Risk assessment and nutritional prognosis of clinical outcome in critically ill patients

Introduction: Nutrition assessment of critically ill patients is challenging but it should be part of the clinical nutrition routine in the hospital setting. Objective: To assess the nutritional risk and prognosis of patients admitted to the intensive care unit (ICU) of a University Hospital in Natal, Brazil. Methods: Cross-sectional study developed with adult and elderly patients between February 2017 and February 2020. The nutritional risk was detected by the modified Nutrition Risk in Critically Ill score (mNUTRIC score). The nutritional prognosis was assessed using the phase angle (PA), calculated from the resistance and reactance values provided by bioimpedance. Mann-Whitney test was used to verify the association of mNUTRIC-score and PA with the outcome (hospital discharge or death). Spearman's correlation coefficient was used to verify the correlation between mNUTRIC-score and PA. Results: A total of 55 patients were included in this study. The average value of the NUTRIC score and PA was 3.13 ± 2.35 and 4.19 ± 1.21, respectively. Most patients had low nutritional risk. Among them, 81.8% were discharged and 18.2% died. Both mNUTRIC-score (p≤0.0001) and PA (p=0.04) were associated with the clinical outcome. These two parameters were negatively correlated (r=-0.3804; p=0.0059). Conclusion: Most of the patients had a low nutritional risk determined by the mNUTRIC-score. Those with high nutritional risk had a worse outcome (death). A negative correlation was observed between the mNUTRIC score and the PA, showing that the higher the nutritional risk, the worse prognosis was found in critically ill patients.

Association between Palliative Performance Scale and nutritional aspects in individuals with cancer in exclusive palliative care.

BACKGROUND & AIMS: Palliative care in incurable cancer should be focused on symptom control, especially those impacting nutrition. This study aims to verify associations between functional performance using the Palliative Performance Scale Version 2 (PPS2) and nutritional and clinical aspects in cancer patients in exclusive palliative care (EPC). METHODS: Through a cross-sectional study, twenty-seven patients recently referred to the EPC outpatient clinic were evaluated. PPS2 was used to define functional performance, while nutritional aspects were obtained using the Patient-Generated Subjective Global Assessment (PG-SGA). Fisher's Exact test and correspondence analysis were used with a 5% level of significance. RESULTS: Of 27 eligible patients, a higher frequency of PPS2 levels 50% and 40% (70.3%) was observed, reflecting important functional impairments. The sample was mainly composed of severely malnourished patients (70.4%), polysymptomatic, and in critical need of nutritional intervention (96.3%). Regarding the primary diagnosis, gastrointestinal (37%) and lung (26%) cancer were the most prevalent. No associations between PPS2 and nutritional and clinical aspects were observed; however, the correspondence analysis demonstrated proximity between low PPS2 levels and worse nutritional markers. CONCLUSIONS: PG-SGA and PPS2 tools combined are suggested due to their importance in guiding assistance to cancer patients in EPC.

A Systematic Review on Processed/Ultra-Processed Foods and Arterial Hypertension in Adults and Older People.

The increase in the availability of processed and ultra-processed foods has altered the eating patterns of populations, and these foods constitute an exposure factor for the development of arterial hypertension. This systematic review analyzed evidence of the association between consumption of processed/ultra-processed foods and arterial hypertension in adults and older people. Electronic searches for relevant articles were performed in the PUBMED, EMBASE and LILACS databases. The review was conducted following the PRISMA guidelines and the Newcastle-Ottawa Scale. The search of the databases led to the retrieval of 2323 articles, eight of which were included in the review. A positive association was found between the consumption of ultra-processed foods and blood pressure/arterial hypertension, whereas insufficient evidence was found for the association between the consumption of processed foods and arterial hypertension. The results reveal the high consumption of ultra-processed foods in developed and middle-income countries, warning of the health risks of such foods, which have a high energy density and are rich in salt, sugar and fat. The findings underscore the urgent need for the adoption of measures that exert a positive impact on the quality of life of populations, especially those at greater risk, such as adults and older people.

Lack of Association between Inadequate Micronutrient Intake and Prognosis in Outpatients with Heart Failure.

Inadequate nutrient intake can lead to worse outcomes in patients with heart failure (HF). This prospective cohort study aimed to assess the prevalence of inadequate micronutrient intake and their association with prognosis in 121 adult and elderly outpatients with HF. Habitual micronutrient intake was evaluated using 24-h dietary recalls (minimum 2 and maximum 6). Participants were grouped into moderate (n = 67) and high (n = 54) micronutrient deficiency groups, according to the individual assessment of each micronutrient intake. Patients' sociodemographic, clinical, and anthropometric data and clinical outcomes (hospitalization and mortality) within 24 months were collected. Overall and event-free survival rates were calculated using Kaplan-Meier estimates, and curves were compared using the log-rank test. The death risk rate (hazard ratio (HR)) was calculated using Cox's univariate model. The rate of inadequate intake was 100% for vitamins B1 and D and above 80% for vitamins B2, B9, and E, calcium, magnesium, and copper. No differences in overall survival and event-free survival were observed between groups of HF outpatients with moderate and high micronutrient deficiencies (HR = 0.94 (CI = 0.36-2.48), p = 0.91, and HR = 1.63 (CI = 0.68-3.92), p = 0.26, respectively), as well as when the inadequacy of each micronutrient intake was evaluated alone (all p > 0.05). In conclusion, a high prevalence of inadequate micronutrient intake was observed in outpatients with HF. Inadequate micronutrient intake was not associated with hospitalization and mortality in this group of patients.

Relação Positiva entre o Ângulo de Fase Padronizado e o Estadiamento Clínico em Indivíduos com câncer / Positive Relation between Standardized Phase Angle and Clinical Neoplasm Staging in Individuals with Cancer / Relación Positiva entre Ángulo de Fase y Estadificación Clínica de Neoplasias Individuos con Cáncer

Introdução: O câncer é caracterizado pela multiplicação desordenada de células de um dado tecido, com potencial para invadir outros órgãos e tecidos. O conhecimento da extensão anatômica do câncer e sua capacidade de infiltração são importantes para nortear terapias e prognóstico, e a evolução dessa doença tem forte impacto negativo no estado nutricional do paciente. O ângulo de fase (AF) se apresenta como ótima ferramenta prognóstica para esse grupo. Objetivo: Associar o ângulo de fase padronizado (AFP) com o estadiamento clínico em indivíduos com câncer. Método: Estudo observacional e transversal, realizado com adultos e idosos com câncer não hospitalizados. As informações clínicas e o estadiamento clínico (TNM) do câncer foram obtidos por meio de prontuário eletrônico. Foi realizada a Avaliação Subjetiva Global Produzia pelo Próprio Paciente (ASG-PPP), e calculados o AF, mediante os valores obtidos pela bioimpedância e, em seguida, o AFP. Resultados: Participaram da pesquisa 25 voluntários com média de idade de 58,3 anos (±13,7), sendo 54,8% do sexo feminino e 54,8% idosos. O tipo de câncer mais frequente foi o de estômago (36%); 44% dos participantes tinham estádios clínicos II e 56%, III ou IV. Segundo a ASG-PPP, 74% dos voluntários apresentavam algum grau de comprometimento nutricional (escores B ou C), e foi detectada associação positiva entre o AFP e o estadiamento tumoral (p>0,0414). Conclusão: O AFP se relacionou positivamente com o estadiamento clínico em indivíduos com câncer

Introduction: Cancer is characterized by the abnormal growth of cells in a tissue, with the potential to invade another organs and tissues. The knowledge of the anatomical extent of cancer and its infiltration capacity are important to guide therapies and prognosis, and the evolution of this disease has severe negative impact on the patient's nutritional status. Phase angle (PA) is an excellent prognostic tool for this group. Objective: To associate the standardized phase angle (SPA) with clinical staging in cancer patients. Method: Observational and cross-sectional study with adults and older adults with cancer non-hospitalized. Clinical information and clinical staging (TNM) of cancer were obtained from electronic charts. PatientGenerated Subjective Global Assessment (PG-SGA) was performed, and the PA was calculated using values collected by bioimpedance and then the standardized PA (SPA). Results: 25 volunteers participated, with mean age of 58.3 years (±13.7), 54.8% females and 54.8% older adults. The most frequent tumor site was in the stomach (36%), 44% of the participants were in clinical stages II and 56%, III or IV. According to the PG-SGA, 74% of the volunteers had some degree of nutritional impairment (score B or C), and a positive association was detected between SPA and tumor staging (p>0.0414). Conclusion: SPA was positively related to clinical staging in individuals with cancer

Introducción: El cáncer se caracteriza por la multiplicación desordenada de células en un tejido, con potencial para invadir otros órganos y tejidos. El conocimiento de la extensión anatómica del cáncer y su capacidad de infiltración son importantes para orientar las terapias y el pronóstico, y la evolución de esta enfermedad tiene un fuerte impacto negativo en el estado nutricional del paciente. Y el ángulo de fase (AF) es una excelente herramienta de pronóstico para este grupo. Objetivo: Asociar el ángulo de fase estandarizado con la estadificación en individuos con cáncer. Método: Estudio observacional y transversal, realizado con adultos y ancianos con cáncer no hospitalizados. La información clínica y la estadificación clínica (TNM) del cáncer se obtuvieron a través de registros médicos electrónicos, y se realizó la Valoración Global Subjetiva Generada por el Paciente (VGSGP) y se calculó el AF y AF estandarizado utilizando los valores obtenidos por bioimpedancia y luego el AF estandarizada. Resultados: Participaron 25 voluntarios, con una edad promedio de 58,3 años (±13,7), 54,8% mujeres y 54,8% eran ancianos. El tipo de cáncer más frecuente fue el de estómago (36%), y el 44% de los participantes tenía estadios clínicos II y 56% III o IV. Según la VG-SGP 74% de los voluntarios presentaban algún grado de deterioro nutricional (puntuaciones B o C) y se detectó una asociación positiva entre el AF estandarizado y estadificación tumoral (p>0,0414). Conclusión: El AF estandarizada se relacionó positivamente con la estadificación en personas con cáncer

Nutritional assessment methods for zinc supplementation in prepubertal non-zinc-deficient children.

BACKGROUND: Zinc is an essential nutrient that is required for numerous metabolic functions, and zinc deficiency results in growth retardation, cell-mediated immune dysfunction, and cognitive impairment. OBJECTIVE: This study evaluated nutritional assessment methods for zinc supplementation in prepubertal non-zinc-deficient children. DESIGN: We performed a randomised, controlled, triple-blind study. The children were divided into a control group (10% sorbitol, n=31) and an experimental group (10 mg Zn/day, n=31) for 3 months. Anthropometric and dietary assessments as well as bioelectrical measurements were performed in all children. RESULTS: Our study showed (1) an increased body mass index for age and an increased phase angle in the experimental group; (2) a positive correlation between nutritional assessment parameters in both groups; (3) increased soft tissue, and mainly fat-free mass, in the body composition of the experimental group, as determined using bioelectrical impedance vector analysis; (4) increased consumption of all nutrients, including zinc, in the experimental group; and (5) an increased serum zinc concentration in both groups (p<0.0001). CONCLUSIONS: Given that a reference for body composition analysis does not exist for intervention studies, longitudinal studies are needed to investigate vector migration during zinc supplementation. These results reinforce the importance of employing multiple techniques to assess the nutritional status of populations.