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1.
Nutr. hosp ; 36(2): 340-349, mar.-abr. 2019. tab
Artigo em Inglês | IBECS | ID: ibc-184328

RESUMO

Background: multiple sclerosis (MS) is an inflammatory, neurodegenerative disease of the central nervous system. Weight loss and malnutrition are prevalent in advanced stages of MS. Objective: the aim of this study was to define the nutritional profile in moderate-advanced MS (especially by documenting malnutrition) and its evolution. Methods: a case-control study was designed; cross-sectional observational study was complemented by a 12-month prospective longitudinal observational study of MS patients. Nutritional status was evaluated by collecting clinical, anthropometric, dietary and analytical data. Results: one hundred and twenty-four patients with MS and 62 controls were recruited; 8% of the patients were malnourished or at risk of malnutrition. Only MS patients with advanced disability needed nutritional support. During the follow-up, five patients died and four of them received nutritional support. Conclusions: malnutrition was unusual in our sample of patients with moderate-advanced MS. The need for nutritional support is related to dysphagia in patients with advanced neurological disability. The nutritional status of patients with moderate-advanced MS is defined by a tendency to overweight and by the decrease in basal energy expenditure and handgrip strength test in relation to the loss of muscle mass. The deficient intake of polyunsaturated fatty acids, fiber and vitamin D is exacerbated in the evolution of the disease


Introducción: la esclerosis múltiple (EM) es una enfermedad inflamatoria y neurodegenerativa del sistema nervioso central. La pérdida de peso y la malnutrición son frecuentes en fases avanzadas de la EM. Objetivo: el objetivo de este estudio fue definir el perfil nutricional de la EM en estadio moderado-avanzado (especialmente, documentando la malnutrición) y su evolución a 12 meses. Métodos: se realizó un estudio de casos-controles; el estudio observacional transversal se complementó con un estudio observacional longitudinal prospectivo a 12 meses de los pacientes con EM. El estado nutricional se evaluó mediante la recogida de datos clínicos, antropométricos, dietéticos y analíticos. Resultados: se incluyeron en el estudio 124 pacientes con EM y 62 controles. El 8% de los pacientes estaban desnutridos o en riesgo de desnutrición. Solo los pacientes con EM con discapacidad avanzada necesitaban soporte nutricional. Durante el seguimiento, cinco pacientes fallecieron y cuatro de ellos estaban recibiendo soporte nutricional. Conclusiones: la desnutrición es infrecuente en nuestra muestra de pacientes con EM moderada-avanzada. La necesidad de apoyo nutricional está relacionada con la disfagia en pacientes con discapacidad neurológica avanzada. El estado nutricional de los pacientes con EM moderada-avanzada se define por una tendencia al sobrepeso y por valores bajos en el gasto energético basal y en la dinamometría manual en relación con la pérdida de masa muscular. La ingesta deficiente de ácidos grasos poliinsaturados, fibra y vitamina D se acentúa en la evolución de la enfermedad


Assuntos
Humanos , Masculino , Feminino , Criança , Esclerose Múltipla/fisiopatologia , Estado Nutricional , Antropometria , Estudos de Casos e Controles , Estudos Transversais , Transtornos de Deglutição , Dieta , Força da Mão , Desnutrição/epidemiologia , Apoio Nutricional , Sobrepeso/epidemiologia , Estudos Prospectivos
2.
Nutr Hosp ; 36(2): 340-349, 2019 Apr 10.
Artigo em Inglês | MEDLINE | ID: mdl-30839222

RESUMO

Introduction: Background: multiple sclerosis (MS) is an inflammatory, neurodegenerative disease of the central nervous system. Weight loss and malnutrition are prevalent in advanced stages of MS. Objective: the aim of this study was to define the nutritional profile in moderate-advanced MS (especially by documenting malnutrition) and its evolution. Methods: a case-control study was designed; cross-sectional observational study was complemented by a 12-month prospective longitudinal observational study of MS patients. Nutritional status was evaluated by collecting clinical, anthropometric, dietary and analytical data. Results: one hundred and twenty-four patients with MS and 62 controls were recruited; 8% of the patients were malnourished or at risk of malnutrition. Only MS patients with advanced disability needed nutritional support. During the follow-up, five patients died and four of them received nutritional support. Conclusions: malnutrition was unusual in our sample of patients with moderate-advanced MS. The need for nutritional support is related to dysphagia in patients with advanced neurological disability. The nutritional status of patients with moderate-advanced MS is defined by a tendency to overweight and by the decrease in basal energy expenditure and handgrip strength test in relation to the loss of muscle mass. The deficient intake of polyunsaturated fatty acids, fiber and vitamin D is exacerbated in the evolution of the disease.


Assuntos
Esclerose Múltipla/fisiopatologia , Estado Nutricional , Antropometria , Estudos de Casos e Controles , Criança , Estudos Transversais , Transtornos de Deglutição , Dieta , Feminino , Força da Mão , Humanos , Masculino , Desnutrição/epidemiologia , Apoio Nutricional , Sobrepeso/epidemiologia , Estudos Prospectivos
3.
Clin Nutr ; 38(6): 2639-2644, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30545660

RESUMO

BACKGROUND & AIMS: Hyponatremia is frequent in hospitalized patients, especially in those receiving total parenteral nutrition (TPN). Furthermore, the presence of hyponatremia is associated with increased morbimortality in both groups. The goal of this study is to describe the prevalence of hyponatremia developing during TPN in non-critical patients, and identify risk factors for its appearance. METHODS: This prospective multicenter study involved 19 Spanish hospitals. Noncritically-ill patients prescribed TPN over a 9-month period were studied. Variables analyzed demographic characteristics, prior comorbidities, drug therapy, PN composition, additional iv fluids, and serum sodium levels. RESULTS: A total of 543 patients were recruited, 60.2% males. Age: 67 (IR 57-76). Of 466/543 who were eunatremic when starting TPN, 18% developed hyponatremia (serum sodium < 135 mmol/L) during TPN. Independent risk factors identified by logistic regression analysis: female (OR 1.74 [95% CI = 1.04-2.92], p = 0.036); severe malnutrition (OR 2.15 [95% CI = 1.16-4.35], p = 0.033); opiates (OR 1.97 [95% CI = 1.10-3.73], p = 0.036); and nausea/vomiting (OR 1.75 [95% CI = 1.04-2.94], p = 0.036). CONCLUSIONS: Previously eunatremic patients frequently develop hyponatremia while receiving TPN. In this group, severe malnutrition is an independent risk factor for hyponatremia, as well as previously described risk factors: opiates, nausea/vomiting, and female gender.

6.
Endocrinol. diabetes nutr. (Ed. impr.) ; 65(1): 5-16, ene. 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-171909

RESUMO

Antecedentes: La imprecisión en la terminología dentro de la nutrición clínica puede acarrear malas interpretaciones entre los distintos profesionales. Objetivo: Por esta razón, la Sociedad Española de Endocrinología y Nutrición (SEEN) ha promovido la realización del presente trabajo, el primero sobre terminología y definiciones en nutrición artificial clínica (enteral y parenteral) publicado en castellano. Métodos: Un total de 47 especialistas en Endocrinología y Nutrición expertos en la materia, miembros del Área de Nutrición de la SEEN, han participado entre los meses de abril y septiembre de 2016. Tras una revisión bibliográfica sistematizada fueron propuestos 52 conceptos, ampliándose a 54 por las coordinadoras y finalmente a 57 por el grupo de trabajo: 13 de carácter general, 30 referidos a la nutrición enteral y 14 a la parenteral. En una fase posterior se determinó el grado de acuerdo mediante un proceso Delphi de 2 circulaciones. Finalmente fue ratificado mediante un análisis de consistencia y concordancia. Resultados: En 54 de los 57 términos hubo un acuerdo muy consistente y resultaban concordantes. Solo 3 no presentaron concordancia, de los que 2 eran muy consistentes y uno inconsistente. En conclusión, queda consensuada la definición de 54 términos básicos en la práctica de la nutrición clínica (AU)


Background: Imprecision in terms used in the field of clinical nutrition may lead to misinterpretations among professionals. Objective: For this reason, the Spanish Society of Endocrinology and Nutrition (SEEN) promoted this document on the terms and definitions used in clinical artificial nutrition (enteral and parenteral), establishing an agreement between Spanish experts of this specialty. Methods: Forty-seven specialists in endocrinology and nutrition, members of the Nutrition Area of the SEEN, participated between April and September 2016. After a systematic literature review, 52 concepts were proposed. The coordinators included two additional concepts, and 57were finally selected by the working group: 13 of a general nature, 30 referring to enteral nutrition and 14 to parenteral nutrition. The degree of agreement was subsequently determined using a two-round Delphi process. It was finally ratified by consistency and concordance analysis. Results: Fifty-four of the 57 terms had a very consistent agreement and were concordant. Only three showed no concordance, of whom two were very consistent and one inconsistent. In conclusion, there was consensus in the definition of 54 basic terms in the practice of clinical nutrition (AU)


Assuntos
Humanos , Masculino , Feminino , Terminologia como Assunto , Ciências da Nutrição/métodos , Endocrinologia/métodos , Nutrição Enteral/métodos , Nutrição Parenteral/métodos , Sociedades Médicas/normas , Técnica Delfos
7.
Endocrinol Diabetes Nutr ; 65(1): 5-16, 2018 Jan.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29233514

RESUMO

BACKGROUND: Imprecision in terms used in the field of clinical nutrition may lead to misinterpretations among professionals. OBJECTIVE: For this reason, the Spanish Society of Endocrinology and Nutrition (SEEN) promoted this document on the terms and definitions used in clinical artificial nutrition (enteral and parenteral), establishing an agreement between Spanish experts of this specialty. METHODS: Forty-seven specialists in endocrinology and nutrition, members of the Nutrition Area of the SEEN, participated between April and September 2016. After a systematic literature review, 52 concepts were proposed. The coordinators included two additional concepts, and 57were finally selected by the working group: 13 of a general nature, 30 referring to enteral nutrition and 14 to parenteral nutrition. The degree of agreement was subsequently determined using a two-round Delphi process. It was finally ratified by consistency and concordance analysis. RESULTS: Fifty-four of the 57 terms had a very consistent agreement and were concordant. Only three showed no concordance, of whom two were very consistent and one inconsistent. In conclusion, there was consensus in the definition of 54 basic terms in the practice of clinical nutrition.


Assuntos
Ciências da Nutrição , Apoio Nutricional/métodos , Terminologia como Assunto , Técnica Delfos , Suplementos Nutricionais/classificação , Endocrinologia/organização & administração , Alimentos Formulados/classificação , Humanos , Linguagem , Necessidades Nutricionais , Ciências da Nutrição/organização & administração , Apoio Nutricional/classificação , Sociedades Médicas , Sociedades Científicas , Espanha
8.
Nutr Hosp ; 34(4): 989-996, 2017 Jul 28.
Artigo em Inglês | MEDLINE | ID: mdl-29095026

RESUMO

INTRODUCTION: Among the objectives of the SENPE Management Working Group is the development of knowledge and tools related to the evaluation of health outcomes. OBJECTIVES: To obtain an approximate profile of clinical nutrition in hospitals in Spain, specifically concerning its organization, endowment, activities and quality indicators. METHODS: A cross-sectional study conducted in 2013 through a structured survey sent to a random sample of 20% of hospitals from the network of the National Health System of Spain, stratified by the number of hospital beds. RESULTS: The overall response rate was 67% (83% in hospitals with over 200 beds). In 65% of hospitals, clinical nutrition is run by a coordinated team or unit, with a doctor working full time in only 50% of centers. Other professionals are often not recognized as part of the team or unit. There is a specialized monographic nutrition clinic in 62% of centers and 72% have more than 40 new inpatient consultations per month (27% with more than 80 per month). Among the centers with a clinical nutrition team or unit, there is a greater tendency to monitor quality indicators related to clinical practice. CONCLUSIONS: There is widespread addition of clinical nutrition teams and units in hospitals in Spain. However, truly multidisciplinary organization is not often found. High workloads are assumed in relation to staffing levels. The existence of well-organized structures may be associated with benefits that directly affect attendance.


Assuntos
Terapia Nutricional/normas , Terapia Nutricional/tendências , Garantia da Qualidade dos Cuidados de Saúde/métodos , Estudos Transversais , Pesquisas sobre Serviços de Saúde , Unidades Hospitalares/estatística & dados numéricos , Humanos , Equipe de Assistência ao Paciente , Espanha
9.
Nutr Hosp ; 34(5): 1080-1088, 2017 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-29130705

RESUMO

INTRODUCTION: Poor nutritional status is associated with increased morbidity and mortality, especially in older people. OBJECTIVE: The aim of this study was to assess nutritional status in elderly nursing home residents with different nutritional test, and to determine which parameters used for nutritional assessment can be carried out in this population, which usually have a high prevalence of functionally dependent residents. METHODS: A cross-sectional study was performed in 383 elderly. The nutritional assessment tools used were the Mini Nutritional Assessment (MNA), the new ESPEN consensus definition of malnutrition, and the tool for Controlling Nutritional Status (CONUT). Moreover, the ability to perform basic activities of daily living was assessed with the Barthel index (BI). RESULTS: According to BI, 78.9% had a total dependence and only 20.9% could be weighed and heighed. The prevalence of malnutrition with MNA, ESPEN and CONUT was 21.3%, 17.6% and 20.7%, respectively. The agreement between MNA vs ESPEN criteria was moderate (kappa = 0.483), but with CONUT was low. CONCLUSIONS: Nursing homes had a high percentage of totally dependent residents. This high degree of functional dependence made difficult to obtain some anthropometric parameters such as weight and height, which are essential to carry out most nutritional tests. MNA, CONUT and the new ESPEN criteria of malnutrition showed a high prevalence of malnutrition and risk of malnutrition in subjects in which they could be performed.


Assuntos
Pessoas com Deficiência , Casas de Saúde , Avaliação Nutricional , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Avaliação Geriátrica , Humanos , Masculino , Desnutrição/diagnóstico , Pessoa de Meia-Idade , Estado Nutricional , Fatores Sexuais
10.
Nutr. hosp ; 34(4): 989-996, jul.-ago. 2017. tab
Artigo em Inglês | IBECS | ID: ibc-165364

RESUMO

Introduction: Among the objectives of the SENPE Management Working Group is the development of knowledge and tools related to the evaluation of health outcomes. Objectives: To obtain an approximate profile of clinical nutrition in hospitals in Spain, specifically concerning its organization, endowment, activities and quality indicators. Methods: A cross-sectional study conducted in 2013 through a structured survey sent to a random sample of 20% of hospitals from the network of the National Health System of Spain, stratified by the number of hospital beds. Results: The overall response rate was 67% (83% in hospitals with over 200 beds). In 65% of hospitals, clinical nutrition is run by a coordinated team or unit, with a doctor working full time in only 50% of centers. Other professionals are often not recognized as part of the team or unit. There is a specialized monographic nutrition clinic in 62% of centers and 72% have more than 40 new inpatient consultations per month (27% with more than 80 per month). Among the centers with a clinical nutrition team or unit, there is a greater tendency to monitor quality indicators related to clinical practice. Conclusions: There is widespread addition of clinical nutrition teams and units in hospitals in Spain. However, truly multidisciplinary organization is not often found. High workloads are assumed in relation to staffing levels. The existence of well-organized structures may be associated with benefits that directly affect attendance (AU)


Introducción: el Grupo de Trabajo de Gestión de SENPE tiene entre sus objetivos el conocimiento y desarrollo de herramientas para la evaluación de resultados en salud. Objetivos: obtener un perfil aproximado de los equipos de Nutrición Clínica en los hospitales de España, específicamente sobre su organización, dotación, actividad e indicadores de calidad. Métodos: estudio transversal realizado en 2013 mediante una encuesta estructurada remitida a una muestra aleatoria del 20% de hospitales de la red del Sistema Nacional de Salud, estratificada por número de camas de hospitalización. Resultados: la tasa de respuesta global fue del 67% (83% en centros con más de doscientas camas). En el 65% de los centros, la Nutrición Clínica está a cargo de un equipo coordinado o una unidad, con médico a tiempo completo en solo un 50% de centros. Con frecuencia no se reconocen otros profesionales como parte del equipo o unidad. Existen consultas monográficas especializadas en nutrición clínica en un 62% y se atienden más de 40 nuevas consultas mensuales de hospitalización en el 72% de los centros (más de 80 en el 27%). Entre los centros con equipo de Nutrición se observa una mayor tendencia al seguimiento de indicadores de calidad relacionados con la práctica clínica. Conclusiones: la incorporación de equipos y unidades de Nutrición Clínica es amplia en los hospitales de España. No es frecuente una verdadera organización multidisciplinar y se asumen cargas de trabajo elevadas en relación a las dotaciones de personal. La existencia de estructuras bien organizadas puede acompañarse de beneficios que repercuten directamente en la calidad de la asistencia (AU)


Assuntos
Humanos , Avaliação Nutricional , Dietoterapia/métodos , Dietoterapia/normas , Qualidade dos Alimentos , Desnutrição/epidemiologia , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Qualidade da Assistência à Saúde/organização & administração , Desnutrição/prevenção & controle , Sociedades Médicas/normas
11.
Endocrine ; 55(1): 231-238, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27704480

RESUMO

Giant prolactinomas are rare tumors characterized by their large size, compressive symptoms, and extremely high prolactin secretion. The aim of this study is to describe our experience with a series of 16 giant prolactinomas cases in terms of clinical presentation, therapeutic decisions, and final outcomes. Retrospective analysis of adult patients diagnosed with giant prolactinomas at the endocrine departments of three university tertiary hospitals. We included 16 patients (43.7 % women); mean age at diagnosis: 42.1 ± 21 years. The most frequent presentation was compressive symptoms. The delay in diagnosis was higher in women (median of 150 months vs. 12 in men; p = 0.09). The mean maximum tumor diameter at diagnosis was 56.9 ± 15.5 mm, and mean prolactin levels were 10,995.9 ± 12,157.8 ng/mL. Dopamine agonists were the first-line treatment in 11 patients (mean maximum dose: 3.9 ± 3.2 mg/week). Surgery was the initial treatment in five patients and the second-line treatment in six. Radiotherapy was used in four cases. All patients but one, are still with dopamine agonists. After a mean follow-up of 9 years, prolactin normalized in 7/16 patients (43.7 %) and 13 patients (81 %) reached prolactin levels lower than twice the upper limit of normal. Mean prolactin level at last visit: 79.5 ± 143 ng/mL. Tumor volume was decreased by 93.8 ± 11.3 %, and final maximum tumor diameter was 18.4 ± 18.8 mm. Three patients are actually tumor free. Giant prolactinomas are characterized by a large tumor volume and extreme prolactin hypersecretion. Multimodal treatment is frequently required to obtain biochemical and tumor control.


Assuntos
Agonistas de Dopamina/uso terapêutico , Procedimentos Neurocirúrgicos/métodos , Hipófise/cirurgia , Neoplasias Hipofisárias/terapia , Prolactinoma/terapia , Radioterapia , Adulto , Terapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Hipofisárias/sangue , Prolactina/sangue , Prolactinoma/sangue , Resultado do Tratamento , Adulto Jovem
12.
Rev Esp Enferm Dig ; 106(8): 522-8, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25544409

RESUMO

The visceral adiposity index (VAI) is a marker of visceral fat distribution and dysfunction. Visceral adiposity is related to nonalcoholic fatty liver disease (NAFLD); however, there is some controversy regarding the association between VAI and NAFLD.The aim of this study was to analyse the relationship between VAI and NAFLD and to describe the related factors in severely obese patients. A total of 139 patients who underwent bariatric surgery were included in this cross-sectional study. Liver biopsy was performed during surgery. Univariate and multivariate analysis were conducted to study the features related to VAI. A univariate analysis was conducted to identify which factors were associated with liver histology. In the univariate analysis, steatosis, liver inflammation, non-alcoholic steatohepatitis (NASH) and fibrosis were associated with VAI. In the multivariate analysis, only HOMA (Beta: 0.06; p < 0.01) and metabolic syndrome (Beta: 1.23; p < 0.01) were related to VAI. HOMA, the presence of metabolic syndrome, and waist circumference (WC) were statistically related to the NAFLD activity score (NAS score): HOMA: 0-2: 5.04; 3-4: 7.83; > or = 5: 11,32; p < 0.01; MS: 0-2: 37 %; 3-4: 33.3 %; > or = 5: 76%; p < 0.01; WC: 0-2: 128.7 cm; 3-4: 130.7; > or = 5: 140.6; p < 0.01). For the prediction of NASH (NAS score > or = 5), the AUROC curve were 0.71 (CI 95 %: 0.63-0.79) for VAI and 0.7 (CI 95 %: 0.62-0.78) for WC. In conclusion, HOMA, WC and metabolic syndrome are related to liver histology in patients with severe obesity. In the multivariate analysis, VAI was associated with HOMA and metabolic syndrome, but not with liver histology.


Assuntos
Adiposidade , Resistência à Insulina , Síndrome Metabólica/etiologia , Hepatopatia Gordurosa não Alcoólica/complicações , Obesidade Mórbida/complicações , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
13.
Rev. esp. enferm. dig ; 106(8): 522-528, sept.-dic. 2014. tab
Artigo em Inglês | IBECS | ID: ibc-130573

RESUMO

The visceral adiposity index (VAI) is a marker of visceral fat distribution and dysfunction. Visceral adiposity is related to nonalcoholic fatty liver disease (NAFLD); however, there is some controversy regarding the association between VAI and NAFLD. The aim of this study was to analyse the relationship between VAI and NAFLD and to describe the related factors in severely obese patients. A total of 139 patients who underwent bariatric surgery were included in this cross-sectional study. Liver biopsy was performed during surgery. Univariate and multivariate analysis were conducted to study the features related to VAI. A univariate analysis was conducted to identify which factors were associated with liver histology. In the univariate analysis, steatosis, liver inflammation, non-alcoholic steatohepatitis (NASH) and fibrosis were associated with VAI. In the multivariate analysis, only HOMA (Beta: 0.06; p < 0.01) and metabolic syndrome (Beta: 1.23; p < 0.01) were related to VAI. HOMA, the presence of metabolic syndrome, and waist circumference (WC) were statistically related to the NAFLD activity score (NAS score): HOMA: 0-2: 5.04; 3-4: 7.83; ≥ 5: 11,32; p < 0.01; MS: 0-2: 37 %; 3-4: 33.3 %; ≥ 5: 76%; p < 0.01; WC: 0-2: 128.7 cm; 3-4: 130.7; ≥ 5: 140.6; p < 0.01). For the prediction of NASH (NAS score ≥ 5), the AUROC curve were 0.71 (CI 95 %: 0.63-0.79) for VAI and 0.7 (CI 95 %: 0.62-0.78) for WC. In conclusion, HOMA, WC and metabolic syndrome are related to liver histology in patients with severe obesity. In the multivariate analysis, VAI was associated with HOMA and metabolic syndrome, but not with liver histology (AU)


No disponible


Assuntos
Humanos , Masculino , Feminino , Síndrome Metabólica/complicações , Síndrome Metabólica/diagnóstico , Fígado Gorduroso/complicações , Fígado Gorduroso/diagnóstico , Obesidade Abdominal/complicações , Obesidade Abdominal/diagnóstico , Fígado Gorduroso Alcoólico/complicações , Fígado Gorduroso Alcoólico/diagnóstico , Comorbidade , Hemocromatose/complicações , Antropometria/métodos , Análise de Variância , Modelos Lineares
14.
Endocrinol. nutr. (Ed. impr.) ; 59(3): 174-196, mar. 2012. ilus
Artigo em Espanhol | IBECS | ID: ibc-105140

RESUMO

Objetivo Proporcionar unas recomendaciones prácticas para la evaluación y tratamiento de la osteoporosis asociada a diferentes enfermedades endocrinas y alteraciones nutricionales. Participantes Miembros del Grupo de Metabolismo Mineral de la Sociedad Española de Endocrinología y Nutrición, un metodólogo y un documentalista. Métodos Las recomendaciones se formularon de acuerdo al sistema Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) para establecer tanto la fuerza de las recomendaciones como el grado de evidencia. Se realizó una búsqueda sistemática en Medline de la evidencia disponible para cada patología usando las siguientes palabras clave asociadas al nombre de cada patología: AND osteoporosis, fractures, bone mineral density, bone markers y treatment. Se revisaron artículos escritos en inglés con fecha de inclusión hasta 18 de octubre de 2011, y cada tema fue revisado por dos personas del Grupo. Un metodólogo resolvió las diferencias que surgieron durante el proceso de revisión de bibliografía y formulación de recomendaciones. Tras la formulación de las recomendaciones estas se discutieron en una reunión conjunta del Grupo de Trabajo. Conclusiones El documento establece unas recomendaciones prácticas basadas en la evidencia acerca de la evaluación y tratamiento de la osteoporosis en las enfermedades endocrinas y nutricionales que asocian baja masa ósea o aumento del riesgo de fractura. Para cada patología, se señala el riesgo de osteoporosis y fracturas asociado, se formulan recomendaciones en cuanto a la evaluación de masa ósea y se enumeran las opciones terapéuticas que han demostrado eficacia en aumentar la densidad mineral ósea y/o reducir el riesgo de fractura (AU)


Objective To provide practical recommendations for evaluation and treatment of osteoporosis associated to endocrine diseases and nutritional conditions. Participants Members of the Bone Metabolism Working Group of the Spanish Society of Endocrinology, a methodologist, and a documentalist. Methods Recommendations were formulated according to the GRADE system (Grading of Recommendations, Assessment, Development, and Evaluation) to describe both the strength of recommendations and the quality of evidence. A systematic search was made in MEDLINE (Pubmed), using the following terms associated to the name of each condition: AND “osteoporosis”, “fractures”, “bone mineral density”, and “treatment”. Papers in English with publication date before 18 October 2011 were included. Current evidence for each disease was reviewed by two group members, and doubts, related to the review process or development of recommendations were resolved by the methodologist. Finally, recommendations were discussed in a meeting of the Working Group. Conclusions The document provides evidence-based practical recommendations for evaluation and management of endocrine and nutritional diseases associated to low bone mass or an increased risk of fracture. For each disease, the associated risk of low bone mass and fragility fractures is given, recommendations for bone mass assessment are provided, and treatment options that have shown to be effective for increasing bone mass and/or to decreasing fragility fractures are listed (AU)


Assuntos
Humanos , Osteoporose/diagnóstico , Osteoporose/tratamento farmacológico , Doenças do Sistema Endócrino/complicações , Transtornos Nutricionais/complicações , Padrões de Prática Médica , Fraturas Ósseas/prevenção & controle , Densidade Óssea/fisiologia
15.
Endocrinol Nutr ; 59(3): 174-96, 2012 Mar.
Artigo em Espanhol | MEDLINE | ID: mdl-22321561

RESUMO

OBJECTIVE: To provide practical recommendations for evaluation and treatment of osteoporosis associated to endocrine diseases and nutritional conditions. PARTICIPANTS: Members of the Bone Metabolism Working Group of the Spanish Society of Endocrinology, a methodologist, and a documentalist. METHODS: Recommendations were formulated according to the GRADE system (Grading of Recommendations, Assessment, Development, and Evaluation) to describe both the strength of recommendations and the quality of evidence. A systematic search was made in MEDLINE (Pubmed), using the following terms associated to the name of each condition: AND "osteoporosis", "fractures", "bone mineral density", and "treatment". Papers in English with publication date before 18 October 2011 were included. Current evidence for each disease was reviewed by two group members, and doubts related to the review process or development of recommendations were resolved by the methodologist. Finally, recommendations were discussed in a meeting of the Working Group. CONCLUSIONS: The document provides evidence-based practical recommendations for evaluation and management of endocrine and nutritional diseases associated to low bone mass or an increased risk of fracture. For each disease, the associated risk of low bone mass and fragility fractures is given, recommendations for bone mass assessment are provided, and treatment options that have shown to be effective for increasing bone mass and/or to decreasing fragility fractures are listed.


Assuntos
Doenças do Sistema Endócrino/complicações , Desnutrição/complicações , Osteoporose/diagnóstico , Osteoporose/tratamento farmacológico , Absorciometria de Fóton , Algoritmos , Anorexia Nervosa/complicações , Anorexia Nervosa/terapia , Densidade Óssea , Conservadores da Densidade Óssea/uso terapêutico , Cálcio/uso terapêutico , Complicações do Diabetes/diagnóstico , Gerenciamento Clínico , Doenças do Sistema Endócrino/tratamento farmacológico , Doenças do Sistema Endócrino/cirurgia , Medicina Baseada em Evidências , Feminino , Humanos , Masculino , Osteoporose/etiologia , Osteoporose/fisiopatologia , Nutrição Parenteral/efeitos adversos , Síndromes Pós-Gastrectomia/tratamento farmacológico , Vitamina D/uso terapêutico
17.
Endocrinol Nutr ; 58(3): 104-11, 2011 Mar.
Artigo em Espanhol | MEDLINE | ID: mdl-21382753

RESUMO

BACKGROUND AND OBJECTIVE: Nutritional assessment in the elderly is difficult and different from that performed in younger people. There are specific tools for that purpose, such as the Geriatric Nutritional Risk Index (GNRI). The study objective was to compare this index to the Nutritional Risk Index (NRI). MATERIALS AND METHODS: A retrospective, observational analytical study including 113 hospitalized patients over 75 years of age receiving nutritional support. Weight, height, age, length of stay, Mini Nutritional Assessment (MNA), nutrition type and duration, and occurrence of complications were collected. GNRI and NRI were calculated. Both indexes were compared to each other and with parameters measured. RESULTS: Mean GNRI was 88.79 (SD: 13.1), mean NRI 79.96 (SD: 10.8), and mean MNA 17.49 (SD: 4.9). Complications occurred in 50.4% of patients, and 14% died. NRI and GNRI did not correlate with length of stay (R=0.136) or with length of nutrition (R=0.041). No significant correlation was seen between GNRI and complications, but a significant relationship was found with NRI. After stratification into surgical and medical patients, NRI was seen to be significantly related to complications in surgical patients only (p<0.05). GNRI was not related to complications in either surgical or medical patients. CONCLUSIONS: In hospitalized elderly patients, NRI is a better predictor of complications and may be more appropriate for assessing the risk of death than GNRI. GNRI underestimated nutritional risk as compared to NRI.


Assuntos
Idoso/fisiologia , Pacientes Internados , Desnutrição/diagnóstico , Programas de Rastreamento/métodos , Avaliação Nutricional , Medição de Risco/métodos , Índice de Gravidade de Doença , Idoso de 80 Anos ou mais , Estudos de Coortes , Comorbidade , Feminino , Idoso Fragilizado , Mortalidade Hospitalar , Humanos , Masculino , Desnutrição/epidemiologia , Desnutrição/terapia , Necessidades Nutricionais , Apoio Nutricional/estatística & dados numéricos , Nutrição Parenteral/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fatores de Risco
18.
Endocrinol. nutr. (Ed. impr.) ; 58(3): 104-111, mar. 2011. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-95821

RESUMO

Antecedentes y objetivo La valoración nutricional en el paciente anciano es compleja y no comparable a la de personas más jóvenes. Para ello existen herramientas específicas como el Índice de riesgo nutricional geriátrico (GNRI). El objetivo del estudio fue comparar este índice con el Índice de riesgo nutricional (NRI). Material y métodos Estudio observacional analítico retrospectivo que incluyó a 113 pacientes hospitalizados mayores de 75 años en seguimiento nutricional. Se recogió: peso, talla, edad, estancia media, Mini Nutritional Assessment (MNA), tipo de nutrición y duración de la misma y presencia de complicaciones. Se calcularon el NRI y el GNRI. Se compararon ambos índices entre sí y con los parámetros medidos. Resultados La media del GNRI fue 88,79 (DE: 13,1), la del NRI 79,96 (DE: 10,8) y la del MNA 17,49 (DE: 4,9). Un 50,4% sufrió complicaciones y un 14% fue éxitus. No se correlacionó el NRI ni el GNRI con estancia media R=0,136 ni con duración de la nutrición R=0,041. Al relacionar el riesgo nutricional con la presencia de complicaciones se observó que no había relación significativa con el GNRI, pero sí cñon el NRI (p<0,05). Estratificando en pacientes quirúrgicos y médicos existió relación significativa del NRI con las complicaciones sólo en pacientes quirúrgicos (p<0,05), siendo no significativa en pacientes médicos. Al analizar el GNRI se observó que no había relación significativa en ninguno de los grupos. Conclusiones En pacientes ancianos hospitalizados, el NRI predice mejor las complicaciones y podría ser más adecuado a la hora de valorar el riesgo de éxitus que el GNRI. El GNRI infraestima el riesgo nutricional respecto del NRI (AU)


Background and objective: Nutritional assessment in the elderly is difficult and different fromthat performed in younger people. There are specific tools for that purpose, such as the GeriatricNutritional Risk Index (GNRI). The study objective was to compare this index to the NutritionalRisk Index (NRI).Materials and methods: A retrospective, observational analytical study including 113 hospitalizedpatients over 75 years of age receiving nutritional support. Weight, height, age, lengthof stay, Mini Nutritional Assessment (MNA), nutrition type and duration, and occurrence ofcomplications were collected. GNRI and NRI were calculated. Both indexes were compared toeach other and with parameters measured. Results: Mean GNRI was 88.79 (SD: 13.1), mean NRI 79.96 (SD: 10.8), and mean MNA 17.49 (SD:4.9). Complications occurred in 50.4% of patients, and 14% died. NRI and GNRI did not correlatewith length of stay (R = 0.136) or with length of nutrition (R = 0.041). No significant correlationwas seen between GNRI and complications, but a significant relationship was found with NRI.After stratification into surgical and medical patients, NRI was seen to be significantly relatedto complications in surgical patients only (p < 0.05). GNRI was not related to complications ineither surgical or medical patients.Conclusions: In hospitalized elderly patients, NRI is a better predictor of complications and maybe more appropriate for assessing the risk of death than GNRI. GNRI underestimated nutritionalrisk as compared to NRI (AU)


Assuntos
Humanos , Masculino , Feminino , Idoso de 80 Anos ou mais , Avaliação Nutricional , Pacientes Internados , Desnutrição/diagnóstico , Programas de Rastreamento/métodos , Idoso Fragilizado , Mortalidade Hospitalar , Desnutrição/epidemiologia , Desnutrição/terapia , Necessidades Nutricionais , Nutrição Parenteral , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença
20.
Endocrinol. nutr. (Ed. impr.) ; 54(7): 395-397, ago. 2007. tab
Artigo em Espanhol | IBECS | ID: ibc-056835

RESUMO

La disminución brusca de concentraciones plasmáticas de corticoides puede producir un auténtico síndrome de abstinencia similar al que se produce con cualquier droga. Presentamos el caso de una mujer con síndrome de abstinencia tras el tratamiento quirúrgico de un síndrome de Cushing, que no fue identificado, por lo que se mantuvo de forma innecesaria el tratamiento con glucocorticoides (AU)


Sharp reductions in plasma corticosteroid levels can produce a genuine withdrawal syndrome similar to that induced by withdrawal of any other drug. We describe the case of a woman who, after undergoing surgical treatment for Cushing's syndrome, suffered from a withdrawal syndrome. Because this syndrome was not identified, the patient was unnecessarily maintained on glucocorticoid treatment (AU)


Assuntos
Feminino , Pessoa de Meia-Idade , Humanos , Corticosteroides/deficiência , Síndrome de Cushing/tratamento farmacológico , Glucocorticoides/efeitos adversos , Transtornos Relacionados ao Uso de Substâncias , Testes de Função Tireóidea
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