Survey on the perception of health professionals on the use of intradialytic oral nutrition in patients under hemodialysis

Abstract Background Intradialytic oral nutrition (ION) has been shown to improve many clinical outcomes, including lowering mortality, in hemodialysis (HD) patients. Despite the benefits, ION is underused in many countries. Objective The objective of our study was to determine the perception of health-care professionals (HCP) in our environment of the use of ION in patients undergoing HD. Methods Survey applied to HCP in Mexico who worked or had worked in an HD unit in their locality. Results From 272 HCP who answered the survey, 74.3% believed that the use of ION has at least one beneficial effect; of these, the most frequently mentioned were an improvement in quality of life (QoL) (54.7%) followed by an improvement in serum albumin (37.9%) and muscle anabolism (31.6%). However, 49% consider that its use involves some risks. Of the respondents, 22% reported that their HD units allowed patients to consume food or supplements during HD sessions; the main reason given to forbid the introduction of food or supplements was the clinic’s policy (41%). Conclusions The personnel surveyed heterogeneous opinions regarding ION, but most believe that it may improve the QoL or the nutritional status of the patients. Nevertheless, the use of ION is uncommon in our country as it is against the internal regulations of most HD units.

Vectores de impedancia bioeléctrica para la composición corporal en población mexicana / Bioimpedance vector analysis for body composition in Mexican population

Objective. To construct bivariate tolerance ellipses from impedance values normalized for height, which can be used in Mexican population for the assessment of body composition and compare them with others made in different populations. Methods. Body composition was assessed by bioelectrical impedance analysis (BIA) in 439 subjects (204 men and 235 women), 18 to 82 years old, with a BMI between 18-31, using an impedanciometer Quadscan 4000. Resistance, reactance and phase angle were used to calculate bioelectrical impedance vectors and construct bivariate tolerance ellipses. Results. Mean age in men was 47.1 ± 16 years and 42.4 ± 13 for women, mean weight (73.4 ± 9 vs. 60.1 ± 8 kg) and height (1.68 vs. 1.55 m) were significant greater in men than in women (p < 0.002). Women in comparison with men, had greater values of impedance (622.96 ± 66.16 Ω vs. 523.59 ± 56.56 Ω) and resistance (618.96 ± 66.10 Ω 61.97 vs. 521.73 ± 61.97Ω), as well as of resistance and reactance standardized by height (398.24 ± 46.30 Ω/m vs. 308.66 ± 38.44) (44.32 ± 7.14 Ω/m vs. 39.75 ± 6.29) respectively, with a significant difference in all of them (p < 0.0001). Similarly, the reactance was greater in females, nevertheless this difference did not reach statistical significance (68.96 ± 11.17 vs. 67.18 ± 10.3; p = 0.0861). The phase angle was greater in men than in women, with a statistically significant difference (7.33° ± 0.88 vs. 6.36° ± 0.97; p < 0.0001). Bivariate tolerance ellipses (50%, 75% y 95%) derived from Mexican subjects showed a significant upward deviation (p < 0.05) from previously published references from Mexican American and Italian populations. New ellipses of tolerance were therefore constructed for the Mexican population. Conclusions. Bioimpedance vectors in Mexican subjects are significantly different from the existing ones, supporting the need of population specific bivariate tolerance ellipses for the evaluation of body composition.

Objetivo. Realizar intervalos bivariados (elipses) de tolerancia a partir de las variables de impedancia estandarizadas por la estatura, las cuales pueden ser utilizadas en la población mexicana para determinar la composición corporal y comparar dichas elipses con las de otras elipses realizadas en otras poblaciones. Material y métodos. Se evaluó la composición corporal por impedancia bioeléctrica (IBE) en 439 sujetos (204 hombres y 235 mujeres), de 18 a 82 años de edad, con un IMC entre 18-31, utilizando un impedanciómetro Quadscan 4000. A partir de las mediciones de resistencia, reactancia y ángulo de fase se obtuvieron vectores de impedancia bioeléctrica para realizar elipses de tolerancia. Resultados. La edad promedio de los hombres fue de 47.1 ± 16 años y 42.4 ± 13 para las mujeres, el peso promedio (73.4 ± 9 vs. 60.1 ± 8) y la estatura (1.68 vs. 1.55 m) fueron significativamente mayores en hombres que en mujeres (p < 0.002). Las mujeres en comparación con los hombres, presentaron valores mayores de impedancia (622.96 ± 66.16 Ω vs. 523.59 ± 56.56 Ω) y resistencia (618.96 ± 66.10 Ω vs. 521.73 ± 61.97 Ω), así como de resistencia y reactancia estandarizadas por la estatura (398.24 ± 46.30 Ω/m vs. 308.66 ± 38.44 Ω/m) (44.32 ± 7.14 Ω/m vs. 39.75 ± 6.29 Ω/m), respectivamente, presentando en todas éstas una diferencia significativa (p < 0.0001). De igual manera, la reactancia fue mayor en el grupo femenino; sin embargo, esta diferencia no alcanzó significancia estadística (68.96 ± 11.17 vs. 67.18 ± 10.3; p = 0.0861). El ángulo de fase fue mayor en los hombres que en las mujeres, con una diferencia estadísticamente significativa (7.33° ± 0.88 vs. 6.36° ± 0.97; p < 0.0001). Las elipses de tolerancia (50%, 75% y 95%) elaboradas en población italiana sana fueron probadas para la población mexicana, encontrando que éstas tienden a situarse en el extremo superior de las elipses de poblaciones mexicoamericanas e italianas de referencia con una diferencia significativa p < 0.05, por lo que se realizaron nuevas elipses de tolerancia para población mexicana. Conclusiones. Los vectores de la población mexicana fueron significativamente diferentes al ser comparados con las existentes, apoyando la necesidad de realizar elipses de tolerancia específicas para cada población para la evaluación de la composición corporal.