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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: Existen diferentes metodologías para la estimación del Gasto Energético Total (GET). Objetivo: Conocer qué herramienta resulta más útil para la estimación del GET en sujetos sanos: SenseWearArmband (SWA) o Harris-Benedict (HB). Metodología: Estudio transversal realizado en 32 voluntarios. Se colocó el SWA durante 24 h y se estimó el GET con HB y el factor de actividad calculado con un cuestionario de actividad de 24 h. Resultados: La diferencia entre ambas estimaciones en el GET fue de 351,9 (IC 95% 222,2 a 481,6) kcal/día (p < 0,001). Dicha diferencia no se relacionó con el sexo pero sí con la obesidad. El valor del CCI fue 65,0% (IC 95% 7,8% a 86,2%) con una significación estadística (p < 0,001). Existió una diferencia significativa en la estimación de la actividad entre ambas técnicas [0,4 (IC 95% 0,1 a 0,7) horas (p = 0,007)]. Conclusiones: Existió una diferencia relevante en la estimación del GET mediante HB y SWA.Introduction: Different methodologies for estimating total energy expenditure (TEE) are currently used. Objective: To know which tool is most useful to estimate TEE in healthy subjects: SenseWearArmband (SWA) or Harris-Benedict (HB). Methodology: Cross-sectional study in 32 volunteers. SWA was placed for 24 hours and TEE was estimated with HB and the activity factor calculated with a 24-h activity questionnaire. Results: The difference between both estimates of TEE was 351.9 (95% CI 222.2 to 481.6) kcal/day (p < 0.001). This difference was associated with obesity, but not with sex. The value of ICC was 65.0% (95% CI 7.8% to 86.2%) being statistically significant (p < 0.001). There was a significant difference in the estimation of the activity between both techniques [0.4 (CI 95% 0.1 to 0.7) hours (p = 0.007)]. Conclusions: A significant difference in the estimation of TEE using HB and SWA has been found.

Introducción: La evaluación de la calidad en las actividades sanitarias exige la elección de unos indicadores acordes con los resultados que queremos medir. De todos los posibles, debemos priorizar aquellos que nos permitan obtener la información más relevante sin sobrecargar el trabajo habitual de nuestras Unidades. Objetivo: Conocer la opinión de los socios de SENPE respecto a la relevancia y la viabilidad del uso de una selección de indicadores de calidad para su aplicación en nutrición clínica. Métodos: Encuesta remitida mediante correo electrónico a los socios de SENPE solicitando a los mismos su opinión sobre 12 indicadores de calidad, valorándose cada uno en cuanto a su relevancia y factibilidad de la aplicación en su medio. Resultados: Contestaron 40 encuestados de 40 centros diferentes de 12 comunidades autónomas. En general, los indicadores fueron considerados más relevantes que factibles. Los indicadores mejor puntuados fueron: "identificación en las bolsas de nutrición artificial", "posición semi-incorporada del paciente con nutrición enteral por sonda nasogástrica" y "protocolos clínicos básicos". Considerando los indicadores por grupos (de estructura, proceso o resultado) los mejor valorados fueron: "identificación del paciente en las bolsas de nutrición artificial" (estructura), "posición semi-incorporada" y "protocolos clínicos básicos" (proceso), y "cumplimiento del objetivo calórico" (resultado). Conclusión: Los resultados de la encuesta permiten seleccionar indicadores prioritarios para su aplicación en las Unidades de Nutrición.Introduction: The quality assessment in health activities requires the choice of indicators in line with the results we want to measure. Of all possible, we should prioritize those that allow us to obtain the most relevant information without overloading the regular work of our units. Objective: To determine the opinion of the members of SENPE regarding the relevance and feasibility of using a selection of quality indicators designed for use in clinical nutrition. Methods: E-mail survey sent to members of SENPE asking them their views on 12 quality indicators, evaluating each in terms of their relevance and feasibility of implementation in their environment. Results: 40 respondents answered from 40 centers in 12 different regions. In general, the indicators were considered more relevant than feasible. The indicators best rated were: "identification in artificial nutrition bags, "semi-recumbent position in patient with nasogastric tube feeding" and "basic clinical protocols". Considering the type of indicator: "patient identification in the bags of artificial nutrition (structure)," a semi-incorporated "and" basic clinical protocols (process), and "fulfillment of the caloric goal" (result). Conclusion: The results of the survey can make a selection of indicators that could be considered for first-line introduction in a Nutrition Unit.

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.

El síndrome de intestino corto (SIC) es una entidad compleja debida a una pérdida anatómica o funcional de una parte del intestino delgado que ocasiona un cuadro clínico de graves alteraciones metabólicas y nutricionales debidas a la reducción de la superficie absortiva intestinal efectiva. El SIC es una causa de la condición más amplia de "fallo intestinal". Actualmente, los accidentes vasculares mesentéricos son la causa principal en adultos, seguidos de la enfermedad inflamatoria intestinal y la enteritis rádica, mientras que en niños las principales causas con las enfermedades congénitas y perinatales. La clínica asociada al SIC también está en función de la longitud y la zona de intestino delgado afectada, la presencia de enfermedad subyacente, la presencia o ausencia de colon y de válvula ileocecal, y la naturaleza de la enfermedad de base. La adaptación intestinal es el proceso que a lo largo de 1-2 años trata de restablecer la absorción intestinal a aquella previa a la resección intestinal y es un factor fundamental para determinar si un paciente con SIC progresará a fracaso intestinal y dependencia de NPD. La adaptación intestinal puede ocurrir gracias a que el paciente haga una ingesta superior a la normal (hiperfagia); pero además, el intestino también es capaz de adaptarse para asegurar una absorción más eficaz por unidad de superficie, bien aumentando su superficie absortiva (adaptación estructural) y/o enlenteciendo el tránsito gastrointestinal (adaptación estructural). Aún no están bien establecidos estos cambios en humanos, aunque sí en modelos animales. En el éxito del proceso de adaptación influye la presencia de nutrientes en la luz intestinal, así como algunas hormonas gastrointestinales, especialmente GLP-2. Los pacientes con SIC están predispuestos a la aparición de sobrecrecimiento bacteriano, que dificulta la adaptación, empeora la sintomatología y es un factor de dependencia de nutrición parenteral.The short bowel syndrome (SBS) is a complex entity due to anatomical or functional loss of part of the small bowel originating a clinical picture with severe metabolic and nutritional impairments due to reduction of the effective absorptive surface area of the gut. SBS is one of the causes of a larger entity known as "intestinal failure". Currently, mesenteric vascular accidents are the main cause in adults, followed by inflammatory bowel disease, and radiation enteritis, whereas in children, the main causes are congenital and perinatal diseases. The clinical picture associated with SBS varies according to the length and location of affected small bowel, the presence of underlying disease, the presence or absence of the large bowel and ileocecal valve, and the nature of the underlying disease. Intestinal adaptation is the process by which, throughout 1-2 years, intestinal absorption is reestablished to the situation prior to intestinal resection, and is a key factor determining whether a patient with SBS will progress to intestinal failure and depend on DPN. Intestinal adaptation may take place if the patient does oral intake higher than the usual one (hyperphagia); besides, the bowel may also adapt to secure a more effective absorption per surface area unit, either by increasing the absorptive surface area (structural adaptation) and/or slowing intestinal transit (functional adaptation). These changes are not still clearly established in humans, but there are so in animal models. The presence of nutrients within the intestinal lumen and certain gastrointestinal hormones, particularly GLP-2, have an influence on a successful adaptation process. Patients with SBS are prone to the occurrence of bacterial overgrowth that makes adaptation difficult and worsens the symptoms, besides being a factor for dependence on parenteral nutrition.

INTRODUCCIÓN: La necrosis avascular representa la muerte del tejido óseo por fallo de su vascularización, y se asocia principalmente al uso de corticoides a dosis elevadas durante tiempo prolongado. CASO CLÍNICO: Una paciente de 25 años tratada con glucocorticoides a altas dosis durante 7 meses por colitis ulcerosa presenta dolor en ambas rodillas y movilidad limitada de caderas y rodillas. En la radiografía simple y la resonancia nuclear magnética (RNM) se observó necrosis avascular en dichas articulaciones; la densitometría ósea demostró osteopenia en cabeza femoral y osteoporosis lumbar. DISCUSIÓN: Presentamos un caso llamativo por la amplia afectación articular (ambas caderas y rodillas) con presencia simultánea de osteoporosis y osteopenia en una paciente joven tratada con corticoides por colitis ulcerosa. Es necesario recomendar el uso prudente de los glucocorticoides, prescribiendo la dosis mínima necesaria y durante el menor tiempo que sea posible para controlar la enfermedad de base.INTRODUCTION. Avascular necrosis represents the bone tissue death from vascularization failure, and it is mainly associated with the use of high-dose corticosteroids for a long time. CLINICAL CASE. A 25 years old female patient treated with high-dose corticosteroids for 7 months for ulcerative colitis presents with both knees pain and limited hip and knee motility. In a plain X-ray and in nuclear magnetic resonance imaging (MRI) avascular necrosis was observed at these joints. Bone densitometry showed osteopenia at the femoral head and lumbar osteoporosis. DISCUSSION. We present a striking case for its large involvement of the joints (both knees and hips) with simultaneous osteoporosis and osteopenia in a young patient treated with corticosteroids for ulcerative colitis. It is necessary to recommend the judicious use of glucocorticoids, prescribing the minimal necessary dose and for the least amount of time necessary to control the underlying disease.

BackgroundTo demonstrate whether a nutritional supplement enriched with arginine, nucleotides, omega-3 fatty acids, and extra virgin olive oil reduces postoperative complications in patients with tumors in the upper digestive tract.MethodsA randomized, controlled, double-blind, multicenter clinical trial, in which a new immunomodulatory formula with extra virgin olive oil was compared with a standard isoprotein and isoenergetic formula. Patients with gastric, esophageal or biliopancreatic tumors were recruited to receive two units of immunomodulatory formula or control, 5 days before the surgical intervention.ResultsA total of 119 patients were recruited. There was a significant reduction in the number of reinterventions (7.7 vs. 20.4%; p = 0.044) in the intervention group. There was a significant reduction in the development of fistulas in patients with phase angles >5.7°. Also, there were fewer readmissions after biliopancreatic surgeries (0.0 vs. 100%; p = 0.014). The length of hospital stay was similar between groups; however, with the immunomodulatory formula, the patients exhibited greater phase angle at the end of follow-up.ConclusionThe immunomodulatory formula with extra virgin olive oil administered 5 days before surgery for stomach, esophageal and biliopancreatic tumors improved cellular health and reduced postoperative complications.Clinical trial registration: [https://clinicaltrials.gov/], identifier [NCT04027088].

Methods: A randomized, double-blind, parallel-group, controlled, multicenter clinical trial was conducted in patients with cancer and malnutrition during outpatient treatment. Patients were randomized to receive either a specific high-calorie, high-protein ONS enriched with leucine, EPA, DHA, and β-glucans or an isocaloric, isonitrogenous standard ONS for eight weeks. Malnutrition was diagnosed using the SGA and body composition was evaluated using bioimpedance. Results: 57 patients were recruited and 37 completed the intervention period. After the nutritional intervention, patients who received the enhanced-ONS showed a significant increase in muscle mass, which was not detected with the standard ONS [1.92 (4.31) kg vs −0.68 (1.45) kg); p = 0.009)], and there was no significant reduction in the percentage of patients with severe and moderate malnutrition. Conclusion: An enhanced ONS enriched in EPA, DHA, leucine, and β-glucans increases muscle mass and could promote nutritional and functional status recovery in patients with cancer and malnourishment.Trial registration: NCT04184713.

The article discusses the importance of improving nutritional care in patients with inflammatory bowel disease (IBD). Malnutrition is common in these patients and can increase mortality and hospital stay. It is recommended to screen for malnutrition and determine the patient's nutritional status before surgery. The importance of treating malnutrition and following a diet rich in fruits, vegetables, and n-3 fatty acids is also mentioned. Exclusive enteral nutrition has positive effects on IBD by reducing local inflammation and restoring intestinal barrier function. Preoperative nutritional intervention with enteral nutrition reduces postoperative complications and helps prevent endoscopic recurrence of the disease. [Extracted from the article]

Medical nutrition therapy is a very useful tool in maintaining and recovering the health of patients with disease-related malnutrition, although its implementation can be complex and is not without risks. Quality processes are understood as sets of activities that are related or interact to transform input elements into results. From the SENPE Management Work Group we present the process of medical nutrition therapy (PMNT), which aims to facilitate the management of clinical nutrition of a multidisciplinary nutrition support team in a hospital setting. This paper describes the seven sub-processes PMNT is comprised of, in addition to a previous nutritional screening sub-process. Each sub-process is divided into a first section with a technical sheet detailing its general aspects, while a second section proposes key objectives, quality indicators, and standards for their evaluation. [ABSTRACT FROM AUTHOR]

Nutriscore is a malnutrition screening tool designed specifically for cancer patients. Our objective was to assess its performance in hospitalized cancer patients. Adult patients diagnosed with any solid neoplasm hospitalized in Medical Oncology were included. In the first 24–48 h, of admission they were screened with Nutriscore and Malnutrition universal screening tool (MUST). Both tests were compared using chi-square, kappa index and ROC curve. Nutriscore sensitivity (S), specificity (Sp) and predictive values (PV) were calculated using MUST as a reference. A total of 93 patients were included. The most frequent tumors were lung (36.6%), colorectal (24.8%) and breast (8.6%). MUST identified 69.9% of the patients at nutritional risk, and Nutriscore 44.1% (p < 0.001), with a low kappa index [k = 0.38 (95% CI 0.23 to 0.54)]. The AUC of the ROC curve for Nutriscore with respect to the MUST was 0.739. Nutriscore showed S = 58.6 (95% CI 45.7 to 71.2), Sp = 89.3% (95% CI 76.0 to 100.0%), VP + = 92.7% (95% CI 83.5 at 100.0%) and VP- = 48.1% (95% CI 33.5 to 62.6). Nutriscore did not provided better screening results in hospitalized cancer patients than a validated tool such as MUST. [ABSTRACT FROM AUTHOR]

Introduction: Introduction: the goal of this work was to evaluate the acceptance of various types of thickeners, specifically modified starch thickener and gum thickener, both with and without flavoring. Patients and methods: a randomized sample of 40 hospitalized patients with oropharyngeal dysphagia was recruited. The taste, smell, and appearance of each type of thickener were evaluated, as well as the volume of liquid ingested by the patients taking each type of thickener (modified starch thickener vs. gum thickener, both with and without flavoring). Results: the overall acceptance of gum thickener was significantly higher than that of modified starch thickener (7.45 (1.57) vs. 5.10 (2.43), respectively; p = 0.001). When a food flavor was added to the thickened water, the overall rating of the product was higher than when no flavor was added (7.70 (1.53) vs. 4.85 (2.16); p < 0.001). The difference between the daily volume of water consumed by the patients who received gum thickeners (928.33 (331.27) mL) and those who received starch thickeners (670.00 (288.35) mL) was statistically significant (p = 0.012). Patient consumption was also higher when flavoring was added as compared to when it was not (943.33 (302.45) mL) vs. (655.00 (304.60) mL; p = 0.005). Conclusion: the acceptances of the thickener and of water intake by patients with dysphagia were both significantly higher when using gum thickeners compared to starch thickeners, and when adding flavoring. [ABSTRACT FROM AUTHOR]

Introduction: Introduction: quality indicators have been proposed in Spain for assessing the various stages of clinical nutrition. However, reference standards for these indicators (feasible and relevant) based on daily practice of artificial nutrition are not available. Goals: the goal of this study was to propose quality indicators standards for their routine application to artificial nutrition in clinical practice. Material and methods: a multicenter, cross-sectional study-based on a survey applied to health professionals in the field of clinical nutrition-on the fulfilment of eight quality criteria was carried out during 2018 and 2019. The total number of processes and those that were correctly accomplished were assessed and compared with the corresponding proposed theoretical standard. Results: fifteen centers were assessed. Of eight indicators assessed, five were within the theoretical standard (correct identification of parenteral nutrition bags, semi-upright position of patients on enteral nutrition, administration of micronutrients in ready-to-use parenteral nutrition bags, checking placement of feeding tubes, and days with glycemia below 60 mg/dL). Two indicators were very close to the theoretical standard. One indicator, hyperglycemia in patients with parenteral nutrition, was far removed from its theoretical standard (15.7 % vs. 5 %). Conclusion: the administration of artificial nutrition in Spanish hospitals was performed with a high quality level. Therefore, standards based on daily clinical practice regarding artificial nutrition in Spain are proposed. [ABSTRACT FROM AUTHOR]

Introduction: Introduction: the objective was to assess the utility of the Eating Assessment Tool (EAT-10) in hospitalisation units with patients at high risk of dysphagia. Patients and methods: a cross-sectional study was conducted in the Neurology and Internal Medicine wards; patients with admission < 24 hours and in a terminal stage of disease were excluded. In the first 24-48 hours of admission the presence of dysphagia as assessed with the EAT-10, the risk of malnutrition as assessed with the Malnutrition Universal Screening Tools (MUST), and comorbidities using the Charlson index were screened. Results: a total of 169 patients were recruited (76.0 years, 52 % women); 19.5 % were at risk of malnutrition. The EAT-10 instrument could be administered in 80.6 % of the patients, and was positive in 26.6 % (women 34.1 % vs. men 18.4 %; p = 0.025). When comparing patients with higher comorbidity with those with a lower Charlson index, a lower response rate to EAT-10 was observed (78.4 % vs. 93.9 %; p = 0.038), without differences in screening positivity (28.3 % vs. 19.4 %; p = 0.310). The prevalence of dysphagia risk was higher in the Internal Medicine unit than in the Neurology unit (30.4 % vs. 19.6 %; p = 0.133), as was the percentage of cases in which screening could not be performed (21.1 % vs. 11.1 %; p = 0.011). There were no significant differences in risk of malnutrition, mortality, hospital stay, or readmission according to the EAT-10. Conclusions: The EAT-10 has limited utility in the studied hospitalisation units due to a high rate of unfeasible tests, especially among patients at higher risk of dysphagia. [ABSTRACT FROM AUTHOR]

Introduction: Nutritional support for malnourished patients undergoing gastrointestinal surgery reduces the complication rate and shortens the length of stay. The efficacy of nutritional support after hospital discharge was analyzed in this systematic review.Methods: The search strategy (nutrition OR "enteral nutrition" OR "nutritional supplements" OR "oral nutritional supplements" OR "sip feed" OR "sip feeding" OR "dietary counseling") AND ("patient discharge" OR discharge OR postdischarge) AND (surgery OR operation OR "surgical procedure") was followed in Medline, CENTRAL, and Trip databases. Inclusion criteria comprised: type of study (randomized controlled trial), language (English, Spanish), and subjects (patients undergoing gastrointestinal surgery). The risk of bias was assessed by using the Cochrane methodology.Results: Five studies which were published in six different articles and recruited 446 patients were included. A high risk of bias was detected for most of them. Nutritional support improved energy intake and protein intake when high-protein oral supplements were provided. The intervention was associated with better weight prognosis, but the data about body composition were inconsistent. In most of the trials, nutritional intervention did not enhance functional capacity or quality of life. None of the studies analyzed the effects on complications after discharge.Conclusion: Nutritional support provided at discharge may increase dietary intake and improve body weight, but the low quality of studies can weaken the validity of results. [ABSTRACT FROM AUTHOR]

Introduction: Hospital diets should provide enough energy from an adequate macronutrient distribution. Aim: To determine the nutritional quality of hospital diets. Methods: Cross-sectional study in routine clinical practice. Nutritional assessment of all hospital diets and an estimation of the energy and protein needs of hospitalized patients were performed. Nutritional and dietary adequacy of current diets taking into account the nutritional needs of the patient was assessed. It was considered as a "complete diet" if the energy and protein value was above the 95th percentile of the detected nutritional requirements of the evaluated patients; as a "potentially complete diet" if the energy and protein value was between the 95-75th percentile of the nutritional requirements; and as an "incomplete diet" if the energy and protein value was below the 75th percentile of the nutritional requirements. Results: 54 types of hospital diets were nutritionally evaluated and 201 patients were assessed. Their median age was 71.60 (21.40 RIC) years and 51.25% were women. Their energy needs were 25.84 (SD 2.55) kcal/kg/day or 1,753.54 (SD 232.51) kcal/day; the 95th percentile was 2,153.9 kcal/day and the 75th percentile was 1,772.5 kcal/day. Their protein requirements were 1.2 (SD 0.10) g/kg/day or 82.30 (SD 16.76) g/day; the 95th percentile was 112.3 g/day and the 75th percentile was 91.8 g/day. 25% of the diets covered energy needs of the hospital population; only one diet covered protein needs. Conclusions: The evaluated diets did not cover the nutritional needs of hospitalized patients. The current restructuring of diets will satisfy patient's nutritional needs as well as their dining expectations. [ABSTRACT FROM AUTHOR]

Purpose: the objective was to demonstrate if treatment modality, nutritional status and oropharyngeal flora contribute to the development of mucositis in radiotherapy- treated head and neck cancer.Methods: single-cohort study of patients with head and neck cancer (H&N) in which radiotherapy was indicated. Nutritional status was evaluated using SGA, BMI, and FFMI. A buccal smear was performed before radiotherapy for cultivation of bacteria and yeasts. Mucositis was evaluated using the WHO grades. Relative risk (RR) and its 95% CI were calculated.Results: the study included 35 patients, 74.3% males, 63.8 (9.9) years of age, and 34.3% malnourished. The diagnoses included larynx (40.0%), oral (25.7%), and pharynx cancer (11.4%). Treatment comprised 66.0 Gy of radiation, chemotherapy (60.0%), and surgery (57.1%). Bacteria were found in 28.6%, including Staphylococcus aureus (8.6%) and Escherichia coli (8.6%). Yeasts (Candida spp.) were found in 35.3%. Mucositis was more frequent in patients with definitive radiotherapy [100% vs. 65%, p = 0.01; RR = 1.54 (CI95% 1.12 to 2.12)]. Neither SGA nor BMI or FFMI were related to the development or severity of mucositis. Positive cultures for bacteria before radiotherapy were related to severe mucositis [44.4% vs. 12%, p = 0.039; RR = 4.17 (CI95% 1.22 to 14.24)], but there was no relationship with the presence of yeasts. Previous surgery was not associated with the appearance of the studied strains of bacteria.Conclusion: bacterial colonization of the oropharynx prior to radiotherapy may be a factor for severe mucositis in H&N patients. [ABSTRACT FROM AUTHOR]

Background: The aim was to evaluate the effects of glutamine on tumor regression and histological damage in patients with rectal patients following chemoradiotherapy previous to surgery. Material and methods: Ten patients with rectal cancer surgically removed after chemoradiotherapy were included, a subgroup of a randomized trial that compared glutamine and placebo in the prevention of acute radiation enteritis. Samples of neoplasm and healthy tissue were evaluated by an expert pathologist searching for signs of tumor regression, muciphages, and signs of radiation-induced damage. Results: There were no differences in the grade of tumor regression with either glutamine or placebo. All patients who received glutamine presented muciphages, compared with 28.6% of the placebo group (p = 0.038). Histological damage was similar in patients receiving glutamine or placebo, and between those with radiation enteritis or without toxicity. Conclusion: Glutamine did not exert a protective effect over chemoradiotherapy in rectal cancer or healthy rectal tissue. [ABSTRACT FROM AUTHOR]

Current nutritional guidelines encourage the reduction of fat intake from animal sources like dairy products. The aim was to determine whether the consumption of low-fat dairy is related to poorer dietary intake and nutritional status in cancer patients at risk of malnutrition. This cross-sectional included patients with solid or hematological malignancies at risk of malnutrition. Nutritional status was studied using Subjective Global Assessment, anthropometry, and grip strength. Dietary intake was evaluated with a 24-h recall and dairy consumption with a structured questionnaire. Seventy-four patients were recruited; 71.6% males of 64.8 yr, most with gastrointestinal malignancies. Only 37.8% consumed whole milk, and 61.4% consumed whole yogurt. Reasons for consumption of low-fat dairies were healthy diet (58.0%), hypercholesterolemia (20.0%), and digestive intolerance (10.0%). There were similar rates of malnutrition according the type of dairy (whole 60.9% vs. low-fat 66.7%,P= 0.640). Low-fat dairies were related to a reduction in energy (whole 1980.1 kcal vs. low-fat 1480.9,P= 0.007) and protein intake (whole 86.0 g vs. low-fat 63.0 g,P= 0.030). [ABSTRACT FROM PUBLISHER]