Valoración del estado nutricional en Geriatría: declaración de consenso del Grupo de Nutrición de la Sociedad Española de Geriatría y Gerontología

Ongoing population ageing is one of the factors influencing the increase in the prevalence of undernutrition, as elderly people are a vulnerable group due to their biological, psychological and social characteristics.Despite its high prevalence, undernutrition is underdiagnosed in the geriatric sphere. For this reason, the aim of this consensus document is to devise a protocol for geriatric nutritional assessment. A multidisciplinary team has been set up within the Spanish Society of Geriatrics and Gerontology (in Spanish Sociedad Española de Geriatría y Gerontología [SEGG]) in order to address undernutrition and risk of undernutrition so that they can be diagnosed and treated in an effective manner.The MNA-SF is a practical tool amongst the many validated methods for nutritional screening. Following suspicion of undernutrition, or after establishing the presence of undernutrition, a full assessment will include a detailed nutritional history of the patient. The compilation of clinical-nutritional and dietetic histories is intended to help in identifying the possible risk factors at the root of a patient's undernutrition. Following this, an anthropometric assessment, combined with laboratory data, will describe the patient's physical and metabolic changes associated to undernutrition. Currently, the tendency is for further nutritional assessment through the use of non-invasive techniques to study body composition in association with functional status. The latter is an indirect index for nutritional status, which is very interesting from a geriatrician's point of view. To conclude, correct nutritional screening is the fundamental basis for an early undernutrition diagnosis and to assess the need for nutritional treatment. In order to achieve this, it is fundamental to foster research in the field of nutritional geriatrics, in order to expand our knowledge base and to increasingly practice evidence-based geriatrics.     

Hígado graso no alcohólico y su asociación con variables clínicas y bioquímicas en niños y adolescentes obesos: efecto de un año de intervención en el estilo de vida

ObjectiveTo study the frequency of non-alcoholic fatty liver disease (NAFLD), its relationship to clinical and biochemical variables, and the effect 12-month's lifestyle intervention in obese children and adolescents.MethodsThirty-six obese patients aged 7 to 18 years, 42% female and 58% male, 72.2% prepubertal and 27.8% pubertal, were selected. Anthropometric measurements and glucose, insulin (baseline and after a glucose load), lipid profile, C-reactive protein, and aminotransferase tests were performed before and 12 months after dietary and physical activity intervention. Liver ultrasound was performed to determine the presence of NAFLD.ResultsNAFLD was found in 66.7% (n = 24), and was mild in 30.6%, moderate in 27.8%, and severe in 8.3%. Subjects with NAFLD had higher body mass index (BMI, p = 0.007), waist (p = 0.005), fat area (p = 0.002), basal insulin (p = 0.01), and HOMA-IR (p = 0.008) values and lower QUICKI (p = 0.02) values than those with no NAFLD. After intervention, physical activity increased (p = 0.0001) and calorie intake remained unchanged. NAFLD disappeared in 9 patients (37.5%, p = 0.02) and disease severity decreased in 3 patients (12.5%). In addition, BMI Z-score (p = 0.005), fat area (p = 0.0001), basal insulin (p < 0.05), insulin resistance (p < 0.005), lipid profile (p < 0.03), and transaminases decreased. Weight loss was the main variable accounting for NAFLD improvement.ConclusionThis group of obese children and adolescents showed a high frequency of NAFLD. The lifestyle intervention with weight reduction is effective for the treatment of NAFLD.     

Evolución del perfil de los cuidadores de personas de 65 y más años con discapacidad en la persistencia de un modelo de cuidado familiar

Introduction

The increasing participation of women in the workforce may make it difficult to sustain the current model of elderly care. The aim of this article was to determine the changing sociodemographic profile of informal elderly caregivers with disabilities, the interaction between employment and care, and the view of the public on the responsibility of that care.

Evolución clínica y funcional de los pacientes que ingresan en residencias tras una fractura de cadera. Implementación de un programa de intervención multinivel

Background and objectiveThe aim of this study was to determine the clinical and functional outcomes of patients discharged to nursing homes after a hip fracture.MethodsThe study included all patients admitted to a group of nursing homes after a hip fracture in 2016. A geriatric assessment protocol was applied, and patients were treated with a specific protocol for 90 days. They were assessed for nutritional status (Mini-Nutritional Assessment and Body Mass Index), pain (Visual Analogue Scale, and the PAINAD Scale), the presence of pressure ulcers, blood test (D vitamin, haemoglobin, proteins), and functional status (Barthel index and Functional Assessment Categories).ResultsOut of a total of 175 patients, 116 (75%) met the inclusion criteria. The mean age was 84.9 years old (±6.7 SD), and 91 (78.4%) were women. At admission, 73.8% of 65 residents had anaemia, 76.7% hypovitaminosis D, 88% malnutrition or «at risk of malnutrition», and 15.3% had pressure ulcers. After 90 days, the moderate-severe functional status (Barthel index < 60) was reduced from 90.4 to 39.6%, dependence due to gait from 97.3 to 36.1%, and moderate-severe pain from 88.9 to 14.4%. Most of the pressure ulcers healed (94.4%).ConclusionsPatients admitted to nursing homes after a hip fracture had poor clinical and functional status. This study shows that after 90 days from admission these patients had positive outcomes in terms of functionality, gait, pain control, and pressure ulcers healing.     

Efecto de los movimientos explosivos y de impacto aplicados en piscina sobre la composición corporal,la fuerza y la densidad mineral ósea de mujeres mayores de 60 años

BackgroundOsteoporosis is characterised by loss of bone mass and deterioration of bone tissue microarchitecture that leads to fragility related to the risk of fractures. The aim of the study is to analyse the effects of a training program based on explosive movements and impact, assessed in a swimming pool, on body composition, explosive strength and bone mineral density in women over 60 years old.Material and methodsA total of 35 healthy physically active women (60 ± 4.19 years) were divided into a training pool group using multi jumps (JG) and a control group (CG). JG trained for 24 weeks, 3 times a week, an hour and a half per session. Body composition testing, explosive strength, and bone mineral density were assessed before and after the program.ResultsThere were differences in the explosive force (JG vs CG = P < .05 to .001) and the estimated power (JG vs CG = P < .05 to .002) between JG vs CG, with significant increases in JG. There were no significant differences in the percentage of fat and lean mass, bone mineral density lumbar and femoral between groups, although slightly significant increases in bone mineral density lumbar and femoral could be seen in JG after program implementation (JG pre-test vs JG post- test = P < .05).ConclusionsThe training program with impact and explosive movements assessed in a pool induces gains in muscle strength and power with slight adaptations in body mass index in women over 60 years.     

Contribución al conocimiento de los líquenes epifíticos del Valle de Sanabria (Zamora,España)

A catalogue of epiphytic lichens from the Sanabria valley (Zamora) is presented in this study. A total of 145 taxa are reported. According to our data, 137 taxa are new records for Zamora Province. For each species, ecological and chorological remarks are included. Chaenotheca furfuracea, Chromatochlamys muscorum, Cladina arbuscula subsp. mitis, Degelia atlantica, Julella lactea, Mycobilimbia hypnorum, Nephroma parile, Pannaria ignobilis, Pannaria pezizoides, Peltigera britannica, P. hymenina, Pertusaria ophthalmiza, Rinodina archaea, R. conradii, Thelenella modesta and Xylographa abietina are specially considered, due to their chorological implications in the Iberian Peninsula. We highlight the area “arroyo de las Truchas”, in Cobreros, because of the particularly wide diversity of epiphytic lichens.     

Efectos del ejercicio físico sobre la calidad del sueño,insomnio y somnolencia diurna en personas mayores. Revisión de la literatura

The ageing process alters the stages of sleep, and the elderly that have this problem tend to be prescribed pharmacological treatment. This has long term side effects and results in increased health costs. On the other hand, frequent or regular physical exercise could be an overall superior alternative, due to its multifactorial effects. It is also less expensive, thus more affordable and accessible. Furthermore, these benefits could be extrapolated to the quality of sleep. Taking this into account the purpose of this paper is to establish the proper amount of physical exercise using the FITT (frequency, intensity, time, type of exercise) principle, and its effect on the quality of sleep, insomnia, and daytime sleepiness in the elderly. This could lead us to a paradigm shift in the treatment of sleep disorders, and also may constitute an alternative method for treating the elderly.     

Actividad física,condición física y sobrepeso en niños y adolescentes: evidencia procedente de estudios epidemiológicos

Physical activity and fitness play a significant role in prevention of overweight and obesity in children and adolescentes. Current understanding and evidence from epidemiologic studies provide useful insights to better understand how they relate to each other and how to develop future intervention strategies. This paper summarizes the most relevant information from cross-sectional and longitudinal studies on the relationships between physical activity, physical fitness, and overweight in early life. According to current scientific evidence: (i) High levels of physical activity during childhood and adolescence, particularly vigorous physical activity, are associated to lower total and central adiposity at this age and later in life; (ii) the level of physical fitness, especially aerobic fitness, is inversely related to current and future adiposity levels; (iii) overweight children and adolescents with a high fitness level have a healthier cardiovascular profile than their overweight, low fit peers and a similar profile to their normal weight, low fit peers. This suggests that high fitness levels may counteract the negative consequences attributed to body fat. These findings suggest that increasing physical fitness in overweight children and adolescentes may have many positive effects on health, including lower body fat levels.     

Revisión Crítica de Investigaciones y Literatura Micológicas Durante Los Años 1950–1960 en Ecuador

Sumario En este trabajo se hace una revisión de los artículos publicados sobre Micología Médica, durante la década de 1950 a 1960, en la República del Ecuador.Por el estudio de este material se advierte que por el esfuerzo de pocos investigadores se ha logrado poner de manifiesto, en el período considerado, la mayor parte de las afecciones micósicas que tienen importancia en Patología humana y que, como era de esperarse, existían en el País.Conviene señalar que por el accidente geográfico de los Andes, el Ecuador posee por un lado, regiones típicamente tropicales en la parte del litoral y en la región oriental o amazónica y por otro lado una serie de matices climáticos cuando se asciende desde las planicies hasta la meseta interandina de clima templado o frío. Por ello en este trabajo se menciona siempre la procedencia de los pacientes, la cual se ubica fácilmente en el mapa que se adjunta.Las micosis superficiales por dermatofitos se encuentran tanto en la costa como en la sierra, pero en la primera región se reparten por igual los casos de microsporias y de tricoficias, en tanto que en la sierra predominan las microsporias.En la costa se han identificado las siguientes especies de dermatofitos:T. tonsurans, T. rubrum, T. mentagrophytes, T. violaceum yT. album;M. canis, M. Audouinii yM. gypseum. Hasta ahora no hay datos ciertos de la existencia deT. Schoenleinii en el País.De micosis profundas se describieron casos de Blastomicosis Sudamericana, Histoplasmosis, Coccidioidomicosis, Cromoblastomicosis, Rhinosporidiosis, Criptococcosis, Geotricosis, Micetomas y Moniliasis.La mayor parte de estas afecciones se encontraron en sitios de la costa, que es zona en general baja, cálida y húmeda.Sin embargo, los casos de Coccidioidomicosis procedieron de valles de la sierra, que no obstante encontrarse en esa región tienen clima semi-tropical. Aún más, alguno de los casos de Blastomicosis Sudamericana ocurrió en uno de esos valles.En el examen de tierras para investigar hongos patógenos, se encontró entre los dermatofitos,M. gypseum yT. mentagrophytes. En 109 muestras de tierra de provincias de la costa y sierra, se encontró dos vecesH. capsulatum, 1 vezCriptococcus sp., dos vecesNocardias y varias veces especies del géneroAspergillus.

---

Summary In this paper a survey is made of published articles about Medical Mycology during the decade 1950 to 1960 in the Republic of Ecuador.Through the study of this material it is noticed that due to the efforts of only a few investigatiors it has been possible to discover, during this period, most of the mycotic affections which are important in human pathology, and as it was expected they really existed in the country.It is convenient to mention that due to the geographical site of the Andes, Ecuador has for one side, typical tropical regions at the part of the litoral and to the oriental region; and for another side several climatic conditions when going up from the low lands to the interandean plateau with a temperate or cold climate. That is why the origin of the patients is always mentioned which is easily located on the included map.The superficial mycoses due to dermatophytes are found in the coastal as in the interandean region, but in the first one the cases of microspories and tricophyties are equaly distributed, meanwhile in the interandean zone the microspories predominate over the other.The following species have been identified on the coast:T. tonsurans, T. rubrum, T. mentagrophytes, T. violaceum andT. album; M. canis, M. Audouinii andM. gypseum. Until now there are no sure facts about the existence ofT. Schoenleinii in the country.The following deep mycoses have been observed: South American Blastomycosis, Histoplasmosis, Coccidioidomycosis, Chromoblastomycosis, Rhinosporidiosis, Cryptococcosis, Geotricosis, Mycetomas and Moniliasis.The greatest part of these affections were found in places of the coast, which is a zone generally low, warm, and humid.However, the cases of Coccidioidomycosis originated from valleys of the interandean zone.Even more, some of the cases of South American Blastomycosis occurred in one of those valleys.In soil surveys, in order to investigate pathogens, there were found among dermatophytes,M. gypseum andT. mentagrophytes. From 109 samples of soils from litoral and interandean provinces, there occurred: twiceH. capsulatum, onceCriptoccocus spp., twiceNocardias and many times species ofAspergillus genus.

---

---

Director del Instituto Nacional de Higiene Leopoldo Izquieta Perez Guayaquil-Ecuador.