Serum IL-15 and IL-15Rα levels are decreased in lean and obese physically active humans.

Circulating IL-15 presence is required to stimulate anti-adipogenic effects of the IL-15/IL-15Rα axis in adipose tissue. Although exercise increases blood IL-15 expression post-exercise, it remains inconclusive whether physical activity can alter the baseline concentrations of this cytokine. The aim of this study was to determine whether physical activity regulates circulating IL-15 and IL-15Rα in lean and obese individuals. Two hundred and seventy-six participants were divided into five groups according to physical activity (PA), body mass and type 2 diabetes mellitus (T2DM) diagnosis: (a) lean PA (N = 25); (b) lean non-PA (N = 28); (c) obese PA (N = 64); (d) obese non-PA (N = 79); and (e) obese non-PA with T2DM (N = 80). Serum IL-15 and IL-15Rα, blood glucose/lipid profile and body composition were measured. Serum IL-15 and IL-15Rα decreased in PA participants compared to non-PA (P < .05), while IL-15 and IL-15Rα increased in obese with T2DM compared to obese without T2DM (P < .05). No differences were observed between lean non-PA and obese PA. Serum IL-15Rα was associated with fasting glucose (R2 = .063), insulin (R2 = .082), HbA1c (R2 = .108), and HOMA (R2 = .057) in obese participants. Circulating IL-15 and IL-15Rα are reduced in lean and obese participants who perform physical activity regularly (≥180 min/week), suggesting a regulative role of physical activity on the circulating concentrations of IL-15 and IL-15Rα at baseline. Moreover, the relationship observed between IL-15Rα and glucose profile may indicate a role of the alpha receptor in glucose metabolism.

[Development of a system of quality indicators for primary care prescriptions]. / Indicadores de calidad de prescripción seleccionados mediante una técnica de consenso.

OBJECTIVE: To identify and validate indicators to improve the assessment of prescribing by primary care paediatricians, incorporating the values and views of the professionals involved. MATERIAL AND METHODS: Nominal group technique, validated through a Delphi survey. PARTICIPANTS: Paediatricians and primary care pharmacists. A nominal group was formed with thirteen specialists. The question raised at the meeting was: "What indicators focusing on the drug and what indicators linked to diagnosis and treatment do you find most helpful in assessing the quality of prescription in paediatrics?", each panellist proposed indicators that were discussed and weighted on a scale from 1 to 9. The highest scored indicators were included in a two round Delphi survey, intended for all paediatricians and primary care pharmacists. MEASUREMENTS: Validity of the indicator; Indicators with a median score equal to or greater than 7 were considered valid. Degree of consensus; it was considered that there was consensus if the interquartile range was not more than 3 points. RESULTS: We generated 29 indicators focusing on the drug and 27 incorporating the diagnosis. Nineteen focusing on the drug and 13 incorporating the diagnosis were included in the survey. There was a high degree of agreement between the group and survey results. CONCLUSIONS: A set of quality indicators for paediatric prescribing has been generated using this tecnique, with consensus of a representative group of stakeholders and validated by all of them.

Indicadores de calidad de prescripción seleccionados mediante una técnica de consenso / Development of a system of quality indicators for primary careprescriptions

Objetivo: Seleccionar y validar indicadores que permitan mejorar la evaluación de la prescripción de los pediatras de atención primaria, incorporando los valores y la opinión de los profesionales implicados. Material y métodos: Técnica de grupo nominal, validación mediante encuesta tipo Delphi. Participaron pediatras y farmacéuticos de atención primaria. Se formó un grupo nominal con 13 expertos. En la sesión se planteó la pregunta: "¿Qué indicadores centrados en el fármaco y qué indicadores que relacionen diagnóstico y tratamiento consideras más útiles para evaluar la calidad de la prescripción en pediatría?", cada panelista propuso indicadores que se discutieron y ponderaron en una escala del 1 al 9. Los indicadores más valorados se incluyeron en una encuesta tipo Delphi a dos rondas dirigida a todos los pediatras y farmacéuticos de atención primaria. Las mediciones realizadas fueron: la validez del indicador, se consideraron válidos los indicadores con una mediana de la puntuación igual o superior a 7; el grado de consenso, se consideró que había consenso si el rango intercuartílico no incluía más de 3 puntos. Resultados: Se generaron 29 indicadores centrados en el fármaco y 27 que incorporaban el diagnóstico. Se incluyeron en la encuesta 19 centrados en el fármaco y 13 que incorporaban el diagnóstico. Hubo un alto grado de acuerdo entre el grupo y los resultados de la encuesta. Conclusiones: Mediante esta técnica se ha generando una serie de indicadores de calidad de prescripción para pediatría consensuados por un grupo representativo de los agentes implicados y validado para el conjunto de éstos (AU)

Objective: To identify and validate indicators to improve the assessment of prescribing by primary care paediatricians, incorporating the values and views of the professionals involved. Material and methods: Nominal group technique, validated through a Delphi survey. Participants: Paediatricians and primary care pharmacists. A nominal group was formed with thirteen specialists. The question raised at the meeting was: "What indicators focusing on the drug and what indicators linked to diagnosis and treatment do you find most helpful in assessing the quality of prescription in paediatrics?", each panellist proposed indicators that were discussed and weighted on a scale from 1 to 9. The highest scored indicators were included in a two round Delphi survey, intended for all paediatricians and primary care pharmacists. Measurements: Validity of the indicator; Indicators with a median score equal to or greater than 7 were considered valid. Degree of consensus; it was considered that there was consensus if the interquartile range was not more than 3 points. Results: We generated 29 indicators focusing on the drug and 27 incorporating the diagnosis. Nineteen focusing on the drug and 13 incorporating the diagnosis were included in the survey. There was a high degree of agreement between the group and survey results. Conclusions: A set of quality indicators for paediatric prescribing has been generated using this tecnique, with consensus of a representative group of stakeholders and validated by all of them (AU)

[Prevalence of obesity among children in Ceuta. PONCE study 2005]. / Prevalencia de obesidad infantil en Ceuta. Estudio PONCE 2005.

The continuous increasing of overweight and obesity, among children and adolescents, constitutes an important public health problem. It is necessary to know and quantify this problem in order to delimit its magnitude and to identify the main risk groups. The enKid study (1998-2000) has estimated an obesity prevalence in Spain of 13,9% within the population group aged 2-22 years. Up to now, there was no data available about the city of Ceuta. In this study, it has been estimated an obesity prevalence of 8,75% among the Ceuta population group aged 6-13 years.

[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.

Estrategia nutricional en el paciente oncológico: ¿nutrición enteral o parenteral?

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Adenocarcinoma renal de células claras que debuta con metástasis vaginal / Clear cell kidney adenocarcinoma presented with vaginal metastasis

- Propósito: El Adenocarcinoma de Células Claras puede tener origen en diversos y distintos órganos pudiendo metastatizar en vagina, principalmente por vía linfática, presentando un pronóstico malo de supervivencia1.- Material y métodos: se presenta un caso clínico de una masa vaginal como forma de debut de un Adenocarcinoma Renal.- Resultados: ante una masa vaginal el diagnóstico diferencial debe incluir en primer lugar la patología local, pero no debe descartarse la patología a distancia 5.- Conclusiones: Las metástasis vaginales, al ser muy infrecuentes, son diagnósticos de exclusión en el que debemos incluir patología local y patología a distancia, siempre orientados por la Anatomía patológica del tumor (AU)

[Nutritional evaluation in patients with total gastrectomy]. / Evaluación nutricional en pacientes con gastrectomía total.

Gastric cancer continues to be the second cause of cancer-related mortality in the world. Surgery is the only potentially curative therapy, although the adverse effects of surgery are considerable and include digestive symptoms, loss of appetite and malnutrition. Our study included 45 patients subjected to gastrectomy who were under treatment at our unit during 2000. The data given here refer to their first visit following surgery. The most frequent complications were diarrhoea (31%), pain (29%) and early dumping (24%). Other complications found were late dumping, nausea/vomiting and dysphagia. Anorexia appeared in 49% and 29% presented a negative attitude towards food. These complications give rise to insufficient food intake, leading to malnutrition, mainly marasmic in nature. Only 7% of the patients were normonourished, with 86% presenting slight or moderate malnutrition and 7% severe malnutrition. The mean Body Mass Index (BMI) of these patients was 20 +/- 3 kg/m2. The most frequent analytical alterations were anaemia with ferropenia and b12 deficit, and a reduction in the levels of zinc and retinol transporting protein. Many patients had impaired quality of life; 43% did not leave home and only 13% were able to work. Three groups were established depending on the time that had passed since the gastrectomy was performed before the first nutritional assessment (less than 3 months, from three months to a year, and over one year), without significant differences being found in any of the parameters studied. In this article we include recommendations for the nutritional handling and treatment of patients following gastrectomy.

[Changes in carbohydrate metabolism in the HIV/AIDS patient]. / Alteraciones del metabolismo hidrocarbonado en el paciente VIH/SIDA.

Over the last few years, there has been a considerable reduction in the mortality and morbidity associated with HIV patients, due to the use of protease inhibitors which have led to a true revolution in the treatment of this infection. A new problem has arisen with the increased life expectancy: the onset of a plurimetabolic syndrome characterized by hypertriglyceridaemia, hypercholesterolaemia and hyperglycaemia; in addition to anomalies in composition and distribution of body fat (central obesity and loss of peripheral fat) due to the associated lipodystrophy. As a result of the metabolic alterations, there is an increase in the risk of cardiovascular disease. Hyperglycaemia is the result of insulin resistance and is detected in between 13.6% and 46% of patients, possibly leading to type 2 diabetes (diagnosed in between 2.4% and 7% of the patients). These alterations have been documented as potentially related with the use of protease inhibitors and other drugs used in the handling of HIV patients. The appropriate treatment of altered metabolism of carbohydrate requires: 1) a customized dietary approach depending on individual BMI and lipid alterations; 2) a physical exercise programme; 3) the use of insulin sensitization drugs: metformin and thiazolidinediones and, where the therapeutic goals are not achieved or there is a contraindication for oral hypoglycaemic drugs; 4) insulin therapy with regimens similar to other diabetic patients.

[Fiber and enteral nutrition]. / Fibra y nutrición enteral.

Dietary fibre is a mixture of various substances and is essential for maintaining appropriate intestinal functionality and it is currently considered to be a necessary part of a healthy diet. Current recommendations for fibre consumption by adults range from 20 to 35 g/day. Enteral nutrition is an emerging therapeutic variation in both hospital and domestic settings. To a great extent, this development has been made possible thanks to the design of new formulas that adapt better and better to the clinicla conditions or our patients. The type of fibre used in these preparations varies greatly. Some have only one source of fibre while others use differnet combinations. There are currently 32 formulas available on the Spanish market, without counting the modules or specific preparations of individual types of fibre. Despite the enormous advances in the knowledge of the beneficial effects of fibre, the fact of the matter is that enteral nutrition that we routinely prescribe in normal clinical practice does not contain fibre. The are several explanations for this, perhaps the most plausible is that these formulas may lead to problems in their administration and tolerance. It is necessary to choose the correct calibre of catheter and define the best infusion method and timing. Another difficulty may be the gastrointestinal tolerance of the formulas containing fibre. No large-scale problems of intolerance have however been described in healthy volunteers nor in patients with acute or chronic pathologies, although it is of fundamental importance to monitor the rhythm of depositions in all patients with enteral nutrition (EN) and ensure proper intake of liquids, which would also be useful to prevent occlusion of the catheter. The theoretical benefits of EN with fibre with a view to maintaining or improving normal intestinal structure and function are very varied. Nonetheless, it has noit yet been possible to prove many of these effects in controlled clinical trials. At the present time, there are sufficient reasons of a physiological nature for using EN with fibre in many patients, particularly in those predisposed to constipation or suffering from diarrhoea, in those requiring long-term EN and in some intestinal pathologies. In the near future, fibre can be expected to form part of EN as standard component and we should define its optimal composition for different pathologies. In the meantime, we need to continue working intensely in this highly promising area of knowledge.

[Home enteral nutrition. Annual report 1999. NADYA-SENPE Group]. / Nutrición enteral domiciliaria. Informe anual 1999. Grupo NADYA-SENPE.

GOAL: During 1999, as in previous years, the NADYA-SENPE Group has maintained an annual register of patients with Artificial Nutrition at Home in order to keep up to date our available knowledge of this therapy. The present paper analyzes the results of the sixth National Register of patients under treatment with Enteral Nutrition at Home corresponding to 1999, produced with the co-operation of twenty-three centres in the Spanish national health network. MATERIAL AND METHODS: The data were collected through a closed questionnaire included on our web site (www.nadya-senpe.com). Apart from epidemiological information, the form includes the indication that led to the prescription of nutrition, nutritional treatment, access path, complications and admissions to hospital, follow-up of the treatment, patients' quality of life and progress. All of the data are processed by the co-ordinating team. The Nutrition Unit at La Paz Teaching Hospital in Madrid has acted as the group co-ordinator. RESULTS: During 1999, a total of 2,262 patients at the twenty-three collaborating centres followed treatment with Home Enteral Nutrition (NED in its Spanish acronym). The mean age was 63.6 (19.67 years (males: 57.6%; females: 42.3%). The mean time with nutritional treatment is 5.89 (4.25 months. The neurological alterations (37.5%) and neoplasias (36.8%) were the most frequent indications for NED. Most patients used oral administration (50.7%), the use of artificial routes is less frequent, with 5NG being used on 27.9% and PEG on 12.7%. The polymeric formulas are the ones most commonly used (87.7%). The number of complications recorded amounted to 1,403 episodes, representing 0.62 complications per patient per year, of which 40.8% were gastro-intestinal (0.26 complications per patient per year) and 18.7% were mechanical complications, with only 9 recorded cases of bronchoaspiration. It was necessary to admit patients to hospital on 836 occasions (0.38 admissions per patient), albeit generally for causes not associated with nutrition (86.1%). At year-end, 51.4% of patients continued to receive nutritional support. CONCLUSIONS: Enteral nutrition at home is a safe technique whose use is growing in Spain. It requires the existence of appropriately equipped nutrition teams as well as the collaboration of the Primary Health Care services and the suitable training of patients and relatives. It is essential to progress more deeply into the development and application of clinical routes that provide a clear and concise methodology covering all nutrition-related aspects. In itself, nutrition is a therapeutic alternative regardless of whether access is obtained through a natural or an artificial route. It is necessary for the persons responsible for health-care administration to realize that the appropriate nutrition of patients leads to an improvement in their general health, a shorter course for their illness and, therefore, a reduction in costs.

Manifestaciones clínicas de sospecha de los trastornos de la conducta alimentaria / Clinical manifestations of suspected disturbances of nutritional behabiour

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Hematologic recovery after central lymphatic irradiation for patients with stage I-III follicular lymphoma.

BACKGROUND: The authors previously reported that central lymphatic irradiation (CLI) can induce molecular remission in patients with Stage I-III follicular lymphoma, as measured by polymerase chain reaction analysis for t(14;18) (q32;q21). Hematologic toxicity has been considered a major consequence of CLI. This study was undertaken to analyze the patterns of hematologic recovery after CLI. METHODS: Thirty-three patients with Stage I-III follicular lymphoma were treated with CLI between January 1993 and February 1998. CLI consisted of irradiation to mantle, upper two-thirds of abdomen, and pelvic fields. Each field was treated to 30.0-30.6 grays (Gy) at 1.5-1.8 Gy per fraction, with a boost to 36.0-39.6 Gy at the same rate to the sites of macroscopic disease. A break of approximately 4 weeks was given after treatment of each field. Twenty-four patients who were followed for a minimum of 1 year from the end of CLI form the basis of this analysis. Fourteen patients were male. Three patients had Stage I disease, 6 patients had Stage II disease, and 15 patients had Stage III disease. The International Prognostic Index (IPI) for malignant lymphoma was 0 for 5 patients, 1 for 13 patients, and 2 for 6 patients. The Eastern Cooperative Oncology Group performance status was 0 for 21 patients and 1 for 3 patients. The median values for their pretreatment characteristics were as follows: age, 60 years (range, 34-73 years); height, 173 cm (range, 155-193 cm); weight, 79 kg (range, 57-107 kg); body surface area (BSA), 1.95 m(2) (range, 1.61-2.31 m(2)); bone marrow cellularity, 27%(range, 2-75%), platelet count, 233,000/mm(3) (range, 139,000-339,000/mm(3)), white blood cell (WBC) counts, 6400/mm(3) (range, 4200-10,900/mm(3)); and hemoglobin, 14.5 mg/dL (range, 11.8 -16.6 mg/dL). The median duration of CLI was 159 days (range, 137-345 days). Ten patients had cardiovascular disease. The number of sites receiving a boost dose of > or = 36.0 Gy was 0 sites in 1 patient, 1 site in 6 patients, 2 sites in 11 patients, 3 sites in 5 patients, and 4 sites in 1 patient. The platelet, hemoglobin, and WBC counts were followed every 3 months after completion of CLI. These counts were normalized to the pretreatment counts for statistical analyses. Univariate and multivariate analyses were performed to investigate the correlations between patient factors and hematologic status at 1 year posttreatment. Pearson correlation analysis was used for the continuous factors (patient age, height, weight, BSA, bone marrow cellularity, and duration of CLI), and the Mann-Whitney test was used for categoric factors (IPI, gender, performance status, stage, number of sites receiving > or = 36.0 Gy, and presence or absence of cardiovascular disease). RESULTS: There was continued recovery, essentially approaching the pretreatment levels, over 3 years for platelet, WBC, and hemoglobin counts. Factors that were associated significantly with normalized platelet counts at 1 year by univariate analyses were age (P = 0.015) and cardiovascular disease (P = 0.041). Age was the only significant factor by multivariate analyses, with older patients having lower platelet counts at 1 year posttreatment. No factors were found that were associated significantly with 1-year normalized WBC or hemoglobin levels by either univariate or multivariate analyses. CONCLUSIONS: All three of the hematologic components (platelets, WBC, and hemoglobin) essentially recover after patients undergo CLI over a 3-year period. Older age was the only significant adverse factor that affected the platelet recovery, as detected by multivariate analysis. (c) 2001 American Cancer Society.

Salvage central lymphatic irradiation in follicular lymphomas following failure of chemotherapy: a feasibility study.

PURPOSE: Management of follicular lymphoma after chemotherapy failure has been controversial and has ranged from watchful waiting to high-dose chemotherapy. High-dose chemotherapy with bone marrow reconstitution may produce clinical and molecular complete responses at the risk of serious morbidity and mortality. It has been previously reported that central lymphatic irradiation (CLI) can achieve long-term relapse-free survival in patients with Stage I, II, or III follicular lymphoma. Therefore, we investigated the feasibility of treating patients in whom front-line chemotherapy failed with salvage CLI instead of instituting more intensive chemotherapy. METHODS AND MATERIALS: Salvage CLI with curative intent for patients with follicular lymphoma was started at The University of Texas M. D. Anderson Cancer Center in 1992. Eleven patients whose disease showed poor response to or relapsed after chemotherapy were managed with this approach. The median age of the patients was 61 years. Criteria for exclusion included bone marrow involvement or other evidence of Ann Arbor Stage IV disease at any time during the course of the disease. Overall survival and relapse-free survival were calculated from the first day of CLI. RESULTS: Ten patients were alive at a median follow-up of 25 months (range 9-73 months). The treatment was well tolerated in general. Two patients could not complete CLI: one 75-year-old patient owing to prolonged platelet count depression and deterioration in general medical condition, and a 66-year-old patient because of exacerbation of preexisting pancytopenia and worsening of heart disease. Everyone who completed CLI remains in remission at the time of this report, except for one patient who had a relapse in the right lacrimal gland at 32 months. This patient was treated with local radiation therapy and is free of disease. Eventual recovery of the blood counts was observed for the patients who completed CLI. CONCLUSION: These results demonstrate for the first time that with CLI, it is possible to achieve complete remission of acceptable quality in follicular lymphoma patients who experience a chemotherapy failure. The main toxicity is limited to transient depression in hematological profiles. The treatment is fairly well tolerated and seems to carry little risk compared with high-dose chemotherapy and bone marrow rescue. Salvage CLI may not necessarily compromise future treatment with chemotherapy, including autologous bone marrow or stem cell transplantation, because the patients' blood counts recover.

[Results of surgical treatment of non-microcytic bronchopulmonary carcinoma in III-A stage]. / Resultados del tratamiento quirúrgico del carcinoma broncopulmonar no microcítico en estadio III-A.

To analyze results and survival after surgical treatment of various stage III-a subgroups. We reviewed 748 case histories of patients with non-small cell bronchopulmonary carcinoma between January 1970 and December 1991, selecting 121 patients who underwent resection of stage III-a tumors, according to the pathologist's report. Overall survival at 3, 5 and 10 years was 26, 16 and 12%, respectively. The subgroup with better response to treatment was that of patients with T-3 tumors (peripheral), N-0, with survival of 21% at five years. If peribronchial and/or hilar (N-1) nodes were affected, survival was slightly less (16%). If mediastinal adenopathy (N-2) was present, there were no survivors after 3 years. In this same T-3 group, but with neoplastic invasion of the pericardium, mediastinal pleura or principal bronchi, survival after 3 years was nil. The survival rates of peripheral T-3 patients undergoing block resections were 27, 20 and 17% at 3, 5 and 10 years, respectively, 16% at 2 years and 0% at 5, for those with extrapleural resection. Patients with the poorest response to treatment were those with mediastinal nodes (N-2), in whom survival was 17, 12 and 8% at 3, 5 and 10 years, respectively. In the 34 patients received postoperative irradiation of the mediastinum, survival was 16% higher. The survival rates after 5 years were similar for epidermoid carcinoma (18%) and adenocarcinoma (14%). The results of surgical treatment are variable and depend on several factors: extension and extrapulmonary location of lesions, surgical technique used for T-3 tumors and histological type.

[Evaluation of the cost of home enteral nutrition in relation to different access routes]. / Evaluación del coste de la nutrición enteral domiciliaria con relación a diferentes vías de acceso.

UNLABELLED: When home enteral nutrition is needed, there is still, despite the undisputed increase in the quality of life that can be achieved with a Percutaneous Endoscopic Gastrostomy (PEG), a reservation in its use because this technique and its maintenance is considered to be very costly. We aim to assess the true cost of home enteral nutrition using the oral route, a nasogastric tube, and PEG. PATIENTS AND METHODS: The data of 65 patients who required home enteral nutrition during 1996, were analyzed retrospectively. The access route was a nasogastric tube in 20 cases, 18 patients had PEG, and 27 candidates used an oral route. The average age was 56 years. 50% were men and 50% were women. The most common diagnoses that led to the indication were oropharyngeal-maxillofacial neoplasms and neurological disorders. In all cases the material and formula used was assessed, as were the associated complications and the cost of the at home enteral nutrition. RESULTS: The average duration of the treatment was 175 +/- 128 days, and this was similar in all three groups. The average formula/day cost was slightly higher in the patients using the oral access route. The average total day cost and the average material/day cost was slightly higher in patients with a PEG. Patients with a PEG presented fewer complications than those with a nasogastric tube. The cost derived from possible complications must be higher in the nasogastric tube group, especially considering the repeated tube changes due to obstruction or loss. CONCLUSIONS: The cost of home enteral nutrition is slightly lower if one uses a nasogastric tube. The greater incidence of complications that were mild but required a tube change, in this case a nasogastric tube, suggests higher indirect costs. The oral route is associated with the need for special formulae that are more expensive.