Prevalence of Malnutrition and Its Association with Clinical Complications in Hospitalized Cardiac Patients: Retrospective Cohort Study

Abstract Background Malnutrition can affect the clinical course of hospitalized patients, increasing hospital stay, infections, mortality, and hospital costs. Among heart disease patients, the malnutrition prevalence ranges from 25 to 51.9%. Objective To assess the prevalence of malnutrition and its association with clinical complications in cardiac patients admitted to a cardiology hospital. Method Retrospective cohort study with patients evaluated within 48 hours of admission to the ward of a referral center for cardiology in Porto Alegre, Brazil. Patients were aged 18 years or older. Malnutrition was assessed by Subjective Global Assessment. Length of hospital stay, transfer to the intensive care unit (ICU), hospital discharge and in-hospital death were collected from medical records. Statistical analysis was performed using the SPSS 22.0 program. Comparisons between groups with and without malnutrition were made by unpaired Student's t-test and chi-square test with adjusted residuals, and multivariate Poisson regression used for analysis of outcomes. The significance level considered was 5%. Results We evaluated 130 patients aged 63 ± 13 years, 63% were male, and the most frequent cause of hospitalization was angina (25%). The prevalence of malnutrition was 27% and, after statistical adjustment for age, malnutrition was positively associated with ICU transfer and length of hospital stay longer than seven days. Conclusion The prevalence of malnutrition found in this sample was 27% and this nutritional diagnosis was positively associated with ICU transfer and length of hospital stay longer than seven days. (Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0)

Adductor muscle thickness of the thumb: A new and reliable parameter for nutritional assessment of pediatric inpatients.

BACKGROUND & AIMS: The adductor pollicis muscle thickness (APMT) is a promising method for evaluation of muscle loss and, consequently, malnutrition in adult and elderly patients. However, to date, there have been no studies of its applicability to the pediatric population. Within this context, we sought to evaluate the association of APMT with anthropometric variables, body mass index (BMI), pediatric Subjective Global Assessment (SGA) of nutrition, nutritional screening, and clinical outcomes in hospitalized pediatric patients. METHODS: This was a cross-sectional study of inpatients aged 4-8.9 years, recruited via convenience sampling from a pediatric hospital in Porto Alegre, Rio Grande do Sul, Brazil. Data collection took place between December 2014 and February 2016. Patients admitted to the intensive care unit, those unable to feed orally, and those with cerebral palsy or Down syndrome were excluded from the study. General and socioeconomic information was collected and the SGA Ped and STRONGkids were administered at hospital admission. Clinical data were collected from the electronic medical record. Anthropometric parameters and APMT were measured by properly calibrated examiners. Data analysis was carried out in SPSS version 21.0. The significance level was set at 5%. RESULTS: The sample consisted of 447 patients. Most (55.9%) were male; the mean age was 6.2 ± 1.4 years. Low APMT was significantly associated with underweight, short stature, low body fat percentage, and poor muscle reserve (p < 0.001). There were also significant associations of moderate and severe malnutrition (assessed by the SGA Ped) and high nutritional risk (assessed by the STRONGkids instrument) with reduced APMT (p < 0.001). Regarding clinical outcomes, a longer hospital stay was observed in patients with reduced APMT (p = 0.001). A receiver operating characteristic (ROC) curve, plotted considering the SGA Ped as the gold standard, suggested APMT cutoff points of 10.2 mm for boys and 9.5 mm for girls. Stratification by age yielded APMT cutoff points of 9.8 mm for boys younger than 6 years and 10.2 mm for those older than 6 years, and 9.2 mm and 9.8 mm for girls younger and older than 6 years, respectively. CONCLUSION: The APMT is an efficient parameter for the detection of malnutrition in hospitalized pediatric patients.

Avaliação do risco nutricional em crianças hospitalizadas: uma comparação da avaliação subjetiva global pediátrica e triagem nutricional STRONGkids com os indicadores antropométricos / Nutritional risk assessment in hospitalized children: a comparison of pediatric subjective global assessment and STRONGkids screening tool with anthropometric indicators

Objetivos: Comparar a Avaliação Nutricional Subjetiva Global (ANSG) e a Triagem de Risco para Estado Nutricional e Crescimento (STRONGkids) com a avaliação antropométrica, na admissão hospitalar, e associá-las ao tempo de internação em crianças hospitalizadas. Métodos: Estudo transversal com pacientes de 4 a 8,9 anos internados em um hospital pediátrico de Porto Alegre, Rio Grande do Sul. A amostragem foi realizada por conveniência, e a coleta de dados ocorreu entre junho e outubro de 2014. Não foram incluídos pacientes internados em Unidade de Terapia Intensiva e aqueles sem condições de alimentação por via oral. Foram coletadas informações gerais e socioeconômicas, e aplicados os questionários de ANSG e STRONGkids na admissão hospitalar. Dados clínicos e antropométricos foram coletados do prontuário eletrônico. Resultados: Avaliaram-se 317 pacientes com idade média de 76,1±17,5 meses e, na maioria, com motivo de internação cirúrgico (21,5%). Segundo a avaliação antropométrica, 5% dos pacientes eram desnutridos, 74,1% eram eutróficos e 20,8% apresentavam excesso de peso. Houve associação significativa entre a desnutrição classificada pela avaliação antropométrica e a desnutrição moderada e grave definida pela ANSG (p<0,001). Também houve associação significativa entre excesso de peso, eutrofia e desnutrição, classificados pela avaliação antropométrica, e risco nutricional baixo, médio e alto, respectivamente (p<0,001). Houve concordância significativa, porém muito fraca, entre a STRONGkids e a avaliação antropométrica (kappa=0,148; p=0,001). Conclusões: Todas as avaliações feitas por meio das ferramentas testadas associaram-se (embora em fraca intensidade) com o tempo de internação hospitalar. Além disso, a STRONGkids apresentou maior concordância, embora ainda fraca, com a avaliação antropométrica quando comparada à ANSG. São necessários mais estudos verificando a concordância dessas ferramentas com outros métodos objetivos de avaliação nutricional.

Aims: To compare the Subjective Global Nutritional Assessment (SGNA) and the Screening Tool for Risk on Nutritional Status and Growth (STRONGkids) protocols with anthropometric measurements at admission, and associate them to length of stay in hospitalized children. Methods: Cross-sectional study with patients from four to 8.9 years admitted to a pediatric hospital in Porto Alegre, Rio Grande do Sul, Brazil. The sample was selected by convenience, and data collection occurred between June and October 2014. Patients in the Intensive Care Unit and those unable to feed orally were not included. We collected general and socioeconomic information and applied STRONGkids and SGNA protocols at admission. Clinical and anthropometric data were retrieved from electronic medical records. Results: We evaluated 317 patients with a mean age of 76.1±17.5 months, most of them admitted for surgery (21.5%). According to anthropometric measurements, 5% of patients were malnourished, 74.1% had normal weight and 20.8% were overweight. There was a statistically significant association between malnutrition classified by anthropometric measurements and moderate and severe malnutrition defined by SGNA (p<0.001). There was also a significant association between overweight, normal weight and malnutrition classified by anthropometric measurements and low, medium and high nutritional risk, respectively (p<0.001). There was a statistically significant agreement, although very weak, between STRONGkids and anthropometric measurements (kappa=0.148; p=0.001). Conclusions: All protocols were associated (though in low intensity) to length of hospital stay. In addition, STRONGkids showed greater agreement, although still weak, with anthropometric measurements when compared to the SGNA. Further studies are needed to verify the agreement of these protocols with other objective methods of nutritional assessment.