Publication: Proyecto Vainica: valoración e intervención nutricional e insuficiencia cardiaca
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2016-11-22
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Universidad Complutense de Madrid
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Abstract
Desde el comienzo del milenio diversos estudios muestran la “paradoja de la obesidad en pacientes con insuficiencia cardiaca”. Existe una epidemiología inversa: la obesidad predispone para desarrollar enfermedades cardiovasculares e insuficiencia cardiaca, pero un índice de masa corporal elevado mejora la supervivencia a dos y cinco años. Esta paradoja se ha extendido con posterioridad, a otras enfermedades de carácter crónico y ha sido un tema controvertido en la comunidad científica. Posteriormente, diversos estudios han ido migrando la orientación, relacionando el pronóstico no con el índice de masa corporal en sí, sino con el estado nutricional y el adelgazamiento no intencionado. De modo que el foco de interés está ahora en el estado nutricional de los pacientes y no en su índice de masa corporal. El peso –y por tanto el índice de masa corporal- es un parámetro cambiante en los pacientes con insuficiencia cardiaca, ya que por la naturaleza de su patología, pueden presentar un volumen hídrico aumentado y son susceptibles a descompensaciones edemo-asciticas. Los episodios de descompensación son habitualmente tratados con diuréticos, con el objetivo de eliminar el exceso de líquido, lo que hace que el peso fluctúe rápidamente, a expensas de la reducción del exceso de volumen hídrico. No existe consenso o marcador universalmente aceptado para definir la malnutrición. Por ello, coexisten múltiples métodos de cribado y valoración nutricional. No destacándose ninguno como “gold estándar”...
From the beginning of the millennium, a variety of studies have detailed the “paradox of patients with obesity and heart failure.” There exists a reverse epidemiology: obesity predisposes the development of cardiovascular diseases and heart failure, but a high body weight improves survivability by two to five years. This paradox has been extended, subsequently, to other chronic diseases and has become a controversial topic in the scientific community. Subsequently, a series of studies have been shifting this focus to correlating the diagnosis not with the body mass index, but instead with the nutritional status and unplanned weight loss. Therefore, the current focus and attention is in the nutritional status of the patients and not in the body mass index. Body weight – and therefore the body mass index – is a variable parameter in patients with incidence of heart failure and because of their pathology, the patients may display an increase water volume and are susceptible to edemoascitic decompensation. The episodes of decompensation are habitually treated with diuretics, in order to eliminate water excess, which results in body weight fluctuations at the expense of reduction in water volume. There is no consensus or a universally accepted score to define malnutrition. Because of this, multiple screening and assessment methods exist. None of them are considered as “gold standard”. In the specific cases of heart failure, a nutritional assessment is very challenging because the masking of body weight and other nutritional scores such as albumin or cholesterol have shown limitations. In the case of albumen, the limitation is due to important inflammatory state of these patients which reduces the validity of nutritional status. In the case of cholesterol, the limitation is due to fact that many patients receive hypolipidemic agents which indirectly affect the cholesterol levels with the dietary intake...
From the beginning of the millennium, a variety of studies have detailed the “paradox of patients with obesity and heart failure.” There exists a reverse epidemiology: obesity predisposes the development of cardiovascular diseases and heart failure, but a high body weight improves survivability by two to five years. This paradox has been extended, subsequently, to other chronic diseases and has become a controversial topic in the scientific community. Subsequently, a series of studies have been shifting this focus to correlating the diagnosis not with the body mass index, but instead with the nutritional status and unplanned weight loss. Therefore, the current focus and attention is in the nutritional status of the patients and not in the body mass index. Body weight – and therefore the body mass index – is a variable parameter in patients with incidence of heart failure and because of their pathology, the patients may display an increase water volume and are susceptible to edemoascitic decompensation. The episodes of decompensation are habitually treated with diuretics, in order to eliminate water excess, which results in body weight fluctuations at the expense of reduction in water volume. There is no consensus or a universally accepted score to define malnutrition. Because of this, multiple screening and assessment methods exist. None of them are considered as “gold standard”. In the specific cases of heart failure, a nutritional assessment is very challenging because the masking of body weight and other nutritional scores such as albumin or cholesterol have shown limitations. In the case of albumen, the limitation is due to important inflammatory state of these patients which reduces the validity of nutritional status. In the case of cholesterol, the limitation is due to fact that many patients receive hypolipidemic agents which indirectly affect the cholesterol levels with the dietary intake...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Enfermería, Fisioterapia y Podología, leída el 17-12-2015