Prevalence and costs of malnutrition in hospitalized patients; the PREDyCES Study.

BACKGROUND AND AIMS: The main objective of the PREDyCES study was twofold. First, to analyse the prevalence of hospital malnutrition in Spain, both at admission and at discharge, and second, to estimate the hospital costs associated with disease-related malnutrition. METHODS: The study was a nationwide, cross-sectional, observational, multicentre study in routine clinical practice, which assessed the prevalence of hospital malnutrition both at patient admission and discharge using NRS-2002. A study extension analysed the incidence of complications associated with malnutrition, excess hospital stay and healthcare costs associated with hospital malnutrition. RESULTS: Malnutrition was observed in 23.7% of patients according to NRS-2002. Multivariate analysis revealed that age, gender, presence of malignant disease, diabetes mellitus, dysphagia and polymedication were the main factors associated with the presence of malnutrition. Malnutrition was associated with an increase in length of hospital stay, especially in patients admitted without malnutrition but who presented malnutrition at discharge (15.2 vs. 8.0 days, p < 0.001), with an associated additional cost of €5,829 per patient. CONCLUSION: In Spanish hospitals, almost one in four patients is malnourished. This condition is associated with increased length of hospital stay and associated costs, especially in patients developing malnutrition during hospitalization. Systematic screening for malnutrition should be generalised in order to implement nutritional interventions with well-known effectiveness.

Prevalence and costs of malnutrition in hospitalized patients; the PREDyCES® Study / Prevalencia y costes de la malnutrición en pacientes hospitalizados; estudio PREDyCES®

Background and aims: The main objective of the PREDyCES® study was twofold. First, to analyse the prevalence of hospital malnutrition in Spain, both at admission and at discharge, and second, to estimate the hospital costs associated with disease-related malnutrition. Methods: The study was a nationwide, cross-sectional, observational, multicentre study in routine clinical practice, which assessed the prevalence of hospital malnutrition both at patient admission and discharge using NRS-2002®. A study extension analysed the incidence of complications associated with malnutrition, excess hospital stay and healthcare costs associated with hospital malnutrition. Results: Malnutrition was observed in 23.7% of patients according to NRS-2002®. Multivariate analysis revealed that age, gender, presence of malignant disease, diabetes mellitus, dysphagia and polymedication were the main factors associated with the presence of malnutrition. Malnutrition was associated with an increase in length of hospital stay, especially in patients admitted without malnutrition but who presented malnutrition at discharge (15.2 vs. 8.0 days, p < 0.001), with an associated additional cost of €5,829 per patient. Conclusion: In Spanish hospitals, almost one in four patients is malnourished. This condition is associated with increased length of hospital stay and associated costs, especially in patients developing malnutrition during hospitalization. Systematic screening for malnutrition should be generalised in order to implement nutritional interventions with well-known effectiveness (AU)

Justificación y objetivos: El estudio PREDyCES® tuvo dos objetivos principales. Primero, analizar la prevalencia de desnutrición hospitalaria (DH) en España tanto al ingreso como al alta, y segundo, estimar sus costes asociados. Métodos: Estudio nacional, transversal, observacional, multicéntrico, en condiciones de práctica clínica habitual que evaluó la presencia de desnutrición hospitalaria al ingreso y al alta mediante el NRS-2002®. Una extensión del estudio analizó la incidencia de complicaciones asociadas a la desnutrición, el exceso de estancia hospitalaria y los costes sanitarios asociados a la DH. Resultados: La prevalencia de desnutrición observada según el NRS-2002® fue del 23.7%. El análisis multivariante mostró que la edad, el género, la presencia de enfermedad oncológica, diabetes mellitus, disfagia y la polimedicación fueron los factores principales que se asociaron a la presencia de desnutrición. La DH se asoció a un incremento de la estancia hospitalaria, especialmente en aquellos pacientes que ingresaron sin desnutrición y que presentaron desnutrición al alta (15.2 vs 8.0 días; p < 0.001), con un coste adicional asociado de 5.829€ por paciente. Conclusiones: Uno de cada cuatro pacientes en los hospitales españoles se encuentra desnutrido. Esta condición se asocia a un exceso de estancia hospitalaria y costes asociados, especialmente en pacientes que se desnutren durante su hospitalización. Se debería generalizar el cribado nutricional sistemático con el objetivo de implementar intervenciones nutricionales de conocida eficacia (AU)

[Analysis of the relevance and feasibility of quality indicators in nutrition support]. / Análisis de la relevancia y factibilidad de indicadores de calidad en las unidades de nutrición.

INTRODUCTION: The quality assessment in health activities requires the choice of indicators in line with the results we want to measure. Of all possible, we should prioritize those that allow us to obtain the most relevant information without overloading the regular work of our units. OBJECTIVE: To determine the opinion of the members of SENPE regarding the relevance and feasibility of using a selection of quality indicators designed for use in clinical nutrition. METHODS: E-mail survey sent to members of SENPE asking them their views on 12 quality indicators, evaluating each in terms of their relevance and feasibility of implementation in their environment. RESULTS: 40 respondents answered from 40 centers in 12 different regions. In general, the indicators were considered more relevant than feasible. The indicators best rated were: "identification in artificial nutrition bags, "semi-recumbent position in patient with nasogastric tube feeding" and "basic clinical protocols". Considering the type of indicator: "patient identification in the bags of artificial nutrition (structure)," a semi-incorporated "and" basic clinical protocols (process), and "fulfillment of the caloric goal" (result). CONCLUSION: The results of the survey can make a selection of indicators that could be considered for first-line introduction in a Nutrition Unit.

The burden of hospital malnutrition in Spain: methods and development of the PREDyCES® study / El coste de la desnutrición hospitalaria en España: método y desarrollo del estudio PREDyCES®

It is well known that hospital malnutrition is ahighly prevalent condition associated to increase morbidity and mortality as well as related healthcarecosts. Although previous studies have already measured the prevalence and/or costs of hospital nutrition in our country, their local focus (at regionalor even hospital level) make that the true prevalence and economic impact of hospital malnutrition for the National Health System remain unknown inSpain. The PREDyCES® (Prevalence of hospitalmal nutrition and associated costs in Spain) study was aimed to assess the prevalence of hospital malnutrition in Spain and to estimate related costs.Some aspects made this study unique: a) It was the first study in a representative sample of hospitals ofSpain; b) different measures to assess hospital malnutrition (NRS2002, MNA as well as anthropometric and biochemical markers) where used both at admission and discharge and, c) the economic consequences of malnutrition where estimated using the perspective of the Spanish National Health System (AU)

Es bien sabido que la desnutrición hospitalaria es un proceso altamente prevalente asociado al aumento de la morbilidad y mortalidad, así como a elevados costes sanitarios. Aunque estudios previos han medido la prevalencia y/o los costes de la nutrición hospitalaria en nuestro país, su enfoque local(regional o incluso a nivel hospitalario) hacen que la verdadera prevalencia e impacto económico de la desnutrición hospitalaria para el Sistema Nacional de Salud sean aún desconocidos en España. El objetivo del estudio PREDyCES®(Prevalencia de la Desnutrición hospitalaria y los Costes asociados en ESpaña) fue evaluar la prevalencia de la desnutrición hospitalaria en España y estimar sus costes asociados.Algunos aspectos de este estudio lo hicieron singular: a) Fue el primer estudio de este tipo con una muestra representativa de los hospitales de España, b) se utilizaron diferente medidas para evaluar la desnutrición hospitalaria (NRS 2002,MNA, así como marcadores antropométricos y bioquímicos)tanto en el momento del ingreso como al alta hospitalaria y, c)se estimaron las consecuencias económicas de la desnutrición desde la perspectiva del Sistema Nacional de Salud español (AU)

The burden of hospital malnutrition in Spain: methods and development of the PREDyCES® study.

It is well known that hospital malnutrition is a highly prevalent condition associated to increase morbidity and mortality as well as related healthcare costs. Although previous studies have already measured the prevalence and/or costs of hospital nutrition in our country, their local focus (at regional or even hospital level) make that the true prevalence and economic impact of hospital malnutrition for the National Health System remain unknown in Spain. The PREDyCES® (Prevalence of hospital malnutrition and associated costs in Spain) study was aimed to assess the prevalence of hospital malnutrition in Spain and to estimate related costs. Some aspects made this study unique: a) It was the first study in a representative sample of hospitals of Spain; b) different measures to assess hospital malnutrition (NRS2002, MNA as well as anthropometric and biochemical markers) where used both at admission and discharge and, c) the economic consequences of malnutrition where estimated using the perspective of the Spanish National Health System.

Evaluación del riesgo nutricional e instauración de soporte nutricional en pacientes oncológicos, según el protocolo del grupo español de Nutrición y Cáncer / Nutricional risk evaluation and establishment of nutricional support in oncology patients according to the protocol of the spanish nutrition and cancer group

Introducción: El cáncer, los tratamientos que lo acompañan y los síntomas consecuentes que a su vez generan, aumentan en los pacientes el riesgo de sufrir malnutrición. La cual produce un gran deterioro del estado de salud, con el consecuente aumento de complicaciones, disminución de la tolerancia al tratamiento oncológico y una disminución de la calidad de vida del paciente. Por este motivo, un grupo de profesionales sanitarios de diferentes puntos de España se reunieron con el objetivo de mejorar la intervención nutricional en pacientes oncológicos, con el apoyo de la Sociedad Española de Nutrición Básica y Aplicada (SENBA). Metodología: Este grupo multidisciplinar de profesionales elaboró un documento de consenso basado en la literatura y en la experiencia personal, creando un protocolo de evaluación y de intervención nutricional en forma de algoritmos. Se clasifican los pacientes en tres pasos: 1. según el tipo de tratamiento oncológico que reciben, ya sea de tipo curativo o paliativo; 2. riesgo nutricional de la terapia antineoplásica (bajo, mediano, o alto riesgo), y 3. de acuerdo a la Valoración Global Subjetiva-Generada por el paciente (VGS-gp), que clasifica a los pacientes en: A. pacientes con adecuado estado nutricional, B. pacientes con malnutrición o a riesgo de malnutrición y C. pacientes con malnutrición severa. Durante un año el protocolo se puso en marcha en 226 pacientes mayores de 18 años de ambos sexos, escogidos al azar en las consultas externas de Radioterapia Oncológica y Oncología Médica. Resultados: Más de la mitad sufren malnutrición (64%), y este valor se incrementa llegando hasta un 81% en pacientes con tratamiento paliativo. La mayoría de los pacientes tienen tratamiento de intención curativa (83%) y reciben tratamiento oncológico de intensidad moderada o de alto riesgo nutricional (69%). Un 68% de los pacientes tienen algún tipo de dificultad en la alimentación. La media en el porcentaje de pérdida de peso es del 6,64% ± 0,87 (min 0, máx 33%). El 32% de la población presenta cifras de albúmina entre 3 y 3,5 g/dl, existiendo una correlación negativa entre ésta y las dificultades con la alimentación p = 0,001. El IMC no mostró ser un parámetro significativo para detectar malnutrición (sólo un 10% se encontraba por debajo de 19,9 kg/m2), pero tiene una tendencia lineal significativa con las dificultades en la alimentación, de forma tal que a medida que disminuye el IMC aumentan las dificultades p = 0,001. Más de la mitad de la población, requirió recomendaciones dietéticas específicas para el control de los síntomas que dificultaban la ingesta y una tercera parte de la población necesitó la indicación de suplementos nutricionales. Tras la intervención nutricional más de la mitad (60%) mantuvo su peso y una sexta parte lo aumentó. Conclusión: La aplicación de este protocolo es útil, sencillo y podría facilitar la detección de malnutrición en los pacientes oncológicos. Seleccionando a los pacientes que realmente se podrían beneficiar de una intervención nutricional específica, pero debería aplicarse al inicio coincidiendo si fuera posible con el diagnóstico de la enfermedad. El soporte nutricional resulta eficaz en la mayoría de los pacientes (AU)

Introduction: Cancer and its oncological treatment cause symptoms which increase the patients risk to suffer from malnutrition. This affects the patients health status negatively by increasing the number of complications, reducing the tolerance to the oncology treatment and a decrease of the patients quality of life. Motivated by this, a group of health professionals from several spanish regions met with the backing of the Sociedad Española de Nutrición Básica y Aplicada (SENBA) to address strategies to improve the quality of nutritional intervention in cancer patients. Methods: This multidisciplinary group developed a protocol describing nutritional assessment and intervention in form of algorithms based on literature and personal experience. The patients are classified in a three step process: 1. type of their oncology treatment (curative or palliative); 2. nutritional risk of the antineoplastic therapy (low, medium or high risk) and 3. depending on the Subjective Global Assessment patient-generated (SGApg). The patients are classified as: A. patients with adequate nutritional state, B. patients with malnutrition or risk of malnutrition and C. patients suffering from severe malnutrition. During one year, the protocol has been used for 226 randomly chosen female and male patients older than 18 years. They were treated by the Medical and Radiotherapy Oncology outpatient clinic. Results: More than a half of the patients were suffering from malnutrition (64%) increasing up to 81% for patients undergoing palliative treatment. Most of them were treated curatively (83%) and received oncology treatment with moderate or high nutritional risk (69%). 68% of patients were affected by some feeding difficulty. The mean percentage of weight loss has been 6.64% ± 0.87 (min 0%, max 33%). Albumin values of 32% of the patients were between 3 and 3.5 g/dl and negatively correlated with feeding difficulties (p = 0.001). The body mass index (BMI) has not found to be a significant parameter for detecting malnutrition (only in 10% of the patients, the value was below 19.9 kg/m2). But a significant linear tendency when compared to feeding problems could be shown, such that in patients with less feeding problems a higher BMI has been found (p = 0.001). More than a half of the patients required nutritional counselling to control symptoms which made food intake difficult. One third of the patients needed oral nutritional supplementation. Following the nutritional intervention the weight of about 60% of the patients could be maintained and of one sixth it could be increased. Conclusion: The application of this protocol is useful, easy and could help detecting malnutrition in oncology patients. It provides the possibility to select those patients who can benefit from a specific nutritional intervention. If possible, the application of the protocol should be started immediatly after cancer is diagnosed. Nutritional support proves efficient for most of the patients (AU)

[Nutritional risk evaluation and establishment of nutritional support in oncology patients according to the protocol of the Spanish Nutrition and Cancer Group]. / Evaluación del riesgo nutricional e instauración de soporte nutricional en pacientes oncológicos, según el protocolo del grupo Español de Nutrición y Cáncer.

INTRODUCTION: Cancer and its oncological treatment cause symptoms which increase the patients risk to suffer from malnutrition. This affects the patients health status negatively by increasing the number of complications, reducing the tolerance to the oncology treatment and a decrease of the patients quality of life. Motivated by this, a group of health professionals from several spanish regions met with the backing of the Sociedad Española de Nutrición Básica y Aplicada (SENBA) to address strategies to improve the quality of nutritional intervention in cancer patients. METHODS: This multidisciplinary group developed a protocol describing nutritional assessment and intervention in form of algorithms based on literature and personal experience. The patients are classified in a three step process: 1. type of their oncology treatment (curative or palliative); 2. nutritional risk of the antineoplastic therapy (low, medium or high risk) and 3. depending on the Subjective Global Assessment patient-generated (SGA-pg). The patients are classified as: A. patients with adequate nutritional state, B. patients with malnutrition or risk of malnutrition and C. patients suffering from severe malnutrition. During one year, the protocol has been used for 226 randomly chosen female and male patients older than 18 years. They were treated by the Medical and Radiotherapy Oncology outpatient clinic. RESULTS: More than a half of the patients were suffering from malnutrition (64%) increasing up to 81% for patients undergoing palliative treatment. Most of them were treated curatively (83%) and received oncology treatment with moderate or high nutritional risk (69%). 68% of patients were affected by some feeding difficulty. The mean percentage of weight loss has been 6.64% +/- 0.87 (min 0%, max 33%). Albumin values of 32% of the patients were between 3 and 3.5 g/dl and negatively correlated with feeding difficulties (p = 0.001). The body mass index (BMI) has not found to be a significant parameter for detecting malnutrition (only in 10% of the patients, the value was below 19.9 kg/m2). But a significant linear tendency when compared to feeding problems could be shown, such that in patients with less feeding problems a higher BMI has been found (p = 0.001). More than a half of the patients required nutritional counselling to control symptoms which made food intake difficult. One third of the patients needed oral nutritional supplementation. Following the nutritional intervention the weight of about 60% of the patients could be maintained and of one sixth it could be increased. CONCLUSION: The application of this protocol is useful, easy and could help detecting malnutrition in oncology patients. It provides the possibility to select those patients who can benefit from a specific nutritional intervention. If possible, the application of the protocol should be started immediatly after cancer is diagnosed. Nutritional support proves efficient for most of the patients.

Algoritmo de actuación

No disponible

[Diet survey and evaluation of ingested nutrients in a group of HIV patients]. / Encuesta dietética y valoración de los nutrientes ingeridos en un grupo de pacientes VIH.

OBJECTIVE: To study the relationship between nutritional status, immunological condition, clinical progress and food consumption in a group of patients infected with HIV. METHOD: Longitudinal descriptive study of 30 HIV/AIDS patients. Anthropometric assessment (weight, height, skin folds, upper arm circumference). The intake of nutrients was calculated using a one-week dietary record. RESULTS: The mean amount of energy intake is 2,791 kcal with a 13.48% of protein, 40.12% of carbohydrates and 45.89% of lipids. The group of patients with weight loss presented a significantly greater proportion of proteins than group with normal weight. Patients with Kwashiorkor-like malnutrition presented an intake of proteins which was significantly lower than the group of well-nourished patients. The group of those whose nutritional status improved presented a significantly higher mean percentage of proteins in the diet than the other groups. CONCLUSIONS: The amount of the energy intake by patients is higher than that recommended. The diets show an excessive consumption of fats and a shortage of carbohydrates and proteins. Deficits are observed in vitamin B6 and vitamin E, magnesium and zinc. The increase in intake, by itself, does not improve the health status of the patients, indicating the need to provide them with the necessary dietary supplements from the early stages of their condition.

Encuesta dietética y valoración de los nutrientes ingeridos en un grupo de pacientes VIH / Dietary survey and assessment of nutrient intake in a group of HIV patients

Objetivo: Estudiar la relación existente entre el estado nutricional, inmunológico, evolución clínica y consumo de alimentos de un grupo de pacientes infectados por el VIH. Método: Estudio descriptivo longitudinal de 30 pacientes VIH/sida. Valoración antropométrica (peso, talla, pliegues cutáneos, circunferencia del brazo). La ingesta de nutrientes fue calculada usando una historia dietética de una semana. Resultados: La cantidad media de energía ingerida es de 2.791 kcal: 13,48 por ciento de proteínas, 40,12 por ciento de hidratos de carbono y 45,89 por ciento de lípidos. El grupo de pacientes con pérdida de peso presentó un aporte de proteínas significativamente superior al grupo con peso normal. Los pacientes con desnutrición tipo Kwashior presentaron una ingesta de proteínas significativamente inferior al grupo de pacientes bien nutridos. El grupo de pacientes que mejora su estado nutricional presenta un porcentaje medio de proteínas en la dieta significativamente superior a los otros grupos. Conclusiones: La cantidad de energía ingerida por los pacientes es superior a la recomendada. Existe un exceso del consumo de grasas en la dieta, un déficit de hidratos de carbono y de proteínas. Se observa déficit de vitamina B6 y E, magnesio y cinc. El aumento de la ingesta, por sí sólo, no mejora el estado de salud de los pacientes, lo que indica la necesidad de aportarles los suplementos dietéticos necesarios desde fases tempranas de la enfermedad (AU)

Objective: To study the relationship between nutritional status, immunological condition, clinical progress and food consumption in a group of patients infected with HIV. Method: Longitudinal descriptive study of 30 HIV/AIDS patients. Anthropometric assessment (weight, height, skin folds, upper arm circumference). The intake of nutrients was calculated using a one-week dietary record. Results: The mean amount of energy intake is 2,791 kcal with a 13.48% of protein, 40.12% of carbohydrates and 45.89% of lipids. The group of patients with weight loss presented a significantly greater proportion of proteins than the group with normal weight. Patients with Kwashiorkor- like malnutrition presented an intake of proteins which was significantly lower than the group of well-nourished patients. The group of those whose nutritional status improved presented a significantly higher mean percentage of proteins in the diet than the other groups. Conclusions: The amount of the energy intake by patients is higher than that recommended. The diets show an excessive consumption of fats and a shortage of carbohydrates and proteins. Deficits are observed in vitamin B6 and vitamin E, magnesium and zinc. The increase in intake, by itself, does not improve the health status of the patients, indicating the need to provide them with the necessary dietary supplements from the early stages of their condition (AU)

Recomendaciones de evaluación y soporte nutricional en el paciente adulto con cáncer / No disponible

No disponible

Estado nutricional del paciente VIH. Descripción y evolución durante un año de un grupo de pacientes / Nutritional status of HIV patients. Description and evolution of a group of patients over a year

Objetivo: Conocer el estado nutricional e inmunológico de una muestra de infectados por el VIII y su evolución a lo largo de un año. Relación del estado nutricional, inmunológico y evolución clínica.Método: Estudio descriptivo longitudinal de 30 pacientes infectados por el VIII. Valoración antropométrica (peso, talla, pliegues cutáneos, circunferencia del brazo) e imnunológica (CD4 y CD4/CD8). El estudio estadístico: medias, frecuencias absolutas y relativas, t de Student.Resultados: Treinta pacientes 73,3 por ciento varones y 26,7 por ciento mujeres. Edad media 34,7 años. Valoración nutricional inicial: El 30 por ciento de los pacientes presentaban peso normal, 36,7 por ciento malnutrición leve, 16,7 por ciento malnutrición moderada, 6,7 por ciento exceso de peso y 10 por ciento obesidad. La evolución del nivel de CD4 y del CD4/CD8, no está significativamente influida por el estado de nutrición.Conclusiones: Los pacientes del estudio presentan un deterioro del estado nutricional, valorado por el pliegue tricipital. El estado de nutrición de los pacientes infectados por el VIH, de nuestro estudio, es independiente del estado inmunológico. El diagnóstico y tratamiento del estado de desnutrición en el momento de diagnosticarse la infección por el VIII permitirá realizar una prevención de complicaciones, reduciendo de esta forma los costes humanos y sanitarios. El aumento de la ingesta, por sí sólo, no mejora el estado de salud de los pacientes, lo que indica la necesidad de aportarles los suplementos dietéticos necesarios desde fases tempranas de la enfermedad (AU)

Abstract Goal: To know the nutritional and immunological status of a sample of patients infected by HIV and their evolution over a one-year period. Relationship between nutritional status, immunological status and clinical evolution. Method: Longitudinal descriptive study of 30 HIV-infected patients. Anthropometric evaluation (weight, height, skin folds, arm circumference) and immunological assessment (CD4 and CD4/CD8). Statistical analysis: means, absolute and relative frequencies, Student's T test. Results: 30 patients, 73.3% males and 27.7% female. Mean age 34.7 years. Initial nutritional assessment: 30% of patients had normal weight, 36.7% presented mild undernourishment, 16.7% moderate undernourishment, 6.7% were overweight and 10% were obese. The evolution of CD4 and CD4/CD8 levels was not significantly influenced by nutritional status. Conclusions: The patients in the study presented a deterioration of their nutritional status, as assessed by triceps skin fold. The nutritional status of the HIV-infected patients in our study is not dependent on their immunological status. The diagnosis and treatment of their de-nourishment on diagnosis of HIV infection will contribute to the prevention of complications, thus reducing the human and health-care costs. An increase in food intake, on its own, does not improve the condition of the patients, indica-ting the need to provide them with the necessary dietary supplements from the early stages of illness (AU)

[Nutritional status of the HIV patient. Description and clinical course of a group of patients over a year]. / Estado nutricional del paciente VIH. Descripción y evolución durante un año de un grupo de pacientes.

GOAL: To know the nutritional and immunological status of a sample of patients infected by HIV and their evolution over a one-year period. Relationship between nutritional status, immunological status and clinical evolution. METHOD: Longitudinal descriptive study of 30 HIV-infected patients. Anthropometric evaluation (weight, height, skin folds, arm circumference) and immunological assessment (CD4 and CD4/CD8). STATISTICAL ANALYSIS: means, absolute and relative frequencies, Student's T test. RESULTS: 30 patients, 73.3% males and 27.7% female. Mean age 34.7 years. Initial nutritional assessment: 30% of patients had normal weight, 36.7% presented mild undernourishment, 16.7% moderate undernourishment, 6.7% were overweight and 10% were obese. The evolution of CD4 and CD4/CD8 levels was not significantly influenced by nutritional status. CONCLUSIONS: The patients in the study presented a deterioration of their nutritional status, as assessed by triceps skin fold. The nutritional status of the HIV-infected patients in our study is not dependent on their immunological status. The diagnosis and treatment of their de-nourishment on diagnosis of HIV infection will contribute to the prevention of complications, thus reducing the human and health-care costs. An increase in food intake, on its own, does not improve the condition of the patients, indicating the need to provide them with the necessary dietary supplements from the early stages of illness.

[Nutritional management of oncologic patients]. / Tratamiento nutricional en el paciente oncológico.

Malnutrition is a common complication in the oncological patient, and this affects his or her quality of life and survival. The majority of these patients show nutritional problems in their evolution, especially anorexia and weight loss. The most severe picture is called neoplastic cachexia. The causes hereof are many and some are not well known as they are related to the tumor metabolism itself, the metabolic response to the release of cytokines, or even to the treatment: surgery, chemotherapy or radiation therapy. The nutritional support will not cure the cancer; the malignant cells must be eradicated by the anti-tumor therapies, but nutrition is a therapy that is complementary to the basic treatment, however, with nutritional intervention we can avoid a greater deterioration of the patient, improve some nutritional and immunological parameters, avoid complications, and improve the quality of life. The nutritional action plan should be based on the knowledge of the specific situation of each patient, assessing his or her nutritional status, type of tumor, expected response to treatment, and the capacity to handle the situation. As in any patient, the access route of the nutritional support may be oral, enteral, or parenteral, depending on the clinical situation. The oral route, supervised by an experienced team, is the safest and the most effective, but this requires an adequately functioning digestive system and that the patient be able to maintain an adequate caloric and proteineic ingestion. When oral feeding is impossible or insufficient, it is necessary to resort to enteral or parenteral nutrition, depending on the functionality of the digestive apparatus. Special attention should be paid to those patients in whom the failure of the oncological therapy leads to an expected fatal outcome. Within the palliative care the nutritional intervention is simple, cheap, and effective with regard to the improvement of the quality of life. Dietary advice and at home enteral nutrition may be of great help.

[Rate of protein catabolism as an indicator of protein ingestion in uremic patients on hemodialysis]. / Tasa de catabolismo proteico como indicador de la ingesta proteica en pacientes urémicos en hemodiálisis.

Protein catabolic rate (PCR) has been proposed as a indirect index of dietary protein intake, but its sensitivity has been discussed. In a group of 140 chronic uremic patients undergoing maintenance hemodialysis, we evaluated the nutritional status (body mas index: BMI, triceps skinfold thickness: TST, arm muscle circumference: AMC, serum total proteins, albumin and lymphocytes) and its relation with dietary survey and PCR levels. PCR was correlated positively with Kt/V (p: 0.0001, r: 0.45) and with seric albumin (p: 0.01, r: 0.22), whereas dietary protein intake by dietary survey (g/Prot/Kg/day) was correlated strongly with anthropometric measurements like BMI, AMC (p: 0.0001) and less with Kt/V (p: 0.01), but not with serum albumin. PCR was correlated with dietary survey results: g Prot/Kg/day (p: 0.04, r: 0.18) and Kcal/Kg/day (p: 0.03, r:0.2). The results suggest that nutritional parameters with slow evolution as anthropometric measurements could be related with usual dietary intake (dietary survey), whereas serum albumin (that vary early with recent changes of dietary intake) could be related better with a biochemical index like PCR, in these way both determinations are complementary.

[New dietetic recommendations in diabetes mellitus: the implications in enteral nutrition]. / Nuevas recomendaciones dietéticas en diabetes mellitus: implicaciones en nutrición enteral.

In diabetes mellitus there are qualitative and quantitative alterations in the lipid metabolism, which contribute to ischaemic heart disease. The monounsaturated fatty acids (MUFA) may favorably influence the cardiovascular risk factors, and they could replace the saturated fats, in detriment of polyunsaturated fatty acids (PUFA) and carbohydrates (CHO). A series of studies have been done, always on NIDDM patients, which have given rise to reconsidering the dietary recommendations in diabetes mellitus: There is no change in the contribution of proteins (10-20% of the caloric intake), saturated fats (< 10% of the caloric intake), dietary cholesterol (< 300 mg/day), PUFA (10% of the caloric intake), fibre (20-35 g/day), and sodium (< 2.4 g/day), however, the caloric distribution of MUFA and CHO is not defined, but is left up to the judgement of the physician. Enteral nutrition has a series of special characteristics which influence the blood glucose levels of the diabetic patient, as well as having different objectives. In the few published studies, the influence on plasma lipids of an enteral diet rich in MUFA is similar to that published for the oral diets. With respect to the blood glucose, this was less than with the standard formulae, especially in diabetics treated with insulin. In conclusion, we can for see a change of course in the international recommendations on "the diet of the diabetic", even though these may be very slight for the time being.(ABSTRACT TRUNCATED AT 250 WORDS)

[The outlook for hormonal therapy in nutrition]. / Perspectivas de hormonoterapia en nutrición.

When the supply of energetic substrates is insufficient to slow the development of the catabolism, the next step is to focus on the neuro-endocrine mechanism which regulates the anabolism-catabolism balance. In this work, we review the endocrine response to stress and its implications in protein metabolism, in order to evaluate the different therapeutic possibilities available. Pharmacological blocking of the secretion of catabolic hormones (glucagon and catecholamines) has been unsuccessful up to now. Insulin is the only hormone which produces anabolism in all energetic substrates, but the results published about its administration with glucose and amino acids and its effects upon the nitrogen balance are controversial. The administration of anabolic steroids such as nandrolone, stanolone, and methenolone are usually associated with protein anabolism with minimum androgenizing action. The most recent works lead to the study of the effects of the use of GH and IGF-1 with clearly hopeful results. We have not yet acquired enough experience to use these methods in the habitual clinical practice. At the moment, the clinical studies are in the experimental stage and their application in nutrition is not accepted by the official authorities.