White fish reduces cardiovascular risk factors in patients with metabolic syndrome: the WISH-CARE study, a multicenter randomized clinical trial.

BACKGROUND AND AIMS: Reduction of cardiovascular risk with high consumption of fish in diet is still a matter of debate, and concerns about heavy metal contamination have limited consumption of oily fish. We aimed to evaluate the effect of regular ingestion of white fish on cardiovascular risk factors in patients with metabolic syndrome. METHODS AND RESULTS: Multicenter randomized crossover clinical trial including 273 individuals with metabolic syndrome. An 8-week only-one dietary intervention: 100 g/d of white fish (Namibia hake) with advice on a healthy diet, compared with no fish or seafood with advice on a healthy diet. Outcomes were lipid profile, individual components of the metabolic syndrome, serum insulin concentrations, homeostasis model of insulin resistance, serum C-reactive protein and serum fatty acid levels. We found a significant lowering effect of the intervention with white fish on waist circumference (P < 0.001) and diastolic blood pressure (P = 0.014). A significant lowering effect was also shown after the dietary intervention with fish on serum LDL concentrations (P = 0.048), whereas no significant effects were found on serum HDL or triglyceride concentrations. A significant rise (P < 0.001) in serum EPA and DHA fatty acids was observed following white fish consumption. Overall adherence to the intervention was good and no adverse events were found. CONCLUSION: In individuals with metabolic syndrome, regular consumption of hake reduces LDL cholesterol concentrations, waist circumference and blood pressure components of the metabolic syndrome. CLINICAL TRIAL REGISTRY: White Fish for Cardiovascular Risk Factors in Patients with Metabolic Syndrome Study, Registered under ClinicalTrials.gov Identifier: NCT01758601.

Validation of a food frequency questionnaire in Spanish patients with familial hypercholesterolaemia.

BACKGROUND AND AIMS: The aim of this study is to validate a semi-quantitative Food Frequency Questionnaire (FFQ) used for general population in Spain, in patients with familial hypercholesterolaemia (FH). SUBJECTS AND METHODS: Subjects with genetic diagnosis of FH were randomly selected from the Spanish FH Registry. They completed an FFQ based in 113 food items at inclusion (FFQ1) and after 1 year (FFQ2), and a 3-day dietary records (DR) every 3 months. Detailed instruction about how to register foods and beverages was given by a trained nutritionist. Each DR and FFQ was systematically coded, and the daily nutrients intake in absolute, percentage and nutrient density terms were estimated using a software system based on food composition tables. Pearson correlation coefficient was calculated with correction-repeated measurements to assess the reproducibility of both FFQ and the four 3-day DRs, as well as the validity of FFQ comparing to the mean of 3 days' DR. RESULTS: A total of 112 subjects (58 females and 54 males, aged 43 ± 16 years) finished the study. There were no differences between FFQ1, FFQ2 and mean FFQ (FFQa) in mean absolute and percentage values of selected daily nutrients' intake. Comparison between FFQ1, FFQ2, FFQa and the mean of four 3-day DRs was statistically significant in all absolute values, but not in percentage or nutrient density terms. Corrected Pearson correlation coefficient ranged from 0.470 to 0.952 for mean values of all nutrients, except alcohol. CONCLUSION: This study demonstrated that FFQ is a reliable tool to assess the dietary pattern in FH patients.

[Education on nutrition: from the university to specialized care]. / Formación en Nutrición: de la universidad a la especialidad.

The 7th Abbott-SENPE Forum is structured facing the new regulations of the European Space of High Education regarding the studies on Nutrition in the different degrees (Medicine, Pharmacology, Nutrition, Nursing) and post-doctoral education. A multi-professional and multidisciplinary discussion on the current situation of university education on nutrition, and its capabilities and limitations, is carried out. The value of the role of continuous medical education, the inhouse training programme, masters, and of scientific societies is also assessed. It is concluded that there is a need to urge academic authorities, the National Commission of Medical Specialties, the persons in charge of continuous medical education, and scientific societies of the importance of the studies relating to nutrition, feeding, and dietetics at both pre-graduate and post-graduate educational levels, and to implement and develop these studies in their areas of influence.

Formación en Nutrición: de la universidad a la especialidad / Education on Nutrition: Drom the university to specialized care

De cara a las nuevas normas del Espacio Europeo de Educación Superior en su relación con los estudios de nutrición tanto en los diferentes grados (medicina, farmacia, nutrición, enfermería) como en el postgrado, se estructura el VIIo FORO Abbott-SENPE. Se efectúa una reflexión multiprofesional y multidisciplinar sobre la actual situación de la formación universitaria en nutrición, sus posibilidades y límites. También se valora el papel de la formación continuada, del sistema de residencia, de los másteres y de las sociedades científicas. Se concluye en instar a las autoridades académicas, a la Comisión Nacional de Especialidades, a los responsables de formación continuada y a las sociedades científicas a reflexionar sobre la importancia de los estudios relacionados con la nutrición, alimentación y dietética tanto en el pregrado como en el postgrado y a implementarlos y desarrollarlos en sus áreas de influencia (AU)

The 7th Abbott-SENPE Forum is structured facing the new regulations of the European Space of High Education regarding the studies on Nutrition in the different degrees (Medicine, Pharmacology, Nutrition, Nursing) and post-doctoral education. A multi-professional and multidisciplinary discussion on the current situation of university education on nutrition, and its capabilities and limitations, is carried out. The value of the role of continuous medical education, the inhouse training programme, masters, and of scientific societies is also assessed. It is concluded that there is a need to urge academic authorities, the National Commission of Medical Specialties, the persons in charge of continuous medical education, and scientific societies of the importance of the studies relating to nutrition, feeding, and dietetics at both pre-graduate and post-graduate educational levels, and to implement and develop these studies in their areas of influence (AU)

Prevalencia de trastornos facticios con síntomas psicológicos en pacientes hospitalizados / Prevalence of factitious disorder with psychological symptoms in hospitalized patients

El trastorno facticio se caracteriza por la invención, producción o falsificación de síntomas físicos o psicológicos que simulan una enfermedad física o mental. Entre los pacientes psiquiátricos tanto ingresados como ambulatorios no es infrecuente observar síntomas que se sospecha que son facticios aunque nunca se llegue a confirmar esta sospecha. Tras establecer unos criterios de sospecha de trastorno facticio con síntomas psicológicos se observó que el 8% de los pacientes ingresados en una unidad de hospitalización psiquiátrica presentaban síntomas facticios. Los pacientes con este diagnóstico eran fundamentalmente mujeres y su media de edad fue de 36,2 años. Los síntomas de sospecha que más se observan son la respuesta poco congruente al tratamiento, el empeoramiento de los síntomas ante la perspectiva del alta, la desaparición de los síntomas rápidamente tras el ingreso y el establecimiento de relaciones intensas con otros pacientes o con el personal durante el ingreso. Aunque no es posible determinar con total exactitud el método utilizado en la producción facticia de los síntomas psicológicos, la estrecha observación de los pacientes permite deducir que el 75% de los pacientes exageran síntomas psicológicos presentes en la actualidad o en el pasado y por tanto experimentados en algún momento de la vida. La invención de síntomas psicológicos aparentemente no experimentados nunca por el paciente y la intervención deliberada con el tratamiento psiquiátrico para afectar la evolución de la enfermedad se observaron con menos frecuencia. El 25% de los pacientes con criterios de sospecha de trastorno facticio con síntomas psicológicos presentaron también síntomas somáticos considerados facticios durante el ingreso. El 62,5% de los pacientes con síntomas facticios establecieron relaciones intensas con otros pacientes (AU)

Factitious disorder is characterized by the invention, production or falsification of physical and psychological symptoms that feign a physical or mental illness. Although it is not rare to find symptoms that seem to be factitious among psychiatric patients (both outpatients and inpatients), we have never been able to confirm this suspicion. Once we had established the suspicion criteria for factitious disorder with psychological symptoms, we discovered that 8% of the patients admitted to an inpatient psychiatric unit had factitious symptoms. The patients were mostly women with a mean age of 36.2 years. The most frequent symptoms were non-consistent response to treatment, worsening of the symptoms when faced with the perspective of a discharge plan, disappearance of the symptoms just after being admitted and intense relationship with other patients or staff during the hospitalization. Although it is not possible to determine the method used in the factitious production of the psychological systems accurately, close observation of the patients helps to infer that 75 % of the patients exaggerate the psychological symptoms currently present or those occurring in the past and thus experienced at some time during their lifespan. Invention of psychological symptoms never felt before by the patient and deliberate intervention in the psychiatric treatment to modify the evolution of the illness were less frequent. A total of 25% of the patients with suspicion criteria for factitious disorder with psychological symptoms also had physical symptoms considered to be factitious during the hospitalization and 62% of patients with factitious symptoms developed intense relationships with other patients (AU)

Prevalence of factitious disorder with psychological symptoms in hospitalized patients.

Factitious disorder is characterized by the invention, production or falsification of physical and psychological symptoms that feign a physical or mental illness. Although it is not rare to find symptoms that seem to be factitious among psychiatric patients (both outpatients and inpatients), we have never been able to confirm this suspicion. Once we had established the suspicion criteria for factitious disorder with psychological symptoms, we discovered that 8% of the patients admitted to an inpatient psychiatric unit had factitious symptoms. The patients were mostly women with a mean age of 36.2 years. The most frequent symptoms were non-consistent response to treatment, worsening of the symptoms when faced with the perspective of a discharge plan, disappearance of the symptoms just after being admitted and intense relationship with other patients or staff during the hospitalization. Although it is not possible to determine the method used in the factitious production of the psychological systems accurately, close observation of the patients helps to infer that 75% of the patients exaggerate the psychological symptoms currently present or those occurring in the past and thus experienced at some time during their lifespan. Invention of psychological symptoms never felt before by the patient and deliberate intervention in the psychiatric treatment to modify the evolution of the illness were less frequent. A total of 25% of the patients with suspicion criteria for factitious disorder with psychological symptoms also had physical symptoms considered to be factitious during the hospitalization and 62% of patients with factitious symptoms developed intense relationships with other patients.

Trends in adult home parenteral nutrition in Spain. 1992-2003.

UNLABELLED: There are very few data on trends in prevalence in home parenteral nutrition (HPN) in different countries. NADYA is the committee of the Spanish Society for Parenteral and Enteral Nutrition that takes care of the Spanish registry since 1992. METHOD: A 12-year retrospective study of the activity of the registry was performed. The data were extracted from the NADYA's database as well as from the publications and abstracts reported on a yearly basis since 1992. Data on years 1993 and 1997-9 were not available. RESULTS: Yearly prevalence has more than doubled to 86 patients since 1992. The number of reporting centres went up to 17 in 2003 (10 centres in 1992) As an average, the number of patients per centre is 5. The prevalence in 2003 was 2.15 patients per million inhabitants. There are trends to increasing age at the time of the first indication (42 years in 1992; 51 in 2003). Ischemic and thrombotic vascular diseases were the most common underlying diagnosis in adults. Tunnelled central venous catheters were chosen in 2/3 of the patients. Only around 17% of the patients received support from home delivery companies (11% in 1992) There were more than 1 complication per patient and year, mostly HPN-related. CONCLUSIONS: We found a steadily increase in the number of reported patients and reporting centres over time. Prevalence went up to 2.15 patients per million inhabitants in 2003, still far behind the figures from other western countries. The NADYA registry allows a close follow-up of the evolution of HPN in Spain.

[The year 2003 National Registry of Home-based Parenteral Nutrition]. / Registro Nacional de la Nutrición Parenteral Domiciliaria del año 2003.

OBJECTIVE: To report the results of the Home-based Parenteral Nutrition (HBPN) registry of the NADYA-SENPE working group, for the year 2003. MATERIAL AND METHODS: Gathering of registry data introduced by all units responsible of HBPN patient care. This an on-line registry available for authorized users of the working group web page (www.nadya-senpe.com). Epidemiological data, diagnosis, access route, complications, hospital admissions, disability degree, and course at December 31st, 2003 RESULTS: Data from 86 patients (62% female and 38% male) from 17 hospitals were gathered. Mean age of adult patients was 50.7 +/- 15.0 years, whereas for patients younger than 14 years was 2.4 +/- 1.5 years (n = 5 patients). Diseases that prone HBPN were neoplasm (21%), followed by mesenteric ischemia (20%), radiation enteritis (16.3%), motility impairments (10.5%), and Crohn's disease (4.6%). Tunneled catheters were used in 66.3% of the cases versus 29.1% of subcutaneous reservoirs. Mean treatment duration has been 8.5 +/- 4.6 months; 67.4% of patients had been on HBPN for a period of time longer than 6 months. Patient follow-up was mostly done from the reference area hospital (88.4%). In no case patient follow-up was done by the primary care team or by specialists other than those prescribing nutritional support. Nutritional support-related complications were seen in 98 occasions. The most frequent complications were infectious ones. They represented 1.60 hospital admissions per patient. The mean number of visits was 7.9 per patient (6.4 for scheduled visits and 1.5 for emergency visits). By the end of the year, we observed that 73.3% of the patients were still on the program, whereas in 23.3% HBPN had been withdrawn. The main reasons for withdrawal were decease (11 patients), and advancing to oral diet (9 patients). As for the disability degree, 13% were confined to a wheelchair or bed, and only 28% had no disability degree or only mild social disability. CONCLUSIONS: We observed a mild increase in HBPN prevalence rate in Spain (2.15 patients pmp). The main indication was cancer followed by short-bowel syndrome secondary to vascular pathology. Nutritional support-related complications were common, especially those of an infectious origin.

[Effects of parenteral glutamine in patients submitted to bone marrow transplantation]. / Efectos de la glutamina parenteral en pacientes sometidos a trasplante de médula ósea.

UNLABELLED: Bone marrow transplantation (BMT) is a therapy used for hematologic malignancies and solid tumors. Associated chemotherapy and radiotherapy to which these patients are submitted induce secondary effects, with a high metabolic stress. Glutamine is considered a conditionally essential amino acid, and has been shown effective in severe catabolic states. The aim of the study was to assess the effect of parenteral nutrition (PN) therapy supplemented with glutamine on duration of nutritional support in a group of patients with BMT. We have also analyzed associated complications, the nutritional status, the clinical course at 6 months, differences as to type of transplantation, and oral ingestion capability. This is a phase IV, randomized, double blind, and parallel clinical trial, done at a single center. The study was performed on 49 patients, 29% male and 71% female patients, with ages between 21-63 years, distributed in 3 diagnostic groups (leukemia, lymphoma, and solid tumors), and admitted to the Hematology Department of our Hospital. Fifty percent of the patients in each group have received PN supplemented with glutamine (0.4 g/kg/day of L-alanine-L-glutamine), and the other 50% have received standard PN. RESULTS: we have not found significant differences nor at the beginning nor at the end of the study between both groups with regards to studied variables. CONCLUSIONS: PN is and effective therapy for maintenance of the nutritional status in patients submitted to a therapy with a, highly catabolic effect such as BMT. Although we have not been able to show the efficacy of glutamine supplementation in this study with the used dose, it does have been effective in other reports.

[National registry of Home Enteral Nutrition in 2003]. / Registro nacional de la Nutrición Enteral Domiciliaria del año 2003.

GOAL: To communicate the information available by the NADYA-SENPE Working Group from patients on Home Enteral Nutrition (HEN) in our country during the year 2003. MATERIAL AND METHODS: The data were collected through a closed questionnaire included in the web site of the Working Group (www.nadya-senpe.com) available only by the authorized users. Variable included were: epidemiological information, the indication to prescribe this treatment, the access path, the specific nutritional formula used, the treatment duration, the complications and hospital readmission related to the nutritional treatment, the follow-up and the quality of life. RESULTS: We register 3,858 patients that belong to twenty-one hospitals. Mean age from those adults 66.2 +/- 18.9 years, and from those younger than 14, 6.0 +/- 4.3 years. Neurological and neoplasic diseases were the diagnostics more frequents (38.9% and 37.4%, respectively). Oral nutrition was the preferential rout used for the enteral nutrition (54.7%) followed by naso-enteral tube (26.6%), and only in 17.6% we used ostomy tubes. Polymeric was the enteral formula mainly utilized (80.1%). The mean time on HEN was 6.6 +/- 4.3 months; the 28.8% of patients stayed in the treatment for less than 3 months, 21.2 % between 3 and 6 months, and 50.0% more than 6 months. Patients were followed mainly by Nutritional Support Unit from the reference hospital (73.1%). While the reference hospital supplies the material (62.4%), reference hospital pharmacy (46.8%) and public pharmacies (32.0%) provides the enteral formula. Complications related to enteral nutrition included change of enteral tube (44.5%), gastrointestinal complications (30.5%), mechanical complications (21.7%), and the metabolic one (3.3%). These complications were followed by 0.02 hospitalizations/patient. At the end of the year, 54.7% of patients were in the HEN programme, and in 35.2 % HEN was finish due to accept oral conventional alimentation (49.2%) or by deceased of patients (40.9%). While 26.6% of the patients were confined to bed or armchair, 19.7 % no or light discapacity degree was observed. CONCLUSIONS: We found a persistence of these treatment in our country. Neurological and neoplasic diseases were the more frequent diagnosis in patients analysed. The high prevalence of cancer patients could be the main cause of oral access for enteral nutrition. Change of enteral tube was the more frequent complication observed during this treatment.

Registro Nacional de la Nutrición Enteral Domiciliaria del año 2003 / National registry of home enteral nutrition in 2003

OBJETIVO: Comunicar los resultados, correspondientes al año 2003, obtenidos del registro que sobre Nutrición Enteral Domiciliaria (NED) realiza el grupo de Trabajo NADYA de la Sociedad Española de Nutrición Parenteral y Enteral (SENPE). MATERIAL Y MÉTODOS: Todos los datos del registro, introducidos por los miembros del grupo NADYA de las Unidades de Nutrición responsables de la atención de los pacientes con NED, se han recopilado y analizado. El registro "on-line" estaba disponible en la página web del grupo (www.nadya-senpe.com) para todos los usuarios autorizados. En él se han recogido los siguientes datos: epidemiológicos, de diagnóstico, vía de acceso, complicaciones, ingresos hospitalarios, grado de incapacidad y evolución al final del año en estudio. RESULTADOS: Se han registrado datos de 3.858 pacientes (53,1% varones y 46.9% hembras) pertenecientes a 21 centros hospitalarios. La edad media de los pacientes adultos fue de 66,2 ± 18,9 años; mientras que la de los pacientes menores de 14 años fue de 6,0 ± 4,3 años. Los diagnósticos que motivaron la indicación de NED fueron las enfermedades neurológicas (38,9%) y las enfermedades neoplásicas (37,4%), seguidas de un amplio abanico de otras enfermedades (enfermedad inflamatoria intestinal, malnutrición, SIDA, etc). La vía oral fue la más utilizada (54,7%) seguida de la sonda nasoenteral (26,6%) y, en sólo el 17,6% de los casos se utilizó ostomía como vía de alimentación. La fórmula polimérica fue la más utilizada (80,1%). La duración media del tratamiento fue de 6,6 ± 4,3 meses; el 28,8% de los pacientes habían permanecido con NED por un periodo inferior a 3 meses; el 21,2% por un periodo entre 3 y 6 meses; el 50,0% más de 6 meses. El seguimiento del paciente fue mayoritariamente realizado desde el hospital de referencia (73,1%). El suministro de material fue proporcionado por el hospital de referencia en el 62,4% de los casos, mientras el suministro de la fórmula se repartió entre la farmacia del hospital de referencia (46,8%) y la farmacia no hospitalaria (32,0%). Se presentaron complicaciones relacionadas con el tratamiento nutritivo en 2.437 ocasiones. De ellas, el cambio de sonda, en el 44,5% fue la más frecuente, seguida de las complicaciones gastrointestinales (30,5%), las mecánicas (21,7%) y las metabólicas (3,3%). Estas complicaciones significaron 0,02 hospitalizaciones por paciente. Al finalizar el año, observamos que seguían en activo en el programa el 54,7% de los pacientes; mientras que en el 35,2% se había suspendido la NED y se dejaron de seguir por diversos motivos el 10,.1% de los pacientes. Las principales causas de retirada fueron por paso a dieta oral convencional (49,2%) y por éxitus en relación a la enfermedad de base (40,9%). En cuanto al grado de incapacidad, el 26,6% estaban confinados en silla o cama y el 19,7% no presentaba ningún grado de incapacidad o sólo una leve incapacidad social CONCLUSIONES: Observamos un mantenimiento en la tasa de registro de NED en España. Las causas principales de empleo de este tratamiento fueron la enfermedad neurológica y la enfermedad neoplásica muy distanciadas del resto de patologías. Persiste el elevado uso de la vía oral y el escaso empleo de las ostomías. De las complicaciones asociadas al tratamiento nutricional el cambio de sonda sigue siendo la complicación más frecuentemente observada (AU)

GOAL. To communicate the information available by the NADYA-SENPE Working Group from patients on Home Enteral Nutrition (HEN) in our country during the year 2003. 
MATERIAL AND METHODS: The data were collected through a closed questionnaire included in the web site of the Working Group (www.nadya-senpe.com) available only by the authorized users. Variable included were: epidemiological information, the indication to prescribe this treatment, the access path, the specific nutritional formula used, the treatment duration, the complications and hospital readmission related to the nutritional treatment, the follow-up and the quality of life. RESULTS: We register 3,858 patients that belong to twenty-one hospitals. Mean age from those adults 66.2 ± 18.9 years, and from those younger than 14, 6.0 ± 4.3 years. Neurological and neoplasic diseases were the diagnostics more frequents (38.9% and 37.4%, respectively). Oral nutrition was the preferential rout used for the enteral nutrition (54.7%) followed by naso-enteral tube (26.6%), and only in 17.6% we used ostomy tubes. Polymeric was the enteral formula mainly utilized (80.1%). The mean time on HEN was 6.6 ± 4.3 months; the 28.8% of patients stayed in the treatment for less than 3 months, 21.2 % between 3 and 6 months, and 50.0% more than 6 months. Patients were followed mainly by Nutritional Support Unit from the reference hospital (73.1%). While the reference hospital supplies the material (62.4%), reference hospital pharmacy (46.8%) and public pharmacies (32.0%) provides the enteral formula. Complications related to enteral nutrition included change of enteral tube (44.5%), gastrointestinal complications (30.5%), mechanical complications (21.7%), and the metabolic one (3.3%).These complications were followed by 0.02 hospitalizations/patient. At the end of the year, 54.7% of patients were in the HEN programme, and in 35.2% HEN was finish due to accept oral conventional alimentation (49.2%) or by deceased of patients (40.9%). While 26.6% of the patients were confined to bed o armchair, 19.7% no o light discapacity degree was observed. CONCLUSIONS: We found a persistence of these treatment in our country. Neurological and neoplasic diseases were the more frequent diagnosis in patients analysed. The high prevalence of cancer patients could be the main cause of oral access for enteral nutrition. Change of enteral tube was the more frequent complication observed during this treatment (AU)

[Home Enteral Nutrition: National Registry 2001]. / Nutrición Enteral Domiciliaria (NED): registro nacional 2001.

GOAL: The NADYA-SENPE Working Group analyzed the registered data of patients on Home Enteral Nutrition (HEN) in our country, during year 2001. 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 to prescribe this treatment, the specific nutritional treatment used and its duration, access path, complications and readmission rate in hospital, follow-up of the treatment, patient's quality of life and progress. All data were processed and analyzed by the coordinating team. RESULTS: Twenty two hospitals participated and 3,458 patients, aged 5.6 +/- 4.0 y for those younger than 14 y, and 67.1 +/- 19.5 y for those older than 14 y, were enrolled. Of these patients, 43.4% were diagnosed with neurological diseases and 33.5% with cancer. The mean time on HEN was 6.5 +/- 4.5 months. Oral nutrition was the preferential route (54.5%), followed by nasoenteral tube (32.3%), and in 13.3% ostomy tubes were placed. Polymeric was the formula composition mainly used (85.9%). Patients were followed (71.1%) by the hospital reference Nutritional Support Unit. The complications related to nutrition included mainly the gastrointestinal (0.16 complications/patient), and the mechanical one (0.15 complications/patient). At the end for the year, 48.3% of the patients were in the HEN program, and in 33.3% HEN was finish due to different reasons. In 22.9% of the patients no, o light, discapacity degree was found. CONCLUSIONS: Neurological diseases and cancer were the more frequent diagnoses in HEN patients. Oral access was the higher feeding route due, probably, to the high prevalence of cancer patients. In spite of the elevated prevalence of neurological diseases, a few number of patients, as previous years, were feed with ostomy tube. Due to the few complications observed, HEN is a safe treatment in our country.

Nutrición enteral domiciliaria (NED): registro nacional 2001 / Home enteral nutrition (HEN) in our country, during the year 2001

Introducción y objetivos: Análisis del registro de los pacientes en programa de Nutrición Enteral Domiciliaria (NED) en nuestro país durante el año 2001. Material y métodos: Estudio analítico realizado mediante una base de datos incluida en la web del Grupo NADYA (www.nadya-senpe.com) con los pacientes en NED el año 2001. Han participado 22 hospitales. Se aportan datos epidemiológicos, diagnósticos, vía de acceso, pautas de administración, fórmulas, duración, complicaciones, evolución y grado de incapacidad. Resultados: Incidencia: Se han comunicado 3.458 pacientes, 1.818 varones (53,7 por ciento) y 1.567 hembras (46,3 por ciento). Edad media 5,6 ñ 4,0 años en los menores de 14 años, y 67,1 ñ 19,5 en los mayores de 14 años. Patologías: Predominio de la patología neurológica (43,4 por ciento), seguida de la neoplásica (33,5 por ciento) sobre las demás. Duración: Tiempo medio en NED de 6,5 ñ 4,5 meses. Vías de administración: La vía oral es la más frecuente (54,5 por ciento), seguida de la sonda naso gástrica (SNG) (32,2 por ciento) y de las ostomías (13,3 por ciento). Formas de administración: Predominio de la forma discontinua (66,1 por ciento), mediante goteo (43,4 por ciento) o bolus (22,7 por ciento). Fórmula: La fórmula polimérica fue la más utilizada (85,9 por ciento). Seguimiento: Los pacientes fueron mayoritariamente controlados por la unidad de nutrición de su hospital de referencia (69,3 por ciento). Hospitalizaciones: Se han registrado 7,3 por ciento hospitalizaciones asociadas a la nutrición [0,02 hospitalizaciones / paciente (c / p)]. Complicaciones: Las más frecuentes relacionadas con la nutrición fueron las gastrointestinales (25,9 por ciento; 0,16 c / p) y las mecánicas (24,2 por ciento, 0,15 c / p). Las diarreas han sido las complicaciones gastrointestinales más frecuentes (11,5 por ciento, 0,07 c / p). Evolución: Al finalizar el año el 48,3 por ciento de los pacientes continuaban en activo, mientras que en un 33,3 por ciento se suspendió la NE y en 18,4 por ciento no hubo continuidad de seguimiento. La causa más común de suspensión fue el paso a nutrición oral convencional (47,3 por ciento), seguido de la muerte relacionada con la enfermedad de base (43,5 por ciento). Un 29,7 por ciento de los pacientes estaban confinados en cama o silla, mientras que un 22,9 por ciento no presentaba prácticamente ningún grado de incapacidad. Conclusiones: Persiste la vía de administración oral como la más prevalente frente a la sonda y ostomía. Predominio de la patología neurológica. El bajo número de complicaciones e ingresos comportan que la NED sea un tratamiento seguro en nuestro medio (AU)

Goal: The NADYA-SENPE Working Group analyzed the registered data of patients on Home Enteral Nutrition (HEN) in our country, during year 2001. 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 to prescribe this treatment, the specific nutritional treatment used and its duration, access path, complications and read-mission rate in hospital, follow-up of the treatment, patient's quality of life and progress. All data were precessed and analyzed by the coordinating team. Results: Twenty two hospitals participated and 3,458 patients, aged 5.6 ± 4.0 y for those younger than 14 y, and 67.1 ± 19.5 y for those older than 14 y, were enrolled. Of these patients, 43.4% were diagnosed with neurological diseases and 33.5% with cancer. The mean time on HEN was 6.5 ± 4.5 months. Oral nutrition was the preferential route (54.5%), followed by nasoenteral tube (32.3%), and in 13.3% ostomy tubes were placed. Polymeric was the formula composition mainly used(85.9%). Patients were followed (71.1%) by the hospital reference Nutritional Support Unit. The complications related to nutrition included mainly the gastrointestinal (0.16 complications/patient), and the mechanical one (0.15 complications/patient). At the end for the year, 48.3% of the patients were in the HEN program, and in 33.3% HEN was finish due to different reasons. In 22.9% of the patients no, o light, discapacity degree was found. Conclusions: Neurological diseases and cancer were the more frequent diagnoses in HEN patients. Oral access was the higher feeding route due, probably, to the high prevalence of cancer patients. In spite of the elevated prevalence of neurological diseases, a few number of patients, as previous years, were feed with ostomy tube. Due to the few complications observed, HEN is a safe treatment in our country (AU)

[Intestinal transplant in patients with parenteral nutrition at home]. / Trasplante intestinal en el paciente con nutrición parenteral domiciliaria.

Failure of the intestine, whether due to functional or anatomical reasons, constrains Parenteral Nutrition Therapy in children or adults who, as a result of intestinal resections, alterations in motility, diseases of the microvilli or other reasons, present insufficient intestine to cover their needs in terms of nutrients and fluids. Nonetheless, the maintenance of support with parenteral nutrition at home in subjects with irreversible intestinal failure is not without life-threatening complications: liver disease, recurrent sepsis and loss of central routes recommend the assessment of the indication of intestinal transplant in this group of patients. The incidence of morbidity and mortality after intestinal transplant is greater than in other transplants (kidney, liver), but the long-term survival is around 50-60%. In Spain, 7 transplants (6 children and 1 adult) have been performed so far: 3 of intestine alone, 3 of liver plus intestine and 1 mutivisceral transplant. In 4 cases, the indication for transplant was due to terminal liver disease, with the remainder being due to the loss of venous access, intractable diarrhoea and intra-abdominal desmoid tumour, respectively. Except for one girl who presented severe rejection of the graft, the rest achieved digestive autonomy. One boy has presented lymphocyte neoplasia (PTLD) after 2 years and another died after the transplant as a result of a routine liver biopsy (with functioning grafts). Of the 38 patients assessed for transplant, 18 were considered as candidates and of these, three youthful candidates for hepato-intestinal transplant (with short intestine syndrome) have died while on the waiting list and a fourth in the operating theatre prior to an attempted multivisceral transplant. Intestinal transplants must not be considered as the last desperate therapeutic option in patients with permanent intestinal failure. The type of graft, clinical expertise and the use of new inducers (Sirulimos) all contribute to the results of this therapy, in which survivors remain free from parenteral support and can take up once more their day-to-day activities, can improve over time.

[Subjective global assessment in neoplastic patients]. / Valoración global subjetiva en el paciente neoplásico.

As malnutrition is a common complication among patients with cancer, it seems necessary identifying it with simple tools. Subjective Global Assessment (SGA) is useful to evaluate nutritional status on a basis of clinical parameters and can be used by any clinician with a basic training. Our intention is to determine usefulness of SGA applied by staff not working at Clinical Nutrition to guess if they identify properly malnourished patients. We included in our study thirty male and female patients with several types of active neoplasm who were being treated with chemo or radiotherapy. Oncology and Clinical Nutrition staff used SGA separately after the patients answered the form; there were also taken biochemical and anthropometrical determinations. Sixty-three percent of patient were diagnosed as malnourished or suspected being so by Oncologists, 30% by Clinical Nutrition staff and 26% by anthropometrical means. Incidence of malnutrition was low because the most common neoplasm among patients in the study was colorectal cancer. Oncologists tended to diagnose more cases of malnutrition due to a deficient training; nevertheless, SGA was useful because none of the malnourished patients was misdiagnosed and half of the well nourished patients were correctly identified as ones with no need for nutritional support.

Neuropatía craneal múltiple como forma de presentación de un tumor gástrico / Multiple cranial neuropathy as the presenting manifestation of a gastric tumor

No disponible

[Artificial nutrition in the home. Annual information 1996.Group NADYA-SENPE]. / Nutrición artificial domiciliaria. Informe Anual 1996. Grupo NADYA-SENPE.

Using a simplified questionnaire from the NADYA group, data referring to age, sex, diagnosis, access route, duration, form of administration, complications, and quality of life have been gathered from 1,400 patients (57% male, 43% female) who receive home enteral nutrition, and from 38 patients (20% male and 18% female) who receive home parenteral nutrition. All of these patients come from the 1996 national registry. The most common indication for home enteral nutrition are neoplasias (39%) followed by neurological alterations (33%). The most common access route is oral (48%), followed by a nasogastric tube in 34%, PEG in 10% and surgical ostomies in 7%. The average treatment duration is 6 months. There is an index of 0.74 complications/patient-year (gastrointestinal 0.28 and mechanical alterations 0.19). At the end of the year 58% of the patients continued to use at home enteral nutrition, with a death rate of 17%. The majority of the treated patients presented a severe social disability (28%) or was bed-ridden (22%). The most common indications for home parenteral nutrition are: neoplasia (42%), Crohn_s disease (10%), and mesenteric ischemia (10%). AIDS (8%), radical enteritis (5%), and motility disorders (5%) are less common. In 42% of the cases tunneled catheters are used, and port-a-cath are used in 53%. The average treatment duration is 6.9 months. 1.06 hospitalizations/patient-year have been registered in relation to the nutritional treatment (mainly catheter sepsis). A mortality of 29% is registered, and there is recovery of the oral route in 7.9% of the cases. 50% of the patients present a severe social disability.

Effect of four enteral foods on the small bowel of undernourished rats after midgut resection.

OBJECTIVE: To describe the effects of new enteral foods on the adaptation of the gut mucosa after massive intestinal resection in rats. DESIGN: Laboratory experiment. SETTING: Teaching hospital, Spain. SUBJECTS: 91 male Wistar rats, 69 of which were studied (5 were excluded and 17 died). INTERVENTIONS: Previously undernourished rats were subjected to either massive bowel resection (n = 30) or laparotomy (n = 26) and fed four enteral hypocaloric diets for 7 days: Alitraq (n = 7 in each group), Impact (n = 8 and 7), Enrich (n = 8 and 6), and Elemental (n = 7 and 6). The remainder were not operated on and fed chow (n = 7) or a diet containing no protein (n = 6). Two diets were high in protein (Alitraq and Impact) and two contained normal amounts (Enrich and Elemental). MAIN OUTCOME MEASURES: Bowel mucosal thickness and proliferation; disaccharidase activity; intestinal weight and length; body weight; and plasma somatostatin, IGF-1, and peptide YY concentrations. RESULTS: Enriched diets provided a higher body and intestinal weight, and increased length of jejunal and ileal villous size. Peptide concentrations were modified by resection but not by the diet given. Concentrations of somatostatin and insulin-like growth factor were reduced in all groups with the exception of somatostatin in the two diets high in protein in the sham-operated rats. CONCLUSIONS: Enriched diets all improve the intestinal adaptive response to massive bowel resection in rats, offering advantages over diets with normal amounts of protein.

[Analysis of the results of treatment of obesity in the hospital outpatient department]. / Análisis de los resultados del tratamiento de la obesidad en consultas externas de un hospital.

The results obtained in the treatment of obesity in the out patient department of the Nutrition Unit of "La Paz" hospital during the first 6 years of experience were analyzed. To this end, different aspects of the treatment of obesity were studied in a successive manner. The first approach prospectively compared the results obtained with individual or group health care education (HCE); with no statistically significant differences being found. Before analyzing the results obtained with the different treatments, one notes a high rate of abandonment (65%). One sees that the global weight lost is statistically significant (7%). The amount of weight los differs depending on the degree of obesity (measured by the Body Mass Index): grade I and II obesities lost the same percentage of weight (7%), grade III lost 8% and grade IV is the grade that loses the most, 12%. Keeping in mind the treatment modality used, the results are as follows: both the diet alone and the diet in association with health care education in a group, achieve a weight loss of 7%, modified fasting yields 6%, adding drugs to the diet achieves a loss of 11% and the most effective is bariatric surgery with a loss of 18%.