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Resumen Introduccion La enfermedad COVID-19 se ha convertido en una prioridad para nuestro sistema sanitario. Los MIR de Endocrinologia y Nutricion (MIR-EyN) se han integrado en los equipos COVID-19. Se ha disenado este estudio con el objetivo de analizar el impacto a nivel formativo, laboral y en la salud de los MIR-EyN. Material y metodos Estudio observacional transversal tipo encuesta via web, dirigida a los MIR-EyN socios de la SEEN, realizado en noviembre de 2020. Se han analizado: variables demograficas, tamano del hospital de formacion en numero de camas, alteracion de las rotaciones, integracion en equipos COVID-19, participacion en teleconsulta, actividad cientifica e impacto sobre la salud fisica y emocional. Resultados Se han obtenido 87 respuestas (27% de los MIR-EyN); 67,8% mujeres, edad media 28,1 ± 1,8 anos, 60% MIR-EyN 4.o ano. El 84% ha participado en equipos COVID-19 y el 93% en las consultas telematicas de su servicio. La mayoria ha visto interrumpidas sus rotaciones. El 97,7% ha participado en reuniones cientificas o congresos virtuales y un tercio de ellos ha colaborado en trabajos cientificos sobre la COVID-19 en relacion con la Endocrinologia y Nutricion. La pandemia ha afectado a su estado de animo mucho o bastante (75,8%) y opinan que ha impactado de forma negativa a su formacion (73,8%). Conclusiones La pandemia por SARS-CoV-2 ha comprometido la formacion, la actividad laboral y la salud de los MIR-EyN. Se han integrado tanto en equipos COVID-19 como en la actividad reestructurada de sus servicios. Sin embargo, han conseguido mantener la formacion en formato virtual y participado en trabajos cientificos.

The Enhanced Recovery After Surgery (ERAS) care pathways include evidence-based items designed to accelerate recovery after surgery. Interdisciplinarity is one of the key points of ERAS programs.To prepare a consensus document among the members of the Nutrition Area of the Spanish Society of Endocrinology and Nutrition (SEEN) and the Spanish Group for Multimodal Rehabilitation (GERM), in which the goal is to homogenize the nutritional and metabolic management of patients included in an ERAS program.69 specialists in Endocrinology and Nutrition and 85 members of the GERM participated in the project. After a literature review, 79 statements were proposed, divided into 5 sections: 17 of general characteristics, 28 referring to the preoperative period, 4 to the intraoperative, 13 to the perioperative and 17 to the postoperative period. The degree of consensus was determined through a Delphi process of 2 circulations that was ratified by a consistency analysis.Overall, in 61 of the 79 statements there was a consistent agreement, with the degree of consensus being greater among members of the SEEN (64/79) than members of the GERM (59/79). Within the 18 statements where a consistent agreement was not reached, we should highlight some important nutritional strategies such as muscle mass assessment, the start of early oral feeding or pharmaconutrition.Consensus was reached on the vast majority of the nutritional measures and care included in ERAS programs. Due to the lack of agreement on certain key points, it is necessary to continue working closely with both societies to improve the recovery of the surgical patients.

Background: The Enhanced Recovery After Surgery (ERAS) care pathways include evidence-based items designed to accelerate recovery after surgery. Interdisciplinarity is one of the key points of ERAS programs. Objective: To prepare a consensus document among the members of the Nutrition Area of the Spanish Society of Endocrinology and Nutrition (SEEN) and the Spanish Group for Multimodal Rehabilitation (GERM), in which the goal is to homogenize the nutritional and metabolic management of patients included in an ERAS program. Methods: 69 specialists in Endocrinology and Nutrition and 85 members of the GERM participated in the project. After a literature review, 79 statements were proposed, divided into 5 sections: 17 of general characteristics, 28 referring to the preoperative period, 4 to the intraoperative, 13 to the perioperative and 17 to the postoperative period. The degree of consensus was determined through a Delphi process of 2 circulations that was ratified by a consistency analysis. Results: Overall, in 61 of the 79 statements there was a consistent agreement, with the degree of consensus being greater among members of the SEEN (64/79) than members of the GERM (59/79). Within the 18 statements where a consistent agreement was not reached, we should highlight some important nutritional strategies such as muscle mass assessment, the start of early oral feeding or pharmaconutrition. Conclusion: Consensus was reached on the vast majority of the nutritional measures and care included in ERAS programs. Due to the lack of agreement on certain key points, it is necessary to continue working closely with both societies to improve the recovery of the surgical patients.

Feasibility; Malnutrition; Morphofunctional assessment Factibilitat; Desnutrició; Avaluació morfofuncional Factibilidad; Desnutrición; Avaluació morfofuncional Disease-related malnutrition (DRM) affects approximately a third of hospitalized patients and is associated with an increased risk of morbimortality. However, DRM is often underdiagnosed and undertreated. Our aim is to evaluate the prognostic value of morphofunctional tools and tests for nutritional assessment in clinical practice. A systematic literature review was conducted to identify studies relating to the morphofunctional assessment of nutritional status and mortality or complications. Evidence was evaluated using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) method. Twelve GRADE recommendations were made and divided into seven topics: food intake and nutrient assimilation, anthropometry, biochemical analysis, hand grip strength, phase angle, muscle imaging, and functional status and quality of life. From these recommendations, 37 statements were developed and scored in a two-survey Delphi method by 183 experts. A consensus was reached on accepting 26/37 statements. Surveys had high internal consistency and high inter-rater reliability. In conclusion, evidence-based recommendations were made on the prognostic value of morphofunctional assessment tools and tests to assess malnutrition, most of which were found to be feasible in routine clinical practice, according to expert opinions. This study was supported by Persan Farma.

Endocrinology and Nutrition is a medical specialty covering the study and treatment of diseases of the endocrine system, metabolism and those derived from the nutritional process, including knowledge of diagnostic techniques and dietary and therapeutic measures. In order to develop these activities and plan the management of resources allocated for this purpose, the so-called Portfolio of Services of the specialty has to be defined. A Portfolio of Services is defined as the set of techniques, technologies or procedures through which care services are provided in a healthcare centre, department or institution. It is an essential tool for organization of a hospital Unit or Department by defining the roles and procedures of its healthcare professionals, and also for structuring the resources required to perform the activity. It also allows for defining how to use these resources and identifying the objectives to be achieved, improving the quality of clinical care. Finally, the definition and preparation of the portfolio of services makes it possible to have an inventory of the offer of healthcare services and to detect new healthcare needs.

Resumen Introduccion La nutricion artificial (NA) es uno de los ejemplos mas representativos de programas terapeuticos coordinados, lo que hace necesario su desarrollo y adecuada organizacion. Las primeras unidades de nutricion clinica (UNC) surgen en los hospitales publicos del Sistema Nacional de Salud (SNS) en la decada de 1980-1990 y se han ido incorporando progresivamente a los servicios de endocrinologia y nutricion (S°EyN). El objeto de nuestro articulo es exponer los resultados obtenidos del estudio RECALSEEN sobre los aspectos profesionales y organizativos relacionados con las UNC, su estructura y funcionamiento. Material y metodos Los datos se han obtenido del estudio RECALSEEN, que es un estudio descriptivo transversal entre los S°EyN del SNS espanol referido a 2016. La encuesta se recogio de marzo a septiembre de 2017. Las variables cualitativas se describen con su distribucion de frecuencias (numero de casos y porcentajes) y las variables cuantitativas con la media, mediana y desviacion estandar. Resultados Se han obtenido 88 (70%) respuestas de S°EyN sobre un total de 125 hospitales generales de agudos del SNS con 200 o mas camas instaladas. El 83% de S°EyN incorporaban una UNC (98% en los hospitales de 500 o mas camas). Como mediana los S°EyN tienen una enfermera dedicada a nutricion (35% no disponian de este recurso). El 53% de S°EyN con unidad de nutricion tenian dietistas integrados en la unidad (mediana: 1). Los S°EyN situadas en hospitales de 500 o mas camas tienen una mayor complejidad, con una amplia cartera de servicios de unidades monograficas (obesidad morbida —78,3%—, nutricion artificial domiciliaria —87%—, enfermedades cronicas —65,2%—) y de tecnicas especificas (impedanciometria —78%—). Sin embargo, solo se realiza un test de cribado universal de desnutricion en el 14% de los centros, y el diagnostico secundario de desnutricion unicamente aparece en 12,3 informes por cada 1.000 altas hospitalarias. Discusion Tras los estudios de 1997 y 2003 los resultados de 2017 arrojan un notable crecimiento y consolidacion de las UNC dentro de los S°EyN de la mayoria de los hospitales. Actualmente, el crecimiento de la especialidad pasa en buena medida por la demanda asistencial que crea la nutricion clinica hospitalaria. La dotacion de personal de enfermeria y de dietistas-nutricionistas en las UNC sigue siendo insuficiente y, en este ultimo caso, son frecuentes los contratos atipicos, o becas financiadas por proyectos de investigacion o por la industria farmaceutica. La presencia de unidades para enfermedades nutricionales especificas, y la participacion en grupos multidisciplinares, bastante heterogenea, se concentra en hospitales de 500 o mas camas y constituye una excelente oportunidad de desarrollo para las UNC. Conclusiones La incorporacion de UNC en los S°EyN es amplia en los hospitales de Espana, y la asistencia se realiza por endocrinologos que dedican la mayor parte de su tiempo a la nutricion clinica en mas de la mitad de los hospitales. Esta circunstancia es mas comun en centros grandes, con elevadas cargas de trabajo en relacion con las dotaciones de personal. Se observa una considerable heterogeneidad entre los hospitales, tanto en terminos de numero como de tipo de actividad de las UNC.

Introduction Artificial nutrition (AI) is one of the most representative examples of coordinated therapeutic programs, and therefore requires adequate development and organization. The first clinical nutrition units (CNUs) emerged in the public hospitals of the Spanish National Health System (NHS) in the 80s and have gradually been incorporated into the departments of endocrinology and nutrition (DENs). The purpose of our article is to report on the results found in the RECALSEEN study as regards the professional and organizational aspects relating to CNUs and their structure and operation. Materials and methods Data were collected from the RECALSEEN study, a cross-sectional, descriptive study of the DENs in the Spanish NHS in 2016. The survey was compiled from March to September 2017. Qualitative variables were reported as frequency distributions (number of cases and percentages), and quantitative variables as the mean, median, and standard deviation (SD). Results A total of 88 (70%) DENs, out of a total of 125 general acute hospitals of the NHS with 200 or more installed beds, completed the survey. CNUs were available in 83% of DENs (98% in hospitals with 500 or more beds). As a median, DENs had one nurse dedicated to nutrition (35% did not have this resource). Fifty-three percent of DENs with nutrition units had dieticians integrated into the unit (median: 1). DENs located in hospitals with 500 or more beds are more complex and have a wide portfolio of monographic unit services (morbid obesity, 78.3%; artificial home nutrition, 87%; chronic diseases, 65.2%) and specific techniques (impedanciometry, 78%). However, only 14% of the centers perform universal screening tests for malnutrition, and a secondary diagnosis of malnutrition only appears in 12.3 reports per 1000 hospital discharges. Discussion After the 1997 and 2003 studies, the results of 2017 show a marked growth and consolidation of CNUs within the DENs in most hospitals. Today, the growth of this specialty is largely due to the care demand created by hospital clinical nutrition. CNUs still have an insufficient nursing staff and dietitians/nutritionists, and in the latter case, atypical contracts or grants funded by research projects or the pharmaceutical industry are common. Units for specific nutritional diseases and participation in multidisciplinary groups, quite heterogeneous, are concentrated in hospitals with 500 or more beds and represent an excellent opportunity for CNU development. Conclusions Many DENs of Spanish hospitals include CNUs where care is provided by endocrinologists, who devote most of their time to clinical nutrition in more than half of the hospitals. This is most common in large centers with a high workload in relation to staffing. There is considerable heterogeneity between hospitals in terms of both the number and type of activity of the CNUs.

Resumen La obesidad supone uno de los grandes retos en salud en la actualidad. Las importantes repercusiones que implica obligan a un manejo integral. El presente documento tiene como objetivo establecer recomendaciones practicas y basadas en la evidencia para el diagnostico y el manejo de la obesidad en Espana, desde la perspectiva del endocrinologo clinico. Se ha realizado un documento de posicionamiento que puede consultarse en www.seen.es , que ha sido consensuado por el Grupo de Obesidad de la Sociedad Espanola de Endocrinologia y Nutricion (GOSEEN), junto con el Area de Nutricion (NutriSEEN) y el Grupo de trabajo de Endocrinologia, Nutricion y Ejercicio Fisico (GENEFSEEN).

Resumen La pandemia SARS-CoV-2 ha tenido un gran impacto en todo el mundo, siendo Espana uno de los paises mas afectados. La demora en la cirugia bariatrica puede tener consecuencias fatales, ya que hasta el 50% de los pacientes que se encuentran en lista de espera desarrollan una nueva comorbilidad durante el tiempo que permanecen en ella y el 1,5% de pacientes fallecen mientras esperan la intervencion. Es por ello por lo que la cirugia bariatrica no debe demorarse en cuanto la ocupacion del hospital por pacientes COVID-19+ disminuya de forma significativa y se disponga de recursos y seguridad suficiente para realizar la cirugia en pacientes con patologia benigna. Este documento recoge las principales recomendaciones para los programas de cirugia bariatrica en nuestro pais desde el punto de vista tanto de seguridad como de preparacion y seguimiento del paciente bariatrico en el contexto de la pandemia SARS-CoV-2.

Palliative care provides a holistic approach and care for patients with a terminal illness and their families. In palliative care physical complaints as well as emotional, social and spiritual aspects are considered. Nutritional care should be also considered within palliative support. For those working in the nutritional support field, to withhold or withdraw nutritional support may be an ethical dilemma in this scenario. The controversy starts when considering nutrition and hydration as basic care or a treatment. The goals of nutrition support in palliative care patients differ from common ones, aiming to improve quality of life, survival or both. The decision should be based on a consideration of prognosis (length of survival), quality of life, and risks-benefits ratio. Regarding oral nutrition (with or without oral supplements) the idea prevails of "comfort feeding", based on providing oral feeding till discomfort or avoidance develop. There is no evidence on the benefit of specific nutrients, despite the fact that omega-3 FAs may have some positive effects in patients with cancer. Regarding nutritional support (enteral or parenteral), no scientific evidence is present, so the decision needs to be agreed according to the desires and beliefs of the patient and their family, and based on a consensus with the interdisciplinary team on the aims of this support.Los cuidados paliativos proporcionan una atención integral que tiene en cuenta los aspectos físicos, emocionales, sociales y espirituales del paciente con enfermedad terminal y su entorno familiar. El tratamiento nutricional debe formar parte activa de los equipos de cuidados paliativos. La necesidad de iniciar o no un tratamiento nutricional sigue siendo, desde hace décadas, uno de los principales problemas éticos a los que se enfrentan los profesionales dedicados a la nutrición clínica. El origen de tal controversia radica, fundamentalmente, en cómo se consideran la nutrición y la hidratación: cuidado/soporte o tratamiento médico. Los objetivos fundamentales del tratamiento nutricional en los pacientes en cuidados paliativos deben ser otros: la mejoría de la calidad de vida, de la supervivencia o de ambas. La decisión de indicar o no el tratamiento nutricional en cuidados paliativos debe tomarse tras considerar el pronóstico, la calidad de vida y la relación “riesgo/beneficio”. En relación a la alimentación por vía oral (con o sin suplementos orales), prevalece la idea de la “alimentación de confort”, que se basa en intentos de alimentación oral hasta que se produzcan la incomodidad y/o el rechazo del paciente. No existen evidencias que justifiquen el uso de nutrientes específicos, aunque desde hace años se señala la posibilidad de lograr beneficios cuando se utilizan ácidos grasos omega-3 en los pacientes con cáncer. En cuanto al tratamiento nutricional (enteral o parenteral), en ausencia de evidencia, las decisiones sobre si iniciar una nutrición artificial en un paciente paliativo deben tomarse teniendo en cuenta los deseos y creencias del paciente y sus familiares, y basarse en el consenso del equipo interdisciplinar sobre los objetivos que se persiguen al iniciarla.

Dementia is an increasingly prevalent disease in our environment, with significant health and social repercussions. Despite the available scientific evidence, there is still controversy regarding the use of enteral tube nutrition in people with advanced dementia. This document aims to reflect on the key aspects of advanced dementia, tube nutritional therapy and related ethical considerations, as well as to respond to several frequent questions that arise in our daily clinical practice.

Resumen Introduccion La prevalencia de la desnutricion relacionada con la enfermedad en el hospital varia del 20 al 50%. La utilizacion de herramientas de cribado debe ser el primer paso en la prevencion y el tratamiento de los pacientes en riesgo de desnutricion o desnutridos. Objetivos Implantar un metodo de cribado nutricional al ingreso en el ambito de un hospital terciario. Metodos La Unidad de Nutricion elaboro un protocolo de deteccion precoz del riesgo nutricional y eligio el NRS 2002 como herramienta de cribado. El protocolo fue aprobado por la Comision de Protocolos y Procedimientos del hospital y difundido en la intranet. El NRS 2002 se incluyo en el programa de prescripcion de dietas para su realizacion por parte del personal de enfermeria de las unidades de hospitalizacion y como sistema de comunicacion directo con la Unidad de Nutricion. Se disenaron 3 fases para la implantacion: fase de pilotaje, fase de implantacion y fase de consolidacion. Resultados En la fase de pilotaje se implanto el NRS 2002 en 2 unidades de hospitalizacion para monitorizar el software. La fase de implantacion se realizo en las mismas unidades y se verificaron todos los protocolos de actuacion relacionados con el mismo. La fase de consolidacion consistio en ir ampliando sucesivamente las unidades de hospitalizacion con el protocolo implantado. Conclusiones La implantacion de un cribado nutricional al ingreso hospitalario es un proceso largo y complejo, con la implicacion de muchos estamentos. El programa informatico ha posibilitado que la realizacion del mismo sea rapido, sencillo y automatizado, y que el resultado del cribado llegue inmediatamente al personal de enfermeria de la unidad de Nutricion y se activen los protocolos de actuacion de la misma.

Resumen Antecedentes y objetivo El tratamiento con antineoplasicos orales tipo inhibidores de tirosina quinasa (ITK) es novedoso, y por ello se conoce poco sobre como afectan al estado nutricional (EN), la ingesta dietetica, la calidad de vida, y su influencia sobre la supervivencia. Este estudio pretende aportar informacion sobre estos componentes, para dirigir las recomendaciones nutricionales futuras. Pacientes y metodo Estudio prospectivo y observacional en adultos que inician ITK, donde se valoro el EN mediante el cuestionario de valoracion subjetiva global generada por el paciente (VSG-GP), medidas antropometricas, parametros bioquimicos e ingesta dietetica (Recuerdo de 24 h). La calidad de vida se estudio con EORTC QLQ-C30. El analisis estadistico empleo pruebas no parametricas y la supervivencia se analizo mediante curvas de Kaplan-Meier y log-rank. Resultados El 21,7% de la muestra presento desnutricion moderada segun VSG-GP; el 74,2% mostro perdida de peso moderada a los 6 meses, aunque ningun paciente tuvo un IMC El 44,4% realizo una ingesta energetica inferior a las recomendaciones ESPEN 2017 y ningun paciente cubrio requerimientos proteicos (1,5 g proteina/kg peso) durante el seguimiento. Una peor puntuacion en la escala global de salud del EORTC QLQ-C30 se relaciono con peor EN. Conclusiones El tratamiento con ITK no parece afectar de manera importante el EN y la calidad de vida a los 6 meses de seguimiento. Se debe prevenir la desnutricion, mediante un consejo nutricional individualizado, pues se relaciona con menor supervivencia.

BACKGROUND AND OBJECTIVE Treatment with oral antineoplastic agents known as tyrosine kinase inhibitors (TKIs) is new and, thus, little is known about their impact on nutritional status (NS), dietary intake, quality of life, and survival. The aim of this study was to provide information on these components in order to guide future nutritional recommendations. PATIENTS AND METHOD A prospective, observational study in adults who start treatment with TKIs, in whom NS was assessed using the Patient-Generated Subjective Global Assessment (PG-SGA), anthropometric measures, biochemical parameters, and dietary intake (24-hour dietary recall). The EORTC QLQ-C30 was used to assess quality of life. Nonparametric tests were used in statistical analysis, and survival was analyzed using Kaplan-Meier and log-rank curves. RESULTS Of the overall sample, 21.7% had moderate malnutrition according to PG-SGA, and 74.2% moderate weight loss at 6 months, but no patient had BMI

Resumen Objetivos Elaborar un registro de situacion de los Servicios y Unidades de Endocrinologia y Nutricion (S°EyN) del Sistema Nacional de Salud (SNS) y valorar sus recursos asistenciales para desarrollar, a partir de los resultados obtenidos, propuestas de politicas de mejora en los S°EyN. Material y metodos Estudio descriptivo transversal de los pacientes atendidos en los S°EyN en hospitales generales de agudos del SNS en 2016. Se utilizaron datos obtenidos mediante RECALSEEN 2017, una encuesta «ad hoc» disenada especificamente para este fin y de las altas dadas por los S°EyN registradas en el CMBD del SNS (2015). Resultados De un total de 125 hospitales generales de agudos de mas de 200 camas instaladas del SNS espanol, se han obtenido 88 respuestas de los S°EyN, que representan el 70%. El 47% de los S°EyN que respondieron eran servicios y el 31% secciones. El promedio de endocrinologos por S°EyN era de 7,4 ± 4,4, siendo la tasa media de endocrinologos por cada 100.000 habitantes de 2,3 ± 1. Las actividades asistenciales mas relevantes eran la consulta (promedio de 12,3 primeras consultas por mil habitantes y ano), hospital de dia (mediana de 2.000 sesiones/ano) e interconsulta hospitalaria (mediana de 900 interconsultas/ano). El 83% de los S°EyN incorporaban una Unidad de Nutricion Clinica. La dotacion de dietistas, tecnicos en nutricion y bromatologos en las Unidades de Nutricion Clinica era baja. En relacion con la gestion de la calidad se detecto un amplio margen de mejora; solamente un 35% de los S°EyN tenian responsable de calidad y el 38% habia implantado una gestion por procesos para aquellos mas frecuentemente atendidos por la unidad. Existen notables diferencias en estructura, recursos y actividad de los S°EyN entre Comunidades Autonomas. Conclusiones La encuesta RECALSEEN 2017 es util para el analisis de los S°EyN. La notable variabilidad hallada en los indicadores de estructura, actividad y gestion probablemente indica relevantes diferencias y, por tanto, un amplio margen de mejora.

Objective Our aim is to assess the changes in clinical nutrition and dietetics education of the residents in endocrinology and nutrition for the last 10 years. Methods During the yearly update course in Clinical Nutrition and Dietetics held by SEEN, a survey about medical training is conducted since 2006. Descriptive data for the last 10 years are reported. Results Every hospital accredited for medical training in endocrinology and nutrition has a unit of nutrition, depending on endocrinology and nutrition departments in 94.5%. While 13.3% of the residents required a different hospital for training in nutrition in 2006, all of them had enough resources in their own hospital in 2018. The training started in their third year of residency in 62.6%. The rotation has been increasing its length and now it lasts 6 months for 66% of the residents. 41.9% of the residents think it should be longer than 6 months. Education in dietetics should be extended the most. The residents take part in study protocols or publications in 72.5%, against only 27.9% in 2009. There is still a percentage of 10.1% to 19% of the residents grading their training in nutrition as insufficient. Conclusion The residents consider their global training in nutrition has improved in these last 10 years, although there is still a chance for optimization in areas such as dietetics.

Resumen Objetivo El objetivo de este trabajo es evaluar los cambios en la formacion en nutricion clinica y dietetica de los residentes de endocrinologia y nutricion en los ultimos 10 anos. Metodologia En el Curso Anual de Actualizacion en Nutricion Clinica y Dietetica que organiza la SEEN se realiza una encuesta de formacion a los residentes desde 2006. Se recogen los datos descriptivos de los 10 ultimos anos. Resultados Todos los hospitales con docencia acreditada en endocrinologia y nutricion disponen de una unidad de nutricion, con dependencia en el 94,5% de los servicios de endocrinologia y nutricion. Mientras que en 2006 un 13,3% de residentes necesitaban hacer su rotacion en nutricion en otro hospital, en 2018 todos tenian en su hospital recursos suficientes para su formacion. Un 62,6% comienzan su formacion en nutricion en su tercer ano de residencia. La duracion de la rotacion se ha ido incrementando y esta en 6 meses para el 66% de los residentes. Un 41,9% de los residentes considera que su rotacion en nutricion debe ser superior a 6 meses. La formacion en dietetica es la que mas consideran que necesitan ampliar. Un 72,5% de los residentes participan en protocolos de estudios o publicaciones, frente a solo un 27,9% en 2009. Existe aun un porcentaje de residentes entre el 10,1 y el 19% que califican como insuficiente su formacion global en nutricion. Conclusion Los residentes consideran que la formacion global en nutricion ha mejorado en estos 10 anos, aunque aun existen posibilidades de optimizacion en areas como dietetica.

Introducción: La enfermedad COVID-19 se ha convertido en una prioridad para nuestro sistema sanitario. Los MIR de Endocrinología y Nutrición (MIR-EyN) se han integrado en los equipos COVID-19. Se ha diseñado este estudio con el objetivo de analizar el impacto a nivel formativo, laboral y en la salud de MIR-EyN. Material y métodos: Estudio observacional transversal tipo encuesta vía web, dirigida a MIR-EyN socios SEEN, realizado en noviembre 2020. Se han analizado: variables demográficas, tamaño del hospital de formación en número de camas, alteración de las rotaciones, integración en equipos COVID-19, participación en teleconsulta, actividad científica e impacto sobre la salud física y emocional. Resultados: Se han obtenido 87 respuestas (27% de los MIR-EyN), 67,8% mujeres, 28,1 ± 1,8 años, 60% MIR-EyN 4º año. El 84% ha participado en equipos COVID-19 y el 93% en las consultas telemáticas de su servicio. La mayoría han visto interrumpidas sus rotaciones. El 97,7% ha participado en reuniones científicas o congresos virtuales y un tercio de ellos ha colaborado en trabajos científicos sobre la COVID-19 en relación a la Endocrinología y Nutrición. La pandemia ha afectado a su estado de ánimo mucho o bastante (75,8%) y opinan que ha impactado de forma negativa a su formación (73,8%). Conclusiones: La pandemia por SARS-CoV-2 ha comprometido la formación, la actividad laboral y la salud de los MIR-EyN. Se han integrado tanto en equipos COVID-19 como en la actividad reestructurada de sus servicios. Sin embargo, han conseguido mantener la formación en formato virtual y participado en trabajos científicos.

espanolLa valoracion y el tratamiento nutricionales, necesarios para poder realizar la prevencion y tratamiento de la desnutricion relacionada con la enfermedad, se deben llevar a cabo por un equipo multidisciplinar en el que cada miembro tenga bien definidas sus competencias y funciones, y donde se establezcan mecanismos que permitan una adecuada coordinacion en el entorno hospitalario y ambulatorio. En Espana, el desarrollo y la implantacion de estos equipos o unidades dedicados a la nutricion clinica han sido muy importantes: hoy en dia estan presentes en la mayor parte de los hospitales. En este articulo se revisan las caracteristicas de las unidades de nutricion clinica, las funciones de los miembros del equipo y la normativa que regula su funcionamiento en nuestro pais. EnglishNutritional assessment and treatment, necessary for the prevention and treatment of disease-related malnutrition, should be carried out by a multidisciplinary team where each member has well-defined skills and functions, and mechanisms are established to allow adequate coordination, both in the inpatient and outpatient settings. In Spain, the development and implementation of these teams or units dedicated to clinical nutrition has been very important: today they are present in most hospitals. This paper reviews the characteristics of clinical nutrition units, the functions of their team members, and the regulatory framework in our country.

[Abstract] Obesity is one of the great challenges in healthcare nowadays with important implications for health so requiring comprehensive management. This document aims to establish practical and evidence-based recommendations for the diagnosis and management of in Spain, from the perspective of the clinical endocrinologist. A position statement has been made that can be consulted at www.seen.es, and that has been agreed by the Obesity Group of the Spanish Society of Endocrinology and Nutrition (GOSEEN), together with the Nutrition Area (NutriSEEN) and the Working Group of Endocrinology, Nutrition and Physical Exercise (GENEFSEEN). [Resumen] La obesidad supone uno de los grandes retos en salud en la actualidad. Las importantes repercusiones que implica obligan a un manejo integral. El presente documento tiene como objetivo establecer recomendaciones prácticas y basadas en la evidencia para el diagnóstico y el manejo de la obesidad en España, desde la perspectiva del endocrinólogo clínico. Se ha realizado un documento de posicionamiento que puede consultarse en www.seen.es, que ha sido consensuado por el Grupo de Obesidad de la Sociedad Española de Endocrinología y Nutrición (GOSEEN), junto con el Área de Nutrición (NutriSEEN) y el Grupo de trabajo de Endocrinología, Nutrición y Ejercicio Físico (GENEFSEEN).

Bariatric surgery (BS) is increasingly used in the treatment of morbid obesity, especially in women. Some issues, such as pregnancy and menopause, deserve special consideration in these patients. Obesity induces infertility and increases the risk of maternal–fetal complications in pregnancy, such as gestational diabetes, hypertension and preeclampsia, and macrosomia. Bariatric surgery can decrease the risk of these obesity-related complications. However, and mainly because of its effect on nutrient intake and absorption, it may also induce adverse consequences on maternal and fetal health. A higher risk of small-for-gestational-age newborn and prematurity have been described. Bariatric surgery in menopausal women decreases body weight and improves cardiovascular risk factors and other associated diseases, such as sleep apnea or osteoarthritis and quality of life. The possible deleterious effect of BS on bone mass and the higher risk of osteoporosis and sarcopenia should be considered, especially when malabsorptive techniques are used.

La obesidad es una enfermedad crónica asociada a incremento de la morbimortalidad en el mundo, y el impacto con la pandemia de COVID-19 puede suponer un nuevo reto sanitario. Disponemos de evidencias que sugieren que algunos factores biológicos y sociales asociados con la obesidad confieren un mayor riesgo de infección por COVID-19, de hospitalización y de mayor gravedad respecto a las personas con normopeso. Sin duda, la obesidad comporta un estado proinflamatorio de bajo grado que produce una desregulación del sistema inmune que compromete su capacidad de respuesta ante la infección respiratoria por la COVID-19 y propicia un empeoramiento de la enfermedad. En esta revisión se exponen los principales datos epidemiológicos y fisiopatológicos que asocian obesidad con la COVID-19.

Resumen Antecedentes La imprecision en la terminologia dentro de la nutricion clinica puede acarrear malas interpretaciones entre los distintos profesionales. Objetivo Por esta razon, la Sociedad Espanola de Endocrinologia y Nutricion (SEEN) ha promovido la realizacion del presente trabajo, el primero sobre terminologia y definiciones en nutricion artificial clinica (enteral y parenteral) publicado en castellano. Metodos Un total de 47 especialistas en Endocrinologia y Nutricion expertos en la materia, miembros del Area de Nutricion de la SEEN, han participado entre los meses de abril y septiembre de 2016. Tras una revision bibliografica sistematizada fueron propuestos 52 conceptos, ampliandose a 54 por las coordinadoras y finalmente a 57 por el grupo de trabajo: 13 de caracter general, 30 referidos a la nutricion enteral y 14 a la parenteral. En una fase posterior se determino el grado de acuerdo mediante un proceso Delphi de 2 circulaciones. Finalmente fue ratificado mediante un analisis de consistencia y concordancia. Resultados En 54 de los 57 terminos hubo un acuerdo muy consistente y resultaban concordantes. Solo 3 no presentaron concordancia, de los que 2 eran muy consistentes y uno inconsistente. En conclusion, queda consensuada la definicion de 54 terminos basicos en la practica de la nutricion clinica.

This paper from the ethics Working Group presents a summary of the recommendations of the nutritional management of patients with advanced dementia.En este documento del Grupo de Trabajo de Ética se presenta un resumen sobre las recomendaciones del manejo nutricional de pacientes con demencia avanzada.

En este documento del Grupo de Trabajo de Etica se presenta un resumen sobre las recomendaciones del manejo nutricional de pacientes con demencia avanzada.

Introduction Prevalence of disease-related malnutrition in hospitals ranges from 20% to 50%. Use of nutritional screening tools should be the first step in the prevention and treatment of patients at risk of malnutrition and/or undernourished. Aims To implement a nutritional screening tool at admission to a tertiary hospital. Methods The nutrition unit prepared a protocol for early detection of nutritional risk and selected the NRS 2002 as screening tool. The protocol was approved by the hospital committee of protocols and procedures and disseminated through the intranet. NRS 2002 was included in the diet prescription software to be implemented by the nursing staff of the hospital wards and as a direct communication system with the nutrition unit. Three phases were designed: pilot phase, implementation phase, and consolidation phase. Results The pilot phase, NRS 2002 was implemented in 2 hospital units to monitor software. The implementation phase was carried out in the same units, and all action protocols related to it were verified. The consolidation phase consisted of sequential extension of the protocol to the other hospital units. Conclusions Implementation of nutritional screening at hospital admission is a long and complex process that requires involvement of many stakeholders. Computer software has allowed for a rapid, simple, and automatic process, so that the results of the screening are immediately available to the nursing staff of the nutrition unit and activate the nutritional protocols when required.

There are no studies that have specifically assessed the role of intravenous lipid emulsions (ILE) enriched with fish oil in people with diabetes receiving total parenteral nutrition (TPN). The objective of this study was to assess the metabolic control (glycemic and lipid) and in-hospital complications that occurred in non-critically ill inpatients with TPN and type 2 diabetes with regard to the use of fish oil emulsions compared with other ILEs. We performed a post-hoc analysis of the Insulin in Parenteral Nutrition (INSUPAR) trial that included patients who started with TPN for any cause and that would predictably continue with TPN for at least five days. The study included 161 patients who started with TPN for any cause. There were 80 patients (49.7%) on fish oil enriched ILEs and 81 patients (50.3%) on other ILEs. We found significant decreases in triglyceride levels in the fish oil group compared to the other patients. We did not find any differences in glucose metabolic control: mean capillary glucose, glycemic variability, and insulin dose, except in the number of mild hypoglycemic events that was significantly higher in the fish oil group. We did not observe any differences in other metabolic, liver or infectious complications, in-hospital length of stay or mortality., This work was supported by Instituto de Salud Carlos III (ISCIII, co-funded by Fondo Europeo de Desarrollo Regional [FEDER], European Union [EU], Una manera de hacer Europa), Ministerio de Ciencia, Innovacion y Universidades, Gobierno de Espana (PI15/01034), and Sociedad Andaluza de Endocrinologia Diabetes y Nutrition (SAEDYN) 2016 research project. Centro de Investigacion Biomedica en Red (CIBERDEM) is an initiative of the Instituto de Salud Carlos III.

Objectives To elaborate a diagnosis of the situation regarding the assistance in the Services and Units of Endocrinology and Nutrition (S°EyN) of the National Health System of Spain (SNHS) and to develop, based on the results obtained, proposals for improvement policies in the S°EyN. Material and methods Cross-sectional descriptive study of the patients treated in the S°EyN departments of acute general hospitals of the SNHS in 2016. Data were obtained through RECALSEEN 2017, an “ad hoc” survey designed specifically for this purpose, and the Minimum Basic Data Set of discharges given by the S°EN of the SNHS (2015). Results 88 responses of S°EyN have been obtained forma total of 125 acute general hospitals of more than 200 beds installed in the SNHS (70% answers). 47% of the S°EyN respondents were services and 31% sections. The average of endocrinologists by S°EyN was 7.4 ± 4.4, and the average rate of endocrinologists per 100,000 inhabitants was 2.3 ± 1. The most relevant care activities were the consultation (average of 12.3 first consultations per thousand inhabitants and year), day hospital (median of 2000 sessions/year) and in-hospital consultations (median of 900 in-hospital consultations/year). 83% of S°EyNhad a Clinical Nutrition Unit. The number of dietitians, nutrition technicians and nutritionists in the Clinical Nutrition Unit was low. In relation to quality management, a large margin for improvement was detected; only 35% of S°EyN had a responsible of quality and 38% had implemented process management for those most frequent processes in the unit. There were notable differences in structure, resources and activity of S°EyN between Autonomous Communities. Conclusions RECALSEEN 2017 survey is a useful tool for the analysis of S°EyN. The remarkable variability found in the structure, activity and management indicators probably indicates significant differences and, therefore, a wide margin for improvement.

Introduction: catheter-related bloodstream infections (CRBSI) are one of the most serious concerns in patients on home parenteral nutrition (HPN) which involve high morbidity and cost for the healthcare system. In the last years, taurolidine lock has proven to be beneficial in the prevention of CRBSI; however, the evidence of its efficiency is limited. Objective: to determine if taurolidine lock is a cost-effective intervention in patients on HPN. Materials and methods: retrospective study in patients on HPN with taurolidine lock. We compared the CRBSI rate and cost of its complications before and during taurolidine lock. Results: thirteen patients, six (46%) males and seven (54%) females, with a mean age of 61.08 (SD = 14.18) years received taurolidine lock. The total days of catheterization pre and per-taurolidine were 12,186 and 5,293, respectively. The underlying disease was benign in five patients (38.5%) and malignant in eight (61.5%). The CRBSI rate pre vs per-taurolidine was 3.12 vs 0.76 episodes per 1,000 catheter days (p = 0.0058). When the indication was a high CRBSI rate, this was 9.72 vs 0.39 (p < 0.001) in pre and per-taurolidine period respectively. No differences have been observed in the occlusion rates. None of the patients reported any adverse effects. The total cost of CRBSI in the pre-taurolidine period was 151,264.14 euros vs 24,331.19 euros in the per-taurolidine period. Conclusions: our study shows that taurolidine lock is a cost-effective intervention in patients on HPN with high risk of CRBSI.

The beneficial effects of fish consumption in both children and adults are well known. However, the intake of methylmercury, mainly from contaminated fish and shellfish, can have adverse health effects. The study group on the prevention of exposure to methylmercury (GEPREM-Hg), made up of representatives from different Spanish scientific societies, has prepared a consensus document in a question and answer format, containing the group's main conclusions, recommendations and proposals. The objective of the document is to provide broader knowledge of factors associated with methylmercury exposure, its possible effects on health amongst the Spanish population, methods of analysis, interpretation of the results and economic costs, and to then set recommendations for fish and shellfish consumption. The group sees the merit of all initiatives aimed at reducing or prohibiting the use of mercury as well as the need to be aware of the results of contaminant analyses performed on fish and shellfish marketed in Spain. In addition, the group believes that biomonitoring systems should be set up in order to follow the evolution of methylmercury exposure in children and adults and perform studies designed to learn more about the possible health effects of concentrations found in the Spanish population, taking into account the lifestyle, eating patterns and the Mediterranean diet.

Pilar Serrano Aguayo , Juan Manuel Garcia de Quiros Munoz *, Irene Breton Lesmes c y Maria Victoria Cozar Leon b Unidad de Endocrinologia y Nutricion, IBCLC, Hospital Virgen del Rocio, Sevilla, Espana Unidad de Endocrinologia y Nutricion, Hospital Virgen de Valme, Sevilla, Espana Unidad de Nutricion y Dietetica, Hospital Gregorio Maranon, Madrid, Espana ww w.els evier .es /med i c in ac l in i c a

Imprecision in terms used in the field of clinical nutrition may lead to misinterpretations among professionals.For this reason, the Spanish Society of Endocrinology and Nutrition (SEEN) promoted this document on the terms and definitions used in clinical artificial nutrition (enteral and parenteral), establishing an agreement between Spanish experts of this specialty.Forty-seven specialists in endocrinology and nutrition, members of the Nutrition Area of the SEEN, participated between April and September 2016. After a systematic literature review, 52 concepts were proposed. The coordinators included two additional concepts, and 57were finally selected by the working group: 13 of a general nature, 30 referring to enteral nutrition and 14 to parenteral nutrition. The degree of agreement was subsequently determined using a two-round Delphi process. It was finally ratified by consistency and concordance analysis.Fifty-four of the 57 terms had a very consistent agreement and were concordant. Only three showed no concordance, of whom two were very consistent and one inconsistent. In conclusion, there was consensus in the definition of 54 basic terms in the practice of clinical nutrition.

To analyze the trends on diabetes mellitus (DM) healthcare management in Spain.Retrospective observational study between January 1st 2007 and 31th December 2015 with DM as the principal diagnosis. The main clinical outcome measures were all-cause, in-hospital mortality and 30-day readmissions. We also analyze three Prevention Quality Indicators (PQI) for DM.The number of hospitalization episodes decreased significantly as well as the frequentation rate and average length of stay (Incidence Rate Ratio [IRR] = 0.963, p 0.001; 0.91, p 0.001 and 0.986, p 0.001, respectively). Crude in-hospital mortality and readmissions rates and risk-standardized in-hospital mortality rates (RSMR), however, remained stable (IRR = 0.988, p = 0.073; IRR = 1.003, p = 0.334 and IRR = 0.997, p = 0.116, respectively). A relevant variability in RSMR, both at hospital (Median Odds Ratio 1.49) and regional level, was found. High volume hospitals (≥105 DM discharges at year) showed better outcomes. High variability was also found in PQI indicators al regional level.The present analysis shows an improvement in hospitalizations related to DM in Spain in the period 2007-2015. There was also a decrease in the frequentation rate and in the average length of stay. These findings are probably explained by quality improvements in the healthcare management of the DM at the ambulatory level. However, there were important differences in the management of diabetic inpatients both at the hospital and the regional level.

Introducción: la esofagitis eosinofílica (EEo) es una enfermedad inmunoalérgica crónica emergente en adultos. Surge como respuesta disfuncional frente a los antígenos de los alimentos y se caracteriza por síntomas recurrentes de disfunción esofágica e inflamación. El tratamiento farmacológico y dietético se basa en su patogénesis y debe ser individualizado. Uno de los posibles abordajes dietéticos se basa en la eliminación empírica de alimentos que con mayor frecuencia causan EEo.Objetivo: evaluar la ingesta dietética de los pacientes con EEo que siguen la dieta de exclusión de los seis grupos de alimentos (DESGA) y conocer sus posibles carencias nutricionales.Métodos: estudio transversal descriptivo en un grupo de pacientes con EEo que inició tratamiento con DESGA durante el periodo de marzo de 2013 hasta marzo de 2015. Se evaluó la ingesta mediante registro de 72 horas. Se compararon los resultados con las referencias para población adulta sana española (23). Para el análisis estadístico se usaron los test de Mann-Whitney, Krhuskall-Wallis y Chi-cuadrado. Significación p0,05.Resultados: se incluyeron en el estudio 14 pacientes. En algunos de ellos, la ingesta dietética siguiendo DESGA fue deficitaria en energía, proteínas y fibra. Tampoco consiguieron cubrir las ingestas de micronutrientes de calcio, zinc, magnesio, ácido fólico, niacina y vitaminas B2 y D, teniendo en cuenta edad y sexo, el 60% de la muestra.Conclusiones: el abordaje terapéutico mediante DESGA, teniendo en cuenta las características de la dieta, debe acompañarse de una evaluación periódica del estado nutricional, que incluya micronutrientes y una pauta de suplementación específica.