Reproducibility and Inter-rater Reliability of 2 Paediatric Nutritional Screening Tools.

OBJECTIVES: The aim of the present study was to assess reproducibility and inter-rater reliability of 2 nutritional screening tools (NST): Screening Tool for Risk on Nutritional Status and Growth (STRONGkids) and Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP). METHODS: Prospective observational multicentre study. Patients ages 1 month or older admitted to paediatric or surgical wards were tested within 24 hours of admission by 2 independent observers: experts specialized in paediatric nutrition (physicians or dieticians) and clinical staff nonexpert in nutrition. Diagnosis on admission, underlying diseases, and length of stay were registered. STATISTICAL ANALYSIS: Kappa index (κ) to evaluate agreement between observers. RESULTS: A total of 223 patients were included (53.4% boys), with mean age of 5.59 (95% confidence interval 4.94-6.22) years. Experts classified 9.9% of patients at high risk with STRONGkids and 19.7% using STAMP, whereas nonexpert staff assigned 6.7% of patients to the high-risk category with STRONGkids and 21.9% with STAMP. Agreement between expert and nonexpert staff was good: 94.78% for STRONGkids (κ 0.72 [P < 0.001]); 92.55% for STAMP (κ 0.74 [P < 0.001]). The rate of malnutrition was significantly higher among high-risk patients with both NST, independent of examiner experience. After adjusting for age, both STRONGkids and STAMP high-risk scores predicted longer length of stay, whether assessed by experts or nonexperts, although differences were higher with STRONGkids. CONCLUSIONS: Agreement between experts and nonexpert staff in nutrition was good, producing a similar high-risk patient profile. Our results demonstrate that these NSTs are appropriate for nutritional screening in settings in which users have no previous experience in the field.

Complicaciones nutricionales después del tratamiento quirúrgico de la obesidad: ¿qué ocurre en el bypass gástrico? / Nutritional deficiencies following bariatric surgery: what happens with gastric bypass?

Fundamento y objetivos: Las deficiencias en macronutrientes y micronutrientes son complicaciones frecuentes de la cirugía de la obesidad. El objetivo de este trabajo es estudiar la repercusión del bypass gástrico en la evolución ponderal y las concentraciones de proteínas, vitaminas y minerales, así como documentar el porcentaje de pacientes que precisan suplementación nutricional. Material y método: Se estudió a 109 pacientes a los que se practicó bypass gástrico antes del 1 de marzo de 2004 y se siguió durante al menos 2 años. Se valoró la evolución del peso, el índice de masa corporal (IMC), la albúmina, la ferritina, el ácido fólico, la vitamina B12, la 25-OH-vitamina D3, vitamina A y vitamina E, a los 0, 6, 12, 18 y 24 meses tras la cirugía. Resultados: El peso y el IMC se estabilizan entre 12 y 18 meses tras la intervención. El porcentaje de sobrepeso perdido a los 6, 12, 18 y 24 meses fue del 53, el 66, el 70 y el 69%, respectivamente. Las concentraciones de ferritina y 25-OH-vitamina D3 fueron significativamente menores que las basales a partir de los 6 meses tras cirugía. El 54,7% de los pacientes requirió ferroterapia oral y el 9,5% recibió hierro vía intravenosa. Al 31,1% se le prescribió vitamina B12 intramuscular y al 31,7%, hidroferol oral a dosis altas. El 10,4% de los pacientes requirió suplementación proteínica y el 7,6%, suplementos de vitamina A. Conclusiones: El bypass gástrico consigue unos buenos resultados ponderales durante los primeros 24 meses después de la intervención. Este período coincide con el de mayores carencias nutricionales, y la ferropenia, la depleción de vitamina B12 y 25-OH-vitamina D3 son las complicaciones nutricionales más frecuentes (AU)

Background and objectives: Deficiencies of vitamins and other nutrients are common complications following bariatric surgery. The aim of this study was to analyze the impact of gastric bypass on weight reduction and analyze protein, vitamin and mineral depletion. Material and method: We studied 109 obese patients in whom gastric bypass was performed before March 2004 and were followed for more than 2 years. We determined weight, body mass index (BMI), serum albumin, ferritin, vitamin B12, folate, 25-OH-vitamin D3, vitamin A and vitamin E at 0, 6, 12, 18 and 24 months following surgery. Results: Weight and BMI nadir occurred at 12 to18 months after gastric bypass. The percentage excess weight loss at 6, 12 18 and 24 months was of 53%, 66%, 70% and 69% respectively. Mean levels of ferritin and 25-OH-vitamin D3 were significantly lower than baseline levels after 6 months following surgery. Oral and parenteral iron supplements were needed in 54.7% and 9.5% of patients respectively. 31.1% of patients received parenteral vitamin B12 and 31.7% high doses of vitamin D supplements. Oral protein supplements and vitamin A supplements were prescribed to 10.4% and 7.6% patients respectively. Conclusions: Gastric bypass showed good weight loss results in the 24 months following surgery. Iron, vitamin B12 and vitamin D3 deficiencies, are the more frequent nutritional complications (AU)

Reducción del efecto presor de la obesidad mórbida tratada con cirugía bariátrica / Reduction of presor effect in patients with morbid obesity submitted to bariatric surgery

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