Nutricion hospitalaria最新文献

Introduction: this study focuses on Home Enteral Nutrition (HEN), whose use has grown enormously in recent years.

Objective: to analyze the prescriptions and, in addition, determine whether National Health System (NHS) funding criteria are met and to explore whether overcosts exist.

Methods: a retrospective observational study was conducted on 844 patients (895 episodes) who received HEN, using information obtained from the healthcare database. Demographic, clinical, dietary, and economic data were analyzed.

Results: in 9.7 % of the episodes analyzed, the funding criteria were met; in 15.1 %, ≥ 50 % kcal/day required was provided through HEN. During the 3 months of the study an average of 118.1 ± 86.8 units/patient were dispensed, which resulted in an average monthly expenditure of € 69.9 ± 66.3/patient. To go to the hospital to collect HEN, an average of 78.1 ± 69.5 km/patient was traveled, with an associated average monthly fuel cost of € 2.65 ± 2.39/patient. The additional expenditure associated with prescriptions not aligned with the funding criteria was estimated at € 574,259.44/year in the health area analyzed, with a quota of 200,000 inhabitants.

Conclusions: the results of this study show a divergence in the use of HEN compared to the conditions established by the NHS for the funding of this treatment. Given the low compliance rate and the current scientific evidence on the use of HEN, it may be necessary to re-evaluate the funding criteria to make them more representative of clinical evidence and actual practice.

Introduction: nutritional screening (NS) is crucial for early detection of malnutrition (MN) and prediction of "nutritional risk".

Objectives: to establish the prevalence of hospital malnutrition by Subjective Global Assessment (SGA) and evaluate the agreement of NS tools and their ability to predict mortality (M), infectious (IC) and non-infectious complications, and prolonged stay (> 11 days).

Methods: a multicenter, prospective, observational study was conducted. Nutritional status was assessed with SGA and simultaneously measured with Malnutrition Screening Tool (MST), Short Nutritional Assessment Questionnaire (SNAQ), Malnutrition Universal Screening Tool (MUST), Nutrition Risk Screening (NRS-2002), and Mini Nutritional Assessment Short Form (MNA-SF). All methods were classified into three categories for equivalence with SGA. Kappa was used to assess agreement and logistic regression, sensitivity, specificity, and area under the ROC curve for predictive ability.

Results: a total of 1546 patients from 64 hospitals in Argentina were included, 52.6 % male, median age 58 years. According to SGA, hospital malnutrition prevalence was 48.06 % (95 % CI 45.57; 50.55), with 37 % moderately malnourished (B) and 11 % severely malnourished (C). MST showed the best agreement with SGA (k 0.41), and among methods, MST with SNAQ (k 0.52). Adverse outcomes were associated with MN by any method. SGA, MNA-SF, and NRS-2002 had the best predictive ability (ROC area 0.74 to 0.72 for M). IC were the hardest to predict (maximum ROC area 0.62). Sensitivities ranged from 60 to 96 %, and specificities were above 90 % for MN by SGA.

Conclusions: variations in predictive ability among NS methods do not affect their clinical applicability.

Introduction: the Dietary Inflammatory Index (DII) provides a quantitative means for assessing the role of diet in relation to health outcomes.

Objetive: this study aimed to assess the association between the inflammatory potential of diet, as measured by the DII and IL-17A levels in young adults.

Methods: a cross-sectional study was conducted on 69 adults between 18-35 y of age in San Luis Potosi, Mexico. Fasting blood samples were collected to analyze lipid profile, glucose homeostasis, and IL-17A. Dietary intake was assessed using a 24-hour recall. DII scores were calculated from 19 available food parameters. Univariate linear regression models were estimated to evaluate the possible dependence of IL-17A levels (dependent variables) on some potential explicative variables such as anthropometric, clinical, biochemical, and dietary variables.

Results: there was a high inflammatory potential, with a mean DII score of +1.04 (range: -2.19 to +2.78). The DII was not associated with BMI, IL-17A levels or cardiometabolic risk factors.

Conclusion: the study shows that the diets of healthy college-aged Mexican adults had a high inflammatory potential.

Background: as chromium (Cr) is known to contaminate components of parenteral nutrition (PN), Cr-free PN is recommended for preterm infants. Exposure to Cr by PN in preterm infants is scarcely investigated.

Objective: to describe Cr levels in plasma (Crp) and urine (Cru) during the first month of life in premature newborns ≤ 1500 g of birthweight (BW) receiving PN, and to evaluate the impact on postnatal clinical parameters.

Methods: a prospective observational study. Cr-free PN was administered at day 1 of life and continued until full enteral feeding with fortified breastmilk began. Crp levels at day 15 and 30 and Cru at day 30 of life were assessed according to demographic factors, biochemical markers and postnatal morbidity.

Results: 97 infants had a median gestational age (GA) of 29.9 weeks, and a median BW of 1205 g. Median Crp remained at 1.0 µg/L at 15 and 30 days (IQR 0.7-1.4 and 0.7-1.3, respectively). Premature babies < 26 weeks had a significantly higher Crp at one month than the remainder (p = 0.043) and higher Cr elimination in the urine (p = 0.026). Crp increased with prolonged PN (p < 0.001), even after adjusting for gestational age (p = 0.001). Laboratory parameters were not influenced by Crp or Cru, nor was morbidity.

Conclusion: Crp increases with days of PN even when a trace mineral supplement without Cr is used, and the level reached persists during the first month of life with the introduction of Cr-supplemented breastmilk feeding. No relation to morbidity was observed.

Introduction and objectives: malnutrition and sarcopenia are prevalent in individuals with cirrhosis, but their diagnosis remains challenging due to limited access to suitable methods across different levels of healthcare. This study aimed to identify the most effective method for diagnosing sarcopenia in outpatients with liver cirrhosis and to evaluate the concordance between subjective and objective diagnostic methods.

Patients and methods: patients aged ≥ 18 years with a diagnosis of cirrhosis (regardless of etiology) under outpatient care were included. Exclusion criteria were: a) neoplasia, b) acute liver failure, c) pregnancy/lactation, d) HIV infection, e) special situations requiring liver transplantation, and f) history of organ failure. Nutritional and sarcopenia assessments used subjective methods, including the Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT), SARC-F, SARC-Calf, and RFH-Global Assessment (RFH-GA); and objective methods, including anthropometry, handgrip strength (HGS), the sit-and-stand test (15s), and appendicular skeletal muscle mass index (ASMI) by Dual-Energy X-ray Absorptiometry (DXA). Concordance between ASMI and traditional methods was analyzed. Significance was set at p < 0.05.

Results: a total of 45 patients were analyzed, with alcoholic liver disease being the most frequent etiology (44.4 %). The sit-and-stand test (15s) combined with muscle depletion by DXA diagnosed the most cases of sarcopenia (42.2 %). Moderate agreement was found between muscle depletion and isolated calf circumference (CC) (κ = 0.581; p < 0.001).

Conclusions: our study suggests excluding SARC-F and SARC-CalF from sarcopenia screening in outpatients with cirrhosis. While ASMI remains the most reliable diagnostic method, CC may serve as a feasible alternative when DXA is unavailable.