ABSTRACT
OBJECTIVES: Anorexia nervosa (AN) is a complex disease that involves malnutrition and a profound depletion in muscle mass. The thickness of the adductor pollicis muscle (APM) has been proposed as a new anthropometric technique to estimate muscle mass, check early changes, and assess its evaluation. This study aimed to evaluate the accuracy and validity of the APM thickness in a cohort of malnourished patients with AN when checking local mass gain. The Doppler ultrasound maybe an affordable and useful method to discriminate all tissues around the APM area. METHODS: A prospective cohort study was conducted of 31 malnourished patients with AN who were admitted to the Regional Eating Disorders Unit for treatment, including re-alimentation. Anthropometric measurements were taken, including arm circumference, triceps skinfold thickness, arm muscle circumference, body mass index, and APM thickness of both hands. Simultaneously, a Doppler ultrasound was performed in the same area, measuring and discriminating fat, skin, and muscle tissues around the APM. RESULTS: Nutritional improvement is accompanied by fat, but not muscle gain in the hand in the adductor pollicis area of patients with AN. A Doppler ultrasound can accurately discriminate between tissues around the APM. CONCLUSIONS: APM thickness reflects the addition of two different muscles plus fat and skin; therefore, this tool is not reliable to assess APM mass.
Subject(s)
Anorexia Nervosa/physiopathology , Malnutrition/physiopathology , Muscular Atrophy/diagnosis , Skinfold Thickness , Adult , Anorexia Nervosa/complications , Anthropometry , Body Mass Index , Female , Humans , Male , Malnutrition/etiology , Muscle, Skeletal/physiopathology , Muscular Atrophy/etiology , Nutrition Assessment , Prospective Studies , Reproducibility of Results , Young AdultABSTRACT
INTRODUCTION: The different types of cancer represent one of the main causes of morbimortality worldwide. Classical anti-tumor therapy (surgery, chemotherapy, radiotherapy) has notably increased the survival rate. Biological therapies, with selective and frequently specific mechanisms of action, are a relatively recent acquisition in oncologic therapy; among the most commonly used ones are: cytokines, monoclonal antibodies, tyrosine kinase inhibitors, and mTOR inhibitors. The nutritional and metabolic adverse effects of classical therapy are well documented in the literature and the clinical guidelines, which is not the case for biological therapy. OBJECTIVE: To review the literature in this field and to detail in an organized manner the results obtained. METHODS: Indexed literature and the technical data sheets of the drugs included in the different families were revised through the Spanish Agency of Medicines and Health Care Products until July of 2013. The symptoms and clinical signs of a theoretical action on the nutritional and metabolic status were recorded. RESULTS: The specific action of each family is described. The possible adverse effects of each one of them on the nutritional and metabolic status are grouped, detailing and differentiating them in tables for easier and more friendly-user consultation. The most prevalent possible side effects observed are those related with the appetite, the gastrointestinal tract, and electrolytic impairments. CONCLUSIONS: the possible side effects associated to biological therapies are plenty and occur with different frequency and severity. It is important to know the nutritional and metabolic impact when using these therapies for preventing and managing them.
Introducción: Los diferentes tipos de cáncer constituyen una de las principales causas de morbi-mortalidad en el mundo. La terapia clásica antitumoral (cirugía, quimioterapia, radioterapia) ha incrementado notoriamente la supervivencia. Las terapias biológicas, con mecanismos de acción selectivos y frecuentemente específicos, constituyen una incorporación relativamente reciente al tratamiento oncológico; entre las más utilizadas se incluyen: citoquinas, anticuerpos monoclonales e inhibidores de tirosin kinasa y de mTOR. Si bien están adecuadamente documentados los efectos adversos nutricionales y metabólicos asociados a la terapia clásica, tanto en literatura como en guías clínicas, no ocurre igual con la terapia biológica. Objetivo: Revisar la literatura al respecto y detallar de modo organizado los resultados obtenidos. Métodos: Se revisó la literatura indizada así como todas las fichas técnicas de los fármacos incluidos en las distintas familias mediante la Agencia Española del Medicamento y Productos Sanitarios a Julio de 2013. Se registran los síntomas y signos clínicos con teórica acción sobre el estado nutricional o metabólico. Resultados: Se describe la acción específica de cada familia. Se agrupan los posibles efectos adversos de cada una sobre el estado nutricional y metabolismo, detallando y diferenciándolos en tablas para una más fácil y cómoda revisión y consulta. Se observan como posibles efectos secundarios más prevalentes los relacionados con el apetito, aparato digestivo y alteraciones electrolíticas. Conclusiones: Los posibles efectos secundarios asociados a terapias biológicas son múltiples y aparecen con diferente frecuencia y gravedad. Es importante al utilizarlas conocer el impacto nutricional y metabólico que pueden presentar, para su prevención y tratamiento.
