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.

[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?

No disponible

[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

No disponible

[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.

[Nutritional support in bone marrow transplantation]. / Soporte nutricional en trasplante de médula ósea.

UNLABELLED: Bone marrow transplant (BMT) implies the treatment with substances which may compromise the nutritional condition, thus increasing the morbido-mortality of these patients. The objective of this study is to evaluate the efficacy of the nutritional support (NS) protocol for patients subjected to a BMT in our center. PATIENTS AND METHODS: 55 patients were included (24 men and 31 women), who were subjected to BMT during 1994, with prior chemotherapy depending on the underlying disease. The nutritional condition (NC) was evaluated upon initiation and at the end of the NS, using anthropometric, biochemical, and immunological parameters. The NS was given by total parenteral nutrition (TPN), adapted to the needs, as of the second post-transplant day, until such time that oral nutrition was sufficient to supply the nutritional needs of the patients; oral ingestion was permitted at all times, according to the possibilities of the patient. For the statistical analysis, we used the Student's t test, Pearson's Chi squared test, and Spearman's test, with differences being considered significant for values < 0.05. RESULTS: The average duration of the TPN was 16 +/- 6 days, with a significantly longer time (p < 0.05) in patients with leukemia. The NC assessment was no different at the beginning and at the end of the NS, although all groups show a drop in the albumin levels at the end with respect to those at the beginning, with this being statistically significant in patients with leukemia (p < 0.05), and with solid tumors (p < 0.01), 14.5% of the patients maintained an acceptable oral ingestion (with 75% having lymphomas), and 34.5% did not show any associated oral ingestion. Te better albumin maintenance was correlated with acceptable oral ingestion (p < 0.05). CONCLUSIONS: Nutritional support of patients subjected to a BMT is effective for maintaining their NC levels. The longest duration of the TPN, the lowest frequency of associated oral ingestion, and the greatest decrease of the serum albumin, levels are seen in those cases which had the most aggressive chemotherapy prior to the BMT, which requires adaptation of the NS in function of the underlying disease. The association of oral ingestion may be beneficial due to its effect on the gastrointestinal tract.

[The consumption of dairy products and their contribution to the nutrients in the diet of schoolchildren in the community of Madrid. The Food Consumption and Nutritional Status of the School-Age Population of the Autonomous Community of Madrid Group]. / Consumo de lácteos y su contribución al aporte de nutrientes en la dieta de los escolares de la Comunidad de Madrid. Grupo CAENPE.

The aim of this report, included in the CAENPE study, was to assess the actual intake of milk products by children from Madrid and their nutrient contribution to the diet. In a sample of 2,608 children, 1,343 boys and 1,265 girls, between 6 and 14 years of age, representative of the school child population from Madrid, a dietary assessment of 4 non-consecutive days was carried out by applying a combination of the methods of 24-hour recall (2 days) and an estimated food intake record (2 days). We found that the average total milk product intake was 410 +/- 173 g/person/day, with this being significantly higher in boys (p < 0.0001) and increasing with age (p < 0.001). Milk products are the primary source of calcium, 1,076 +/- 374 mg/person/day, which represents 61% of the total calcium intake and is below the RDA for children over 10 years of age. In addition, following meat and meat products, dairy products are the second largest source of saturated fat (28% of total intake). They also supply 31% of the dietary phosphorus, 17% of protein, 16% of total fat, 15% of the cholesterol, 10% of the carbohydrates and 14% of the the energy intake. We conclude that milk products are the major source of calcium in the diet of schoolchildren. Their low consumption explains the insufficient calcium intake in certain age groups, which might be associated to a higher risk of osteoporosis in later life. We encourage an increase in the intake of milk products, especially milk, and a reduction in the consumption of sweets and meat in order to decrease the dietary saturated fats.

[Home and ambulatory artificial nutrition. Parenteral nutrition. The NADYA Group]. / Nutrición artificial domiciliaria y ambulatoria (NADYA). Nutrición parenteral. Grupo NADYA.

In recent years and increase in the use of parenteral nutrition in the home, as an alternative to covering the nutritional needs of patients incapable of covering them orally or enterally and who do not require hospitalization, is being seen. The number of patients undergoing treatment with, or as candidates for, this specialized nutritional support in Spain, is unknown. The data of 39 patients from 10 therapeutic teams at the national level, have been collected and evaluated. With an average age of 42 years, 54% were male. The pathology which most frequently indicated a need for at home parenteral nutrition was mesenteric thrombosis, followed by intestinal inflammatory disease (24 and 18%). The indication was definite in 54% of the cases. The blood vessel most frequently accessed was the subclavian (73%), preferently using tunneled catheters of the Hickman type (53%), and scarcely using the implanted type (6%). Practically all patients receive individualized formulas, adapted to their nutritional needs. The infusion is nocturnal in 65% of the cases, and only 58% of the cases use an infusion pump. IN the majority of cases, the supply of the formulas as well as the infusion material, is taken on entirely by the reference hospital which also takes care of the follow up of the patient. An adequate network of distribution which enables the patient to access this material in his usual environment, is not available. An improvement in quality of life and nutritional state is seen in the evaluated patients, of which 41% finished treatment (transitory indications), 23% had died, and the rest continued treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

[Home and ambulatory artificial nutrition. Enteral nutrition. The NADYA Group]. / Nutrición artificial domiciliaria y ambulatoria (NADYA). Nutrición enteral. Grupo NADYA.

Home enteral nutrition is, at present, a therapeutic alternative which can be applied to a great number of patients who only require hospitalization for the nutritional treatment, thus improving their quality of life and reducing costs. The experience in this field is great in other countries, and we believe its use is growing in Spain. To better understand this situation, the data of 589 patients from 25 hospitals of the entire national territory, have been evaluated. When analyzing the diseases which led to the instigation of enteral nutrition, the most frequent causes were found to be neurological afflictions and tumoral processes. At the time of establishing the indication, only 50% of the patients were undergoing curative therapy. The nasogastric tube was used in the majority of cases (69%), even during prolonged periods of time. The formula of enteral nutrition which was most used was the standard, possibly due to the difficulty of acquiring other types of formulas when this is not specifically indicated. The formula is frequently administered by syringe (44%) and by bolus (41%). The cost of the formula and the necessary infusion material, was mainly carried by the referring hospital. The complications registered were rare (0.18 episodes/patient) and of a slight character, of gastrointestinal of mechanical origin, which could be resolved in the home. The follow up of the patient was done in similar percentages by the Departments of Nutrition, by the at home hospitalization teams, and, in a coordinated way, between Nutrition and Primary Attention. 23 % of the patients finished the treatment due to improvement, 20 % died, and 15 % continued treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

[The nutritional status and respiratory function of patients diagnosed with COPD]. / Estado nutricional y función respiratoria en pacientes diagnosticados de EPOC.

Given that patients affected with chronic obstructive pulmonary disease show a progressive weight loss, and the great socioeconomic repercussions of these diseases due to their high incidence in the general population, we started this study with the objective of analyzing the possible connection between the nutritional state and the ventilatory function of a group of patients from our midst, who did not have continuous oxygen therapy at home. We studied a total of 43 patients who had been diagnosed with COPD (excluding those with a BMI < 32), evaluating anthropometric, biochemical and pulmonary function parameters. Among the obtained results, it should be noted that 84% of the patients were normally nourished and only 16% were undernourished. In the lung function analysis, we found a pattern of air flow obstruction. We found a significant correlation between the nutritional state and the type of COPD (p < 0.01), with the emphysematous patients being more undernourished than those suffering from bronchial disease. We also found a significant correlation between the types of COPD and the levels of prealbumin, RBP and albumin, and a positive correlation between the evolution time of the disease and the levels of albumin, PO2 and FEV1. With the obtained results, we do not consider it necessary to establish a nutritional support protocol in ambulatory patients suffering from COPD, whose conditions are similar to those of the patients in our study group.

[Anthropometric-nutritional status of a Spanish middle-class juvenile population. Study by age and sex groups]. / Estado antropométrico-nutricional de una población infantil de clase media española. Estudio por grupos de edad y sexo.

To make an initial approach to the current nutritional situation of the Spanish infant population, we carried out an anthropometric study of the children from 6 to 15 years of age in two schools in Fuenlabrada (Madrid) in a middle to lower class social environment. A total of 1,026 children were studied, to determine weight, height, tricipital fold and arm circumference. These parameters were used to calculate the weight/height ratio (w/h) and the muscular circumference of the arm. All these parameters were tabulated in percentile terms for comparison. The sample was divided into groups according to sex and to age (under 9, 9 to 12 and over 12). We found an overall w/h ratio of 108.8 +/- 17.4, more than the theoretical 100% (p < 0.001); 20.6% of the children over 120%. The Tricipital Fold (TFp) percentile was 62.5 +/- 27, with no differences according to age or sex. The percentile for arm muscular circumference (AMCp) was 48.8 +/- 27 for girls and 41.6 +/- 28 for boys (p < 0.001). Finally, we found a positive and significant correlation (p < 0.05) between w/h and AMCp (r = 0.51) and between w/h and TFp (r = 0.57). We conclude that the population studied is significantly overweight, confirming previous studies. Girls showed better nutritional parameters than the boys, apparently less nutritionally affected by the middle to low social environment. Finally, the w/h ratio, as an isolated parameter, is a good overall index of the nutritional state of children.