Alberto Miján de la Torre

Efectos adversos metabólicos y nutricionales asociados a la terapia biológica del cáncer

INTRODUCTION The different types of cancer represent one of the main causes of morbimortality worldwide. Classical anti-tumor therapy (surgery, chemotherapy, radiotherapy) has notably increased the survival rate. Biological therapies, with selective and frequently specific mechanisms of action, are a relatively recent acquisition in oncologic therapy; among the most commonly used ones are: cytokines, monoclonal antibodies, tyrosine kinase inhibitors, and mTOR inhibitors. The nutritional and metabolic adverse effects of classical therapy are well documented in the literature and the clinical guidelines, which is not the case for biological therapy. OBJECTIVE To review the literature in this field and to detail in an organized manner the results obtained. METHODS Indexed literature and the technical data sheets of the drugs included in the different families were revised through the Spanish Agency of Medicines and Health Care Products until July of 2013. The symptoms and clinical signs of a theoretical action on the nutritional and metabolic status were recorded. RESULTS The specific action of each family is described. The possible adverse effects of each one of them on the nutritional and metabolic status are grouped, detailing and differentiating them in tables for easier and more friendly-user consultation. The most prevalent possible side effects observed are those related with the appetite, the gastrointestinal tract, and electrolytic impairments. CONCLUSIONS the possible side effects associated to biological therapies are plenty and occur with different frequency and severity. It is important to know the nutritional and metabolic impact when using these therapies for preventing and managing them.

Is an integral nutritional approach to eating disorders feasible in primary care

Patients with eating disorders (ED) show alterations in both their behaviour and their intake of food, frequently presenting nutritional and somatic affectations. Besides the classical forms such as anorexia or bulimia nervosa, there has recently been an increase in atypical or incomplete forms of ED, such as binge eating. Primary care (PC) services form the central and closest nucleus of health care for the individual and the family, where ED occur and leave their mark. This allows PC to provide an integral response at all levels of care for ED. Primary prevention at school, in the family and community is fundamental to avoiding its inception. Secondary prevention is based on early diagnosis and treatment of ED and favours a better prognosis of the illness. Tertiary prevention tries to reduce the serious consequences with rehabilitation measures to alleviate complications and avoid risk to life. Due to its complexity, these patients are afforded the attention of multidisciplinary teams of specialists with experience in treating this condition. In consultation with the team, the general practitioner should adopt a leading role at all levels of attention, as he/she is the link between the team, the family and the patient. This requires both regulated, specific training in the disease and the allocation of resources to carry it through. Putting into practice all these plans would allow us to give a positive answer to the question posed in the title of the present article.

Efecto de la realimentación en la composición corporal de mujeres con anorexia nerviosa restrictiva: antropometría frente a impedancia bioeléctrica

OBJECTIVE To assess the body composition in a group of malnourished patients with anorexia nervosa as compared to healthy controls, before and after nutritional support, by means of anthropometry and bioimpedance. METHODS Prospective observational study. Complete anthropometry was performed as well as bioimpedance analysis in 12 women (24.5 years) with restrictive anorexia nervosa at hospital admission and weekly thereafter during re-feeding. The control group was formed by 24 healthy women (21 years). The Students t test, the Mann-Whitney U test, the Students t test for repeated measurements, and the Wilcoxons test were applied. The level of agreement between anthropometry and BIA was calculated by the interclass correlation coefficient and the Bland-Altman s test. RESULTS The patients had significant improvements in all indexes of body composition throughout their hospital staying although their values at discharge still were lower than those of the control subjects. The average weight gain was 5.22 kg (SD: 1.42), of which 51.4% was fat mass, preferentially centrally distributed. In the control subjects, the BIA equation that correlated the best with anthropometrics was Sun s equation (CCI = 0.896); in the patients, the level of agreement was weaker, both at hospital admission and at hospital discharge. CONCLUSIONS Re-feeding produces weight gain, essentially at the expense of fat mass, which is centrally distributed; the nutritional status is not reestablished. The level of agreement between anthropometry and bioimpedance for studying body composition is acceptable, especially in healthy subjects. In those cases with severe changes in body composition and/or water balance, anthropometry is recommended when vectorial BIA or some other gold standard method are not available for the analysis of body composition.

Body mass index and waist circumference are not good surrogate indicators of adiposity in psychogeriatric patients

to assess the utility of body mass index (BMI) and waist circumference (WC) as surrogate indicators of adiposity with respect to the total body fat estimated with bioimpedance analysis in psychogeriatric patients.

Transient hyperthyroidism after total laryngectomy for laryngeal cancer

INTRODUCTION Thyroid damage is a complication of total laryngectomy (TL) and may be caused by manipulation of the gland. There are isolated descriptions in the literature related to transient hyperthyroidism (HT) post-head and neck surgery. The aim of this study was to determine the frequency of HT after TL and to evaluate its relationship with the surgical procedure. METHODS Retrospective cohort study. Forty-four patients were included and stratified in Group 1 (TL + pharyngectomy), and Group 2 (TL + neck dissection). Post-op thyroid function was measured in all patients. Results were analyzed with chi square plus Yates and OR (p<0.05). RESULTS Twenty-four patients (54.6%) developed HT, with a mean TSH 0.11±0.09 uU/ml and a median FT4 1.5 ng/dl (1.2-1.8, IQR 0.30). Four patients (16.6%) required a pharmacological approach, because of their clinical course. Patients in Group 1 showed significantly more hyperthyroidism compared to Group 2 (p=0.04, OR 4, CI 95% CI,1.03-15.53). All became euthyroid before discharge. CONCLUSION We found a high prevalence of HT after TL, and it was related indeed to the surgical procedure. All patients became euthyroid before discharge. We suggest to check thyroid function in routine lab tests in this setting. The hypothetical repercussion of these findings on resting energy expenditure and haemodynamics requires further studies.

El músculo, elemento clave para la supervivencia en el enfermo neoplásico

El sindrome de caquexia cancerosa es responsable de la muerte de un numero significativo de pacientes con cancer. Se caracteriza por la presencia de una ingesta reducida, con inflamacion sistemica y un metabolismo alterado. Los enfermos presentan caracteristicamente una progresiva perdida de peso y de masa muscular, junto a deterioro funcional. La perdida muscular se debe a la combinacion de reduccion de la sintesis proteica con aumento de su degradacion. Ello conduce tanto a un acortamiento como a una reduccion en el area de la fibra muscular. Asimismo, existen datos que apoyan que selectivamente algunos de los tipos de fibra muscular se ven mas afectados. Es necesario definir bien los valores de corte de sarcopenia para diagnosticar la perdida muscular y existen diferentes metodos. El sistema de la ubiquitina-proteasoma parece desempenar un papel predominante en la degradacion de la proteina miofibrilar. La tendencia a perder masa muscular en los pacientes con caquexia cancerosa parece estar asociada a la activacion de senales catabolicas por citoquinas proinflamatorias, asi como por productos tumorales del tipo factor inductor de proteolisis. En referencia a los factores pronosticos, el riesgo de muerte esta bien documentado en pacientes con sarcopenia y, especialmente, en aquellos con obesidad asociada a la sarcopenia. Asimismo, se ha establecido una relacion directa entre la perdida intensa de masa muscular y la supervivencia en pacientes con diferentes tipos de tumores del tipo de cancer de pancreas, pulmon, tracto biliar o cancer colorrectal. Respecto de la terapia en el sindrome de caquexia cancerosa, es factible que requiera tratamiento con varios grupos combinados que incluyan, junto al soporte nutricional, farmacos orexigenos, con efecto anabolico y antinflamatorio, asociados a intervenciones que estimulen el ejercicio fisico.

Associated metabolic and nutritional side effects to biological cancer therapy

INTRODUCTION The different types of cancer represent one of the main causes of morbimortality worldwide. Classical anti-tumor therapy (surgery, chemotherapy, radiotherapy) has notably increased the survival rate. Biological therapies, with selective and frequently specific mechanisms of action, are a relatively recent acquisition in oncologic therapy; among the most commonly used ones are: cytokines, monoclonal antibodies, tyrosine kinase inhibitors, and mTOR inhibitors. The nutritional and metabolic adverse effects of classical therapy are well documented in the literature and the clinical guidelines, which is not the case for biological therapy. OBJECTIVE To review the literature in this field and to detail in an organized manner the results obtained. METHODS Indexed literature and the technical data sheets of the drugs included in the different families were revised through the Spanish Agency of Medicines and Health Care Products until July of 2013. The symptoms and clinical signs of a theoretical action on the nutritional and metabolic status were recorded. RESULTS The specific action of each family is described. The possible adverse effects of each one of them on the nutritional and metabolic status are grouped, detailing and differentiating them in tables for easier and more friendly-user consultation. The most prevalent possible side effects observed are those related with the appetite, the gastrointestinal tract, and electrolytic impairments. CONCLUSIONS the possible side effects associated to biological therapies are plenty and occur with different frequency and severity. It is important to know the nutritional and metabolic impact when using these therapies for preventing and managing them.