaloric and isoproteic formula (standard-ONS) without specific ingredients. Food intake was assessed with a 3-day dietary survey, and adherence to the supplement with a patient self-completed diary. RESULTS: Thirty-seven patients completed the intervention period. The combined intervention of dietary advice and ONS managed to increase the energy intake of the overall cohort by 792.55 (378.57) kcal/day, protein by 40.72 (19.56) g/day. Increases in energy and nutrient intakes were observed in both groups, both in dietary intake and associated exclusively with the supplement. The group that received the enhanced-ONS ingested a greater volume of product when there was a greater severity of malnutrition; a tumor location in the head, neck, upper digestive area, liver, or pancreas; more advanced stages of the tumor; or the receipt of more than one antineoplastic treatment. CONCLUSION: The use of an enhanced-ONS helps meet the nutritional requirements of cancer patients, especially those who have a more compromised clinical condition, with high adherence, good tolerance, and acceptance.

Metodología multidisciplinar y dieta cetogénica en la práctica clínica real: eficacia y rapidez en la pérdida de peso. Análisis de supervivencia. Estudio PROMET Lipoinflamación / Multidisciplinary methodology and ketogenic diet in real clinical practice: efficacy and rapidity in weight loss. Survival analysis PROMET Lipoinflammation Study

OBJETIVO: el objetivo del estudio fue evaluar el tiempo de respuesta, definido como pérdida del 10 % del peso, al tratamiento con un método multidisciplinar de pérdida de peso que incluye dieta (inicialmente cetogénica), ejercicio físico y soporte emocional. MÉTODOS: los datos se obtuvieron a partir del registro de pacientes reclutados en el estudio Promet Lipoinflamación, un estudio observacional de práctica clínica real en pacientes obesos o con sobrepeso tratados con el método multidisciplinar, basado inicialmente en una dieta cetogénica de muy bajas calorías. La velocidad se valoró mediante un análisis de supervivencia Kaplan-Meier y los factores asociados mediante regresión de Cox. RESULTADOS: la muestra estudiada fue de 6369 sujetos. El 74,4 % consiguió alcanzar una pérdida de peso del 10 % en una media de tiempo de 57,64 días (IC 95 %: 56,95-58,33]. Los factores asociados a mayor probabilidad de alcanzar pérdida del 10 % o más fueron género masculino (RR: 1,37; p < 0,001), obesidad de tipos I, II y III frente a sobrepeso (RR: 1,24; p < 0,001; 1,26; p < 0,001 y 1,22; p < 0,001, respectivamente) y edad joven frente a mayor de 55 años (RR: 2,17; p < 0,001). CONCLUSIONES: los resultados obtenidos a través de la práctica clínica real muestran que el método produce una pérdida de peso rápida e intensa. Tres de cada cuatro pacientes perdieron, como mínimo, el 10 % del peso corporal en una media de 58 días

OBJECTIVE: the aim of the current work was to evaluate the response time to a method of weight loss that includes dietary guidelines, physical exercise and emotional support. The response was defined as a loss of 10 % of the baseline weight. METHODS: data was obtained from the patients' record recruited in Promet Lipoinflamación, an observational study of real world data in obese or overweight patients treated with a multidisciplinary method and based initially on a very-low-calorie ketogenic (VLCK) diet. Weight loss rate was evaluated through a survival analysis Kaplan-Meier and related factors through Cox regression). RESULTS: 6,369 subjects were included and 74.4 % managed to reach a weight loss of 10 % in a mean time of 57.64 days (IC 95 %: 56.95-58.33). The factors associated with a greater probability of reaching a loss of 10 % or more were male gender (RR: 1.37, p < 0.001), obesity types I, II and III vs. overweight (RR: 1.24, p < 0.001, 1.26, p < 0.001 and 1.22, p < 0.001, respectively) and young age vs. more than 55 years old (RR: 2.17, p < 0.001). CONCLUSION: results obtained through real clinical practice show that the method produces fast and intense weight loss. Three out of four patients lost at least 10 % of body weight in an average of 58 days

Abordaje nutricional del paciente con diabetes mellitus e insuficiencia renal crónica, a propósito de un caso / Nutritional approach of the patient with diabetes mellitus and chronic kidney disease. A case report

La prevención y el tratamiento de la enfermedad renal crónica (ERC) en pacientes con diabetes ha sido un tema de gran interés a lo largo de los años. Para conseguir un adecuado control glucémico, una función renal estable y una reducción del riesgo cardiovascular, es fundamental un correcto aporte de hidratos de carbono, lípidos y proteínas. Las medidas dietéticas realizadas se irán modificando a lo largo de la evolución de la ERC. La malnutrición energético-proteica es muy frecuente en pacientes con ERC y diabetes y es un importante predictor de morbimortalidad. Revisamos el manejo nutricional de un paciente diabético a lo largo de la progresión de su ERC (AU)

The prevention and treatment of chronic kidney disease (CKD) in diabetes through diet and lifestyle have been a topic of much interest over the years. Consideration of the type and amount of carbohydrate, protein and fat is required for optimal blood glucose control, for clinical outcomes related to renal function and for consideration of risk reduction for cardiovascular disease. Depending on the CKD stage different dietary changes should be considered protein-calorie malnutrition is common in chronic kidney disease patients and is a powerful predictor of morbidity and mortality. We review the nutritional management of a diabetic patient throughout the progression of their CKD (AU)

TRABECULAR BONE SCORE IN PATIENTS WITH NORMOCALCEMIC HYPERPARATHYROIDISM.

OBJECTIVE: The effects of normocalcemic hyperparathyroidism (NHPT) on bone remain unclear. The objective of this study was to evaluate differences in the trabecular bone score (TBS) of NHPT patients and asymptomatic hypercalcemic hyperparathyroidism (HHPT) patients. METHODS: We performed a prospective study that enrolled consecutive patients with asymptomatic hyperparathyroidism (NHPT and HHPT) with a follow-up ≥1 year at the University Hospital of Valladolid, Spain. Metabolic phosphocalcium plasma and urine parameters were evaluated in ≥2 determinations during follow-up to classify patients as NHPT patients or asymptomatic HHPT patients. A control group was enrolled during the same period. TBS and bone mineral density (BMD) were evaluated. RESULTS: Thirty-nine patients with asymptomatic HPT (24 with NHPT and 15 with HHPT) and 24 controls were recruited. NHPT patients and HHPT patients had a similar mean age, vitamin D level, TBS, and areal BMD (all sites). Compared to controls, symptomatic HPT patients had significantly higher parathyroid hormone (PTH) and calcium levels and significantly lower TBS and areal BMD at all sites (all P<.05). A significant negative relationship between TBS and PTH was found in asymptomatic HPT patients (r = -0.320, P = .043), which remained significant after adjustment for age, sex, and body mass index. CONCLUSION: There was no difference in the TBS between NHPT and HHPT patients. However, there was a reduction in the TBS of patients with asymptomatic HPT that was related to PTH levels but had no repercussion on bone mass. Higher levels of PTH seem to be responsible for this alteration in microarchitecture texture. ABBREVIATIONS: aBMD = areal bone mineral density BMD = bone mineral density BMI = body mass index DXA = dual-energy X-ray absorptiometry HHPT = hypercalcemic hyperparathyroidism HPT = hyperparathyroidism HR-MRI = high-resolution magnetic resonance HR-pQcT = high-resolution peripheral quantitative computed tomography NHPT = normocalcemic hyper-parathyroidism PTH = parathyroid hormone TBS = trabecular bone score 25vitD = 25-hydroxyvitamin D.

Role of rs9939609 FTO gene variant in weight loss, insulin resistance and metabolic parameters after a high monounsaturated vs a high polyunsaturated fat hypocaloric diets / Papel de la variante del gen FTO RS9939609 en la pérdida de peso, resistencia a la insulina y parámetros metabólicos tras dos dietas hipocalóricas, ricas en grasas monoinsaturadas vs polinsaturadas

Introduction: common polymorphisms (rs9939609) of the fat mass and obesity associated gene (FTO) have been linked to obesity. Objectives: our aim was to investigate the role of this polymorphism on insulin resistance, metabolic changes and weight loss secondary to a high monounsaturated fat vs a high polyunsaturated fat hypocaloric diets. Material and Methods: a sample of 233 obese subjects was enrolled in a prospective way. In the basal visit, patients were randomly allocated during 3 months to; Diet M (high monounsaturated fat hypocaloric diet) or Diet P (high polyunsaturated fat hypocaloric diet). Results: after treatment with two diets and in both genotypes, weight, fat mass and waist circumference decreased. Lower levels of body mass index (BMI), weight and fat mass were detected after Diet P in A allele carriers than TT genotype subjects. With the diet type P and in both genotypes (TT and AT + AA), total cholesterol levels (-15.3 + 35.1 mg/dl vs -11.6 + 32.1 mg/dl: p > 0.05) and LDL cholesterol levels (-11.5 + 34.1 mg/dl vs -8.5 + 30.1 mg/dl: p > 0.05) decreased. In A allele carriers a significant decreased was detected in insulin levels (-2.8 + 2.1 UI/L vs -1.3 + 8.0 UI/L: p < 0.05) and HOMA index (-1.0 + 1.3 vs -0.2 + 2.1: p > 0.05), too. With the diet M and in both genotype groups, leptin levels (-8.0 + 17.1 ng/ ml vs -4.9 + 18.7 ng/ml: p > 0.05) decreased. Conclusiones: metabolic improvement secondary to weight loss was better in A carriers with a high polyunsaturated fat hypocaloric diet (AU)

Introducción: un polimorfismo comun (rs9939609) del gen de la masa grasa y la obesidad (FTO) se ha relacionado con la obesidad. Objetivos: nuestro objetivo fue investigar el papel de este polimorfismo en la resistencia a la insulina, los cambios metabólicos y la pérdida de peso secundarios a una dieta hipocalórica con alto contenido en grasas monoinsaturadas vs. una dieta hipocalórica con alto contenido en grasas poliinsaturadas. Material y métodos: fue estudiada una muestra de 233 sujetos obesos de forma prospectiva. En la visita basal, los pacientes fueron asignados al azar durante tres meses a Dieta M (dieta hipocalórica con alto contenido en grasa monoinsaturada) o dieta P (dieta hipocalórica con alto contenido en grasa poliinsaturada). Resultados: después del tratamiento con las dos dietas y en ambos genotipos, la circunferencia de la cintura, el peso, la masa grasa y la cintura disminuyeron. Se detectaron niveles más bajos de índice de masa corporal (IMC), peso y masa de grasa después de la dieta P en los portadores del alelo A comparados con los sujetos de genotipo TT. Con la dieta P y en los dos genotipos (TT y AT + AA), los niveles de colesterol total (-15,3 + 35,1 mg/ dl vs. -11,6 + 32,1 mg/dl: p > 0,05) y los niveles de colesterol LDL (-11,5 + 34,1 mg/dl vs. -8,5 + 30,1 mg/dl: p > 0,05) disminuyeron. En los portadores del alelo A se detectó una disminución significativa en los niveles de insulina (-2,8 + 2,1 UI/L vs. -1,3 + 8,0 UI/L: p < 0,05) y el índice HOMA-R (-1,0 + 1,3 vs. -0,2 + 2,1: p > 0.05). Con la dieta M y en los dos genotipos, los niveles de leptina (-8,0 + 17,1 ng/ml vs. -4,9 + 18,7 ng/ml: p > 0,05) disminuyeron. Conclusiones: las mejorías metabólicas secundarias a la pérdida de peso fueron superiores en los portadores del alelo A tras recibir una dieta hipocalórica rica en grasa poliinsaturada (AU)