Miguel Ángel Martínez Olmos

A home enteral nutrition (HEN); Spanish registry of NADYA-SENPE group; for the year 2013

AIM To present the results of the Spanish home enteral nutrition (HEN) registry of the NADYA-SENPE group for the year 2013. MATERIAL AND METHODS From January 1st to December 31st 2013 data was recorded for the HEN registry and further descriptive and analytical analysis was done. RESULTS In this period 3 223 patients (50.6% men) and a total of 3 272 episodes of HEN were registered in 33 Spanish hospitals. The rate of prevalence was of 67,11 patients/million habitants/ year 2013. A high percentage of patients (98,24%) were older than 14 years. Adults mean age was 69,14 years (sd 17,64) and men were younger than women p-value <0,001. Children mean age was 2,38 years (sd 4,35). The most frequent indication for HEN was neurological disease for children (49,1%). and for adults (60,6%). Gastrostomy was the most used administration route for children (51%) while younger ones were fed with NGT (p-value 0,003) also older adults (48%) were fed with this type of tube (p-value <0,001). The most frequent reasons for cessation of treatment was death, 44,4% were children and 54,7% were adults. CONCLUSIONS The number of patients and hospitals registered increased in the last years while the other variables maintain steady. The registry developed allowing contrasted analysis of data in order to get more information.

Epidemiology of home enteral nutrition: an approximation to reality

INTRODUCTION home enteral nutrition (HEN) has undergone an important development; however, there is a notable lack of information with regard to its incidence and characteristics. OBJECTIVES our aim was to assess the state of HEN in our area. METHODS an observational, prospective study, involving all patients who had initiated HEN in the Nutrition Unit during a year. Epidemiological, functional, and nutritional evolution of the patients was described and incidence of HEN was calculated. RESULTS HEN incidences totalled 229/100,000 inhabitants/year. The HEN population in our area was characterized by the aged and a high frequency of comorbidity and functional limitations. Neurological and oncological diseases accounted for 50% of indications. The remaining cases were malnourished patients who had received short periods of HEN after hospitalization or a hip fracture. Oral supplements (60%) with standard and hypercaloric formulas were used the most. At baseline, 75% of the patients suffered from malnutrition. During the follow-up, patients showed weight gain (1.6%), an increase in the percentage of normal weight and overweight (from 74% to 82.7%, p = 0.001) and a reduction in pressure ulcers (15.7% vs10.3%, p < 0.001). The median duration of HEN was 8.5 months. Only a quarter of the patients experienced complications (mostly mild gastrointestinal complications); 43.1% had died at the end of the follow-up. CONCLUSIONS in our area, the HEN incidence was much higher than those described in the literature. HEN appears to be a safe therapy with few complications that improves the nutritional status of the patients, even with short periods of administration.

Términos, conceptos y definiciones en nutrición clínica artificial. Proyecto ConT-SEEN

BACKGROUND Imprecision in terms used in the field of clinical nutrition may lead to misinterpretations among professionals. OBJECTIVE For this reason, the Spanish Society of Endocrinology and Nutrition (SEEN) promoted this document on the terms and definitions used in clinical artificial nutrition (enteral and parenteral), establishing an agreement between Spanish experts of this specialty. METHODS Forty-seven specialists in endocrinology and nutrition, members of the Nutrition Area of the SEEN, participated between April and September 2016. After a systematic literature review, 52 concepts were proposed. The coordinators included two additional concepts, and 57were finally selected by the working group: 13 of a general nature, 30 referring to enteral nutrition and 14 to parenteral nutrition. The degree of agreement was subsequently determined using a two-round Delphi process. It was finally ratified by consistency and concordance analysis. RESULTS Fifty-four of the 57 terms had a very consistent agreement and were concordant. Only three showed no concordance, of whom two were very consistent and one inconsistent. In conclusion, there was consensus in the definition of 54 basic terms in the practice of clinical nutrition.

Evidence-based recommendations and expert consensus on enteral nutrition in the adult patient with diabetes mellitus or hyperglycemia

OBJECTIVE The aim of this study was to develop evidence-based recommendations for glycemic control of patients with diabetes mellitus or stress hyperglycemia who are receiving enteral nutrition (EN). METHODS A Delphi survey method using Grading Recommendations Assessment, Development and Evaluation criteria was utilized for evaluation of suitable studies. RESULTS In patients with diabetes or stress hyperglycemia who were on EN support, the following results were found: CONCLUSIONS: These recommendations and suggestions regarding enteral feeding in patients with diabetes and hyperglycemia have direct clinical applicability.

Utilidad en la clínica de la goma guar parcialmente hidrolizada: revisión de la evidencia y experiencia

Introduction: Dietary fiber is an important component of human diet. Since each fiber type has specific metabolic and gastrointestinal function effects, in each specific pathology we will have to choose the optimum type of fiber, considering its chemical, physical and physiological properties. Objective:to put partially hydrolyzed guar gum in its place in the complex framework of dietary fiber, to review its physicochemical properties and possible mechanisms of action; as well as its potential usefulness in different clinical situations in adult patients. Methods: non-systematic review in Medline. Results: Partially hydrolyzed guar gum (PHGG) is obtained from a partial enzymatic hydrolysis of guar gum by the enzyme β-endo-mannanase. It is a soluble, highly fermentable fiber with low viscosity. The fermentation of GGPH in colon produces short chain fatty acids, implicated in the main pathophysiological mechanisms responsible for their clinical effects. Its use in enteral nutrition associated diarrhea is supported by several studies and by the recommendations of scientific societies such as the European Society for Clinical Nutrition and Metabolism and the American Society for Parenteral and Enteral Nutrition. The usefulness of GGPH has been studied in many other clinical situations, such as diabetes, hypercholesterolemia, bacterial overgrowth, etc. with promising results. Conclusions: GGPH is useful in the management of enteral nutrition associated diarrhea. In other clinical situations, more quality studies would be necessary in order to make concrete recommendations.