La educación ante el consumo de riesgo de bebidas alcohólicas: propuesta de actuación multidisciplinar desde el profesional de la salud / Education facing risk consumption of alcoholic beverages - A proposal for multidisciplinary action from the health care professionals

Educar y sensibilizar al consumidor para moderar el consumo de alcohol es clave para potenciar un estilo de vida saludable. Los profesionales de la salud (PS) en general, y los farmacéuticos comunitarios o los médicos y enfermeros de Atención Primaria (AP) en particular, son influenciadores clave en la educación para prevenir conductas de riesgo. El desconocimiento por parte del consumidor de conceptos como la unidad de bebida estándar, las recomendaciones de consumo, o las equivalencias de alcohol en las bebidas consumidas, puede generar consumos de riesgo alto, dado que el alcohol es alcohol y no depende de la bebida que lo contiene. Asimismo, los PS no suelen estar familiarizados con estos conceptos y con el uso de herramientas para la detección precoz, como puede ser el cuestionario AUDIT (Alcohol Use Disorders Identification Test). Proponemos un abordaje multidisciplinar (médicos y enfermeros de AP, farmacia comunitaria, dietistas-nutricionistas) para educar al consumidor sobre el riesgo asociado al consumo de alcohol, sustentado en la elaboración de un protocolo de actuación consensuado entre las sociedades científicas de estos colectivos profesionales, cuyo objetivo fundamental es contribuir a la formación óptima y actualizada de los PS. Este protocolo de actuación pretende, por tanto, prevenir conductas de riesgo mediante la educación del consumidor y la detección de hábitos de consumo de alto riesgo. Asimismo, este abordaje multidisciplinar y coordinado debe servir para impulsar la comunicación entre los distintos colectivos a la hora de proporcionar información relevante para abordar el consumo de riesgo desde la AP de Salud

Educating and increasing awareness in the consumer to achieve a moderate alcohol consumption is key to promote a healthy lifestyle. Health care professionals (HCP), in particular community pharmacists and Primary Care (PC) physicians and nurses, are key influencers in the education to prevent risk behaviors. A consumer's poor knowledge of concepts such as standard unit, the recommendations on alcohol use, or the alcohol equivalence in the drinks consumed, can lead to a high-risk use, since "alcohol is alcohol" no matter what beverage contains it. Moreover, HCPs are usually not familiar with these concepts and with early detection tools such as the AUDIT (Alcohol Use Disorders Identification Test). We propose a multidisciplinary approach (PC physicians and nurses, community pharmacy, dietists-nutritionists) to educate consumers on the risks associated with the use of alcohol, supported by the development of a protocol of action subscribed by the scientific societies of these professional groups, with the main objective of contributing to optimal and updated training for HCPs. Thus, this protocol of action aims to prevent risk behaviors through consumer education, and to detect high-risk alcohol use. Moreover, this multidisciplinary and coordinated approach should help to boost communication between the different collectives involved when providing relevant information to tackle risky alcohol use from PC

Consensus document on exclusion diets in irritable bowel syndrome (IBS).

This paper summarizes the contents of a consensus document on exclusion diets in irritable bowel disease that was developed by a task force from SEPD, FEAD, SENPE, FESNAD, SEÑ, SEEN, SEGHNP, SEDCA and ADENYD. The complete document is available at the FEAD and in SENPE websites. Irritable bowel syndrome is a highly prevalent functional digestive disorder where, in addition to drugs, therapy includes diet and acquisition of healthy habits as basic elements for its control. In order to facilitate dietary counseling for these patients in daily practice, the present consensus document on the role of exclusion diets was developed. To this end, consensus opinions were collected from various experts in the national scientific societies aiming at establishing recommendations applicable to the health care of patients with irritable bowel syndrome.

Consensus document on exclusion diets in irritable bowel syndrome (IBS) / Documento de consenso sobre las dietas de exclusión en el síndrome del intestino irritable (SII)

This paper summarizes the contents of a consensus document on exclusion diets in irritable bowel disease that was developed by a task force from SEPD, FEAD, SENPE, FESNAD, SEÑ, SEEN, SEGHNP, SEDCA and ADENYD. The complete document is available at the FEAD and in SENPE websites. Irritable bowel syndrome is a highly prevalent functional digestive disorder where, in addition to drugs, therapy includes diet and acquisition of healthy habits as basic elements for its control. In order to facilitate dietary counseling for these patients in daily practice, the present consensus document on the role of exclusion diets was developed. To this end, consensus opinions were collected from various experts in the national scientific societies aiming at establishing recommendations applicable to the health care of patients with irritable bowel syndrome

Este documento resume el contenido del documento de consenso sobre las dietas de exclusión en el síndrome del intestino irritable elaborado por el grupo de trabajo de la SEPD, FEAD, SENPE, FESNAD, SEÑ, SEEN, SEGHNP, SEDCA y ADENYD. El documento completo está disponible en la web de la FEAD. El síndrome del intestino irritable es un trastorno funcional digestivo muy prevalente en el que, aparte del farmacológico, el tratamiento dietético y la adquisición de hábitos saludables son básicos para su control. Para facilitar el consejo dietético a estos pacientes en la práctica diaria se ha elaborado el presente documento de consenso sobre el papel de las dietas de evitación en el síndrome del intestino irritable. Para ello se ha recogido la opinión consensuada de diferentes expertos que representan a las principales sociedades científicas nacionales para establecer unas recomendaciones aplicables en la práctica asistencial en los pacientes con síndrome del intestino irritable

Documento de consenso sobre las dietas de exclusión en el síndrome del intestino irritable (SII) / Consensus document on exclusion diets in irritable bowel syndrome (IBS)

Este documento resume el contenido del documento de consenso sobre las dietas de exclusión en el síndrome del intestino irritable elaborado por el grupo de trabajo de la SEPD, FEAD, SENPE, FESNAD, SEÑ, SEEN, SEGHNP, SEDCA y ADENYD. El documento completo está disponible en la web de la SEPD. El síndrome del intestino irritable es un trastorno funcional digestivo muy prevalente en el que, aparte del farmacológico, el tratamiento dietético y la adquisición de hábitos saludables son básicos para su control. Para facilitar el consejo dietético a estos pacientes en la práctica diaria se ha elaborado el presente documento de consenso sobre el papel de las dietas de evitación en el síndrome del intestino irritable. Para ello se ha recogido la opinión consensuada de diferentes expertos que representan a las principales sociedades científicas nacionales para establecer unas recomendaciones aplicables en la práctica asistencial en los pacientes con síndrome del intestino irritable

This paper summarizes the contents of a consensus document on exclusion diets in irritable bowel disease that was developed by a task force from SEPD, FEAD, SENPE, FESNAD, SEÑ, SEEN, SEGHNP, SEDCA and ADENYD. The complete document is available at the SEPD website. Irritable bowel syndrome is a highly prevalent functional digestive disorder where, in addition to drugs, therapy includes diet and acquisition of healthy habits as basic elements for its control. In order to facilitate dietary counseling for these patients in daily practice, the present consensus document on the role of exclusion diets was developed. To this end, consensus opinions were collected from various experts in the national scientific societies aiming at establishing recommendations applicable to the health care of patients with irritable bowel syndrome

Consensus document on exclusion diets in irritable bowel syndrome (IBS).

This paper summarizes the contents of a consensus document on exclusion diets in irritable bowel disease that was developed by a task force from SEPD, FEAD, SENPE, FESNAD, SEÑ, SEEN, SEGHNP, SEDCA and ADENYD. The complete document is available at the SEPD website. Irritable bowel syndrome is a highly prevalent functional digestive disorder where, in addition to drugs, therapy includes diet and acquisition of healthy habits as basic elements for its control. In order to facilitate dietary counseling for these patients in daily practice, the present consensus document on the role of exclusion diets was developed. To this end, consensus opinions were collected from various experts in the national scientific societies aiming at establishing recommendations applicable to the health care of patients with irritable bowel syndrome.

Body mass index through self-reported data and body image perception in Spanish adults attending dietary consultation.

OBJECTIVES: The aim of this study was to explore, based on sex and age, knowledge regarding weight, height, and the perception of body shape in Spanish adults who attend dietary consultation. We also wanted to determine the participants' desired body shapes and what they considered their best health status. METHODS: The sample consisted of 8100 women and 1220 men from Spain. They were between the ages of 18 and 75 y. Weight (kg) and height (cm) were measured and body mass index (BMI) was calculated. Participants were nutritionally classified following the cutoffs proposed by the World Health Organization. Each individual was asked about his or her weight and height and self-reported BMI was calculated. They also answered a test of body image perception through drawings of human silhouettes that corresponded to an exact BMI. With this, perceived BMI, desired BMI, and BMI considered healthy were estimated. Parametric statistic tests for contrast of mean and percentages were applied. RESULTS: Self-reported and perceived BMI underestimate the BMI obtained through anthropometry. Differences between measured and self-reported BMI are lower in women and increase with age in both sexes. The same result was obtained when comparing measured BMI with perceived BMI through silhouette test. On average, desired BMI and healthy BMI were in the limits of normal weight for all ages and both sexes. However, the difference between them was also lower in women. CONCLUSION: Age and sex influence the perception of excess weight and body image. This could condition the demand of dietary treatment to improve the nutritional status.

[Utility of self-reported anthropometric data for evaluation of obesity in the Spanish population; study EPINUT-ARKOPHARMA]. / Utilidad de los datos antropométricos auto-declarados para la evaluación de la obesidad en la población española; estudio EPINUT-ARKOPHARMA.

INTRODUCTION: Epidemiological studies frequently use weight and height collected by questionnaires, but the inaccuracy of self-reported data may bias the evaluation result. The aim of this study is to validate the self-report in Spanish adult population emphasizing the effect of age and nutritional status of the subjects. METHODS: The sample consist of 9,294 adults (8,072 women and 1,222 men) recruited from dietetic counselling centers dependents of Arkopharma laboratories in 46 Spanish provinces. Weight and height were asked and subsequently measured, calculating differences between self-reported and real parameters. Error in the estimation of body mass index (BMI) was evaluated considering the effect of age and nutritional status (T-test and multiple linear regression). Correlation between the classification based on self-reported BMI and anthropometric was analyzed using the Kappa test. RESULTS AND DISCUSSION: Using the self-reported data, BMI was underestimated (2.62% in men, 3.10% in women). The error increases with age and extreme nutritional categories. The agreement between self-reported and real BMI in the nutritional assessment was good and correctly classified 74.71% of the males and 89.5% of women (Kappa: 0.695 and 0.782 respectively). CONCLUSIONS: Considering the effect of age and nutritional status on the self-awareness of body size, we recommend caution in the use of questionnaires for epidemiological assessment.

Introducción: En epidemiología es frecuente recabar el peso y talla mediante cuestionario, pero la inexactitud de los datos auto-referidos puede sesgar el resultado de la evaluación. El objetivo es validar el auto-reporte en población adulta española enfatizando el efecto de la edad y la condición nutricional de los sujetos. Material y métodos: La muestra consta de 9.294 adultos (8.072 mujeres y 1.222 varones) reclutados en centros de orientación dietética dependientes de los laboratorios Arkopharma en 46 provincias españolas. Se preguntaron peso y talla midiéndose posteriormente y calculando las diferencias entre parámetros auto-referidos y reales. Se evaluó el error en la estima del Índice de Masa Corporal (IMC) considerando el efecto de la edad y la condición nutricional (T de Student y regresión lineal múltiple). Se analizó la concordancia entre la clasificación realizada a partir del IMC auto-referido y antropométrico mediante el test de Kappa. Resultados y discusión: Utilizando datos auto-referidos, el IMC se infravalora (2,62% en varones; 3,10% en mujeres). El error aumenta con la edad y en las categorías nutricionales extremas. El acuerdo en la evaluación nutricional a partir del IMC auto-referido y real es bueno, clasificándose de manera correcta el 74,71% de los varones y el 89,5 % de las mujeres (Kappa: 0,695 y 0,782 respectivamente). Conclusiones: Teniendo en cuenta el efecto de la edad y de la condición nutricional sobre el auto-conocimiento del tamaño corporal, se recomienda cautela en el empleo de cuestionarios encaminados a la valoración epidemiológica.

Utilidad de los datos antropométricos auto-declarados para la evaluación de la obesidad en la población española; estudio EPINUT-ARKOPHARMA / Utility of self-reported anthropometric data for evaluation of obesity in the spanish population; study epinut-arkopharma

Introducción: En epidemiología es frecuente recabar el peso y talla mediante cuestionario, pero la inexactitud de los datos auto-referidos puede sesgar el resultado de la evaluación. El objetivo es validar el auto-reporte en población adulta española enfatizando el efecto de la edad y la condición nutricional de los sujetos. Material y métodos: La muestra consta de 9.294 adultos (8.072 mujeres y 1.222 varones) reclutados en centros de orientación dietética dependientes de los laboratorios Arkopharma en 46 provincias españolas. Se preguntaron peso y talla midiéndose posteriormente y calculando las diferencias entre parámetros auto-referidos y reales. Se evaluó el error en la estima del Índice de Masa Corporal (IMC) considerando el efecto de la edad y la condición nutricional (T de Student y regresión lineal múltiple). Se analizó la concordancia entre la clasificación realizada a partir del IMC auto-referido y antropométrico mediante el test de Kappa. Resultados y discusión: Utilizando datos auto-referidos, el IMC se infravalora (2,62% en varones; 3,10% en mujeres). El error aumenta con la edad y en las categorías nutricionales extremas. El acuerdo en la evaluación nutricional a partir del IMC auto-referido y real es bueno, clasificándose de manera correcta el 74,71% de los varones y el 89,5 % de las mujeres (Kappa: 0,695 y 0,782 respectivamente). Conclusiones: Teniendo en cuenta el efecto de la edad y de la condición nutricional sobre el auto-conocimiento del tamaño corporal, se recomienda cautela en el empleo de cuestionarios encaminados a la valoración epidemiológica (AU)

INTRODUCTION: Epidemiological studies frequently use weight and height collected by questionnaires, but the inaccuracy of self-reported data may bias the evaluation result. The aim of this study is to validate the self-report in Spanish adult population emphasizing the effect of age and nutritional status of the subjects. METHODS: The sample consist of 9,294 adults (8,072 women and 1,222 men) recruited from dietetic counselling centers dependents of Arkopharma laboratories in 46 Spanish provinces. Weight and height were asked and subsequently measured, calculating differences between self-reported and real parameters. Error in the estimation of body mass index (BMI) was evaluated considering the effect of age and nutritional status (T-test and multiple linear regression). Correlation between the classification based on self-reported BMI and anthropometric was analyzed using the Kappa test. RESULTS AND DISCUSSION: Using the self-reported data, BMI was underestimated (2.62% in men, 3.10% in women). The error increases with age and extreme nutritional categories. The agreement between self-reported and real BMI in the nutritional assessment was good and correctly classified 74.71% of the males and 89.5% of women (Kappa: 0.695 and 0.782 respectively).CONCLUSIONS: Considering the effect of age and nutritional status on the self-awareness of body size, we recommend caution in the use of questionnaires for epidemiological assessment (AU)

Modulation of lysozyme activity by lead administered by different routes. In vitro study and analysis in blood, kidney, and lung.

Modifications in the enzyme activity of lysozyme, a protein implied in the defence barrier of the organism, can be a good biomarker of alterations in the immune system as a result of exposure to toxic metal, such as lead. The aim of this work was to evaluate the effect of a 200 ppm dose of lead on lysozyme activity in blood, kidney, and lung, and also on tissue structure. Previously, the effect of lead acetate on lysozyme activity in vitro was determined; the in vitro results indicated that lead produced a decrease in enzyme activity. The activity loss was 16 % at 200 ppm of lead. Lead acetate was administered to Wistar rats by oral and intraperitoneal injections. An increase in lysozyme activity was observed in blood when lead was administered by introperitoneal route and in kidney by the oral route. The possible immunostimulation in kidney was discarded because of the structural alterations observed in the tissue. In lung, the decrease in specific lysozyme activity, for both routes of lead exposure, seems to indicate immunosupression, which was in accordance with the structural alterations observed in this tissue.

Study of response of thymic and submaxillary lymph node lymphocytes to administration of lead by different routes.

A number of studies have reported that heavy metals are not only toxic for the organism but they may modulate immune responses. In the current study, the effect of 4-week administration of 200 ppm of PbAc(2), using different routes of administration (orally and intraperitoneal injection), on lymphatic organs was evaluated. In the thymus, the number of lymphocyte cells and the cellularity diminished significantly for both routes of treatment. Regarding the submaxillary lymph nodes, no significant variations took place. Cell-mediated immune response is commonly evaluated by cell proliferation assays. Mitogens are known to induce a vigorous proliferative response in lymphoid cells from mammals. An increase in the proliferation of T lymphocytes stimulated by concanavalin A and the proliferation of B lymphocytes stimulated with lipopolysaccharides was found in thymus for both routes of administration, whereas in the lymph nodes, there was a decrease in proliferation of T lymphocytes. Furthermore, lead administration by intraperitoneal route caused an effect on B and T lymphocyte subpopulations. Thus, there was an increase in B+ cells and a decrease in T+ cells. Regarding CD4+ and CD8+ T cells, there were only variations, concretely a drop in both subpopulations, in lymph nodes when lead was administered intraperitoneally. It is important to emphasize that an increase in apoptosis was found in this tissue. At the histological level, evident alterations were described in thymus both for the oral and for the intraperitoneal route. Therefore, it is possible to show that lead administered by both routes generated effects on an immunological level.