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Objective: It has been proposed that a mild form of acquired resistance to thyroid hormone may occur in the general population. Its clinical significance remains largely unknown. The objective of the study was to explore whether a newly described thyroid hormone resistance index is associated with the risk of mortality in a sample of community-dwelling euthyroid subjects representative of the adult population of Spain.; Design: Longitudinal observational study including 3750 individuals, free of thyroid disease, TPO antibodies-negative ( p5 and =p25; >p25 and =p50; >p50 and =p75; >p75 and =p95 and >p95 were 1.01, (0.47-2.19), 1.42 (0.68-2.97), 1.54 (0.74-3.22), 1.47 (0.70-3.11) and 2.61 (1.16-5.89), respectively (P for trend 0.003). The association remained significant after multivariate adjustment of the data (P for trend 0.017).; Conclusions: A thyroid hormone resistance index focused on deviations of the average pituitary response to thyroid hormones may be associated with all-cause mortality independently of other conventional risk factors and comorbidities.

Como es habitual, coincidiendo con el comienzo de un nuevo ejercicio, el Comité Editorial da cuenta del último año en Nutrición Hospitalaria (NH), de su situación general, de los cambios producidos y de los resultados obtenidos. Dos son los aspectos relevantes durante 2017, en apariencia, contrapuestos: el incremento en la visibilidad de la revista y, a la vez, la disminución en el factor de impacto Journal Citation Report (JCR).

Background: The Cystic Fibrosis Questionnaire-Revised (CFQ-R+ 14) is a disease-specific, health-related quality of life instrument for cystic fibrosis (CF) patients >= 14 years. We have developed a Spanish electronic version of the CFQ-R (e-CFQ-R+ 14 Spain). Our aim was to compare the paper and electronic versions and to validate the electronic version. Methods: Fifty CF patients completed the study. All answered the paper and electronic versions on day 1 and repeated the e-CFQR version 15 days later. Results: Concordance between the electronic and paper copy versions was high, with correlations above 0.9 in all domains. Test-retest reliability of the e-CFQ-R results was strong, with coefficients ranging from 0.8 to 0.9. Conclusions: The e-CFQ-R version is reliable and valid and can replace the paper copy, thus simplifying the assessment of quality of life. It also provides immediate results with no errors in scoring. It is a useful new tool in CF care. (C) 2017 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.

Introduction: Home parenteral nutrition (HPN) improves quality of life, allowing patients to receive nutrition at home and providing a social and labor integration to these patients. Objective: To assess the direct costs of HPN in adult population in Spain. Methods: A literature review of the records of HPN in Spain, carry out by NADYA-SENPE Group (years 2007-2014), was performed. The analysis included the evolution of: patients requiring HPN, number of episodes/patient, mean duration of episodes, description of delivery routes and complications rate. HPN consumption and cost were estimated. Patients were grouped according to their pathological group: benign and malignant. Direct costs ((sic),2015) included were: parenteral nutrition bags, delivery sets and costs due to complications. Results: The number of patients who receive HPN has increased over years (2007: 133 patients; 2014: 220 patients). The average number of episodes per patient ranged from 1-2 episodes per year. The average duration of those episodes decreased (2007: 323 days; 2014: 202.8 days). Tunneled catheters were the most used and septic complications were the most common. The average annual cost per patient was estimated at (sic)8,393.30 and (sic)9,261.60 for benign and malign disease respectively. Considering that 220 patients required HPN in 2014, an annual cost of (sic)1,846.524.96 ((sic)1,389,910.55 directly due to HPN) and (sic)2,037,551.90 ((sic)1,580,937.50 directly due to HPN) was estimated for patients with benign and malignant pathologies respectively. Conclusions: These results can be used to develop future economic evaluations on HPN and to establish efficient prioritization strategies to allocate available resources.

Journal Article; Research Support, Non-U.S. Gov't; Review; BACKGROUND & AIMS By means of this update, the GARIN working group aims to define its position regarding the treatment of patients with diabetes or stress hyperglycaemia and artificial nutrition. In this area there are many aspects of uncertainty, especially in non-critically ill patients. METHODS Bibliographical review, and specific questions in advance were discussed and answered at a meeting in the form of conclusions. RESULTS We propose a definition of stress hyperglycaemia. The indications and access routes for artificial nutrition are no different in patients with diabetes/stress hyperglycaemia than in non-diabetics. The objective must be to keep pre-prandial blood glucose levels between 100 and 140 mg/dl and post-prandial levels between 140 and 180 mg/dl. Hyperglycemia can be prevented through systematic monitoring of capillary glycaemias and adequately calculate energy-protein needs. We recommend using enteral formulas designed for patients with diabetes (high monounsaturated fat) to facilitate metabolic control. The best drug treatment for treating hyperglycaemia/diabetes in hospitalised patients is insulin and we make recommendations for adapt the theoretical insulin action to the nutrition infusion regimen. We also addressed recommendations for future investigation. CONCLUSIONS This recommendations about artificial nutrition in patients with diabetes or stress hyperglycaemia can add value to clinical work. Yes Introducción y objetivos: En el tratamiento de los pacientes con diabetes o hiperglucemia de estrés y la nutrición artificial existen muchas áreas de incertidumbre, sobre todo en pacientes no críticos. El grupo de trabajo GARIN tiene como objetivo definir su posición en este campo. Material y métodos: Revisión bibliográfica previa y reunión presencial en la que se discutieron y contestaron preguntas específicas sobre el tema. Resultados: Proponemos una definición de hiperglucemia de estrés. Las indicaciones y las rutas de acceso a la nutrición artificial no difieren en los pacientes con hiperglucemia de estrés o diabetes respecto a los no diabéticos. El objetivo debe ser mantener los niveles de glucemia preprandial entre 100 y 140 mg/dl y postprandial entre 140 y 180 mg/dl. La hiperglucemia puede prevenirse a través de una monitorización sistemática de las glucemias capilares y un cálculo adecuado de las necesidades energético-proteicas. Recomendamos el uso de fórmulas enterales diseñadas para pacientes con diabetes (alto contenido en grasas monoinsaturadas) para facilitar el control metabólico. El mejor tratamiento farmacológico para tratar la hiperglucemia/diabetes en pacientes hospitalizados es la insulina, aconsejando adaptar la acción teórica de la insulina al régimen de infusión de la nutrición. También realizamos recomendaciones para investigaciones futuras. Conclusiones: Estas recomendaciones aportan respuestas concretas sobre cuestiones comunes en la asistencia a pacientes con diabetes o hiperglucemia de estrés y nutrición artificial.

OBJETIVE: To report the data of the Home Parenteral Nutrition (HPN) registry of the NADYA-SENPE working group for the years 2011 and 2012. METHODOLOGY: We compiled the data from the on-line registry introduced by reviewers of NADYA group responsible for monitoring of NPD introduced by since January 1, 2011 to december 31, 2012. Included fields were: age, sex, diagnosis and reason for HPN, access path, complications, beginning and end dates, complementary oral or enteral nutrition, activity level, autonomy degree, product and fungible material supply, withdrawal reason and intestinal transplant indication. RESULTS: Year 2010: 184 patients from 29 hospitals , representing a rate of 3.98 patients/million inhabitants/ year 2011, with 186 episodes were recorded NPD . During 2012, 203 patients from 29 hospitals , representing a rate of 4.39 patients/million inhabitants/year 2012 , a total of 211 episodes were recorded NPD . CONCLUSIONS: We observe an increase in registered patients with respect to previous years.Neoplasia remains as the main pathology since 2003. Although NADYA is consolidated registry and has been indispensable source of information relevant to the understanding of the progress of Home Artificial Nutrition in our country, there is ample room for improvement. Especially that refers to the registration of pediatric patients and the registration of complications. Yes Objetivo: Comunicar los datos del registro de Nutrición Parenteral Domiciliaria (NPD) del grupo de trabajo NADYA-SENPE de los años 2011 y 2012. Material y métodos: Recopilación de los datos del registro “on-line” introducidos por los colaboradores del grupo NADYA responsables del seguimiento de la NPD desde el 1 de enero de 2011 al 31 de diciembre de 2012 dividido por años naturales. Resultados: Año 2010: Se registraron 184 pacientes, procedentes de 29 hospitales, lo que representa una tasa de 3,98 pacientes/millón habitantes/año 2011, con 186 episodios de NPD. Durante el año 2012 se registraron 203 pacientes, procedentes de 29 hospitales, lo que representa una tasa de 4,39 pacientes/millón habitantes/año 2012, con un total de 211 episodios de NPD. Conclusiones: Se observa un aumento progresivo de los pacientes registrados respecto a años anteriores. El principal grupo patológico sigue siendo oncológico ocupando el primer lugar desde 2003. Aunque el registro NADYA es un registro consolidado y ha sido y es fuente imprescindible de información relevante para el conocimiento de los avances de la Nutrición Artificial Domiciliaria en nuestro país, queda un amplio margen para la mejora. En especial lo que hace referencia al registro de pacientes pediátricos y al registro de las complicaciones.

English Abstract; Journal Article; Health economics pretends to assign resources that are short in essence and that may be used for other purposes. Health costs analysis pretends to compare the pros and cons of several options among which an election can be made in order to obtain greater benefits with lower costs. The current legislation on prescription of enteral nutrition entails confusing definitions about the administration route and the requirements of home-based enteral nutrition, without a specific regulation comprising the prescription of oral supplements (OS). From the year 2000 to 2007, the consumption of homebased enteral nutrition in Andalusia increased considerably; the costs generated being multiplied by 37. Although the number of persons that daily consumed supplements was higher than the number of diets through nasogastric tube (DT) during the years evaluated, the costs derived from OS surpassed those of DT from the year 2005 due to the combination of two factors: a progressive increase in the number of persons to whom supplements were prescribed, and on the other hand the incorporation of more expensive specific formulations. The use of oral supplements seems to be cost/effective in hospitalized surgical patients (during the pre- and postsurgical period) and possibly in hospitalized malnourished elderly, especially after performing a hyponutrition screening. Although they may be effective, under other circumstances, such as ambulatory patients, studies with an adequate methodology are necessary in order to adopt clinical decisions based on evidence and cost analysis. Yes La economía de la salud pretende asignar unos recursos que son, por definición, escasos y que, a su vez, pueden ser invertidos para otros usos. El análisis de costes en salud pretende comparar los pro y los contras de diversas opciones entre las que se puede elegir, para obtener los mayores beneficios con menores costes. La legislación actual sobre prescripción de nutrición enteral recoge definiciones confusas acerca de la vía de administración y los requerimientos en la nutrición enteral domiciliaria, no existiendo una normativa específica que recoja la prescripción de suplementos orales (SO). Desde el año 2000 a 2007, el consumo de nutrición enteral domiciliaria en Andalucía aumentó notablemente, multiplicándose los costes generados por 37. Aunque el número de personas que consumieron diariamente suplementos fue superior al de las dietas por sonda (DS) durante todos los años evaluados, los costes derivados de los SO superaron a los de las DS a partir del año 2005, debido a la combinación de dos factores: incremento progresivo del número de personas a las que se les prescribieron suplementos y, por otro lado, por la incorporación de formulaciones específicas más caras. El empleo de suplementos orales parece ser coste/efectivo en pacientes quirúrgicos hospitalizados (en el pre y post operatorio) y, posiblemente, en ancianos malnutridos hospitalizados, especialmente tras realización de cribado de desnutrición. Aunque podrían ser eficaces, en otras circunstancias, como en pacientes ambulatorios, son necesarios más trabajos con metodología adecuada, para poder realizar decisiones clínicas basadas en la evidencia y en los análisis de costes.

Caso clínico Gastric cancer is a frequent cause of cancer-related mortality in the world. Surgery is the only potentially curative therapy, although the adverse effects of surgery are common and considerable. Common variable immunodeficiency is in many cases cause of gastrointestinal system problems such as chronic diarrhea caused by infestation with giardia lamblia, nodular lymphoid hiperplasia ad loss of villi leading frequently to malapsortion and malnutrition. Nutritional deficiencies due to malapsorption (postgastrectomy and secondary to loss of villi, giardiasis and common variable inmunodeficiency) are common. We present the case of a patient with gastric cancer who underwent a gastrectomy with common variable hipogammaglobulinemia and chronic infestation by giardia lamblia, with serious diarrhea resistant to treatment and malabsorption. Yes El adenocarcinoma gástrico es una de las causas más frecuentes de mortalidad en el mundo, siendo la cirugía el único tratamiento potencialmente curativo, aunque los efectos adversos digestivos y nutricionales son frecuentes y abundantes. La hipogammaglobulinemia variable común es causa de frecuentes manifestaciones digestivas, derivándose las más importantes en diarrea crónica causada por giardiasis, hiperplasia nodular linfoide o atrofia vellosa, siendo frecuente la malabsorción y la desnutrición. Los déficits nutricionales secundarios a la malabsorción (postgastrectomía y asociada a la atrofia vellosa y la giardiasis por hipogammaglobulinemia variable común) son asimismo frecuentes. Presentamos el caso de un paciente gastrectomizado por adenocarcinoma gástrico y con hipogammaglobulinemia variable común e infestación crónica por giardiasis que presenta una importante diarrea crónica refractaria a tratamiento y malabsorción.

Background: The aim was to measure symptoms of depression and anxiety in patients with bronchiectasis and evaluate their relationship with a Mediterranean diet. Methods: This cross-sectional study recruited patients with bronchiectasis at four Spanish centers. Patients completed the hospital anxiety and depression scale (HADS) and the Mediterranean diet questionnaire (PREDIMED). Demographic, health and outcome data were recorded from medical charts. Logistic regression was used to determine the predictors of elevated symptoms of depression and anxiety (HADS >= 11). Results: Of the 205 participants recruited, 37 (18.0%) had elevated anxiety-related scores and 26 (12.7%) had elevated depression-related scores (HADS >= 11). Increased symptoms of depression were significantly associated with being unemployed, a lower education, older age, comorbidity, major dyspnea, worse quality of life (QOL) and a lower PREDIMED score. Increased symptoms of anxiety were significantly associated with more exacerbations, worse QOL and a lower PREDIMED score. Regression analyses indicated that, after adjustment, QOL and the PREDIMED score predicted elevated symptoms of depression and QOL predicted elevated symptoms of anxiety. Conclusions: The prevalence of elevated symptoms of depression and anxiety is high in patients with bronchiectasis and greater adherence to a Mediterranean diet is associated with a lower likelihood of having these symptoms, particularly for depression. (C) 2014 Elsevier Inc. All rights reserved.

Background & aims: By means of this update, the GARIN working group aims to define its position regarding the treatment of patients with diabetes or stress hyperglycaemia and artificial nutrition. In this area there are many aspects of uncertainty, especially in non-critically ill patients. Methods: Bibliographical review, and specific questions in advance were discussed and answered at a meeting in the form of conclusions. Results: We propose a definition of stress hyperglycaemia. The indications and access routes for artificial nutrition are no different in patients with diabetes/stress hyperglycaemia than in non-diabetics. The objective must be to keep pre-prandial blood glucose levels between 100 and 140 mg/dl and post-prandial levels between 140 and 180 mg/dl. Hyperglycemia can be prevented through systematic monitoring of capillary glycaemias and adequately calculate energy-protein needs. We recommend using enteral formulas designed for patients with diabetes (high monounsaturated fat) to facilitate metabolic control. The best drug treatment for treating hyperglycaemia/diabetes in hospitalised patients is insulin and we make recommendations for adapt the theoretical insulin action to the nutrition infusion regimen. We also addressed recommendations for future investigation. Conclusions: This recommendations about artificial nutrition in patients with diabetes or stress hyperglycaemia can add value to clinical work. Introducción y objetivos: En el tratamiento de los pacientes con diabetes o hiperglucemia de estrés y la nutrición artificial existen muchas áreas de incertidumbre, sobre todo en pacientes no críticos. El grupo de trabajo GARIN tiene como objetivo definir su posición en este campo. Material y métodos: Revisión bibliográfica previa y reunión presencial en la que se discutieron y contestaron preguntas específicas sobre el tema. Resultados: Proponemos una definición de hiperglucemia de estrés. Las indicaciones y las rutas de acceso a la nutrición artificial no difieren en los pacientes con hiperglucemia de estrés o diabetes respecto a los no diabéticos. El objetivo debe ser mantener los niveles de glucemia preprandial entre 100 y 140 mg/dl y postprandial entre 140 y 180 mg/dl. La hiperglucemia puede prevenirse a través de una monitorización sistemática de las glucemias capilares y un cálculo adecuado de las necesidades energético-proteicas. Recomendamos el uso de fórmulas enterales diseñadas para pacientes con diabetes (alto contenido en grasas monoinsaturadas) para facilitar el control metabólico. El mejor tratamiento farmacológico para tratar la hiperglucemia/diabetes en pacientes hospitalizados es la insulina, aconsejando adaptar la acción teórica de la insulina al régimen de infusión de la nutrición. También realizamos recomendaciones para investigaciones futuras. Conclusiones: Estas recomendaciones aportan respuestas concretas sobre cuestiones comunes en la asistencia a pacientes con diabetes o hiperglucemia de estrés y nutrición artificial.

El adenocarcinoma gástrico es una de las causas más frecuentes de mortalidad en el mundo, siendo la cirugía el único tratamiento potencialmente curativo, aunque los efectos adversos digestivos y nutricionales son frecuentes y abundantes. La hipogammaglobulinemia variable común es causa de frecuentes manifestaciones digestivas, derivándose las más importantes en diarrea crónica causada por giardiasis, hiperplasia nodular linfoide o atrofia vellosa, siendo frecuente la malabsorción y la desnutrición. Los déficits nutricionales secundarios a la malabsorción (postgastrectomía y asociada a la atrofia vellosa y la giardiasis por hipogammaglobulinemia variable común) son asimismo frecuentes. Presentamos el caso de un paciente gastrectomizado por adenocarcinoma gástrico y con hipogammaglobulinemia variable común e infestación crónica por giardiasis que presenta una importante diarrea crónica refractaria a tratamiento y malabsorción. Gastric cancer is a frequent cause of cancer-related mortality in the world. Surgery is the only potentially curative therapy, although the adverse effects of surgery are common and considerable. Common variable immunodeficiency is in many cases cause of gastrointestinal system problems such as chronic diarrhea caused by infestation with giardia lamblia, nodular lymphoid hiperplasia ad loss of villi leading frequently to malapsortion and malnutrition. Nutritional deficiencies due to malapsorption (postgastrectomy and secondary to loss of villi, giardiasis and common variable inmunodeficiency) are common. We present the case of a patient with gastric cancer who underwent a gastrectomy with common variable hipogammaglobulinemia and chronic infestation by giardia lamblia, with serious diarrhea resistant to treatment and malabsorption.

Está muy bien documentado en la literatura médica que la desnutrición es un problema común en todos los niveles de atención sanitaria, desde atención primaria a especializada y en centros de atención geriátrica. Este problema no se limita a países con pocos recursos económicos o con limitado desarrollo social y económico. También es un problema universal en Europa. La desnutrición aumenta las cifras de morbilidad, mortalidad, ingresos hospitalarios y duración de la estancia. Estas cifras más elevadas suponen lógicamente un aumento del uso de recursos sanitarios. A pesar de esto, el problema de la desnutrición a menudo puede pasar desapercibido y el paciente no recibir el tratamiento necesario. Este problema requiere la cooperación de múltiples agentes tales como los Gobiernos de los Estados, los profesionales de la salud y los mismos ciudadanos. El VIII Foro de Debate concluye con la necesidad de establecer un claro plan de actuación (a semejanza de la European Alliance for Health Nutrition) y la creación de una plataforma (coalición) que reúna las voces de asociaciones de profesionales sanitarios, instituciones, colegios profesionales, asociaciones de pacientes, industria y entidades aseguradoras. Los fines de esta plataforma consistirán en informar de la extensión del problema, identificar y potenciar líderes que transmitan los fines de esta iniciativa ante las autoridades autonómicas y nacionales, propuesta de soluciones y colaboración en su puesta en marcha y finalmente, evaluación/ control de las acciones desarrolladas, It has been well documented in medical literature that hyponutrition is a common issue at all healthcare levels, from primary to specialized health care, as well as geria - tric healthcare facilities. This problem is not limited to countries with scarce economic resources or limited social development; it is also a universal issue in Europe. Hyponutrition increases the rates of morbidity, mortality, hospital admissions, and hospital stay. These higher figures also represent a higher use of healthcare resources. In spite of this, hyponutrition may often go undetected and the patient may not receive the necessary treatment. This problem requires the cooperation of multiple agents such as the Governments, the healthcare professionals, and the citizens themselves. The VIII Discussion Forum concludes on the need to establish a clear-cut plant for action (similar to the European Alliance for Health Nutrition) and the creation of a platform (coalition) encompassing the voices of healthcare professionals associations, institutions, professional colleges, patients associations, the pharmaceutical companies, and insurance companies. The goals of this platform will be to inform about the extent of this issue, to identity and promote leaders that will convey the aims of this initiative to regional and national healthcare authorities, to present solutions and to collaborate in their implementation, and finally to assess/control the actions taken