1
|
Ramos-Leví AM, Fernández-Pombo A, García-Fontao C, Gómez-Vázquez E, Cantón-Blanco A, Martínez-Olmos MÁ, Andújar-Plata P, Mariño PB, Rodríguez-Carnero MG, Villar-Taibo R. Gestational weight gain influences neonatal outcomes in women with obesity and gestational diabetes. ENDOCRINOL DIAB NUTR 2022; 69:852-858. [PMID: 36526355 DOI: 10.1016/j.endien.2022.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/11/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Obesity and gestational diabetes mellitus (GDM) are associated with an increased risk of perinatal complications and obesity in the offspring. However, the impact of gestational weight gain (GWG) on maternal and foetal outcomes is controversial. PATIENTS AND METHODS Retrospective study of 220 women with GDM and pre-pregnancy body mass index (BMI)>30kg/m2. Pregnant women were classified according to the Institute of Medicine (IOM) recommendations regarding their prior BMI and GWG. We evaluated the impact of GWG on perinatal and obstetric outcomes. RESULTS Mean maternal age was 34.7±5.3 years. Pre-pregnancy obesity was classified as class I in 55.3% of the cases, class II in 32.0% and class III in 12.7%. GWG was adequate (5-9kg) in 24.2%, insufficient (<5kg) in 41.8% and excessive (>9kg) in 34.2%. Birth weight was within normal range in 81.9%, 3.6% were small for gestational age (microsomia) and 14.4% were large for gestational age (macrosomia). Insufficient GWG was associated with a higher rate of microsomal offspring, excessive GWG was associated to macrosomia and adequate GWG with normal birth weight. CONCLUSION GWG in women with pre-pregnancy obesity and GDM impacts neonatal birthweight. Insufficient GWG is associated with microsomia and excessive GWG is associated with macrosomia. Women with adequate GWG according to the IOM guidelines obtained better perinatal outcomes.
Collapse
Affiliation(s)
- Ana M Ramos-Leví
- Department of Endocrinology and Nutrition, Hospital Universitario La Princesa, Instituto de Investigación Princesa, Universidad Autónoma, Madrid, Spain
| | - Antía Fernández-Pombo
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Santiago de Compostela, Universidad de Santiago de Compostela, Spain
| | - Cristina García-Fontao
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Santiago de Compostela, Universidad de Santiago de Compostela, Spain
| | - Eva Gómez-Vázquez
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Santiago de Compostela, Universidad de Santiago de Compostela, Spain
| | - Ana Cantón-Blanco
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Santiago de Compostela, Universidad de Santiago de Compostela, Spain
| | - Miguel Ángel Martínez-Olmos
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Santiago de Compostela, Universidad de Santiago de Compostela, Spain
| | - Paula Andújar-Plata
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Santiago de Compostela, Universidad de Santiago de Compostela, Spain
| | - Pilar Bolaño Mariño
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Santiago de Compostela, Universidad de Santiago de Compostela, Spain
| | - Maria Gemma Rodríguez-Carnero
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Santiago de Compostela, Universidad de Santiago de Compostela, Spain.
| | - Rocío Villar-Taibo
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Santiago de Compostela, Universidad de Santiago de Compostela, Spain
| |
Collapse
|
2
|
Fernández-Pombo A, Rodríguez-Carnero G, Castro AI, Cantón-Blanco A, Seoane LM, Casanueva FF, Crujeiras AB, Martínez-Olmos MA. Relevance of nutritional assessment and treatment to counteract cardiac cachexia and sarcopenia in chronic heart failure. Clin Nutr 2021; 40:5141-5155. [PMID: 34461588 DOI: 10.1016/j.clnu.2021.07.027] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/24/2021] [Accepted: 07/21/2021] [Indexed: 12/18/2022]
Abstract
Chronic heart failure (CHF) is frequently associated with the involuntary loss of body weight and muscle wasting, which can determine the course of the disease and its prognosis. While there is no gold standard malnutrition screening tool for their detection in the CHF population, several bioelectrical and imaging methods have been used to assess body composition in these patients (such as Dual Energy X-Ray Absorptiometry and muscle ultrasound, among other techniques). In addition, numerous nutritional biomarkers have been found to be useful in the determination of the nutritional status. Nutritional considerations include the slow and progressive supply of nutrients, avoiding high volumes, which could ultimately lead to refeeding syndrome and worsen the clinical picture. If oral feeding is insufficient, hypercaloric and hyperproteic supplementation should be considered. β-Hydroxy-β-methylbutyrate and omega-3 polyunsaturated fatty acid administration prove to be beneficial in certain patients with CHF, and several interventional studies with micronutrient supplementation have also described their possible role in these subjects. Taking into account that CHF is sometimes associated with gastrointestinal dysfunction, parenteral nutritional support may be required in selected cases. In addition, potential therapeutic options regarding nutritional state and muscle wasting have also been tested in clinical studies. This review summarises the scientific evidence that demonstrates the necessity to carry out a careful nutritional evaluation and nutritional treatment to prevent or improve cardiac cachexia and sarcopenia in CHF, as well as improve its course.
Collapse
Affiliation(s)
- Antía Fernández-Pombo
- Division of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Santiago (CHUS/SERGAS), Santiago de Compostela, Spain
| | - Gemma Rodríguez-Carnero
- Division of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Santiago (CHUS/SERGAS), Santiago de Compostela, Spain; Epigenomics in Endocrinology and Nutrition Group, Epigenomics Unit, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Complejo Hospitalario Universitario de Santiago (CHUS/SERGAS), Santiago de Compostela, Spain
| | - Ana I Castro
- Division of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Santiago (CHUS/SERGAS), Santiago de Compostela, Spain; CIBER Fisiopatologia de la Obesidad y Nutricion (CIBERobn), Madrid, Spain
| | - Ana Cantón-Blanco
- Division of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Santiago (CHUS/SERGAS), Santiago de Compostela, Spain; Epigenomics in Endocrinology and Nutrition Group, Epigenomics Unit, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Complejo Hospitalario Universitario de Santiago (CHUS/SERGAS), Santiago de Compostela, Spain; CIBER Fisiopatologia de la Obesidad y Nutricion (CIBERobn), Madrid, Spain
| | - Luisa M Seoane
- CIBER Fisiopatologia de la Obesidad y Nutricion (CIBERobn), Madrid, Spain; Endocrine Physiopathology Group, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Complejo Hospitalario Universitario de Santiago (CHUS/SERGAS), Santiago de Compostela, Spain
| | - Felipe F Casanueva
- CIBER Fisiopatologia de la Obesidad y Nutricion (CIBERobn), Madrid, Spain; Laboratory of Molecular and Cellular Endocrinology, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Complejo Hospitalario Universitario de Santiago de Compostela (CHUS/SERGAS), Santiago de Compostela, Spain; Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Ana B Crujeiras
- Epigenomics in Endocrinology and Nutrition Group, Epigenomics Unit, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Complejo Hospitalario Universitario de Santiago (CHUS/SERGAS), Santiago de Compostela, Spain; CIBER Fisiopatologia de la Obesidad y Nutricion (CIBERobn), Madrid, Spain.
| | - Miguel A Martínez-Olmos
- Division of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Santiago (CHUS/SERGAS), Santiago de Compostela, Spain; Epigenomics in Endocrinology and Nutrition Group, Epigenomics Unit, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Complejo Hospitalario Universitario de Santiago (CHUS/SERGAS), Santiago de Compostela, Spain; CIBER Fisiopatologia de la Obesidad y Nutricion (CIBERobn), Madrid, Spain; Universidade de Santiago de Compostela, Santiago de Compostela, Spain.
| |
Collapse
|
3
|
González-Rodríguez M, Villar-Taibo R, Fernández-Pombo A, Pazos-Couselo M, Sifontes-Dubón MA, Ferreiro-Fariña S, Cantón-Blanco A, Martínez-Olmos MA. Early versus conventional nutritional intervention in head and neck cancer patients before radiotherapy: benefits of a fast-track circuit. Eur J Clin Nutr 2020; 75:748-753. [PMID: 33097829 DOI: 10.1038/s41430-020-00786-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 07/27/2020] [Accepted: 10/13/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES Radiotherapy (RT) is a component of therapy for head and neck cancer (HNC) with a negative nutritional impact. Our aim was to compare an early versus a conventional nutritional intervention. SUBJECTS AND METHODS Retrospective study of HNC patients undergoing RT. Evolution before and after the establishment of a fast-track circuit was evaluated. A conventional group (CG) made up of patients submitted to the nutrition unit during RT after nutritional deterioration, was compared to an early group (EG) represented by patients included in a fast-track circuit, starting nutritional follow-up before the beginning of RT. Only patients with preserved oral intake were involved. Demographic, nutritional and clinical variables were analyzed. Data of hospitalizations and deaths were collected up to three months after RT. RESULTS 135 subjects constituted the EG and 39 the CG. At baseline, the prevalence of malnutrition was lower in the EG (31.9% vs 69.5%, p = 0.0001), as was the need for nutritional supplements (40% vs 79.5%, p = 0.0001) or nasogastric tube (0% vs 12.8%, p = 0.0001) in comparison to the CG. Three months after RT, there were less patients with oral nutritional support in the EG (79.1% vs 96.9%, p = 0.018), and the number of emergency visits (0.75 vs 1.1 episodes per patient, p = 0.021) and hospitalizations was also lower in this group (29% vs 59%, p = 0.044). CONCLUSIONS The fast-track approach made early intervention possible. Therefore, patients maintained a better nutritional status, needed less nutritional support and their evolution improved, with a significant decrease in hospitalizations.
Collapse
Affiliation(s)
- M González-Rodríguez
- Endocrinology and Nutrition Department, Complejo Hospitalario Universitario de Santiago de Compostela, A Coruña, Spain
| | - R Villar-Taibo
- Endocrinology and Nutrition Department, Complejo Hospitalario Universitario de Santiago de Compostela, A Coruña, Spain.
| | - A Fernández-Pombo
- Endocrinology and Nutrition Department, Complejo Hospitalario Universitario de Santiago de Compostela, A Coruña, Spain
| | - M Pazos-Couselo
- Endocrinology and Nutrition Department, Complejo Hospitalario Universitario de Santiago de Compostela, A Coruña, Spain.,Psychiatry, Radiology and Public Health Department, University of Santiago de Compostela, A Coruña, Spain
| | - M A Sifontes-Dubón
- Endocrinology and Nutrition Department, Complejo Hospitalario Universitario de Santiago de Compostela, A Coruña, Spain
| | - S Ferreiro-Fariña
- Endocrinology and Nutrition Department, Complejo Hospitalario Universitario de Santiago de Compostela, A Coruña, Spain
| | - A Cantón-Blanco
- Endocrinology and Nutrition Department, Complejo Hospitalario Universitario de Santiago de Compostela, A Coruña, Spain
| | - M A Martínez-Olmos
- Endocrinology and Nutrition Department, Complejo Hospitalario Universitario de Santiago de Compostela, A Coruña, Spain.,Psychiatry, Radiology and Public Health Department, University of Santiago de Compostela, A Coruña, Spain.,CIBERObn, Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
4
|
Fernández-Pombo A, Seijo-Raposo IM, López-Osorio N, Cantón-Blanco A, González-Rodríguez M, Arias-Rivas S, Rodríguez-Yáñez M, Santamaría-Nieto A, Díaz-Ortega C, Gómez-Vázquez E, Martínez-Olmos MÁ. Lesion location and other predictive factors of dysphagia and its complications in acute stroke. Clin Nutr ESPEN 2019; 33:178-182. [DOI: 10.1016/j.clnesp.2019.05.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 05/23/2019] [Indexed: 11/17/2022]
|
5
|
Sánchez-Guillén L, López de Los Reyes R, Vives-Rodríguez E, Mato Iglesias A, Cantón-Blanco A. Enteral nutrition in Crohn's disease with a high output enteroatmospheric fistula. Cir Esp 2016; 94:547-550. [PMID: 27238861 DOI: 10.1016/j.ciresp.2016.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 04/05/2016] [Accepted: 04/17/2016] [Indexed: 11/18/2022]
Affiliation(s)
- Luis Sánchez-Guillén
- Servicio de Cirugía General y del Aparato Digestivo, Complexo Hospitalario Universitario de Ferrol, Ferrol, La Coruña, España.
| | - Ramón López de Los Reyes
- Servicio de Cirugía General y del Aparato Digestivo, Complexo Hospitalario Universitario de Ferrol, Ferrol, La Coruña, España
| | - Eulalia Vives-Rodríguez
- Servicio de Cirugía General y del Aparato Digestivo, Complexo Hospitalario Universitario de Ferrol, Ferrol, La Coruña, España
| | - Almudena Mato Iglesias
- Servicio de Cirugía General y del Aparato Digestivo, Complexo Hospitalario Universitario de Ferrol, Ferrol, La Coruña, España
| | - Ana Cantón-Blanco
- Servicio de Endocrinología y Nutrición, Complexo Hospitalario Universitario de Santiago, Santiago de Compostela, La Coruña, España
| |
Collapse
|
6
|
García-Rodríguez JF, Álvarez-Díaz H, Vilariño-Maneiro L, Lorenzo-García MV, Cantón-Blanco A, Ordoñez-Barrosa P, Mariño-Callejo AI, Sesma-Sánchez P. Epidemiology and impact of a multifaceted approach in controlling central venous catheter associated blood stream infections outside the intensive care unit. BMC Infect Dis 2013; 13:445. [PMID: 24063563 PMCID: PMC3849631 DOI: 10.1186/1471-2334-13-445] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 09/20/2013] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Outside ICUs, CVC-ABSIs epidemiology and the results of strategies for their prevention are not well known. The aim of this study was to investigate the epidemiology and the impact of a multifaceted "bundle" approach in controlling CVC-ABSIs outside ICU. METHODS From 1991 we performed prevalence studies of device and parenteral nutrition use, and prospective surveillance of all episodes of CVC-ABSIs in a 350-bed teaching hospital. CVC-ABSIs incidence/1,000 inpatient-days was calculated. An estimated CVC-ABSIs incidence/1,000 catheter-days was calculated based on the prevalence rates of catheter use and the total number of inpatient-days in each year. On november 2008, an education programme was instituted for care of catheter lines: reinforcing instructions in aseptic insertion technique, after care and hand-washing; in order to assess the adherence to these measures the quantity of alcohol-based hand-rub consumption/1,000 patient-days was quoted in litres. From January 2009, a checklist intervention for CVC insertion in ICU was started: hand hygiene, using full barrier precautions, cleaning the skin with alcoholic chlorhexidine, avoiding femoral access and removing unnecessary catheters. Compliance with the central line insertion checklist was measured by real-time audits and was achieved in 80% of cases. RESULTS Prevalence of use of CVC and parenteral nutrition was similar throughout the study. We followed-up 309 CVC-ABSIs cases. Estimated CVC-ABSIs rate progressively increased to 15.1/1,000 catheter-days in 2008 (0.36/1,000 inpatient-days). After the intervention, the alcohol-based hand-rub consumption increased slightly and estimated CVC-ABSIs rate fell to 10.1 /1,000 catheter-days in last three years (0.19/1,000 inpatient-days), showing a 32.9% decrease. The infection rates achieved were lower in Internal Medicine wards: decreased from 14.1/1,000 catheter-days (0.17/patient-days) in 2008 to 5.2/1,000 catheter-days (0.05/1,000 inpatient-days) in last three years, showing a 63.1% decrease. In 2009, the estimated CVC-ABSIs incidence rate was significantly lower in the Internal Medicine ward compared to the Surgery ward: rate ratio (RR) = 0.14, 95%CI: 0.03-0.60), and within the Internal Medicine ward, the estimated CVC-ABSIs incidence rate was significantly lower in 2009 compared to 2008 (RR = 0.20, 95%CI: 0.04-0.91). CONCLUSION The rate of CVC-ABSIs increased outside-ICU, and the implementation of multifaceted infection control programme decreased their clinical impact.
Collapse
Affiliation(s)
- José Francisco García-Rodríguez
- Infectious Diseases Unit, Internal Medicine Ward, Health Area of Ferrol, SERGAS, La Coruña, Spain
- C/ San Amaro 10-12, 6° Derecha, 15403, Ferrol, La Coruña, Spain
| | - Hortensia Álvarez-Díaz
- Infectious Diseases Unit, Internal Medicine Ward, Health Area of Ferrol, SERGAS, La Coruña, Spain
| | | | | | | | | | | | | |
Collapse
|