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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Background</span><p id="par0005" class="elsevierStylePara elsevierViewall">Malnutrition is a common comorbidity in patients hospitalized for heart failure &#40;HF&#41; and represents a potent predictor of mortality&#44; such that 2 years after the hospital discharge&#44; malnourished patients have almost 4 times the risk of dying than patients who have a normal nutritional status&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> The results of the Nutritional Intervention Program for Malnourished Patients Hospitalized for Heart Failure &#40;PICNIC&#41; study showed that a nutritional intervention for malnourished patients hospitalized for HF reduces the risk of all-cause death and readmission for HF during the 12 months after hospital discharge&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> The objective of the present study was to assess the long-term effects of the nutritional intervention on patients included in the PICNIC study&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0010" class="elsevierStylePara elsevierViewall">The design of the PICNIC study has already been published&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2&#44;3</span></a> Briefly&#44; this was a multicenter clinical trial in which the malnourished patients hospitalized for HF were assigned &#40;using a simple randomization process&#41; to undergo &#40;or not&#41; an individual nutritional intervention&#44; added to the conventional treatment for HF&#46; The patients signed the informed consent document and participated in the study according to the protocol approved by the ethics committees of the participating centers&#46; The diagnosis of malnutrition was established after obtaining a score of &#60;17 points on the Mini Nutritional Assessment survey&#46; In accordance with the protocol&#44; the intervention was extended for 6 months and was based on 3 points&#58; diet optimization&#44; specific recommendations and nutritional supplements &#40;prescribed for 12&#37; of the patients&#41; when the nutritional objectives were not reached with the diet&#46; The primary endpoint was the combined event of all-cause death or readmission for HF&#46; The analysis was performed by intention to treat&#46; PICNIC is registered in ClinicalTrial&#46;gov &#40;<a href="ctgov:NCT01472237">NCT01472237</a>&#41;&#46; In this analysis&#44; we assessed the effects of the intervention at 2 years of follow-up&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0015" class="elsevierStylePara elsevierViewall">Between March 2012 and April 2014&#44; a total of 120 patients were included in the study&#46; The 2 groups were homogeneous in terms of their baseline characteristics&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> At 2 years&#44; the combined event occurred in 47&#46;5&#37; of the intervention group and in 73&#46;8&#37; of the control group &#40;hazard ratio&#44; 0&#46;45&#59; 95&#37; confidence interval 0&#46;28&#8211;0&#46;72&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Thirty-nine percent of the intervention group and 59&#37; of the control group died &#40;hazard ratio&#44; 0&#46;53&#59; 95&#37; confidence interval 0&#46;31&#8211;0&#46;89&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;017&#41;&#46; The readmission rate for HF was also lower in the intervention group &#40;18&#46;6&#37; vs&#46; 39&#46;3&#37;&#44; respectively&#59; log-rank test&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0020" class="elsevierStylePara elsevierViewall">The results of this analysis demonstrate that the benefit of a nutritional intervention applied for 6 months in malnourished patients hospitalized for HF is maintained in the long term&#46; It is possible that a nutritional intervention can help optimize energy intake and thereby moderate the imbalance between anabolism&#47;catabolism&#44; which is the result of the neurohormonal and inflammatory activation of HF itself&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> Nutritional measures can also optimize the protein supply and increase protein synthesis&#44; which is necessary for maintaining muscle mass and serum albumin concentrations&#46; The catabolic state&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> the reduction in muscle mass<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> and hypoalbuminemia<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> are predictors of mortality in HF&#46; Early modification of these factors could change the disease progression in malnourished patients and explain the benefit of the nutritional intervention&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In summary&#44; a nutritional intervention for 6 months in malnourished patients hospitalized for HF improved the prognosis&#44; not only immediately but also after the intervention ended&#46; It is essential to include a nutritional state assessment in the comprehensive of patients with HF and act early when malnutrition is detected&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Funding</span><p id="par0030" class="elsevierStylePara elsevierViewall">The PICNIC study was funded as a Clinical Research Project in Cardiology by the Spanish Society of Cardiology&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To assess the long-term effect of nutritional intervention on malnourished&#44; hospitalised patients with heart failure &#40;HF&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A total of 120 malnourished patients hospitalized for HF were randomized to undergo &#40;or not&#41; an individual nutritional intervention for 6 months&#46; The primary event was the combination of all-cause death and readmission for HF&#46; We performed an intent-to-treat analysis and assessed the effect of the intervention at 24 months&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The combined event occurred in 47&#46;5&#37; of the intervention group and in 73&#46;8&#37; of the control group &#40;hazard ratio&#58; 0&#46;45&#59; 95&#37; confidence interval&#58; 0&#46;28&#8211;0&#46;72&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46; Thirty-nine percent of the intervention group and 59&#37; of the control group died &#40;hazard ratio&#58; 0&#46;53&#59; 95&#37; confidence interval&#58; 0&#46;31&#8211;0&#46;89&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;017&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A nutritional intervention for malnourished patients hospitalised for HF maintains its prognostic benefit in the long-term follow-up&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Evaluar el efecto a largo plazo de una intervenci&#243;n nutricional en pacientes hospitalizados con insuficiencia cardiaca &#40;IC&#41; y desnutridos&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Un total de 120 pacientes hospitalizados por IC y desnutridos fueron aleatorizados a recibir o no una intervenci&#243;n nutricional individualizada durante 6 meses&#46; El evento primario fue el combinado de muerte por cualquier causa o reingreso por IC&#46; Se realiz&#243; un an&#225;lisis por intenci&#243;n de tratar y se evalu&#243; el efecto de la intervenci&#243;n a los 24 meses&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">El evento combinado ocurri&#243; en el 47&#44;5&#37; de los pacientes del grupo de intervenci&#243;n y en el 73&#44;8&#37; del grupo control &#40;<span class="elsevierStyleItalic">hazard ratio</span>&#58; 0&#44;45&#59; intervalo de confianza del 95&#37;&#58; 0&#44;28-0&#44;72&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Fallecieron el 39&#37; en el grupo de intervenci&#243;n y el 59&#37; en el grupo control &#40;<span class="elsevierStyleItalic">hazard ratio</span>&#58; 0&#44;53&#59; intervalo de confianza del 95&#37;&#58; 0&#44;31-0&#44;89&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;017&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Una intervenci&#243;n nutricional en pacientes hospitalizados por IC que est&#225;n desnutridos mantiene su beneficio pron&#243;stico en el seguimiento a largo plazo&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Bonilla-Palomas JL&#44; G&#225;mez-L&#243;pez AL&#44; Castillo-Dom&#237;nguez JC&#44; Moreno-Conde M&#44; L&#243;pez-Ib&#225;&#241;ez MC&#44; Anguita-S&#225;nchez M&#46; &#191;Mantiene la intervenci&#243;n nutricional en pacientes hospitalizados por insuficiencia cardiaca desnutridos su beneficio pron&#243;stico a largo plazo&#63; Rev Clin Esp&#46; 2018&#59;218&#58;58&#8211;60&#46;</p>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Kaplan&#8211;Meier curves of the 2 patient groups &#40;intervention and control&#41; for the study events&#46;</p>"
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      "titulo" => "References"
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                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;L&#46; Bonilla-Palomas"
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                            4 => "D&#46; Garcia-Fuertes"
                            5 => "M&#46; Crespin-Crespin"
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                      ]
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                  ]
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                          "etal" => true
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                            0 => "J&#46;L&#46; Bonilla-Palomas"
                            1 => "A&#46;L&#46; G&#225;mez-L&#243;pez"
                            2 => "J&#46;C&#46; Castillo-Dom&#237;nguez"
                            3 => "M&#46; Moreno-Conde"
                            4 => "M&#46; L&#243;pez-Ib&#225;&#241;ez"
                            5 => "R&#46; Alhambra-Exp&#243;sito"
                          ]
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                  ]
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                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
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                            0 => "J&#46;L&#46; Bonilla-Palomas"
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Brief Original
DOI: 10.1016/j.rceng.2017.10.006
Does nutritional intervention maintain its prognostic benefit in the long term for malnourished patients hospitalised for heart failure?
¿Mantiene la intervención nutricional en pacientes hospitalizados por insuficiencia cardiaca desnutridos su beneficio pronóstico a largo plazo?
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J.L. Bonilla-Palomasa,
Corresponding author
juanl.bonilla.sspa@juntadeandalucia.es

Corresponding author.
, A.L. Gámez-Lópeza, J.C. Castillo-Domínguezb, M. Moreno-Condec, M.C. López-Ibáñezc, M. Anguita-Sánchezb
a Área de Cardiología, Unidad de Gestión Clínica de Medicina Interna, Hospital San Juan de la Cruz, Úbeda, Jaén, Spain
b Unidad de Gestión Clínica de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain
c Unidad de Gestión Clínica de Medicina Interna, Hospital San Juan de la Cruz, Úbeda, Jaén, Spain
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