Intervención dietético-terapéutica en candidiasis intestinal

Antecedentes: Las candidiasis son infecciones oportunistas producidas por levaduras, cuyo agente etiológico implicado más frecuente C.albicans generando problemas a varios niveles. Caso clínico: Mujer de 39 años diagnosticada de Candidiasis intestinal crónica cursando con sintomatología amplia y variada. Tras la valoración se procede a complementar el tratamiento con una alimentación centrada en la eliminación de azúcares simples, levaduras y productos fermentados. Además, se incluyen ácido caprílico, aceite de orégano y L.acidophylus. Conclusiones: Existe un aumento de la actividad inmunológica acompañada de la mejora sintomatológica.

A propósito de un caso de malnutrición muy extrema en una paciente que presenta Anorexia Nerviosa Restrictiva de larga evolución y no recibía tratamiento

La anorexia nerviosa es un trastorno de la conducta alimentaria que con frecuencia ocasiona malnutrición y asocia riesgo de mortalidad. Requiere la colaboración de un equipo multidisciplinar con amplia experiencia clínica para obtener óptimos resultados, una exitosa educación nutricional y evitar el síndrome de realimentación. El caso que se presenta constituye la malnutrición más severa secundaria a anorexia nerviosa que hemos tratado en nuestra unidad: una paciente de 33 años con IMC de 8.8 kg/m² y elevación de enzimas hepáticas, que, a pesar de la situación de extrema gravedad en la que se encontraba, no presentó complicaciones durante el proceso de realimentación, que se detalla.

Alimentación y desarrollo infantil I: el estado nutritivo de los niños en edad escolar de un suburbio madrileño (Rev Clin Esp 1944; XII:87-94)

El estudio clínico del estado nutritivo de un grupo de niños en edad escolar, habitantes de un suburbio madrileño revela la existencia, relativamente rara, de signos carenciales específicos, que contrasta vivamente con el considerable retraso que se observa en su desarrollo somático. Los hechos parecen demostrar que el problema nutritivo de estos niños es sobre todo un problema cuantitativo. El retraso de la evolución está en relación con la insuficiencia global de la dieta y con el déficit de calcio que es probablemente el elemento individual con mayor grado de carencia en las dietas. La anemia que presenta el 98% de los niños no parece deberse únicamente a una deficiencia de hierro porque la dieta parece tener una cantidad adecuada; probablemente esté más en relación con el exiguo contenido de proteínas animales de la ración.

Alimentación y desarrollo infantil II: el desarrollo físico comparativo de dos grupos de niños en edad escolar y distinto nivel económico (Rev Clin Esp 1944; 12:155-164)

El estudio comparativo de dos grupos de niños en edad escolar y de nivel económico diferente demuestra que los que pertenecen a un suburbio madrileño económicamente pobre sufren un retraso en el crecimiento que se caracteriza por una talla y un peso inferiores en relación con la edad. El retraso del peso corporal es proporcionalmente mayor al de la talla. Cuando se calcula según WETZEL la edad que teóricamente corresponde al desarrollo corporal de estos niños se observa un retraso de 2,94 años para una edad término medio de 10,14 años. El retraso global del desarrollo somático representa por tanto el 29 por 100 de la edad cronológica media. Este retraso en el desarrollo debe atribuirse principalmente a causas dietéticas y no solo a carencias específicas, sino sobre todo a insuficiencia cuantitativa en la dieta consumida. Desde el punto de vista cualitativo es probablemente la falta de leche en la dieta uno de los más importantes factores en la génesis de este trastorno del desarrollo.

A genetic variant of the CAPN10 gene in Mexican subjects with dyslipidemia is associated with increased HDL-cholesterol concentrations after the consumption of a soy protein and soluble fiber dietary portfolio

Dyslipidemia is a major public health problem, and therefore, it is important to develop dietary strategies to diminish the prevalence of this disorder. It was recently reported that diet may play an important role in triggering insulin resistance by interacting with genetic variants at the CAPN10 gene locus in patients with metabolic syndrome. Nonetheless, it remains unknown whether genetic variants of genes involved in the development of type 2 diabetes are associated with variations in high-density lipoprotein cholesterol (HDL-C). The study used a single-center, prospective, cohort design. Here, we assessed the effect of four variants of the CAPN10 gene on HDL-C levels in response to a soy protein and soluble fiber dietary portfolio in subjects with dyslipidemia. In 31 Mexican dyslipidemic individuals, we analyzed four CAPN10 gene variants (rs5030952, rs2975762, rs3792267, and rs2975760) associated with type 2 diabetes. Subjects with the GG genotype of the rs2975762 variant of the CAPN10 gene were better responders to dietary intervention, showing increased HDL-C concentrations from the first month of treatment. HDL-C concentrations in participants with the wild type genotype increased by 17.0%, whereas the HDL-C concentration in subjects with the variant genotypes increased by only 3.22% (p = 0.03); the low-density lipoprotein cholesterol levels of GG carriers tended to decrease (-12.6%). These results indicate that Mexican dyslipidemic carriers of the rs2975762-GG genotype are better responders to this dietary intervention.

The influence of the initial state of nutrition on the lifespan of patients with amyotrophic lateral sclerosis (ALS) during home enteral nutrition

Aim: Amyotrophic lateral sclerosis (ALS) is a chronic, neurodegenerative disease, which leads to development of malnutrition. The main purpose of this research was to analyze the impact of malnutrition on the course of the disease and long-term survival. Material and methods: A retrospective analysis has been performed on 48 patients (22 F [45,83%] and 26 M [54,17%], the average age of patients: 66,2 [43-83]) in 2008-2014.The analysis of the initial state of nutrition was measured by body mass index (BMI), nutritional status according to NRS 2002, SGA and concentration of albumin in blood serum. Patients were divided into two groups, depending on the state of nutrition: well-nourished and malnourished. The groups were created separately for each of these, which allowed an additional comparative analysis of techniques used for the assessment of nutritional status. Results: Proper state of nutrition was interrelated with longer survival (SGA: 456 vs. 679 days, NRS: 312 vs. 659 vs. 835 days, BMI: respectively, 411, 541, 631 days, results were statistically significant for NRS and BMI). Concentration of albumin was not a prognostic factor, but longer survival was observed when level of albumin was increased during nutritional therapy. Conclusions: The initial nutrition state and positive response to enteral feeding is associated with better survival among patients with ALS. For this reason, nutritional therapy should be introduced as soon as possible.

One-year follow-up of the nutritional status of patients undergoing liver transplantation

Background: Choosing the method of nutritional assessment is essential for proper follow-up of the nutritional status of patients undergoing liver transplantation. Objectives: Evaluate and compare the nutritional status of cirrhotic patients before and after liver transplantation over a year by different methods of nutritional assessment. Methods: Patients undergoing liver transplantation were assessed in five phases: pre-transplant, 1, 3, 6 and 12 months after transplantation at the hospital Santa Casa de Misericordia de Porto Alegre, RS, Brazil. The methods used for nutritional assessment were anthropometry, grip strength of the non-dominant hand (HGS) by dynamometry, thickness of the adductor pollicis muscle (APM) and phase angle (PA) by bioelectrical impedance analysis (BIA). In all evaluations, the same measurements were taken. Results: Evaluations were performed in 22 patients. Methods that showed a higher prevalence of malnourished patients before transplantation were PA by BIA (25%), arm muscle circumference (AMC) (21.9%) and arm circumference (AC) (18.8%). When comparing the nutritional status of patients during follow-up, there was a significant difference only in the evaluation methods AC, triceps skinfold thickness and PA by BIA. At the end, the methods of nutritional assessment were compared again. They showed a significant statistical difference, with HGS being the best method for detecting malnutrition. Conclusions: In conclusion, it is suggested that the method PA by BIA could be widely used with this population since the results are consistent with other findings in the literature and they are significant, reliable, and reproducible.

Early consumption of liquids different to breast milk in Mexican infants under 1 year: results of the probabilistic National Health and Nutrition Survey 2012

Introduction: Studies on infant dietary intake do not generally focus on the types of liquids consumed. Objective: To document by age and breastfeeding status, the types of liquids present in the diet of Mexican children under 1 year of age (< 1 y) who participated in the National Health and Nutrition Survey 2012 (ENSANUT-2012). Methods: Analysis of the infant < 1 y feeding practices from the ENSANUT-2012 survey in non-breastfed (non-BF) and breastfed (BF) infants by status quo for the consumption of liquids grouped in: water, formula, fortified LICONSA milk, nutritive liquids (NL; thin cereal-based gruel with water or milk and coffee with milk) and non-nutritive liquids (non-NL) as sugared water, water-based drinks, tea, beans or chicken broth, aguamiel and coffee. In this infants < 1 y we analyzed the not grouped consumption of liquids in the first three days of life (newborns) from the mother's recall. Percentage and confidence intervals (95% CI) were calculated adjusting for survey design. Statistical differences were analyzed by Z test. Results: We observed a high consumption of human milk followed by formula (56.7%) and water (51.1%) in infants under 6 months of age (< 6 mo). The proportion of non-BF infants consuming non-NL was higher than for BF infants (p < 0.05). More than 60% of older infants (6 mo and < 1 y) consumed formula and were non-BF. In newborns formula consumption was predominant, followed by tea or infusion and water. Conclusions: Non-breast milk liquids are present undesirably in Mexican infants' diet and non-NL are consumed earlier than NL, revealing inadequate early dietary practices.

The most significant deficiencies in macro and micro nutrients in adolescents living with HIV/AIDS in antiretroviral therapy

Objective: To evaluate macro and micronutrients intake of adolescents living with HIV/AIDS in use of antiretroviral therapy and compare it to the Dietary Reference Intakes. Methodology: Cross-sectional study conducted with adolescents of both genders with HIV/AIDS, assessing the dietary composition of macro and micronutrients, using the 24h dietary recall. Results: 39 adolescents, average age of 15 years, 51.3% males. The participants intake of total calories, total fiber (g/d), liposoluble vitamins (A, D, E, K), vitamin B5 (mg/d), vitamin B9 (mg/d), vitamin C (mg/d), calcium (mg/d), phosphorus (mg/d), potassium (mg/d), and magnesium (mg/d) was lower than recommended. The percentages of intake lower than recommended were 79.5% for calories, 82.1% for total fibers, 89.7% for vitamin A, 100% for vitamin D, 87.2% for vitamin E, 100% for vitamin K, 71.8% for vitamin B5, 82.1% for vitamin B9, 76.9% for vitamin C, 92.3% for calcium, 61.5% for phosphorus, 97.4% for potassium, and 76.9% for magnesium. The participants ingested more carbohydrates (g), proteins (g), vitamins B2 (mg/d), B3 (mg/d), B8 (mg/d) and sodium (g/d) than recommended, the percentages above the recommendations being 92.3% for carbohydrates, 64.1% for proteins and vitamin B2, 56.4% for vitamin B3, 82.1% for vitamin B8, and 59% for sodium. The remaining nutrients were within the amounts recommended by the DRIs. Conclusion: Food intake was inadequate as compared to the recommendations of the International Nutrition Guidelines.

Nutritional status in children with esophageal stenosis and dysphagia associated with caustic ingestion

Introduction: Caustic ingestion (CI) in children and adolescents may lead to esophageal burns, esophageal stenosis and secondary dysphagia. These complications may limit the normal feeding process leading to malnutrition and growth impairment. Aims: Our aim was to evaluate the nutritional status and its association with dysphagia and esophageal stenosis in children with CI. Methods: Sixty-two patients with caustic ingestion treated at a pediatric referral hospital were included in this cross-sectional study. Independent variables were dysphagia/normal swallowing and esophageal stenosis/normal barium-swallow. The dependent variables were growth and nutritional status evaluated by anthropometry. Analysis: χ² test, OR, 95% CI, kappa test and Student's t-test. Results: The average age at the time of CI was 39.7 months; 38.7% of the patients were girls. Endoscopy performed upon admission revealed erosive esophagitis (II-b, III-a, and III-b) in 46 (77.8%) of the patients, dysphagia in twenty-four (38.7%) and esophageal stenosis in forty (64.5%). Both complications occurred simultaneously in 20 children (32.3%, kappa = 0.3, p = 0.014). The z-score of height-for-age was below -2 SD in five children (8.1%). The z score of body mass index (BMI) was < -2 SD in three children (4.8%) and it was above +1 SD in 24.2%. The z-score means of the arm anthropometric indicators of fat stores and muscle mass in both the dysphagia and esophageal stenosis groups were located in the negative area of the z-score curve and their values differed significantly from the z-scores of the non-dysphagia and non-stenosis groups. Conclusions: The proportion of erosive esophagitis, esophageal stenosis and dysphagia was high. Children with dysphagia and/or esophageal stenosis associated with CI had lower fat stores and muscle mass than the cases without esophageal complications.

Análisis del perfil de los pacientes ancianos diabéticos y hospitalizados que participaron en el estudio VIDA

Introducción: la malnutrición es un problema de primer orden en el paciente hospitalizado que prolonga la estancia hospitalaria y la tasa de infecciones. El paciente diabético representa un porcentaje importante de la población hospitalizada. El estudio VIDA tiene como objetivo analizar el estado nutricional de pacientes ancianos con diabetes hospitalizados en España. Objetivo: describir la población del estudio VIDA, incluyendo datos del perfil bioquímico y antropométrico en el momento del ingreso. Métodos: estudio multicéntrico, transversal, observacional llevado a cabo en 1098 pacientes mayores de 65 años. Se incluyeron 35 hospitales españoles. Resultados: la edad media de los pacientes ingresados fue 78 ± 7,1 años. El motivo de ingreso más frecuente fueron las infecciones respiratorias (32,4%). El 51,2% estaban diagnosticados de diabetes desde hacía más de 10 años. Un 33,09% recibía tratamiento con insulina. Un 39,07% presentaba riesgo de malnutrición y un 21,22% estaba mal nutrido en el momento del ingreso. Se encontró mayor prevalencia de malnutrición en el grupo de mujeres (p < 0,0002) Conclusiones: el estudio VIDA es el primero que analiza el estado nutricional de una cohorte de pacientes ancianos diabéticos en España. En los resultados de este proyecto se concluye que un 21,2% de la muestra presenta malnutrición. Esta condición es edad y sexo dependiente, y puede empeorar la tasa de mortalidad.

Compliance in food consumption of young and long-lived elderly of a city in southern Brazil

Introduction: Life expectancy is increasing and becoming a characteristic phenomenon of developed countries and, increasingly, of developing countries, such as Brazil. The aging process causes changes of some physiological functions such as loss of smell, taste, loss of appetite, among other things that end up changing the food intake of these individuals. Objectives: This study aimed to assess food consumption of the young and long-lived elderly in a city in southern Brazil. Methods: A cross-sectional survey conducted through home visits in Palmeira das Missões - RS, Brazil. The sociodemographic, anthropometrical and dietary data were collected through questionnaires and 24-hour recall. The adequacy of nutrients was assessed according to the Dietary Reference Intakes. Data were analyzed using SPSS 18.0 software. Results: The study included 424 older adults, 84,4% (n = 358) aged less than 80 years old and 15,6% (n = 66) older than 80. The intake of energy and protein was insufficient for both young elderly and the oldest. The consumption of vitamins and minerals has been insufficient in all seniors except for iron, which presented an excessive intake. There was a statistically significant difference between the elderly and oldest only for the consumption of lipids and vitamin B12. Conclusion: The majority of studies with elderly corroborate the results found in this article. An inadequate intake of nutrients can develop nutritional deficiencies, and consequently it can result in physiological and pathological changes which would compromise the functional capacity of the elderly. Energy consumption was insufficient and macronutrients were inadequate, both for the young elderly as for the oldest. Additionally, the consumption of vitamins and minerals was insufficient to everyone except the iron, which presented excessive intake for young and oldest elderly.

25-hydroxy vitamin D and syndrome metabolic components in candidates to bariatric surgery

Aim: The aim of this study was to assess the prevalence of hypovitaminosis D in candidates to bariatric surgery (BS) and its relationship with risk factors and components of the metabolic syndrome. Material and methods: Clinical, anthropometric and biochemical parameters were measured in 56 Caucasian patients included in a protocol of BS between January and June 2014. Patients were stratified into three groups according to their vitamin D status: sufficiency (≥ 40 ng/ml), insufficiency (40-20 ng/ml) and deficiency (< 20 ng/ml). Results: Data showed vitamin D deficiency in 75% of patients. These patients had greater BMI (p = 0.006) and lower PTH concentrations in plasma (p = 0.045). In addition, there were more patients with diabetes mellitus type 2 (DM2) and dyslipidemia (DLPM) in the group with 25 (OH) D < 20 ng/ml levels. Another finding was that 25(OH) D levels were observed to be negatively correlated with fat mass (r = -0.504; p = 0.009), BMI (r = -0.394; p = 0.046) and hypertension (r = -0.637; p = 0.001). Conclusion: We conclude that vitamin D deficiency is extremely common among candidates to BS, who are associated with DM2 and DLPM. Although there are limited data regarding the best treatment for low Vitamin D status in BS candidate patients, screening for vitamin D deficiency should be regularly performed in cases of morbid obesity.