Evaluación nutricional del paciente con cáncer Nutritional assessment for cancer patient

La pérdida de peso y la desnutrición es frecuente en pacientes oncológicos, siendo ambas origen de complicaciones durante el transcurso de la enfermedad. Aunque la reducción de peso se debe predominantemente a la pérdida de masa grasa, el riesgo morbimortalidad está dado por la disminución de masa muscular. Las causas de desnutrición son múltiples, sin embargo la caquexia tumoral y la anorexia son las principales. La evaluación del estado nutricional es fundamental para un diagnóstico del compromiso nutricional y para el manejo multidisciplinario que se requiere. La evaluación global subjetiva combina antecedentes clínicos con el examen físico para catalogar a los pacientes como bien nutridos, moderada o severamente desnutridos. La evaluación global subjetiva generada por el paciente incluye además síntomas nutricionales y pérdida de peso. Ambos instrumentos pueden servir como indicadores de sobrevida. En la evaluación objetiva, una baja de peso significativa (> 10%) durante 6 meses se considera indicador de déficit nutricional. El IMC por su parte no ha demostrado ser buen indicador de desnutrición. La albúmina y la prealbúmina, aunque de uso corriente, deben ser empleadas con precaución. Éstas son proteínas de fase aguda, situación que alteraría especificidad para el diagnóstico de desnutrición proteica visceral. La bioimpedanciometria, además de determinar composición corporal, se ha relacionado con tiempo de supervivencia y mortalidad. Aunque hay diversos métodos, no existe un "Gold Estándar". Los instrumentos para la evaluación nutricional deben ser escogidos según la condición del paciente.Weight loss and malnutrition is common in cancer patients, both origin of complications during the course of the disease. Although weight loss is predominantly due to loss of fat mass, the morbidity risk is given by the decrease in muscle mass. The causes of malnutrition are numerous, but the tumor cachexia and anorexia are the principals. The assessment of nutritional status is essential for a diagnosis of nutritional compromise and for the multidisciplinary management required. Subjective Global Assessment combines medical history, physical examination to classify patients as well nourished, moderately or severely malnourished. Subjective global assessment generated by the patient also includes nutritional symptoms and weight loss. Both instruments can serve as indicators of survival. The objective assessment, a significant weight loss (> 10%) for 6 months is considered an indicator of nutritional deficiency. BMI on the other hand has not proven to be a good indicator of malnutrition. Albumin and prealbumin, although widely used, should be used with caution. These are acute phase proteins, a situation that would alter specificity for diagnosis of visceral protein malnutrition. The bioelectrical impedance, in addition to determine body composition, has been linked to survival time and mortality. Although there are various methods, there is no "Gold Standard". The nutritional assessment instruments should be chosen according to the patient´s condition

Incorporación de la sustentabilidad en la formación del nutricionista de la Universidad de Chile: Experiencia piloto en la línea de técnicas culinarias.

Introduction: The Nutrition and Dietetics program of University of Chile incorporated sustainability as a value in its development plan in 2018. This considers its incorporation and implementation in management activities, connection with the community and teaching. Teaching requires a curricular redesign, currently underway, that includes it in graduation and competencies profile. While this is taking place, piloting was carried out in culinary techniques courses to assess its pedagogical and operational implications. Objectives: To assess the effectiveness of the piloting in the sustainable behavior of students who took the course. Material and Method: Adjustments were made to the course program, its methodology and physical adaptation of the laboratory. On the other hand, to evaluate the effect of these adaptations on the students, a pre and post-test was carried out to determine their behaviors in responsible waste management, water saving and efficient use of energy resources. Results: Before the courses, a high percentage of students complied with water saving behaviors (77%) and energy efficiency (97%), while 73.1% presented some type of action in responsible waste management; after passing through the subjects, no significant changes in these behaviors were evident. Despite this, this pilot allowed the installation of responsible waste management in all food handling laboratories of the training program, and the students valued it in their training, awareness and improvement of sustainable behaviors. Conclusions: Sustainability in nutritionist training appears as a necessity in the current scenario, given the strong relationship between climate change and food security, however, there is no published teaching-learning-evaluation methodology for this topic in Nutrition programs in Chile, reason why this pilot experience represents a contribution in this sense.Introducción: La carrera de Nutrición y Dietética de la Universidad de Chile incorporó el año 2018 la sustentabilidad como valor en su plan de desarrollo. Esto considera su integración en las actividades de gestión, vinculación con el medio y docencia. Para esta última se requiere un rediseño curricular, actualmente en marcha, que la incluya en el perfil de egreso y competencias. Mientras ello se concreta, se realizó un pilotaje en las asignaturas de técnicas culinarias para evaluar sus implicancias pedagógicas y operativas. Objetivos: Evaluar la eficacia del pilotaje en la conducta sustentable de los estudiantes que realizaron el curso. Material y Método: Se realizaron ajustes al programa de los cursos, su metodología y adecuación física del laboratorio. Por otra parte, para evaluar el efecto de estas adaptaciones en los estudiantes, se realizó un pre y post test que determinó sus conductas en manejo responsable de residuos, ahorro de agua y uso eficiente de recursos energéticos. Resultados: Antes de los cursos, un alto porcentaje de los estudiantes cumplía con conductas de ahorro de agua (77%) y eficiencia energética (97%), mientras que 73,1% presentaba algún tipo de acción en manejo responsable de residuos; posterior al paso por las asignaturas, no se evidenciaron cambios significativos en dichas conductas. Pese a esto, este piloto permitió instalar el manejo responsable de residuos en todos los laboratorios de manipulación de alimentos de la carrera, y los estudiantes lo valoraron en su formación, concientización y mejora de conductas sustentables. Conclusiones: La sustentabilidad en la formación del nutricionista se presenta como una necesidad en el escenario actual, dada la fuerte relación entre cambio climático y seguridad alimentaria; sin embargo, no hay publicada una metodología de enseñanza-aprendizaje-evaluación para este tema en las carreras de Nutrición en Chile, por lo que esta experiencia piloto representa un aporte en este sentido

Heme- and nonheme-iron absorption and iron status 12 mo after sleeve gastrectomy and Roux-en-Y gastric bypass in morbidly obese women

Background: The effect of bariatric surgery on iron absorption is only partially known. Objective: The objective was to study the effects of sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGBP) on heme- and nonheme-iron absorption and iron status. Design: Fifty-eight menstruating women were enrolled in this prospective study [mean (±SD) age: 35.9 ± 9.1 y; weight: 101.7 ± 13.5 kg; BMI (in kg/m2): 39.9 ± 4.4]. Anthropometric, body-composition, dietary, and hematologic indexes and heme- and nonheme-iron absorption - using a standardized meal containing 3 mg Fe - were determined before and 12 mo after surgery. Forty-three subjects completed the 12-mo follow-up. Iron supplements were strictly controlled. Results: Heme-iron absorption was 23.9% before and 6.2% 12 mo after surgery (P < 0.0001). Nonheme-iron absorption decreased from 11.1% to 4.7% (P < 0.0001). No differences were observed by type of surgery. Iron intakes from all sources of supplements were 27.9 ± 6.2 mg/d in the SG

Iron absorption and iron status are reduced after Roux-en-Y gastric bypass

Background: Iron deficiency and iron deficiency anemia are common in patients who undergo gastric bypass. The magnitude of change in iron absorption is not well known. Objective: The objective was to evaluate the effects of Roux-en-Y gastric bypass (RYGBP) on iron status and iron absorption at different stages after surgery. We hypothesized that iron absorption would be markedly impaired immediately after surgery and would not improve after such a procedure. Design: Anthropometric, body-composition, dietary, hematologic, and iron-absorption measures were determined in 67 severe and morbidly obese women [mean age: 36.9 ± 9.8 y; weight: 115.1 ± 15.6 kg, body mass index (BMI: in kg/m2); 45.2 ± 4.7] who underwent RYGBP. The Roux-en-Y loop length was 125-150 cm. Determinations were carried out before and 6, 12, and 18 mo after surgery. Fifty-one individuals completed all 4 evaluations. Results: The hemoglobin concentration decreased significantly throughout the study (repeated-measures ana

Zinc absorption and zinc status are reduced after Roux-en-Y gastric bypass: A randomized study using 2 supplements

Background: Micronutrient deficiencies are common in patients undergoing gastric bypass. The effect of this type of surgery on zinc absorption and zinc status is not well known. Objective: The objective was to evaluate the effects of Roux-en-Y gastric bypass (RYGBP) on zinc status and zinc absorption at different stages after surgery. We hypothesized that zinc status would be significantly impaired after surgery and that this impairment would be less severe in subjects receiving increased supplemental zinc. We also hypothesized that zinc absorption would be lower after surgery. Design: Anthropometric and body-composition variables and dietary and biochemical indexes of zinc status and zinc absorption were determined in 67 severe and morbidly obese women [mean (±SD) age: 36.9 ± 9.8 y; BMI (in kg/m 2): 45.2 ± 4.7] who underwent RYGBP. The subjects were randomly assigned to 1 of 2 vitamin-mineral supplementation groups. Measurements were made before and 6, 12, and 18 mo after surgery. Fi