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Resumen Introduccion Aunque las recomendaciones actuales sugieren el empleo de formulas especificas en nutricion enteral en personas con diabetes, hay poca evidencia de su efectividad a largo plazo en el control glucemico. El objetivo principal de este estudio es evaluar la eficacia a largo plazo (24 semanas) de una formula de nutricion enteral hipercalorica hiperproteica especifica para personas con diabetes en control glucemico y mejora del estado nutricional. Metodologia Estudio multicentrico observacional prospectivo en vida real de pacientes con prescripcion de nutricion enteral de larga duracion a traves de sonda de gastrostomia o nasogastrica que recibieron una formula hipercalorica hiperproteica especifica para diabetes. Una vez obtenido el consentimiento informado del participante y comprobados los criterios de inclusion y exclusion, se recogieron datos relativos a control glucemico, parametros de inflamacion, bioquimicos, situacion nutricional y tolerancia gastrointestinal a 0, 12 y 24 semanas. Resultados Se recluto a 112 pacientes, 44,6% mujeres, edad 75,0 (12,0) anos y tiempo medio de evolucion de la diabetes 18,1 (9,5) anos. El porcentaje de pacientes con desnutricion segun la valoracion global subjetiva descendio a lo largo del tratamiento del 78,6% al 29,9% (p Conclusion Nuestro estudio en vida real apoya que el empleo de una formula hipercalorica hiperproteica especifica para diabetes durante un tratamiento nutricional a 6 meses permite un adecuado control glucemico y evolucion nutricional, con una buena tolerancia gastrointestinal.

INTRODUCTION: Although current recommendations suggest the use of specific formulas in enteral nutrition in people with diabetes, there is little evidence of their long-term effectiveness in glycemic control. The main objective of this study is to evaluate the long-term efficacy (24 weeks) of a specific high-protein hypercaloric enteral nutrition formula for people with diabetes in glycemic control and in their improvement in nutritional status. METHODOLOGY: This was a multicenter, prospective, observational, real-life study of patients with long-term enteral nutrition prescription through gastrostomy or nasogastric tube who received a high protein hypercaloric formula specific for diabetes. Once the participant's informed consent was obtained and the inclusion and exclusion criteria were verified, data relating to glycemic control, inflammation parameters, biochemical data, nutritional status and gastrointestinal tolerance at 0, 12 and 24 weeks were collected. RESULTS: 112 patients were recruited, 44.6% women, age 75.0 (12.0) years and a mean time of evolution of diabetes of 18.1 (9.5) years. The percentage of patients with malnutrition according to VGS decreased throughout the treatment from 78.6% to 29.9% (p?0.001). Glycemic and HbA1c levels were significantly reduced at 12 and 24 weeks (Blood glucose 155.9-139.0-133.9?mg/dl, p?

Several therapeutic nutritional strategies are currently available in preoperative bariatric surgery. According to their caloric content, they are classified into moderately low-calorie diets that provide >1200 kcal per day and very low-calorie diets (VLCD) that provide between 800 and 1200 kcal per day. These types of diets can be considered safe and effective if they are used appropriately, in properly selected individuals and under close medical control. They can achieve a significant weight reduction, contributing to the improvement of metabolic parameters and the control of obesity’comorbidities such as diabetes, hypertension, dyslipidemia, and sleep apnea-hypopnea syndrome. VLCDs are increasingly used in preoperative bariatric surgery, as they also contribute to the reduction of hepatic steatosis and visceral abdominal fat. However, the results in perioperative complications and postsurgical weight loss remain controversial.

The increase in the prevalence of type 2 diabetes and the worldwide expansion of overweight and obesity are intrinsically linked. The percentage of diabetes attributable to weight gain amounts to more than 80% in many countries. This relationship is addressed in a Spanish Consensus Document from SEMI, SED, redGDPS, SEC, SEEDO, SEEN, SEMERGEN and SEMFYC published in 2015 and which gathers best available evidences. Based on the statements of this consensus document, we propose five recommendations for clinical practice to establish a diagnosis of precision and the most appropriate treatment for joint diabetes and obesity. These recommendations have been agreed by the SENDIMAD, SOMAMFYC, SEMG Madrid and RedGDPS Working Groups: 1. For every patient with diabetes and obesity, in addition to the calculation of the body mass index, the percentage of body fat and the approximation to the assessment of body composition should be evaluated throughout the whole process (both at the beginning and follow up). 2. The approximation to the degree and distribution of body fat requires the measurement and recording of the waist circumference of these patients. 3. The integrated assessment of the patient with type 2 diabetes-obesity requires the evaluation of the degree of physical activity and/or characterization of the sedentary condition. 4. The prescription of lifestyle changes should be incorporated into therapeutic education (individualized, flexible, autonomous and sustainable diet and physical activity plan. 5. The pharmacological approach in the treatment of type 2 diabetes-obesity implies the choice of anti-diabetic drugs that facilitate the loss of fat.

The increase in the prevalence of type 2 diabetes and the worldwide expansion of overweight and obesity are intrinsically linked. The percentage of diabetes attributable to weight gain amounts to more than 80% in many countries. This relationship is addressed in a Spanish Consensus Document from SEMI, SED, redGDPS, SEC, SEEDO, SEEN, SEMERGEN and SEMFYC published in 2015 and which gathers best available evidences. Based on the statements of this consensus document, we propose five recommendations for clinical practice to establish a diagnosis of precision and the most appropriate treatment for joint diabetes and obesity. These recommendations have been agreed by the SENDIMAD, SOMAMFYC, SEMG Madrid and RedGDPS Working Groups: 1. For every patient with diabetes and obesity, in addition to the calculation of the body mass index, the percentage of body fat and the approximation to the assessment of body composition should be evaluated throughout the whole process (both at the beginning and follow up). 2. The approximation to the degree and distribution of body fat requires the measurement and recording of the waist circumference of these patients. 3. The integrated assessment of the patient with type 2 diabetes-obesity requires the evaluation of the degree of physical activity and/or characterization of the sedentary condition. 4. The prescription of lifestyle changes should be incorporated into therapeutic education (individualized, flexible, autonomous and sustainable diet and physical activity plan. 5. The pharmacological approach in the treatment of type 2 diabetes-obesity implies the choice of anti-diabetic drugs that facilitate the loss of fat.El aumento en la prevalencia de diabetes tipo 2 y la expansión a nivel mundial de los estados de sobrepeso y obesidad están intrínsecamente vinculados, de forma que el porcentaje de diabetes atribuible al aumento de peso llega a ser superior al 80% en muchos países. En 2015 se publica un Documento de Consenso español de SEMI, SED, redGDPS, SEC, SEEDO, SEEN, SEMERGEN y SEMFYC que aborda esta doble condición de acuerdo con las mejores evidencias. Desde las afirmaciones de dicho consenso proponemos cinco recomendaciones para la práctica clínica consensuadas por los Grupos de trabajo de SENDIMAD, SOMAMFYC, SEMG Madrid y RedGDPS, con el fin de establecer un diagnóstico de precisión y el tratamiento más adecuado:1. En todo paciente con diabetes y obesidad debe abordarse, tanto al inicio como en el seguimiento, además del cálculo del índice de masa corporal (IMC), el porcentaje de grasa corporal y la valoración de la composición corporal.2. La aproximación al grado y distribución de la grasa corporal requiere incluir la medición y registro del perímetro de cintura de estos pacientes.3. La valoración integral del paciente con diabetes tipo 2-obesidad exige la evaluación del grado de actividad física y/o caracterizar la condición de sedentarismo.4. La prescripción de cambios del estilo de vida debe ser incorporada a la educación terapéutica (plan dietético y de actividad física individualizado, flexible, autónomo y sostenible).5. El abordaje farmacológico en el tratamiento de la diabetes-obesidad implica la elección de fármacos antidiabéticos que faciliten la pérdida de grasa.

Background Diffuse Large B cell lymphoma (DLBCL) is usually diagnosed between the 5th-6th decade of life. Its incidence increases with age. Chemotherapy (CT) with R-CHOP is the standard treatment for any age. However, in the clinical practice, alternative treatments with less toxicities are offered to elderly patients. This group of patients is usually not well represented in clinical trials. Our aim is to asses the benefit of standard treatment in this population, as well as discontinuation of treatment and its impact on overall survival (OS). As secondary endpoint, we have analyzed the survival rate in the subgroup of patients older than 75 years of age treated with CT. Methods A retrospective review was performed in patients ≥65 years who were diagnosed with DLBCL during the years 2013-2015 in the Hospital of Leon. Patients with histological confirmation of the primary diagnosis and who received treatment were included. Results 65 patients were analyzed. The average age was 75 years. 64% were male and 30% had stage 4 disease at the time of diagnosis. The CT schemes were: R-CHOP (N = 28), R-CEOP (N = 11) and R-miniCHOP (N = 8). 10 patients had grade 4 AEs. One death ocurred after receiving the first cicle. 70% completed at least 4 cicles of CT. Median OS was 51 months versus (vs) 11 months in favor of R-CHOP group (HR = 0,59, p = 0,112 IC 95%=0,30-1,13). Results were not statistically significant likely because of the small sample size. 45% of patients had a complete response, 20% had a partial response and 10% had no response to treatment.The main cause of death was disease progression. Median OS was 15 months in both groups, in patients older than 75 treated with CT vs Conclusions In clinical practice, age is an important variable to account for when deciding on the management approach for heamatological malignancies such as DLBCL. Although our results show a non-statistically significant benefit in OS of R-CHOP vs other schemes, this could be due to the small sample size. Given the prevalence of elderly population in our country, and the proved benefit of standard chemotherapy in the approach of DLBCL, more studies are needed. Legal entity responsible for the study The authors. Funding Has not received any funding. Disclosure All authors have declared no conflicts of interest.

Background: Puberty can affect vitamin D levels. Objectives: The goal of this study was to analyze the relation between vitamin D deficiency and puberty in obese Spanish children, along with the possible interrelation between vitamin D status and degree of insulin resistance. Methods: A cross-sectional study was carried out, in which clinical and biochemical data were gathered from 120 obese and 50 normal weight children between January 2011 and January 2013. Results: Mean vitamin D levels were 19.5 and 31.6 ng/mL in obese pubertal and obese prepubertal children, respectively. About 75% of the obese pubertal subjects and 46% of the obese prepubertal subjects had vitamin D deficiency. Vitamin D levels were significantly lower in pubescent subjects compared with pre-pubescent subjects in summer, fall, and winter. There was no apparent relation between vitamin D levels and homeostasis model assessment index for insulin resistence (expressed in standard deviation score for sex and Tanner stage) in either puberty or pre-puberty. Conclusion: Puberty may be a risk factor for the vitamin D deficiency commonly found in the obese child population. This deficiency is not associated with higher insulin resistance in obese pubertal children compared with obese prepubertal children