White fish reduces cardiovascular risk factors in patients with metabolic syndrome: the WISH-CARE study, a multicenter randomized clinical trial.

BACKGROUND AND AIMS: Reduction of cardiovascular risk with high consumption of fish in diet is still a matter of debate, and concerns about heavy metal contamination have limited consumption of oily fish. We aimed to evaluate the effect of regular ingestion of white fish on cardiovascular risk factors in patients with metabolic syndrome. METHODS AND RESULTS: Multicenter randomized crossover clinical trial including 273 individuals with metabolic syndrome. An 8-week only-one dietary intervention: 100 g/d of white fish (Namibia hake) with advice on a healthy diet, compared with no fish or seafood with advice on a healthy diet. Outcomes were lipid profile, individual components of the metabolic syndrome, serum insulin concentrations, homeostasis model of insulin resistance, serum C-reactive protein and serum fatty acid levels. We found a significant lowering effect of the intervention with white fish on waist circumference (P < 0.001) and diastolic blood pressure (P = 0.014). A significant lowering effect was also shown after the dietary intervention with fish on serum LDL concentrations (P = 0.048), whereas no significant effects were found on serum HDL or triglyceride concentrations. A significant rise (P < 0.001) in serum EPA and DHA fatty acids was observed following white fish consumption. Overall adherence to the intervention was good and no adverse events were found. CONCLUSION: In individuals with metabolic syndrome, regular consumption of hake reduces LDL cholesterol concentrations, waist circumference and blood pressure components of the metabolic syndrome. CLINICAL TRIAL REGISTRY: White Fish for Cardiovascular Risk Factors in Patients with Metabolic Syndrome Study, Registered under ClinicalTrials.gov Identifier: NCT01758601.

[The year 2003 National Registry of Home-based Parenteral Nutrition]. / Registro Nacional de la Nutrición Parenteral Domiciliaria del año 2003.

OBJECTIVE: To report the results of the Home-based Parenteral Nutrition (HBPN) registry of the NADYA-SENPE working group, for the year 2003. MATERIAL AND METHODS: Gathering of registry data introduced by all units responsible of HBPN patient care. This an on-line registry available for authorized users of the working group web page (www.nadya-senpe.com). Epidemiological data, diagnosis, access route, complications, hospital admissions, disability degree, and course at December 31st, 2003 RESULTS: Data from 86 patients (62% female and 38% male) from 17 hospitals were gathered. Mean age of adult patients was 50.7 +/- 15.0 years, whereas for patients younger than 14 years was 2.4 +/- 1.5 years (n = 5 patients). Diseases that prone HBPN were neoplasm (21%), followed by mesenteric ischemia (20%), radiation enteritis (16.3%), motility impairments (10.5%), and Crohn's disease (4.6%). Tunneled catheters were used in 66.3% of the cases versus 29.1% of subcutaneous reservoirs. Mean treatment duration has been 8.5 +/- 4.6 months; 67.4% of patients had been on HBPN for a period of time longer than 6 months. Patient follow-up was mostly done from the reference area hospital (88.4%). In no case patient follow-up was done by the primary care team or by specialists other than those prescribing nutritional support. Nutritional support-related complications were seen in 98 occasions. The most frequent complications were infectious ones. They represented 1.60 hospital admissions per patient. The mean number of visits was 7.9 per patient (6.4 for scheduled visits and 1.5 for emergency visits). By the end of the year, we observed that 73.3% of the patients were still on the program, whereas in 23.3% HBPN had been withdrawn. The main reasons for withdrawal were decease (11 patients), and advancing to oral diet (9 patients). As for the disability degree, 13% were confined to a wheelchair or bed, and only 28% had no disability degree or only mild social disability. CONCLUSIONS: We observed a mild increase in HBPN prevalence rate in Spain (2.15 patients pmp). The main indication was cancer followed by short-bowel syndrome secondary to vascular pathology. Nutritional support-related complications were common, especially those of an infectious origin.

[Effects of parenteral glutamine in patients submitted to bone marrow transplantation]. / Efectos de la glutamina parenteral en pacientes sometidos a trasplante de médula ósea.

UNLABELLED: Bone marrow transplantation (BMT) is a therapy used for hematologic malignancies and solid tumors. Associated chemotherapy and radiotherapy to which these patients are submitted induce secondary effects, with a high metabolic stress. Glutamine is considered a conditionally essential amino acid, and has been shown effective in severe catabolic states. The aim of the study was to assess the effect of parenteral nutrition (PN) therapy supplemented with glutamine on duration of nutritional support in a group of patients with BMT. We have also analyzed associated complications, the nutritional status, the clinical course at 6 months, differences as to type of transplantation, and oral ingestion capability. This is a phase IV, randomized, double blind, and parallel clinical trial, done at a single center. The study was performed on 49 patients, 29% male and 71% female patients, with ages between 21-63 years, distributed in 3 diagnostic groups (leukemia, lymphoma, and solid tumors), and admitted to the Hematology Department of our Hospital. Fifty percent of the patients in each group have received PN supplemented with glutamine (0.4 g/kg/day of L-alanine-L-glutamine), and the other 50% have received standard PN. RESULTS: we have not found significant differences nor at the beginning nor at the end of the study between both groups with regards to studied variables. CONCLUSIONS: PN is and effective therapy for maintenance of the nutritional status in patients submitted to a therapy with a, highly catabolic effect such as BMT. Although we have not been able to show the efficacy of glutamine supplementation in this study with the used dose, it does have been effective in other reports.

[Intestinal transplant in patients with parenteral nutrition at home]. / Trasplante intestinal en el paciente con nutrición parenteral domiciliaria.

Failure of the intestine, whether due to functional or anatomical reasons, constrains Parenteral Nutrition Therapy in children or adults who, as a result of intestinal resections, alterations in motility, diseases of the microvilli or other reasons, present insufficient intestine to cover their needs in terms of nutrients and fluids. Nonetheless, the maintenance of support with parenteral nutrition at home in subjects with irreversible intestinal failure is not without life-threatening complications: liver disease, recurrent sepsis and loss of central routes recommend the assessment of the indication of intestinal transplant in this group of patients. The incidence of morbidity and mortality after intestinal transplant is greater than in other transplants (kidney, liver), but the long-term survival is around 50-60%. In Spain, 7 transplants (6 children and 1 adult) have been performed so far: 3 of intestine alone, 3 of liver plus intestine and 1 mutivisceral transplant. In 4 cases, the indication for transplant was due to terminal liver disease, with the remainder being due to the loss of venous access, intractable diarrhoea and intra-abdominal desmoid tumour, respectively. Except for one girl who presented severe rejection of the graft, the rest achieved digestive autonomy. One boy has presented lymphocyte neoplasia (PTLD) after 2 years and another died after the transplant as a result of a routine liver biopsy (with functioning grafts). Of the 38 patients assessed for transplant, 18 were considered as candidates and of these, three youthful candidates for hepato-intestinal transplant (with short intestine syndrome) have died while on the waiting list and a fourth in the operating theatre prior to an attempted multivisceral transplant. Intestinal transplants must not be considered as the last desperate therapeutic option in patients with permanent intestinal failure. The type of graft, clinical expertise and the use of new inducers (Sirulimos) all contribute to the results of this therapy, in which survivors remain free from parenteral support and can take up once more their day-to-day activities, can improve over time.

[Artificial nutrition in the home. Annual information 1996.Group NADYA-SENPE]. / Nutrición artificial domiciliaria. Informe Anual 1996. Grupo NADYA-SENPE.

Using a simplified questionnaire from the NADYA group, data referring to age, sex, diagnosis, access route, duration, form of administration, complications, and quality of life have been gathered from 1,400 patients (57% male, 43% female) who receive home enteral nutrition, and from 38 patients (20% male and 18% female) who receive home parenteral nutrition. All of these patients come from the 1996 national registry. The most common indication for home enteral nutrition are neoplasias (39%) followed by neurological alterations (33%). The most common access route is oral (48%), followed by a nasogastric tube in 34%, PEG in 10% and surgical ostomies in 7%. The average treatment duration is 6 months. There is an index of 0.74 complications/patient-year (gastrointestinal 0.28 and mechanical alterations 0.19). At the end of the year 58% of the patients continued to use at home enteral nutrition, with a death rate of 17%. The majority of the treated patients presented a severe social disability (28%) or was bed-ridden (22%). The most common indications for home parenteral nutrition are: neoplasia (42%), Crohn_s disease (10%), and mesenteric ischemia (10%). AIDS (8%), radical enteritis (5%), and motility disorders (5%) are less common. In 42% of the cases tunneled catheters are used, and port-a-cath are used in 53%. The average treatment duration is 6.9 months. 1.06 hospitalizations/patient-year have been registered in relation to the nutritional treatment (mainly catheter sepsis). A mortality of 29% is registered, and there is recovery of the oral route in 7.9% of the cases. 50% of the patients present a severe social disability.

[Artificial nutrition in the home. 1995 yearly report. NADYA-SENPE Group (Natiional Registry of Patient-Spanish Society for Parnteral and Enterlal Nutrition]. / Nutrición artificial domiciliaria. Informe anual 1995. Grupo NADYA-SENPE.

By means of a simplified questionnaire, the NADYA group has gathered and analyzed data with regard to the age, sex, diagnosis, access route, duration, form of administration, complications, and quality of life, in 812 patients (62% male; 37% female) with At Home Enteral Nutrition (AHEN), and 19 patients (42% male; 57% female) with At Home Parenteral Nutrition (AHPN) corresponding the National Registry of 1995. The most frequent indication of AHEN was a neoplasm (41%), followed by neurological alterations (33%). The most common access route is the NGT (37%) followed by oral administration in 37%, PEG in 13% and surgical ostomics in 8%. The mean treatment time is 8 months. The index of complications/patient-year is 0.50 (gasterointestinal 0.17, and mechanical alterations 0.9). At the end of the study, 63% of the patients continued to receive AHEN, showing a mortality rate of 70%. The majority of the patients undergoing treatment presented a sever social disability (20%) or were bed ridden (18%). The most common indications for the AHPN are: radical enteritis (26%), Crohn's disease (21%), and mesenteric ischemia (16%). AIDS, motility alterations, and neoplasic diseases are scantly represented (10%). Tunneled catheters are used in 58% of the cases, and Port-a-Cath in 31%). The mean duration for the treatment was 7.9 months. An index of 0.47 hospitalization/patient-year was seen in relation to the nutritional treatment (mainly due to catheter septicemia). A mortality of 16% is noted, and 21% show a recovery of the oral route. 42% of the patients did not present an assessable social disability.

[Results of nutritional treatment of anorexia nervosa: our experience (1989-1995)]. / Resultado del tratamiento nutricional de la anorexia nervosa: nuestra experiencia (1989-1995).

With the alm of evaluating the nutritional treatment of anorexia nervosa (AN) in our center, evolutive data were collected, as well as anthropometric and biochemical parameters, of out out patient department (OPD) as well as of our hospital admissions (HA) which took place between 1989-91 (period A) and between 1992-95 (period B). 79 cases of HA were included (5 men, 31 women), with a duration of hospitalization of 36.96 +/- 22.02 days, with the reason for release most often (86.84%) being reaching the agreed upon weight, and 124 cases of OPD (12 men and 112 women), who were followed for 11.53 +/- 12.13 months achieving a final release rate of 14.14%. The nutritional status (NS) of the HA patients upon admission was most often sever caloric malnutrition (CM) (64.55%), and upon release this was moderate CM (60.75%), while in the OPD the moderate CM was most frequent at the initial visit and at the last visit registered. The anthropometric parameter which was most affected, was the triceps fold (TF), followed by the wight (W). The biochemical abnormalities were few, with hypercholesterolemia and ferropenia being notable. The nutritional treatment in the OPD required the addition of dietary supplements in 31% of the cases, and of psycho-medication in 43%. In the HA cases, only 6 patients reached the agreed upon wight with a free oral diet, and 35 patients required dietary supplements, 20 needed mixed therapy (enteral nutrition and supplements), and 17 cases required enteral nutrition through a naso-gastric tube. Significant multivariant models are presented which find independent associations for the probability of release (lower age upon diagnosis, male, lower income, absence of bulimia's, no need for dietary supplements), of amenorrhoea (worse NS, absence of vomiting), and for the HA time (more interventionist treatment, lower weight, lower age). The comparison between periods, shows an initial contact of the patients with AN with our OPD, with a better nutritional status y recent years, as well as a better nutritional result, a greater tendency towards the use of enteral nutrition, and a shorter time of HA.

[Domiciliary artificial nutrition. Annual Report 1994. NADYA Group]. / Nutrición artificial domiciliaria. Informe anual 1994. Grupo NADYA.

The NADYA Group, integrated in the Spanish Society of Parenteral and Enteral Nutrition (SENPE), and made up of professionals dedicated to Artificial Nutrition, and specifically, to Artificial Nutrition in the home, annually undertakes the task of collecting data on diagnosis, type of support, follow up characteristics, complications, and quality of life, of patients included in programs of at home artificial nutrition in Spain. In the Annual Register corresponding to 1994, 17 hospitality groups have participated, providing 369 patients with Home Enteral Nutrition, and 30 with Home Parenteral Nutrition. Home Enteral Nutrition is mainly applied in patients with neoplasias (36%) or neurological alterations (35%). The most commonly used access route in the nasogastric tube, although there is an observed increase in the application of Percutaneous Gastrostomies (21%) in relation to previous data of the Spanish population. There is an observed complications index of 0.07 episodes/patient-year, a mortality of 30% (neoplasias) and 20% (neurological alterations), and low rehabilitation indexes in this group. In Home Parenteral Nutrition, post-radiation enteritis, neoplasias, and mesenteric ischemia, are the main diagnostic groups. The majority of the patients have a tunneled tube (63%), with 37% using an implanted tube. With an index of hospitalizations of 0.83 hospitalizations/ patient-year, catheter septicemia justifies the majority of the re-hospitalizations derived from nutritional treatment (0.56 hospitalizations/patient-year), note the mortality of 37%. There are complete rehabilitations, continuing the previously normal activity in 80% of the cases.

[Nutrient and food consumption by ages and gender in school children from the Community of Madrid (CAENPE)]. / Consumo de alimentos y nutrientes por edades y sexo en escolares de la Comunidad de Madrid (CAENPE).

UNLABELLED: The objective of the present work was to know the consume of foodstuffs and nutrients among schoolchildren in the Madrid Autonomous Community and also the relative contribution of each group of foodstuffs to the overall intake of macronutrients. This study had a sectional observational design involving 2,608 children (51% males and 49% females) with ages ranging from 6 to 14 years who were randomly recruited from conglomerate of schools, according to socio-economic status and rural/urban residence. The inquiry on nutrients in 4 non consecutive days was analyzed (2 "24 hour-recall" and 2 "intake recall"). RESULTS: a) the consume of proteins, lipids, and carbohydrates represented 17%, 43% and 40% of the total caloric value, respectively; b) the intake of meats, sausages, sweets, tidbits, and processed products was very high. This fact is in origin of the excessive total and saturated lipid intake; c) there was a scarce intake of vegetables, cereals and potatoes among children of all ages and dairy products in children older than 12 years; d) the intake of legumes, eggs and fruits was appropriate; e) males consumed proportionally higher amounts than females of the following groups of foodstuffs: cereals, sweets and tidbits. The consume of meat, sausages, fish, eggs, potatoes, dry fruits and dairy products was similar in both sexes. Females consumed proportionally more fat foodstuffs, vegetables, fruits, legumes and processed products; f) females consumed a diet with a still higher lipid and protein content than males. These findings can serve as a basis to develop educational guidelines with a practical impact on family and school menus.

[National Task Force on Home and Ambulatory Artificial Nutrition. NADYA. The NADYA Group]. / Grupo de Trabajo Nacional en Nutrición Artificial Domiciliaria y Ambulatoria. NADYA. Grupo NADYA.

When a patient needs parenteral or enteral nutrition, be it in a transitory way or as a permanent form, and hospitalization is not strictly required, this treatment should take place in the home of the patient whenever possible. The support with artificial nutrition can be equally efficient, improving the life expectancy ad the quality of life of patients who would otherwise be faced with a much prolonged hospital stay. The Ambulatory and Home Artificial Nutrition group (NADYA) is a multidisciplinary team of health care professionals, from different areas of the national territory, who are dedicated to Clinical Nutrition. With the objective of promoting health and well-being of patients undergoing treatment, and to ease the therapeutic activity of the implicated professionals, this group has developed a series of suggestions for the practice of enteral or parenteral nutrition in the home of the patient. These suggestions include specifications about the technical team, criteria for selection and training of the patients, routes of access, formulas and material needed, follow up characteristics, and associated complications, and the represent a consensus of the regulations necessary for the guarantee of an adequate level of security and efficiency of the at home care of patients who require artificial nutrition support.

[Food consumption and the nutritional status of schoolchildren of the Community of Madrid (CAENPE): general methodology and overall food consumption. Consumo de alimentos y estado nutricional de la población escolar]. / Consumo de alimentos y estado nutricional de los escolares de la Comunidad de Madrid (CAENPE): metodología general y consumo global de alimentos.

The CAENPE study (Food Consumption and Nutritional State of the School Population) was a transversal observational study funded and promoted by the Directorate-General of Food Hygiene in the Ministry of Health, implemented in 1991-93, with the main aim of quantifying food consumption in the school population (6-14 years of age) in the Regional Community of Madrid, together with an anthropometric study and nutritional analysis of that population. This project sets our the General Methodology for the study, paying particular attention to the sampling design, to ensure that the sample is representative of the community, and the results of the overall consumption of food and its comparison with recommended diet and other population studies. Quantification shows a high and rising consumption of meat, meat products, sweets, snacks and prepared dishes, suitable consumption of eggs, legumes and fruit and a notable lack of greens, vegetables and potatoes. The basic results underline the need to introduce educational measures with practical effect on home and school menus.

[Analysis of energy intake, macronutrients and micronutrients in a child population]. / Análisis de la ingesta de energía, macronutrientes y micronutrientes en una población infantil.

With the objective to know precisely the qualitative and quantitative food intake of the infant population of a Health Care Area, the weekly intake of Energy, Proteins, Total and Saturated Fat, Food Fiber, Cholesterol, Calcium, Phosphorus, Magnesium. Iron, Zinc and Vitamin A is studied in 187 pupils, representative of the whole (835 children) population of two schools of Fuenlabrada and Leganés (Madrid), following the Weekly Register technique. Total consumption is quantified, and stratified according to sex and age groups. In order to perform a proper evaluation of these parameters, their adequacy to the Intake Recommendations for age and sex is analyzed, finding an excessive intake of calories, proteins and lipids in all age groups: being saturated Fat a third of the total daily Fat; Carbohydrates intake less than 50% of total energy, which would be desirable to maintain the nutritional ratio. Calcium intake, insufficient in some age group, together with the strong correlation proteins-phosphorus as well as total and saturated Fat with Cholesterol of the diet, allow to conclude that the excessive protein intake is predominantly due to meat products. It is also noted the lower intake of Zinc, Calcium, Magnesium, as to the recommended in certain age groups, therefore said individuals are at risk to suffer deficit of these micronutrients.

[The consumption of commercial foods in childhood. The influence of a nutritional information program]. / Consumo de alimentos comerciales en la infancia. Influencia de un programa de información en nutrición.

In order to perform an in-depth study on food standards among school children and evaluate the effect of a nutritional educational programme on eating habits, an analysis was made of the data on the intake of foods over a period of 1,890 days, in 187 school children from 2 schools in the Leganés-Fuenlabrada area. The consumption of global and stratified rations was quantified based on age, commercial foods (buns, fried foods and sweets) accounting for a large part of the children's diet, as well as dairy products, vegetables, fruit and fish, representing basic foodstuffs supposed to form part of their diet. The consumption of these was compared in two stages, before and after receiving the educational programme. It was observed that there was an excessive consumption of foodstuffs considered as lacking in nutritional value (commercial), which increased with age and a lack of natural foods evaluated in their food standards. We also observed that the applied health intervention modified the consumption of these foods recently incorporated into the children's diet, without achieving results with regard to family eating habits.

[The effect of the customary intake of energy and nutrients on the nutritional status of schoolchildren 6 to 15 years old]. / Influencia de la ingesta habitual de energía y nutrientes en el estado nutricional de escolares de seis a quince años.

An investigation was performed with regard to the effect of consuming energy and energetic nutrients, cholesterol and fibre in 187 children aged from 6 to 15 years in the Leganés-Fuenlabrada Health Area (Madrid) on the build and nutritional state of the children. An excessive global intake of calories, total and saturated fats, cholesterol and proteins was observed, and a deficit of carbohydrates, with a corresponding loss of nutritional balance. It should be mentioned that 74% of the children studied could be considered normal from the nutritional standpoint, with 18% of overweight children and 8% of children suffering from malnutrition. The results also provided information on the effect of the consumption of energy and fats on the weight and obesity of the children, as well as the interesting relationship between the habitual intake of proteins and carbohydrates on the children's build.