Publications by authors named "Daniel de Luis Román"

48 Publications

Effect of the type of specialized nutrition support on the course of the patient with amyotrophic lateral sclerosis (ALS). Interhospital registry SCLEDyN.

Endocrinol Diabetes Nutr 2021 Jun 11. Epub 2021 Jun 11.

Hospital Clínico Universitario de Valladolid, Valladolid, España; Instituto de Investigación en Endocrinología y Nutrición (IENVA), Universidad de Valladolid, Valladolid, España.

Introduction: Amyotrophic Lateral Sclerosis (ALS) is a neurodegenerative disease in which specialized nutritional support is essential. The objectives of our study were to describe nutritional support at the beginning of follow-up and its impact on anthropometry and survival.

Methods: An interhospital registry was created for the hospitals of Castilla-León through a web platform designed for this purpose. An anamnesis was carried out on the evolution and nutritional history of the disease; and classical anthropometry was determined. The prescribed nutritional treatment was recorded. The parameters were measured at the beginning, at six and twelve months of nutritional follow-up.

Results: A total of 93 patients [49 (52.7%) spinal; 44 (47.3%) bulbar)] were analyzed. The nutritional support route at the beginning was oral diet in 36 (38.7%) patients; oral nutritional supplementation (SON) in 46 (49.5%) patients; and in 11 (11.8%) patients percutaneous endoscopic gastrostomy (PEG). A decrease in the body mass index (BMI) was observed between the first and second visit [Start: 24.18 (3.29) kg/m2; 6 months: 23.69 (4.12) kg/m2; P<.05]. Less weight loss was observed at 6 months compared to the start of nutritional follow-up [Start: 8.09 (8.72)%; 6 months: 1.4 (6.29)%; P<.01]. 36 (38.7%) patients died but with no differences according to when nutritional support was started. Survival from the onset of symptoms was higher in the group of patients with artificial nutrition, although without reaching statistical significance [Oral: 28 (20.25) months; SON: 30 (16.75-48.25) months; PEG: 39 (27-52) months; P=.90].

Conclusions: Patients with ALS present a severe deterioration in nutritional status before the start of nutritional support. After the nutritional intervention, a slowdown in weight loss and nutritional deterioration was observed.
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http://dx.doi.org/10.1016/j.endinu.2021.01.010DOI Listing
June 2021

Adiponectin Gene Variant rs3774261, Effects on Lipid Profile and Adiponectin Levels after a High Polyunsaturated Fat Hypocaloric Diet with Mediterranean Pattern.

Nutrients 2021 May 26;13(6). Epub 2021 May 26.

Center of Investigation of Endocrinology and Nutrition, Department of Endocrinology and Investigation, Medicine School, Hospital Clinico Universitario, University of Valladolid, 47005 Valladolid, Spain.

The role of gene variants on metabolic improvements after weight change secondary to different hypocaloric diets remained unclear. We evaluate the effect of rs3774261 of polymorphism on biochemical improvements and weight change after high polyunsaturated fat hypocaloric diet with a Mediterranean dietary pattern for 12 weeks. A population of 361 obese subjects was enrolled in an intervention trial with a calorie restriction of 500 calories over the usual intake and 45.7% of carbohydrates, 34.4% of fats, and 19.9% of proteins. The percentages of different fats was; 21.8% of monounsaturated fats, 55.5% of saturated fats, and 22.7% of polyunsaturated fats. Before and after intervention, an anthropometric study, an evaluation of nutritional intake and a biochemical evaluation were realized. All patients lost weight regardless of genotype and diet used. After 12 weeks with a similar improvement in weight loss (AA vs. AG vs. GG); total cholesterol (delta: -28.1 ± 2.1 mg/dL vs. -14.2 ± 4.1 mg/dL vs. -11.0 ± 3.9 mg/dL; = 0.02), LDL cholesterol (delta: -17.1 ± 2.1 mg/dL vs. -6.1 ± 1.9 mg/dL vs. -6.0 ± 2.3 mg/dL; = 0.01), triglyceride levels (delta: -35.0 ± 3.6 mg/dL vs. 10.1 ± 3.2 mg/dL vs. -9.7 ± 3.1 mg/dL; = 0.02), C reactive protein (CRP) (delta: -2.3 ± 0.1 mg/dL vs. -0.2 ± 0.1 mg/dL vs. -0.2 ± 0.1 mg/dL; = 0.02), serum adiponectin (delta: 11.6 ± 2.9 ng/dL vs. 2.1 ± 1.3 ng/dL vs. 3.3 ± 1.1 ng/dL; = 0.02) and adiponectin/leptin ratio (delta: 1.5 ± 0.1 ng/dL vs. 0.3 ± 0.2 ng/dL vs. 0.4 ± 0.3 ng/dL; = 0.03), improved only in AA group. AA genotype of (rs3774261) is related with a significant increase in serum levels of adiponectin and ratio adiponectin/leptin and decrease on lipid profile and C-reactive protein (CRP).
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http://dx.doi.org/10.3390/nu13061811DOI Listing
May 2021

[Influence of prior ischemic events on the nutritional status of patients hospitalized for stroke].

Nutr Hosp 2021 May 17. Epub 2021 May 17.

Hospital Clínico Universitario de Valladolid.

Background And Aims: a poor nutritional status may worsen the prognosis of stroke. We assessed which factors were associated with a worse nutritional status in patients with stroke at the time of hospitalization.

Methods: a cross-sectional study in patients with stroke needing enteral nutritional support, from January 2014 to September 2016. Nutritional status was evaluated by the Mini-Nutritional Assessment tool, and the Subjective Global Assessment. We performed a multivariate regression analysis including demographic, baseline disability (modified Rankin scale), and clinical and anthropometric variables, and we stratified the sample based on median age.

Results: we included 226 patients, 58.3 % male, with a median age of 77 (66.7-83) years. Forty-four percent were at risk of malnutrition, and 24 % were malnourished. The factors that were associated with a worse nutritional status were age (odds ratio (OR): 1.03; 95 % CI: 1.01-1.08) and modified Rankin scale score (OR: 1.96; 95 % CI: 1.32-2.67). In the stratified analysis, associated factors were, in the subgroup of patients older than 77 years, the baseline degree of disability (OR: 1.88; 95 % CI: 1.26-2.80), whereas in the subgroup of patients younger than 77 years, it was a prior history of ischemic events (OR: 2.86; 95 % CI: 1.01-8.16).

Conclusion: in patients hospitalized due to stroke, older age and worse functional status were associated with a worse nutritional status at the time of hospitalization. In elderly patients, the main factor was prior functional status, while in younger patients it was a prior history of ischemic events.
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http://dx.doi.org/10.20960/nh.03479DOI Listing
May 2021

The risk variant of CDKAL1 (rs7756992) impairs fasting glucose levels and insulin resistance improvements after a partial meal-replacement hypocaloric diet.

Endocrinol Diabetes Nutr (Engl Ed) 2021 May 5. Epub 2021 May 5.

Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid. Centro de Investigación de Endocrinología y Nutrición Clínica, Facultad de Medicina, Universidad de Valladolid, Valladolid, España. Electronic address:

Background: The CDKAL1 (CDK5 Regulatory Subunit Associated Protein 1 Like 1) gene encodes cyclin-dependent kinase 5 (CDK5) regulatory subunit-associated proten1 like 1. This protein has been shown to contribute to the glucose-dependent regulation of insulin secretion in pancreatic islets.

Aims: The aim of our study was to analyze the effects of the rs7756992 genetic variant of CDKAL1 gene on fasting glucose and insulin resistance after weight loss secondary to partial meal replacement hypocaloric diet (pMRHD).

Methods: This was a non-randomized, single-treatment study with a formula-diet in 44 obese subjects. The patients received nutritional education and a modified diet with two intakes of a normocaloric hyperproteic formula for 3-months. Anthropometric parameter and biochemical profile were measured at basal time and after 3 months. The variant of CDKAL1 gene rs7756992 was assessed.

Results: The following genetic distribution was observed; [27AA (61.3%), 12 AG (27.3%) and 5 GG (11.4%)]. After the pMRHD, body weight, the body mass index (BMI), fat mass, waist circumference and blood pressure decreased in both genotypes. Non-G allele carriers showed a significant improvement in fasting glucose levels (AA vs. AG + GG) (-6.1 ± 1.4 md/dL vs. -1.2 ± 0.7 mg/dl; p = 0.01), fasting insulin levels (-3.6 ± 0.2 mU/L vs. -1.3 ± 0.6 mU/L; p = 0.02) and HOMA-IR (-1.2 ± 0.2 units vs. -0.3 ± 0.2 units; p = 0.01). Fasting plasma glucose levels were higher in G allele carriers than non G allele carriers.

Conclusions: Our data suggest that the genetic variant (rs7756992) of CDKAL1 gene is associated with glycaemic status after a pMRHD, with greater improvements in fasting glucose, insulin and HOMA-IR in subjects without the G allele.
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http://dx.doi.org/10.1016/j.endinu.2020.08.009DOI Listing
May 2021

Assessment of metabolic control and use of flash glucose monitoring systems in a cohort of pediatric, adolescents, and adults patients with Type 1 diabetes.

Endocrine 2021 Jul 23;73(1):47-51. Epub 2021 Mar 23.

Endocrinology and Nutrition Department, Hospital Clínico Universitario Valladolid, Avenida Ramón y Cajal 3, 47005, Valladolid, Spain.

Purpose: Flash glucose monitoring (FGM) in patients with type 1 diabetes (DM1) provides glucometric data that allow assessing glycemic control beyond HbA1c. The objective of this study was to evaluate metabolic control and use of FGM in a cohort of the pediatric and adult population with DM1.

Material And Methods: A cross-sectional study of patients with DM1 and FGM. Data on the use of the system and metabolic control were evaluated, carrying out a comparative study between different age ranges, ≤12 years; 13-19 years, 20-25 years, and ≥26 years.

Results: One hundred and ninety-five patients have included: 35.9% children and adolescents (≤19 years), 42.6% female, 26.2% in treatment with an insulin pump. Mean age was 28.5 ± 15.9 years, mean duration of diabetes 13.7 ± 11.0 years, and mean HbA1c 7.1 ± 0.9% (54 ± 6 mmol/l). Average daily FGM scans were 11.1 ± 6.7. Mean glucose was 162 ± 35 mg/dl, mean standard deviation (SD) 66.1 ± 20.4 mg/dl, mean coefficient of variation 41.4 ± 7.9%, mean time in range (TIR) 58.8 ± 17.0%, mean time above range 33.7 ± 17.6% and mean time below range 7.5 ± 5.8%. The pediatric group showed higher TIR, lower HbA1c, lower glycemic variability, lower mean glucose, and higher use of the device than the adult population. In the entire cohort, the device scans showed a negative quadratic correlation with HbA1c, mean glucose, SD, and age and a positive quadratic correlation with TIR.

Conclusions: Children under 12 years showed the best metabolic control and the most frequent use of the device. Metabolic control deteriorates with age. The greater number of device scans was in correlation with better metabolic control in all age groups.
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http://dx.doi.org/10.1007/s12020-021-02691-4DOI Listing
July 2021

Executive summary: Position document: Evaluation and management of hypoglycemia in the patient with diabetes mellitus 2020. Diabetes Mellitus Working Group of the Spanish Society of Endocrinology and Nutrition.

Endocrinol Diabetes Nutr (Engl Ed) 2021 Apr 7;68(4):270-276. Epub 2021 Jan 7.

Servicio de Endocrinología y Nutrición. Hospital Universitario Virgen de las Nieves, Granada, España.

Objective: To provide practical recommendations for the evaluation and management of hypoglycemia in patients with diabetes mellitus.

Participants: Members of the Diabetes Mellitus Working Group of the Spanish Society of Endocrinology and Nutrition (SEEN).

Methods: The recommendations were made based on the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system to establish both the strength of the recommendations and the level of evidence. A systematic search was made in MEDLINE (PubMed) for the available evidence on each subject, and articles written in English and Spanish with an inclusion date up to 28 February 2020 were reviewed. This executive summary takes account of the evidence incorporated since 2013.

Conclusions: The document establishes practical evidence-based recommendations regarding the evaluation and management of hypoglycemia in patients with diabetes mellitus.
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http://dx.doi.org/10.1016/j.endinu.2020.08.007DOI Listing
April 2021

Effect of lockdown for COVID-19 on self-reported body weight gain in a sample of obese patients.

Nutr Hosp 2020 Dec;37(6):1232-1237

Centro de Investigación de Endocrinología y Nutrición. Servicio de Endocrinología y Nutrición. Hospital Clínico Universitario de Valladolid.

Introduction: Objective: the COVID-19 pandemic, by restricting population mobility, may exacerbate the risk factors for weight gain associated with physical inactivity and increased consumption of calorie-dense foods. The aim of this cross-sectional study was to evaluate the risk factors related to self-reported body weight gain among obese subjects. Methods: the study involved a population of 284 adult obese subjects. After a 7-week confinement period starting on March 17, a telephone interview (May 4 through 7) was conducted. In this phone call, self-reported body weight gain and a number of factors were recorded. In order to obtain the baseline data of this population, biochemical and anthropometric parameters were collected from electronic medical records. Results: mean age was 60.4 ± 10.8 years (range: 23-71) and mean body mass index (BMI) was 35.4 ± 4.7 kg/m2 (range: 30.6-41.2). Gender distribution was 211 females (74.3 %) and 73 males (25.7 %). Self-reported body weight gain was 1.62 ± 0.2 kg. Among patients who reported doing a lot of exercise self-reported body weight gain was lower (1.62 ± 0.2 vs 1.12 ± 0.3 kg; p = 0.02). Regarding eating habits, patients recognized snacking in 17 % of the sample. Patients who reported snacking had higher self-reported body weight gains (2.60 ± 0.36 vs 1.30 ± 0.17 kg; p = 0.001). The remaining variables did not influence self-reported body weight gain. In the multiple regression analysis with self-reported body weight gain as dependent variable, adjusted for age, sex, and physical activity, the snaking habit remained a risk factor: beta = 1.21 (95 % CI: 1.11-2.13; p = 0.01). Conclusions: the lockdown decreed during SARS-CoV-2 pandemic has produced an increase in self-reported body weight among obese subjects, which was related to the habit of taking snacks.
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http://dx.doi.org/10.20960/nh.03307DOI Listing
December 2020

A circadian rhythm-related MTNR1B genetic variant (rs10830963) modulates glucose metabolism and insulin resistance after body weight loss secondary to biliopancreatic diversion surgery.

Nutr Hosp 2020 Dec;37(6):1143-1149

Centro de Investigación de Endocrinología y Nutrición. Servicio de Endocrinología y Nutrición. Hospital Clínico Universitario de Valladolid.

Introduction: Objective: the rs10830963 SNP of the MTNR1B gene may be related with biochemical changes after weight loss induced by caloric restriction. We investigated the role of this SNP on biochemical parameters after biliopancreatic diversion (BPD) surgery in morbid obese subjects. Patients and methods: one hundred and fifty-four patients with morbid obesity, without diabetes mellitus type 2, were enrolled. Their biochemical and anthropometric parameters were recorded before the procedure and after one, two, and three years of follow-up. All subjects were genotyped (rs10830963) at baseline. Results: the decrease in fasting insulin levels seen after the first year (delta: -3.9 ± 1.2 mIU/L vs. -1.8 ± 1.1 mIU/L; p = 0.03), the second year (delta: -5.0 ± 0.3 mIU/L vs. -2.3 ± 0.2 mIU/L; p = 0.01) and the third year (delta: -5.1 ± 1.9 mIU/L vs. -2.8 ± 1.1 mIU/L; p = 0.02) was higher in non-G-allele carriers than in G-allele carriers. Additionally, the improvement of HOMA-IR levels at year one (delta: -0.7 ± 0.2 mIU/L vs. -0.2 ± 0.2 mIU/L; p = 0.03), year two (delta: -1.0 ± 0.3 mIU/L vs. -0.5 ± 0.2 mIU/L; p = 0.01) and year three (delta: -1.2 ± 0.3 mIU/L vs. -0.4 ± 0.2 mIU/L; p = 0.03) was also higher in non-G-allele carriers than in G-allele carriers. Finally, basal glucose levels after the first year (delta: -10.1 ± 2.4 mg/dL vs. -3.6 ± 1.8 mg/dL; p = 0.02), the second year (delta: -16.0 ± 2.3 mg/dL vs. -8.4 ± 2.2 mg/dL; p = 0.01) and the third year (delta: -17.4 ± 3.1 mg/dL vs. -8.8 ± 2.9 mg/dL; p = 0.03) were higher in non-G-allele carriers than in G-allele carriers, too. Improvements seen in comorbidities were similar in both genotype groups. Conclusion: our study showed an association of the rs10830963 MTNR1B polymorphism after massive weight loss with lower glucose response, insulin resistance, and fasting insulin levels in G-allele carriers.
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http://dx.doi.org/10.20960/nh.03153DOI Listing
December 2020

Influence of nutritional status on hospital length of stay in patients with type 2 diabetes.

Endocrinol Diabetes Nutr (Engl Ed) 2020 Dec 11;67(10):617-624. Epub 2020 Oct 11.

Hospital Clínico Universitario de Valladolid (HCUV), Instituto de Endocrinología y Nutrición (IENVA), Valladolid, España.

Introduction: In the hospitalized patient, Diabetes mellitus type 2 (DM2) may result in a worse nutritional status due to its pathophysiology and dietary treatment.

Objectives: The aim of this study was to know if a hospitalized diabetic patient has a worse nutritional status, and to establish the influence of DM2 on the hospital length of stay in patients with malnutrition.

Material And Methods: This was a transveral study from January 2014 to October 2016; 1017 patients were included who were assessed by the Endocrinology and Nutrition Department. The data collected included anthropometry, plasma albumin, delay in performing the nutrition interconsultation and hospital length of stay. Nutritional status was evaluated using the Mini Nutritional Assesment (MNA) questionnaire and the nutritional risk score (NRS).

Results: 24.4% of the patients were diabetic and 75.6% were not. Diabetic patients had a higher body mass index (BMI) [23.18 (20.78-25.99) kg/m vs. 22.31 (19.79-25.30) kg/m2, P˂.01], a lower total score in the MNA questionnaire [16.5(13.12-19) points vs. 17(14-20) points, P˂.01], and a lower NRS score [83.09(77.72-91.12) points vs. 85.78(79.27-92.83) points, p=0.03]. According to the MNA and the NRS, diabetic patients had an increased risk of malnutrition (<17.5 points) [OR=1.39, IC95%(1.04-1.86), p=0.02]; and NRS (<85 points) [OR=1.65, IC 95% (1.07-2.54) p=0.02], respectively. When adjusted for age these significant results disappeared. Diabetes combined with malnutrition showed that diabetic patients with malnutrition (MNA˂17.5) spent longer in hospital [21(12-36) days vs. 17(9-30) days, P=.01].

Conclusions: Diabetic patients have a worse nutritional status than non-diabetic patients. Diabetic patients with a poor nutritional status spend a longer period in hospital.
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http://dx.doi.org/10.1016/j.endinu.2020.05.004DOI Listing
December 2020

ACYL-CoA synthetase long-chain 5 polymorphism is associated with weight loss and metabolic changes in response to a partial meal-replacement hypocaloric diet.

Nutr Hosp 2020 Aug;37(4):757-762

Centro de Investigación de Endocrinología y Nutrición. Servicio de Endocrinología y Nutrición. Hospital Clínico Universitario de Valladolid.

Introduction: Aims:to analyze the effects of the rs2419621 genetic variant of the ACSL5 gene on weight change and metabolic parameters after a partial meal-replacement hypocaloric diet. Methods: this was a non-randomized, single-treatment study with a formula-diet in 44 obese subjects with body mass index (BMI) greater than 35 kg/m2. Patients received nutritional education and a modified diet with two intakes of a normocaloric hyperproteic formula during 3 months. Anthropometric parameters and biochemical profile were measured at baseline and after 3 months. The rs2419621 variant of the ACSL5 gene was assessed using real-time polymerase chain reaction. Results: T-allele carriers showed greater improvement in body weight (CC vs. CT + TT; -7.4 ± 2.1 kg vs. -9.3 ± 1.8 kg; p = 0.01), body mass index (-3.1 ± 0.4 kg/m2 vs. -3.4 ± 0.5 kg/m2; p = 0.02), fat mass (-5.2 ± 1.4 kg vs. -6.4 ± 1.2 kg; p = 0.01) and waist circumference (-6.1 ± 1.1 cm vs. -8.6 ± 0.8 cm; p = 0.02) than non-T-allele carriers. Only subjects with the T allele showed significant improvement in triglyceride levels (-4.6 ± 2.4 md/dL vs. -14.4 ± 2.3 mg/dL; p = 0.01). Finally, improvements in insulin (-2.0 ± 0.3 mU/L vs. -4.5 ± 0.5 mU/L; p = 0.01) and HOMA-IR (-0.4 ± 0.2 units vs. -1.3 ± 0.3 units; p = 0.02) were higher in T-allele carriers than in non-T-allele carriers. Conclusions: our data suggest that the genetic variant (rs2419621) of the ACSL5 gene is associated with diet response after a partial-meal replacement intervention, with greater improvements in adiposity and biochemical parameters in subjects with the T allele.
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http://dx.doi.org/10.20960/nh.03019DOI Listing
August 2020

[Effect of a Mediterranean-pattern diet on the metabolic response secondary to weight loss; role of the single nucleotide polymorphism (rs16147) of neuropeptide Y].

Nutr Hosp 2020 Aug;37(4):742-749

Centro de Investigación de Endocrinología y Nutrición. Servicio de Endocrinología y Nutrición. Hospital Clínico Universitario de Valladolid.

Introduction: Background and aims: intervention studies that evaluate the effect of rs16147 on metabolic response and weight change after dietary intervention are scarce. We propose to evaluate the role of the rs16147 genetic variant in the metabolic effects produced by a hypocaloric Mediterranean-pattern diet with high content of omega-9. Material and methods: a sample of 363 obese subjects was recruited. At the baseline visit the patients were randomly assigned to one of two hypocaloric diets for 12 weeks (diet M, Mediterranean pattern; diet C, standard hypocaloric). All patients, at baseline and at 12 weeks, had biochemical and anthropometric variables measured, and genotyping performed for the rs16147 variant. Results: in all subjects, and with both diets, the parameters of adiposity, blood pressure, and circulating leptin improved. In obese subjects with allele (A) insulin levels (GG vs. GA + AA) (-0.9 ± 1.1 IU/L vs. -4.4 ± 1.0 IU/L; p = 0.01) and HOMA-IR (-0.3 ± 0.1 units vs. -1.2 ± 0.3 units; p = 0.02) decreased significantly with diet M. Subjects carrying the minor allele showed a significant decrease in basal insulin levels (GG vs. GA + AA) (0.7 ± 0.3 IU/L vs. -2.2 ± 0.9 IU/L: p = 0.02) and HOMA-IR (-0.3 ± 0.2 units vs. -0.7 ± 0.1 units: p = 0.01) after diet C. This decrease in circulating insulin and HOMA-IR levels in patients with allele A was significantly higher with diet M than with diet C. Conclusions: the A allele of the rs16147 variant produces a better metabolic response in terms of insulin resistance and basal insulin secondary to weight loss with two different hypocaloric diets in obese subjects, with improvement being higher with the Mediterranean diet.
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http://dx.doi.org/10.20960/nh.02941DOI Listing
August 2020

Malnutrition at diagnosis in amyotrophic lateral sclerosis (als) and its influence on survival: Using glim criteria.

Clin Nutr 2021 01 21;40(1):237-244. Epub 2020 May 21.

Hospital Clínico Universitario de Valladolid, Universidad de Valladolid, Spain; Instituto de Investigación en Endocrinología y Nutrición (IENVA), Universidad de Valladolid, Spain.

Background: Malnutrition is a prognostic factor in Amyotrophic Lateral Sclerosis (ALS). Sometimes, this condition is underdiagnosed, and it might influence on disease progression.

Aims: To evaluate a) nutritional status at the beginning of specialized nutritional treatment and b) the influence of initial nutritional status on disease evolution and survival in a group of patients with amyotrophic lateral sclerosis (ALS).

Methods: An interhospital registry of patients with motor neuron disease treated at the Clinical Nutrition Clinics of six hospitals in the region of Castilla y León in Spain was created. The study was developed from January 2015 to December 2017. An anamnesis, affiliation data, past medical history, disease evolution, nutritional history and an anthropometry and bioelectrical impedance analysis were performed at baseline. The mortality rate was compared among those patients with worse nutritional status at the beginning of the follow-up against those with a better nutritional situation using two tools: The Subjective Global Assessment (SGA) and the criteria of the Global Leadership Initiative for Malnutrition (GLIM).

Results: A total of 93 patients were analysed. The median age of the patients was 67 (57.5-75.5) years. The median Body Mass Index was 24.4 (21.7-25.9) kg/m and the median percentage of weight loss was 9.32 (2.7-17.6)% without differences between the onset type. According to the SGA, 27 (29%) patients were in grade A; 43 (46.3%) patients were in grade B and 23 (24.7%) were in grade C. According to the new GLIM malnutrition criteria, 45 patients (48.4%) had malnutrition. Patients with worse nutritional status had a lower survival median with both SGA (SGA A: 20.5 (10.2-35) months vs SGA B-C: 12 (5.2-23.7) months (p = 0.03)) or the new GLIM criteria according to severity (severe malnutrition: 18 (5-24) months vs. no severe malnutrition: 20 (12-33) months (p = 0.01)). In the multivariate analysis, malnutrition measured by SGA was an independent risk factor (HR: 4.6 (1.5-13.9) p = 0.007) for survival over 15 months when adjusted for age, sex and type of onset of ALS.

Conclusions: Patients with ALS have a severe deterioration in nutritional status when analysed using a classical malnutrition test (SGA) or a new one (GLIM criteria). Patients with a better nutritional situation according to SGA and GLIM severity classification were associated with a longer survival time.
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http://dx.doi.org/10.1016/j.clnu.2020.05.014DOI Listing
January 2021

Effects of a snack enriched with carob and Undaria pinnatifida (wakame) on metabolic parameters in a double blind, randomized clinical trial in obese patients.

Nutr Hosp 2020 Jul;34(3):465-473

Centro de Investigación de Endocrinología y Nutrición. Servicio de Endocrinología y Nutrición. Hospital Clínico Universitario de Valladolid.

Introduction: Introduction: the composition of snack foods likely influences the overall effect that snacking has on metabolism and obesity. The objective of the current study was to assess the responses to two different snacks, one of them supplemented with wakame and carobs, on cardiovascular risk factors, satiety, and subsequent food intake in obese subjects with metabolic syndrome. Material and Methods: forty patients were randomized in a clinical trial (NCT03420989, clinicaltrial.gov) to group I (enriched snack, n = 16) or group II (control snack, n = 16). At baseline and after 8 weeks biochemical parameters, dietary intakes, and nutritional status were assessed. The subjects also rated their feelings of satiety/hunger with a test meal. Results: no differences were detected in anthropometric parameters between both snacks. Changes in other parameters were detected in patients with enriched snacks, with a significant decrease in LDL-cholesterol by 7.4 % (intervention snack, -8.9 ± 2.3 mg/dL vs control snack, -0.9 ± 3.3 mg/dL; p = 0.03), in total cholesterol by 5.8 % (intervention snack, -10.4 ± 2.9 mg/dL vs control snack, -1.4 ± 3.2 mg/dL; p = 0.02), and in resistin level by 15.9 % (intervention snack, -1.0 ± 0.2 mg/dL vs control snack, -0.1 ± 0.3 mg/dL: p = 0.03). After the test meal, satiety scores (after 20 min and 40 min) were higher than fasting levels in both groups. The same results were obtained with the 100-mm, 5-point visual satiety scale. Conclusion: our study indicates that a wakame- and carob-enriched snack induces a significant decrease in total cholesterol, LDL-cholesterol, and resistin levels when compared to a control snack, without effects on food consumption, other cardiovascular parameters, or anthropometric parameters.
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http://dx.doi.org/10.20960/nh.02906DOI Listing
July 2020

[Variations in echocardiography after bariatric surgery. Biliopancreatic diversion vs vertical gastrectomy].

Nutr Hosp 2020 Jul;34(3):474-482

Hospital Universitario Río Hortega.

Introduction: Introduction: obesity has become a worldwide health problem due to its relationship with cardiovascular morbimortality, thus bariatric surgery is considered as one of the main solutions for the correction of excess weight and, consequently, the improvement of its associated heart diseases. Objective: to compare vertical gastrectomy (VG) and biliopancreatic diversion (BPD) by observing echocardiographic characteristics both before and after surgery, as well as to evaluate surgical outcome in terms of the BAROS scale. Methods: results were collected from the echocardiographic testing requested for the preoperative study of patients who underwent surgery over the course of 24 months (from January 2014 to December 2015), as well as their anthropometric data. These were compared with postoperative parameters measured at 3 years after surgery. Results: finally, 26 patients were selected (13 VG and 13 BPD) with a mean age of 42 yrs. VG: initial BMI: 44.6 ± 7.1; final BMI: 31.8 ± 11.3 (p < 0.01); BPD: initial BMI: 48.1 ± 14.2; final BMI: 32.7 ± 10.4 (p < 0.01). Echocardiography: normal systolic function: 100% vs 92%; normal diastolic function: 88.5% vs 69.2%; no valvulopathy: 80% vs 69%; normal left atrium: 76.9% vs 73.1% (p > 0.05); HTA: 38.5% vs 19.2% (p < 0.05), preoperatively and postoperatively, respectively. Conclusions: no significant differences were found between the two groups studied with different techniques, although a slight deterioration in diastolic function was found in both groups. The comorbidities associated with obesity improved in both groups, and the surgery was scored as positive. The scant variation revealed by echocardiography prompts to reconsider its systematic preoperative use in these patients given the low cost-benefit ratio.
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http://dx.doi.org/10.20960/nh.02907DOI Listing
July 2020

Effect of Two Meal Replacement strategies on Cardiovascular Risk Parameters in Advanced Age Patients with Obesity and Osteoarthritis.

Nutrients 2020 Apr 1;12(4). Epub 2020 Apr 1.

Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, Av. Ramón y Cajal, 3, 47003 Valladolid, Spain.

Background And Aims: Meal replacement diets consist of replacing one or more meals with an artificial nutritional supplement. The objective of this study was to compare the effect of one against two meal replacement strategies on body composition and cardiovascular risk parameters in patients with obesity.

Methods: A randomized clinical trial was designed with a modified hypocaloric diet with an artificial nutritional preparation replacing one or two meals for three months in patients with obesity and osteoarthritis pending orthopedic surgery. An anthropometric evaluation and a measurement of the body composition were done with bioelectrical impedance measurement at the beginning and at three months.

Results: A total of 112 patients were recruited. Fifty-two patients (46.4%) were randomized to one replacement and 60 patients (53.6%) to two meal replacements. Eighty-one patients (72.3%) were women, and the average age was 61 (11.03) years. The percentage of weight loss at three months was 8.27 (4.79)% (one meal replacement: 7.98 (5.97)%; two meal replacements: 8.50 (3.48)%; = 0.56). A decrease in fat mass measured by the fat mass index (FMI) was detected (one meal replacement: -2.15 (1.45) kg/m vs. two meal replacements: -2.78 (2.55) kg/m; > 0.05), and a relative increase in fat-free mass was observed (one meal replacement: +3.57 (4.61)% vs. two meal replacements: +2.14 (4.45)%; > 0.05). A decrease in HOMA-IR, systolic blood pressure (SBP), and total cholesterol was observed in both groups without differences between them.

Conclusions: The substitution strategies of one or two meal replacements were effective in weight loss and fat mass decrease without differences between the two groups. An improvement in lipid parameters, glycemic control, and systolic blood pressure was observed without differences between strategies.
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http://dx.doi.org/10.3390/nu12040976DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7230305PMC
April 2020

[Home and Ambulatory Artificial Nutrition (NADYA) Group Report. Home parenteral nutrition in Spain, 2018].

Nutr Hosp 2020 Apr;37(2):403-407

Hospital Universitario Gran Canaria Dr. Negrín.

Introduction: Aim: to communicate home parenteral nutrition (HPN) data obtained from the HPN registry of the NADYA-SENPE group (www.nadya-senpe.com) for the year 2018 Material and methods: descriptive analysis of the data collected from adult and pediatric patients with HPN in the NADYA-SENPE group registry from January 1st, 2018 to December 31st, 2018. Results: there were 278 patients from 45 Spanish hospitals (54.7% women), 23 children and 255 adults, which represent a prevalence rate of 5.95 patients/million inhabitants/year 2018. The most frequent diagnosis in adults was "palliative cancer" (22.0%), followed by "others". In children it was Hirschsprung's disease together with necrotizing enterocolitis, with four cases (17.4%). The first indication was short bowel syndrome in both children (60.9%) and adults (35.7%). The most frequently used type of catheter was tunneled in both children (81.0%) and adults (41.1%). Ending 75 episodes, the most frequent cause was death (52.0%) and change to oral feeding (33.3%). Conclusions: the number of centers and collaborating professionals in the registry of patients receiving HPN remains stable, as well as the main indications and reasons for termination of HPN.
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http://dx.doi.org/10.20960/nh.02976DOI Listing
April 2020

[The rs10401670 variant of the resistin gene is related to circulating resistin levels, insulin resistance, and presence of type-2 diabetes mellitus in obese patients].

Nutr Hosp 2020 Apr;37(2):293-298

Centro de Investigación de Endocrinología y Nutrición.

Introduction: Background: the SNP 3´UTR C/T (rs10401670) of the RETN gene is a polymorphism that has been associated with the presence of type-2 diabetes mellitus in a single work in the literature. Objective: the objective of our study was to evaluate the influence of this resistin gene SNP (rs10401670) on the serum levels of resistin, as well as on the presence of type-2 diabetes mellitus in obese subjects and on insulin resistance. Material and methods: a Caucasian population of 653 obese subjects was analyzed. All subjects underwent an anthropometric evaluation (weight, waist circumference, fat mass), an evaluation of their nutritional intake, a biochemical profile (glucose, insulin, C-reactive protein, lipid profile, insulin, HOMA-IR), and an assessment of the rs10401670 genotype. Determinations were made in the presence of type-2 diabetes mellitus (DM2). A univariate analysis was carried out and a logistic regression was performed with a dichotomy parameter (DM2: yes/no) (SPSS, 17.0, IL, EUA). Results: genotype distribution was as follows: CC, 212 subjects (32.4%); CT, 340 subjects (52.0%); and TT, 101 subjects (15.6%). There were no significant differences between both genotypes in lipid profile, basal glucose, C-reactive protein, anthropometric parameters, nutritional intake, and blood pressure levels. Serum resistin levels (delta: 1.0 ± 0.2 ng/mL; p = 0.02), insulin levels (delta: 1.3 ± 0.1 ng/mL; p = 0.02), and HOMA-IR (delta: 1.2 ± 0.2 ng/mL; p = 0.01) were higher in T-allele carriers than non-T-allele carriers. The overall prevalence of type-2 diabetes mellitus (DM2) in the sample was 21.8%. With respect to the rs10401670 polymorphism, 17.9% of subjects with the CC genotype had DM2, and 23.8% of T-allele carriers had DM2. In the logistic regression analysis the T-allele of the SNP rs10401670, adjusted by age, sex, resistin levels, and body weight showed an association with DM2 - OR: 2.27 (95% CI: 1.26-4.09). Conclusions: the T-allele of the rs10401670 genetic variant is associated with higher levels of resistin, basal insulin, and insulin resistance, and a higher prevalence of type-2 diabetes mellitus, in obese subjects.
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http://dx.doi.org/10.20960/nh.02896DOI Listing
April 2020

[Influence of rs670 variant of APOA1 gene on serum HDL response to an enriched-polyunsaturated vs. an enriched-monounsaturated fat hypocaloric diet].

Nutr Hosp 2019 Dec;36(6):1288-1295

Departamento de Endocrinología y Nutrición. Hospital Clínico Universitario.

Introduction: Background and objectives: genetic variants of the APOA1 gene have been related to lipid profile in obese subjects. Our aim was to analyze the effects of the rs670 APOA1 gene polymorphism on metabolic changes secondary to an enriched-polyunsaturated fat vs. an enriched-monounsaturated fat hypocaloric diet. Methods: 360 Caucasian obese subjects were randomly allocated to two groups. One group received an enriched-polyunsaturated fat (diet P) and the other an enriched-monounsaturated fat hypocaloric diet (diet M) during 12 weeks. The effects on serum biomarkers related to lipid and carbohydrate metabolism were evaluated before and after the dietary intervention. Results: after both diets, body mass index, weight, fat mass, waist circumference, systolic blood pressure, plasma leptin concentration, and waist circumference decreased in all patients. After 12 weeks of intervention with diet P, plasma insulin levels and HOMA-IR decreased in A-allele carriers: delta: -7.3 ± 2.2 IU/L (p = 0.01), and delta: -2.8 ± 0.5 units (p = 0.02), respectively. The same changes in delta were observed after diet M in A-allele carriers: insulin delta: -5.9 ± 1.2 IU/L (p = 0.01), and HOMA-IR delta: -2.1 ± 0.8 units (p = 0.02). In A-allele carriers, LDL-cholesterol decreased and HDL-cholesterol increased after the dietary intervention with diet P: delta: -12.1 ± 4.3 mg/dL (p = 0.01), and delta: 2.6 ± 0.7 mg/dL (p = 0.01), respectively. No differences in lipid profile were observed after diet M. These improvements were not observed in non-A-allele carriers after both interventions. Conclusions: our study showed the association of the rs670 ApoA1 polymorphism with insulin resistance changes as induced by both diets. An enriched-polyunsaturated fat diet produced an additional improvement of HDL-cholesterol and LDL-cholesterol in A-allele carriers.
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http://dx.doi.org/10.20960/nh.02390DOI Listing
December 2019

Influence of Hyperglycemia Associated with Enteral Nutrition on Mortality in Patients with Stroke.

Nutrients 2019 Apr 30;11(5). Epub 2019 Apr 30.

Servicio de Endocrinología y Nutrición. Hospital Clínico Universitario Valladolid (HCUV), Valladolid 47003, Spain.

Objectives To evaluate in patients admitted for stroke: (1) The frequency of hyperglycaemia associated with enteral nutrition (EN). (2) The risk of morbidity and mortality associated with the development of this type of hyperglycaemia.

Methods: A longitudinal observational study was conducted in 115 non-diabetic patients admitted for stroke with EN. Age, functional capacity (Rankin scale), and blood plasma glucose (BPG) were recorded. Hyperglycaemia was considered as: a value higher than 126 mg/dL before the EN and/or a value higher than 150 mg/dL after a week of enteral nutrition. According to this, three groups were differentiated: HyperES: Those who had hyperglycemia before the beginning of the EN (33% patients); NoHyper: those who did not have hyperglycemia before or after (47.8% patients); and HyperEN: Those who did not have hyperglycemia before but suffered it after the beginning of the EN (19.1% patients).

Results: The age was 72.72 (15.32) years. A higher rate of mortality was observed in the HyperEN group 45.50%, than HyperES 15.80% or NoHyper: 10.90%). A lower recovery of the oral feeding was observed in those patients of the HyperEN group 27.30%, than HyperES: 42.10% or NoHyper: 61.80%). In the multivariate analysis adjusting for age, sex, and Rankin scale the development of hyperglycemia in those who did not have it at the beginning (HyperEN) was an independent risk factor for non-recovery of the oral feeding (OR: 4.21 (1.20-14.79), p = 0.02); and mortality adjusted for age, sex and Rankin scale (OR: 6.83 (1.76-26.47), p < 0.01).

Conclusions: In non-diabetic patients admitted for stroke with EN, the development of hyperglycaemia in relation to enteral nutrition supposes an independent risk factor for mortality and for the non-recovery of the oral feeding.
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http://dx.doi.org/10.3390/nu11050996DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6567189PMC
April 2019

Effect of weight loss on bone metabolism in postmenopausal obese women with osteoarthritis.

Obes Res Clin Pract 2019 Jul - Aug;13(4):378-384. Epub 2019 Apr 19.

Endocrinology and Nutrition Service, Hospital Clínico Universitario de Valladolid, Spain; Investigation Center on Endocrinology and Nutrition (IEN), University of Valladolid, Spain.

Background: The choice of hypocaloric diets in obesity can affect bone health.

Aims: The aim of this study is to assess the effect of a hypocaloric diet in postmenopausal obese women and to determine the influence of weight reduction on bone metabolism.

Methods: This was a non-randomised, single-treatment study in 96 postmenopausal women with a body mass index (BMI) greater than 35kg/m and osteoarthritis. The patients received a formula diet with two intake levels of a normocaloric hyperproteic formula (1035kcal (25% protein)). Anthropometry and biochemistry with CrossLaps, osteocalcin, parathyroid hormone (PTH) and 25-OH vitamin D were measured. Consumption of protein, calcium and vitamin D were determined at the beginning of and 3 and 6 months into the study. The response to treatment was compared (high-responder (HR): weight loss greater than 15%, and low-responder (LR): weight loss less than 15%).

Results: The mean age was 64.2 (7.5) years. After 6 months of treatment, a weight loss of 10.2% (8.2-13.8) was observed. There was a significant increase in vitamin D (HR: 21.8% (36.2) vs. LR: 22.7% (36.9), p=0.93) and CrossLaps (HR: 26.8% (19.5-35.2)) vs. LR: 13.3% (-6.1 to 27.9), p=0.01). The loss of more than 15% of initial body weight was an independent risk factor for an increase in CrossLaps (OR: 4.22 (1.1-16.8), p=0.04).

Conclusions: In postmenopausal obese women, weight loss was associated with an increase in the biochemical parameters of bone resorption. The increase in resorption parameters was related to the magnitude of weight loss.
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http://dx.doi.org/10.1016/j.orcp.2019.03.002DOI Listing
June 2020

[Spanish home enteral nutrition registry of the year 2016 and 2017 from the NADYA-SENPE Group].

Nutr Hosp 2019 Mar;36(1):233-237

Complejo Hospitalario Universitario de Canarias.

Introduction: Objective: to present the results of the Spanish home enteral nutrition (HEN) registry of the NADYA-SENPE group for the year 2016 and 2017. Material and methods: from January 1st 2016 to December 31st 2017, the HEN registry was recorded and afterwards a further descriptive and analytical analysis was done. Results: in 2016, 4,578 active patients were recorded and prevalence was 98.33 patients per one million inhabitants; in 2017, 4,777 patients were recorded, with a prevalence of 102.57 per one million inhabitants; 50.8% were males in 2016 and 50.5% in 2017. During the period 2016-17, median age was 71.5 years (IIQ 57-83), 1,558 HEN episodes were finished and the main cause was death (793 patients, 50.89%). Adult males were younger than females (65.3 vs. 73.3 years, p-value < 0.001). The most frequent diagnosis was the neurological disorder that presents with aphagia or severe dysphagia (59%). Nasogastric tube was the most frequent administration route (48.3%) and it is the most widely used in elderly patients (p < 0.001). One hundred and twenty-six pediatric patients were registered (57.1% females). Median age at the beginning of HEN in children was four months. "Other disorders" was the most recorded diagnostic group (41.3%), followed by the group of neurological disorder that presents with aphagia or severe dysphagia. Regarding children, 57.6% were fed through gastrostomy and the younger ones were fed through nasogastric tube (p-value 0.001). Conclusions: the number of patients in the registry, as well as the number of participating centers, is progressively increasing. The main characteristics of the patients have not changed. Despite the increase in diagnostic possibilities in the pediatric population, the classification within the group of "Other pathologies" is quite significant.
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http://dx.doi.org/10.20960/nh.02365DOI Listing
March 2019

Association of the rs10830963 polymorphism in MTNR1B with fasting glucose, serum adipokine levels and components of metabolic syndrome in adult obese subjects.

Nutr Hosp 2019 Mar;36(1):60-65

Hospital Clínico Universitario.

Introduction: Background and objectives: the aim of the present investigation was to describe the association of this single nucleotide polymorphism (SNP) with fasting glucose levels, serum adipokine levels and diabetes mellitus. Methods: the study involved a population of 1,002 adult obese subjects. Measurements of anthropometric parameters, blood pressure, fasting blood glucose, C-reactive protein (CRP), insulin concentration, insulin resistance (HOMA-IR), HOMA-B, lipid profi le and adipocytokines levels were performed. Genotype of MTNR1B gene polymorphism (rs10830963) was evaluated. Results: fasting glucose levels (GG: 101.5 ± 19.1 mg/dl vs GT: 103.5 ± 8.1 units vs TT: 107.2 ± 8.0 mg/dl; p = 0.01) and HOMA-IR (GG: 3.1 ± 1.6 units vs GT: 3.4 ± 1.1 units vs TT: 3.7 ± 1.0 units; p = 0.02) were higher in subjects with GG genotype than in other genotypes. Total adiponectin levels (CC: 20.5 ± 8.4 ng/dl vs CG: 21.8 ± 5.4 ng/dl vs GG: 15.4 ± 1.4 ng/dl; p = 0.02) and HOMA-B (CC: 2.3 ± 0.8 units vs CG: 2.2 ± 1.1 units vs GG: 1.9 ± 0.9 units; p = 0.01) were lower in subjects with GG genotype than GC or CC genotypes. Logistic regression analysis showed an increased risk of hyperglicemia (OR = 1.31, 95% CI = 1.12-2.78, p = 0.03) and diabetes mellitus (OR = 1.37, 95% CI = 1.14-2.86, p = 0.04). Conclusions: this study showed that the MTNR1B rs10830963 polymorphism was associated with increased fasting glucose levels, HOMA-IR, and risk of DM2. This SNP was associated with decreased adiponectin levels and HOMA-B.
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http://dx.doi.org/10.20960/nh.2013DOI Listing
March 2019

Comparative study of overweight and obese patients with nonalcoholic fatty liver disease.

Rev Esp Enferm Dig 2019 Apr;111(4):256-263

Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid.

Background And Aims: non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disorder in the western world. Although NAFLD prevalence is higher in patients with a BMI > 25 kg /m2, it is unclear if there are differences between overweight and obese patients. The associated biochemical, dietary and genetic parameters were compared between overweight and obese patients with NAFLD.

Methods: patients with biopsy-proven NAFLD (n = 203) were enrolled in a cross-sectional study. The MEDAS questionnaire was used to assess adherence to the Mediterranean diet. Biochemical, anthropometrical parameters and the I148M variant (rs738409) of the PNPLA3 gene and rs180069 of the TNF-α gene were evaluated.

Results: overweight patients had higher serum adiponectin levels (22.5 ± 21.9 vs 11.2 ± 18.1 ng/ml; p < 0.05) and lower resistin (3.3 ± 1.7 vs 8.1 ± 8 ng/ml; p < 0.001) and leptin concentrations (22.9 ± 21.9 vs 55.8 ± 45 ng/ml; p < 0.001) than obese patients. Non-alcoholic steatohepatitis (NASH) was more frequent in the obese group (59.3% vs 41.3%; p = 0.02). The multivariate analysis showed adherence to the Mediterranean diet to be an independent protective factor for NASH and liver fibrosis in overweight patients (OR 0.7, 95% CI 0.5-0.8).

Conclusions: NASH was more prevalent in obese patients than in overweight subjects. HOMA-IR and adherence to the Mediterranean diet provided protection against fibrosis in overweight patients. Adherence to the Mediterranean diet was the only independent factor associated with NASH in these patients.
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http://dx.doi.org/10.17235/reed.2019.5926/2018DOI Listing
April 2019

Development of hyponatremia in non-critical patients receiving total parenteral nutrition: A prospective, multicenter study.

Clin Nutr 2019 12 30;38(6):2639-2644. Epub 2018 Nov 30.

Endocrinology and Nutrition Department, Hospital Clínico Universitario de Valladolid-IEN, Universidad de Valladolid, Valladolid, Spain.

Background & Aims: Hyponatremia is frequent in hospitalized patients, especially in those receiving total parenteral nutrition (TPN). Furthermore, the presence of hyponatremia is associated with increased morbimortality in both groups. The goal of this study is to describe the prevalence of hyponatremia developing during TPN in non-critical patients, and identify risk factors for its appearance.

Methods: This prospective multicenter study involved 19 Spanish hospitals. Noncritically-ill patients prescribed TPN over a 9-month period were studied. Variables analyzed demographic characteristics, prior comorbidities, drug therapy, PN composition, additional iv fluids, and serum sodium levels.

Results: A total of 543 patients were recruited, 60.2% males. Age: 67 (IR 57-76). Of 466/543 who were eunatremic when starting TPN, 18% developed hyponatremia (serum sodium < 135 mmol/L) during TPN. Independent risk factors identified by logistic regression analysis: female (OR 1.74 [95% CI = 1.04-2.92], p = 0.036); severe malnutrition (OR 2.15 [95% CI = 1.16-4.35], p = 0.033); opiates (OR 1.97 [95% CI = 1.10-3.73], p = 0.036); and nausea/vomiting (OR 1.75 [95% CI = 1.04-2.94], p = 0.036).

Conclusions: Previously eunatremic patients frequently develop hyponatremia while receiving TPN. In this group, severe malnutrition is an independent risk factor for hyponatremia, as well as previously described risk factors: opiates, nausea/vomiting, and female gender.
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http://dx.doi.org/10.1016/j.clnu.2018.11.014DOI Listing
December 2019

[Home and Ambulatory Artificial Nutrition (NADYA) Report. Home Parenteral Nutrition in Spain, 2017].

Nutr Hosp 2018 Dec 3;35(6):1491-1496. Epub 2018 Dec 3.

1. Hospital General Universitario de Alicante, Alicante, España. 2. Fundación para el Fomento de la Investigación Sanitaria y Biomédica (ISABIAL-FISABIO), Alicante, España..

Aim: to communicate HPN data obtained from the HPN registry of the NADYA-SENPE group (www.nadya-senpe.com) for the year 2017.

Material And Methods: descriptive analysis of the data collected from adult and pediatric patients with HPN in the NADYA-SENPE group registry from January 1st, 2017 to December 31st, 2017.

Results: there were 308 patients from 45 Spanish hospitals (54.5% women), 38 children and 270 adults, with 3,012 episodes, which represent a prevalence rate of 6.61 patients/million inhabitants/year 2017. The most frequent diagnosis in adults was "palliative cancer" (25.6%), followed by "others". In children, it was Hirschsprung's disease with six cases (15.8%). The first indication was short bowel syndrome in both children (55.3%) and adults (33.7%). The most frequently used type of catheter was tunneled in both children (73.4%) and adults (38.2%). Ending 81 episodes, the most frequent cause was death (62.9%) and transition to oral feeding (34.7%).

Conclusions: the progressive increase of collaborating centers and professionals in the registry of patients receiving NPD is maintained. The main indications of HPN and the motive for ending have remained stable.
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http://dx.doi.org/10.20960/nh.2364DOI Listing
December 2018

The 10-item eating assessment tool is associated with nutritional status, mortality and hospital stay in elderly individuals requiring hospitalization with acute diseases.

Nutr Hosp 2018 Jun 28;35(4):827-832. Epub 2018 Jun 28.

.

Objective: the purpose of this investigation was to investigate the associations between nutritional status by Mini Nutritional Assessment (MNA) test and dysphagia by EAT-10 in elderly individuals requiring nutritional oral care in an acute hospital.

Patients: this was a cross-sectional survey covering a sample of 560 elderly individuals. As anthropometric parameters, weight and body mass index (BMI) have been included. Glucose, creatinine, sodium, potassium, albumin, prealbumin and transferrin serum levels were measured. The EAT-10 and MNA tests were carried out. The days of hospital stay and mortality were recorded.

Results: the mean EAT-10 was 11.2 ± 0.89, the median was 10 and the interquartile range, 6-15. A total of 465 (83.1%) elderly patients had EAT-10 scores between 3 and 40, indicating the presence of dysphagia. The mean MNA test was 15.2 ± 1.1, median was 15 and interquartile rage, 11-18.5. According to their MNA score, a total of 340 (60.7%) elderly patients had MNA scores under 17 (malnutrition) and 177 subjects (31.6%) had a MNA score of 17-23.5 (risk of malnutrition). The MNA score and EAT-10 score were independently associated with hospital stance Beta -0.111 (CI 95%: -0.031- -0.78) and Beta 0.122 (CI 95%: 0.038-0.43), respectively. MNA score was associated with EAT-10 score Beta -0.236 (CI 95%: -0.213-0.09). The MNA score and EAT-10 score were independently associated with mortality odds ratio 0.91 (CI 95%: 0.84-0.96) and 1.040 (CI 95%: 1.008-1.074), respectively.

Conclusion: dysphagia assessed by the EAT-10 is associated with nutritional status in elderly subjects requiring acute hospitalization. Subsequently, malnutrition and dysphagia were associated with poor outcome such as hospital stay and mortality.
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http://dx.doi.org/10.20960/nh.1698DOI Listing
June 2018

[Clinical and economic implications of disease-related malnutrition in a surgical service].

Nutr Hosp 2018 02 16;35(2):384-391. Epub 2018 Feb 16.

Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid Instituto de Endocrinología y Nutrición, Universidad de Valladolid.

Introduction: disease-related malnutrition (DRM) is currently a major challenge in our hospitals, both because of its high prevalence and because of the clinical and economic impact. Our study aims to assess the feasibility and importance of establishing a nutritional screening strategy in our Health Care System.

Patients And Methods: this is a prospective study carried out in a Surgery Ward. The nutritional risk was assessed by applying to patients MUST at admission and weekly until discharge. Nutritional evaluation and nutritional intervention were performed if required, as well as coding of diagnoses and nutritional procedures at discharge. Clinical data, length of stay (LOS) and hospital costs were analyzed.

Results: MUST detected 15.6% of patients at risk of malnutrition at admission. Patients with malnutrition at admission (MA) had four days longer LOS, higher annual mortality rate and urgent hospital readmissions in 2.4 and 2.0 times, respectively, one year after discharge. Age and urgent hospital admission were the factors associated with a higher annual mortality rate. Nine per cent of patients with an initial MUST < 2 suffered deterioration in their nutritional status during admission (DNS). These patients had longer LOS in seven days with equal comorbidity. Considering only the costs related to LOS in patients who presented MA or DNS, an overcost of 57% and 145%, respectively, was observed.

Conclusion: patients with malnutrition on admission had longer LOS, higher mortality rate and urgent hospital readmissions one year after discharge. Patients who present MA or DNE cause an economic cost overrun. A nutritional screening tool is essential for the management and early detection of DRM.
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http://dx.doi.org/10.20960/nh.1315DOI Listing
February 2018

Influence of a meal-replacement diet on quality of life in women with obesity and knee osteoarthritis before orthopedic surgery.

Nutr Hosp 2018 Jan 16;35(1):71-77. Epub 2018 Jan 16.

Hospital Clínico Universitario Valladolid.

Background: Knee osteoarthritis is a disease with a high prevalence in our environment, especially in women. Weight loss can improve the quality of life of these patients before surgery.

Objectives: To evaluate the effect of a meal-replacement diet on weight loss, body composition, and the improvement of the quality of life in obese women with knee osteoarthritis pending surgery.

Methods: One branch intervention study was performed over three months on 81 women with a body mass index greater than 30 kg/m2 with knee osteoarthritis before surgery. Patients received a hyperproteic meal-replacement diet with two bottles of an oral nutrition supplement in lunch and dinner (1,035 kcal). Anthropometric parameters, and body composition were measured. The quality of life was assessed by WOMAC and SF-36 test.

Results: The mean age of the patients was 62.23 (8.50) years. The percentage of weight loss was 8.23% (4.04). An improvement in the SF-36 total score was observed (basal: 49.35 [20.41], three months: 58.71 [17.07], p < 0.01). There was an improvement in WOMAC test (basal: 49.24% [25.53], three months: 40.59% [21.76], p < 0.01). It was observed that a 10% improvement in the SF-36 test was independently related to weight loss (OR: 1.2 [1.03-1.36], p < 0.02) adjusted by age and changes in body composition.

Conclusions: In women with osteoarthritis of the knee treated with a meal-replacement diet, there is a significant decrease in weight and fat mass with a relative increase of the latter. There is an improvement in the quality of life according to SF-36 and WOMAC. There is an independent relationship between weight loss and SF-36 improvement.
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http://dx.doi.org/10.20960/nh.1148DOI Listing
January 2018

Histopathological differences in patients with biopsy-proven non-alcoholic fatty liver disease with and without type 2 diabetes.

Endocrinol Diabetes Nutr (Engl Ed) 2018 Jun - Jul;65(6):354-360. Epub 2018 Feb 21.

Hospital Clinico Universitario, Center of Investigation of Endocrinology and Nutrition, Medicine School and Dept of Endocrinology and Nutrition, Valladolid, Spain.

Background And Aims: Prevalence of non-alcoholic fatty liver disease (NAFLD) in developed countries is 30% in the general population and 50% in patients with type 2 diabetes mellitus (T2DM). The aim of this study was to compare the severity of NAFLD, as assessed by liver biopsy and using the non-invasive index NAFLD Fibrosis Score (NFS), in subjects with and without T2DM.

Patients And Methods: The study sample consisted of 217 patients with biopsy-proven NAFLD. Anthropometric assessments, laboratory tests, histological criteria established by the Non-alcoholic Steatohepatitis Clinical Research Network (NASH CRN), and the NFS were recorded.

Results: Patients with T2DM (n=36; 16.5%) had higher HOMA-IR values (6.3±3.6 vs. 3.3±2.4; p<0.0001), GGT levels (125.2±102.3 vs. 82.5±70.6IU/l; p<005), and NFS index (-0.6±0.2 vs. -1.8±0.1; p<0.001) than subjects with no T2DM. Patients with T2DM were found higher rates of NASH (72.2% vs. 48.6%; p<0.05), advanced steatosis (80.6% vs. 63%; p<0.05), and liver fibrosis (75% vs. 43.1%, p<0.05) than patients with no T2DM. Patients with T2DM also had higher NFS values (-0.6±1.2 vs. -1.8±1.8: p=0.01). A logistic regression analysis adjusting for age, gender and BMI showed a significant independent association between NASH and presence of T2DM (OR=4.2: 95% CI: 1.4-12.1; p=0.007). A second model adjusting for the same covariates showed T2DM to be an independent factor associated to advanced fibrosis (OR=4.1; 95% CI: 1.7-9.7).

Conclusion: Patients with T2DM have more advanced degrees of NAFLD and advanced fibrosis as assessed by liver biopsy and the NFS index. Particular attention should be paid to the study and monitoring of NASH in patients with T2DM.
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http://dx.doi.org/10.1016/j.endinu.2017.12.011DOI Listing
April 2019

Influence of a multidisciplinary protocol on nutritional status at diagnosis in amyotrophic lateral sclerosis.

Nutrition 2018 04 28;48:67-72. Epub 2017 Nov 28.

Department of Endocrinology and Nutrition, Clinic University Hospital of Valladolid, Valladolid, Spain; Investigation Institute of Endocrinology and Nutrition, Clinic University Hospital of Valladolid, Valladolid, Spain.

Objective: The aim of this study were to understand the influence of a multidisciplinary care protocol in amyotrophic lateral sclerosis (ALS) on the change in the delay of remission to the nutrition specialist and the initial nutritional status.

Methods: A cohort study was performed in 43 patients with ALS who were referred to the Nutrition Unit between April 2015 and April 2017. Anthropometric parameters and diagnostic times were collected, and the nutritional status was studied through subjective global assessment (SGA). Patients who were included before (control cohort [NoP]) and after (protocol cohort [P]) a multidisciplinary protocol were compared. The mean age of the participants was 66.79 y (10.86 y). Of the patients, 62.8% belonged to the protocol cohort.

Results: Patients who started the protocol had a lower delay in initial assessment by a nutrition specialist (P:2 [1-6] mo/NoP:12 [10-29] mo; P = 0.03). When the nutritional status was analyzed according to the SGA, more patients who did not initiate protocol were in the state of severe malnutrition (C) (P 22.2% versus NoP 60%; P = 0.01). Entry into the protocol was an independent protective factor of the presence of severe malnutrition at the beginning of the nutritional follow-up (odds ratio, 0.20; 95% confidence interval, 0.03-0.73; P = 0.02).

Conclusions: The implementation of a multidisciplinary protocol in ALS allowed patients to present a lower percentage of severe malnutrition in an initial assessment by the nutrition specialist. This protocol is a protective factor for the presence of malnutrition at the beginning of support.
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http://dx.doi.org/10.1016/j.nut.2017.11.010DOI Listing
April 2018