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

OBJECTIVE

To report the data of the Home Parenteral Nutrition (HPN) registry of the NADYA-SENPE working group for the years 2011 and 2012.

METHODOLOGY

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.

RESULTS

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 .

CONCLUSIONS

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.

Assessing risk screening methods of malnutrition in geriatric patients: Mini Nutritional Assessment (MNA) versus Geriatric Nutritional Risk Index (GNRI)

INTRODUCTION

Elderly subjects are considered a vulnerable group and they have more risk of nutritional problems. The risk of malnutrition increases in hospitalized geriatric patients.

OBJECTIVES

To compare the correlation between MNA and GNRI with anthropometric, biochemical and Barthel Index in hospitalized geriatric patients and to test the concordance between MNA and GNRI and between Mini Nutritional Assessment Short Form (MNA-SF) and MNA.

METHODS

It was a cross-sectional study on a sample of 40 hospitalized geriatric patients. For determination nutritional status we used MNA and GNRI; we evaluated the correlation between this both test with biochemical and anthropometric parameters and functional questionnaires. We used Pearson's simple correlation model, oneway ANOVA and multiple logistic regression to evaluate the relationship between MNA and GNRI.

RESULTS

According to MNA, 17 patients (42.5%) were malnourished and according to GNRI, 13 patients (32.5%) had high risk of nutritional complications. The concordance of MNA and GNRI was 39% and between MNA-SF and MNA was 81%. The most significant differences were detected in weight, BMI, arm and calf circumference and weight loss parameters. Barthel index was significantly different in both tests. The MNA and GRNI had significant correlations with albumin, total protein, transferring, arm and calf circumference, weight loss and BMI parameters.

CONCLUSIONS

In conclusion, it would be reasonable to use GRNI in cases where MNA is not applicable, or even use GRNI as a complement to MNA in hospitalized elderly patients. There is no reason why they should be deemed incompatible, and patients could benefit from more effective nutritional intervention.

[Home-Based Parenteral Nutrition (HBPN)-associated hepatobiliary complications]

Home-based parenteral nutrition (HBPN) allows recovering or maintaining the nutritional status of patients with chronic intestinal failure that cannot afford their nutritional requirements through the digestive route. Frequently, liver function impairments develop along the treatment, which in the most severe cases, and especially in premature and low-weight infants, may lead to an irreversible liver failure. The proper composition of the parenteral nutrition bag, avoiding an excess of energy intake, together with the use of new types of lipid emulsions (with lower content in -6 fatty acids and voided of phytosterols) as well as the use, although being minimal, of the enteral route, may contribute to a decrease in the occurrence of HBPN-associated liver disease. It is necessary to perform monthly clinical and biochemical checks to early detect liver function impairments in order to perform the appropriate changes in the treatment and assess the indication of a potential bowel transplant before the liver damage becomes irreversible.

[Per os early nutrition for colorectal pathology susceptible of laparoscopy-assisted surgery]

Current less invasive surgical techniques, the use of new analgesic and anesthetic drugs, and early mobilization ("multimodal surgical strategies") reduce the occurrence of post-surgery paralytic ileus and vomiting, making possible early nutrition by the digestive route. With these premises, a nutrition protocol was designed for its implementation in colorectal pathology susceptible of laparoscopy-assisted surgery.

OBJECTIVE

to assess the efficacy of this protocol that comprises 3 phases. Phase I: home preparation with 7 days duration; low-residues and insoluble fiber diet, supplemented with 400 mL of hyperproteic polymeric formula with no lactose or fiber, bowel cleansing 2 days prior to surgery and hydration with water, sugared infusions, and vegetable broth. Phase II: immediate post-surgical period with watery diet for 3 days with polymeric diet with no fiber. Phase III: semi-solid diet with no residues, nutritional formula and progressive reintroduction of food intake in four stages of varying duration according to surgery and digestive tolerance.

SETTING AND PATIENTS

prospective study performed at our hospital with patients from our influence area, from February 2003 to May 2004, including 25 patients, 19 men and 6 women, with mean age of 63.3 years (range = 33-79) and mean body mass index of 26.25 kg/m2 (range = 20.84-31.3), all of them suffering from colorectal pathology susceptible of laparoscopy-assisted surgery, and to which the study protocol was applied. Fourteen left hemicolectomies, 5 right hemicolectomies, 4 low anterior resections with protective colostomy, and subtotal colectomies and lateral ileostomy were done. Final diagnoses were: 3 diverticular diseases; 3 adenomas; 7 rectosigmoidal neoplasms; and 12 large bowel neoplasms in other locations. The pathology study confirmed: pT3N0 (n = 7), pT3N1 (n = 3), pT3N2 (n = 1), and pT3N1M1 (n = 1), pT1N0 (n = 4), pT1N1 (n = 2), pTis (n = 1). Twelve patients were started on adjuvant therapy of which 3 had received an initial treatment with QT or RT.

RESULTS

Intestinal cleansing was poorly effective in 3 patients diagnosed with sub-occlusive neoplasm. Feeding was started within 24 hours in 13 patients, within 48 h in 7 patients, and at day 5 in one patient because of paralytic ileus. Hospital discharge was within the 3d-5th day in 60% of the patient, between 6th-10th day in 28%, and in 12% it occurred more than 20 days later due to complications. Progressive regimens were well tolerated by all patients, with no occurrence of diarrhea syndrome, the number of defecations varying from 2 to 4 and with a soft-normal consistency. In ponderal evolution, it is remarkable disease-related weight loss greater than 5% in 8 patients. By the end of the progressive diet, 5 patients had weight loss greater than 10% (4 for adjuvant therapy, 1 for depressive syndrome because of carrying a stoma). These patients were monitored 3 months later and they had recovered their regular weight.

CONCLUSIONS

Early nutrition in colorectal surgery is possible. Following a progressive feeding regimen allows for a better digestive tolerance as well as a good physical and functional recovery of the patient.

[Quality of the home parenteral nutrition program: 14 years of experience at a general university hospital]

The quality of home parenteral nutrition (NPD in its Spanish acronym) depends on the frequency and type of complication associated with NPD treatment and the likelihood of survival. The present study assesses the quality of the NPD programme in place in our hospital in terms of survival, infections and mechanical complications. A retrospective study was carried out into the clinical follow-up data of all the patients (n = 24) included in our NPD programme since its start in 1985 until 1998 (14 years). An estimate is made for: a) the annual index of infectious complications (IAC in its Spanish acronym), b) the annual index of mechanical complications (MAC in its Spanish acronym) and c) the likelihood of survival by means of the Kaplan-Meier method. The quality specifications adopted are those of the literature reflecting the current provision of NPD programmes and the survival values of patients undergoing dialysis for chronic kidney failure. The most frequent pathology in our context is benign (70.8%), distributed as follows: small bowel syndrome of ischaemic origin (45.8%), small bowel syndrome of non-ischaemic origin (12.5%) and idiopathic intestinal pseudo-obstruction (12.5%). The patients with benign pathologies present a higher survival rate than patients with neoplastic disease (95% in the fifth year of treatment versus 45% at twenty months), with a statistically significant difference. The annual index of infectious complications is 0.6 (median value of the 14 years studied). Similarly, the annual indices of obstructions and thromboses are 0.11 and 0.0095, respectively. In our opinion, the quality of the NPD programme in place at our hospital is highly satisfactory because both the survival rate and the annual indices of mechanical and infectious complications are acceptable with regard to the programmes in place in the international sphere. In addition, in terms of survival, NPD seems slightly more effective than dialysis for chronic kidney disease.