Nutricion hospitalaria最新文献

Introduction: Background and objective: identifying patients at high risk of avoidable readmission remains a challenge for healthcare professionals. Despite the recent interest in Machine Learning in this topic, studies are scarce and commonly using only black box algorithms. The aim of our study was to develop and validate in silico an interpretable predictive model using a decision tree inference to identify pediatric patients at risk of 30-day potentially avoidable readmissions. Methods: a retrospective cohort study was conducted with all patients under 18 years admitted to a tertiary university hospital. Demographic, clinical and nutritional data were collected from electronic databases. The outcome was the potentially avoidable 30-day readmissions. The J48 algorithm was used to develop the best-fit trees capable of classifying the outcome efficiently. Leave-one-out cross-validation was applied and we computed the area under the receiver operating curve (AUC). Results: the most important attributes of the model were C-reactive protein, hemoglobin and sodium levels, besides nutritional monitoring. We obtained an AUC of 0.65 and accuracy of 63.3 % for the full training and leave-one-out cross-validation. Conclusion: our model allows the identification of 30-day potentially avoidable readmissions through practical indicators facilitating timely interventions by the medical team, and might contribute to reduce this outcome.

Introduction:

Introduction:

Objective: this study assessed the association between serum 25(OH)D concentrations and anthropometric indicators of adiposity in people living with HIV/AIDS taking highly active antiretroviral therapy.

Methods: the study included 244 people living with HIV/AIDS who received outpatient care at the Institute of Tropical Diseases in the city of Teresina, Brazil. Sociodemographic, clinical, anthropometric and laboratory characteristics were examined. Serum 25(OH)D was analyzed by high-performance liquid chromatography in accordance with the Vitamin D Standardization Program. Multiple linear regression analysis adjusted for gender, age, disease stage and duration of highly active antiretroviral therapy was performed to assess the association between 25(OH)D concentrations and adiposity indicators.

Results: the study included 142 (58.2 %) men and 102 (41.8 %) women, with a mean (± SD) age of 39.13 (± 10.83) years. A proportion of 57.8 per cent of the participants had insufficient concentrations of 25(OH)D below 30 ng/mL. Individuals in more advanced stages of immunodeficiency had lower concentrations of 25(OH)D (30.30 ± 16.10 ng/mL) compared to those with mild immunodeficiency or no immunodeficiency. There was no significant association between 25(OH)D concentrations and any of the adiposity indicators considered in this study.

Conclusion: vitamin D concentrations in people living with HIV/AIDS using antiretroviral therapy are related to the degree of immunosuppression, but not to the individual's adiposity status.

Introduction: the NOA project analyses the nutritional care of cancer patients in different centres in Andalusia, establishes areas for improvement (phases 1 and 2) and evaluates its implementation during a period of 6 months (phase 3). The results of the different phases have been previously published.

Objectives: to evaluate the degree of implementation of the different measures in clinical practice 6 months after the end of the project (12 months after the start of the project) in the Hospital Puerta del Mar (Cádiz).

Methods: prospective evaluation of the percentage of patients with nutritional screening, during hospitalisation and in outpatient clinics of Medical Oncology and Radiation Oncology, of the participation of members of the Nutrition Unit in oncology committees and of the assessment of the patients presented at these sessions.

Results: during the duration of the project we observed a progressive increase in the percentage of patients with nutritional screening (both in hospitalised patients and in outpatients), a regular incorporation of members of the Nutrition Unit in tumour committees and an increase in the number of patients undergoing nutritional assessment and intervention. These results have been maintained after the end of the project.

Conclusions: the implementation of these measures has resulted in a change in the usual clinical practice in the nutritional care of cancer patients and an increase in the detection of patients in need of nutritional intervention.

Introduction: the emotional state influences the selection of foods that an individual consumes. In Colombia, no tool allows to detect the people most susceptible to develop emotional intake.

Objective: to validate the Emotional Intake Questionnaire-Garaulet in a student population of the National University of Colombia.

Methods: a cross-sectional descriptive observational study was conducted with a convenience sample of students in all the University's campuses in two stages employing the Spanish and the Colombian questionnaires through e-mail. Two questions were included in the survey, to assess the emotions of sadness and anxiety; a linearity relationship was established with the cut-off scores to maintain proportionality and preserve the dimensions of the study phenomenon.

Results: in phase 1, 1177 subjects participated, and in phase 2, 831 subjects participated. Of these, 63.6 % and 52.8 % were emotional and very emotional eaters in the Colombian and Spanish versions, respectively. Taking the total amount of people, 22.3 % were emotional and very emotional eaters with body mass index > 25 kg/m². In addition, 4.7 % had an eating disorder and 14.2 % had a psychiatric disorder. Finally, sensitivity, specificity, and positive and negative predictive values were 99.0 %, 49.3 %, 89.9 % and 91.2 %, respectively.

Conclusions: the Colombian version of the Emotional Eating Questionnaire demonstrates acceptable validity and reliability compared to the Spanish version. A high prevalence of emotional eaters was observed in the university population, which could be detected early through the use of this questionnaire. Suffering from this disorder is a risk factor for developing obesity and other metabolic diseases in the future.

Introduction: valproic acid (VPA) is a drug with narrow therapeutic index (50-100 µg/mL) with a high pharmacokinetic variability due to plasma protein binding saturation (PPBU).

Case report: we present a clinical case of a 60-year-old patient under treatment with VPA, whose plasma VPA concentrations were analyzed and a decrease in these concentrations was detected when administrated with protein supplement. When the intake was spaced out, VPA serum concentrations returned to the therapeutic range.

Discussion: administration with food does not appear to be important according to the majority of the literature available to date. However, this case seems to show that protein supplements can interact with VPA and it is important to space out the intake between them to minimize variation in plasma concentrations.

Background: cashew nut is an almond known for its cardiovascular benefits in adults and weight gain effects in malnourished children, as supported by research. However, its impact on overweight children remains unexplored.

Objective: to analyze the effect of consuming biscuits made with cashew nut flour on the blood glucose and serum triglyceride levels of children with overweight/obesity over four weeks.

Methods: a pilot, randomized, open-label clinical study was conducted with 19 overweight children (11 in intervention group 1 [G1] and 8 in group 2 [G2], aged between 7 and 15 years. Over four consecutive weeks, they consumed, daily, three biscuits with 50 % cashew nut flour composition (G1) and six biscuits with 50 % cashew nut flour composition (G2). The biomarkers analyzed were glycated hemoglobin (HbA1c), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and total cholesterol (TC) at baseline and seven days post-biscuit consumption.

Results: post-experiment, the TG (p = 0.153), HDL-C (p = 0.895), and TC (p = 0.122) biomarkers showed no significant changes. LDL-C levels experienced a slight but statistically significant increase of 0.52 % across all participants (p = 0.031). In contrast, non-HDL cholesterol levels saw a minor yet significant reduction of -1.7 % in serum concentration (p = 0.014). Independent of group allocation, the participants' HbA1c and average blood glucose levels significantly decreased by 12.1 % (p < 0.001) and 17.9 % (p < 0.001), respectively (Cohen's Δ = 1, in both instances).

Conclusion: consumption of biscuits containing cashew nut flour by overweight/obese children positively affected the reduction of blood glucose and non-HDL cholesterol biomarkers in both groups, regardless of the formulations used.

Background: animal studies have shown that enteral stimuli play an important role in modulating gut-associated lymphoid tissue.

Objective: the main objectives of this study were 1) to evaluate the effect of 3-day fasting on secretory immunoglobulin A (S-IgA) in parotid saliva and 2) to determine the levels of lymphotoxin (LT) transcription in peripheral blood mononuclear cells (PBMNC) from healthy volunteers as a proxy for studying GALT health.

Methods: these adult volunteers had fasted for three days as part of a cultural ritual. Eleven volunteers (seven men and four women) with a median age of 43 (40-56) were included. Parotid saliva and blood samples were collected on day 0 (no fasting) and three days after fasting. Parotid saliva was obtained using a modified on-Crittenden device, and S-IgA was quantified using ELISA. Total RNA was isolated from peripheral blood mononuclear cells, and the level of lymphotoxin (LT) mRNA expression was determined by RT-PCR. Lipopolysaccharide (LPS), IL-10 (interleukin), tumor necrosis factor (TNF)α, body composition and other metabolic indicators were measured.

Results: the median BMI was 27.3 kg/m2 (24.9-29.1). After 3 days of fasting, there were no significant differences in S-IgA concentrations (p = 0.657), LT expression (p = 0.063), LPS (p = 0.182), or IL-10 (p = 0.110). We found a statistical difference in TNFα levels (13.5 vs 11.3 pg/mL; p = 0.005) between the 0 and 3-day samples; TNFα decreased after fasting.

Conclusion: further studies are needed to clarify the role of LT in the production of S-IgA and its relationship with nutritional status and inflammatory factors.

Introduction: we aimed to analyze the predictive values of body mass index (BMI), prognostic nutritional index (PNI) and C-reactive protein to prealbumin ratio (CRP/PA) for the prognosis of patients receiving radical gastrectomy.

Materials and methods: one hundred patients subjected to radical gastrectomy from August 2015 to January 2018 were enrolled. The cut-off values of BMI, PNI and CRP/PA on the receiver operating characteristic (ROC) curves were obtained and applied to establish a low BMI group (n = 46) and a high BMI group (n = 54), a low PNI group (n = 48) and a high PNI group (n = 52), as well as a low CRP/PA group (n = 57) and a high CRP/PA group (n = 43).

Results and conclusion: through comparing the low BMI group with the high BMI group, there were differences in the tumor diameter, invasion depth, clinical stage, and lymph node metastasis status (p < 0.05). Differences were found in the invasion depth, tumor diameter, lymph node metastasis status, clinical stage, and postoperative adjuvant therapy in the low CRP/PA group compared with the high CRP/PA group (p < 0.05). The survival rate of all patients was 45.00 % (45/100) during the 5 years of follow-up. According to the Kaplan-Meier survival analysis, the low BMI group, low PNI group and high CRP/PA group had significantly reduced overall survival rates in comparison to those of the high BMI group, high PNI group and low CRP/PA group, respectively (p < 0.05). BMI, PNI and CRP/PA have important predictive values for the prognosis of patients undergoing radical gastrectomy.