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Objectives Anorexia nervosa (AN) is a complex disease that involves malnutrition and a profound depletion in muscle mass. The thickness of the adductor pollicis muscle (APM) has been proposed as a new anthropometric technique to estimate muscle mass, check early changes, and assess its evaluation. This study aimed to evaluate the accuracy and validity of the APM thickness in a cohort of malnourished patients with AN when checking local mass gain. The Doppler ultrasound maybe an affordable and useful method to discriminate all tissues around the APM area. Methods A prospective cohort study was conducted of 31 malnourished patients with AN who were admitted to the Regional Eating Disorders Unit for treatment, including re-alimentation. Anthropometric measurements were taken, including arm circumference, triceps skinfold thickness, arm muscle circumference, body mass index, and APM thickness of both hands. Simultaneously, a Doppler ultrasound was performed in the same area, measuring and discriminating fat, skin, and muscle tissues around the APM. Results Nutritional improvement is accompanied by fat, but not muscle gain in the hand in the adductor pollicis area of patients with AN. A Doppler ultrasound can accurately discriminate between tissues around the APM. Conclusions APM thickness reflects the addition of two different muscles plus fat and skin; therefore, this tool is not reliable to assess APM mass.

Eating disorders (ED) are characterized by persistent changes in eating habits that negatively affect a person's health and psychosocial abilities. They are considered psychiatric disorders, highly variable in their presentation and severity, with a huge impact on nutrition, which conditions various therapeutic approaches within a key multidisciplinary context. A group of experts in nutrition, we decided to set up a task force adscribed to the "Sociedad Española de Nutrición Parenteral y Enteral" (SENPE), which has stated as one of its goals the development of a consensus document to generate a protocol based on the best scientific evidence and professional experience available in order to improve health care in this field.

Bulimia nervosa and binge eating disorder are unique nosological entities. Both show a large variability related to its presentation and severity which involves different therapeutic approaches and the need to individualize the treatment, thus it is indispensable a multidisciplinary approach. Patients with bulimia nervosa may suffer from malnutrition and deficiency states or even excess weight, while in binge eating disorders, it is common overweight or obesity, which determine other comorbidities. Many of the symptoms and complications are associated with compensatory behaviors. There are many therapeutic tools available for the treatment of these patients. The nutritional approach contemplates the individualized dietary advice which guarantees an adequate nutritional state and nutritional education. Its objective is to facilitate the voluntary adoption of eating behaviors that promote health and allow the long-term modification of eating habits and the cessation of purgatory and bingeing behaviors. Psychological support is a first-line treatment and it must address the frequent disorder of eating behavior and psychiatric comorbidities. Psychotropic drugs are effective and widely used although these drugs are not essential. The management is carried out mainly at an outpatient level, being the day hospital useful in selected patients. Hospitalization should be reserved to correct serious somatic or psychiatric complications or as a measure to contain non-treatable conflict situations. Most of the guidelines' recommendations are based on expert consensus, with little evidence which evaluates clinical results and cost-effectiveness.

Anorexia nervosa is the most common psychiatric disease among young women and it is assumed to be of multifactorial origin. Diagnostic criteria have recently been modified; therefore amenorrhea has ceased to be a part of them. This disease shows a large variability in its presentation and severity which conditions different therapeutic approaches and the need to individualize the treatment, thus it is indispensable a multidisciplinary approach. The goals are to restore nutritional status (through an individualized diet plan based on a healthy consumption pattern), treat complications and comorbidities, nutritional education (based on healthy eating and nutritional patterns), correction of compensatory behaviors and relapse prevention. The treatment will vary according to the patient's clinical situation, and it may be performed in outpatient clinics (when there is clinical stability), in a day hospital or ambulatory clinic (intermediate mode between traditional outpatient treatment and hospitalization) or hospitalization (when there is outpatient management failure or presence of serious medical or psychiatric complications). Artificial nutrition using oral nutritional supplements, enteral nutrition and exceptionally parenteral nutrition may be necessary in certain clinical settings. In severely malnourished patients the refeeding syndrome should be avoided. Anorexia nervosa is associated with numerous medical complications which determines health status, life quality, and is closely related to mortality. There is little clinical evidence to assess the results of different treatments in anorexia nervosa, when most of the recommendations are being based on expert consensus.

Bulimia nervosa and binge eating disorder are unique nosological entities. Both show a large variability related to its presentation and severity which involves different therapeutic approaches and the need to individualize the treatment, thus it is indispensable a multidisciplinary approach. Patients with bulimia nervosa may suffer from malnutrition and deficiency states or even excess weight, while in binge eating disorders, it is common overweight or obesity, which determine other comorbidities. Many of the symptoms and complications are associated with compensatory behaviors. There are many therapeutic tools available for the treatment of these patients. The nutritional approach contemplates the individualized dietary advice which guarantees an adequate nutritional state and nutritional education. Its objective is to facilitate the voluntary adoption of eating behaviors that promote health and allow the long-term modification of eating habits and the cessation of purgatory and bingeing behaviors. Psychological support is a first-line treatment and it must address the frequent disorder of eating behavior and psychiatric comorbidities. Psychotropic drugs are effective and widely used although these drugs are not essential. The management is carried out mainly at an outpatient level, being the day hospital useful in selected patients. Hospitalization should be reserved to correct serious somatic or psychiatric complications or as a measure to contain non-treatable conflict situations. Most of the guidelines' recommendations are based on expert consensus, with little evidence which evaluates clinical results and cost-effectiveness.

Objective to assess the utility of body mass index (BMI) and waist circumference (WC) as surrogate indicators of adiposity with respect to the total body fat estimated with bioimpedance analysis in psychogeriatric patients. Methods Anthropometric and hand-to-foot bioimpedance measurements were performed according to standard procedures in a sample of 128 psychogeriatric patients (87 males, 41 females). WC cutoffs proposed by the International Diabetes Federation were used to define abdominal obesity. Z-scores of fat and fat-free mass indices (Z-FMI and Z-FFMI) were calculated. Results Males with WC values below the cutoff were normal weight, and showed normal levels of FM and low FFM (Z-FFMI below 1.5 SD). Males with WC values above the cutoff were overweight, showed high levels of FM (Z-FMI: 1.34 SD) and a slight depletion of FFM (Z-FFMI: −0.59 SD). In females with WC values below the cutoff, BMI was close to 20 kg/m2 and both FM and FFM were depleted (Z-FMI: −0.7 SD; Z-FFMI: −1.76 SD). In females with WC above the cutoff, the average BMI was 25.6 kg/m2, Z-FMI was 0.48 SD, and Z-FFMI was −0.56 SD. Conclusions Our results indicate that it is necessary to establish age and sex-specific BMI and WC cutoffs, and also highlight the importance of focusing on body composition analysis to ensure an accurate nutritional diagnosis in older-adults and in psychogeriatric patients. Am. J. Hum. Biol., 2015. © 2015 Wiley Periodicals, Inc.

The prevalence of hospital malnutrition (HM) is variable, explained by the variability of patients, the nutritional evaluation method used among others. The aim is to determine the frequency of malnutrition in hospitals in Latin America, and estimate its association with mortality and length of hospital stay.This is an analytical, observational cohort study that included 7,973 patients of both genders, 18 and older, who provided their consent. The survey was administered during the first three days of admission. The nutritional status was estimated using Subjective Global Assessment (SGA) and the Nutrition Risk Screening (NRS), body mass index (BMI), percentage of change of weight (PCW) and co-morbidities. Serum albumin was obtained from the clinical chart. Length of stay (LOS) and the survival status at discharge (dead or alive) were also recorded.By SGA: 10.9% had severe malnutrition and 34% moderate malnutrition. By NRS: 36.9% had nutritional risk. Univariate analysis showed that NRS score and serum albumin were prognostic factors for mortality: NRS 3-4 (OR: 2.3, 95% CI: 1.9-2.8), NRS 5-7 (OR: 5.8, 95% CI: 4.9-6.9), serum albumin2.5 g/dl, (OR: 2.9, 95% CI: 2.2-3.8). These results were consistent and similar to a multivariate analysis. Both NRS and serum albumin were also independently and clinically associated to LOS.The prevalence of hospital malnutrition in Latin America is high. Our results show that screening with NRS and serum albumin can identify hospital malnutrition as well as providing clinically relevant prognostic value.

Background and aim: The prevalence of hospital malnutrition (HM) is variable, explained by the variability of patients, the nutritional evaluation method used among others. The aim is to determine the frequency of malnutrition in hospitals in Latin America, and estimate its association with mortality and length of hospital stay. Methods: This is an analytical, observational cohort study that included 7,973 patients of both genders, 18 and older, who provided their consent. The survey was administered during the first three days of admission. The nutritional status was estimated using Subjective Global Assessment (SGA) and the Nutrition Risk Screening (NRS), body mass index (BMI), percentage of change of weight (PCW) and co-morbidities. Serum albumin was obtained from the clinical chart. Length of stay (LOS) and the survival status at discharge (dead or alive) were also recorded. Results: By SGA: 10.9% had severe malnutrition and 34% moderate malnutrition. By NRS: 36.9% had nutritional risk. Univariate analysis showed that NRS score and serum albumin were prognostic factors for mortality: NRS 3-4 (OR: 2.3, 95% CI: 1.9-2.8), NRS 5-7 (OR: 5.8, 95% CI: 4.9-6.9), serum albumin < 2.5 g/dl, (OR: 2.9, 95% CI: 2.2-3.8). These results were consistent and similar to a multivariate analysis. Both NRS and serum albumin were also independently and clinically associated to LOS. Conclusions: The prevalence of hospital malnutrition in Latin America is high. Our results show that screening with NRS and serum albumin can identify hospital malnutrition as well as providing clinically relevant prognostic value. Introducción y objetivo: la prevalencia de la malnutrición hospitalaria (MH) es variable y puede explicarse por la variabilidad de los pacientes, el método de evaluación nutricional entre otros. El propósito de esta investigación es determinar la frecuencia de malnutrición en hospitales de Latinoamérica y estimar su asociación con mortalidad y estancia hospitalaria. Métodos: es un estudio analítico, observacional de cohorte que incluyó a 7.973 pacientes de ambos géneros, mayores de 18 años y que estuvieron de acuerdo en participar en el estudio. La evaluación fue aplicada durante los primeros tres días de admisión al hospital. El estado nutricional fue estimado usando la evaluación global subjetiva (SGA) y el score de riesgo nutricional (NRS-2002). Se evaluó el índice de masa corporal (IMC), el porcentaje de cambio de peso (PCW) y las comorbilidades. La albúmina sérica se obtuvo del expediente clínico. La estancia hospitalaria (LOS) y las condiciones del egreso (vivo o muerto) fueron también registrados. Resultados: por SGA: 10,9% tuvieron malnutrición severa y 34% malnutrición moderada. Por NRS: 36,9% tuvieron riesgo nutricional. El análisis univariado mostró que el NRS y la albúmina sérica fueron factores pronósticos de mortalidad: NRS 3-4 (OR: 2,3, 95%CI: 1,9-2,8), NRS 5-7 (OR: 5,8, 95% CI: 4,9-6,9), albúmina sérica < 2,5 g/dl, (OR: 2,9, 95% CI: 2,2-3,8); estos resultados fueron coherentes y similares al análisis multivariado. Tanto el NRS y como la albúmina sérica fueron también independientemente y clínicamente asociados a la estancia hospitalaria prolongada. Conclusión: la prevalencia de malnutrición hospitalaria en Latinoamérica es alta. Nuestros resultados muestran que el tamizaje con NRS y la albúmina sérica inicial pueden identificar la malnutrición hospitalaria, así como proporcionar un valor clínico relevante.

El síndrome de caquexia cancerosa es responsable de la muerte de un número significativo de pacientes con cáncer. Se caracteriza por la presencia de una ingesta reducida, con inflamación sistémica y un metabolismo alterado. Los enfermos presentan característicamente una progresiva pérdida de peso y de masa muscular, junto a deterioro funcional. La pérdida muscular se debe a la combinación de reducción de la síntesis proteica con aumento de su degradación. Ello conduce tanto a un acortamiento como a una reducción en el área de la fibra muscular. Asimismo, existen datos que apoyan que selectivamente algunos de los tipos de fibra muscular se ven más afectados. Es necesario definir bien los valores de corte de sarcopenia para diagnosticar la pérdida muscular y existen diferentes métodos. El sistema de la ubiquitina-proteasoma parece desempeñar un papel predominante en la degradación de la proteína miofibrilar. La tendencia a perder masa muscular en los pacientes con caquexia cancerosa parece estar asociada a la activación de señales catabólicas por citoquinas proinflamatorias, así como por productos tumorales del tipo factor inductor de proteólisis. En referencia a los factores pronósticos, el riesgo de muerte está bien documentado en pacientes con sarcopenia y, especialmente, en aquellos con obesidad asociada a la sarcopenia. Asimismo, se ha establecido una relación directa entre la pérdida intensa de masa muscular y la supervivencia en pacientes con diferentes tipos de tumores del tipo de cáncer de páncreas, pulmón, tracto biliar o cáncer colorrectal. Respecto de la terapia en el síndrome de caquexia cancerosa, es factible que requiera tratamiento con varios grupos combinados que incluyan, junto al soporte nutricional, fármacos orexígenos, con efecto anabólico y antinflamatorio, asociados a intervenciones que estimulen el ejercicio físico.

El síndrome de caquexia cancerosa es responsable de la muerte de un número significativo de pacientes con cáncer. Se caracteriza por la presencia de una ingesta reducida, con inflamación sistémica y un metabolismo alterado. Los enfermos presentan característicamente una progresiva pérdida de peso y de masa muscular, junto a deterioro funcional. La pérdida muscular se debe a la combinación de reducción de la síntesis proteica con aumento de su degradación. Ello conduce tanto a un acortamiento como a una reducción en el área de la fibra muscular. Asimismo, existen datos que apoyan que selectivamente algunos de los tipos de fibra muscular se ven más afectados. Es necesario definir bien los valores de corte de sarcopenia para diagnosticar la pérdida muscular y existen diferentes métodos. El sistema de la ubiquitina-proteasoma parece desempeñar un papel predominante en la degradación de la proteína miofibrilar. La tendencia a perder masa muscular en los pacientes con caquexia cancerosa parece estar asociada a la activación de señales catabólicas por citoquinas proinflamatorias, así como por productos tumorales del tipo factor inductor de proteólisis. En referencia a los factores pronósticos, el riesgo de muerte está bien documentado en pacientes con sarcopenia y, especialmente, en aquellos con obesidad asociada a la sarcopenia. Asimismo, se ha establecido una relación directa entre la pérdida intensa de masa muscular y la supervivencia en pacientes con diferentes tipos de tumores del tipo de cáncer de páncreas, pulmón, tracto biliar o cáncer colorrectal. Respecto de la terapia en el síndrome de caquexia cancerosa, es factible que requiera tratamiento con varios grupos combinados que incluyan, junto al soporte nutricional, fármacos orexígenos, con efecto anabólico y antinflamatorio, asociados a intervenciones que estimulen el ejercicio físico.

Background and aim: The prevalence of hospital malnutrition (HM) is variable, explained by the variability of patients, the nutritional evaluation method used among others. The aim is to determine the frequency of malnutrition in hospitals in Latin America, and estimate its association with mortality and length of hospital stay. Methods: This is an analytical, observational cohort study that included 7,973 patients of both genders, 18 and older, who provided their consent. The survey was administered during the first three days of admission. The nutritional status was estimated using Subjective Global Assessment (SGA) and the Nutrition Risk Screening (NRS), body mass index (BMI), percentage of change of weight (PCW) and co-morbidities. Serum albumin was obtained from the clinical chart. Length of stay (LOS) and the survival status at discharge (dead or alive) were also recorded. Results: By SGA: 10.9% had severe malnutrition and 34% moderate malnutrition. By NRS: 36.9% had nutritional risk. Univariate analysis showed that NRS score and serum albumin were prognostic factors for mortality: NRS 3-4 (OR: 2.3, 95% CI: 1.9-2.8), NRS 5-7 (OR: 5.8, 95% CI: 4.9-6.9), serum albumin < 2.5 g/dl, (OR: 2.9, 95% CI: 2.2-3.8). These results were consistent and similar to a multivariate analysis. Both NRS and serum albumin were also independently and clinically associated to LOS. Conclusions: The prevalence of hospital malnutrition in Latin America is high. Our results show that screening with NRS and serum albumin can identify hospital malnutrition as well as providing clinically relevant prognostic value.

although there are precise and accurate techniques for estimating resting energy expenditure, like the indirect calorimetry (IC), daily practice needs faster, easier and cheaper methods as the predictive equations.the aim of the study was to develop a new predictive equation for estimating resting energy expenditure (REE) for healthy Spanish population. Méthods: the REE of 95 healthy normal weighted volunteers was determined by indirect calorimetry (IC). The new equation was obtained by multiple lineal regression by using the analytical criteria of the Cp of Mallows and the adjusted R2. Then, the behavior of the new formula was studied in a group of overweight volunteers through the intraclass correlation coefficient (ICC) and Bland-Almand plots. The level of signification was reached at p0,05.the average age was 42 years (range: 2.0-63.2). Mean REE determined by IC was 1 589.1 kcal/d (312.0). The selected equation was: [y = 1 376.4 - 308 Sex (M = 0; W = 1) + 11.1 Weigh (kg) - 8 Age (years)] (R2: 0.68; EE: 175.95). The ICC between the new equation and the IC in normal weighted subjects was 0.901 (95%CI: 0.851 - 0.934). The new formula showed a good level of agreement in the overweight group (ICC: 0.880; 95%IC: 0.772 - 0.937).we propose a new predictive equation for estimating the REE for healthy Spanish population which has an easy application and includes sex, age and weigh. The selected equation shows an adequate behavior in overweight subjects too.Introducción: aunque se dispone de técnicas precisas y exactas para la estimación del GER, como la calorimetría indirecta (CI), en la práctica diaria se precisan métodos rápidos, fáciles de aplicar y económicos, como los modelos predictivos. Objetivo: desarrollar una nueva ecuación predictiva del gasto energético en reposo (GER) para población española adulta sana. Métodos: se determinó el GER en 95 sujetos sanos con normopeso mediante CI. Se utilizó la regresión lineal múltiple para la obtención del modelo, empleando como criterios analíticos la Cp de Mallows y el R2 ajustado. Se estudió el comportamiento del modelo generado en una muestra de 39 sujetos con IMC ≥ 25 kg/m2 mediante el coeficiente de correlación intraclase (ICC) y la prueba de Bland-Altman. La significación se alcanzó con p0,05. Resultados: la edad media fue de 42 años (rango: 23,0– 63,2). El valor medio del GER estimado fue de 1.589,1 kcal/d (312,0). La ecuación seleccionada fue: [GER (kcal/d) = 1.376,4 – 308 Sexo (V = 0; M = 1) + 11,1 Peso (kg) – 8 Edad (años)] (R2: 0,68; EE: 175,95). El CCI entre el nuevo modelo predictivo y la CI fue de 0,901 (IC del 95%: 0,851 – 0,934) en la muestra con normopeso. La aplicación del modelo en la muestra de sujetos con IMC ≥ 25 kg/m2 alcanzó una buena concordancia (CCI de 0,880; IC del 95%: 0,772 – 0,937). Conclusiones: se presenta un nuevo modelo de estimación del GER para población sana española fácilmente aplicable en la práctica diaria, que incluye las variables sexo, edad y peso. La ecuación propuesta presenta un comportamiento adecuado en sujetos con IMC ≥ 25 kg/m2.

the aim of this study was to analyze the agreement between the resting energy expenditure (REE) obtained by indirect calorimetry (IC) and that obtained by prediction equations in a sample of healthy adults from Spain. Méthods: a descriptive cross-sectional study was conducted in 95 healthy, normal-weight adults. REE was determined by IC and 45 population-specific prediction equations which were based on weight, height, sex and/or body composition (BC). The Intraclass Correlation Coefficient (ICC) and Bland-Alman plots were used to analyze the agreement between the REE obtained by IC and that obtained by prediction equations. The level of signification was reached at p0,05.mean age was 42 years (range: 23.0-63.2). Mean REE determined by CI was 1589 (312) kcal/d [1822.3 (224.3) kcal/d in men and 1379.3 (216.1) kcal/d in women; p0.05]. The De-Lorenzo, Harris-Benedict, Schofield, and especially the Korth equations showed the greatest level of agreement with respect to IC.there is high variability in the estimates of REE depending on the prediction equation used. The De Lorenzo, Harris-Benedict, and the Schofield equations showed a good level of agreement in our sample; however, the Korth equation was the most appropriate. Equations based on weight and/or height were more accurate than those which included body composition variables.Objetivo: estudiar la concordancia entre el gasto energético en reposo (GER) obtenido mediante calorimetría indirecta (CI), y las ecuaciones de estimación más utilizadas en población adulta sana española. Métodos: estudio transversal en el que se determinó el GER en 95 sujetos sanos con normopeso mediante calorimetría indirecta y modelos predictivos (se seleccionaron 45 fórmulas desarrolladas en adultos de características similares a la muestra estudiada que incluían peso, talla, sexo y/o composición corporal). La concordancia entre ambos métodos se analizó mediante el Coeficiente de Correlación Intraclase (CCI) y la prueba de Bland-Altman. La significación se alcanzó con p0,05. Resultados: la edad media fue de 42 años (rango: 23,0– 63,2). El GER medio estimado por CI en la muestra fue de 1589 (312) kcal/día [1822,3 (224,3) kcal/día en varones y 1379,3 (216,1) kcal/día en mujeres; p0,05]. Las fórmulas que mejor se ajustaron a la muestra fueron las de De-Lorenzo, Harris-Benedict, Schofield y, especialmente, Korth. Conclusiones: existen grandes variaciones en la estimación del gasto energético en reposo en función de la ecuación predictiva utilizada. Las fórmulas de De-Lorenzo, Harris-Benedic y Schofield se comportan adecuadamente en la muestra evaluada; sin embargo, la de Korth demostró ser la más apta. Los modelos que incluyen peso y/o talla obtuvieron mejores resultados que los que contienen variables de composición corporal.

Los trastornos de la conducta alimentaria (TCA) se caracterizan por una alteración persistente de la conducta relacionada con el hecho de alimentarse que impacta negativamente sobre la salud y las capacidades psicosociales de aquellos que los padecen. Se consideran enfermedades psiquiátricas con una gran variabilidad en su presentación y gravedad, con gran repercusión nutricional, lo que condiciona diferentes planteamientos terapéuticos, haciéndose indispensable un enfoque multidisciplinar. Expertos en nutrición hemos decidido crear un grupo de trabajo adscrito a la Sociedad Española de Nutrición Parenteral y Enteral (SENPE), que ha asumido entre sus objetivos el elaborar un documento de consenso que genere un protocolo basado en la mejor evidencia científica posible y en la experiencia profesional, con la finalidad de mejorar la práctica asistencial en este campo.

to assess the utility of body mass index (BMI) and waist circumference (WC) as surrogate indicators of adiposity with respect to the total body fat estimated with bioimpedance analysis in psychogeriatric patients.Anthropometric and hand-to-foot bioimpedance measurements were performed according to standard procedures in a sample of 128 psychogeriatric patients (87 males, 41 females). WC cutoffs proposed by the International Diabetes Federation were used to define abdominal obesity. Z-scores of fat and fat-free mass indices (Z-FMI and Z-FFMI) were calculated.Males with WC values below the cutoff were normal weight, and showed normal levels of FM and low FFM (Z-FFMI below 1.5 SD). Males with WC values above the cutoff were overweight, showed high levels of FM (Z-FMI: 1.34 SD) and a slight depletion of FFM (Z-FFMI: -0.59 SD). In females with WC values below the cutoff, BMI was close to 20 kg/m(2) and both FM and FFM were depleted (Z-FMI: -0.7 SD; Z-FFMI: -1.76 SD). In females with WC above the cutoff, the average BMI was 25.6 kg/m(2) , Z-FMI was 0.48 SD, and Z-FFMI was -0.56 SD.Our results indicate that it is necessary to establish age and sex-specific BMI and WC cutoffs, and also highlight the importance of focusing on body composition analysis to ensure an accurate nutritional diagnosis in older-adults and in psychogeriatric patients.

To assess the body composition in a group of malnourished patients with anorexia nervosa as compared to healthy controls, before and after nutritional support, by means of anthropometry and bioimpedance.Prospective observational study. Complete anthropometry was performed as well as bioimpedance analysis in 12 women (24.5 years) with restrictive anorexia nervosa at hospital admission and weekly thereafter during re-feeding. The control group was formed by 24 healthy women (21 years). The Student's t test, the Mann-Whitney U test, the Student's t test for repeated measurements, and the Wilcoxon's test were applied. The level of agreement between anthropometry and BIA was calculated by the interclass correlation coefficient and the Bland-Altman s test.The patients had significant improvements in all indexes of body composition throughout their hospital staying although their values at discharge still were lower than those of the control subjects. The average weight gain was 5.22 kg (SD: 1.42), of which 51.4% was fat mass, preferentially centrally distributed. In the control subjects, the BIA equation that correlated the best with anthropometrics was Sun s equation (CCI = 0.896); in the patients, the level of agreement was weaker, both at hospital admission and at hospital discharge.Re-feeding produces weight gain, essentially at the expense of fat mass, which is centrally distributed; the nutritional status is not reestablished. The level of agreement between anthropometry and bioimpedance for studying body composition is acceptable, especially in healthy subjects. In those cases with severe changes in body composition and/or water balance, anthropometry is recommended when vectorial BIA or some other gold standard method are not available for the analysis of body composition.Objetivo: Evaluar la composición corporal en un grupo de pacientes desnutridas con anorexia nerviosa, respecto de controles sanas, antes y después del soporte nutricional, mediante antropometría y bioimpedancia. Métodos: Estudio observacional prospectivo. Se realizó una antropometría completa y un análisis de bioimpedancia a 12 mujeres con anorexia nerviosa restrictiva (24,5 años) al ingreso hospitalario y semanalmente durante la realimentación. El grupo control estuvo formado por 24 mujeres sanas (21 años). Se aplicaron los test t-Student, U-Mann-Whitney, t-Student para medidas repetidas o Wilcoxon. La concordancia entre antropometría y BIA se analizó mediante el coeficiente de correlación intraclase y Bland-Altman. Resultados: Las pacientes mejoraron significativamente todos los índices de composición corporal a lo largo de la estancia hospitalaria, aunque sus valores al alta siguieron siendo menores que los de las controles. La media de peso ganado fue 5,22 kg (DE: 1,42), de los que el 51,4% fueron masa grasa, con distribución central preferentemente. En las controles la ecuación de BIA que mejor concuerda con antropometría es la de Sun (CCI = 0,896); en las pacientes la concordancia fue más débil, al ingreso y al alta. Conclusiones: La realimentación produce una ganancia ponderal, fundamentalmente a expensas de masa grasa, con distribución central; no se consigue restablecer el estado nutricional. La concordancia entre antropometría y bioimpedancia para el estudio de la composición corporal es aceptable, especialmente en sujetos sanos. Se recomienda emplear antropometría, si no se dispone de BIA vectorial o algún método gold estandard para el análisis de la composición corporal, en casos de alteraciones importantes en la composición corporal y/o el balance hídrico.

Previous studies have shown a reduction in lymphocyte mitochondrial complex I activity (CIA) in malnourished patients, which is restored after refeeding. Our aim was to evaluate the usefulness of CIA as an indicator of nutritional status in anorexia nervosa patients. Twelve malnourished anorexia nervosa females (mean age, 24.5 years) were admitted to the Eating Disorders Unit. Basal and weekly anthropometrics, bioelectric impedance (BIA), body composition, and CIA were performed until discharge. Patients were matched to 25 healthy females and refeeding was adjusted according to the Unit’s protocol. Statistics were used as appropriated and significance was reached at p < 0.05. Patients showed a significant reduction in body mass index, fat mass and fat free mass (FFM), triceps skinfold, and waist circumference on admission as compared with the control group. Parameters improved during hospitalization, but they failed to reach normal values at discharge. Compared with controls, CIA was significantly lower in patients on admission (2.16 vs. 5.68 nmol·min−1·mg protein−1). Refeeding and weight gain did not restore CIA. A positive association (r2= 0.69) was found between FFM and CIA in patients at discharge. Malnourished females with anorexia nervosa have lower CIA than controls that is not recovered after refeeding. This could be because of a low FFM exacerbated by physical inactivity while in hospital.

To assess the nutritional status of a group of institutionalized elderly with dementia by analysing the changes in the body composition according to their evolutionary state.A cross-sectional study was carried out assessing the nutritional status and the body composition (anthropometry, MNA and bioimpedance) in 63 institutionalized elderly with a diagnosis of dementia in evolutionary stages 5, 6 and 7 of the GDS (Global Deterioration Scale) scales and the FAST (Functional Assessment Stating) scale. The fat mass index (FMI) and the fat-free mass index (FFMI) were calculated. The results were analysed by one-factor ANOVA and Kruskal-Wallis factorial ANOVA and Scheffé's a posteriori contrasts. The significance level was set at p0.05.Mean age was 80.6 years (95%CI: 78.3-83.0; Range: 51-95). According to MNA, 38.1% of the sample had hyponutrition, 60.3% was at risk for malnourishment; and 1.6% had normal nutrition. The average body mass index was 23.06 (22.01-24.10) kg/m2, without any significant difference by the degree of evolutionary state, except for those on palliative care (mean: 19.85; 95%CI: 78.3-83.0 kg/m2). The patients in the non-palliative stages GDS/FAST 5, 6 and 7 presented a Z-Score of FMI close to a 0 SD, and a Z-Score for the FFMI of approximately -1 DS. These results are compatible with a sarcopenia situation. In patients on palliative care (GDS/FAST =?7c) both indexes were significantly lower.The analysis of body composition should always be included in the assessment of the nutritional status. If not, it would not be possible to detect situations of sarcopenic obesity, which is rather prevalent in elderly people with these characteristics.Objetivo: Valorar el estado nutricional de un grupo de ancianos institucionalizados con demencia, analizando los cambios en la composición corporal en función de su estadío evolutivo. Método: Se ha realizado un estudio transversal en el que se valoró el estado nutricional y la composición corporal (antropometría, MNA, y bioimpedancia) en 63 ancianos institucionalizados con diagnóstico de demencia en estadíos evolutivos 5, 6 y 7 de las escalas GDS (Global Deterioration Scale) y FAST (Functional Assessment Stating). Se calcularon los índices de masa grasa (IMG) y de masa libre de grasa (IMLG). Los resultados se analizaron mediante el ANOVA de un factor y ANOVA factorial o Kruskal-Wallis, y contrastes a posteriori de Scheffé. La significación se alcanzó con p0,05. Resultados: La media de edad fue 80,6 (IC 95%: 78,3- 83,0; Rango: 51-95) años. Según el MNA, el 38,1% de la muestra presentaba malnutrición, el 60,3% riesgo de malnutrición, y el 1,6% normalidad nutricional. La media del índice de masa corporal fue 23,06 (22,01-24,10) kg/m2, sin diferencias significativas en función del estadío evolutivo, salvo en los paliativos (media: 19,85; IC 95%: 78,3-83,0 kg/m2). Los pacientes en estadíos GDS/FAST 5, 6 y 7 no paliativos presentan una Z-Score del IMG próxima a 0 DS, y una Z-Score del IMLG de aproximadamente -1 DS, resultados compatibles con una situación de sarcopenia. En los paliativos (GDS/FAST =?7c) ambos índices son significativamente inferiores. Conclusión: El análisis de la composición corporal debe ser incluido en la valoración del estado nutricional siempre. De lo contrario no sería posible detectar situaciones de obesidad sarcopénica, muy prevalentes en ancianos con estas características.

To provide recent observations on the interrelation between chronic heart failure (CHF), cachexia and human nutrition and updating epidemiological issues in CHF.Present evidence suggests that impairment in cardiac muscle energetics plays an important role in the pathogenesis of heart failure. New concepts such as microRNA expression are emerging as potential agents in heart failure. Recent research suggests mechanisms by which inflammatory catabolic states may persist in the presence of adequate growth factors and nutrition. A consensus panel has recently designed a definition for general cachexia and its stratification. Together with classicals, new nutrients and substrates are showing efficacies in the malnutrition associated with CHF. Although still promising, ghrelin, growth factors and other biological compounds maintain emergent therapeutical positions for heart failure or associated catabolic states or both.Altered intestinal function as an agent for CHF is rising in evidence. New techniques to well diagnose and stratify malnutrition and cardiac cachexia in CHF are needed. Treatment of cachexia in CHF appears to be a combination of different approaches, in which metabolic, nutritional, immunological and hormonal strategies may play an important role. Although the current experimental research is of great help, well designed randomized controlled trials are needed to test these hypothesis and generate clinical evidence.

Producción Científica, Patients with eating disorders (ED) show alterations in both their behaviour and their intake of food, frequently presenting nutritional and somatic affectations. Besides the classical forms such as anorexia or bulimia nervosa, there has recently been an increase in atypical or incomplete forms of ED, such as binge eating. Primary care (PC) services form the central and closest nucleus of health care for the individual and the family, where ED occur and leave their mark. This allows PC to provide an integral response at all levels of care for ED. Primary prevention at school, in the family and community is fundamental to avoiding its inception. Secondary prevention is based on early diagnosis and treatment of ED and favours a better prognosis of the illness. Tertiary prevention tries to reduce the serious consequences with rehabilitation measures to alleviate complications and avoid risk to life. Due to its complexity, these patients are afforded the attention of multidisciplinary teams of specialists with experience in treating this condition. In consultation with the team, the general practitioner should adopt a leading role at all levels of attention, as he/she is the link between the team, the family and the patient. This requires both regulated, specific training in the disease and the allocation of resources to carry it through. Putting into practice all these plans would allow us to give a positive answer to the question posed in the title of the present article.