M. A. Martínez-Olmos

Metabolic syndrome, insulin resistance and the inflammation markers C-reactive protein and ferritin.

Background:Patients with metabolic syndrome (MS) have above-average risk of developing atherosclerosis and cardiovascular disease. Inflammation plays a key role in the development of atherosclerosis. High levels of the acute phase reactants C-reactive protein (CRP) and ferritin have been reported to correlate with various components of MS.Patients and methods:The serum CRP, ferritin, glucose, insulin, triglycerides, HDL-cholesterol and total cholesterol concentrations of 598 obese or overweight patients were determined, together with relevant anthropometric parameters. Insulin resistance was evaluated by the HOMA method. MS was diagnosed using the ATP III criteria.Results:CRP levels were higher among patients with central obesity than in those without (5.8 vs 3.9u2009mg/l; P=0.003), and higher among those with fasting plasma glucose concentrations ⩾110u2009mg/dl than in those with lower concentrations (7.4 vs 4.1u2009mg/l; P=0.01). Serum ferritin levels were higher among patients with triglyceride concentrations ⩾150u2009mg/dl than in those with lower levels (76.8 vs 40.1u2009ng/ml; P<0.001), and higher among those with fasting plasma glucose concentrations ⩾110u2009mg/dl than in those with lower concentrations (75.7 vs 41.7u2009ng/ml; P=0.005). The number of MS criteria that were satisfied increased with CRP and ferritin levels. Patients with insulin resistance also had higher CRP and ferritin levels than those without, 7.3 vs 4.3u2009mg/l for CRP (P=0.032) and 124.5 vs 80.1u2009ng/ml for ferritin (P<0.001).Conclusions:MS and insulin resistance are associated with elevated serum CRP and ferritin. Evaluation of subclinical chronic inflammation in patients with MS and/or insulin resistance by determination of these markers might aid in their evaluation as candidates for aggressive intervention against cardiovascular risk factors.

Body composition changes after very low-calorie-ketogenic diet in obesity evaluated by three standardized methods

Context: Common concerns when using low-calorie diets as a treatment for obesity are the reduction in fat-free mass, mostly muscular mass, that occurs together with the fat mass (FM) loss, and determining the best methodologies to evaluate body composition changes. Objective: This study aimed to evaluate the very-low-calorie ketogenic (VLCK) diet-induced changes in body composition of obese patients and to compare 3 different methodologies used to evaluate those changes. Design: Twenty obese patients followed a VLCK diet for 4 months. Body composition assessment was performed by dual-energy X-ray absorptiometry (DXA), multifrequency bioelectrical impedance (MF-BIA), and air displacement plethysmography (ADP) techniques. Muscular strength was also assessed. Measurements were performed at 4 points matched with the ketotic phases (basal, maximum ketosis, ketosis declining, and out of ketosis). Results: After 4 months the VLCK diet induced a −20.2 ± 4.5 kg weight loss, at expenses of reductions in fat mass (FM) of −16.5 ± 5.1 kg (DXA), −18.2 ± 5.8 kg (MF-BIA), and −17.7 ± 9.9 kg (ADP). A substantial decrease was also observed in the visceral FM. The mild but marked reduction in fat-free mass occurred at maximum ketosis, primarily as a result of changes in total body water, and was recovered thereafter. No changes in muscle strength were observed. A strong correlation was evidenced between the 3 methods of assessing body composition. Conclusion: The VLCK diet-induced weight loss was mainly at the expense of FM and visceral mass; muscle mass and strength were preserved. Of the 3 body composition techniques used, the MF-BIA method seems more convenient in the clinical setting.

Intestinal Absorption and Pancreatic Function are Preserved in Anorexia Nervosa Patients in Both a Severely Malnourished State and After Recovery

INTRODUCTIONnAnorexia nervosa (AN) is characterised by a refusal to normal body weight accompanied by a marked restriction of food intake, frequently leading to severe malnutrition. In severe malnutrition and wasting syndromes, mucosal atrophy, altered gastrointestinal motility and pancreatic atrophy, which alter digestive function and can exacerbate malnutrition, have been described. The objective of this work was to determine intestinal absorption and pancreatic function in severely malnourished AN patients before and after recovery.nnnMETHODSnTen severely malnourished AN women were studied at hospital admittance (body mass index = 11.44-16.16 kg/m(2)) and after weight recovery with artificial nutrition (body mass index ≥ 20 kg/m(2)). A (13)C-labelled triglycerides digestion test, faecal elastase test and d-xylose absorption test were performed.nnnRESULTSnIn nine patients, (13)C-labelled triglycerides digestion tests and the faecal elastase and d-xylose tests were normal both before and after weight recovery. In one patient, the results were abnormal, and they led to the detection of a previously undiagnosed celiac disease in addition to her AN.nnnCONCLUSIONnIn this series, there was neither intestinal absorption nor pancreatic function disturbances in severely malnourished AN patients either before or after weight recovery. The usefulness of these tests in the differentiation of functional versus structural changes needs further studies.

Registro del Grupo NADYA-SENPE de Nutrición Enteral Domiciliaria en España en el año 2008

Objective: To present the results of the Spanish home enteral nutrition (HEN) registry of the NADYA-SENPE group for the years 2014 and 2015.nMethods: From January 1st 2014 to December 31st 2015 the HEN registry was recorded and afterwards a further descriptive and analytical analysis was done.nResults: In 2014, 3749 patients were recorded, and 4202 in 2015; prevalence was 80.58 patients/one million inhabitants in Spain in 2014 and 90.51 in 2015. There were 49.9% females in 2014 and 50.3% in 2015. Median age was 73 years (IQI 59-83) in 2014 as well as in 2015. 684 episodes finished in 2014 and 631 in 2015, with death as the main cause, in 54.9% and 50.4%, respectively. The ones who were fed through nasogastric tube had a mean age higher than the ones fed by any other route (p-value < 0.001). Sisty-seven paediatric patients were recorded in 2014 (56.7% females) and 77 in 2015 (55.8% females). Median age at the beginning of HEN among children was 5 months in 2014 and 5 months in 2015. The main route of administration was gastrostomy, in 52.5% in 2014 and nasogastric tube in 50.8% in 2015. 7 episodes finished in 2014 and 13 in 2015, having death as the main cause (57.1% in 2014 and 38.5% in 2015). It was found that were younger children the ones who were mainly fed by nasogastric tubes (p-value 0.004 vs. 0.002). Among paediatric patients as well as adults, the main diagnosis leading to HEN was neurological disease which gives aphagia or severe dysphagia.nConclusions: There has been an increase in the number of patients in the registry as well as the participating centers and the number of patients per center, without any significant change in the characteristics of the patients other than longer duration of the episodes.

Resting metabolic rate of obese patients under very low calorie ketogenic diet

BackgroundThe resting metabolic rate (RMR) decrease, observed after an obesity reduction therapy is a determinant of a short-time weight regain. Thus, the objective of this study was to evaluate changes in RMR, and the associated hormonal alterations in obese patients with a very low-calorie ketogenic (VLCK)-diet induced severe body weight (BW) loss.MethodFrom 20 obese patients who lost 20.2xa0kg of BW after a 4-months VLCK-diet, blood samples and body composition analysis, determined by DXA and MF-Bioimpedance, and RMR by indirect calorimetry, were obtained on four subsequent visits: visit C-1, basal, initial fat mass (FM) and free fat mass (FFM); visit C-2, −u20097.2xa0kg in FM, −u20094.3xa0kg in FFM, maximal ketosis; visit C-3, −u200914.4xa0kg FM, −u20094.5xa0kg FFM, low ketosis; visit C-4, −u200916.5xa0kg FM, −u20093.8xa0kg FFM, no ketosis. Each subject acted as his own control.ResultsDespite the large BW reduction, measured RMR varied from basal visit C-1 to visit C-2, −u20091.0%; visit C-3, −u20092.4% and visit C-4, −u20098.0%, without statistical significance. No metabolic adaptation was observed. The absent reduction in RMR was not due to increased sympathetic tone, as thyroid hormones, catecholamines, and leptin were reduced at any visit from baseline. Under regression analysis FFM, adjusted by levels of ketonic bodies, was the only predictor of the RMR changes (R2u2009=u20090.36; pu2009<u20090.001).ConclusionThe rapid and sustained weight and FM loss induced by VLCK-diet in obese subjects did not induce the expected reduction in RMR, probably due to the preservation of lean mass.Trial registrationThis is a follow up study on a published clinical trial.

ECONOMIC BURDEN OF HOME ARTIFICIAL NUTRITION IN THE HEALTH AREA OF SANTIAGO DE COMPOSTELA.

INTRODUCTIONnhome artificial nutrition (HAN) is a growing therapy, but the absence of obligatory registries complicates the calculation of its real economic burden. The aim of this study was to assess the state and economic impact of HAN in our health area.nnnMETHODSnan observational, prospective study was designed to calculate the cost of nutritional formulas and materials in patients who initiated HAN in the nutrition unit during a year.nnnRESULTSnwe included 573 new patients with HAN during the study period, 60% of whom were treated with oral supplements. The median daily cost of oral HAN was 3.65 (IQR 18.63) euros compared to a cost of 8.86 (IQR 20.02) euros for enteral-access HAN. The daily expenditure per 1 000 kcal of diet was higher for patients on oral HAN than for patients with tubes (5.13 vs. 4.52 euros, p < 0.001). The median cost of the complete HAN treatments during the study period was also calculated (186.60 euros and 531.99 euros for oral and tube HAN, respectively). The total estimated cost for all patients who initiated HAN in the study period was around one million euros.nnnCONCLUSIONSnHAN represented an important economic burden in our health area, but the estimated daily cost of HAN was moderate, probably because of the high frequency of oral HAN, the adjusted treatments, and the centralized dispensation by the hospital pharmacy.

Prevalencia del síndrome metabólico en una población de pacientes con sobrepeso y obesidad

Objetivo Estimar la prevalencia del sindrome metabolico en una poblacion gallega de pacientes con sobrepeso y obesidad, utilizando las 3 definiciones mas actuales: la del tercer informe del Grupo de Expertos sobre la Deteccion, Evaluacion y Tratamiento de la Hipercolesterolemia en Adultos del Programa Nacional de Educacion sobre el Colesterol (ATP III), la de la Organizacion Mundial de la Salud (OMS) y la del Grupo Europeo para el Estudio de la Resistencia a la Insulina (EGIR). Pacientes y metodos Durante un periodo comprendido entre los anos 1996 y 2003 se valoro, en la consulta de endocrinologia, una poblacion gallega de 634 pacientes con sobrepeso u obesidad, con una edad media de 38,27xa0±xa015,95 anos, con una distribucion de 416 mujeres (65,6%) y 218 varones (34,4%). Resultados La prevalencia del sindrome metabolico aplicando la definicion de la ATP III fue del 27,6%; teniendo en cuenta los criterios del EGIR fue del 15,7% y empleando los criterios de la OMS fue del 35,8%. Si aplicasemos como criterio el valor de glucemia en ayunas de 100 mg/dl en vez de 110, se observaria, como es de esperar, un incremento en la prevalencia del sindrome metabolico con respecto al valor inicial del 32,97%, segun la definicion de la ATP III; de un 22,29% utilizando la definicion de la EGIR, y del 28,77% empleando la clasificacion de la OMS. Conclusiones Estos resultados muestran que en una poblacion de pacientes con sobrepeso u obesidad, la prevalencia del sindrome metabolico es mas alta que en la poblacion general. Estos hallazgos pueden tener implicaciones relevantes a la hora de plantear un diagnostico temprano de la enfermedad cardiovascular y de la diabetes mellitus de estos pacientes, con objeto de intervenir terapeuticamente de forma temprana disminuyendo asi sus complicaciones metabolicas y cardiovasculares.

Patients’ and professionals’ preferences in terms of the attributes of home enteral nutrition products in Spain. A discrete choice experiment

Background/objectivesTo elicit and compare preferences in terms of the attributes of home enteral nutrition (HEN) among patients and physicians, using a discrete choice experiment (DCE).Subjects/methodsA DCE comprising eight choice scenarios, with six HEN attributes (tolerability, adaptation to comorbidities, nutrition and calories, handling, connections and information; two levels each) was designed. The Relative Importance (RI) for patients and physicians of each attribute was estimated. Sociodemographic and clinical variables, as well as additional questions (nu2009=u20098) were compiled to analyze possible explanatory variables and other preferences.ResultsA total of 148 HEN patients (71 needing caregivers to answer on their behalf) and 114 physicians completed the DCE. The most important attributes for patients were adaptation to comorbidities (33% RI), tolerability (33% RI), and nutrition and calories (26% RI). Significantly, younger patients had stronger preferences for tolerability whereas elderly ones (≥75 years) were more concerned about handling. In comparison, physicians gave a higher RI to tolerability, and nutrition and calories compared to patients (pu2009=u20090.002). Overall, a higher percentage of physicians answered that HEN characteristics such as easy-handling bags (85.1 vs. 64.9%; pu2009=u20090.001), container material (69.3 vs. 57.1%; pu2009=u20090.003) or reusable containers (79.8 vs. 70.3%; pu2009=u20090.01) were “important” or “very important” compared to patients.ConclusionsOur findings showed that although patients and physicians have a similar perception about the relevance of different HEN attributes, the relative weight given to each one varies between them. Therefore, both points of view should be considered when choosing a HEN product in order to improve patients’ satisfaction and clinical outcomes.

Preferencias por los atributos de la nutrición enteral domiciliaria (NED) en España. ¿Conocen los cuidadores las preferencias de los pacientes?

INTRODUCTIONnEstablishing a home enteral nutrition (HEN) that is adapted to the patients needs and preferences can improve their quality of life and adherence, contributing to a higher treatment efficiency, better prognosis and cost reduction. As in most cases, patients need total or partial help from their caregivers, and there is a need for evaluating how well do caregivers know their patients priorities.nnnOBJECTIVESnExploring patients preferences for HEN characteristics in Spain, and the concordance between patients and caregivers.nnnMETHODSnA cross-sectional observational study based on the discrete choice experiment methodology. A set of eight choice scenarios generated from six attributes with two levels each was presented along with an ad hoc questionnaire on the importance and satisfaction with HEN. The relative importance (RI) of each attribute and the patient-caregiver concordance was estimated in every question.nnnRESULTSnOne hundred and forty-eight patients participated, and in 77 cases both the patient and the caregiver took the survey. The most important attributes (RI) for HEN were adaptation to comorbidities (33%), tolerability (33%), nutrients and calories (26%) and package characteristics (8%). Patients showed a high degree of satisfaction with the assistance received. Concordance between patient and caregiver was found in every question, being it moderate to good.nnnCONCLUSIONSnAccording to patients, an ideal HEN product would be adaptable to comorbidities, easy to tolerate, providing the necessary nutrients and calories, with an easy to handle package. Caregivers know well their patients preferences.

SUN-P104: Preferences for the Characteristics of Home Enteral Nutrition Viatube Feeding: A Discrete-Choice Experiment

Preferencias Nutrición Enteral Domiciliaria SUN-P104 Preferences for the characteristics of home enteral nutrition via tube feeding: a discrete-choice experiment (DCE) Authors: Olveira G1, Martínez-Olmos MA2, Fernández de Bobadilla B3, Ferrer M4, Virgili N5, Vega B6, Blanco M7, Layola M7, Lizán L8, Tribaldos Causadias M8 Filiation: 1. Hospital Regional Universitario de Málaga, Málaga, Spain; 2. Hospital Universitario de Santiago, A Coruña, Spain; 3. Hospital General Universitario de Ciudad Real, Ciudad Real, Spain; 4. Hospital Universitario Clínico Virgen de la Arrixaca, Murcia, Spain; 5. Hospital Universitario de Bellvitge, Barcelona, Spain; 6. Hospital Universitario Ramón y Cajal, Madrid, Spain; 7. Nestlé Health Science, Barcelona, Spain; 8. Outcomes’10, Castellón, Spain.