Publications by authors named "Luis Miguel Luengo Pérez"

30 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

Standards of the nutritional support process in Spain - Towards benchmarking.

Nutr Hosp 2021 Jun;38(3):661-666

Hospital Universitario Nuestra Señora de Valme.

Introduction: Introduction: quality indicators have been proposed in Spain for assessing the various stages of clinical nutrition. However, reference standards for these indicators (feasible and relevant) based on daily practice of artificial nutrition are not available. Goals: the goal of this study was to propose quality indicators standards for their routine application to artificial nutrition in clinical practice. Material and methods: a multicenter, cross-sectional study-based on a survey applied to health professionals in the field of clinical nutrition-on the fulfilment of eight quality criteria was carried out during 2018 and 2019. The total number of processes and those that were correctly accomplished were assessed and compared with the corresponding proposed theoretical standard. Results: fifteen centers were assessed. Of eight indicators assessed, five were within the theoretical standard (correct identification of parenteral nutrition bags, semi-upright position of patients on enteral nutrition, administration of micronutrients in ready-to-use parenteral nutrition bags, checking placement of feeding tubes, and days with glycemia below 60 mg/dL). Two indicators were very close to the theoretical standard. One indicator, hyperglycemia in patients with parenteral nutrition, was far removed from its theoretical standard (15.7 % vs. 5 %). Conclusion: the administration of artificial nutrition in Spanish hospitals was performed with a high quality level. Therefore, standards based on daily clinical practice regarding artificial nutrition in Spain are proposed.
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http://dx.doi.org/10.20960/nh.03543DOI Listing
June 2021

[COVID pandemic and clinical nutrition response in Spain: results of a national survey].

Nutr Hosp 2021 Feb;38(1):207-212

Hospital Universitario Ntra.Sra. de Valme.

Introduction: Introduction: the SARS-CoV-2 pandemic has forced major organizational and care changes in the health system. However, in Spain, the circumstances suffered by the health professionals who have cared for pandemic patients from a clinical nutrition standpoint has remained unknown up to this moment. Objectives: the management and care changes made in clinical nutrition units in Spain, and their impact on clinical practice are described. Material and methods: a cross-sectional study was carried out using a survey directed at SENPE members (June 2020). Responses sent by health professionals in the field of clinical nutrition who had treated patients with COVID-19 in Spanish hospitals were included in the study. Resultados: a total of 116 survey forms were analyzed, mostly filled out by doctors (57.8 %) working at hospitals with more than 500 beds (56 %); 46 % of survey respondents were on telework. There was a nutritional care plan in 68 % of cases, such plan being present mainly in hospitals with more than 500 beds (p < 0.001). In these hospitals more specific diets for COVID-19 were implemented than in those under 500 beds: 18 (35.3 %) vs 44 (67.7 %), (p < 0.001). The use of recommendations issued by scientific societies was reported in 86 % of cases. Never or almost never could a satisfactory nutritional assessment be performed for 38.8 %. The prescription of nutritional supplements was not less than 50 %. Health workers rated their performance as satisfactory or very satisfactory (51.7 %), and this was not related to hospital size but to having implemented a COVID-19 diet (p < 0.05). Conclusions: clinical nutrition in Spain has responded to the COVID-19 pandemic with organizational and managerial changes and, although care has been clearly affected, some quality standards were ultimately maintained. Larger hospitals have had some advantages in making these adjustments.
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http://dx.doi.org/10.20960/nh.03370DOI Listing
February 2021

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

[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

[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

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

Searching for a nutritional screening tool. The value of an analytical method when staff trained in clinical nutrition is not available.

Endocrinol Diabetes Nutr (Engl Ed) 2018 Oct 2;65(8):439-443. Epub 2018 Jul 2.

Sección Endocrinología y Nutrición, Hospital Infanta Cristina, Badajoz, Spain.

Introduction: Disease-related malnutrition (DRM) is highly prevalent. Various European resolutions urge to screen and treat DRM. No policy in this regard has yet been developed in Extremadura (Spain).

Objectives: To assess the prevalence of DRM (defined as NRS 2002≥3) using an analytical method (FILNUT), and to compare it with the official rate.

Results: FILNUT scores≥3 showed values of sensitivity (S) and positive predictive value (PPV) of 82.3% and 72.3% respectively. No statistically significant differences were found between men and women using this tool. FILNUT showed a significantly higher sensitivity for detecting malnutrition in medical - as compared to surgical - diseases when low scores were used. The estimated prevalence of DRM was 21.4%. Prevalence of DRM is much greater than officially reported.

Conclusions: FILNUT scores≥3 show high sensitivity and PPV for detecting DRM, and is a good alternative as a nutritional screening tool to detect malnutrition at our center.
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http://dx.doi.org/10.1016/j.endinu.2018.03.011DOI Listing
October 2018

[Nutritional support and parenteral nutrition in the oncological patient: an expert group consensus report].

Nutr Hosp 2018 Jan 10;35(1):224-233. Epub 2018 Jan 10.

Servicio de Endocrinología y Nutrición. Hospital General Universitario Gregorio Marañón. Madrid..

Background: Malnutrition is a frequent medical problem of cancer patients that negatively impacts their quality of life.

Objective: To analyze and respond to different issues related to the nutritional management of cancer patients in the clinical setting.

Methods: A multidisciplinary group of experts in Medical Oncology, Pharmacy, and Nutrition developed a list of topics related to the nutritional status of cancer patients, which were grouped into three blocks: Nutritional support; Parenteral nutrition (PN); and Home PN (HPN) in cancer patients. A literature search, which included articles published in Spanish, English, and French until February 2017, was carried out. The document was organized as a questionnaire with those questions that, according to the panel's criteria, could generate greater controversy or doubt.

Results: Of the 18 questions addressed, 9 focused on nutritional support: 5 were related to PN and 4 about HPN. Among the different recommendations, the panel emphasized that in the cancer patient, PN is indicated mainly when it is not possible to use the digestive tract and/or oral feeding and/or enteral nutrition is not sufficient or possible. Additionally, the objective of the HPN is to improve or maintain the nutritional status of a patient at home.

Conclusions: This document seeks to lay down a set of recommendations and to identify key issues that may be useful for the nutritional management of cancer Patients.
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http://dx.doi.org/10.20960/nh.1361DOI Listing
January 2018

Nutritional support and parenteral nutrition in cancer patients: An expert consensus report.

Endocrinol Diabetes Nutr 2018 Mar 29;65 Suppl 1:17-23. Epub 2017 Dec 29.

Servicio de Endocrinología y Nutrición, Hospital General Universitario Gregorio Marañón, Madrid, España.

Malnutrition is a common medical problem in cancer patients with a negative impact on quality of life. The aim of this study was to address different issues related to nutritional management of cancer patients in clinical practice. A multidisciplinary group of experts in Medical Oncology, Pharmacy, and Endocrinology and Nutrition prepared a list of topics related to the nutritional status of cancer patients and grouped them into three blocks: nutritional support, parenteral nutrition (PN), and home PN (HPN). A literature review was made of articles published in Spanish, English and French until April 2017. This consensus emphasizes several key elements that help physicians standardize management of the nutritional status of cancer patients in clinical practice, and establishes common guidelines for indication, monitoring, nutritional requirements, and access routes to PN.
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http://dx.doi.org/10.1016/j.endinu.2017.10.012DOI Listing
March 2018

[Home and Ambulatory Artificial Nutrition (NADYA) Group Report - Home parenteral nutrition in Spain, 2016].

Nutr Hosp 2017 Nov 24;34(5):1497-1501. Epub 2017 Nov 24.

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

Objective: To communicate HPN data obtained from the HPN registry of the NADYA-SENPE group (www.nadya-senpe.com) for the year 2016.

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, 2016 to December 31st, 2016.

Results: There were 286 patients from 42 Spanish hospitals (54.2% women), 34 children and 252 adults, with 294 episodes, which represent a prevalence rate of 6.16 patients / million inhabitants / year 2016. The most frequent diagnosis in adults was "palliative cancer" (25.8%), followed by "others". In children it was "motility alterations" with 6 cases (17.6%), Hirschsprung's disease and necrotising enterocolitis, both with 5 children (14.7%). The first indication was short bowel syndrome in both children (64.7%) and adults (37.3%), followed by intestinal obstruction in 28.6% adults and 14.7% in children. The most frequently used type of catheter was tunnelled in both children (70.6%) and adults (37.9%). The most frequent complication in adults was infection related to the catheter, which presented a rate of 0.48 infections / 1,000 days of NPD. During this period, 71 episodes ended in adults and the main cause was death (57.7%) followed by resuming the oral route (31%).

Conclusions: There is a progressive increase of centers and professional collaborators in the registry who report patients receiving parenteral nutrition at home. The main indications of HPN and the motive for ending have remained stable.
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http://dx.doi.org/10.20960/nh.1686DOI Listing
November 2017

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

Organization and management of clinical nutrition in Spain. How do we assess the quality of our activities?

Nutr Hosp 2017 Jul 28;34(4):989-996. Epub 2017 Jul 28.

.

Introduction: Among the objectives of the SENPE Management Working Group is the development of knowledge and tools related to the evaluation of health outcomes.

Objectives: To obtain an approximate profile of clinical nutrition in hospitals in Spain, specifically concerning its organization, endowment, activities and quality indicators.

Methods: A cross-sectional study conducted in 2013 through a structured survey sent to a random sample of 20% of hospitals from the network of the National Health System of Spain, stratified by the number of hospital beds.

Results: The overall response rate was 67% (83% in hospitals with over 200 beds). In 65% of hospitals, clinical nutrition is run by a coordinated team or unit, with a doctor working full time in only 50% of centers. Other professionals are often not recognized as part of the team or unit. There is a specialized monographic nutrition clinic in 62% of centers and 72% have more than 40 new inpatient consultations per month (27% with more than 80 per month). Among the centers with a clinical nutrition team or unit, there is a greater tendency to monitor quality indicators related to clinical practice.

Conclusions: There is widespread addition of clinical nutrition teams and units in hospitals in Spain. However, truly multidisciplinary organization is not often found. High workloads are assumed in relation to staffing levels. The existence of well-organized structures may be associated with benefits that directly affect attendance.
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http://dx.doi.org/10.20960/nh.911DOI Listing
July 2017

Financial impact of disease-related malnutrition at the San Pedro de Alcántara hospital. Estimated cost savings associated to a specialized nutritional survey.

Endocrinol Diabetes Nutr 2017 Oct 13;64(8):446-450. Epub 2017 Jul 13.

Endocrinología y Nutrición, Hospital Valdecilla, Santander (Cantabria), España.

Introduction And Objectives: DRM is a highly prevalent condition in Spanish hospitals and is associated to increased healthcare costs. Costs associated to DRM were calculated using the methods of the PREDyCES study. The potential savings derived from specialized nutritional treatment were calculated by extrapolating the results of the SNAQ strategy.

Results: Median cost per procedure in patients with DRM was €9,679.85, with a final cost of €28,700,775.2. The cost of each patient with DRM was 2.63 times higher than the cost of patients with no DRM. The potential cost saving associated to specialized nutritional treatment was estimated at €1,682,317.28 (5.86% of total cost associated to DRM).

Conclusions: Patients with DRM showed a higher consumption of financial resources as compared to well-nourished patients. Specialized nutritional treatment is a potential cost-saving procedure.
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http://dx.doi.org/10.1016/j.endinu.2017.05.004DOI Listing
October 2017

Efficiency, cost-effectiveness and need of inversion in nutritional therapy. Importance of detecting and documenting undernutrition.

Clin Nutr ESPEN 2016 06 14;13:e28-e32. Epub 2016 Apr 14.

Valdecilla Hospital, Santander, Spain.

Disease Related Malnutrition (DRM) is highly prevalent in Spanish hospitals. WHO estimates that 20-40% of health-associated expenses are lost due to inefficiency. Demonstration that DRM is a component of inefficiency and hiring a specialist physician for its detection and treatment is cost-effective.

Material And Methods: Comparison between nutritional diagnosis and procedures detected and encoded at discharge using McNemar test. Recoding of 162 discharge reports including nutritional diagnoses and procedures. Determine changes on Case-Mix Index (IC), cost of procedure and cost procedure/DRG index. Comparison using T-student paired test.

Results: Only 10 of 162 diagnoses of malnutrition were coded in delivery statements (p < 0.001). After right codification, IC increased in 103,3 DRG points (p < 0.001). Consequently, procedure cost/DRG index was reduced in 978.81 € (p < 0.001).

Conclusions: DRM is underdiagnosed in our hospital. DRM and nutritional procedures detection by a doctor specialist in clinical nutrition led to a reduction in cost procedure/DRG index of 16.8% of officially established by the Health System. Loss of 16.8% of health expenses, estimated in 424.785,15 € was described. Proper codification would have justified 343.291,2 € reimbursement just for nutritional diagnoses and processes. Both expenses were lost due to system's inefficiency. Those amounts are much higher than cost associated of hiring a specialist in clinical nutrition.
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http://dx.doi.org/10.1016/j.clnesp.2016.03.004DOI Listing
June 2016

Reply.

Med Clin (Barc) 2017 07 2;149(2):90-91. Epub 2017 May 2.

Doctor en Medicina, Universidad de Cantabria, Hospital Universitario Marqués de Valdecilla, Santander, España.

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http://dx.doi.org/10.1016/j.medcli.2017.03.024DOI Listing
July 2017

Cost analysis of home parenteral nutrition in Spain

Nutr Hosp 2017 03 30;34(2):271-276. Epub 2017 Mar 30.

Hospital Vall d'Hebrón. Barcelona.

Introduction: Home parenteral nutrition (HPN) improves quality of life, allowing patients to receive nutrition at home and providing a social and labor integration to these patients. Objective: To assess the direct costs of HPN in adult population in Spain. Methods: A literature review of the records of HPN in Spain, carry out by NADYA-SENPE Group (years 2007-2014), was performed. The analysis included the evolution of: patients requiring HPN, number of episodes/patient, mean duration of episodes, description of delivery routes and complications rate. HPN consumption and cost were estimated. Patients were grouped according to their pathological group: benign and malignant. Direct costs (€, 2015) included were: parenteral nutrition bags, delivery sets and costs due to complications. Results: The number of patients who receive HPN has increased over years (2007: 133 patients; 2014: 220 patients). The average number of episodes per patient ranged from 1-2 episodes per year. The average duration of those episodes decreased (2007: 323 days; 2014: 202.8 days). Tunneled catheters were the most used and septic complications were the most common. The average annual cost per patient was estimated at € 8,393.30 and € 9,261.60 for benign and malign disease respectively. Considering that 220 patients required HPN in 2014, an annual cost of € 1,846.524.96 (€ 1,389,910.55 directly due to HPN) and € 2,037,551.90 (€ 1,580,937.50 directly due to HPN) was estimated for patients with benign and malignant pathologies respectively. Conclusions: These results can be used to develop future economic evaluations on HPN and to establish effi cient prioritization strategies to allocate available resources.
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http://dx.doi.org/10.20960/nh.705DOI Listing
March 2017

Nutrición Parenteral Domiciliaria en España durante 2015; informe del Grupo de Nutrición Artificial Domiciliaria y Ambulatoria NADYA.

Nutr Hosp 2016 Nov 29;33(6):1487-1490. Epub 2016 Nov 29.

Hospital General Universitario de Alicante. ISABIAL-FISABIO.

Objetivo: Comunicar los datos del registro de Nutrición Parenteral Domiciliaria (NPD) del grupo de trabajo NADYA-SENPE del años 2015.Material y métodos: Recopilación de los datos de NPD del registro "on-line" del grupo de Nutrición Artificial Domiciliaria y Ambulatoria (NADYA) desde el 1 de enero de 2015 al 31 de diciembre de 2015.Resultados: Se registraron 236 pacientes, con 243 episodios de NPD procedentes de 40 hospitales. Lo que representa una tasa de 5,08 pacientes/millón de habitantes/ año 2015. La patología más frecuente en los adultos fue "otros" (26,3%) seguido por "oncológico paliativo" (21,6%).  La complicación más frecuente fue la séptica relacionada con el catéter que presentó una tasa de 0,53 infecciones/1000 días de NPD. Finalizaron 64 episodios, la principal causa fue el fallecimiento (43,7%) y el 'paso a la vía oral' (32,8%).Conclusiones: constatamos el aumento de los centros y profesionales colaboradores, dando respuesta a la cantidad progresivamente mayor de pacientes con soporte nutricional parenteral en domicilio. Se mantienen estables las principales indicaciones para el establecimiento de NPD y las causas de finalización del tratamiento.
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http://dx.doi.org/10.20960/nh.464DOI Listing
November 2016

Benefits of early specialized nutritional support in malnourished patients.

Med Clin (Barc) 2017 Apr 16;148(7):303-307. Epub 2016 Dec 16.

Sección de Endocrinología y Nutrición, Hospital Valdecilla, Santander, España.

Introduction And Objective: Disease related malnutrition (DRM) is highly prevalent in Spain, affecting 23% of in-hospital patients, and is associated with clinical complications. Specialized nutritional support (SNS) can reduce these complications.

Material And Methods: Prospective study carried out in standard clinical practice conditions to test if SNS during the first 5 days of hospitalization, or subsequently, was associated to a lower length of stay or reduced complications in patients with a NRS-2002 score≥3 points.

Results: In the group of patients who initiated early SNS, the length of stay was 8.83 days shorter than in the group with a later introduction (95% CI 3.55-14.10); nevertheless, the higher prevalence of male and oncological patients in this group could have impacted the results. A tendency towards a statistically significant lower mortality rate and a reduced amount of total complications was described.

Conclusion: The early introduction of SNS (within the first 5 days of hospitalization) in patients with DRM was associated with a 32.4% reduction in the length of stay.
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http://dx.doi.org/10.1016/j.medcli.2016.10.032DOI Listing
April 2017

Adecuación de las peticiones de los niveles de vitamina D al laboratorio.

Nutr Hosp 2016 Sep 20;33(5):581. Epub 2016 Sep 20.

Servicio de Análisis Clínicos. Complejo Hospitalario Universitario de Badajoz. Badajoz.

Introducción: ante las nuevas implicaciones atribuidas a la vitamina D y la asociación con enfermedades tales como el cáncer, diabetes, enfermedades cardiovasculares, autoinmunes y mortalidad, no es de extrañar que se haya defendido la medición de los niveles de vitamina D en la población general. Sin embargo, no existen datos experimentales que demuestren la viabilidad y rentabilidad de la estrategia de cribado en la población y tampoco se ha comprobado la existencia de beneficios para la salud, por lo que en la actualidad solo es aconsejable la medida de 25 (OH) vitamina D en los grupos de personas de alto riesgo como indican las guías clínicas internacionales.Objetivos: analizar las peticiones de vitamina D comprobando si se adecuan a las guías clínicas.Métodos: realizamos un estudio descriptivo transversal en el Área de Salud de Badajoz (España) estudiando las peticiones de determinación de vitamina D durante 12 meses consecutivos (n = 3.907). En dicho estudio revisamos el diagnóstico de petición y la historia clínica del paciente para discriminar entre peticiones que se adecuaban a las guías clínicas y peticiones injustificadas. Por último, realizamos el estudio económico.Resultados: en nuestros resultados encontramos que casi un tercio de peticiones no se adecuaban a las guías clínicas, en patologías tales como diabetes, dislipemias e hipertensión en las que no está recomendada la medición de los niveles de vitamina D, por lo que suponía un exceso de gasto para el sistema sanitario. Gasto que se incrementa cada año, tanto es así que se ha producido un aumento en las peticiones de más del 1.000% en los últimos 6 años.Conclusiones: concluimos la necesidad de crear protocolos de petición de vitamina D que se ajusten a las guías clínicas hasta que existan más estudios experimentales sobre las nuevas implicaciones de la vitamina D y así conseguir una correcta utilización de los recursos económicos del hospital.
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http://dx.doi.org/10.20960/nh.581DOI Listing
September 2016

[Not Available].

Nutr Hosp 2016 Feb 16;33(1):19. Epub 2016 Feb 16.

Complejo Hospitalario de Cáceres. Avda. Pablo Naranjo, s/n. 10003 Cáceres.

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http://dx.doi.org/10.20960/nh.v33i1.19DOI Listing
February 2016

[HOME AND AMBULATORY ARTIFICIAL NUTRITION (NADYA) GROUP REPORT, HOME PARENTERAL NUTRITION IN SPAIN, 2014].

Nutr Hosp 2015 Dec 1;32(6):2380-4. Epub 2015 Dec 1.

Hospital Universitario Severo Ochoa, Leganés, Madrid..

Aim: to communicate the results of the Spanish Home Parenteral Nutrition (HEN) registry of the NADYASENPE group for the year 2014.

Material And Methods: data was recorded online by NADYA group collaborators that were responsible of the HPN follow-up from 1st January to 31st December 2014.

Results: a total of 220 patients and 229 episodes of HPN were registered from 37 hospitals that represents a rate of 4.7 patients/million habitants/year 2014. The most frequent disease in adults was other diseases (23.3%), neoplasm (20.4%) followed by radical active neoplasm (11.8%) and mesenteric ischemia (10.9%). The most frequent diagnosis for children were the congenital intestinal disorders (33.3%) followed by traumatic short bowel and other diagnosis.

Conclusions: the number of participating centers and registered patients increased progressively respect to preceding years. We consider that the HPN should be regulated by the Sanitary Administration within the framework of the National Health Service Interregional Council. And its inclusion in the portfolio of health services of the different Autonomous Comunities would be beneficial for patients and professionals.
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http://dx.doi.org/10.3305/nh.2015.32.6.10056DOI Listing
December 2015

Differences in quality standards when prescribing nutritional support: Differences between specialist and non-specialist physicians.

Endocrinol Nutr 2016 Jan 23;63(1):27-31. Epub 2015 Oct 23.

Unidad de Endocrinología y Nutrición, Hospital Valdecilla, Santander, España.

Unlabelled: Adequate nutritional support includes many different aspects, but poor understanding of clinical nutrition by health care professionales often results in an inadequate prescription.

Material And Methods: A study was conducted to compare enteral and parenteral nutritional support plans prescribed by specialist and non-specialist physicians.

Results: Non-specialist physicians recorded anthropometric data from only 13.3% of patients, and none of them performed nutritional assessments. Protein amounts provided by non-specialist physicians were lower than estimated based on ESPEN (10.29g of nitrogen vs 14.62; P<.001). Differences were not statistically significant in the specialist group (14.88g of nitrogen; P=.072). Calorie and glutamine provision and laboratory controls prescribed by specialists were significantly closer to those recommended by clinical guidelines.

Conclusion: Nutritional support prescribed by specialists in endocrinology and nutrition at San Pedro de Alcántara Hospital was closer to clinical practice guideline standards and of higher quality as compared to that prescribed by non-specialists.
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http://dx.doi.org/10.1016/j.endonu.2015.08.002DOI Listing
January 2016

A Home and Ambulatory Artificial Nutrition (NADYA) group report, Home Parenteral Nutrition in Spain, 2013.

Nutr Hosp 2015 Jun 1;31(6):2533-8. Epub 2015 Jun 1.

Hospital Clinic, Barcelona..

Aim: To communicate the results of the Spanish Home Parenteral Nutrition (HPN) registry of the NADYA-SENPE group for the year 2013.

Material And Methods: Data was recorded online by NADYA group collaborators that were responsible of the HPN follow-up from 1st January to 31st December 2013.

Results: A total of 197 patients and 202 episodes of HPN were registered from 35 hospitals that represents a rate of 4,22 patients/million habitants/year 2013. The median age was 53 years (IQR 40-64) for 189 adult patients and 7 months (IQR 6-35,5) for children. The most frequent disease in adults was neoplasm (30,7%) followed by other diseases (20,1%) and mesenteric ischemia (12,7%). Short bowel syndrome and intestinal obstruction (25,9%) were in 35.7% cases the indications for HPN. The most frequent diagnosis for children were the congenital intestinal disorders and other diagnosis, both with a (37,5%) and short bowel syndrome and intestinal obstruction were the indication for treatment, each was present in 50% of the sample. Tunneled catheters (50%) and subcutaneous reservoirs (27,7%) were frequently used. The septic complications related with catheter were commonly frequent with a rate of 0.74 infections/1000 HPN days. HPN duration presented a median of 1,69 days. A total of 86 episodes finalized during the year, death was the principal reason (45%), followed by "resumed oral via" (43,75%) while it happened inversely for children, 66,7% of them resumed oral via and 16,7% deceased. Fifteen per cent were considered for intestinal transplant, children were proportionally candidates, p-value 0.002.

Conclusions: The number of participating centers and registered patients increased progressively respect to preceding years. Since 2003 Neoplasm is still being the principal pathological group. Death is adult's principal reason for finalizing HPN and "resuming oral via" for children. Despite that NADYA registry is consolidate as a essential source of relevant information about the advances in Home Artificial Nutrition in our country, currently is in an improvement process of the available information about patients characteristics with a special emphasis on children even though they still being a minority group.
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http://dx.doi.org/10.3305/nh.2015.31.6.9052DOI Listing
June 2015

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

Nutr Hosp 2015 Jun 1;31(6):2518-22. Epub 2015 Jun 1.

Hospital Fundació Esperit Sant (Santa Coloma de Gramanet), Barcelona..

Aim: To present the results of the Spanish home enteral nutrition (HEN) registry of the NADYA-SENPE group for the year 2013.

Material And Methods: From January 1st to December 31st 2013 data was recorded for the HEN registry and further descriptive and analytical analysis was done.

Results: In this period 3 223 patients (50.6% men) and a total of 3 272 episodes of HEN were registered in 33 Spanish hospitals. The rate of prevalence was of 67,11 patients/million habitants/ year 2013. A high percentage of patients (98,24%) were older than 14 years. Adult's mean age was 69,14 years (sd 17,64) and men were younger than women p-value <0,001. Children mean age was 2,38 years (sd 4,35). The most frequent indication for HEN was neurological disease for children (49,1%). and for adults (60,6%). Gastrostomy was the most used administration route for children (51%) while younger ones were fed with NGT (p-value 0,003) also older adults (48%) were fed with this type of tube (p-value <0,001). The most frequent reasons for cessation of treatment was death, 44,4% were children and 54,7% were adults.

Conclusions: The number of patients and hospitals registered increased in the last years while the other variables maintain steady. The registry developed allowing contrasted analysis of data in order to get more information.
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http://dx.doi.org/10.3305/nh.2015.31.6.8983DOI Listing
June 2015

[Efficiency, cost-effectiveness and justification of need for investment in nutrition therapy in a hospital of third level; the role of specialists in endocrinology and nutrition and the coding unit].

Nutr Hosp 2015 Apr 1;31(4):1868-73. Epub 2015 Apr 1.

Sección de Endocrinología y Nutrición, Hospital Valdecilla, Santander. España..

Unlabelled: Disease Related Malnutrition (DRM) is highly prevalent in Spanish hospitals. WHO estimates that 20-40% of health-associated expenses are lost due to inefficiency. Demonstration that DRM is a component of inefficiency and hiring a specialist physician for its detection and treatment is cost-effective.

Matherial And Methods: Comparison between nutritional diagnosis and procedures detected and encoded at discharge using McNemar test. Recoding of 55 discharge reports including nutritional diagnoses and procedures. Determine changes on Case-Mix Index (IC), cost of procedure and cost procedure/GRD index. Comparison using Wilcoxon test.

Results: Only 2 of 55 diagnoses of malnutrition were coded in delivery statements (p<0,001). After right codification,IC increased in 42,67 GRD points (p<0,05). Consequently, procedure cost/GRD index was reduced in 976,81€ (p<0,05).

Conclusions: DRM is underdiagnosed in our hospital. DRM and nutritional procedures detection by a specialist on endocrinology and nutrition led to a reduction in cost procedure/GRD index of 20% of officially established by the Health System. Loss of 20% of health expenses,estimated in 172690€ was described. Proper codification would have justified 154581€ reimbursement just for nutritional diagnoses and processes. Both expenses were lost due to system's inefficiency. Those amounts are much higher than cost associated of hiring a specialist, so there is no economic reason for denying it.
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http://dx.doi.org/10.3305/nh.2015.31.4.8512DOI Listing
April 2015

[Analysis of knowledge about healthy breakfast and its relation to life style habits and academic performance in compulsory secondary students].

Endocrinol Nutr 2014 May 31;61(5):242-51. Epub 2014 Jan 31.

Departamento de Didáctica de la Expresión Musical, Plástica y Corporal, Facultad de Educación, Universidad de Extremadura, Badajoz, España.

Objectives: The main objective of the study is to analyze whether students of Compulsory Secondary Education (ESO) of Badajoz city known foods that are part of a healthy breakfast. It also intends to see the relationship of this knowledge with lifestyle habits and academic performance.

Materials And Method: A representative sample of 1197 secondary students in the city of Badajoz (Spain) (50.1% female) was calculated their Body Mass Index (BMI) and were asked to fill in a questionnaire, previously validated in a pilot study, which included sociodemographic items as well as others related with life style habits. They were also asked to choose among a series of food, which of them were a part of a healthy breakfast.

Results: 49.2% of adolescents know foods which are a part of a healthy breakfast. Very low correlations were obtained between all the variables analyzed and knowledge of foods that make up a healthy breakfast. However, within a few variables are significant differences (P<.05) between subgroups, such as families of students with low cultural level of aided schools, repeaters, without reading habit, passing lot of time with friends, who have been on a diet, make less than 3 meals a day and spend less than 10minutes for breakfast and know the amount of fruit that should be consumed daily.

Conclusions: Life style habits of adolescents are not related to the knowledge about the foods that are part of a healthy breakfast.
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http://dx.doi.org/10.1016/j.endonu.2013.11.006DOI Listing
May 2014

[Dietary intake of secondary education students in Badajoz].

Endocrinol Nutr 2012 Aug-Sep;59(7):407-15. Epub 2012 Jul 10.

Departamento de Didáctica de la Expresión Musical, Facultad de Educación, Plástica y Corporal, Universidad de Extremadura, Badajoz, España.

Objectives: To quantify dietary intake of secondary education students in Badajoz, Spain, evaluating food frequency use in teenagers of both sexes.

Material And Methods: The study sample consisted of 1197 secondary education students (49.9% male and 50.1% female). After giving informed consent, they completed a self-administered food frequency questionnaire (FFQ) including 51 food items divided into five separate categories. This questionnaire was modified from the one used at the Valencian Community in 2003 and previously validated in a pilot study on 374 students.

Results: Male and females students reported higher intakes of 70.6% and 17.6% of foods analyzed respectively, while intake of 11.8% of food items was similar in both sexes. Sex differences were statistically significant for 35% of foods (of which 72% and 28% were taken more frequently by males and females respectively). Intake of milk and dairy products appeared to be adequate, while intake of fish and seafood was low consumption of meat products was high. Intake of vegetables, fruits, bread, and cereals was below the recommended levels. Intake of pasta, rice, and oils was adequate, and there was not a high consumptio of cookies or industrial pastries. There was an excess intake of sweets, but intake of soft drinks was not high.

Conclusions: These results show intermediate values as compared to other national surveys.
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http://dx.doi.org/10.1016/j.endonu.2012.05.010DOI Listing
December 2012

[Validation of alternative anthropometric indexes as cardiovascular risk markers].

Endocrinol Nutr 2009 Nov;56(9):439-46

Sección de Endocrinología y Nutrición, Hospital Universitario Infanta Cristina, Cátedra de Nutrición, Facultad de Medicina, Universidad de Extremadura, Badajoz, España.

Introduction: Obesity is considered as a cardiovascular risk factor (CVRF). Anthropometric indexes as body mass index (BMI) or waist-to-hip ratio (WHR) may not reflect properly an increased risk due to obesity, but abdominal circumference is the most accepted as cardiovascular risk marker. As height is important in some instances as insulin resistance, is mandatory to take it into account to evaluate more accurately cardiovascular risk.

Objective: To test the utility of alternative anthropometrical indexes as cardiovascular risk markers.

Material And Methods: A descriptive cross-sectional study was developed with 883 subjects in East Portugal, having anthropometric measurements, blood pressure, laboratory tests, CVRF, and history reported. Cardiovascular risk was calculated according to modified Framingham method.

Results: All of the anthropometric indexes showed statistically significant correlation with cardiovascular risk, but WHR (r=0.48), followed by waist-to-height ratio (r=0.41) and abdominal circumference (r=0.45) were the most accurate. When data were analyzed by sex, waist-to-height ratio (r=0.46) was better in women and WHR (r=0.44) in men.

Conclusions: This study shows that waist-to-height ratio is as useful as others to estimate cardiovascular risk, being better among women.
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http://dx.doi.org/10.1016/S1575-0922(09)72964-XDOI Listing
November 2009