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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. .El tratamiento médico nutricional es de gran utilidad en el mantenimiento y recuperación de la salud de los pacientes con desnutrición relacionada con la enfermedad, aunque su implementación puede ser compleja y no está exenta de riesgos. Se entiende por proceso aquel conjunto de actividades que están mutuamente relacionadas o que interactúan para transformar elementos de entrada en resultados. Desde el Grupo de Trabajo de Gestión de la SENPE presentamos el Proceso de Tratamiento Médico Nutricional (PTMN), que tiene por objetivo facilitar la gestión de la nutrición clínica, pensando en un equipo de soporte nutricional multidisciplinar de atención al paciente hospitalizado. En este documento se describen los siete subprocesos que constituyen el PTMN, además de un subproceso previo de cribado nutricional. Cada subproceso se divide en una primera sección con una ficha técnica en la que se detallan sus aspectos generales, mientras que en la segunda sección se proponen objetivos clave, indicadores de calidad y estándares para su evaluación.

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% (Nutriscore did not provided better screening results in hospitalized cancer patients than a validated tool such as MUST.

BACKGROUND: In patients receiving total parenteral nutrition (TPN), the frequency of hyponatraemia is high. However, the causes of hyponatraemia in TPN have not been elucidated, although diagnosis is required for appropriate therapy. The aim of this study is to describe the aetiology of hyponatraemia in non-critical hospitalised patients receiving TPN. METHODS: Prospective multicentre study in 19 Spanish hospitals. Non-critically hyponatraemic patients receiving TPN and presenting hyponatraemia over a 9-month period were studied. Data collected included sex, age, previous comorbidities, and serum sodium levels (SNa) before and following TPN initiation. Parameters for study of hyponatraemia were also included: clinical volaemia, the presence of pain, nausea, gastrointestinal losses, diuretic use, oedema, renal function, plasma and urine osmolality, urinary electrolytes, cortisolaemia, and thyroid stimulating hormone. RESULTS: 162 patients were included, 53.7% males, age 66.4 (SD13.8) years. Volume status was evaluated in 142 (88%): 21 (14.8%) were hypovolaemic, 96 (67.6%) euvolaemic and 25 (17.6%) hypervolaemic. In 111/142 patients the analytical assessment of hyponatraemia was completed. Hypovolaemic hyponatraemia was secondary to GI losses in 10/111 (9%), and to diuretics in 3/111 (2.7%). Euvolaemic hyponatraemia was due to Syndrome of Inappropriate Antidiuretic Hormone secretion (SIADH) in 47/111 (42.4%), and to physiological stimuli of Arginine Vasopressin (AVP) secretion in 28/111 (25.2%). Hypervolaemic hyponatraemia was induced by heart failure in 19/111 (17.1%), cirrhosis of the liver in 4/111 (3.6%). CONCLUSIONS: SIADH was the most frequent cause of hyponatraemia in patients receiving TPN. The second most frequent cause was physiological stimuli of AVP secretion induced by pain/nausea.

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); p0.001). 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.Introducción: el objetivo de este trabajo fue evaluar la aceptación de varios tipos de espesantes (almidón modificado frente a gomas) con y sin saborizante. Pacientes y métodos: se reclutaron 40 pacientes hospitalizados con disfagia orofaríngea. Se evaluaron el sabor, el olor y la apariencia de cada tipo de espesante, así como el volumen de líquido ingerido por los pacientes que tomaban cada tipo de espesante (espesante de almidón modificado vs. espesante de goma, ambos con o sin saborizante). Resultados: la aceptación general del espesante de goma fue significativamente mayor que la del almidón modificado (7,45 (1,57) vs. 5,10 (2,43); p = 0,001). Cuando se añadió un saborizante al agua espesada, la calificación general fue mejor (7,70 (1,53) frente a 4,85 (2,16); p0,001). La diferencia entre el volumen diario de agua consumida por los pacientes que recibieron espesantes de goma (928,33 (331,27) ml) y los que recibieron espesantes de almidón (670,00 (288,35) ml) fue estadísticamente significativa (p = 0,012). El consumo de líquido también fue mayor cuando se agregó el saborizante (943,33 (302,45) ml frente a 655,00 (304,60) ml; p = 0,005). Conclusión: la aceptación del espesante y la ingesta de agua por parte de los pacientes con disfagia fueron significativamente mayores cuando se utilizaron espesantes de goma, en comparación con los espesantes de almidón, y al agregar saborizantes.

espanolIntroduccion: en Espana se han propuesto indicadores de calidad para evaluar las diversas etapas de la asistencia en nutricion clinica. Sin embargo, no se encuentran disponibles estandares de referencia de estos indicadores (factibles y relevantes) basados en la practica diaria de la nutricion artificial. Objetivos: ofrecer estandares de indicadores de calidad para su aplicacion rutinaria en la practica clinica de la nutricion artificial. Material y metodos: estudio transversal multicentrico, basado en una encuesta remitida a profesionales sanitarios del ambito de la nutricion clinica, sobre el cumplimiento de 8 criterios de calidad durante el ano 2018 y 2019. Se analizo el numero total de procesos evaluados y los que se cumplieron correctamente, y se compararon con el estandar teorico propuesto. Resultados: se estudiaron 15 centros. De los 8 indicadores estudiados, 5 estuvieron dentro del estandar teorico (identificacion correcta de las bolsas de nutricion parenteral, posicion semi-incorporada de los pacientes con nutricion enteral, administracion de micronutrientes en las bolsas de nutricion parenteral “listas para su uso”, comprobacion de la colocacion de las sondas, y dias de glucemia por debajo de 60 mg/dl); dos indicadores estuvieron muy proximos al estandar teorico y, uno, la hiperglucemia en los pacientes con nutricion parenteral, lejos del estandar teorico (15,7 % vs. 5 %). Conclusion: la aplicacion de la nutricion artificial se realiza en los hospitales espanoles con un elevado nivel de calidad. De esta manera, se ofrecen unos estandares basados en la practica clinica diaria de la nutricion artificial en Espana. EnglishIntroduction: 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.

Introducción: la pandemia ocasionada por el SARS-CoV-2 ha obligado a realizar importantes cambios organizativos y asistenciales en el sistema sanitario. Sin embargo, hasta ahora se desconoce cuáles han sido las circunstancias que han sufrido los profesionales sanitarios que han atendido esta pandemia desde los servicios de nutrición clínica en España. Objetivos: describir los cambios de gestión y asistenciales realizados en las unidades de nutrición clínica en España y su repercusión en la práctica clínica. Material y métodos: estudio transversal mediante técnica de encuesta dirigida a socios de la SENPE (junio 2020). Se incluyen en el estudio res puestas remitidas por profesionales sanitarios del ámbito de la nutrición clínica que atendieron a pacientes con COVID-19 en hospitales españoles. Resultados: se analizan 116 encuestas provenientes en su mayoría de médicos (57,8 %) y de hospitales de más de 500 camas (56 %); el 46 % de los encuestados teletrabajó. Se contó con la presencia de un plan de atención nutricional en el 68 % de los casos, plan que fue mayoritario en los hospitales con más de 500 camas (p < 0,001). En estos hospitales se implantaron más dietas específicas para COVID-19 que en los menores de 500 camas: 18 (35,3 %) vs. 44 (67,7 %), (p < 0,001). El uso de las recomendaciones de las sociedades científicas se notificó en el 86 % de los casos. El 38,8 % nunca o casi nunca pudieron hacer una valoración nutricional satisfactoria. La prescripción de suplementos nutricionales fue no inferior al 50 %. El 51,7 % de los encuestados calificaron su actuación como satisfactoria o muy satisfactoria, y esta no se relacionó con el tamaño de hospital pero sí con haber implantado una dieta para la COVID-19 (p < 0,05). Conclusiones: la nutrición clínica en España ha respondido a la pandemia de COVID-19 con cambios organizativos y de gestión y, aunque la asistencia se ha visto claramente afectada, se han podido mantener algunos estándares de calidad. Los hospitales de mayor tamaño han tenido cierta ventaja para realizar estos ajustes. Introduction: the SARS-CoV-2 pandemic has forced major organizational and care changes in the health system. However, in Spain, the circumstances suffered by the health professionals who have cared for pandemic patients from a clinical nutrition standpoint has remained unknown up to this moment. Objectives: the management and care changes made in clinical nutrition units in Spain, and their impact on clinical practice are described. Material and methods: a cross-sectional study was carried out using a survey directed at SENPE members (June 2020). Responses sent by health professionals in the field of clinical nutrition who had treated patients with COVID-19 in Spanish hospitals were included in the study. Resultados: a total of 116 survey forms were analyzed, mostly filled out by doctors (57.8 %) working at hospitals with more than 500 beds (56 %); 46 % of survey respondents were on telework. There was a nutritional care plan in 68 % of cases, such plan being present mainly in hospitals with more than 500 beds (p < 0.001). In these hospitals more specific diets for COVID-19 were implemented than in those under 500 beds: 18 (35.3 %) vs 44 (67.7 %), (p < 0.001). The use of recommendations issued by scientific societies was reported in 86 % of cases. Never or almost never could a satisfactory nutritional assessment be performed for 38.8 %. The prescription of nutritional supplements was not less than 50 %. Health workers rated their performance as satisfactory or very satisfactory (51.7 %), and this was not related to hospital size but to having implemented a COVID-19 diet (p < 0.05). Conclusions: clinical nutrition in Spain has responded to the COVID-19 pandemic with organizational and managerial changes and, although care has been clearly affected, some quality standards were ultimately maintained. Larger hospitals have had some advantages in making these adjustments.

Tolvaptan introduction has constituted the main therapeutic novelty in the management of hyponatremia in recent years.To describe the experience with this drug at Complejo Asistencial Universitario de León, Spain.Retrospective, observational study of tolvaptan outpatient use in a tertiary care hospital from March 2014 to August 2017.A total of 9 patients were treated with tolvaptan in the outpatient setting. Eunatremia was reached in 24 h by 23.1%. After tolvaptan administration, a reduction in days of hospitalization was recorded (361 vs. 70; p = 0.007), especially in those days of hospitalization that were attributable to hyponatremia (306 vs. 49; p = 0.009).Long-term use of tolvaptan appears to be safe and is associated with a decrease in days of hospitalization.La introducción de tolvaptan ha supuesto la principal novedad en el tratamiento de la hiponatremia en los últimos años.Describir la experiencia con tolvaptan en el Complejo Asistencial Universitario de León, España.Estudio observacional retrospectivo de utilización ambulatoria de tolvaptan en un hospital de tercer nivel, de marzo de 2014 a agosto de 2017.Fueron tratados con tolvaptan de forma ambulatoria nueve pacientes, 23.1 % alcanzó eunatremia en 24 horas. Posterior a la administración de tolvaptan se registró reducción en días de hospitalización (361 versus 70, p = 0.007), especialmente por hiponatremia (306 versus 49, p = 0.009).El uso a largo plazo de tolvaptan parece ser seguro y se relaciona con descenso en los días de hospitalización.

Introduction: the SARS-CoV-2 pandemic has forced major organizational and care changes in the health system. However, in Spain, the circumstances suffered by the health professionals who have cared for pandemic patients from a clinical nutrition standpoint has remained unknown up to this moment. Objectives: the management and care changes made in clinical nutrition units in Spain, and their impact on clinical practice are described. Material and methods: a cross-sectional study was carried out using a survey directed at SENPE members (June 2020). Responses sent by health professionals in the field of clinical nutrition who had treated patients with COVID-19 in Spanish hospitals were included in the study. Resultados: a total of 116 survey forms were analyzed, mostly filled out by doctors (57.8 %) working at hospitals with more than 500 beds (56 %); 46 % of survey respondents were on telework. There was a nutritional care plan in 68 % of cases, such plan being present mainly in hospitals with more than 500 beds (p0.001). In these hospitals more specific diets for COVID-19 were implemented than in those under 500 beds: 18 (35.3 %) vs 44 (67.7 %), (p0.001). The use of recommendations issued by scientific societies was reported in 86 % of cases. Never or almost never could a satisfactory nutritional assessment be performed for 38.8 %. The prescription of nutritional supplements was not less than 50 %. Health workers rated their performance as satisfactory or very satisfactory (51.7 %), and this was not related to hospital size but to having implemented a COVID-19 diet (p0.05). Conclusions: clinical nutrition in Spain has responded to the COVID-19 pandemic with organizational and managerial changes and, although care has been clearly affected, some quality standards were ultimately maintained. Larger hospitals have had some advantages in making these adjustments.Introducción: la pandemia ocasionada por el SARS-CoV-2 ha obligado a realizar importantes cambios organizativos y asistenciales en el sistema sanitario. Sin embargo, hasta ahora se desconoce cuáles han sido las circunstancias que han sufrido los profesionales sanitarios que han atendido esta pandemia desde los servicios de nutrición clínica en España. Objetivos: describir los cambios de gestión y asistenciales realizados en las unidades de nutrición clínica en España y su repercusión en la práctica clínica. Material y métodos: estudio transversal mediante técnica de encuesta dirigida a socios de la SENPE (junio 2020). Se incluyen en el estudio respuestas remitidas por profesionales sanitarios del ámbito de la nutrición clínica que atendieron a pacientes con COVID-19 en hospitales españoles. Resultados: se analizan 116 encuestas provenientes en su mayoría de médicos (57,8 %) y de hospitales de más de 500 camas (56 %); el 46 % de los encuestados teletrabajó. Se contó con la presencia de un plan de atención nutricional en el 68 % de los casos, plan que fue mayoritario en los hospitales con más de 500 camas (p0,001). En estos hospitales se implantaron más dietas específicas para COVID-19 que en los menores de 500 camas: 18 (35,3 %) vs. 44 (67,7 %), (p0,001). El uso de las recomendaciones de las sociedades científicas se notificó en el 86 % de los casos. El 38,8 % nunca o casi nunca pudieron hacer una valoración nutricional satisfactoria. La prescripción de suplementos nutricionales fue no inferior al 50 %. El 51,7 % de los encuestados calificaron su actuación como satisfactoria o muy satisfactoria, y esta no se relacionó con el tamaño de hospital pero sí con haber implantado una dieta para la COVID-19 (p0,05). Conclusiones: la nutrición clínica en España ha respondido a la pandemia de COVID-19 con cambios organizativos y de gestión y, aunque la asistencia se ha visto claramente afectada, se han podido mantener algunos estándares de calidad. Los hospitales de mayor tamaño han tenido cierta ventaja para realizar estos ajustes.

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 admission24 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.Introducción: el objetivo del estudio fue evaluar la utilidad del Eating Assessment Tool (EAT-10) en unidades de hospitalización con pacientes de alto riesgo de disfagia. Pacientes y métodos: estudio transversal de pacientes hospitalizados en Medicina Interna y Neurología; los pacientes con ingreso24 horas y en fase terminal de la enfermedad fueron excluidos. En las primeras 24-48 horas de ingreso se cribó la disfagia con el EAT-10, el riesgo de desnutrición con el Malnutrition Universal Screening Tool (MUST) y la comorbilidad con el índice de Charlson. Resultados: se reclutaron 196 pacientes (76,0 años, 52 % mujeres). El 19,5 % estaban en riesgo de desnutrición. El EAT-10 se pudo realizar en el 80,6 % de la muestra y fue positivo en el 26,6 % (mujeres 34,1 % vs. hombres 18,4 %; p = 0,025). Al comparar a los pacientes con mayor comorbilidad con aquellos que tenían un índice de Charlson más bajo, se observó una tasa de respuesta más baja al EAT-10 (78,4 % vs. 93,9 %; p = 0,038), sin diferencias en la positividad del cribado (28,3 % vs. 19,4 %; p = 0,310). La prevalencia del riesgo de disfagia fue mayor en la unidad de Medicina Interna que en la de Neurología (30,4 % vs. 19,6 %; p = 0,133), así como el número de casos en que no se pudo realizar el cribado (21,1 % vs. 11,1 %; p = 0,011). No hubo diferencias significativas en el riesgo de desnutrición, mortalidad, estancia hospitalaria o reingreso según el EAT-10. Conclusiones: el EAT-10 tiene una utilidad limitada en las unidades de hospitalización estudiadas debido a una alta tasa de pruebas no realizables, especialmente entre los pacientes con mayor riesgo de disfagia.

To determine the impact of the type of hospital kitchen on the dietary intake of patients.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.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 (p0.001). 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.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.

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 5 years, 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.

Cancer patients are at high risk of malnutrition due to several symptoms such as lack of appetite. The aim of this study was to determine the prevalence of different appetite disorders in cancer patients and their influence on dietary intake, nutritional status, and quality of life. We conducted a cross-sectional study of cancer patients 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 patients were questioned about the presence of changes in appetite (none, anorexia, early satiety, or both). Quality of life was measured using EORTC-QLQ-C30. Multivariate analysis was performed using linear regression. 128 patients were evaluated. 61.7% experienced changes in appetite: 31% anorexia, 13.3% early satiety, and 17.2% both. Appetite disorders were more common in women and with the presence of cachexia. The combination of anorexia and satiety resulted in a lower weight and BMI. However, there were no significant effects on energy or macronutrient intake among different appetite alterations. Patients with a combination of anorexia and early satiety had worse overall health perception, role function, and fatigue. Appetite disorders are highly prevalent among cancer patients at risk of malnutrition. They have a significant impact on nutritional status and quality of life, especially when anorexia and early satiety are combined.

Background and Aims: Abdominal radiotherapy (RT) causes harm to the mid gastrointestinal mucosa by release of pro-inflammatory cytokines and promotes autophagic changes in tumor cells. This study was aimed to measure the effect of glutamine administration on markers of inflammation and autophagy in cancer patients treated with RT. Methods: In this double-blind, randomized, controlled pilot trial 43 patients under abdominal RT diagnosed of pelvic or abdominal malignancies receiving glutamine (30 g/d) or placebo (casein, 30 g/d). Patient recruitment took place in the Complejo Asistencial Universitario of León (CAULE), Spain. Patient evaluation took place at three different time points during the study: before RT (pre-treatment), in the middle of the RT period (mid-treatment), and after finishing RT (post-treatment). Data were compared by analysis of variance and the Newmann Keuls test. Significance was accepted at p < 0.05. Results Abdominal RT increased whole blood mRNA levels of inflammatory and autophagic markers, but glutamine administration showed significantly lower expression of toll-like receptor 4 (TLR4), CD36, interleukin-1β (IL-1β), tumor necrosis factor-alpha (TNF-α), cyclooxygenase-2 (COX-2), and matrix metalloproteinase-9 (MMP-9). Moreover, glutamine reduced the expression of the transcription factors nuclear factor kappa B (NF-κB) and activator protein 1 (AP-1). Glutamine also inhibited the autophagic response, with changes in expression of beclin-1, UV radiation resistance associated gene (UVRAG), autophagy-related protein-5 (Atg5), protein 1 light chain 3 (LC3), sequestosome 1 (p62/SQSTM1) and lysosome-associated membrane protein (LAMP)-1. Conclusions Findings provide evidence that glutamine decreases the inflammatory response and abolishes the changes of the autophagy machinery in patients receiving abdominal RT. The protective effect of glutamine must continue being investigated to disclose further molecular pathways.

The Management Working Group of SENPE has among its objectives the development of evaluation processes in Clinical Nutrition. Previously, the document entitled "Process of nutritional care: self-evaluation guide" was prepared as a tool designed to help assess the quality of nutritional therapy in hospitalized patients, mainly from the perspective of artificial nutrition. Now a complementary text of the previous one is presented, that describes the process by which hospitalized patients are fed. We have divided the hospital feeding process into six sections, for which a general description is made and quality indicators are proposed. We hope that this work will serve to improve the quality of hospital food and to help hospital food professionals to make their work more satisfactory and effective.El Grupo de Trabajo de Gestión de SENPE tiene entre sus objetivos el desarrollo de procesos de evaluación en Nutrición Clínica. Con anterioridad se elaboró el documento denominado “Proceso de atención nutricional: guía de autoevaluación”, como una herramienta concebida para ayudar a evaluar la calidad de la terapia nutricional en pacientes hospitalizados, fundamentalmente desde la perspectiva de la nutrición artificial. Ahora se presenta un texto complementario del anterior, en el que se describe el proceso por el que alimenta a los pacientes hospitalizados. Hemos dividido el proceso de alimentación hospitalaria en seis secciones, para las que se hace una descripción general y se proponen indicadores de calidad para su evaluación. Confiamos en que este trabajo sirva para mejorar la calidad de las dietas de los hospitales y para ayudar a los profesionales de la alimentación de los hospitales a hacer su labor más satisfactoria y efectiva.

Background: there is a high number of dependent older adults with risk of malnutrition in the institutionalized geriatric population. Among others, the related factors are weight loss inherent to age, which favors frailty and sarcopenia, low body mass index (BMI) and the worsening of chronic diseases, which entails a deterioration in the quality of life. Objective: to analyze the relationship between dependence and nutritional status in elderly institutionalized people. Method: prospective observational and descriptive study in a sample of elderly institutionalized people. Dependence was studied by the Barthel index, sex, BMI, presence of chronic diseases and nutritional status with the Mini Nutritional Assessment (MNA). The association between the different variables was made with the Spearman correlation. Results: one hundred and sixty-four patients were included in the study; 45.10% (n = 74) of the patients had a total dependence and 18.30% (n = 30) had a moderate dependence. Women had a higher risk of total dependence than men (p0.0001). There was a significant relationship between the level of dependence and nutritional status, so that greater dependence increased the risk of malnutrition (p0.0001). Patients who were underweight had a greater risk of total dependence (RR 11.05 [95% CI 4.41, 27.7]). Patients with dementia were more dependent (p0.0001). Conclusion: most of the institutionalized elderly people presented some degree of dependence, which supposed a risk for the nutritional status that was aggravated if they suffered dementia and low weight.Introducción: en la población geriátrica institucionalizada existe un elevado número de adultos mayores dependientes y en riesgo de malnutrición. Entre otros, los factores relacionados son la pérdida de peso inherente a la edad, que favorece la fragilidad y la sarcopenia, el índice de masa corporal (IMC) bajo y el empeoramiento de enfermedades crónicas, lo cual conlleva un deterioro en la calidad de vida. Objetivo: analizar la relación entre dependencia y estado nutricional en personas mayores que viven institucionalizadas. Método: estudio prospectivo observacional y descriptivo en una muestra de ancianos institucionalizados. Se valoraron la dependencia mediante el índice de Barthel, el género, el IMC, la presencia de enfermedades crónicas y el estado nutricional mediante el Mini Nutricional Assessment (MNA). La asociación entre las distintas variables se llevó a cabo mediante la correlación de Spearman. Resultados: ciento sesenta y cuatro pacientes fueron incluidos en el estudio. Según el índice de Barthel, el 45,10% (n = 74) de los pacientes tenían una dependencia total y un 18,30% (n = 30), una dependencia moderada. Las mujeres tenían mayor riesgo de dependencia total que los hombres (p0,0001). Existió una relación significativa entre el nivel de dependencia y el estado nutricional: a mayor dependencia, mayor riesgo de desnutrición (p0,0001). Los residentes que tenían bajo peso tenían un riesgo mayor de sufrir dependencia total en un RR de 11,05 (IC 95% 4,41; 27,7). Los residentes que presentaban demencia tenían mayor dependencia (p0,0001). Conclusión: la mayoría de los ancianos institucionalizados presentaron algún grado de dependencia, lo que implicó un riesgo para el estado nutricional que se vio agravado si padecían demencia y bajo peso.

espanolIntroduccion: las enfermedades oncohematologicas asocian una elevada prevalencia de malnutricion, especialmente durante la hospitalizacion. Objetivo: analizar la aparicion de malnutricion y su repercusion en pacientes normonutridos al ingreso. Metodos: estudio prospectivo de un ano en una cohorte de ingresados hematologicos. El Malnutrition Screening Tool (MST) se realizo al ingreso, repitiendose semanalmente. Los pacientes con cribado negativo al ingreso que desarrollaron malnutricion durante la hospitalizacion constituyeron nuestra muestra. Se realizo evaluacion e intervencion nutricional, analizando el efecto de la aparicion de malnutricion en el pronostico, comparado con los pacientes que permanecieron normonutridos. Resultados: el 21% de los pacientes normonutridos al ingreso desarrollo malnutricion en la hospitalizacion. El 62.4% preciso intervencion nutricional (100% suplementos orales, 21,4% cambios dieteticos, 5.2% nutricion parenteral). La intervencion logro un aumento de ingesta real de 623 kcal y 27,3 g proteina/dia, frenando la perdida de peso y estabilizando las proteinas viscerales. La estancia fue 8,5 dias mayor en nuestra muestra que en los pacientes que permanecieron normonutridos. Conclusiones: uno de cada cinco ingresados normonutridos al ingreso desarrollo malnutricion en la hospitalizacion, asociando mayor estancia. La intervencion nutricional puede mejorar la ingesta y el estado nutricional, por tanto, la vigilancia nutricional deberia ser obligatoria. EnglishIntroduction: oncohematological diseases are associated with a high prevalence of malnutrition during hospitalization. Our aim was to analyze the appearance and repercussions of malnutrition in well-nourished hematological inpatients at admission. Method: a prospective one-year study conducted in hematology inpatients. The Malnutrition Screening Tool (MST) was used at admission and repeated weekly. Patients with a negative screening at admission who developed malnutrition during hospitalization constituted our study sample. A nutritional evaluation and intervention was performed. We also analyzed the effect of newly diagnosed malnutrition on patients’ outcomes in comparison with the outcomes of patients that remained well-nourished during hospitalization. Results: twenty-one percent of hematological inpatients who were well nourished at admission developed malnutrition during hospitalization. Of the patients, 62.4% needed a nutritional intervention (100% oral supplements, 21.4% diet changes, 5.2% parenteral nutrition). After intervention, an increase in real intake was achieved (623 kcal and 27.3 g of protein/day). Weight loss was slowed and visceral protein was stabilized. Length of stay was 8.5 days longer for our sample than for well-nourished patients. Conclusions: newly diagnosed malnutrition appeared in one in five hematological well-nourished inpatients, leading to a longer length of stay. Nutritional intervention improved intake and nutritional status. Nutritional surveillance should be mandatory.

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.

Giant prolactinomas are rare tumors characterized by their large size, compressive symptoms, and extremely high prolactin secretion. The aim of this study is to describe our experience with a series of 16 giant prolactinomas cases in terms of clinical presentation, therapeutic decisions, and final outcomes. Retrospective analysis of adult patients diagnosed with giant prolactinomas at the endocrine departments of three university tertiary hospitals. We included 16 patients (43.7 % women); mean age at diagnosis: 42.1 ± 21 years. The most frequent presentation was compressive symptoms. The delay in diagnosis was higher in women (median of 150 months vs. 12 in men; p = 0.09). The mean maximum tumor diameter at diagnosis was 56.9 ± 15.5 mm, and mean prolactin levels were 10,995.9 ± 12,157.8 ng/mL. Dopamine agonists were the first-line treatment in 11 patients (mean maximum dose: 3.9 ± 3.2 mg/week). Surgery was the initial treatment in five patients and the second-line treatment in six. Radiotherapy was used in four cases. All patients but one, are still with dopamine agonists. After a mean follow-up of 9 years, prolactin normalized in 7/16 patients (43.7 %) and 13 patients (81 %) reached prolactin levels lower than twice the upper limit of normal. Mean prolactin level at last visit: 79.5 ± 143 ng/mL. Tumor volume was decreased by 93.8 ± 11.3 %, and final maximum tumor diameter was 18.4 ± 18.8 mm. Three patients are actually tumor free. Giant prolactinomas are characterized by a large tumor volume and extreme prolactin hypersecretion. Multimodal treatment is frequently required to obtain biochemical and tumor control.

Texture-modified diets (TMDs) should fulfil nutritional goals, guarantee homogenous texture, and meet food safety regulations. The food industry has created texture-modified food (TMF) that meets the TMD requirements of quality and safety for inpatients. To design and develop a tool that allows the objective selection of foodstuffs for TMDs that ensures nutritional requirements and swallowing safety of inpatients in order to improve their quality of life, especially regarding their food satisfaction. An evaluation tool was designed to objectively determine the adequacy of food included in the TMD menus of a hospital. The "Objective Evaluation Tool for Texture-Modified Food" (OET-TMF) consists of seven items that evaluate the food's nutritional quality (energy and protein input), presence of allergens, texture and viscosity, cooking, storage type, useful life, and patient acceptance. The total score ranged from 0 to 64 and was divided into four categories: high quality, good quality, medium quality, and low quality. Studying four different commercial TMFs contributed to the validation of the tool. All the evaluated products scored between high and good regarding quality. There was a tendency (p = 0.077) towards higher consumption and a higher overall quality of the product obtained with the OET-TMF. The product that scored highest with the tool was the best accepted; the product with the lowest score had the highest rate of refusal. The OET-TMF allows for the objective discrimination of the quality of TMF. In addition, it shows a certain relationship between the observed and assessed quality intake.

home enteral nutrition (HEN) has undergone an important development; however, there is a notable lack of information with regard to its incidence and characteristics.our aim was to assess the state of HEN in our area.an observational, prospective study, involving all patients who had initiated HEN in the Nutrition Unit during a year. Epidemiological, functional, and nutritional evolution of the patients was described and incidence of HEN was calculated.HEN incidences totalled 229/100,000 inhabitants/year. The HEN population in our area was characterized by the aged and a high frequency of comorbidity and functional limitations. Neurological and oncological diseases accounted for 50% of indications. The remaining cases were malnourished patients who had received short periods of HEN after hospitalization or a hip fracture. Oral supplements (60%) with standard and hypercaloric formulas were used the most. At baseline, 75% of the patients suffered from malnutrition. During the follow-up, patients showed weight gain (1.6%), an increase in the percentage of normal weight and overweight (from 74% to 82.7%, p = 0.001) and a reduction in pressure ulcers (15.7% vs10.3%, p0.001). The median duration of HEN was 8.5 months. Only a quarter of the patients experienced complications (mostly mild gastrointestinal complications); 43.1% had died at the end of the follow-up.in our area, the HEN incidence was much higher than those described in the literature. HEN appears to be a safe therapy with few complications that improves the nutritional status of the patients, even with short periods of administration.

The universal screening for osteoporosis by bone mineral density (BMD) is not feasible because of its unfavorable cost-benefit due to its low sensitivity. The aim of the present study was to estimate the population and economic impact of the diagnostic criteria of the National Osteoporosis Guideline Group (NOGG) and the National Osteoporosis Foundation (NOF) and assess the appropriateness of the BMD tests performed in routine clinical practice. A cross-sectional study was conducted in individuals referred for BMD testing who were not receiving antiresorptive therapy. The absolute risk of major and hip fracture was calculated using the British formula of the Fracture Risk Assessment Tool. NOGG and NOF guidelines diagnostic thresholds interventions were used. A total of 640 individuals were included, of which 95% were women, with a median age of 59.4 years (interquartile range = 14). When applying the NOGG criteria, BMD testing was recommended in 32.3% of the individuals, whereas this percentage increased to 75.6% with the NOF guidelines (p < 0.05). Regarding the appropriateness of the BMD tests performed, 31.9% were deemed appropriate according to both the NOGG and NOF guidelines, whereas 23.9% were considered inappropriate. In conclusion, the application of the NOGG and NOF guidelines led to a decrease in BMD indications, reducing costs and improving efficiency in the diagnostic management of osteoporosis, although variability exists between the guidelines.

Malnutrition in hospitalized patients is associated with an increased risk of death, in both the short and the long term.The purpose of this study was to determine which nutrition-related risk index predicts long-term mortality better (three years) in patients who receive total parenteral nutrition (TPN).This prospective, multicenter study involved noncritically ill patients who were prescribed TPN during hospitalization. Data were collected on Subjective Global Assessment (SGA), Nutritional Risk Index (NRI), Geriatric Nutritional Risk Index (GNRI), body mass index, albumin and prealbumin, as well as long-term mortality.Over the 1- and 3-year follow-up periods, 174 and 244 study subjects (28.8% and 40.3%) respectively, died. Based on the Cox proportional hazards survival model, the nutrition-related risk indexes most strongly associated with mortality were SGA and albumin (2.5 g/dL) (after adjustment for age, gender, C-reactive protein levels, prior comorbidity, mean capillary blood glucose during TPN infusion, diabetes status prior to TPN, diagnosis, and infectious complications during hospitalization).The SGA and very low albumin levels are simple tools that predict the risk of long-term mortality better than other tools in noncritically ill patients who receive TPN during hospitalization.

Bariatric surgery is currently the treatment of choice for those patients with severe obesity, but the procedure of choice is not clearly established. We describe weight loss and nutritional parameters in severely obese patients after biliopancreatic diversion for 10 years of follow-up. Patients were followed by the same multidisciplinary team, and data are shown for 10 years. Bariatric Analysis and Reporting Outcome System (BAROS) questionnaire, data regarding the evolution of obesity-related diseases, and nutritional parameters are reported. Two hundred ninety-nine patients underwent biliopancreatic diversion, 76.1 % women, initial BMI 50.1 kg/m2 (7.2). Weight loss was maintained throughout 10 years with EWL% around 65 % and EBMIL% around 70 %. More than 80 % of the patients showed EWL higher than 50 %. Blood pressure, glucose metabolism, and lipid profile clearly improved after surgery. Mean nutritional parameters remained within the normal range during follow-up. Protein malnutrition affected less than 4 % and anemia up to 16 %. Fat-soluble vitamin levels decreased along the time, with vitamin D deficiency in 61.5 % of patients. No significant differences were found either in nutritional parameters or weight loss regarding gastrectomy or gastric preservation, or common limb length longer or shorter than 55 cm Biliopancreatic diversion is an effective surgical procedure in terms of weight loss, quality of life, and evolution of obesity-related diseases. Nutritional deficiencies are less frequent than feared for a malabsorptive procedure, but must be taken into account, especially for fat-soluble vitamins.

Summary Introduction Arginine improves healing and modulates inflammation and the immune response. A systematic review and meta-analysis were conducted to assess whether arginine-enriched enteral formulas reduce complications (fistulas, wound infections, other infections) and hospital length of stay (LoS) in patients undergoing surgery for head and neck cancer. Methods Medline, CENTRAL, and Trip Database were searched using the search strategy "Head and Neck Neoplasms" AND "Enteral Nutrition" AND "Arginine" OR "Immunonutrition". Inclusion criteria comprised: type of study (RCT), language (English, Spanish), outcomes (complications of surgery, LoS), and methodological quality (Jadad scale). The odds ratio (OR) and confidence intervals (95% CI) were calculated using the Mantel–Haenszel method, and the mean difference (MD) with the random effects method. Heterogeneity was assessed using Cochran's Q . Results Six studies were included, with 397 patients receiving peri/postoperative enteral nutrition with different doses of arginine (6.25–18.7 g/L). Enteral formulas containing arginine were associated with a reduction in fistulas [OR = 0.36 (95% CI 0.14–0.95), p = 0.039; Q = 3.93, p = 0.269], and LoS [MD = −6.8 (95% CI −12.6 to −0.9) days, p = 0.023; Q = 2.44, p = 0.486]. There were no reductions in wound infections [OR = 1.04 (95% CI 0.49–2.17), p = 0.925; Q = 1.60, p = 0.809] or other infections [OR = 0.79 (95% CI 0.48–1.31); p = 0.369; Q = 7.94, p = 0.094]. Arginine administration did not increase the occurrence of diarrhoea [OR = 1.80 (95% CI 0.50–6.52), p = 0.375; Q = 0.16, p = 0.691]. Conclusions The administration of arginine-enriched enteral nutrition led to a significant reduction in fistulas and hospital stay in patients undergoing surgery for head and neck cancer.

Introduction: Among the objectives of the SENPE Management Working Group is the development of knowledge and tools related to the evaluation of health outcomes. Objectives: To obtain an approximate profile of clinical nutrition in hospitals in Spain, specifically concerning its organization, endowment, activities and quality indicators. Methods: A cross-sectional study conducted in 2013 through a structured survey sent to a random sample of 20% of hospitals from the network of the National Health System of Spain, stratified by the number of hospital beds. Results: The overall response rate was 67% (83% in hospitals with over 200 beds). In 65% of hospitals, clinical nutrition is run by a coordinated team or unit, with a doctor working full time in only 50% of centers. Other professionals are often not recognized as part of the team or unit. There is a specialized monographic nutrition clinic in 62% of centers and 72% have more than 40 new inpatient consultations per month (27% with more than 80 per month). Among the centers with a clinical nutrition team or unit, there is a greater tendency to monitor quality indicators related to clinical practice. Conclusions: There is widespread addition of clinical nutrition teams and units in hospitals in Spain. However, truly multidisciplinary organization is not often found. High workloads are assumed in relation to staffing levels. The existence of well-organized structures may be associated with benefits that directly affect attendance

Aim: To assess if insulin resistance is related to a different inflammatory status (especially lymphocyte subpopulations) in severely obese people and to evaluate changes after weight loss either following a very-low calorie diet (VLCD) or bariatric surgery. Research Methods & Procedures: Severely obese patients were consecutively recruited in our Obesity Unit. Blood lymphocyte subpopulations and inflammatory parameters were measured baseline, after a VLCD during 6 weeks and one year after biliopancreatic diversion. Insulin resistance was evaluated by Homeostasis Model Assessment (HOMA) index. Results: After excluding diabetic patients, 58 patients were studied. HOMA index classified 63.8% of them as insulin resistant (IR). Serum baseline levels of inflammatory cytokines were not significantly different between IR and insulinsensitive (IS) patients but, regarding lymphocyte subpopulations, Natural Killer (NK) cells were higher in IR patients [(305.0 (136.7) vs. 235.0 (80.7) cells/µL, p=0.047]. NK cells showed a significant positive correlation with HOMA index (r=0.484, p=0.000) and with the carbohydrate content of the diet (r=0.420, p=0.001). After VLCD, NK cells significantly decreased, but only in IR patients and in those losing more than 10% of their initial weight. After biliopancreatic diversion, total and CD8 T Lymphocytes, B lymphocytes and NK cells also decreased but only in IR individuals. Conclusion: NK cells are significantly increased in IR severely obese people in respect to IS, suggesting a slightly different immune status in these patients with a probable dietary relationship. Weight loss could reverse this increase either after VLCD or after bariatric surgery.

espanolIntroduccion: las enfermedades oncohematologicas se asocian con una elevada prevalencia de malnutricion. Objetivo: nuestro objetivo es determinar si la deteccion y el tratamiento precoz de la malnutricion en los pacientes hematologicos hospitalizados pueden mejorar su ingesta, su estado nutricional y reducir la estancia hospitalaria. Metodos: estudio prospectivo de 2 anos de duracion realizado en una cohorte de pacientes hematologicos hospitalizados. El Malnutrition Screening Tool (MST) fue el metodo de cribado efectuado el primer dia del ingreso. En los pacientes con un resultado positivo en el cribado se realizo una valoracion nutricional completa y una intervencion terapeutica cuando fue preciso, siguiendo la practica clinica habitual. La valoracion nutricional se repitio una semana despues de la inicial. Resultados: se evaluaron 617 pacientes hematologicos (de los cuales el 37,8% tuvo un resultado positivo en el cribado). Tras una semana de ingreso, la mediana de ingesta aumento del 80% al 90% de la dieta (p Conclusiones: la implantacion de un metodo de cribado nutricional precoz y la realizacion de intervenciones nutricionales cortas consiguio mejorar la ingesta calorico-proteica, aumentando el porcentaje de pacientes que cubrian sus necesidades y evitando el deterioro del estado nutricional. EnglishIntroduction: Oncohematological diseases are associated with an important prevalence of malnutrition. Aim: Our aim is to determine if early recognition and treatment of malnourished hematological inpatients can improve their oral intake, nutritional status and reduce the length of hospital stay. Methods: Prospective 2-year study conducted in a cohort of hematology inpatients. Malnutrition Screening Tool (MST) was carried out on the first day of admission. Patients with a positive screening were recruited to have a complete nutritional evaluation and intervention, following usual clinical practice. Nutritional evaluation was repeated after one week. Results: Six hundred and seventeen hematological patients were screened (37.8% with positive screening). After one week, median diet intake increased from 80% to 90% (p Conclusions: The implementation of early malnutrition screening and short nutritional interventions improved energy and protein intake, increasing the percentage of patients who meet their requirements and avoiding deterioration of nutritional status

AIM: To communicate the results of the Spanish Home Parenteral Nutrition (HPN) registry of the NADYA-SENPE group for the year 2013. MATERIAL AND METHODS: Data was recorded online by NADYA group collaborators that were responsible of the HPN follow-up from 1st January to 31st December 2013. RESULTS: A total of 197 patients and 202 episodes of HPN were registered from 35 hospitals that represents a rate of 4,22 patients/million habitants/year 2013. The median age was 53 years (IQR 40-64) for 189 adult patients and 7 months (IQR 6-35,5) for children. The most frequent disease in adults was neoplasm (30,7%) followed by other diseases (20,1%) and mesenteric ischemia (12,7%). Short bowel syndrome and intestinal obstruction (25,9%) were in 35.7% cases the indications for HPN. The most frequent diagnosis for children were the congenital intestinal disorders and other diagnosis, both with a (37,5%) and short bowel syndrome and intestinal obstruction were the indication for treatment, each was present in 50% of the sample. Tunneled catheters (50%) and subcutaneous reservoirs (27,7%) were frequently used. The septic complications related with catheter were commonly frequent with a rate of 0.74 infections/1000 HPN days. HPN duration presented a median of 1,69 days. A total of 86 episodes finalized during the year, death was the principal reason (45%), followed by "resumed oral via" (43,75%) while it happened inversely for children, 66,7% of them resumed oral via and 16,7% deceased. Fifteen per cent were considered for intestinal transplant, children were proportionally candidates, p-value 0.002. CONCLUSIONS: The number of participating centers and registered patients increased progressively respect to preceding years. Since 2003 Neoplasm is still being the principal pathological group. Death is adult's principal reason for finalizing HPN and "resuming oral via" for children. Despite that NADYA registry is consolidate as a essential source of relevant information about the advances in Home Artificial Nutrition in our country, currently is in an improvement process of the available information about patients characteristics with a special emphasis on children even though they still being a minority group. Yes Objetivo: comunicar los datos del registro de Nutrición Parenteral Domiciliaria (NPD) del grupo de trabajo NADYA-SENPE del años 2013. Material y métodos: recopilación de los datos del registro “on-line” introducidos por los colaboradores del grupo NADYA responsables del seguimiento de la NPD desde el 1 de enero de 2013 al 31 de diciembre de 2013. Resultados: se registraron 197 pacientes, procedentes de 35 hospitales, lo que representa una tasa de 4,22 pacientes/ millón habitantes/año 2013, con 202 episodios de NPD. La edad media de los 189 pacientes mayores de 14 años fue de 53 años (IIQ 40 – 64), y en los niños de 7 meses (IIQ 6 – 35,5). La patología más frecuente en los adultos fue la neoplasia (30,7%) seguida por otras patologías (20,1%) y la isquemia mesentérica (12,7%). En el 35,4% de los casos el motivo de indicación fue el síndrome de intestino corto, seguido de la obstrucción intestinal (25,9%). En los niños el diagnóstico más frecuente fueron las alteraciones congénitas intestinales y ‘otros diagnósticos’, ambas con un 37,5 %, y la causa de la indicación el síndrome de intestino corto y la obstrucción intestinal, que se repartieron el 50% de la muestra. Los catéteres más utilizados fueron los tunelizados (50%) y los reservorios subcutáneos (27,7%). Las complicaciones más frecuentes fueron las sépticas, relacionadas con el catéter, con una tasa de 0,74 infecciones/1.000 días de NPD. La duración de la NPD presentó una mediana de 1,69 años. Durante el año finalizaron 86 episodios, la principal causa de la finalización en adultos fue el fallecimiento (45%) seguido del ‘paso a la vía oral’ (43,75%) y en los niños a la inversa 66,7% pasan a vía oral y 16,7% fallecen. Se consideraron candidatos para trasplante intestinal el 15% de los pacientes, siendo proporcionalmente los candidatos niños, p-valor 0,002. Conclusiones: se observa un aumento progresivo de los centros participantes y de los pacientes registrados respecto a años anteriores. El principal grupo patológico sigue siendo oncológico, ocupando el primer lugar desde 2003. La principal causa de finalización de la NPD es en los adultos el fallecimiento y en los niños el ‘paso a vía oral’. Aunque el registro NADYA es un registro consolidado y ha sido y es fuente imprescindible de información relevante para el conocimiento de los avances de la Nutrición Artificial Domiciliaria en nuestro país, se encuentra en proceso de mejorar la información que ofrece sobre las características de los pacientes, con especial atención en el grupo de niños, aunque estos siguen siendo un número reducido.

OBJECTIVE Hyperglycemia may increase mortality in patients who receive total parenteral nutrition (TPN). However, this has not been well studied in noncritically ill patients (i.e., patients in the nonintensive care unit setting). The aim of this study was to determine whether mean blood glucose level during TPN infusion is associated with increased mortality in noncritically ill hospitalized patients. RESEARCH DESIGN AND METHODS This prospective multicenter study involved 19 Spanish hospitals. Noncritically ill patients who were prescribed TPN were included prospectively, and data were collected on demographic, clinical, and laboratory variables as well as on in-hospital mortality. RESULTS The study included 605 patients (mean age 63.2 ± 15.7 years). The daily mean TPN values were 1.630 ± 323 kcal, 3.2 ± 0.7 g carbohydrates/kg, 1.26 ± 0.3 g amino acids/kg, and 0.9 ± 0.2 g lipids/kg. Multiple logistic regression analysis showed that the patients who had mean blood glucose levels >180 mg/dL during the TPN infusion had a risk of mortality that was 5.6 times greater than those with mean blood glucose levels CONCLUSIONS Hyperglycemia (mean blood glucose level >180 mg/dL) in noncritically ill patients who receive TPN is associated with a higher risk of in-hospital mortality.

Carnitine is an endogenous metabolite and exogenous nutrient with a pivotal role in lipid metabolism. Plasma levels of carnitine are reduced in type 2 Diabetes Mellitus (T2DM). The aim was to evaluate the metabolic effects of the administration of L-carnitine in T2DM.A systematic review was performed. Relevant randomized, controlled-trials trials were searched in Pubmed, Trip Database and Cochrane Library, and selected when they had enough methodological quality assessed with the Jadad scale. Article search strategy included "Carnitine" OR "L-carnitine" AND "Diabetes -Mellitus" OR "Diabetes mellitus, type 2" OR "Noninsulindependent-diabetes mellitus". Meta-analysis was performed, and the difference of means calculated with a 95% confidence interval. Heterogeneity was evaluated with the Q statistic.The systematic review included 4 trials with 284 patients. Oral L-carnitine lowered fasting plasma glucose [-14.3 mg/dl (CI95% - 23.2 to -5.4); p=0,002], total cholesterol [-7.8 mg/dL (95%CI -15.5 to -0.1); p=0.09], low density lipoprotein [-8.8 mg/dl (CI95% -12.2 to -8.5), p0.0001], apolipoprotein-B100 [-7.6 mg/dl (CI95% -13.6 to -1.6); p=0.013] and apolipoprotein-A1 [-6.0 mg/dl (CI95% -10.5 a -1.5); p=0.523]. There was no significant heterogeneity. The changes in triglycerides, lipoprotein (a) or HbA(1c) were not significant.The administration of L-carnitine in type 2 diabetes mellitus is associated with an improvement in glycaemia and plasma lipids.

Objective The aim of the study was to compare two nutritional screening tools in oncohematologic inpatients. Methods A cross-sectional study was performed in a hematology ward from August to December 2015. Within the first 24 h of admission, the following nutritional screenings were performed: Malnutrition Universal Screening Tool (MUST), Malnutrition Screening Tool (MST), and Subjective Global Assessment (SGA). Patients who stayed in the hematologic ward were reevaluated with the three screening tools 1 and 2 wk after admission. The SGA was used as the gold standard in the detection of malnutrition. Results Sixty-three patients were included in the study. Of these, 61.9% were men, ages 64 y (SD = 17.9 y) with 90.5% having a diagnosis of cancer. The prevalence of patients with nutritional risk at admission was 17.5% with SGA, 16.7% at week 1, and 31.6% at week 2. According to MST, the prevalence was 41.3% at admission, 13.9% at week 1, and 15.8% at week 2. According to MUST, the prevalence was 36.5%, 25%, and 36.8%, respectively. The results of diagnostic tests on admission were an area under the curve receiver operating characteristic of 0.691 for MST and 0.830 for MUST at admission; at week 1, 0.717 for MST and 0.850 for MUST; and at week 2 of assessment, 0.506 for MST and 0.840 for MUST. Conclusion MUST might be a better screening tool than MST for detecting the risk for malnutrition in oncohematological inpatients.

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.

la desnutrición relacionada con la enfermedad (DRE) afecta al menos a una cuarta parte de los pacientes hospitalizados, aumentando la morbimortalidad del paciente durante su hospitalización y al alta. Sin embargo, su repercusión en la actividad hospitalaria no está bien cuantificada.determinar el impacto de una adecuada codificación de la DRE y los procedimientos empleados para revertirla en el peso medio del hospital y otros índices hospitalarios.estudio comparativo realizado en todos los pacientes subsidiarios de soporte nutricional artificial seguidos por la Unidad de Nutrición Clínica y Dietética de la Sección de Endocrinología y Nutrición (UNCyD-SEyN) del Complejo Asistencial Universitario de León durante los años 2008 y 2013. Se realizó un informe de codificación nutricional del diagnóstico, el tratamiento nutricional y la vía de acceso según la CIE-9-MC. Se comparó el peso medio depurado del hospital, el índice de estancia media ajustada (IEMA), la casuística e índice de funcionamiento previo a la codificación nutricional y tras la misma.el peso medio depurado del hospital se incrementó tras la codificación, tanto en 2008 (+ 4,1%) como en 2013 (+1,7%) y especialmente en aquellos servicios en los que se realiza cribado nutricional (Hematología, +10,5%). El IEMA se redujo por debajo de 1 (-5,7% y -0,2% en 2008 y 2013), indicando un mejor funcionamiento, y también disminuyó el índice funcional (-5,6% y -0,4% en 2008 y 2013), lo que supondría una mayor eficiencia.la correcta codificación del diagnóstico y el tratamiento nutricional del paciente con desnutrición aumenta el peso medio depurado de un hospital de tercer nivel, y mejora el IEMA y el índice de funcionamiento.

la dieta hospitalaria deberá aportar la suficiente cantidad de energía a partir de una adecuada distribución de macronutrientes.determinar la calidad nutricional de las dietas hospitalarias.estudio transversal realizado en condiciones de práctica clínica habitual. Se realizó una valoración nutricional de todas las dietas hospitalarias y una estimación de las necesidades energéticas y proteicas del paciente hospitalizado. Finalmente, se valoró la adecuación del diseño nutricional y dietético de las dietas actuales teniendo en cuenta las necesidades nutricionales del paciente. Se consideró: "Dieta energética y proteicamente completa" si el aporte de energía y proteínas estaba por encima del percentil 95 de las necesidades nutricionales detectadas en los pacientes del centro; "Dieta energética y proteicamente potencialmente completa" si el aporte de energía y proteínas estaba comprendido entre el percentil 75 y 95 de las necesidades nutricionales detectadas en el centro; "Dieta energética y proteicamente incompleta" si el aporte de energía y proteínas estaba por debajo del percentil 75 de las necesidades nutricionales detectadas en el centro.fueron evaluadas nutricionalmente 54 dietas destinadas a pacientes adultos. Fueron valorados un total de 201 pacientes con una mediana de edad de 71,60 (RIC 21,40) años y el 51,25% fueron mujeres. Sus necesidades energéticas fueron 25,84 (DE 2,55) kcal/kg peso/ día o 1.753,54 (DE 232,51) kcal/día, el percentil 95 fue de 2.153,9 kcal/día y el percentil 75 fue 1.772,5 kcal/día. Las necesidades proteicasfueron 1,2 (DE 0,10) g/kg peso/día o 82,30 (DE 16,76) g/día, el percentil 95 fue 112,3 g/día y el 75 fue 91,8 g/día. El 25% de las dietas cubrían las necesidades energéticas de la población hospitalaria; una dieta cubría las necesidades proteicas.las dietas evaluadas no cubrían las necesidades nutricionales del paciente hospitalizado. La reestructuración actual logrará satisfacer sus necesidades nutricionales así como sus expectativas gastronómicas.

Stiffness has been associated to malignancy in prostate and breast, as well as thyroid. Ultrasound elastography objectively measures tissue elasticity, and previous studies have described it as a high sensitivity and specificity technique for the detection of malignant thyroid nodules in high-risk populations. The aim was to assess the accuracy of elastography in a population with low risk of malignancy. 128 consecutive patients with nodular goiter were recruited. Elastography and ultrasound-guided fine-needle aspiration were performed. When malignancy was suspected by citology, surgery was recommended. Thyroid nodules were classified by elastography according the criteria described by Ueno, and an alternative classification. Sensitivity, specificity, predictive values, and odds ratio were calculated. Most patients were female, aged 56.1 year, with single nodule (52.0%) or multinodular goiter (45.6%), and a few thyroiditis (2.4%). The majority of nodules were mostly elastic. Fine-needle aspiration found 86% of benign nodules, 9.3% of indeterminate, and 4.7% possibly malignant. After surgery, 3 malignant nodules were confirmed, all of them being papillary carcinomas. All the malignant nodules were mostly elastic, as well as 75% of indeterminate nodules. Low values of sensitivity and specificity were found for elastic nodules being benign and hard nodules malignant. In a low-risk population for thyroid cancer, elastography lacks accuracy for the diagnosis of malignant nodules. Clinical Trials Registration Number: NCT01102127

to communicate the results of the Spanish Home Parenteral Nutrition (HEN) registry of the NADYASENPE group for the year 2014.data was recorded online by NADYA group collaborators that were responsible of the HPN follow-up from 1st January to 31st December 2014.a total of 220 patients and 229 episodes of HPN were registered from 37 hospitals that represents a rate of 4.7 patients/million habitants/year 2014. The most frequent disease in adults was other diseases (23.3%), neoplasm (20.4%) followed by radical active neoplasm (11.8%) and mesenteric ischemia (10.9%). The most frequent diagnosis for children were the congenital intestinal disorders (33.3%) followed by traumatic short bowel and other diagnosis.the number of participating centers and registered patients increased progressively respect to preceding years. We consider that the HPN should be regulated by the Sanitary Administration within the framework of the National Health Service Interregional Council. And its inclusion in the portfolio of health services of the different Autonomous Comunities would be beneficial for patients and professionals.Objetivo: comunicar los datos del registro de Nutrición Parenteral Domiciliaria (NPD) del grupo de trabajo NADYA-SENPE del año 2014. Material y métodos: recopilación de los datos de NPD del registro “on-line” del grupo de Nutrición Artificial Domiciliaria y Ambulatoria (NADYA) desde el 1 de enero de 2014 al 31 de diciembre de 2014. Resultados: se registraron 220 pacientes, con 229 episodios de NPD, procedentes de 37 hospitales; lo que representa una tasa de 4,73 pacientes/millón de habitantes/ año 2014. Las patologías más frecuentes en los adultos fueron: ‘otros diagnósticos’ (22,3%), la neoplasia paliativa (20,4%), seguida por la neoplasia activa radical (11,8%) y la isquemia mesentérica (10,9%). En los niños las patologías más frecuentes fueron: ‘alteraciones congénitas intestinales’ (33,3%), seguidas por ‘intestino corto traumático’ y ‘otro diagnóstico’. Conclusiones: se observa un aumento del número de pacientes que reciben nutrición parenteral domiciliaria y de los centros colaboradores. Consideramos que la NPD debería ser regulada por la Administración Sanitaria en el marco del Consejo Interterritorial del Sistema Nacional de Salud, y que su inclusión en la Cartera de Servicios de los diferentes Servicios de Salud de las diferentes comunidades autónomas redundaría en un beneficio para el paciente y los profesionales.

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.La disfagia es un problema habitual entre la población anciana o en situaciones patológicas, como algunas enfermedades neurodegenerativas o algún tipo de cáncer. La confección de una dieta adaptada a este tipo de situaciones puede presentar diversas dificultades. A través de este documento se pretende realizar un estudio detallado de las características técnicas que presentan los diferentes productos disponibles en el mercado español para hidratar y nutrir a un paciente con disfagia. La industria alimentaria y farmacéutica ha desarrollado una amplia gama de productos diseñados para garantizar una textura homogénea y una viscosidad que permita lograr una correcta hidratación, así como contribuir a un adecuado estado nutricional del paciente con disfagia, sin comprometer su seguridad. Los compuestos empleados para alcanzar una viscosidad adecuada pueden ser diferentes tipos de almidones, gomas u otras sustancias. Se han desarrollado espesantes y agua gelificada para una correcta hidratación y, en el caso de la alimentación, purés (deshidratados, liofilizados, pasteurizados y esterilizados), purés de frutas, flan de frutas y cereales deshidratados. Los pacientes que no cubren sus necesidades nutricionales disponen además de suplementos orales con diferentes viscosidades. Las empresas ofrecen una amplia información sobre las características técnicas de estos productos, excepto en el caso de la viscosidad. Se recomienda a los fabricantes detallar en las fichas técnicas de los productos la metodología empleada y los resultados obtenidos en los análisis de viscosidad para que puedan ser consultadas por los profesionales de las Unidades de Nutrición Clínica y Dietética que tratan a estos pacientes.

the radiation of tumours located in pelvic organs can cause mucositis in the bowel. The aim of this study was to determine the prevalence, risk factors, and complications of chronic radiation enteritis in patients who had received pelvic radiotherapy.cross-sectional study recruiting 150 patients that had been treated with radiation therapy during the year 2008 because of a prostate, cervical, endometrial or rectal cancer. The patients were asked about symptoms related to enteritis, and about changes in body weight and in dietary patterns. Sex, age, treatment modalities, acute enteritis, and type of cancer were considered possible risk factors, and were analysed with univariate and multivariate methods.the study included 100 patients, 84% males, median age 72.3 years. Chronic radiation enteritis was found in 20% of the patients, most of them grade 1 (45%). Furthermore, 10% had lost ≥ 5 kg of weight, 3% had been hospitalized due to diarrhoea or bowel obstruction, and 11% had changed their diet, mainly by removing vegetables, legumes and pastry. Male gender, age, previous acute radiation enteritis, and chemotherapy were associated with chronic enteritis, but only chemotherapy remained independently related to bowel toxicity after multivariate analysis (OR = 3.59 [95% CI 1.20-10.73]).chronic enteritis is common among patients treated with pelvic radiotherapy, especially if chemotherapy is associated. The complication rate is low, but a significant number of patients change their usual diet in order to prevent symptoms.Introducción: la radiacion de los tumores de la cavidad pelvica puede provocar mucositis a nivel intestinal. El objetivo de nuestro estudio fue determinar la prevalencia, los factores de riesgo y las complicaciones de la enteritis radica cronica en los pacientes tratados con radioterapia pelvica. Pacientes y métodos: estudio transversal sobre 150 pacientes tratados con radioterapia pelvica durante el ano 2008 debido a un cancer de prostata, cervix, endometrio o recto. Se interrogo a los pacientes sobre la presencia de sintomas sugestivos de enteritis y sobre cambios en el peso habitual y modificaciones en su dieta. Los parametros considerados como posibles factores de riesgo de enteritis cronica (sexo, edad, tratamiento antitumoral, enteritis aguda previa y tipo de tumor) se analizaron con metodos univariantes y multivariantes. Resultados: el estudio incluyo finalmente a 100 pacientes, el 84% varones, con una mediana de edad de 72,3 anos. Se encontro una prevalencia de enteritis radica cronica del 20%, en la mayoria de grado 1 (45%). Por otra parte, el 10% referian una perdida de peso ≥ 5 kg, el 3% habian requerido hospitalizacion debido a diarrea incoercible o a obstruccion intestinal, y el 11% habian modificado su patron de alimentacion habitual, reduciendo principalmente el consumo de verduras, legumbres y dulces. Se encontro asociacion entre la enteritis radica cronica y el sexo masculino, la edad, la enteritis radica aguda previa y la quimioterapia, pero solo esta resulto asociarse de forma independiente con el desarrollo de enteritis radica cronica despues del analisis multivariante (OR = 3,59 [95% CI 1,20–10,73]). Conclusión: la enteritis cronica es una entidad frecuente en los pacientes tratados con radioterapia pelvica, sobre todo cuando se asocia con quimioterapia. La tasa de complicaciones por esta patologia es baja, pero un numero importante de pacientes realiza modificaciones en su dieta habitual para aliviar o evitar la sintomatologia derivada de aquella.

Background and objective Nutritional assessment of the elderly is difficult and different to that performed on younger people. Specific tools for this purpose include 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 recorded. GNRI and NRI were calculated. Both indexes were compared to each other and to the 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. The NRI and the GNRI did not correlate either with length of stay (R = 0.136) or with length of nutrition (R = 0.041). No significant correlation was seen between the GNRI and complications, but a significant relationship was found with the NRI. After stratification into surgical and/or patients, the NRI was shown to be significantly related to complications in surgical patients only (p Conclusions In hospitalized elderly patients, the NRI is a better predictor of complications and may be more appropriate for assessing the risk of death than the GNRI. The GNRI underestimates nutritional risk as compared to NRI.

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.single-cohort study of patients with head and neck cancer (HN) 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.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.bacterial colonization of the oropharynx prior to radiotherapy may be a factor for severe mucositis in HN patients.Objetivo: el objetivo fue demostrar si la modalidad de tratamiento, el estado nutricional y la flora orofaríngea contribuyen al desarrollo de mucositis en pacientes con cáncer de cabeza y cuello tratados con radioterapia. Métodos: estudio de cohorte de pacientes con cáncer de cabeza y cuello (CyC) tratados con radioterapia. El estado nutricional se evaluó utilizando VGS, IMC e IMM. Se realizó un frotis bucal antes de la radioterapia para el cultivo de bacterias y levaduras. Se evaluó la mucositis usando los criterios de la OMS. Se calcularon el riesgo relativo (RR) y su IC del 95%. Resultados: el estudio incluyó a 35 pacientes, 74,3% hombres, 63,8 (9,9) años de edad, y 34,3% desnutridos. Los tumores estaban localizados en laringe (40,0%), boca (25,7%) y faringe (11,4%). El tratamiento consistió en 66,0 Gy de radiación, quimioterapia (60,0%) y cirugía (57,1%). Se encontraron bacterias en 28,6%, incluyendo Staphylococcus aureus (8,6%) y Escherichia coli (8,6%). Se encontró Candida spp. en el 35,3%. La mucositis fue más frecuente en los pacientes con radioterapia radical [100% vs. 65%, p = 0,01; RR = 1,54 (IC95% 1,12 a 2,12)]. Ni VGS, IMC ni IMM se relacionaron con el desarrollo o la gravedad de la mucositis. Los cultivos positivos para bacterias antes de la radioterapia se relacionaron con mucositis severa [44,4% vs. 12%, p = 0,039; RR = 4,17 (IC95% 1,22 a 14,24)], pero no hubo ninguna relación con la presencia de levaduras. La cirugía no se asoció con la aparición de las cepas estudiadas de bacterias. Conclusión: la colonización bacteriana de la orofaringe antes de la radioterapia puede ser un factor para la mucositis graves en pacientes con cáncer CyC.

biliopancreatic diversion (BPD) has been shown to be one of the most effective techniques for losing weight, although nutritional education also might play an important role. Our aim was to determine the effect of the combination of a nutrition educational program (NEP) and BPD on changes in the intake of energy and macronutrients after the surgery.this longitudinal study included all patients eligible for BPD who filled in a dietary record. Two assessments were performed: six weeks before and twelve months after surgery. The nutrition educational program was given two weeks after surgery by a registered dietitian and a 3-day food record was collected for further analysis at both of the assessments.68 patients were included. The percentage of excess weight loss was 60.76% (SD 14.50%). A year after the surgery there was a reduction of energy (-602.27 kcal [SD 930.19 kcal], p0.001), fat (-41.70 g [SD 77.87 g], p0.001), percentage of fat (-4.79% [SD 11.38%], p = 0.001), and an increase in the percentage of protein (+ 2.72% [SD 7.10%], p = 0.002). A lower consumption of fat, especially of polyunsaturated fatty acids, was observed in the patients that achieved the nutritional recommendations and in the super-obese patients.The combination of NEP and BPD resulted in an improvement in the nutritional profile, with a reduction of fat and maintenance of the protein intake.Introducción: la derivación biliopancreática (DBP) ha demostrado ser una de las técnicas más efectivas en la pérdida de peso, aunque la educación nutricional también puede jugar un papel importante. El objetivo del estudio fue determinar el efecto de la combinación de un programa de educación nutricional (PEN) y DBP en los cambios de ingesta energética y de macronutrientes después de la cirugía. Métodos: estudio transversal que incluyó a todos los pacientes subsidiarios de DBP que cumplimentaron la encuesta dietética. Se realizaron dos valoraciones: seis semanas antes y doce meses después de la cirugía. El PEN fue impartido dos semanas después de la cirugía por una dietista-nutricionista. Fue recogida una encuesta dietética de tres días en ambas visitas para realizar el análisis nutricional de la ingesta. Resultados: fueron incluidos 68 pacientes. El porcentaje de exceso de peso perdido fue de 60,76% (DE 14,50%). Un año después de la intervención se produjo una disminución de la ingesta calórica (−602,27 kcal [DE 930,19 kcal], p.

Malnutrition in oncology and hematology-oncology patients is important due to its prevalence and associated mortality and morbidity. The aims of the study were to assess the prevalence of malnutrition in oncology and hematology patients and determine if intake or malnutrition influences hospitalization outcomes.A cohort study was performed in all patients admitted to the oncology and hematology wards in a 30-day period. Nutritional assessment was performed within 24-hours of admission and repeated after 7 days of hospitalization, including Subjective Global Assessment, anthropometry, dietary assessment (24-hour recall) and estimation of caloric and protein needs. Medical records were reviewed 30 days after discharge.Seventy-three patients were evaluated on admission and 29 on day 7 of hospitalization. The prevalence of malnutrition was 47.7%. On admission, patients consumed 71.6 (SD 22.0)% of the prescribed dietary calories and 68.2 (SD 23.5)% of prescribed proteins. The death rate was 2.8% among patients who ate ≥75% and 17.9% among those who ate75% (p = 0.040). No significant differences were observed between the intake of calories (p = 0.124) and protein (p = 0.126) on admission and on day 7 of hospitalization. Nutritional status was related to readmission rate, being 35.1% for malnourished vs. 8% for well-nourished (p = 0.014). Nutritional status and food intake were not related to the rest of the studied outcomes (length of stay and mechanical, metabolic or infectious complications).Intake did not decrease during hospitalization. There was an upward trend between reduced intake and mortality. Malnutrition was related to hospital readmission.Introducción: la malnutrición en el paciente oncohematológico es importante debido a su prevalencia y a su morbimortalidad asociadas. El objetivo de este estudio fue analizar la prevalencia de malnutrición en el paciente oncohematológico y determinar si la ingesta o la malnutrición afectan a las complicaciones del paciente hospitalizado. Metodología: estudio de corte realizado en todos los pacientes admitidos en las plantas de oncología y hematología durante un periodo de 30 días. La valoración nutricional se realizó durante las 24 primeras horas tras el ingreso y se repitió a los 7 días de hospitalización, incluyendo Valoración Subjetiva Global, antropometría, recuerdo de 24 horas y estimación de las necesidades calóricas y proteicas. Las historias médicas fueron revisadas a los 30 días tras el alta. Resultados: setenta y tres pacientes fueron evaluados al ingreso y 29 a los siete días de su hospitalización. La prevalencia de malnutrición fue 47,7%. Al ingreso, los pacientes consumieron 71,6 (DE 22,0)% de las calorías prescritas y 68,2 (DE 22,0)% de las proteínas prescritas. La tasa de fallecimientos fue 2,8% entre los pacientes que consumieron ≥75% y 17,9% entre aquellos que consumieron.

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.To evaluate the most appropriate tool for nutritional screening, globally and by hospital wards, in a tertiary hospital.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.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.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.Introducción: La elevada prevalencia de desnutrición en el medio hospitalario y sus repercusiones hacen necesario el empleo de herramientas de cribado nutricional para su detección, diagnóstico y tratamiento precoz. Objetivo: Evaluar la herramienta de cribado nutricional más adecuada para el paciente hospitalizado en un hospital de tercer nivel, a nivel global y por servicios de hospitalización. Metodología: Estudio transversal realizado en condiciones de práctica clínica habitual. Se evaluaron 4 métodos de cribado nutricional: Valoración Subjetiva Global (VSG), Mini Nutritional Assessment (MNA), Malnutrition Universal Screening Tool (MUST) y Nutritional Risk Screening 2002 (NRS-2002). Los servicios de hospitalización se agruparon en: servicios médicos, Cirugía General, Traumatología, otros servicios quirúrgicos y Oncología-Hematología. Se realizó un análisis estadístico de sensibilidad (S) y especificidad (Sp) y fueron comparados mediante curva COR. Resultados: Fueron valorados 201 pacientes con mediana de edad de 71,6 (RIC 21,4) años y el 51,2% fueron mujeres. La prevalencia de riesgo nutricional (RN) y desnutrición (DN) detectada fue: VSG 62,1%, MNA 68,6%, MUST 53,7% y NRS-2002 35,8%. Con todas las herramientas de cribado nutricional, excepto el MNA, se detectó una mayor prevalencia de RN y DN en los servicios médicos y quirúrgicos. En el análisis global el MNA obtuvo una S =93,3%, una Sp = 71,6% y un área bajo la curva COR de 0,825; el MUST obtuvo una S = 82,4%, una Sp = 93,4% y un área bajo la curva COR de 0,879; el NRS-2002 obtuvo una S = 56,0%, una Sp = 97,4% y un área bajo la curva COR de 0,766. Estos resultados fueron similares en el análisis por servicios de hospitalización. Conclusión: La herramienta de cribado nutricional recomendada en un centro hospitalario de tercer nivel y población envejecida sería el MUST por los adecuados resultados de sensibilidad y especificidad y la facilidad en su realización.

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.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.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.Glutamine did not exert a protective effect over chemoradiotherapy in rectal cancer or healthy rectal tissue.Introducción: El objetivo fue evaluar los efectos de la administración de glutamina sobre la regresión tumoral y sobre el tejido sano en pacientes con cáncer rectal que recibieron quimiorradioterapia. Material y métodos: Se incluyó 10 pacientes con cáncer rectal operado después de quimiorradioterapia, un subgrupo de un ensayo clínico que comparó glutamina con placebo en la prevención de enteritis aguda. Un patólogo experto analizó las muestras de tumor y tejido sano, buscando datos de regresión tumoral, mucífagos y daño por radiación. Resultados: No hubo diferencias entre placebo y glutamina en el grado de regresión tumoral. Todos los pacientes con glutamina presentaron mucífagos, frente al 28,6% con placebo (p = 0,038). El daño sobre tejido sano fue similar en los pacientes con glutamina y placebo, y entre aquellos con y sin enteritis. Conclusión: La glutamina no ejerce un efecto protector frente a la quimiorradioterapia sobre el tumor o el tejido rectal sano.

To update previous recommendations developed by the Working Group on Osteoporosis and Mineral Metabolism of the Spanish Society of Endocrinology and Nutrition for the evaluation and treatment of osteoporosis associated to different endocrine and nutritional diseases.Members of the Working Group on Osteoporosis and Mineral Metabolism of the Spanish Society of Endocrinology and Nutrition.Recommendations were formulated according to the GRADE system (Grading of Recommendations, Assessment, Development, and Evaluation) to describe both the strength of recommendations and the quality of evidence. A systematic search was made in MEDLINE (Pubmed) using the following terms associated to the name of each condition: AND "osteoporosis", "fractures", "bone mineral density", and "treatment". Papers in English with publication date between 18 October 2011 and 30 October 2014 were included. The recommendations were discussed and approved by all members of the Working Group.This update summarizes the new data regarding evaluation and treatment of osteoporosis associated to endocrine and nutritional conditions.

The prevalence of malnutrition in hospitals ranges from 20 to 50% and the hospital diet could be a potential risk factor. The aim of the study was to determine the overall and per services prevalence of hospital malnutrition, and assess its impact on clinical outcomes in patients receiving nutritionally complete menus.Cross-sectional study in a university hospital. Nutritional status was assessed using Subjective Global Assessment (SGA), anthropometry, and biochemical parameters. For the assessment of outcomes during hospitalization, length of stay, rate of deaths, and readmissions were collected.201 patients were evaluated. The median age was 71.59 (IQR 21.43) years old, and 51.20% were women. According to the results obtained by SGA, 37.8% of individuals were well nourished (WN), 50.2% were at nutritional risk (NR), and 11.9% were malnourished (MN). The prevalence of malnourished (NR+MN) was higher in oncology-hematology and medical wards (80.0% and 70.5%) than in surgical ones (52.4%) (p = 0.047). The worse nutritional status was, the longer the length of stay [WN: 8.0 (IQR 8.0) days; NR: 12.0 (IQR 13.5) days; MN: 18.5 (IQR 18.5) days, p0.001).The prevalence of malnutrition in the evaluated hospital was very high, being particularly striking in medical services, and doubling length of stay.La prevalencia de malnutrición hospitalaria oscila entre el 20 y el 50% y las características de la dieta hospitalaria pueden contribuir a su desarrollo. El objetivo del estudio fue determinar la prevalencia de malnutrición hospitalaria general y por servicios y conocer su impacto en la evolución de los pacientes subsidiarios de dietas nutricionalmente completas.Estudio transversal realizado en un hospital universitario. Se empleó la Valoración Global Subjetiva (VGS), técnicas antropométricas y parámetros bioquímicos para la valoración nutricional. Para conocer el impacto en la evolución del paciente se estudiaron las complicaciones durante la hospitalización, la duración del ingreso hospitalario, tasa de fallecimiento y de reingresos hospitalarios.Fueron reclutados 201 pacientes. La mediana de edad fue 71,6 (RIC 21,43) años y el 51,2% eran mujeres. Según los resultados obtenidos con la VGS, el 37,8% estaba bien nutrido (BN), el 50,2% presentaba un riesgo nutricional (RN) y el 11,9% estaba malnutrido (MN). La prevalencia de malnutrición (RN+MN) fue superior en los Servicios de Oncología-Hematología y otros servicios médicos (80,0% and 70,5%) respecto a los quirúrgicos (52,4%) (p = 0,047). Un peor estado nutricional aumentó la estancia hospitalaria [BN: 8,0 (RIC 8,0) días; RN: 12,0 (RIC 13,5) días; MN: 18,5 (RIC 18,5) días, p0,001).La prevalencia de malnutrición hospitalaria fue muy elevada en el centro evaluado, duplicando la estancia media y estando especialmente presente en servicios médicos.

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).