Impact of nutritional risk on 28-day mortality and the prevalence of underfeeding in critically ill patients: a prospective cohort study / Impacto del riesgo nutricional sobre la mortalidad al día 28 y prevalencia de subalimentación en pacientes de terapia intensiva: estudio prospectivo de cohorte

INTRODUCTION: nutritional risk is an important prognostic factor in hospitalized patients, but frequently it is underappreciated and not considered as a part of the prognostic evaluation in patients from intensive care units. OBJECTIVE: to evaluate the association between nutritional risk and 28-day mortality and characterize the nutritional support in critically ill patients. METHODS: this was a single-center, prospective cohort study was performed over 7 months in a Medical-surgical ICU of a tertiary hospital in Mexico. From 352 admissions a consecutive sample of 110 patients was included. All of them were ≥ 18 years old, with ≥ 48 h of stay in ICU and with the consent to participate. Nutritional risk assessed by the modified NUTRIC score (mNUTRIC score), 28-day mortality and nutritional support characteristics were recorded. RESULTS: the patient characteristics: mean age 50.7 ± 16.8 years, APACHE II score 15.5 ± 5.8, SOFA score 6.9 ± 3, invasive mechanical ventilation (IMV) 65.5 % and 28-day mortality 23.6 %. High nutritional risk (31.8 %) was associated with 28-day mortality (RR 5.81, 95 % CI 2.69-12.53). In the surviving group, the mNUTRIC score correlated with the length of stay (LOS) in the ICU (r = 0.216, p = 0.049), LOS in the hospital (r = 0.230, p = 0.036) and IMV duration (r = 0.306, p = 0.037). Nutritional support was administered in 55.4 % of the patients, reaching only 52.9 % and 46 % of the energy and protein requirements, respectively. Only 18 % and 21.3 % of the patients achieved the energy and protein requirements, respectively. CONCLUSIONS: high nutritional risk was associated with a higher risk of 28-day mortality. Less than a quarter of the patients receiving nutritional support reached the energy and protein requirements

INTRODUCCIÓN: el riesgo nutricional es un factor pronóstico importante en pacientes hospitalizados, pero frecuentemente es infravalorado y no se considera dentro de la evaluación de los pacientes en unidades de cuidados intensivos. OBJETIVO: evaluar la asociación del riesgo nutricional con la mortalidad al día 28 en pacientes críticos y caracterizar el soporte nutricional. MÉTODOS: se desarrolló un estudio de cohorte prospectivo durante 7 meses en una UCI de tercer nivel en México. Se obtuvo una muestra consecutiva con 110 pacientes de 352 elegibles, con edad ≥ 18 años, estancia ≥ 48 h en UCI, datos completos y consentimiento para participar. El riesgo nutricional fue evaluado con NUTRIC score modificado (mNUTRIC score) y se registró la mortalidad al día 28 y las características del soporte nutricional. RESULTADOS: los pacientes tenían una edad de 50,7 ± 16,8 años; APACHE II, 15,5 ± 5,8; SOFA, 6,9 ± 3; ventilación mecánica invasiva (VMI) en 65,5 % y el 23,6 % de los pacientes falleció al día 28. El alto riesgo nutricional (31,8 %) se asoció con la mortalidad al día 28 (RR 5,81, IC 95 %, 2,69-12,53). En los supervivientes, el mNUTRIC score tuvo correlación con las duraciones de la estancia en UCI (ℓ = 0,216, p = 0,049), estancia hospitalaria (ℓ = 0,230, p = 0,036) y VMI (ℓ = 0,306, p = 0,037). El 55,4 % de los pacientes recibió soporte nutricional. Lograron el 52,9 % y 46 % de las metas energéticas y proteicas, respectivamente. Solo el 18 % alcanzó la meta energética y el 21,3 %, la meta proteica. CONCLUSIONES: los pacientes con alto riesgo nutricional tienen mayor riesgo de morir al día 28. Menos de un cuarto de los pacientes con soporte nutricional alcanzó las metas nutricionales

Impact of nutritional risk on 28-day mortality and the prevalence of underfeeding in critically ill patients: A prospective cohort study.

INTRODUCTION: Introduction: nutritional risk is an important prognostic factor in hospitalized patients, but frequently it is underappreciated and not considered as a part of the prognostic evaluation in patients from intensive care units. Objective: to evaluate the association between nutritional risk and 28-day mortality and characterize the nutritional support in critically ill patients. Methods: this was a single-center, prospective cohort study was performed over 7 months in a Medical-surgical ICU of a tertiary hospital in Mexico. From 352 admissions a consecutive sample of 110 patients was included. All of them were ≥ 18 years old, with ≥ 48 h of stay in ICU and with the consent to participate. Nutritional risk assessed by the modified NUTRIC score (mNUTRIC score), 28-day mortality and nutritional support characteristics were recorded. Results: the patient characteristics: mean age 50.7 ± 16.8 years, APACHE II score 15.5 ± 5.8, SOFA score 6.9 ± 3, invasive mechanical ventilation (IMV) 65.5 % and 28-day mortality 23.6 %. High nutritional risk (31.8 %) was associated with 28-day mortality (RR 5.81, 95 % CI 2.69-12.53). In the surviving group, the mNUTRIC score correlated with the length of stay (LOS) in the ICU (r = 0.216, p = 0.049), LOS in the hospital (r = 0.230, p = 0.036) and IMV duration (r = 0.306, p = 0.037). Nutritional support was administered in 55.4 % of the patients, reaching only 52.9 % and 46 % of the energy and protein requirements, respectively. Only 18 % and 21.3 % of the patients achieved the energy and protein requirements, respectively. Conclusions: high nutritional risk was associated with a higher risk of 28-day mortality. Less than a quarter of the patients receiving nutritional support reached the energy and protein requirements.

INTRODUCCIÓN: Introducción: el riesgo nutricional es un factor pronóstico importante en pacientes hospitalizados, pero frecuentemente es infravalorado y no se considera dentro de la evaluación de los pacientes en unidades de cuidados intensivos. Objetivo: evaluar la asociación del riesgo nutricional con la mortalidad al día 28 en pacientes críticos y caracterizar el soporte nutricional. Métodos: se desarrolló un estudio de cohorte prospectivo durante 7 meses en una UCI de tercer nivel en México. Se obtuvo una muestra consecutiva con 110 pacientes de 352 elegibles, con edad ≥ 18 años, estancia ≥ 48 h en UCI, datos completos y consentimiento para participar. El riesgo nutricional fue evaluado con NUTRIC score modificado (mNUTRIC score) y se registró la mortalidad al día 28 y las características del soporte nutricional. Resultados: los pacientes tenían una edad de 50,7 ± 16,8 años; APACHE II, 15,5 ± 5,8; SOFA, 6,9 ± 3; ventilación mecánica invasiva (VMI) en 65,5 % y el 23,6 % de los pacientes falleció al día 28. El alto riesgo nutricional (31,8 %) se asoció con la mortalidad al día 28 (RR 5,81, IC 95 %, 2,69-12,53). En los supervivientes, el mNUTRIC score tuvo correlación con las duraciones de la estancia en UCI (ℓ = 0,216, p = 0,049), estancia hospitalaria (ℓ = 0,230, p = 0,036) y VMI (ℓ = 0,306, p = 0,037). El 55,4 % de los pacientes recibió soporte nutricional. Lograron el 52,9 % y 46 % de las metas energéticas y proteicas, respectivamente. Solo el 18 % alcanzó la meta energética y el 21,3 %, la meta proteica. Conclusiones: los pacientes con alto riesgo nutricional tienen mayor riesgo de morir al día 28. Menos de un cuarto de los pacientes con soporte nutricional alcanzó las metas nutricionales.

Effect of a family and interdisciplinary intervention to prevent T2D: randomized clinical trial.

BACKGROUND: Lifestyle changes can reduce the risk of T2D; however, no study has evaluated the effect of a lifestyle intervention involving patients´ family. The aim of this study was to compare the impact of an interdisciplinary family (FI) Vs individual intervention (II) on glucose metabolism, insulin resistance (IR), pancreatic ß-cell function and cardiovascular risk markers in patients with prediabetes, as well as to measure the impact on their families' metabolic risk. METHODS: Randomized Clinical Trial (RCT) to compare the impact of FI and II on IR and pancreatic ß-cell function in subjects with prediabetes. There were 122 subjects with prediabetes (and 101 family members) randomized to FI or II. Data were collected in 2015-2016 and analyzed in 2017-2018. FI group had the support of their family members, who also received personalized diet and exercise recommendations; patients and their family members attended monthly a lifestyle enhancement program. II group received personalized diet and exercise recommendations. The follow-up was for 12 months. Glucose, IR, pancreatic ß-cell function and secondary outcomes (body composition and lipid profile) were assessed at baseline, 6 and 12 months. RESULTS: FI group improved area under the glucose curve (AUC) (from 18,597 ± 2611 to 17,237 ± 2792, p = 0.004) and the Matsuda index (from 3.5 ± 2.3 to 4.7 ± 3.5, p = 0.05) at 12 months. II group improved Disposition Index (from 1.5 ± 0.4 to 1.9 ± 0.73, p < .0001) at 12 months. The improvements achieved in weight and lipids at 6 months, were lost in II group at 12 moths, whereas in FI persisted. Adherence up to 12 months was not different between the study groups (FI 56% Vs II 60%). CONCLUSIONS: FI intervention was more effective by improving glucose AUC, insulin sensitivity and lipid profile, besides that, metabolic risk in family members of the FI group was maintained, while the risk of II group was increased. TRIAL REGISTRATION: This study was retrospectively registered at clinicaltrials.gov on December 15, 2015 (NTC026365646).

Progressive Shifts in the Gut Microbiome Reflect Prediabetes and Diabetes Development in a Treatment-Naive Mexican Cohort.

Type 2 diabetes (T2D) is a global epidemic that affects more than 8% of the world's population and is a leading cause of death in Mexico. Diet and lifestyle are known to contribute to the onset of T2D. However, the role of the gut microbiome in T2D progression remains uncertain. Associations between microbiome composition and diabetes are confounded by medication use, diet, and obesity. Here we present data on a treatment-naive cohort of 405 Mexican individuals across varying stages of T2D severity. Associations between gut bacteria and more than 200 clinical variables revealed a defined set of bacterial genera that were consistent biomarkers of T2D prevalence and risk. Specifically, gradual increases in blood glucose levels, beta cell dysfunction, and the accumulation of measured T2D risk factors were correlated with the relative abundances of four bacterial genera. In a cohort of 25 individuals, T2D treatment-predominantly metformin-reliably returned the microbiome to the normoglycemic community state. Deep clinical characterization allowed us to broadly control for confounding variables, indicating that these microbiome patterns were independent of common T2D comorbidities, like obesity or cardiovascular disease. Our work provides the first solid evidence for a direct link between the gut microbiome and T2D in a critically high-risk population. In particular, we show that increased T2D risk is reflected in gradual changes in the gut microbiome. Whether or not these T2D-associated changes in the gut contribute to the etiology of T2D or its comorbidities remains to be seen.

Carbohydrate source affects the synthesis of silver nanoparticles by Lactobacillus plantarum 1449 and Lactobacillus ruminis 1313.

Strains of Lactobacillus have been used for the synthesis of metallic nanoparticles. Since the carbohydrate source could influence the yield and size of the synthesised nanoparticles, the authors evaluated the potential of Lactobacillus plantarum 1449 and Lactobacillus ruminis 1313 to produce silver nanoparticles (AgNPs) using three carbohydrate sources and AgNO3. The presence of AgNO3 in the medium extended the duration of the acceleration and logarithmic phases of the two strains independently of the carbohydrate source used but did not inhibit their growth. The synthesis of AgNPs started at the second day of culture. In general, the size of the AgNPsranged from 10 to 150 nm; they were smaller and more homogeneous in lactose. In the medium supplemented with glucose, there was a lower production of nanoparticles for both strains. The AgNPs synthesised by L. ruminis 1313 remained enclosed in an extracellular polymeric substance, which probably played an important role in the synthesis of the nanoparticles. The carbohydrate source influenced the yield and size of the AgNPssynthesised by L. plantarum 1449 and L. ruminis 1313; the pH was also important for obtaining nanoparticles of uniform size.

Chemical and pharmacological aspects of capsaicin.

Capsaicin is a unique alkaloid found primarily in the fruit of the Capsicum genus and is what provides its spicy flavor. Generally extracted directly from fruit, high demand has driven the use of established methods to increase production through extraction and characterization. Over time these methods have improved, usually be applying existing techniques in conjunction. An increasingly wide range of potential applications has increased interest in capsaicin. Especially compelling are the promising results of medical studies showing possible beneficial effects in many diseases. Capsaicin's pungency has limited its use in clinical trials to support its biological activity. Characterization and extraction/ synthesis of non-pungent analogues is in progress. A review is made of capsaicin research focusing mainly on its production, synthesis, characterization and pharmacology, including some of its main potential clinical uses in humans.