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Introduction: Disease-related malnutrition (DRM) is a frequent community healthcare problem that predominantly affects adults over 65 years of age and increases morbidity and mortality rates, while also decreasing quality of life. Objective: To study the prevalence of DRM in adults over 65 in different community healthcare centres belonging to the Regional Social Welfare Service of the Community of Madrid. Methods: We conducted a cross-sectional study in 33 community healthcare centres in Madrid (6 primary healthcare centres (PC), 9 care centres for the elderly (CE), 9 hospitals (H) and 9 nursing homes (NH)) selected by means of multistage sampling. The variables studied were age, sex, level of dependence according to the Red Cross disability scale, reason for admission and underlying disease, habitat (urban-periurban-rural) and geographical distribution (north-centre-south). The Mini Nutritional Assessment (MNA-screening) was employed as a nutritional screening tool in all the centres. In the case of patients with positive screening (at risk-malnutrition), the MNA-assessment was carried out. Statistical analysis was conducted with the SPSS 21.0 package and included descriptive statistics, Chi-square test and Fisher's exact test, one-way ANOVA, Kruskal-Wallis test and univariate and multivariate binary logistic regression analysis (LR). Statistical significance was considered to be p < 0.05. Results: A total of 1,103 subjects were recruited (275 PC, 278 CE, 281 H, 269 NH), mean age 79.5 ± 8.4 years (41.2% were males and 58.8% females). The subjects from H and NH had a higher degree of disability (p < 0.001). The overall prevalence of DRM was 10%, 23.3% being at risk of malnutrition, with differences among the 4 types of community healthcare centres (p < 0.001). The univariate LR analysis showed significant differences in the prevalence of malnutrition according to age, sex, degree of dependence, type of community healthcare centre, habitat and geographical zone. Nevertheless, in the multivariate analysis, only the degree of dependence, the type of centre and habitat were statistically significant. Conclusions: The prevalence of DRM in adults over 65 years of age in the Community of Madrid amounts to 10%, with another 23.3% at risk of malnutrition. The variables that were independently related with malnutrition in the multivariate analysis were only the patients' level of dependence and the type and setting of the community healthcare centre. [ABSTRACT FROM AUTHOR]

Background: the underlying cause of the deficiency of ornithine carbamoyltransferase (OTCD) is a gene mutation on the X chromosome. In females, the phenotype is highly variable, ranging from asymptomatic to neurologic compromise secondary to hyperammonemia and it can be prompted by numerous triggers, including pregnancy. Objective: the objective of this article is to report a case of two pregnancies of an OTCD-carrier, and to review the literature describing OTCD and pregnancy, parturition and postpartum. Methods: an extensive search in PubMed in December 2021 was conducted using different search terms. After screening all abstracts, 23 papers that corresponded to our inclusion criteria were identified. Results: the article focuses on the management of OTCD during pregnancy, parturition, and the postpartum period in terms of clinical presentation, ammonia levels and treatment. Conclusions: females with OTCD can certainly plan a pregnancy, but they need a careful management during delivery and particularly during the immediate postpartum period. If possible, a multidisciplinary team of physicians, dietitians, obstetrician-gynecologist, neonatologists, pharmacists, etc. with expertise in this field should participate in the care of women with OTCD and their children during this period and in their adult life. [ABSTRACT FROM AUTHOR]

This ESPEN practical guideline will inform physicians, nurses, dieticians, pharmacists, caregivers and other home enteral nutrition (HEN) providers in a concise way about the indications and contraindications for HEN, as well as its implementation and monitoring. This guideline will also inform interested patients requiring HEN. Home parenteral nutrition is not included but will be addressed in a separate ESPEN guideline. The guideline is based on the ESPEN scientific guideline published before, which consists of 61 recommendations that have been reproduced and renumbered, along with the associated commentaries that have been shorted compared to the scientific guideline. Evidence grades and consensus levels are indicated. The guideline was commissioned and financially supported by ESPEN and the members of the guideline group were selected by ESPEN. [ABSTRACT FROM AUTHOR]

Aim: the objective of this study was to describe the results of the implementation of a home parenteral nutrition (HPN) care programme (Nutrihome©) in a cohort of patients treated at a tertiary hospital. Methods: retrospective study of the patients included in Nutrihome© at Hospital General Universitario Gregorio Marañón, Madrid, Spain. Nutrihome consists of different modules including pre-discharge nursing hospital visits and nursing home visits, deliveries of the infusion pump, consumables and parenteral nutrition bags, patient training, weekly scheduled nursing home visits, scheduled nursing phone calls, stock control phone calls and 24-hour on-call line manned by the nurses. Results: the study included 8 (75 % women) and 10 (70 % women) patients in the Nutrihome© pilot and Nutrihome© programme, respectively. A total 37 adverse events were reported during Nutrihome© pilot, 26 of which were technical, 9 clinical, 1 was catheter-related and 1 other event. Nutrihome© programme registered a total of 107 adverse events reported, 57 of which were technical, 21 clinical, 16 were catheter-related and 13 were other events. A total of 99 % of these events were solved by Nutrihome© via phone calls or home visits. Conclusions: Nutrihome© programme has been extremely useful during this pandemic, facilitating both the start of HPN and training at the patient home without the need for hospitalisation. Additionally, the adverse events reported and solved by Nutrihome© not only reduced the physicians’ burden during those tough times and the patients´ stress of being hospitalised during a pandemic, but supported the entire healthcare system. [ABSTRACT FROM AUTHOR]

Introduction: Health-related quality of life (HRQoL) provides a global view of the state of health of a patient receiving home enteral nutrition (HEN). Objective: To evaluate the HRQoL of patients receiving HEN using the NutriQoL® questionnaire, a specific instrument regardless of the underlying disease and route of administration. Materials and methods: Observational, prospective and multicentre study conducted in the context of the validation and assessment of the NutriQoL® questionnaire's psychometric properties. Results: One-hundred-and-forty individuals [disease: cancer (58.6%), malabsorption and other (27.1%), neurological (13.6%); HEN: supplement (61.4%), sole source of nutrition (35.7%); administration route: oral (54.3%), ostomy (31.4%), nasoenteric tube (12.1%)] participated. NutriQoL® was reliable [ICC: 0.88 (95%CI: 0.80-0.93); Cronbach's α: 0.77 (1st visit) and 0.83 (2nd visit)], valid (significant Rho), lowly sensitive to changes (effect size 0.23), can be completed by either patients or caregivers (ICC: 0.82). The mean HRQoL (SD) with NutriQoL® was 14.98 (14.86), EQ-5D tariff: 53(0.25), EQ-5D VAS: 54.15(20.64) and COOP/WONCA charts: 23.32(5.66). HRQoL with NutriQoL® was better (p < 0.05) for oral HEN [19.54(13,23)], than nasoenteric tube [14(11.71)], ostomy [7.02 (15.48)]; administered orally [19.54 (13.23)], than by gravity [10.97 (14.46)], pump [8.5 (19.78)] or syringe bolus [7 (11.40)]; as a supplement [19.33 (13.73)] instead of sole source of nutrition [8.18 (14.23)]. Conclusions: NutriQoL® is valid, reliable, even if lowly sensitive to change, and useful to measure HRQoL in this population. More studies are needed to know HRQoL in routine practice. [ABSTRACT FROM AUTHOR]

Background: Home parenteral nutrition (HPN) was introduced in Spain in the late 1980s. Our hospital was a pioneering medical centre in this field. Aim: Analyze outcomes of our HPN program. Methods: Retrospective study of patients receiving HPN between 1986-2012. Study variables are expressed as frequency, mean ± SD (range), median [interquartile range]. Parametrics, non-parametrics test and survival analysis (p < 0.05) were applied. Results: 91 patients (55 females and 36 males, mean age: 50.6 ± 5 yrs.) who received HPN for an accrual period of 55,470 days (median: 211 days [range: 63-573]) were included. The most prevalent underlying condition was cancer (49.5%), with the commonest HPN indication being short bowel syndrome (41.1%). The most frequently used catheter type was the tunneled catheter (70.7%). The complication rate was 3.58/1,000 HPN days (2.68, infection; 0.07, occlusion; 0.07 thrombosis; and 0.59, metabolic complications). Complications were consistently associated with both the underlying condition and HPN length. Infections were most frequent within the first 1,000 days of HPN. Liver disease incidence was related to HPN duration. HPN could be discontinued in 42.3% of patients. Ten-year survival rate was 42%, and varied across the underlying conditions. Conclusions: In the present series, the commonest reason for HPN was cancer. Our complication rate is in keeping with that reported in the literature. The overall survival rate was 42%, and varied across the underlying conditions. [ABSTRACT FROM AUTHOR]

The group of standardization and protocols of the Spanish Society of Parenteral and Enteral Nutrition (SENPE) published in 2011 a consensus document SENPE/SEGHNP/ANECIPN/SECP on enteral access for paediatric nutritional support. Along the lines of this document, we have developed another document on adult patients to homogenize the clinical practice and improve the quality of care in enteral access in this age group. The working group included health professionals (nurses, dietitians and doctor) with extensive experience in enteral nutrition and access. We tried to find scientific evidence through a literature review and we used the criteria of the Agency for Health-care Research and Quality (AHRQ) to classify the evidence (Grade of Recommendation A, B or C). Later the document was reviewed by external experts to the group and requested the endorsement of the Scientific and Educational Committee (CCE) and the group of home artificial nutrition (NADYA) of the SENPE. The full text will be published as a monograph number in this journal. [ABSTRACT FROM AUTHOR]