Publications by authors named "Irina Delgado-Brito"

7 Publications

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Comparison of Clinical Outcomes in Surgical Patients Subjected to CIPA Nutrition Screening and Treatment versus Standard Care.

Nutrients 2019 Apr 20;11(4). Epub 2019 Apr 20.

General and Digestive Surgery Department, HUNSC, 38010 Santa Cruz de Tenerife, Spain.

Malnutrition is prevalent in surgical patients and leads to comorbidities and a poorer postoperative course. There are no studies that compare the clinical outcomes of implementing a nutrition screening tool in surgical patients with standard clinical practice. An open, non-randomized, controlled study was conducted in general and digestive surgical hospitalized patients, who were either assigned to standard clinical care or to nutrition screening using the Control of Food Intake, Protein, and Anthropometry (CIPA) tool and an associated treatment protocol ( = 210 and 202, respectively). Length of stay, mortality, readmissions, in-hospital complications, transfers to critical care units, and reinterventions were evaluated. Patients in the CIPA group had a higher Charlson index on admission and underwent more oncological and hepatobiliary-pancreatic surgeries. Although not significant, a shorter mean length of stay was observed in the CIPA group (-1.48 days; < 0.246). There were also fewer cases of exitus (seven vs. one) and fewer transfers to critical care units in this group ( = 0.068 for both). No differences were detected in other clinical variables. In conclusion, patients subjected to CIPA nutrition screening and treatment showed better clinical outcomes than those receiving usual clinical care. The results were not statistically significant, possibly due to the heterogeneity across patient groups.
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http://dx.doi.org/10.3390/nu11040889DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6520912PMC
April 2019

Cost-effectiveness of the hospital nutrition screening tool CIPA.

Arch Med Sci 2020 11;16(2):273-281. Epub 2019 Jan 11.

Internal Medicine Department, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain.

Introduction: Hospital malnutrition is very common and worsens the clinical course of patients while increasing costs. Lacking clinical-economic studies on the implementation of nutrition screening encouraged the evaluation of the CIPA (Control of Food Intake, Protein, Anthropometry) tool.

Material And Methods: An open, non-randomized, controlled clinical trial was conducted on patients admitted to internal medicine and general and digestive surgery wards, who were either assigned to a control (standard hospital clinical care) or to an intervention, CIPA-performing ward (412 and 411, respectively; = 823). Length of stay, mortality, readmission, in-hospital complications, and quality of life were evaluated. Cost-effectiveness was analysed in terms of cost per quality-adjusted life years (QALYs).

Results: The mean length of stay was higher in the CIPA group, though not significantly (+ 0.95 days; = 0.230). On the surgical ward, more patients from the control group moved to critical care units ( = 0.014); the other clinical variables did not vary. Quality of life at discharge was similar ( = 0.53), although slightly higher in the CIPA group at 3 months ( = 0.089). Patients under CIPA screening had a higher mean cost of € 691.6 and a mean QALY gain over a 3-month period of 0.0042. While the cost per QALY for the internal medicine patients was € 642 282, the results for surgical patients suggest that the screening tool is both less costly and more effective.

Conclusions: The CIPA nutrition screening tool is likely to be cost-effective in surgical but not in internal medicine patients.
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http://dx.doi.org/10.5114/aoms.2018.81128DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7069439PMC
January 2019

[Optimisation of nutritional screening tool CIPA: are two parameters of protein really necessary?]

Nutr Hosp 2018 Aug 2;35(4):914-919. Epub 2018 Aug 2.

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Introduction: the preliminary nutritional screening tool CIPA (food intake, proteins, anthropometry) is positive when it fulfills one of the following: control food intake (CI) 48-72 h < 50%, albumin < 3 g/dl, total protein < 5 g/dl, body mass index (BMI) < 18,5 kg/m2 or mid-upper arm circumference (MUAC) ≤ 22,5 cm. The use of two protein parameters increases costs and difficulty; one of them can be suppressed without affecting validity.

Objectives: to evaluate the effectiveness of screening CIPA after exclusion of total protein.

Method: prospective study of hospitalized patients; prevalence or risk of malnutrition was evaluated through CIPA and Subjective Global Assessment (SGA). Hospital malnutrition according to complete CIPA screening (with total proteins and albumin, [CIPAc] and without total proteins [CIPAw/p]) and concordance between both methods were analyzed, as well as the association of the positive screening result with clinical outcomes.

Results: three hundred and forty-three patients were analyzed. The prevalence or risk of malnutrition identified by complete CIPA (c) was 38.19% (33.02-43.36); by CIPA without protein (w/p), 37.32% (32.17-42.46); and SGA was 29.15% (24.32-33.99). Kappa index: 0.981 between both CIPAs, p < 0.001. Both CIPA and SGA detect patients with higher mortality in hospital and one month after discharge. Early readmission was higher in positive CIPA, statistical significantly in CIPAw/p (screening with positive results 21.88% vs screening with negative results 13.49%, p = 0.044), SGA 20.01% vs 15.23%, p = 0.28. Length of stay was higher in patients with positive screening in CIPAc, CIPAw/p and SGA.

Conclusions: CIPAw/p is equally or more effective than the previously validated full CIPA; therefore, it could replace the latter saving costs. The prevalence of malnutrition is high in both variants and they are able to predict which patient has worse clinical prognosis.
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http://dx.doi.org/10.20960/nh.1701DOI Listing
August 2018

Clinical and cost-effectiveness analysis of early detection of patients at nutrition risk during their hospital stay through the new screening method CIPA: a study protocol.

BMC Health Serv Res 2017 04 20;17(1):292. Epub 2017 Apr 20.

General and digestive surgery Department, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain.

Background: Malnutrition is highly prevalent in hospitalized patients and results in a worsened clinical course as well as an increased length of stay, mortality, and costs. Therefore, simple nutrition screening systems, such as CIPA (control of food intake, protein, anthropometry), may be implemented to facilitate the patient's recovery process. The aim of this study is to evaluate the effectiveness and cost-effectiveness of implementing such screening tool in a tertiary hospital, consistent with the lack of similar, published studies on any hospital nutrition screening system.

Methods: The present study is carried out as an open, controlled, randomized study on patients that were admitted to the Internal Medicine and the General and Digestive Surgery ward; the patients were randomized to either a control or an intervention group (n = 824, thereof 412 patients in each of the two study arms). The control group underwent usual inpatient clinical care, while the intervention group was evaluated with the CIPA screening tool for early detection of malnutrition and treated accordingly. CIPA nutrition screening was performed upon hospital admission and classified positive when at least one of the following parameters was met: 72 h food intake control < 50%, serum albumin < 3 g/dL, body mass index < 18.5 kg/m (or mid-upper arm circumference ≤ 22.5 cm). In this case, the doctor decided on whether or not providing nutrition support. The following variables will be evaluated: hospital length of stay (primary endpoint), mortality, 3-month readmission, and in-hospital complications. Likewise, the quality of life questionnaires EQ-5D-5 L are being collected for all patients at hospital admission, discharge, and 3 months post-discharge. Analysis of cost-effectiveness will be performed by measuring effectiveness in terms of quality-adjusted life years (QALYs). The cost per patient will be established by identifying health care resource utilization; cost-effectiveness will be determined through the incremental cost-effectiveness ratio (ICER). We will calculate the incremental cost per QALY gained with respect to the intervention.

Discussion: This ongoing trial aims to evaluate the cost-effectiveness of implementing the malnutrition screening tool CIPA in a tertiary hospital.

Trial Registration: Clinical Trial.gov ( NCT02721706 ). First receivevd: March 1, 2016 Last updated: April 8, 2017 Last verified: April 2017.
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http://dx.doi.org/10.1186/s12913-017-2218-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5397674PMC
April 2017

Análisis del grado de satisfacción alimentaria percibido por los pacientes en un hospital de tercer nivel.

Nutr Hosp 2016 Nov 29;33(6):1361-1366. Epub 2016 Nov 29.

Sección de Nutrición Clínica y Dietética. Servicio de Endocrinología y Nutrición. Hospital Universitario Nuestra Señora de Candelaria. Santa Cruz de Tenerife.

Introducción: la alimentación constituye el pilar fundamental del soporte nutricional de los pacientes hospitalizados. Evaluar el grado de aceptación de la dieta es imprescindible en aras de combatir la desnutrición hospitalaria.Objetivos: a) determinar el grado de satisfacción de los pacientes en relación con las dietas; y b) analizar posibles variables asociadas a un grado de satisfacción mayor (apetito y tipo de dieta).Material y métodos: estudio descriptivo de corte transversal. Se emplea una encuesta de 17 preguntas con datos sociodemográficos, datos cualitativos, así como la valoración general del paciente. Se comparó el grado de satisfacción global en función del apetito y el tipo de dieta (terapéutica vs.basal; con sal vs.sosa) (Test no paramétric o Krustal-Wallis y T-Student para muestras independientes, respectivamente).Resultados: mil cuatrocientos trece pacientes. Edad: 53,9 ± 19 años; 51,3% mujeres. Dieta terapéutica (34,9%). Solo el 39,4% tomó dieta con sal. El 66,8% refirió ingresos previos. La alimentación del hospital para un 43% de pacientes fue ''como esperaba'', mientras que para un 44,1% fue ''mejor de lo que esperaba''. El horario de comidas era adecuado (89,1%) y el tiempo para comer, suficiente (96,4%). En cuanto a las características de la comida servida, consideraron como buenas o muy buenas la misma el porcentaje reflejado: sabor/gusto (56.3%), olor (65,5%), cocinado (69,2%), presentación (80,4%), tamaño de ración (75,9%), calidad (73%), cantidad (77,9%), variedad (67,6%), temperatura (70,4%). La valoración global de la alimentación en una escala de 1 a 10 fue de 6,8 ± 2,3. El apetito se asoció a un aumento significativo de la satisfacción global alimentaria del paciente (p < 0,01). El tipo de dieta o la presencia de sal en la misma no se asociaron a un aumento significativo de la satisfacción con la dieta de los pacientes (p = 0,99 y 0,35, respectivamente).Conclusiones: aunque el grado de satisfacción de la dieta de nuestro hospital es aceptable, es preciso introducir mejoras que aumenten su aceptación. El apetito se asocia a un aumento significativo de la satisfacción global alimentaria. La presencia de sal y el tipo de dieta (basal versusterapéutica) no se relacionan con una mejoría significativa de la valoración global de la dieta.
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http://dx.doi.org/10.20960/nh.796DOI Listing
November 2016

Relationship between Mid-Upper Arm Circumference and Body Mass Index in Inpatients.

PLoS One 2016 5;11(8):e0160480. Epub 2016 Aug 5.

Endocrinology and Nutrition Department of Hospital Universitario Nuestra Señora de Candelaria, Ctra. Del Rosario n°145, 38010, Santa Cruz de Tenerife, Spain.

Introduction: Nutritional screening is a fundamental aspect of the initial evaluation of the hospitalised patient. Body Mass Index (BMI) in association with other parameters is a good marker of malnutrition (<18.5 kg/m2), but it presents the handicap that the great majority of patients cannot be weighed and measured. For this reason it is necessary to find other indicators that can be measured in these patients.

Objectives: 1) Analyse the relationship between BMI and Mid-Upper Arm Circumference (MUAC); 2) establish a cut-off point of MUAC equivalent to BMI <18.5 kg/m2.

Materials And Methods: The anthropometric data of patients hospitalised over the period 2004-2013 were retrospectively revised. The following variables were collected: weight, height, BMI, MUAC, sex and age.

Results: 1373 patients were evaluated, who presented a mean weight of: 65.04±15.51 kg; height: 1.66±0.09 m; BMI: 23.48±5.03 kg/m2; MUAC: 26.95±4.50 cm; age: 56.24±16.77. MUAC correlates suitably to BMI by means of the following equation (simple linear regression): BMI = - 0.042 + 0.873 x MUAC (cm) (R2 = 0.609), with a Pearson r value of 0.78 (p<0.001). The area under the curve of MUAC for the diagnosis of malnutrition was 0.92 (95% CI: 0.90-0.94; p<0.001). The MUAC value ≤22.5 cm presented a sensitivity of 67.7%, specificity of 94.5%, and a correct classification of 90%. No significant statistical differences were found in the cut-off point of MUAC for the diagnosis of malnutrition based on sex (p = 0.115) and age (p = 0.694).

Conclusions: 1) MUAC correlates positively and significantly with BMI. 2) MUAC ≤ 22.5 cm correlates properly with a BMI of <18.5 kg/m2, independent of the age or sex of the patient, although there are other alternatives. MUAC constitutes a useful tool as a marker of malnutrition, fundamentally in patients for whom weight and height cannot be determined.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0160480PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4975446PMC
August 2017

[CONCORDANCE IN THE RESULTS OF CONTROL INTAKE PERFORMANCE OF 72 H BY DIFFERENT HEALTH PROFESSIONALS IN A TERTIARY HOSPITAL].

Nutr Hosp 2015 Dec 1;32(6):2893-7. Epub 2015 Dec 1.

Servicio de Endocrinología y Nutrición. Sección de Nutrición Clínica y Dietética..

Introduction: the nutritional screening CIPA is positive when it fulfills one of the following parameters: Control food Intake (CI) 72 h < 50%; albumin < 3 g/dl; Body Mass Index (BMI) < 18,5 kg/m2 or Mid-Upper Arm Circumference (MUAC) ≤ 22,5 cm (if BMI cannot be determined). The only parameter no totally objective is the CI so that this study seeks to reinforce its validity.

Objectives: analyze the existing concordance among different health professionals when assessing a CI of 72 h.

Materials And Method: retrospective study of patients admitted in hospitalization wards (February-October 2014). Variables considered: age, sex, health service, CI of 72 h and type of diet. The aim of CI is to assess the amount of food consumed, differing between superior or inferior intakes to 50%. It is analyzed the concordance of the results CI determined by a doctor, a nurse and a nutritionist (gold-standard) by the coefficient Kappa (K). Subsequently the sensitivity (S) and specificity (Sp) of positive CI were computed.

Results: 176 control of food intake were analyzed. Age 63.70 } 14.46 years; 42% women. Units: Digestive (22.2%), Pneumology (42%), Internal Medicine (21.6%), Nephrology (9.1%), others (5.1%). Type of diet: basal (23%), therapeutic (67%), consistency (4%), progressive (3.4%), others (2.3%). It was compared the nursing CI vs. nutritionist (K = 0.798; p < 0.001), and the doctor vs. nutritionist (K = 0.823; p < 0.001). The S and Sp of nursing vs. nutritionist was 84% and 97% while between the doctor and the nutritionist was 84% and 98% respectively.

Conclusions: the concordance of the results of a CI of 72 hours (intakes < or > to 50%) performed in patients hospitalized by a doctor, nurse, and nutritionist is high, minimizing subjectivity to this parameter. The CI is helpful for its use within the routine clinical practice, and particularly within the nutritional screenings, such as CIPA.
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http://dx.doi.org/10.3305/nh.2015.32.6.9740DOI Listing
December 2015
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