Publications by authors named "Julia Ocón Bretón"

11 Publications

  • Page 1 of 1

Multidisciplinary consensus on nutritional and metabolic therapy in enhanced recovery after abdominal surgery programs: NutRICA Project.

Endocrinol Diabetes Nutr (Engl Ed) 2021 Jun 1. Epub 2021 Jun 1.

Unidad de Nutrición Clínica y Dietética, Hospital General Universitario Gregorio Marañón, Madrid, España.

Background: The Enhanced Recovery After Surgery (ERAS) care pathways include evidence-based items designed to accelerate recovery after surgery. Interdisciplinarity is one of the key points of ERAS programs.

Objective: To prepare a consensus document among the members of the Nutrition Area of the Spanish Society of Endocrinology and Nutrition (SEEN) and the Spanish Group for Multimodal Rehabilitation (GERM), in which the goal is to homogenize the nutritional and metabolic management of patients included in an ERAS program.

Methods: 69 specialists in Endocrinology and Nutrition and 85 members of the GERM participated in the project. After a literature review, 79 statements were proposed, divided into 5 sections: 17 of general characteristics, 28 referring to the preoperative period, 4 to the intraoperative, 13 to the perioperative and 17 to the postoperative period. The degree of consensus was determined through a Delphi process of 2 circulations that was ratified by a consistency analysis.

Results: Overall, in 61 of the 79 statements there was a consistent agreement, with the degree of consensus being greater among members of the SEEN (64/79) than members of the GERM (59/79). Within the 18 statements where a consistent agreement was not reached, we should highlight some important nutritional strategies such as muscle mass assessment, the start of early oral feeding or pharmaconutrition.

Conclusion: Consensus was reached on the vast majority of the nutritional measures and care included in ERAS programs. Due to the lack of agreement on certain key points, it is necessary to continue working closely with both societies to improve the recovery of the surgical patients.
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http://dx.doi.org/10.1016/j.endinu.2021.02.005DOI Listing
June 2021

Surgical treatment for colorectal cancer: analysis of the influence of an enhanced recovery programme on long-term oncological outcomes-a study protocol for a prospective, multicentre, observational cohort study.

BMJ Open 2020 10 27;10(10):e040316. Epub 2020 Oct 27.

Miguel Servet University Hospital, Zaragoza, Aragón, Spain.

Introduction: The evidence currently available from enhanced recovery after surgery (ERAS) programmes concerns their benefits in the immediate postoperative period, but there is still very little evidence as to whether their correct implementation benefits patients in the long term. The working hypothesis here is that, due to the lower response to surgical aggression and lower rates of postoperative complications, ERAS protocols can reduce colorectal cancer-related mortality. The main objective of this study is to analyse the impact of an ERAS programme for colorectal cancer on 5-year survival. As secondary objectives, we propose to analyse the weight of each of the predefined items in the oncological results as well as the quality of life.

Methods And Analysis: A multicentre prospective cohort study was conducted in patients older than 18 years of age who are scheduled to undergo surgery for colorectal cancer. The study involved 12 hospitals with an implemented enhanced recovery protocol according to the guidelines published by the Spanish National Health Service. The intervention group includes patients with a minimum implementation level of 70%, and the control group includes those who fail to reach this level. Compliance will be studied using 18 key performance indicators, and the results will be analysed using cancer survival indicators, including overall survival, cancer-specific survival and relapse-free survival. The time to recurrence, perioperative morbidity and mortality, hospital stay and quality of life will also be studied, the latter using the validated EuroQol Five questionnaire. The propensity index method will be used to create comparable treatment and control groups, and a multivariate regression will be used to study each variable. The Kaplan-Meier estimator will be used to estimate survival and the log-rank test to make comparisons. A p value of less than 0.05 (two-tailed) will be considered to be significant.

Ethics And Dissemination: Ethical approval for this study was obtained from the Aragon Ethical Committee (C.P.-C.I. PI20/086) on 4 March 2020. The findings of this study will be submitted to peer-reviewed journals (, ). Abstracts will be submitted to relevant national and international meetings.

Trial Registration Number: NCT04305314.
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http://dx.doi.org/10.1136/bmjopen-2020-040316DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7597515PMC
October 2020

Fish Oil Enriched Intravenous Lipid Emulsions Reduce Triglyceride Levels in Non-Critically Ill Patients with TPN and Type 2 Diabetes. A Post-Hoc Analysis of the INSUPAR Study.

Nutrients 2020 May 27;12(6). Epub 2020 May 27.

Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Regional Universitario de Málaga-Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain.

There are no studies that have specifically assessed the role of intravenous lipid emulsions (ILE) enriched with fish oil in people with diabetes receiving total parenteral nutrition (TPN). The objective of this study was to assess the metabolic control (glycemic and lipid) and in-hospital complications that occurred in non-critically ill inpatients with TPN and type 2 diabetes with regard to the use of fish oil emulsions compared with other ILEs. We performed a post-hoc analysis of the Insulin in Parenteral Nutrition (INSUPAR) trial that included patients who started with TPN for any cause and that would predictably continue with TPN for at least five days. The study included 161 patients who started with TPN for any cause. There were 80 patients (49.7%) on fish oil enriched ILEs and 81 patients (50.3%) on other ILEs. We found significant decreases in triglyceride levels in the fish oil group compared to the other patients. We did not find any differences in glucose metabolic control: mean capillary glucose, glycemic variability, and insulin dose, except in the number of mild hypoglycemic events that was significantly higher in the fish oil group. We did not observe any differences in other metabolic, liver or infectious complications, in-hospital length of stay or mortality.
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http://dx.doi.org/10.3390/nu12061566DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7352525PMC
May 2020

Association of positive screening for dysphagia with nutritional status and long-term mortality in hospitalized elderly patients.

Endocrinol Diabetes Nutr (Engl Ed) 2018 Aug - Sep;65(7):402-408. Epub 2018 Apr 24.

Departamento de Endocrinología y Nutrición, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España.

Objectives: To assess the prevalence of oropharyngeal dysphagia (OD) using the Eating Assessment Tool (EAT-10) and its association with malnutrition and long-term mortality.

Material And Methods: A retrospective cohort study of patients admitted to the general internal medicine ward. In the first 48hours after hospital admission, OD was assessed using the EAT-10, and presence of malnutrition with the Mini Nutritional Assessment-Short Form (MNA-SF). Association of OD to malnutrition and long-term mortality was analyzed.

Results: Ninety patients with a mean age of 83 (SD: 11.8) years were enrolled. Of these, 56.7% were at risk of OD according to EAT-10. This group of patients had greater prevalence rates of malnutrition (88.2% vs. 48.7%; P=.001) and mortality (70% vs 35.9%; P=.001). During follow-up for 872.71 (SD: 642.89) days, risk of DO according to EAT-10 was an independent predictor of mortality factor in a multivariate analysis (HR: 2.8; 95%CI: 1.49-5.28; P=.001).

Conclusions: The EAT-10 is a useful tool for screening OD. Adequate screening for OD is important because of its associated risks of malnutrition and long-term mortality.
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http://dx.doi.org/10.1016/j.endinu.2018.02.004DOI Listing
April 2019

Terms, concepts and definitions in clinical artificial nutrition. The ConT-SEEN Project.

Endocrinol Diabetes Nutr (Engl Ed) 2018 Jan 8;65(1):5-16. Epub 2017 Dec 8.

Grupo de trabajo ConTSEEN del Área de Nutrición de la 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.
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http://dx.doi.org/10.1016/j.endinu.2017.10.008DOI Listing
January 2018

[NUTRITION, SURGERY AND PROGRAMMES OF MULTIMODAL REHABILITATION].

Nutr Hosp 2015 Jul 1;32(1):2-3. Epub 2015 Jul 1.

Vocal del Comité científico del GERM. Servicio de Cirugía. Hospital Universitario de Elche, España..

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http://dx.doi.org/10.3305/nh.2015.32.1.9203DOI Listing
July 2015

[Maternal and neonatal complications in a pregnant woman with biliopancreatic diversion].

Nutr Hosp 2010 Jan-Feb;25(1):120-2

Unidad de Nutrición, Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España.

Biliopancreatic diversion (BPD) is a bariatric technique which can lead to the development of nutritional complications such as protein-calorie malnutrition and deficiencies in fat-soluble vitamins. Many women in childbearing age undergone DBP, pregnancy frequently occurs afterwards. Vitamin A is essential for the differentiation and growth of cell during embryonic development. Although BPD has shown beneficial effects in some obstetric and reproductive complications as infertility and macrosomia, several reports suggest a link between maternal malnutrition and fetal or neonatal complications. We present the case of a pregnant woman with a severe malnutrition associated with vitamin A deficiency as a result of a BPD. The patient delivered a premature infant, with low birth weight and significant eye and kidney malformations. We review and discuss the probable relationship between adverse neonatal outcome, malnutrition and vitamin A deficiency during pregnancy.
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May 2010

[Effect of gastric bypass on the metabolic syndrome and on cardiovascular risk].

Nutr Hosp 2010 Jan-Feb;25(1):67-71

Unidad de Nutrición, Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España.

Background: Obesity is associated with increased morbimortality cardiovascular. Individual with metabolic syndrome (MS) are a high risk of developing cardiovascular disease (CVD). The aim of this study was to determine the prevalence of the MS in morbidly obese patients enrolling in a bariatric surgery program and to evaluate the impact of weigh loss induced by gastric bypass on the MS and on the predicted 10-year cardiovascular risk.

Material And Methods: We studied 46 morbidly obese patients who underwent laparoscopic gastric bypass and were followed for 2 years. MS was defined following the IDF 2005 criteria and the insulin resistance (IR) was calculated by using HOMA index. Risk assessment for estimating 10-year ECV risk was carried out according to Framingham score.

Results: Before surgery, 67.2% of patients had IR and 60,9% met the definition of the MS. 17.3% of patients had an elevated cardiovascular risk category. 2 years after gastric bypass, the percentage of excess body weight lost was 72%. All patients restored their HOMA index and only 1 patient (3.6%) had MS. Resolution of hypertension, disglucemia and dislipemia has been observed in 85%, 93.8% and 95.6% of patients. Estimated cardiovascular risk decreased from 4.5% at baseline to 1% at 2 years after surgery.

Conclusions: SM is common in morbidly obese patients. Bypass gastric is associated with an improvement or resolution in cardiovascular risk factors and IR and result in a significant reduction in MS prevalence and of predicted 10-year cardiovascular risk.
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May 2010

[Prevalence and predictive factors of parietal cell antibody positivity in autoimmune thyroid disease].

Endocrinol Nutr 2010 Feb 10;57(2):49-53. Epub 2010 Feb 10.

Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España.

Background And Objectives: Our aim was to evaluate the prevalence of parietal cell antibodies (PCA) in patients with autoimmune thyroid disease (ATD).

Material And Methods: We performed a descriptive, cross-sectional study of patients with ATD. The presence of PCA was determined. Elevated antithyroid antibodies (ATAs) were defined as those higher than the 75th percentile of distribution. Multivariate logistic regression models were built to assess the independent contribution of the following variables to PCA positivity: age, sex, hemoglobin, medium corpuscular volume (MCV), dose/Kg of levothyroxine (LT4), disease duration and elevated ATA levels.

Results: A total of 148 patients were included (137 females). The mean age was 45.7 (SD 15) years and disease duration was 4.5 (SD 4) years. Forty-three patients (29%) with Graves' disease and 105 (71%) with primary hypothyroidism were included. The 75th percentile of distribution was 420U/ml for anti-peroxidase antibodies and 200U/ml for anti-thyroglobulin antibodies. PCA positivity was found in 30 patients, with an overall prevalence of 20.3%. PCA positivity with titers higher than 1/640 was found in 19 patients (12.8%). The only independent predictive factor of PCA positivity was the presence of elevated levels of ATAs (odds ratio (OR)=3; 95% confidence interval (CI): 1.1-8.6; p=0.04). The only independent predictive factor of PCA positivity at titers >/=1/640 was also the presence of elevated levels of ATAS (OR=7.3; 95% CI: 1.6-32.7; p=0.009).

Conclusions: The prevalence of PCA positivity in patients with ATD was 20%. Elevated levels of ATAs increase the risk of PCA positivity.
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http://dx.doi.org/10.1016/j.endonu.2009.11.001DOI Listing
February 2010