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The objective of our study is to determine the prevalence of malnutrition in elderly patients with fragility hip fractures through different diagnostic tools and to determine which nutritional assessment tool better predicts mortality. Methods: This is a prospective study in patients over 65 years of age hospitalized with a diagnosis of hip fracture. A nutritional assessment was performed using several tools: the Mini Nutritional Assessment Short Form (MNA-SF), the Subjective Global Assessment (SGA), and the GLIM criteria. For the definition of low muscle mass, four different methods were used: hand grip strength (HGS), calf circumference (CC), anthropometry, and bioelectrical impedance (BIA). Mortality was registered at three, six and twelve months. Results: 300 patients were included, 79.3% female, mean age 82.9 ± 7.1 years. The MNA-SF found 42% at risk of malnutrition, and 37.3% malnourished. Using SGA, there were 44% with moderate malnutrition, and 21.7% with severe malnutrition. In application of the GLIM criteria, 84.3%, 47%, 46%, and 72.7% of patients were malnourished when HGS, anthropometry, BIA, and CC were used, respectively. Mortality was 10%, 16.3% and 22% at 3, 6 and 12 months, respectively. In malnourished patients according to MNA-SF, mortality was 5.7 times greater [95%CI 1.3–25.4; p = 0.022] at 6 months and 3.8 times greater [95%CI 1.3–11.6; p = 0.018] at 12 months. In malnourished patients according to SGA, mortality was 3.6 times greater [95%CI 1.02–13.04; p = 0.047] at 3 months, 3.4 times greater [95%CI 1.3–8.6; p = 0.012] at 6 months and 3 times greater [95%CI 1.35–6.7; p = 0.007] at 12 months. Conclusion: The prevalence of malnutrition in patients admitted for fragility hip fracture is high. The SGA and MNA-SF are postulated as adequate tools to diagnose malnutrition in these patients, with predictive value for mortality at three, six, and twelve months.

Background: Muscle ultrasonography of the quadriceps rectus femoris (QRF) is a technique on the rise in the assessment of muscle mass in application of nutritional assessment. The aim of the present study is to assess the usefulness of muscle ultrasonography in patients with cystic fibrosis, comparing the results with other body composition techniques such as anthropometry, bioelectrical impedance analysis (BIA), dual-energy X-ray absorptiometry (DXA), and handgrip strength (HGS). At the same time, we intend to assess the possible association with the nutritional and respiratory status. Methods: This was a prospective observational study in adult patients with cystic fibrosis in a clinically stable situation. Muscle ultrasonography of the QRF was performed, and the results were compared with other measures of body composition: anthropometry, BIA, and DXA. HGS was used to assess muscle function. Respiratory parameters were collected, and nutritional status was assessed using Global Leadership Initiative on Malnutrition (GLIM) criteria. Results: A total of 48 patients were included, with a mean age of 34.1 ± 8.8 years. In total, 24 patients were men, and 24 patients were women. Mean BMI was 22.5 ± 3.8 kg/m2. Mean muscular area rectus anterior (MARA) was 4.09 ± 1.5 cm2, and mean muscular circumference rectus was 8.86 ± 1.61 cm. A positive correlation was observed between the MARA and fat-free mass index (FFMI) determined by anthropometry (r = 0.747; p < 0.001), BIA (r = 0.780; p < 0.001), and DXA (r = 0.678; p < 0.001), as well as muscle function (HGS: r = 0.790; p < 0.001) and respiratory parameters (FEV1; r = 0.445, p = 0.005; FVC: r = 0.376, p = 0.02; FEV1/FVC: r = 0.344, p = 0.037). A total of 25 patients (52.1%) were diagnosed with malnutrition according to GLIM criteria. Differences were observed when comparing the MARA based on the diagnosis of malnutrition (4.75 ± 1.65 cm2 in normo-nourished vs. 3.37 ± 1.04 in malnourished; p = 0.014). Conclusions: In adults with cystic fibrosis, the measurements collected by muscle ultrasound of the QRF correlate adequately with body composition techniques such as anthropometry, BIA, DXA, and handgrip strength. Muscle ultrasound measurements, particularly the MARA, are related to the nutritional status and respiratory function of these patients.

Background There are no previous studies aimed at assessing the validity of the screening scales for depression and anxiety in adult patients with bronchiectasis. Aims To analyze the psychometric properties of Hospital Anxiety and Depression Scale (HADS), Beck Depression Inventory (BDI) and Hamilton Anxiety Scale and to evaluate the concordance for the diagnosis of depression and anxiety between these screening scales and the structured clinical interview in adult patients with bronchiectasis. Method Cross sectional study. 52 patients with bronchiectasis completed HADS, BDI and Hamilton Anxiety Scale; afterwards, were individually interviewed by a mental health care professional using the structured Mini International Neuropsychiatric Interview (MINI), which evaluates for depression and anxiety according to DSM-IV criteria. Results Based on MINI, 18 subjects (34.6%) had a diagnosis of depression and 25 (48.1%) had anxiety. Optimal cut-off values to detect depression were ≥9 for the HADS-D (sensitivity 0.833, specificity 0.971, AUC 0.962 [95% CI 0.918–1]), and 17 for BDI (sensitivity 0.889, specificity 0.912, AUC 0.978 [95% CI 0.945–1]). Optimal cut-off values to detect anxiety were ≥4 for the HADS-A (sensitivity 0.960, specificity 0.593, AUC 0.833 [95% CI 0.723–0.943]), and 17 for Hamilton Anxiety Scale (sensitivity 0.800, specificity 0.852, AUC 0.876 [95% CI 0.781–0.970]). Conclusion The self-rating screening scales HADS, BDI and Hamilton Anxiety Scale are reliable tools to screen for depression and anxiety in adult patients with bronchiectasis. However, the use of specific cut-off values may improve the diagnostic accuracy of the previous scales in this specific group of patients.

Introduction: Poor physical performance has been shown to be a good predictor of complications in some pathologies. The objective of our study was to evaluate, in patients with colorectal neoplasia prior to surgery, physical performance and its relationship with postoperative complications and in-hospital mortality, at 1 month and at 6 months. Methods: We conducted a prospective study on patients with preoperative colorectal neoplasia, between October 2018 and July 2021. Physical performance was evaluated using the Short Physical Performance Battery (SPPB) test and hand grip strength (HGS). For a decrease in physical performance, SPPB < 10 points or HGS below the EWGSOP2 cut-off points was considered. Nutritional status was evaluated using subjective global assessment (SGA). The prevalence of postoperative complications and mortality during admission, at 1 month, and at 6 months was evaluated. Results: A total of 296 patients, mean age 60.4 ± 12.8 years, 59.3% male, were evaluated. The mean BMI was 27.6 ± 5.1 kg/m2. The mean total SPPB score was 10.57 ± 2.07 points. A total of 69 patients presented a low SPPB score (23.3%). Hand grip strength showed a mean value of 33.1 ± 8.5 kg/m2 for men and 20.7 ± 4.3 kg/m2 for women. A total of 58 patients presented low HGS (19.6%). SGA found 40.2% (119) of patients with normal nourishment, 32.4% (96) with moderate malnutrition, and 27.4% (81) with severe malnutrition. Postoperative complications were more frequent in patients with a low SPPB score (60.3% vs. 38.6%; p = 0.002) and low HGS (64.9% vs. 39.3%, p = 0.001). A low SPPB test score (OR 2.57, 95% CI 1.37–4.79, p = 0.003) and low HGS (OR 2.69, 95% CI 1.37–5.29, p = 0.004) were associated with a higher risk of postoperative complications after adjusting for tumor stage and age. Patients with a low SPPB score presented an increase in in-hospital mortality (8.7% vs. 0.9%; p = 0.021), at 1 month (8.7% vs. 1.3%; p = 0.002) and at 6 months (13.1% vs. 2.2%, p < 0.001). Patients with low HGS presented an increase in mortality at 6 months (10.5% vs. 3.3%; p = 0.022). Conclusions: The decrease in physical performance, evaluated by the SPPB test or hand grip strength, was elevated in patients with colorectal cancer prior to surgery and was related to an increase in postoperative complications and mortality.

Background: Anxiety and depression are common in patients with cancer. The aim of this study is to determine the prevalence of anxiety and depression symptoms in colorectal cancer (CRC) patients awaiting elective surgery and whether there is an association with their preoperative nutritional status and postoperative mortality. Methods: A prospective study was conducted on 215 patients with CRC proposed for surgery. Data about nutritional status were collected using the Global Leadership Initiative on Malnutrition (GLIM) criteria, while anxiety and depression symptoms data were collected using Hospital Anxiety and Depression Scale (HADS). Results: HADS detected possible anxiety in 41.9% of patients, probable anxiety in 25.6%, possible depression in 21.9%, and probable depression in 7.9%. GLIM criteria found 116 (53.9%) patients with malnutrition. The HADS score for depression subscale was significantly higher in malnourished patients than in well-nourished (5.61 ± 3.65 vs. 3.95 ± 2.68; p = 0.001). After controlling for potential confounders, malnourished patients were 10.19 times more likely to present probable depression (95% CI 1.13–92.24; p = 0.039). Mortality was 1.9%, 4,2%, and 5.6% during admission and after 6 and 12 months, respectively. Compared to patients without depressive symptomatology, in patients with probable depression, mortality risk was 14.67 times greater (95% CI 1.54–140.21; p = 0.02) during admission and 6.62 times greater (95% CI 1.34–32.61; p = 0.02) after 6 months. Conclusions: The presence of anxiety and depression symptoms in CRC patients awaiting elective surgery is high. There is an association between depression symptoms, preoperative nutritional status, and postoperative mortality.

Introduction: few studies have evaluated body composition (BC) through different techniques, and the degree of agreement between them in adults with cystic fibrosis (CF). Objectives: to describe BC using techniques to assess nutritional status and to test their concordance in CF. Methods: a cross-sectional study in CF patients in a clinically stable situation. Nutritional assessment was performed using skinfold measurement (SM) and densitometry (DXA). Fat-free mass index (FFMI) was also determined. The diagnosis of malnutrition was established if body mass index (BMI)18.5 kg/m2. Fat-free mass (FFM) malnutrition was diagnosed when FFMI was17 kg/m2 in males and15 kg/m2 in females (FFMI: fat-free mass in kg/height in m2). Results: forty-one patients were studied (twenty-two females, 53.7 %); median age was 29.8 (interquartile range, 20.9-33.7); BMI was 21.6 (19.8-23.0). Only four (9.8 %) patients had a BMI18.5. By DXA, FFM (kg) results were: median, 52.8 (47.8-56.9) with FFMI of 17.9 (16.7-19.3) in males and 36.7 (33.1-38.9) in females, FFMI of 14.7 (14.2-15.8). Twenty (48.6 %) patients presented FFM malnutrition, with 16.7 % of males and 59.1 % of females being affected. By SM, the FFMI was 18.7 (17.2-20.0) in males and 14.9 (14.2-15.8) in females; moreover, sixteen (39.1 %) patients presented malnutrition of FFM, with 20.8 % of males and 61.8 % of females being affected. For FFM (kg), a high concordance was obtained between SM and DXA (intraclass correlation coefficient of 0.950); likewise when they were compared by applying the ESPEN criteria for FFM malnutrition. However, when the techniques were compared to classify malnutrition according to FFMI, the kappa coefficient was only moderate (k = 0.440). The mean difference between FFM by DXA and SM was +1.44 ± 0.62 kg in favor of SM, with greater dispersion as FFM increased. Conclusions: the prevalence of FFM malnutrition is high in adult CF patients, despite a normal BMI, especially in females. Notwithstanding the good statistical agreement between SM and DXA, concordance was moderate. Therefore, DXA remains the technique of choice, and SM may be used when the former is not available.Introducción: pocos estudios han evaluado la composición corporal (BC) mediante diferentes técnicas y el grado de concordancia entre ellas en adultos con fibrosis quística (FQ). Objetivos: describir la BC mediante técnicas de evaluación nutricional y comprobar su concordancia en la FQ. Métodos: estudio transversal de adultos con FQ en situación de estabilidad clínica. La evaluación nutricional se realizó mediante medición de pliegues cutáneos (SM) y densitometría (DXA). También se determinó el índice de masa libre de grasa (FFMI). El diagnóstico de desnutrición se estableció si el índice de masa corporal era18,5 kg/m2. Se diagnosticó desnutrición por masa libre de grasa (FFM) cuando el FFMI era17 kg/m2 en 4 hombres y15 kg/m2 en mujeres (FFMI: masa libre de grasa en kg/estatura en m2). Resultados: se estudiaron 41 pacientes (22 mujeres (53,7 %), con una edad media de 29,8 años (rango intercuartílico, 20,9-33,7) e IMC de 21,6 (19,8-23,0). Solo 4 (9,8 %) pacientes tenían un IMC18,5. Mediante DXA, los resultados de FFM (kg) fueron (mediana y RIC): 52,8 (47,8-56,9) con FFMI de 17,9 (16,7-19,3) en los varones y 36,7 (33,1-38,9) en las mujeres con FFMI de 14,7 (14,2-15,8). Veinte (48,6 %) pacientes presentaban desnutrición del FFM, con el 16,7 % de varones y el 59,1 % de mujeres afectados. Mediante el SM, el FFMI fue de 18,7 (17,2-20,0) en los varones y de 14,9 (14,2-15,8) en las mujeres. En el caso de la FFM (kg), se obtuvo una alta concordancia entre el SM y la DXA (coeficiente de correlación intraclase de 0,950); igualmente cuando se compararon las técnicas aplicando los criterios ESPEN para la desnutrición de la FFM. Sin embargo, cuando se compararon las técnicas para clasificar la malnutrición según el FFMI, el coeficiente kappa fue solo moderado (coeficiente kappa = 0,440). La diferencia media entre el FFM por DXA y el SM fue de +1,44 ± 0,62 kg a favor del SM, con mayor dispersión a medida que aumenta el FFM. Conclusiones: la prevalencia de la malnutrición por FFM es elevada en pacientes adultos con FQ, a pesar de presentar un IMC normal, especialmente en el caso de las mujeres. A pesar de existir una buena correlación estadística entre el SM y la DXA, la concordancia fue moderada. Por lo tanto, la DXA sigue siendo la técnica de elección y el SM puede ser una alternativa cuando la DXA no esté disponible.

Background In individuals with bronchiectasis, fat-free mass depletion may be common despite a low prevalence of underweight and is considered a risk factor for increased morbidity and mortality. Techniques to adequately estimate fat-free mass and its changes over time are needed. Objective The purpose of this study was to assess agreement among values obtained with three different body composition techniques: skinfold thickness measurement (STM), bioelectrical impedance analysis (BIA), and dual-energy x-ray absorptiometry (DXA). Design The study was a secondary analysis of data from a randomized controlled trial. Participants/setting A respiratory rehabilitation program was administered for 3 months to individuals with bronchiectasis from the bronchiectasis unit of the Regional University Hospital in Malaga, Spain, from September 2013 to September 2014. Individuals with a body mass index (calculated as kg/m 2 ) >18.5 who were aged 65 years or younger and those with a body mass index >20 who were older than 65 years were included. Main outcome measures At baseline and at 3 and 6 months, body composition was determined by DXA and STM. Statistical analyses performed Statistical concordance was assessed with the intraclass correlation coefficient (ICC), kappa coefficient, and the degree of agreement using the Bland Altman method. For comparison of the quantitative variables at baseline vs at 3 months and 6 months, the paired sample t test (or the Wilcoxon test) was used. Results Thirty participants were included. Strong agreement was observed between body composition values determined by BIA and DXA in fat mass (ICC: 0.92) and fat-free mass (ICC: 0.87). Strong agreement was observed between STM and DXA in the values for fat-free mass (ICC: 0.91) and fat mass (ICC: 0.94), and lower agreement was observed for the longitudinal data and in the regional values. The mean difference between fat-free mass determined by BIA and DXA was + 4.7 with a standard deviation of 2.4 kg in favor of BIA. The mean difference between fat-free mass determined by STM and DXA was +2.3 with a standard deviation of 2.7 kg in favor of STM. Six individuals were classified as having a low fat-free mass index (20%) by DXA vs four by STM (13%; kappa: 0.76) and only two by BIA (6.6%; kappa: 0.44) compared with DXA. Conclusions Despite good statistical agreement among values obtained with DXA, STM, and BIA, the study findings indicate that STM and BIA, above all, tended to overestimate fat-free mass compared with DXA.

Background: Loss of fat-free mass (FFM) is associated with an increase in morbidity and mortality in cystic fibrosis (CF) patients. Handgrip strength (HGS) measures muscle function and may be associated with clinical parameters with prognostic value. Our objectives were to evaluate muscle strength through HGS in CF patients and to determine if there are any associations with respiratory clinical variables, FFM, and bone mineral density (BMD). Methods: A cross-sectional study conducted in clinically stable patients. We evaluated muscle function through HGS, respiratory function—forced expiratory volume in 1 s (FEV1) (%), forced vital capacity (FVC) (%), bronchorrhea, annual exacerbations, and body composition (FFM and FFM index, FFMI: fat-free mass in kg/height in m2) and Bone Mineral Density (BMD) through densitometry (DXA). Results: The study included 53 CF patients (58.5% females, mean age 28.3 ± 8.1, body mass index (BMI) 21.7 ± 3.4). The mean values for dynamometry were 40.2 ± 8.1 kg in males and 23.1 ± 7.0 kg in women, being 20.8% below the 10th percentile. Patients with lower muscle strength showed significantly more exacerbations and lower FEV1% and FVC%, as well as lower BMI, worse BMD (g/cm2), T-score, and Z-score. A significant and positive correlation was found between the mean and maximum dynamometry values and age, FVC%, BMI, FFMI, FFM (kg), and BMD. Conclusions: For adults with CF, HGS is a practical tool for assessment of health status. Low values reflect poor nutritional status and are associated with poor respiratory function, low fat-free mass and low bone mineral density.

In addition to their antibiotic effect, macrolides appear to modulate the inflammatory response in cystic fibrosis (CF) and could influence oxidative stress. The objective of this study was to assess oxidation biomarkers and levels of inflammation and to determine whether there is an association between these parameters and the intake of macrolides.The subjects included in this cross-sectional study were, on the one hand, clinically stable patients with CF and, on the other, healthy controls. The following serum and plasma inflammatory and oxidative stress biomarkers were measured: interleukin-6 (IL-6), reactive C protein (RCP), tumor necrosis alpha (TNF-α), glutathione peroxidase (GPx), total antioxidant capacity (TAC), catalase (CAT), and superoxide dismutase (SOD), together with markers of lipid peroxidation (8-isoprostanes and thiobarbituric acid reactive substances [TBARS]). Clinical, anthropometric, lung function, radiological, and analytical variables (albumin, prealbumin, vitamins, and zinc) were also recorded.We studied 36 adults with CF and 41 controls. No differences were observed in age, gender, or anthropometric variables. The patients had significantly higher levels of IL-6, TNF-α, RCP, TBARS, and isoprostanes, and lower levels of SOD than the controls. Twenty-three of the patients were treated with azithromycin, and they had more severe clinical and radiological parameters than those who were not but nevertheless presented significantly lower levels of TNF-α. No differences were observed in the markers of oxidation.Inflammation and oxidation biomarkers were increased in patients with CF compared with controls. The use of azithromycin was associated with reduced TNF-α levels and did not influence oxidation parameters.Makrolitlerin, antibiyotik etkilerine ek olarak, kistik fibrolizlerde (KF) enflamatuvar yanıtı değiştirdikleri görülmektedir ve oksidatif stresi etkileyebilirler. Bu çalışmanın amacı enflamasyon düzeylerini ve oksidasyon biyobelirteçlerini değerlendirmek ve bu parametreler ile makrolit alımı arasında bir ilişki olup olmadığını belirlemektir.Bu kesitsel çalışmaya klinik olarak stabil kistik fibrozis (KF) hastaları ve sağlıklı controller dahil edildi. Şu serum ve plazma enflamatuvar ve oksidatif stres biyobelirteçleri ölçüldü: Lipid peroksidasyon belirteçleri (8-isoprostanler ve TBARs) ile birlikte, interlökin-6 (IL6), C-reaktif protein (CRP), tümör nekroz factor alfa (TNF-α), glutatyon peroksidaz (GPx), total antioksidan kapasite (TAC), katalaz (CAT) ve süperoksit dismutaz (SOD). Aynı zamanda klinik, antropometrik, akciğer fonksiyonu, radyolojik ve analitik değişkenler de (albümin, prealbümin, vitaminler ve çinko) kaydedildi.Otuz altı yetişkin KF hastası ve kırk bir kontrol grubu hastası ile çalışma yapıldı. Yaş, cinsiyet ve de antropometrik değişkenler açısından farklılık gözlenmedi. Kontrollerle kıyaslandığında, KF hastalarında IL-6, TNF-α, RCP, TBARS ve izoprostan düzeyleri önemli ölçüde daha yüksekti ve SOD düzeyleri daha düşüktü. Hastaların 23’üne azitromisin tedavisi verildi ve bu tedaviyi almayan hastalara göre daha ağır klinik ve radyolojik parametreler sergilediler, ancak TNF-α düzeyleri anlamlı ölçüde daha düşüktü. Oksidasyon belirteçlerinde farklılık gözlenmedi.Enflamasyon ve oksidasyon biyobelirteçleri KF hastalarında kontrollere göre yüksekti. Azitromisin kullanımı düşük TNF-α düzeyleri ile ilişkili bulundu ve oksidasyon parametrelerini etkilemedi.

Background: systemic inflammation and oxidative stress are important factors in the pathogenesis of bronchiectasis. Pulmonary rehabilitation (PR) is recommended for bronchiectasis, but there is no data about its effect on the inflammatory and REDOX status of these patients. Aims: to investigate the effect of PR in non-cystic-fibrosis bronchiectasis (NCFB) patients, and to compare it with the effect of PR plus a hyperproteic oral nutritional supplement (PRS) enriched with beta-hydroxy-beta-methylbutyrate (HMB) on serum inflammatory and oxidative biomarkers. Materials and methods: this was an open randomized, controlled trial. Thirty individuals (65 years old or younger with a body mass index over 18.5, older than 65 years with a body mass index over 20) were recruited from September 2013 to September 2014, and randomly assigned to receive PR or PRS. Total neutrophils, and inflammatory and oxidative biomarker levels were measured at baseline, and then at 3 and 6 months. Results: in the PRS group neutrophil levels were decreased from baseline at 6 months. A significantly different fold change was found between the PR and PRS groups. In the PR group, IL-6 and adiponectin were increased by the end of the study while TNFα levels were decreased from baseline at 6 months. REDOX biomarkers remained stable throughout the study except for 8-isoprostane levels, which were increased from baseline at 6 months in both groups of patients. Conclusion: a PR program induced a pro-oxidative effect accompanied by changes in circulating inflammatory cytokine levels in NCFB patients. Our results would also suggest a possible beneficial effect of the HMB enriched supplement on neutrophil level regulation in these patients. The information provided in this study could be useful for choosing the right therapeutic approach in the management of bronchiectasis. Yes Introducción: la inflamación sistémica y el estrés oxidativo son factores importantes en la patogénesis de la bronquiectasia. La rehabilitación pulmonar (PR) está recomendada en los sujetos con bronquiectasias, pero no hay datos sobre sus posibles efectos sobre el estado inflamatorio y REDOX de estos pacientes. Objetivos: investigar el efecto de la PR en pacientes con bronquiectasias no asociadas a fibrosis quística (NCFB) sobre los biomarcadores oxidativos e inflamatorios, y compararlo con los efectos de la PR junto con la suplementación oral de un suplemento hiperproteico (PRS) enriquecido con beta-hidroxi-beta-metilbutirato (HMB). Material y métodos: ensayo clínico abierto, aleatorizado y controlado. Treinta pacientes (de 65 años o menos con un índice de masa corporal por encima de 18,5, y mayores de 65 años con un índice de masa corporal de más de 20) se aleatorizaron para recibir PR o PRS. Los niveles circulantes de neutrófilos totales y los de biomarcadores de estado inflamatorio y oxidativo se determinaron al inicio del estudio y a los 3 y 6 meses. Resultados: los niveles de neutrófilos en el grupo de PRS se redujeron desde el inicio a los 6 meses, presentando una tasa de cambio significativamente diferente según el tratamiento. En el grupo de PR, la IL-6 y la adiponectina aumentaron al final del estudio, mientras que los niveles de TNFα disminuyeron desde el inicio a los 6 meses. Los biomarcadores de estrés oxidativo se mantuvieron estables durante todo el estudio excepto por los niveles de 8-isoprostano, que aumentaron desde el inicio a los 6 meses en ambos grupos de pacientes. Conclusión: el programa de PR indujo un efecto pro-oxidativo acompañado de cambios en los niveles de citoquinas inflamatorias circulantes en pacientes con NCFB. Nuestros resultados también sugieren un posible efecto beneficioso del suplemento nutricional sobre la regulación de los niveles de neutrófilos de estos pacientes.

Summary Background & aims Pulmonary Rehabilitation (PR) is recommended for bronchiectasis but there is no data about its effect on body composition. The aim of this study is to assess the effect of Pulmonary Rehabilitation (PR) for 12 weeks in normally-nourished non-cystic-fibrosis bronchiectasis patients compared with the effect of PR plus a hyperproteic oral nutritional supplement enriched with beta-hydroxy-beta-methylbutyrate (HMB) on body composition, muscle strength, quality of life and serum biomarkers. Methods single center randomized controlled trial, parallel treatment design: Participants were randomly assigned to receive PR for 12 weeks or PR plus ONS (PRONS) (one can per day). Outcome assessments were performed at baseline, 12 weeks and 24 weeks: body composition (Dual-energy X-Ray Absorptiometry (DEXA), mid-arm muscle circumference (MAMC), phase angle by Bio-impedance), health related quality of life (Spanish QOL-B-V3.0, Physical Functioning Scale), handgrip strength, diet questionnaire, and plasma levels of prealbumin, myostatin and somatomedin-c. Results Thirty patients were randomized (15 per group) without differences in clinical and respiratory variables. In the PRONS group bone mineral density (BMD), mean and maximum handgrip dynamometry, MAMC, QOLB and prealbumin were significantly increased from baseline at 12 and 24 weeks and Fat free Mass (FFM) and FFM index, at 12 weeks. In the PR group only mean handgrip dynamometry and prealbumin were significantly increased at 12 and 24 weeks. In both groups plasma myostatin was reduced at 12 weeks (without significant differences). Conclusion The addition of a hyperproteic ONS enriched with HMB to Pulmonary Rehabilitation could improve body composition, BMD, muscle strength and health related quality of life in bronchiectasis patients. Clinical Trials Number NCT02048397 .

The relationship between the perception of the resident community as far as the effects of tourism and their quality of life is a subject that has recently sparked the interest of researchers. As currently there is no uniformity in either the approach adopted for measuring variables or the significance of their inter-relationships, our study will aim to contribute to the topic by introducing a series of new factors, among which we can highlight the methodology employed, the means of assessing quality of life on the basis of community satisfaction, the disaggregation of the effects of tourism according to typology and the nature of the relationship established between the two variables. Among the results obtained, and in contrast to those obtained from previous studies, the current research reveals that it is not possible to establish a unique relationship between community satisfaction and the effects of tourism as the satisfaction aspect studied as well as the nature and sign (positive or negative) of the effects taken into account condition both the nature and intensity of the relationship established between the two variables.

Purpose Pulmonary rehabilitation (PR) is recommended for bronchiectasis, but there is little evidence of its efficacy in these patients. The aim of this study was to assess the effect of PR in normally nourished patients with noncystic fibrosis bronchiectasis compared with the effect of PR plus an oral nutritional supplement (PRONS). Methods A single-center randomized controlled trial, parallel treatment design in which participants were randomly assigned to receive PR for 12 wk or PR plus a high-protein nutritional supplement enriched with beta-hydroxy-beta-methylbutyrate. Outcome assessments were performed at baseline, 12 and 24 wk including cardiopulmonary exercise testing, health-related quality of life (HRQOL), bronchorrhea, dyspnea, psychological symptoms, spirometry, and exacerbations. Results Thirty patients were randomized into 2 groups of 15 participants. In both groups, cardiopulmonary exercise testing, HRQOL, dyspnea, and spirometry parameters significantly increased from baseline at 3 and/or 6 mo. Conclusion PR improved exercise capacity, HRQOL, and respiratory parameters. The use of PRONS did not have a significant effect on the results.

Background and objectives: The objective of this study was to establish reference values for hand grip strength, compare the results obtained with Collin and Jamar type dynamometers and determine their association with anthropometric and lean mass measurements. Material and methods: This cross-sectional population-based study was undertaken in Pizarra (Málaga, Spain). The grip strength of the dominant hand was measured using Collin and Jamar dynamometers. Skinfolds (triceps, abdominal, biceps of dominant arm and subscapular) were measured, and body composition was estimated. Eight hundred seventeen adults randomly selected from the census were recruited. Dynamometry reference values are presented for the dominant hand, by gender and age groups. Results: No determinations could be made with the Collin dynamometer in 69 women due to the difficulty in grasping the dynamometer. We found significant positive correlations between the measurements with Jamar and Collin dynamometers (r = 0.782; p < 0.001) and between grip strength and lean mass index (LMI), determined by both dynamometers (r = 0.538, p < 0.001 and r = 0.462, p < 0.001, respectively). Malnourished patients according to LMI had significantly lower grip strength than normally nourished patients (p < 0.001 for Jamar; p < 0.02 for Collin). Conclusions: Dynamometry reference values in the Spanish population are presented. We recommend the use of the Jamar type dynamometer versus the Collin type dynamometer. Hand grip dynamometry is associated with lean mass, which confirms its usefulness in nutritional assessment.

In this study several extrinsic and intrinsic variables, from different theoretical approaches, have been integrated with the object of building an explanatory model for residents’ attitude toward tourism development. This model is applied to a destination not yet overcrowded but with a high, and increasing, seasonality. Its most notable contribution is in its findings regarding the influence of seasonality on the residents’ attitudes and in the factors impacting on it. These findings show that, in the low season, the effects of tourism, and tourists themselves, are perceived more favorably, leading to a more positive attitude toward further tourism development. Two hypotheses in the proposed model reveal a disparate seasonal behavior: only in the high season does the perception of the level of tourism development determine the net perception of the effects of tourism, and residents’ community attachment exerts a direct and negative influence on their attitude toward tourism.

Fat-free mass depletion has been related to increased inflammatory activity and to increased morbidity and mortality in chronic respiratory diseases. The aims of our study were to determine the nutritional status and serum levels of adipocytokines and inflammatory cytokines in patients with bronchiectasis of any etiology and their relation with respiratory parameters. A cross-sectional study was designed that included patients aged >14 years with diagnostic criteria for bronchiectasis. Anthropometric parameters; a diet questionnaire; hand grip dynamometry; levels of leptin, adiponectin, interleukin-6 (IL-6), tumor necrosis factor-α, and ultrasensitive C-reactive protein; as well as respiratory parameters (ie, clinical, radiologic, and spirometric values) were assessed. Ninety-three clinically stable patients were recruited, 43 with cystic fibrosis, 31 with noncystic fibrosis bronchiectasis, and 19 with cystic fibrosis transmembrane conductance regulator-related bronchiectasis. Fat-free mass depletion was present in 31% of patients, with no differences according to the etiology of the bronchiectasis. Correlations were found between inflammatory cytokines (ie, IL-6) and exacerbations, bronchorrea, forced expiratory volume in 1 second, and Bhalla score. Patients with worse respiratory disease severity, malnutrition, and diabetes had significantly higher levels of IL-6. Adiponectin correlated significantly and positively with fat mass and fat mass index and negatively with fat-free mass, fat-free mass index, and hand dynamometry. Leptin correlated positively with body mass index, fat mass and fat mass index, and negatively with fat-free mass, fat-free mass index, and dynamometry. Patients with bronchiectasis present a high percentage of fat-free mass depletion, independent of the etiology of the disease. The levels of inflammatory cytokines (especially IL-6) may be useful markers of disease severity. Adiponectin levels were higher in patients with fat-free mass depletion.

ObjectiveChanges in eating habits may be influential in the ever-increasing rate of childhood obesity. Our aim was to determine whether those children who consume olive oil have a lower risk of weight gain compared with children who consume other oils.Design and methodsThe study included 18 girls and 74 boys, all aged 13–166 months. A survey was completed for each subject about eating habits and physical activity. A sample of subcutaneous adipose tissue was also obtained for cellular study. Data were recorded on the mean size of the adipocytes, the number of preadipocytes, and the concentration of particular fatty acids. The weight and height of the children were measured 13 months later.ResultsThe likelihood that after 1 year the children would have increased their body mass index (BMI)Z-score above the initial score was less in the children who consumed only olive oil (odds ratio (OR)=0.22; 95% confidence interval (CI): 0.08–0.63;P=0.005). These results remained after adjusting for age, physical activity and BMI (OR=0.19; 95% CI: 0.06–0.61;P=0.005) and after adjusting for age, physical activity and adipocyte volume (OR=0.15; 95% CI: 0.04–0.52;P=0.003).ConclusionsDiets with mono unsaturated fatty acid (MUFA)-rich olive oil could reduce the risk of obesity in childhood.

The topic of residents’ attitudes towards tourism development has been analyzed by many authors, leading us to discuss the possibility of proposing a universal model to explain it. The difficulties and progress made in this field are argued. The main contribution of this study is the inclusion of variables for the “behaviour of tourists”, “density of tourists” and “level of tourism development perceived by the resident”, which are either absent or only minimally incorporated in the majority of models. We have constructed an enhanced explanatory model and tested it in the particular case of the Spanish province of Huelva, which is considered as an emerging destination. These findings have significant repercussions both in the scientific field and for tourism planning.

Resumen Objetivos Estudiar la validez y fiabilidad de la version espanola del cuestionario revisado de calidad de vida para fibrosis quistica (FQ) en adolescentes y adultos (CFQR 14+ Spain). Pacientes y metodos Se estudiaron 43 adolescentes y adultos con FQ, clinicamente estables. Se utilizaron como medidas del estado de salud parametros radiologicos, espirometricos, numero de reagudizaciones, prueba de la marcha de 6 min, antropometricos (indice de masa corporal, desnutricion de masa magra), grasa en heces y el cuestionario respiratorio de St.George (SGRQ). Resultados El alfa de Cronbach fue ≥0,70 para todas las escalas, excepto para «sintomas digestivos» y «carga de tratamiento». Cuarenta items (de 50) presentaron correlaciones items-escala mayores a 0,70 y el 98% mayores a 0,40. La reproductibilidad test-retest (coeficiente de Spearman) oscilo entre 0,49–0,95 y el coeficiente de correlacion intraclase alcanzo puntuaciones mayores de 0,70 en 10 de 12 escalas. Todas las dimensiones correlacionaron significativamente con las puntuaciones del SGRQ. Se observaron correlaciones significativas entre las dimensiones del cuestionario y las variables respiratorias y nutricionales que pretendian medir y permitio diferenciar adecuadamente los distintos grados de gravedad en funcion de los parametros respiratorios evaluados. La desnutricion y la malabsorcion condicionaron significativamente peores puntuaciones solo en algunos dominios relacionados (como problemas con el peso). El efecto suelo fue menor al 15% en todas las dimensiones y el efecto techo fue elevado en 7 dimensiones. Conclusiones El cuestionario CFQR 14+ Spain es valido y fiable para su aplicacion en Espana, aunque podria ser mejorado en algunas de las subescalas.

The topic of residents' attitudes toward tourism development has been analyzed by many authors, but there have been few studies that have included: (1) the impacts resulting from tourism perceived by residents of a particular region in a very early stage of tourism development, where, consequently, this industry is not yet economically important; (2) the relationship between the impacts of tourism perceived by residents and their degree of satisfaction with their community; and (3) a specific tourism segment, such as industrial tourism. The article presented here addresses these gaps in the literature, and focuses attention on the attitudes of the residents of Minas de Riotinto—a locality of the Spanish province of Huelva, traditionally involved in mining activity, which is now in decline and in the very initial phase of tourism development—toward greater development of tourism in their municipality, and on the factors that may determine and explain those attitudes.

Introduction: Pulmonary rehabilitation (PR) has become a basic element in treatment of chronic lung diseases but has not been sufficiently studied in Bronchiectasis (BC); there is little evidence about its effect on exercise capacity. Specific nutritional supplements may improve these results. Aims: To compare the effect of PR for 12 weeks vs PR plus hyperproteic supplement enriched with beta-hydroxy-beta-methylbutyrate (HMB) in non-cystic fibrosis BC on different parameters of cardiopulmonary exercise test. Methods: Prospective randomized study in which a structured PR program for patients with BC was applied for three months. Hyperproteic HMB supplementation (PRHMB) was added to one of the groups. Exercise test with incremental cycle ergometer protocol was performed at baseline, three and six months. Data were analyzed by intention to treat. Results: 30 patients with non-CF BC (15 in each arm) were included, with no differences in clinical and respiratory variables between groups. All 30 patients completed the PR. Both groups significantly increased values of maximum oxygen uptake (VO2max) at 3 and 6 months, as well as METs at 6 moths. PR isolated group significantly increased its heart rate at 3 and 6 months. Conclusions: Pulmonary rehabilitation program improved exercise capacity (VO2max and METs) in patients with BC. Adding a supplement did not improve outcome other than a minor tachycardic response to exercise. Study funded by Consejeria de Salud de la Junta de Andalucia (PI-0239-2013), SEPAR 016/2013 and Neumosur 3/2013.

Background Childhood obesity has grown very fast over recent decades and now it represents a serious public health problem. The number of adipocytes is set in childhood and adolescence and then, an effective understanding of the development of adipose tissue during these periods will help in the prevention of this pathology. Objectives The current study aimed to determine which adipose tissue characteristics are related to a high weight Z-score in childhood. Patients and Methods The current study included 82 children aged 5-130 months who underwent inguinal hernia surgery. Anthropometric variables were measured, and a nutritional and physical activity questionnaire was completed. Subcutaneous adipose tissue samples, taken during the operation, were analyzed for preadipocyte number, adipocyte volume, fatty acid composition (gas chromatography of FAME), and relative gene expression of various genes (real time PCR). Results The results showed that children with a higher weight Z-score spend more time in sedentary activities and less time running or involved in active games. SCD-1 activity index, arachidonic/linoleic index, and adipocyte volume were significantly higher in children with a weight Z-score greater than 0. The preadipocyte number and the genetic expression of the studied genes did not differ between the groups. A multiple regression analysis was done to determine which variables were related to the weight Z-score. R2 values indicated that the model which included adipocyte volume, SREBP-1c, SCD-1 expression, and activity index, predicted 59% of the variability in the weight Z-score among the children. The main variables associated with adipocyte volume were PPARγ, Adiponectin, CB1R expressions, as well as the SCD-1 activity and normalized weight. Conclusions It was concluded that in childhood, the weight Z-score is related to adipocyte volume and adipose tissue gene expression.

Summary Background & aim Recent studies suggest that white rice consumption increases risk of diabetes. Aim: to assess the association between white rice intake and the incidence of diabetes in a population from Southern Spain. Methods A population-based cohort study was undertaken in Pizarra, Spain. At baseline and follow-up, participants underwent an interview and a standardized clinical examination which included an oral glucose tolerance test in those subjects without known diabetes. Incidence and odds ratio (OR) for diabetes were calculated. Multivariate analysis was performed using stepwise logistical regression. Results Thirty eight percent of subjects reported rice consumption 2–3 times a week, 58.5% once or less a week, and 3.6% no rice consumption. In subjects who reported rice intake 2–3 times a week, incidence of diabetes after 6 years follow-up was 12.0%, and in those who reported once or less a week, 20.2% (p = 0.04, non adjusted). Subjects who ate rice frequently had lower risk to develop diabetes 6 years later (OR = 0.43, p = 0.04; adjusted for age, sex, obesity, and presence of impaired fasting glucose and/or impaired glucose tolerance at baseline). Conclusions A negative association was found between white rice intake in the way it is consumed in Southern Spain, and the 6 years incidence of diabetes.

The development of the tourism industry in the province of Huelva, situated the extreme southwest of Spain, with a population of around half a million inhabitants, is a recent phenomenon but one that is beginning to impinge palpably on the physiognomy of the area and the way of life of the communities that are affected by the rapid growth of this economic activity.