Diseño y valoración del nivel de aceptación de la guía de lectura de etiquetado nutricional en pacientes con enfermedades crónicas no transmisibles que asisten a un centro privado, diciembre 2011- enero 2012

La etiqueta nutricional se establece en los productos procesados, aproximadamente desde 1990, debido principalmente a la necesidad que tenían las personas, por estar al tanto de lo que están consumiendo. La etiqueta nutricional, también denominada información nutricional, detalla propiedades y mensajes nutricionales que dan cuenta de la composición del producto. Por otro lado, es de conocimiento general el crecimiento acelerado que tienen las ECNT (enfermedades crónicas no transmisibles), a nivel mundial, entre las que se incluyen a la diabetes tipo 2, hipertensión arterial y obesidad, que se hallan relacionados, entre factores, con los inadecuados hábitos de alimentación y el sedentarismo. Debido al incremento de la oferta de alimentos procesados se consideró importante desarrollar material informativo a través de una Guía de lectura de etiquetas nutricionales, que permita a los pacientes portadores de ECNT crear una óptima selección y compra de alimentos procesados. Para establecer el grado de aceptación de la Guía, se midió el nivel de aceptación con 120 pacientes (diabéticos, hipertensos, dislipidemicos, obesos), mediante una encuesta personal, lo que le permitió evaluar los elementos de la Guía y sobre la base de las sugerencias, para establecer la Guía definitiva. La Guía brinda al lector, los elementos de la información nutricional a tomar en cuenta para la adecuada selección y compra de productos procesados y recomendaciones generales. En diabetes se señaló a las calorías, carbohidratos y azúcares, en hipertensión arterial al sodio, en dislipidemias a la grasa total, grasa saturada..

Comparison of fatty acid profiles of dried and raw by products from cultured and wild fishes

Fish by-products may become alternative sources of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). However, due to the high enzymatic activity in these biological tissues, special care must be taken to prevent lipid oxidation and hydrolysis. In this work, several by-products from Chilean fishes (farmed salmon and wild red cusk-eel and yellowtail kingfish) were dried at 105 degrees C for 3h to remove water and inactivate enzymes. The effect of temperature on EPA and DHA levels was assessed by comparing fatty acid profiles of raw and dried by-products. Drying at 105 degrees C for 3h was considered an adequate process to obtain dried powders from fish by-products with appreciable amounts of EPA and DHA, even though EPA and DHA values showed a certain decrease after drying. Several methodologies involving food-grade solvents were checked to evaluate their suitability for lipid extraction from dried by-products, being Soxhlet extraction with n-hexane identified as the most suitable process in terms of extraction yield and EPA/DHA values. Cholesterol amount was also studied, being the highest and lowest amounts found in liver and viscera from farmed salmon, respectively. Practical applications: In fish processing plants, raw by-products are collected after fish evisceration, and they can be transported to oil extraction facilities, although their lipids may be easily degraded unless special precautions are taken to preserve such biomass. Raw fish by-products must be subjected to water removal and enzyme inactivation to prevent lipid degradation and hydrolysis, and it is desirable that such actions are carried out in the processing plants themselves to ensure the maximum oil quality. Drying at 105 degrees C for a short time (3h) was assayed in this work because of its simplicity, low cost, scalability, and feasibility to be installed in fish processing plants. Soxhlet procedure with n-hexane is effective to extract lipids containing EPA and DHA from dried by-products for nutritional or nutraceutical purposes. Because of water removal, lipid extraction efficiency from dried by- products is enhanced and less solvent is needed, which is economically and environmentally desirable. Raw by-products from cultured and wild fishes are dried at 105 degrees C for 3h and fatty acid profiles are compared between raw and dried by-products to assess the potential decreasing effect of temperature on the levels of polyunsaturated fatty acids, especially EPA and DHA. Different lipid extractions using solvents are also compared to check their influence on fatty acid profiles. Additionally, cholesterol amount is quantified in the lipid fraction extracted from dried fish by-products.University of Chile UI008/1

Stoma-free Survival After Rectal Cancer Resection With Anastomotic Leakage: Development and Validation of a Prediction Model in a Large International Cohort.

Objective:To develop and validate a prediction model (STOMA score) for 1-year stoma-free survival in patients with rectal cancer (RC) with anastomotic leakage (AL).Background:AL after RC resection often results in a permanent stoma.Methods:This international retrospective cohort study (TENTACLE-Rectum) encompassed 216 participating centres and included patients who developed AL after RC surgery between 2014 and 2018. Clinically relevant predictors for 1-year stoma-free survival were included in uni and multivariable logistic regression models. The STOMA score was developed and internally validated in a cohort of patients operated between 2014 and 2017, with subsequent temporal validation in a 2018 cohort. The discriminative power and calibration of the models' performance were evaluated.Results:This study included 2499 patients with AL, 1954 in the development cohort and 545 in the validation cohort. Baseline characteristics were comparable. One-year stoma-free survival was 45.0% in the development cohort and 43.7% in the validation cohort. The following predictors were included in the STOMA score: sex, age, American Society of Anestesiologist classification, body mass index, clinical M-disease, neoadjuvant therapy, abdominal and transanal approach, primary defunctioning stoma, multivisceral resection, clinical setting in which AL was diagnosed, postoperative day of AL diagnosis, abdominal contamination, anastomotic defect circumference, bowel wall ischemia, anastomotic fistula, retraction, and reactivation leakage. The STOMA score showed good discrimination and calibration (c-index: 0.71, 95% CI: 0.66-0.76).Conclusions:The STOMA score consists of 18 clinically relevant factors and estimates the individual risk for 1-year stoma-free survival in patients with AL after RC surgery, which may improve patient counseling and give guidance when analyzing the efficacy of different treatment strategies in future studies

Stoma-free survival after anastomotic leak following rectal cancer resection: worldwide cohort of 2470 patients

Background: The optimal treatment of anastomotic leak after rectal cancer resection is unclear. This worldwide cohort study aimed to provide an overview of four treatment strategies applied. Methods: Patients from 216 centres and 45 countries with anastomotic leak after rectal cancer resection between 2014 and 2018 were included. Treatment was categorized as salvage surgery, faecal diversion with passive or active (vacuum) drainage, and no primary/secondary faecal diversion. The primary outcome was 1-year stoma-free survival. In addition, passive and active drainage were compared using propensity score matching (2: 1). Results: Of 2470 evaluable patients, 388 (16.0 per cent) underwent salvage surgery, 1524 (62.0 per cent) passive drainage, 278 (11.0 per cent) active drainage, and 280 (11.0 per cent) had no faecal diversion. One-year stoma-free survival rates were 13.7, 48.3, 48.2, and 65.4 per cent respectively. Propensity score matching resulted in 556 patients with passive and 278 with active drainage. There was no statistically significant difference between these groups in 1-year stoma-free survival (OR 0.95, 95 per cent c.i. 0.66 to 1.33), with a risk difference of -1.1 (95 per cent c.i. -9.0 to 7.0) per cent. After active drainage, more patients required secondary salvage surgery (OR 2.32, 1.49 to 3.59), prolonged hospital admission (an additional 6 (95 per cent c.i. 2 to 10) days), and ICU admission (OR 1.41, 1.02 to 1.94). Mean duration of leak healing did not differ significantly (an additional 12 (-28 to 52) days). Conclusion: Primary salvage surgery or omission of faecal diversion likely correspond to the most severe and least severe leaks respectively. In patients with diverted leaks, stoma-free survival did not differ statistically between passive and active drainage, although the increased risk of secondary salvage surgery and ICU admission suggests residual confounding