Nutrition In Spain Research Articles

Consensus on criteria and minimum data set for the referral of candidate patients for home enteral nutrition teleconsultation: TELENUT project

Introduction: teleconsultation is a useful healthcare tool in the multidisciplinary management of patients with indications of home enteral nutrition (HEN). The use of different teleconsultation platforms, as it happens in the Andalusian Health System (SAS), results in heterogeneous referral processes between Primary Care and hospital services in the same region. Objectives: to establish a consensus on patient profiles and the minimum data set necessary to guarantee an adequate referral to NED teleconsultation regardless of the existing platform. These agreed aspects in Andalusia can serve as a reference in other regions. Methods: three consecutive steps were followed: a) non-systematic review of the indexed literature on teleconsultation in clinical nutrition in Spain; b) survey to know the implementation and unmet needs of teleconsultation platforms in Andalusian public hospitals; and c) working meetings and consensus of 14 health professionals of Primary Care (n = 4) and endocrinology and hospital clinical nutrition (n = 10). Results: three referral forms were agreed in which three patient profiles were defined, with the corresponding minimum set of data necessary to request NED teleconsultation. The Primary Care team should provide this set of data to the clinical nutrition specialist via a teleconsultation platform, implemented in the SAS. Conclusions: three agreed forms between healthcare professionals involved in the referral process serve to standardize the request for teleconsultation of NED between healthcare teams based on patient profiles.

Home and Ambulatory Artificial Nutrition (NADYA) Group report: home parenteral nutrition in Spain, 2019

Aim: to communicate the home parenteral nutrition (HPN) data obtained from the HPN registry of the NADYA-SENPE group (www.nadya-senpe.com) for the year 2019. Material and methods: a descriptive analysis of the data collected from adult and pediatric patients with HPN in the NADYA-SENPE group registry from January 1 to December 31, 2019. Results: a total of 283 patients (51.9 % women), 31 children, and 252 adults from 47 Spanish hospitals were registered, which represents a prevalence rate of 6.01 patients per million inhabitants for year 2019. The most frequent diagnosis in adults was "palliative oncological" and "others" (21.0 %). In children, it was Hirschsprung's disease together with necrotizing enterocolitis, alterations in intestinal motility, and chronic intestinal pseudo-obstruction, with 4 cases each (12.9 %). The first reason for the indication was short-bowel syndrome in both children (51.6 %) and adults (37.3 %). The most used type of catheter was tunnelled both in children (75.9 %) and in adults (40.8 %). Sixty-eight episodes ended, all in adults, and the most frequent cause was death (54.4 %); 38.2 % were switched to oral. Conclusions: the number of collaborating centers and professionals in the NADYA registry is increasing. The main indications and reasons for HPN termination remain stable.Objetivo: comunicar los datos de nutrición parenteral domiciliaria (NPD) obtenidos del registro del grupo NADYA-SENPE (www.nadya-senpe.com) del año 2019. Material y métodos: análisis descriptivo de los datos recogidos de pacientes adultos y pediátricos con NPD en el registro NADYA-SENPE desde el 1 de enero al 31 de diciembre de 2019. Resultados: se registraron 283 pacientes (51,9 %, mujeres), 31 niños y 252 adultos procedentes de 47 hospitales españoles, lo que representa una tasa de prevalencia de 6,01 pacientes/millón de habitantes/año 2019. El diagnóstico más frecuente en los adultos fue “oncológico paliativo” y “otros” (21,0 %). En los niños fue la enfermedad de Hirschsprung junto a la enterocolitis necrotizante, las alteraciones de la motilidad intestinal y la pseudoobstrucción intestinal crónica, con 4 casos cada uno (12,9 %). El primer motivo de indicación fue el síndrome del intestino corto tanto en los niños (51,6 %) como en los adultos (37,3 %). El tipo de catéter más utilizado fue el tunelizado tanto en los niños (75,9 %) como en los adultos (40,8 %). Finalizaron 68 episodios, todos en adultos: la causa más frecuente fue el fallecimiento (54,4 %). Pasaron a la vía oral el 38,2 %. Conclusiones: el número de centros y profesionales colaboradores con el registro NADYA va incrementándose. Se mantienen estables las principales indicaciones y los motivos de finalización de la NPD.

Iodine nutrition in Spain: Future requirements

Although iodine nutrition in Spain has improved in recent years, the problem is not completely resolved. It is necessary that health institutions establish measures to ensure an adequate iodine nutrition of the population, especially among the highest risk groups (children and adolescents, women of childbearing age, pregnant women and nursing mothers). A low salt intake should be advised, but it should be iodized. It is also imperative that food control agencies establish effective control over adequate iodization of salt. Indicators on iodine nutrition should be included in future health surveys. The EUthyroid study and the Krakow Declaration on iodine nutrition provide an opportunity to set up a pan-European plan for the prevention of iodine deficiency that should be considered and used by health authorities.

COVID pandemic and clinical nutrition response in Spain: results of a national survey

Introduction: the SARS-CoV-2 pandemic has forced major organizational and care changes in the health system. However, in Spain, the circumstances suffered by the health professionals who have cared for pandemic patients from a clinical nutrition standpoint has remained unknown up to this moment. Objectives: the management and care changes made in clinical nutrition units in Spain, and their impact on clinical practice are described. Material and methods: a cross-sectional study was carried out using a survey directed at SENPE members (June 2020). Responses sent by health professionals in the field of clinical nutrition who had treated patients with COVID-19 in Spanish hospitals were included in the study. Resultados: a total of 116 survey forms were analyzed, mostly filled out by doctors (57.8 %) working at hospitals with more than 500 beds (56 %); 46 % of survey respondents were on telework. There was a nutritional care plan in 68 % of cases, such plan being present mainly in hospitals with more than 500 beds (p < 0.001). In these hospitals more specific diets for COVID-19 were implemented than in those under 500 beds: 18 (35.3 %) vs 44 (67.7 %), (p < 0.001). The use of recommendations issued by scientific societies was reported in 86 % of cases. Never or almost never could a satisfactory nutritional assessment be performed for 38.8 %. The prescription of nutritional supplements was not less than 50 %. Health workers rated their performance as satisfactory or very satisfactory (51.7 %), and this was not related to hospital size but to having implemented a COVID-19 diet (p < 0.05). Conclusions: clinical nutrition in Spain has responded to the COVID-19 pandemic with organizational and managerial changes and, although care has been clearly affected, some quality standards were ultimately maintained. Larger hospitals have had some advantages in making these adjustments.

Home and Ambulatory Artificial Nutrition (NADYA) Group Report. Home parenteral nutrition in Spain, 2018

Aim: to communicate home parenteral nutrition (HPN) data obtained from the HPN registry of the NADYA-SENPE group (www.nadya-senpe.com) for the year 2018 Material and methods: descriptive analysis of the data collected from adult and pediatric patients with HPN in the NADYA-SENPE group registry from January 1st, 2018 to December 31st, 2018. Results: there were 278 patients from 45 Spanish hospitals (54.7% women), 23 children and 255 adults, which represent a prevalence rate of 5.95 patients/million inhabitants/year 2018. The most frequent diagnosis in adults was "palliative cancer" (22.0%), followed by "others". In children it was Hirschsprung's disease together with necrotizing enterocolitis, with four cases (17.4%). The first indication was short bowel syndrome in both children (60.9%) and adults (35.7%). The most frequently used type of catheter was tunneled in both children (81.0%) and adults (41.1%). Ending 75 episodes, the most frequent cause was death (52.0%) and change to oral feeding (33.3%). Conclusions: the number of centers and collaborating professionals in the registry of patients receiving HPN remains stable, as well as the main indications and reasons for termination of HPN.

La nutrición de yodo en España. Necesidades para el futuro

Although iodine nutrition in Spain has improved in recent years, the problem is not completely resolved. It is necessary that health institutions establish measures to ensure an adequate iodine nutrition of the population, especially among the highest risk groups (children and adolescents, women of childbearing age, pregnant women and nursing mothers). A low salt intake should be advised, but it should be iodized. It is also imperative that food control agencies establish effective control over adequate iodization of salt. Indicators on iodine nutrition should be included in future health surveys. The EUthyroid study and the Krakow Declaration on iodine nutrition provide an opportunity to set up a pan-European plan for the prevention of iodine deficiency that should be considered and used by health authorities.

Home and Ambulatory Artificial Nutrition (NADYA) Report. Home Parenteral Nutrition in Spain, 2017

to communicate HPN data obtained from the HPN registry of the NADYA-SENPE group (www.nadya-senpe.com) for the year 2017. descriptive analysis of the data collected from adult and pediatric patients with HPN in the NADYA-SENPE group registry from January 1st, 2017 to December 31st, 2017. there were 308 patients from 45 Spanish hospitals (54.5% women), 38 children and 270 adults, with 3,012 episodes, which represent a prevalence rate of 6.61 patients/million inhabitants/year 2017. The most frequent diagnosis in adults was "palliative cancer" (25.6%), followed by "others". In children, it was Hirschsprung's disease with six cases (15.8%). The first indication was short bowel syndrome in both children (55.3%) and adults (33.7%). The most frequently used type of catheter was tunneled in both children (73.4%) and adults (38.2%). Ending 81 episodes, the most frequent cause was death (62.9%) and transition to oral feeding (34.7%). the progressive increase of collaborating centers and professionals in the registry of patients receiving NPD is maintained. The main indications of HPN and the motive for ending have remained stable.

Dos películas filmadas en el hospital Ramón y Cajal en 1978, pioneras de la nutrición artificial en España

Se han recuperado dos películas filmadas en 16 mm en el Hospital Ramón y Cajal en 1978. Una se titula «Nutrición parenteral y enteral en un fistula yeyunal alta» y la otra «Intestino artificial (nutrición parenteral ambulante)». Son dos obras pioneras en la nutrición artificial en Ensaña. Se hacen amplios comentarios sobre la temática de las películas y su importancia en el momento actual. En las fistulas yeyunales altas la nutrición artificial, parenteral y enteral, es indicación prínceps, con eficacia comprobada. En la película «Nutrición parenteral ambulante» se muestra un modelo de nutrición parenteral ambulatoria bastante similar al actual. Se comenta que esta forma de terapia debería ser regulada por la Administración Sanitaria, hecho que hoy, cuarenta años después, todavía no ha sucedido a pesar de los cientos de pacientes con múltiples indicaciones que son sometidos a nutrición parenteral a domicilio en España cada año, con el consiguiente ahorro. Se ofrece el link para poder visualizar ambas películas.

Inequality, health and nutrition in Spain: a regional view of the body mass index

a number of environmental determinants influence children growth and development and influence the potential expression or its evolution over time. In this paper we analyse the influence of selected sociodemographic factors on overweight, body weight and height in the Spanish adult population. the analysis was conducted in a subsample (25 to 64 years of age) of the ENPE study, a cross-sectional observational study on a random population sample. Information was collected on age, gender, educational level, occupation and place of residence. Social class was coded according to occupation. Individual body weight and height were measured. the prevalence of obesity is higher in men, increases with age and there is an inverse relationship with the level of education and social class. Higher prevalence rates were observed in Asturias, Galicia and in Andalusia. Short stature is more frequent in people with incomplete primary education and low social class, in contrast to high stature, which is also more frequent in the North-East and central regions. Low body weight is less frequent in people with very poor education and low social class. based on the unequal distribution of overweight and obesity, preventive strategies in Community Nutrition should consider improving the level of nutrition education and literacy of the population, with special emphasis on the most disadvantaged people.

Dissemination of clinical nutrition through societies and scientific journals. A meeting at the Spanish Royal Academy of Pharmacy>

This special article defines very briefly some central aspects of artificial nutrition as nutritional support in special situations in patients that are not able to maintain a sufficient and adequate digestive function to restore or maintain optimal nutritional status or in those who are malnourished or in the way to be. It also reviews the central aspects of a round table attended by executives of journals and scientific entities in the field of health and, in particular, of nutrition. The roundtable was organized under the auspices of a tribute to Dr. Jesus M. Culebras, in January 2018 at the headquarters of the Spanish Royal Academy of Pharmacy. Prof. Culebras was founder of the journal Nutrición Hospitalaria journal and architect of many achievements and initiatives of the Spanish Society of Enteral and Parenteral Nutrition of great importance for nutrition and artificial nutrition in Spain. During the workshop, the convenience of increasing collaboration between the scientific journals Nutrición Hospitalaria, Farmacia Hospitalaria, Anales de la Real Academia Nacional de Farmacia and Journal of Negative and No Positive Results and the entities they represent was highlighted, especially concerning the framework of clinical nutrition and, particularly, artificial feeding, insisting on the need to initiate a series of meetings in the very near future with the purpose of delimiting competencies and rights, and taking joint positions in publications, and consensus agreements that would guarantee the dissemination and visibility of this issue of enormous importance for health.

Home and Ambulatory Artificial Nutrition (NADYA) Group Report - Home parenteral nutrition in Spain, 2016

To communicate HPN data obtained from the HPN registry of the NADYA-SENPE group (www.nadya-senpe.com) for the year 2016. Descriptive analysis of the data collected from adult and pediatric patients with HPN in the NADYA-SENPE group registry from January 1st, 2016 to December 31st, 2016. There were 286 patients from 42 Spanish hospitals (54.2% women), 34 children and 252 adults, with 294 episodes, which represent a prevalence rate of 6.16 patients / million inhabitants / year 2016. The most frequent diagnosis in adults was "palliative cancer" (25.8%), followed by "others". In children it was "motility alterations" with 6 cases (17.6%), Hirschsprung's disease and necrotising enterocolitis, both with 5 children (14.7%). The first indication was short bowel syndrome in both children (64.7%) and adults (37.3%), followed by intestinal obstruction in 28.6% adults and 14.7% in children. The most frequently used type of catheter was tunnelled in both children (70.6%) and adults (37.9%). The most frequent complication in adults was infection related to the catheter, which presented a rate of 0.48 infections / 1,000 days of NPD. During this period, 71 episodes ended in adults and the main cause was death (57.7%) followed by resuming the oral route (31%). There is a progressive increase of centers and professional collaborators in the registry who report patients receiving parenteralnutrition at home. The main indications of HPN and the motive for ending have remained stable.

Organization and management of clinical nutrition in Spain. How do we assess the quality of our activities?

Among the objectives of the SENPE Management Working Group is the development of knowledge and tools related to the evaluation of health outcomes. To obtain an approximate profile of clinical nutrition in hospitals in Spain, specifically concerning its organization, endowment, activities and quality indicators. A cross-sectional study conducted in 2013 through a structured survey sent to a random sample of 20% of hospitals from the network of the National Health System of Spain, stratified by the number of hospital beds. The overall response rate was 67% (83% in hospitals with over 200 beds). In 65% of hospitals, clinical nutrition is run by a coordinated team or unit, with a doctor working full time in only 50% of centers. Other professionals are often not recognized as part of the team or unit. There is a specialized monographic nutrition clinic in 62% of centers and 72% have more than 40 new inpatient consultations per month (27% with more than 80 per month). Among the centers with a clinical nutrition team or unit, there is a greater tendency to monitor quality indicators related to clinical practice. There is widespread addition of clinical nutrition teams and units in hospitals in Spain. However, truly multidisciplinary organization is not often found. High workloads are assumed in relation to staffing levels. The existence of well-organized structures may be associated with benefits that directly affect attendance.

A Home and Ambulatory Artificial Nutrition (NADYA) group report, Home Parenteral Nutrition in Spain, 2013.

To communicate the results of the Spanish Home Parenteral Nutrition (HPN) registry of the NADYA-SENPE group for the year 2013. Data was recorded online by NADYA group collaborators that were responsible of the HPN follow-up from 1st January to 31st December 2013. A total of 197 patients and 202 episodes of HPN were registered from 35 hospitals that represents a rate of 4,22 patients/million habitants/year 2013. The median age was 53 years (IQR 40-64) for 189 adult patients and 7 months (IQR 6-35,5) for children. The most frequent disease in adults was neoplasm (30,7%) followed by other diseases (20,1%) and mesenteric ischemia (12,7%). Short bowel syndrome and intestinal obstruction (25,9%) were in 35.7% cases the indications for HPN. The most frequent diagnosis for children were the congenital intestinal disorders and other diagnosis, both with a (37,5%) and short bowel syndrome and intestinal obstruction were the indication for treatment, each was present in 50% of the sample. Tunneled catheters (50%) and subcutaneous reservoirs (27,7%) were frequently used. The septic complications related with catheter were commonly frequent with a rate of 0.74 infections/1000 HPN days. HPN duration presented a median of 1,69 days. A total of 86 episodes finalized during the year, death was the principal reason (45%), followed by "resumed oral via" (43,75%) while it happened inversely for children, 66,7% of them resumed oral via and 16,7% deceased. Fifteen per cent were considered for intestinal transplant, children were proportionally candidates, p-value 0.002. The number of participating centers and registered patients increased progressively respect to preceding years. Since 2003 Neoplasm is still being the principal pathological group. Death is adult's principal reason for finalizing HPN and "resuming oral via" for children. Despite that NADYA registry is consolidate as a essential source of relevant information about the advances in Home Artificial Nutrition in our country, currently is in an improvement process of the available information about patients characteristics with a special emphasis on children even though they still being a minority group.

PIH81 - Health Related Quality of Life in Patients Receiving Home Enteral Nutrition in Spain Assessed By A Specific Questionnaire: Nutriqol®

PIH81 - Health Related Quality of Life in Patients Receiving Home Enteral Nutrition in Spain Assessed By A Specific Questionnaire: Nutriqol®

Home enteral nutrition in Spain: NADYA registry in 2010

To describe the results of the home enteral nutrition (HEN) registry of the NADYA-SENPE group in 2010. We retrieved the data of the patients recorded from January 1st to December 31st 2010. We registered 6,591 patients (51% males) with 6,688 episodes of HEN, from 32 hospitals. Mean age in those younger than 14 yr (4%) was 1 ± 2 yrs (m ± SD) and 69,9 ± 17,8 yrs in those older than 14 yr. The length of HEN was longer than 2 yrs in 76% of the patients. The most frequent underlying disease was neurological disorders 42%, followed by cancer 28% (mostly head and neck cancer 18%). We had information related to the enteral access route in only 626 cases (9,4%), 51% of them used nasogastric tubes, 27% gastrostomies, 10% oral route and 3% jejunostomies. Only 251 episodes were closed during the year, mostly due to patient death 57% and progress to oral diet 14%. The activity level was limited in 29% of the patients and 39% of them were bed- or chairridden. Total or partial help was needed by 68% of the patients. The hospitals and the private pharmacies delivered the enteral formula in 63% and 34% of the cases, respectively. The hospitals and the primary care centres delivered the disposables in 83% and 16% of the cases, respectively. The results of the 2010 HEN registry are similar to those published in previous years regarding the number and characteristics of the patients. We continue finding problems in the entrance of data referred to the enteral access route and the closing of the episodes.

Home parenteral nutrition in Spain 2011 and 2012; a report of the home and ambulatory artificial nutrition group NADYA

To report the data of the Home Parenteral Nutrition (HPN) registry of the NADYA-SENPE working group for the years 2011 and 2012. We compiled the data from the on-line registry introduced by reviewers of NADYA group responsible for monitoring of NPD introduced by since January 1, 2011 to december 31, 2012. Included fields were: age, sex, diagnosis and reason for HPN, access path, complications, beginning and end dates, complementary oral or enteral nutrition, activity level, autonomy degree, product and fungible material supply, withdrawal reason and intestinal transplant indication. Year 2010: 184 patients from 29 hospitals , representing a rate of 3.98 patients/million inhabitants/ year 2011, with 186 episodes were recorded NPD . During 2012, 203 patients from 29 hospitals , representing a rate of 4.39 patients/million inhabitants/year 2012 , a total of 211 episodes were recorded NPD . We observe an increase in registered patients with respect to previous years.Neoplasia remains as the main pathology since 2003. Although NADYA is consolidated registry and has been indispensable source of information relevant to the understanding of the progress of Home Artificial Nutrition in our country, there is ample room for improvement. Especially that refers to the registration of pediatric patients and the registration of complications.

A personal view of nutrition in Spain.

This paper stems from the special lecture given by the author at 20th International Congress of Nutrition, held from 16 to 20 September 2013 in Granada (Spain), following for his appointment as "Living Legend" of the International Union of nutritional sciences (IUNS), in recognition of his outstanding contribution to research and development in nutritional science. The development of nutrition in Spain from the 1960s to the present, which the author had the opportunity to experience first hand, is described. The contribution covers an extensive period in the history of this science, and highlights the advances made in our knowledge of nutrition and several of the misunderstandings that existed and still exist in this science: 1) The Anglo-Saxon dietary pattern and the high incidence of death from myocardial infarction, and the subsequent recognition of the Mediterranean diet as a model of a varied and balanced and healthy eating. 2) The relationship between cardiovascular disease and the consumption of oily fish. Since the discovery of the syn - thesis of prostaglandins makes it clear that fish fat is heart-healthy. 3) The epidemic of prosperity, overweight and obesity and the appearance of miracle diets. However, there are not miracles, the only solution being a healthy lifestyle and a balanced hypocaloric diet. 4) In the field of nutrition, diet and health, the harmful effect of: "In my opinion", a single allusion that undermines all science. The author also acknowledges all the researchers whose efforts, tenacity and enthusiasm have contributed to the advances made in nutrition science in Spain.

Recent changes in school-based policies on physical activity and nutrition in Spain

This study evaluates the changes in Spain between 2006 and 2012, of school-based policies encouraging healthy eating and the undertaking of physical activity (PA). A longitudinal study was undertaken comprising 277 representative schools from all the regions of Spain. The questionnaires were completed by the school management board. An indicator for school policies on PA was constructed (score 0-4) from the following indicators: (i) participation in PA programmes, (ii) existence of written PA guidelines, (iii) training of teachers about PA and (iv) organization of extracurricular PA activities. For nutrition, indicators similar to the first three for PA were evaluated, together with access to healthy foods (score 0-4). In addition to comparing the scores for 2006 and 2012, multivariate linear regression was used to study the association between the characteristics of the schools and the changes in the scores. The indicators for school-based policies on nutrition and PA improved between 2006 and 2012: the average score for PA increased from 1.33 to 1.79 (P < 0.001) and that for nutrition from 1.28 to 1.92 (P < 0.001). The greatest changes were seen regarding the written guidelines for action and participation in PA and nutrition programmes as well as the training of teachers about nutrition. The schools with the least number of students had the highest changes in scores for policies on nutrition (P < 0.05). There has been an increase of school-based policies on PA and nutrition, although there is still room for improvement.

The Subjective Global Assessment Predicts In-Hospital Mortality Better than Other Nutrition-Related Risk Indexes in Noncritically Ill Inpatients Who Receive Total Parenteral Nutrition in Spain (Prospective Multicenter Study)

Malnutrition in hospitalized patients is associated with an increased risk of death and complications. The purpose of this study was to determine which nutrition-related risk index predicts mortality better in patients receiving total parenteral nutrition. This prospective, multicenter study involved noncritically ill patients who were prescribed total parenteral nutrition. Data were collected on Subjective Global Assessment (SGA), Nutritional Risk Index, Geriatric Nutritional Risk Index, body mass index, albumin and prealbumin, as well as in-hospital mortality, length of stay, and infectious complications. Of the 605 patients included in the study, 18.8% developed infectious complications and 9.6% died in the hospital. SGA, albumin, Nutritional Risk Index and Geriatric Nutritional Risk Index were associated with longer hospital stay. Prealbumin levels were associated with infectious complications. Multiple logistic regression analysis showed (after adjustment for age, sex, C-reactive protein levels, mean blood glucose levels, use of corticoids, prior comorbidity, carbohydrates infused, diagnosis, and infectious complications) that the SGA, Geriatric Nutritional Risk Index, body mass index, albumin, and prealbumin were associated with an increased risk for in-hospital mortality. SGA was the tool that best predicted mortality and adequately discriminated the values of the other nutrition-related risk indexes studied. The SGA is a clinically effective and simple tool for nutrition assessment in noncritically ill patients receiving total parenteral nutrition and detects the risk of inpatient mortality better than others.

Looking Back to Move Forward

Looking Back to Move Forward