Carlos Sánchez-Juan

A wide range of factors contribute to the overlap of hyperglycemia—acute or chronic—and sarcopenia, as well as their associated adverse consequences, which can lead to impaired physical function, reduced quality of life, and increased mortality risk. These factors include malnutrition (both overnutrition and undernutrition) and low levels of physical activity. Hyperglycemia and sarcopenia are interconnected through a vicious cycle of events that mutually reinforce and worsen each other. To explore this association, our review compiles evidence on: (i) the impact of hyperglycemia on motor and muscle function, with a focus on the mechanisms underlying biochemical changes in the muscles of individuals with or at risk of diabetes and sarcopenia; (ii) the importance of the clinical assessment and control of sarcopenia under hyperglycemic conditions; and (iii) the potential benefits of medical nutrition therapy and increased physical activity as muscle-targeted treatments for this population. Based on the reviewed evidence, we conclude that a regular intake of key functional nutrients, together with structured and supervised resistance and/or aerobic physical activity, can help maintain euglycemia and improve muscle status in all patients with hyperglycemia and sarcopenia.

Background: Hip fractures are prevalent among older people, often leading to reduced mobility, muscle loss, and bone density decline. Malnutrition exacerbates the prognosis post surgery. This study aimed to evaluate the impact of a 12-week regimen of a high-calorie, high-protein oral supplement with β-hydroxy-β-methylbutyrate (HC-HP-HMB-ONS) on nutritional status, daily activities, and compliance in malnourished or at-risk older patients with hip fractures receiving standard care. Subjects and Methods: A total of 270 subjects ≥75 years of age, residing at home or in nursing homes, malnourished or at risk of malnutrition, and post hip fracture surgery, received HC-HP-HMB-ONS for 12 weeks. Various scales and questionnaires assessed outcomes. Results: During the 12 weeks of follow-up, 82.8% consumed ≥75% of HC-HP-HMB-ONS. By week 12, 62.4% gained or maintained weight (+0.3 kg), 29.2% achieved normal nutritional status (mean MNA score +2.8), and 46.8% improved nutritional status. Biochemical parameters improved significantly. Subjects reported good tolerability (mean score 8.5/10), with 87.1% of healthcare providers concurring. Conclusions: The administration of HC-HP-HMB-ONS markedly enhanced nutritional status and biochemical parameters in older hip-fracture patients, with high compliance and tolerability. Both patients and healthcare professionals expressed satisfaction with HC-HP-HMB-ONS.

Guidelines for bioelectrical impedance analysis (BIA) recommend fasting before measurements, but how it affects the outcomes is unclear. This descriptive, before-and-after study examines the effect of fasting on BIA results and its impact on the diagnosis of malnutrition in hospitalized cancer patients. Fifty-three oncology patients (admitted in January-March 2020) were consecutively enrolled regardless of their nutritional status. Patients were assessed by the same dietician 24-48 h after admission, following the usual clinical practice. The measurements were taken after 12-h fasting (fasting state) and 60-90 min after breakfast (non-fasting state). Bioimpedance parameters (resistance [R], reactance [Xc], phase angle [PA]) and body composition indices (free-fat mass index [FFMI] and appendicular skeletal muscle index [ASMI]) were calculated. On average, R values did not significantly differ between fasting and non-fasting states (mean difference: +1.82 & OHM;; p = 0.64). The non-fasting Xc and PA were reduced (mean differences: -1.55 & OHM;, p = 0.93 and 0.09 & DEG;, p = 0.82, respectively). Fasting and non-fasting FFMI and ASMI were similar (mean differences: -0.13 kg/m(2) (p = 0.5) and -0.10 kg/m(2) (p not calculated)). These results suggest that BIA does not require fasting, facilitating its routine use in hospitalized cancer patients.

Aim. To investigate the relation between malnutrition and nosocomial infections (NI) in hospitalized cancer patients. Methods. This observational, cross-sectional, noninterventional, descriptive study was conducted in a 500-bed university hospital in Valencia (Spain). Adult cancer patients admitted to the oncology ward were consecutively enrolled regardless of their nutritional status between November 2019 and March 2020. Patients were nutritionally assessed 24 to 48 hours after admission. Body weight, height and BMI, body composition through measurement of bioelectrical impedance analysis (BIA), and muscle strength and functionality using hand grip strength (HGS) were prospectively collected. The diagnosis of malnutrition and sarcopenia was assessed using the Global Leadership Initiative on Malnutrition (GLIM) criteria and the European Working Group on Sarcopenia in Older People (EWGSOP) criteria, respectively. Patients were followed up during their hospital stay or outpatient oncology visits to identify possible NI. Results. A total of 107 patients were included in this study (mean age 66 years; 66.4% were men). The most frequent reason for admission was cancer treatment (19.6%), followed by infections (18.7%) and digestive tract symptoms (18.7%). Overall, 77.5% (83/107) of the patients were malnourished at admission according to the GLIM criteria, while 52.3% (56/107) were sarcopenic. Nosocomial infections (NI) were significantly more frequent in malnourished (52.1%; 25/48) and severely malnourished (42.1%; 8/19) patients, compared with well-nourished patients without malnutrition (25%; 10/40; ). The mean length of hospital stay was 13.9 days, significantly longer in patients with an NI compared to those without infections (18.6 vs. 10.8 days, ). Conclusion. This study evidenced the need to implement a routine protocol for the nutritional assessment and support of cancer patients at risk of malnutrition and sarcopenia to reduce the risk of NI during their hospital stay.

La Enfermedad Renal Crónica (ERC) tiene una prevalencia mundial de aproximadamente el 7,2% en pacientes mayores de 30 años. La ERC cada día va en aumento en los países desarrollados, por lo que ofrecer una educación multidisciplinar a los pacientes en prediálisis puede retardar la progresión de la enfermedad, reducir la diálisis y tasa de mortalidad. El Objetivos de la investigación es valorar un programa de educación alimentaria en pacientes con Enfermedad Renal Crónica en fase de prediálisis. El enfoque del Estudio prospectivo observacional en la Escuela del Paciente Renal (EPR), en las que fueron impartidos talleres de educación alimentaria. Se evaluaron medidas antropométricas, test de conocimientos al inicio y al final de la intervención. Luego de las actividades observó mejora de los resultados del test sobre conocimientos tras la EPR. También aumentó la utilización de las técnicas de doble cocción. Y se observó un aumento del consumo de verduras y frutas con bajo contenido de potasio. Se concluye la realización de la EPR ha aumentado sus conocimientos, mejorando sus hábitos alimentarios y técnicas culinarias, lo cual puede sugerir una repercusión positiva sobre el control de su enfermedad.

Introduction: Hyperaldosteronism usually presents with hypertension and hypokalemia; however, there is recent evidence of a relationship with the parathyroid hormone. There are different theories to try to explain this relationship. Hyperaldosteronism treatment is medical or surgical depending upon etiology. We present three cases in which treatment solely for hyperaldosteronism also cured hyperparathyroidism. Materials and methods: We report three patients in whom hyperaldosteronism was diagnosed during 2015 and detected simultaneously hyperparathyroidism. We recorded epidemiological data, pre- and post-surgical phospho-calcium metabolism, as well as hyperaldosteronism. Results: Case 1: A 38 year old male was referred for suspected hyperaldosteronism. A nodule was detected in left adrenal in TC image. Levels of PTH 150 pg/ml were objectified with normal serum and urinary calcium and phosphorus. Levels of vitamin D were 19.9 ng/ml. After left adrenalectomy, PTH levels were normalized. Case 2: A 55 years old woman referred for study of hypokalemia. Her PTH levels were 162 pg/ml with normal serum phosphorus and urinary calcium. Lesion 20 mm in left adrenal was detected in TC image. After adrenalectomy, PTH levels down to 34 pg/ml. Case 3: A 63 years old woman was referred to rule out hyperaldosteronism. She presented PTH levels of 136 pg/ml and normal levels of serum calcium and phosphorus. Vitamin D levels were 24 ng/ml. MRI image showed right adrenal injury that was removed. After surgery, PTH levels diminished. Conclusions: In cases of primary hyperaldosteronism is advisable to assess the phospho-calcium metabolism, especially PTH. The effect of hyperaldosteronism on bone long-term is still unknown. In any case, the calcium/phosphorus levels were not pathological. Sometimes treatment solely of hyperaldosteronism can simultaneously treat hyperparathyroidism.

Introducción y objetivos: La nutrición enteral (NE) está indicada en pacientes que, aunque no pueden consumir suficientes cantidades de alimentos, mantienen una función del aparato digestivo suficiente para recibir, digerir y absorber nutrientes. Los Suplementos Orales Nutricionales (SON) son fórmulas nutricionalmente completas o incompletas (en función de que aporten o no todos los nutrientes necesarios para servir como única fuente de nutrientes), que completan una dieta oral insuficiente. Con este estudio se pretende valorar las características organolépticas de suplementos nutricionales orales hiperproteicos, normoproteicos y enriquecidos con fibra. Material y métodos: Cata de SON, llevada a cabo en el Servicio de Endocrinología y Nutrición del Consorcio Hospital General Universitario de Valencia desde octubre de 2012 a febrero de 2013. Se evaluaron 137 SON en total, de los cuales 47 eran hiperproteicos, 46 normoproteicos y 44 con fibra. Resultados: De los SON evaluados, en el grupo de los hiperproteicos obtuvieron los 3 siguientes las mejores puntuaciones: Fresenius Prot Energy Drink® (21,27, sabor vainilla), Nut Avant Estándar® (20,3, sabor fresa) y Resource Protein® (20,01, sabor chocolate). En el grupo de los SON normoproteicos los 3 mejor valorados fueron: Ensure Plus® (22,3, sabor plátano), Ensure Plus® (21,9, sabor melocotón) y Fresubin Energy Drink® (21, sabor fresa) En el grupo de los SON enriquecidos con fibra los 3 más apreciados fueron: Fresubin 2 Kcal Fibre Drink® (23,78, sabor vainilla), Ensure Plus TwoCal® (22,9, sabor plátano) y Fortimel Compact® (21,5, sabor fresa). Conclusiones: El estudio puede orientar a los profesionales sanitarios sobre los SON que pueden resultar más aceptados por el paciente, de manera que los SON cumplan su objetivo y restauren o mejoren el estado nutricional, pues la intervención con SON es segura y costo-efectiva, ya que mejora tanto la funcionalidad como la calidad de vida

Reactive oxygen species induce oxidative modification of critical macromolecules. Oxygen derived free radicals may act as potential cytotoxic intermediates inducing inflammatory and degenerative processes, or as signal messengers for the regulation of gene expression. This dual effect mainly depends on the availability of free radicals in terms of concentration, as well as on the environmental characteristics in which they are produced. The formation of free radicals has been proposed to be the linking factor between certain metabolic disturbances and cancer. Circulating mononuclear cells of patients with high cholesterol levels, insulin resistance, metabolic syndrome or obesity present lower levels of antioxidant enzymes and increased concentrations of oxidative stress by-products such as isoprostanes or the DNA oxidized and highly mutagenic base 8-oxo-7,8-dihydro-2′-deoxyguanosine. Overweight or obese subjects also exhibit hormonal changes as a consequence of the increase of mass fat, and these hormonal alterations have been implicated in the alteration of different signal transduction mechanisms and in cell growth and differentiation. A significant correlation has been found between body mass index and cancer. The biological factors and molecular mechanisms implicated in obesity associated cancer susceptibility will be reviewed.