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BACKGROUND: Disease-associated malnutrition (DAM) is a health problem involving all sanitary levels, especially hospitalised elderly patients. Different MNA (Mini Nutritional Assessment)-based forms have been validated in different settings, but it remains unclear if they are appropriate to evaluate the nutritional status of geriatric hospitalised patients with diabetes. OBJECTIVE: The aim of this work was to analyse the accuracy of several MNA reduced forms to detect malnutrition in hospitalised elderly diabetic patients. METHODS: A multicentre observational study was carried out in diabetic patients, who were over the age of 65, from 35 Spanish hospitals. Principal component analysis (PCA) selected the minimal components to elaborate the newly-proposed reduced new version of the MNA (r-MNA). Cohen's Kappa index (KI), with its 95% confidence interval (CI), was used to measure the agreement between the different reduced forms (r-MNA, MNA-SF-BMI, MNA-SF-CC, m-MNA) with the original MNA. RESULTS: Five hundred and ninety-one elderly diabetic patients were included in the study. ROC analysis determined the following cut-off points for the newly proposed r MNA: 0-<10 "malnourished", 10-12 "at risk" and >12-15 "well-nourished". The upper cut-off point demonstrated a sensitivity of 87.7%, a specificity of 78.3% and an area under the curve of 0.93. The lower cut-off point showed a sensitivity of 95.9%, a specificity of 78.3% and an area under the curve of 0.95. The best agreement with the original MNA was observed for the MNA-SF-BMI (Κ index 80.7; 95% CI: 77.4-84) and the worst for the r-MNA (Κ index 72; 95% CI: 68.2-75.4). CONCLUSIONS: This study found that MNA-SF-BMI is the most accurate screening tool for determining the nutritional status of hospitalised diabetic elderly patients. This is an easy-to-use, fast screening tool with a low risk of misclassification.

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Antecedentes y objetivos. La nutrición enteral mediante dispositivos como la sonda nasogástrica (SNG) o la gastrostomía percutánea (GP) es un método efectivo de alimentación que puede dar lugar a complicaciones. Hemos estudiado la relación entre los dispositivos de nutrición enteral en los pacientes ingresados en los Servicios de Medicina Interna y el desarrollo de complicaciones pulmonares (aspiración broncopulmonar y neumonía aspirativa). Pacientes y métodos. Se analizan todos los pacientes dados de alta entre 2005 a 2009 de los Servicios de Medicina Interna de hospitales públicos del Sistema Nacional de la Salud en España. Los datos de los enfermos con aspiración broncopulmonar o neumonía aspirativa, que además eran portadores de SNG o GP, se obtuvieron del Conjunto Mínimo Básico de de Datos (CMBD). Resultados. De un total de 2.767.259 altas hospitalarias se identificaron 26.066 (0,92%) pacientes con SNG o GP. El 21,5 y el 25,9% de los pacientes con SNG y GP respectivamente, tenían codificado en su informe de alta un episodio de broncoaspiración frente a un 1,2% de los enfermos sin dispositivos de alimentación enteral. En el análisis multivariante la probabilidad de sufrir una broncoaspiración fue 9 veces más elevada en los pacientes con SNG (OR:9,1; IC 95%:8,7-9,4) y 15 veces superior en los sujetos con GP (OR:15,2; IC 95%:14,5-15,9), que en los sujetos sin SNG o GP. La estancia media (9,2 y 12,7 más días), complejidad diagnóstica y costes fueron muy superiores en los enfermos con SNG o PG en comparación con los pacientes ingresados que no requirieron estos dispositivos. Conclusiones. Existe una asociación entre la SNG y la GP para la alimentación enteral y las complicaciones pulmonares. La estancia media, complejidad diagnóstica y coste por ingreso de estos pacientes fueron más elevados que los que no precisaron dispositivos de nutrición enteral(AU)

Background and aims. Enteral nutrition using feeding devices such as nasogastric (NG) tube or percutaneous endoscopic gastrostomy (PEG) is an effective feeding method subject that may give rise to complications. We have studied the relationship between enteral nutrition feeding devices in patients admitted to the Internal Medicine Departments and the development of pulmonary complications (bronchial aspiration and aspiration pneumonia). Patients and methods. All of the patients discharge between 2005 and 2009 from the Internal Medicine (IM) Departments of the public hospitals of the National Health System in Spain were analyzed. The data of patients with bronchial aspiration or aspiration pneumonia who also were carriers of NG tubes or PEG, were obtained from the Minimum Basic Data Set (MBDS). Results. From a total of 2,767,259 discharges, 26,066 (0.92%) patients with nasogastric tube (NG tube) or percutaneous gastrostomy (PEG) were identified. A total of 21.5% of patients with NG tube and 25.9% of patients with PEG had coding for a bronchopulmonary aspiration on their discharge report versus 1.2% of patients without an enteral feeding tube. In the multivariate analysis, the likelihood of suffering bronchoaspiration was 9 times greater in patients with SNG (OR: 9.1; 95% CI: 8.7-9.4) and 15 greater in subjects with PEG (OR: 15.2; 95% CI: 14.5-15.9) than in subjects without SNG or PEG. Mean stay (9.2 and 12.7 more days), diagnostic complexity and costs were much higher in patients with SNG or PEG compared to patients in hospital who did not require these devices. Conclusions. An association was found between SNG and PEG for enteral feeding and pulmonary complications. Mean stay, diagnostic complexity and cost per admission of these patients was higher in patients who did not require enteral nutrition(AU)

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BACKGROUND AND AIMS: Enteral nutrition using feeding devices such as nasogastric (NG) tube or percutaneous endoscopic gastrostomy (PEG) is an effective feeding method subject that may give rise to complications. We have studied the relationship between enteral nutrition feeding devices in patients admitted to the Internal Medicine Departments and the development of pulmonary complications (bronchial aspiration and aspiration pneumonia). PATIENTS AND METHODS: All of the patients discharge between 2005 and 2009 from the Internal Medicine (IM) Departments of the public hospitals of the National Health System in Spain were analyzed. The data of patients with bronchial aspiration or aspiration pneumonia who also were carriers of NG tubes or PEG, were obtained from the Minimum Basic Data Set (MBDS). RESULTS: From a total of 2,767,259 discharges, 26,066 (0.92%) patients with nasogastric tube (NG tube) or percutaneous gastrostomy (PEG) were identified. A total of 21.5% of patients with NG tube and 25.9% of patients with PEG had coding for a bronchopulmonary aspiration on their discharge report versus 1.2% of patients without an enteral feeding tube. In the multivariate analysis, the likelihood of suffering bronchoaspiration was 9 times greater in patients with SNG (OR: 9.1; 95% CI: 8.7-9.4) and 15 greater in subjects with PEG (OR: 15.2; 95% CI: 14.5-15.9) than in subjects without SNG or PEG. Mean stay (9.2 and 12.7 more days), diagnostic complexity and costs were much higher in patients with SNG or PEG compared to patients in hospital who did not require these devices. CONCLUSIONS: An association was found between SNG and PEG for enteral feeding and pulmonary complications. Mean stay, diagnostic complexity and cost per admission of these patients was higher in patients who did not require enteral nutrition.

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Los pacientes con insuficiencia intestinal que reciben NPD presentan un elevado riesgo de presentar EMO. El origen de esta afectación ósea es multifactorial y depende en gran parte de la enfermedad de base que origina la necesidaddel soporte. En nuestro medio no disponemos de datos acerca de la prevalencia de esta enfermedad, por lo que elgrupo NADYA-SENPE ha patrocinado este estudio transversal para intentar conocer la prevalencia de la EMO. Material y métodos: Se han recogido datos retrospectivos de 51 pacientes pertenecientes a 13 hospitales. La encuesta realizada incluía datos demográficos y los datos clínicos más relevantes que pudieran influir en la apariciónde EMO. También se han registrados los datos analíticosmás significativos para este proceso (calciuria, PTH,25 OH vitamina D) y los resultados de la primera y la última densitometría realizadas. Resultados: Solamente 21 pacientes tenían realizada una densitometría en el momento de iniciar la NPD. La calidad del hueso está alterada al inicio de la NPD en un porcentaje significativo de casos (52%) Tras un seguimiento medio de 6 años ese porcentaje se eleva hasta el 81%. Dado el carácter retrospectivo del estudio y el escaso número de sujetos no esposible determinar el papel que juega la NPD en la etiología de la EMO. Sólo un 35% de los pacientes presentan niveles de vitamina D por encima de los niveles recomendados y la mayoría de ellos no recibe suplementación específica. Conclusiones: La NPD se asocia a un riesgo muy elevado de presentar EMO, por tanto es necesario disponer de protocolos de actuación que permitan detectar precozmente este problema y orientar el seguimiento y tratamiento de estos pacientes (AU)

Patients with intestinal failure who receive HPN are at high risk of developing MBD. The origin of this bonealteration is multifactorial and depends greatly on theunderlying disease for which the nutritional support is required. Data on the prevalence of this disease in our environment is lacking, so NADYA-SEMPE group has sponsored this transversal study with the aim of knowing the actual MBD prevalence.Material and methods: Retrospective data from 51 patients from 13 hospitals were collected. The questionnaire included demographic data as well as the most clinically relevant for MBD data. Laboratory data (calciuria,PTH, 25 -OH -vitamin D) and the results from the first and last bone densitometry were also registered. Results: Bone mineral density had only been assessed by densitometry in 21 patients at the moment HPN was started. Bone quality is already altered before HPN in a significant percentage of cases (52%). After a mean follow up of 6 years, this percentage increases up to 81%. Due toretrospective nature of the study and the low number of subjects included it has not been possible to determine the role that HPN plays in MBD etiology. Only 35% of patients have vitamin D levels above the recommended limits and the majority of them is not on specific supplementation. Conclusions: HPN is associated with very high risk ofMBD, therefore, management protocols that can lead toearly detection of the problem as well as guiding for followup and treatment of these patients are needed (AU)

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UNLABELLED: Patients with intestinal failure who receive HPN are at high risk of developing MBD. The origin of this bone alteration is multifactorial and depends greatly on the underlying disease for which the nutritional support is required. Data on the prevalence of this disease in our environment is lacking, so NADYA-SEMPE group has sponsored this transversal study with the aim of knowing the actual MBD prevalence. MATERIAL AND METHODS: Retrospective data from 51 patients from 13 hospitals were collected. The questionnaire included demographic data as well as the most clinically relevant for MBD data. Laboratory data (calciuria, PTH, 25 -OH -vitamin D) and the results from the first and last bone densitometry were also registered. RESULTS: Bone mineral density had only been assessed by densitometry in 21 patients at the moment HPN was started. Bone quality is already altered before HPN in a significant percentage of cases (52%). After a mean follow up of 6 years, this percentage increases up to 81%. Due to retrospective nature of the study and the low number of subjects included it has not been possible to determine the role that HPN plays in MBD etiology. Only 35% of patients have vitamin D levels above the recommended limits and the majority of them is not on specific supplementation. CONCLUSIONS: HPN is associated with very high risk of MBD, therefore, management protocols that can lead to early detection of the problem as well as guiding for follow up and treatment of these patients are needed.

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OBJECTIVE: To describe the Home Enteral Nutrition Characteristics (HEN) recorded by the group NADYA-SENPE during 2009. MATERIAL AND METHOD: collection and analysis of the data voluntary recorded in the HEN registry from the NADYA-SENPE group from January 1st to December 31st. RESULTS: 6.540 HEN patients were registered, 5.11% more than the previous year and 6,649 episodes (3,135 in women, 47,93%) from 32 different hospitals. 6,238 of them (95,38%) were over 14 years. The mean age of the patients under 14 yr was 3,67 ± 2,86 and it was 72,10 ± 16,89 in those over 14 yr group. The base illness registered more frequently was the neurological disorders in 2,732 (41,77%) patients, followed by cancer patients in 1,838; 28,10%. The enteral access route was registered in 1,123 (17,17%) of the episodes, being more frequent the administration by nasogastric tube 562 (50,04%). The mean length of nutritional treatment by episode was 323 days (10,77 months). 606 episodes of HEN ended, being the principal reasons for discontinuing treatment the patient death in 295 (48,68%) occasions. The transition to oral feeding occurred in 219 (36,14%) cases. Patients maintained normal activity in 2162 (32,55%) HEN episodes and 2,468 (37,13%) cases were living "bed-couch". The level of dependence was "total" in 2,598 (39,07%) of the episodes recorded. The nutritional formula was provided by the hospital in 4,183 (62,91%) cases and by the reference pharmacy in 2,262 (el 34,02%). Consumables were provided by the hospital in 3,531 (53,11%) cases. CONCLUSIONS: The number of HEN patients recorded increased from the year 2008, continuing the gradual growth increase since the start of registration. The characteristics of the patients remain in the same profile as in previous years.

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AIM: To present the results of the Spanish home enteral nutrition (HEN) registry of the year 2008 from the NADYA-SENPE group. MATERIAL AND METHODS: We recorded the HEN registry data from January 1st to December 31st 2008. RESULTS: The number of patients registered in this period was 6206 (51% male) with up to 6,279 episodes of HEN, from 31 Spanish hospitals. Most of the patients (95%) were older than 14 yr. Mean age was 4.83±3.29 yr in the children group, and 70.75±18.14 yr in the adult group (older than 14 yr). Neurological disorders (39%) and cancer (27%) were the two most prevalent diagnoses. The oral route was the most frequently used (43,4%), followed by nasogastric tube (40,4%), and gastrostomy tube (14,7%). Mean length of treatment was 305,36 days (10 months). The principal reasons for discontinuing treatment were death (43%) and progress to oral diet (40%). Only 33% of the patients had a normal activity level, being limited in different grades in the rest of the patients. Most of the patients required partial (25%) or total help (38%). The enteral formula was provided by the hospital in 65% of the cases and by private pharmacies in 32%. The disposables were provided by the hospital (82,4%) and primary care services (17,2%). CONCLUSIONS: The number and the age of the patients registered have increased comparing to previous years, with little variations in the rest of analyzed variables. The increase in the length of treatment could reflect misreporting of the weaning process in the registry.

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Objetivo: Comunicar los datos del registro nacional de nutrición enteral domiciliaria del grupo NADYA-SENPE de 2007. Material y métodos: Se incluyeron todos los pacientes con nutrición enteral domiciliaria del registro del grupo NADYA entre el 1 de enero y el 31 de diciembre de 2007. Resultados: El número de pacientes con nutrición enteral domiciliaria durante 2007 fue de 5107 (52% varones) de 28 centros hospitalarios. El 95,4% tenían más de 14 años, con una edad media de 67,96 ± 18,12 años mientras en los menores de 15 años fue de 4,2 ± 3,38 años. Las patologías más prevalentes entre ellos fueron las neurológicas (37,8%) y las neoplásicas (29,3%). La vía de administración más empleada fue la oral (63,5%), seguida de sonda nasogástrica (25,9%), mientras la gastrostomía sólo se empleó en el 9,2%. La duración media de la nutrición enteral fue de 9,4 meses y las causas de finalización más frecuentes fueron el fallecimiento (58,77%) y el paso a ingesta oral (26,57%). La actividad estaba limitada en el 31,4% de los pacientes y realizaban vida cama-sillón el 36,01% y la mayoría de los pacientes precisaban ayuda parcial (26,51%) o total (37,68%). El suministro de la fórmula se hacía desde el hospital en el 69,14% de los casos y en las farmacias de referencia en el 30,17%, mientras que el material fungible se suministraba desde el hospital en el 81,63% y desde Atención Primaria en el resto. Conclusiones: Durante 2007, ha habido un incremento de más del 30% de pacientes con nutrición enteral domiciliaria registrados respecto a 2006, sin que esto haya supuesto grandes diferencias en el resto de datos, salvo el mayor aumento de los casos de nutrición enteral-oral (AU)

Objective: To communicate the results from the registry of Home-Based Enteral Nutrition of the NADYASENPE group in 2007. Material and methods: We included every patient in the registry with home enteral nutrition any time from January 1st to December 31st of 2007. Results: The number of patients with home enteral nutrition in 2007 was 5,107 (52% male) from 28 different hospitals. 95.4% of them were 15 yr or older, with a mean age of 67.96 ± 18.12, and 4.2 ± 3.38 among patients aged 14 yr or less. The most common underlying diseases were neurological (37.8%) and neoplastic diseases (29.3%). Enteral nutrition was administered p.o. in most patients (63.5%), followed by nasogastric tube (25.9%), while gastrostomy was only used in 9.2%. The mean time in enteral nutrition support was 9.4 months and the most common reasons for withdrawal were death (58.7%) and switching to oral intake (32%). Activity was limited in 31.4% of patients and 36.01% were house-bound. Most patients needed partial (26.51%) or total (37.68%) care assistance. Enteral formula was provided by hospitals to 69.14% of patients and by pharmacies to 30.17% of them, while disposable material was provided by hospitals to 81.63% and by Primary Care to the remaining patients. Conclusions: In 2007, there has been an increase of more than 30% of patients registered with home enteral nutrition comparing with 2006, without any big difference in other data, but a higher proportion of patients with enteral nutrition p.o (AU)

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OBJECTIVE: To communicate the results from the registry of Home-Based Enteral Nutrition of the NADYASENPE group in 2007. MATERIAL AND METHODS: We included every patient in the registry with home enteral nutrition any time from January 1st to December 31st of 2007. RESULTS: The number of patients with home enteral nutrition in 2007 was 5,107 (52% male) from 28 different hospitals. 95.4% of them were 15 yr or older, with a mean age of 67.96 +/- 18.12, and 4.2 +/- 3.38 among patients aged 14 yr or less. The most common underlying diseases were neurological (37.8%) and neoplastic diseases (29.3%). Enteral nutrition was administered p.o. in most patients (63.5%), followed by nasogastric tube (25.9%), while gastrostomy was only used in 9.2%. The mean time in enteral nutrition support was 9.4 months and the most common reasons for withdrawal were death (58.7%) and switching to oral intake (32%). Activity was limited in 31.4% of patients and 36.01% were house-bound. Most patients needed partial (26.51%) or total (37.68%) care assistance. Enteral formula was provided by hospitals to 69.14% of patients and by pharmacies to 30.17% of them, while disposable material was provided by hospitals to 81.63% and by Primary Care to the remaining patients. CONCLUSIONS: In 2007, there has been an increase of more than 30% of patients registered with home enteral nutrition comparing with 2006, without any big difference in other data, but a higher proportion of patients with enteral nutrition p.o.

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OBJECTIVE: To communicate the results obtained from the registry of Home-Based Enteral Nutrition (HBEN) of the NADYA-SENPE group for the year 2006. MATERIAL AND METHODS: Recompilation of the data from the HBEN registry of the NADYA-SENPE group from January 1st to December 31st of 2006. RESULTS: During the year 2006, 3,921 patients (51% men) from 27 hospital centers were registered. Ninety-seven percent were older than 14 years. The mean age for those < 14 years was 4.9 +/- 3.9 (m +/- SD) and in those > or = 14 years, it was 68.5 +/- 18.2 years. The most common underlying disease was neurological pathology (42%), followed by cancer (28%). Enteral nutrition was administered p.o. in 44% of the patients, through nasogastric tube in 40%, gastrostomy in 14%, and jejunostomy in 1%. The average time of nutritional support was 8.8 months. The most common reasons for ending the therapy were patient's death (54%) and switching to oral feeding (32%). Thirty-one percent of the patients presented a limited activity and 40% were confined to bed/coach. Most of the patients required partial (25%) or total (43%) care assistance. The nutritional formula was provided by the hospital in 62% of the cases and from the reference pharmacy in 27%. The fungible material was provided by the hospital in 80% of the cases and by primary care in the remaining patients. CONCLUSIONS: Although the number of registered patients is slightly higher than that from the last years, there are no important changes in the patients characteristics, or way of administration and duration of enteral nutrition.

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