[Cardiac cachexia]. / Caquexia cardiaca.

Chronic heart failure (CHF), especially affecting the right heart, frequently leads to malnutrition. If the latter is severe and is combined to other factors, it may lead to cardiac cachexia. This one is associated to increased mortality and lower survival of patients suffering from it. The causes of cardiac cachexia are diverse, generally associated to maintenance of a negative energy balance, with increasing evidence of its multifactorial origin. Neurohumoral, inflammatory, immunological, and metabolic factors, among others, are superimposed in the patient with CHF, leading to involvement and deterioration of several organs and systems, since this condition affects both lean (or active cellular) mass and adipose and bone tissue osteoporosis. Among all, the most pronounced deterioration may be seen at skeletal muscle tissue, at both structural and functional levels, the heart not being spared. As for treatment, it should be based on available scientific evidence. Assessment of nutritional status of any patient with CHF is a must, with the requirement of nutritional intervention in case of malnutrition. In this situation, especially if accompanied by cardiac cachexia, it is required to modify energy intake and oral diet quality, and to consider the indication of specific complementary or alternative artificial nutrition. Besides, the causal relationship of the beneficial role of moderate physical exertion is increasing, as well as modulation of metabolic and inflammatory impairments observed in cardiac cachexia with several drugs, leading to a favorable functional and structural response in CHF patients.

Caquexia cardíaca / Cardiac cachexia

La insuficiencia cardíaca de carácter crónico (ICC), en especial si afecta al corazón derecho, ocasiona con frecuencia malnutrición. Si esta es grave y se unen otros componentes, puede producirse caquexia cardíaca. Esta se asocia a mayor morbilidad y menor supervivencia de los pacientes que la padecen. Las causas de la caquexia cardíaca son diversas, en general asociadas a mantener balance energético negativo, surgiendo cada vez mayor evidencia que apoya un origen multifactorial de la misma. Entre otros, factores neurohormonales, inflamatorios, inmunológicos y metabólicos se superponen en el paciente con ICC, pudiendo producir afectación y deterioro de diversos órganos o sistemas, incluyendo la caquexia cardíaca. Esta puede definirse de diversos modos que, en general, concretan una reducción de peso en un tiempo definido o de estructuras corporales, ya que esta entidad afecta tanto a la masa magra o celular activa, como a los tejidos adiposo y óseo ”osteoporosis. De todos ellos, el deterioro más acusado puede observarse en el tejido muscular esquelético, tanto a nivel estructural como funcional, no quedando exento el corazón de su afectación. Respecto del tratamiento, este debe basarse en la evidencia científica disponible. La valoración del estado nutricional de todo paciente con ICC es obligada, debiendo intervenir nutricionalmente ante MEP o riesgo de desarrollarla. En esta situación, mas si existe caquexia cardíaca, es necesaria una modificación de la dieta oral en energía y calidad de la misma, debiendo valorar la indicación de nutrición artificial específica complementaria o alternativa. Asimismo, cada vez adquiere mayor fuerza causal el papel beneficioso del ejercicio físico moderado, así como de la modulación por determinados fármacos de las alteraciones metabólicas e inflamatorias observadas en la caquexia cardíaca, que incluyen una respuesta favorable a nivel funcional y estructural del paciente con ICC (AU)

Chronic heart failure (CHF), especially affecting the right heart, frequently leads to malnutrition. If the latter is severe and is combined to other factors, it may lead to cardiac cachexia. This one is associated to increased mortality and lower survival of patients suffering from it. The causes of cardiac cachexia are diverse, generally associated to maintenance of a negative energy balance, with increasing evidence of its multifactorial origin. Neurohumoral, inflammatory, immunological, and metabolic factors, among others, are superimposed in the patient with CHF, leading to involvement and deterioration of several organs and systems, since this condition affects both lean (or active cellular) mass and adipose and bone tissue - osteoporosis. Among all, the most pronounced deterioration may be seen at skeletal muscle tissue, at both structural and functional levels, the heart not being spared. As for treatment, it should be based on available scientific evidence. Assessment of nutritional status of any patient with CHF is a must, with the requirement of nutritional intervention in case of malnutrition. In this situation, especially if accompanied by cardiac cachexia, it is required to modify energy intake and oral diet quality, and to consider the indication of specific complementary or alternative artificial nutrition. Besides, the causal relationship of the beneficial role of moderate physical exertion is increasing, as well as modulation of metabolic and inflammatory impairments observed in cardiac cachexia with several drugs, leading to a favorable functional and structural response in CHF patients (AU)

Clinical evidence for enteral nutritional support with glutamine: a systematic review.

OBJECTIVE: The purpose of this systematic review was to locate and assess the quality of scientific evidence to establish a graded recommendation based on the effectiveness of glutamine-enriched enteral nutrition in different medical and surgical conditions. We were concerned with the following topics: 1) benefits of enteral administration of glutamine in different pathologic conditions, and 2) dose, duration, and time of initiation of glutamine-enriched diets. METHODS: The sources consulted for the search were MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Healthstar and HSTAT. Ninety-one studies were assessed; after a methodologic review (primary review), only 16 studies met the inclusion criteria for analysis by a group of experts (secondary review). The coordinators supervised all data, and a final consensus was reached among the coordinators, experts, and methodologists. RESULTS AND CONCLUSIONS: Glutamine-enriched diets showed good overall tolerance, improvement of immunologic aspects in multiple trauma patients, cost reduction in critically ill patients, and improvement of mucositis in post-chemotherapy patients (grade B recommendations). The doses given and the duration of therapy varied widely depending on the pathologic condition. Intake of 20 to 30 g/d, early initiation of diet, and maintenance for 5 d or longer are recommended (grade C recommendations).

Coinfección VIH/VHC: ¿tenemos derecho a no tratar a nuestros pacientes? / Human immunoficiency virus/hepatitis C virus co-infection: do we have the right not to treat our patients?

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