Objective
To assess the impact of ambient temperature (AT) on the evolution of bodyweight in patients with heterogeneous types of cancer in advanced stages of the disease (stages III and IV) and ...anorexia- cachexia syndrome (ACS).
Methods
A prospective naturalistic multicenter study of patients undergoing oncological treatment at four hospitals during a three-year period (2017–2020) in the Autonomous Community of Extremadura in southwestern Spain with a continentalized Mediterranean climate of mild and relatively rainy winters, and particularly hot and sunny summers. Bodyweight changes were obtained from the medical records of 84 oncological patients (59 men and 25 women, age range 37–91 yrs). Mean monthly AT was used to examine the association of weight changes across cold and warm bimesters -BIMs (December and January, vs. July and August), Trimesters -TRIMs (July to September vs. December to February), and Semesters -SEMs (May to October vs. November to April). Weight changes between two consecutive weight measures were categorized as weight gain, weight loss, or no weight change. Differences across cold and warm seasons were analysed using parametric (ANOVA), and nonparametric statistics (Chi-square and binomial z tests). An alpha-rate of 0.05 was used for all analyses.
Results
A weight loss trend was observed during BIMs cold periods in comparison to warm ones (
p
0.04). However, differences in average bodyweight were not significant. The negative impact of cold periods was more marked in men than in women, (
p
= 0.05;
p
= 0.03, for cold vs. warm BIMs and TRIMs, respectively). In contrast, significantly higher weight gain percentages were found in women during warm TRIMs and SEMs (
p
= 0.03, and
p
= 0.01, respectively). As for the number of patients dying during the study (
N
= 56; 39 men, 17 women), there were a significant interaction between temperature (cold/warm), and mean weight
F (
1, 499) = 6.06,
p
= 0.01, which revealed a pattern of weight loss in the cold semester as opposed to weight gain during the warm SEM months.
Conclusions
AT temperature modulated body weight changes in patients with advanced oncological disease and ACS. Two main limitations of the study were the absence of information on diets as a moderating factor of weight loss/gain, and the lack of the patients’ weight measurements closest to the date of diagnosis prior to admittance to the study. As for the practical implications, it remains to be seen whether an adjunctive heat supply will serve a buffering effect on weight loss during colder seasons for patients with advanced cancer and ACS.
Small increases in temperature result in enhanced elongation of the hypocotyl and petioles and hyponastic growth, in an adaptive response directed to the cooling of the leaves and to protect the ...shoot meristem from the warm soil. This response, collectively termed as thermomorphogenesis, relies on the faster reversion of phyB Pfr at warmer temperatures, which leads to enhanced activity of the basic-helix-loop-helix PHYTOCHROME INTERACTING FACTOR 4 (PIF4). PIF4 acts as a molecular hub integrating light and temperature cues with endogenous hormonal signaling, and drives thermoresponsive growth by directly activating auxin synthesis and signaling genes. Growth promotion by PIF4 depends on brassinosteroid (BR) signaling, as indicated by the impaired thermoresponse of BR-defective mutants and the partial restoration of
pifq
thermoresponsive defects by brassinolide (BL) application. Also, phyB limits thermomorphogenic elongation through negative regulation of the E3 ubiquitin ligase COP1 that triggers nuclear degradation of multiple photomorphogenesis-promoting factors acting antagonistically to PIF4. COP1 is indeed observed to accumulate in the nucleus in darkness, or in response to warm temperatures, with constitutive photomorphogenic
cop1
mutants failing to respond to temperature. Here we explored the role of BR signaling on COP1 function, by growing
cop1
seedlings on BL or the inhibitor
brassinazole
(BRZ), under different light and temperature regimes. We show that weak
cop1
alleles exhibit a hyposensitive response to BL. Furthermore, while
cop1-6
mutants display as described a wild-type response to temperature in continuous darkness, this response is abolished by BRZ. Application of this inhibitor likewise suppressed temperature-induced COP1 nuclear accumulation in
N. benthamiana
leaves. Overall these results demonstrate that
cop1-6
is not a temperature-conditional allele, but this mutation allows for a partially active protein which unveils a pivotal role of active BR signaling in the control of COP1 activity.
(1) Background: Hyperglycaemia that occurs during enteral nutrition (EN) should be prevented and treated appropriately since it can have important consequences for morbidity and mortality. However, ...there are few quality studies in the literature regarding the management of EN in this situation. The objective of this project was to attempt to respond, through a panel of experts, to those clinical problems regarding EN in patients with diabetes or stress hyperglycaemia (hereinafter referred to only as hyperglycaemia) for which we do not have conclusive scientific evidence; (2) Methods: The RAND/UCLA Appropriateness Method, a modified Delphi panel method, was applied. A panel of experts made up of 10 clinical nutrition specialists was formed, and they scored on the appropriateness of EN in hyperglycaemia, doing so in two rounds. A total of 2992 clinical scenarios were examined, which were stratified into five chapters: type of formula used, method of administration, infusion site, treatment of diabetes, and gastrointestinal complications. (3) Results: consensus was detected in 36.4% of the clinical scenarios presented, of which 23.7% were deemed appropriate scenarios, while 12.7% were deemed inappropriate. The remaining 63.6% of the scenarios were classified as uncertain; (4) Conclusions: The recommendations extracted will be useful for improving the clinical management of these patients. However, there are still many uncertain scenarios reflecting that the criteria for the management of EN in hyperglycaemia are not completely standardised. More studies are required to provide quality recommendations in this area.
Hyponatremia is frequent in hospitalized patients, especially in those receiving total parenteral nutrition (TPN). Furthermore, the presence of hyponatremia is associated with increased ...morbimortality in both groups. The goal of this study is to describe the prevalence of hyponatremia developing during TPN in non-critical patients, and identify risk factors for its appearance.
This prospective multicenter study involved 19 Spanish hospitals. Noncritically-ill patients prescribed TPN over a 9-month period were studied. Variables analyzed demographic characteristics, prior comorbidities, drug therapy, PN composition, additional iv fluids, and serum sodium levels.
A total of 543 patients were recruited, 60.2% males. Age: 67 (IR 57–76). Of 466/543 who were eunatremic when starting TPN, 18% developed hyponatremia (serum sodium < 135 mmol/L) during TPN. Independent risk factors identified by logistic regression analysis: female (OR 1.74 95% CI = 1.04–2.92, p = 0.036); severe malnutrition (OR 2.15 95% CI = 1.16–4.35, p = 0.033); opiates (OR 1.97 95% CI = 1.10–3.73, p = 0.036); and nausea/vomiting (OR 1.75 95% CI = 1.04–2.94, p = 0.036).
Previously eunatremic patients frequently develop hyponatremia while receiving TPN. In this group, severe malnutrition is an independent risk factor for hyponatremia, as well as previously described risk factors: opiates, nausea/vomiting, and female gender.
•Total Parenteral Nutrition (TPN) patients are at high risk for development of hyponatremia, with 18% of previously eunatremic patients developing it during TPN.•Severe malnutrition was the most important risk factor for development of hyponatremia during TPN.•The total amount of sodium and liquids administered did not influence the development of hyponatremia during total parenteral nutrition.
Introduction: the SARS-CoV-2 pandemic has forced major organizational and care changes in the health system. However, in Spain, the circumstances suffered by the health professionals who have cared ...for pandemic patients from a clinical nutrition standpoint has remained unknown up to this moment. Objectives: the management and care changes made in clinical nutrition units in Spain, and their impact on clinical practice are described. Material and methods: a cross-sectional study was carried out using a survey directed at SENPE members (June 2020). Responses sent by health professionals in the field of clinical nutrition who had treated patients with COVID-19 in Spanish hospitals were included in the study. Resultados: a total of 116 survey forms were analyzed, mostly filled out by doctors (57.8 %) working at hospitals with more than 500 beds (56 %); 46 % of survey respondents were on telework. There was a nutritional care plan in 68 % of cases, such plan being present mainly in hospitals with more than 500 beds (p < 0.001). In these hospitals more specific diets for COVID-19 were implemented than in those under 500 beds: 18 (35.3 %) vs 44 (67.7 %), (p < 0.001). The use of recommendations issued by scientific societies was reported in 86 % of cases. Never or almost never could a satisfactory nutritional assessment be performed for 38.8 %. The prescription of nutritional supplements was not less than 50 %. Health workers rated their performance as satisfactory or very satisfactory (51.7 %), and this was not related to hospital size but to having implemented a COVID-19 diet (p < 0.05). Conclusions: clinical nutrition in Spain has responded to the COVID-19 pandemic with organizational and managerial changes and, although care has been clearly affected, some quality standards were ultimately maintained. Larger hospitals have had some advantages in making these adjustments.
Introducción: La malnutrición es un problema médico frecuente de los pacientes oncológicos que impacta de forma negativa en la calidad de vida. Objetivo: analizar y dar respuesta a diferentes ...cuestiones a la hora de afrontar el manejo nutricional de un paciente oncológico en la práctica clínica. Métodos: Un grupo multidisciplinar de expertos en Oncología Médica, Farmacia y Nutrición elaboró una lista de temas relacionados con el estado nutricional del paciente oncológico, que fueron agrupados en tres bloques: soporte nutricional; nutrición parenteral (NP) y NP domiciliaria (NPD) en el paciente oncológico. Se realizó una revisión de la literatura que incluyó artículos publicados en español, inglés y francés hasta abril de 2017. El documento se estructuró como un cuestionario con aquellas preguntas que, según el criterio del panel, podrían generar mayor controversia o duda. Resultados: De las 17 cuestiones abordadas, 9 versaron sobre el soporte nutricional; 5 relacionadas con la NP y 3 trataron sobre la NPD. Dentro de las recomendaciones del panel destacar que, en el paciente oncológico, la NP está indicada principalmente cuando no es posible el uso del tubo digestivo y/o la alimentación oral y/o la nutrición enteral no es suficiente o posible. Además, el objetivo de la NPD es mejorar o mantener, el estado de nutrición de un paciente en el ámbito domiciliario. Conclusiones: Esta revisión constituye una herramienta para oncólogos y especialistas responsables del manejo nutricional del paciente con cáncer.
Resumen Introducción: la pandemia ocasionada por el SARS-CoV-2 ha obligado a realizar importantes cambios organizativos y asistenciales en el sistema sanitario. Sin embargo, hasta ahora se desconoce ...cuáles han sido las circunstancias que han sufrido los profesionales sanitarios que han atendido esta pandemia desde los servicios de nutrición clínica en España. Objetivos: describir los cambios de gestión y asistenciales realizados en las unidades de nutrición clínica en España y su repercusión en la práctica clínica. Material y métodos: estudio transversal mediante técnica de encuesta dirigida a socios de la SENPE (junio 2020). Se incluyen en el estudio respuestas remitidas por profesionales sanitarios del ámbito de la nutrición clínica que atendieron a pacientes con COVID-19 en hospitales españoles. Resultados: se analizan 116 encuestas provenientes en su mayoría de médicos (57,8 %) y de hospitales de más de 500 camas (56 %); el 46 % de los encuestados teletrabajó. Se contó con la presencia de un plan de atención nutricional en el 68 % de los casos, plan que fue mayoritario en los hospitales con más de 500 camas (p < 0,001). En estos hospitales se implantaron más dietas específicas para COVID-19 que en los menores de 500 camas: 18 (35,3 %) vs. 44 (67,7 %), (p < 0,001). El uso de las recomendaciones de las sociedades científicas se notificó en el 86 % de los casos. El 38,8 % nunca o casi nunca pudieron hacer una valoración nutricional satisfactoria. La prescripción de suplementos nutricionales fue no inferior al 50 %. El 51,7 % de los encuestados calificaron su actuación como satisfactoria o muy satisfactoria, y esta no se relacionó con el tamaño de hospital pero sí con haber implantado una dieta para la COVID-19 (p < 0,05). Conclusiones: la nutrición clínica en España ha respondido a la pandemia de COVID-19 con cambios organizativos y de gestión y, aunque la asistencia se ha visto claramente afectada, se han podido mantener algunos estándares de calidad. Los hospitales de mayor tamaño han tenido cierta ventaja para realizar estos ajustes.
Process of medical nutrition therapy Martín Folgueras, Tomás; Vidal Casariego, Alfonso; Álvarez Hernández, Julia ...
Nutrición hospitalaria : organo oficial de la Sociedad Española de Nutrición Parenteral y Enteral,
10/2022, Letnik:
39, Številka:
5
Journal Article
Odprti dostop
IntroductionMedical nutrition therapy is a very useful tool in maintaining and recovering the health of patients with disease-related malnutrition, although its implementation can be complex and is ...not without risks. Quality processes are understood as sets of activities that are related or interact to transform input elements into results. From the SENPE Management Work Group we present the process of medical nutrition therapy (PMNT), which aims to facilitate the management of clinical nutrition of a multidisciplinary nutrition support team in a hospital setting. This paper describes the seven sub-processes PMNT is comprised of, in addition to a previous nutritional screening sub-process. Each sub-process is divided into a first section with a technical sheet detailing its general aspects, while a second section proposes key objectives, quality indicators, and standards for their evaluation. .
Resumen Objetivo: exponer los resultados del registro de nutrición enteral domiciliaria (NED) de los años 2016 y 2017 del Grupo NADYA-SENPE. Material y métodos: se recopilaron los pacientes ...introducidos en el registro del 1 de enero al 31 de diciembre de 2016 y la mismas fechas de 2017 para proceder al análisis descriptivo y analítico de los datos. Resultados: en el año 2016 se obtuvieron 4.578 pacientes activos (prevalencia = 98,33 pacientes/millón de habitantes) y en 2017 fueron 4.777 (prevalencia = 102,57). Por sexos, hubo un 50,8% de varones en 2016 y un 50,5% en 2017. En el periodo 2016-17, la edad mediana fue de 71,5 años (IIQ 57-83); asimismo, finalizaron 1.558 episodios de NED y la causa principal fue el fallecimiento (793 pacientes, 50,89%). Los varones adultos fueron más jóvenes que las mujeres (65,3 vs. 73,3 años, p-valor < 0,001) y el diagnóstico más frecuente fue la enfermedad neurológica que cursa con afagia o disfagia severa (59%). La sonda nasogástrica (SNG) fue la vía de acceso más utilizada (48,3%) y se observa, además, que esta es la vía que se utiliza en los pacientes más ancianos (p < 0,001). Se registraron 126 pacientes pediátricos (57,1% niñas). La edad mediana de inicio de la NED fue de cuatro meses. Otras patologías fue el grupo diagnóstico más registrado (41,3%), seguido por la enfermedad neurológica que cursa con afagia o disfagia severa. Se alimentaban a través de gastrostomía en el 57,6% de los casos. Se observó que los niños más pequeños eran los que se alimentaban preferentemente por SNG (p-valor 0,001). Conclusiones: el número de pacientes del registro, así como el número de centros participantes, se va incrementando progresivamente. Las principales características de los pacientes no han variado. A pesar del aumento de posibilidades diagnósticas en la población pediátrica, llama la atención la clasificación dentro del grupo de Otras patologías.
Bioelectrical impedance analysis (BIA) serves as a method to estimate body composition. Parameters such as phase angle (PA), standardized phase angle (SPA), body mass cell (BCM), BCM index (BCMI), ...and fat-free mass (FFM) might significantly impact the prognosis of head and neck cancer (HNC) patients. The present study aimed to investigate whether bioelectrical parameters can be used to predict survival in the HNC population and establish the optimal cutoff points for predictive accuracy.
A multicenter observational study was performed across 12 tertiary hospitals in Andalusia (a region from the south of Spain). A total of 494 patients diagnosed with HNC between 2020 and 2022 at different stages were included in this study, with a minimum follow-up period of 12 months. The BIA assessment was carried out during the first 2 weeks of radical radiotherapy treatment with chemotherapy or other systemic treatments. A multivariate logistic regression analysis of overall survival, complications, hospital admission, and palliative care and its relationship with BIA nutritional assessment was performed.
Significant prognostic factors identified in the multivariable analysis encompassed phase angle (PA), standardized phase angle (SPA), body cell mass (BCM), and BCM index (BCMI). Lower PA and BCM values were significantly associated with adverse clinical outcomes. A BCM threshold above 17 kg/m
was the most significant predictor for predicting survival within the overall HNC population. The PA values of <5.1° in male and <4.8° in female patients showed the best predictive potential for mortality. Increased PA (as a continuous variable) demonstrated a significantly reduced risk for mortality (OR, 0.64; 95% CI, 0.43-0.94;
< 0.05) and a decreased likelihood of hospital admission (OR, 0.75; 95% CI, 0.52-1.07;
< 0.05). Higher BCM correlated with a lower risk of mortality (OR, 0.88; 95% CI, 0.80-0.96;
< 0.01) and a diminished probability of hospital admission (OR, 0.91; 95% CI, 0.83-0.99;
< 0.05).
BIA is a crucial tool in the nutritional assessment of HNC patients. BCM and PA are the main bioelectrical parameters used to predict clinical outcomes in this population. Future studies are needed to validate BIA variables in a large cohort to ensure whether early intensification of nutritional treatment would improve survival.
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