Asociación entre obesidad sarcopénica con resistencia a la insulina y síndrome metabólico / Association between sarcopenic obesity with insulin resistance and metabolic syndrome

IntroducciónExiste un debate en cuanto a si la obesidad sarcopénica conduce a mayor riesgo de síndrome metabólico (SM) en adultos jóvenes.ObjetivosDeterminar la asociación entre obesidad sarcopénica y el SM y resistencia la insulina (RI).MétodosEstudio transversal retrospectivo durante 5 años. Se incluyeron sujetos de la consulta de especialidad entre 18 y 55 años, con IMC≥35 con comorbilidad o IMC≥40 con y sin comorbilidad. La asociación se calculó mediante odds ratio (OR) con intervalos de confianza del 95% (IC 95%).ResultadosDoscientos cincuenta y cuatro sujetos fueron analizados, el 76,4% fueron mujeres, la edad promedio fue de 38,36±8,78 años. El OR de RI en sujetos con o sin obesidad sarcopénica fue de 2,224 (IC 95%, 1,127-4,389; p=0,02). El OR del SM en sujetos con o sin sarcopenia fue de 1,045 (IC 95%: 0,624-1,748; p=0,868). Se encontró una diferencia entre la masa grasa en el grupo con RI vs. sin RI de 60,58±14,4kg vs. 53,98±12,2kg (p<0,001); igualmente entre el IMC y masa muscular de 46,15±6,78kg/m2 vs. 43,51±6,11kg/m2 (p<0,05) y 30,05±7,48kg vs. 27,86±5,91kg (p<0,05) respectivamente.ConclusiónLa asociación de obesidad sarcopénica con RI en adultos jóvenes resultó significativa, no así con el SM. Nuestros hallazgos enfatizan la necesidad de tomar conciencia sobre la importancia del mantenimiento de la masa magra en sujetos con obesidad. (AU)

BackgroundThere is a debate as to whether sarcopenic obesity leads to an increased risk of metabolic syndrome (MS) in young adults.ObjectiveTo determine the association between sarcopenic obesity with MS and insulin resistance (IR).MethodsA 5-year retrospective cross-sectional study. Subjects of the specialty consultation between 18 and 55 years old, with BMI≥35 with comorbidity or BMI≥40 with and without comorbidity were included. The association was calculated using an odds ratio (OR) with 95% confidence intervals (95% CI).ResultsTwo hundred and fifty-four subjects were analyzed, 76.4% were women and average age was 38.36±8.78 years. The OR of IR in subjects with or without sarcopenic obesity was 2.224 (95% CI, 1127 to 4389, P=.02). The OR of MS in subjects with or without sarcopenia was 1.045 (95% CI, 0.624 to 1.748, P=.868). A difference was found between the fat mass in the group with IR vs. without IR of 60.58±14.4kg vs. 53.98±12.2kg (P<.001); likewise, between the BMI and muscle mass of 46.15±6.78kg/m2 vs. 43.51±6.11kg/m2 (P<.05) and 30.05±7.48kg vs. 27.86±5.91kg (P<.05) respectively.ConclusionThe association between sarcopenic obesity with IR in young adults was significant, but not with MS. Our findings emphasize the need to become aware of the importance of maintaining lean mass in obese subjects. (AU)

Effect of Phentermine on Hepatic Steatosis in Bariatric Surgery: A Pilot Study.

OBJECTIVE: Hepatic steatosis is associated with increased surgical complications in bariatric surgery patients. We aimed to evaluate the effect of phentermine in reducing hepatic steatosis, adipose tissue, and surgical complications in patients undergoing bariatric surgery. METHODS: This was a two-arm, double-blind, randomized, controlled pilot trial of 64 adult subjects with BMI >35 kg/m2 selected for bariatric surgery randomized into phentermine group (15 mg once daily) or placebo group for 8 weeks. Both groups adhered to a hypocaloric diet (500 calories/day) and an individualized exercise program. The primary endpoint was reducing the frequency of hepatic steatosis measured by ultrasound and reducing adipose tissue through fat mass in total kilograms or percentage. Key secondary points were the prevalence of surgical complications. Baseline and final biochemical parameters and blood pressure too were assessments. RESULTS: In the phentermine group, the frequency of hepatic steatosis decreased by 19%, and the percentage of patients with a normal ultrasound increased from 9% to 28% (p = 0.05). Likewise, the decrease in fat mass in kilograms was more significant in the phentermine group (56.1 kg vs. 51.8 kg, p = 0.02). A significant reduction in the HOMA-IR index was observed regardless of weight loss. No differences in surgical complications were observed between groups. Phentermine was well-tolerated; no differences were observed in the frequency of adverse events between the groups. CONCLUSIONS: Phentermine decreased the proportion of individuals with hepatic steatosis by 19% and promoted a more significant fat mass loss in kilograms among candidates for bariatric surgery.

Immunonutrition for the acute treatment of MELAS syndrome.

MELAS syndrome (Mitochondrial Encephalopathy, Lactic Acidosis and Stroke-like episodes) is one of the most frequent mitochondrial pathologies. Its diagnosis is based on the classic triad of symptoms its acronym stands for and the presence of ragged red fibres. There is currently no curative therapy for MELAS, and treatment focuses on managing complications that affect specific organs and functions. However, some immunonutrients can be used as a therapeutic alternative in patients with MELAS. We present a scientific literature review accompanied by the clinical case of a patient with dementia and seizures admitted to the intensive care unit.

Association between sarcopenic obesity with insulin resistance and metabolic syndrome. / Asociación entre obesidad sarcopénica con resistencia a la insulina y síndrome metabólico.

BACKGROUND: There is a debate as to whether sarcopenic obesity leads to an increased risk of metabolic syndrome (MS) in young adults. OBJECTIVE: To determine the association between sarcopenic obesity with MS and insulin resistance (IR). METHODS: A 5-year retrospective cross-sectional study. Subjects of the specialty consultation between 18 and 55 years old, with BMI≥35 with comorbidity or BMI≥40 with and without comorbidity were included. The association was calculated using an odds ratio (OR) with 95% confidence intervals (95% CI). RESULTS: Two hundred and fifty-four subjects were analyzed, 76.4% were women and average age was 38.36±8.78 years. The OR of IR in subjects with or without sarcopenic obesity was 2.224 (95% CI, 1127 to 4389, P=.02). The OR of MS in subjects with or without sarcopenia was 1.045 (95% CI, 0.624 to 1.748, P=.868). A difference was found between the fat mass in the group with IR vs. without IR of 60.58±14.4kg vs. 53.98±12.2kg (P<.001); likewise, between the BMI and muscle mass of 46.15±6.78kg/m2 vs. 43.51±6.11kg/m2 (P<.05) and 30.05±7.48kg vs. 27.86±5.91kg (P<.05) respectively. CONCLUSION: The association between sarcopenic obesity with IR in young adults was significant, but not with MS. Our findings emphasize the need to become aware of the importance of maintaining lean mass in obese subjects.

Immunonutrition for the acute treatment of MELAS syndrome.

MELAS syndrome (Mitochondrial Encephalopathy, Lactic Acidosis and Stroke-like episodes) is one of the most frequent mitochondrial pathologies. Its diagnosis is based on the classic triad of symptoms its acronym stands for and the presence of ragged red fibres. There is currently no curative therapy for MELAS, and treatment focuses on managing complications that affect specific organs and functions. However, some immunonutrients can be used as a therapeutic alternative in patients with MELAS. We present a scientific literature review accompanied by the clinical case of a patient with dementia and seizures admitted to the intensive care unit.

Impact of obesity and diabetes mellitus in critically ill patients with SARS-CoV-2.

PURPOSE: Evaluate the associations of obesity and diabetes with the risk of mortality in critically ill patients infected with SARS-CoV-2. MATERIALS AND METHODS: This cohort study included 115 adult patients admitted to the ICU with SARS-CoV-2 pneumonia. Anthropometric variables and biochemical (C-reactive protein, ferritin, leukocyte, neutrophils, and fibrinogen) were measured. Multivariate logistic regression analyses were used to investigate the associations. RESULTS: Mean age was 50.6±11.2 years, 68.7% were male. Median BMI was 30.9kg/m2. All patients had invasive mechanical ventilation. Patients with diabetes had increased risk of mortality with OR of 2.86 (CI 95% 1.1-7.4, p=0.026); among those patients who, in addition to diabetes had obesity, the risk was de 3.17 (CI 95% 1.9-10.2, p=0.038). Patients with obesity had 1.25 times greater risk of developing a severe SARS-CoV-2 infection (95% CI 1.09-1.46, p=0.025). Negative correlation was observed between BMI and the PaO2/FiO2 ratio (r=-0.023, p<0.05). Obese patients required more days of mechanical ventilation and longer hospital stay compared to non-obese patients. CONCLUSIONS: Diabetes and obesity are risk factors for increasing severity of SARS-CoV-2 infection, and they are both associated with an increase in mortality.

[Nutritional strategies in the management of patients with diabetes mellitus]. / Estrategias nutricionales en el tratamiento del paciente con diabetes mellitus.

Diabetes mellitus is a highly prevalent disease in the world and in Mexico. Due to its chronic evolution it causes multiple sequelae, disability and mortality. An adequate control of diabetic patients based on reaching glycemic targets, maintenance of healthy weight, as well as lipid and blood pressure control is essential to reduce the risk of progression of its complications. Lifestyle changes are also key for preventing and treating the disease. Knowledge of the relationship and mechanism involved between diabetes and alterations in nutrient metabolism should be considered to provide an adequate nutritional program. This article aims to bring healthcare professionals the concepts and strategies, proposed by several scientific societies, about nutritional management of adult patients with diabetes mellitus.

La diabetes mellitus es una enfermedad altamente prevalente en el mundo y en México. Debido a su evolución crónica, es también causa de múltiples secuelas, discapacidad y mortalidad. Un adecuado control del paciente diabético que se logre a partir de metas de glucemia, mantenimiento de peso sano, así como control de lípidos y presión arterial es indispensable a fin de disminuir el riesgo de progresión de las complicaciones de la diabetes mellitus. Los cambios en el estilo de vida son clave en la prevención y el tratamiento de la enfermedad. El conocimiento de la relación y el mecanismo involucrados entre la diabetes y las alteraciones en el metabolismo de los nutrientes debe ser considerado para brindar un programa nutricional adecuado. Este artículo pretende aproximar a los profesionales de la salud los conceptos y las estrategias nutricionales actuales, propuestos por diversas sociedades científicas, para el manejo nutricional de pacientes adultos con diabetes mellitus.

Factores de riesgo para mortalidad en pacientes con infección por Clostridium difficile.

INTRODUCTION: Clostridium difficile infection (CDI) causes potentially lethal diarrhea. OBJECTIVE: To identify the risk factors for mortality in hospitalized patients with CDI. METHOD: Cross-sectional, retrospective study. The analyzed risk factors were age, comorbidities, nutritional status, past and current use of antibiotics, proton pump inhibitors, steroids, immunosuppressive therapy and chemotherapy, as well as development of acute kidney injury (AKI). RESULTS: Sixty-eight cases were assessed. Mean age was 51.4 ± 19.37 years. Mortality was 22.2 %. Moderate to severe undernutrition (Odds ratio [OR] = 20.15; 95% confidence interval [CI] = 1.13-35; p = 0.004), use of more than 2 antibiotics (OR = 1.61; 95% CI = 0.39-6.65; p = 0.01), AKI as determined by creatinine levels (OR = 1.34; 95% CI = 0.09-2.21; p = 0.02), hypotension with vasopressor use (OR = 1.28; 95% CI = 0.30-1.23; p = 0.001) and multiple organ failure (OR = 1.13; 95% CI = 0.31-4.92; p = 0.002) were associated with mortality. CONCLUSIONS: CDI represents an important problem in hospitalized patients and confers them an additional morbidity and mortality risk.

INTRODUCCIÓN: La infección por Clostridium difficile (ICD) es causa de diarrea hospitalaria potencialmente letal. OBJETIVO: Identificar los factores de riesgo para mortalidad en pacientes hospitalizados con ICD. MÉTODO: Estudio transversal y retrospectivo. Se analizaron factores de riesgo: edad, comorbilidades, estado nutricional, antecedente y uso de antibióticos, de inhibidores de bomba de protones, esteroides, inmunosupresores, quimioterapia y desarrollo de lesión renal aguda (LRA). RESULTADOS: Fueron evaluados 68 casos (incidencia de 25.7/10 000 egresos hospitalarios). La edad fue de 51.4 ± 19.37 años y la mortalidad de 22.2 %. La desnutrición moderada a severa mostró RM = 20.15, IC 95 % = 1.13-35, p = 0.004; el uso de más de dos antibióticos, RM = 1.61, IC 95 % = 0.39-6.65, p = 0.01; la LRA determinada por elevación de los niveles de creatinina, RM = 1.34, IC 95 % = 0.09-2.21, p = 0.02; la hipotensión con uso de vasopresores, RM = 1.28, IC 95 % = 0.30-1.23, p = 0.001; y el desarrollo de falla orgánica múltiple (FOM), RM = 1.13, IC 95 % = 0.31-4.92, p = 0.002. CONCLUSIONES: La desnutrición moderada a severa, el uso de más de dos antibióticos, la LRA, la hipotensión con uso de vasopresores y la FOM se asocian con incremento en la mortalidad en pacientes con ICD.

Factores de riesgo para mortalidad en pacientes con infección por Clostridium difficile / Risk factors for mortality in patients with Clostridium difficile infection

Resumen Introducción: La infección por Clostridium difficile (ICD) es causa de diarrea hospitalaria potencialmente letal. Objetivo: Identificar los factores de riesgo para mortalidad en pacientes hospitalizados con ICD. Método: Estudio transversal y retrospectivo. Se analizaron factores de riesgo: edad, comorbilidades, estado nutricional, antecedente y uso de antibióticos, de inhibidores de bomba de protones, esteroides, inmunosupresores, quimioterapia y desarrollo de lesión renal aguda (LRA). Resultados: Fueron evaluados 68 casos (incidencia de 25.7/10 000 egresos hospitalarios). La edad fue de 51.4 ± 19.37 años y la mortalidad de 22.2 %. La desnutrición moderada a severa mostró RM = 20.15, IC 95 % = 1.13-35, p = 0.004; el uso de más de dos antibióticos, RM = 1.61, IC 95 % = 0.39-6.65, p = 0.01; la LRA determinada por elevación de los niveles de creatinina, RM = 1.34, IC 95 % = 0.09-2.21, p = 0.02; la hipotensión con uso de vasopresores, RM = 1.28, IC 95 % = 0.30-1.23, p = 0.001; y el desarrollo de falla orgánica múltiple (FOM), RM = 1.13, IC 95 % = 0.31-4.92, p = 0.002. Conclusiones: La desnutrición moderada a severa, el uso de más de dos antibióticos, la LRA, la hipotensión con uso de vasopresores y la FOM se asocian con incremento en la mortalidad en pacientes con ICD.

Abstract Introduction: Clostridium difficile infection (CDI) causes potentially lethal diarrhea. Objective: To identify the risk factors for mortality in hospitalized patients with CDI. Method: Cross-sectional, retrospective study. The analyzed risk factors were age, comorbidities, nutritional status, past and current use of antibiotics, proton pump inhibitors, steroids, immunosuppressive therapy and chemotherapy, as well as development of acute kidney injury (AKI). Results: Sixty-eight cases were assessed. Mean age was 51.4 ± 19.37 years. Mortality was 22.2 %. Moderate to severe undernutrition (Odds ratio [OR] = 20.15; 95% confidence interval [CI] = 1.13-35; p = 0.004), use of more than 2 antibiotics (OR = 1.61; 95% CI = 0.39-6.65; p = 0.01), AKI as determined by creatinine levels (OR = 1.34; 95% CI = 0.09-2.21; p = 0.02), hypotension with vasopressor use (OR = 1.28; 95% CI = 0.30-1.23; p = 0.001) and multiple organ failure (OR = 1.13; 95% CI = 0.31-4.92; p = 0.002) were associated with mortality. Conclusions: CDI represents an important problem in hospitalized patients and confers them an additional morbidity and mortality risk.

Validation and Adaptation of the Spanish Version of the STRONGkids Nutrition Screening Tool.

BACKGROUND: The use of malnutrition screening tools (MSTs) among hospitalized pediatric patients is a simple practice that may allow the identification of patients at nutrition risk. There are different tools developed in the English language, but there are limited data available on their validity when translated into other languages. The aim of this study was to construct a Spanish version (SV) of the STRONGkids MST and determine its validity and reliability in a pediatric population. METHODS: The translation and cross-cultural adaptation of the tool was performed, followed by the reliability, feasibility, and validity of the SV of the STRONGkids MST. Anthropometric assessment was used as the reference standard to evaluate the criterion validity of the MST. The length of hospital stay was used to determine predictive validity. RESULTS: A total 400 children were included in the study, 90 of whom took part in the reliability phase. The interrater agreement between dietitians and nursing staff was kappa (κ) = 0.67, while the intrarater agreement among dietitians was κ = 0.82. The feasibility of the MST was adequate for clinical use. The results for criterion validity between STRONGkids and anthropometric assessment was κ = 0.56, and the criterion validity between STRONGkids and length of hospital stay was κ = 0.20. The sensitivity of the MST was 86% and the specificity was 72%. CONCLUSIONS: The SV of the MST showed good reliability and feasibility. The validity is moderate, and the MST could be considered a useful resource for early detection of malnutrition risk.

[Tratamiento nutricional hiperproteico precirugía bariátrica en obesidad mórbida]. / High-protein diet in morbidity obesity patient before bariatric surgery.

OBJETIVO: Comparar la efectividad de un plan de alimentación hipocalórico hiperproteico con otro normoproteico sobre la composición corporal, los parámetros bioquímicos y las citocinas inflamatorias en pacientes obesos precirugía bariátrica sometidos a un tratamiento integral. MÉTODO: Se estudiaron 76 pacientes con un índice de masa corporal (IMC) ≥ 40 kg/m² previamente a la cirugía bariátrica. Un grupo fue tratado con una dieta hipocalórica hiperproteica y se comparó con una dieta hipocalórica normoproteica. Se evaluaron parámetros bioquímicos, parámetros antropométricos, composición corporal y valores de citocinas inflamatorias en suero al inicio y después de 4 meses de tratamiento. RESULTADOS: En ambos grupos se observó una disminución de peso, de IMC y de masa grasa, así como un incremento de la masa muscular respecto al momento basal (p < 0.05), sin diferencias entre los grupos estudiados. No se encontraron cambios en los parámetros bioquímicos ni en las concentraciones séricas de factor de necrosis tumoral (TNF) e interleucina (IL)-6 antes y después de 4 meses de tratamiento, ni entre los grupos evaluados (p > 0.05). Las concentraciones séricas de IL-1ß disminuyeron únicamente con la dieta hipocalórica normoproteica (p = 0.02). CONCLUSIONES: La dieta hipocalórica hiperproteica no muestra ventajas en la reducción de peso y grasa corporal, ni en la ganancia de masa muscular, en comparación con la dieta hipocalórica normoproteica en pacientes con obesidad mórbida precirugia bariátrica sometidos a un tratamiento integral. OBJECTIVE: Compare the effectiveness of a hyperproteic hypocaloric feeding plan with a normoproteic on body composition, biochemical parameters and inflammatory cytokines in obese pre-bariatric surgery patients in the integral treatment. METHOD: Seventy-six pre-bariatric surgery patients with body mass index (BMI) ≥ 40 kg/m² were studied. One group was treated with a hyperproteic hypocaloric diet and compared with a normoproteic hypocaloric diet. Biochemical parameters, anthropometric parameters, body composition and levels of tumor necrosis factor (TNF), interleukin (IL)-6 and IL-1ß in serum were evaluated at the initiation of treatment and after 4 months. RESULTS: In both groups studied, a decrease in weight, BMI and fat mass was observed, as well as an increase in muscle mass compared to baseline (p < 0.05), no differences showed between the groups studied. No change was found in the biochemical parameters and serum levels of TNF and IL-6 before and after 4 months of treatment, nor among the groups evaluated (p > 0.05). Serum IL-1ß levels decreased after treatment with only a normoprotein hypocaloric diet (p = 0.02). ­. CONCLUSIONS: Hyperproteic hypocaloric diet does not show advantages in weight reduction and body fat or in muscle mass gain compared to the normoproteic hypocaloric diet in patients with morbid obesity bariatric pre-surgery in the integral treatment.

Evaluación de la disfagia en pacientes con enfermedades neurológicas y su relación con riesgo de desnutrición / Assessment of dysphagia in neurological disease patients and its relation to risk factor for malnutrition

Resumen: ANTECEDENTES Los pacientes con enfermedades neurológicas son susceptibles a padecer disfagia frecuentemente no diagnosticada. OBJETIVO Determinar la existencia de disfagia en pacientes con enfermedad neurológica atendidos en la consulta externa y su relación con el riesgo de desnutrición. MATERIAL Y MÉTODO Estudio descriptivo transversal, efectuado de enero a diciembre de 2016. Se realizó valoración clínica de las fases de la deglución, se aplicó el cuestionario EAT-10 versión en español, se tomaron medidas antropométricas, se estimó la ingesta calórica y se determinó el riesgo nutricional, el índice de Quetelet y la Evaluación Global Subjetiva. RESULTADOS Se analizaron 55 pacientes, 54.5% mujeres, con edad media de 47.29 años. La disfagia afectó a 49.1% de los pacientes; los pacientes con riesgo de desnutrición representaron 25.5%. Los pacientes con disfagia representaron 33.3% y tuvieron mayor riesgo de desnutrición vs 17.9% sin disfagia (p < 0.001). El género femenino (OR 1.23; IC95% 0.42-3.58; p = 0.451), la diabetes mellitus (OR 2.95; IC95% 0.52-16.75; p = 0.196), el antecedente de neumonía (OR 2.12; IC95% 1.59-2.81; p = 0.236) y la enfermedad neurológica crónica (OR 1.65; IC95% 0.49-5.53; p = 0.301) se relacionaron con incremento de disfagia. CONCLUSIONES La prevalencia de disfagia no diagnosticada es elevada y se asocia con mayor desnutrición.

Abstract: BACKGROUND Neurological diseases patients are susceptible to dysphagia, frequently not diagnosed. OBJECTIVE To determine the presence of dysphagia in patients attending for neurological pathology of extern consult and its relation with malnutrition. MATERIAL AND METHOD A prospective, cross-sectional study, performed from January to December 2016, that evaluated dysphagia symptoms, clinically phases of swallowing, and EAT-10 questionnaire validated to Spanish was applied. Risk factors were determined, as well as nutritional risk, Quetelet Index, Global Subjective Assessment, and demographics data. RESULTS Of the 55 patients, 54.5% were women; mean age was of 47.29 years. The prevalence of dysphagia was 49.1%; patients with risk malnutrition represented 25.5%. Dysphagia patients accounted for 33.3% and had a higher risk of malnutrition vs 17.9% without dysphagia (p < 0.001). The risk of dysphagia increased in women (OR 1.23, 95% CI 0.42-3.58, p = 0.45), diabetes mellitus (OR 2.95, 95 % CI 0.52-16.75, p = 0.19), patients with history of pneumonia (OR 2.12, 95% CI 1.59-2.81; p = 0.236) and chronic neurological disease (OR 1.65, 95% CI 0.49-5.53, p = 0.30). CONCLUSIONS There is high prevalence of undiagnosed dysphagia and it's associated with greater risk of malnutrition.

Association of nutritional status and functional capacity in gastrointestinal cancer patients. / Cáncer del tracto digestivo: asociación entre el estado nutricional y la capacidad funcional.

Objective: To determine the nutritional status and its association with functional capacity in patients with digestive tract cancer. Methods: We retrospectively studied all adult patients hospitalized who were diagnosed as having a cancer of the digestive tract. Nutritional status and functional capacity were assessed. Descriptive statistic and odds ratio were used to determine the association in SPSS 14.0. Results: 57 patients were included, 96% had weight loss. Using subjective global assessment (SGA) as a method of screening, 82.5% of the patients were found malnutrition and by biochemical and immunological test 82% and 65% respectively. Functional capacity was assessed by Karnofsky index, finding that 75.5% of the patients have some activity limitation. Results show an association between malnutrition by SGA and limitation in functional capacity (c2 = 1.56; p = 0.212; OR: 2.46; 95% confidence interval [95% CI]: 0.581-10.465). In addition, we observe an association between the total lymphocyte count and limitation in functional capacity (χ2 = 6.94; p = 0.008; OR: 5.23; 95% CI: 1.441-19.025). Conclusions: Malnutrition in patients with digestive tract cancer was associated with limitation in functional capacity.

EFFECTIVENESS OF IMMUNONUTRITION ON INFLAMMATORY MARKERS IN PATIENTS WITH CANCER; RANDOMIZED CLINICAL TRIAL.

BACKGROUND: malnutrition is a common complication in patients with cancer and is associated with immunosuppression and alterations with inflammatory response. OBJECTIVE: the aim of our study was to evaluate the effect of enteral nutrition supplemented with two enteral formulas on inflammatory markers (CRP, IL-6 and FNTα) in cancer patients undergoing chemotherapy. DESIGN AND METHODS: randomized control trial, conducted at the Hospital Juarez of Mexico in patients with cancer undergoing chemotherapy with IRN < 97.5 and SGA B/C. Patients were randomly allocated to two groups: group I (immunomodulatory), group II (high ω3). The intervention began on the first day of chemotherapy until day 10 after. We evaluated nutritional status and an inflammatory marker on days 0, +5, +10 QT. Statistical analysis was performed with T Student, x2 and analysis of variance for repeated measurements. P < 0.05 was considered statistically significant. RESULTS: a total of 29 patients were analyzed, 27 (62.8%) females and 16 (37.2%) males. Mean age 43.91 + 11.3 years old. Malnutrition prevalence was 48.8% moderate and 51.2% severe. Prealbumin levels significantly increase in group II vs group I (p < 0.05). Both groups maintenance body weight, lean mass and fat mass. No decrease levels of CRP, IL-6 and FNTα. CONCLUSIONS: enteral supplementation during chemotherapy inhibits nutritional deterioration and maintenance body weight and lean mass. No decreased levels of inflammatory markers.

Antecedentes: la desnutrición es una complicación frecuente en los pacientes oncológicos y se relaciona con inmunosupresión y alteraciones en la respuesta inflamatoria. Objetivo: evaluar los efectos de la suplementación de dos fórmulas enterales sobre los marcadores inflamatorios (PCR, IL-6 y el TNF-) en pacientes con cáncer sometidos a quimioterapia. Diseño y métodos: se hizo un ensayo clínico, aleatorizado, realizado en el Hospital Juárez de México en pacientes con cáncer sometidos a quimioterapia con IRN < 97,5 y EGS B o C. Los pacientes se dividieron en dos grupos: grupo I (imunomoduladora), grupo II (ácidos -3). La intervención se inició en el primer día de la quimioterapia hasta el décimo día posterior a esta. Se valoró el estado nutricional y se determinaron los marcadores inflamatorios en los días 0, +5 y +10 de QT. Se hizo análisis paramétrico. Se aplicó t de Student, X2 y análisis de varianza para mediciones repetidas. Se consideró p < 0.05 como estadísticamente significativo. Resultados: se estudiaron 43 pacientes, 27(62,8%) mujeres y 16 (37,2%) hombres. La media de edad fue de 43,91 + 11,3 años. La prevalencia de desnutrición moderada fue de 48,8% y severa de 51,2%. El grupo II presentó un incremento en los niveles de prealbúmina con respecto a la basal vs el grupo I (p < 0,05). En ambos grupos se observó el mantenimiento del peso corporal, el porcentaje de masa magra y de masa grasa. No se observó disminución de los niveles séricos de PCR, IL-6 y TNF(p = NS). Conclusiones: la administración de suplementos enterales durante la quimioterapia inhibe el deterioro nutricional y mantiene el peso y la masa magra. No se observó disminución de los marcadores inflamatorios.

Effectiveness of immunonutrition on inflammatory markers in patients with cancer; randomized clinical trial / Efectividad de la inmunonutrición sobre los marcadores inflamatorios en pacientes con cáncer; ensayo clínico aleatorizado

Background: malnutrition is a common complication in patients with cancer and is associated with immunosuppression and alterations with inflammatory response. Objective: the aim of our study was to evaluate the effect of enteral nutrition supplemented with two enteral formulas on inflammatory markers (CRP, IL-6 and FNTα) in cancer patients undergoing chemotherapy. Design and methods: randomized control trial, conducted at the Hospital Juarez of Mexico in patients with cancer undergoing chemotherapy with IRN < 97.5 and SGA B/C. Patients were randomly allocated to two groups: group I (immunomodulatory), group II (high ω3). The intervention began on the first day of chemotherapy until day 10 after. We evaluated nutritional status and an inflammatory marker on days 0, +5, +10 QT. Statistical analysis was performed with T Student, x2 and analysis of variance for repeated measurements. P < 0.05 was considered statistically significant. Results: a total of 29 patients were analyzed, 27 (62.8%) females and 16 (37.2%) males. Mean age 43.91 + 11.3 years old. Malnutrition prevalence was 48.8% moderate and 51.2% severe. Prealbumin levels significantly increase in group II vs group I (p<0.05). Both groups maintenance body weight, lean mass and fat mass. No decrease levels of CRP, IL-6 and FNTα. Conclusions: enteral supplementation during chemotherapy inhibits nutritional deterioration and maintenance body weight and lean mass. No decreased levels of inflammatory markers (AU)

Antecedentes: la desnutrición es una complicación frecuente en los pacientes oncológicos y se relaciona con inmunosupresión y alteraciones en la respuesta inflamatoria. Objetivo: evaluar los efectos de la suplementación de dos fórmulas enterales sobre los marcadores inflamatorios (PCR, IL-6 y el TNF-α) en pacientes con cáncer sometidos a quimioterapia. Diseño y métodos: se hizo un ensayo clínico, aleatorizado, realizado en el Hospital Juárez de México en pacientes con cáncer sometidos a quimioterapia con IRN < 97,5 y EGS B o C. Los pacientes se dividieron en dos grupos: grupo I (imunomoduladora), grupo II (ácidos ω-3). La intervención se inició en el primer día de la quimioterapia hasta el décimo día posterior a esta. Se valoró el estado nutricional y se determinaron los marcadores inflamatorios en los días 0, +5 y +10 de QT. Se hizo análisis paramétrico. Se aplicó t de Student, X2 y análisis de varianza para mediciones repetidas. Se consideró p < 0.05 como estadísticamente significativo. Resultados: se estudiaron 43 pacientes, 27(62,8%) mujeres y 16 (37,2%) hombres. La media de edad fue de 43,91 + 11,3 años. La prevalencia de desnutrición moderada fue de 48,8% y severa de 51,2%. El grupo II presentó un incremento en los niveles de prealbúmina con respecto a la basal vs el grupo I (p < 0,05). En ambos grupos se observó el mantenimiento del peso corporal, el porcentaje de masa magra y de masa grasa. No se observó disminución de los niveles séricos de PCR, IL-6 y TNFα (p = NS). Conclusiones: la administración de suplementos enterales durante la quimioterapia inhibe el deterioro nutricional y mantiene el peso y la masa magra. No se observó disminución de los marcadores inflamatorios (AU)

[Association between malnutrition and depression in elderly]. / Asociación entre desnutrición y depresión en el adulto mayor.

BACKGROUND: Malnutrition and depression are common geriatric disorders. The aim of this study was determined the prevalence of malnutrition and depression in the elderly, as well as assess the association between depression and malnutrition. METHODS: A cross-sectional study was done with elderly of external consult in a Public Specialized Hospital of México City. The nutritional status was classified by the Mini Nutritional Assessment (MNA) and Quetelet's Index was categorized according to The World Health Organization. Depression was assessed using the Geriatric Depression Scale (GDS). The functional autonomy indicators were obtained by Katz Index. Differences between groups were analyzed using the Chisquare test and t-test. The associations between the MNA and GDS and determination of risk factors for malnutrition were analyzed using multivariate analysis and the odds ratio (OR) estimates were determined. RESULTS: 96 patients were included, 79.2 female; 15.5% were classified as adequate nutritional status, 72.2% were classified as being at risk of malnutrition and 11.3% as malnourished. The prevalence of depression was reported by 63.9%. Multiple logistic regression analysis revealed that depression and male sex are independent predictors of malnutrition. Depression was positively associated with the risk of malnutrition OR 2.4 (95% CI 0.79-7.38). For individuals male the OR for malnutrition was 1.42 (95% CI 1.0-2.0). CONCLUSION: Depression and male sex was associated with the risk of malnutrition in the elderly.

Antecedentes: La desnutrición y la depresión son trastornos geriátricos comunes. Nuestro objetivo fue determinar la prevalencia de desnutrición y depresión en adultos mayores, así como evaluar su asociación. Métodos: Estudio transversal que se realizó en población geriátrica de la consulta externa de un Hospital Público de referencia de Alta Especialidad de la Ciudad de México. El estado nutricional se clasifico mediante la Evaluación Mínima Nutricional (MNA), el Índice de Quetelet se clasificó acorde a la Organización Mundial para la Salud. La depresión se evaluó mediante la Escala de Depresión Geriátrica (GDS). La funcionalidad se obtuvo mediante el Índice de Katz. Las diferencias entre grupos se analizaron usando la prueba de Chi cuadrada y t-student. La asociación entre el MNA y GDS, así como la determinación de factores predictores para desnutrición se analizó usando análisis multivariado y se determinó la razón de momios (RM). Resultados: 96 pacientes de ≥65 años fueron evaluados, 79,2% fueron mujeres. El 15,5% de la población se clasifico con adecuado estado nutricional, el 72,2% con riesgo de desnutrición y 11,3% con desnutrición. La prevalencia de depresión fue de 63,9%. El análisis de regresión múltiple reveló que la depresión y el sexo masculino son factores predictores independientes de desnutrición. La depresión se asoció positivamente con desnutrición en RM 2,4 (IC 95% 0,79-7,38). Para los individuos del sexo masculino la RM para desnutrición fue de 1,42 (IC 95% 1,0-2,0). Conclusión: La depresión y el sexo masculino están fuertemente asociados con el riesgo de desnutrición en los adultos mayores.

Asociación entre desnutrición y depresión en el adulto mayor / Association between malnutrition and depression in elderly

Antecedentes: La desnutrición y la depresión son trastornos geriátricos comunes. Nuestro objetivo fue determinar la prevalencia de desnutrición y depresión en adultos mayores, así como evaluar su asociación. Métodos: Estudio transversal que se realizó en población geriátrica de la consulta externa de un Hospital Público de referencia de Alta Especialidad de la Ciudad de México. El estado nutricional se clasifico mediante la Evaluación Mínima Nutricional (MNA), el Índice de Quetelet se clasificó acorde a la Organización Mundial para la Salud. La depresión se evaluó mediante la Escala de Depresión Geriátrica (GDS). La funcionalidad se obtuvo mediante el Índice de Katz. Las diferencias entre grupos se analizaron usando la prueba de Chi cuadrada y t-student. La asociación entre el MNA y GDS, así como la determinación de factores predictores para desnutrición se analizó usando análisis multivariado y se determinó la razón de momios (RM). Resultados: 96 pacientes de ≥ 65 años fueron evaluados, 79,2% fueron mujeres. El 15,5% de la población se clasifico con adecuado estado nutricional, el 72,2% con riesgo de desnutrición y 11,3% con desnutrición. La prevalencia de depresión fue de 63,9%. El análisis de regresión múltiple reveló que la depresión y el sexo masculino son factores predictores independientes de desnutrición. La depresión se asoció positivamente con desnutrición en RM 2,4 (IC 95% 0,79-7,38). Para los individuos del sexo masculino la RM para desnutrición fue de 1,42 (IC 95% 1,0-2,0). Conclusión: La depresión y el sexo masculino están fuertemente asociados con el riesgo de desnutrición en los adultos mayores (AU)

Background: Malnutrition and depression are common geriatric disorders. The aim of this study was determined the prevalence of malnutrition and depression in the elderly, as well as assess the association between depression and malnutrition. Methods: A cross-sectional study was done with elderly of external consult in a Public Specialized Hospital of México City. The nutritional status was classified by the Mini Nutritional Assessment (MNA) and Quetelet’s Index was categorized according to The World Health Organization. Depression was assessed using the Geriatric Depression Scale (GDS). The functional autonomy indicators were obtained by Katz Index. Differences between groups were analyzed using the Chisquare test and t-test. The associations between the MNA and GDS and determination of risk factors for malnutrition were analyzed using multivariate analysis and the odds ratio (OR) estimates were determined. Results: 96 patients were included, 79.2 female; 15.5% were classified as adequate nutritional status, 72.2% were classified as being at risk of malnutrition and 11.3% as malnourished. The prevalence of depression was reported by 63.9%. Multiple logistic regression analysis revealed that depression and male sex are independent predictors of malnutrition. Depression was positively associated with the risk of malnutrition OR 2.4 (95% CI 0.79-7.38). For individuals male the OR for malnutrition was 1.42 (95% CI 1.0-2.0). Conclusion: Depression and male sex was associated with the risk of malnutrition in the elderly (AU)

Anorexia nerviosa en el anciano: mito o realidad / Anorexia nervosa in the elderly: myth or reality?

El crecimiento mundial de la población geriátrica es un fenómeno relacionado con mayor esperanza de vida que permite una diversidad de manifestaciones de la senectud. El envejecimiento conlleva un declive natural de funciones, entre ellas, disminución del apetito que resulta en pérdida de peso, pero que a veces tiene orígenes patológicos. La anorexia nerviosa en el anciano es una entidad cuyo reconocimiento se ha omitido sistemáticamente en la práctica médica, debido a que el clínico la relaciona solamente con adolescentes y su identificación en la vejez es esporádica con referencias anecdóticas en la literatura médica. La importancia del tema radica en que se desconoce la historia natural de este trastorno alimentario crónico y de baja mortalidad en el paciente mayor, por lo que debemos preguntarnos si existe la anorexia nerviosa en el anciano, y si es así, si se trata de recaídas del problema del adolescente o es una aparición tardía de la enfermedad

The worldwide growth of the ageing population has resulted from greater life expectancy and in turn has led to a wide spectrum of clinical alterations in the elderly. This process encompasses a gradual loss of body functions, such as appetite loss. Loss of appetite is a frequent finding in this group and is related to weight loss; nevertheless, weight loss can sometimes be a consequence of concomitant diseases rather than of ageing itself. Anorexia nervosa in the elderly is consistently overlooked in general practice as clinicians associate it only with adolescents. Diagnosis in the elderly is sporadic and reports in the literature are rare. The importance of the subject lies in the lack of knowledge of the natural history of this chronic eating disorder, which has low mortality in the elderly. Questions that should be asked are whether anorexia nervosa occurs in the elderly and, if so, whether the patient is experiencing a relapse of anorexia in adolescence or late onset of the disorder