[Nutrition and primary care]. / Nutrición y atención primaria.

The dietary habits are a determining factor in the health status of the population and eating habits are a part both of the etiopathogenicity and of the treatment of the diseases with the greatest morbido-mortality in our current society. Primary care is the first level of contact between the individual and the National Health System, and as this integrates the promotion, prevention, treatment, and rehabilitation of health problems, eating habits and nutrition have to be included in the activities carried out by health care professionals in the global treatment of the individual and the community's health care problems. Even though most health care professionals in primary care recognize the importance of dietary treatment and advice in their daily practice, there are studies that indicate that only a third actually do so. There are several reasons for this situation, especially the scant knowledge of nutrition held by family practitioners despite the fact that their training in this area is included in the teaching program of the Family and Community Medicine specialization program; the lack of motivation, time and material resources to do this, and the lack of confidence in the individual ability of give the advice. One of the aspects to be noted in the tasks of the health care professional in primary care is that he or she must not only assess and rapidly treat any nutritional problem that he or she may detect, but he or she must also, given his or her strategic position in the National Health System, emphasize the task of prevention and give advice regarding healthy eating habits in order to decrease all those risk factors that are related to eating habits despite there not being any guidelines at present as to how to give dietary advice to make this effective over time. We have to note the great importance of carrying out activities, studies, and projects that increase the primary care physician's knowledge about nutrition, as this, in short, improves the global health of the population.

[Assessment of various anthropologic methods for estimation of the height of persons over 65 years of age]. / Valoración de distintos métodos antropométricos en la estimación de la talla en personas mayores de 65 años.

The height measurement of people older than 65 years of age is limited in may cases by alterations of the vertebral column, which is why the determination of the body mass index for the evaluation of the nutritional status may be very imprecise. Formulae have been developed based on the height of the knee or the distance between the knee and the external malleolus, for estimating the height. With this study we wish to contrast the estimated height using these formulae with the height obtained in standing people older than 65 years of age. We studied a total of 202 patients, assessing the height based on the different methods of estimation, as well as using the body mass index. When analyzing the results, we found that there were no significant differences between the average height estimated from the height of the knee or the distance from the knee to the malleolus, and the average height obtained by diet measurement, and that the height estimated from the height of the knee has a greater average relative error (0.43) than the height estimated using the knee to malleolus distance (0.08). The obtained results show us that the height assessment of people older than 65 years of age should always take place by measuring them while standing, and in those subjects in whom this is not possible, the height will be estimated using one of the two formulae, as both are useful in our environment, although we recommended using the estimate based on the knee malleolus distance as this is simpler.

[Artificial nutrition in the home. 1995 yearly report. NADYA-SENPE Group (Natiional Registry of Patient-Spanish Society for Parnteral and Enterlal Nutrition]. / Nutrición artificial domiciliaria. Informe anual 1995. Grupo NADYA-SENPE.

By means of a simplified questionnaire, the NADYA group has gathered and analyzed data with regard to the age, sex, diagnosis, access route, duration, form of administration, complications, and quality of life, in 812 patients (62% male; 37% female) with At Home Enteral Nutrition (AHEN), and 19 patients (42% male; 57% female) with At Home Parenteral Nutrition (AHPN) corresponding the National Registry of 1995. The most frequent indication of AHEN was a neoplasm (41%), followed by neurological alterations (33%). The most common access route is the NGT (37%) followed by oral administration in 37%, PEG in 13% and surgical ostomics in 8%. The mean treatment time is 8 months. The index of complications/patient-year is 0.50 (gasterointestinal 0.17, and mechanical alterations 0.9). At the end of the study, 63% of the patients continued to receive AHEN, showing a mortality rate of 70%. The majority of the patients undergoing treatment presented a sever social disability (20%) or were bed ridden (18%). The most common indications for the AHPN are: radical enteritis (26%), Crohn's disease (21%), and mesenteric ischemia (16%). AIDS, motility alterations, and neoplasic diseases are scantly represented (10%). Tunneled catheters are used in 58% of the cases, and Port-a-Cath in 31%). The mean duration for the treatment was 7.9 months. An index of 0.47 hospitalization/patient-year was seen in relation to the nutritional treatment (mainly due to catheter septicemia). A mortality of 16% is noted, and 21% show a recovery of the oral route. 42% of the patients did not present an assessable social disability.

[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.

[The assessment and nutritional support of patients with the acquired immunodeficiency syndrome]. / Valoración y soporte nutricional en pacientes con síndrome de inmunodeficiencia adquirida.

Given the negative effect of malnutrition on the immune function, the possibility must be considered that this also affects the clinical progression of AIDS patients. This study was aimed at assessing the state and nutritional support indicated for patients diagnosed as having AIDS. 114 patients admitted to our hospital in the period 1990-1991 were studied, with assessment of the nutritional state by means of anthropometric parameters (weight, size, tricipital fold, arm muscle circumference), biochemical parameters (albumin, lymphocytes, transferrin, RBP) and the treatment prescribed. Average age was 31.44 +/- years, 81.5% were male, 68% parenteral drug addicts. 71% had a stage IV C diagnosis. 37.72% had diarrhea before beginning treatment. The malnutrition diagnosed was as follows: moderate, 50.89%, severe 36%, slight, 12.5%, and mixed (calorific-protein), 62.5%, calorific 34.8%, and protein 2.6% of cases, 33% of the patients received dietary supplements, 33.84% enteral alimentation and 33% parenteral alimentation. Nutritional support was suspended as follows: improvement, 54.46%; transfers, 1.79%; death, 27.68%, and terminal situation, 16.07%. Deceased or terminal patients were more severely malnourished (p < 0.001) than the remainder. AIDS patients are studied and treated nutritionally in a very advanced stage of the illness, with severe malnutrition which conditions a poorer evolutive diagnosis. This suggests a change of attitude, with assessment being necessary of nutritional state and the appropriate therapy at the time of diagnosis, in order to slow the progression of the illness.

[Our experience in the nutritional treatment of anorexia nervosa (1989-1991)]. / Nuestra experiencia en el tratamiento nutricional de la anorexia nerviosa (1989-1991).

The purpose of this study was to assess the evolution in the nutritional situation of patients diagnosed with anorexia nervosa in the Clinical Nutrition Service between January 1 1989 and December 31 1991. Twenty-eight admitted patients (4 men and 24 women) and 38 outpatients (3 men and 35 women) were monitored, with an age of 22.4 +/- 6.4 years and average evolution time of the illness of 3.8 +/- 5 years. Nutritional state was evaluated with anthropometric, biochemical and immunological parameters. Following nutritional therapy, malnutrition and BMI (Body Mass Index) improved significantly over the initial evaluation in all patients, whether admitted or outpatients. All anthropometric parameters improved significantly during the period of treatment of admitted patients, but AMC (arm muscle circumference) rose only in outpatients. An unrestricted diet plus nutritional counselling was the most-used therapeutic procedure in outpatients while most of the admitted patients required dietary supplements. Calorie malnutrition is very common in patients diagnosed with anorexia nervosa: vitamin or trace element deficiencies are very infrequent. Nutritional therapy, suitably coordinated with psychotherapeutic treatment, is effective, enhancing both the nutritional state and anomalous dietary habits.