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To evaluate the adequacy of TSH suppression therapy (TSHst) at the first disease assessment and the last follow-up visit.Retrospective observational study of those patients under follow-up of DTC in a reference hospital.216 patients (79.2% women) were evaluated, with a mean age 59.0 ± 13.1 years-old and a mean follow-up of 6.9 ± 4.3 years. 88.4% were papillary carcinomas. At diagnosis, 69.2% had a low risk of recurrence (RR) compared to 13.6% with a high RR. Dynamic risk stratification (DRS) classified patients at first disease assessment and the last visit as excellent response (ER) in 60.0% and 70.7%, respectively. Those patients with ER in the first and last follow-up control maintained TSHst in 30.7% and 16.3% of the cases, respectively (p 0.001). The factors associated with maintaining TSHst at the last control were younger age, higher RR at diagnosis, DRE at follow-up, presence of multifocality and histological vascular invasion (p 0.05). In a logistic regression analysis adopting tsTSH at follow-up as the dependent variable, exclusively age (β = -0.062; p 0.001), RR at diagnosis (β = 1.074; p 0.05) and EDR during follow-up (β = 1.237; p 0.05) maintained statistical significance.Despite the current recommendations, 30.7% of patients with low RR and initial ER are under TSHst. This percentage reduced to 16.3% in those patients with ER after a mean follow-up of 6.9 years. Age, baseline RR, and DRE during follow-up were associated to maintaining tsTSH.

Resumen Introduccion La monitorizacion flash de glucosa (MFG) mejora algunas variables de control glucemico y parametros de calidad de vida. Objetivo Evaluar la calidad de vida y el control glucemico tras el inicio de MFG en pacientes con DM1 en la practica clinica. Material y metodos Estudio observacional prospectivo en pacientes con DM1 que iniciaron MFG (de junio de 2019 a abril de 2020). Se evaluaron las puntuaciones de: cuestionario de calidad de vida especifico para la diabetes mellitus (EsDQOL), escala de distres relacionado con la diabetes (EsDDS), Diabetes Treatment Satisfaction Questionnaire (EsDTSQ) y variables de control glucemico al inicio y a los 3 meses de MFG. Resultados Se selecciono a 114 pacientes, el 56% varones, con una edad media de 37,2 anos (DE 12,4) con 18,7 anos (DE 11,5) de DM1. El 24,6% tenia infusion subcutanea continua de insulina. Se observaron diferencias (basalmente vs. 3 meses) en la puntuacion de EsDTSQ (22 [15,5-27] vs. 25 [22-28]; p Conclusiones El inicio de la MFG, asociado a un programa educativo estructurado, en pacientes adultos con DM1, se asocio a mejoria en la calidad de vida y a mayor satisfaccion con el tratamiento de la diabetes. Se observo mejoria en la HbA1c y menor numero de eventos de hipoglucemia, pero no hubo efectos en el resto de los parametros glucemicos.

Resumen Objetivo Evaluar la progresion de la incidencia del carcinoma de tiroides (CDT), asi como la evolucion de los pacientes en seguimiento en una unidad de alta resolucion de tiroides (UART) mediante la estadificacion dinamica del riesgo. Metodos Estudio observacional retrospectivo sobre los casos incidentes en el registro de tumores del periodo 2002-2017 y la evolucion de los pacientes en seguimiento en la UART. Resultados Un total de 444 pacientes (78,5% mujeres, con una edad media de 52,1 ± 14,9 anos) fueron diagnosticados durante el periodo 2002-2017. La tasa de incidencia de CDT aumento de 5,2 a 25,7 × 105 habitantes/ano en mujeres y de 2,3 a 7,1 × 105 habitantes/ano en varones (p Al evaluar a los pacientes en seguimiento en la UART (84% carcinomas papilares), el 65,7% presentaban un riesgo bajo de recurrencia, frente a un 14,5% con riesgo elevado. El 88,8% de los pacientes con respuesta excelente al diagnostico se mantenian libres de enfermedad en la ultima visita de seguimiento. Aquellos pacientes con respuesta indeterminada o estructural incompleta al diagnostico evolucionaban a respuesta excelente en un 55,8% y 42,9% de los casos, respectivamente; frente al 14,8% en aquellos con respuesta bioquimica incompleta (p Conclusiones El aumento de la incidencia de CDT sigue una tendencia semejante a las publicadas en nuestro medio. Los sistemas de estadificacion dinamica del riesgo clasifican adecuadamente a los pacientes y permiten adecuar las herramientas de diagnostico y tratamiento, especialmente en los subgrupos de bajo riesgo.

Producción Científica, Purpose: To evaluate the predictive value of the rhTSH thyroglobulin stimulation test (rhTSH-Tg) compared to basal high- sensitive thyroglobulin (hs-Tg) under TSH suppressive therapy at 12 months after the completion of initial treatment to predict the long-term response and Dynamic Risk Stratification (DRS) at the last follow-up visit in a long-term DTC cohort. Methods: Prospective study in 114 DTC patients (77.2% women, mean age 46.4 ± 14.1 years old, median/IQR evolution 6.7[3.1–8.0] years) from 2013 to 2020 undergoing total thyroidectomy and radioiodine ablation in whom hs-Tg and rhTSH- Tg was performed 12 months after completing initial treatment. Pearson correlation, receiving operating characteristics (ROC) and DRS at initial and last follow-up visit were analyzed. Results: hs-Tg and rhTSH-Tg show a strong positive linear correlation (r = 0.864, p < 0.001). The diagnostic performance of initial hs-Tg and rhTSH-Tg levels were evaluated via ROC-AUC as a predictor of excellent response (ER) in the last follow-up visit. Hs-Tg showed a better AUC (0.969, 95%CI = 0.941–0.997) than rhTSH-Tg (0.944, 95%IC = 0.905–0.984; p < 0.001). The hs-Tg and rhTSH-Tg cutoff point of highest sensitivity (S) and specificity (E) was 0.110 and 0.815 ng/dl, respectively. Hs-Tg showed a higher diagnostic accuracy than rhTSH-Tg (S = 100% vs 96.8%, E = 84.3% vs 84.3%, NPV = 100% vs 98.6%, PPV = 70.5% vs 69.7%; p < 0.05). The DRS based on initial hs-Tg showed better ability to predict ER (93.3% vs 86.7%) and biochemical incomplete response (53.3%vs13.3%) in the last follow-up visit compared to rhTSH-Tg. Conclusions: Both initial hs-Th and rhTSH-Tg were good predictors of long-term ER. In patients with hs-Tg, the rhTSH-test did not provide relevant prognosis information. An ER after initial treatment was associated with a very high NPV at subsequent follow-up., Publicación en abierto financiada por el Consorcio de Bibliotecas Universitarias de Castilla y León (BUCLE), con cargo al Programa Operativo 2014ES16RFOP009 FEDER 2014-2020 DE CASTILLA Y LEÓN, Actuación:20007-CL - Apoyo Consorcio BUCLE

To evaluate metabolic control and satisfaction with a telemedicine diabetes education programme for the initiation of flash glucose monitoring (FGM) in type 1 diabetes.Prospective study in 48 patients (52.1% women, 22.9% on insulin pump) who started FGM. They were analysed at baseline and 3 months after the beginning of the FGM. The results were compared with an on-site learning cohort matched by age, sex and HbA1c.At the beginning and 3 months after the MFG, HbA1c improvement was observed (7.9±1.4 vs 7.3±1.1%), p0.01; with a decrease in time below range - TBR - (4.7±4.9 vs 3.5±3.5%), p0.05 and number of hypoglycaemic events (9.4±8.7 vs 6.9±5.7/15 days), p0.05, associated with a worsening in time above range - TAR - (33.5±19.9 vs 37.0±20.9%), p0.05. No significant differences were observed in the TIR 70-180mg/dl (61.7±18.6 vs 59.4±20.0%), glycemic variability or the use of FGM. Patient satisfaction with telemedicine training was 4.8±0.3 out of 5. No significant differences were observed in the follow-up, either in HbA1c or other glucometer parameters between on-site and online training. In a multivariate analysis adopting the HbA1c at follow-up as the dependent variable, only the TIR (β=-0.034; p0.001) and the initial HbA1c (β=0.303; p0.001) maintained statistical significance, unrelated to the on-site or online training (β=0.136; p=ns).A telemedicine programme is an adequate tool for training in FGM, with results similar to on-site training, and it was associated with a high degree of satisfaction.

Resumen Objetivos La monitorizacion flash de glucosa en pacientes con diabetes tipo 1 proporciona nuevos datos glucometricos que permiten evaluar el control glucemico mas alla de la HbA1c. El objetivo del presente estudio fue evaluar la relacion de la HbA1c, el tiempo en rango (TIR) y la variabilidad glucemica en una cohorte de pacientes pediatricos y adultos con diabetes tipo 1 y monitorizacion flash de glucosa. Material y metodos Estudio transversal en 195 pacientes con diabetes tipo 1 (42,6% mujeres, 70 pediatricos, 26,2% infusor subcutaneo de insulina, 28,7% coeficiente de variacion [CV] ≤ 36%) en tratamiento intensivo y monitorizacion flash de glucosa. Se evaluaron datos clinicos, analiticos y glucometricos. Resultados La relacion entre el TIR y la HbA1c mostro una correlacion lineal fuerte negativa (R = −0,746; R2 = 0,557; p ≤ 36% (R = −0,852; R2 = 0,836) frente a aquellos con un CV > 36% (R = −0,703; R2 = 0,551). Esta misma correlacion se observo al evaluar el TIR y el Glucose Management Indicator(R = −0,846; R2 = 0,715; p ≤ 36% (R = −0,980; R2 = 0,960) como en aquellos con CV > 36% (R = −0,837; R2 = 0,701); p Conclusiones La variabilidad glucemica definida por el CV modifica la relacion entre el TIR y la HbA1c/Glucose Management Indicator y debe tenerse en cuenta a la hora de individualizar objetivos de TIR, independientemente de la edad o el tipo de tratamiento utilizado.

Introduction: hyponatremia is the most frequent disturbance in hospitalized patients. This situation may influence the therapeutic approach in patients with total enteral tube feeding (TEN). Objective: to study the prevalence of hyponatremia and the clinical factors that are associated with increased risk in a population with TEN. Methods: a retrospective study from January 2014 to January 2020; 1,651 non-critically ill patients receiving TEN were included who were assessed by the Department of Endocrinology and Nutrition. Data collected included sex, age, body mass index (BMI) (kg/m2), and nutritional status by Mini Nutritional Assessment (MNA); main disease diagnosis and development of hyponatremia at onset or during TEN were also included. Results: in all, 53.9 % of the total sample were males aged 76.8 [65.7-85.3] years. Neurological pathology was the most frequent primary diagnosis on admission (37.3 %). We found hyponatremia in 26.1 % -11.0 % at onset and 16.7 % during TEN-. Hyponatremia was more frequent in patients with digestive disease (28.7 %) and infectious disease (27.65 %). According to the MNA questionnaire 41.1 % were malnourished and nutritional status was worse in patients with hyponatremia (76.3 % vs. 55.8 %; p0.001). By multivariate analysis, malnutrition was only associated with hyponatremia status; OR, 2.86 [95 % CI: 1.5-4.88]. Conclusions: in this study, hyponatremia was detected in a third of patients. This was up to two more times as common in malnourished patients; however, age, sex, BMI, and baseline pathology were not related.Introducción: la hiponatremia es el trastorno electrolítico más frecuente a nivel hospitalario. En pacientes con nutrición enteral (NE) puede influir en el abordaje terapéutico, así como en la selección del preparado nutricional. Objetivos: describir la prevalencia de la hiponatremia en pacientes con NE y factores asociados. Métodos: estudio retrospectivo de 1651 pacientes no críticos con NE, valorados por el Servicio de Endocrinología y Nutrición desde enero de 2014 hasta enero de 2020. Se recogieron la edad, el sexo, el índice de masa corporal (IMC) (kg/m2), el estado nutricional mediante el cuestionario Mini Nutritional Assessment (MNA), el diagnóstico principal y la presencia de hiponatremia al inicio y durante la NE. Resultados: del total, el 53,9 % fueron hombres, con una mediana de edad de 76,8 [65,7-85,3] años. El diagnóstico principal más frecuente fue la patología neurológica (37,3 %). El 26,1 % de los pacientes presentaron hiponatremia: un 11,0 % al inicio de la NE y el 16,7% durante su administración. La hiponatremia fue más frecuente en aquellos con patología digestiva (28,7 %) e infecciosa (27,65 %). Según el MNA, hasta el 41,1 % presentaron desnutrición y la frecuencia de esta fue estadísticamente superior en los pacientes con que en aquellos sin hiponatremia (76,3 % vs. 55,8 %; p0,001). En el análisis multivariante, únicamente la desnutrición se asoció de manera significativa con la presencia de hiponatremia, con una OR de 2,86 [IC 95 %: 1,5-4,88]. Conclusiones: la hiponatremia se detectó en un tercio de los pacientes con NE. Su presencia fue hasta 2 veces más frecuente en los pacientes desnutridos, independientemente de la edad, el sexo, el IMC y la patología basal.

Resumen Introduccion En el paciente hospitalizado la diabetes mellitus tipo 2 (DM2) puede condicionar una peor situacion nutricional debido a su fisiopatologia y tratamiento dietetico prescrito. Objetivos Valorar si el paciente con DM2 hospitalizado tiene peor situacion nutricional que el no diabetico. Determinar la influencia de la DM2 en la estancia media en pacientes con mala situacion nutricional. Material y metodos Estudio transversal desde enero de 2014 hasta octubre de 2016, en 1.017 pacientes en los que se solicito valoracion nutricional al servicio de endocrinologia y nutricion. Se recopilaron datos de antropometria, albumina plasmatica, demora en la realizacion de la interconsulta a nutricion y tiempo de estancia hospitalaria. Se analizo el estado nutricional mediante el cuestionario Mini Nutritional Assesment (MNA) y el indice de riesgo nutricional (IRN). Resultados Del total de pacientes el 24,4% eran pacientes con DM2 y 75,6% no lo eran. Los pacientes con DM2 presentaban mayor indice de masa corporal (23,18 [20,78-25,99] kg/m2 vs. 22,31 [19,79-25,30] kg/m2, p ˂ 0,01], menor puntuacion total del cuestionario MNA (16,5 [13,12-19]) puntos vs. 17 [14-20] puntos, p ˂ 0,01), menor puntuacion del indice IRN (83,09[77,72-91,12] puntos vs. 85,78 [79,27-92,83] puntos, p = 0,03). El paciente con DM2 tiene un riesgo aumentado de padecer malnutricion segun el cuestionario MNA ( Conclusiones Los pacientes con DM2 tienen peor situacion nutricional que los pacientes sin DM2. Los pacientes con diabetes con peor situacion nutricional presentan mayor estancia media hospitalaria.

Introduction In the hospitalized patient, Diabetes mellitus type 2 (DM2) may result in a worse nutritional status due to its pathophysiology and dietary treatment. Objectives The aim of this study was to know if a hospitalized diabetic patient has a worse nutritional status, and to establish the influence of DM2 on the hospital length of stay in patients with malnutrition. Material and methods This was a transveral study from January 2014 to October 2016; 1017 patients were included who were assessed by the Endocrinology and Nutrition Department. The data collected included anthropometry, plasma albumin, delay in performing the nutrition interconsultation and hospital length of stay. Nutritional status was evaluated using the Mini Nutritional Assesment (MNA) questionnaire and the nutritional risk score (NRS). Results 24.4% of the patients were diabetic and 75.6% were not. Diabetic patients had a higher body mass index (BMI) [23.18 (20.78–25.99) kg/m2 vs. 22.31 (19.79–25.30) kg/m2, p Conclusions Diabetic patients have a worse nutritional status than non-diabetic patients. Diabetic patients with a poor nutritional status spend a longer period in hospital.

Background: cancer patients are a group at high nutritional risk. Oral nutritional supplementation (ONS) can improve nutritional status. Objective: the objective of our study was to evaluate the effectiveness on nutritional parameters and quality of life of a ω3-enriched ONS in oncology outpatients in a real-world study. Material and methods: a total of 35 outpatient cancer patients who received 2 ONS per day were recruited. Chemistry, anthropometric, impedance measurement, nutritional survey, malnutrition universal screening tool (MUST) test, and EQ5D quality of life test were all used before and after 3 months of intervention. Results: mean age was 65.4 ± 10.7 years (18 females/17 males). Mean completion of the group was 81.7 ± 7.2 %. During the intervention, total protein (1.5 ± 0.2 g/dL; p = 0.01), albumin (0.9 ± 0.1 mg/dL; p = 0.04), and transferrin (53.9 ± 21.1 mg/dL; p = 0.02) levels increased. At the beginning of the study, 100 % of the patients were in the high nutritional risk category according to MUST. After the intervention, 34.3 % (n = 12) were in the low nutritional risk category, 51.4 % (n = 18) in the moderate nutritional risk category, and only 14.3 % (n = 5) in the category of high nutritional risk; previously, 100 % of patients had high nutritional risk (p = 0.02). The total score in the quality of life test increased significantly (0.51 ± 0.06 vs 0.84 ± 0.03 points; p = 0.01), with improvement in 5 dimensions. Conclusions: the use of a ω3-enriched ONS in a real-world study with cancer outpatients showed a beneficial effect on nutritional parameters and quality of life.Antecedentes: los pacientes oncológicos son un grupo de alto riesgo nutricional. Los suplementos orales nutricionales (SON) pueden ayudar a mejorar su situación nutricional. Objetivo: el objetivo de nuestro estudio fue evaluar en un estudio en vida real la efectividad sobre los parámetros nutricionales y la calidad de vida de un SON enriquecido con ω-3 en pacientes ambulatorios oncológicos. Material y métodos: se reclutaron 35 pacientes oncológicos ambulatorios que recibieron 2 SON al día. Se realizaron: valoración bioquímica y antropométrica, impedanciometría, encuesta nutricional, test Malnutrition Universal Screening Tool (MUST) y test de calidad de vida EQ5D, antes y a los 3 meses de intervención. Resultados: la edad media fue de 65,4 ± 10,7 años (18 mujeres/17 hombres). La cumplimentación media del grupo fue de un 81,7 ± 7,2 %. Durante la intervención aumentaron los niveles de proteínas totales (1,5 ± 0,2 g/dl; p = 0,01), albúmina (0,9 ± 0,1 mg/dl; p = 0,04) y transferrina (53,9 ± 21,1 mg/dl; p = 0,02). Al inicio del estudio, un 100 % de los pacientes presentaban en el test MUST la categoría de alto riesgo nutricional. Tras la intervención, un 34,3 % (n = 12) presentaban la categoría de bajo riesgo nutricional, un 51,4 % (n = 18) presentaban en el test MUST la categoría de moderado riesgo nutricional, y solo un 14,3 % (n = 5) presentaban la categoría de alto riesgo nutricional; previamente, el 100 % de los pacientes tenían la categoría alto riesgo (p = 0,02). La puntuación total del test de calidad de vida aumentó significativamente (0,51 ± 0,06 vs. 0,84 ± 0,03 puntos; p = 0,01), mejorando cualitativamente las 5 dimensiones. Conclusiones: la utilización de un SON enriquecido con ω-3 en pacientes oncológicos ambulatorios en condiciones de vida real muestra un efecto beneficioso sobre los parámetros nutricionales y la calidad de vida.

Background and aims: a poor nutritional status may worsen the prognosis of stroke. We assessed which factors were associated with a worse nutritional status in patients with stroke at the time of hospitalization. Methods: a cross-sectional study in patients with stroke needing enteral nutritional support, from January 2014 to September 2016. Nutritional status was evaluated by the Mini-Nutritional Assessment tool, and the Subjective Global Assessment. We performed a multivariate regression analysis including demographic, baseline disability (modified Rankin scale), and clinical and anthropometric variables, and we stratified the sample based on median age. Results: we included 226 patients, 58.3 % male, with a median age of 77 (66.7-83) years. Forty-four percent were at risk of malnutrition, and 24 % were malnourished. The factors that were associated with a worse nutritional status were age (odds ratio (OR): 1.03; 95 % CI: 1.01-1.08) and modified Rankin scale score (OR: 1.96; 95 % CI: 1.32-2.67). In the stratified analysis, associated factors were, in the subgroup of patients older than 77 years, the baseline degree of disability (OR: 1.88; 95 % CI: 1.26-2.80), whereas in the subgroup of patients younger than 77 years, it was a prior history of ischemic events (OR: 2.86; 95 % CI: 1.01-8.16). Conclusion: in patients hospitalized due to stroke, older age and worse functional status were associated with a worse nutritional status at the time of hospitalization. In elderly patients, the main factor was prior functional status, while in younger patients it was a prior history of ischemic events.Introducción y objetivos: el mal estado nutricional empeora el pronóstico del ictus. El objetivo de este trabajo fue evaluar qué factores se asociaban a una mala situación nutricional en pacientes con ictus en el momento del ingreso. Material y método: estudio transversal de pacientes hospitalizados con ictus que precisaron soporte nutricional enteral, desde enero de 2014 hasta septiembre de 2016. Determinamos el estado nutricional mediante el Mini-Nutritional Assesment y la valoración global subjetiva. Se realizó un análisis de regresión multivariante, incluyendo variables demográficas, situación funcional (escala de Rankin) y variables clínicas y antropométricas, estratificándose por la edad mediana de la muestra. Resultados: se incluyeron 226 pacientes, el 58,3 % varones, con una edad mediana de 77 (66,7-83) años. El 44 % presentaban riesgo de malnutrición y el 24 % desnutrición. Los factores asociados a una mala situación nutricional fueron la edad (odds ratio (OR): 1,03, IC 95 %: 1,01-1,08) y la puntuación en la escala de Rankin (OR: 1,96; IC 95 %: 1,32-2,67). En el análisis estratificado, los factores asociados a una mala situación nutricional fueron, en el subgrupo de los mayores de 77 años, la capacidad funcional previa (OR: 1,88; IC 95 %: 1,26-2,80), y en el subgrupo de los menores de 77 años, la historia de eventos isquémicos previos (OR: 2,86; IC 95 %: 1,01-8,16). Conclusiones: en pacientes hospitalizados por ictus, la mayor edad y la peor situación funcional previa se asociaron a una peor situación nutricional. En los pacientes de mayor edad, el factor principal fue la situación funcional previa, mientras que en los pacientes más jóvenes, fue el antecedente de patología isquémica.

Flash glucose monitoring (FGM) improves some glycaemic control variables and quality of life parameters.Our aim was to evaluate the quality of life and glycaemic control parameters after initiating FGM in patients with type 1 diabetes (DM1) in clinical practice.A prospective observational study in DM1 patients that started using FGM between June 2019 and April 2020. We analysed their scores on the Diabetes Quality of Life (DQOL) questionnaire, Diabetes Distress Scale (DDS), Diabetes Treatment Satisfaction Questionnaire (DTSQ) and glycaemic control parameters at baseline and 3 months after the FGM onset.We recruited 114 patients, 56% male, mean age 37.2 (standard deviation, SD 12.4), with 18.7 (SD 11.5) years of DM1, 24.6% of which used continuous subcutaneous insulin infusion. Differences were observed (baseline vs. 3 months) in the DTSQ score (22 [15.5-27] vs. 25 [22-28], P0.001) and in the DQOL score (88 [74-104] vs. 84 [70-101], P = 0.017) but not in the DDS score. HbA1c was 7.8% (SD 1.3) vs. 7.4% (SD 1.1) (P0.001), without improvement in other glycaemic control variables, except for the mean number of hypoglycaemic events/14 days: 14 (SD 9) at baseline vs. 11.5 (SD 7) at 3 months (P0.001).The initiation of FGM, combined with a structured educational programme, was associated with improvement in quality of life and patient satisfaction in DM1 patients. An improvement in HbA1c and a reduction in the number of hypoglycaemia events was observed, but not in the rest of glycaemic control parameters.

espanolObjetivos: en la practica clinica habitual existen multitud de situaciones y patologias que pueden interrumpir la digestion y la absorcion intestinal, cursando con desnutricion y requiriendo el uso de suplementos orales nutricionales (SON). El objetivo de nuestro estudio fue evaluar, en el contexto de la vida real, el uso de un SON basado en peptidos, y el cumplimiento con el mismo, en pacientes adultos desnutridos con compromiso intestinal tras mas de 14 dias de nutricion parenteral. Material y metodos: el estudio se realizo en 44 pacientes desnutridos que requirieron nutricion parenteral total al menos 14 dias, sin utilizacion de la via oral durante el ingreso hospitalario. Se les administro de manera ambulatoria 1 brik al dia de Vital 1.5® para su consumo durante 12 semanas. Al inicio del tratamiento y tras el periodo de intervencion se les recogieron las variables siguientes: peso, talla, IMC, test de valoracion subjetiva global, bioquimica nutricional, encuesta nutricional, efectos adversos generados por la formula y cumplimentacion. Resultados: se incluyeron 44 pacientes con una edad media de 70,4 ± 10,4 anos (20 mujeres/24 hombres). Tras la intervencion aumentaron el IMC (0,51 ± 0,1 kg/m2; p = 0,02), el peso (1,4 ± 0,3 kg; p = 0,03), la prealbumina (3,5 ± 4,1 mg/dl; p = 0,01), la albumina (1,3 ± 0,1 mg/dl; p = 0,03) y la transferrina (71,5 ± 24,1 mg/dl; p = 0,02). La toma del SON represento a los 3 meses un 14,4 % del aporte calorico total de la dieta, un 17,5 % de los hidratos de carbono, un 12,9 % de las proteinas y un 12,3 % de las grasas. La cumplimentacion media del grupo fue del 87,7 ± 7,2 % de las tomas prescritas. En relacion a la situacion nutricional, a la entrada del estudio un 52,3 % (n = 23) de los pacientes presentaban en el test de valoracion subjetiva global la categoria B (malnutricion moderada o riesgo nutricional) y un 47,7 % (n = 21) la categoria C (desnutricion severa). Tras la intervencion, un 75 % de los pacientes presentaban la categoria A (buena situacion nutricional (n = 33), un 13,6 % (n = 6) de los pacientes presentaban la categoria B y un 11,4 % (n = 5) la categoria C. Conclusiones: la utilizacion de un suplemento peptidico con trigliceridos de cadena corta en pacientes ambulatorios tras haber recibido una nutricion parenteral total muestra un efecto beneficioso sobre los parametros bioquimicos y antropometricos, y la situacion nutricional, con una alta cumplimentacion y buena tolerancia. EnglishObjectives: in routine clinical practice many disorders are found that can disrupt the sequence of reactions in digestion and absorption, leading to malnutrition and requiring the use of oral nutritional supplements (ONS). The objective of our study was to evaluate in a real world setting the use of and compliance with a peptide-based ONS in malnourished adult patients with intestinal compromise after more than 14 days of parenteral nutrition. Material and methods: the study was carried out in 44 malnourished patients who required total parenteral nutrition for at least 14 days without using the oral route during their hospital stay. All patients were administered, on an outpatient basis, 1 brick per day of Vital 1.5® for 12 weeks. At the beginning of treatment and after the intervention period evaluated, the following variables were collected: weight, height, body mass index (BMI), global subjective assessment test, nutritional biochemistry, 3-day nutritional survey, adverse effects generated by the formula, and completion rate. Results: 44 patients were enrolled. Mean age was 70.4 ± 10.4 years (20 women & 24 men). After the intervention the following parameters had increased: BMI (0.51 ± 0.1 kg/m2; p = 0.02), weight (1.4 ± 0.3 kg; p = 0.03), prealbumin (3.5 ± 4.1 mg/dl; p = 0.01), albumin (1.3 ± 0.1 mg/dl; p = 0.03), and transferrin (71.5 ± 24.1 mg/dl; p = 0.02). Dietary intake of the ONS represented 14.4 % of the diet’s total caloric intake at 3 months, 17.5 % of carbohydrates, 12.9 % of proteins, and 12.3 % of fats. Mean compliance was 87.7 ± 7.2 % of the prescribed intakes. In relation to the nutritional situation, at the beginning of the study, 52.3 % (n = 23) of patients were in the global subjective assessment test in category B (moderate malnutrition or nutritional risk), and 47.7 % (n = 21) in category C (severe malnutrition). After the intervention, 75 % of patients were in category A (n = 33), 13.6 % (n = 6) in category B, and 11.4 % (n = 5) in category C. Conclusions: the use of a peptide-based ONS with short-chain triglycerides in outpatients showed a beneficial effect on biochemical and anthropometric parameters, and improved the nutritional status of patients with high compliance and good tolerance rates.

Aim: the objective of our real-life study was to evaluate adherence and taste preferences of a hypercaloric and hyperprotein oral nutritional supplement (ONS) in malnourished hospitalized patients. Methods: a total of 34 in patients with recent weight loss were included in this study. One flavor (coffe, vanilla or strawberry) was administered each day in a random way to each patient during three consecutive days. In the first three days, patients were asked to fulfill two questionnaires intended to reflect ONS (Renutryl®) tolerance and acceptance. Adherence to the ONS was measured during hospital stay. Results: the sweet flavor was higher for strawberry (4.54 ± 0.2 points) than for the vanilla flavor (3.13 ± 0.1 points; p0.03) and coffee flavor (3.03 ± 0.1 points; p0.02). When analyzing the total number of patients who took supplements after choosing the flavor, the patients who chose coffee took a total of 13.3 ± 1.1 packages on average during hospitalization (0.91 ± 0.2 per day), the patients who chose strawberry took 13.4 ± 1.3 packages (0.92 ± 0.1 per day), and finally the patients who chose vanilla packages took 8.3 ± 0, 9 packages during admission (0.61 ± 0.1 per day), with significant differences in favor of the strawberry and coffee flavors versus vanilla. The ONS chosen mostly by the patients at hospital discharge was the multiflavor pack (n = 20; 50 %). Conclusions: taste preferences for the three flavored ONSs are similar, although adherence was higher during admission to the coffee- and strawberry-flavored ONS. Sweetness may have influenced this finding, especially with the strawberry flavor, with a good tolerance of all three flavors.Objetivo: el objetivo de nuestro estudio en vida real fue evaluar en pacientes ingresados desnutridos la adherencia y las preferencias de sabor de un suplemento oral nutricional (SON) hipercalórico e hiperproteico. Métodos: se incluyeron en este estudio en vida real un total de 34 pacientes ingresados con pérdida de peso reciente. Se administró un sabor (café, vainilla o fresa) cada día de forma aleatoria a cada paciente durante tres días consecutivos. En los primeros tres días se pidió a los pacientes que completaran dos cuestionarios destinados a reflejar la tolerancia y aceptación del SON (Renutryl®). La adherencia del SON fue evaluada durante el ingreso hospitalario. Resultados: el sabor dulce fue más elevado para el sabor fresa (4,54 ± 0,2 puntos) que para el sabor vainilla (3,13 ± 0,1 puntos; p0,03) y el sabor café (3,03 ± 0,1 puntos; p0,02). Al analizar a los pacientes que tomaron suplementos después de elegir el sabor, los pacientes que eligieron café tomaron un total de 13,3 ± 1,1 envases de promedio durante la hospitalización (0,91 ± 0,2 por día), los pacientes que eligieron fresa tomaron 13,4 ± 1,3 envases (0,92 ± 0,1 por día) y, finalmente, los pacientes que eligieron envases de vainilla tomaron 8,3 ± 0,9 envases durante el ingreso (0,61 ± 0,1 por día), con diferencias significativas a favor de los sabores de fresa y café frente al sabor de vainilla. Por otra parte, el SON elegido mayoritariamente por los pacientes al alta hospitalaria fue el pack multisabor (n = 20; 50 %). Conclusiones: las preferencias de sabor de los SON de tres sabores son similares, aunque la adherencia fue más elevada durante el ingreso con respecto a los SON con sabor a café y fresa. La dulzura puede haber influido en este hallazgo, sobre todo con el sabor fresa, con una buena tolerancia de los 3 sabores.

espanolIntroduccion y objetivos: los estudios de intervencion que evaluan el efecto del rs16147 sobre la respuesta metabolica y el cambio de peso despues de una intervencion dietetica son escasos. Evaluamos el papel de la variante genetica rs16147 en los efectos metabolicos que produce una dieta hipocalorica de patron mediterraneo y alto contenido en omega-9. Material y metodos: se recluto una muestra de 363 sujetos obesos. En visita basal, los pacientes se asignaron aleatoriamente, durante 12 semanas, a recibir una de dos dietas: dieta M, de patron mediterraneo, o dieta C, hipocalorica estandar. Se determinaron momento basal y a las 12 semanas, una serie de variables bioquimicas y antropometricas, realizandose el genotipado de la variante rs16147. Resultados: en todos los sujetos con ambas dietas mejoraron los parametros de adiposidad, tension arterial y leptina circulante. En sujetos obesos con el alelo menor (A), los niveles de insulina (GG vs. GA + AA) (-0,9 ± 1,1 UI/L vs. -4,4 ± 1,0 UI/L; p = 0,01) y HOMA-IR (-0,3 ± 0,1 unidades vs. -1,2 ± 0,3 unidades; p = 0,02) disminuyeron significativamente con dieta M. Los sujetos portadores del alelo menor tras dieta C mostraron disminucion significativa de niveles de insulina basal (GG vs. GA + AA) (0,7 ± 0,3 UI/L vs. -2,2 ± 0,9 UI/L: p = 0,02) y HOMA-IR (-0,3 ± 0,2 unidades vs. -0,7 ± 0,1 unidades: p = 0,01). Esta disminucion de los niveles de insulina circulante y HOMA-IR en los pacientes con alelo A fue significativamente superior con la dieta M que con la dieta S. Conclusiones: el alelo A de la variante rs16147 se relaciona con mejor respuesta metabolica, en terminos de resistencia a insulina e insulina basal secundaria a perdida de peso, a dos dietas hipocaloricas, siendo superior el efecto obtenido con una dieta de patron mediterraneo. EnglishBackground and aims: intervention studies that evaluate the effect of rs16147 on metabolic response and weight change after dietary intervention are scarce. We propose to evaluate the role of the rs16147 genetic variant in the metabolic effects produced by a hypocaloric Mediterranean-pattern diet with high content of omega-9. Material and methods: a sample of 363 obese subjects was recruited. At the baseline visit the patients were randomly assigned to one of two hypocaloric diets for 12 weeks (diet M, Mediterranean pattern; diet C, standard hypocaloric). All patients, at baseline and at 12 weeks, had biochemical and anthropometric variables measured, and genotyping performed for the rs16147 variant. Results: in all subjects, and with both diets, the parameters of adiposity, blood pressure, and circulating leptin improved. In obese subjects with allele (A) insulin levels (GG vs. GA + AA) (-0.9 ± 1.1 IU/L vs. -4.4 ± 1.0 IU/L; p = 0.01) and HOMA-IR (-0.3 ± 0.1 units vs. -1.2 ± 0.3 units; p = 0.02) decreased significantly with diet M. Subjects carrying the minor allele showed a significant decrease in basal insulin levels (GG vs. GA + AA) (0.7 ± 0.3 IU/L vs. -2.2 ± 0.9 IU/L: p = 0.02) and HOMA-IR (-0.3 ± 0.2 units vs. -0.7 ± 0.1 units: p = 0.01) after diet C. This decrease in circulating insulin and HOMA-IR levels in patients with allele A was significantly higher with diet M than with diet C. Conclusions: the A allele of the rs16147 variant produces a better metabolic response in terms of insulin resistance and basal insulin secondary to weight loss with two different hypocaloric diets in obese subjects, with improvement being higher with the Mediterranean diet.

We evaluated the incidence, progression and the dynamic risk stratification in differentiated thyroid cancer (DTC) under follow-up in a high-resolution clinic (HRC).This was a retrospective observational study on incident cases in the tumor registry from 2002 to 2017 and their evolution under follow-up in HRC.A total of 444 patients (78.5% women, 52.1±14.9 mean years old) were DTC diagnosed from 2002 to 2017. The incidence rate of DTC increased from 5.2 to 25.7×10

Introduction and objective: familial heterozygous hypercholesterolemia (HFH) is the most common monogenic lipid metabolism disorder that associates premature cardiovascular disease. Our aim was to describe the degree of metabolic control, cardiovascular profile, and adherence to the Mediterranean diet in a cohort of HFH patients. Subjects and methods: a retrospective cohort study of the index cases and their relatives genetically diagnosed with HFH by the Endocrinology and Nutrition Service in the HCUV from 2009 to 2017. Anthropometric, clinical, laboratory, genetic, and treatment data were analyzed. Results: a total of 138 subjects were studied, with a mean age of 48.8 (17.7) years, 55.8% of them women. A gene mutation was found in 55.8%, and 10.1% had previous ischemic heart disease. At diagnosis mean total cholesterol was 281.1 (68.4) mg/dL, and LDL-C was 204 (65) mg/dL. Among family cases, at diagnosis, a lower mean age was observed [32.89 (19.2) years vs 50.3 (17.6) years, p0.001] as well as lower LDL values [181.9 (64.3) mg/dL vs 226.8 (52) mg/dL, p0.005] as compared to index cases. A positive correlation was observed between lipid-lowering treatment dose and LDL level reduction (r = 0.254, p0.05), although only 30% of patients reached their LDL target. Patients with HFH were highly adherent to Mediterranean diet, with an average score of 9.5 (1.9) in the Predimed test. Conclusions: early HFH detection is necessary to prevent premature cardiovascular events. A diagnosis of cases among family members anticipates the treatment of patients with HFH. Patients with HFH are more sensitive to heart-healthy diets.Antecedentes y objetivo: la hipercolesterolemia familiar heterocigota (HFH) es el trastorno del metabolismo lipídico monogénico más común que se asocia a patología cardiovascular prematura. Nuestro objetivo fue describir el grado de control metabólico, el perfil cardiovascular y la adherencia a la dieta mediterránea de una cohorte de pacientes con HFH. Material y métodos: estudio de cohortes retrospectivo de casos índices y familiares diagnosticados genéticamente de HFH desde 2009 a 2017. Se analizaron los datos antropométricos, clínicos, analíticos, del estudio genético y del tratamiento. Resultados: se estudiaron 138 sujetos con una edad media de 48,8 (17,7) años, el 55,8% mujeres. Se encontró la mutación positiva en el 55,8%. La media de colesterol total al diagnóstico fue de 281,1 (68,4) mg/dl y la de LDL de 204 (65) mg/dl. El 10,1% presentaban cardiopatía isquémica previa. Entre los casos familiares se observó una menor edad media [32,89 (19,2) años vs. 50,3 (17,6) años, p0,001], así como valores de LDL inferiores en el momento del diagnóstico [181,9 (64,3) mg/dl vs. 226,8 (52) mg/dl, p0,005] en comparación con los casos índice. Se evidenció una correlación positiva entre dosis de tratamiento hipolipemiante y reducción de los niveles de LDL (r = 0,254, p0,05), aunque solo el 30% de los pacientes alcanzaron sus objetivos de LDL. Los pacientes con HFH presentaron una elevada adherencia a la dieta mediterránea, con una puntuación media de 9,5 (1,9) en el test Predimed. Conclusiones: la detección precoz de la HFH es necesaria para prevenir eventos cardiovasculares prematuros. El diagnóstico de casos familiares anticipa el tratamiento de los pacientes con HFH. Los pacientes con HFH están más sensibilizados sobre la adherencia a las dietas cardiosaludables.

The main aim of this research is to know the habits of our students due to our concern to educate students about the importance of caring for and improving their health. Students of the First Cycle of ESO of the Centres of the Cordoba regions of the south of the province have fulfilled a survey about their daily habits related to health; In addition, to know the thoughts, beliefs and knowledge of the Physical Education teachers of these students through the conduct of a Discussion Group, in order to learn more about this perspective in relation to Physical Education and Education for Health. Among other data from the analysis and taking into account the food pyramid for these ages, it can be deduced that the students eat few vegetables and that a percentage close to 25% of the students consumes sweets 3-4 days a week. It is noteworthy that 59.3% of boys and 24.1% of girls regularly do physical activity, apart from the Physical Education class. Regarding the teaching sector, teachers thinks that students are aware of what is advisable to take and what is not; since in schools the diet is changing towards healthier habits, however, the students sometimes eat food that is not conducive to them and they do not even eat. As for hygiene habits, the teachers say that they are consolidated, but the same does not happen with postural habits that they consider not to have correct habits.

espanolObjetivo: la pandemia de COVID-19, al restringir la movilidad de la poblacion, podria exacerbar los factores de riesgo del aumento de peso asociados a la inactividad fisica y un mayor consumo de alimentos ricos en calorias. El objetivo de este estudio transversal fue evaluar los factores de riesgo relacionados con el aumento de peso corporal autoinformado entre sujetos obesos. Metodos: el estudio incluyo una muestra de 284 sujetos obesos adultos. Despues de un periodo de reclusion de 7 semanas a partir del 17 de marzo, se realizo una entrevista telefonica (del 4 al 7 de mayo). En esta llamada telefonica se registraron el aumento de peso corporal autoinformado y diferentes factores asociados. Para obtener los datos basales de esta poblacion, se registraron parametros bioquimicos y antropometricos a partir de la historia clinica electronica. Resultados: la edad media fue de 60,4 ± 10,8 anos (rango: 23-71) y el indice de masa corporal (IMC) medio de 35,4 ± 4,7 kg /m2 (rango: 30,6-41,2). La distribucion por generos fue de 211 mujeres (74,3 %) y 73 hombres (25,7 %). El aumento de peso corporal autoinformado fue de 1,62 ± 0,2 kg. Los pacientes que reconocieron que hacian mucho ejercicio informaron de que la ganancia de peso corporal habia sido menor (1,62 ± 0,2 vs 1,12 ± 0,3 kg; p = 0,02). En cuanto a los habitos alimentarios, los pacientes reconocieron practicar el picoteo en el 17 % de la muestra. Los pacientes que reconocieron picar entre horas presentaron una mayor ganancia de peso corporal autoinformada (2,60 ± 0,36 vs 1,30 ± 0,17 kg; p = 0,001). Las demas variables no influyeron en el aumento de peso corporal autoinformado. En el analisis de regresion multiple, con la ganancia de peso corporal autoinformada como variable dependiente y ajuste de edad, sexo y actividad fisica, el habito del picoteo permanecio como factor de riesgo: beta = 1,21 (IC 95 %: 1,11-2,13; p = 0,01). Conclusiones: el encierro decretado durante la pandemia por el SARS-CoV-2 ha producido un aumento del peso corporal autoinformado en los sujetos obesos y este se ha relacionado con el habito de picar entre horas. EnglishObjective: the COVID-19 pandemic, by restricting population mobility, may exacerbate the risk factors for weight gain associated with physical inactivity and increased consumption of calorie-dense foods. The aim of this cross-sectional study was to evaluate the risk factors related to self-reported body weight gain among obese subjects. Methods: the study involved a population of 284 adult obese subjects. After a 7-week confinement period starting on March 17, a telephone interview (May 4 through 7) was conducted. In this phone call, self-reported body weight gain and a number of factors were recorded. In order to obtain the baseline data of this population, biochemical and anthropometric parameters were collected from electronic medical records. Results: mean age was 60.4 ± 10.8 years (range: 23-71) and mean body mass index (BMI) was 35.4 ± 4.7 kg/m2 (range: 30.6-41.2). Gender distribution was 211 females (74.3 %) and 73 males (25.7 %). Self-reported body weight gain was 1.62 ± 0.2 kg. Among patients who reported doing a lot of exercise self-reported body weight gain was lower (1.62 ± 0.2 vs 1.12 ± 0.3 kg; p = 0.02). Regarding eating habits, patients recognized snacking in 17 % of the sample. Patients who reported snacking had higher self-reported body weight gains (2.60 ± 0.36 vs 1.30 ± 0.17 kg; p = 0.001). The remaining variables did not influence self-reported body weight gain. In the multiple regression analysis with self-reported body weight gain as dependent variable, adjusted for age, sex, and physical activity, the snaking habit remained a risk factor: beta = 1.21 (95 % CI: 1.11-2.13; p = 0.01). Conclusions: the lockdown decreed during SARS-CoV-2 pandemic has produced an increase in self-reported body weight among obese subjects, which was related to the habit of taking snacks.

espanolAntecedentes: se hipotetiza que el genotipo de la acil-CoA-sintetasa 5 (ACSL5) podria influir en la perdida de peso secundaria a la restriccion de energia. Objetivos: el objetivo de nuestro estudio fue analizar los efectos de la variante genetica rs2419621 del gen ACSL5 sobre el cambio de peso y los parametros metabolicos despues de una dieta hipocalorica parcial de reemplazo. Metodos: estudio no aleatorizado, de centro unico, con una formula dietetica, en 44 sujetos obesos con un indice de masa corporal (IMC) superior a 35 kg/m2. Los pacientes recibieron educacion nutricional y una dieta modificada con dos tomas de una formula hiperproteica normocalorica durante 3 meses. Los parametros antropometricos y el perfil bioquimico se determinaron en el tiempo basal y tras 3 meses. La variante rs2419621 del gen ACSL5 se evaluo mediante reaccion en cadena de la polimerasa en tiempo real. Resultados: los portadores del alelo T mostraron mejorias de peso corporal (CC vs. CT + TT; -7,4 ± 2,1 kg vs. -9,3 ± 1,8 kg; p = 0,01), indice de masa corporal (-3,1 ± 0,4 kg/m2 vs. -3,4 ± 0,5 kg/m2; p = 0,02), masa grasa (-5,2 ± 1,4 kg vs. -6,4 ± 1,2 kg; p = 0,01) y circunferencia de la cintura (-6,1 ± 1,1 cm vs. -8,6 ± 0,8 cm; p = 0,02) superiores a las de los portadores de alelos distintos de T. Solo los sujetos con alelo T mostraron una mejoria significativa en los niveles de trigliceridos (-4,6 ± 2,4 md/dL vs. -14,4 ± 2,3 mg/dL; p = 0,01). Por ultimo, la mejoria de la insulina (-2,0 ± 0,3 mU/L vs. -4.5 ± 0.5 mU/L; p = 0,01) y HOMA-IR (-0,4 ± 0,2 unidades vs. -1,3 ± 0,3 unidades; p = 0,02) fueron mayores en los portadores de alelos T que en los portadores de alelos no T. Conclusiones: nuestros resultados sugieren que la variante genetica (rs2419621) del gen ACSL5 esta asociada a la respuesta a la dieta despues una dieta hipocalorica parcial de reemplazo, con una mejoria superior de los parametros relacionados con la adiposidad y los parametros bioquimicos en los sujetos con alelo T. EnglishAims:to analyze the effects of the rs2419621 genetic variant of the ACSL5 gene on weight change and metabolic parameters after a partial meal-replacement hypocaloric diet. Methods: this was a non-randomized, single-treatment study with a formula-diet in 44 obese subjects with body mass index (BMI) greater than 35 kg/m2. Patients received nutritional education and a modified diet with two intakes of a normocaloric hyperproteic formula during 3 months. Anthropometric parameters and biochemical profile were measured at baseline and after 3 months. The rs2419621 variant of the ACSL5 gene was assessed using real-time polymerase chain reaction. Results: T-allele carriers showed greater improvement in body weight (CC vs. CT + TT; -7.4 ± 2.1 kg vs. -9.3 ± 1.8 kg; p = 0.01), body mass index (-3.1 ± 0.4 kg/m2 vs. -3.4 ± 0.5 kg/m2; p = 0.02), fat mass (-5.2 ± 1.4 kg vs. -6.4 ± 1.2 kg; p = 0.01) and waist circumference (-6.1 ± 1.1 cm vs. -8.6 ± 0.8 cm; p = 0.02) than non-T-allele carriers. Only subjects with the T allele showed significant improvement in triglyceride levels (-4.6 ± 2.4 md/dL vs. -14.4 ± 2.3 mg/dL; p = 0.01). Finally, improvements in insulin (-2.0 ± 0.3 mU/L vs. -4.5 ± 0.5 mU/L; p = 0.01) and HOMA-IR (-0.4 ± 0.2 units vs. -1.3 ± 0.3 units; p = 0.02) were higher in T-allele carriers than in non-T-allele carriers. Conclusions: our data suggest that the genetic variant (rs2419621) of the ACSL5 gene is associated with diet response after a partial-meal replacement intervention, with greater improvements in adiposity and biochemical parameters in subjects with the T allele.

Background and aims: Meal replacement diets consist of replacing one or more meals with an artificial nutritional supplement. The objective of this study was to compare the effect of one against two meal replacement strategies on body composition and cardiovascular risk parameters in patients with obesity. Methods: A randomized clinical trial was designed with a modified hypocaloric diet with an artificial nutritional preparation replacing one or two meals for three months in patients with obesity and osteoarthritis pending orthopedic surgery. An anthropometric evaluation and a measurement of the body composition were done with bioelectrical impedance measurement at the beginning and at three months. Results: A total of 112 patients were recruited. Fifty-two patients (46.4%) were randomized to one replacement and 60 patients (53.6%) to two meal replacements. Eighty-one patients (72.3%) were women, and the average age was 61 (11.03) years. The percentage of weight loss at three months was 8.27 (4.79)% (one meal replacement: 7.98 (5.97)%, two meal replacements: 8.50 (3.48)%, p = 0.56). A decrease in fat mass measured by the fat mass index (FMI) was detected (one meal replacement: &minus, 2.15 (1.45) kg/m2 vs. two meal replacements: &minus, 2.78 (2.55) kg/m2, p &gt, 0.05), and a relative increase in fat-free mass was observed (one meal replacement: +3.57 (4.61)% vs. two meal replacements: +2.14 (4.45)%, 0.05). A decrease in HOMA-IR, systolic blood pressure (SBP), and total cholesterol was observed in both groups without differences between them. Conclusions: The substitution strategies of one or two meal replacements were effective in weight loss and fat mass decrease without differences between the two groups. An improvement in lipid parameters, glycemic control, and systolic blood pressure was observed without differences between strategies.

Summary Background Malnutrition is a prognostic factor in Amyotrophic Lateral Sclerosis (ALS). Sometimes, this condition is underdiagnosed, and it might influence on disease progression. Aims To evaluate a) nutritional status at the beginning of specialized nutritional treatment and b) the influence of initial nutritional status on disease evolution and survival in a group of patients with amyotrophic lateral sclerosis (ALS). Methods An interhospital registry of patients with motor neuron disease treated at the Clinical Nutrition Clinics of six hospitals in the region of Castilla y Leon in Spain was created. The study was developed from January 2015 to December 2017. An anamnesis, affiliation data, past medical history, disease evolution, nutritional history and an anthropometry and bioelectrical impedance analysis were performed at baseline. The mortality rate was compared among those patients with worse nutritional status at the beginning of the follow-up against those with a better nutritional situation using two tools: The Subjective Global Assessment (SGA) and the criteria of the Global Leadership Initiative for Malnutrition (GLIM). Results A total of 93 patients were analysed. The median age of the patients was 67 (57.5–75.5) years. The median Body Mass Index was 24.4 (21.7–25.9) kg/m2 and the median percentage of weight loss was 9.32 (2.7–17.6)% without differences between the onset type. According to the SGA, 27 (29%) patients were in grade A; 43 (46.3%) patients were in grade B and 23 (24.7%) were in grade C. According to the new GLIM malnutrition criteria, 45 patients (48.4%) had malnutrition. Patients with worse nutritional status had a lower survival median with both SGA (SGA A: 20.5 (10.2–35) months vs SGA B–C: 12 (5.2–23.7) months (p = 0.03)) or the new GLIM criteria according to severity (severe malnutrition: 18 (5–24) months vs. no severe malnutrition: 20 (12–33) months (p = 0.01)). In the multivariate analysis, malnutrition measured by SGA was an independent risk factor (HR: 4.6 (1.5–13.9) p = 0.007) for survival over 15 months when adjusted for age, sex and type of onset of ALS. Conclusions Patients with ALS have a severe deterioration in nutritional status when analysed using a classical malnutrition test (SGA) or a new one (GLIM criteria). Patients with a better nutritional situation according to SGA and GLIM severity classification were associated with a longer survival time.

Objective The aim of this study were to understand the influence of a multidisciplinary care protocol in amyotrophic lateral sclerosis (ALS) on the change in the delay of remission to the nutrition specialist and the initial nutritional status. Methods A cohort study was performed in 43 patients with ALS who were referred to the Nutrition Unit between April 2015 and April 2017. Anthropometric parameters and diagnostic times were collected, and the nutritional status was studied through subjective global assessment (SGA). Patients who were included before (control cohort [NoP]) and after (protocol cohort [P]) a multidisciplinary protocol were compared. The mean age of the participants was 66.79 y (10.86 y). Of the patients, 62.8% belonged to the protocol cohort. Results Patients who started the protocol had a lower delay in initial assessment by a nutrition specialist (P:2 [1–6] mo/NoP:12 [10–29] mo; P = 0.03). When the nutritional status was analyzed according to the SGA, more patients who did not initiate protocol were in the state of severe malnutrition (C) (P 22.2% versus NoP 60%; P = 0.01). Entry into the protocol was an independent protective factor of the presence of severe malnutrition at the beginning of the nutritional follow-up (odds ratio, 0.20; 95% confidence interval, 0.03–0.73; P = 0.02). Conclusions The implementation of a multidisciplinary protocol in ALS allowed patients to present a lower percentage of severe malnutrition in an initial assessment by the nutrition specialist. This protocol is a protective factor for the presence of malnutrition at the beginning of support.

The purpose of this research is to assess a Project-Based Learning (PBL) intervention program within the context of Physical Education. Research approaches PBL methodology in order to evaluate its importance regarding students’ ability to develop certain personal values and attitudes. The sample involved 38 girls and 37 boys among sixth year students in Spanish Primary Education (11-12 year olds) and the intervention program was carried and developed throughout the academic year in 2014/15 This study approaches an Action Research methodology assessing key items such as teachers’ journals, students’ questionnaires and also an interview reflecting the different opinions of the students. This research validates the suitability of the intervention program as results show increased students’ awareness respecting critical values and attitudes such as responsibility and respect.

Resumen Introduccion La desnutricion relacionada con la enfermedad es un reto en nuestros hospitales. Nuestro objetivo fue valorar la factibilidad e importancia de establecer una estrategia de cribado nutricional en nuestro medio. Pacientes y metodos Estudio de cohortes prospectivo en un servicio de Medicina Interna durante 3 meses. El cribado nutricional se realizo al ingreso y se repitio semanalmente mediante la herramienta Malnutrition Universal Screening Tool . Se analizaron los datos clinicos, la estancia media y los gastos. Resultados Se incluyeron 330 pacientes (53,9% varones), con una edad media de 77,8 anos; la estancia mediana fue de 7 dias, y el indice de comorbilidad de Charlson de 5,4. La herramienta Malnutrition Universal Screening Tool detecto al ingreso un 26,9% de pacientes con riesgo de desnutricion. Un 18% de pacientes con buen estado nutricional desarrollaron desnutricion durante la hospitalizacion. Los pacientes con desnutricion grave inicial presentaron una estancia mediana mayor. Los pacientes cuya situacion nutricional empeoro durante el ingreso tuvieron una estancia significativamente mayor (2,5 dias) con respecto a los que no empeoro. Ademas, ocasionaron un sobrecoste de 767€ por ingreso (35% superior), lo que implica un exceso de gastos relacionados con la desnutricion de 646.419,93 € anuales en el servicio estudiado. La adecuada codificacion implico un incremento en el peso medio de 2,11 a 2,81, lo que supondria 82.568,52€, que no se habrian cuantificado previamente. Conclusion La alta prevalencia y repercusiones clinicas y economicas de la desnutricion relacionada con la enfermedad en los pacientes ingresados en Medicina Interna hacen recomendable establecer protocolos para su deteccion precoz y tratamiento.

In the hospitalized patient, Diabetes mellitus type 2 (DM2) may result in a worse nutritional status due to its pathophysiology and dietary treatment.The aim of this study was to know if a hospitalized diabetic patient has a worse nutritional status, and to establish the influence of DM2 on the hospital length of stay in patients with malnutrition.This was a transveral study from January 2014 to October 2016; 1017 patients were included who were assessed by the Endocrinology and Nutrition Department. The data collected included anthropometry, plasma albumin, delay in performing the nutrition interconsultation and hospital length of stay. Nutritional status was evaluated using the Mini Nutritional Assesment (MNA) questionnaire and the nutritional risk score (NRS).24.4% of the patients were diabetic and 75.6% were not. Diabetic patients had a higher body mass index (BMI) [23.18 (20.78-25.99) kg/mDiabetic patients have a worse nutritional status than non-diabetic patients. Diabetic patients with a poor nutritional status spend a longer period in hospital.

Objectives: To evaluate in patients admitted for stroke: (1) The frequency of hyperglycaemia associated with enteral nutrition (EN). (2) The risk of morbidity and mortality associated with the development of this type of hyperglycaemia. Methods: A longitudinal observational study was conducted in 115 non-diabetic patients admitted for stroke with EN. Age, functional capacity (Rankin scale), and blood plasma glucose (BPG) were recorded. Hyperglycaemia was considered as: a value higher than 126 mg/dL before the EN and/or a value higher than 150 mg/dL after a week of enteral nutrition. According to this, three groups were differentiated: HyperES: Those who had hyperglycemia before the beginning of the EN (33% patients), NoHyper: those who did not have hyperglycemia before or after (47.8% patients), and HyperEN: Those who did not have hyperglycemia before but suffered it after the beginning of the EN (19.1% patients). Results: The age was 72.72 (15.32) years. A higher rate of mortality was observed in the HyperEN group 45.50%, than HyperES 15.80% or NoHyper: 10.90%). A lower recovery of the oral feeding was observed in those patients of the HyperEN group 27.30%, than HyperES: 42.10% or NoHyper: 61.80%). In the multivariate analysis adjusting for age, sex, and Rankin scale the development of hyperglycemia in those who did not have it at the beginning (HyperEN) was an independent risk factor for non-recovery of the oral feeding (OR: 4.21 (1.20&ndash, 14.79), p = 0.02), and mortality adjusted for age, sex and Rankin scale (OR: 6.83 (1.76&ndash, 26.47), p &lt, 0.01). Conclusions: In non-diabetic patients admitted for stroke with EN, the development of hyperglycaemia in relation to enteral nutrition supposes an independent risk factor for mortality and for the non-recovery of the oral feeding.

El mundo fascinante del corcho jamás conocido como uno de los conservantes de los sin números de sabores de los vinos, permitiendo atesorar sus propiedades originales, las cuales llegan a los paladares de los altos catadores con un alto grado de exquisitez, así como los ajenos del vino que en su desconocimiento no magnifican la importancia de la participación de esta estructura, que no solo permite que liquido no se salga de su empaque, conteniendo la presión dentro de la botella, sino que le da el toque original como un acompañante natural del vino. Por esto, el propósito del presente artículo es dar a conocer su importancia y aspectos más relevantes, como son los comerciales y ambientales; y en general, aportarle a cada lector más información desde su gusto personal por el gran universo del vino, tomando como referencia la Corticeira Amorím, S.G.P.S. S.A, una de las más importantes empresas productoras de corcho en Chile, quienes nos permitieron conocer el proceso de producción de este importante producto.

Resumen Antecedentes y objetivo No existen datos concluyentes sobre la utilidad de las Unidades de alta resolucion de tiroides en el manejo de la patologia nodular tiroidea. El objetivo del presente estudio fue evaluar el impacto economico y la satisfaccion del usuario tras la puesta en marcha de una consulta de alta resolucion de nodulo tiroideo (CARNT) en coordinacion con Atencion Primaria. Pacientes y metodo Estudio prospectivo, observacional y descriptivo en 3.726 pacientes (edad media: 61 ± 12 anos; 85% mujeres) evaluados en la CARNT durante los anos 2014 y 2015. Se evaluaron datos demograficos (sexo y edad), centro y especialidad de derivacion, numero de ecografias y punciones aspiracion aguja fina ecoguiada (PAAF) de tiroides y tipo de consulta. Resultados En 2014 y 2015 se realizaron 3.726 ecografias cervicales y 926 PAAF con un 3,8% con resultado de muestra insuficiente. De las 1.227 primeras visitas, el 21,5% fueron altas directas sin revision de resultados con un ahorro medio estimado de 14.354,55 euros. El 41,1% procedian de Atencion Primaria, 33,4% de Endocrinologia general y el 26,5% de otras especialidades. La reduccion en 2014 y 2015 del numero de ecografias solicitadas al Servicio de Radiodiagnostico frente a 2013 fue de un 65,3 y un 59,7%, respectivamente, con un ahorro medio estimado de 137.563,92 euros. La satisfaccion media evaluada por el usuario fue de 4,0 puntos (intervalo de confianza 95%: 3,7-4,3) sobre 5 puntos. Conclusiones Las CARNT en Endocrinologia y en coordinacion con Atencion Primaria es una alternativa viable, coste-eficiente y con una percepcion positiva por parte del usuario.

Background and objective No conclusive data exist on the value of a high resolution thyroid nodule clinic for management of nodular thyroid disease. The aim of this study was to evaluate the economic impact of and user satisfaction with a high resolution thyroid nodule clinic (HRTNC) in coordination with primary care. Patients and method A prospective, observational, descriptive study was conducted to analyze data from 3726 patients (mean age 61 ± 12 years; 85% women) evaluated at an HRTNC during 2014 and 2015. Demographic data (sex and age), number of ultrasound examinations and fine needle aspiration cytologies (FNAC), referral center and consultation type were assessed. Results In 2014 and 2015, 3726 neck ultrasound examinations and 926 FNACs (3.8% rated as non-diagnostic) were performed. Among the 1227 patients evaluated for the first time, 21.5% did not require a second endocrine appointment, which resulted in mean estimated savings of 14,354.55 euros. Of all patients, 41.1% were referred from primary care, 33.4% from endocrinology, and 26.5% from other specialties. As compared to 2013, the number of thyroid ultrasound examinations requested decreased by 65.3% and 59.7% in 2014 and 2015 respectively, with mean estimated savings of 137,563.92 euros. Mean user satisfaction assessed was 4.0 points (95% confidence interval, 3.7–4.3) on a 5-point scale. Conclusions HRTNCs at endocrinology departments, coordinated with primary care, are a viable, cost-effective alternative with a positive user perception.

Background The choice of hypocaloric diets in obesity can affect bone health. Aims The aim of this study is to assess the effect of a hypocaloric diet in postmenopausal obese women and to determine the influence of weight reduction on bone metabolism. Methods This was a non-randomised, single-treatment study in 96 postmenopausal women with a body mass index (BMI) greater than 35 kg/m2 and osteoarthritis. The patients received a formula diet with two intake levels of a normocaloric hyperproteic formula (1035 kcal (25% protein)). Anthropometry and biochemistry with CrossLaps, osteocalcin, parathyroid hormone (PTH) and 25-OH vitamin D were measured. Consumption of protein, calcium and vitamin D were determined at the beginning of and 3 and 6 months into the study. The response to treatment was compared (high-responder (HR): weight loss greater than 15%, and low-responder (LR): weight loss less than 15%). Results The mean age was 64.2 (7.5) years. After 6 months of treatment, a weight loss of 10.2% (8.2–13.8) was observed. There was a significant increase in vitamin D (HR: 21.8% (36.2) vs. LR: 22.7% (36.9), p = 0.93) and CrossLaps (HR: 26.8% (19.5–35.2)) vs. LR: 13.3% (−6.1 to 27.9), p = 0.01). The loss of more than 15% of initial body weight was an independent risk factor for an increase in CrossLaps (OR: 4.22 (1.1–16.8), p = 0.04). Conclusions In postmenopausal obese women, weight loss was associated with an increase in the biochemical parameters of bone resorption. The increase in resorption parameters was related to the magnitude of weight loss.

Resumen Introducción: la desnutrición relacionada con la enfermedad (DRE) tiene una alta prevalencia e importantes repercusiones clínicas y económicas. Nuestro objetivo es valorar la factibilidad e importancia de establecer una estrategia de cribado nutricional en nuestro medio. Pacientes y métodos: estudio prospectivo realizado en una planta quirúrgica. Se realizó el Malnutrition Universal Screening Tool (MUST) al ingreso y semanalmente, hasta el alta hospitalaria, a todos los pacientes. Cuando fue necesario, se realizó valoración e intervención nutricional así como codificación al alta de los diagnósticos y procedimientos nutricionales. Datos de estancia hospitalaria (EH), costes hospitalarios y parámetros clínicos fueron analizados posteriormente. Resultados: en un 15,6% de pacientes, el MUST detectó riesgo de desnutrición (≥ 2 puntos). Los pacientes con desnutrición al ingreso (DI) presentaron una estancia hospitalaria (EH) cuatro días superior y mayor tasa de mortalidad y de reingresos urgentes (2,4 y 2,0 veces, respectivamente), un año después del alta hospitalaria. La edad y el ingreso urgente fueron los factores asociados a mayor tasa de mortalidad anual. Un 9% de los pacientes con MUST < 2 inicial sufrieron un deterioro del estado nutricional (DEN) durante el ingreso. Estos pacientes, tuvieron mayor EH (siete días) a igualdad de comorbilidad. Considerando los costes relacionados con la EH, en los pacientes que presentaron DI o DEN se observó un sobrecoste del 57% y el 145%, respectivamente. Conclusión: los pacientes con DI presentaron mayor EH y tasa de mortalidad y de reingresos urgentes un año después del alta hospitalaria. Los pacientes con DI o DEN ocasionan un sobrecoste económico. El cribado nutricional es indispensable para el manejo y la detección precoz de la DRE.

Objective: the purpose of this investigation was to investigate the associations between nutritional status by Mini Nutritional Assessment (MNA) test and dysphagia by EAT-10 in elderly individuals requiring nutritional oral care in an acute hospital. Patients: this was a cross-sectional survey covering a sample of 560 elderly individuals. As anthropometric parameters, weight and body mass index (BMI) have been included. Glucose, creatinine, sodium, potassium, albumin, prealbumin and transferrin serum levels were measured. The EAT-10 and MNA tests were carried out. The days of hospital stay and mortality were recorded. Results: the mean EAT-10 was 11.2 ± 0.89, the median was 10 and the interquartile range, 6-15. A total of 465 (83.1%) elderly patients had EAT-10 scores between 3 and 40, indicating the presence of dysphagia. The mean MNA test was 15.2 ± 1.1, median was 15 and interquartile rage, 11-18.5. According to their MNA score, a total of 340 (60.7%) elderly patients had MNA scores under 17 (malnutrition) and 177 subjects (31.6%) had a MNA score of 17-23.5 (risk of malnutrition). The MNA score and EAT-10 score were independently associated with hospital stance Beta -0.111 (CI 95%: -0.031- -0.78) and Beta 0.122 (CI 95%: 0.038-0.43), respectively. MNA score was associated with EAT-10 score Beta -0.236 (CI 95%: -0.213-0.09). The MNA score and EAT-10 score were independently associated with mortality odds ratio 0.91 (CI 95%: 0.84-0.96) and 1.040 (CI 95%: 1.008-1.074), respectively. Conclusion: dysphagia assessed by the EAT-10 is associated with nutritional status in elderly subjects requiring acute hospitalization. Subsequently, malnutrition and dysphagia were associated with poor outcome such as hospital stay and mortality.

Background The endogenous cannabinoid system plays a role in metabolic aspects of body weight and feeding behaviour. A polymorphism (1359 G/A) (rs1049353) of the CB1 gene was reported as a common polymorphism in the Caucasian population. The present study aimed to investigate the association of the polymorphism (G1359A) of the CB1 receptor gene on macronutrient intake in females with obesity. Methods A sample of 896 females was analysed. A bioimpedance measurement, a blood pressure measurement, a serial assessment of nutritional intake with 3 days of written food records, and a biochemical analysis were all performed. The genotype of the CNR1 receptor gene polymorphism (rs1049353) was studied. Results Five hundred and sixteen patients (57.6%) had the genotype G1359G (non-A carriers) and 380 (42.4%) patients had G1359A (328 patients, 36.6%) or A1359A (52 patients, 5.8%) (A carriers). Triglycerides and high-density lipoprotein (HDL) cholesterol levels were higher in A non-A allele carriers than non-A allele carriers. The intakes of dietary cholesterol and saturated fat for the upper tertile (T3) compared to the baseline tertile were inversely associated with the CB1-R 1359 G/A polymorphism [odds ratio (OR) = 0.59; 95% confidence interval (CI) = 0.30–0.92 and OR = 0.66; 95% CI = 0.39–0.91, respectively]. These data were observed in the second tertile (T2) (OR = 0.61; 95% CI = 0.29–0.94 and OR = 0.58; 95% CI = 0.31–0.90, respectively). Conclusions The present study reports an association of the A allele with a better lipid profile (triglycerides and HDL cholesterol) than non-A allele carriers. In addition, this polymorphism is associated with a specific macronutrient intake, as well as with low cholesterol and fat saturated intakes.

Aim: The aim of our study was to evaluate a hypercaloric sweet milk-based oral nutrition supplement in a prospective 3-day study designed to assess the taste preferences of this oral nutritional supplement (ONS) in malnourished inpatients and the influence on adherence in daily intake. Methods: A total of 46 in patients with recent weight loss were included in this study. One flavor (chocolate, vanilla or strawberry) was administered each day in a random way to each patient during 3 consecutive days. In the first 3 days, patients were asked to fill 2 questionnaires intended for reflecting ONS tolerance and acceptance. Results: Sweet was better for chocolate flavor (3.9 ± 2.4 points) than for vanilla flavor (2.7 ± 2.3 points; p < 0.02) and strawberry flavor (3.1 ± 2.3 points; p < 0.01). Chocolate flavored ONSs were rated as having more aftertaste (3.4 ± 2.1 points) than vanilla (2.4 ± 2.1 points; p < 0.01) and strawberry (2.6 ± 1.5 points; p < 0.03). Patients who chose chocolate took a total of 20.7 ± 20.9 average bricks during hospitalization (1.95 ± 0.2 per day), patients who chose vanilla took 18.6 ± 21.0 bricks (1.90 ± 0.7 per day) and finally patients who chose strawberry took 14.5 ± 13.5 bricks during admission (1.78 ± 0.1 per day; p < 0.01). Conclusions: The taste preferences of all the ONSs are similar although the consumption is high in chocolate flavored ONS during hospitalization. Sweetness may have influenced this finding.

disease-related malnutrition (DRM) is currently a major challenge in our hospitals, both because of its high prevalence and because of the clinical and economic impact. Our study aims to assess the feasibility and importance of establishing a nutritional screening strategy in our Health Care System.this is a prospective study carried out in a Surgery Ward. The nutritional risk was assessed by applying to patients MUST at admission and weekly until discharge. Nutritional evaluation and nutritional intervention were performed if required, as well as coding of diagnoses and nutritional procedures at discharge. Clinical data, length of stay (LOS) and hospital costs were analyzed.MUST detected 15.6% of patients at risk of malnutrition at admission. Patients with malnutrition at admission (MA) had four days longer LOS, higher annual mortality rate and urgent hospital readmissions in 2.4 and 2.0 times, respectively, one year after discharge. Age and urgent hospital admission were the factors associated with a higher annual mortality rate. Nine per cent of patients with an initial MUST2 suffered deterioration in their nutritional status during admission (DNS). These patients had longer LOS in seven days with equal comorbidity. Considering only the costs related to LOS in patients who presented MA or DNS, an overcost of 57% and 145%, respectively, was observed.patients with malnutrition on admission had longer LOS, higher mortality rate and urgent hospital readmissions one year after discharge. Patients who present MA or DNE cause an economic cost overrun. A nutritional screening tool is essential for the management and early detection of DRM.