Impacto de la diabetes, la desnutrición y la sarcopenia en el pronóstico de los pacientes hospitalizados en Medicina Interna / Impact of diabetes, malnutrition and sarcopenia on the prognosis of patients admitted to Internal Medicine

Objetivo Describir los pacientes hospitalizados en medicina interna en términos de desnutrición y sarcopenia, en función de la presencia o no de diabetes mellitus tipo 2 (DM2), así como evaluar la mortalidad a corto y largo plazo relacionada con ambas. Métodos Estudio de cohortes, unicéntrico, que recoge pacientes consecutivos ingresados en Medicina Interna en mayo y octubre del 2021. La desnutrición se determinó mediante el Mini Nutritional Assessment-Short Form (MNA-SF) y la sarcopenia mediante SARC-F y dinamometría. Se excluyó a los pacientes hospitalizados más de 48 h. Resultados Se analiza a 511 pacientes, 49,1% varones, edad media de 75,2±15 años, 210 (41,1%) DM2. Se generan 6 grupos (diseño 2 × 3) en función de la presencia de DM2 y del estado nutricional acorde con el resultado del MNA-SF: 12-14 puntos, sin riesgo; MNA-SF 8-12 puntos, alto riesgo; MNA-SF 0-7 puntos, desnutridos. Los pacientes con DM2 y desnutridos tenían significativamente mayor sarcopenia, comorbilidad, inflamación y úlceras por presión. Los principales determinantes de mortalidad intrahospitalaria fueron la sarcopenia (OR 1,27, IC del 95%, 1,06-1,54, p=0,01), la comorbilidad (OR 1,27, IC del 95%, 1,08-1,49, p=0,003) y la inflamación (OR 1,01, IC del 95%, 1,00-1,02, p=0,02). El pronóstico a 120 días fue peor entre los pacientes desnutridos (p=0,042). Conclusión Los pacientes ingresados con DM2 presentan similar grado de desnutrición que el resto, pero con mayor sarcopenia. Esta sarcopenia, junto a la inflamación y la comorbilidad determinan un peor pronóstico. La identificación activa y temprana de la desnutrición y la sarcopenia, y su abordaje posterior podrían mejorar el pronóstico de los pacientes (AU)

Objective To describe patients hospitalized in internal medicine in terms of malnutrition and sarcopenia, depending on the presence or absence of type 2 diabetes mellitus (DM2), as well as to evaluate short- and long-term mortality related to both. Methods Cross-sectional, single-center study, which included consecutive patients admitted to internal medicine in May and October 2021. Malnutrition was determined using the Mini Nutritional Assessment-Short Form (MNA-SF) and sarcopenia using SARC-F and handgrip strength. Patients hospitalized for more than 48h are excluded. Results Five hundred and 11patients were analyzed, 49.1% male, mean age 75.2±15 years, 210 (41.1%) DM2. Six groups (2×3 design) are generated based on the presence of DM2 and the nutritional status according to the result of the MNA-SF: 12–14 points, without risk; MNA-SF 8–12 points, high risk; MNA-SF 0–7 points, malnourished. Malnourished patients with DM2 had significantly higher sarcopenia, comorbidity, inflammation, and pressure ulcers. The main determinants of in-hospital mortality were sarcopenia (OR 1.27, 95% CI: 1.06–1.54, p=0.01), comorbidity (OR 1.27, 95% CI: 1.08–1.49, p=0.003) and inflammation (OR 1.01, 95% CI: 1.00–1.02, p=0.02). The 120-day prognosis was worse among malnourished patients (p=0.042). Conclusion Patients admitted with DM2 have a similar degree of malnutrition than the rest, but with greater sarcopenia. This sarcopenia, together with inflammation and comorbidity determine a worse prognosis. The active and early identification of malnutrition and sarcopenia and their subsequent approach could improve the prognosis of patients (AU)

Impact of diabetes, malnutrition and sarcopenia on the prognosis of patients admitted to internal medicine.

OBJECTIVE: To describe patients hospitalized in internal medicine in terms of malnutrition and sarcopenia, depending on the presence or absence of type 2 diabetes mellitus (DM2), as well as to evaluate short- and long-term mortality related to both. METHODS: Cross-sectional, single-center study, which included consecutive patients admitted to internal medicine in May and October 2021. Malnutrition was determined using the Mini Nutritional Assessment-Short Form (MNA-SF) and sarcopenia using SARC-F and handgrip strength. Patients hospitalized for more than 48 h are excluded. RESULTS: 511 patients were analyzed, 49.1% male, mean age 75.2 +/- 15 years, 210 (41.1%) DM2. 6 groups (2 × 3 design) are generated based on the presence of DM2 and the nutritional status according to the result of the MNA-SF: 12-14 points, without risk; MNA-SF 8-12 points, high risk; MNA-SF 0-7 points, malnourished. Malnourished patients with DM2 had significantly higher sarcopenia, comorbidity, inflammation, and pressure ulcers. The main determinants of in-hospital mortality were sarcopenia (OR 1.27, 95%CI 1.06-1.54, p = 0.01), comorbidity (OR 1.27, 95%CI 1,08-1,49, p = 0.003) and inflammation (OR 1.01, 95%CI 1.00-1.02, p = 0.02). The 120-day prognosis was worse among malnourished patients (p = 0.042). CONCLUSION: Patients admitted with DM2 have a similar degree of malnutrition than the rest, but with greater sarcopenia. This sarcopenia, together with inflammation and comorbidity determine a worse prognosis. The active and early identification of malnutrition and sarcopenia and their subsequent approach could improve the prognosis of patients.

Asociación entre rigidez arterial y masa grasa en pacientes con obesidad / Association between arterial stiffness and fat mass in patients with obesity

Objetivo Comprobar si la composición corporal en los pacientes con obesidad de riesgo alto (índice de masa corporal>35 o entre 30 y 34,9kg/m2 con un perímetro abdominal mayor de 102cm en varones o mayor de 88cm en mujeres) se relaciona con la enfermedad vascular. Métodos Estudio transversal de pacientes con obesidad de riesgo alto. Se mide su masa grasa mediante bioimpedancia y la rigidez arterial mediante la velocidad de la onda de pulso (VOP). Se analizan los terciles de pacientes según la distribución de la VOP. Resultados Se ha estudiado a 59 pacientes. Con incrementos de la VOP, aumentan el IMC (p=0,02) y el contenido de masa grasa (p<0,00). Existe, además, un incremento significativo de los indicadores de inflamación. Conclusiones En pacientes con obesidad de riesgo alto existen diferencias relativas a su composición corporal que se asocian a modificaciones de su rigidez arterial y de su carga inflamatoria (AU)

Objective The aim is to observe whether body composition in patients with high-risk obesity (body mass index>35 or between 30 and 34.9kg/m2 with a waist circumference greater than 102cm in men or greater than 88cm in women) is related with vascular disease. Methods This is a cross-sectional study of patients with high-risk obesity. Their fat mass was measured through bioimpedance and arterial stiffness through pulse wave velocity (PWV). Tertiles of patients were analyzed according to PWV distribution. Results A total of 59 patients were analyzed. As PWV increased, BMI (p=0.02) and fat mass content (p<0.00) increased. There was also a significant increase in inflammation indicators. Conclusions In patients with high-risk obesity, there were differences in their body composition which were associated with changes in arterial stiffness and inflammatory burden (AU)

Association between arterial stiffness and fat mass in patients with obesity.

OBJECTIVE: The aim is to observe whether body composition in patients with high-risk obesity (body mass index >35 or between 30 and 34.9kg/m2 with a waist circumference greater than 102cm in men or greater than 88cm in women) is related with vascular disease. METHODS: This is a cross-sectional study of patients with high-risk obesity. Their fat mass was measured through bioimpedance and arterial stiffness through pulse wave velocity (PWV). Tertiles of patients were analyzed according to PWV distribution. RESULTS: A total of 59 patients were analyzed. As PWV increased, BMI (p=0.02) and fat mass content (p<0.00) increased. There was also a significant increase in inflammation indicators. CONCLUSIONS: In patients with high-risk obesity, there were differences in their body composition which were associated with changes in arterial stiffness and inflammatory burden.

Recomendaciones para el tratamiento oral de pacientes adultos con enfermedad de Gaucher tipo 1 / Recommendations for oral treatment for adult patients with type 1 Gaucher disease

Revisión de la evidencia científica sobre el tratamiento oral de pacientes adultos con enfermedad de Gaucher tipo 1 (EG1), con formato de guía clínica, según la normativa Agree II. Se describen las principales diferencias entre los 2 tratamientos orales disponibles actualmente para el tratamiento de esta entidad (miglustat y eliglustat).En esta revisión se recuerda que los criterios para iniciar el tratamiento oral en los pacientes con EG1 deben valorarse de forma individualizada. Si bien miglustat y eliglustat son inhibidores de la enzima glucosilceramida sintetasa, los 2 presentan diferentes mecanismos de acción y propiedades farmacológicas y nunca se deben considerar como equivalentes. Miglustat está indicado en pacientes con EG1 no grave que no pueden recibir otro tratamiento de primera línea, mientras que eliglustat está indicado en pacientes con EG1 con cualquier gravedad, en primera línea y sin necesidad de estabilización previa con tratamiento de reemplazo enzimático. Es importante enfatizar que para iniciar tratamiento con eliglustat debemos conocer el fenotipo metabólico CYP2D6 y que su asociación con fármacos metabolizados a través de los citocromos CYP2D6 y CYP3A4 –o bien que utilicen la glucoproteína P– se debe evaluar individualmente. Durante el embarazo se debe evitar el uso de eliglustat, pudiéndose emplear únicamente el tratamiento de reemplazo enzimático. A diferencia de miglustat, cuyos efectos adversos han limitado su utilización, eliglustat no solo ha demostrado una eficacia similar a la del tratamiento de reemplazo enzimático, sino que ha demostrado mejoría en la calidad de vida de los pacientes EG1. (AU)

This work is a review of the scientific evidence on the oral treatment of adult patients with Gaucher disease type 1 (GD1) with a clinical guideline format according to the Agree II regulations. It describes the main differences between the 2 oral treatments currently available for treating this disease (miglustat and eliglustat).This review reminds us that the criteria for starting oral treatment in patients with GD1 must be assessed individually. Although miglustat and eliglustat are both glucosylceramide synthase enzyme inhibitors, they have different mechanisms of action and pharmacological properties and should never be considered equivalent. Miglustat is indicated in patients with non-severe GD1 who cannot receive other first-line treatments, while eliglustat is indicated as first-line treatment for patients with GD1 of any severity without the need for prior stabilization with enzyme replacement therapy. It is important to emphasize that in order to start treatment with eliglustat, we must know the CYP2D6 metabolic phenotype and its association with drugs metabolized through the CYP2D6 and CYP3A4 cytochromes –or alternatively those that use P-Glycoprotein– must be evaluated on an individual basis. During pregnancy, the use of eliglustat should be avoided; only enzyme replacement therapy can be used. Unlike miglustat, whose adverse effects have limited its use, eliglustat has not only demonstrated similar efficacy to enzyme replacement therapy but has also been shown to improve the quality of life of patients with GD1. (AU)

Recommendations for oral treatment for adult patients with type 1 Gaucher disease.

This work is a review of the scientific evidence on the oral treatment of adult patients with Gaucher disease type 1 (GD1) with a clinical guideline format according to the Agree II regulations. It describes the main differences between the two oral treatments currently available for treating this disease (miglustat and eliglustat). This review reminds us that the criteria for starting oral treatment in patients with GD1 must be assessed individually. Although miglustat and eliglustat are both glucosylceramide synthase (GCS) enzyme inhibitors, they have different mechanisms of action and pharmacological properties and should never be considered equivalent. Miglustat is indicated in patients with non-severe GD1 who cannot receive other first-line treatments, while eliglustat is indicated as first-line treatment for patients with GD1 of any severity without the need for prior stabilization with enzyme replacement therapy (ERT). It is important to emphasize that in order to start treatment with eliglustat, we must know the CYP2D6 metabolic phenotype and its association with drugs metabolized through the CYP2D6 and CYP3A4 cytochromes-or alternatively those that use P-Glycoprotein must be evaluated on an individual basis. During pregnancy, the use of eliglustat should be avoided; only ERT can be used. Unlike miglustat, whose adverse effects have limited its use, eliglustat has not only demonstrated similar efficacy to ERT but has also been shown to improve the quality of life of patients with GD1.

Integración de los sistemas de información entre niveles de Atención Sanitaria. Visión desde un Servicio de Salud. Proyecto JARA / The Integration of information systems between health care levels. View from a health

No disponible