Is the risk of refeeding syndrome a problem in reaching nutritional requirements? A cohort of patients on enteral nutrition support / ¿Es el riesgo de síndrome de realimentación un problema para alcanzar los requerimientos nutricionales? Cohorte de pacientes con nutrición enteral

Background: refeeding syndrome (RS) is a metabolic complication associated with nutritional support. The lack of management protocols for patients on nutritional support may lead to the development of RS or undernourishment. Objective: to evaluate adherence to the algorithm for total enteral nutritional support (ASNET), and the efficacy of reaching nutrient requirements in patients at risk of RS. Methods: a cohort study: screening and nutritional evaluation of patients and risk of RS were performed. Adults admitted to hospital for noncritical illness who received exclusively enteral nutrition (EN) were eligible. Patients with RS, intestinal failure or chronic diarrhea were excluded. Adherence to ASNET was evaluated along with the efficacy of nutritional support to reach the optimal protein and energy requirement (OPER) and any associated complications. Patient follow-up ended when the feeding route was changed or upon discharge. Results a total of 73 patients were included (mean age, 62 ± 16 yrs; BMI, 18.5 ± 4.2 kg/m2), and 55 % were men. All had nutritional risk of developing RS (57, low; 15, high; 1, very high); 34 % had adequate adherence to ASNET, and 33 % managed to cover the total requirement between 4 and 6 days. OPER was reached by 38 % by the fourth day of EN, and adequate adherence to ASNET increased the probability of achieving it (RR, 2.2; 95 % CI, 1.6-3.2, p < 0.0001) without increasing the associated complications. Nonetheless, 36 % developed complications, of whom 96 % did not adhere to ASNET. Conclusion: adherence to ASNET in patients at risk of RS allowed the achievement of OPER safely by day four with fewer associated complications (AU)

Antecedentes: el síndrome de realimentación (SR) es una complicación metabólica asociada al soporte nutricional y la falta de protocolos puede conducir a su desarrollo o a desnutrición. Objetivo: evaluar la adherencia al algoritmo de soporte nutricional enteral total (ASNET) y la eficacia de alcanzar los requisitos de nutrientes en pacientes con riesgo de SR. Métodos: se realizó un estudio de cohortes con evaluación nutricional del paciente y del riesgo de SR. Fueron elegibles los adultos ingresados en el hospital por una enfermedad no crítica que recibían exclusivamente nutrición enteral (NE). Se excluyeron los pacientes con SR, falla intestinal o diarrea crónica. Se evaluaron la adherencia al ASNET y la eficacia para alcanzar el requerimiento óptimo de proteína, energía (OPER) y cualquier complicación asociada. El seguimiento finalizó cuando se cambió la ruta de alimentación o al alta. Resultados:se incluyeron 73 pacientes (edad de 62 ± 16 años, IMC de 18,5 ± 4,2 kg/m2) y el 55 % fueron hombres. Todos tenían riesgo nutricional de desarrollar SR (57 bajo; 15 alto; 1 muy alto). El 34 % presentaron una adherencia adecuada y el 33 % lograron cubrir el requerimiento total entre 4 y 6 días. La OPER se alcanzó en el 38 % al cuarto día de NE, y la adecuada adherencia al ASNET aumentó la probabilidad de lograrla (RR: 2.2; IC 95 %: 1,6-3,2, p < 0,0001) sin incrementar las complicaciones asociadas. No obstante, el 36 % desarrollaron complicaciones y el 96 % de estos casos no se habían adherido al ASNET. Conclusión: la adherencia al ASNET en los pacientes con riesgo de SR permitió lograr la OPER de forma segura al cuarto día y con menos complicaciones asociadas (AU)

Tratamiento médico y nutricional en el paciente adulto con fallo intestinal agudo / Medical and nutritional treatment in adult patients with acute intestinal failure

El fallo intestinal agudo es una condición clínica reversible que se caracteriza por la reducción de la función intestinal, en la cual se requiere de la suplementación intravenosa de nutrientes, agua y/o electrólitos durante semanas o meses para mantener un óptimo estado de salud. Ocurre principalmente en pacientes posquirúrgicos de cirugía abdominal o en pacientes críticos con disfunción orgánica. El manejo médico y nutricional puede ser un proceso complejo y prolongado debido a las complicaciones asociadas, como son el desequilibrio hidroelectrolítico, la desnutrición, la sepsis y las alteraciones metabólicas. El tratamiento médico se centra en la prevención y control de la sepsis, la restitución de líquidos y los electrólitos, y la rehabilitación intestinal. El tratamiento nutricional busca atenuar el catabolismo proteico, prevenir deficiencias nutricionales y alteraciones metabólicas, y optimizar el estado nutricional. Esta revisión pretende entregar información actualizada y útil respecto al manejo del fallo intestinal agudo

Acute intestinal failure is a reversible clinical condition characterised by reduced intestinal function, which requires the intravenous supplementation of nutrients, water and/or electrolytes for weeks or months to maintain an optimal state of health. Acute intestinal failure occurs mainly in postsurgical patients who have undergone abdominal operations or are critically ill and have organ dysfunction. These patients' medical and nutritional management can be a complex and prolonged process due to the associated complications such as electrolyte imbalances, malnutrition, sepsis and metabolic disorders. Medical treatment is focused on preventing and controlling sepsis, restoring fluids and electrolytes and rehabilitating the intestine. Nutritional therapy seeks to attenuate protein catabolism, prevent nutritional deficiencies and metabolic disorders and optimise the nutritional state. This review seeks to provide updated and useful information on the management of acute intestinal failure

Medical and nutritional treatment in adult patients with acute intestinal failure. / Tratamiento médico y nutricional en el paciente adulto con fallo intestinal agudo.

Acute intestinal failure is a reversible clinical condition characterised by reduced intestinal function, which requires the intravenous supplementation of nutrients, water and/or electrolytes for weeks or months to maintain an optimal state of health. Acute intestinal failure occurs mainly in postsurgical patients who have undergone abdominal operations or are critically ill and have organ dysfunction. These patients' medical and nutritional management can be a complex and prolonged process due to the associated complications such as electrolyte imbalances, malnutrition, sepsis and metabolic disorders. Medical treatment is focused on preventing and controlling sepsis, restoring fluids and electrolytes and rehabilitating the intestine. Nutritional therapy seeks to attenuate protein catabolism, prevent nutritional deficiencies and metabolic disorders and optimise the nutritional state. This review seeks to provide updated and useful information on the management of acute intestinal failure.

A dietary intervention with functional foods reduces metabolic endotoxaemia and attenuates biochemical abnormalities by modifying faecal microbiota in people with type 2 diabetes.

AIM: To study the effects of a functional food-based dietary intervention on faecal microbiota and biochemical parameters in patients with type 2 diabetes (T2D). MATERIALS AND METHODS: This placebo-controlled, randomized, double-blind study included 81 patients with T2D divided into two 3-month treatment groups: one following a reduced-energy diet with a dietary portfolio (DP) comprising high-fibre, polyphenol-rich and vegetable-protein functional foods; the other taking a placebo (P). The primary outcome was the effect of the DP on faecal microbiota. Secondary endpoints were biochemical parameters, lipopolysaccharide, branched-chain amino acids, trimethylamine N-oxide, glycosylated haemoglobin (HbA1c) and free fatty acids (FFAs). RESULTS: Patients with T2D exhibited intestinal dysbiosis characterized by an increase in Prevotella copri. Dietary intervention with functional foods significantly modified faecal microbiota compared with P by increasing alpha diversity and modifying the abundance of specific bacteria, independently of antidiabetic drugs. There was a decrease in P. copri and increases in Faecalibacterium prausnitzii and Akkermansia muciniphila, two bacterial species known to have anti-inflammatory effects. The DP group also exhibited significant reductions in areas under the curve for glucose, total and LDL cholesterol, FFAs, HbA1c (P< 0.05), triglycerides and CRP, and an increase in antioxidant activity (P< 0.01) vs. the P group. CONCLUSION: Long-term adherence to a high-fibre, polyphenol-enriched and vegetable-protein-based diet provides benefits for the composition of faecal microbiota, and may offer potential therapies for improvement of glycaemic control, dyslipidaemia and inflammation.

Accurate determination of energy requirements in hospitalised patients with parenteral nutrition.

BACKGROUND: The prescription of parenteral nutrition (PN) in hospitalised patients requires an estimation of the energy requirements. Most studies employing prediction equations (PEs) to estimate energy requirements have focused on critically ill patients. The present study aimed to evaluate several PEs of the resting energy expenditure (REE) to identify the most accurate equation for estimating the REE required for PN. METHODS: This cross-sectional and descriptive study included patients hospitalised with medical or surgical diagnoses, making them candidates for PN. Epidemiological data, the reason for hospital admission, nutritional screening results, characteristics of the PN administered and REE by indirect calorimetry (IC) were recorded and, subsequently, PEs were calculated. RESULTS: In total, 116 patients were recruited with a mean (SD) age of 56.7 (13.8) years and body mass index of 21.3 (4.25) kg m-2 . The diagnosis was medical in 52% of patients and surgical in 48%. The mean (SD) REEs of patients, according to IC, were: 6.11 (1.18) MJ [1461 (281) kcal]; and according to PEs: Mifflin, 5.07 (1.05) MJ [1212 (252) kcal]; Owen, 5.43 (0.72) MJ [1298 (172) kcal]; Harris-Benedict, 5.38 (0.85) MJ [1285 (204) kcal]; Ireton-Jones, 6.20 (1.69) MJ [1481 (403) kcal]; and short equation, 6.12 (0.92) MJ [1464 (220) kcal]. A comparison of the results obtained for the REE by IC and with PEs indicated that the short equation had less bias than the other equations, with an accuracy of 54% CONCLUSIONS: In hospitalised patients who receive PN, determination of the REE should ideally be made by IC. PEs are acceptable but not exact and so their estimation could overfeed or underfeed the patient.

Amino acid profiles of young adults differ by sex, body mass index and insulin resistance.

BACKGROUND AND AIMS: An increase in plasma branched-chain amino acids is associated with a higher risk of developing type 2 diabetes and cardiovascular diseases. However, little is known about the basal plasma amino acid concentrations in young adults. Our aim was to determine the plasma amino acid profiles of young adults and to evaluate how these profiles were modified by sex, body mass index (BMI) and insulin resistance (IR). METHODS AND RESULTS: We performed a transversal study with 608 Mexican young adults aged 19.9 ± 2.4 years who were applicants to the Universidad Autónoma de San Luis Potosí. The subjects underwent a physical examination and provided a clinical history and a blood sample for biochemical, hormonal and amino acid analyses. The women had higher levels of arginine, aspartate and serine and lower levels of α-aminoadipic acid, cysteine, isoleucine, leucine, methionine, proline, tryptophan, tyrosine, urea and valine than the men. The obese subjects had higher levels of alanine, aspartate, cysteine, ornithine, phenylalanine, proline and tyrosine and lower levels of glycine, ornithine and serine than the normal weight subjects. Subjects with IR (defined as HOMA > 2.5) had higher levels of arginine, alanine, aspartate, isoleucine, leucine, phenylalanine, proline, tyrosine, taurine and valine than the subjects without IR. Furthermore, we identified two main groups in the subjects with obesity and/or IR; one group was composed of amino acids that positively correlated with the clinical, biochemical and hormonal parameters, whereas the second group exhibited negative correlations. CONCLUSION: This study demonstrates that young adults with obesity or IR have altered amino acid profiles characterized by an increase in alanine, aspartate, proline and tyrosine and a decrease in glycine.

Clinical and immunological features of common variable immunodeficiency in Mexican patients

BACKGROUND: Common variable immunodeficiency (CVID) is characterised by hypogammaglobulinaemia and a broad clinical spectrum, mainly showing recurrent bacterial infections accompanied sometimes by increased susceptibility to chronic lung disease, autoimmunity, and neoplastic diseases. OBJECTIVES: To evaluate the clinical and immunological characteristics of patients with CVID in Mexico. METHODS: This is a retrospective analysis of 43 patients with CVID from the Immunology Division of seven different reference centres in Mexico. Patients were diagnosed according to the diagnostic criteria of the European Society for Immunodeficiency Diseases. We collected demographics, clinical and immunological data from each patient and a statistical analysis was performed. RESULTS: There were 23 (53.5%) male and 20 (46.5%) female patients. Median age at onset of disease was 13.7 years, and median age at diagnosis was 19 years. Average delay in diagnosis was 12.5 years. The median total serum levels of IgG, IgM, and IgA at diagnosis were 175, 18, and 17.8 mg/dL, respectively. The mean percentage of CD19+ B cells was 8.15%. Sinusitis (83%), pneumonia (83%), gastrointestinal infection (70%), and acute otitis media (49%) were the most common manifestations. Bronchiectasis was present in 51% of the patients, 44% manifested non-infectious chronic diarrhoea, and 70% experienced weight loss. Autoimmunity was present in 23% of the patients; haemolytic anaemia and autoimmune thrombocytopenic purpura were the most common presentations. Allergy was present in 30.2% of patients, with allergic rhinitis and asthma being the most frequent types. Two patients developed malignancy. All the patients received Intravenous immunoglobulin (IVIG) as a fundamental part of the treatment at a mean dose of 408 mg/kg. CONCLUSION: This is the first cohort of CVID reported in Mexico We found that infection diseases were the most frequent presentations at onset. Moreover, patients had an average diagnosis delay of twelve years and thus a major prevalence of bronchiectasis. We suggest performing an extended analysis of patients with CVID patients in other Latin American countries

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Clinical and immunological features of common variable immunodeficiency in Mexican patients.

BACKGROUND: Common variable immunodeficiency (CVID) is characterised by hypogammaglobulinaemia and a broad clinical spectrum, mainly showing recurrent bacterial infections accompanied sometimes by increased susceptibility to chronic lung disease, autoimmunity, and neoplastic diseases. OBJECTIVES: To evaluate the clinical and immunological characteristics of patients with CVID in Mexico. METHODS: This is a retrospective analysis of 43 patients with CVID from the Immunology Division of seven different reference centres in Mexico. Patients were diagnosed according to the diagnostic criteria of the European Society for Immunodeficiency Diseases. We collected demographics, clinical and immunological data from each patient and a statistical analysis was performed. RESULTS: There were 23 (53.5%) male and 20 (46.5%) female patients. Median age at onset of disease was 13.7 years, and median age at diagnosis was 19 years. Average delay in diagnosis was 12.5 years. The median total serum levels of IgG, IgM, and IgA at diagnosis were 175, 18, and 17.8mg/dL, respectively. The mean percentage of CD19+ B cells was 8.15%. Sinusitis (83%), pneumonia (83%), gastrointestinal infection (70%), and acute otitis media (49%) were the most common manifestations. Bronchiectasis was present in 51% of the patients, 44% manifested non-infectious chronic diarrhoea, and 70% experienced weight loss. Autoimmunity was present in 23% of the patients; haemolytic anaemia and autoimmune thrombocytopenic purpura were the most common presentations. Allergy was present in 30.2% of patients, with allergic rhinitis and asthma being the most frequent types. Two patients developed malignancy. All the patients received Intravenous immunoglobulin (IVIG) as a fundamental part of the treatment at a mean dose of 408mg/kg. CONCLUSION: This is the first cohort of CVID reported in Mexico We found that infection diseases were the most frequent presentations at onset. Moreover, patients had an average diagnosis delay of twelve years and thus a major prevalence of bronchiectasis. We suggest performing an extended analysis of patients with CVID patients in other Latin American countries.

Survival of Mexican patients with paediatric-onset systemic lupus erythematosus and abnormal electroencephalogram

Background: Over the past three decades, there has been a remarkable improvement in the outcome of children diagnosed with systemic lupus erythematosus (SLE). In general, paediatric-onset SLE has been associated with higher mortality rates and more disease damage than adults with SLE. The objective was to determinate the impact of clinical, laboratory, and electroencephalographic findings on survival amongst patients with paediatric-onset SLE. Methods: Charts of Mexican patients with paediatric-onset SLE diagnosed between 1970 and 2001 were analysed retrospectively; univariate and multivariate analyses were used for analysing associations between clinical and laboratory features and death; Kaplan–Meier tests were used to estimate survival curves. Results: 159 patients were included, 105 were female, with a median age of 12.7 years at diagnosis and a median duration of symptoms prior to diagnosis of 8.4 months. Univariate analysis showed that haematuria, leukocyturia, proteinuria, presence of urine cast, <60% glomerular filtration rate, haemolytic anaemia, and abnormal electroencephalogram, were all poor prognostic factors (p<0.05). Multivariate analysis showed that the presence of proteinuria and abnormal electroencephalograms (p<0.05) were independent factors associated with death. The overall survival rate was 82.9% at five years and 77.4% at ten years upon follow-up. Infection and high disease activity were the most common causes of death. Conclusions: Survival of paediatric-onset SLE patients was lower compared to that reported for patients in wealthier countries. Amongst the patients who died, the presence of proteinuria and abnormal electroencephalograms were found to be determinant for survival. Infection and activity were the most common causes of death(AU)

Survival of Mexican patients with paediatric-onset systemic lupus erythematosus and abnormal electroencephalogram.

BACKGROUND: Over the past three decades, there has been a remarkable improvement in the outcome of children diagnosed with systemic lupus erythematosus (SLE). In general, paediatric-onset SLE has been associated with higher mortality rates and more disease damage than adults with SLE. The objective was to determinate the impact of clinical, laboratory, and electroencephalographic findings on survival amongst patients with paediatric-onset SLE. METHODS: Charts of Mexican patients with paediatric-onset SLE diagnosed between 1970 and 2001 were analysed retrospectively; univariate and multivariate analyses were used for analysing associations between clinical and laboratory features and death; Kaplan-Meier tests were used to estimate survival curves. RESULTS: 159 patients were included, 105 were female, with a median age of 12.7 years at diagnosis and a median duration of symptoms prior to diagnosis of 8.4 months. Univariate analysis showed that haematuria, leukocyturia, proteinuria, presence of urine cast, <60% glomerular filtration rate, haemolytic anaemia, and abnormal electroencephalogram, were all poor prognostic factors (p<0.05). Multivariate analysis showed that the presence of proteinuria and abnormal electroencephalograms (p<0.05) were independent factors associated with death. The overall survival rate was 82.9% at five years and 77.4% at ten years upon follow-up. Infection and high disease activity were the most common causes of death. CONCLUSIONS: Survival of paediatric-onset SLE patients was lower compared to that reported for patients in wealthier countries. Amongst the patients who died, the presence of proteinuria and abnormal electroencephalograms were found to be determinant for survival. Infection and activity were the most common causes of death.

Malnutrition and associated factors in elderly hospitalized.

OBJECTIVES: To investigate the frequency of malnutrition and associated factors in patients over 65 years of age in a hospital. METHODS: We conducted an observational, crosssectional and descriptive study. Department of Nutritional Support, Hospital Medica Sur, Mexico, we evaluated patients over 65 years of age within the first 24 hours of admission. RESULTS: We evaluated 769 patients, 49% of whom were women and 51% were men, with an average age of 75.3 ± 7.7 years. Among the patients evaluated, 53.6% exhibited an altered nutritional state. In addition, 9% were diagnosed as obese and 15% as overweight. Their risk of malnutrition was determined to be 22.5%, and at the time of admission, 7% were malnourished. CONCLUSION: The prevalence of malnutrition in hospitalized patients over 65 years of age was high. Thus, the early diagnosis of patients who are at risk for malnutrition or who are malnourished is essential and allows for prompt treatment.

Association between maternal perceptions and actual nutritional status for children in a study group in Mexico.

BACKGROUND: Mexico has the highest rates of childhood obesity of any country in the world. As an environmental risk factor, family perception and behavior concerning child obesity is thought to have an important influence on the prevention and treatment of obesity. OBJECTIVE: the aim of this study was to evaluate maternal perceptions of children's weight and to determine whether these perceptions are associated with the actual weight of the children. METHODS: A descriptive study was conducted that assessed 273 children and included interviews with their mothers. Maternal perceptions of the children's weight status were compared with the measured weights, statures and body mass indices (BMI). RESULTS: The mean BMIs of the children and mothers were 18.1 ± 3.6 and 27.7 ± 4.7 kg/m², respectively. The perceptions of mothers of children's weight are not associated with actual BMI category of children (p < 0.0001). We found 74 children who were overweight and obese (27%); 62.2% of the mothers of these children considered them to be overweight and obese and 37.8% of these mothers felt that their sons were of normal weight when in fact they were overweight (p = 0.038). CONCLUSIONS: We found no association between actual BMI category of children and their mother's perceptions of their weight. In addition, found that third of mothers with obese or overweight children reported that their children had a normal nutritional status.

Malnutrition and associated factors in elderly hospitalized / Desnutrición y factores asociados en adultos mayores hospitalizados

Objectives: To investigate the frequency of malnutrition and associated factors in patients over 65 years of age in a hospital. Methods: We conducted an observational, crosssectional and descriptive study. Department of Nutritional Support, Hospital Medica Sur, Mexico, we evaluated patients over 65 years of age within the first 24 hours of admission. Results: We evaluated 769 patients, 49% of whom were women and 51% were men, with an average age of 75.3 ± 7.7 years. Among the patients evaluated, 53.6% exhibited an altered nutritional state. In addition, 9% were diagnosed as obese and 15% as overweight. Their risk of malnutrition was determined to be 22.5%, and at the time of admission, 7% were malnourished. Conclusion: The prevalence of malnutrition in hospitalized patients over 65 years of age was high. Thus, the early diagnosis of patients who are at risk for malnutrition or who are malnourished is essential and allows for prompt treatment (AU)

Objetivos: Investigar la frecuencia de la desnutrición y factores asociados en pacientes mayores de 65 años de edad en un hospital. Métodos: Se realizó un estudio observacional, transversal y descriptivo. En el departamento de Soporte Nutricional del Hospital Médica Sur, México, DF, se evaluaron los pacientes mayores de 65 años de edad en las primeras 24 horas de su ingreso. Resultados: En nuestro estudio evaluamos a 769 pacientes, 49% mujeres y 51% hombres, con una edad promedio de 75,3 ± 7,7 años. Encontramos un estado de nutrición alterado en el 53,6% del total. El 9% fueron diagnosticados con obesidad y el 15% con sobrepeso. El riesgo de desnutrición fue del 22,5% y al ingreso el 7% estaban desnutridos. Conclusión: La prevalencia de un mal estado de nutrición al ingreso es alta. Es indispensable un diagnóstico temprano de los pacientes que se encuentran en riesgo de desnutrición o desnutridos lo cual permitirá el inicio del tratamiento adecuado (AU)

Association between maternal perceptions and actual nutritional status for children in a study group in Mexico / Asociación entre la percepción materna y el estado nutricional real de los niños en un grupo de estudio en México

Background: Mexico has the highest rates of childhood obesity of any country in the world. As an environmental risk factor, family perception and behavior concerning child obesity is thought to have an important influence on the prevention and treatment of obesity. Objective: the aim of this study was to evaluate maternal perceptions of children’s weight and to determine whether these perceptions are associated with the actual weight of the children. Methods: A descriptive study was conducted that assessed 273 children and included interviews with their mothers. Maternal perceptions of the children’s weight status were compared with the measured weights, statures and body mass indices (BMI). Results: The mean BMIs of the children and mothers were 18.1 ± 3.6 and 27.7 ± 4.7 kg/m², respectively. The perceptions of mothers of children’s weight are not associated with actual BMI category of children (p < 0.0001).We found 74 children who were overweight and obese(27%); 62.2% of the mothers of these children considered them to be overweight and obese and 37.8% of these mothers felt that their sons were of normal weight when in fact they were overweight (p = 0.038).Conclusions: We found no association between actual BMI category of children and their mother’s perceptions of their weight. In addition, found that third of mothers with obese or overweight children reported that their children had a normal nutritional status (AU)

Antecedentes: México tiene una alta prevalencia de obesidad infantil incluso colocándolo en el primer lugar a nivel mundial. Como un factor de riesgo ambiental, la percepción de la familia y el comportamiento relativo a la obesidad infantil se cree que tiene una influencia importante en la prevención y el tratamiento de la obesidad. Métodos: Estudio descriptivo mediante el que se evaluaron 273 niños y se realizaron entrevistas con sus madres. La percepción materna del estado de nutrición o el peso de los niños se compararon con los pesos medidos, tallas e índices de masa corporal (IMC). Resultados: El IMC promedio de los niños y las madres fueron 18,1 ± 3,6 y 27,7 ± 4,75 kg/m², respectivamente. Las percepciones de las madres acerca del peso de los niños no se correlacionaron con la categoría real del IMC de los niños (p < 0,0001). Se encontraron 74 niños (27%)con sobrepeso y obesidad; 62,2% de las madres de estos niños les consideró en la categoría correcta al mencionar que los percibían con sobrepeso y obesidad y 37,8% de estas madres percibieron, que sus hijos tenían un peso normal cuando en realidad tenían sobrepeso (p = 0,038). Conclusiones: No se encontró asociación entre la categoría del IMC de los niños y las percepciones de la madre. Además, la tercera parte de las madres con niños obesos o con sobrepeso informaron que sus hijos tenían un estado nutricional normal (AU)

Prevalencia de desnutrición del adulto mayor al ingreso hospitalario / Prevalence of hyponutrition in the elderly at admission to the hospital

Antecedentes: Los cambios demográficos en México están aumentando la proporción de adultos mayores de 60 años en riesgo de inseguridad alimentaria. La desnutrición en este grupo de edad es frecuente en la comunidad pero se exacerba durante las hospitalizaciones frecuentes, lo que aumenta la morbi-mortalidad y los costos en los servicios de salud. Objetivo: Describir la frecuencia de desnutrición al ingreso hospitalario de pacientes mayores de 60 años. Diseño: Observacional, transversal y descriptivo. Ubicación: Hospital de tercer nivel de referencia. Sujetos: 97 pacientes mayores de 60 años de edad ingresados consecutivamente a los sectores de hospitalización durante un periodo de seis meses del año 2006.Intervenciones: Al ingreso se realizó la valoración nutricional mediante la aplicación de la Mini Valoración Nutricional (MNA: Mini Nutritional Assessment) y la Valoración Global Subjetiva más la recolección de datos de laboratorio rutinarios (albúmina sérica y linfocitos totales) y del estado socioeconómico y educativo. Resultados: De 97 pacientes incluidos, 48% sólo completaron educación primaria y 66% tenían ingresos económicos medios. La Mini Valoración Nutricional clasificó a 69% de los pacientes con riesgo franco asociado a desnutrición (18% severa y 50% moderada) lo que se correlación o a la versión corta de este instrumento que identificó a 73% de los individuos en riesgo. La Valoración Global Subjetiva clasificó a 46% de pacientes con desnutrición moderada y 20% con desnutrición severa. El valor de Kappa entre ambos métodos fue del 42%. El Índice de Riesgo Nutricio promedio fue de 85,9 ± 11 puntos, con 80% de los pacientes con riesgo asociado a desnutrición moderada y severa, siendo la concordancia con la Mini Valoración Nutricional de sólo 11%. 70% de los pacientes tuvieron valores de albúmina menores de 3 g/dl. Según el método Chang 52% tuvieron desnutrición calórica, 29%proteica y 18% mixta. Conclusiones: La desnutrición al ingreso hospitalario de los adultos mayores es un hallazgo frecuente a partir de los diferentes métodos aplicados. La Mini Valoración Nutricional y la Valoración Global Subjetiva son métodos estructurados de bajo costo que pueden ser fácilmente aplicados y replicados, útiles para establecer la frecuencia de desnutrición en esta población de pacientes. La Mini Valoración Nutricional podría tener más utilidad como predictor de morbi-mortalidad tanto en los ancianos institucionalizados como los hospitalizados

Background: The population older than 60 years in Mexico is growing changing the classic pyramidal demographic structure. This fact is increasing the risk of malnutrition in the elderly, specially under nutrition which is a common problem among elderly people living at home and during hospitalizations, condition that is closely related to the increasing of morbidity, mortality and costs. Objective: Describe the prevalence of malnourished elderly who needs hospital admission. Design: Cross-sectional observational study. Setting: Third-level reference hospital. Subjects: Ninety seven consecutive subjects older than60 years admitted to hospitalization. Interventions: During the first three days of admission all subjects were evaluated to determine their nutritional status using Mini Nutritional Assessment and Subjective Global Assessment; albumin, total lymphocytes, level of income and school grade were also included. Results: Just 48% of patients have finished primary school and 66% had middle economic incomes. According to Mini Nutritional Assessment 69% of patients had risk associated to malnutrition (18% at high risk and 50% at moderate risk). The short form of the MiniNutritional Assessment described 73% of patients at-risk related to malnutrition in correlation with the complete Mini Nutritional Assessment. 46% and 20%of patients were classified at moderate malnutrition and severe malnutrition respectively using the Subjective Global Assessment. Kappa between Mini Nutritional Assessment and Subjective Global Assessment was of 42%. The Nutritional Risk Index mean value was of85.9 ± 11, with 80% of patients at risk associated with malnutrition when moderate and severe risk was included. Kappa between Nutritional Risk Index and MiniNutritional Assessment was 11%. 70% of patients had serum albumin values under 3 g/dl. According to Chang’s method 52% had caloric under nutrition, 29%protein under nutrition and 18% mixed undernutrition.Conclusions: Malnutrition is a common problem in elderly population at hospital admissions according to different methods used. Mini Nutritional Assessment and Subjective Global Assessment are useful low cost and replicable nutritional evaluation tools in elderly population. Mini Nutritional Assessment could have a better value to predict morbidity and mortality in institutionalized and community elderly subjects