Probióticos y prebióticos en la práctica clínica.

This article revises the concepts of prebiotics, probiotics and symbiotics, and their use in different situations of daily clinical practice. With a high level of evidence, it is concluded that the use of certain strains of probiotics significantly reduces the risk for antibiotic-induced diarrhea. Although further studies are needed, the use of probiotics, prebiotics, and symbiotics in people suffering from inflammatory bowel disease (particularly ulcerative colitis, and pouchitis) might improve the rates of remission induction/maintenance. The administration of probiotics and symbiotics to patients with liver transplant, severe acute pancreatitis, and intensive and surgical care patients, emerges as a promising therapeutic option that seems to reduce the number of infections; however, it is currently no possible to establish evidence-based recommendations, with a need for a higher number of better designed works. About safety of probiotics and symbiotics, the benefits/risks ratio clearly favors the former since the risk for infection is low, even in immunosuppressed patients. There are, however, selected groups of patients in which caution is advised.

NUTRISOL: un programa informático para la evaluación nutricional comunitaria y hospitalaria de acceso libre.

We have developed the computer programme NUTRISOL, a nutritional programme destined to analysis of dietary intake by means of the food transformation to nutrient. It has been performed under Windows operative system, using Visual Basic 6.0. It is presented in a CD-Rom. We have used the Spanish CSIC Food Composition Table and domestic food measures commonly used in Spain which could be modified and updated. Diverse kind of diets and reference anthropometric data are also presented. The results may be treated using various statistical programmes. The programme contains three modules: 1) Nutritional epidemiology, which allows to create or open a data base, sample management, analyse food intake, consultation of nutrient content and exportation of data to statistical programmes. 2) Analyses of diets and recipes, creation or modification of new ones. 3) To ask different diets for prevalent pathologies. Independent tools for modifying the original tables, calculate energetic needs, recommend nutrient intake and anthropometric indexes are also offered. In conclusion, NUTRISOL Programme is an application which runs in PC computers with minimal equipment in a friendly interface, of easy use, freeware, which may be adapted to each country, and has demonstrated its usefulness and reliability in different epidemiologic studies. Furthermore, it may become an efficient instrument for clinical nutrition and health promotion.

Proceso INFORNUT: validación de la fase de filtro-FILNUT--y comparación con otros métodos de detección precoz de desnutrición hospitalaria.

INTRODUCTION According to several series, hospital hyponutrition involves 30-50% of hospitalized patients. The high prevalence justifies the need for early detection from admission. There several classical screening tools that show important limitations in their systematic application in daily clinical practice. OBJECTIVES To analyze the relationship between hyponutrition, detected by our screening method, and mortality, hospital stay, or re-admissions. To analyze, as well, the relationship between hyponutrition and prescription of nutritional support. To compare different nutritional screening methods at admission on a random sample of hospitalized patients. Validation of the INFORNUT method for nutritional screening. MATERIAL AND METHODS In a previous phase from the study design, a retrospective analysis with data from the year 2003 was carried out in order to know the situation of hyponutrition in Virgen de la Victoria Hospital, at Malaga, gathering data from the MBDS (Minimal Basic Data Set), laboratory analysis of nutritional risk (FILNUT filter), and prescription of nutritional support. In the experimental phase, a cross-sectional cohort study was done with a random sample of 255 patients, on May of 2004. Anthropometrical study, Subjective Global Assessment (SGA), Mini-Nutritional Assessment (MNA), Nutritional Risk Screening (NRS), Gassull's method, CONUT and INFORNUT were done. The settings of the INFORNUT filter were: albumin < 3.5 g/dL, and/or total proteins <5 g/dL, and/or prealbumin <18 mg/dL, with or without total lymphocyte count < 1.600 cells/mm3 and/or total cholesterol <180 mg/dL. In order to compare the different methods, a gold standard is created based on the recommendations of the SENPE on anthropometrical and laboratory data. The statistical association analysis was done by the chi-squared test (a: 0.05) and agreement by the k index. RESULTS In the study performed in the previous phase, it is observed that the prevalence of hospital hyponutrition is 53.9%. One thousand six hundred and forty four patients received nutritional support, of which 66.9% suffered from hyponutrition. We also observed that hyponutrition is one of the factors favoring the increase in mortality (hyponourished patients 15.19% vs. non-hyponourished 2.58%), hospital stay (hyponourished patients 20.95 days vs. non-hyponourished 8.75 days), and re-admissions (hyponourished patients 14.30% vs. non-hyponourished 6%). The results from the experimental study are as follows: the prevalence of hyponutrition obtained by the gold standard was 61%, INFORNUT 60%. Agreement levels between INFORNUT, CONUT, and GASSULL are good or very good between them (k: 0.67 INFORNUT with CONUT, and k: 0.94 INFORNUT and GASSULL) and wit the gold standard (k: 0.83; k: 0.64 CONUT; k: 0.89 GASSULL). However, structured tests (SGA, MNA, NRS) show low agreement indexes with the gold standard and laboratory or mixed tests (Gassull), although they show a low to intermediate level of agreement when compared one to each other (k: 0.489 NRS with SGA). INFORNUT shows sensitivity of 92.3%, a positive predictive value of 94.1%, and specificity of 91.2%. After the filer phase, a preliminary report is sent, on which anthropometrical and intake data are added and a Nutritional Risk Report is done. CONCLUSIONS Hyponutrition prevalence in our study (60%) is similar to that found by other authors. Hyponutrition is associated to increased mortality, hospital stay, and re-admission rate. There are no tools that have proven to be effective to show early hyponutrition at the hospital setting without important applicability limitations. FILNUT, as the first phase of the filter process of INFORNUT represents a valid tool: it has sensitivity and specificity for nutritional screening at admission. The main advantages of the process would be early detection of patients with risk for hyponutrition, having a teaching and sensitization function to health care staff implicating them in nutritional assessment of their patients, and doing a hyponutrition diagnosis and nutritional support need in the discharge report that would be registered by the Clinical Documentation Department. Therefore, INFORNUT would be a universal screening method with a good cost-effectiveness ratio.

Estudio bibliométrico de la revista Nutrición Hospitalaria en el periodo 2001 a 2005: Parte I, Análisis de la producción científica.

OBJECTIVE To assess the scientific activity and information production of the journal Nutrición Hospitalaria, for the period 2001-2005 by means of a Bibliometric study. METHOD Cross-sectional descriptive study of the results obtained from the analysis of the articles published in the journal Nutrición Hospitalaria. The data were obtained by consulting the electronic version through the Web. In those cases in which there was a link breakdown, and thus, the inability to have access to the electronic document the printed version was consulted. All the documental possibilities were taken into account with the exception of communications to congresses. RESULTS A total of 345 articles were published, 187 (54.20%) being original articles. The geographical distribution of the first author was Spanish in 287 articles (83.19%) and Latin American in 27 (7.83%). Most of the articles are from health care centers (172 articles (49.86%)), and the cooperation index being 4.15. Madrid is the most productive province, for both the absolute and adjusted frequencies. The median number of references per article is 18, the mean being 23.52 (95% CI 20.93 - 26.10). The predominant language was Spanish, with 308 articles (89.28%). CONCLUSION Nutrición Hospitalaria may be considered as a reference journal regarding information and scientific communication on Nutrition for both the Spanish and Latin American communities. The bibliometric parameters studied compare with those verified for the remaining top of the list Spanish scientific journals on health sciences.

Estudio bibliométrico de la revista Nutrición Hospitalaria en el periodo 2001 a 2005: parte 2, análisis de consumo; las referencias bibliográficas.

OBJECTIVE To describe and assess the consumption of the information consulted and cited in the articles published in the journal Nutrición Hospitalaria for the period 2001--2005 by means of bibliometric analysis. METHOD Cross-sectional descriptive analysis of the results obtained from the analysis of the lists of bibliographic references of the articles published at Nutrición Hospitalaria. We studied the most cited journals, the signatures index, the type of document referred, the publication language, the distribution of geographical origin, and obsolescence and readiness index. We took into account all types of documents with the exception of Communications to Congresses. RESULTS 345 articles were published at Nutr Hosp, containing 8,113 bibliographic references, with a median of 18, a maximum of 136 and minimum of 0 BR per article. The mean (rate of publications per published article during the specified period) is 23.52 (95% IC 20.93-26.10) and the mean at 5% is 20.66 per article. The 25th and 75th percentiles are 6 and 32, respectively, the interquartile interval being 26 BR per document. The semi-period of Burton and Kebler is 7 years and the Price Index is 38.18%. CONCLUSION The bibliographic references, the consumption of information, of the articles published at Nutrición Hospitalaria present parameters similar to other journals on health science. However, good data on obsolescence are observed, which reveal the good validity of most of the references studied.

Compliance with dietary and nutrient recommendations in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Granada cohort at recruitment

BACKGROUND: The overall intake of energy and nutrients in the Granada EPIC-cohort (European Prospective Investigation into Cancer and Nutrition) is examined in order to assess compliance with the Spanish Nutritional Objectives (NO) and the Recommended Intakes (RI). METHODS: During recruitment (1992-1996), 7,789 participants, aged 35-69, were asked about diet through a validated diet history questionnaire. Nutrient intake is compared to the NO and RI that were valid at that time. Risk of inadequate intake is estimated as the percentage of the sample with intakes: ≤ 1/3 RI (high risk), ≤ 2/3 RI- > 1/3 RI (moderate risk), ≤ RI- > 2/3 RI, > RI. Differences in intakes have been analyzed by sex and age, and by smoking status and BMI. RESULTS: The daily intake of nutrients did not meet the NO as the total contribution of energy from proteins and fats exceeded these guidelines. Whilst intake of most nutrients was above the RI, the amount of iron, magnesium and vitamins D and E provided by the diet was not enough to meet the RI: in women aged 20-49 years, about 55% were at moderate risk for iron inadequacy, and a 20% of women for magnesium. Both sexes were at high risk of inadequacy for vitamin D, although sunlight exposure may supply adequate amounts. Never smokers showed a higher compliance to the NO. CONCLUSION: At recruitment, the nutrient profile of the diet was unbalanced. The observed nutrient inadequacy for iron, magnesium and vitamin E might be attributed to inappropriate dietary habits, and may have implications for future disease risk.

Influencia de un programa de actividad física en niños y adolescentes obesos con apnea del sueño; protocolo de estudio.

Recent studies show an alarming increase in the rate of overweight / obesity among the infant - juvenile population. Obesity in childhood is associated with a significant number of complications, such as sleep apnea syndrome, insulin resistance and type 2 diabetes, hypertension, cardiovascular disease and some cancers. It is estimated that the prevalence of sleep apnea in children is 2-3% in the general population, while in obese adolescents, varies between 13% and 66%, according to various studies. It is associated with impairment of neurocognitive function, behavior, cardiovascular system, metabolic disorders and growth. Sleep apnea is a serious public health problem that increases when children and adolescents are overweight or obese. We hypothesize that aerobic endurance exercise can be an effective treatment for obesity and apnea at the same time. The aim of this study was to determine the influence of physical activity in children and adolescents with overweight / obesity in sleep apnea. An observational, descriptive, prospective, longitudinal study will be carried out in children with sleep apnea and obesity. The universe will be made up of 60 children and adolescents aged between 10 and 18 years, attending the endocrinology service for suffering of obesity in the Hospital Clinico San Cecilio of Granada during the period September 2012-September 2013. The smple will consist of children and adolescents that meet these characteristics and to hom their arents/tutors have authorized through the informed consent. Sleep apnea in children wil be measured by polysomnography and sleep quality questionnaire. There will also be a nutritional assessment by a food frequency questionnaire and an anthropometric assessment. Among the expected results are the lower overweight and obesity in children through the physical activity program. To reduce apnea and to improve sleep quality

Soberanía alimentaria y cambios en la dieta en México 1961-2009. Una primera aproximación a partir de los datos sobre consumo aparente de la FAO

El trabajo que se desarrolla a continuación persigue un doble objetivo: por una parte, realizar una primera aproximación a los cambios que se han producido en la dieta de la población de México en los últimos 50 años. Unos cambios que se desarrollan en el contexto de la denominada transición nutricional, y que, como tendremos ocasión de constatar, adoptan en países en desarrollo como México unas características que no se ajustan totalmente al modelo de transición que en su momento determinaron las transformaciones experimentadas por los países de la Europa noroccidental. En segundo lugar, evaluar y analizar el proceso paralelo de progresiva pérdida de la soberanía alimentaria y de globalización de la dieta experimentada por México. Desde los años 1960 la dieta de las poblaciones centroamericanas se ha transformado de forma espectacular. En el marco de la llamada transición nutricional se ha producido un aumento del consumo de energía y nutrientes, a la vez que se ha modificado su procedencia tanto en lo que concierne a los productos como al lugar donde han sido producidos y la forma en que han sido procesados previamente. En concreto, se constata la reducción del consumo y aportación nutritiva de algunos integrantes tradicionales de la dieta, como los frijoles, en beneficio de otros productos vegetales como la patata, y especialmente de productos de origen animal como la carne de pollo, la leche o los huevos. Destacar la creciente importación directa e indirecta de alimentos básicos, como el maíz, componente importante de la dieta humana y de la alimentación de la creciente cabaña ganadera donde se destinan gran parte de las disponibilidades. Finalmente se analiza el impulso que desde la perspectiva de la oferta alimentaria disponible suponen en este proceso las medidas liberalizadoras que siguen a la crisis de la deuda externa de 1982 y la entrada en vigor del NAFTA en 1994.

"Blade Runner" o la pregunta por la dignidad humana

Al pensar en la relación entre el fundamento de la dignidad humana y la resolución de algunos problemas bioéticos, me vino a la cabeza Blade Runner, la película de Ridley Scott basada en un relato de Philip K. Dickque lleva el extravagante título de ¿Sueñan los androides con ovejas eléctricas? (extravagante si vemos la película pero no tanto si leemos el relato)...

Ética ecológica y bioética: algunos apuntes

Desde fines del siglo XX muchos autores se han dedicado a reflexionar los alcances de la técnica humana y la acción del hombre en el mundo, desde diferentes matices. En lí­neas gruesas, se aprecia la reflexión de la ética aplicada en dos ámbitos: la bioética y la ética ecológica. Ambas son complementarias entanto una ética relacionada a la vida humana y los diferentes retos a los que la enfrenta su manipulación técnica, se vincula estrechamente con las conceptualizaciones y alcances prácticos de la manipulación técnica del ecosistema y la Biósfera, así­ como de los destinos de los componentes de estosecosistemas, considerados tanto a nivel de comunidades como de seres o entidades individuales. No podemos hablar de una Bioética centrada en los problemas de la vida humana, ni de una Ética ambiental centrada en las dinámicas y procesos colectivos, sin interpelar a ambas dimensiones y definir espacios de reflexióncomunes. Es una tarea acuciante para la ética aplicada huir de lo uní­voco y pensar desde la complejidad de lo real. Para ello, es necesario generar unas reflexiones que relacionan la especie humana con otros individuos y con otras especies, re-pensar el lugar que el hombre tiene en el cosmos y las conductas que puede asumir en función de la libertad y la racionalidad que lo caracterizan.A efectos prácticos, en la primera parte del trabajo analizará conceptos relevantes de la ética ecológica, en una segunda parte sus principales corrientes, los desarrollos conceptuales de cada cual y las crí­ticas internas relacionadas a sus contenidos y alcances prácticos. En la tercera parte analizará la relación de la ética ecológica y sus conceptos con la bioética, para delinear algunos escenarios analí­ticos deseables y posibles para el desarrollo de una bioética a la altura de la complejidad de los tiempos que hoy vivimos.

Documento sobre congelación de ovocitos para la reproducción humana

Con este documento se pretende informar sobre la congelación de ovocitos para la reproducción humana y abordar el problema desde distintos punto de vista, con el fin de proporcionar argumentos y participar en el debate generado sobre el uso y aplicación de las técnicas de reproducción asistida y fomentar la necesaria actualización de una normativa que, si bien fue pionera en su momento, presenta hoy las carencias y contradicciones que el avance científico y el devenir social han ocasionado, y que requieren su puesta al día.

"Blade Runner" o la pregunta por la dignidad humana

Al pensar en la relación entre el fundamento de la dignidad humana y la resolución de algunos problemas bioéticos, me vino a la cabeza Blade Runner, la película de Ridley Scott basada en un relato de Philip K. Dickque lleva el extravagante título de ¿Sueñan los androides con ovejas eléctricas? (extravagante si vemos la película pero no tanto si leemos el relato)...

Documento sobre congelación de ovocitos para la reproducción humana

Con este documento se pretende informar sobre la congelación de ovocitos para la reproducción humana y abordar el problema desde distintos punto de vista, con el fin de proporcionar argumentos y participar en el debate generado sobre el uso y aplicación de las técnicas de reproducción asistida y fomentar la necesaria actualización de una normativa que, si bien fue pionera en su momento, presenta hoy las carencias y contradicciones que el avance científico y el devenir social han ocasionado, y que requieren su puesta al día.

Status epistemológico de la ciencia y de la ética

Hay unanimidad en la admisión de las proposiciones científicas, ya que pueden contrastarse con el análisis de las mismaso su verificación empírica; en las proposiciones éticas hay serias discrepancias entre quienes las profieren o entre quienes las examinan.Sin embargo, en toda la tradición filosófica se ha aceptado, junto a la racionalidad teórica, una racionalidad práctica.Se examinan en el artículo las características de ambas, tras exponer las raíces de la dimensión ética humana y los a priori de toda reflexión, ética o científica. Se propone como eje de la racionalidad científica la categoría de causalidad, mientras que la de finalidad caracterizaría la racionalidad ética. Las diferencias entre ambas categorías fundamentarían las distintas racionalidades, haciéndose depender la práctica de una concepción antropológica, y aplicándoseles a las proposiciones éticas, siguiendo el análisisque hace Aristóteles de la prudencia, la cualificación de razonables.

Luis de León (1527-1591) y su teoría de la justicia: aspectos principales de su doctrina

Las investigaciones sobre Luis de León se han centrado, sobre todo, en su mística, narrativa y teoría literaria. En este trabajo, el autor intenta desarrollar los principales aspectos de su teoría jurídica. Al igual que otros grandes teólogos de la Escuela de Salamanca, también León ha estudiado el problema de la naturaleza de la ley humana y su vinculación con el derecho natural. Éste es, justamente, el tema del siguiente trabajo.