Estudio aleatorio de dos emulsiones grasas diferentes en la nutrición parenteral total del enfermo quirúrgico desnutrido: efecto sobre la morbilidad infecciosa y la mortalidad Randomized study of two different fat emulsions in total parenteral nutrition of malnourished surgical patients: effect on infectious morbidity and mortality

Objetivo: Las infusiones lipídicas de una mezcla física de triglicéridos de cadena media/triglicéridos de cadena larga (MCT/LCT), utilizadas en la nutrición parenteral total (NPT) peroperatoria, tienen menos efecto inmunosupresor en estudios de laboratorio que las emulsiones que contienen únicamente triglicéridos de cadena larga (LCT). El objetivo de este estudio fue comparar la incidencia de infecciones nosocomiales y la mortalidad hospitalaria de los pacientes quirúrgicos severamente desnutridos, tratados con NPT con una emulsión lipídica de MCT/LCT, o con una mezcla LCT, administradas de forma aleatoria y a doble ciego. Pacientes y métodos: Se reclutaron de forma prospectiva 72 pacientes severamente desnutridos sometidos a una laparotomía programada o urgente, estratificados por la presencia o ausencia de cáncer, e ingresados en los Servicios de Cirugía General y Medicina Intensiva de un hospital universitario. El desenlace principal fue la incidencia de infección nosocomial intrahospitalaria y el desenlace secundario fue la mortalidad. Resultados: Los pacientes del grupo de estudio (MCT/LCT) y el grupo control (LCT) tenían características similares. Los pacientes del grupo de MCT/LCT tuvieron una menor incidencia de abscesos intraabdominales (2/26) que el grupo LCT (10/31) de forma significativa (p Goal: Lipid infusions of a physical mixture of medium- chain triglycerides and long-chain triglycerides (MCT/LCT) used in peri-operative total parenteral nutrition (TPN) have a lower immunosuppressive effect in laboratory studies than emulsions containing only longchain triglycerides (LCT). The purpose of the present study was to compare the incidence of nosocomial infections and the in-hospital mortality of severely undernourished surgical patients treated with TPN using an MCT/LCT lipid emulsion or with an LCT mixture, administered under a randomized, double blind protocol. Patients and methods: A total of 72 severely undernourished patients subjected to planned or emergency laparotomy were prospectively recruited and stratified by the presence or absence of cancer, on admission to the departments of General Surgery and Intensive Care Medicine at a teaching hospital. The main outcome was the incidence of intra-hospital nosocomial infection and the secondary outcome was mortality. Results: The patients in the study group (MCT/LCT) and the control group (LCT) shared similar characteristics. The patients in the MCT/LCT group had a significantly lower incidence of intra- abdominal abscesses (2/26) than those in the LCT group (10/31) (p < 0.05; RR 0.18; CI 95%; 0.03-0.89). There were no significant differences in the incidence of other infections. Nor was there a difference between the two groups in terms of the intrahospital mortality (4/26 versus 11/31). In the stratified analysis, patients without cancer treated with MCT/LCT presented significantly fewer intra-abdominal abscesses (2/14) than those with LCT (5/8) (p < 0.05; RR 0.1; CI 95%; 0.01-0.79) and a significantly lower mortality (2/14 versus 5/8; p < 0.05; RR 0.1; CI 95%; 0.01-0.79). Conclusions: Lipid infusions of MCT/LCT used in perioperative TPN protect severely undernourished sur- gical patients against the onset of intra-abdominal abscesses when compared with LCT infusions. Patients without cancer may obtain more benefit from the use of these mixtures

Aspetti radiografici delle localizzazioni metastatiche al piede

The authors present the radiographical features in 8 cases with metastatic tumors to the foot bones. Seven of them have been histologically confirmed. In 4 cases the tumor was monostotic and mainly osteolytic. In the other 4 the neoplasia, having osteolytic or osteoblastic appearance, involved multiple contiguous bone

Intake and home use of olive oil or mixed oils in relation to healthy lifestyles in a Mediterranean population. Findings from the prospective Pizarra study

Discordances exist in epidemiological studies regarding the association between the intake of nutrients and death and disease. We evaluated the social and health profile of persons who consumed olive oil in a prospective population cohort investigation (Pizarra study) with a 6-year follow-up. A food frequency questionnaire and a 7d quantitative questionnaire were administered to 538 persons. The type of oil used in food preparation was determined by direct measurement of the fatty acids in samples obtained from the kitchens of the participants at baseline and after follow-up for 6 years. The fatty acid composition of the serum phospholipids was used as an endogenous marker of the type of oil consumed. Total fat intake accounted for a mean 40% of the energy (at baseline and after follow-up). The concordance in intake of MUFA over the study period was high. The fatty acid composition of the serum phospholipids was significantly associated with the type of oil consumed and with fish intake. The concentration of polar compounds and polymers, indicative of degradation, was greater in oils from the kitchens where sunflower oil or refined olive oil was used, in oils used for deep frying and in oils that had been reused for frying five times or more. Consumption of olive oil was directly associated with educational level. Part of the discordance found in epidemiological studies between diet and health may be due to the handling of oils during food preparation. The intake of olive oil is associated with other healthy habits. © 2009 The Authors.The present study was supported by Fondo de Investigación Sanitaria (PI041883, PI051307), Junta de Andalucía (0124/2005, P06-CTS-01 684) and Fundación Centro de Excelencia en Investigación sobre Aceite de oliva y Salud (CEAS). CIBERDEM and CIBEROBN are initiatives of Instituto de Salud Carlos III, Spain.Peer Reviewe

Oleic acid from cooking oils is associated with lower insulin resistance in the general population (Pizarra study)

[Aim]: To evaluate the relation between type of dietary fatty acid and degree of insulin resistance. Design: A cross-sectional study. [Methods]: Anthropometrical data were measured in 538 subjects, aged 18-65 years, selected randomly from the municipal census of Pizarra (Spain). An oral glucose tolerance test (OGTT) was given to all subjects and measurements were made of glycemia, insulinemia and the proportion of fatty acids in plasma phospholipids. Insulin resistance (IR) was estimated by homeostasis model assessment. Samples of cooking oil being used were obtained from the kitchens. The strength of association between variables was measured by calculating the odds ratio (OR) from logistic models, and the relationships were measured by linear correlation coefficients. [Results]: Insulin resistance was significantly less in people who used olive oil compared with those who used sunflower oil or a mixture. Statistical significance remained in the group of people with normal OGTT after adjusting for obesity. In the whole sample, IR correlated negatively with the concentration of oleic acid (r = -0.11; P = 0.02) and positively with that of linoleic acid (r = 0.10; P = 0.02) from the cooking oil. In subjects with normal OGTT, IR correlated negatively with oleic acid from cooking oil (r = -0.17; P = 0.004) and from plasma phospholipids (r = -0.11; P = 0.01) and positively with the concentration of linoleic acid in cooking oil (r = 0.18; P = 0.004) and plasma phospholipids (r = 0.12; P = 0.005). The risk (OR) of having raised IR was significantly lower in people who consumed olive oil, either alone (OR = 0.50) or mixed (OR = 0.52) compared with those who consumed only sunflower oil. [Conclusion]: There is an association between the intake of oleic acid, the composition of oleic acid in plasma phospholipids and peripheral insulin action.This work was supported by grants from the Fondo de Investigación Sanitaria of the Instituto de Salud Carlos III (98/0475 and Red de Centros RCMN C03/08), Junta de Andalucía (6/98), Fondo Europeo de Desarrollo Regional (IFD97/0718) and Asociación Maimónides