The aim of this study was to compare the metabolic benefits of diabetes-specific formulas (DSF) high in monounsaturated fatty acids (MUFA) with standard formulas (STDF) in adult patients with type 1, ...type 2 diabetes or stress-induced hyperglycaemia.
A systematic review and meta-analysis were conducted through a literature search using different electronic databases from the index date to December 2018. We included randomised controlled trials that assessed the health benefits of high MUFA DSF vs STDF. Included outcomes were glycaemic control, lipid metabolism and tolerance. Effect sizes were calculated as standardised mean differences (SMDs) (<0.4 were considered small, 0.4–0.7 moderate and >0.7 large). This systematic review was registered as CRD42018108931 on Prospero.
Of 385 references reviewed, 18 studies involving 845 adults met our inclusion criteria and contributed to the meta-analysis. Use of a high MUFA DSF compared with a STDF was associated with a statistically significant decrease in peak of postprandial glucose SMD −1.53, 95% confidence interval (CI) −2.44 to −0.61, incremental glucose response (SMD −1.19, 95% CI −1.71 to −0.68), area under the curve of plasma insulin (SMD −0.65, 95% CI −1.03 to −0.26), mean blood glucose level (SMD −0.41, 95% CI −0.63 to −0.19), glycosylated haemoglobin (HbA1c) change (SMD −0.63, 95% CI −1.21 to −0.05), glucose variability (SMD −0.93, −1.55 to −0.31), mean administered insulin dose (SMD −0.49, 95% CI −0.85 to −0.14), mean blood triglycerides (SMD −0.34, 95% CI −0.65 to −0.03) and increase of mean blood high-density lipoproteins (SMD +0.42, 95% CI 0.08 to 0.76). Non-significant differences were found for tolerance odds ratio (OR) 0.95, 95% CI 0.87 to 1.05.
This meta-analysis shows that a DSF (oral supplements and tube feeds) high in MUFAs can improve glucose control and metabolic risk factors among patients with diabetes or stress-induced hyperglycaemia compared with a STDF.
Resumen El desarrollo de programas preventivos eficaces, coste-efectivos y ampliamente accesibles es crucial para reducir la carga de enfermedad relacionada con los TCA. Los programas que usan ...enfoques basados en la disonancia y los cognitivo-conductuales son los más efectivos para la prevención selectiva. Los programas de prevención universal e indicada deben investigarse más. Y se deben expandir los programas a un rango más amplio de edades, razas y culturas, y abordar múltiples problemas de salud pública como la obesidad y los TCA, problemas relacionados con el peso con factores de riesgo compartidos. El Body Project, MABIC y ZARIMA son exitosos programas de prevención de los problemas relacionados con la alimentación y el peso (PRAP). También se deben realizar intervenciones universales en colaboración con programas de prevención del uso de drogas o conductas sexuales de riesgo. Una evaluación rigurosa de la eficacia, la efectividad, la implementación y la diseminación es necesaria. Podría ser óptimo implementar el Body Project con grupos dirigidos por pares para abordar las barreras asociadas con la intervención dirigida por un clínico. Las limitaciones de los programas tradicionales podrían superarse con intervenciones basadas en Internet y móviles. La intervención basada en Internet podría maximizar el alcance y el impacto de los esfuerzos preventivos. Sin embargo, las pruebas científicas actuales para la prevención de los TCA online son limitadas. Las intervenciones por Internet son menos efectivas que cara a cara, con tamaños del efecto pequeños o medianos.
Summary Background & aims The European Society for Clinical Nutrition and Metabolism (ESPEN) recently provided new diagnosis criteria of malnutrition and called to confirm those criteria in specific ...populations. The aims of our study were 1) to determine the prevalence of malnutrition according to the new ESPEN definition in elder hospitalized diabetic patients, and 2) to evaluate whether this new diagnosis of malnutrition predicted clinical outcomes in these patients. Methods 1014 hospitalized diabetic patients (≥65 years) from 35 hospitals in Spain were screened for being at risk of malnutrition using the short version of the Mini Nutritional Assessment. Subsequently, at risk individuals were considered malnourished if they met at least one of the two options: 1) body mass index (BMI) < 18.5 kg/m2 , or 2) unintentional weight loss >5% of their body weight with reduced BMI (<20 kg/m2 in subjects younger than 70 years or <22 kg/m2 in subjects older than 70 years). Results The new ESPEN definition, with MNA-SF as initial screening, identified 68 malnourished geriatric individuals with diabetes (6.73% of the cohort). Additionally, malnutrition lengthened the hospital stay, increased 2.7 times the odds of dying in hospital, and decreased to one third the odds of being discharged home. Conclusions Our study confirms that the new ESPEN definition for the diagnosis of malnutrition is a reliable tool that is capable of predicting clinical outcomes in a large population of elder hospitalized individuals with diabetes.
Abstract Objective To develop evidence-based recommendations for glycemic control of patients with diabetes mellitus or stress hyperglycemia receiving enteral nutrition. Methods A Delphi survey ...method using GRADE criteria for evaluation of suitable studies. Results In patients with diabetes or stress hyperglycemia and enteral nutrition support, we suggested the following: 1) to apply the same goals of metabolic control than for all diabetic patients; 2) that the caloric intake provided by enteral nutrition should be similar to that of patients without diabetes and with the same clinical condition; 3) to determine the percentage of macronutrients based on an individualized assessment of metabolic goals and comorbidities; 4) diabetes-specific enteral nutrition formulas should contain low glycemic index carbohydrates and a moderate or high percentage of monounsaturated fatty acids in relation to the total caloric value; 5) specific formulas for diabetes should contain fiber, although its presence is not a determining factor for reducing of postprandial glycemia; 6) the use of diabetes-specific hyperproteic formulas rather than standard hyperproteic formulas in mechanically-ventilated ICU patients since these formulas besides improving metabolic control may reduce respiratory infectious complications; 7) the use of diabetes-specific formulas for home enteral nutrition; and 8) insulin therapy with basal-bolus regimens for hospitalized patients with hyperglycemia and enteral feeding; and 9) postpyloric route for patients with diabetic gastroparesis requiring enteral feeding is strongly recommended. Benefits of supplementation with vitamins/minerals above standard requirements remain unclear. Conclusions These recommendations and suggestions regarding enteral feeding in patients with diabetes and hyperglycemia have direct clinical applicability.
RATIONALEPoor muscle quality in COPD patients relates to exercise intolerance and mortality. Muscle quality can be estimated on computed tomography (CT) by estimating psoas density (PsD). We tested ...the hypothesis that PsD is lower in COPD patients than in controls and relates to all-cause mortality. METHODSAt baseline, PsD was measured using axial low-dose chest CT images in 220 COPD patients, 80% men, who were 65±8 years old with mild to severe airflow limitation and in a control group of 58 subjects matched by age, sex, body mass index (BMI) and body surface area (BSA). COPD patients were prospectively followed for 76.5 (48-119) months. Anthropometrics, smoking history, BMI, dyspnoea, lung function, exercise capacity, BODE index and exacerbations history were recorded. Cox proportional risk analysis determined the factors more strongly associated with long-term mortality. RESULTSPsD was lower in COPD patients than in controls (40.5 vs 42.5, p=0.045). During the follow-up, 54 (24.5%) deaths occurred in the COPD group. PsD as well as age, sex, pack-year history, FEV1%, 6MWD, mMRC, BODE index, were independently associated with mortality. Multivariate analysis showed that age (HR 1.06; 95% CI 1.02-1.12, p=0.006) and CT-assessed PsD (HR 0.97; 95%CI 0.94-0.99, p=0.023) were the variables independently associated with all-cause mortality. CONCLUSIONSIn COPD patients with mild to severe airflow limitation, chest CT-assessed psoas muscle density was lower than in matched controls and independently associated with long-term mortality. Muscle quality using the easy to evaluate psoas muscle density from chest CT may provide clinicians with important prognostic information in COPD.
Background and objective
The availability of chest computed tomography (CT) imaging can help diagnose comorbidities associated with chronic obstructive pulmonary disease (COPD). Their systematic ...identification and relationship with all‐cause mortality have not been explored. Furthermore, whether their CT‐detected prevalence differs from clinical diagnosis is unknown.
Methods
The prevalence of 10 CT‐assessed comorbidities was retrospectively determined at baseline in 379 patients (71% men) with mild to severe COPD attending pulmonary clinics. Anthropometrics, smoking history, dyspnoea, lung function, exercise capacity, BODE (BMI, Obstruction, Dyspnoea and Exercise capacity) index and exacerbations rate were recorded. The prevalence of CT‐determined comorbidities was compared with that recorded clinically. Over a median of 78 months of observation, the independent association with all‐cause mortality was analysed. A ‘CT‐comorbidome’ graphically expressed the strength of their association with mortality risk.
Results
Coronary artery calcification, emphysema and bronchiectasis were the most prevalent comorbidities (79.8%, 62.7% and 33.9%, respectively). All were underdiagnosed before CT. Coronary artery calcium (hazard ratio HR 2.09; 95% CI 1.03–4.26, p = 0.042), bronchiectasis (HR 2.12; 95% CI 1.05–4.26, p = 0.036) and low psoas muscle density (HR 2.61; 95% CI 1.23–5.57, p = 0.010) were independently associated with all‐cause mortality and helped define the ‘CT‐comorbidome’.
Conclusion
This study of COPD patients shows that systematic detection of 10 CT‐diagnosed comorbidities, most of which were not detected clinically, provides information of potential use to patients and clinicians caring for them.
This multicentric study shows that chest computed tomography (CT) to evaluate the presence of 10 comorbidities detects important pathologies not diagnosed in the clinical management of those patients. While emphysema, coronary artery calcification (CAC) and bronchiectasis were the most prevalent CT‐detected comorbidities, CAC, bronchiectasis and low Psoas muscle density were independently associated with all‐cause mortality.
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Background
Diabetes and older age are associated with an increased risk of malnutrition and mortality. Recently, the Global Leadership Initiative on Malnutrition (GLIM) provided a 2‐step approach for ...the malnutrition diagnosis. In this study, we aimed to determine whether GLIM nutrition status at admission was associated with long‐term survival in elderly patients with type 2 diabetes mellitus (T2DM). Additionally, we aimed to identify which GLIM criteria were more able to become prognostic indicators of early or late death.
Methods
Our study included a convenience sample of 159 patients with T2DM older than 65 years and admitted to the internal medicine wards of different Spanish hospitals: the VIDA‐survival cohort. Nutrition status was retrospectively assessed with the new GLIM criteria. The main outcome was long‐term mortality in the cohort during an 8‐year follow‐up. Bivariate tables summarized the variables of interest. Kaplan‐Meier survival curves and adjusted Cox regressions were also performed.
Results
According to the GLIM criteria, we observed that the 35.8% and 16.3% of the VIDA‐survival cohort were categorized as having moderate and severe malnutrition, respectively. Severe malnutrition was associated with increased mortality (hazard ratio HR = 2.09; 95% CI, 1.29–3.38), compared with nonmalnourished participants. Moderate malnutrition had a neutral effect on all‐cause mortality (HR = 1.30; 95% CI, 0.88–1.92). Low plasma albumin levels, a surrogate marker of inflammation, were strongly associated with early mortality.
Conclusion
Our study provides evidence that severe malnutrition according to GLIM criteria is associated with increased long‐term all‐cause mortality among elderly individuals with T2DM.
Resumen La anorexia nerviosa es la enfermedad psiquiátrica más frecuente entre las mujeres jóvenes y se asume de origen multifactorial. Los criterios diagnósticos han sido recientemente modificados ...de forma que la amenorrea deja de formar parte de ellos. Esta enfermedad muestra una gran variabilidad en su presentación y gravedad, lo que condiciona diferentes abordajes terapéuticos y la necesidad de individualizar el tratamiento, haciéndose indispensable un enfoque multidisciplinar. Los objetivos persiguen restaurar el estado nutricional (a través de un plan dietético individualizado y basado en un patrón de consumo saludable), tratar las complicaciones y comorbilidades, la educación nutricional (basada en patrones alimentarios y nutricionales sanos), corrección de las conductas compensatorias y la prevención de recaídas. El tratamiento variará según la situación clínica del paciente, pudiendo realizarse en consultas externas (cuando existe estabilidad clínica), en hospital de día (modalidad intermedia entre el tratamiento ambulatorio tradicional y la hospitalización) o en hospitalización (fracaso del manejo ambulatorio o presencia de complicaciones médicas o psiquiátricas graves). La nutrición artificial a través del empleo de suplementos nutricionales orales, nutrición enteral y excepcionalmente nutrición parenteral puede ser necesaria en determinados escenarios clínicos. En pacientes severamente desnutridos se debe evitar el síndrome de realimentación. La anorexia nerviosa está asociada a numerosas complicaciones médicas que condicionan el estado de salud, la calidad de vida y que se relacionan estrechamente con la mortalidad. Existe poca evidencia clínica para evaluar los resultados de los distintos tratamientos en la anorexia nerviosa, estando basados la mayoría de las recomendaciones en consenso de expertos.
Resumen La bulimia nerviosa y el trastorno por atracón constituyen entidades nosológicas propias. Ambas muestran una gran variabilidad en su presentación y gravedad, lo que implica la ...individualización del tratamiento y la necesidad de equipos multidisciplinares. Los pacientes con bulimia nerviosa pueden presentar desde desnutrición y estados carenciales a exceso de peso, mientras que en los trastornos por atracón es habitual el sobrepeso u obesidad, que condiciona a su vez otras comorbilidades. Muchos de los síntomas y complicaciones derivan de las conductas compensatorias. Se dispone de diversas herramientas terapéuticas para el tratamiento de estos pacientes. El abordaje nutricional contempla el consejo dietético individualizado que garantice un adecuado estado nutricional y la correcta educación nutricional. Su objetivo es facilitar la adopción voluntaria de comportamientos alimentarios que fomenten la salud y que permitan la modificación a largo plazo de los hábitos alimentarios y el cese de conductas purgantes y atracones. El soporte psicológico es el tratamiento de primera línea y debe abordar el trastorno de la conducta alimentaria y las comorbilidades psiquiátricas que frecuentemente presentan. Los psicofármacos, aunque eficaces y ampliamente utilizados, no son imprescindibles. El manejo se realiza principalmente a nivel ambulatorio, siendo el hospital de día útil en pacientes seleccionados. Se debe reservar la hospitalización para corregir aquellas complicaciones somáticas o psiquiátricas graves o como medida de contención de las situaciones conflictivas no tratables de forma ambulatoria. La mayoría de las recomendaciones de las guías se basan en consensos de expertos, existiendo poca evidencia que evalúe los resultados clínicos y de coste-eficacia.
Background & aims: the last large multicenter study on disease-related malnutrition (DRM) in Spain (the PREDyCES study) showed a 23.7 % prevalence of malnutrition, according to the Nutritional Risk ...Screening (NRS-2002) tool. The main objective of the SeDREno study was to assess the prevalence of hospital malnutrition upon admission, according to GLIM criteria, ten years later. Methods: a cross-sectional, observational, multicenter study in standard clinical practice, conducted in 17 hospitals during a period of five to seven days. Patients were initially screened using the Malnutrition Universal Screening Tool (MUST), and then assessed using the GLIM criteria for diagnosis and severity grading. Results: a total of 2,185 patients, 54.8 % males, mean age 67.1 (17.0) years (50.2 % aged ≥ 70 years), were evaluated. Malnutrition was observed in 29.7 % of patients according to GLIM criteria (12.5 % severe, 17.2 % moderate). In patients ≥ 70 years malnutrition was observed in 34.8 %. The clinical conditions significantly associated with a higher prevalence of malnutrition were dysphagia (47.6 %), cognitive impairment (43.4 %), cancer (39.1 %), gastrointestinal disease (37.7 %), diabetes (34.8 %), and cardiovascular disease (33.4 %). The multivariate analysis revealed that gender, BMI, diabetes, cancer, gastrointestinal disorders, and polypharmacy were the main independent factors associated with DRM. Malnutrition was associated with an increase in length of hospital stay and death (p < 0.001). Conclusions: DRM in admitted patients has increased in Spain in the last 10 years paralleling ageing of the population. In the SeDREno study almost one in three patients are malnourished. A systematic assessment of nutritional status allows early detection and implementation of nutritional interventions to achieve a better clinical outcome.
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