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1.
Endocr Pract ; 2020 Mar 11.
Artigo em Inglês | MEDLINE | ID: mdl-32160049

RESUMO

BACKGROUND Treatment of hyperglycemia with insulin is associated with increased risk of hypoglycemia in Type 2 Diabetes Mellitus (T2DM) patients receiving total parenteral nutrition (TPN). AIMS To determine the predictors of hypoglycemia in hospitalized T2DM patients receiving total parenteral nutrition (TPN). DESIGN Post-hoc analysis of the INSUPAR study, which is a prospective, open-label, multi-center, clinical trial on adult inpatients with Type 2 Diabetes in a non-critical setting with indication for TPN. RESULTS The study included 161 patients, 31 (19.3%) had hypoglycemic events, none of them was severe. In univariate analysis, hypoglycemia was significantly associated with the presence of diabetes with end-organ damage, duration of diabetes, use of insulin prior to the admission, glycemic variability (GV), belonging to the Glargine insulin group in the INSUPAR trial, mean daily g of lipids in TPN, mean insulin per 10 g of carbohydrates, duration of TPN and increase of urea during TPN. Multiple logistic regression analysis showed that the presence of diabetes with end-organ damage, GV, use of Glargine insulin and TPN duration were risk factors for hypoglycemia. CONCLUSION The presence of DM with end-organ damage complications, longer TPN duration, belonging to the Glargine insulin group and greater GV are factors associated with the risk of hypoglycemia in diabetic non-critically ill inpatients with parenteral nutrition.

2.
Clin Nutr ; 39(2): 388-394, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30930133

RESUMO

BACKGROUND: There is no established insulin regimen in T2DM patients receiving parenteral nutrition. AIMS: To compare the effectiveness (metabolic control) and safety of two insulin regimens in patients with diabetes receiving TPN. DESIGN: Prospective, open-label, multicenter, clinical trial on adult inpatients with type 2 diabetes on a non-critical setting with indication for TPN. Patients were randomized on one of these two regimens: 100% of RI on TPN or 50% of Regular insulin added to TPN bag and 50% subcutaneous GI. Data were analyzed according to intention-to-treat principle. RESULTS: 81 patients were on RI and 80 on GI. No differences were observed in neither average total daily dose of insulin, programmed or correction, nor in capillary mean blood glucose during TPN infusion (165.3 ± 35.4 in RI vs 172.5 ± 43.6 mg/dL in GI; p = 0.25). Mean capillary glucose was significantly lower in the GI group within two days after TPN interruption (160.3 ± 45.1 in RI vs 141.7 ± 43.8 mg/dL in GI; p = 0.024). The percentage of capillary glucose above 180 mg/dL was similar in both groups. The rate of capillary glucose ≤70 mg/dL, the number of hypoglycemic episodes per 100 days of TPN, and the percentage of patients with non-severe hypoglycemia were significantly higher on GI group. No severe hypoglycemia was detected. No differences were observed in length of stay, infectious complications, or hospital mortality. CONCLUSION: Effectiveness of both regimens was similar. GI group achieved better metabolic control after TPN interruption but non-severe hypoglycemia rate was higher in the GI group. CLINICAL TRIAL REGISTRY: This trial is registered at clinicaltrials.gov as NCT02706119.

3.
Endocrinol. diabetes nutr. (Ed. impr.) ; 66(10): 654-662, dic. 2019.
Artigo em Espanhol | IBECS | ID: ibc-184793

RESUMO

Las enfermedades endocrinas están experimentando un importante incremento de su prevalencia, debido a causas de diversa índole, entre ellas la epidemia de obesidad y de desnutrición, el envejecimiento de la población, pero también el efecto de los disruptores endocrinos, entre otros. Por otra parte, las nuevas tecnologías, tanto a nivel de analítica molecular y genética, de imagen y de nuevos dispositivos terapéuticos, obligan a que la comunidad profesional endocrina en España tenga que estar en constante formación. La conexión con los pacientes a través de sus asociaciones, cada vez más activas, y con la sociedad civil en general, el compromiso profesional y la demanda de diversos colectivos sociales de una atención moderna y equitativa, y a llevar a cabo investigación que facilite la consecución de avances para los pacientes, obligan al especialista en Endocrinología y Nutrición, y a la Sociedad Española de Endocrinología y Nutrición (SEEN), a posicionarse y dar respuesta a todos estos retos. En el presente documento, la SEEN expone sus propuestas y su estrategia hasta el 2022


Endocrine diseases are experiencing an important increase in their prevalence, due to causes of various kinds, including the epidemic of obesity and malnutrition, the aging of the population, but also the effect of endocrine disruptors, among others. On the other hand, new technologies, both in terms of molecular and genetic analysis, image and new therapeutic devices, require that the endocrine professional community in Spain must be in constant training. The connection with patients through their associations, increasingly active, and with the civil society in general, the professional commitment and demand of various social groups for a modern and equitable care, and to carry out research that facilitates the achievement of advances for patients, forces the specialist in endocrinology and nutrition and the Spanish Society of Endocrinology and Nutrition (SEEN) to position themselves and respond to all these challenges. In this document, the SEEN presents its proposals and its strategy until 2022


Assuntos
Endocrinologia/organização & administração , Sociedades Médicas/organização & administração , Sociedades Médicas/tendências , Estratégias , Endocrinologia/tendências , Sistemas Nacionais de Saúde , Medicina/organização & administração , Promoção da Saúde , Espanha
4.
Therap Adv Gastroenterol ; 12: 1756284819862152, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31391867

RESUMO

Background: The objective of this study was to analyse the prevalence of metabolic bone disease (MBD) in a cohort of Southern European patients with inflammatory bowel disease (IBD) and to identify associated risk factors in this population. Methods: We conducted a retrospective, both cross-sectional and longitudinal study of MBD, assessed by dual energy X-ray absorptiometry (DXA), among patients diagnosed with IBD and previously recognized risk factors for this complication from two referral Spanish institutions. Results: A total of 612 patients (58.6% diagnosed with Crohn's disease) were included. Mean (SD) age was 44.9 (14.7) years; 71.7% of patients received at least one tapered dosage of corticosteroids before first DXA. MBD and osteoporosis were diagnosed in 66.4% and 21.4% of patients, respectively. At baseline, male gender, menopause and ulcerative colitis were found as independent risks factors for osteoporosis, whereas age, more than three IBD-related hospitalizations and previous steroid treatment were found as independent risks factors for MBD. A total of 261 patients had at least a second DXA and were included in the longitudinal study; median follow up was 56.4 months. Logistic regression model identified menopause, ulcerative colitis and baseline lumbar DXA T-score value, but not steroid treatment, as risk factors for worsening ⩾1 SD in follow-up DXA T-score. According to guidelines, all patients under treatment with corticosteroids received calcium and vitamin D supplements. Conclusion: MBD is a frequent complication in south-European IBD patients. Routine evaluation of bone density when risk factors are present, as well as calcium plus D vitamin prophylaxis in patients under corticosteroid treatment should be recommended.

5.
Endocrinol Diabetes Nutr ; 66(10): 654-662, 2019 Dec.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31272927

RESUMO

Endocrine diseases are experiencing an important increase in their prevalence, due to causes of various kinds, including the epidemic of obesity and malnutrition, the aging of the population, but also the effect of endocrine disruptors, among others. On the other hand, new technologies, both in terms of molecular and genetic analysis, image and new therapeutic devices, require that the endocrine professional community in Spain must be in constant training. The connection with patients through their associations, increasingly active, and with the civil society in general, the professional commitment and demand of various social groups for a modern and equitable care, and to carry out research that facilitates the achievement of advances for patients, forces the specialist in endocrinology and nutrition and the Spanish Society of Endocrinology and Nutrition (SEEN) to position themselves and respond to all these challenges. In this document, the SEEN presents its proposals and its strategy until 2022.

6.
Obes Surg ; 29(2): 585-592, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30397876

RESUMO

CONTEXT: Information concerning the risk-benefit profile of bariatric surgery in subjects with liver cirrhosis is scarce. Our aim was to describe the long-term outcomes of bariatric surgery in a cohort of patients with liver cirrhosis submitted to bariatric surgery. METHODS: This was a multicenter, retrospective observational study performed by the Obesity Group of the Spanish Society of Endocrinology and Nutrition (GOSEEN), with a review of patients with cirrhosis who had undergone bariatric surgery during the period from April 2004 to March 2017 in ten public reference hospitals in Spain. RESULTS: Data on 41 patients with cirrhosis submitted to obesity surgery were collected (mean age 53.8 ± 7.9 years, 46.3% women, presurgical BMI 45 ± 8.3 kg/m2). All but one patient belonged to Child-Pugh class A, and sleeve gastrectomy was conducted in 68.3% of cases. Percentage of total weight loss (%TWL) was 26.33 ± 8.3% and 21.16 ± 15.32% at 1 and 5 years after surgery, respectively. This was accompanied by a significant reduction of type 2 diabetes, high blood pressure, and dyslipidemia and by an improvement of liver enzymes over time. Model for End-Stage Liver Disease (MELD) index increased from 7.2 ± 1.9 to 9.8 ± 4.6 after 5 years. Seven patients (17%) developed early postsurgical complications. No postsurgical mortality was observed. During follow-up, only five patients developed liver decompensation. CONCLUSIONS: Bariatric surgery in selected patients with liver cirrhosis has metabolic benefits that could have a positive impact on liver prognosis. TRIAL REGISTRATION: Controlledtrials.com Identifier: 10.1186/ISRCTN15009106.


Assuntos
Cirurgia Bariátrica , Cirrose Hepática/complicações , Obesidade Mórbida/cirurgia , Adulto , Cirurgia Bariátrica/efeitos adversos , Cirurgia Bariátrica/métodos , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/complicações , Obesidade Mórbida/epidemiologia , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento , Perda de Peso
7.
Clin Nutr ; 37(1): 354-396, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29274834

RESUMO

Neurological diseases are frequently associated with swallowing disorders and malnutrition. Moreover, patients with neurological diseases are at increased risk of micronutrient deficiency and dehydration. On the other hand, nutritional factors may be involved in the pathogenesis of neurological diseases. Multiple causes for the development of malnutrition in patients with neurological diseases are known including oropharyngeal dysphagia, impaired consciousness, perception deficits, cognitive dysfunction, and increased needs. The present evidence- and consensus-based guideline addresses clinical questions on best medical nutrition therapy in patients with neurological diseases. Among them, management of oropharyngeal dysphagia plays a pivotal role. The guideline has been written by a multidisciplinary team and offers 88 recommendations for use in clinical practice for amyotrophic lateral sclerosis, Parkinson's disease, stroke and multiple sclerosis.


Assuntos
Doenças do Sistema Nervoso , Política Nutricional , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/dietoterapia , Transtornos de Deglutição/fisiopatologia , Humanos , Doenças do Sistema Nervoso/diagnóstico , Doenças do Sistema Nervoso/dietoterapia , Doenças do Sistema Nervoso/fisiopatologia , Estado Nutricional , Prognóstico , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/dietoterapia , Acidente Vascular Cerebral/fisiopatologia
9.
Redox Biol ; 11: 415-428, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-28064117

RESUMO

Human age-related diseases, including obesity and type 2 diabetes (T2DM), have long been associated to mitochondrial dysfunction; however, the role for adipose tissue mitochondria in these conditions remains unknown. We have tackled the impact of aging and T2DM on adipocyte mitochondria from obese patients by quantitating not only the corresponding abundance changes of proteins, but also the redox alterations undergone by Cys residues thereof. For that, we have resorted to a high-throughput proteomic approach based on isobaric labeling, liquid chromatography and mass spectrometry. The alterations undergone by the mitochondrial proteome revealed aging- and T2DM-specific hallmarks. Thus, while a global decrease of oxidative phosphorylation (OXPHOS) subunits was found in aging, the diabetic patients exhibited a reduction of specific OXPHOS complexes as well as an up-regulation of the anti-oxidant response. Under both conditions, evidence is shown for the first time of a link between increased thiol protein oxidation and decreased protein abundance in adipose tissue mitochondria. This association was stronger in T2DM, where OXPHOS mitochondrial- vs. nuclear-encoded protein modules were found altered, suggesting impaired mitochondrial protein translocation and complex assembly. The marked down-regulation of OXPHOS oxidized proteins and the alteration of oxidized Cys residues related to protein import through the redox-active MIA (Mitochondrial Intermembrane space Assembly) pathway support that defects in protein translocation to the mitochondria may be an important underlying mechanism for mitochondrial dysfunction in T2DM and physiological aging. The present draft of redox targets together with the quantification of protein and oxidative changes may help to better understand the role of oxidative stress in both a physiological process like aging and a pathological condition like T2DM.


Assuntos
Envelhecimento/metabolismo , Diabetes Mellitus Tipo 2/metabolismo , Proteínas Mitocondriais/metabolismo , Obesidade/metabolismo , Proteoma/genética , Adipócitos/metabolismo , Adipócitos/patologia , Adulto , Envelhecimento/patologia , Diabetes Mellitus Tipo 2/genética , Diabetes Mellitus Tipo 2/patologia , Humanos , Pessoa de Meia-Idade , Mitocôndrias/metabolismo , Mitocôndrias/patologia , Obesidade/genética , Obesidade/patologia , Oxirredução , Fosforilação Oxidativa , Transporte Proteico/genética , Proteoma/metabolismo , Proteômica , Compostos de Sulfidrila/metabolismo
10.
Endocrinol Diabetes Nutr ; 64 Suppl 1: 15-22, 2017 Mar.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-27543006
11.
Obes Facts ; 9(1): 41-51, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26901345

RESUMO

BACKGROUND: Severe postprandial hypoglycemia after bariatric surgery is a rare but invalidating complication. Our aim was to describe the different tests performed for its diagnosis and their outcomes as well as the response to the prescribed pharmacological and surgical treatments. METHODS: Multicenter, retrospective systematic review of cases with recurrent severe postprandial hypoglycemia. RESULTS: Over 11 years of follow-up, 22 patients were identified. The test most used to provoke hypoglycemia was the oral glucose load test followed by the mixed meal test which was the least standardized test. With pharmacological treatment, 3 patients were symptom-free (with octreotide) and in 12 patients hypoglycemic episodes were attenuated. Seven patients had persistent hypoglycemic episodes and underwent surgery. Partial pancreatectomy was performed in 3 patients who had positive selective arterial calcium stimulation, and nesidioblastosis was confirmed in 2 patients. Reconversion to normal anatomy was performed in 3 patients, and 1 patient underwent a resection of the 'candy cane' roux limb, with resolution of hypoglycemia in all cases. CONCLUSIONS: There is high heterogeneity in the evaluation and treatment options for postoperative hypoglycemia. In patients that do not respond to pharmacological treatment, reconstruction of gastrojejunal continuity may be the safest and most successful procedure.


Assuntos
Cirurgia Bariátrica/efeitos adversos , Hiperinsulinismo/etiologia , Hipoglicemia/etiologia , Adulto , Feminino , Teste de Tolerância a Glucose , Humanos , Hiperinsulinismo/sangue , Hipoglicemia/diagnóstico , Hipoglicemia/epidemiologia , Hipoglicemia/terapia , Incidência , Jejuno/cirurgia , Masculino , Pessoa de Meia-Idade , Nesidioblastose/complicações , Nesidioblastose/diagnóstico , Nesidioblastose/epidemiologia , Octreotida/uso terapêutico , Pancreatectomia , Sistema de Registros , Estudos Retrospectivos , Espanha/epidemiologia , Estômago/cirurgia
12.
Endocrinol. nutr. (Ed. impr.) ; 63(1): 32-42, ene. 2016. ilus
Artigo em Espanhol | IBECS | ID: ibc-148480

RESUMO

La cirugía bariátrica es una modalidad terapéutica para la obesidad grave que se utiliza cada vez con más frecuencia, y permite que el paciente consiga una pérdida de peso mantenida en el tiempo y una resolución o mejoría de la mayor parte de las enfermedades asociadas. Una de las principales complicaciones a medio y a largo plazo es el déficit de hierro y la anemia ferropénica, que puede afectar hasta al 50% de los casos, y deteriora de manera importante la calidad de vida del paciente. Estas alteraciones pueden estar presentes desde el preoperatorio. El objetivo de la presente revisión es elaborar unos esquemas de diagnóstico y tratamiento del déficit de hierro y la anemia ferropénica en el pre y postoperatorio de la cirugía bariátrica (AU)


Bariatric surgery (BS) is an increasingly used therapeutic option for severe obesity which allows patients to achieve sustained weight loss over time and resolution or improvement in most associated pathological conditions. Major mid- and long-term complications of BS include iron deficiency and iron-deficient anemia, which may occur in up to 50% of cases and significantly impair patient quality of life. These changes may be present before surgery. The aim of this review was to prepare schemes for diagnosis and treatment of iron deficiency and iron-deficient anemia before and after bariatric surgery (AU)


Assuntos
Humanos , Cirurgia Bariátrica/estatística & dados numéricos , Obesidade/fisiopatologia , Anemia Ferropriva/epidemiologia , Compostos de Ferro/uso terapêutico , Cuidados Pré-Operatórios/métodos , Deficiência de Ferro/tratamento farmacológico , Complicações Pós-Operatórias , Obesidade Mórbida/cirurgia
13.
Endocrinol Nutr ; 63(1): 32-42, 2016 Jan.
Artigo em Espanhol | MEDLINE | ID: mdl-26611153

RESUMO

Bariatric surgery (BS) is an increasingly used therapeutic option for severe obesity which allows patients to achieve sustained weight loss over time and resolution or improvement in most associated pathological conditions. Major mid- and long-term complications of BS include iron deficiency and iron-deficient anemia, which may occur in up to 50% of cases and significantly impair patient quality of life. These changes may be present before surgery. The aim of this review was to prepare schemes for diagnosis and treatment of iron deficiency and iron-deficient anemia before and after bariatric surgery.


Assuntos
Anemia/diagnóstico , Anemia/terapia , Cirurgia Bariátrica , Ferro/deficiência , Humanos , Obesidade Mórbida/cirurgia , Qualidade de Vida
14.
Obes Surg ; 26(8): 1836-42, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-26661106

RESUMO

BACKGROUND: Specific data is needed to safely expand bariatric surgery and to preserve good surgical outcomes in response to the non-stop increase in obesity prevalence worldwide. OBJECTIVE: The aims of this study are to provide an overview of the baseline characteristics, type of surgery, and 30-day postoperative morbidity and mortality in patients undergoing bariatric surgery in Spanish public hospitals, and evaluate changes throughout the 2000-2014 period. MATERIAL AND METHODS: This is a descriptive study using data from the RICIBA, a computerized multicenter and multidisciplinary registry created by the Obesity Group of the Endocrinology and Nutrition Spanish Society. Three periods according to the date of surgery were created: January 2000 to December 2004 (G1), January 2005 to December 2009 (G2), and January 2010 to December 2014 (G3). RESULTS: Data from 3843 patients were available (44.8 ± 10.5 years, a 3:1 female-to-male ratio, 46.9 ± 8.2 kg/m(2)). Throughout the 15-year period assessed, candidate patients for bariatric surgery were progressively older and less obese, with an increase in associated comorbidities and in the prevalence of men. The global trend also showed a progressive decrease in Roux-en-Y gastric bypass, the most performed bariatric procedure (75.1 % in G1, 69.3 % in G2, and 42.6 % in G3; p < 0.001), associated with a parallel increase in sleeve gastrectomy (0.8 % in G1, 18.1 % in G2, and 39.6 % in G3; p < 0.001). An overall mortality rate of 0.3 % was reported. CONCLUSIONS: Data from Spain is similar to data observed worldwide. Information recorded in the National Registries like RICIBA is necessary in order to safely expand bariatric surgery in response to increasing demand.


Assuntos
Cirurgia Bariátrica/estatística & dados numéricos , Obesidade Mórbida/cirurgia , Cirurgia Bariátrica/métodos , Cirurgia Bariátrica/tendências , Comorbidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/mortalidade , Período Pós-Operatório , Prevalência , Sistema de Registros , Espanha/epidemiologia
15.
Nutr. hosp ; 31(1): 84-91, ene. 2015. tab
Artigo em Espanhol | IBECS | ID: ibc-132585

RESUMO

Desde la Conferencia de Consenso de Tarpon Spring en 1987, el Balón Intragástrico de Bioenterics se ha impuesto como modelo en el tratamiento de la obesidad con esta técnica. No obstante, a lo largo de los 30 últimos años, y en especial en los 10 últimos, han aparecido nuevos conceptos de balón intragástrico así como modelos alternativos de balón que revisamos en este trabajo (AU)


Since de Tarpon Springs Consensus Conference in 1987, the Bioenterics Intragastric Balloon represents the standard model for obesity treatment with this technique. Nevertheless, over the last 30 years, especially for the last ten years, novel concept of balloons has appeared, as well as new alternative models, which are reviewed in this paper (AU)


Assuntos
Humanos , Balão Gástrico/classificação , Balão Gástrico/tendências , Obesidade/terapia , Desenho de Equipamento , Peso Corporal , Comportamento Alimentar/psicologia
16.
Clin Nutr ; 34(5): 962-7, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25466952

RESUMO

BACKGROUND: Malnutrition in hospitalized patients is associated with an increased risk of death, in both the short and the long term. AIMS: The purpose of this study was to determine which nutrition-related risk index predicts long-term mortality better (three years) in patients who receive total parenteral nutrition (TPN). METHODS: This prospective, multicenter study involved noncritically ill patients who were prescribed TPN during hospitalization. Data were collected on Subjective Global Assessment (SGA), Nutritional Risk Index (NRI), Geriatric Nutritional Risk Index (GNRI), body mass index, albumin and prealbumin, as well as long-term mortality. RESULTS: Over the 1- and 3-year follow-up periods, 174 and 244 study subjects (28.8% and 40.3%) respectively, died. Based on the Cox proportional hazards survival model, the nutrition-related risk indexes most strongly associated with mortality were SGA and albumin (<2.5 g/dL) (after adjustment for age, gender, C-reactive protein levels, prior comorbidity, mean capillary blood glucose during TPN infusion, diabetes status prior to TPN, diagnosis, and infectious complications during hospitalization). CONCLUSIONS: The SGA and very low albumin levels are simple tools that predict the risk of long-term mortality better than other tools in noncritically ill patients who receive TPN during hospitalization.


Assuntos
Desnutrição/epidemiologia , Nutrição Parenteral Total , Adulto , Idoso , Glicemia/metabolismo , Índice de Massa Corporal , Peso Corporal , Proteína C-Reativa/metabolismo , Comorbidade , Estado Terminal , Ingestão de Energia , Seguimentos , Avaliação Geriátrica , Hospitalização , Humanos , Pacientes Internados , Tempo de Internação , Desnutrição/diagnóstico , Pessoa de Meia-Idade , Avaliação Nutricional , Estado Nutricional , Modelos de Riscos Proporcionais , Estudos Prospectivos , Medição de Risco , Albumina Sérica/metabolismo , Adulto Jovem
17.
Nutrition ; 31(1): 58-63, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25441588

RESUMO

OBJECTIVE: Hypoglycemia is a common problem among hospitalized patients. Treatment of hyperglycemia with insulin is potentially associated with an increased risk for hypoglycemia. The aim of this study was to determine the prevalence and predictors of hypoglycemia (capillary blood glucose <70 mg/dL) in hospitalized patients receiving total parenteral nutrition (TPN). METHODS: This prospective multicenter study involved 19 Spanish hospitals. Noncritically ill adults who were prescribed TPN were included, thus enabling us to collect data on capillary blood glucose and insulin dosage. RESULTS: The study included 605 patients of whom 6.8% (n = 41) had at least one capillary blood glucose <70 mg/dL and 2.6% (n = 16) had symptomatic hypoglycemia. The total number of hypoglycemic episodes per 100 d of TPN was 0.82. In univariate analysis, hypoglycemia was significantly associated with the presence of diabetes, a lower body mass index (BMI), and treatment with intravenous (IV) insulin. Patients with hypoglycemia also had a significantly longer hospital length of stay, PN duration, higher blood glucose variability, and a higher insulin dose. Multiple logistic regression analysis showed that a lower BMI, high blood glucose variability, and TPN duration were risk factors for hypoglycemia. Use of IV insulin and blood glucose variability were predictors of symptomatic hypoglycemia. CONCLUSIONS: The occurrence of hypoglycemia in noncritically ill patients receiving PN is low. A lower BMI and a greater blood glucose variability and TPN duration are factors associated with the risk for hypoglycemia. IV insulin and glucose variability were predictors of symptomatic hypoglycemia.


Assuntos
Hipoglicemia/epidemiologia , Nutrição Parenteral Total/efeitos adversos , Administração Intravenosa , Idoso , Glicemia/metabolismo , Índice de Massa Corporal , Estado Terminal , Relação Dose-Resposta a Droga , Feminino , Hospitalização , Humanos , Hipoglicemia/etiologia , Insulina/administração & dosagem , Insulina/efeitos adversos , Tempo de Internação , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Prevalência , Estudos Prospectivos , Fatores de Risco , Espanha/epidemiologia
18.
Obes Surg ; 25(3): 436-42, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25125138

RESUMO

BACKGROUND: Bariatric surgery (BS) has become more frequent among women of child-bearing age. Data regarding the underlying maternal and perinatal risks are scarce. The objective of this nationwide study is to evaluate maternal and perinatal outcomes after BS. METHODS: We performed a retrospective observational study of 168 pregnancies in 112 women who underwent BS in 10 tertiary hospitals in Spain over a 15-year period. Maternal and perinatal outcomes, including gestational diabetes mellitus (GDM), pregnancy-associated hypertensive disorders (PAHD), pre-term birth cesarean deliveries, small and large for gestational age births (SGA, LGA), still births, and neonatal deaths, were evaluated. Results were further compared according to the type of BS performed: restrictive techniques (vertical-banded gastroplasty, sleeve gastrectomy, and gastric banding), Roux-en-Y gastric bypass (RYGB), and biliopancreatic diversion (BPD). RESULTS: GDM occurred in five (3 %) pregnancies and there were no cases of PAHD. Women whose pregnancies occurred before 1 year after BS had a higher pre-gestational body mass index (BMI) than those who got pregnant 1 year after BS (34.6 ± 7.7 vs 30.4 ± 5.3 kg/m(2), p = 0.007). In pregnancies occurring during the first year after BS, a higher rate of stillbirths was observed compared to pregnancies occurring after this period of time (35.5 vs 16.8 %, p = 0.03). Women who underwent BPD delivered a higher rate of SGA babies than women with RYGB or restrictive procedures (34.8, 12.7, and 8.3 %, respectively). CONCLUSIONS: Pregnancy should be scheduled at least 1 year after BS. Malabsorptive procedures are associated to a higher rate of SGA births.


Assuntos
Cirurgia Bariátrica , Obesidade Mórbida/cirurgia , Complicações na Gravidez/cirurgia , Adulto , Feminino , Humanos , Recém-Nascido , Gravidez , Resultado da Gravidez , Estudos Retrospectivos , Espanha
19.
Endocr Pract ; 21(1): 59-67, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25148810

RESUMO

OBJECTIVE: The prevalence of carbohydrate metabolism disorders in patients who receive total parenteral nutrition (TPN) is not well known. These disorders can affect the treatment, metabolic control, and prognosis of affected patients. The aims of this study were to determine the prevalence in noncritically ill patients on TPN of diabetes, prediabetes, and stress hyperglycemia; the factors affecting hyperglycemia during TPN; and the insulin therapy provided and the metabolic control achieved. METHODS: We undertook a prospective multicenter study involving 19 Spanish hospitals. Noncritically ill patients who were prescribed TPN were included, and data were collected on demographic, clinical, and laboratory variables (glycated hemoglobin, C-reactive protein [CRP], capillary blood glucose) as well as insulin treatment. RESULTS: The study included 605 patients. Before initiation of TPN, the prevalence of known diabetes was 17.4%, unknown diabetes 4.3%, stress hyperglycemia 7.1%, and prediabetes 27.8%. During TPN therapy, 50.9% of patients had at least one capillary blood glucose of >180 mg/dL. Predisposing factors were age, levels of CRP and glycated hemoglobin, the presence of diabetes, infectious complications, the number of grams of carbohydrates infused, and the administration of glucose-elevating drugs. Most (71.6%) patients were treated with insulin. The mean capillary blood glucose levels during TPN were: known diabetes (178.6 ± 46.5 mg/dL), unknown diabetes (173.9 ± 51.9), prediabetes (136.0 ± 25.4), stress hyperglycemia (146.0 ± 29.3), and normal (123.2 ± 19.9) (P<.001). CONCLUSION: The prevalence of carbohydrate metabolism disorders is very high in noncritically ill patients on TPN. These disorders affect insulin treatment and the degree of metabolic control achieved.


Assuntos
Diabetes Mellitus/epidemiologia , Hiperglicemia/epidemiologia , Insulina/uso terapêutico , Nutrição Parenteral Total/efeitos adversos , Estado Pré-Diabético/epidemiologia , Adulto , Idoso , Glicemia/análise , Diabetes Mellitus/metabolismo , Feminino , Humanos , Hiperglicemia/metabolismo , Masculino , Pessoa de Meia-Idade , Estado Pré-Diabético/metabolismo , Prevalência , Estudos Prospectivos
20.
Nutr Hosp ; 30(2): 359-65, 2014 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-25208791

RESUMO

BACKGROUND: Home parenteral nutrition (HPN) was introduced in Spain in the late 1980s. Our hospital was a pioneering medical centre in this field. AIM: Analyze outcomes of our HPN program. METHODS: Retrospective study of patients receiving HPN between 1986-2012. Study variables are expressed as frequency, mean ± SD (range), median [interquartile range]. Parametrics, non-parametrics test and survival analysis (p < 0.05) were applied. RESULTS: 91 patients (55 females and 36 males, mean age: 50.6 ± 5 yrs.) who received HPN for an accrual period of 55,470 days (median: 211 days [range: 63-573]) were included. The most prevalent underlying condition was cancer (49.5%), with the commonest HPN indication being short bowel syndrome (41.1%). The most frequently used catheter type was the tunneled catheter (70.7%). The complication rate was 3.58/1,000 HPN days (2.68, infection; 0.07, occlusion; 0.07 thrombosis; and 0.59, metabolic complications). Complications were consistently associated with both the underlying condition and HPN length. Infections were most frequent within the first 1,000 days of HPN. Liver disease incidence was related to HPN duration. HPN could be discontinued in 42.3% of patients. Ten-year survival rate was 42%, and varied across the underlying conditions. CONCLUSIONS: In the present series, the commonest reason for HPN was cancer. Our complication rate is in keeping with that reported in the literature. The overall survival rate was 42%, and varied across the underlying conditions.


Assuntos
Nutrição Parenteral no Domicílio , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Hospitais Gerais , Humanos , Lactente , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
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