[Adherence and fidelity in patients treated with intragastric balloon]. / Adherencia y fidelidad en el paciente tratado con balon intragastrico.

A correct treatment of obesity needs a program of habits modification regardless of the selected technique, especially if it is minimally invasive as the intragastric balloon (BIG). The adherence of the obese patients with regard to recommended drugs measures to medium- and long-term is less than 50%. Given that the results obtained using the technique of gastric balloon must be seen influenced by adherence to the modification of habits program and its fulfillment, we reviewed series published in attention to the program proposed with the BIG. The series published to date provide few details about the used Therapeutic Programs as well as the adherence of patients to them, and even less concerning the Monitoring Plan and the loyalty of the patient can be seen. We conclude the convenience to agree on a follow-up strategy, at least the 6 months during which the BIG remain in the stomach.

[Minimally invasive emergent techniques in obesity treatment]. / Técnicas mínimamente invasivas emergentes en el tratamiento de la obesidad.

INTRODUCTION: Obesity is a chronic disease for which several modalities of treatment are investigated today. One of them is the set of minimally aggressive techniques that have been added to the intragastric balloon. OBJECTIVE: To review the minimally invasive techniques described in the last years for the treatment of obesity. MATERIAL AND METHOD: It consisted in reviewing the bibliography through the habitual finders, in addition to the obtained data of the companies. They are classified in restrictive and malabsortive, and the restrictive are divides in mechanical or functional restriction. RESULT: Between mechanical restrictive the classified as we included in the restrictive emergent techniques the adjustable intragastric balloon, the intragastric prosthesis, the vertical endoluminal gastroplasty and the transoral gastroplasty. In order to obtain a functional restriction, we have the gastric pacemaker and the botulinic toxin. And finally, the endoluminal duodenojejunal bypass is described as a malabsortive technique. DISCUSSION: With less than 10 years of existence, it seems that the described techniques compensate their smaller effectiveness compared to the surgical techniques, with the absence of substantial modifications in the anatomy of the alimentary tract. None of these techniques is free of risks and complications.

Immunoenhanced enteral nutrition formulas in head and neck cancer surgery: a systematic review.

INTRODUCTION: Significant malnutrition exists in a high percentage of patients with head and neck cancer. Malnutrition is associated with defects in immune function that may impair the host response to malignancy. Malnutrition and immunosupression make patients highly susceptible to postoperative infections and complications. OBJECTIVES: Some studies of patients receiving immuno-nutrition in the perioperative period in head and neck cancer have shown beneficial effects on clinical outcome and inmune status. The authors carried out a systematic review of randomised control trials to determine whether perioperative immunonutrition has a role in the treatment of head and neck cancer. METHODS: 14 trials of polymeric nutritional supplementation with immunonutrition were identified. Two studies compared two types of immunonutrition. RESULTS: A reduction in the length of postoperative hospital stay was seen in some trials, but the reason for this reduction is not clear. Some studides showed statistical differences with less complications in arginine-enhanced group and also showed a significant decrease of fistula complications in patients treated with a high arginine dose enhanced formula, if compared with a medium dose of arginine. CONCLUSION: [corrected] Those planning future studies face challenges. A suitable powered clinical trial is required before firm recommendations can be made on the use of immunonutrition in head and neck cancer patients postoperatively.

[Informed consent in the intragastric balloon supported by SENPE, SEEDO, SEN and SECO: legal aspects]. / Consentimiento informado en el balón intragástrico avalado por SENPE, SEEDO, SEN y SECO: aspectos médico-legales.

INTRODUCTION: Intra-gastric balloon (IGB) is an invasive, temporary, non-surgical technique for the treatment of obesity. Its outcomes mainly depend on the patient's collaboration. OBJECTIVE: The aim was to adapt the informed consent used for bariatric surgery to a method that has especial characteristics. MATERIALS AND METHODS: We used the informed consent proposed by ASAC for bariatric surgery and 8 statements related to IGB included in the WESTLAW ES database. RESULTS: The review of the statements defines the IGB treatment as a curative-intended and non-satisfactive therapy with an obligation of the means used, but not the outcomes, by the treating physician. Moreover, the obligations of providing a correct and complete information -which includes the dietary regime- should be observed, as well as the possible therapeutic alternatives and finally, the proceeding used should be in written. CONCLUSIONS: The informed consent is a medico-legal document which content should consider the latest jurisprudence on the minimally invasive techniques for the treatment of obesity.

[Nutritional Sciences' Journals in Ibero Latin American countries in the XXIst Century]. / Revistas de Ciencias de la Nutrición en los países Ibero Latinoamericanos en el Siglo XXI.

The presence of nutrition as an independent matter in the educational programs of the Spanish Faculties of Medicine has been scanty until the end of the XXth century. We have witnessed an important development of the specific opportunities for the nutritional sciences in terms of quality and quantity in the XXIst century. Only one Ibero Latin American journal, Archivos Latinoamericanos de Nutrición (ALAN, ISSN 0004-0622), was present in the Journal Citation Reports, Science Edition among the 51 journals under the heading of Nutrition & Dietetics. Three more ibero latin American journals have been incorporated to JCR in the XXIst century, Nutrición Hospitalaria (Nutr Hosp, ISSN 0212-1611) in 2006, Revista de Nutricao (Rev Nutr, ISSN 1415-5273) and Revista Española de Nutrición Comunitaria (Rev Esp Nutr Comunit, ISSN 1135-3074) in 2007. The four journals are having a growing importance in other electronic platforms, rendering an important service to the scientific society, not only in their environment, but also in the rest of the world. Although English language dominates scientific communications, the critical mass of already existing journals in Spanish and the area of influence of this language is a good stimulus for continuing its utilization.

[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.

[Long-term efficacy and safety of Roux-en-Y gastric bypass and gastric banding: systematic review]. / Efectividad y seguridad a largo plazo del bypass gástrico en "Y" de Roux y de la banda gástrica: revisión sistemática.

BACKGROUND: Bariatric surgery has increased substantially in the last years. However, there are controversies of the long-term efficacy and safety. OBJECTIVE: To evaluate the long-term efficacy and safety of Roux-en-Y gastric bypass (BGRY) and gastric banding (Band) in randomized controlled trials and cohort studies. METHODS: We searched for randomized controlled trials and cohort studies of BGRY and Band, with a follow-up > 48 months, with description of weight loss, complications and mortality. RESULTS: Four randomized trials and one cohort study met the inclusion criteria. Mean weight loss was greater with BGRY (27%-39%) than with Band (13%-35%). In both procedures the complication rate is high. Second operation rate is higher with Band. CONCLUSIONS: The outcomes observed from this revision are not sufficient to generalize the efficacy and safety of bariatric surgery to population attended at different health care systems.

Intragastric balloon and multidisciplinary team.

BACKGROUND: The intragastric balloon is widely used for weight reduction in obese patients, but results are variable. We describe our results enhancing the importance of a Multidisciplinary Team (MT) taking part in the treatment. METHODS: A retrospective review was done concerning a total of 119 balloons , placed in 116 patients, under endoscopic control and conscious sedation, from May 2001 until August 2006. 49 patients were prepared and recommended to be followed by a MT in a physical unit, at least every 15 days during 6 months. 67 were indicated and followed by other colleagues, without MT. Removal was performed 6 months later. RESULTS: Concerning our 49 patients, mean age was 38, 1 years, 31 female and 18 males, with BMI ranged between 32 and 63, average of 42. The average decrease of weight excess was 31, 85% (-4, 45-80, 4%), and the BMI diminished 5,3 points (from 13,6 to gain of 0,9). The treatment failed in 34,6 % of our patients -including 4 patients lost of follow-up (8, 16%)-, compared with 53, 8% of patients without structured MT for selection and follow-up. Physical exercise enhanced markedly the results with 45, 8% of excess of weight loss in women and 39, 7% in males, compared with 14, 6 and 15, 6% in patients who didn't follow the program. The weight loss was mostly fat mass, 89,9% in men and 75,6% in women.- The results maintenance was obtained in 40% of patients one year later. There were no major complications; one balloon had to be removed at 3 weeks because of intolerance, another at 5 months because of gastroesophageal reflux. CONCLUSIONS: BIB is an effective help to achieve a short term weight loss in obese patients; nevertheless, good and long lasting results will depend on the modification of life style obtained by a multidisciplinary approach.

[The impact factor of Nutrición Hospitalaria is 1.096]. / El factor de impacto de Nutrición Hospitalaria es 1,096.

The editors of Nutrición Hospitalaria (Nutr Hosp) analyze the journal from its foundation in 1979 to the present time, on occasion of the first publication of its impact factorby Journal Citation Reports (JCR). The actions taken along this thirty year period are described, including its incorporation to multiple web databases, the Open Access policy of the journal, its progressive internationality, and the bibliometric analysis made in 1999. A figure with the journal citation trends is included. Nutr Hosp, included in the "Nutrition & Dietetics" group of JCR, is in the position 42/59, i.e. in the third quartile. Among the Spanish journals included in JCR,Nutr Hosp is located in the 14/37 position. A few considerations are made related to the economical aspects of the journal, the number of articles received so far, the articles expected in the future, the rejection rate and the language (Spanish or English) in which Nutr Hosp should be published.

[Intragastric balloon in obesity treatment]. / Balón intragástrico en el tratamiento de la obesidad.

Obesity is considered a chronic and epidemic illness, hece difficult to treat. As conservative treatment has a high rate of failure, and considering morbimortality and sequels of surgery, less invasive techniques appeared to contribute to the treatment of this illness. The most implanted technique nowadays is the Intragastric Balloon, considered more efficient as conservative treatments and with less risks tan surgery, but having today a lack of consensus on indications and few information on his limitations, while its apparition in medias promote an important expansion in the 4 last years. In this publication, we do a critical revision, and describe limitations of this treatment, based on the evidences given by literature. We conclude this revision with some recommendations concerning the technique and indications, material and human requiring, need of a Multidisciplinary Team, as well as an adequate control and following.

Immunoenhanced enteral nutrition formulas in head and neck cancer surgery: a prospective, randomized clinical trial.

INTRODUCTION: Significant malnutrition exists in a high percentage of patients with head and neck cancer. Malnutrition is associated with defects in immune function that may impair the host response to malignancy. Malnutrition and immunosupression make patients highly susceptible to postoperative infections and complications. OBJECTIVES: Compare two immunoenhanced enteral nutritions with a control diet, and evaluate the effect in postoperative infections, length of stay and inflammatory markers. PATIENTS: A population of 44 patients with oral and laryngeal cancer was enrolled in a randomized trial. At surgery, patients were randomly allocated to three groups: (group I); patients receiving an arginine-enhanced formula (group II); patients receiving a standard polymeric formula, and (group III) patients receiving an arginine, RNA and omega-3 fatty acids enhanced formula, in an isonitrogenous way. RESULTS: The duration of enteral nutrition in the three groups was similar with an average duration of 14,5 +/- 8 days. The length of postoperative stay was similar, with an average of 19,8 +/- 8,5 days. Wound infections and general infections were more frequent in the control group. Fistula rates were not improved in the enhanced diet groups. No significant intergroup differences in the trend of the two plasma proteins (albumin, transferrin), lymphocytes, weight, IL-6, CPR and TNFalpha were detected. The control group showed the highest levels of TNFalpha at the fourteenth postoperative day. Gastrointestinal tolerance and diarrhoea rate were similar in all the patients. CONCLUSIONS: Immunoenhanced enteral nutrition formulas improved the infection rate in the postoperative of head and neck cancer patients. In the fistula rates, we observed that technical problems and nutritional status might have played an equally important role, and therefore the positive effect of immunonutrition in this parameter might have been overestimated.

[Bibliometric study of the Journal Nutrición Hospitalaria for the period 2001-2005: Part 1, Analysis of the scientific production]. / Estudio bibliométrico de la revista Nutrición Hospitalaria en el periodo 2001 a 2005: Parte I, Análisis de la producción científica.

OBJECTIVE: To assess the scientific activity and information production of the journal Nutrición Hospitalaria, for the period 2001-2005 by means of a Bibliometric study. METHOD: Cross-sectional descriptive study of the results obtained from the analysis of the articles published in the journal Nutrición Hospitalaria. The data were obtained by consulting the electronic version through the Web. In those cases in which there was a link breakdown, and thus, the inability to have access to the electronic document the printed version was consulted. All the documental possibilities were taken into account with the exception of communications to congresses. RESULTS: A total of 345 articles were published, 187 (54.20%) being original articles. The geographical distribution of the first author was Spanish in 287 articles (83.19%) and Latin American in 27 (7.83%). Most of the articles are from health care centers (172 articles (49.86%)), and the cooperation index being 4.15. Madrid is the most productive province, for both the absolute and adjusted frequencies. The median number of references per article is 18, the mean being 23.52 (95% CI 20.93 - 26.10). The predominant language was Spanish, with 308 articles (89.28%). CONCLUSION: Nutrición Hospitalaria may be considered as a reference journal regarding information and scientific communication on Nutrition for both the Spanish and Latin American communities. The bibliometric parameters studied compare with those verified for the remaining top of the list Spanish scientific journals on health sciences.

[Bibliometric study of the journal Nutrición Hospitalaria for the period 2001--2005: Part 2, consumption analysis; the bibliographic references]. / Estudio bibliométrico de la revista Nutrición Hospitalaria en el periodo 2001 a 2005: parte 2, análisis de consumo; las referencias bibliográficas.

OBJECTIVE: To describe and assess the consumption of the information consulted and cited in the articles published in the journal Nutrición Hospitalaria for the period 2001--2005 by means of bibliometric analysis. METHOD: Cross-sectional descriptive analysis of the results obtained from the analysis of the lists of bibliographic references of the articles published at Nutrición Hospitalaria. We studied the most cited journals, the signatures index, the type of document referred, the publication language, the distribution of geographical origin, and obsolescence and readiness index. We took into account all types of documents with the exception of Communications to Congresses. RESULTS: 345 articles were published at Nutr Hosp, containing 8,113 bibliographic references, with a median of 18, a maximum of 136 and minimum of 0 BR per article. The mean (rate of publications per published article during the specified period) is 23.52 (95% IC 20.93-26.10) and the mean at 5% is 20.66 per article. The 25th and 75th percentiles are 6 and 32, respectively, the interquartile interval being 26 BR per document. The semi-period of Burton and Kebler is 7 years and the Price Index is 38.18%. CONCLUSION: The bibliographic references, the consumption of information, of the articles published at Nutrición Hospitalaria present parameters similar to other journals on health science. However, good data on obsolescence are observed, which reveal the good validity of most of the references studied.