Aims: This study was undertaken to report indications and practice of home enteral nutrition (HEN) in Europe.
Methods: A questionnaire on HEN practice was sent to 23 centres from Belgium (B), Denmark ...(D), France (F), Germany (G), Italy (I), Poland (P), Spain (S) and the United Kingdom (UK). This involved adult patients newly registered in HEN programme from 1 January 1998 to 31 December 1998.
Results: A total of 1397 patients (532 women, 865 men) were registered. The median incidence of HEN was 163 patients/million inhabitants/year (range: 62–457). Age distribution was 7.5%, 16–40 years; 37.1%, 41–65 years; 34.5%, 66–80 years and 20.9% >80 years. The chief underlying diseases were a neurological disorder (49.1%), or head and neck cancer (26.5%); the main reason for HEN was dysphagia (84.6%). A percutaneous endoscopic gastrostomy (58.2%) or a naso-gastric tube (29.3%) were used to infuse commercial standard or high energy diets (65.3%), or fibre diets (24.5%); infusion was cyclical (61.5%) or bolus (34.1%). Indications and feeds were quite similar throughout the different centres but some differences exist concerning the underlying disease. There was greater variation in the choice of tubes and mode of infusion. In F, G, I, S, and UK, costs of HEN are fully funded. In B, D, and P patients have to pay part or all of the charges.
Conclusions: In Europe, HEN was utilised mainly in dysphagic patients with neurological disorders or cancer, using a standard feed via a PEG. However, there were important differences among the countries in the underlying diseases treated, the routes used, the mode of administration and the funding.
To examine the relationship between several psychological factors and the feeling of burden experienced by caregivers of children with home enteral nutrition.
Fifty-six mothers of pediatric patients ...with chronic diseases requiring long-term home enteral nutrition were recruited. They were asked to respond to specific questionnaires about their anxiety symptoms (State-Trait Anxiety Inventory), psychological distress (SCL-90-R) and feeling of burden (Zarit-scale).
Caregivers' feeling of burden was found to be statistically associated to psychological distress (r = .516, p < .001) and trait anxiety (r = .376, p = .005). No significant differences were found between the type of diagnosis and caregiver burden. Regression analysis indicated psychological distress has a partial mediational effect in the relationship between trait anxiety and caregivers' burden.
Psychological distress and anxiety show a positive correlation with caregivers' feeling of burden, and may disrupt family well-being. Early identification of high-risk situations is essential in order to plan specific psychosocial aid efficiently.
our aim was to measure the osmolality of several PN formulas at different component concentrations to determine if equations described in literature to calculate osmolarity accurately predict ...osmolalality in other experimental conditions different than these used to develop them.
osmolality of 12 different types of PN solutions, 9 for central and 3 for peripheral perfusion were measured by using freezing point depression in cross-sectional study. We evaluated the agreement (Pearson correlation test) and differential bias between measured osmolality and calculated osmolarity for three different equations described in the literature: Pereira Da Silva, ASPEN Practice Manual and ASPEN guidelines.
mean ± SD osmolality of PN solutions was 1789 ± 256 (range 1 540 - 2 372) and 751 ± 64 mOsm/kg (range 689 - 817) for central and peripheral infusion, respectively. The osmolality of PN formulations was mainly due to glucose (r = 0.975) and amino acids (r = 0.948). All studied equations had a good correlation in the bivariate analysis (p = 0.000). All equations had a trend to underestimate the osmolality compared with the measured value. However, ASPEN guidelines equation overestimated the osmolality for peripheral PN.
measurement of osmolality of peripheral PN solutions is important to reduce the risk of phlebitis. The different equations described previously show a good correlation between them although in general underestimate the osmolality.
Hasta el infinito… y más allá Moreno Villares, José Manuel
Nutrición hospitalaria : organo oficial de la Sociedad Española de Nutrición Parenteral y Enteral,
2016, Letnik:
33, Številka:
1
Journal Article
Odprti dostop
Acaban de cumplirse 20 años del estreno de la película “Toy Story”, primera de la factoría Disney Pixar y que marcaría un hito en la animación cinematográfica. Con esa frase (“To infinity… and ...eyond”) el protagonista, Buzz Lightyear iniciaba su tarea, su reto, su misión…
the recent economic and financial crisis has affected most Western countries, especially families of low socioeconomic classes. We speculate that worsening of socioeconomic condition associated with ...the crisis would increase obesity, mainly in disadvantaged families.
cross-sectional study of the 290,111 children aged three to 12 years old attending public school during the term 2014-2015 in Madrid City, by means of a stratified weighted sample randomly chosen, taking into account age (grade), city district and schools. The questionnaire included weight and height (auto-reported), dietary report (weekly frequency of intake), as well as socioeconomic variables.
1,208 questionnaires were evaluated from 64 classes. Half of participants were boys; 42% were younger than five years old, 35% werebetween six and eight years old, and 23% older than eight. Undernutrition was present in 5.0%, and excess of weight (overweight + obesity) in 36.7%. Undernutrition was higher in children under the age of six (9.1%). No relationship was found between undernutrition and the characteristics of the families but was slightly higher in families where both parents were unemployed. Excess of weight was higher in children of non-Spaniard parents (44% vs 32%, p < 0.0001), as well as in those families with economic problems (41% vs 31%, p = 0.0005). Only for meat, grains and dairy, the weekly intake was close to the recommendations.
children from lower income households were at a higher risk of being overweight compared with their peers. Participation in a school-based food aid program may reduce food insecurity for children and their families.
Logros y retos de Nutrición Hospitalaria 2016-2017 Moreno, José Manuel; Olveira, Gabriel
Nutrición hospitalaria : organo oficial de la Sociedad Española de Nutrición Parenteral y Enteral,
01/2017, Letnik:
34, Številka:
1
Journal Article
Odprti dostop
Un edificio no se construye sino ladrillo a ladrillo. Y antes de construir ya hubo quien roturó el terreno y asentó los cimientos. Y cuando la construcción esté terminada otros diseñarán los ...interiores, la amueblarán y harán que sea no un edificio sino una casa. Una revista científica se parece un poco a una construcción: se trabaja por fases, se precisa la colaboración de muchos, busca ser hogar de todos.Hace un año asumíamos el reto de continuar la tarea de la anterior Dirección de Nutrición Hospitalaria. Bajo la dirección del actual director emérito, el Dr. Jesús Culebras, y del profesor Abelardo García de Lorenzo, la revista primero apareció en los repositorios internacionales de mayor prestigio y luego siguió un crecimiento progresivo hasta el lugar que ocupa hoy. Nuevo equipo directivo, nueva editorial. Muchos de los mimbres que la habían llevado a ocupar un lugar destacado en el mundo de las publicaciones sobre nutrición y dietética humana han continuado siendo su principal activo: el apoyo de las sociedades científicas, en especial de la SENPE, los editores adjuntos y los revisores. El camino, sin embargo, no ha sido fácil. Quedan flecos por pulir, objetivos por alcanzar.
La afectación hepática relacionada con la nutrición parenteral (PNALD) es un problema importante especialmente en los pacientes que requieren nutrición parenteral durante un tiempo prolongado y en ...los recién nacidos prematuros. La prevalencia es muy variable según las series y existen diferencias en la presentación entre los niños y los pacientes adultos. A pesar de haberse propuesto diferentes teorías en relación a la patogénesis del cuadro, su etiología no está bien definida. Es probable que intervengan varios factores al mismo tiempo. Podemos dividir los factores de riesgo de PNALD en tres grandes grupos: 1) derivados de la alteración de la función intestinal secundaria a la ausencia de estímulos enterales; 2) componentes de la NP que actúen como tóxicos para el hígado o la ausencia de determinados nutrientes que ocasionen afectación hepática, y 3) la contribución de la enfermedad de base. Cuando la NP es de corta duración y la afectación hepática se limita a una elevación de los enzimas de función hepática, generalmente no precisa ningún tratamiento. Cuando aparece una bilirrubina directa > 2 mg/dl durante un periodo largo y persiste la necesidad de NP es necesario primero descartar otras posibles causas de afectación hepática y luego minimizar los factores de riesgo. Se repasan en este artículo las distintas estrategias de manejo de la PNALD, incluyendo la estimulación enteral, el ajuste en el aporte de nutrientes, la adición de nutrientes específicos -taurina, colina- o el uso de fármacos coleréticos como el ácido ursodeoxicólico. Si la enfermedad hepática progresa puede llevar a una cirrosis y obligar a la realización de un trasplante hepato-intestinal.
Parenteral nutrition-associated liver disease Moreno Villares, J M
Nutrición hospitalaria : organo oficial de la Sociedad Española de Nutrición Parenteral y Enteral
23 Suppl 2
Journal Article
Parenteral nutrition associated liver disease (PNALD) is an important problem in patients who require longterm parenteral nutrition as well as in preterm infants. Prevalence varies according to ...different series. Clinical presentation is different in adults and infants. Although since its first descriptions several hypothesis have been elucidated, the aetiology is not quite clear. It is possible that different factors could be involved. PNALD risk factors can be classified in three groups: 1) those derived from the lack of enteral nutrition stimulus; 2) parenteral nutrition components acting as toxic or the lack of specific nutrients and 3) those due to the underlying disease. If PNALD appears in short-term PN and it presents only as a mild elevation of liver enzymes, there is no need to treat. On the contrary, when direct bilirubin is > 2 mg/dL and lasts longer, there is a need to consider different causes and to minimize risk factors. We review the different approaches to manage PNALD, including optimizing enteral nutrition, modify parenteral solutions, use of specific nutrients -taurine, choline, etc.- or the use of drugs (mainly ursodeoxicolic acid). If liver disease progresses to cirrhosis a liver transplant must be considered.
Home enteral nutrition (HEN) is a type of enteral nutrition (EN) which is becoming progressively more widespread in pediatrics due to the benefits it affords to patients, their families and to ...reducing hospital costs. However, the true extent of its use is unknown in Spain as the data-base set up for this purpose is still underused (Registro de Nutrición Enteral Pediátrica Ambulatoria y Domiciliaria -NEPAD-). More thorough registration of patients in the NEPAD online register will provide information about the characteristics of HEN in Spain: prevalence, diagnosis, the population sector being administered HEN, complications and developments. Likewise, forecast and planning of the necessary resources could be made while those in use could be analysed.
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