Hambre oculta / Hidden Hunger

El hambre oculta es un problema a nivel mun-dial que ocasiona altas tasas de mortalidad si se compara con algunas de las enfermedades infectocontagiosas como malaria y tuberculo-sis. Cuando existe la desnutrición aumenta el deterioro en la capacidad de producción, trabajo y por ende en la producción de alimen-tos. Hambre oculta se de ne como la de cien-cia crónica de micronutrientes. Afecta la salud de forma silenciosa y grave, llegando a ocasio-nar en muchos casos la muerte. El problema engloba a los niños con desnutrición y también a aquellos con sobrepeso que esconden la escasez de nutrientes, por lo que debemos educar a la población sobre como recibir una alimentación balanceada y equilibrada.En Centroamérica y el Caribe existe un dé cit importante de micronutrientes. Debemos de ser proactivos en mejorar la alimentación para disminuir la desnutrición y obesidad. Para ello debemos mejorar la producción de alimentos. La forti cación de granos y cereales es la opción más rentable y sostenible en las mejo-ras del estado nutricional, aumentando su biodisponibilidad de los nutrientes.Erradicar el hambre y la desnutrición debe ser nuestra meta concreta, por lo que el objetivo de esta revisión es resaltar la importancia de administrar una cantidad y composición adecuada de micronutrientes desde el primer día de la gestación para hacer que disminuyaeste agelo. Es nuestra responsabilidad, y debe ser parte de la política pública, ya que a los problemas éticos ligados a la desnutrición, se añaden consecuencias negativas que afecta-ran a todos los niños...(AU)

Nutritional Risk, Micronutrient Status and Clinical Outcomes: A Prospective Observational Study in an Infectious Disease Clinic.

Malnutrition has been associated with increased morbidity and mortality. The objective of this study was to determine the nutritional status and micronutrient levels of hospitalized patients in an infectious disease clinic and investigate their association with adverse clinical outcomes. The nutritional status of the study participants was assessed using the Nutritional Risk Screening 2002 (NRS 2002) and micronutrient levels and routine biochemical parameters were tested within the first 24 h of the patient's admission. The incidence of zinc, selenium, thiamine, vitamin B6, vitamin B12 deficiency were 66.7% (n = 40), 46.6% (n = 29), 39.7% (n = 27), 35.3% (n = 24), 14.1% (n = 9), respectively. Selenium levels were significantly higher in patients with urinary tract infections, but lower in soft tissue infections. Copper levels were significantly higher in patients with soft tissue infections. In the Cox regression models, lower albumin, higher serum lactate dehydrogenase levels and higher NRS-2002 scores were associated with increased death. Thiamine, selenium, zinc and vitamin B6 deficiencies but not chromium deficiencies are common in infectious disease clinics. New associations were found between micronutrient levels and infection type and their adverse clinical outcomes. Hypoalbuminemia and a high NRS-2002 score had the greatest accuracy in predicting death, systemic inflammatory response syndrome and sepsis on admission.

Inflammation, vitamin deficiencies and organ failure in critically ill patients.

It is unknown whether biochemical vitamin deficiencies in critical illness are associated with severity of illness, organ dysfunction, inflammation or mortality. This nested cohort study recruited 98 patients admitted as emergencies to the intensive care unit, who had a stay of greater than 48 hours. Patient data were prospectively collected. Within the first 48 hours of admission, concentrations of C-reactive protein, vitamins A, E, B1, B12 and folate were measured on arterial blood. These measures were then repeated at least once during the later (> 48 hours) period of their stay. Seventy patients (71%) had completed vitamin studies eligible for inclusion in the analysis. Ten patients died (14.3%) during their hospital stay and mortality was associated with age, admission source and severity of illness scores. Vitamin B12 concentration was weakly associated with C-reactive protein concentrations on admission to the intensive care unit (r on days one and two = 0.4 [P = 0.002], 0.36 [P = 0.04], respectively) and with the Sequential Organ Failure Assessment score between days two and four (Spearman's r = 0.361 [P = 0.04], 0.42 [P = 0.02] and 0.48 [P = 0.02], respectively). Vitamin A concentration was weakly associated with the C-reactive protein concentrations on days one and five (Spearman's r = -0.5 [P = 0.001], -0.4 [P = 0.03], respectively). Change in deficiency status of any of the vitamins over time in the first week of intensive care admission did not appear to influence mortality. We conclude that while weak correlations were identified between vitamins A and B12 and C-reactive protein and Sequential Organ Failure Assessment scores, the importance of these associations and their relationship to hospital mortality remain to be determined.