Autopercepción de los pacientes con cáncer sobre la relación existente entre su estado nutricional, su alimentación y la enfermedad que padecen / Self-perception of cancer patients on the relationship existing between their nutritional status, their feeding status, and their illness

Introducción: Conocer la opinión de los pacientes oncológicos sobre la importancia que dan a su alimentación, a las dificultades para alimentarse, su imagen, su peso, los cambios ponderales, la relación entre su alimentación y su enfermedad, la relación entre la actividad física y el estado de ánimo y su salud, es básico para buscar alternativas terapéuticas nutricionales que nos lleven a mejorar su calidad de vida y en general su sensación de bienestar. Para ello, es imprescindible conocer la opinión de los pacientes respecto a estos temas. Material y métodos: Se elaboró una encuesta a 131 pacientes. Los pacientes fueron reclutados en el Hospital de día de Oncología Médica, consulta de Oncología Radioterápica y el Servicio de Hospitalización de Oncología Médica. En la encuesta se preguntó de manera sencilla sobre la importancia que dan los pacientes a todos estos aspectos. Ha sido una encuesta de 20 preguntas, dividida en 6 partes: 1) Datos de filiación. 2) Percepción de la enfermedad y la relación de ésta con la alimentación. 3) Percepción de la relación de la actividad física y del estado de ánimo con la alimentación. 4) Tratamientos nutricionales indicados al paciente y la percepción de su efecto sobre la evolución de la enfermedad. 5) Dificultades actuales de alimentación. 6) Demanda de atención nutricional. Resultados: Los pacientes presentaban una edad media de 57 ± 13 años. El 45% correspondían a hombres y el resto mujeres. El 81% vive en el área urbana, y solo el 14% en el área rural. El nivel educativo se clasificó en 5 grupos: sin estudios, estudios básicos, EGB, bachiller superior o estudios universitarios. El 28% poseía estudios básicos, el 19% estudios universitarios, y un 8% no tenía ningún estudio. Con respecto a su ocupación también se clasificó en cinco grupos: hogar, estudiante, sin empleo, empleado y jubilado. Un 33% eran empleados, 29% jubilados y un 34% se ocupaba del hogar. La mayoría de los pacientes , un 74% son conscientes de su enfermedad y la perciben como grave o muy grave. La mayoría de estos pacientes están pendientes de su imagen, de su peso y de los cambios ponderales y los relacionan con su alimentación. El 74% de los pacientes encuentran relación entre su estado nutricional y la actividad física que desarrollan y un 73% lo relacionan con su estado de ánimo. Al menos la mitad de los pacientes perciben su estado de ánimo como decaído. Aunque el 47% manifiesta tener alguna dificultad para alimentarse, sólo el 34% ha recibido alguna información sobre su alimentación, el 26% ha consumido suplementos nutricionales y el 81% continúa consumiendo una dieta sin modificaciones. Las dificultades de alimentación más comunes fueron disminución del apetito 38%, saciedad precoz 32% y náuseas 20%. La intervención nutricional más solicitada por los pacientes es la educación nutricional general y específica para paliar los síntomas asociados a los tratamientos oncológicos. Conclusiones: La mayoría de los pacientes son consientes de la gravedad de su enfermedad y están pendientes de su imagen, peso y cambios ponderales, que asocian con su alimentación. La mayoría de los pacientes encontraron una estrecha asociación entre su estado nutricional, la actividad física que desarrollan y su estado de ánimo. Más de la mitad manifestó tener alguna dificultad para alimentarse pero sólo a un tercio de la población se le había hablado de su alimentación en alguna ocasión. Es evidente que el paciente oncológico necesita de diferentes medidas de intervención nutricional efectivas que contribuyan a mejorar su sensación de bienestar (AU)

Introduction: Knowing the opinion of oncologic patients about the importance they give to their feeding, the difficulties they have with feeding, their body image, weight, and ponderal changes, the relationship between their feeding and their illness, the relationship between their physical activity and their mood and health is essential to look for nutritional therapeutic interventions leading to improvement of quality of life and, in general, the feeling of well being. Thus, it is paramount to know the patients' opinion of these issues. Material and methods: We passed a questionnaire to 131 patients. The patients were recruited from the Day-Hospital of the Medical Oncology and Radiotherapeutic Oncology Departments, and from the Hospitalization Department of Medical Oncology. In the questionnaire, we asked in a simple manner about the importance the patients give to all these issues. This is a 20-item questionnaire, divided into six parts: 1. Vital statistics; 2) perception about the disease and its relationship with feeding; 3) Perception of the relationship between physical activity and mood with feeding; 4) Nutritional therapies prescribed to the patients and their perception on its effect on the disease progression; 5) Current difficulties with feeding; 6) Demand of nutritional care. Results: The patients mean age was 57 ± 13 years. 45% were males, and the remaining females. 81% life in an urban area, and only 14% in a rural area. The educational level was categorized in 5 groups: without education, basic education, elementary school, high school, or college studies. 28% had basic education, and 19% college studies, and only 8% had no education at all. Their occupation was also categorized in five groups: home-keeping, student, unemployed, employed, and retired. 33% were employed, 29% retired, and 34% were home-keepers. Most of the patients (74%) are aware of their illness and perceive it as severe or very much severe. Most of these patients worry about their body image, weight, and ponderal changes, and they relate them with their feeding status. 74% find a relationship between their nutritional status and their physical activity, and 73% relate it with their mood. At least half of the patients perceive their mood as being low. Although 47% manifested having some difficulty for feeding, only 34% had received some information about their diet, 26% had consumed nutritional supplements, and 81% still consumed their diet without any change. The most common difficulties for feeding were decreased appetite (38%), early satiety (32%), and nausea (20%). The nutritional intervention most commonly required by the patients was general and specific nutritional education to alleviate the symptoms associated to oncologic therapies. Conclusions: Most of the patients are aware of the severity of their illness and care about their body image, weight, and ponderal changes, which they associate with their nutrition. Most of the patients find a close relationship between their nutritional status, their physical activity and their mood. More than half of the patients manifest having some difficulty feeding, but only one third of the population has received information about their diet some time. It is clearly shown that oncologic patients need different effective nutritional intervention measures contributing to improve their feeling of well being (AU)

[Self-perception of cancer patients on the relationship existing between their nutritional status, their feeding status, and their illness]. / Autopercepción de los pacientes con cáncer sobre la relación existente entre su estado nutricional, su alimentación y la enfermedad que padecen.

INTRODUCTION: Knowing the opinion of oncologic patients about the importance they give to their feeding, the difficulties they have with feeding, their body image, weight, and ponderal changes, the relationship between their feeding and their illness, the relationship between their physical activity and their mood and health is essential to look for nutritional therapeutic interventions leading to improvement of quality of life and, in general, the feeling of well being. Thus, it is paramount to know the patients' opinion of these issues. MATERIAL AND METHODS: We passed a questionnaire to 131 patients. The patients were recruited from the Day-Hospital of the Medical Oncology and Radiotherapeutic Oncology Departments, and from the Hospitalization Department of Medical Oncology. In the questionnaire, we asked in a simple manner about the importance the patients give to all these issues. This is a 20-item questionnaire, divided into six parts: 1. Vital statistics; 2) perception about the disease and its relationship with feeding; 3) Perception of the relationship between physical activity and mood with feeding; 4) Nutritional therapies prescribed to the patients and their perception on its effect on the disease progression; 5) Current difficulties with feeding; 6) Demand of nutritional care. RESULTS: The patients mean age was 57 +/- 13 years. 45% were males, and the remaining females. 81% life in an urban area, and only 14% in a rural area. The educational level was categorized in 5 groups: without education, basic education, elementary school, high school, or college studies. 28% had basic education, and 19% college studies, and only 8% had no education at all. Their occupation was also categorized in five groups: home-keeping, student, unemployed, employed, and retired. 33% were employed, 29% retired, and 34% were home-keepers. Most of the patients (74%) are aware of their illness and perceive it as severe or very much severe. Most of these patients worry about their body image, weight, and ponderal changes, and they relate them with their feeding status. 74% find a relationship between their nutritional status and their physical activity, and 73% relate it with their mood. At least half of the patients perceive their mood as being low. Although 47% manifested having some difficulty for feeding, only 34% had received some information about their diet, 26% had consumed nutritional supplements, and 81% still consumed their diet without any change. The most common difficulties for feeding were decreased appetite (38%), early satiety (32%), and nausea (20%). The nutritional intervention most commonly required by the patients was general and specific nutritional education to alleviate the symptoms associated to oncologic therapies. CONCLUSIONS: Most of the patients are aware of the severity of their illness and care about their body image, weight, and ponderal changes, which they associate with their nutrition. Most of the patients find a close relationship between their nutritional status, their physical activity and their mood. More than half of the patients manifest having some difficulty feeding, but only one third of the population has received information about their diet some time. It is clearly shown that oncologic patients need different effective nutritional intervention measures contributing to improve their feeling of well being.

Úlcera corneal bilateral como consecuencia de malnutrición calóricoprotéica y déficit de vitamina A en un paciente con alcoholismo crónico, pancreatitis crónica y colecistostomía / Bilateral corneal ulceration as a result of energy-protein hyponutrition and vitamin a deficit in a patient with chronic alcoholism, chronic pancreatitis and cholecystostomy

Desde el descubrimiento de las vitaminas ha existido un creciente interés por relacionar las vitaminas con ciertas enfermedades. Para la vitamina A en particular se ha determinado su singular importancia en múltiples funciones vitales y su relación con enfermedades tanto por déficit como por exceso esta ahora completamente demostrada. En países desarrollados las enfermedades por déficit vitamínicos han disminuido de manera importante; sin embargo en pacientes con características particulares deben tenerse siempre presente. Se trata de un hombre de 45 años, con antecedentes de alcoholismo crónico, pancreatitis crónica, diabetes mellitus no insulinodependiente y colecistostomía con alto drenaje biliar secundario a colecistitis enfisematosa y absceso perivesicular. Consulta por dolor ocular bilateral, fotofobia y disminución de la agudeza visual además de una historia de heces pastosas, pegajosas y malolientes. Ingresa a cargo de Oftalmología y diagnostican úlcera córneal bilateral. Cursan una interconsulta al Servicio de Nutrición por presencia de caquexia. Se detecta malnutrición calórica severa y proteica leve con IMC de 18,2 y pérdida del 23% de su peso habitual en los últimos 6 meses, déficit de vitaminas liposolubles (A, D y E), malabsorción grasa leve y anemia macrocítica é hipocrómica. Suplementamos la dieta del paciente con una formula hiperproteica e hipercalórica especial para diabéticos, se administran las vitaminas deficitarias, enzimas pancreáticas para mejorar la malabsorción y se controlan las glucemias con insulina. Cuatro meses después paciente es evaluado y presenta un IMC de 20, la anemia esta resuelta y desde el punto de vista oftalmológico evoluciona favorablemente, las ulceras mejoran y la agudeza visual se recupera casi por completo. En pacientes alcohólicos crónicos con un nivel bajo de ingesta y complicaciones clínicas con repercusiones nutricionales (pancreatitis que produce malabsorción o colecistostomia con drenaje biliar percutáneo) no debemos olvidar que los déficits de micronutrientes pueden explicar la etiología de otras patologías asociadas en este caso las ulceras cornéales (AU)

Since the discovery of vitamins, there has been an increasing interest at relating vitamins with particular diseases. In particular, for vitamin A its singular importance has been determined in multiple vital functions, and its relationship with diseases, both in deficit and in excess, is nowadays completely demonstrated. In developed countries, vitamin deficiency-related diseases have been greatly reduced; however, in some patients with particular features they must be kept in mind. This is the case of a 45 year-old man, with a history of chronic alcoholism, non insulin-dependent diabetes mellitus and cholecystectomy with a high biliary drainage secondary to emphysematous cholecystitis and perivesicular abscess. He complains of bilateral ocular pain, photophobia, and decreased visual acuity besides a history of pasty, sticky and foul-smelling feces. He is admitted in the Ophthalmology Department and bilateral corneal ulceration is diagnosed. A consultation to the Nutrition Department is made because of cachexia. Severe caloric and mil protein hyponutrition is observed with a BMI of 18.2 and a 23% weight loss for the last 6 months, fat-soluble vitamins (A, D and E) deficit, mild fat malabsorption, and macrocytic and hypochromic anemia. The patient's diet is supplemented with a special hyperproteinic and hypercaloric diet for diabetics, deficient vitamins and pancreatic enzymes to improve absorption are administered, and glycemia is controlled with insulin. Four months later, the patient is assessed and has a BMI of 20, anemia has resolved and from an ophthalmologic viewpoint the course is favorable, the ulcers improve and visual acuity is almost completely recovered. In chronic alcoholic patients with a low dietary intake and clinical complications with nutritional repercussions (pancreatitis that produces malabsorption or cholecystectomy with biliary percutaneous drainage) we should not forget that micronutrients deficits may explain the etiology of other associated diseases, in the present case corneal ulceration (AU)

[Bilateral corneal ulceration as a result of caloric-protein malnutrition and vitamin A deficit in a patient with chronic alcoholism, chronic pancreatitis and cholecystostomy]. / Ulcera corneal bilateral como consecuencia de malnutrición calórico- protéica y déficit de vitamina A en un paciente con alcoholismo crónico, pancreatitis crónica y colecistostomía.

Since the discovery of vitamins, there has been an increasing interest at relating vitamins with particular diseases. In particular, for vitamin A its singular importance has been determined in multiple vital functions, and its relationship with diseases, both in deficit and in excess, is nowadays completely demonstrated. In developed countries, vitamin deficiency-related diseases have been greatly reduced; however, in some patients with particular features they must be kept in mind. This is the case of a 45 year-old man, with a history of chronic alcoholism, non insulin-dependent diabetes meIlitus and cholecystectomy with a high biliary drainage secondary to emphysematous cholecystitis and perivesicular abscess. He complains of bilateral ocular pain, photophobia, and decreased visual acuity besides a history of pasty, sticky and foul-smelling feces. He is admitted in the Ophthalmology Department and bilateral corneal ulceration is diagnosed. A consultation to the Nutrition Department is made because of cachexia. Severe caloric and mil protein hyponutrition is observed with a BMI of 18.2 and a 23% weight loss for the last 6 months, fat-soluble vitamins (A, D and E) deficit, mild fat malabsorption, and macrocytic and hypochromic anemia. The patient's diet is supplemented with a special hyperproteinic and hypercaloric diet for diabetics, deficient vitamins and pancreatic enzymes to improve absorption are administered, and glycemia is controlled with insulin. Four months later, the patient is assessed and has a BMI of 20, anemia has resolved and from an ophthalmologic viewpoint the course is favorable, the ulcers improve and visual acuity is almost completely recovered. In chronic alcoholic patients with a low dietary intake and clinical complications with nutritional repercussions (pancreatitis that produces malabsorption or cholecystectomy with biliary percutaneous drainage) we should not forget that micronutrients deficits may explain the etiology of other associated diseases, in the present case corneal ulceration.