Introduction: The resting energy expenditure (REE) evolution after liver transplantation is not fully understood. Objective: To assess longitudinally the REE evolution in adults undergoing liver transplantation, in association with other nutritional measurements that characterize the metabolic profile. Methods: A single-center cohort of consecutive end-stage liver disease patients with indication for liver transplantation was recruited. REE, subjective global assessment (SGA), handgrip strength and body composition measurements were assessed before transplantation (T0) and at median nine (T1) and 36 (T2) days after transplantation. Mixed effects regression models were used for analysis. Results: Fifty-six patients with a mean age of 53.7 (8.5) years were included; 87.5% were males. In T0, 41% of patients were normometabolic, 37.5% were hypometabolic and 21.4% were hypermetabolic. After transplantation, the mean REE decreased progressively in patients initially hypermetabolic and the opposite occurred in those initially hypometabolic. The REE evolution was positively associated with body weight (β = 9.6, p < 0.001) and energy intake (β = 13.6, p = 0.005) in the whole sample; it was positively associated with body weight (β = 7.1, p = 0.018) and percentage of energy intake from lipids (β = 18.9, p = 0.003) in initially hypometabolic patients, and positively associated with body weight (β = 14.1, p < 0.001) and negatively associated with SGA-undernourishment (β = -171, p = 0.007) in initially normometabolic patients. Conclusion: Different REE evolutions after liver transplantation are associated with the preoperative metabolic status. In patients initially hypometabolic, the REE evolution is positively associated with body weight and percentage of energy intake from lipids, and in those initially normometabolic, it is positively associated with body weight and negatively associated with SGA-undernourishment.

Introducción: el gasto energético en reposo (GER) después del trasplante hepático no está totalmente esclarecido. Objetivo: evaluar longitudinalmente la evolución del GER y de otros parámetros nutricionales que caracterizan el perfil metabólico en adultos que recibieron un trasplante hepático. Métodos: cohorte consecutiva de pacientes con enfermedad hepática terminal con indicación para trasplante, reclutada en un centro. Las siguientes variables fueron medidas antes del trasplante (T0) y en las medianas de nueve (T1) y 36 (T2) días de postoperatorio: GER, valoración global subjetiva (VGS), dinamometría manual y composición corporal. Se utilizaron modelos de regresión de efectos mixtos. Resultados: se incluyeron 56 pacientes con una edad media de 53,7 (8,5) años; el 87,5% de ellos eran varones. En T0, el 41% de los pacientes eran normometabólicos; el 37,5%, hipometabólicos, y el 21%, hipermetabólicos. Después del trasplante, el GER disminuyó progresivamente en los pacientes inicialmente hipermetabólicos y lo contrario ocurrió en los inicialmente hipometabólicos. La evolución del GER se asoció positivamente con el peso (β = 9,6, p < 0,001) y la ingesta energética (β = 13,6, p = 0,005) en toda la muestra. Asimismo, se asoció positivamente con el peso (β = 7,1, p = 0,018) y el porcentaje de ingesta energética de grasas (β = 18,9, p = 0,003) en los inicialmente hipometabólicos, mientras que en los inicialmente normometabólicos se relacionó positivamente con el peso (β = 14,1, p < 0,001) y negativamente con la subnutrición por VGS (β = -171, p = 0,007). Conclusión: la evolución del GER después del trasplante hepático se asocia con el estado metabólico preoperatorio, de forma positiva con el peso y el porcentaje de ingesta energética de grasas en los inicialmente hipometabólicos, mientras que en los pacientes inicialmente normometabólicos se relaciona positivamente con el peso y negativamente con la subnutrición valorada por VGS.

Resumo Objetivo O reconhecimento precoce e preciso do sucesso no tratamento da obesidade pode aumentar a adesão de crianças obesas e suas famílias a programas de intervenção. Este estudo observacional prospectivo visa a avaliar a capacidade e o tempo de detecção de uma redução significativa na adiposidade estimada pelo índice de massa corporal (IMC) no percentual de massa gorda (% MG) e no índice de massa gorda (IMG) durante o controle de peso em crianças obesas pré-púberes. Métodos Em uma coorte de 60 crianças obesas pré-púberes entre três e nove anos, incluídas em um programa ambulatorial de controle de peso, o IMC, o % MG e o IMG foram monitorados mensalmente e as duas últimas medições avaliadas foram feitas com pletismografia por deslocamento de ar. As medições resultantes foram redução de > 5% de cada indicador e atingir o tempo para tanto. Resultados A taxa de detecção do resultado foi de 33,3% (IC de 95% 25,9-41,6) com o uso de IMC, significativamente menor (p < 0,001) do que 63,3% com % MG (IC de 95% 50,6-74,8) ou 70,0% (IC de 95% 57,5-80,1) com IMG. O tempo médio para detectar o resultado foi de 71 dias com o IMG, menos do que 88 dias com %MG e semelhante a 70 dias com o IMC. A concordância entre o resultado detectado pelo IMG e pelo % MG foi elevada (kappa 0,701), porém muito baixa entre o sucesso detectado pelo IMC e pelo IMG (kappa 0,231) ou %MG (kappa 0,125). Conclusões O IMG atingiu a melhor combinação de capacidade e precocidade para identificar redução na adiposidade durante o monitoramento do controle de peso em crianças obesas pré-púberes.

Abstract Objective An early and accurate recognition of success in treating obesity may increase the compliance of obese children and their families to intervention programs. This observational, prospective study aimed to evaluate the ability and the time to detect a significant reduction of adiposity estimated by body mass index (BMI), percentage of fat mass (%FM), and fat mass index (FMI) during weight management in prepubertal obese children. Methods In a cohort of 60 prepubertal obese children aged 3–9 years included in an outpatient weight management program, BMI, %FM, and FMI were monitored monthly; the last two measurements were assessed using air displacement plethysmography. The outcome measures were the reduction of >5% of each indicator and the time to achieve it. Results The rate of detection of the outcome was 33.3% (95% CI: 25.9–41.6) using BMI, significantly lower (p < 0.001) than either 63.3% using %FM (95% CI: 50.6–74.8) or 70.0% (95% CI: 57.5–80.1) using FMI. The median time to detect the outcome was 71 days using FMI, shorter than 88 days using %FM, and similar to 70 days using BMI. The agreement between the outcome detected by FMI and by %FM was high (kappa 0.701), but very low between the success detected by BMI and either FMI (kappa 0.231) or %FM (kappa 0.125). Conclusions FMI achieved the best combination of ability and swiftness to identify reduction of adiposity during monitoring of weight management in prepubertal obese children.

Objective: To evaluate the practices of neonatal parenteral nutrition (PN) compounding in Portugal and the agreement to the recommendations from the Spanish Consensus on Compounding of Parenteral Nutrition Mixtures 2008. Methods: Survey based on an electronic questionnaire on PN preparation emailed, between July and October 2009, to the pharmacists or nurses responsible for preparing neonatal PN in the 50 public and private Portuguese hospitals with neonatal special care units. Results: From the 30 hospitals where neonatal PN was prepared, 22 (73%) responded to the questionnaire. In 76.7% hospitals the PN was prepared in the hospital pharmacy and the remaining in the neonatal unit. In most hospitals the PN was only prepared in the working days. In half of cases the professional responsible for the preparation received the prescription in electronic support. The problems related with interpretation and validations of the prescriptions were not unusual (14-41%). Most of the Portuguese hospitals referred practices in agreement with the main recommendations from the Spanish Consensus regarding the documentation, equipment and facilities, human resources and labeling. In relation to PN admixtures, most hospitals follow the recommendations on deadlines to use, protection from light, use of terminal filters for infusion, and physical and chemical control by visual inspection and microbiological control. Conclusions: The results from this study provide a good insight of the practice of preparation of neonatal NP in Portugal. The comparison with the Spanish Consensus contributes to identify weaknesses.

Objetivo: Evaluar la práctica de preparación de nutrición parenteral (NP) neonatal en Portugal y su concordancia con las recomendaciones del Consenso Español sobre Preparación de Mezclas Nutrientes Parenterales 2008. Métodos: Cuestionario electrónico sobre elementos relativos a la preparación de la NP, enviado entre junio y octubre 2009 a los farmacéuticos o enfermeros responsables de la preparación de la NP neonatal en los 50 hospitales (públicos y privados) de Portugal con unidades de cuidados especiales neonatales. Resultados: Se preparaba NP neonatal en 30 hospitales, de los que 22 (73,3%) respondieron la encuesta. En el 77% de los hospitales, la NP neonatal se preparaba en los servicios farmacéuticos y en la propia unidad neonatal en el resto. En la mayoría de hospitales se preparaba apenas en los días laborables, y la en la mitad de los casos la prescripción llegaba a los responsables en soporte digital. Los responsables identificaron diversos problemas asociados a la interpretación de la prescripción (14-41% de las NP). La práctica de la mayoría de los hospitales portugueses estaba en concordancia con el Consenso Español en documentación, instalaciones y equipamientos, recursos humanos y etiquetado. En cuanto a las soluciones, la mayoría estaba en concordancia con los plazos límite de utilización, fotoprotección, utilización de filtros terminales, control físico-químico por inspección visual y control microbiológico. Conclusiones: Los resultados del presente estudio proporcionan un buen panorama de la práctica de preparación de la NP neonatal en Portugal. La comparación con el Consenso Español permitió identificar los puntos débiles y de mejora.