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Introducción: Se ha comunicado recientemente que la reducción de peso previa a cirugía bariátrica mediante dieta muy baja en calorías (VLCD) durante 2 semanas supone menor tasa de complicaciones postoperatorias. Es debatido, sin embargo, si la pérdida de peso preoperatoria con VLCD puede favorecer pérdida de peso postoperatoria. Objetivos: Valorar la eficacia de una VLCD, seguida durante 6 semanas preoperatorias, en el descenso de peso conseguido al año de la cirugía bariátrica. Evaluar los cambios en parámetros antropométricos y bioquímicos conseguidos con dicha dieta. Metodología: Estudio prospectivo no controlado en los pacientes obesos sometidos a derivación biliopancréatica en la Unidad de Obesidad de referencia en el periodo 2008-2010. Los pacientes recibieron durante 6 semanas previas a la intervención una VLCD que aportaba diariamente 840 kcal y 60 g de proteínas (Optisource®). Los datos descriptivos se presentan como media y desviación estándar (DS), y tras comprobar su distribución normal, fueron analizados mediante prueba t de Student, ANOVA o correlación de Pearson. Resultados: Fueron valorados 107 pacientes obesos, de 43,5 (10,2) años, el 72 % fueron mujeres con peso inicial 122,4 (18,6) Kg e IMC de 46,8 (5,5) kg/m². Un 24,5% perdieron más de 10 % de su peso inicial y un 73,5% más de 5% tras VLCD. La media de porcentaje pérdida de exceso de peso (% PSP) a los 12 meses de la intervención fue 59,6 (13,4)%, y aunque fue mayor en los pacientes que habían perdido peso con VLCD, no se asoció de forma significativa: aquellos pacientes con pérdida mayor de 5% perdieron a los 12 meses 59,5 (13,8)% de PSP y 68,4 and 71 (16,2) % de exceso de IMC (%PEIMC), frente a 57,9 (13,1) % y 68,5 (16,6) % si no conseguían esa pérdida. El grupo de pacientes con pérdida mayor de 10 % consiguió %PSP de 63,3 (13,7) y %PEIMC de 70,9 (14,7) vs 58,2 (14,0) y 67,7 (16,7) si no perdieron >10% del peso inicial. No se encontró correlación entre la pérdida preoperatoria con VLCD y %PSP ni de exceso de IMC (%PEIMC) a 3,6,9 y 12 meses, sólo el %PSP a 1 mes se correlacionó con %PSP con VLCD (r = 0,454, p = 0,003). Conclusiones: La pérdida de peso preoperatoria mediante VLCD en pacientes obesos mórbidos no ha demostrado favorecer la pérdida de exceso de peso ni de exceso de IMC al año de la cirugía bariátrica.

Background: The maintenance of weight loss may be influenced by the distribution of macronutrients in the diet and insulin sensitivity. Objective: The objective of the study was to evaluate the longterm effect of two hypocaloric diets with different protein/carbohydrate ratios in overweight and obese individuals either with insulin resistance (IR) or without insulin resistance (IS). Design: Prospective, randomized, clinical intervention study. Forty patients were classified as IR/IS after a 75 g oral glucose tolerance test and then randomized to a diet with either 40% carbohydrate/30% protein/30% fat (diet A) or 55% carbohydrate/15% protein/30% fat (diet B). Results: After one year of follow-up there was no difference in weight loss between diets A and B in each group, but the IS group maintained weight loss better than the IR group [-5.7 (3.9) vs. -0.6 (4.1); P = 0.04]. No differences were found in either Homeostasis Model Assessment (HOMA) or other metabolic glucose parameters except lower insulin at 120 minutes with diet A [21.40 (8.30) vs. 71.40 (17.11); P = 0.02]. Conclusions: The hypocaloric diets with different protein/carbohydrate ratios produced similar changes in weight. Insulin resistance may play a negative role in maintaining weight loss.Introducción: El mantenimiento de la pérdida de peso puede estar influido por la distribución de macronutrientes en la dieta y la sensibilidad a la insulina. Objetivo: El objetivo del estudio fue evaluar el efecto a largo plazo de dos dietas hipocalóricas con diferente distribución de proteínas y carbohidratos (HCO) en individuos con sobrepeso y obesos ya fuese con resistencia a la insulina (IR) o sin resistencia a la insulina (IS). Metodología: Estudio prospectivo, aleatorizado, de intervención clínica. Cuarenta pacientes fueron clasificados como IR / IS después de una prueba de tolerancia oral de 75 g de glucosa y luego asignados al azar a una dieta con 40% de HCO/ 30% proteína /30% grasa (dieta A) o el 55% HCO /15% proteína /30% grasa (dieta B). Resultados: Tras un año de seguimiento, no se observaron diferencias en la pérdida de peso entre las dietas A y B en cada grupo, pero el grupo IS mantuvo la pérdida de peso mejor que el grupo IR [-5,7 (3,9) vs -0,6 (4,1), p = 0,04]. No se encontraron diferencias en ninguno en el Homeostasis Model Assessment (HOMA) u otros parámetros metabólicos de glucosa excepto en una insulina inferior a los 120 minutos con la dieta A [21,40 (8,30) vs 71,40 (17,11), p = 0,02]. Conclusiones: Las dietas hipocalóricas con diferentes proporciones de proteínas y carbohidratos produjeron cambios similares en el peso. La resistencia a la insulina puede jugar un papel negativo en el mantenimiento de la pérdida de peso.

Introducción: La implantación de hábitos alimentarios saludables en la población infantil en el ámbito escolar y familiar es de gran importancia para la prevención de la obesidad infanto-juvenil. Objetivos: Conocer los hábitos de almuerzo de una población escolar, su prevalencia de sobrepeso y obesidad así como instaurar hábitos dietéticos saludables y educar nutricionalmente a ésta para mejorar las costumbres alimentarias a través de un almuerzo saludable. Métodos: Se realizó un estudio prospectivo de intervención en escolares. Se incluyeron niños de 10-13 años. El estudio se llevó a cabo en 3 fases: preintervención (valoración antropométrica y cuestionario de frecuencia de almuerzo y de alimentos consumidos), intervención (charlas formativas al profesorado y los padres sobre "la importancia de una correcta alimentación en el escolar", enfocadas en la trascendencia de una alimentación sana y equilibrada que incluyese un almuerzo saludable diariamente en el escolar y entrega del almuerzo durante dos semanas a los alumnos que incluía lácteos, fruta y bocadillo tradicional), postintervención (cuestionario de frecuencia de almuerzo y de alimentos consumidos). Resultados: La frecuencia de sobrepeso fue del 10,6% y de obesidad del 2,6%. Tras la intervención se produjo un incremento del 9,2% de individuos que almorzaban y una modificación de los alimentos consumidos. Conclusión: La modificación de los hábitos dietéticos del almuerzo de los escolares es posible con campañas sencillas de intervención nutricional.Background: The establishment of healthy eating habits in children at school and in family life is very important for preventing obesity in children. Aims: To know the habits of late-breakfast in a scholar population, the prevalence of overweight and obesity, and establish healthy dietary habits through the late-breakfast. Methods: A prospective interventional study was performed in a school group. Children from 10 to 13 years-old were included. The study had three phases: pre-intervention (anthropometric assessment and questionnaire of late-breakfast frequency), intervention (parents and teachers received information about "the importance of proper nutrition in school" focused on the transcendence of a healthy and balanced diet that includes a suitable late-breakfast every day at school, and the students received the late-breakfast during two weeks that included milk, fruit and a traditional sandwich), and post-intervention (questionnaire of late-breakfast frequency). Results: Frequency of overweight was 10.6% and obesity 2.6%. After the intervention the proportion of children who had late-breakfast increased by 9.2%, and the kind of food which they ate changed. Conclusion: Dietary habits can be modified in a scholar population with an easy nutritional intervention.

Introducción: La desnutrición influye en la morbimortalidad del paciente con ELA. La unidad de nutrición debe evaluar al paciente precoz y periódicamente ofreciendo las medidas necesarias en la evolución de la enfermedad. Métodos: Estudio retrospectivo de cohortes en el que se analizaron 46 pacientes con diagnóstico de ELA, de los cuáles 21 se encontraban en tratamiento nutricional. Se estudió la edad, forma de inicio de la enfermedad, fecha de entrada en protocolo nutricional, la colocación o no de PEG, y la supervivencia. Se realizó un test de Breslow comparando pacientes que estuvieron en protocolo nutricional respecto de aquellos que no recibieron terapia nutricional, y de aquellos que entraron antes en protocolo respecto de los que entraron después. Resultados: Existió un aumento en la mediana de supervivencia en los pacientes en tratamiento nutricional tanto en ELA bulbar (452 vs 55 días) como en ELA espinal (1.798 vs 357 días; p = 0,002). La mediana de retraso en el inicio de tratamiento nutricional en la ELA espinal fue de 557 días mientras que en la ELA bulbar fue de 230 días: en la ELA espinal los que entraron en protocolo nutricional antes de la mediana tuvieron una supervivencia de 325 días respecto a 181 días (p = 0,09); en la ELA bulbar los que entraron antes de la mediana tuvieron una supervivencia de 435 días respecto a 177 días (p = 0,38). Conclusiones: La entrada de los pacientes con ELA en un protocolo nutricional conlleva un aumento de la supervivencia. Existe una ventaja en la evolución en los pacientes que comienzan antes el tratamiento nutricional.Introduction: Malnutrition affects morbidity and mortality of patients with ALS. The nutrition unit should evaluate these patients early and regularly providing the necessary steps in the evolution of the disease. Methods: A retrospective cohort study in which we analyzed 46 patients diagnosed with ALS, 21 of them received nutritional therapy. We studied age, mode of onset, date of entry into a nutritional protocol, placement of PEG and survival. We performed a test of Breslow comparing patients who were at nutritional protocol with those not receiving nutritional support, and those who received early nutritional therapy with those with delayed nutrition. Results: There was an increase in median survival for patients in nutritional therapy in bulbar ALS (452 vs 55 days) and in spinal ALS (1,798 vs 357 days) (p = 0.002). The median delay in the initiation of nutritional therapy in spinal ALS was 557 days while in bulbar ALS was 230 days. The survival in the spinal ALS of those who entered into nutritional protocol before the median survival was 325 days to 181 days (p = 0.09) while in bulbar ALS those who entered before had a median survival of 435 days to 177 days (p = 0.38). Conclusions: The entry of patients with ALS in a nutritional protocol increases survival. There is an advantage in the evolution of patients with early nutritional treatment.

La enfermedad inflamatoria intestinal es una entidad de etiopatogenia aún no bien conocida, con importantes implicaciones nutricionales y metabólicas, por la alta prevalencia de malnutrición que conlleva; por la posible implicación de factores dietéticos en su patogenia; y por la hipótesis de que la intervención nutricional pudiera ser un tratamiento primario de la enfermedad. Algunos nutrientes, además de su función exclusivamente nutricional, podrían inducir un bajo estímulo antigénico, regular respuestas inflamatorias e inmunológicas y estimular el trofismo de la mucosa intestinal. La evidencia disponible actual apoya el empleo de nutrición enteral en enfermedad de Crohn como terapia primaria en adultos si el tratamiento con corticoides no es posible (fracaso o contraindicación) (grado de recomendación A) o bien en terapia combinada con fármacos en pacientes malnutridos y estenosis inflamatoria del intestino. En los pacientes en remisión clínica duradera no se ha demostrado beneficio de la nutrición enteral o suplementos en ausencia de déficits nutricionales. No se recomienda el uso de fórmulas elementales ni modificadas (glutamina, ácidos grasos omega 3). En colitis ulcerosa, no se ha demostrado la influencia de la nutrición sobre la actividad de la enfermedad, aunque disponemos de datos prometedores sobre el papel de los ácidos grasos w3 con cubierta entérica y de un posible papel de los probióticos. En el tratamiento y profilaxis de la pouchitis crónica, el empleo de probióticos puede tener un papel (VSL#3). La nutrición debe considerarse un componente integral en el manejo de los pacientes con EII.Inflammatory bowel disease is an entity with not wellknown pathogenesis, and important nutritional and metabolic implications because of the high prevalence of malnutrition, the possible implication of dietary factors in its pathogenesis and because of the hypothesis that nutritional intervention could be a primary treatment for the disease. Some nutrients could induce a low antigenic stimuli, regulate inflammatory and immunological responses and stimulate intestinal mucosal trophism. Present available evidence supports enteral nutrition in Crohn's disease as a primary treatment if treatment with steroids is not possible (failure or contraindication) (grade of recommendation A) or either combined treatment with drugs in malnourished patients or those with inflammatory bowel stenosis. In those patients with sustained clinical remission, no benefit of either enteral nutrition or supplements in the absence of nutritional deficits has been shown. Elemental or modified formula (glutamine, omega 3 fatty acids) could not be recommended. In ulcerative colitis, nutritional influence over the activity of the disease has not been shown, although there are some promising results regarding enteric coated W3 fatty acids and a possible role for probiotics. In the treatment and prevention of pouchitis, there could be a role for probiotics (VSL#3). Nutritional treatment should be considered an integral component in the Management of patients with inflammatory bowel disease.

Presentamos el caso de un paciente diagnosticado de amiloidosis primaria y síndrome nefrótico que acude a la consulta de dietoterapia. En la consulta inicial se realizó una historia nutricional que incluyó una valoración antropométrica completa, composición corporal, bioquímica completa y análisis de la ingesta. El paciente presentó un exceso de agua corporal, proteinuria, niveles disminuidos de proteínas totales, albúmina, prealbúmina y colesterol HDL y concentraciones elevadas de colesterol total, de LDL y de triglicéridos. El consumo de proteínas y sodio era superior a la recomendación. Se elaboró una dieta personalizada. Tras seis meses de dieta el paciente presentó una pérdida de peso a partir de agua, manteniendo el estado nutricional, una disminución de la proteinuria, manteniéndose la función renal y una mejora del perfil lipídico. El tratamiento dietético del síndrome nefrótico es eficaz para disminuir la proteinuria recuperar y mejorar el perfil lipídico y prevenir la desnutrición del paciente.We present the case of a male patient suffering from a primary amyloidosis and a nephrotic syndrome who came to dietotherapy clinic. In the first visit we made a nutritional record including an anthropometric evaluation, body composition, biochemistry, and food intake. The patient had an excess of body water, proteinuria, low plasma protein, albumin, prealbumin and HDL cholesterol levels, and high concentrations of total cholesterol, LDL and triglycerides. The consumption of protein and sodium was higher than the recommendation. An individualized diet was made. Six months later, his weight and the excess of body water decreased, but the fat free mass remained unchanged. The levels of albumin and prealbumin increased, the proteinuria decreased. Total cholesterol, LDL and triglycerides decreased until normal levels. Dietetary treatment in nephrotic syndrome is effective to decrease proteinuria, improve cholesterol and triglycerides levels, and to prevent malnutrition.

Background Aims: Body composition measurements seem to be not reliable enough in obese patients. Our aim was to compare single frequency-bioelectrical impedance (SF-BIA) analysis; foot-to-foot impedance meters (FFI) or upper body fat analysers (UBFA) and DXA (Dual-energy X-ray absorptiometry) in severely obese patients. Patients and methods: Cross-sectional study including 40 severely obese patients. Bioelectrical impedance was performed for SF-BIA (Holtain (H) and OMRON BF 500 (O500)), FFI (Tanita TBF-300 (T)) and UBFA (Omron BF 300 (O300)). DXA scans were performed using a Lunar iDXA. The data were analysed using Pearson's correlation and Bland Altman plots were also drawn to evaluate any agreements. Results: The percentage and total body fat values were 49.2% and 55.2 kg measured with DXA, 44.3%/53.4 kg with O300, 50.6%/58.3 kg with O500, 45.4%/55.4 kg with H and 49.1%/60.3 kg with T. The Holtain BIA showed the worst correlation with DXA for both %BF and FFM. Although the measurements of % body fat, fat mass and fat-free mass were significantly correlated with DXA, each method showed wide limits of agreement, although T was most closely correlated with DXA. Conclusion: Compared to DXA, FFI and UBFA could be useful for assessing body composition in severely obese people, although they appeared to underestimate %BF and FM and their limits of agreement were too wide.Introducción: La medida de la composición corporal parece no tener suficiente fiabilidad en los pacientes obesos. Nuestro objetivo fue comparar técnicas de impedancia monofrecuencia (SF-BIA), impedanciómetros de arco inferior (FFI) o de arco superior (UBFA) con densitometría (DXA) en pacientes con obesidad severa. Pacientes y métodos: Estudio transversal de 40 pacientes con obesidad severa. Se realizó medida de composición corporal mediante impedancia bioeléctrica realizada con dos instrumentos de medida de impedancia monofrecuencia (Holtain (H) y OMRON BF 500 (O500)), FFI (Tanita TBF-300 (T)) y UBFA (Omron BF 300 (O300)). La densitometría para composición corporal se llevó a cabo en un DXA Lunar iDXA. Se analizaron los datos mediante correlación de Pearson y se empleó el método de Bland Altman para evaluar los acuerdos entre técnicas. Resultados: Los valores absolutos y porcentajes grasa corporal fueron 49,2% y 55,2 kg medidos con DXA, 44,3%/53,4 kg con O300, 50,6%/58,3 kg con O500, 45,4%/55,4 kg con H y 49,1%/60,3 kg con T. El impedanciómetro tipo Holtain mostró la peor correlación con DXA, tanto para Porcentaje de grasa como masa libre de grasa. Aunque las medidas de porcentaje de grasa, masa grasa total y masa libre de grasa se correlacionaron con DXA de forma significativa, los límites de concordancia de cada método fueron demasiado amplios. T fue el método mejor correlacionado con DXA. Conclusión: En comparación con DXA, FFI y UBFA podrían ser útiles para valorar composición corporal en pacientes obesos severos, aunque teniendo en cuenta que parecen infraestimar %BF y FM y que sus límites de concordancia son bastante amplios.

Introduction: Background and aims: low muscle mass (LMM) conditions the nutritional status of an individual and has implications for quality of life and prognosis. The aim of this study was to evaluate body composition and determine normal values in the diagnosis of LMM in a control group of healthy individuals. Methods: a cross-sectional study of healthy volunteers aged 18 to 45 years with body mass index (BMI) < 30 kg/m2. A descriptive study was performed including demographic, clinical, anthropometric, and body composition variables (by bioimpedance, TANITA MC 780 MA; TANITA, Tokyo, Japan), stratified by age, sex and BMI. Values corresponding to -1/-2 standard deviations (SD) were determined to consider low muscle mass/function. Results: we included 67 patients, 71,60 % women, with a median age of 28.29 (IQR 4.05) years. Males presented higher weight, BMI, fat-free mass (FFM), muscle mass (MM), appendicular lean mass (ALM), appendicular lean mass index (ALMI), and dynamometry values when compared to females. The -1/-2 SD values of the various muscle parameters were determined according to sex. Conclusion: this study determined normal LMM values in healthy and young people, and the most commonly used indexes to express it, which will allow the diagnosis of LMM in disease-related situations using the corresponding -2 DS value.

Objective: Validation of a questionnaire designed to stratify the level of digital competence in chronic patients., Method: Cross-sectional study, carried out in the Endocrinology and Nutrition Section of the Complejo Asistencial Universitario de León (CAULE). We selected the digital competencies section of the Cambados questionnaire, designed for the identification of digital chronic patient, with a maximum score of 20 points. The questionnaire was completed for validation by patients for whom were prescribed a digital tool for glycemic control. Reliability was assessed by assessing the correct use of the prescribed tool and internal consistency., Results: The questionnaire was completely filled in by 171 patients, with a mean age of 44.36 (SD 17.36). The mean score obtained in the questionnaire was 11.04 (SD 4.74) and a score over 12 was the most appropriate cut-off point to discriminate between patients according to their level of digital competence. 48.54% of the patients made adequate use of the tool. The scale showed good internal consistency with a Cronbach's alpha of 0.77., Conclusions: The results reached in the present study allow us to affirm that the responses obtained from the patients in the digital competency definition questionnaire are a good indicator of the use of digital tools., (Copyright © 2022 FECA. Publicado por Elsevier España, S.L.U. All rights reserved.)

Obesity and diabetes are two closely related disorders. Lifestyle changes and drug treatment do not achieve successful diabetes remission. A treatment option for these patients is bariatric surgery (BS). The partial and complete remission rates vary, depending on the type of technique used (restrictive or malabsorptive), with malabsorptive surgery being more effective in terms of both weight reduction and diabetes remission (DR). Different scales (DiaRem, Ad-DiaRem or 5y-Ad-DiaRem) predict the probability of DR after BS, particularly after gastric bypass surgery. Some studies report higher DR rates in surgery with a greater malabsorptive component. Our aim was to study the benefits of BS at one year and 5 years in terms of the weight and blood glucose profile in patients with obesity and type 2 diabetes mellitus; assess percentage DR according to ADA criteria; determine the DR predictive capacity of different scores; and examine which variables predict DR at one and five years after biliopancreatic diversion (BPD). Percentage overweight reduction and the decrease in both blood glucose and HbA1c were greater with BPD. Complete diabetes remission was approximately 80% at one and 5 years after BS. In general, the scores that determine the probability of DR show poor discriminative capacity in malabsorptive surgery. Presurgery HbA1c predicts DR at one and 5 years after BPD. The type of surgery performed should be individualized, based on the severity of diabetes and the specific characteristics of each patient., (Copyright © 2020 SEEN y SED. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: Disease-related malnutrition (DRM) is underdiagnosed and underreported despite its well-known association with a worse prognosis. The emergence of Big Data and the application of artificial intelligence in Medicine have revolutionized the way knowledge is generated. The aim of this study is to assess whether a Big Data tool could help us detect the amount of DRM in our hospital., Methodology: This was a descriptive, retrospective study using the Savana Manager® tool, which allows for automatically analyzing and extracting the relevant clinical information contained in the free text of the electronic medical record. A search was performed using the term "malnutrition", comparing the characteristics of patients with DRM to the population of hospitalized patients between January 2012 and December 2017., Results: Among the 180,279 hospitalization records with a discharge report in that period, only 4,446 episodes (2.47%) included the diagnosis of malnutrition. The mean age of patients with DRM was 75 years (SD 16), as compared to 59 years (SD 25) for the overall population. There were no sex differences (51% male). In-hospital death occurred in 7.08% of patients with DRM and 2.98% in the overall group. Mean stay was longer in patients with DRM (8 vs. 5 days, P<.0001) and there were no significant differences in the 72-hour readmission rate. The most common diagnoses associated with DRM were heart failure (35%), respiratory infection (23%), urinary infection (20%), and chronic kidney disease (15%)., Conclusion: Underdiagnosis of DRM remains a problem. Savana Manager® helps us to better understand the profile of these patients., (Copyright © 2020. Publicado por Elsevier España, S.L.U.)

Background: Head and neck cancer patients have a high rate of complications during the postoperative period that could increase their morbidity rate. Arginine has been shown to improve healing and to modulate inflammation and immune response. The aim of our study was to assess whether use of arginine-enriched enteral formulas could decrease fistulas and length of stay (LoS)., Methods: A retrospective study was conducted in patients who had undergone head and neck cancer surgery and were receiving enteral nutrition through a nasogastric tube in the postoperative period between January 2012 and May 2018. The differences associated to use of immunoformula vs. standard formulas were analysed. Sociodemographic, anthropometric, and nutritional intervention variables, as well as nutritional parameters, were recorded during the early postoperative period. Occurrence of complications (fistulas), length of hospital stay, readmissions, and 90-day mortality were recorded., Results: In a univariate analysis, patients who received nutritional support with immunonutrition had a lower fistula occurrence rate (17.91% vs. 32.84%; p=0.047) and a shorter mean LoS [28.25 (SD 16.11) vs. 35.50 (SD 25.73) days; p=0.030]. After adjusting for age, energy intake, aggressiveness of surgery and tumour stage, fistula occurrence rate and LoS were similar in both groups irrespective of the type of formula., Conclusions: Use of arginine-enriched enteral nutrition appears to decrease the occurrence of fistulas in the postoperative period in patients with head and neck cancer, with a resultant reduction in length of hospital stay. However, the differences disappeared after adjusting for age, tumour stage, or aggressiveness of the surgery., (Copyright © 2019 SEEN y SED. Publicado por Elsevier España, S.L.U. All rights reserved.)

Aim: To determine the impact of the type of hospital kitchen on the dietary intake of patients., Methods: A cross-sectional, two-centre study, of cooking in a traditional kitchen (TK) and in a chilled kitchen (CK). Subjective global assessment (SGA) was used for nutritional diagnosis. Before study start, a dietician performed a nutritional assessment of the menus of each hospital. All dishes were weighed upon arrival to the ward and at the end of the meal., Results: 201 and 41 patients from the centres with TK and CK respectively were evaluated. Prevalence of malnutrition risk was 50.2% at the hospital with TK and 48.8% at the hospital with CK (p=0.328). Forty-eight and 56 dishes were nutritionally evaluated at the hospitals with TK and CK respectively. Intake analysis consisted of 1993 and 846 evaluations in the hospitals with TK and CK respectively. Median food consumption was 76.83% at the hospital with TK (IQR 45.76%) and 83.43% (IQR 40.49%) at the hospital with CK (p<0.001). Based on the prevalence of malnutrition, a higher protein and energy intake was seen in malnourished patients from the CK as compared to the TK hospital, but differences were not significant after adjustment for other factors., Conclusions: Cooking in a chilled kitchen, as compared to a traditional kitchen, may increase energy and protein intake in hospitalized patients, which is particularly beneficial for malnourished patients., (Copyright © 2017 SEEN. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: The recent FRIDEX calibration proposed cost-effectiveness thresholds for the Spanish population. The aim of our study is to evaluate the impact of its application in routine clinical practice and to compare its thresholds with those of the National Osteoporosis Guideline Group (NOGG)., Material and Methods: Cross-sectional study in women referred to a bone densitometry unit who were not receiving antiresorptive therapy. The absolute risk of major fracture or hip fracture was calculated with the Spanish and British formulas of the FRAX ® tool using the intervention thresholds of the FRIDEX calibration and the NOGG guideline, respectively., Results: The study included 607 women with a median age of 59.4 (IQR=14) years. Treatment was initiated in 31.4% after bone mineral densitometry. With the application of the FRIDEX calibration, bone mineral density testing would have been indicated in 35.4% of the sample and treatment in 26.7%, reducing costs by 18.8% over a 5-year period. The NOGG guideline would have recommended testing in 32% and treatment in 21.3% of the participants, resulting in a reduction in costs of 35% over 5years, when compared with the standard approach. Agreement between the FRIDEX calibration and the NOGG guideline, as defined by Cohen's kappa coefficient, was low in terms of both diagnostic (0.16 [95%CI, 0.09-0.24]) and therapeutic indications (0.39 [95%CI, 0.31-0.47])., Conclusions: The application of the FRIDEX calibration and the NOGG guideline improves efficiency in the management of osteoporosis, although the level of agreement between the two is low., (Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.)

Background: Disease-related malnutrition is a challenge for Spanish hospitals. Our objective was to assess the feasibility and importance of establishing a nutritional screening strategy in our community., Patients and Methods: A prospective cohort study was conducted in a department of internal medicine for 3 months. The nutritional screening was conducted at admission and was repeated weekly using the Malnutrition Universal Screening Tool. We analysed the clinical data, mean stay and expenses., Results: The study included 330 patients (53.9% men), with a mean age of 77.8 years. The mean stay was 7 days, and the Charlson comorbidity index was 5.4. At admission, the Malnutrition Universal Screening Tool detected 26.9% of patients with a risk of malnutrition. Eighteen percent of the patients with a good nutritional state developed malnutrition during the hospitalisation. The patients with initially severe malnutrition had a longer mean stay. The patients whose nutritional state worsened during the hospitalisation had a significantly longer stay (2.5 days) compared with those whose state did not worsen. These cases of malnutrition caused a cost overrun of €767 per hospitalisation (35% greater), which entailed a malnutrition-related excess expenditure of €646,419.93 annually in the studied department. The appropriate coding resulted in an increase in mean weight from 2.11 to 2.81, which represented €82,568.52 and has not been previously quantified., Conclusion: The high prevalence and clinical and financial implications of Disease-related malnutrition in patients hospitalised in internal medicine warrants establishing protocols for its early detection and treatment., (Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.)

Los datos del estudio PREDYCES® nos revelaron que en España la desnutrición relacionada con la enfermedad (DRE) afecta a uno de cada cuatro pacientes hospitalizados. Esta cifra aumenta hasta el 36,8% en los pacientes hematológicos. Se calcula que un 20% de los pacientes oncológicos muere por complicaciones relacionadas con la DRE. Nuestro grupo se planteó en 2011 comenzar la implantación de un cribado nutricional en los servicios con mayor riesgo de DRE. La presente revisión trata de describir todo el proceso que hemos seguido para mejorar la situación nutricional en los pacientes ingresados en el Servicio de Hematología del Complejo Asistencial Universitario de León (CAULE), mayoritariamente con diagnóstico de neoplasias hematológicas. En un primer estudio piloto, detectamos una alta prevalencia de desnutrición, que tendió a aumentar durante la hospitalización. Además, solo el 8,3% los enfermos valorados recibieron algún tipo de soporte nutricional y no se estaban cubriendo sus necesidades ni calóricas ni proteicas, lo que se asociaba a un peor pronóstico. Por este motivo, nos decidimos a implantar de manera sistemática un cribado y una intervención nutricional adecuada, que comenzó en 2011 y que ha recibido el reconocimiento como Buena Práctica del Sistema Nacional de Salud.

Dysphagia is a common problem among elderly and also in some pathological conditions such as neurodegenerative diseases or tumors. Making an adequate diet for this disease may present some difficulties. The aim of this document is to make a detailed technical report about the characteristics of the products that are available in Spain to hydrate and to feed patients with dysphagia. Food and pharmaceutical industries have developed a range of products designed to ensure homogeneous texture and a suitable viscosity to guaranty an adequate hydration. An adequate nutritional status is also achieved with these products for patients with dysphagia, without compromising their safety. The ingredients used to achieve a suitable viscosity are different types of starches, gums and other substances. It has been developed thickeners and gellified water for hydratation, and in case of food there are purees (dehydrated, lyophilized, pasteurized and sterilized), fruit purees, fruit pudding, and dehydrated cereal. Patients who do not meet their nutritional needs have also oral supplements with different viscosities. The industry offers extensive information about the technical characteristics of the products, except for viscosity. It would be recommended for the manufacturers to include in detail the technical specifications of the used methodology and the measurement and the results obtained in the analysis of viscosity that can be consulted by professionals of the Clinical Nutrition and Dietetics Units who treat these patients., (Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.)

Introduction: The high prevalence of malnutrition in hospitals and its impact make the use of a nutritional screening tool necessary for its detection, diagnosis and early treatment., Objective: To evaluate the most appropriate tool for nutritional screening, globally and by hospital wards, in a tertiary hospital., Methodology: cross-sectional study in routine clinical practice. Four nutritional screening tools were evaluated: Subjective Global Assessment (SGA), Mini Nutritional Assessment (MNA), Malnutrition Universal Screening Tool (MUST), and Nutritional Risk Screening 2002 (NRS-2002). Hospital wards were grouped into: medical wards, General Surgery, Orthopedics, other surgical wards, and Oncology-Hematology. A statistical analysis of sensitivity (S) and specificity (Sp) were performed, and were compared using ROC curve., Results: There were evaluated 201 patients with median age of 71.6 (RIC 21.4) years and 51.2% were women. The prevalence of nutritional risk (NR) and malnutrition (MN) was: SGS 62.1%, 68.6% MNA, MUST 53.7%, and NRS-2002 35.8%. All the evaluated nutritional screening tools, except MNA, detected a higher prevalence of RN and DN in the medical wards than surgical wards. In the overall analysis the MNA obtained S=93.3%, Sp=71.6% and an area under the ROC curve of 0.825; the MUST obtained S=82.4%, Sp=93.4% and an area under the ROC curve of 0.879; NRS-2002 obtained S=56.0%, Sp=97.4% and an area under the ROC curve of 0.766. These results were similar in the analysis by hospital wards., Conclusion: MUST could be the recommended nutritional screening tool to use in a tertiary hospital with elderly population, as the overall good results of sensitivity and specificity, as well as its simplicity., (Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.)

Background: Weight loss before bariatric surgery, achieved by means of a very low calorie diet (VLCD) has been recently reported to be related to a lower rate of postoperative complications. However, it is controversial if preoperative weight loss after VLCD could improve postoperative weight loss., Aims: To assess the effectiveness of a preoperative VLCD for 6 weeks in weight loss one year after bariatric surgery. To evaluate the changes obtained in anthropometric measures and biochemical parameters after VLCD., Methods: Prospective uncontrolled study including severely obese patients undergoing biliopancreatic diversion in our Obesity Unit in 2008-2010. Patients included followed a VLCD providing 840 kcal and 60 g of protein (Optisource®). Descriptive data are presented as mean (standard deviation) and after checking a normal distribution is followed, they were analyzed by Student s T test, ANOVA or Pearson correlation., Results: We evaluated 107 obese patients, 43.5 (10.2) years-old, 72% women, with initial weight 122.4 (18.6) Kg and BMI 46.8 (5.5) kg/m(2). 24.5% of them lost more than 10 % of initial weight and 73.5% more than 5% after following VLCD. Mean percentage of excess weight loss (% PSP) one year after surgery was 59.6 (13.4)%, and although it was higher for those patients losing more weight after VLCD, a significant correlation was not found: those who lost more than 5% showed %PSP 59.5 (13.8) % after twelve months and 68.4 (16.2) % of percentage of excess BMI loss (%PEIMC), vs 57,9 (13,1) % and 68.5 (16.6) % if they didn t lose that amount of weight. Those patients losing more than 10% achieved %PSP 63.3 (13.7) and %PEIMC 70.9 (14.7) vs 58.2 (14.0) y 67.7 (16.7) vs those not losing that amount. Significant correlations between preoperative loss with VLCD and %PSP or %PEIMC at 3,6,9 and 12 months were not found, and only %PSP 1 month after surgery correlated with %PSP after VLCD (r = 0.454, p = 0.003)., Conclusions: Preoperative weight loss with VLCD in severely obese patients did not show to improve either %PSP or %PEIMC one year after bariatric surgery., (Copyright © AULA MEDICA EDICIONES 2013. Published by AULA MEDICA. All rights reserved.)

Introduction: Malnutrition affects morbidity and mortality of patients with ALS. The nutrition unit should evaluate these patients early and regularly providing the necessary steps in the evolution of the disease., Methods: A retrospective cohort study in which we analyzed 46 patients diagnosed with ALS, 21 of them received nutritional therapy. We studied age, mode of onset, date of entry into a nutritional protocol, placement of PEG and survival. We performed a test of Breslow comparing patients who were at nutritional protocol with those not receiving nutritional support, and those who received early nutritional therapy with those with delayed nutrition., Results: There was an increase in median survival for patients in nutritional therapy in bulbar ALS (452 vs 55 days) and in spinal ALS (1,798 vs 357 days) (p = 0.002). The median delay in the initiation of nutritional therapy in spinal ALS was 557 days while in bulbar ALS was 230 days. The survival in the spinal ALS of those who entered into nutritional protocol before the median survival was 325 days to 181 days (p = 0.09) while in bulbar ALS those who entered before had a median survival of 435 days to 177 days (p = 0.38)., Conclusions: The entry of patients with ALS in a nutritional protocol increases survival. There is an advantage in the evolution of patients with early nutritional treatment.

Background: The establishment of healthy eating habits in children at school and in family life is very important for preventing obesity in children., Aims: To know the habits of late-breakfast in a scholar population, the prevalence of overweight and obesity, and establish healthy dietary habits through the late-breakfast., Methods: A prospective interventional study was performed in a school group. Children from 10 to 13 years-old were included. The study had three phases: pre-intervention (anthropometric assessment and questionnaire of late-breakfast frequency), intervention (parents and teachers received information about "the importance of proper nutrition in school" focused on the transcendence of a healthy and balanced diet that includes a suitable late-breakfast every day at school, and the students received the late-breakfast during two weeks that included milk, fruit and a traditional sandwich), and post-intervention (questionnaire of late-breakfast frequency)., Results: Frequency of overweight was 10.6% and obesity 2.6%. After the intervention the proportion of children who had late-breakfast increased by 9.2%, and the kind of food which they ate changed., Conclusion: Dietary habits can be modified in a scholar population with an easy nutritional intervention.

Background and Objective: Nutritional assessment in the elderly is difficult and different from that performed in younger people. There are specific tools for that purpose, such as the Geriatric Nutritional Risk Index (GNRI). The study objective was to compare this index to the Nutritional Risk Index (NRI)., Materials and Methods: A retrospective, observational analytical study including 113 hospitalized patients over 75 years of age receiving nutritional support. Weight, height, age, length of stay, Mini Nutritional Assessment (MNA), nutrition type and duration, and occurrence of complications were collected. GNRI and NRI were calculated. Both indexes were compared to each other and with parameters measured., Results: Mean GNRI was 88.79 (SD: 13.1), mean NRI 79.96 (SD: 10.8), and mean MNA 17.49 (SD: 4.9). Complications occurred in 50.4% of patients, and 14% died. NRI and GNRI did not correlate with length of stay (R=0.136) or with length of nutrition (R=0.041). No significant correlation was seen between GNRI and complications, but a significant relationship was found with NRI. After stratification into surgical and medical patients, NRI was seen to be significantly related to complications in surgical patients only (p<0.05). GNRI was not related to complications in either surgical or medical patients., Conclusions: In hospitalized elderly patients, NRI is a better predictor of complications and may be more appropriate for assessing the risk of death than GNRI. GNRI underestimated nutritional risk as compared to NRI., (Copyright © 2010 SEEN. Published by Elsevier Espana. All rights reserved.)

Inflammatory bowel disease is an entity with not wellknown pathogenesis, and important nutritional and metabolic implications because of the high prevalence of malnutrition, the possible implication of dietary factors in its pathogenesis and because of the hypothesis that nutritional intervention could be a primary treatment for the disease. Some nutrients could induce a low antigenic stimuli, regulate inflammatory and immunological responses and stimulate intestinal mucosal trophism. Present available evidence supports enteral nutrition in Crohn's disease as a primary treatment if treatment with steroids is not possible (failure or contraindication) (grade of recommendation A) or either combined treatment with drugs in malnourished patients or those with inflammatory bowel stenosis. In those patients with sustained clinical remission, no benefit of either enteral nutrition or supplements in the absence of nutritional deficits has been shown. Elemental or modified formula (glutamine, omega 3 fatty acids) could not be recommended. In ulcerative colitis, nutritional influence over the activity of the disease has not been shown, although there are some promising results regarding enteric coated W3 fatty acids and a possible role for probiotics. In the treatment and prevention of pouchitis, there could be a role for probiotics (VSL#3). Nutritional treatment should be considered an integral component in the Management of patients with inflammatory bowel disease.

We present the case of a male patient suffering from a primary amyloidosis and a nephrotic syndrome who came to dietotherapy clinic. In the first visit we made a nutritional record including an anthropometric evaluation, body composition, biochemistry, and food intake. The patient had an excess of body water, proteinuria, low plasma protein, albumin, prealbumin and HDL cholesterol levels, and high concentrations of total cholesterol, LDL and triglycerides. The consumption of protein and sodium was higher than the recommendation. An individualized diet was made. Six months later, his weight and the excess of body water decreased, but the fat free mass remained unchanged. The levels of albumin and prealbumin increased, the proteinuria decreased. Total cholesterol, LDL and triglycerides decreased until normal levels. Dietetary treatment in nephrotic syndrome is effective to decrease proteinuria, improve cholesterol and triglycerides levels, and to prevent malnutrition.