Oligomeric enteral nutrition in undernutrition, due to oncology treatment-related diarrhea. Systematic review and proposal of an algorithm of action

Oncology treatment-related diarrhea and malnutrition appear together in oncological patients because of the disease itself, or the treatments that are administered for it. Therefore it is essential to carry out a nutritional treatment. Enteral nutrition formulas, containing peptides and medium chain triglycerides, can facilitate absorption in cases of malabsorption. There are few references to the use of enteral nutrition in the clinical society guidelines of patient management with oncology treatment-related diarrhea (OTRD). A bibliographic review of the studies with oligomeric enteral nutrition in OTRD found only nine studies with chemotherapy (all with the same oligomeric formula in which oral mucositis improves, while the rest of the outcomes show different results), and eight studies with radiotherapy (with different products and very heterogeneous results). We hereby present our action algorithm to supplement the diet of OTRD patients with an oligomeric enteral nutrition formula. The first step is the nutritional assessment, followed by the assessment of the functional capacity of the patient’s intestine. With these two aspects evaluated, the therapeutic possibilities available vary in degrees of complexity: These will range from the usual dietary recommendations, to supplementation with oral oligomeric enteral nutrition, along with complete enteral nutrition with oligomeric formula, and up to potentially total parenteral nutrition

A comparison of effects induced on urinary calcium by thiazides and different doses of salt in the diet: Implications in clinical practice

Introduction: Both dietary restriction of sodium chloride (NaCl) and treatment with thiazides have been used in hypercalciuric patients. Objectives: To calculate regular salt intake and investigate the correlation between natriuresis and urinary calcium with usual diet (B) and after changing the amount of NaCl intake and administration of thiazides. Material and methods: Nineteen healthy young individuals had their diet replaced by 2 l of Nutrison® Low Sodium (500 mg sodium/day) daily for two days. Then, 5 g of NaCl were added every two days (“5”, “10” and “15”), administering 50 mg (H50) and 100 mg (H100) of Higroton® on the last two days. Blood sodium, plasma renin activity (PRA) and aldosterone were determined in venous blood samples, as were urinary sodium and calcium. Statistical analysis: Wilcoxon t-test and the Pearson linear correlation were calculated. Results: Urinary Na (mEq/24 h): 210.3 ± 87.6 (“B”); 42.7 ± 20.4 (“5”); 135.5 ± 50.6 (“10”); 225.5 ± 56.7 (“15”). Urinary calcium (mg/24 h): 207.8 ± 93.6 (“B”); 172.8 ± 63.1 (“5”); 206.2 ± 87.7 (“10”); 227.4 ± 84.1 (“15”). A positive correlation was observed between natriuresis and urinary calcium in “10” (r = 0.47) and “15” (r = 0.67). After Higroton®, natriuresis: 232.3 ± 50.7; 377 ± 4 (H50); 341.1 ± 68.4 (H100); Ca in urine: 209.8 ± 57.4; 213.2 ± 67.6 (H50); 159.1 ± 52.2 (H100). Conclusions: Salt intake in the population studied was estimated to be 14.9 ± 4.9 g/day with a positive correlation found between sodium and calcium urine output with daily intakes of 11.25 and 16.25 g of salt. With the usual intake, for each gram of salt, urinary calcium increased by 5.46 mg/24 h and with 100 mg of Higroton® it decreased by 50.7 mg/24 h. These data could be useful for the management of patients with excretory hypercalciuria or hypoparathyroidism. Resumen: Introducción: La restricción de ClNa en la dieta y el tratamiento con tiazidas han sido utilizados en pacientes hipercalciúricos. Objetivos: Conocer la ingesta habitual de sal y la correlación entre natriuria y calciuria con la dieta habitual (B) y tras la modificación de la cantidad de ClNa y la administración de tiazidas. Material y métodos: Diecinueve jóvenes sanos, a los que se les sustituyó su dieta por 2 l diarios de Nutrison® Low Sodium (500 mg de Na) durante 2 días. Posteriormente se añadieron cada 2 días 5 g de ClNa («5», «10» y «15») y durante los 2 últimos días 50 y 100 mg de Higrotona® (H50) y (H100). Se determinaron iones, ARP y aldosterona en sangre venosa, así como la natriuria y calciuria. Valoración estadística: se calcula la t de Wilcoxon y la correlación lineal de Pearson. Resultados: Natriuria (mEq/24 h): 210,3 ± 87,6 («B»); 42,7 ± 20,4 («5»); 135,5 ± 50,6 («10»); 225,5 ± 56,7 («15»). Calciuria (mg/24 h): 207,8 ± 93,6 («B»); 172,8 ± 63,1 («5»); 206,2 ± 87,7 («10»); 227,4 ± 84,1 («15»). Correlación positiva entre natriuria y calciuria en «10» (r = 0,47) y en «15» (r = 0,67). Tras Higrotona®, natriuria: 232,3 ± 50,7; 377 ± 4 (H50); 341,1 ± 68,4 (H100); Ca en orina: 209,8 ± 57,4; 213,2 ± 67,6 (H50); 159,1 ± 52,2 (H100). Conclusiones: La ingesta de sal en la población estudiada es de 14,9 ± 4,9 g/día. Encontramos correlación entre natriuria y calciuria con ingestas de 11,25 y 16,25 g de sal. Con la ingesta habitual, por cada gramo de sal aumenta la calciuria 5,46 mg y con 100 mg de Higrotona®, la calciuria disminuye 50,7 mg/24 h. Los datos podrían ser de utilidad para el manejo de pacientes con hipercalciuria excretora o hipoparatiroidismo. Keywords: Sodium-restricted diet, Calcium, Diuretics, Hypercalciuria, Thiazides, Palabras clave: Dieta hiposódica, Calcio, Diuréticos, Hipercalciuria, Tiazida