Proceso de Atención Nutricional: Elementos para su implementación y uso por los profesionales de la Nutrición y la Dietética

Introduction: The Nutrition Care Process (NCP) and NCP Terminology (NCPT) provides a performance protocol that allows encouraging critical thinking, promoting evidence-based professional practice, documenting it, measuring outcomes and evaluating the quality of nutritional care. Objective: To increase awareness of using NCP and NCPT, its basic elements, application in nutritional care in professionals of Nutrition and Dietetics and evaluating its international implementation.Material and methods: A review of the published works about NCP and NCPT in English and Spanish. Search terms: Nutrition Care Process, Dietetic Care Process, Standardized Terminology, Proceso/Plan de Atención/Cuidado Nutricional/Dietético and TE. It was not limited by date of publication and those articles with low scientific evidence or with changes from the original model were excluded.Results: The NCP provides a holistic approach and contributes to improving the quality of nutritional care, the exchange information and nutritional follow-up. The implementation of the NCP improves the productivity of those professionals, who are using it, and furthermore, promotes and strengthens the functions of the Nutrition professional in clinical-community healthcare settings.Conclusions: NCP and NCPT are internationally recognized tools to promote the professional practice in the clinical-community setting and nutritional research, emphasizing the requirement to include it in the academic curriculum and the professional practice of Nutrition and Dietetics.Introducción: El Proceso de Atención Nutricional (PAN) y la Terminología Estandarizada (TE) proporcionan un protocolo de actuación que permite fomentar el pensamiento crítico, estructurar y documentar el cuidado dietético-nutricional basado en la evidencia científica, medir los resultados y evaluar la calidad de la atención nutricional. Objetivo: Dar a conocer a los profesionales de la Nutrición y la Dietética el PAN y la TE, sus elementos básicos y su aplicación en la atención nutricional, evaluando su implementación internacional.Material y métodos: Revisión de los trabajos publicados del PAN y la TE en inglés y castellano. Términos de búsqueda: Nutrition Care Process, Dietetic Care Process, Standardized Terminology, Proceso/Plan de Atención/Cuidado Nutricional/Dietético y TE. La búsqueda no se limitó por año de publicación, excluyéndose los artículos publicados con baja evidencia científica o con cambios respecto al modelo original.Resultados: El PAN aporta un enfoque holístico y contribuye a mejorar la calidad asistencial, el intercambio de información y el seguimiento nutricional. La implementación del PAN mejora la productividad profesional y promueve y fortalece aún más las funciones del profesional de la Nutrición y la Dietética en la práctica sanitaria-comunitaria.Conclusiones: El PAN y la TE son reconocidos internacionalmente como herramientas necesarias para promover la atención y cuidado nutricional en clínica, salud pública e investigación nutricional, subrayando la necesidad de incluirlo en el currículo académico y en la práctica profesional de la Nutrición y la Dietética

Evaluación del índice de masa corporal con factores clínicos-nutricionales en ancianos institucionalizados sin deterioro cognitivo

Introduction: Overweight and obesity are recognized mortality risk factors in the general population. The aim of the study was to analyse the phenotypic distribution of body mass index (BMI), and to identify the prevalence of malnutrition and clinical and nutritional factors related to BMI in autonomous institutionalized elders.Material and Methods: Cross-sectional and descriptive study in 104 institutionalized aged people (73% female, mean of age 86.4 [±6.2] years and time on institutionalization 25.7 [±21.7] months). Mini-Nutritional Assessment (MNA), anthropometric measures and laboratory parameters were used for nutritional assessment. Bioimpedance analysis (BIA-101; RJL-System) was used for body composition analysis. The sample was classified into BMI tertiles (Tn): T1=<26.2kg/m2; T2=26.3-29.7kg/m2; and T3=≥29.8kg/m2.Results: The phenotypic distribution of BMI was: overweight 51% and, prevalence of obesity 29.8%. Mean of BMI: 28.3 (±4.6) kg/m2. Nutritional risk or malnutrition were 60.6% and 11.5%, respectively in the sample. The tertiles of BMI showed significant differences with: mid-arm muscle circumference, triceps-skinfold thickness, total body water (TBW) (all, p<0.001). Subjects into T1 had significantly higher nutritional risk or malnutrition compared with T2 and T3 counterparts (p=0.015). Waist-circumference, calf-circumference (at least, p<0.01), and TBW (p<0.001) were independent predictors of BMI in the linear regression analysis (R2=0.52).Conclusions: Overweight and obesity measured by BMI is not an exclusion criterion of malnutrition in the geriatric population. Nutritional screening by MNA and the conjoint use of clinical-nutritional parameters are useful for identifying at nutritional risk or malnutrition. Further studies are needed to define the potential nutritional risk factors associated with BMI in autonomous institutionalized aged.Introducción: El sobrepeso y la obesidad son reconocidos factores de riesgo de mortalidad en la población general. El objetivo del estudio fue analizar la distribución fenotípica del índice de masa corporal (IMC), e identificar la prevalencia de desnutrición y los factores clínico-nutricionales relacionados con el IMC en ancianos autónomos institucionalizados.Material y Métodos: Estudio descriptivo transversal en 104 adultos mayores institucionalizados (73% mujeres, edad media 86,4 [±6,2] años, tiempo de institucionalización 25,7 [±21,7] meses). Valoración nutricional mediante Mini-Nutritional Assessment (MNA), parámetros antropométricos y analíticos. Análisis de composición corporal por bioimpedancia eléctrica (BIA101; RJL-System). La muestra se clasificó según el IMC en terciles (Tn): T1=<26,2kg/m2; T2=26,3-29,7kg/m2; y T3=≥29,8kg/m2.Resultados: Distribución fenotípica del IMC: sobrepeso 51% y, prevalencia de obesidad 29,8%. Media del IMC: 28,3 (±4,6) kg/m2. El riesgo nutricional o desnutrición fue 60,6% y 11,5%, respectivamente en la muestra. Los terciles del IMC mostraron diferencias significativas con la circunferencia muscular braquial, pliegue tricipital y, agua corporal total (ACT) (todos, p<0,001). En el T1, se observó mayor riesgo nutricional o desnutrición comparado con T2 y T3 (p=0,015). El perímetro de la cintura, circunferencia de la pantorrilla (p<0,01), y el ACT (p<0,001), fueron predictores independientes del IMC en el modelo de regresión lineal (R2=0,52).Conclusiones: El sobrepeso o la obesidad medido por el IMC, no es un criterio excluyente de desnutrición en la población geriátrica. El cribaje nutricional mediante el MNA y la utilización conjunta de parámetros clínico-nutricionales, permiten identificar el riesgo nutricional y la desnutrición. Nuevos estudios son necesarios para definir los factores potenciales de riesgo nutricional asociados con el IMC en ancianos autónomos institucionalizados

Clinical evaluation of an evidence-based method based on food characteristics to adjust pancreatic enzyme supplements dose in cystic fibrosis

[EN] Background: Patients with cystic fibrosis (CF) and pancreatic insufficiency need pancreatic enzyme replacement therapy (PERT) for dietary lipids digestion. There is limited evidence for recommending the adequate PERT dose for every meal, and controlling steatorrhea remains a challenge. This study aimed to evaluate a new PERT dosing method supported by a self-management mobile-app. Methods: Children with CF recruited from 6 European centres were instructed to use the app, including an algorithm for optimal PERT dosing based on in vitro digestion studies for every type of food. At base-line, a 24h self-selected diet was registered in the app, and usual PERT doses were taken by the patient. After 1 month, the same diet was followed, but PERT doses were indicated by the app. Change in faecal fat and coefficient of fat absorption (CFA) were determined. Results: 58 patients (median age 8.1 years) participated. Baseline fat absorption was high: median CFA 96.9%, median 2.4g faecal fat). After intervention CFA did not significantly change, but range of PERT doses was reduced: interquartile ranges narrowing from 1447-3070 at baseline to 1783-2495 LU/g fat when using the app. Patients with a low baseline fat absorption (CFA<90%, n= 12) experienced significant improvement in CFA after adhering to the recommended PERT dose (from 86.3 to 94.0%, p=0.031). Conclusion: the use of a novel evidence-based PERT dosing method, based on in vitro fat digestion studies incorporating food characteristics, was effective in increasing CFA in patients with poor baseline fat absorption and could safely be implemented in clinical practice.We acknowledge the support of the MyCyFAPP Project consortium. We especially thank the participation and the effort of the patients involved in the study and their families. This work was fully funded by the European Union and the Horizon 2020 Research and Innovation Framework Programme (PHC-26-2014 call Self management of health and disease: citizen engagement and mHealth) under grant number 643806.Calvo-Lerma, J.; Boon, M.; Colombo, C.; De Koning, B.; Asseiceira, I.; Garriga, M.; Roca, M.... (2021). Clinical evaluation of an evidence-based method based on food characteristics to adjust pancreatic enzyme supplements dose in cystic fibrosis. Journal of Cystic Fibrosis. 20(5):e33-e39. https://doi.org/10.1016/j.jcf.2020.11.016Se33e3920

Assessing gastro-intestinal related quality of life in cystic fibrosis: Validation of PedsQL GI in children and their parents

Background: Most patients with cystic fibrosis (CF) suffer from pancreatic insufficiency, leading to fat malabsorption, malnutrition and abdominal discomfort. Until recently, no specific tool was available for assessing gastro-intestinal related quality of life (GI QOL) in patients with CF. As the Horizon2020 project MyCyFAPP aims to improve GI QOL by using a newly designed mobile application, a sensitive and reliable outcome measure was needed. We aimed to study the applicability of the existing child-specific Pediatric Quality of Life Inventory, Gastrointestinal Symptoms Scales and Module (PedsQL GI) in children with CF. Methods: A multicenter, prospective observational study was performed in 6 European centers to validate the PedsQL GI in children with CF during 3 months. Results: In total, 248 children and their parents were included. Within-patient variability of PedsQL GI was low (24.11), and there was reasonable agreement between children and parents (ICC 0.681). Nine of 14 subscales were informative (no ceiling effect). The PedsQL GI and the median scores for 4 subscales were significantly lower in patients compared to healthy controls. Positive associations were found between PedsQL GI and age (OR = 1.044, p = 0.004) and between PedsQL GI and BMI z-score (OR = 1.127, p = 0.036). PedsQL GI correlated with most CFQ-R subscales (r 0.268 to 0.623) and with a Visual Analogue Scale (r = 0.20). Conclusions: PedsQL GI is a valid and applicable instrument to assess GI QOL in children with CF. Future research efforts should examine the responsiveness of the CF PedsQL GI to change in the context of clinical interventions and trials

Educación ambiental y sociedad. Saberes locales para el desarrollo y la sustentabilidad

EL LIBRO PERMITE REFLEXIONAR SOBRE LA IMPORTANCIA DE FOMENTAL LA EDUCACIÓN AMBIENTAL PARA RESOLVER LA PROBLEMÁTICA AMBIENTALEL LIBRO PRESENTA DIFERENTES TRABAJOS QUE ESTUDIAN EL TEMA D ELA SUSTENTABILIDAD, ENFATIZANDO LA IMPORTANCIA DE LA EDUCACIÓN AMBIENTAL Y LA TRANSDISCIPLINANINGUN

EDUCACIÓN AMBIENTAL Y SOCIEDAD. SABERES LOCALES PARA EL DESARROLLO Y LA SUSTENTABILIDAD

Este texto contribuye al análisis científico de varias áreas del conocimiento como la filosofía social, la patología, la educación para el cuidado del medio ambiente y la sustentabilidad que inciden en diversas unidades de aprendizaje de la Licenciatura en Educación para la Salud y de la Maestría en Sociología de la SaludLas comunidades indígenas de la sierra norte de Oaxaca México, habitan un territorio extenso de biodiversidad. Sin que sea una área protegida y sustentable, la propia naturaleza de la región ofrece a sus visitantes la riqueza de la vegetación caracterizada por sus especies endémicas que componen un paisaje de suma belleza

The Extracellular Mass to Body Cell Mass Ratio as a Predictor of Mortality Risk in Hemodialysis Patients

The extracellular mass/body cell mass ratio (ECM/BCM ratio) is a novel indicator of nutritional and hydration status in hemodialysis (HD) patients. This study aimed to explore the ECM/BCM ratio as a predictor of mortality risk with nutritional-inflammatory markers in HD patients. A prospective observational study was conducted in 90 HD patients (male: 52.2%; DM: 25.60%). Clinical and biochemical parameters [serum albumin, serum C-reactive protein (s-CRP), interleukine-6 (IL-6)] were analysed and bioelectrical impedance analysis (BIA) was performed. Protein-energy wasting syndrome (PEW) was diagnosed using malnutrition-inflammation score (MIS). Based on BIA-derived measurements, the ECM/BCM ratio with a cut-off point of 1.20 was used as a PEW-fluid overload indicator. Comorbidity by Charlson index and hospital admissions were measured. Out of 90 HD patients followed up for 36 months, 20 patients (22.22%) died. PEW was observed in 24 survivors (34.28%) and all non-survivors. The ECM/BCM ratio was directly correlated with MIS, s-CRP, Charlson index and hospital admissions but was negatively correlated with phase angle and s-albumin (all, p &lt; 0.001). Values of the ECM/BCM ratio &ge; 1.20 were associated with higher probability of all-cause mortality (p = 0.002). The ECM/BCM ratio &ge; 1.20, IL-6 &ge; 3.1 pg/mL, s-CRP and s-albumin &ge; 3.8 g/dL and Charlson index were significantly associated with all-cause mortality risk in multivariate adjusted analysis. This study demonstrates that the ECM/BCM ratio &ge; 1.20 as a nutritional marker and/or fluid overload indicator had a significant prognostic value of death risk in HD patients