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[Abstract] This paper presents baseline results from the NutriEcoMuscle study, a multicenter observational study conducted in Spain which focused on changes in nutritional status, body composition, and functionality in post-intensive care unit (ICU) COVID-19 patients following a nutritional intervention. Assessments at hospital discharge included Subjective Global Assessment (SGA), Global Leadership Initiative on Malnutrition (GLIM) criteria, the Barthel index, handgrip strength (HGS) and the Timed Up-and-Go test, bioelectrical impedance analysis (BIA), and nutritional ultrasound (US). The study involved 96 patients (71.9% male, mean age 58.8 years, mean BMI 28.8 kg/m2, 36.5% obese). All patients were malnourished at discharge according to GLIM and SGA. Functional status declined from admission up to hospital discharge. A total of 33.3% of patients had a low fat-free mass index (FFMI) and 29.5% had a low phase angle (PhA). Myosteatosis was observed in 83.7% of the population. There was a positive correlation between rectus femoris cross-sectional area, PhA, FFMI, and HGS. In conclusion, post-critically ill COVID-19 patients commonly suffer from malnutrition and reduced muscle mass, causing a loss of independence at hospital discharge. BIA and US could be valuable tools for assessing body composition in these patients. The NutriEcoMuscle study highlights the need for a thorough nutritional and morphofunctional status assessment of post-ICU patients.

[Abstract] Introduction: Nutritional ultrasound (US) is an emerging technique in clinical nutrition for the morphological and structural study of muscle mass. Currently, all definitions of malnutrition include the measurement of muscle mass; however, there is no single way to assess it. It is necessary to develop new techniques to identify muscle involvement in malnutrition that are valid, standardised, reliable, accurate and profitable. Objective: To value the new muscle US techniques aimed to measure muscle and functional status, to make a more accurate diagnosis and a better prediction of complications and morbidity and mortality in patients at nutritional risk. Primary outcome: to assess the feasibility of US or muscle US techniques in both nutritional diagnosis and follow-up in a nutritional intervention programme. Methods and analysis: Disease-Related caloric-protein malnutrition EChOgraphy (DRECO) is a prospective, multicentre (25 Spanish hospitals), uncontrolled clinical study in standard clinical practice to value the usefulness of nutritional US (muscle US) in the nutritional diagnosis and follow-up, over 3-6 months, after standard nutritional clinical practice intervention and physical activity, to control their disease-related malnutrition. 1000 patients are expected to be included in. Discussion: This study will standardise nutritional US measures. It will validate and define specific cut-off values for nutritional US and correlate it with already well-known nutritional tools such as Subjective Global Assessment or Global Leadership Initiative on Malnutrition criteria. Thus, muscle US will become not only a tool to diagnose malnutrition, but it will also be integrated in the daily practice to evaluate nutritional interventions.

[Abstract] Disease-related malnutrition (DRM) affects approximately a third of hospitalized patients and is associated with an increased risk of morbimortality. However, DRM is often underdiagnosed and undertreated. Our aim is to evaluate the prognostic value of morphofunctional tools and tests for nutritional assessment in clinical practice. A systematic literature review was conducted to identify studies relating to the morphofunctional assessment of nutritional status and mortality or complications. Evidence was evaluated using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) method. Twelve GRADE recommendations were made and divided into seven topics: food intake and nutrient assimilation, anthropometry, biochemical analysis, hand grip strength, phase angle, muscle imaging, and functional status and quality of life. From these recommendations, 37 statements were developed and scored in a two-survey Delphi method by 183 experts. A consensus was reached on accepting 26/37 statements. Surveys had high internal consistency and high inter-rater reliability. In conclusion, evidence-based recommendations were made on the prognostic value of morphofunctional assessment tools and tests to assess malnutrition, most of which were found to be feasible in routine clinical practice, according to expert opinions.

[Abstract] Phase angle (PhA) is a valuable tool for evaluating the nutritional and inflammatory status, which can accompany acute and severe disorders. PhA is a cellular health biomarker, whose value is particularly substantial due to the negative consequences of these situations in the pediatric population. Relevant literature was collected with the aim of comprehensively analysing the evidence on the association between an altered PhA can serve as a predictive-marker for mortality and poor-outcomes in at-risk-pediatric patients. Understanding this relationship could have significant implications for identifying high-risk individuals and implementing timely interventions. A systematic review with meta-analysis was conducted in the primary electronic databases from inception until January 2023. Overall, four studies with a total of 740 patients were eligible for our analysis. Evidence demonstrates that PhA is associated with nutritional status, reflecting undernutrition and changes in body composition related to illness. This review suggests that PhA can indeed be used as an indicator of nutritional status and a tool for predicting prognosis, including mortality and poor-outcomes, in hospitalized pediatric patients. A low PhA was associated with a significant mortality risk [RR:1.51;95%CI (1.22-1.88),p = 0.0002;I2 = 0%,(p = 0.99)] and an increased complications risk [OR:8.17;95%CI (2.44-27.4),p = 0.0007;I2 = 44%,(p = 0.18)]. These findings highlight the importance of taking a comprehensive approach to clinical nutrition, integrating multiple evaluation aspects to establish an accurate diagnosis and personalized therapeutic plans. While PhA emerges as a valuable tool for assessing the risk of malnutrition and as a prognostic-indicator for poor-outcomes in pediatric patients. Further future studies are needed to focus on investigating this relationship in larger and diverse population to strengthen the evidence base.

[Resumen] Introducción: la EHGNA es la causa mas comun de enfermedad hepatica cronica, afectando a una cuarta parte de la poblacion adulta mundial. La EGHNA esta estrechamente relacionada con la DM2, la obesidad y el sindrome metabolico. La evolucion de la patologia es todavia incierta, pero se conoce que la presencia de fibrosis es el principal predictor de progresion de la enfermedad, complicaciones y mortalidad, por lo que, identificar la presencia de fibrosis avanzada resulta de vital importancia. Objetivo: estimar la prevalencia de EHNA avanzada en una poblacion con DM2 y definir sus caracteristicas fenotipicas. Material y metodos: se analizaron los datos de 577 pacientes con DM2 que acudieron de forma sucesiva a consultas para su revision rutinaria. La muestra estudidada incluyo a 265 (45,8%) hombres y 312 (54,2 %) mujeres, con edad media de de 65,4 } 7,8 anos, un IMC medio de 31,50 } 5,36 Kg/m2 y un tiempo de evolucion de su DM2 de 12,9 } 8,56 anos. Los sujetos fueron evaluados clinicamente, se realizaron 4 indices indirectos de fibrosis (APRI, NAFLD Fibrosis Score, FIB-4, Hepamet Fibrosis Score) y elastrografia hepatica de transicion a traves de Fibroscanâ con sonda M y XL. Se realizo un analisis estadistico de los datos disponibles con SPSS R version 22. Resultados: se observo una prevalencia de EHGNA con fibrosis avanzada (³ F3) del 10%. Se observo una asociacion estadisticamente significativa entre la fibrosis avanzada y los valores de RI medidos por HOMA2-IR asi como con el grado de IMC y el PC. No se encontro asociacion estadisticamente significativa con el tiempo de evolucion de la DM2 ni con el grado de control de esta. Conclusiones: una proporcion significativa de los pacientes con DM2 pueden presentar fibrosis en estadios avanzados (³ F3). El grado de RI, el IMC y el PC pueden ser predictores de riesgo para evaluar los pacientes en riesgo., [Resumo] Introdución: A EHGNA e a causa mais comun de enfermidade hepatica cronica, afectando a unha cuarta parte da poboacion adulta mundial. A EHGNA esta intimamente relacionado coa DM2, a obesidade e a sindrome metabolica. A evolucion da patoloxia ainda e incerta, pero sabese que a presenza de fibrose e o principal predictor de progresion da enfermidade, complicacions e mortalidade, polo que e de vital importancia identificar a presenza de fibrose avanzada. Obxectivo: estimar a prevalencia de EHGNA avanzada nunha poboacion con DM2 e definir as suas caracteristicas fenotipicas. Material e metodos: analizaronse os datos de 577 pacientes con DM2 que acudiron sucesivamente as consultas para a sua revision de rutina. A mostra estudada incluiu 265 (45,8%) homes e 312 (54,2%) mulleres, cunha idade media de 65,4 } 7,8 anos, un IMC medio de 31,50 } 5,36 kg/m2 e un tempo de evolucion da DM2 de 12,9 } 8,56 anos. Avaliaronse clinicamente os suxeitos, realizaronse 4 indices indirectos de fibrose (APRI, NAFLD Fibrosis Score, FIB-4, Hepamet Fibrosis Score) e elastografia hepatica de transicion mediante Fibroscanâ con sonda M e XL. Realizouse unha analise estatistica dos datos disponibles con SPSS R version 22. Resultados: observouse unha prevalencia de EGHNA con fibrose avanzada (³ F3) do 10%. Observouse unha asociacion estatisticamente significativa entre a fibrose avanzada e os valores de RI medidos por HOMA2-IR, asi como co grao de IMC e PC. Non se atopou ningunha asociacion estatisticamente significativa co tempo de evolucion da DM2 nin co grao de control da mesma. Conclusions: unha proporcion significativa de pacientes con DM2 poden presentar fibrose en fases avanzadas (³ F3). O grao de RI, o IMC e o PC poderian ser predictores de risco de fibrose., [Abstract] Introduction: Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease, affecting a quarter of the world's adult population. NAFLD is closely related to type 2 diabetes mellitus (T2DM), obesity and metabolic syndrome. The evolution of the pathology is still uncertain, but it is known that the presence of fibrosis is the main predictor of disease progression, complications, and mortality, therefore identifying the presence of advanced fibrosis is of vital importance. Objective: to estimate the prevalence of advanced NASH in a population with DM2 and to define its phenotypic characteristics. Material and methods: the data of 577 patients with T2DM who successively attended consultations for their routine check-up were analyzed. The sample studied included 265 (45.8%) men and 312 (54.2%) women, with a mean age of 65.4 } 7.8 years, a mean BMI of 31.50 } 5.36 Kg/ m2 and a T2DM evolution time of 12.9 } 8.56 years. Subjects were clinically evaluated, 4 indirect fibrosis test were performed (APRI, NAFLD Fibrosis Score, FIB-4, Hepamet Fibrosis Score) and transient hepatic elastography through FibroscanÒ with M and XL probe. A statistical analysis of the available data was performed with SPSS R version 22. Results: a prevalence of NAFLD with advanced fibrosis (³ F3) of 10% was observed. A statistically significant association was observed between advanced fibrosis and insulin resistance (IR) values measured by HOMA2-IR as well as with the degree of BMI and AC. No statistically significant association was found with the time of evolution of T2DM or with the degree of control. Conclusions: a significant proportion of patients with T2DM may present fibrosis in advanced stages (³ F3). The degree of IR, the BMI and the PC could be predictors of risk.

[Abstract] Metabolic syndrome (MetS) increases the risk of cardiovascular disease, type 2 diabetes mellitus, and cancer. Despite the higher prevalence of MetS in obese adults, little is known about the effectiveness of intensive and group interventions in improving MetS prevalence. This study aimed to investigate the effectiveness of an intensive lifestyle program in reducing the prevalence of MetS in adults with obesity. Patients with obesity (n = 456, 48.8 ± 12.8 years, 18.5% male) were randomized in two groups as indicated in a prospective interventional real-life study: a control group (CG), in which patients received usual care, and an interventional group (IG), in which the patients participate in a healthy lifestyle habits program in six weekly sessions, IGOBE program. Anthropometric, body composition, medications, and MetS features data were analyzed in both groups at the pre-intervention and post-intervention stages using a completer’s analysis. At 12 months of follow-up, the IG showed a relative reduction of 13.4% in the prevalence of MetS from baseline, while the CG showed a reduction of 2.1% (p < 0.001). A significant reduction was also observed in four of five MetS features. In this trial, implementation of the IGOBE program resulted in a significant reduction in MetS prevalence and better control of MetS features compared with the standard of care.

Recent scientific evidence has shown the importance of diet and lifestyle habits for the proper functioning of the human body. A balanced and healthy diet, physical activity, and psychological well-being have a direct beneficial effect on health and can have a crucial role in the development and prognosis of certain diseases. The Southern European Atlantic diet, also named the Atlantic diet, is a unique dietary pattern that occurs in regions that present higher life expectancy, suggesting that this specific dietary pattern is associated with positive health effects. In fact, it is enriched with nutrients of high biological value, which, together with its cooking methods, physical activity promotion, reduction in carbon footprint, and promoting of family meals, promote these positive effects on health. The latest scientific advances in the field of nutri-epigenetics have revealed that epigenetic markers associated with food or nutrients and environmental factors modulate gene expression and, therefore, are involved with both health and disease. Thus, in this review, we evaluated the main aspects that define the Southern European Atlantic diet and the potential epigenetic changes associated with them based on recent studies regarding the main components of these dietary patterns. In conclusion, based on the information existing in the literature, we postulate that the Southern European Atlantic diet could promote healthy aging by means of epigenetic mechanisms. This review highlights the necessity of performing longitudinal studies to demonstrate this proposal

El cáncer colorrectal (CCR) supone una de las patologías con mayor prevalencia en un Servicio de cirugía general y del aparato digestivo. En base a la bibliografía publicada al iniciar un programa de cribado de CCR cabe esperar un incremento en el número de intervenciones quirúrgicas por encima del 50% en el rango de edad del cribado (entre 50-69 años). Con este estudio pretendemos conocer como ha sido el impacto, a nivel quirúrgico, del cribado del CCR en el área Sanitaria de Ferrol, describir las características de localización anatómica del CCR, la técnica quirúrgica y de anastomosis empleada, y valorar si existe diferencia entre los diferentes grupos de pacientes (con cribaje y sin cribaje). La finalidad es recabar y obtener datos para optimizar la planificación quirúrgica del CCR en nuestro ámbito y conocer el efecto de la obesidad como factor de riesgo.

[Resumen] La neuropatía diabética constituye la complicación más habitual derivada de la diabetes mellitus llegando a afectar al 50% de estos pacientes con más de 10 años de evolución. Esta afección es considerada el principal factor de riesgo para el desarrollo de úlceras y por tanto es la responsable del 75% de las amputaciones que se llevan a cabo en personas diabéticas. Para su correcto diagnóstico es fundamental realizar una historia clínica detallada junto con una valoración de la sensibilidad vibratoria y de la sensibilidad protectora con el diapasón graduado de Rydel – Seiffer de 128 Hz y con el monofilamento de 10 gramos respectivamente. Objetivos: Los objetivos principales de este proyecto de estudio son, por un lado, determinar la prevalencia de neuropatía diabética en una muestra de diabéticos tipo 2 del área sanitaria de Ferrol, y por otro, determinar la concordancia entre los dos métodos diagnósticos empleados e incluidos en los protocolos de actuación clínica de la Asociación Americana de diabetes. De forma secundaria, se determinará la relación entre la neuropatía diabética y determinados factores clínicos y sociodemográficos de los participantes. Metodología: Este proyecto de estudio contempla la realización de dos tipos de estudio diferentes. Por un lado, un estudio transversal observacional prospectivo de prevalencia de la neuropatía diabética y por otro, un estudio de concordancia de pruebas diagnósticas en pacientes con diagnóstico de diabetes mellitus tipo 2 con más de 10 años de evolución en seguimiento en el Servicio de Endocrinología y Nutrición del Complejo Hospitalario de Ferrol sin diagnóstico previo de neuropatía diabética., [Resumo] A neuropatía diabética constitúe a complicación máis habitual derivada da diabetes mellitus chegando a afectar ao 50% dos pacientes con máis de 10 anos de evolución. Esta afección é considerada o principal factor de risco para o desenvolvemento de úlceras e por tanto é a responsable do 75% das amputacións que se levan a cabo en persoas diabéticas. Para o seu correcto diagnóstico é fundamental realizar unha historia clínica detallada xunto cunha valoración da sensibilidade vibratoria e da sensibilidade protectora có diapasón graduado de Rydel – Seiffer de 128 Hz e có monofilamento de 10 gramos respectivamente. Obxectivos: Os obxectivos principais deste proxecto de estudo son, por unha banda, determinar a prevalencia de neuropatía diabética nunha mostra de diabéticos tipo 2 da área sanitaria de Ferrol, e por outra banda, determinar a concordancia entre os dous métodos diagnósticos empleados e incluídos nos protocolos de actuación clínica da Asociación Americana de Diabetes. De forma secundaria, determinarase a relación entre a neuropatía diabética e determinados factores clínicos e sociodemográficos dos participantes. Metodoloxía: Este proxecto de estudo contempla a realización de dous tipos de estudo diferentes. Por unha banda, un estudo transversal observacional prospectivo de prevalencia da neuropatía diabética e por outra, un estudo de concordancia de probas diagnósticas en pacientes con diagnóstico de diabetes mellitus tipos 2 con máis de 10 anos de evolución en seguimento no Servizo de Endocrinoloxía e Nutrición do Complexo Hospitalario de Ferrol sen diagnóstico previo de neuropatía diabética., [Abstract] Diabetic neuropathy is the most common medical complication derived from diabetes mellitus, affecting 50% of the patients who have been suffering from this condition for 10 years. This condition is considered the main risk factor for the development of ulcers and it is therefore responsible for 75% of amputations carried out in diabetic patients. For its correct diagnosis, it is essential to carry out a detailed clinical history along with an assessment of vibratory sensitivity and protective sensitivity with the 128 Hz Rydel-Seiffer graduated tuning fork and with the 10-gram monofilament, respectively. Objectives: The main objectives of this study project are, on the one hand, to determine the prevalence of diabetic neuropathy in a sample of type 2 diabetic patients from the health area of Ferrol, and on the other hand, to determine the concordance between the two diagnostic methods used and included in the clinical protocols of action of the American Diabetes Association. Secondarily, the relationship between diabetic neuropathy and certain clinical and sociodemographic factors of the participants will be determined. Methodology: This study project contemplates the realization of two different types of study. On the one hand, a prospective cross-sectional observational study on the prevalence of diabetic neuropathy and on the other hand, a study on the concordance of diagnostic tests in patients diagnosed with type 2 diabetes mellitus with more than 10 years of evolution under supervision in the Endocrinology and Nutrition Service of the Hospital Complex in Ferrol without previous diagnosis of diabetic neuropathy.

[Abstract] Objectives: To determine the of undiagnosed lower extremity artery disease using the pulse oximetry in a type 2 diabetic population sample. Methods: Observational, cross-sectional, descriptive study that included 594 type 2 diabetic patients, with no previous history of lower extremity artery disease. Medical history, physical examination, determination of the ankle-brachial index (portable Doppler) and measurement of oxygen saturation in upper and lower extremities (pulse oximeter) were performed. Results: Frequency of lower extremity artery disease determined by ankle-brachial index was 18.4%. No significant correlations were detected between oxygen saturation and the ankle-brachial index except for the relationship between ankle-brachial index vs. oxygen saturation at 30 cm lower limb elevation vs. the supine position at no elevation (0 cm) in subjects under the age of 40. Pulse oximetry showed little diagnostic value in the screening of lower extremity artery disease. A relationship between lower extremity artery disease and age has been found. Its diagnosis was associated with a lower body mass index and lower systolic blood pressure in the lower extremities and higher in the upper extremities. Conclusions: We conclude that pulse oximetry is not useful in the screening for asymptomatic lower extremity artery disease in type 2 diabetics.

[Abstract] Objective: Our aim was to go deeper in the self-perception of weight and health status among the Spanish population, together with the connections of familiar relationships, physical activity practice, nutritional habits, and sleep patterns with the presence of obesity. Methods: A total of 1,000 subjects were enrolled in April 2017 in a representative adult Spanish population sample. Computer-assisted telephone interviewing was used and self-reported anthropometric data was obtained. Results: The population was composed of 51.3% women, with a mean age of 48 (36-63) years and a BMI of 23.2 (20.3-26.6). Although only 17.7% of subjects with self-reported obesity exhibited the self-perception to suffer from obesity, they referred a bad (16%) or regular (47%) self-perceived health status. Subjects who considered themselves as people with overweight and obesity displayed a BMI of 30.5 (28.7-32.2) and 37.1 (34.8-41.5), respectively. The obesity group displayed the highest percentage (71.9%) of participants with some first-degree relative with overweight or obesity (p < 0.001) in comparison with the other groups. The main reason put forward of preventing healthy eating among subjects with obesity was that they dislike healthy food. The multivariable logistic regression model for presence of obesity showed that there was a significant association with older age, presence of a first-degree relative with weight excess, a positive snacking habit, and daily alcohol consumption (p ≤ 0.019). Conclusion: The Spanish population has a low self-perception of obesity. Our data also reinforces the strong association between obesity and age, family interactions, usual snacking, and daily consumption of wine or beer.

[Resumen] Introducción: Los jóvenes universitarios se encuentran en una etapa vital para su conocimiento y maduración, es vital conocer sus hábitos y practicas saludables para percatarse de las posibles carencias y guiarles a hacia una mejor praxis que no les comprometa la salud en un futuro con la aparición de enfermedades no transmisibles. Estos universitarios sufrirán cambios en su etapa en la universidad, tales como la vivencia fuera del domicilio familiar, preparar su propia comida o compartir piso con otras personas. Todo esto podrá modificar sus hábitos y costumbres, al igual que se guiaran por información nutricional no formal, que puede poner en peligro los patrones saludables que había adquirido en la infancia. Objetivos: Describir los hábitos y conductas relacionadas con la alimentación de los universitarios y analizar si existen diferencias en función del sexo, IMC, tipo de titulación y residencia habitual. Metodología: Estudio observacional transversal descriptivo de una muestra de 465 alumnos del Campus de Ferrol, correspondiente a la UDC. Los datos se recogieron mediante una encuesta en las diferentes facultades del campus en la que se preguntaban datos antropométricos, edad, sexo, comunidad autónoma de procedencia, titulación que cursaban y 37 preguntas sobre hábitos y conductas saludables. Las respuestas recibidas se analizaron con el paquete estadístico SPSS versión 24.0. Resultados: El cambio en su vida que supone el acceso a la universidad repercute en sus hábitos, dado que cambian sus costumbres y sus prácticas. Aumenta el consumo de alimentos ricos en azúcar de los estudiantes que no residen en su residencia habitual, al igual que es más elevado el consumo de alcohol. Se demuestra la participación mayoritaria de mujeres en la encuesta, y se reafirma como el género más numeroso cursando estudios universitarios. Conclusiones: De los primeros estudios que se realizan en el campus de Ferrol y sirve para conocer las peculiaridades de la población un, [Resumo] Introducción: Os mozos universitarios atópanse nunha etapa vital para o seu coñecemento e maduración, é vital coñecer os seus hábitos e prácticas saudables para decatarse das posibles carencias e levalos cara unha mellor praxe que non comprometa a súa saúde nun fututro coa aparición de enfermidades non trasmisibles. Estes universitarios sufrirán cambios na súa etapa na universidade, como a vivencia fora do domicilio familiar, preparar a súa propia comida ou compartir piso con outras persoas. Todo isto poderá modificar os seus hábitos e costumes, o igual que se guiarán por información nutricional non formal, que pode poñer en perigo os patróns saudables que tiñan aprendidos na infancia. Obxectivos: Describir os hábitos e condutas relacionadas ca alimentación dos universitarios e analizar se existen diferenzas en función do sexo, IMC, tipo de titulación e residencia habitual. Metodoloxía: Estudio observacional transversal descritivo dunha mostra de 465 alumnos do Campus de Ferrol, correspondente a UDC. Os datos recolleronse a través dunha enquisa nas diferentes facultades do campus na que se preguntaban datos antropométricos, idade, sexo, comunidade autónoma de procedencia, titulación que cursaban e 37 preguntas sobre hábitos e condutas saudables. As respostas recibidas analizaronse co paquete estatístico SPSS versión 24.0. Resultados: O cambio que supón na súa vida o acceso a universidade repercute nos seus hábitos, xa que cambian os seus costumes e as suas prácticas. Aumenta o consumo de alimentos ricos en azucre dos estudantes que non residen na sua residencia habitual, tamén aumenta o consumo de alcohol. Demóstrase a participación maioritaria de mulleres na enquisa e reafirmanse como o xénero máis numeroso cursando estudos universitarios. Conclusións: Dos primeiros estudos que se realizan no Campus de Ferrol e serve para coñecer as peculiaridades da poboación universitaria e como as características da universidade inflúen no individuo. Con esta informació, [Abstract] Introduction: Young university students are at a vital stage in their knowledge and maturity. It is vital to know their healthy habits and practices in order to become aware of possible deficiencies and to guide them towards a better practice that does not compromise their health in the future with the appearance of noncommunicable diseases. These university students will suffer changes during their time at university, such as living outside the family home, preparing their own food or sharing a flat with other people, all of which may modify their habits and customs, as well as being guided by non-formal nutritional information, which may endanger the healthy patterns they had acquired in childhood. Objectives: To describe the habits and behaviors related to the feeding of university students and to analyze if there are differences according to sex, BMI, type of degree and habitual residence. Methodology: Descriptive transversal observational study of a sample of 465 students from the Ferrol Campus, corresponding to the UDC. The data were collected through a survey in the different faculties of the campus asking anthropometric data, age, sex, autonomous community of origin, degree being studied and 37 questions on healthy habits and behaviours. The responses received were analysed with the SPSS statistical package version 24.0. Results: The change in their lives that access to university implies has an impact on their habits, given that they change their customs and practices. The consumption of sugar-rich foods by students who do not live in their usual residence increases, as does alcohol consumption. The majority participation of women in the survey is demonstrated, and it is reaffirmed as the most numerous gender studying at university. Conclusions: From the first studies carried out in the Ferrol campus and serves to know the peculiarities of the university population, as well as the characteristics of the university that influence the individual. W

[Abstract] Introduction: The aim of this Delphi study is to unveil the management of patients with type 2 diabetes (T2D) and different levels of complexity in the clinical practice in Spain. Methods: Based on the common management practices of T2D profiles reported by Spanish endocrinologists, a Delphi questionnaire of 55 statements was developed and responded to by a national panel (n = 101). Results: A consensus was reached for 30 of the 55 statements. Regarding overweight patients inadequately controlled with metformin, treatment with a sodium-glucose transport protein 2 inhibitor (SGLT2-I) is preferred over treatment with a dipeptidyl peptidase-4 inhibitor (DPP4-I). If the patient is already being treated with a DPP4-I, an SGLT2-I is added on to the treatment regimen rather than replacing the DPP4-I. Conversely, if the treatment regimen includes a sulfonylurea, it is usually replaced by other antihyperglycemic agents. Current treatment trends in uncontrolled obese patients include the addition of an SGLT2-I or a glucagon-like peptide-1 receptor agonist (GLP1-RA) to background therapy. When the glycated hemoglobin target is not reached, triple therapy with metformin + GLP1-RA + SGLT2-I is initiated. Although SGLT2-Is are the treatment of choice in patients with T2D and heart failure or uncontrolled hypertension, no consensus was reached regarding the preferential use of SGLT2-Is or GLP1-RAs in patients with established cardiovascular disease. Conclusion: Consensus has been reached for a variety of statements regarding the management of several T2D profiles. Achieving a more homogeneous management of complex patients with T2D may require further evidence and a better understanding of the key drivers for treatment choice.

[Abstract] Background: Basal insulin reduces fasting blood glucose levels, but postprandial blood glucose levels may remain higher. Traditional strategies with rapid insulin intensification can cause hypoglycemic episodes and weight gain. Glucagon-like peptide-1 receptor agonists, such as the short-acting lixisenatide, are able to control postprandial excursions, without weight gain, and with a low risk of hypoglycemic events. Objective: Due to the limited data on the combination of lixisenatide with basal insulin (with or without oral antidiabetes drugs) in clinical practice, this study evaluated changes in parameters associated with glycemic control and anthropometric data after 24 weeks of this therapy intensification. Methods: This was a multicenter, retrospective observational study of 129 patients with type 2 diabetes that was uncontrolled by basal insulin. Their treatment was intensified by the addition of lixisenatide at least 24 weeks before being included in the study. Data were retrospectively collected to determine changes in glycated hemoglobin (HbA1c) levels, blood glucose levels, weight, and body mass index. Adverse reactions and hypoglycemic events were also recorded. Results: After 24 weeks of therapy intensification with lixisenatide, a significant reduction in HbA1c levels was observed (–1.1%; P < 0.001). An HbA1c < 7% was achieved in 30.2% of patients, and 17.1% reached an HbA1c < 6.5%. There was a reduction in fasting blood glucose (31.8 [60.3] mg/dL; P < 0.001) and postprandial blood glucose (55.0 [49] mg/dL; P < 0.001) levels, as well as body weight (4.0 [5.4] kg; P < 0.001) and body mass index (1.5 [1.9]; P < 0.001). The most commonly observed adverse reactions were nausea (n = 9), in line with previous studies. Hypoglycemia events were rare; only reported in 2 patients. Conclusions: Intensification strategy based on lixisenatide added to basal insulin (with or without oral antidiabetes drugs) can be an effective treatment option in patients

[Abstract] Introduction: home enteral nutrition (HEN) has undergone an important development; however, there is a notable lack of information with regard to its incidence and characteristics. Objectives: our aim was to assess the state of HEN in our area. Methods: an observational, prospective study, involving all patients who had initiated HEN in the Nutrition Unit during a year. Epidemiological, functional, and nutritional evolution of the patients was described and incidence of HEN was calculated. Results: HEN incidences totalled 229/100,000 inhabitants/year. The HEN population in our area was characterized by the aged and a high frequency of comorbidity and functional limitations. Neurological and oncological diseases accounted for 50% of indications. The remaining cases were malnourished patients who had received short periods of HEN after hospitalization or a hip fracture. Oral supplements (60%) with standard and hypercaloric formulas were used the most. At baseline, 75% of the patients suffered from malnutrition. During the follow-up, patients showed weight gain (1.6%), an increase in the percentage of normal weight and overweight (from 74% to 82.7%, p = 0.001) and a reduction in pressure ulcers (15.7% vs 10.3%, p < 0.001). The median duration of HEN was 8.5 months. Only a quarter of the patients experienced complications (mostly mild gastrointestinal complications); 43.1% had died at the end of the follow-up. Conclusions: in our area, the HEN incidence was much higher than those described in the literature. HEN appears to be a safe therapy with few complications that improves the nutritional status of the patients, even with short periods of administration., [Resumen] Introducción: la nutrición enteral domiciliaria (NED) ha experimentado un importante desarrollo, aunque aún existe una notable carencia de información acerca de su incidencia y características. Objetivos: evaluar el estado de la NED en nuestra área. Métodos: estudio observacional y prospectivo que incluyó a todos los pacientes que iniciaron NED en el periodo de un año. Describimos su evolución epidemiológica, funcional y nutricional y calculamos la incidencia de NED. Resultados: la incidencia de NED alcanzó los 229/100.000 habitantes/año. La población con NED se caracterizó por ser añosa, con una elevada frecuencia de comorbilidad y limitación funcional. Las enfermedades neurológicas y oncológicas representaron el 50% de las indicaciones. El resto fueron pacientes malnutridos que recibieron periodos cortos de NED tras una hospitalización o fractura de cadera. Los suplementos orales con fórmulas estándar o hipercalóricas fueron los más utilizados (60%). Al inicio, el 75% de los pacientes tenía malnutrición. En el seguimiento, los pacientes lograron aumento de peso (1,6%) y mayor porcentaje de normopeso o sobrepeso (de 74% a 82,7%, p = 0,001). Las úlceras por presión se redujeron (15,7% vs. 10,3%, p < 0,001). La duración mediana de NED fue 8,5 meses. Solo una cuarta parte de los pacientes experimentaron complicaciones, la mayoría de ellas gastrointestinales y leves. El 43,1% había fallecido al final del seguimiento. Conclusiones: en nuestra área, la incidencia de NED es más elevada respecto a lo descrito en la literatura. La NED es un tratamiento seguro con pocas complicaciones que mejora el estado nutricional de los pacientes, incluso con periodos cortos de administración

[Abstract] Background: The resting metabolic rate (RMR) decrease, observed after an obesity reduction therapy is a determinant of a short-time weight regain. Thus, the objective of this study was to evaluate changes in RMR, and the associated hormonal alterations in obese patients with a very low-calorie ketogenic (VLCK)-diet induced severe body weight (BW) loss. Method: From 20 obese patients who lost 20.2 kg of BW after a 4-months VLCK-diet, blood samples and body composition analysis, determined by DXA and MF-Bioimpedance, and RMR by indirect calorimetry, were obtained on four subsequent visits: visit C-1, basal, initial fat mass (FM) and free fat mass (FFM); visit C-2, − 7.2 kg in FM, − 4. 3 kg in FFM, maximal ketosis; visit C-3, − 14.4 kg FM, − 4.5 kg FFM, low ketosis; visit C-4, − 16.5 kg FM, − 3.8 kg FFM, no ketosis. Each subject acted as his own control. Results: Despite the large BW reduction, measured RMR varied from basal visit C-1 to visit C-2, − 1.0%; visit C-3, − 2.4% and visit C-4, − 8.0%, without statistical significance. No metabolic adaptation was observed. The absent reduction in RMR was not due to increased sympathetic tone, as thyroid hormones, catecholamines, and leptin were reduced at any visit from baseline. Under regression analysis FFM, adjusted by levels of ketonic bodies, was the only predictor of the RMR changes (R2 = 0.36; p < 0.001). Conclusion: The rapid and sustained weight and FM loss induced by VLCK-diet in obese subjects did not induce the expected reduction in RMR, probably due to the preservation of lean mass.

[Resumen] Introducción: Un programa de intervención educativa grupal sobre modificación de la dieta y modificación de patrones hacia hábitos de estilo de vida saludable, tiene efectos positivos en adultos con obesidad y aporta mejores resultados que los obtenidos mediante el tratamiento habitual llevado a cabo en la consulta médica, siendo la pérdida de peso mayor y sostenida en el tiempo, así como objetivándose unos cambios de hábitos mantenidos en el tiempo. Objetivo: Desarrollar y evaluar la efectividad de un programa de intervención educativa grupal de estilo de vida saludable en adultos con obesidad. Material y métodos: Se analizaron los datos en momento pre-intervención y post-intervención (al año) de los sujetos que participan en el “Programa IGOBE”. La muestra fue de 437 pacientes, 81 (18.5%) hombres y 356 (81.5%) mujeres, con edades comprendidas entre los 18 y los 77 años, edad media de 48.78 ± 12.89 años y IMC medio de 40.39 ± 6.74 kg/m2. Los sujetos fueron aleatorizados en 2 grupos, Grupo Control, con práctica clínica habitual y Grupo Intervención, en el que los pacientes participan en un programa de intervención grupal sobre hábitos de vida saludable con sesiones semanales durante 6 semanas tras la que se vuelve a hacer una reevaluación a los 6 meses y un seguimiento al año. Se realiza un análisis estadísticos de los datos disponibles con SPSS ® versión 20. Resultados: Partiendo de dos muestras iguales, aplicando en el grupo intervención un programa educativo grupal, el programa IGOBE objetiva una pérdida de peso media de 8.08 kg, 7.54% del peso inicial, mientras que en el grupo control, siguiendo el tratamiento habitual, se objetiva una ganancia de peso de 2.92 kg, 2.7% del peso inicial. Produciéndose además un cambio de hábitos estadísticamente significativo a favor del grupo de intervención. Conclusiones: El tratamiento intensivo grupal, proporciona mejores resultados en pérdida de peso, IMC, cintura, kg de grasa corporal, % grasa y grasa visceral, as, [Resumo] Introdución: Un programa de intervención educativa grupal sobre modificación da dieta e modificación de patróns cara a hábitos de estilo de vida saudable, ten efectos positivos en adultos con obesidad e aporta mellores resultados que os obtidos mediante o tratamento habitual levado a cabo na consulta médica, sendo a perda de peso maior e sostida no tempo, así como objetivándose uns cambios de hábitos mantidos no tempo. Obxectivo: Desenvolver e evaluar a efectividad dun programa de intervención educativa grupal de estilo de vida saudable en adultos con obesidad. Material e métodos: Analizáronse os datos en momento pre-intervención e post-intervención (ao ano) dos suxeitos que participan no “Programa IGOBE”. A mostra foi de 437 pacientes, 81 (18.5%) homes e 356 (81.5%) mulleres, con idades comprendidas entre os 18 e os 77 anos, idade media de 48.78 ± 12.89 anos e IMC medio de 40.39 ± 6.74 kg/m2. Os suxeitos foron aleatorizados en 2 grupos, Grupo Control, con práctica clínica habitual e Grupo Intervención, no que os pacientes participan nun programa de intervención grupal sobre hábitos de vida saudable con sesións semanales durante 6 semanas trala que se volve a facer unha reevaluación aos 6 meses e un seguimiento ao ano. Realízase unha análises estatísticas dos datos dispoñibles con SPSS ® versión 20. Resultados: Partindo de dúas mostras iguais, aplicando no grupo intervención un programa educativo grupal, o programa IGOBE obxectiva unha perda de peso media de 8.08 kg, 7.54% do peso inicial, mentres que no grupo control, seguindo o tratamento habitual, se obxectiva unha ganancia de peso de 2.92 kg, 2.7% do peso inicial. Producíndose ademais un cambio de hábitos estadísticamente significativo a favor do grupo de intervención. Conclusións: O tratamento intensivo grupal, proporciona mellores resultados en perda de peso, IMC, cintura, kg de graxa corporal, % graxa e graxa visceral, así como no cambio de hábitos e na adherencia á dieta mediterránea, que o realizad, [Abstract] Introduction: A program of educative intervention grupal on modification of the diet and modification of patterns to frocks of style of life saludable, has positive effects in adults with obesity and aporta better results that the obtained by means of the usual treatment carried out in the medical query, being the loss of main weight and sustained in the time, like this as objetivándose some changes of frocks maintained in the time. Aim: Develop and evaluate the effectiveness of a program of educative intervention grupal of style of life saludable in adults with obesity. Material and methods: they analysed the data in moment pre-intervention and post-intervention (to the year) of the subjects that take part in the “Program IGOBE”. The sample was of 437 patient, 81 (18.5%) men and 356 (81.5%) women, with ages comprised between the 18 and the 77 years, half age of 48.78 ± 12.89 years and half IMC of 40.39 ± 6.74 kg/m2. The subjects were aleatorizados in 2 groups, Group Control, with usual clinical practice and Group Intervention, in which the patients take part in a program of intervention grupal on frocks of life saludable with weekly sessions during 6 weeks after which go back to do a reevaluación to the 6 months and a follow-up to the year. It realizes a statistical analysis of the available data with SPSS ® version 20. Results: Splitting of two equal samples, applying in the group intervention an educative program grupal, the program IGOBE objective a loss of weight takes part of 8.08 kg, 7.54% of the initial weight, whereas in the group control, following the usual treatment, objective a gain of weight of 2.92 kg, 2.7% of the initial weight. Producing besides a change of frocks estadísticamente significant in favor of the group of intervention. Conclusions: The intensive treatment grupal, provides better results in loss of weight, IMC, waist, kg of corporal fat, % fat and fat visceral, like this as in the change of frocks and in the adherencia to the M