Characteristics of patients receiving nutrition care and its associations with prognosis in a tertiary hospital

SUMMARY OBJECTIVE: The aim of this study was to describe the medical nutritional therapy (MNT) of adult non-critically ill hospitalization patients. METHODS: In a retrospective study, adults hospitalized for more than 48 h in non-intensive care unit medical and surgical areas that were classified as being at nutritional risk were included. Malnutrition was defined according to Global Leadership Initiative on Malnutrition (GLIM) criteria. RESULTS: A total of 255 patients, aged 54.13±18.4 years, who were at risk of malnutrition were included in this study. Of these, 50% were males. Notably, 52.5% received oral nutrition supplementation (ONS), 23.5% enteral nutrition (EN), 15% parenteral nutrition (PN), and 9% received enteral and parenteral nutrition (EPN). Patients with EPN presented the highest frequency of malnutrition (52%), and therefore they received more than 100% of energy and protein requirements. The median length of stay was 25 days. Among patients with nutritional risk receiving EPN, no deaths occurred. Patients, identified at nutritional risk, but without malnutrition according to GLIM, and receiving ONS had significantly lower mortality than patients receiving other MNT. CONCLUSIONS: Oral nutrition supplementation was the more frequent MNT prescribed. The frequency of malnutrition and percentage of prescribed energy and protein were higher in patients receiving PN and EPN compared with those receiving ONS.

A low phase angle determined by bioelectrical impedance analysis is associated with oropharyngeal dysphagia among institutionalized older adults

SUMMARY OBJECTIVE The aim was to evaluate the prevalence of oropharyngeal dysphagia (OD) and its association with body composition by bioelectrical impedance analysis (BIA) and functionality among institutionalized older adults. METHODS A cross-sectional study was conducted. The swallowing function and diagnosis of OD were evaluated with a volume-viscosity swallow test. Activities of daily living were evaluated by the Barthel Index. Body composition was evaluated by BIA, and phase angle (PhA) was determined. RESULTS Eighty institutionalized older adults were evaluated. The mean age of the study population was 82±9.5 years, and 65% were females. The OD prevalence was 30%, dependence was 30%, and sarcopenia was 16%. In the multivariate analysis, a low PhA (<3.5°) was independently associated with the presence of OD adjusted by sex and age (OR: 2.60, 95%CI 2.41-2.90, p=0.01). CONCLUSIONS A higher prevalence of OD was found. Significant and independent associations were found between low PhA, dependence, and sarcopenia with the presence of OD among institutionalized older persons.

Séncope en el anciano: hallazgos de pruebas complementarias en un Centro Hospitalario Universitario / Syncope in the elderly: findings of diagnostic complementary tests in a University Hospital

Syncope is a common symptom among older adults. Its aetiologic diagnosis is mainly clinical, but when it has an unknown origin, complementary studies are necessary. We present the experience of a single center in diagnosing Unknown Origin Syncope (UOS). METHODS: We performed a transversal retrolective study to assess the different tests done to patients studied because of USO. RESULTS: The mean age of the older group was 77.6 +/- 6.9 years. The 24-hour Hotter were abnormal in 77.9% of patients, but diagnostic in only 16.3%. Age older than 65 years was associated with a 1.9 increase (CI 95% 0.9-4) in the possibilities of having a diagnosis, while age lesser than 65 was associated with a 0.5 risk CI 95% 0.2-1.08 of having a diagnosis. The 48-hour holter showed similar results. Older age was associated with a 1.69 OR, CI 95% 0.6-4.4 to have a positive Tilt test (91% of older patients). They had mainly the vasodepressor variety of neurally-mediated syncope. (57.1% Vs 40.1%, p = 0.01). Of the 6 electrophysiologic studies performed in people older than 65 years, 3 where diagnostic (50% Vs 33.3%, p = 0.6). CONCLUSIONS: Complimentary tests in people elder than 65 years are diagnostic in a higher proportion than in their younger counterparts. Nevertheless there is a higher risk of false-positive results, so tests such as head-up tilt test should be more carefully interpreted.

Aldosterone receptor antagonists induce favorable cardiac remodeling in diastolic heart failure patients / Antagonistas de receptores de aldosterona inducen remodelación cardiaca favorable en pacientes con insuficiencia cardiaca diastólica

Background. Serum levels of aldosterone in heart failure are increased up to 20 times compared to normal subjects. After an acute myocardial infarction, aldosterone increases progressively as well as interstitial fibrosis and collagen synthesis from cardiac fibroblasts, forming a patchy heterogeneous interstitial collagen matrix that affects ventricular function. Even if angiotensine converting enzyme inhibitors (ACEI) or angiotensin II receptor antagonists (ARA) can reduce aldosterone levels early during treatment, they increase again after a 12 week treatment. The aim of this study was to evaluate the changes in structure and function of the left ventricle in symptomatic (NYHA I-III) diastolic heart failure patients receiving an aldosterone receptor antagonist. Methods. Twenty-eight subjects with diastolic heart failure, on BB, ACEI and/or ARA were randomized to receive spironolactone (group A) on a mean dose of 37.5 mg once a day (n =14, age 63.7 ± 21.6 years and body mass index, BMI 27.5 ± 9.4), or not (group B, n = 14, Age 64.8 ± 11.9, BMI 26.9 ± 4.7). All patients were followed-up for a mean of 13.79 ± 0.99 months. Results. Group A showed a 42.8% ischemic origin of heart failure, while in group B was 55% (p = 0.2). No other co-morbidities were significativelly different among both groups. Mean percentage of changes by echocardiogram was as follows: Interventricular septum (IVS) -12.2 ± 11% vs. 1.3 ± 15.2 (p = 0.03), pulmonary systolic artery pressure (PSAP was 0.99 ± 3.8% vs. 10.5 ± 9.1, p = 0.05). Other parameters did not show statistically significant differences. Conclusion. Aldosterone receptor antagonists reduce or avoid increasing of PSAP and inducing a favorable remodeling of the left ventricle, especially in the IVS in diastolic heart failure patients.

Antecedentes. En pacientes con insuficiencia cardiaca existen aumentos de aldosterona hasta 20 veces mayores que en sujetos control. Después de un infarto miocárdico la aldosterona aumenta progresivamente, así como la fibrosis intersticial y la síntesis de colágena por fibroblastos cardiacos, provocando parches intersticiales heterogéneos en la matriz de colágena que afecta la función ventricular. El tratamiento inicial con inhibidores de enzima convertidora de angiotensina (IECA) y/o antagonistas de receptores de angiotensina II (ARA) puede reducir estos niveles; sin embargo, aumentan nuevamente después de 12 semanas de tratamiento. El propósito de este estudio fue evaluar los cambios estructurales y funcionales en el ventrículo izquierdo en pacientes con insuficiencia diastólica tratados con ARA angiotensina (NYHAI-III). Métodos. Veintiocho pacientes con insuficiencia cardiaca diastólica en tratamiento con BB, IECA y/o ARA se aleatorizaron a recibir una dosis media de 37.5 mg una vez al día de espironolactona (grupo A) (n - 14, edad 63.7 ± 0 21.6 años e índice masa corporal IMC 27.5 ± 9.4), o no (grupo B, n =14, edad 64.8 ± 11.9, IMC 26.9 ± 4.7). Todos los pacientes fueron seguidos por 13.79 ± 0.99 meses. Resultados. De los pacientes del grupo A, 42.8% y el 55 del grupo B (p = 0.2), tenían cardiopatía isquémica. No se encontraron diferencias significativas en otras comorbilidades. El porcentaje promedio de cambios en el ecocardiograma se observó en septum interventricular (SIV) -12.2 ± 11% vs. 1.3 ± 15.3% (p = 0.02), y la presión sistólica de la arteria pulmonar (PSAP, 0.99 ± 3.8% vs. 10.5 ± 9.1, p = 0.05, para los grupos A y B, respectivamente). Los otros parámetros no mostraron diferencias estadísticamente significativas. Conclusión. El tratamiento con antagonistas de receptores de aldosterona disminuye o limita aumentos de PSAP e inducen una remodelación favorable del ventrículo izquierdo, especialmente del SIV en pacientes con insuficiencia cardiaca diastólica.

Prevalence of self-reported overweight-obesity and its association with socioeconomic and health factors among older Mexican adults

OBJECTIVE: To investigate the prevalence of obesity and its association with socioeconomic factors and comorbidities in a population-based study. MATERIAL AND METHODS: Data were examined from 4 605 persons ages 60 and older that participated in the 2001 Mexican Health and Aging Study, conducted in rural and urban communities in Mexico. The prevalence of obesity (according to self-reported weight and height) was obtained, stratified by age, and logistic regression was used to study cross-sectional associations between obesity and socioeconomic factors. RESULTS: Of the population studied, 20.9 percent were classified as obese and the prevalence diminishes with age. Overall, women were more likely than mentobe obese. Lower educational level was associated with lower risk of overweight. In both men and women, obesity was more common between subjects with hypertension (OR 1.38 and 1.71, respectively) and long-distance walk limitation (OR 2.08 and 2.21, respectively). CONCLUISON: In older Mexican adults, hypertension and long-distance walk limitation were independent associated factors for higher prevalence of obesity.

OBJETIVO: Estudiar la prevalencia de obesidad y su asociación con factores socioeconómicos y comorbilidades. MATERIAL Y MÉTODOS: Se analizaron los datos de 4 605 personas de 60 años y más que participaron en el Estudio Nacional sobre Salud y Envejecimiento en México 2001 (ENASEM 2001) en zonas rurales y urbanas. La prevalencia de obesidad (peso y talla autorreportados) se obtuvo estratificada por edad y mediante una regresión logística se asoció con factores socioeconómicos. RESULTADOS: 20.9 por ciento se clasificaron como obesos y la prevalencia disminuyó con la edad. En general las mujeres tuvieron mayor probabilidad de ser obesas. Una baja escolaridad se asoció con menor riesgo de sobrepeso. En hombres y mujeres la obesidad se asoció con hipertensión (RM 1.38 y 1.71 respectivamente) y con dificultad para caminar (RM 2.08 y 2.21 respectivamente). CONCLUSION: En la población de edad avanzada en México la hipertensión y la dificultad para caminar varias cuadras se asoció con mayor prevalencia de obesidad.

Comportamiento diferencial de la tensión arterial de pacientes con síncope neuro-cardiogénico en la fase inicial de la prueba de inclinación / Differential behaviour of blood pressure in patients with neurocardiogenic syncope during the initial stage of the tilt table test

Neurocardiogenic syncope (NCS) is diagnosed by means of a head-up tilt table tests (HUTT). This is a prolonged test although early outcome predictors are known. METHODS: We conducted a study among patients engaged in a syncope study protocol. We performed HUTT in all of them and compared the basal arterial pressure with the arterial pressure at the end of a the 70 degrees tilting. RESULTS: We performed 185 HUTT studies. Systolic blood pressure (BP) raised 0.9% among patients with a negative test, whereas patients with a positive HUTT showed a 2.3% decrease (p = 0.2) in the same measurement. Diastolic BP increased 34% among negative HUTT patients and 14.9% among patients with positive test (p = 0.02). We calculated a relative risk of 1.45 for positive test when the combination of systolic BD decrease and dyastolic increase was present, according to the percentage of change (IC95%: 1.1 to 7.8). CONCLUSIONS: The combination of systolic BP reduction and diastolic BP elevation at the end of the 70 degrees tilting is associated with an increased risk of having a positive HUTT. These changes might be related to differential sympathetic stimulation.

Reproductibilidad y sensibilidad de un cuestionario de actividad física en población mexicana / Reproducibilidad y sensitivity of a physical activity questionnaire in Mexican people

Objetivo. Determinar si el cuestionario de actividad física (CAF) de Laval es reproducible y sensible para detectar diferencias en grupos de mexicanos con peso normal y en obesos. Material y métodos. Estudio efectuado en el Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, entre enero y mayo de 1999, en México, D.F. El CAF se tradujo al castellano y se adaptó a población mexicana. Se midió la reproducibilidad por prueba-reprueba, con cuatro semanas de diferencia (n=30 sujetos con obesidad). Para determinar la sensibilidad del cuestionario se comparó un grupo de jóvenes cadetes (n=18) con otro de jóvenes civiles (n=32). Se utilizó como concordancia el coeficiente de correlación intraclase y se empleó la prueba t de student pareada o para muestras independientes, según fuera necesario. Resultados. El coeficiente de correlación intraclase fue de 0.86. El CAF fue sensible al demostrar diferencias de más de 400 kcal/día (1 674 kJ/día) y más de 4 kcal/kg/día (17 kJ/kg/día) entre jóvenes con actividad física importante (t de Student). Conclusiones. El CAF es un instrumento sensible y reproducible que puede ser utilizado en población mexicana. El texto completo en inglés de este artículo está disponible en: http://www.insp.mx/salud/index.html

Estudio antropométrico en un grupo de hombres y mujeres de la tercera edad en la Ciudad de México / Anthropometric study in a group of elderly men and women from Mexico city

Estimar valores antropométricos en un grupo de hombres y mujeres de la tercera edad en la Ciudad de México. Material y métodos. Se realizó un estudio de corte transversal en 508 sujetos mayores de 60 años, registrados como jubilados y pensionados del Instituto Mexicano del Seguro Social o asistentes al Instituto Nacional de la Senectud, durante el segundo semestre de 1995. Se utilizaron protocolos de estandarización para registrar sus caractarísticas antropométricas. Se realizaron pruebas t de Student para detectar diferencias en los valores promedio entre hombres y mujeres, en general, como en cada subgrupo de edad conformado; también el análisis de correlación de Pearson del índice de masa corporal (IMC) con las variables antropométricas; se tomó un nivel de significancia de p<0.05. Resultados. Doscientos treinta individuos de la población de estudio correspondieron al sexo masculino y 278 al femenino, la edad promedio fue de 66.9 y 67.3 años, respectivamente. El promedio de peso en los hombres fue de 70.7 kg, con una desviación estándar (DE) de 9.9, la estatura de 164 cm (DE 6.5) y el IMC de 26.4 (DE 3.7). La distribución del IMC mostró que 50.9 por ciento de los hombres y 54 por ciento de las mujeres evaluados se ubicaron en el rango de 25.0 a 29.9; se obtuvo un coeficiente de correlación superior a r 0.70 (p<0.001) entre el IMC con las circunferencias de cintura y cadera. Conclusiones. Con base en el IMC, aproximadamente tres cuartas partes de la población de estudio presentó sobrepeso u obesidad. Es posible que la evaluación tanto de sobrepeso como de obesidad en el anciano requiera de un ajuste en los valores de normalidad de este índice

The aim of the present study was to estimate basic anthropometric measurements in a group of elderly men and women from Mexico City. Material and methods. A cross-sectional study was carried out among senior citizens registered in the National Institute of the Elderly and National Institute of Social security in Mexico City. Standardized protocols were used to measure the anthropometric characteristics of the study group. The analysis included Student t tests to detect differences in average values between men and women in general and in each age subgroup formed. In addition, Pearson correlation analysis of the body mass index (BMI) with anthropometric variables was performed; p<0.05 was taken as the level of significance. Results. A total of 508 people aged 60 or older participated in the study; 230 were males and 278 were females. The average age was 66.9-years-old in the male group and 67.3-years-old in the female group. Among men the average weight was 70.7 kg, standard deviation (SD 9.9), height was 164 cm (SD 6.5) and BMI was 26.4 (SD 3.7). Among women the average weight was 60.8 kg (SD 9.9), height was 150 cm (SD 5.9) and BMI was 27.1 (SD 4.0). The distribution of the BMI showed that 50.9% of men and 54% of women were between 25.0 and 29.9. A correlation coefficient over r 0.70 (