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Introduction: the relationship between thirst and dehydration in terminal patients at end of life is limited and the current bibliography agree with this controversy. Due to the lacking of scientific evidences the decision to rehydrate of these patients is based on the usual clinical practice. Objectives: to evaluate the hydration status of oncological patients with palliative care by Bioelectrical impedance analysis (BIA). Method: this scientific initiative will evaluate the hydration status of 50 oncological patients admitted with palliative care at University Hospital La Paz by BIA, excluding those who according with their Palliative- Pronostic-Score (PaP-Score) get a 30-day survival probability <30%. It is a descriptive, observational and cross-sectional study. The main variable will be the phase angle and as secondary variables: evaluation of the nutritional status by Subjective-Global-Assessment (SGA), corporal composition (BIA) and functional capability (dynamometry). Besides it will evaluate: PaP-Score, Palliative-Performance-Scale (PPS), disability (Barthel-Test), cognitive function (Pfeffer-Test), dehydration symptoms and biochemical parameters. Results: preliminary results of statistical analysis will be exposed once they achieve the estimated sample size (confidence level 95%, differences' average 0.610, DS 2,200). Conclusions: the study of the oncological with palliative care patient's hydration status provides scientific evidence to implementation of action protocols to properly rehydrate those patients. [ABSTRACT FROM AUTHOR]

Background <£ Aim: n-3 fatty acid intake has been associated with inflammatory benefits in cardiovascular disease (CVD). Functionalising meat may be of great interest. The aim of the present study was to assess the effect of functional meat containing n-3 and rosemary extract on inflammatory and oxidative status markers in subjects with risk for CVD. Methods and results: A randomised, double-blind, cross-over study was undertaken to compare the effects on the above markers of consuming functional or control meat products. 43 volunteers with at least two lipid profile variables showing risk for CVD were randomly assigned to receive functional meat (FM) or control meat (CM) over 12-weeks with a 4-week wash-out interval before crossover. Functional effects were assessed by examining lipid profile, CRP, PAI-1, TNF-alpha, IL-6, fibrinogen (inflammatory markers), and TEARS, FRAP and 8-iso-PGF2a (oxidative status markers). 33 subjects (24 women) aged 50.7±8.8 years completed the study. In FM treatment, PAI-1, fibrinogen and 8-iso-PGF2a decreased significantly after 12 weeks, while FRAP significantly increased. In contrast, in CM treatment, a significant increase was seen in PAI-1, while FRAP significantly declined. Significant differences were also seen between the FM and CM treatments after 12 weeks in terms of the change observed in PAI-1, FRAP and 8-iso-PGF2a values. No significant differences were seen in anthropometric variables nor were adverse effects reported. Conclusion: The consumption of FM containing n-3 and rosemary extract improved oxidative and inflammatory status of people with at least two lipid profile variables showing risk for CVD. The inclusion of such functional meat in a balanced diet might be a healthy lifestyle option. ClinicalTrials.gov NCT0199088. [ABSTRACT FROM AUTHOR]

Background and objectives: The aim of this study was to describe the hormonal and inflammatory status of a group of overweight/obese women. Patients and methods: The sample studied was a crosssectional cohort of women > 18 years of age, BMI >= 25 < 40 kg/m², prior to starting a weight control program. Data collected were: demographic characteristics, blood pressure, anthropometric parameters, physical activity data, and biochemical, hormonal and inflammatory biomarkers. Results: The study involved 104 women with a mean age of 48.4 ± 9 years and a BMI of 29.8 ± 3.5 kg/m². Some 48% of the women studied were in menopause. Some 8.9% had hyperinsulinemia. The mean ghrelin value was 38.8 ± 33.6 pg/ml; there was no correlation between ghrelin levels and anthropometric and biochemical variables. CRP, leptin, adiponectin, resistin, IL6, IL10, and PAI1 were 3.0 ± 2.7 mg/dl, 36.3 ± 19.5 ng/ml, 8.3 ± 4.5 mg/ml, 24.3 ± 23.2 ng/ml, 51.6 ± 93.6 pg/ml, 10.0 ± 34.2 pg/ml and 22.3 ± 30.6 ng/ml, respectively. Obese patients had significantly higher mean values of resistin and PAI 1 than those who were overweight. These levels correlated significantly with anthropometric and biochemical variables; however, the correlations were weak. Age, menopause or the regular practice of physical activity had no effect on mean values. Conclusions: The group of women studied had altered inflammatory biomarkers in relation to people of normal weight. The study shows the inflammatory status of overweight/ obese individuals, and the values obtained may help to establish standard ranges for these markers. [ABSTRACT FROM AUTHOR]

Background and objectives: The aim of this study was to describe the hormonal and inflammatory status of a group of overweight/obese women. Patients and methods: The sample studied was a cross-sectional cohort of women > 18 years of age, BMI ≥ 25 < 40 kg/m², prior to starting a weight control program. Data collected were: demographic characteristics, blood pressure, anthropometric parameters, physical activity data, and biochemical, hormonal and inflammatory biomarkers. Results: The study involved 104 women with a mean age of 48.4 ± 9 years and a BMI of 29.8 ± 3.5 kg/m². Some 48% of the women studied were in menopause. Some 8.9% had hyperinsulinemia. The mean ghrelin value was 38.8 ± 33.6 pg/ml; there was no correlation between ghrelin levels and anthropometric and biochemical variables. CRP, leptin, adiponectin, resistin, IL6, ILIO, and PAI1 were 3.0 ± 2.7 mg/dl, 36.3 ± 19.5 ng/ml, 8.3 ± 4.5 mg/ml, 24.3 ± 23.2 ng/ml, 51.6 ± 93.6 pg/ml, 10.0 ± 34.2 pg/ml and 22.3 ± 30.6 ng/ml, respectively. Obese patients had significantly higher mean values of resistin and PAI 1 than those who were overweight. These levels correlated significantly with anthropometric and biochemical variables; however, the correlations were weak. Age, menopause or the regular practice of physical activity had no effect on mean values. Conclusions: The group of women studied had altered inflammatory biomarkers in relation to people of normal weight. The study shows the inflammatory status of overweight/obese individuals, and the values obtained may help to establish standard ranges for these markers. [ABSTRACT FROM AUTHOR]

Introduction: designing functional foods to control appetite could be a useful strategy for managing overweight and obesity. Fiber and proteins could be interesting ingredients to consider., Objectives: to evaluate the appetite profile of two experimental yogurts (fiber-enriched [FEY] and protein-enriched [PEY]) versus a control yogurt (CY) in a group of overweight/obesity people., Material and Methods: an acute, randomized, double-blind, crossover clinical trial was carried out in a group of twelve healthy overweight/obesity type I people; randomized to consume 3 yogurts in a different order for 3 acute study days. The appetite profile (1. hunger, 2. satiety, 3. fullness, 4. prospective food consumption, 5. desire to eat something fatty, salty, sweet or savoury) was assessed using a Visual Analog Scale (ranging from 0 ''not at all'' to 10 ''extremely") at 12 moments in each acute study. Additionally, total food consumption in an ad libitum lunch was assessed., Results: FEY produce a significantly lower desire to consume any food at 30 (1.50 ± 0.42) and 60 minutes (2.78 ± 0.42) after consumption compared to PEY (3.46 ± 0.53; 4.33 ± 0.54) and CY (3.27 ± 0.69; 4.0 ± 0.78) respectively (p < 0.016). Also, FEY consumption produced a higher satiety and fullness and a lower desire to ingest something fatty, salty or savory after 90 minutes consumption compared to the other products, but the difference was not significance., Conclusion: FEY might be a good functional food prototype to control appetite in overweight and obese people.

Introduction: Anorexia nervosa (AN) is a multifactorial disorder. A possible role of the social network and the gut microbiota in pathogenesis has been added. Exogenous shocks such as the COVID19 pandemic have had a negative impact on patients with AN. The potential medical and nutritional impact of malnutrition and/or compensatory behaviors gives rise to a complex disease with a wide range of severity, the management of which requires a multidisciplinary team with a high level of subject matter expertise. Coordination between levels of care is necessary as well as understanding how to transition the patient from pediatric to adult care is essential. A proper clinical evaluation can detect possible complications, as well as establish the organic risk of the patient. This allows caregivers to tailor the medical-nutritional treatment for each patient. Reestablishing adequate nutritional behaviors is a fundamental pillar of treatment in AN. The design of a personalized nutritional treatment and education program is necessary for this purpose. Depending on the clinical severity, artificial nutrition may be necessary. Although the decision regarding the level of care necessary at diagnosis or during follow-up depends on a number of factors (awareness of the disease, medical stability, complications, suicidal risk, outpatient treatment failure, psychosocial context, etc.), outpatient treatment is the most frequent and most preferred choice. However, more intensive care (total or partial hospitalization) may be necessary in certain cases. In severely malnourished patients, the appearance of refeeding syndrome should be prevented during renourishment. The presence of AN in certain situations (pregnancy, vegetarianism, type 1 diabetes mellitus) requires specific care. Physical activity in these patients must also be addressed correctly.

Introduction: The present document has the objective of justifying the incorporation of a dietician/nutritionist to the multidisciplinary teams of specialized care that provide education, food anamnesis, nutritional recommendations, treatment and follow up of those patients in risk of malnutrition in Madrid. The appropriate nutritional status of hospitalized patients bears a close relationship with the existence of dieticians at hospitals. Dieticians use nutrition therapy as a cost-effective means to achieve significant health benefits by preventing or altering the course of diabetes, obesity, hypertension, lipid metabolism disorders, heart failure, osteoporosis, celiac disease, and chronic kidney disease, among other diseases.

Anorexia nervosa (AN) is a multifactorial disorder. A possible role of the social network and the gut microbiota in pathogenesis has been added. Exogenous shocks such as the COVID19 pandemic have had a negative impact on patients with AN. The potential medical and nutritional impact of malnutrition and/or compensatory behaviors gives rise to a complex disease with a wide range of severity, the management of which requires a multidisciplinary team with a high level of subject matter expertise. Coordination between levels of care is necessary as well as understanding how to transition the patient from pediatric to adult care is essential. A proper clinical evaluation can detect possible complications, as well as establish the organic risk of the patient. This allows caregivers to tailor the medical-nutritional treatment for each patient. Reestablishing adequate nutritional behaviors is a fundamental pillar of treatment in AN. The design of a personalized nutritional treatment and education program is necessary for this purpose. Depending on the clinical severity, artificial nutrition may be necessary. Although the decision regarding the level of care necessary at diagnosis or during follow-up depends on a number of factors (awareness of the disease, medical stability, complications, suicidal risk, outpatient treatment failure, psychosocial context, etc.), outpatient treatment is the most frequent and most preferred choice. However, more intensive care (total or partial hospitalization) may be necessary in certain cases. In severely malnourished patients, the appearance of refeeding syndrome should be prevented during renourishment. The presence of AN in certain situations (pregnancy, vegetarianism, type 1 diabetes mellitus) requires specific care. Physical activity in these patients must also be addressed correctly.

Introduction: Introduction: oral nutritional supplements (ONS) are nutritional therapies used to treat malnutrition in cancer patients, therefore, innovation in these treatments, from nutrients to sensory quality, is essential to ensure their consumption. Objectives: to evaluate the organoleptic characteristic of different prototypes of oral nutritional supplements specifically designed for cancer patients. Method: cross-sectional, randomized, double-blind pilot clinical study in patients with any type of cancer, with or without oncological treatment, who tasted five ONS prototypes with different flavors (brownie, tropical, pineapple, tomato and ham) and different sensory qualities in order to evaluate their organoleptic characteristics (color, smell, taste, residual taste, texture and density) through a specific questionnaire. Results: thirty patients aged 67.5 ± 11.2 years and body mass index (BMI) of 22.3 ± 3.52 kg/m2 were evaluated. The most prevalent tumors were head and neck (30 %), pancreas (20 %) and colon (17 %); 65 % of the patients had lost ≥ 10 % of their body weight in six months. The best rated supplements by the cancer population were those with brownie flavor (23.67 ± 3.91 points) and tropical (20.33 ± 3.37 points), while the least valued were tomato (16.33 ± 5.44 points) and ham flavor (13.97 ± 4.64 points). Conclusions: cancer patients value the organoleptic characteristics of ONS with sweet flavors, such as brownie, and fruity flavors, such as tropical, much more positively. Less appreciated by these patients are those with a salty taste, such as ham and tomato flavor.

Introduction: The challenge of assessing a patient's nutritional status and its evolution during treatment. From critical patients to outpatients (II).

Introduction: Introduction: eating disorders (EDs) entail a therapeutic challenge. Objective: to describe ED care from the perspective of Nutrition Units (NU) in relation to human and care resources, the activities carried out, and satisfaction with care in Spain; to collect demands from professionals to improve assistance. Methods: a cross-sectional, observational study based on a questionnaire sent online to members of the Spanish Society of Clinical Nutrition and Metabolism (SENPE) and to the Nutrition Area of the Spanish Society of Endocrinology and Nutrition (SEEN). The data were analyzed according to number of beds of the hospitals surveyed (< 500/≥ 500). Results: 23 responses from 8 autonomous communities. In 87 % of NUs care was given to eating disorders; 65.2 % had a specific process; 91.3 % collaborated with Psychiatry; 34.8 % had their own hospitalization area; 56.5 % had a day hospital, but 21.7 % participated in it; 39.1 % had a monographic consultation office; nutritional education was carried out in 87 %, especially by nursing; individualized diets and oral supplements were frequently prescribed in 39.1 % and 56.5 %, respectively; only the largest hospitals participated in research on EDs (62.5 %), and 21.7 % collaborated with patient associations. Hospitals with ≥ 500 beds had more resources and were more satisfied. Professionals demanded resources and processes agreed with Psychiatry. Conclusions: resources and care practices are uneven in the NUs surveyed, as well as multidisciplinary collaboration. The collected evidence allows us to design improvement strategies in this area.

Introduction: Type 2 diabetes mellitus is a highly prevalent disease worldwide, generating an increasing clinical and economic burden due to its micro- and macrovascular complications. Frequently, people with diabetes are hospitalized for various pathologies. These patients generally have higher risk of complications, prolonged hospitalizations and mortality. An additional factor that worsens the prognosis in these patients is the concurrence of malnutrition, especially in elderly people. All this makes the management of these patients challenging and requires a specific nutritional approach, whose purpose is to cover the nutritional requirements while always maintaining glycemic control. The purpose of this work is to provide, based on the evidence available in the literature and clinical experience, consensus recommendations by eighteen experts in Endocrinology and Nutrition on the nutritional approach of hospitalized patients with diabetes/ hyperglycemia and compare the optimal management, based on these recommendations with bedside usual care according to a panel of Spanish doctors surveyed about their daily clinical practice. This first article of this extraordinary issue of the journal Nutrición Hospitalaria describes the methodology of the study and the results obtained regarding common issues for all pathologies.

Introduction: Sarcopenia is a multidimensional condition that negatively affects muscle mass, muscle strength, and physical performance. The prevalence of sarcopenia in people with diabetes is much higher than that of the general population, especially in individuals with poor nutritional status. Both sarcopenia and malnutrition are conditions amenable to intervention to improve clinical prognosis. This article describes the results of the expert consensus and the responses of the panelists on the nutritional management in routine clinical practice of patients with diabetes/hyperglycemia hospitalized (non-critically ill) with sarcopenia.

Introduction: Heart failure (HF) is one of the leading causes of morbidity and mortality among older people, making it a major public health problem. Cardiovascular diseases in general, and HF in particular, are common comorbidities in people with type 2 diabetes (DM2). The concurrence of DM2 and HF is associated with more severe clinical symptoms and signs, and poorer quality of life and prognosis. Furthermore, due to the hypercatabolic state and nutrient absorption disorders, malnutrition is present in many HF cases. This article describes the results of the expert consensus and the responses of the panelists on the nutritional management in routine clinical practice of patients with diabetes/hyperglycemia hospitalized (non-critically ill) with HF.

Introduction: Liver cirrhosis is a progressive and chronic disease of the liver, of diverse etiology, which is frequently associated with glucose intolerance and in some cases concurs with type 2 diabetes (DM2). DM2 is associated with adverse outcomes in patients with cirrhosis, including a higher rate of hospitalizations, a higher prevalence of hepatocellular carcinoma, and an increased risk of mortality. Malnutrition is another frequent complication of cirrhosis, the prevalence of which increases with the degree of liver dysfunction, worsening the prognosis. This article describes the results of the expert consensus and the responses of the panelists on the nutritional management in routine clinical practice of patients with diabetes/hyperglycemia hospitalized (non-critically ill) with liver cirrhosis.

Introduction: The yearly incidence of hip fracture is very high, which generates significant healthcare and socioeconomic burden. These fractures can occur at any age, but the vast majority occur in people over 65 years of age and predominantly in women, due to the increased risk of menopause-associated osteoporosis. Type 2 diabetes mellitus (DM2), apart from altering glucose, lipid and protein metabolisms, also causes a deregulation of calcium, phosphorus and magnesium and dysfunction in bone metabolism. The prevalence of malnutrition in patients with hip fracture is also high, due to their advanced age, and the acute injury itself provokes catabolic and inflammatory responses that result in disease-related malnutrition and sarcopenia, which aggravates the patient's clinical condition. This article describes the results of the expert consensus and the responses of the panelists on the nutritional management in routine clinical practice of patients with diabetes/hyperglycemia hospitalized (non-critically ill) with hip fracture.

Introduction: People with diabetes are at high risk of requiring surgical intervention throughout their lives, and of perioperative complications in case of poor metabolic control. Hospitalization represents a stressful event that, together with other factors associated with diagnostic and therapeutic procedures, leads to a deterioration in the nutritional status of the patients. An association between poor nutritional status and adverse outcomes in surgical patients has been observed. This article describes the results of the expert consensus and the responses of the panelists on the nutritional management in routine clinical practice of patients with diabetes/hyperglycemia hospitalized (non-critically ill) in the perioperative setting.

Introduction: Exhaustive bibliographc research in PubMed/Medline.

Introduction: Diabetes is a frequent comorbidity in cancer patients, since they share common risk factors. In cancer, the concurrence of cachexia represents a poor prognostic factor, which is aggravated by poor nutritional status. Clinically, cancer cachexia manifests as a significant reduction in body weight, accompanied by changes in body composition and alterations in the balance of the biological system, and causes progressive dysfunction. This article describes the results of the expert consensus and the responses of the panelists on the nutritional management in routine clinical practice of patients with diabetes/hyperglycemia hospitalized (non-critically ill) with cancer cachexia.

Introduction: Introduction: excess weight represents a public health problem due to its associated risk factors. A sedentary lifestyle, an inadequate diet or a decrease in the feeling of satiety are some of the causes. Objetives: to evaluate the satiating properties of the consumption of a functional Iberian broth enriched with phospho-fructooligosaccharides (FOS) in healthy people through the plasma concentration of hormones involved in appetite. Material and method: acute, crossover, randomized, double-blind and controlled nutritional clinical trial carried out in 18 randomized participants in two treatment sequences (functional broth (CF), composed of 5.6 g POS/100 g and control broth (CC), with 0.4 g of maltodextrin/100 g) with 14 days of washing in between. Satiety-related parameters (glucose, insulin, leptin, ghrelin, GLP-1, PYY) and visual analog scales (VAS) were measured. Results: the percentage of body fat decreased in those who took the CF (-0.15 ± 0.32 vs 0.09 ± 0.52) (p < 0.05). Leptin concentration was higher with CF (p < 0.001), which was shown at time points -30 (p < 0.001), 0 (p < 0.001), 30 (p = 0.026) and 120 (p = 0.049) when compared to CC. The areas under the curve (AUC) for GLP-1 (p = 0.0033) and PYY (p = 0.022) were higher for CF as compared to CC. Conclusions: consumption of an Iberian broth enriched with POS improves the plasma concentration of hormones involved in the control of satiety, and reduces the amount of body fat. This result could have beneficial effects for the prevention and treatment of overweight.

Introduction: Aim: to present the results of the Spanish home enteral nutrition (HEN) registry of the NADYA-SENPE group for the years 2018 and 2019. Material and methods: from January 1, 2018 to December 31, 2019 the home enteral nutrition registry was recorded, and afterwards a further descriptive and analytical analysis was done. Results: in 2018, 4756 active patients were registered and the prevalence was 101.79 patients per one million inhabitants; in 2019 there were 4633 patients with a prevalence of 98.51 patients per one million inhabitants. They originated in 46 hospitals: 51.3 % were male, and median age was 71.0 years in both periods. The most frequent diagnosis was a neurological disorder that presents with aphagia or severe dysphagia - 58.7 % and 58.2 %, respectively. The main cause of episode termination was death. A total of 116 pediatric patients were registered in 2018 and 115 in 2019. Females represented 57.8 % and 59.1 %, respectively, in each of the periods. Median age at the beginning of HEN was 5 and 7 months. The most commonly recordered diagnostic group (42.2 % and 42.6 %) was included within the other pathologies group, followed by neurological disorders that present with aphagia or severe dysphagia in 41.4 % and 41.7 % of children. The route of administration was gastrostomy in 46.6 % and 46.1 %, respectively, in each of the periods. Conclusions: the NED registry of the NADYA-SENPE group continues to operate uninterruptedly since its inception. The number of registered patients and the number of participating hospitals remained stable in the last biennium analyzed.

Introduction: Aim: to communicate the home parenteral nutrition (HPN) data obtained from the HPN registry of the NADYA-SENPE group (www.nadya-senpe.com) for the year 2019. Material and methods: a descriptive analysis of the data collected from adult and pediatric patients with HPN in the NADYA-SENPE group registry from January 1 to December 31, 2019. Results: a total of 283 patients (51.9 % women), 31 children, and 252 adults from 47 Spanish hospitals were registered, which represents a prevalence rate of 6.01 patients per million inhabitants for year 2019. The most frequent diagnosis in adults was "palliative oncological" and "others" (21.0 %). In children, it was Hirschsprung's disease together with necrotizing enterocolitis, alterations in intestinal motility, and chronic intestinal pseudo-obstruction, with 4 cases each (12.9 %). The first reason for the indication was short-bowel syndrome in both children (51.6 %) and adults (37.3 %). The most used type of catheter was tunnelled both in children (75.9 %) and in adults (40.8 %). Sixty-eight episodes ended, all in adults, and the most frequent cause was death (54.4 %); 38.2 % were switched to oral. Conclusions: the number of collaborating centers and professionals in the NADYA registry is increasing. The main indications and reasons for HPN termination remain stable.

Introduction: Introduction: breast cancer is the most common invasive cancer among women in developed countries. At diagnosis, approximately 70 % of women are overweight, and the additional weight gain that can result from the ensuing treatments has been associated with cancer recurrence and progression. Objectives: the main objective was to compare the effect of only a nutritional intervention (CG) with a nutrition education program (nutritional intervention, nutrition education, and physical activity) (IG) for 1 year. Methods: a total of 65 women with breast cancer who had been evaluated at the Clinical Nutrition Department, La Paz University Hospital, Madrid, Spain were recruited into 2 groups: a control group (CG) and an intervention group (IG). Results: the IG showed a significant reduction in body weight (-1.87 ± 3.41 vs. 1.48 ± 2.01 kg, p < 0.05), BMI (-0.61 ± 1.40 vs. 0.65 ± 0.88 kg/m2, p < 0.05), total cholesterol (-32.92 ± 38.45 vs. -3.23 ± 39.73 mg/dl, p < 0.05), and low-density lipoprotein cholesterol (-35.29 ± 27.50 vs. 6.33 ± 40.70 mg/dl, p < 0.05). Both groups were shown to be more conscious of the importance of physical activity, with increased consumption of grains, fruits, oily fish, and dairy. Conclusions: dietary interventions and physical activity were shown to be important to achieving several physical and physiological benefits that could reduce some risk factors associated with breast cancer recurrence and progression.

Introduction: Surgical stress predisposes patients to have immune dysfunction and an increased risk of infection. Malnourished surgical patients have higher postoperative morbidity and mortality rates, higher readmission rates, and higher hospital costs. The use of an immunomodulatory formula is associated in the ESPEN guidelines with a reduction in wound healing problems, suture failure, and infectious and global complications. Several authors have suggested that, since most clinical trials evaluating the efficacy of immunonutrition have been carried out in a traditional perioperative setting, it would be interesting to investigate its efficacy in a more controlled setting, such as in the ERAS (Enhanced Recovery after Surgery) protocol. The objective of this work was: a) to define the role that immunonutrition should play in ERAS protocols based on the best scientific evidence available; b) to analyze the difficulties that continue to exist in real-life clinical practice to screen the nutritional risk of patients; c) to make a proposal of algorithms adapted to the characteristics of our environment regarding the screening, assessment, and nutritional treatment of surgical patients in fast-track surgery.

Introduction: Introduction: disease-related malnutrition (DRM) is a specific type of malnutrition caused by the inflammatory response to the underlying disease. Its prevalence worldwide varies from 30 % to 50 %, being similar in Spanish hospitals. DRE is not commonly recognized but is usually misdiagnosed and generally not treated. It is associated with an increased risk of morbidity, mortality, and costs. Nutritional societies recommend that screening be performed within the first 24 to 48 hours after admission for the early detection of malnutrition. No screening tool is universally accepted. Objectives: to evaluate the predictive validity (hospital stay, complications, readmissions and mortality) of the CONUT method as compared to SGA and NSA. Material and method: a retrospective study included in a prospective observational study of 365 hospitalized patients from July to December 2012. Results: the most frequent admission services were Internal Medicine and Oncology (30.7 % and 29.3 %). Moderate and severe risk of malnutrition: CONUT, 42.2 % and 12.1 %, SGA 25.8 % and 10.1 %, and NSA 13.7 % and 14.5 %. Malnutrition evaluated using the CONUT method was significantly related to complications (p = 0.036), readmissions (p = 0.041) and mortality (p = 0.007). The ROC curves for mortality, for all the methods evaluated, showed that CONUT is the best tool. Conclusions: CONUT is an automatic detection tool that can be used as a first step in the diagnosis risk of malnutrition. CONUT offers the advantage of being a prognostic factor for complications, readmission, and mortality.

Over the last years, there has been an increase in adverse food reactions, probably associated with life style changes in the past decades. An adverse food reaction is any clinically abnormal response that can be attributed to ingestion, contact or inhalation of a food, its derivatives or an additive contained in it. They can be classified as food allergy or intolerance. Food allergies are usually immune-mediated, associated with IgE. Adverse reactions to food have a large clinical and social repercussion, which can be fatal in some cases and impair the quality of life of patients. This implies directly the services of collective catering and food manufacturing, which is why a legislature and regulations were implemented for its correct management. The most allergenic foods change according to the age group; being the egg the most frequent in children under 5 years, and fresh fruits in the older than 5 years. The most frequent clinical manifestations are cutaneous-mucous type. Food intolerances may be due to a pharmacological, metabolic, mixed or idiosyncratic mechanism. Clinical manifestations are usually dose dependent. The most common and known food intolerance is lactose, which is a metabolic type. The main treatment of both types of adverse reaction to foods is avoidance of the causal food of the reaction.

Eating disorders (ED) are characterized by persistent changes in eating habits that negatively affect a person's health and psychosocial abilities. They are considered psychiatric disorders, highly variable in their presentation and severity, with a huge impact on nutrition, which conditions various therapeutic approaches within a key multidisciplinary context. A group of experts in nutrition, we decided to set up a task force adscribed to the "Sociedad Española de Nutrición Parenteral y Enteral" (SENPE), which has stated as one of its goals the development of a consensus document to generate a protocol based on the best scientific evidence and professional experience available in order to improve health care in this field.

Bulimia nervosa and binge eating disorder are unique nosological entities. Both show a large variability related to its presentation and severity which involves different therapeutic approaches and the need to individualize the treatment, thus it is indispensable a multidisciplinary approach. Patients with bulimia nervosa may suffer from malnutrition and deficiency states or even excess weight, while in binge eating disorders, it is common overweight or obesity, which determine other comorbidities. Many of the symptoms and complications are associated with compensatory behaviors. There are many therapeutic tools available for the treatment of these patients. The nutritional approach contemplates the individualized dietary advice which guarantees an adequate nutritional state and nutritional education. Its objective is to facilitate the voluntary adoption of eating behaviors that promote health and allow the long-term modification of eating habits and the cessation of purgatory and bingeing behaviors. Psychological support is a first-line treatment and it must address the frequent disorder of eating behavior and psychiatric comorbidities. Psychotropic drugs are effective and widely used although these drugs are not essential. The management is carried out mainly at an outpatient level, being the day hospital useful in selected patients. Hospitalization should be reserved to correct serious somatic or psychiatric complications or as a measure to contain non-treatable conflict situations. Most of the guidelines' recommendations are based on expert consensus, with little evidence which evaluates clinical results and cost-effectiveness.

Introduction: disease-related malnutrition has a high prevalence, with clinical consequences potentially severe for the patient, and of high economic impact for the healthcare system., Objective: to perform a review of the literature regarding the economic burden of disease-related malnutrition, to assess complications, and to determine the usefulness of enteral or oral nutritional supplementation from a cost analysis perspective., Methods: a review of the literature up to June 2016 was carried out regarding economic costs of disease-related malnutrition and cost analysis of nutritional treatment, with special focus on retrieval of systematic reviews, meta-analysis, and randomized clinical trials., Results: a total of 31 publications were selected, 15 on costs of disease-related malnutrition and 16 on costs of treatment. Disease-related malnutrition increases health care costs in relation to a longer hospital stay, higher incidence of infectious and non-infectious complications, greater need of treatment, increase in readmissions, more prolonged stay in the intensive care unit and/or the need of referral to continuing care centers at discharge. Publications regarding treatment with oral nutritional supplements suggest that these oral supplements are cost-effective and cost-beneficial both in ambulatory and hospitalized patients., Conclusions: disease-related malnutrition causes an increase in health care costs that could be minimized, among other approaches, by an early diagnosis and treatment for which oral nutritional supplements are cost-effective and cost-beneficial.

Introduction: Fiber definition includes all those carbohydrates which are not digested nor absorbed in the upper gastrointestinal tract allowing them to reach the colon with no previous processing. Traditionally fiber has been classified according to their solubility into soluble and insoluble and different physiological properties have been defined for each type. The physiologic role of the fiber intake has been studied in diabetes, dyslipidemia or obesity. Fiber intake has also demonstrated to be beneficial in the prevention of many neoplastic diseases like colorectal cancer. It´s also known that fiber plays an important role in the faecal excretion of nitrogen., Aim: To evaluate the current evidence that fiber intake plays in the management and prevention of several different diseases, being able to determine, if possible, the most recommended fiber type for each clinical condition., Methods: A non-systematic review by searching the Medline and Pubmed was made and studies which met the inclusion criteria were identified and selected for analysis., Results: Different fiber types can be useful for the treatment of several gastrointestinal diseases like constipation, diarrhea, irritable bowel syndrome, ulcerative colitis remission or short bowel syndrome. Patients diagnosed with diabetes, obesity, hyperlipidemia, hypertension and other cardiometabolic diseases can get a clinical improvement with soluble fiber intake. Dietary fiber has demonstrated to play a role in the prevention of colorrectal cancer and other neoplastic diseases. Patients with hepatic encephalopathy or chronic kidney disease will also benefit from fermentable fiber intake., Discussion: Fiber plays an important role in the prevention and treatment of many clinical conditions. However further investigations are needed to establish specific fiber intake recommendations., (Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.)

Introduction: For the last 20 years, most adult patients following home parenteral nutrition (HPN) under the care of the Clinical Nutrition and Dietetics Dept. of the La Paz University Hospital (Unidad de Nutrición Clínica y Dietética del Hospital Universitario La Paz), Madrid, Spain, have received their nutrition formula via a catering system (Nutriservice) responsible for its preparation and home distribution., Aim: To assess the clinical characteristics, quality of life and degree of satisfaction with the care received, of patients undergoing HPN who received their nutrition formulae via the named catering service., Materials and Methods: The characteristics of the patients who received HPN via this service between 1992 and 2013 were retrospectively collected. Those patients still undergoing treatment completed a quality of life questionnaire, plus a survey of their satisfaction with the catering system and the care provided by our department., Results: Seventy eight patients were examined; 57.7% were men. The mean age of the patients was 53.1±14.3 years. The most common underlying disease was cancer, both in advanced stage (33.8% of all cases) and in stages in which active treatment was being provided (34%). The most common indication for HPN was intestinal obstruction (46%). The median duration of HPN treatment was 96 [1-5334] days. The most common complication was catheter infection (72%). For the analysis of the results, the patients were divided depending on disease type: those with advanced stage cancer, those with cancer under active treatment and with a better prognosis, and those with non-oncological disease. The patients undergoing active oncological treatment believed the quality of their lives to have been improved by the Nutriservice catering system, and rated the care received by our department positively., Conclusion: In our experience, patients with cancer are those who most commonly receive HPN, especially those with advanced disease. Given the seriousness of their conditions, and the complexity surrounding the use of HPN, catering systems appear to offer a means of improving their quality of life., (Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.)

Anorexia nervosa is an eating disorder that often causes malnutrition and carries high mortality risk. A multidisciplinary and highly experienced team is needed to succeed in nutrition education and avoid the refeeding syndrome. We report the most severe case of malnutrition secondary to anorexia nervosa treated in our unit, a 33-year-old woman with a BMI of 8.8 kg/m2 and high liver aminotranferases who did not experience any complication during the refeeding process despite the extreme gravity of her situation., (Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.)

Unlabelled: Disease-Related Malnutrition (DRM) is present in a high percentage of patients admitted to hospital and their impact is diverse and of great importance., Objectives: Nutrition Department of University Hospital La Paz, in collaboration with all members of the Nutrition Committee, we decided to implement some method of screening in our centre which allowed us to detect as many patients with malnutrition risk as possible., Results: Due to the large size of our centre, with about 1,500 beds and the few human resources in our unit, we chose to use the CONUT system (Nutritional Control), a 100% automatic method based on analytical parameters, very easy to use, low cost and whose validity is confirmed, characteristics that fulfilled our needs. The method collects information from databases of Admission Service (affiliation, age, date) and Laboratory (albumin, cholesterol, total lymphocytes) and generates, in the report of analytical results, "alert" information about each patient''s nutritional risk and also nutritional recommendations based on the risk identified. Prior to its implantation several evaluations were performed in order to allow us to better know the extra workload, as it was the main factor that could limit our ability to assume that screening method and also many training activities for doctors and hospital health professionals who were increasingly assuming responsibilities in the nutritional treatment of their patients. This screening system has been working from June of 2010 and it has detected risk of malnutrition in 32% of the evaluated patients. In general, only in those cases where the alert corresponded to a high-risk nutritional situation, which represents approximately 10% of the total, specialized intervention by the Clinical Nutrition Unit was required. Later, as we have detected some possible causes that justify the system does not work properly; the screening system has undergone several changes . In this sense, we have made a retrospective evaluation of 233 patients admitted to the General Surgery plants and documented that those entering for scheduled surgery, having a alarm of malnutrition (50% of cases), its presence increases significantly the hospital stay and mortality., Conclusions: The implementation of this nutritional screening method has led to a change in the "nutritional" culture of our centre respect to DRM in most of our professionals: doctors and nurses and even in the management team, so all of them understand the importance of the process and know about the available tools and knowledge to indicate an adequate and early nutritional support., (Copyright AULA MEDICA EDICIONES 2013. Published by AULA MEDICA. All rights reserved.)

Introduction and Objectives: Advanced Chronic Kidney Disease (ACKD) is associated with high prevalence of malnutrition. The habitual continuous dietary restrictions used in clinical practice. increased the malnutrition risk. The aim of this study was to evaluate the effects of a Nutritional intervention Program (NIP) on renal function and nutritional status in patients with ACKD., Patients and Methods: 93 patients, (53.7% men, 66±17 years) were included in a prospective longitudinal study. The patients recived a NIP during 6 months with mensual visits. At baseline and six months the outcome assessed were: nutritional status by Chang criteria, anthropometric, dietetic and biochemical parameters (albumin, prealbumin, creatinine clearance, serum phosphorus, potassium, total-Cholesterol, LDL, HDL, triglycerides, and PCR)., Results: After intervention, caloric intake decreased in nourished patients (1833 ±318 vs. 1571±219 kcal p=.001). and it was constant in malnourished patients. The intake of protein (69,9 ± 16,6 vs 54,9 ± 11 g p < 0.001), potassium (2938 ± 949 vs 2377 ± 743 mg p < 0.001) and phosphorus (1180 ± 304 vs 946,6 ± 211 mg p < 0.001) significantly decreased. 16.5% patients required supplementation. A total of 41.7% of patients were malnourished at baseline (27.8% mild, 10.10% moderate and 3.8% severe), and 16.8% at the end (8% mild, 5% moderate and 3.8% severe) by Chang criteria. At the end of NIP, patients significantly increased creatinine clearance (17,8 ± 5,2 vs 19,4 ± 6,9 ml/min, p < 0,01), albumin (3,3 ± 0,5 vs. 3,5 ± 0,4 g/dL, p < 0,05), and decreased serum potassium (4,8 ± 0,6 vs 4,5 ± 0,5 mmol/L, p < 0,05), total cholesterol (179,8 ± 44,3 vs 170,0 ± 15,1 mg/dL, p < 0,05), LDL (113,2 ± 37,0 vs 108,3 ± 27,3 mg/dL, p < 0.01) and tryglicerides (141.9 ± 60.8 vs 129.9 ± 52.7 mg/dL, p < 0.05).\, Conclusions: The study reflected a NIP usefulness in the nutritional status and renal function improvements within an interdisciplinary framework during ACKD consultations., (Copyright AULA MEDICA EDICIONES 2013. Published by AULA MEDICA. All rights reserved.)

Introduction: Conjugated linoleic acids (CLAs) have shown beneficial effects in weight control therapy however this relation is not clear., Objetive: The aim of the study was to examine the effects and safety of 3g of a 1:1 mix of c9-t11 and t10-c12 on weight control and body composition in healthy overweight individuals., Methods: A prospective, placebo-controlled, randomised double-blind, parallel clinical trial lasting 24 weeks was carried out in 38 volunteers (29w, 9m) aged 30-55 years and BMI ≥27-<30 kg/m2 who consumed 200 ml/day of skimmed milk with 3g of CLAs or 3g olive oil (placebo). Anthropometric, biochemical and dual x-ray absorptiometry (DXA) tests were measured. Diet and physical activity were assessed., Results: Subjects maintained their habitual dietary and exercise patterns over the study. Only CLA group showed a significant decrease in weight (74.43 ± 10.45 vs 73.54 ± 11.66 kg, p = 0.029) and waist circumference (91.45 ± 10.33 vs 90.65 ± 9.84 cm, p = 0.012) between baseline and end of the study. BMI and waist height ratio decreased (28.44 ± 1.08 vs 27.81 ± 1.43 kg/m2, p = 0.030 and 0.57 ± 0.05 vs 0.56 ± 0.04 p = 0.013 respectively) in CLA group at the end. CLA group experienced a reduction in total fat mass after 24 weeks (38.62 ± 5.02 vs 36.65 ± 5.64%, p = 0.035). No decrease was observed in Control group. HOMA index had no changes., Conclusions: The consumption of skimmed milk enriched with 3g of a 1:1 mixture of c9-t11 and t10-c12 for 24 weeks led to a decrease in body weight and total fat mass in healthy, overweight subjects who maintained habitual diets and exercise patterns. No adverse effects were observed. Registered under ClinicalTrials.gov Identifier No. NCT01503047., (Copyright AULA MEDICA EDICIONES 2013. Published by AULA MEDICA. All rights reserved.)

Objectives: To identify predictive variables of low adherence to a pilot Lifestyle Modification Program (LMP) for overweight and obesity treatment in primary health care (PC )., Material and Methods: Sixty subjects with BMI > 27 kg/m(2) were recruited. Health professionals directed the program in a group structure and biweekly, based on nutrition education with individualized dietary guidelines, promotion of physical activity and motivational support. A validated questionnaire on lifestyle habits for overweight and obesity subjects was used to identify variables related with program adherence and anthropometric variables were measured before and 6 months after intervention. Low adherence was considered when patients attended to less than 80% of visits., Results: Twenty-seven subjects (45%) presented high adherence to the program. The variables associated to low adherence were related to baseline with IMC ≥ 35 kg/m(2) (p < 0.05); ex smoker period ≤ 4 months (p < 0.01); high caloric diet (p < 0.01) and scarce physical activity (p < 0.05). At 6 months the subjects who finalized the program presented a significant decrease of weight (86.0 ± 15.6 vs 79.2 ± 13.4 kg; p < 0,001); fat mass percentage (41,6 ± 4,6 vs 38.8 ± 5,4%; p < 0.001), blood glucose (108 ± 45.48 vs 94.38 ± 11.97 mg/dl; p < 0.01). It also improved caloric diet profile, above all decreasing the percentage of fat (39.6 ± 4.8 vs 35.5 ± 5.6%; p < 0.01)., Conclusion: Have recently left smoking, obesity degree two or higher, a high caloric diet and scarce physical activity were basal variables identified as predictive of a low adhesion to a LMP for the treatment of overweight and obesity in primary health care. We do not consider this pilot experience as satisfactory and other new strategies are under development., (Copyright © AULA MEDICA EDICIONES 2013. Published by AULA MEDICA. All rights reserved.)

In the last three decades, the prevalence of obesity in developed countries has reached epidemic proportions, and continues rising. Many factors have influence on the incidence of obesity, and with the decline of physical activity, overeating plays a role in the emergence of this public health problem. Although a clear relationship between fat intake and weight gain has been established, the role of carbohydrates and more specifically from sucrose and the development of obesity is more controversial. Much of this controversy is due to the growing demand for sweetened drinks and caloric increase posed by these in the diet. Despite multiple studies and communications on this subject in recent years, there are still many areas of uncertainty about the role played by diets rich in sugars over the increase in obesity in last years., (Copyright © AULA MEDICA EDICIONES 2013. Published by AULA MEDICA. All rights reserved.)

Background & Aims: Several authors have reported low folate intake in patients with eating disorders (ED). This vitamin plays an essential role in synthesis reactions for neurotransmitters and structural elements of neurons, and therefore its deficiency has been associated with the presence of different disorders linked to mental function. The aim of this study was to determine the effect of folic acid supplementation on homocysteine levels and the cognitive and depressive status of a group of patients with eating disorders with low folate intake., Subjects/methods: The study was designed as a randomised, prospective clinical trial, which included 24 participants assigned to two treatment groups for six months: supplemented group (SG) (10 mg/day of folic acid [ACFOL]) and a placebo group (PG). Both groups maintained their medical, dietary and psychological treatment. At baseline and end of the intervention, anthropometric, dietary and biochemical parameters (plasma homocysteine [Hcy], serum and red blood cell folate) were recorded. Cognitive and depressive status questionnaires were administered (Stroop Test, Trail Making Test and Beck Depression Inventory)., Results: Twenty-two patients completed the study (SG: 12, PG: 10, mean age: 24.2 ± 8.8 years, BMI 18.9 ± 3.5 kg/m2). The SG significantly increased their serum and red blood cell folate levels and lowered Hcy levels (9.4 ± 2.4 μmol/l vs. 7.5 ± 1.7 μmol/l, P < 0.01). The SG also significantly improved most of their test scores for cognitive and depressive status. The PG showed no significant changes in any of the evaluated variables., Conclusions: The results show that folic acid supplementation may be used as another tool within the comprehensive and multidisciplinary treatment applied to patients with ED., (Copyright © AULA MEDICA EDICIONES 2013. Published by AULA MEDICA. All rights reserved.)

Background: Oncohematological diseases such as lymphoma or leukaemia affect an increasing number of newly diagnosed patients in Spain and other countries. Both disease and treatment may have a negatively impact in the nutritional status of the patient. Malnutrition is not uncommon among oncohematological patients. This situation can compromised the course of the disease, the clinical response of the treatment and the patient's quality of life., Method: The implementation of a multidisciplinary approach and a systematic and protocolled nutritional assessment would be useful when dealing with haematological malignancies., Results: We present a proposal of protocol for nutritional intervention in oncohematological patients. This proposal is been developed from the analysis of the published literature as well as clinical practice of a multi-disciplinary team specialized in the management of patients with haematological malignancies.