Luis Miguel Luengo Pérez

Estimación del coste de la nutrición parenteral domiciliaria en España

Introduction: Home parenteral nutrition (HPN) improves quality of life, allowing patients to receive nutrition at home and providing a social and labor integration to these patients. Objective: To assess the direct costs of HPN in adult population in Spain. Methods: A literature review of the records of HPN in Spain, carry out by NADYA-SENPE Group (years 2007-2014), was performed. The analysis included the evolution of: patients requiring HPN, number of episodes/patient, mean duration of episodes, description of delivery routes and complications rate. HPN consumption and cost were estimated. Patients were grouped according to their pathological group: benign and malignant. Direct costs (€, 2015) included were: parenteral nutrition bags, delivery sets and costs due to complications. Results: The number of patients who receive HPN has increased over years (2007: 133 patients; 2014: 220 patients). The average number of episodes per patient ranged from 1-2 episodes per year. The average duration of those episodes decreased (2007: 323 days; 2014: 202.8 days). Tunneled catheters were the most used and septic complications were the most common. The average annual cost per patient was estimated at € 8,393.30 and € 9,261.60 for benign and malign disease respectively. Considering that 220 patients required HPN in 2014, an annual cost of € 1,846.524.96 (€ 1,389,910.55 directly due to HPN) and € 2,037,551.90 (€ 1,580,937.50 directly due to HPN) was estimated for patients with benign and malignant pathologies respectively. Conclusions: These results can be used to develop future economic evaluations on HPN and to establish effi cient prioritization strategies to allocate available resources.

Análisis de los conocimientos sobre el desayuno saludable y su relación con los hábitos de estilo de vida y el rendimiento académico en la enseñanza secundaria obligatoria

OBJECTIVES The main objective of the study is to analyze whether students of Compulsory Secondary Education (ESO) of Badajoz city known foods that are part of a healthy breakfast. It also intends to see the relationship of this knowledge with lifestyle habits and academic performance. MATERIALS AND METHOD A representative sample of 1197 secondary students in the city of Badajoz (Spain) (50.1% female) was calculated their Body Mass Index (BMI) and were asked to fill in a questionnaire, previously validated in a pilot study, which included sociodemographic items as well as others related with life style habits. They were also asked to choose among a series of food, which of them were a part of a healthy breakfast. RESULTS 49.2% of adolescents know foods which are a part of a healthy breakfast. Very low correlations were obtained between all the variables analyzed and knowledge of foods that make up a healthy breakfast. However, within a few variables are significant differences (P<.05) between subgroups, such as families of students with low cultural level of aided schools, repeaters, without reading habit, passing lot of time with friends, who have been on a diet, make less than 3 meals a day and spend less than 10minutes for breakfast and know the amount of fruit that should be consumed daily. CONCLUSIONS Life style habits of adolescents are not related to the knowledge about the foods that are part of a healthy breakfast.

Searching for a nutritional screening tool. The value of an analytical method when staff trained in clinical nutrition is not available

INTRODUCTION Disease-related malnutrition (DRM) is highly prevalent. Various European resolutions urge to screen and treat DRM. No policy in this regard has yet been developed in Extremadura (Spain). OBJECTIVES To assess the prevalence of DRM (defined as NRS 2002≥3) using an analytical method (FILNUT), and to compare it with the official rate. RESULTS FILNUT scores≥3 showed values of sensitivity (S) and positive predictive value (PPV) of 82.3% and 72.3% respectively. No statistically significant differences were found between men and women using this tool. FILNUT showed a significantly higher sensitivity for detecting malnutrition in medical - as compared to surgical - diseases when low scores were used. The estimated prevalence of DRM was 21.4%. Prevalence of DRM is much greater than officially reported. CONCLUSIONS FILNUT scores≥3 show high sensitivity and PPV for detecting DRM, and is a good alternative as a nutritional screening tool to detect malnutrition at our center.

Organization and management of clinical nutrition in Spain. How do we assess the quality of our activities

INTRODUCTION Among the objectives of the SENPE Management Working Group is the development of knowledge and tools related to the evaluation of health outcomes. OBJECTIVES To obtain an approximate profile of clinical nutrition in hospitals in Spain, specifically concerning its organization, endowment, activities and quality indicators. METHODS A cross-sectional study conducted in 2013 through a structured survey sent to a random sample of 20% of hospitals from the network of the National Health System of Spain, stratified by the number of hospital beds. RESULTS The overall response rate was 67% (83% in hospitals with over 200 beds). In 65% of hospitals, clinical nutrition is run by a coordinated team or unit, with a doctor working full time in only 50% of centers. Other professionals are often not recognized as part of the team or unit. There is a specialized monographic nutrition clinic in 62% of centers and 72% have more than 40 new inpatient consultations per month (27% with more than 80 per month). Among the centers with a clinical nutrition team or unit, there is a greater tendency to monitor quality indicators related to clinical practice. CONCLUSIONS There is widespread addition of clinical nutrition teams and units in hospitals in Spain. However, truly multidisciplinary organization is not often found. High workloads are assumed in relation to staffing levels. The existence of well-organized structures may be associated with benefits that directly affect attendance.

Soporte nutricional y nutrición parenteral en el paciente oncológico: informe de consenso de un grupo de expertos

Malnutrition is a common medical problem in cancer patients with a negative impact on quality of life. The aim of this study was to address different issues related to nutritional management of cancer patients in clinical practice. A multidisciplinary group of experts in Medical Oncology, Pharmacy, and Endocrinology and Nutrition prepared a list of topics related to the nutritional status of cancer patients and grouped them into three blocks: nutritional support, parenteral nutrition (PN), and home PN (HPN). A literature review was made of articles published in Spanish, English and French until April 2017. This consensus emphasizes several key elements that help physicians standardize management of the nutritional status of cancer patients in clinical practice, and establishes common guidelines for indication, monitoring, nutritional requirements, and access routes to PN.espanolIntroduccion: la malnutricion es un problema medico frecuente de los pacientes oncologicos 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 oncologico en la practica clinica. Metodos: un grupo multidisciplinar de expertos en Oncologia Medica, Farmacia y Nutricion elaboro una lista de temas relacionados con el estado nutricional del paciente oncologico que fueron agrupados en tres bloques: soporte nutricional; nutricion parenteral (NP); y nutricion parenteral domiciliaria (NPD) en el paciente oncologico. Se realizo una revision de la literatura que incluyo articulos publicados en espanol, ingles y frances hasta febrero de 2017. El documento se estructuro como un cuestionario con aquellas preguntas que, segun el criterio del panel, podrian generar mayor controversia o duda. Resultados: de las 18 cuestiones abordadas, 9 versaron sobre el soporte nutricional: 5 relacionadas con la NP y 4 trataron sobre la NPD. Dentro de las recomendaciones del panel destacar que, en el paciente oncologico, la NP esta indicada principalmente cuando no es posible el uso del tubo digestivo y/o la alimentacion oral y/o nutricion enteral no es suficiente o posible. Ademas, el objetivo de la NPD es mejorar o mantener, el estado de nutricion de un paciente en el ambito domiciliario. Conclusiones: esta revision constituye una herramienta para oncologos y especialistas responsables del manejo nutricional del paciente con cancer. EnglishBackground: Malnutrition is a frequent medical problem of cancer patients that negatively impacts their quality of life. Objective: To analyze and respond to different issues related to the nutritional management of cancer patients in the clinical setting. Methods: A multidisciplinary group of experts in Medical Oncology, Pharmacy, and Nutrition developed a list of topics related to the nutritional status of cancer patients, which were grouped into three blocks: Nutritional support; Parenteral nutrition (PN); and Home PN (HPN) in cancer patients. A literature search, which included articles published in Spanish, English, and French until February 2017, was carried out. The document was organized as a questionnaire with those questions that, according to the panel’s criteria, could generate greater controversy or doubt. Results: Of the 18 questions addressed, 9 focused on nutritional support: 5 were related to PN and 4 about HPN. Among the different recommendations, the panel emphasized that in the cancer patient, PN is indicated mainly when it is not possible to use the digestive tract and/or oral feeding and/or enteral nutrition is not sufficient or possible. Additionally, the objective of the HPN is to improve or maintain the nutritional status of a patient at home. Conclusions: This document seeks to lay down a set of recommendations and to identify key issues that may be useful for the nutritional management of cancer patients.

Impacto económico de la desnutrición relacionada con la enfermedad en el hospital San Pedro de Alcántara. Estimación del ahorro asociado a una atención nutricional especializada de calidad

INTRODUCTION AND OBJECTIVES DRM is a highly prevalent condition in Spanish hospitals and is associated to increased healthcare costs. Costs associated to DRM were calculated using the methods of the PREDyCES study. The potential savings derived from specialized nutritional treatment were calculated by extrapolating the results of the SNAQ strategy. RESULTS Median cost per procedure in patients with DRM was €9,679.85, with a final cost of €28,700,775.2. The cost of each patient with DRM was 2.63 times higher than the cost of patients with no DRM. The potential cost saving associated to specialized nutritional treatment was estimated at €1,682,317.28 (5.86% of total cost associated to DRM). CONCLUSIONS Patients with DRM showed a higher consumption of financial resources as compared to well-nourished patients. Specialized nutritional treatment is a potential cost-saving procedure.

Diferencias en estándares de calidad a la hora de pautar un soporte nutricional: diferencias entre médicos especialistas y no especialistas

UNLABELLED Adequate nutritional support includes many different aspects, but poor understanding of clinical nutrition by health care professionales often results in an inadequate prescription. MATERIAL AND METHODS A study was conducted to compare enteral and parenteral nutritional support plans prescribed by specialist and non-specialist physicians. RESULTS Non-specialist physicians recorded anthropometric data from only 13.3% of patients, and none of them performed nutritional assessments. Protein amounts provided by non-specialist physicians were lower than estimated based on ESPEN (10.29g of nitrogen vs 14.62; P<.001). Differences were not statistically significant in the specialist group (14.88g of nitrogen; P=.072). Calorie and glutamine provision and laboratory controls prescribed by specialists were significantly closer to those recommended by clinical guidelines. CONCLUSION Nutritional support prescribed by specialists in endocrinology and nutrition at San Pedro de Alcántara Hospital was closer to clinical practice guideline standards and of higher quality as compared to that prescribed by non-specialists.

Validación de índices antropométricos alternativos como marcadores del riesgo cardiovascular

INTRODUCTION Obesity is considered as a cardiovascular risk factor (CVRF). Anthropometric indexes as body mass index (BMI) or waist-to-hip ratio (WHR) may not reflect properly an increased risk due to obesity, but abdominal circumference is the most accepted as cardiovascular risk marker. As height is important in some instances as insulin resistance, is mandatory to take it into account to evaluate more accurately cardiovascular risk. OBJECTIVE To test the utility of alternative anthropometrical indexes as cardiovascular risk markers. MATERIAL AND METHODS A descriptive cross-sectional study was developed with 883 subjects in East Portugal, having anthropometric measurements, blood pressure, laboratory tests, CVRF, and history reported. Cardiovascular risk was calculated according to modified Framingham method. RESULTS All of the anthropometric indexes showed statistically significant correlation with cardiovascular risk, but WHR (r=0.48), followed by waist-to-height ratio (r=0.41) and abdominal circumference (r=0.45) were the most accurate. When data were analyzed by sex, waist-to-height ratio (r=0.46) was better in women and WHR (r=0.44) in men. CONCLUSIONS This study shows that waist-to-height ratio is as useful as others to estimate cardiovascular risk, being better among women.INTRODUCTION Obesity is considered as a cardiovascular risk factor (CVRF). Anthropometric indexes as body mass index (BMI) or waist-to-hip ratio (WHR) may not reflect properly an increased risk due to obesity, but abdominal circumference is the most accepted as cardiovascular risk marker. As height is important in some instances as insulin resistance, is mandatory to take it into account to evaluate more accurately cardiovascular risk. OBJECTIVE To test the utility of alternative anthropometrical indexes as cardiovascular risk markers. MATERIAL AND METHODS A descriptive cross-sectional study was developed with 883 subjects in East Portugal, having anthropometric measurements, blood pressure, laboratory tests, CVRF, and history reported. Cardiovascular risk was calculated according to modified Framingham method. RESULTS All of the anthropometric indexes showed statistically significant correlation with cardiovascular risk, but WHR (r=0.48), followed by waist-to-height ratio (r=0.41) and abdominal circumference (r=0.45) were the most accurate. When data were analyzed by sex, waist-to-height ratio (r=0.46) was better in women and WHR (r=0.44) in men. CONCLUSIONS This study shows that waist-to-height ratio is as useful as others to estimate cardiovascular risk, being better among women.