Association between protein energy wasting and peritoneal membrane transport in peritoneal dialysis.

Introduction: Background: fast peritoneal transport (FT) has been associated with peritoneal albumin loss and protein energy wasting (PEW); however, this relationship has not been fully studied. Aim: the aim of this study was to analyze the differences in nutritional parameters between fast-transport peritoneal membrane (FT-PET) and slow-transport peritoneal membrane (ST-PET), and analyze the association between FT-PET and PEW in peritoneal dialysis (PD) patients. Methods: a cross-sectional study of patients on PD. Peritoneal transport characteristics were assessed using the peritoneal equilibration test (PET). Malnutrition inflammation score (MIS) was used for PEW identification. Clinical and biochemical characteristics between patients with and without PEW were assessed. Association between FT-PET status and PEW were evaluated using univariate and multivariate logistic regression. Results: a total of 143 patients were included. FT-PET group showed a higher prevalence of hypoalbuminemia, edema, lower phase angle, lower energy intake, and higher values of MIS score. FT-PET was significantly associated with PEW on univariate (OR: 3.5, 95 % CI: 1.56-7.83, p = 0.002) and multivariate models (OR: 2.6, 95 % CI: 1.02-6.6, p = 0.04). This association was maintained in patients where baseline PET was performed after initiating PD therapy (OR: 6.2, 95 % CI: 1.01-38.6, p = 0.04). Conclusion: FT-PET is associated with PEW evaluated by MIS score. Clinical trials to study nutritional interventions personalized to peritoneal-membrane transport characteristics should be designed.

Introducción: Antecedentes: las características del transporte peritoneal rápido se han asociado a una mayor pérdida de albúmina peritoneal, así como a un mayor riesgo de presentar desgaste proteico energético (DPE); sin embargo, está relación no está esclarecida en la literatura. Objetivo: el objetivo de la investigación fue analizar las diferencias de indicadores nutricionales entre la membrana peritoneal con transporte rápido y la membrana peritoneal con transporte lento, así como analizar la asociación entre el transporte peritoneal rápido y el diagnóstico de DPE en pacientes con diálisis peritoneal. Métodos: estudio transversal. Las características del transporte peritoneal se evaluaron mediante la prueba del equilibrio peritoneal (PET). Se utilizó la escala de malnutrición e inflamación (MIS) para la identificación del DPE. Se evaluaron las diferencias entre las características clínicas y bioquímicas en pacientes con y sin DPE. La asociación entre pacientes con transporte rápido y DPE se evaluó mediante regresión logística. Resultados: se incluyeron un total de 143 pacientes. El transporte peritoneal rápido mostró una mayor prevalencia de hipoalbuminemia, edema, menor valor de ángulo de fase e ingesta energética y mayor puntaje MIS. El transporte peritoneal rápido se asoció con la presentación de DPE en el modelo univariado (OR: 3,5, IC 95 %: 1,56-7,83, p = 0,002) y en el análisis multivariado (OR: 2,6, IC 95 %: 1,02-6,6, p = 0,04). Esta asociación persiste independientemente del momento de realización del PET (OR: 6,2, IC 95 %: 1,01-38,6, p = 0,04). Conclusión: el transporte peritoneal rápido se asoció con mayor riesgo de DPE evaluado mediante la herramienta MIS. Se requieren de ensayos clínicos para diseñar la intervención nutricional más óptima según las características del PET.

Association between longitudinal changes in phase angle and mortality rate in adults critically ill with COVID-19: A retrospective cohort study.

BACKGROUND: Phase angle (PhA) obtained by bioelectrical impedance analysis (BIA) works as a predictor of clinical outcomes. Specific cutoff values for longitudinal changes and their relationship with clinical outcomes are still undetermined for patients with critical illness. Thus, the aim of this study was to analyze the association between longitudinal changes in PhA during intensive care unit (ICU) stay and all-cause 90-day mortality in patients critically ill with COVID-19. METHODS: This was a retrospective cohort study of adults critically ill with COVID-19 undergoing invasive mechanical ventilation with a length of stay >14 days. BIA was performed at ICU admission and at days 7 and 14 of ICU stay; PhA and hydration parameters were collected. Differences between survivors and nonsurvivors were assessed. Longitudinal changes were evaluated using repeated-measures analysis of variance. A receiver operating characteristics curve for PhA declined (%) during the first 14 days, and all-cause 90-day mortality was performed. Survival probability was reported using hazard ratios (HR). RESULTS: One-hundred nine patients were included. The change in the value of PhA was close to 17.1%. Nonsurvivors had a higher prevalence of individuals with a decrease in PhA >22.2% (area under the curve = 0.65) in the first 14 days in comparison with survivors (70% vs 34.8%, P < 0.01). PhA decrease >22.2% at 14 days was a significant predictor of all-cause 90-day mortality (HR = 2.2, 95% CI 1.71-3.6, P = 0.04). CONCLUSION: Changes in PhA are associated with all-cause 90-day mortality. Future studies should be directed to interventions to prevent changes in this nutrition marker.

Validity of bioelectric impedance analysis for body composition assessment in interstitial lung disease patients.

Introduction: Background: changes in body composition (BC) are common in interstitial lung disease, which leads to an increased risk of complications and infections, and are associated with poor quality of life and worse outcomes. BC assessment is important to identify malnutrition and sarcopenia. However, gold-standard techniques are not available in all clinical settings. Aims: this study aimed to evaluate the agreement and reliability of body composition estimated by bioelectric impedance analysis (BIA) and measured using dual-energy X-ray absorptiometry (DEXA) in women with interstitial lung disease. Methods: this is a cross-sectional study. BC (fat mass and appendicular skeletal muscle mass) were assessed using BIA multifrequency and DEXA in standardized conditions. Agreement and reliability between techniques were evaluated using Bland-Altman plots and the intraclass correlation coefficient (ICC). Results: a total of 50 women were evaluated. No differences were observed for FM (BIA, 25.8 ± 10.2 kg and DEXA, 26.3 ± 10.0 kg, p = 0.77) and ASMM (BIA, 14.1 ± 2.7 kg and DEXA, 13.9 ± 2.3 kg, p = 0.83). Based on ICC, good reliability was observed for FM (ICC, 0.98) and ASMM (ICC, 0.93). Conclusion: BC estimated by BIA showed good agreement and reliability with DEXA measurements. In the absence of this method, BIA can replace the DEXA technique for body composition assessment.

Introducción: Introducción: los cambios en la composición corporal son comunes en la enfermedad pulmonar intersticial, lo cual incrementa el riesgo de complicaciones e infecciones, además de asociarse a peor calidad de vida y peores desenlaces clínicos. La evaluación de la composición corporal es importante para identificar la desnutrición y la sarcopenia, sin embargo, las técnicas consideradas "estándar de oro" no se encuentran disponibles en todos los entornos clínicos. Objetivo: este estudio tiene por objetivo evaluar la validez y concordancia de los parámetros de composición corporal obtenidos por análisis de bioimpedancia eléctrica (BIA) en comparación con la técnica de absorciometría de rayos X de doble energía (DEXA) en mujeres con enfermedad pulmonar intersticial. Métodos: estudio transversal donde se midió la composición corporal (masa grasa y masa muscular apendicular esquelética) utilizando un equipo de bioimpedancia eléctrica multifrecuencia y DEXA en condiciones estandarizadas. Se evaluó la concordancia y validez entre las técnicas utilizando gráficos Bland-Altman y el coeficiente de correlación intraclase (CCI). Resultados: se evaluaron un total de 50 mujeres. No se observaron diferencias en los valores de masa grasa (BIA: 25,8 ± 10,2 kg y DEXA: 26,3 ± 10,0 kg, p = 0,77), ni en los de masa muscular apendicular esquelética (BIA: 14,1 ± 2,7 kg y DEXA: 13,9 ± 2,3 kg, p = 0,83). Acorde a los valores del CCI, se observa una validez buena para los valores de masa grasa (CCI: 0,98) y de masa muscular apendicular esquelética (CCI: 0,93). Conclusión: la composición corporal estimada por BIA muestra una buena concordancia y validez con el resultado obtenido por DEXA en mujeres con enfermedad pulmonar intersticial. En ausencia de este método, la BIA puede utilizarse para la valoración de la composición corporal en este grupo de pacientes.

Zinc and selenium supplementation on treated HIV-infected individuals induces changes in body composition and on the expression of genes responsible of naïve CD8+ T cells function.

Background and aim: Deficiency of zinc and selenium is common in persons living with human immunodeficiency virus (PLWHIV) and has been associated with the development of non-AIDS related comorbidities, impaired immune system function and mortality. Micronutrient supplementation on long-term-treated PLWHIV could bring potential clinical and immunological benefits improving their health status and quality of life. The aim of the present study is to analyze the effect of zinc and selenium supplementation on body composition, bone mineral density, CD4+ T-cell counts, metabolic profile and immune system status on clinical stable PLWHIV on long-term antiretroviral therapy (ART). Methods: This is a randomized pilot clinical trial in which we recruited 60 PLWHIV on ART who were assigned to the intervention groups: zinc (30 mg of zinc gluconate), selenium (200 µg of selenium yeast), zinc + selenium (same doses and presentations) or to a control group (without nutritional supplementation) who received supplementation during 6 months. Primary outcome was defined as changes in body composition (weight, muscle and fat mass and bone mineral density) and secondary outcomes as changes in biochemical and immunological parameters (CD4+ T-cell count, cholesterol, glucose, triglycerides and seric zinc and selenium seric concentrations) before and after supplementation. Peripheral blood mononuclear cells (PBMCs) of one individual of each intervention group were analyzed for single cell transcriptomics before and after supplementation. Results: BMI (p = 0.03), fat mass (p = 0.03), and trunk fat (p = 0.01) decreased after 6 months of selenium supplementation. No changes were observed for cholesterol, glucose or triglycerides after supplementation (p > 0.05 in all cases). CD4+ T cells percentage increased after 6 months of selenium supplementation (p = 0.03). On the transcriptome analysis, zinc and selenium supplementation induced changes on de expression of genes associated with the function of naive and memory CD8+ T-cells (p < 0.05 in all cases). Conclusion: Zinc and selenium supplementation could represent a complementary intervention that may improve the health status and immune response of treated PLWHIV.

Fluid Status Assessment in Critically Ill Patients with COVID-19: A Retrospective Cohort Study.

Fluid status (FS) is a diagnostic challenge in critically ill patients with COVID-19. Here, we compared parameters related to FS derived from cumulative fluid balance (CFB), bioelectrical impedance analysis (BIA) and venous congestion assessed by ultrasound (VExUS) to predict mortality. We retrospectively reviewed the medical records of individuals with severe pneumonia due to COVID-19 between July and November 2021 in a single center. Comorbidities, demographic, clinical and laboratory data as well as results from CFB, BIA and VExUS measurements were collected on admission and weekly afterwards for two consecutive evaluations. Seventy-nine patients were included, of which eighteen (14.2%) died. Abnormalities of FS were only identified by BIA. Extracellular water/total body water ratio (ECW/TBW) > 0.394 (overhydrated) by BIA was a good predictor of mortality (AUC = 0.78, 95% CI: 0.067-0.89). Mortality risk was higher in overhydrated patients (OR: 6.2, 95% CI: 1.2-32.6, p = 0.02) and in persistently overhydrated patients (OR: 9.57, 95% CI: 1.18-77.5, p = 0.03) even after adjustment to age, serum albumin and acute kidney injury (AKI) in stages 2-3. Time to death was shorter in overhydrated patients (HR: 2.82, 95% CI: 1.05-7.5, log-rank test p = 0.03). Abnormalities in FS associated with mortality were only identified by BIA in critically ill patients with COVID-19.

Changes in pulmonary mechanics from supine to prone position measured through esophageal manometry in critically ill patients with COVID-19 severe acute respiratory distress syndrome.

OBJECTIVE: To describe changes in pulmonary mechanics when changing from supine position (SP) to prone position (PP) in mechanically ventilated (MV) patients with Acute Respiratory Distress Syndrome (ARDS) due to severe COVID-19. DESIGN: Retrospective cohort. SETTING: Intensive Care Unit of the National Institute of Respiratory Diseases (Mexico City). PATIENTS: COVID-19 patients on MV due to ARDS, with criteria for PP. INTERVENTION: Measurement of pulmonary mechanics in patients on SP to PP, using esophageal manometry. MAIN VARIABLES OF INTEREST: Changes in lung and thoracic wall mechanics in SP and PP RESULTS: Nineteen patients were included. Changes during first prone positioning were reported. Reductions in lung stress (10.6 vs 7.7, p=0.02), lung strain (0.74 vs 0.57, p=0.02), lung elastance (p=0.01), chest wall elastance (p=0.003) and relation of respiratory system elastances (p=0.001) were observed between patients when changing from SP to PP. No differences were observed in driving pressure (p=0.19) and transpulmonary pressure during inspiration (p=0.70). CONCLUSIONS: Changes in pulmonary mechanics were observed when patients were comparing values of supine position with measurements obtained 24h after prone positioning. Esophageal pressure monitoring may facilitate ventilator management despite patient positioning.

Feeding intolerance during prolonged prone position in overweight and obese patients with severe COVID-19.

Introduction: Objective: the aim of this study was to compare the incidence rate of feeding intolerance (FI) during supine (SP) or prone positioning (PP) in critically ill COVID-19 patients. Methods: this was a retrospective cohort study of critically ill patients with overweight or obesity who received enteral nutrition (EN) in prone or supine positioning continuously during the first five days of mechanical ventilation. Nutritional risk, anthropometric measurements and body composition were assessed at the first 24 hours upon Intensive Care Unit (ICU) admission. Biochemical and clinical variables (Sequential Organ Failure Assessment [SOFA], Acute Physiology and Chronic Health Evaluation II [APACHE II], Acute Kidney Injury [AKI] or comorbidities diagnosis) were collected. Pharmacotherapy (prokinetics, sedatives or neuromuscular blocking agents) and FI incidence (gastric residual volume [GRV] ≥ 200 ml or ≥ 500 ml, vomiting or diarrhea) were daily recorded. Constipation was defined as the absence of evacuation for five consecutive days. Results: eighty-two patients were included. Higher rate of prophylactic prokinetic prescription was observed in PP (42.8 vs 12.5 %, p = 0.002). GRV ≥ 200 in supine position was not different when compared to PP (p = 0.47). Vomiting episodes in supine compared to PP showed no difference between groups (15 % vs 24 %, p = 0.31). No differences in diarrhea events were detected (10 % vs 4.7 %, p = 0.36). Constipation was common in both groups (95 % vs 82 %, p = 0.06). Conclusion: FI during prone position was not different in comparison to supine position. Routinely use of prokinetics in continuous prone position may help to prevent FI incidence. Algorithm development is necessary for FI prevention and treatment so to avoid EN interruptions and adverse clinical outcomes.

Introducción: Objetivo: comparar la incidencia de intolerancia a la alimentación entre pacientes críticos en posición supino (PS) o prono (PP). Métodos: cohorte retrospectiva de pacientes bajo ventilación mecánica por distrés respiratorio por COVID-19 y sobrepeso y obesidad, quienes recibieron nutrición enteral (NE) en PP o PS. Se evaluaron riesgo nutricional, mediciones antropométricas y composición corporal en las primeras 24 horas de ingreso a la Unidad de Cuidados Intensivos (UCI). Se recolectaron variables bioquímicas y clínicas (Sequential Organ Failure Assessment [SOFA], Acute Physiology and Chronic Health Evaluation II [APACHE II], lesión renal aguda y otras comorbilidades). Se registró el esquema de farmacoterapia prescrita durante los primeros cinco días (procinéticos, sedantes y bloqueadores neuromusculares). Se evaluó la incidencia de intolerancia a la alimentación, definida como la presencia de residuo gástrico (RG) ≥ 200 o ≥ 500 ml, vómito, diarrea o estreñimiento. Resultados: fueron incluidos 82 pacientes. Se observó una mayor prescripción de procinéticos como terapia profiláctica en PP (42,8 vs. 12,5 %, p = 0,002). No se observaron diferencias en RG ≥ 200 ml (p = 0,47) ni vómito (p = 0,31) entre ambos grupos. No se observaron diferencias en episodios de diarrea (10 % en PS vs. 4,7 % en PP, p = 0,36). El estreñimiento fue común en ambos grupos de estudio (95 vs. 82 %, p = 0,06). Conclusiones: la PP no se relaciona con una mayor incidencia de intolerancias a la alimentación. El uso rutinario de procinéticos durante la PP continua puede ayudar a prevenir la incidencia de dichas intolerancias. Es necesario el desarrollo de algoritmos para la prevención y tratamiento de las intolerancias a la alimentación para evitar interrupciones en la NE y desenlaces no deseables.

Association between kidney biopsy findings in CKD patients with diabetes and renal replacement therapy initiation, a perspective from a low-middle income country.

Kidney disease in diabetes mellitus is usually explained by diabetic kidney disease, but other superimposed etiologies occur frequently. The distinction between diabetic kidney disease and non-diabetic kidney disease can only be made by performing kidney biopsy. Our objective was to evaluate the association of diabetic kidney disease, non-diabetic kidney disease, or both with renal replacement therapy initiation. This is a retrospective cohort that included patients with type 2 diabetes mellitus for whom a kidney biopsy was indicated. Subjects were followed-up for 5 years, until renal replacement therapy initiation or were lost to follow up. One hundred and forty-one patients were included, 53 (39%) had diabetic kidney disease, 13 (9%) had non-diabetic kidney disease and 75 (54%) had both. Ninety-four percent of the cohort initiated renal replacement therapy during the 5-year follow-up. Higher degree of fibrosis was associated with a trend towards higher risk of requiring renal replacement therapy. In addition, the combined diabetic kidney disease + non-diabetic kidney disease group was associated with higher need of renal replacement therapy initiation when compared to the diabetic kidney disease group.

Phase angle as predictor of malnutrition in people living with HIV/AIDS.

BACKGROUND: Phase angle (PhA), measured by bioelectrical impedance analysis (BIA) has been studied as an indicator of survival in people living with HIV (PLWH). However, it remains unclear whether PhA is associated with malnutrition or low CD4+ T-cell counts. OBJECTIVE: In this study, we assessed the discriminative capacity of PhA for malnutrition detection using Global Leadership Initiative on Malnutrition (GLIM) criteria in PLWH, aiming to propose cutoff points for this population. METHODS: This retrospective observational study included 427 adult PLWH (13% female). Participants were classified according to malnutrition status by using GLIM criteria. Body composition was assessed by using BIA. CD4+ T-cell counts were determined by flow cytometry. RESULTS: According to GLIM criteria, 30% of the participants were malnourished. Multivariate regression analysis showed that PhA (adjusted odds ratio [OR], 0.10; 95% CI, 0.05-0.18; P < 0.001), fat-mass percentage (adjusted OR, 0.86; 95% CI, 0.82-0.90; P < 0.001), and male sex (adjusted OR, 0.26; 95% CI, 0.09-0.76; P = 0.013) were independently associated with malnutrition. A PhA cutoff of 5.45° in men and 4.95° in women may predict malnutrition with sensitivity and specificity >70%. CONCLUSION: PhA could be a valid, useful, and simple predictor of malnutrition in PLWH.

Low phase angle is associated with 60-day mortality in critically ill patients with COVID-19.

BACKGROUND: Malnutrition status, body composition indicators, and bioelectrical impedance analysis (BIA) parameters have been associated with increased risk of death in several pathologies. The aim of this study was to describe the associations between phase angle (PhA) indicators obtained by BIA with length of hospital stay, days on mechanical ventilation, and 60-day mortality in critically ill patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). METHODS: This is a prospective cohort of mechanically ventilated patients with coronavirus disease 2019 (COVID-19). We assessed nutrition risk and body composition with BIA within 48 h from intensive care unit admission. Logistic and linear regression models were used to analyze the association between variables and clinical outcomes. Survival analysis by PhA value was performed using Kaplan-Meier curves. RESULTS: Sixty-seven patients were included. PhA (odds ratio [OR], 0.36; P = .002), standardized PhA (SPA) (OR, 0.45; P = .001), and extracellular water/total body water ratio (OR, 3.25; P = .002) were significant predictors of 60-day mortality. PhA <3.85° in females and <5.25° in males showed good and fair discrimination, respectively, for mortality prediction. Using cutoff values, low PhA was associated with a significantly increased risk of 60-day mortality (hazard ratio, 3.08; 95% CI, 1.12-8.41; P = .02). No association was detected for SPA. CONCLUSION: Low PhA values could be a predictor of 60-day mortality in critically ill patients with COVID-19. This biological marker could be incorporated as part of nutrition and mortality risk assessment in this population.

High nutritional risk using NUTRIC-Score is associated with worse outcomes in COVID-19 critically ill patients.

INTRODUCTION: Background: nutritional risk has been associated with worse outcomes at the critical care unit. The aim of this study was to describe the association between nutritional risk and length of stay, days on mechanical ventilation, and in-hospital mortality in patients infected with SARS-CoV-2. Methods: a retrospective cohort of ventilated, critically ill patients. We assessed nutrition risk at baseline using NUTRIC-score. Logistic and linear regression models were used to analyze the association between NUTRIC-score and clinical outcomes (days on mechanical ventilation, hospital length of stay, and in-hospital mortality). A survival analysis was performed using Kaplan-Meier curves. Results: a total of 112 patients were included, 39.3 % were overweight and 47.3 % were obese. Based on NUTRIC-Score, 66 % and 34 % of patients were at high and low nutritional risk, respectively. High nutritional risk was associated with increased mortality risk (OR: 2.4, 95 % CI, 1.06-5.47, p = 0.036) and higher 28-day mortality (HR: 2.05, 95 % CI, 1.01-4.23, p = 0.04) in comparison with low risk. Conclusion: high nutritional risk is related to mortality in SARS-CoV-2 critically ill patients. Overweight and obesity are common in this sample. More studies are needed to elucidate the impact of nutritional therapy on infection course and outcomes.

INTRODUCCIÓN: Introducción: el riesgo nutricional se asocia a peores desenlaces en los pacientes en estado crítico. El objetivo de este estudio es describir la asociación entre el riesgo nutricional y los días de estancia hospitalaria, los días de ventilación mecánica y la mortalidad en pacientes infectados por el SARS-CoV-2. Métodos: cohorte retrospectiva de pacientes en estado crítico bajo ventilación mecánica invasiva. Se evaluó el riesgo nutricional utilizando la herramienta NUTRIC-Score. Se utilizaron regresiones lineares y logísticas para evaluar la asociación entre el riesgo nutricional y los desenlaces clínicos (días de ventilación mecánica, días de estancia hospitalaria y mortalidad hospitalaria). Se utilizaron curvas de Kaplan-Meier para analizar la sobrevivencia. Resultados: se incluyeron 112 pacientes, el 39,3 % con diagnóstico de sobrepeso y el 47,3 % con obesidad de acuerdo con el IMC. Utilizando la herramienta NUTRIC-Score, el 66 % tenían riesgo nutricional alto y el 34 % riesgo nutricional bajo. El riesgo nutricional alto se asoció a un mayor riesgo de mortalidad (OR: 2,4; IC 95 %: 1,06-5,47; p = 0,036) y mayor mortalidad a 28 días (HR: 2,05; IC 95 %: 1,01-4,23; p = 0,04) en comparación con los individuos con riesgo nutricional bajo. Conclusión: el riesgo nutricional alto se asocia con mortalidad en los pacientes con infección por SARS-CoV-2 en estado crítico. El sobrepeso y la obesidad son comunes en este grupo de pacientes. Se necesitan más estudios que evalúen el impacto de la terapia nutricional sobre el curso de la infección y los desenlaces clínicos.

[Nutrition and peritoneal dialysis: Fundaments and practical aspects for dietary prescription]. / Nutrición y diálisis peritoneal: fundamentos y aspectos prácticos para la prescripción dietética.

The number of patients with advanced / end-stage chronic kidney disease (ESRD) with some modality of renal replacement therapy (RRT) has been on the rise significantly. Peritoneal dialysis (PD) represents 11% of the world dialysis population. Different options for RRT have been associated with a greater risk of developing complications, such infections, metabolic alterations and nutritional complications, specifically a higher incidence of protein-energy wasting (PEW), ranging from 32 to 49% in PD patients. Peritoneal transporter type plays an important role in the development of nutritional complications, where the high transporter compared to the slow or low transporter has been associated with a higher nutritional risk by increasing the risk of volume overload, hypertension, and inflammation; as well as greater loss of proteins in the dialysate due to the greater number of replacements that characterize its prescription. Nutrition specialists needs to consider diverse aspects to achieve an individualized nutritional approach based on the characteristics of the patient, where knowing peritoneal transporter type is essential. The aim of this study is to review the evidence available to date regarding nutritional therapy in patients with peritoneal dialysis, as well as to analyze some basic aspects of dialysis therapy.

El número de pacientes con enfermedad renal crónica avanzada/terminal (ERCT) con alguna modalidad de terapia de reemplazo renal (TRR) ha ido en ascenso. A nivel mundial, la diálisis peritoneal (DP) representa el 11% del total de pacientes con TRR. Las diferentes opciones de TRR se han asociado con un mayor riesgo para desarrollar complicaciones infecciosas, metabólicas y nutricionales, reportándose cifras alarmantes de desgaste proteico energético (DPE) que oscilan entre 32-49% en pacientes en DP. El tipo de transportador peritoneal juega un rol importante en el desarrollo de complicaciones nutricionales, donde el transportador alto, en comparación con el lento o bajo, se ha asociado con un mayor riesgo nutricional al incrementar el riesgo de sobrecarga de volumen, hipertensión e inflamación; así como mayor pérdida de proteínas en el dializado por el mayor número de recambios que caracteriza su prescripción. Por tal motivo, el profesional de la nutrición debe considerar diversos aspectos para lograr un abordaje nutricional individualizado a partir de las características del paciente, en el que conocer el tipo de transportador peritoneal es fundamental. El objetivo del presente trabajo es realizar una revisión de la evidencia disponible hasta la fecha respecto a la terapia nutricional del paciente con diálisis peritoneal, así como analizar algunos aspectos básicos de la terapia dialítica.

Malnutrition and tuberculosis: the gap between basic research and clinical trials.

Mycobacterium tuberculosis (M.tb) is the causative agent of tuberculosis (TB), an infectious disease that leads to numerous deaths worldwide. Malnutrition, smoking, alcohol abuse, Human Immunodeficiency Virus infection, and diabetes are some of the most important risk factors associated with TB development. At present, it is necessary to conduct studies on risk factors to establish new effective strategies and combat this disease. Malnutrition has been established as a risk factor since several years ago; although there is in vitro experimental evidence that reveals the importance of micronutrients in activating the immune response against M.tb, evidence from clinical trials is controversial. Currently, nutritional assessment is recommended in all TB patients upon diagnosis. However, there is insufficient evidence to indicate micronutrient supplementation as adjuvant therapy or prophylactic to prevent micronutrient depletion. Strengthening the interaction between basic and clinical research is necessary to carry out studies that will help establish adjuvant therapies to improve outcomes in TB patients. In this review, we discuss the experimental evidence, provided by basic research, regarding micronutrients in the TB field. However, when these studies are applied to clinical trials, the data are inconsistent, indicating that still missing mechanisms are necessary to propose alternatives to the treatment of TB patients.

Agreement between body composition techniques in children and adolescents: narrative review of the literature. / Concordancia entre técnicas de composición corporal en niños y adolescentes: revisión narrativa de la literatura

Body composition monitoring is important to understand the effect of diet, physical activity, illness and growth on body stores. Body composition determination by accuracy and reproducibility techniques is essential. The objective of this study was to analyze the agreement between body composition techniques in children and adolescents. Literature search was performed using the PubMed, Scielo and Google Scholar databases. Only observational studies realized in children and adolescents that analyze agreement between two or more body composition techniques were included. Thirty studies were included. Dual-energy X-ray absorptiometry, air displacement plethysmography, hydrodensitometry, deuterium dilution and four compartment model were the techniques for body composition measurement and bioelectrical impedance and anthropometry were used to estimate body composition. Agreement and correlation between methods was influenced by study populations and by technique considered as gold standard for comparisons. In conclusion, there is a low agreement between the different methods to assess body composition. Correlation and agreement interpretation are essential for body composition assessment in children and adolescents. Is recommended the use of equations developed and validated in this populations.

El monitoreo de la composición corporal (CC) permite comprender los efectos de la dieta, el ejercicio físico, la presencia de procesos patológicos y el crecimiento en las reservas corporales; de ahí la importancia de su determinación con técnicas exactas y reproducibles. El objetivo de la presente revisión es analizar la concordancia entre las distintas técnicas para evaluar la CC en población infantil y adolescente. Se realizó una búsqueda no sistemática de la literatura en las bases de datos PubMed, Scielo y Google Scholar para identificar estudios cuyo objetivo primario fuera la evaluación de la concordancia entre dos o más métodos de determinación de la CC. Se incluyeron 30 estudios para la revisión. Los métodos identificados para la medición de la CC fueron la absorciometría dual de rayos X, la pletismografía de gases (BOD-POD), la hidrodensitometría, la dilución de deuterio (D2O) y el modelo de cuatro compartimentos, utilizando bioimpedancia eléctrica y antropometría para la estimación. La concordancia y la correlación entre métodos varía según los diferentes grupos poblacionales y la técnica utilizada como método de referencia. Se concluye que existe una baja concordancia entre los distintos métodos para evaluar la composición corporal. La interpretación de la correlación y la concordancia de los diferentes métodos resulta esencial para evaluar la CC en niños y adolescentes. Se sugiere utilizar ecuaciones desarrolladas o validadas para el grupo en estudio.

Zinc and selenium indicators and their relation to immunologic and metabolic parameters in male patients with human immunodeficiency virus.

OBJECTIVES: Micronutrient deficiencies are common among people living with HIV (PLWHIV). The clinical and immunologic consequences of micronutrient deficiencies have been poorly explored in the context of human immunodeficiency virus (HIV) infection. The aim of this study was to determine the prevalence of zinc and selenium deficiency (dietary intake and serum concentrations) and analyze their associations with absolute CD4+ T-cell counts, inflammation markers, and metabolic disorders in a cohort of antiretroviral-experienced HIV-infected individuals. METHODS: The zinc and selenium intakes of 124 HIV-infected men were estimated using 3-d food records. In a subcohort of 45 individuals, serum zinc and selenium concentrations and proinflammatory cytokines were determined. Body composition, bone mineral density (BMD), CD4+ T-cell counts, lipid profile, glucose, and blood pressure were determined and were associated with zinc and selenium dietary intake and serum concentrations. RESULTS: Of the PLWHIV studied, 58% had suboptimal intake of zinc and 8% demonstrated suboptimal intake of selenium. Serum deficiencies for zinc and selenium were 23.9% and 65.9%, respectively. Zinc and selenium intake were correlated with increased muscle mass. Selenium intake was associated with increased BMD of the lumbar region. An inverse correlation between serum selenium concentration and several proinflammatory cytokines (interleukin-1ß, interleukin-6, and tumor necrosis factor-α) was found. CONCLUSION: Suboptimal zinc and selenium intake and serum concentration deficiencies are highly prevalent in treated HIV-positive individuals and are associated with body composition, BMD, and inflammation. Clinical trials should be designed to explore the effect of zinc and selenium supplementation on metabolic, inflammatory, and immunologic parameters on the HIV-positive population.

Phase angle and mid arm circumference as predictors of protein energy wasting in renal replacement therapy patients.

INTRODUCTION: Objective: to analyze the association between phase angle (PA) and mid arm circumference (MAC) with protein energy wasting (PEW) in renal replacement therapy (RRT) patients. Methods: cross-sectional study. Hemodiafiltration (HDF) and automated peritoneal dialysis (PD) patients were enrolled in the study. MAC and body composition were measured using impedance bioelectric (BIA); PA, fat free mass (FFM), fat mass (FM) and ECW/TBW were obtained. Biochemical (serum albumin and cholesterol) and dietary data (energy and protein intake) were collected. Body mass index (BMI) was calculated. Patients were classified with PEW according to ISRNM criteria (low BMI, low albumin or cholesterol concentrations, low muscle mass and overhydration). Cut-off point of PA and MAC was obtained by ROC analysis. Logistic regression analysis was applied to evaluate the ability of both indicators to predict PEW. Results: sixty-nine patients were included in the study. Fifty-two (52%) were female. Thirty-nine (39%) patients had PEW. The ROC curve reveals that the optimal PA cut-off value for malnutrition risk was 4.64° with 77.8% sensitivity and 76.2% specificity. For MAC, a cut-off value of 29.6 cm shows a sensitivity of 66.6% and specificity of 69.0%. Both indicators showed significant association to PEW after multivariate adjustment. Conclusion: PEW is present almost in 39% of the RRT patients. PA and MAC are useful, simple and independents indicators for predicting PEW in Chronic Kidney disease patients on RRT.

INTRODUCCIÓN: Objetivo: analizar la asociación entre el ángulo de fase (AF) y la circunferencia media del brazo (CMB) con la presencia de desgaste proteico energético (DPE) en pacientes en terapia de remplazo renal (TRR). Métodos: estudio transversal. Fueron incluidos pacientes en hemodiafiltración y en diálisis peritoneal automatizada. Se tomaron mediciones de CMB y de composición corporal utilizando bioimpedancia eléctrica (AF, masa libre de grasa, masa grasa y agua extracelular/agua corporal total). Se obtuvieron mediciones de albúmina y colesterol y se cuantificó el consumo dietético de energía y proteína. Se calculó el IMC. Se diagnosticó el DPE utilizando los criterios de ISRNM (bajo IMC, baja albúmina o colesterol, baja musculatura y sobrehidratación). Se evaluó la habilidad del AF y CMB para predecir DPE a través de una regresión logística. Se obtuvieron puntos de corte para ambos indicadores utilizando una prueba ROC. Se evaluó la habilidad del AF y CMB para predecir DPE a través de una regresión logística. Resultados: se incluyeron 69 pacientes en el estudio, el 52% de sexo femenino, y el 39% cumplieron criterios para DPE. El AF y el CMB predicen de forma adecuada el DPE según el análisis multivariado. Los puntos de corte obtenidos por la prueba ROC son < 4,64° para AF, con una sensibilidad del 77,8% y una especificidad del 76,2%, y < 29,6 cm para la CMB, con una sensibilidad del 66,6% y una especificidad del 69%. Conclusión: el DPE está presente en el 39% de pacientes en TRR. El AF y CMB son indicadores independientes, útiles y simples para predecir DPE en pacientes con enfermedad renal crónica en TRR.

Accuracy of Predictive Equations for Energy Expenditure in Mexicans Living With HIV/AIDS With and Without Antiretroviral Therapy.

INTRODUCTION: Determination of the resting energy expenditure (REE) is essential for planning nutrition therapy in patients with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) to help to improve their nutrition status. We aim to evaluate the agreement and accuracy of prediction equations that estimate the REE in a Mexican population with a diagnosis of HIV/AIDS with and without antiretroviral therapy (ART). METHODS: A cross-sectional study in Mexican patients with HIV/AIDS with and without ART. Weight, height, and body composition measured with dual-energy x-ray absorptiometry were evaluated. The REE was determined with indirect calorimetry and estimated using the Mifflin-St Jeor (MSJ), Harris-Benedict (HB), Schofield 1 and 2, Cunningham, Melchior 91, Melchior 93, and Batterham equations. The Bland-Altman method assessed agreement between the real and estimated values, and the percent difference between these values was used to assess the prediction accuracy. RESULTS: Sixty-five adults without ART and 102 adults with ART were included. The mean REE (kcal/kg) was 24.8 ± 2.4 and 23.8 ± 3.6 in patients without and with ART, respectively. Good agreement and reliability were observed in the HB (intraclass correlation coefficient [ICC], 0.75; P < .05), Batterham (ICC, 0.79; P < .05), Schofield 1 (ICC, 0.74; P < .05), and Schofield 2 (ICC, 0.78; P < .05) results in individuals without ART. In individuals with ART, good agreement and reliability were observed with the HB equation (ICC, 0.76; P < .05). The MSJ equation showed good agreement with poor reliability (ICC, 0.05; P < .05). CONCLUSION: The equations with the best agreement and accuracy were Schofield 2, Batterham, and HB in individuals without ART and HB and MSJ in the population with ART.

Feeding intolerance during prolonged prone position in overweight and obese patients with severe COVID-19 / Intolerancia a la alimentación durante el prono prolongado en pacientes con COVID-19 y sobrepeso y obesidad

Objective: the aim of this study was to compare the incidence rate of feeding intolerance (FI) during supine (SP) or prone positioning (PP) in critically ill COVID-19 patients. Methods: this was a retrospective cohort study of critically ill patients with overweight or obesity who received enteral nutrition (EN) in prone or supine positioning continuously during the first five days of mechanical ventilation. Nutritional risk, anthropometric measurements and body composition were assessed at the first 24 hours upon Intensive Care Unit (ICU) admission. Biochemical and clinical variables (Sequential Organ Failure Assessment [SOFA], Acute Physiology and Chronic Health Evaluation II [APACHE II], Acute Kidney Injury [AKI] or comorbidities diagnosis) were collected. Pharmacotherapy (prokinetics, sedatives or neuromuscular blocking agents) and FI incidence (gastric residual volume [GRV] ≥ 200 ml or ≥ 500 ml, vomiting or diarrhea) were daily recorded. Constipation was defined as the absence of evacuation for five consecutive days. Results: eighty-two patients were included. Higher rate of prophylactic prokinetic prescription was observed in PP (42.8 vs 12.5 %, p = 0.002). GRV ≥ 200 in supine position was not different when compared to PP (p = 0.47). Vomiting episodes in supine compared to PP showed no difference between groups (15 % vs 24 %, p = 0.31). No differences in diarrhea events were detected (10 % vs 4.7 %, p = 0.36). Constipation was common in both groups (95 % vs 82 %, p = 0.06). Conclusion: FI during prone position was not different in comparison to supine position. Routinely use of prokinetics in continuous prone position may help to prevent FI incidence. Algorithm development is necessary for FI prevention and treatment so to avoid EN interruptions and adverse clinical outcomes. (AU)

Objetivo: comparar la incidencia de intolerancia a la alimentación entre pacientes críticos en posición supino (PS) o prono (PP). Métodos: cohorte retrospectiva de pacientes bajo ventilación mecánica por distrés respiratorio por COVID-19 y sobrepeso y obesidad, quienes recibieron nutrición enteral (NE) en PP o PS. Se evaluaron riesgo nutricional, mediciones antropométricas y composición corporal en las primeras 24 horas de ingreso a la Unidad de Cuidados Intensivos (UCI). Se recolectaron variables bioquímicas y clínicas (Sequential Organ Failure Assessment [SOFA], Acute Physiology and Chronic Health Evaluation II [APACHE II], lesión renal aguda y otras comorbilidades). Se registró el esquema de farmacoterapia prescrita durante los primeros cinco días (procinéticos, sedantes y bloqueadores neuromusculares). Se evaluó la incidencia de intolerancia a la alimentación, definida como la presencia de residuo gástrico (RG) ≥ 200 o ≥ 500 ml, vómito, diarrea o estreñimiento. Resultados: fueron incluidos 82 pacientes. Se observó una mayor prescripción de procinéticos como terapia profiláctica en PP (42,8 vs. 12,5 %, p = 0,002). No se observaron diferencias en RG ≥ 200 ml (p = 0,47) ni vómito (p = 0,31) entre ambos grupos. No se observaron diferencias en episodios de diarrea (10 % en PS vs. 4,7 % en PP, p = 0,36). El estreñimiento fue común en ambos grupos de estudio (95 vs. 82 %, p = 0,06). Conclusiones: la PP no se relaciona con una mayor incidencia de intolerancias a la alimentación. El uso rutinario de procinéticos durante la PP continua puede ayudar a prevenir la incidencia de dichas intolerancias. Es necesario el desarrollo de algoritmos para la prevención y tratamiento de las intolerancias a la alimentación para evitar interrupciones en la NE y desenlaces no deseables. (AU)