Registro del año 2010 de Nutrición Parenteral Domiciliaria en España: Grupo NADYA-SENPE / Home parenteral nutrition registry in Spain for the year 2010: NADYA-SENPE

Objetivos: Comunicar los datos del Registro del Grupo NADYA SENPE de Nutrición Parenteral Domiciliaria NPD en España del año 2010. Material y métodos: Estudio descriptivo de la base de datos del Registro de ámbito nacional de NPD del grupo NADYA-SENPE (1 de enero de 2010 al 31 de diciembre de 2010). Para el cálculo de prevalencias se utilizó los últimos datos publicados por el Instituto Nacional de Estadística. Resultados: Se registraron 148 pacientes procedentes de 23 hospitales, 86 mujeres (58,11%) y 9 niños (6,08%). La edad media de los 139 pacientes adultos fue de 53,06 ± 15,41 años. La duración media de la NPD fue de 316,97 días/paciente. El diagnóstico más frecuente en los niños (menores de 14 años) fue intestino corto traumático con 5 casos (55,55%) y en los adultos la neoplasia en tratamiento paliativo 29 (19,59%). El motivo de la indicación de la NPD fue el síndrome de intestino corto en 74 ocasiones (47%). La vía de acceso más frecuentemente registrada fue el catéter tunelizado en 36 (22,78%) casos seguido del reservorio en 13 (8,23%) y otras vías en 3 ocasiones (1,90%). Se registraron 23 infecciones relacionadas con el catéter (82,14%), lo que representa 0,49/1000 días de NP y todas ellas ocurrieron en los adultos. A lo largo del año finalizaron 24 episodios de NPD, la causa más frecuente fue el paso a la vía oral en 12 episodios (50%). Se registró que los pacientes tenían una actividad normal en 70 episodios de NPD (44,30%) con una total autonomía en 88 de episodios (55,69%). Se identificaron 39 (24,68%) posibles candidatos para trasplante intestinal. Conclusiones: El número de pacientes registrados es discretamente inferior al del año anterior, aunque el número de hospitales participantes es el mismo. La complicación más frecuente sigue siendo la infección relacionada con el catéter aunque ha disminuido su incidencia respecto a años anteriores, presentándose la tasa más baja desde la creación del registro. Las diferencias en la participación en el registro observadas por Comunidades Autónomas lleva a plantear el desarrollo de estrategias de implementación del registro. Se observa un aumento progresivo de la duración de los días de NPD a lo largo de los años que hace pensar en la cronicidad de algunos pacientes, pero nos obliga a estudiar la existencia de un posible factor de confusión, en el caso de que existiera un olvido de cierre de algún episodio por lo que se hace necesario actualizar el registro con sistemas de alertas periódicas que faciliten la revisión de los pacientes incluidos y optimice la validez del registro (AU)

Objectives: To report the Group Registry NADYA SENPE data about home parenteral nutrition (HPN) in Spain in 2010. Material and methods: A descriptive study of the database of the national registry of HPN of NADYA-SENPE (December 10, 2009 to December 10, 2010). For the calculation of prevalence the latest data published by the Institute National Statistics Office (01/01/2009) was used. Results: There were registered 148 patients from 23 hospitals, 86 women (58.11%) and 9 children (6.08%). The average age of the 139 patients older than 14 years was 53.06 ± 15.41 years. The average duration of HPN was 316.97 days/patient. The most common diagnosis in those younger than 14 years was short bowel traumatic with 5 cases (55.55%) and in those older than 14 years, palliative care cancer with 29 cases (19.59%). The reason for the indication for HPN was short bowel syndrome in 74 cases (47%). The access via most frequently recorded was tunneled catheter in 36 cases (22.78%) followed by implanted port-catheters in 13 cases (8.23%) and other pathways in 3 cases (1.90%). There were 23 catheter related infections (82.14%) which represented 0.49 /1,000 days of PN, all of which occurred in cases older than 14 years. During the year 24 episodes of HPN ended, the most frequent cause was the transition to oral nutrition in 12 episodes (50%). It was reported that patients had a normal activity in 70 episodes of HPN (44.30%) with complete autonomy in 88 episodes (55.69%). Some patients 39 (24.68%) were potential candidates for intestinal transplantation. Conclusions: The number of registered patients is slightly lower than the previous year, although the number of participating hospitals is the same. The most frequent complication remains catheter-related infection but its incidence has decreased from previous years, presenting the lowest rate since the creation of the record. Differences in participation in the registry observed in the Autonomous Communities causes the development of implementation strategies. There is a gradual increase in day length of HPN over the years, which suggests the chronic treatments of some patients and obliges to study the existence of a possible confounding factor, in case there is an oversight of closing an episode. Therefore, it is necessary to update the registry with warning systems that facilitate periodic review of the patients and optimize the validity of registration (AU)

[Study of the nutritional status of elders in Cantabria]. / Estudio del estado nutricional de los ancianos de Cantabria.

INTRODUCTION: Population ageing is a main concern under the biosanitary point of view. AIM: To assess the nutritional status of people 65 year-old and older in Cantabria (Spain) METHOD: A total of 1605 persons were studied by means of the MNA (Mini Nutritional Assessment); a) by primary care (59.9% in the unit, and 4.7% at home) and, b) in nursing homes (35.4%). RESULTS: Nutritional score (NS) was 23.4 ± 4.1 for women and 24.4 ± 4 in males (p < 0.001). We emphasize the fact that 22.3% of people studied in the nursing homes were malnourished or at risk of malnutrition, compared with 14.2% of those studied at the unit, and only 3.3% of the home visited elders. The correlation between the value of the NS and the subjective estimation of nutrition status showed a high value (0.65). We emphasize the negative correlation (-0.53) between BNI value and the incidence of skin lesions. CONCLUSION: Our results highlight the importance of identifying malnutrition or its risk in elders in order to prevent the negative consequences of this deficiency.

Estudio del estado nutricional de los ancianos de Cantabria / Study of the nutritional status of elders in Cantabria

Introducción: El envejecimiento de la población representa uno de los retos más importantes desde el punto de vista biosanitario Objetivo: Valorar el estado nutricional de las personas de 65 y más años de Cantabria. Métodos: Un total de 1605 personas fueron evaluadas por medio del MNA; a) en atención primaria (59,9% en la consulta y 4,7% en domicilios) y, b) en residencias de ancianos (35,4%).Resultados: La puntuación nutricional (PN) obtenida de la suma de los ítems del MNA fue 23,4 ± 4,1 para las mujeres y 24,4 ± 4 en los varones (p < 0,001). Destaca el hecho de que el 22,3% de las personas estudiadas en residencias está malnutrida o en riesgo de malnutrición, frente al 14,2% de las que acuden a consulta, y sólo el3,3% de las estudiadas en su domicilio. La correlación entre los valores de la PN y la apreciación subjetiva del estado de nutrición mostró un valor elevado (0,65). Destacamos la correlación negativa (-0,53) entre los valores del IMC y la incidencia de lesiones cutáneas. Conclusiones: Nuestros resultados indican la importancia de la identificación de la desnutrición o su riesgo, en personas mayores, por las consecuencias negativas que presenta este estado carencial (AU)

Introduction: Population ageing is a main concern under the biosanitary point of view. Aim: To assess the nutritional status of people 65 year old and older in Cantabria (Spain) Method: A total of 1605 persons were studied by means of the MNA (Mini Nutritional Assessment); a) by primary care (59.9% in the unit, and 4.7% at home) and, b) in nursing homes (35.4%).Results: Nutritional score (NS) was 23.4 ± 4.1 for women and 24.4 ± 4 in males (p < 0.001). We emphasize the fact that 22.3% of people studied in the nursing homes were malnourished or at risk of malnutrition, compared with 14.2% of those studied at the unit, and only 3.3% of the home visited elders. The correlation between the value of the NS and the subjective estimation of nutrition status showed a high value (0.65).We emphasize the negative correlation (-0.53) between BNI value and the incidence of skin lesions. Conclusion: Our results highlight the importance of identifying malnutrition or its risk in elders in order to prevent the negative consequences of this deficiency (AU)

[Home parenteral nutrition registry in Spain for the year 2010: NADYA-SENPE Group]. / Registro del año 2010 de nutrición parenteral domiciliaria en España: Grupo NADYA-SENPE.

OBJECTIVES: To report the Group Registry NADYASENPE data about home parenteral nutrition (HPN) in Spain in 2010. MATERIAL AND METHODS: A descriptive study of the database of the national registry of HPN of NADYA-SENPE (December 10, 2009 to December 10, 2010). For the calculation of prevalence the latest data published by the Institute National Statistics Office (01/01/2009) was used. RESULTS: There were registered 148 patients from 23 hospitals, 86 women (58.11%) and 9 children (6.08%). The average age of the 139 patients older than 14 years was 53.06 ± 15.41 years. The average duration of HPN was 316.97 days/patient. The most common diagnosis in those younger than 14 years was short bowel traumatic with 5 cases (55.55%) and in those older than 14 years, palliative care cancer with 29 cases (19.59%). The reason for the indication for HPN was short bowel syndrome in 74 cases (47%). The access via most frequently recorded was tunneled catheter in 36 cases (22.78%) followed by implanted port-catheters in 13 cases (8.23%) and other pathways in 3 cases (1.90%). There were 23 catheterrelated infections (82.14%) which represented 0.49 /1,000 days of PN, all of which occurred in cases older than 14 years. During the year 24 episodes of HPN ended, the most frequent cause was the transition to oral nutrition in 12 episodes (50%). It was reported that patients had a normal activity in 70 episodes of HPN (44.30%) with complete autonomy in 88 episodes (55.69%). Some patients 39 (24.68%) were potential candidates for intestinal transplantation. CONCLUSIONS: The number of registered patients is slightly lower than the previous year, although the number of participating hospitals is the same. The most frequent complication remains catheter-related infection but its incidence has decreased from previous years, presenting the lowest rate since the creation of the record. Differences in participation in the registry observed in the Autonomous Communities causes the development of implementation strategies. There is a gradual increase in day length of HPN over the years, which suggests the chronic treatments of some patients and obliges to study the existence of a possible confounding factor, in case there is an oversight of closing an episode. Therefore, it is necessary to update the registry with warning systems that facilitate periodic review of the patients and optimize the validity of registration.

[Anthropometric values in a very elderly institutionalized population]. / Valores antropométricos en una población institucionalizada muy anciana.

The purpose of the present study has been to determine, in a population group over 80 years of age in a publicly-funded geriatric institution, the anthropometric parameters that represent reference values for the study of nutritional status. These parameters allow detection of alterations in the nutritional status which, once corrected, will contribute to maintaining an appropriate quality of life in a population group that is highly sensitive to the associated morbidity and mortality processes. In order to carry out this study, a sample of 56 healthy elderly individuals was selected (13 men and 43 women) with a mean age of 86.5 +/- 4.8 years and a range from 80 to 101 years. The parameters measured were: weight, height, tricipital fold, brachial perimeter and the following values calculated on the basis of these figures: body mass index, percentage of body fat, brachial muscular area, brachial muscular perimeter, brachial adipose area and the ratio of muscle to adipose tissue. These values were processed statistically with the assistance of the RSB-SIGMA computer software, with calculation of the percentiles, the mean, and the comparison between the sexes. The criterion for statistical significance was set at p < 0.05. Our results confirm the presence of significant differences in the muscle parameters, which are greater in men than in women, whereas the fat parameters are higher in the latter. Thus, it is concluded that weight, height, brachial muscle area and brachial muscle perimeter are significantly higher in men whereas tricipital fold, percentage of body fat, the brachial adipose area and the muscle to adipose tissue ratio are significantly superior among women. There are no significant differences by gender in the body mass index and the brachial perimeter.

Valores antropométricos en una población institucionalizada muy anciana / Anthropometric values in a very elderly institutionalized population

El objetivo del presente trabajo ha sido determinar, en un grupo de población de más de 80 años de una residencia geriátrica pública, los parámetros antropométricos que constituyen valores de referencia para el estudio del estado nutricional. Estos parámetros permiten detectar alteraciones en el estado nutricional que corrregidas ayudarán a mantener una adecuada calidad de vida en un grupo de población muy sensible a los procesos asociados de morbimortalidad. Para la realización de este estudio se seleccionó una muestra de 56 ancianos sanos (13 varones y 43 mujeres), con una media de edad de 86,5 +/- 4,8 años y un rango comprendido entre 80 y 101 años. Los parámetros medidos fueron: peso, talla, pliegue tricipital, perímetro braquial y los valores calculados a partir de éstos: índice de masa corporal, porcentaje de grasa corporal, área muscular braquial, perímetro muscular braquial, área adiposa braquial y el índice adiposo muscular. Estos valores fueron procesados estadísticamente con ayuda del programa informático RSB-SIGMA y se calcularon los percentiles, la media, y la comparación entre sexos. Se estableció como criterio de diferencias significativas una p<0,05. Nuestros resultados constatan la presencia de diferencias significativas en los parámetros musculares, los cuales son mayores en los varones que en las mujeres, mientras que los parámetros grasos son más elevados en éstas últimas. Así se concluye que, peso, tala, área muscular braquial y perímetro muscular braquial son significativamente más elevados en los varones que en las mujeres. Por otra parte el pliegue tricipital, el porcentaje de grasa corporal, el área adiposa braquial y el índice adiposo muscular lo son en mujeres. No hay diferencias significativas por sexos en el índice de masa corporal y el perímetro braquial (AU)

The purpose of the present study has been to determine, in a population group over 80 years of age in a publicly- funded geriatric institution, the anthropometric parameters that represent reference values for the study of nutritional status. These parameters allow detection of alterations in the nutritional status which, once corrected, will contribute to maintaining an appropriate quality of life in a population group that is highly sensitive to the associated morbidity and mortality processes. In order to carry out this study, a sample of 56 healthy elderly individuals was selected (13 men and 43 women) with a mean age of 86.5 ± 4.8 years and a range from 80 to 101 years. The parameters measured were: weight, height, tricipital fold, brachial perimeter and the following values calculated on the basis of these figures: body mass index, percentage of body fat, brachial muscular area, brachial muscular perimeter, brachial adipose area and the ratio of muscle to adipose tissue. These values were processed statistically with the assistance of the RSB-SIGMA computer software, with calculation of the percentiles, the mean, and the comparison between the sexes. The criterion for statistical significance was set at p < 0.05. Our results confirm the presence of significant differences in the muscle parameters, which are greater in men than in women, whereas the fat parameters are higher in the latter. Thus, it is concluded that weight, height, brachial muscle area and brachial muscle perimeter are significantly higher in men whereas tricipital fold, percentage of body fat, the brachial adipose area and the muscle to adipose tissue ratio are significantly superior among women. There are no significant differences by gender in the body mass index and the brachial perimeter (AU)

[Home enteral nutrition. Annual report 1999. NADYA-SENPE Group]. / Nutrición enteral domiciliaria. Informe anual 1999. Grupo NADYA-SENPE.

GOAL: During 1999, as in previous years, the NADYA-SENPE Group has maintained an annual register of patients with Artificial Nutrition at Home in order to keep up to date our available knowledge of this therapy. The present paper analyzes the results of the sixth National Register of patients under treatment with Enteral Nutrition at Home corresponding to 1999, produced with the co-operation of twenty-three centres in the Spanish national health network. MATERIAL AND METHODS: The data were collected through a closed questionnaire included on our web site (www.nadya-senpe.com). Apart from epidemiological information, the form includes the indication that led to the prescription of nutrition, nutritional treatment, access path, complications and admissions to hospital, follow-up of the treatment, patients' quality of life and progress. All of the data are processed by the co-ordinating team. The Nutrition Unit at La Paz Teaching Hospital in Madrid has acted as the group co-ordinator. RESULTS: During 1999, a total of 2,262 patients at the twenty-three collaborating centres followed treatment with Home Enteral Nutrition (NED in its Spanish acronym). The mean age was 63.6 (19.67 years (males: 57.6%; females: 42.3%). The mean time with nutritional treatment is 5.89 (4.25 months. The neurological alterations (37.5%) and neoplasias (36.8%) were the most frequent indications for NED. Most patients used oral administration (50.7%), the use of artificial routes is less frequent, with 5NG being used on 27.9% and PEG on 12.7%. The polymeric formulas are the ones most commonly used (87.7%). The number of complications recorded amounted to 1,403 episodes, representing 0.62 complications per patient per year, of which 40.8% were gastro-intestinal (0.26 complications per patient per year) and 18.7% were mechanical complications, with only 9 recorded cases of bronchoaspiration. It was necessary to admit patients to hospital on 836 occasions (0.38 admissions per patient), albeit generally for causes not associated with nutrition (86.1%). At year-end, 51.4% of patients continued to receive nutritional support. CONCLUSIONS: Enteral nutrition at home is a safe technique whose use is growing in Spain. It requires the existence of appropriately equipped nutrition teams as well as the collaboration of the Primary Health Care services and the suitable training of patients and relatives. It is essential to progress more deeply into the development and application of clinical routes that provide a clear and concise methodology covering all nutrition-related aspects. In itself, nutrition is a therapeutic alternative regardless of whether access is obtained through a natural or an artificial route. It is necessary for the persons responsible for health-care administration to realize that the appropriate nutrition of patients leads to an improvement in their general health, a shorter course for their illness and, therefore, a reduction in costs.

Nutrición enteral domiciliaria. informe anual 1999. Grupo NADYA-SENPE / Enteral nutrition at home. annual report 1999. NADYA-SENPE group

Objetivo: Durante 1999, como en años anteriores, el Grupo NADYA-SENPE ha realizado el registro anual de pacientes con Nutrición Artificial Domiciliaria, con el objetivo de mantener actualizados los conocimientos que sobre esta terapéutica tenemos. En el presente trabajo analizamos los resultados del sexto Registro Nacional de pacientes en tratamiento con Nutrición Enteral Domiciliaria correspondiente al año 1999, en el que han colaborado veintitrés centros de la red sanitaria nacional.Material y Métodos: La información se ha recogido en un cuestionario cerrado incluido en nuestra pagina web (www.nadya-senpe.com). El formulario incluye, además de los datos epidemiológicos, la indicación que motivó la nutrición, tratamiento nutricional, vía de acceso, complicaciones y hospitalizaciones, seguimiento del tratamiento, calidad de vida y evolución de los pacientes. La información total es procesada por el equipo coordinador. La Unidad de Nutrición del Hospital Universitario La Paz de Madrid, ha actuado como coordinador del grupo.Resultados: Durante el año 1999 han seguido tratamiento con Nutrición Enteral Domiciliaria (NED) 2262 pacientes en los veintitrés centros colaboradores. La edad media ha sido de 63,6 ñ 19,67 (H: 57,6 por ciento; M: 42,3 por ciento). El tiempo medio con tratamiento nutricional es de 5,89 ñ 4,25 meses. Las alteraciones neurológicas (37,5 por ciento) y las neoplasias (36,8 por ciento) han sido las indicaciones de NED más frecuentes. La mayoría de los pacientes utilizan la vía oral (50,7 por ciento), la utilización de vías artificiales es menos frecuente, la SNG es utilizada en el 27,9 por ciento y la PEG en un 12,7 por ciento. Las formulas polimericas son las mas empleadas (87,7 por ciento). Se contabilizaron 1403 episodios de complicaciones, lo que representa 0,62 complicac./paciente/año, el 40,8 por ciento gastrointestinales (0,26 complicaciones/paciente/año), el 18,7 por ciento complicaciones mecánicas, solo se contabilizaron 9 casos de broncoaspiración. En 836 ocasiones (0,38 hospitaliz./paciente) fue necesario hospitalizar al paciente, aunque debido generalmente a causas no asociadas con la nutrición (86,1 por ciento).Al finalizar el año el 51,4 por ciento de los pacientes continuaban con el soporte nutricional Conclusiones: La nutrición enteral domiciliaria es una técnica segura en pleno desarrollo en nuestro país.Requiere la existencia de equipos de nutrición adecuadamente dotados así como la colaboración de los servicios de atención primaria y la adecuada formación de familiares y pacientes. Es indispensable profundizar en el desarrollo y aplicación de vías clínicas que contemplen una metodología clara y concisa que abarque todos los aspectos relativos a la nutrición. La nutrición es, en si misma, una alternativa terapéutica independientemente de si el acceso se realiza por una vía natural o artificial. Es necesario que los responsables administrativos se den cuenta de que una nutrición adecuada de los pacientes redunda en una mejoría de su estado general, un tiempo de evolución mas corto y, por lo tanto, en una disminución de los costes (AU)

Goal: During 1999, as in previous years, the NADYA-SENPE Group has maintained an annual register of patients with Artificial Nutrition at Home in order to keep up to date our available knowledge of this therapy. The present paper analyzes the results of the sixth National Register of patients under treatment with Enteral Nutrition at Home corresponding to 1999, produced with the co-operation of twenty-three centres in the Spanish national health network. Material and Methods: The data were collected through a closed questionnaire included on our web site (www.nadya-senpe.com). Apart from epidemiological information, the form includes the indication that led to the prescription of nutrition, nutritional treatment, access path, complications and admissions to hospital, follow-up of the treatment, patients’ quality of life and progress. All of the data are processed by the coordinating team. The Nutrition Unit at La Paz Teaching Hospital in Madrid has acted as the group co-ordinator. Results: During 1999, a total of 2,262 patients at the twenty-three collaborating centres followed treatment with Home Enteral Nutrition (NED in its Spanish acronym). The mean age was 63.6 ( 19.67 years (males: 57.6%; females: 42.3%). The mean time with nutritional treatment is 5.89 ( 4.25 months. The neurological alterations (37.5%) and neoplasias (36.8%) were the most frequent indications for NED. Most patients used oral administration (50.7%), the use of artificial routes is less frequent, with 5NG being used on 27.9% and PEG on 12.7%. The polymeric formulas are the ones most commonly used (87.7%). The number of complications recorded amounted to 1,403 episodes, representing 0.62 complications per patient per year, of which 40.8% were gastro-intestinal (0.26 complications per patient per year) and 18.7% were mechanical complications, with only 9 recorded cases of bronchoaspiration. It was necessary to admit patients to hospital on 836 occasions (0.38 admissions per patient), albeit generally for causes not associated with nutrition (86.1%). At year-end, 51.4% of patients continued to receive nutritional support Conclusions: Enteral nutrition at home is a safe technique whose use is growing in Spain. It requires the existence of appropriately equipped nutrition teams as well as the collaboration of the Primary Health Care services and the suitable training of patients and relatives. It is essential to progress more deeply into the development and application of clinical routes that provide a clear and concise methodology covering all nutrition-related aspects. In itself, nutrition is a therapeutic alternative regardless of whether access is obtained through a natural or an artificial route. It is necessary for the persons responsible for health-care administration to realize that the appropriate nutrition of patients leads to an improvement in their general health, a shorter course for their illness and, therefore, a reduction in costs (AU)