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Miguélez M, Velasco C, Camblor M, Cedeño J, Serrano C, Bretón I, Arhip L, Motilla M, Carrascal M, Olivares P, Morales A, Brox N, Cuerda C. Nutritional management and clinical outcome of critically ill patients with COVID-19: A retrospective study in a tertiary hospital. Clin Nutr 2022; 41:2940-2946. [PMID: 34782169 PMCID: PMC8559438 DOI: 10.1016/j.clnu.2021.10.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 10/26/2021] [Accepted: 10/27/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND & AIMS Severe COVID-19 infection is characterized by an inflammatory response and lung injury that can evolve into an acute respiratory distress syndrome that needs support treatment in intensive care unit. Nutritional treatment is an important component of the management of critically ill patients and should be started in the first 48 h of ICU admission to avoid malnutrition. This study describes the characteristics of the patients treated in a tertiary hospital in Madrid during the months of March-May 2020 (first wave), the medical nutrition treatment employed and its influence in the clinical outcome of these patients. METHODS This is a retrospective study including COVID-19 patients admitted in ICU that needed medical nutrition treatment (MNT). Collected variables included sex, age, BMI, underlying diseases, time from hospitalisation to ICU admission, type of respiratory support (invasive mechanical ventilation (IMV) or high flow nasal cannula (HFNC) or non-invasive ventilation (non-IMV)), caloric and protein requirements (25 kcal/kg adjusted body weight (ABW), 1.3 g/kg ABW/day), MNT type (enteral nutrition (EN), parenteral nutrition (PN), mixed EN + PN), total calories (including propofol) and proteins administered, percentage of caloric and protein goal in ICU day 4th and 7th, metabolic complications, acute kidney failure (AKF), length of stay (LOS) and mortality. Data are expressed as mean ± SD, median (IQR) or frequencies. Statistical analysis was performed with the IBM SPSS Statistics for Windows, Version 25.0. p < 0.05 were considered statistically significant. RESULTS A total of 176 patients were included (72.7% male), 60.1 ± 13.5 years, BMI 29.9 ± 5.4 kg/m2. Underlying diseases included 47.4% overweight, 39.8% obesity, 49.1% hypertension, 41.4% dyslipidaemia. 88.6% of patients needed IMV, 89.1% prone position, 2.9% ECMO. Time to ICU admission: 2 (4.75) days. Estimated caloric and protein requirements were 1775 ± 202 kcal and 92.4 ± 10.3 g. Calories and proteins administered at days 4th and 7th were 1425 ± 577 kcal and 66 ± 26 g and 1574 ± 555 and 74 ± 37, respectively. Most of the patients received PN (alone or complementary to EN) to cover nutritional requirements (82.4% at day 4th and 77.9% at day 7th). IVM patients received more calories and proteins during the first week of ICU admission. Complications included 77.8% hyperglycaemia, 13.2% hypoglycaemia, 83.8% hypertriglyceridemia, and 35.1% AKF. ICU LOS was 20.5 (26) days. The mortality rate was 36.4%. CONCLUSIONS In our series, the majority of patients reached energy and protein requirements in the first week of ICU admission due to the use of PN (total or complementary to EN). Patients with HFNC or non-IMV may be at risk of malnutrition if total or complementary PN to oral diet/ONS/tube feeding is not used to cover nutritional requirements. Therefore, if EN is not possible or insufficient, PN can be safely used in critically ill patients with COVID-19 with a close monitoring of metabolic complications.
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Affiliation(s)
- M. Miguélez
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - C. Velasco
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain,Corresponding author. Nutrition Unit, Hospital General Universitario Gregorio Marañón, c/ Doctor Esquerdo 46, 28007, Madrid, Spain
| | - M. Camblor
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - J. Cedeño
- Intensive Care Service. Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - C. Serrano
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - I. Bretón
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - L. Arhip
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - M. Motilla
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - M.L. Carrascal
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - P. Olivares
- Intensive Care Service. Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - A. Morales
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - N. Brox
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - C. Cuerda
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
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Morales Cerchiaro Á, Velasco C, Frías L, Carrascal M, Arhip L, Serrano C, Motilla M, Bretón I, Camblor M, Cuerda C. Fulfilment of the phenotypic and etiological criteria when diagnosing malnutrition according to the glim criteria. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2020.09.187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Morales Cerchiaro Á, Velasco C, Frías L, Carrascal M, Arhip L, Motilla M, Serrano C, Bretón I, Camblor M, Cuerda C. Our experience implementing glim criteria to diagnose malnutrition at hospital. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2020.09.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Compés CC, Gimeno CV, Miguelez M, Carrascal M, Romero R, Carrasco P, Serrano C, Bretón I, Motilla M, Arhip L, Morales Á, Rubio S, Calvo C, Wong J, Camblor M. Nutritional treatment in critically ill patients with COVID-19 disease: Spanish experience in a nniversity hospital (Extended). Clin Nutr ESPEN 2020. [PMCID: PMC7834358 DOI: 10.1016/j.clnesp.2020.09.685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/30/2022]
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Carrascal M, Arhip L, Rubio S, Morales A, Velasco C, Cuerda C, Bretón I, Motilla M, Serrrano C, Camblor M. Pre-surgical assessment of dietary intake of patients with peritoneal carcinomatosis who are undergoing cytoreductive surgery and hyperthermic intraoperative chemotherapy. Preliminary results. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2020.09.767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Cuerda C, Velasco C, Miguélez M, Romero R, Carrasco P, Serrano C, Bretón I, Motilla M, Arhip L, Morales Á, Carrascal M, Rubio S, Calvo C, Camblor M. Nutritional treatment in critically ill patients with COVID-19 disease: spanish experience in a university hospital. Clin Nutr ESPEN 2020. [PMCID: PMC7831567 DOI: 10.1016/j.clnesp.2020.09.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Picallo M, Sandoval D, Lago J, Zabalegui A, Juane A, Arhip L, Bretón I, Camblor M, Motilla M, Velasco C, García-Peris P, Cuerda C. Medical nutrition therapy of ICU patients undergoing extracorporeal membrane oxygenation treatment (ECMO). Clin Nutr 2018. [DOI: 10.1016/j.clnu.2018.06.1614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Arhip L, García-Peris P, Romero R, Frías L, Bretón I, Camblor M, Motilla M, Velasco C, Morales Á, Carrascal M, Herranz A, Sanjurjo M, Cuerda C. Economic appraisal of a home parenteral nutrition programme. Clin Nutr 2018. [DOI: 10.1016/j.clnu.2018.06.1510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Arhip L, García-Peris P, Romero RM, Frías L, Bretón I, Camblor M, Motilla M, Velasco C, Morales A, Carrascal ML, Herranz A, Sanjurjo M, Cuerda C. Direct costs of a home parenteral nutrition programme. Clin Nutr 2018; 38:1945-1951. [PMID: 30005903 DOI: 10.1016/j.clnu.2018.06.972] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 05/06/2018] [Accepted: 06/21/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND & AIMS Home parenteral nutrition (HPN) is a lifesaving treatment for people with chronic intestinal failure and its cost has been reported to be very high. The purpose of the present paper was to study the direct healthcare and non-healthcare costs associated with the HPN programme managed by a tertiary hospital. METHODS Observational, retrospective study of all adult patients on HPN from 11.1.2014 to 10.31.2015 treated at Gregorio Marañón University Hospital (Madrid, Spain). An economic evaluation was undertaken to calculate the direct healthcare (HPN provision, outpatient monitoring and management of complications) and non-healthcare costs (transportation process) of the HPN programme. The variables were collected from medical records, the dispensary and the hospital's financial services. The unit costs were taken from official price lists. RESULTS Thirty-two patients met the inclusion criteria. Total direct healthcare and non-healthcare costs amounted to €13,363.53 per patient (€124.02 per patient per day). The direct healthcare costs accounted for 98.32% of overall costs, while the non-healthcare costs accounted for the remaining 1.68%. HPN provision accounted for the majority of the costs (74.25%), followed by management of complications (21.85%) and outpatient monitoring (2.23%). CONCLUSIONS The direct healthcare costs accounted for the majority of HPN expenditure, specifically HPN provision was the category with the highest percentage.
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Affiliation(s)
- L Arhip
- Nutrition Unit, University General Hospital Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Universidad Complutense de Madrid, Madrid, Spain.
| | - P García-Peris
- Nutrition Unit, University General Hospital Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - R M Romero
- Pharmacy Service, University General Hospital Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - L Frías
- Nutrition Unit, University General Hospital Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - I Bretón
- Nutrition Unit, University General Hospital Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - M Camblor
- Nutrition Unit, University General Hospital Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - M Motilla
- Nutrition Unit, University General Hospital Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - C Velasco
- Nutrition Unit, University General Hospital Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - A Morales
- Nutrition Unit, University General Hospital Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - M L Carrascal
- Nutrition Unit, University General Hospital Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - A Herranz
- Pharmacy Service, University General Hospital Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - M Sanjurjo
- Pharmacy Service, University General Hospital Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - C Cuerda
- Nutrition Unit, University General Hospital Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
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Bretón I, Gutiérrez G, Velasco C, Cuerda C, Arhip L, Maíz M, Muñoz-Blanco J, García-Peris P. SUN-P107: Nutritional and Micronutrient Status in Bulbar and Spinal Onset Amyotrophic Lateral Sclerosis Patients. Clin Nutr 2016. [DOI: 10.1016/s0261-5614(16)30450-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Camblor M, Carrascal M, Velasco C, Higuera I, Cuerda C, Bretón I, Vásquez W, González Bayón L, García Sabrido J, García Peris P. PP097-SUN: One Year Evolution of Nutritional and Quality of Life Status in Patients Undergoing Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. Clin Nutr 2014. [DOI: 10.1016/s0261-5614(14)50139-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Mazure RA, Cancer E, Martínez Olmos MA, De Castro ML, Abilés V, Abilés J, Bretón I, Álvarez V, Peláez N, Culebras JM. [Adherence and fidelity in patients treated with intragastric balloon]. NUTR HOSP 2014; 29:50-6. [PMID: 24483961 DOI: 10.3305/nh.2014.29.1.7022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 10/09/2013] [Indexed: 12/01/2022] Open
Abstract
A correct treatment of obesity needs a program of habits modification regardless of the selected technique, especially if it is minimally invasive as the intragastric balloon (BIG). The adherence of the obese patients with regard to recommended drugs measures to medium- and long-term is less than 50%. Given that the results obtained using the technique of gastric balloon must be seen influenced by adherence to the modification of habits program and its fulfillment, we reviewed series published in attention to the program proposed with the BIG. The series published to date provide few details about the used Therapeutic Programs as well as the adherence of patients to them, and even less concerning the Monitoring Plan and the loyalty of the patient can be seen. We conclude the convenience to agree on a follow-up strategy, at least the 6 months during which the BIG remain in the stomach.
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García-Peris P, Velasco C, Lozano MA, Moreno Y, Paron L, de la Cuerda C, Bretón I, Camblor M, García-Hernández J, Guarner F, Hernández M. Effect of a mixture of inulin and fructo-oligosaccharide on Lactobacillus and Bifidobacterium intestinal microbiota of patients receiving radiotherapy: a randomised, double-blind, placebo-controlled trial. NUTR HOSP 2013; 27:1908-15. [PMID: 23588438 DOI: 10.3305/nh.2012.27.6.5992] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2012] [Accepted: 07/15/2012] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND & AIMS The pathogenesis of enteritis after abdominal radiotherapy is unknown, although changes in faecal microbiota may be involved. In several studies, Lactobacillus and Bifidobacterium have proven beneficial for the host. Prebiotics stimulate the proliferation of Lactobacillus and Bifidobacterium, and this may have positive effects on the intestinal mucosa during abdominal radiotherapy. METHODS We performed a randomised double-blind, placebo-controlled trial including 31 patients with gynaecological cancer who received radiotherapy (29 sessions, 52.2 Gy) after surgery. Patients were randomised to two groups: prebiotic and placebo. The first group received a mixture of fibre (50% inulin and 50% fructo-oligosaccharide) and the second received 6 g of maltodextrin twice daily from one week before to three weeks after radiotherapy. Lactobacillus and Bifidobacterium counts were determined in faeces samples (day -7 before radiotherapy, day 15 of radiotherapy, at the end of treatment, and three weeks after radiotherapy) by culture in selective media and fluorescent in situ hybridization (FISH) using genus-specific probes. Bacterial counts by FISH were significantly higher than by culture method. RESULTS There were no differences in baseline microbiota between groups. At the end of radiotherapy, we observed a statistically significant decrease in Lactobacillus and Bifidobacterium counts in both groups. By cultural analysis, we observed higher numbers of Lactobacillus and Bifidobacterium three weeks after radiotherapy in the prebiotic group (5.6 vs. 6.3, p = 0.04 and 5.5 vs. 6 log cfu/g, p = 0.03). CONCLUSIONS Abdominal radiotherapy negatively affects Lactobacillus and Bifidobacterium counts. The prebiotic mixture of inulin and fructoligosaccharide can improve the recovery of both genera after radiotherapy. Registered under ClinicalTrials.gov Identifier no. NCT01549782.
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Affiliation(s)
- P García-Peris
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
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Camblor M, Carrascal M, Velasco C, Higuera I, Cuerda C, Bretón I, Vasquez W, Gonzalez Bayón L, García Sabrido J, García-Peris P. PP107-MON SHORT TERM EVOLUTION OF NUTRITIONAL STATUS IN PATIENTS UNDERGOING CYTOREDUCTIVE SURGERY AND HYPERTHERMIC INTRAPERITONEAL CHEMOTHERAPY. Clin Nutr 2013. [DOI: 10.1016/s0261-5614(13)60418-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Cuerda C, Higuera I, Velasco C, Bretón I, Camblor M, Frías L, Carrascal M, Romero R, García-Peris P. PP126-MON HOME PARENTERAL NUTRITION (HPN) IN A GENERAL HOSPITAL: DESCRIPTIVE STUDY OF 26 YEARS OF ACTIVITY. Clin Nutr 2013. [DOI: 10.1016/s0261-5614(13)60437-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Tapia M, Olveira G, Ocón J, Cabrejas-Gómez C, Ballesteros-Pomar M, Vidal-Casariego A, Arraiza-Irigoyen C, Olivares J, Conde-García M, García-Manzanares Á, Botella-Romero F, Quílez-Toboso R, Cabrerizo L, Matía P, Chicharro L, Burgos R, Pujante P, Ferrer M, Zugasti A, Manjón L, Diéguez M, Carrera M, Vila-Bundo A, Urgelés J, Aragón-Valera C, Rovira A, Bretón I, García-Peris P, Muñoz-Garach A, Márquez E, Del Olmo D, Pereira J, Tous M. PP005-SUN PREVALENCE AND PREDICTORS OF HYPOGLYCEMIA DURING TOTAL PARENTERAL NUTRITION IN NONCRITICALLY ILL INPATIENTS. Clin Nutr 2013. [DOI: 10.1016/s0261-5614(13)60051-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Cáncer E, Abilés V, Abilés J, Martínez Olmos MA, Bretón I, Peláez N, Álvarez V, Culebras JM, Mazure RA. [Minimally invasive emergent techniques in obesity treatment]. NUTR HOSP 2012; 27:1025-30. [PMID: 23165538 DOI: 10.3305/nh.2012.27.4.5867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Accepted: 03/27/2012] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Obesity is a chronic disease for which several modalities of treatment are investigated today. One of them is the set of minimally aggressive techniques that have been added to the intragastric balloon. OBJECTIVE To review the minimally invasive techniques described in the last years for the treatment of obesity. MATERIAL AND METHOD It consisted in reviewing the bibliography through the habitual finders, in addition to the obtained data of the companies. They are classified in restrictive and malabsortive, and the restrictive are divides in mechanical or functional restriction. RESULT Between mechanical restrictive the classified as we included in the restrictive emergent techniques the adjustable intragastric balloon, the intragastric prosthesis, the vertical endoluminal gastroplasty and the transoral gastroplasty. In order to obtain a functional restriction, we have the gastric pacemaker and the botulinic toxin. And finally, the endoluminal duodenojejunal bypass is described as a malabsortive technique. DISCUSSION With less than 10 years of existence, it seems that the described techniques compensate their smaller effectiveness compared to the surgical techniques, with the absence of substantial modifications in the anatomy of the alimentary tract. None of these techniques is free of risks and complications.
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Palmeiro R, Arosa V, Cuerda C, Bretón I, Camblor M, Rodríguez MC, García Peris P. [Persistent chylothorax in patient with lymphangioleiomyomatosis]. NUTR HOSP 2012; 27:940-2. [PMID: 23114958 DOI: 10.3305/nh.2012.27.3.5734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Accepted: 01/12/2012] [Indexed: 12/01/2022] Open
Abstract
Lymphangioleiomyomatosis (LAM) is a rare disease that affects women in fertile age and presents a systemic progressive evolution, being the lung and the mediastinic lymph nodes the most affected organs. The pulmonary disease is characterized by dyspnea, pleural effusion, hemoptysis and spontaneous pneumothorax, being the chylothorax a frequent complication in the course of this disease, appearing in up to 30% of cases. The treatment of chylothorax is not standardized and it is necessary a multidisciplinary approach: nutritional, pharmacological, respiratory and even surgery. These patients present high risk of malnutrition due to the constant loss of chyle, therefore a suitable nutritional management is essential to avoid more complications.
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Affiliation(s)
- R Palmeiro
- Unidad de Nutrición, Hospital General Universitario Gregorio Marañón, Madrid, España
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Abilés V, Martínez Olmos MA, Escartí MA, Bretón I, Cáncer E, Pelaez N, Álvarez V, Culebras JM, Mazure RA. [Informed consent in the intragastric balloon supported by SENPE, SEEDO, SEN and SECO: legal aspects]. NUTR HOSP 2012; 27:419-24. [PMID: 22732963 DOI: 10.1590/s0212-16112012000200011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Accepted: 09/28/2011] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Intra-gastric balloon (IGB) is an invasive, temporary, non-surgical technique for the treatment of obesity. Its outcomes mainly depend on the patient's collaboration. OBJECTIVE The aim was to adapt the informed consent used for bariatric surgery to a method that has especial characteristics. MATERIALS AND METHODS We used the informed consent proposed by ASAC for bariatric surgery and 8 statements related to IGB included in the WESTLAW ES database. RESULTS The review of the statements defines the IGB treatment as a curative-intended and non-satisfactive therapy with an obligation of the means used, but not the outcomes, by the treating physician. Moreover, the obligations of providing a correct and complete information -which includes the dietary regime- should be observed, as well as the possible therapeutic alternatives and finally, the proceeding used should be in written. CONCLUSIONS The informed consent is a medico-legal document which content should consider the latest jurisprudence on the minimally invasive techniques for the treatment of obesity.
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Affiliation(s)
- V Abilés
- Hospital Costa del Sol, Marbella, España
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Lizarraga A, Cuerda C, Junca E, Bretón I, Camblor M, Velasco C, García-Peris P. Atrophy of the intestinal villi in a post-gastrectomy patient with severe iron deficiency anemia. NUTR HOSP 2009; 24:618-621. [PMID: 19893874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Accepted: 04/15/2009] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND & AIMS Iron deficiency anemia is a common complication of gastric surgery that in certain patients can be refractory to treatment with oral iron and needs to be treated parenterally. METHODS A 48-year woman underwent gastric surgery for a gastric ulcer. She was referred to the nutrition unit for the study and treatment of a 3-year iron deficiency anemia refractory to oral iron supplementation. Blood tests, endoscopy and jejunal biopsy were made to study the case. RESULTS Intestinal villi atrophy in the absence of celiac disease was the result. She was treated with intravenous iron, resolving the villous atrophy and thus oral iron supplementation could be effective. CONCLUSION This case illustrates that iron deficiency may cause villous atrophy. In this setting, parenteral iron administration is necessary to correct the haematological and non-hematological alterations associated with this deficiency.
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Affiliation(s)
- A Lizarraga
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, España
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Egaña N, Parón L, Cuerda C, Bretón I, Camblor M, Velasco C, García-Peris P. [Sea-blue histiocyte syndrome associated with home parenteral nutrition]. NUTR HOSP 2009; 24:361-363. [PMID: 19721912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2008] [Accepted: 02/02/2009] [Indexed: 05/28/2023] Open
Abstract
A case of a 55 years-old male with long-term Crohn's disease without response to medical treatment and many intestinal fistula is presented. After the last bowel resection, home parenteral nutrition was started. He presented chronic hepatopathy and pancytopaenia. After 9 months of home parenteral nutrition hepatic function and pancytopaenia began to deteriorate. Bone marrow examination revealed an infiltrate of sea-blue histiocytes. He made unsatisfactory progress and died due to a multiorganic failure.
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Affiliation(s)
- N Egaña
- Unidad de Nutrición, Hospital General Universitario Gregorio Marañón, Madrid, España
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22
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Camblor M, De la Cuerda C, Bretón I, Pérez-Rus G, Alvarez S, García P. Copper deficiency with pancytopenia due to enteral nutrition through jejunostomy. Clin Nutr 2007; 16:129-31. [PMID: 16844585 DOI: 10.1016/s0261-5614(97)80239-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/1997] [Indexed: 12/15/2022]
Abstract
Copper deficiency is a rare complication of enteral nutrition. Haematologic abnormalities such as neutropenia and anaemia, but not pancytopenia, have been described associated to copper deficiency. We report the case of a patient requiring long term enteral nutrition through jejunostomy who developed copper deficiency and pancytopenia. In 1991, a 47-year-old woman was admitted with severe gastroesophageal mucositis after an attempted suicide with caustic intake. Enteral nutrition with a commercial, polymeric, fiber-containing formula was started. Twenty-eight months later, the patient developed anemia and neutropenia that did not respond to combined iron and parenteral vitamin B(12) supplementation. In 1996 the patient showed pancytopenia and low serum levels of copper and ceruloplasmin. Pancytopenia improved after copper supplementation. Possible mechanism causing copper deficiency and pancytopenia are discussed. We conclude that assessment of copper status is advisable in patients receiving long-term enteral nutrition by jejunostomy.
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Affiliation(s)
- M Camblor
- Nutrition Section, Hospital General Universitario 'Gregoria Marañón', Madrid, Spain
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23
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Cuerda C, Camblor M, Bretón I, Velasco C, Parón L, Hervás E, Muñoz-Calero A, García-Peris P. [Gastric surgery as a nutritional risk factor]. NUTR HOSP 2007; 22:330-6. [PMID: 17612375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND The stomach has a role in the digestion and absorption of nutrients, so patients are in nutritional risk after gastric resection. The aim of this work was to study the nutritional status of postgastrectomy outpatients followed in our hospital. METHODS We retrospectively studied 54 patients (27 M, 27 F) followed more than 12 months postgastrectomy. Mean age was 61 +/- 14 yr and median follow-up was 35 months. The nutritional assessment included anthropometry, biochemical data and measurement of bone mineral density by dual-energy X-ray absorptiometry. The statistical analysis was performed by non-parametric tests. RESULTS Malignancy was the most frequent indication (85%), 63% of patients had total gastrectomy. Patients were supplemented with iron (43%), B12 (87%), calcium (18%) and vitamin D (17%). 13% of patients had a BMI < 18.5. The incidence of 25 OH vitamin D deficiency and secondary hyperparathyroidism was 45% and 76%, respectively. The incidence of osteoporosis at lumbar spine was 46%. Matched with same age-sex people patients had 85.6% of bone mineral density. CONCLUSIONS The loss of weight and the metabolic bone disease were the most prevalent impairments after gastric resection. These impairments point to the importance of a nutritional surveillance of patients after gastric resection.
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Affiliation(s)
- C Cuerda
- Unidad de Nutrición, Hospital General Universitario Gregorio Marañón, Madrid. España.
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24
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Cuerda C, Ruiz A, Velasco C, Bretón I, Camblor M, García-Peris P. How accurate are predictive formulas calculating energy expenditure in adolescent patients with anorexia nervosa? Clin Nutr 2007; 26:100-6. [PMID: 17045705 DOI: 10.1016/j.clnu.2006.09.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2005] [Revised: 07/06/2006] [Accepted: 09/01/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND & AIMS To compare resting energy expenditure, measured by indirect calorimetry, to values estimated by different predictive formulas in adolescent patients with anorexia nervosa. METHODS We studied 22 female in-patients with a mean age of 14.7 years (SD 1.2). Resting energy expenditure was measured by indirect calorimetry (Deltatrac II MBM-200). We compared measured resting energy expenditure to values estimated by several predictive formulas [Fleisch, Harris-Benedict, FAO, Schofield-HW, Schebendach] using the intraclass correlation coefficient and the Bland-Altman method. RESULTS Body mass index increased significantly (P<0.001). Measured resting energy expenditure increased during hospitalization (P<0.05). All formulas overestimated resting energy expenditure with respect to indirect calorimetry except the Schebendach formula. The intraclass correlation between indirect calorimetry and the formulas were poor (0.09-0.20). We observed a poor clinical agreement (Bland-Altman). CONCLUSIONS Body mass index and resting energy expenditure increased during hospitalization. The majority of the predictive formulas overestimate resting energy expenditure in adolescent patients with anorexia nervosa. Therefore, indirect calorimetry may be a very useful tool for calculating caloric requirements in these patients.
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Affiliation(s)
- C Cuerda
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, c/Doctor Esquerdo 46, 28007 Madrid, Spain.
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25
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Menchén L, Ripoll C, Bretón I, Moreno C, de la Cuerda C, Camblor M, García-Peris P, González-Lara V, Cos E. [Osteoporosis and inflammatory bowel disease]. NUTR HOSP 2005; 20:26-37. [PMID: 15762417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
Inflammatory bowel disease is a chronic disease with an unknown ethiology although multiple factors intervene such as individual, genetic and immunologic susceptibility, as well as different environmental factors. Like other multisystemic diseases, its clinical manifestations are diverse and it may affect other organs besides the gastrointestinal tract. In the last few years there is a growing interest for one of these extraintestinal manifestations, osteoporosis and osteopenia that may affect up to 42% of patients and can condition an important increase in morbility. Inactivity, prolonged corticosteroid treatment, nutritional deficiencies and the disease per se have an important role in the development of this complication. This article reviews clinical and ethiological aspects of inflammatory bowel disease associated osteoporosis and offers a strategy for diagnosis and treatment.
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Affiliation(s)
- L Menchén
- Servicio de Aparato Digestivo, Hospital General Universitario Gregorio Marañón, Madrid
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26
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Temprano JL, Bretón I, Zugasti A, Cuerda C, Camblor M, Pérez-Díaz MD, García P. [Severe hypophosphataemia after starting parenteral nutrition in a patient with an intestinal fistula]. NUTR HOSP 2004; 19:243-7. [PMID: 15315116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
Abstract
Hypophosphataemia is a complication that may appear in undernourished patients who are given nutrition by either enteral or parenteral means. It is associated with several clinical manifestations, including cardiological, neurological and haematological conditions of note, and may potentially be even life-threatening. It is therefore mandatory to ensure prevention and follow-up in those patients at risk of suffering this condition, taking into account the considerable morbidity and mortality associated with it.
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Affiliation(s)
- J L Temprano
- Unidad de Nutrición, Hospital General Universitario Gregorio Marañón, Madrid, España.
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27
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Cuerda C, Camblor M, Bretón I, García-Peris P. [Long-term follow-up of home parenteral nutrition at a general hospital: complications and quality of life]. NUTR HOSP 2002; 17:15-21. [PMID: 11939123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
OBJECTIVE The present study assesses the septic, thrombotic and hepatic complications and also the quality of life of patients with home parenteral nutrition (NPD in its Spanish acronym). METHODS The case histories of patients treated with NPD at our hospital were collected for the period January, 1986, to January, 2001. We had 20 patients, mean age 48 +/- 14 years (mean +/- SD), with a total catheterization time of 16,292 days. The main causes of intestinal failure were mesenteric ischaemia and radical enteritis. Quality of life was assessed by means of the Sickness Impact Profile (SIP) and the Karnofsky Index (KI). RESULTS We found a catheter infection rate of 0.42 per 100 days of catheter, mostly produced by coagulase-negative staphylococci (63%). In 30% of the cases, it was necessary to remove the catheter, including in all cases produced by Candida. Cather occlusion rate was 0.05 per 100 days. Five patients presented an increase in transaminases and alkaline phosphatase, and one female patient developed cholestasis. Two patients died of NPD-related causes. The results of the quality of life analysis showed it was moderately affected, with SIP scores of 14.6 +/- 3.5 and KI results of 70 +/- 20 (mean +/- SD). CONCLUSIONS Home parenteral nutrition allows a greater survival in cases of intestinal failure. The most frequent complication is an infection of the catheter. The results of the quality of life analysis in our series reveal it was moderately affected in most cases.
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Affiliation(s)
- C Cuerda
- Sección de Nutrición Clínica y Dietética, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo, 46, 28007 Madrid.
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Cuerda C, Lucas T, Silvestre RA, Bretón I, García P, Marco J, Barceló B. Growth hormone secretory response to intravenous galanin infusion in acromegalic patients. Exp Clin Endocrinol Diabetes 1998; 106:68-73. [PMID: 9516063 DOI: 10.1055/s-0029-1211953] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Galanin is a 29-amino acid neuropeptide which stimulates the secretion of growth hormone (GH) in normal men. Although the diagnosis of acromegaly involves demonstrating hypersecretion of GH and/or abnormalities in GH secretory dynamics, sometimes it is difficult to establish the activity of the disease. The aim of our study was to assess the response to galanin infusion in acromegalic patients (active and cured). We studied 19 subjects: 5 healthy volunteers (group I), 9 patients with active acromegaly (group II), and 5 with acromegaly cured after transsphenoidal surgery (group III). We performed a test of infusion with porcine galanin (8 microg/Kg/h) to study the secretory response of the GH. Galanin produced a marked increase in GH in the controls, group I (F9,36 = 5.34; p < 0.01) and in the cured patients, group III (F9,36 = 7.35; p < 0.01). On the other hand, galanin did not significantly modify the secretion of GH in the patients with active disease, group II. The areas under the curve (AUC) were higher in groups I and III compared to group II (p < 0.01). Nevertheless, there were no statistically significant differences in the AUC of groups I and III. Our results indicate that the differences in the GH response to galanin in patients with active and cured acromegaly could be of value in the study of the disease.
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Affiliation(s)
- C Cuerda
- Division of Nutrition, Hospital Gregorio Marañón, Madrid, Spain
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