Nutrición infantil y salud ósea

Producción CientíficaMantener un adecuado estado nutricional en todas las etapas de la vida es decisivo para lograr un metabolismo óseo que favorezca la salud. La osteoporosis se caracteriza por una alteración en la cantidad y calidad de la mineralización ósea, lo que origina una fragilidad del esqueleto con riesgo aumentado de fracturas, especialmente vertebrales y de cadera. Es un problema público a nivel mundial, que afecta a una proporción elevada de hombres y mujeres, y que se desarrolla de forma asintomática hasta que se manifiesta de forma imprevista y causa una fractura del esqueleto. Estudios en niños han demostrado que el desarrollo de osteoporosis en la edad adulta puede verse condicionada por el estado nutricional durante la infancia, especialmente en lo referente a los aportes de calcio y vitamina D. No obstante, existen aún muchas cuestiones abiertas, tanto en lo referente a su patogenia y diagnóstico como a su tratamiento; algunas de éstas se revisan en este trabajo

Evaluation of Nutritional Practices in the Critical Care patient (The ENPIC study) : Does nutrition really affect ICU mortality?

The importance of artificial nutritional therapy is underrecognized, typically being considered an adjunctive rather than a primary therapy. We aimed to evaluate the influence of nutritional therapy on mortality in critically ill patients. Methods: This multicenter prospective observational study included adult patients needing artificial nutritional therapy for >48 h if they stayed in one of 38 participating intensive care units for ≥72 h between April and July 2018. Demographic data, comorbidities, diagnoses, nutritional status and therapy (type and details for ≤14 days), and outcomes were registered in a database. Confounders such as disease severity, patient type (e.g., medical, surgical or trauma), and type and duration of nutritional therapy were also included in a multivariate analysis, and hazard ratios (HRs) and 95% confidence intervals (95%CIs) were reported. We included 639 patients among whom 448 (70.1%) and 191 (29.9%) received enteral and parenteral nutrition, respectively. Mortality was 25.6%, with non-survivors having the following characteristics: older age; more comorbidities; higher Sequential Organ Failure Assessment (SOFA) scores (6.6 ± 3.3 vs 8.4 ± 3.7; P < 0.001); greater nutritional risk (Nutrition Risk in the Critically Ill [NUTRIC] score: 3.8 ± 2.1 vs 5.2 ± 1.7; P < 0.001); more vasopressor requirements (70.4% vs 83.5%; P=0.001); and more renal replacement therapy (12.2% vs 23.2%; P=0.001). Multivariate analysis showed that older age (HR: 1.023; 95% CI: 1.008-1.038; P=0.003), higher SOFA score (HR: 1.096; 95% CI: 1.036-1.160; P=0.001), higher NUTRIC score (HR: 1.136; 95% CI: 1.025-1.259; P=0.015), requiring parenteral nutrition after starting enteral nutrition (HR: 2.368; 95% CI: 1.168-4.798; P=0.017), and a higher mean Kcal/Kg/day intake (HR: 1.057; 95% CI: 1.015-1.101; P=0.008) were associated with mortality. By contrast, a higher mean protein intake protected against mortality (HR: 0.507; 95% CI: 0.263-0.977; P=0.042). Old age, higher organ failure scores, and greater nutritional risk appear to be associated with higher mortality. Patients who need parenteral nutrition after starting enteral nutrition may represent a high-risk subgroup for mortality due to illness severity and problems receiving appropriate nutritional therapy. Mean calorie and protein delivery also appeared to influence outcomes. ClinicaTrials.gov NCT: 03634943