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Copyright of Revista Nutrición Clínica y Dietética Hospitalaria is the property of Sociedad Espanola de Dietetica y Ciencias de la Alimentacion and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: telemedicine can improve the standards of clinical care and use of resources. The COVID-19 pandemic has required its implementation in routine practice. For this reason, a group of endocrinologists from Valencia, Murcia and the Balearic Islands created a committee for its development. Objectives: to establish recommendations in order to improve the quality of consultation in nutritional disorders, and to create indicators for its management. Methodology: the Delphi methodology was followed with the participation of 13 professionals in order to reach the widest consensus. A 16-item questionnaire was distributed within 3 rounds: in the first round, the degree of consensus was established; in the second round, the participants responded to the posed questions after having access to the first-round results. Agreement was considered if ≥ 75 % participants reached consensus, while strong agreement was considered if consensus was reached by ≥ 90 %. In addition, quality indicators were established. In a third round, these indicators were developed. Results: after 3 rounds and a revision 5 recommendations with strong agreement were established based on organizational aspects. Regarding administrative aspects, 6 recommendations with strong agreement were established while 4 recommendations reached the level of agreement. Eight quality indicators were selected and developed. Conclusions: this document compiles a list of recommendations about needs and requirements to be taken into account for a quality telematic consultation in patients with nutritional disorders. In addition, health care quality indicators have been created and developed. [ABSTRACT FROM AUTHOR]

La bioética es el estudio sistemático de la conducta humana en los campos de las ciencias biológicas y de la atención de la salud. La nutrición clínica es parte de las ciencias de la salud, y los profesionales de la nutrición deben considerarse dentro del marco bioético internacional como parte de la comunidad científica. La investigación científica constituye la única manera de resolver las preguntas científicas de forma rigurosa, integral y sistemática; es por esto por lo que la investigación en nutrición clínica debe regirse por los principios de la bioética, y los protocolos de investigación en nutrición clínica deben seguir todos los principios de las buenas prácticas clínicas de investigación plasmados en la Declaración de Helsinki.

Establecer una relación entre las bioéticas latinoamericanas (BLA) y la nutrición clínica, que permita a esta última enriquecer su reflexión mediante la incorporación de categorías de reflexión moral que le hagan responder de mejor manera a los desafíos colocados por la actual pandemia

La malnutrición asociada a la enfermedad es una entidad clínica multifactorial que representa un problema sostenido a lo largo del tiempo, con implicaciones graves para el paciente y para los sistemas de salud. Además de los factores de riesgo que presenta el paciente como su entorno económico, sociocultural y estado clínico, también el factor de mala praxis del personal de salud influye en que la malnutrición asociada a la enfermedad no se detecte ni se trate y se mantenga.

Introduction: Introduction: malnutrition in cancer patients can lead to a reduction in patient quality of life, increased morbidity and mortality, and associated healthcare costs. Objective: to analyze nutritional interventions in the different phases of the oncological process, integrating the needs of patients and those of healthcare professionals. Material and methods: "Design Thinking" techniques were used to address the analysis of the current situation and identify key aspects. Thirteen professionals from 8 public health centers (endocrinology and nutrition, medical and radiotherapy oncology, primary care (PC), nursing and dietetics) participated in the study. Results: nutritional screening is not carried out in a systematic way in the different phases of the oncological process, and there is no universal consensus on the protocols for action and nutritional intervention. A wide compliance with the pathways and referral times of the selected processes has been observed. In the therapeutic phase, there is the possibility of consulting the Clinical Nutrition and Dietetics Unit (UNCYD) and 75 % have specific referral protocols. The nurse case manager is present in all hospitals and in PC. Patient access to the center psychologist was possible in 87 % of the hospitals. Participation of the UNCYD in Tumor Committees was low (only in 25 % of the centers). In all centers there is some kind of collaboration and support by patient associations and the School of Patients, especially in the therapeutic and the control and follow-up phases. Conclusions: variations are observed between the different hospitals and areas in Andalusia, both in terms of means and structures and in activities and procedures. Key points have been selected and prioritized to improve nutritional care in oncology. [ABSTRACT FROM AUTHOR]

The health industry has experienced great innovation and will continue to do so in the coming years. The term innovation comes from "outside to inside" driven by the need for knowledge and research to truly translate into effective improvements (hence the sequence from Research and Development to Innovation: R+D+I); but it also comes from "bottom up" as a drive of the health organization (based, as few others, on knowledge as a fundamental asset) to give way to their creativity and their ability to find new solutions to old and new problems. The current health system must advance in the development of a more global and integrated philosophy of care, which allows dealing with the consequences of aging and the increase in chronic diseases and dependence, which represent an increase in the demand for care. In the mediumlong term, a care logic based on individual characteristics from the molecular perspective should be promoted, which is known as 5P medicine (personalized, preventive, predictive, participatory and population), also called personalized medicine, a paradigm that has already initiated its entry, slow and uneven, in health systems. And it must also adapt to a society with more informed and participatory people in the management of their own health, which increasingly use technologies whose development speed grows exponentially. Taking into account these characteristics and objectives, in this article we seek to define the fundamental features of the intersection between innovation and clinical nutrition. [ABSTRACT FROM AUTHOR]

El manejo exitoso de la nutrición hospitalaria requiere un abordaje de equipo interdisciplinario y de un liderazgo que fomente la comunicación abierta entre las disciplinas. Para tener éxito, todos los miembros del equipo de salud tienen que entender la relevancia del cuidado nutricional para mejorar el pronóstico del paciente y el impacto financiero. El equipo interdisciplinario debe estar articulado y capacitado, de manera que permita brindar al paciente las mejores opciones en cuanto a su tratamiento, pronóstico, monitoreo y evaluación de las situaciones particulares dadas por el cuadro clínico. En esta interdisciplinaridad, los servicios de nutrición y dietética toman protagonismo considerando los múltiples beneficios evidenciados en los pacientes que reciben un abordaje nutricional desde las primeras horas de ingreso a las instituciones. Todos estos procedimientos para el tratamiento nutricional de los pacientes, deben estar soportados en políticas, programas y planes que sirven de sustento ideológico, teórico y preponderante para el correcto manejo nutricional en cada institución, considerando además la alimentación como un criterio trasversal en todas las etapas de la vida y en el proceso de salud y enfermedad. El objetivo de este articulo es describir las acciones realizadas por la Empresa Social del Estado Hospital Universitario Erasmo Meoz, en el ámbito del direccionamiento estratégico para la prestación de servicios relacionados con la nutrición y dietética en búsqueda de la calidad, el mejoramiento continuo, la prevención de las complicaciones, disminución de los costos de tratamiento y estancia hospitalaria, el bienestar y seguridad del paciente.

Introduction: the SARS-CoV-2 pandemic has forced major organizational and care changes in the health system. However, in Spain, the circumstances suffered by the health professionals who have cared for pandemic patients from a clinical nutrition standpoint has remained unknown up to this moment. Objectives: the management and care changes made in clinical nutrition units in Spain, and their impact on clinical practice are described. Material and methods: a cross-sectional study was carried out using a survey directed at SENPE members (June 2020). Responses sent by health professionals in the field of clinical nutrition who had treated patients with COVID-19 in Spanish hospitals were included in the study. Resultados: a total of 116 survey forms were analyzed, mostly filled out by doctors (57.8 %) working at hospitals with more than 500 beds (56 %); 46 % of survey respondents were on telework. There was a nutritional care plan in 68 % of cases, such plan being present mainly in hospitals with more than 500 beds (p < 0.001). In these hospitals more specific diets for COVID-19 were implemented than in those under 500 beds: 18 (35.3 %) vs 44 (67.7 %), (p < 0.001). The use of recommendations issued by scientific societies was reported in 86 % of cases. Never or almost never could a satisfactory nutritional assessment be performed for 38.8 %. The prescription of nutritional supplements was not less than 50 %. Health workers rated their performance as satisfactory or very satisfactory (51.7 %), and this was not related to hospital size but to having implemented a COVID-19 diet (p < 0.05). Conclusions: clinical nutrition in Spain has responded to the COVID-19 pandemic with organizational and managerial changes and, although care has been clearly affected, some quality standards were ultimately maintained. Larger hospitals have had some advantages in making these adjustments. [ABSTRACT FROM AUTHOR]

Introduction: Clinical nutrition has evolved in our country from the super-specialization of parenteral nutrition (PN) in the Intensive Care Unit (ICU) up to the community care of health. In the beginning, PN was used in a minimum percentage of hospitalized patients; the development of the enteral nutrition (EN) meant an extension of the beneficiaries to achieve a correct nutritional contribution. By getting involved in the diet code the responsibility was extended to the entire hospitalized population. Artificial nutrition techniques were subsequently extended to the patient's home and consolidated with the inclusion of the home enteral nutrition (HEN) in the Spanish National Health Service (SNS) portfolio. To improve the prevention of malnutrition, after the PREDYCES study, the Multidisciplinary Consensus emerged and later the Alianza Más Nutridos was developed, in which the field of clinical nutrition was extended to Primary Care and nursing homes. The last step is community health care, a strategy that is based on the concept that health is more than the absence of disease along with the need to involve citizens in their own decisions about their lifestyle and how to address health problems. [ABSTRACT FROM AUTHOR]

Introduction: The Management Working Group of SENPE has among its objectives the development of evaluation processes in Clinical Nutrition. Previously, the document entitled "Process of nutritional care: self-evaluation guide" was prepared as a tool designed to help assess the quality of nutritional therapy in hospitalized patients, mainly from the perspective of artificial nutrition. Now a complementary text of the previous one is presented, that describes the process by which hospitalized patients are fed. We have divided the hospital feeding process into six sections, for which a general description is made and quality indicators are proposed. We hope that this work will serve to improve the quality of hospital food and to help hospital food professionals to make their work more satisfactory and effective. [ABSTRACT FROM AUTHOR]

El estado nutricional del paciente hospitalizado, forma parte de la terapia, es bien conocido que existe alta prevalencia de pacientes desnutridos o en riesgo de desnutrición en el ambiente hospitalario. La nutrición parenteral, es una herramienta terapéutica para pacientes que no pueden ocupar la vía oral y/o enteral o esta no cubre los requerimiento. Es la menos fisiológica, ya que los nutrientes llegan directamente al torrente sanguíneo, su uso no está exento de riesgos, además está clasificada como un medicamento de alto riesgo, por lo que requiere supervisión y monitorización constante. En consecuencia, la misión del profesional químico farmacéutico es participar activamente en el equipo de soporte nutricional; en las visitas diarias a pacientes, colaborar en la prescripción de la mezcla, en la validación farmacéutica en relación a su estabilidad fisicoquímica y de los aportes de macronutrientes, micronutrientes y elementos traza. También es responsable de su elaboración, seguimiento de la terapia, en la detección de errores e incidentes relacionados a la terapia. Monitorización de ella con exámenes y en relación a la clínica del paciente, participación en las recomendaciones en la dispensación, administración y conservación de la mezcla. En este artículo se señalan de manera práctica, algunos tópicos como la indicación de uso de esta terapia, en pacientes pediátricos y adultos. Recomendaciones de macro, micronutrientes y elementos traza, consideraciones antes de prescribir y en relación a su seguimiento, validación farmacéutica y algunas presentaciones de nutrientes, electrolitos e insumos disponibles en el mercado nacional para prescribir y elaborar y recomendaciones de administración y conservación.

Copyright of Archivos Latinoamericanos de Nutrición is the property of Sociedad Latinoamericana de Nutricion and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

La situación económica actual ha dado pie al tema de esta conferencia que se desarrollará en dos grandes apartados: primero, trataremos de ideas generales sobre la racionalización versus el racionamiento en la sanidad, y, posteriormente, del racionamiento en la práctica de la nutrición clínica. Racionalizar, según la Real Academia Española de la Lengua, es organizar la producción o el trabajo de manera que aumente los rendimientos o reduzca los costos con el mínimo esfuerzo. Mientras que por racionamiento se entiende la acción y efecto de racionar o limitar el consumo de algo para evitar consecuencias negativas. En Europa, el porcentaje del Producto Interior Bruto destinado a Sanidad cae progresivamente mientras el coste de la Sanidad no para de aumentar. Desde el punto de vista económico, éste sería el principal motivo por el que las autoridades sanitarias parece que no tienen más alternativa que racionar. ¿Hasta qué punto el principio ético de justicia es compatible con el racionamiento? Éticamente, parece que para aceptar el racionamiento debería cumplirse no sólo una distribución justa de los recursos limitados sino también el uso racional de los mismos. Si se acepta que el recorte en prestaciones sanitarias es necesario, deberíamos responder a diversas preguntas: ¿qué es lo ético no recortar?, ¿quién decide lo que es médicamente necesario?, ¿cómo se decide? Sin respuestas coherentes a estas preguntas resulta difícil, éticamente, aceptar el racionamiento a nivel sanitario. Al tratar el racionamiento en la práctica de la nutrición clínica, debemos centrarnos en cómo el racionamiento afecta a la desnutrición, y más concretamente de la desnutrición relacionada con la enfermedad, ya que ello centra el origen de la Nutrición Clínica. Por su importancia e implicaciones se están llevando a cabo, en diversos países entre ellos en España, acciones integradas en la estrategia de la Unión Europea: "Together for health: a Strategic Approach for the EU 2008-2013" encaminadas a tomar medidas dirigidas a prevenir y tratar la desnutrición. Pero a pesar de ello, las restricciones persisten, situándonos en la necesidad imperativa de utilizar todas las herramientas a nuestro alcance para prevenir el desarrollo de la desnutrición en los pacientes en riesgo, para detectar precozmente los pacientes con desnutrición o riesgo de desarrollarla y para establecer las medidas de actuación más adecuadas.

Nutrition plays a fundamental role in the maintenance of health and the treatment of disease, and serves as the crossroads for many disciplines. Biochemistry and Molecular Biology represents a key brand of science to ascertain the mechanism of action of nutrients and other food bioactive compounds in health and disease. The aim of the present Jesús M. Culebras lecture is to consider the future of the relationships between Molecular Biology and Clinical Nutrition and to discuss the use of molecular and genetic tools to study molecular responses to dietary factors and the metabolic consequences of food and to consider major challenges on human nutrition sciences in the 21st century. Particular emphasis is given to the identification and use of novel biomarkers in inflammatory diseases. Likewise, the importance of the human microbiome and how microorganisms can be safely utilized in the prevention and management of infectious and chronic diseases are discussed. Moreover, the key role of nutrigenetics, nutrigenomics and epigenetics in the new era of nutrition is considered. Nutrigenetics refers to the role of DNA sequence variation in the responses to nutrients, whereas nutrigenomics is the study of the role of nutrients in gene expression. Epigenetics is the study of mitotically heritable alterations in gene expression potential that are not caused by DNA sequence alterations. In the past decade, it has increasingly been recognized that dysregulation of epigenetic mechanisms may play an important role in human disease. Indeed, there is increasing interest in epigenetic mechanisms underlying phenotype modification modulated by nutrients. Further research in those areas should contribute to evaluate functionality of specific nutrients and bioactive compounds in Clinical Nutrition and allow personalized nutritional advice.

Introducción: El problema de la desnutrición hospitalaria afecta según las series entre un 30-50% de los pacientes ingresados. Esta alta prevalencia justifica la necesidad de su detección precoz al ingreso. Existen múltiples herramientas clásicas de cribaje que muestran limitaciones importantes en su aplicación sistemática en la práctica clínica habitual. Objetivos: Ver la relación entre desnutrición, detectada por nuestro método de cribaje, y mortalidad, estancia o reingresos. Asimismo analizar la relación entre desnutrición y prescripción de soporte nutricional. Comparar distintos métodos de cribaje nutricional al ingreso sobre una muestra aleatoria de pacientes hospitalizados. Validación del método INFORNUT para cribaje nutricional. Material y Métodos: En una fase previa al diseño del estudio se realizo un análisis retrospectivo con datos del año 2003 con el fin de conocer la situación de la desnutrición en el Hospital Virgen de la Victoria de Málaga, recogiendo datos del CMBD (Conjunto Mínimo Básico de Datos), analíticas de riesgo nutricional (filtro FILNUT) y prescripción de soporte nutricional. En la fase experimental se realizo un estudio de cohorte transversal con una muestra aleatoria de 255 pacientes en Mayo del 2004. Se realiza estudio antropométrico, Valoración Subjetiva Global (VSG), Mini-Nutritional Assessment (MNA) y Nutrtional Risk Screening (NRS), método de Gassull, CONUT® e INFORNUT. Las condiciones de filtro aplicadas por INFORNUT son: albúmina < 3.5 g/dL y/o proteinas totales < 5 g/dL y/o prealbúmina< 18 mg/dL con o sin linfocitos totales < 1.600 cel/ml y/o colesterol total Introduction: According to several series, hospital hyponutrition involves 30-50% of hospitalized patients.The high prevalence justifies the need for early detection from admission. There several classical screening tools that show important limitations in their systematic application in daily clinical practice. Objectives: To analyze the relationship between hyponutrition, detected by our screening method, and mortality, hospital stay, or re-admissions. To analyze, as well, the relationship between hyponutrition and prescription of nutritional support. To compare different nutritional screening methods at admission on a random sample of hospitalized patients.Validation of the INFORNUT method for nutritional screening. Material and methods: In a previous phase from the study design, a retrospective analysis with data from the year 2003 was carried out in order to know the situation of hyponutrition in Virgen de la Victoria Hospital, at Malaga, gathering data from the MBDS (Minimal Basic Data Set), laboratory analysis of nutritional risk (FILNUT filter), and prescription of nutritional support. In the experimental phase, a cross-sectional cohort study was done with a random sample of 255 patients, on May of 2004. Anthropometrical study, Subjective Global Assessment (SGA), Mini-Nutritional Assessment (MNA), Nutritional Risk Screening (NRS), Gassull"s method,CONUT® and INFORNUT® were done. The settings of the INFORNUT filter were: albumin< 3.5 g/dL, and/or total proteins < 5 g/dL, and/or prealbumin < 18 mg/dL, with or without total lymphocyte count < 1.600 cells/mm3 and/or total cholesterol < 180 mg/dL. In order to compare the different methods, a gold standard is created based on the recommendations of the SENPE on anthropometrical and laboratory data. The statistical association analysis was done by the chi-squared test (a: 0.05) and agreement by the k index. Results: In the study performed in the previous phase, it is observed that the prevalence of hospital hyponutrition is 53.9%. One thousand six hundred and forty four patients received nutritional support, of which 66,9% suffered from hyponutrition. We also observed that hyponutrition is one of the factors favoring the increase in mortality (hyponourished patients 15.19% vs. non-hyponourished 2.58%), hospital stay (hyponourished patients 20.95 days vs. non-hyponourished 8.75 days), and re-admissions (hyponourished patients 14.30% vs. non-hyponourished 6%). The results from the experimental study are as follows: the prevalence of hyponutrition obtained by the gold standard was 61%, INFORNUT 60%. Agreement levels between INFORNUT, CONUT, and GASSULL are good or very good between them (k: 0.67 INFORNUT with CONUT, and k: 0.94 INFORNUT and GASSULL) and wit the gold standard (k: 0.83; k: 0.64 CONUT; k: 0.89 GASSULL). However, structured tests (SGA, MNA, NRS) show low agreement indexes with the gold standard and laboratory or mixed tests (Gassull), although they show a low to intermediate level of agreement when compared one to each other (k: 0.489 NRS with SGA). INFORNUT shows sensitivity of 92.3%, a positive predictive value of 94.1%, and specificity of 91.2%. After the filer phase, a preliminary report is sent, on which anthropometrical and intake data are added and a Nutritional Risk Report is done. Conclusions: Hyponutrition prevalence in our study (60%) is similar to that found by other authors. Hyponutrition is associated to increased mortality, hospital stay, and re-admission rate. There are no tools that have proven to be effective to show early hyponutrition at the hospital setting without important applicability limitations. FILNUT, as the first phase of the filter process of INFORNUT represents a valid tool: it has sensitivity and specificity for nutritional screening at admission. The main advantages of the process would be early detection of patients with risk for hyponutrition, having a teaching and sensitization function to health care staff implicating them in nutritional assessment of their patients, and doing a hyponutrition diagnosis and nutritional support need in the discharge report that would be registered by the Clinical Documentation Department. Therefore, INFORNUT would be a universal screening method with a good cost-effectiveness ratio.

El soporte nutricional del paciente crítico constituye un pilar importante dentro de la especialidad de medici-na intensiva. Los pacientes en la Unidad de Cuidados Intensivos (UCI) son frecuentemente hipercatabólicos y requieren de un soporte nutricional adecuado. La prescripción del tipo de nutrición, la cantidad y el seguimiento de los pacientes suele ser indicada generalmente por el médico intensivista, no obstante, no se conoce la calificación de estos médicos en relación a nutrición clínica. Objetivo: Investigar el grado de conocimiento sobre nutrición artificial y el interés por la nutrición en médicos intensivistas. Metodología: La encuesta prospectiva fue realizada a 60 médicos intensivistas de tres hospitales públicos de Asunción (22 especialistas y 38 residentes), con una edad media de 34 ± 6 años y con una experiencia media profesional de 5,8 ± 6 años. La encuesta constaba de 10 preguntas y respuestas de selección múltiple para determinar el grado de conocimiento según la calificación obtenida y 5 preguntas sobre formación propia y actitud frente al soporte nutricional en UCI. Resultados: El 98,3% de los encuestados consideraron que el tratamiento nutricional del paciente internado en la UCI incide sobre la morbimortalidad de los pacientes. A pesar de ello el 88,3% de los médicos consideraron insuficiente su formación en nutrición en UCI. El 70% no lee regularmente artículos de nutrición en revistas científicas. Sólo un 25% de los encuestados formulan nutrición parenteral y un 30% ha participado en algún curso de nutrición en UCI en los últimos 5 años. La calificación final de las 10 preguntas, para el valor máximo de 10, fue de 6,1 ± 1,9 para especialistas en UCI frente a 5,59 ± 2,3 para residentes (p = 0,3). Al analizar las repuestas correctas según los años de experiencia encontramos una media de 5,2 ± 2,3 en los que tienen menos de dos años de experiencia versus 6,4 ± 1,7 en los que tenían más de dos años de experiencia. (p = 0,02). Conclusiones: la formación en nutrición en medicina intensiva no es completa y el grado de conocimiento de nutrición en pacientes críticos es insuficiente, menor en los de experiencia limitada en UCI. Estos resultados apuntan la necesidad inmediata de educación y capacitación en nutrición clínica de los médicos intensivistas para que la atención al paciente crítico sea completa.Nutritional support in the critically ill patient is an important mainstay within the specialty of intensive care medicine. Patients at the Intensive Care Unit (ICU) are usually hypercatabolic and require an adequate nutritional support. Usually, the intensive care physician prescribes nutrition type, its amount, and follow-up of patients; however, the qualification of these physicians regarding clinical nutrition is unknown. Objective: to investigate the degree of knowledge on artificial nutrition and the interest on nutrition of intensive care physicians. Methodology: a prospective survey was done on 60 intensive care physicians from three public hospitals of Asunción (22 staff physicians and 38 internal residents), with a mean age of 34 ± 6 years, and a mean professional practice of 5.8 ± 6 years. The survey contained 10 questions and multiple-choice answers to determine the degree of knowledge depending on the grade obtained, and 5 questions on personal training and attitude towards nutritional support in the ICU. Results: 98.3% of surveyed physicians considered that nutritional support of the ICU-admitted patient has an effect on morbidity and mortality of patients. Nevertheless, 88.3% of physicians considered their nutritional training in the ICU as insufficient. Seventy percent do not usually read papers on nutrition on scientific journals. Only 25% of them formulate parenteral nutrition, and 30% have attended a course on nutrition in the ICU within the last 5 years. The final grade for the 10 questions, the maximum grade possible being 10, was 6.1 ± 1.9 for staff physicians, and 5.59 ± 2.3 for internal residents (p = 0.3). When analyzing the correct answers by years of practice, the mean grade was 5.2 ± 2.3 in those with less than 2 years of practice versus 6.4 ± 1.7 in those with more than 2 years of practice (p = 0.02). Conclusions: nutritional training in intensive care medicine is incomplete and the degree of knowledge on nutrition in the critically ill patient is insufficient, being lower in physicians with a limited practice in the ICU. These results suggest the urgent need for training on clinical nutrition of intensive care physicians for the care of the critically ill patient being complete.

Background: The serious problem of hospital undernutrition is still being underestimated, despite its impact on clinical evolution and costs. The screening methods developed so far are not useful for daily clinical practice due to their low effectiveness/cost ratio. Objective:We present an screening tool for CONtrolling NUTritional status (CONUT) that allows an automatic daily assessment of nutritional status of all inpatients that undergo routine analysis. Design: The system is based on a computer application that compiles daily all useful patient information available in hospital databases, through the internal network. It automatically assesses the nutritional status taking into account laboratory information including serum albumin, total cholesterol level and total lymphocyte count. We have studied the association between the results of the Subjective Global Assessment (SGA) and Full Nutritional Assessment (FNA) with those from CONUT, in a sample of 53 individuals. Results: The agreement degree between CONUT and FNA as measured by kappa index is 0.669 (p = 0.003), and between CONUT and SGA is 0.488 (p = 0.034). Considering FNA as "gold standard" we obtain a sensitivity of 92.3 and a specificity of 85.0. Conclusions: CONUT seems to be an efficient tool for early detection and continuous control of hospital undernutrition, with the suitable characteristics for these screening functions.Antecedentes: El grave problema de la desnutrición hospitalaria sigue siendo infravalorado, pese a sus repercusiones sobre la evolución clínica y los costes de la hospitalización. Los procedimientos de filtro desarrollados hasta ahora no son útiles para la práctica diaria por su baja relación efectividad/costo. Objetivo: Presentamos un sistema de cribado para el CONtrol NUTricional que permite valorar a diario, de manera automática, la situación nutricional de la totalidad de los pacientes ingresados a los que se practica análisis de rutina. Diseño: El sistema se basa en una aplicación informática que recopila a diario, a través de la red interna, aquellos datos de los pacientes ingresados que se consideran útiles para evaluar su estado nutricional y que están disponibles en bases de datos del hospital. Automáticamente determina la situación nutricional de los pacientes considerando los datos de laboratorio: albúmina, colesterol y linfocitos totales. Hemos estudiado la asociación entre los resultados del Subjective Global Assessment (SGA) y del Full Nutritional Assessment (FNA) con aquellos del CONUT, en una muestra de 53 individuos. Resultados: El grado de concordancia entre el CONUT y el FNA, medido por el índice kappa es de 0,699 (p = 0,003), y entre el CONUT y el SGA es de 0,488 (p = 0,034). Si consideramos que el FNA es la "prueba de referencia", obtenemos una sensibilidad del 92,3 y una especificidad del 85,0. Conclusiones: Parece que CONUT es una herramienta eficaz para la detección precoz y el control continuo de la desnutrición hospitalaria, con las características adecuadas a las funciones de cribado.

Changes in nutritional status are related to an increase in morbidity and mortality. It is well established that health care professionals, particularly physicians, lack formal education to recognize nutritional disorders, which malnutrition may worsen in the hospital, and that appropriate education could effectively correct this problem. Aim: To evaluate the awareness of the health care university students and professionals about the nutrition disorders in Amazon region hospitalized patients before and after a specific education program. Study design: An intensive Course on Clinical Nutrition, given in three weekly classes was offered to the multidisciplinary health care students and professionals of the health care tem. Cases and methods: 195 participants started the course. They were 97 students of nursing, 52 students of medicine, 20 nurses, 15 resident physicians, 3 physicians, 3 dietitians, 2 others, 1 no answer. 165 participants concluded it. Precourse and postcourse tests were answered. The results of these tests are presented in this study. Results and Discussion: 76.4% of the participants were graduation students. 40% of participants had no contact with patients yet. When the exposure of the participants of the course to the theme Nutrition was analyzed, 46.7% of the resident physicians considered their contact with the subject superficial and 13.3% had no contact with it, reinforcing the physician´s lack of knowledge to recognize malnutrition. Participants admitted having significantly profited from the course. Conclusions: the lack of awareness of the multidisciplinary health care team about nutritional disorders may contribute to worsen hospital malnutrition. An intensive course for graduate students and residents may help to raise awareness for clinical nutrition. The great interest and enthusiasm shown by the students and other participants and the profit obtained by them from the course suggest that teaching of clinical nutrition should be implemented in all health care schools.Las alteraciones del estado nutricional están relacionadas con el aumento de la morbilidad y mortalidad. A pesar de no haber consenso en relación a los criterios diagnósticos de la malnutrición, ésta se agrava a medida que aumenta el tiempo de internación hospitalaria. Diversos autores concluyen que el equipo de salud, particularmente los médicos, no están siendo enseñados a reconocer la malnutrición, que esta malnutrición es agravada en el hospital y que la educación puede efectivamente corregir el problema. Objetivo: Evaluar la concientización de los estudiantes de graduación en salud y de los profesionales de la comisión multidisciplinar de salud al respecto de los desórdenes nutricionales de pacientes hospitalizados antes y después del programa intensivo de educación. Diseño del estudio: Un curso intensivo de Nutrición Clínica, fue administrado en tres clases semanales para los estudiantes de graduación en salud y profesionales en el equipo de salud. Pacientes y métodos. 195 participantes iniciaron el curso, frecuentado por 97 estudiantes de enfermería, 52 estudiantes de medicina, 20 enfermeros, 15 médicos residentes, 3 médicos, 3 nutricionistas, 2 otras actividades y 1 sin respuesta. 165 concluyeron el curso. Una prueba antes y una prueba después del curso fueron respondidas. El resultado de estas pruebas es presentado en este estudio. Resultados y discusión: 76,4% de los participantes son alumnos, con edad media de 24,39 años. 40% de los participantes aún no habían tenido contacto con pacientes. Cuando la exposición de los participantes del curso al tema Nutrición fue analizada, 46,7% de los médicos residentes consideró su contacto anterior con el tema como superficial y 13,3% no habían tenido ningún contacto, reforzando la idea de muchos autores que los médicos no están siendo enseñados a reconocer una malnutrición debido a falta de énfasis dada a la nutrición del currículum médico. Los participantes del curso de Nutrición Clínica reconocieron haber obtenido lucro significante. Conclusiones: Malnutrición hospitalaria puede ser agravada por la falta de concientización de la comisión multidisciplinar de salud al respecto del problema. Pero el gran interés y entusiasmo demostrado por los participantes y el lucro obtenido con el curso sugiere que la llave para abrir la puerta del armario es la educación. La enseñanza de Nutrición debe ser implementada en todas las escuelas de profesiones que cuidan de la salud.

Objective: Almost half of all hospitalized patients are malnourished with low physician awareness or implementation of nutrition support¹. To address this problem, a 2-day immersion course in clinical nutrition for physicians was developed by the Latin American Federation of Parenteral and Enteral Nutrition (FELANPE) with support from Abbott Laboratories. The goal of Total Nutritional Therapy (TNT) is to help physicians utilize this nutrition knowledge to increase their awareness of malnutrition and implementation of nutritional therapy. Since 1997, over 8,000 physicians have completed the TNT course in 16 Latin American countries. Research Methods & Procedures: During 1999 and 2000, 675 participants responded to a survey 6 months after having completed the TNT course to determine what impact the course had on the use of nutrition assessment, nutrition support teams, or nutrition consultations in their clinical practice, and if they had participated in any nutrition association or conferences. Results: The majority of physicians who completed the survey increased their use of nutrition assessment and time dedicated to nutrition therapy, and increased the number of their patients placed on nutrition therapy. Conclusions: The TNT course has been shown to be an efficient model of clinical nutrition education for general physicians. The course should be considered as part of the training of medical residents.Objetivo: Casi la mitad de todos los pacientes hospitalizados se encuentran desnutridos y los médicos tienen muy poco conocimiento o apenas utilizan el soporte nutricional¹. Para corregir este problema, la Federación Latinoamericana de Nutrición Parenteral y Enteral (FELANPE) ideó un curso introductorio de nutrición clínica para médicos de dos días, con el apoyo de los Laboratorios Abbott. El objetivo del tratamiento nutricional total (TNT) es ayudar al médico a aprovechar sus conocimientos de nutrición para incrementar la conciencia sobre malnutrición y aplicación del tratamiento nutricional. Desde 1997, más de 8.000 médicos han completado el curso TNT en 16 países latinoamericanos. Métodos y procedimientos experimentales: Durante 1999 y 2000, 675 participantes respondieron, seis meses después de haber terminado el curso TNT, a una encuesta en la que se pretendía averiguar la repercusión que había tenido el curso en el uso de la evaluación nutricional, los equipos de apoyo nutricional o las consultas sobre nutrición en la práctica clínica y si habían participado en alguna asociación o conferencia de nutrición. Resultados: La mayoría de los médicos que rellenaron la encuesta había aumentado el uso de las herramientas de evaluación nutricional y el tiempo dedicado a este tratamiento; asimismo, había aumentado el número de pacientes que recibieron tratamiento nutricional. Conclusiones: El curso TNT ha resultado un modelo eficiente para la educación de los médicos generales en nutrición clínica. Este curso debería integrarse en la formación de los médicos residentes.

Dado que la malnutrición es una complicación frecuente en los pacientes con cáncer, es necesario identificarla con herramientas sencillas. La valoración subjetiva global (SGA) es un medio para valorar el estado nutricional basado en parámetros clínicos y puede ser empleada por un clínico con un entrenamiento básico. Nuestra intención es determinar la utilidad de la SGA empleada por personal ajeno a Nutrición Clínica para comprobar si se identifican adecuadamente los pacientes con malnutrición. En nuestro estudio se incluyeron treinta pacientes ambulatorios de ambos sexos con diversas formas activas de neoplasia, en tratamiento con quimio o radioterapia. Se realizó la SGA de forma independiente por el personal de Oncología y el de Nutrición Clínica tras completar los pacientes parte del cuestionario; asimismo se realizaron determinaciones bioquímicas y antropométricas. Se diagnosticó malnutrición o sospecha de la misma en el 63% de los pacientes al ser valorados por Oncología, el 30% por Nutrición Clínica y por medidas antropométricas el 26%. La incidencia de malnutrición fue baja debido a que el tipo de cáncer mayoritario fue el colorrectal. En Oncología se tendía a diagnosticar más malnutrición debido a un entrenamiento insuficiente; sin embargo, la SGA fue útil ya que no se perdió ningún paciente malnutrido y se identificó al 50% de los pacientes bien nutridos, quienes no necesitan intervención nutricional.As malnutrition is a common complication among patients with cancer, it seems necessary identifying it with simple tools. Subjective Global Assessment (SGA) is useful to evaluate nutritional status on a basis of clinical parameters and can be used by any clinician with a basic training. Our intention is to determine usefulness of SGA applied by staff not working at Clinical Nutrition to guess if they identify properly malnourished patients. We included in our study thirty male and female patients with several types of active neoplasm who were being treated with chemo or radiotherapy. Oncology and Clinical Nutrition staff used SGA separately after the patients answered the form; there were also taken biochemical and anthropometrical determinations. Sixty-three percent of patient were diagnosed as malnourished or suspected being so by Oncologists, 30% by Clinical Nutrition staff and 26% by anthropometrical means. Incidence of malnutrition was low because the most common neoplasm among patients in the study was colorectal cancer. Oncologists tended to diagnose more cases of malnutrition due to a deficient training; nevertheless, SGA was useful because none of the malnourished patients was misdiagnosed and half of the well nourished patients were correctly identified as ones with no need for nutritional support.

Introduction: the implementation of quality management systems (QMS) in the health sector has made great progress in recent years, remains a key tool for the management and improvement of services provides to patients. Aim: to describe the process of implementing a quality management system (QMS) according to the standard ISO 9001:2008 in a Nutrition Unit. Methods: the implementation began in October 2012. Nutrition Unit was supported by Hospital Preventive Medicine and Quality Management Service (PMQM). Initially training sessions on QMS and ISO standards for staff were held. Quality Committee (QC) was established with representation of the medical and nursing staff. Every week, meeting took place among members of the QC and PMQM to define processes, procedures and quality indicators. We carry on a 2 months follow-up of these documents after their validation. Results: a total of 4 processes were identified and documented (Nutritional status assessment, Nutritional treatment, Monitoring of nutritional treatment and Planning and control of oral feeding) and 13 operating procedures in which all the activity of the Unit were described. The interactions among them were defined in the processes map. Each process has associated specific quality indicators for measuring the state of the QMS, and identifying opportunities for improvement. All the documents associated with requirements of ISO 9001:2008 were developed: quality policy, quality objectives, quality manual, documents and records control, internal audit, nonconformities and corrective and preventive actions. The unit was certified by AENOR in April 2013. [ABSTRACT FROM AUTHOR]

Background/objectives: the incidence of hospital undernutrition and its consequences for both the patient and the hospital has demanded procedures that ensure the delivery of good-quality hospital nutritional care. On the basis of literature reports, this study aimed to build a hospital nutritional care propositions that the scientific community later evaluated and endorsed.Methods: forty-one propositions concerning patient clinical nutritional care and hospital food service management by the Hospital Nutrition and Food Service were designed. One hundred professionals, researchers, and professors evaluated the propositions. Agreement with the propositions was analyzed by means of a five-point Likert scale (I strongly disagree; I partially disagree; I have no opinion; I partially agree; I totally agree) associated with each proposition. Agreement was considered to occur when 70% or more of the interviewees agreed (partially or totally) with the proposition. The procedure Proc Corresp of the software SAS 10, version 8, aided descriptive statistics and correspondence analysis.Results: more than 90% of the interviewees completely or partially agreed with 85% (35) of the 41 propositions; between 80 and 90% of the interviewees totally or partially agreed with 15% (6) of the 41 propositions. All the proposed criteria had over 70% agreement (total and partial). The lowest value of total agreement was 70%, attributed to the proposition that suggested patient's participation in nutritional intervention.Conclusions: the scientific community presented high level of agreement with the hospital nutritional care propositions, which suggested an important consensus about it. [ABSTRACT FROM AUTHOR]

Nowadays, balanced scorecards have updated traditional management systems in the business sector. In this way, Kaplan and Norton propose performance measurement through several perspectives with a logical sequence: internal processes and learning impact client services, so that financial performance is affected. The aim of the present paper is to analyze the main characteristics of balanced scorecard when it is applied to non-for-profit companies and, specifically to the health sector in the clinical nutrition field. This model improves the economic vision of management with clinical indicators that represent healthcare professional's perspective. The balanced scorecard would allow a proper monitoring and tracking system for the main healthcare indicators. This contributes to a better control in comparison with standards that are associated with adequate quality assistance. Owing to the role of management accounting and cost calculations, the definition of healthcare professionals as clients or users, and clinical results relevance, it is necessary to adapt the balanced scorecard to the specific characteristics of the clinical field, redefining both perspectives and indicators. [ABSTRACT FROM AUTHOR]

Introduction: The contribution of diet and treatment planning in the treatment of Chronic Kidney Disease (CKD) has been recognized as having a significant clinical impact if introduced early. Objective: determine the levels of carbohydrates, proteins, lipids, energy and energy density (ED) in an oral hospital diet prescribed to CKD patients, and to evaluate the adequacy of this diet with respect to dietary recommendations. Methods: Diets were collected in a Brazilian public hospital on two non-consecutive days of six different weeks. The carbohydrate, protein, and lipid (total, saturated, monounsaturated, polyunsaturated, linoleic, linolenic and trans fatty acids) contents were determined in a laboratory. The amount of energy and the ED of the diets were calculated using the correction factor Atware and by dividing the total energy of the diet by weight, respectively. Results and Discussion: About 14.3% of the diets produced for patients with CKD were analyzed. The average density of the diets was low (0.7 kcal/g). In terms of nutritional adequacy, the average lipid content (15%) and linolenic fatty acid content (0.4%) were below the recommendation, as was energy (23.4 kcal / kg / day). The average carbohydrate content (63.5%) and protein content (1.0 g/kg/day) exceeded the recommendations levels. Conclusion: The oral hospital diet prepared for patients with CKD were considered unbalanced, and an unfavorable clinical treatment for these patients. [ABSTRACT FROM AUTHOR]

Objective: To determine the usefulness of CONUT against the application of MNA instrument and biochemical evaluation in the assessment of the nutritional status of elderly patients (EP), hospitalized in the Internal Medicine 6C National Hospital Edgardo Rebagliati Martins EsSalud. Material and Methods: Cross-sectional study, in which CONUT MNA questionnaires were applied to 74 hospitalized EP. Statistical analysis was performed using the chi square test and analysis of variance. Results: The mean age was 75.65 ± 4.8 years, predominantly male. The weight was 66.95 ± 10 kg, height 1.62 ± 0.07 m, BMI 27.4 ± 6.6, 3.26 ± 0.5 g albumin / dL, cholesterol 184.3 ± 59.3 mg / d, and the lymphocyte count, 1847 ± 967 cells/ mm3. The result of the MNA identified 26 malnourished (35.15%), 32 with risk of malnutrition (43.25%) and 16 with normal nutritional status (21.60%). According to CONUT's variables associated with the results of MNA, we found that with increasing degree of malnutrition, albumin, cholesterol and lymphocyte levels decline. The percentages of the categories of MNA, for different degrees of nutrition as CONUT categories are significantly associated in the variable albumin. The sensitivity and specificity for the CONUT against MNA was high (86% and 62% respectively). Conclusions: Statistically, CONUT was associated with MNAin the identification of hospitalized patients at riskof malnutrition. [ABSTRACT FROM AUTHOR]

Nutrition plays a fundamental role in the maintenance of health and the treatment of disease, and serves as the crossroads for many disciplines. Biochemistry and Molecular Biology represents a key brand of science to ascertain the mechanism of action of nutrients and other food bioactive compounds in health and disease. The aim of the present Jesús M. Culebras lecture is to consider the future of the relationships between Molecular Biology and Clinical Nutrition and to discuss the use of molecular and genetic tools to study molecular responses to dietary factors and the metabolic consequences of food and to consider major challenges on human nutrition sciences in the 21st century. Particular emphasis is given to the identification and use of novel biomarkers in inflammatory diseases. Likewise, the importance of the human microbiome and how microorganisms can be safely utilized in the prevention and management of infectious and chronic diseases are discussed. Moreover, the key role of nutrigenetics, nutrigenomics and epigenetics in the new era of nutrition is considered. Nutrigenetics refers to the role of DNA sequence variation in the responses to nutrients, whereas nutrigenomics is the study of the role of nutrients in gene expression. Epigenetics is the study of mitotically heritable alterations in gene expression potential that are not caused by DNA sequence alterations. In the past decade, it has increasingly been recognized that dysregulation of epigenetic mechanisms may play an important role in human disease. Indeed, there is increasing interest in epigenetic mechanisms underlying phenotype modification modulated by nutrients. Further research in those areas should contribute to evaluate functionality of specific nutrients and bioactive compounds in Clinical Nutrition and allow personalized nutritional advice. [ABSTRACT FROM AUTHOR]

Introduction: According to several series, hospital hyponutrition involves 30-50% of hospitalized patients. The high prevalence justifies the need for early detection from admission. There several classical screening tools that show important limitations in their systematic application in daily clinical practice. Objectives: To analyze the relationship between hyponutrition, detected by our screening method, and mortality, hospital stay, or re-admissions. To analyze, as well, the relationship between hyponutrition and prescription nutritional support. To compare different nutritional screening methods admission on a random sample of hospitalized patients. Validation of the INFORNUT method for nutritional screening. Material and methods: In a previous phase from the study design, a retrospective analysis with data from the year 2003 was carried out in order to know the situation of hyponutrition in Virgen de la Victoria Hospital, at Malaga, gathering data from the MBDS (Minimal Basic Data Set), laboratory analysis of nutritional risk (FILNUT filter), and prescription of nutritional support. In the experimental phase, a cross-sectional cohort study was done with a random sample of 255 patients, on May 2004. Anthropometrical study, Subjective Global Assessment (SGA), Mini-Nutritional Assessment (MNA), Nutritional Risk Screening (NRS), Gassull's method, CONUT® and INFORNUT® were done. The settings of the INFORNUT filter were: albumin 3.5 g/dL, and/or total proteins < 5 g/dL, and/or prealbumin < 18 mg/dL, with or without total lymphocyte count < 1.600 cells/mm3 and/or total cholesterol < 180 mg/dL. In order to compare the different methods, a gold standard is created based on the recommendations of the SENPE on anthropometrical and laboratory data. The statistical association analysis was done by the chi-squared test (a: 0.05) and agreement by the k index. Results: In the study performed in the previous phase, it is observed that the prevalence of hospital hyponutrition is 53.9%. One thousand six hundred and forty four patients received nutritional support, of which 66,9% suffered from hyponutrition. We also observed that hyponutrition is one of the factors favoring the increase in mortality (hypo-nourished patients 15.19% vs. non-hyponourished 2.58%), hospital stay (hyponourished patients 20.95 days vs. non-hyponourished 8.75 days), and re-admissions (hypo-nourished patients 14.30% vs. non-hyponourished 6% I. The results from the experimental study are as follows: the prevalence of hyponutrition obtained by the gold standard was 61%, INFORNUT 60%. Agreement levels between INFORNUT, CONUT, and GASSULL are good or very good between them (k: 0.67 INFORNUT with CONUT, and k: 0.94 INFORNUT and GASSULL) and wit the gold standard (k: 0.83; k: 0.64 CONUT; k: 0.89 GASSULL). However, structured tests (SGA, MNA, NRS) show low agreement indexes with the gold standard and laboratory or mixed tests (Gassull), although they show a low to intermediate level of agreement when compared one to each other (k: 0.489 NRS with SGA). INFORNUT shows sensitivity of 92.3%, a positive predictive value of 94.1%, and specificity of 91.2%. After the filer phase, a preliminary report is sent, on which anthropometrical and intake data are added and a Nutritional Risk Report is done. Conclusions: Hyponutrition prevalence in our study (60%) is similar to that found by other authors. Hyponutrition is associated to increased mortality, hospital stay, and re-admission rate. There are no tools that have proven to be effective to show early hyponutrition at the hospital setting without important applicability limitations. FILNUT, as the first phase of the filter process of INFORNUT represents a valid tool: il has sensitivity and specificity fur nutritional screening at admission.… [ABSTRACT FROM AUTHOR]

Introduction: Resident physicians' proper use of nutritional support and knowledge about Clinical Nutrition is essential to ensuring that their patients receive suitable nutritional care., Materials and Method: An online survey was sent to resident physicians at our hospital in specialisations with hospital beds. The survey featured 20 multiple-choice questions scored from 1 to 10 (1 being "completely disagree" and 10 being "completely agree") across the following themes: nutritional assessment, diets, oral nutritional supplements, enteral nutrition and perception of the Nutrition Unit., Results: The survey was completed by 69% of resident physicians in medical specialisations and 70% of those in surgical specialisations. Overall, the average survey score was 6.28, with higher scores among medical residents than surgical residents (6.86 versus 5.38; p < 0.001), especially in the sections on nutritional assessment, diets and oral nutritional supplements. The respondents had a positive perception of the Nutrition Unit (mean score 7.6)., Discussion: Residents in medical specialisations afford greater importance to their patients' nutrition than residents in surgical specialisations, although in both groups the average score was rather low. There is much room for improvement in the training in Clinical Nutrition of this group, and it is important to include topics in Clinical Nutrition in training programmes for all residents in hospital specialisations., (Copyright © 2021 SEEN and SED. Published by Elsevier España, S.L.U. All rights reserved.)