Qualidade dos dados antropométricos de crianças menores de cinco anos em sistemas de informação no estado de São Paulo, Brasil / The quality of the anthropometric data on children under five years of age in information systems in the State of São Paulo, Brazil

Resumo O objetivo foi analisar a qualidade dos dados antropométricos de crianças menores de cinco anos em dois sistemas de informação no estado de São Paulo. A amostra compreendeu 2.117.108 crianças do Sistema de Vigilância Alimentar e Nutricional (Sisvan) e 748.551 do Projeto Estadual do Leite (Vivaleite). Inicialmente, avaliamos a frequência de valores faltantes e fora do espectro do equipamento, e calculamos o índice de preferência de dígito para peso. Após calcular os índices de altura para idade (A-I), peso para idade (P-I) e índice de massa corporal para idade (IMC-I), identificamos os valores biologicamente implausíveis (VBI) e calculamos o desvio-padrão (DP). Para cada município, calculamos a média e o DP de A-I, P-I e IMC-I; e plotamos os valores de DP em função da média. A preferência de dígito no peso foi maior em crianças de 24 a 59 meses no Sisvan. A frequência de VBI para A-I (SISVAN 2,56%; Vivaleite 0,98%) foi maior do que para P-I (Sisvan 2,10%; Vivaleite 0,18%). Para o índice A-I as variações entre os municípios foram mais acentuadas no Vivaleite do que no Sisvan. A variável altura apresentou baixa confiabilidade nos dois sistemas. A variável peso apresentou qualidade satisfatória no Vivaleite e insatisfatória no Sisvan.

Abstract This paper involves the analysis of the quality of anthropometric data on children under five years of age in two information systems in the State of São Paulo. The sample included 2,117,108 children from the Food and Nutrition Surveillance System (SISVAN), and 748,551 from the State Milk Project (VIVALEITE). Initially, we evaluated the frequency of missing values and others outside the equipment spectrum and calculated the digit-to-weight preference index. After calculating height-for-age (HAZ), weight-for-age (WAZ), and body mass index-for-age (BAZ), we flagged the biologically implausible values (BIV) and calculated the standard deviation (SD). For each municipality, we calculated the mean and the SD of HAZ, WAZ, and BAZ; and plotted the SD values as a function of the mean. The digit-to-weight preference index was greater among children aged between 24 and 59 months in SISVAN. The frequency of BIV for HAZ (SISVAN 2.56%; VIVALEITE 0.98%) was higher than for WAZ (SISVAN 2.10%; VIVALEITE 0.18%). For HAZ, variations among municipalities were more pronounced in VIVALEITE than in SISVAN. The height variable presents low reliability in both systems. The weight variable reveals satisfactory quality in VIVALEITE and unsatisfactory quality in SISVAN.

O Índice Nutricional Prognóstico está Associado ao Grau de Circulação Colateral Coronariana em Pacientes com Angina Estável e Oclusão Total Crônica / Prognostic Nutritional Index is Associated with the Degree of Coronary Collateral Circulation in Stable Angina Patients with Chronic Total Occlusion

Resumo Fundamento: A circulação colateral coronária (CCC) pode efetivamente melhorar o suprimento sanguíneo miocárdico para a área de OCT (oclusão coronariana total crônica) e pode, assim, melhorar o prognóstico de pacientes com síndrome coronariana estável (SCE). O grau de inflamação e alguns marcadores de inflamação foram associados ao desenvolvimento de colaterais. Objetivo: Investigar se o índice nutricional prognóstico (INP) tem associação com o desenvolvimento de CCC em pacientes com SCE. Métodos: Um total de 400 pacientes com SCE com presença de OTC em pelo menos uma importante artéria coronária epicárdica foi incluído neste estudo. Os pacientes foram divididos em dois grupos de acordo com o escore Rentrop. Escores de 0 a 1 foram considerados CCC pouco desenvolvidas e escores de 2 a 3 foram aceitos como CCC bem desenvolvidas. A significância estatística foi definida como um valor p < 0,05 para todas as análises. Resultados: A média de idade da coorte do estudo foi de 63±10 anos; 273 (68,3%) eram do sexo masculino. O grupo CCC pouco desenvolvido apresentou um nível de INP significativamente mais baixo em comparação com o grupo CCC bem desenvolvido (38,29±5,58 vs 41,23±3,85, p<0,001). Na análise multivariada, o INP (odds ratio 0,870; intervalo de confiança de 95% 0,822-0,922; p<0,001) foi um preditor independente de CCC pouco desenvolvida. Conclusão: O INP pode ser utilizado como um dos preditores independentes da formação do CCC. Foi positivamente associado ao desenvolvimento de colaterais coronárias em pacientes com SCE com OTC.

Abstract Background: Coronary collateral circulation (CCC) can effectively improve myocardial blood supply to the area of CTO (chronic total coronary occlusion) and can, thus, improve the prognosis of patients with stable coronary syndrome (SCS). The degree of inflammation and some inflammation markers were associated with the development of collaterals. Objective: To investigate whether prognostic nutritional index (PNI) has an association with the development of CCC in patients with SCS. Methods: A total of 400 SCS patients with the presence of CTO in at least one major epicardial coronary artery were included in this study. The patients were divided into two groups according to the Rentrop score. Scores of 0 to 1 were considered poor developed CCC, and scores of 2 to 3 were accepted as good developed CCC. Statistical significance was set as a p-value < 0.05 for all analyses. Results: The mean age of the study cohort was 63±10 years; 273 (68.3%) were males. The poor-developed CCC group had a significantly lower PNI level compared with the good-developed CCC group (38.29±5.58 vs 41.23±3.85, p< 0.001). In the multivariate analysis, the PNI (odds ratio 0.870; 95% confidence interval 0.822-0.922; p< 0.001) was an independent predictor of poorly developed CCC. Conclusion: The PNI can be used as one of the independent predictors of CCC formation. It was positively associated with the development of coronary collaterals in SCS patients with CTO.

Effects of Preoperative Nutritional Status and Lymphocyte Count on the Development of Early-term Atrial Fibrillation After Coronary Artery Bypass Grafting: A Retrospective Study

ABSTRACT Introduction: Although there are publications in the literature stating that parameters related to the nutritional status of patients are associated with the clinical outcomes of those with coronary artery disease, it is also stated that there is insufficient data on the relationship between nutritional indices and long-term outcomes and major adverse cardiovascular events in patients undergoing isolated coronary artery bypass grafting. Methods: This retrospective study was conducted with patients who underwent isolated elective on-pump coronary artery bypass grafting in our hospital. Patients who underwent emergency coronary artery bypass grafting or those with known atrial fibrillation in the preoperative period were excluded. Patients were analyzed and compared in two groups according to the development of postoperative atrial fibrillation. Results: The data of 93 coronary artery bypass grafting patients (71 [76%] males) with a mean age of 62.86 ± 9.53 years included in the study were evaluated. Both groups had similar preoperative ejection fraction value, hemoglobin level, age, number of distal bypasses, and postoperative mortality rates. Although the mean cardiopulmonary bypass and aortic cross-clamping times were higher in Group 1, they were not statistically significant. In our study, the mean prognostic nutrition index value was 51.76 ± 3002. Conclusion: According to our study results, there was no statistically significant difference between prognostic nutrition index values and the development of atrial fibrillation after coronary artery bypass grafting, which is similar to some publications in the literature. We think that it would be beneficial to conduct randomized studies involving more patients on this subject.

O valor do índice nutricional prognóstico pré-operatório no câncer gástrico após ressecção curativa / The value of preoperative prognostic nutritional index in gastric cancer after curative resection

ABSTRACT BACKGROUND: Predicting short- and long-term outcomes of oncological therapies is crucial for developing effective treatment strategies. Malnutrition and the host immune status significantly affect outcomes in major surgeries. AIMS: To assess the value of preoperative prognostic nutritional index (PNI) in predicting outcomes in gastric cancer patients. METHODS: A retrospective cohort analysis was conducted on patients undergoing curative-intent surgery for gastric adenocarcinoma between 2009 and 2020. PNI was calculated as follows: PNI=(10 x albumin [g/dL])+(0.005 x lymphocytes [nº/mm3]). The optimal cutoff value was determined by the receiver operating characteristic curve (PNI cutoff=52), and patients were grouped into low and high PNI. RESULTS: Of the 529 patients included, 315 (59.5%) were classified as a low-PNI group (PNI<52) and 214 (40.5%) as a high-PNI group (PNI≥52). Older age (p=0.050), male sex (p=0.003), American Society of Anesthesiologists score (ASA) III/IV (p=0.001), lower hemoglobin level (p<0.001), lower body mass index (p=0.001), higher neutrophil-lymphocyte ratio (p<0.001), D1 lymphadenectomy, advanced pT stage, pN+ and more advanced pTNM stage were related to low-PNI patient. Furthermore, 30-day (1.4 vs. 4.8%; p=0.036) and 90-day (3.3 vs. 10.5%; p=0.002) mortality rates were higher in low-PNI compared to high-PNI group. Disease-free and overall survival were worse in low-PNI patients compared to high-PNI (p<0.001 for both). ASA III/IV score, low-PNI, pT3/T4, and pN+ were independent risk factors for worse survival. CONCLUSIONS: Preoperative PNI can predict short- and long-term outcomes of patients with gastric cancer after curative gastrectomy. Low PNI is an independent factor related to worse disease-free and overall survival.

RESUMO RACIONAL: Estimar os desfechos de curto e longo prazo das terapias contra o câncer é crucial para o desenvolvimento de estratégias de tratamento eficazes. A desnutrição e o estado imunológico do hospedeiro afetam significativamente os desfechos em cirurgias de grande porte. OBJETIVOS: Avaliar o valor do índice nutricional prognóstico pré-operatório (INP) na predição de desfechos em pacientes com câncer gástrico. MÉTODOS: Foi realizada uma análise de coorte retrospectiva de pacientes submetidos à cirurgia com intenção curativa para adenocarcinoma gástrico entre 2009 e 2020. O INP foi calculado da seguinte forma: INP=(10 x albumina [g/dL])+(0.005 x linfócitos [nº/mm3]). O valor de corte ideal foi determinado pela curva característica de operação do receptor (ponto de corte do INP=52), e os pacientes foram agrupados em INP baixo ou alto. RESULTADOS: Dos 529 pacientes incluídos, 315 (59,5%) foram classificados como grupo de baixo INP (INP<52) e 214 (40,5%) como grupo de alto INP (INP>52). Idade mais avançada (p=0,050), sexo masculino (p=0,003), escore da Sociedade Americana de Anestesiologistas (ASA) III/IV (p=0,001), menor nível de hemoglobina (p<0,001), menor índice de massa corpórea (p=0,001), maior relação neutrófilos-linfócitos (p<0,001), linfadenectomia D1, estágio pT avançado, pN+ e estágio pTNM mais avançado foram relacionados ao paciente com baixo INP. Além disso, as taxas de mortalidade em 30 dias (1,4 vs. 4,8%; p=0,036) e em 90 dias (3,3 vs. 10,5%; p=0,002) foram maiores no grupo com baixo PNI em comparação ao grupo com alto INP. A sobrevida livre de doença e a sobrevida global foram piores em pacientes com baixo INP em comparação com pacientes com alto INP (p<0,001 para ambos). Escore ASA III/IV, baixo INP, pT3/T4 e pN+ foram fatores de risco independentes para pior sobrevida. CONCLUSÕES: O INP pré-operatório pode predizer desfechos de curto e longo prazo de pacientes com câncer gástrico após gastrectomia curativa. Baixo INP é um fator independente relacionado a piores sobrevida livre de doença e sobrevida global.

Impact of pretransplantation malnutrition risk on the clinical outcome and graft survival of kidney transplant patients / Impacto do risco de desnutrição pré-transplante no desfecho clínico e na sobrevida do enxerto de pacientes transplantados renais

ABSTRACT Background: The prevalence of malnourished patients before transplantation and the influence of malnutrition on graft and patient outcomes remain underestimated, despite being associated with higher postoperative morbidity and mortality. This study aimed to develop an easy nutritional screening tool and evaluate the impact of nutritional status on clinical outcome, graft survival (GS) and mortality risk in kidney transplant patients (KTP). Methods: In this retrospective cohort study including 451 KTP, we developed a score by using anthropometric, clinical, and laboratory measures performed in the pretransplant evaluation. The patients were stratified into 3 groups according to the final score: G1 (0 or 1 point)=low risk, G2 (2 to 4 points)=moderate risk, and G3 (>5 points)=high risk of malnutrition. The patients were monitored after transplantation at least 1 to 10 years. Results: Stratifying the 451 patients based on the pretransplant risk score, G1, G2, and G3 were composed of 90, 292, and 69 patients, respectively. Patients from G1 maintained the lowest serum creatinine levels at hospital discharge when compared with others (p = 0.012). The incidence of infection in the patients from G3 was higher than patients from G1 and G2 (p = 0.030). G3 recipients showed worse GS than G1 patients (p = 0.044). G3 patients showed almost threefold higher risk for graft loss (HR 2.94, 95% CI 1.084-7.996). Conclusions: KTP with higher malnutrition risk score were associated with worse outcomes and GS. The nutritional screening tool is easy to be used in clinical practice to evaluate the patient in preparation for kidney transplant.

RESUMO Antecedentes: A prevalência de pacientes desnutridos antes do transplante e a influência da desnutrição nos desfechos do enxerto e do paciente permanecem subestimadas, embora estejam associadas a maior morbimortalidade pós-operatória. Este estudo buscou desenvolver uma ferramenta simples de triagem nutricional e avaliar o impacto do estado nutricional no desfecho clínico, sobrevida do enxerto (SE) e risco de mortalidade em pacientes transplantados renais (PTR). Métodos: Neste estudo de coorte retrospectivo incluindo 451 PTR, desenvolvemos um escore usando medidas antropométricas, clínicas e laboratoriais tomadas na avaliação pré-transplante. Os pacientes foram estratificados em 3 grupos segundo a pontuação final: G1 (0-1 ponto) = baixo risco, G2 (2-4 pontos) = risco moderado e G3 (>5 pontos) = alto risco de desnutrição. Eles foram monitorados por pelo menos 1 a 10 anos após o transplante. Resultados: Os 451 pacientes foram estratificados em G1, G2 e G3, que consistiram em 90, 292 e 69 pacientes, respectivamente. Os pacientes do G1 mantiveram os menores níveis de creatinina sérica na alta hospitalar em relação aos demais (p = 0,012). A incidência de infecção nos pacientes do G3 foi maior que nos pacientes do G1 e G2 (p = 0,030). Os pacientes do G3 apresentaram SE pior do que os pacientes do G1 (p = 0,044) e um risco quase três vezes maior de perda do enxerto (HR 2,94; IC 95% 1,084-7,996). Conclusões: PTR com maior escore de risco de desnutrição foram associados a piores desfechos e menor SE. A ferramenta de triagem nutricional é fácil de usar na prática clínica para avaliar pacientes em preparação para transplante renal.

Impact of preoperative body composition in patients with renal cell carcinoma submitted to surgical treatment / Impacto da composição corporal pré-operatória em pacientes com carcinoma de células renais submetidos a tratamento cirúrgico

Abstract Objective: To evaluate the impact of preoperative body composition in patients with renal cell carcinoma (RCC) undergoing surgical treatment. Materials and Methods: This was a retrospective study of 52 patients with RCC undergoing total or partial nephrectomy. Body composition assessment was performed using the body mass index, together with computed tomography analysis at the level of the third lumbar vertebra to measure the area of visceral adipose tissue, as well as the area and density of skeletal muscle mass. Results: Malnutrition, obesity and inadequate skeletal muscle gauge (SMG) were associated with higher hospital length of stay (p = 0.028, p = 0.02 and p = 0.012, respectively). Although the rates of postoperative symptoms and readmissions were low, survival was better among the patients with an adequate SMG than among those with an inadequate SMG (p = 0.003). Conclusion: Among patients with RCC undergoing surgical treatment, preoperative body composition does not seem to be associated with the rates of perioperative complications, although an inadequate SMG seems to be associated with worse overall survival.

Resumo Objetivo Avaliar o impacto da composição corporal pré-operatória em pacientes portadores de carcinoma de células renais (CCR) submetidos a tratamento cirúrgico. Materiais e Métodos: Foi realizado estudo retrospectivo de 52 pacientes portadores de CCR submetidos a tratamento cirúrgico. A avaliação da composição corporal foi realizada por meio do índice de massa corporal e análise da L3 obtida pela tomografia computadorizada para mensurar a área do tecido adiposo visceral, área e densidade da massa muscular esquelética. Resultados: Os pacientes desnutridos, obesos e que apresentaram produto muscular esquelético (PME) inadequado permaneceram mais tempo internados (p = 0,028, p = 0,02 e p = 0,012, respectivamente). As taxas de sintomas e reinternações no pósoperatório foram baixas em toda a amostra, no entanto, observou-se que pacientes com PME inadequado apresentaram uma pior sobrevida em relação aos pacientes com PME adequado (p = 0,003). Conclusão: A análise da composição corporal pré-operatória não mostrou associação com as taxas de complicações periope-ratórias em pacientes portadores de CCR submetidos a nefrectomia total ou parcial, no entanto, a inadequação do PME está associada a uma pior sobrevida.

High Platelet-to-Lymphocyte Ratio is Associated with Dynapenia in COVID-19 Inpatients: a Case-Control Study / Elevada Relação Plaqueta-Linfócito Está Associada com a Dinapenia em Pacientes Hospitalizados com COVID-19: um Estudo Caso-Controle

SARS-CoV-2 virus infection can cause a cytokine storm leading to symptoms like fever, fatigue, anorexia, and myalgia, which are associated with impaired nutritional status including dynapenia. However, few studies have examined the relationship between dynapenia and prognostic markers in COVID-19 patients. This study aimed to evaluate the occurrence of dynapenia in hospitalized COVID-19 patients and investigate its association with prognostic markers. This study was a case-control design, including inpatients with and without a COVID-19 diagnosis. The occurrence of dynapenia was evaluated according to the European Working Group on Sarcopenia 2 criteria. Additionally, inflammatory markers and 4C Mortality Score were assessed. The study sample consisted of 96 patients, and there were no differences between groups regarding age (p=0.656), sex (p=0.777), presence of comorbidities such as type 2 diabetes (p=0.659) and systemic arterial hypertension (p=0.427), and Body Mass Index (p=0.657). Dynapenia was observed in 53.1% of patients with COVID-19. Dynapenic COVID-19 patients had a lower mean Phase Angle (p=0.029), hematocrit (p=0.046), and hemoglobin (p=0.045) and higher Platelet-to-Lymphocyte Ratio (p=0.089). The occurrence of dynapenia in patients with COVID-19 was associated with Phase Angle <5º (p = 0.013) and high PLR >180 (p = 0.019) (markers of worse inflammatory prognosis). Dynapenia was associated with high PLR and PA, but did not relate to other prognostic variables. These findings emphasize the importance of evaluating muscle strength and quality to prevent and/or treat dynapenia.(AU)

A infecção pelo vírus SARS-CoV-2 pode causar uma tempestade de citocinas levando a sintomas como febre, fadiga, anorexia e mialgia, que estão associados a um estado nutricional comprometido, incluindo a dinapenia. No entanto, poucos estudos examinaram a relação entre dinapenia e marcadores prognósticos em pacientes com COVID-19. Este estudo teve como objetivo avaliar a ocorrência de dinapenia em pacientes hospitalizados com COVID-19 e investigar sua associação com marcadores prognósticos. Este é um estudo caso-controle, incluindo pacientes internados com e sem diagnóstico de COVID-19. A dinapenia foi avaliada de acordo com os critérios do Grupo de Trabalho Europeu sobre Sarcopenia 2. Marcadores inflamatórios e o Escore de Mortalidade 4C também foram avaliados. 96 pacientes foram avaliados, e não houve diferenças entre os grupos em relação à idade (p=0,656), sexo (p=0,777), presença de comorbidades como diabetes tipo 2 (p=0,659) e hipertensão arterial sistêmica (p=0,427) e Índice de Massa Corporal (p=0,657). A dinapenia foi observada em 53,1% dos pacientes com COVID-19. Pacientes com COVID-19 e dinapenia apresentaram uma média menor de Ângulo de Fase (p=0,029), hematócrito (p=0,046) e hemoglobina (p=0,045), e uma maior relação plaquetas/linfócitos (RPL) (p=0,089). A ocorrência de dinapenia em pacientes com COVID-19 foi associada a um Ângulo de Fase <5º (p=0,013) e uma RPL alta >180 (p=0,019) (marcadores de pior prognóstico inflamatório). A dinapenia foi associada a RPL alta e Ângulo de Fase, mas não se relacionou com outras variáveis prognósticas. Esses achados enfatizam a importância de avaliar a força muscular e a qualidade para prevenir e/ou tratar a dinapenia.(AU)

Associação do risco nutricional com parâmetros clínicos e nutricionais de pacientes internados em um hospital universitário / Association of nutritional risk with clinical and nutritional parameters of patients hospitalized in a university hospital

Introdução: O reconhecimento do risco nutricional na admissão do indivíduo hospitalizado é fundamental, pois possibilita que intervenções nutricionais adequadas e especializadas sejam implementadas precocemente. Objetivo: Identificar o risco nutricional dos pacientes internados e associar com parâmetros clínicos e nutricionais. Materiais e Métodos: O estudo foi transversal, descritivo, cuja amostra foi não-probabilística, realizado em pacientes com faixa etária superior a 18 anos admitidos nas enfermarias de clínica médica e cirúrgica do Hospital Universitário da Universidade Federal de Juiz de Fora (HU-UFJF/Ebserh). Para identificação do risco nutricional, foi aplicado instrumento de triagem nutricional (NRS-2002) na admissão hospitalar, além da verificação de peso, altura, dados demográficos (sexo, idade, raça/cor), clínicos (diagnóstico médico, tipo e número de comorbidades, tempo de internação hospitalar e desfecho clínico) e nutricionais (risco nutricional, uso e tempo em terapia nutricional). Para as associações estatísticas, foram utilizados os testes qui-quadrado ou exato de Fisher (a depender do tamanho amostral) para as variáveis categóricas e teste de Mann-Witney, para as variáveis contínuas. Em todas as análises foi considerado o nível de significância de 0,05. Resultados: Foram avaliados ao final 147 pacientes, sendo 74 (50,34%) do sexo feminino, 94 (63,95%) de raça/cor branca e 91 (61,90%) adultos. Apenas 15,65% desta população apresentou risco nutricional e este parâmetro foi associado aos indivíduos com doenças hematológicas (p= 0,02) e pulmonares (p= 0,02), àqueles em uso de terapia nutricional (p<0,01), ao maior tempo de internação (p<0,01) e ao menor Índice de Massa Corporal (IMC) (p= 0,02). Os pacientes em risco que fizeram uso de terapia nutricional permaneceram mais dias internados. Conclusão: Este estudo revelou que o risco nutricional, determinado pela NRS-2002, apresentou associação significativa à presença de doenças hematológicas e pulmonares, bem como ao uso de terapia nutricional, número de dias em uso de terapia nutricional, maior tempo de internação hospitalar e menor IMC, estando em concordância com outros trabalhos. Os resultados poderão contribuir para a melhoria do serviço e do tratamento dos pacientes internados.

Introduction: The recognition of the nutritional risk in the admission of the hospitalized individual is essential, as it allows appropriate and specialized nutritional interventions to be implemented early. Objective: To identify the nutritional risk of hospitalized patients and associate with clinical and nutritional parameters. Materials and Methods: The study was cross-sectional, descriptive, whose sample was non-probabilistic, carried out on patients aged over 18 years admitted to the medical and surgical clinic wards of the University Hospital of the Federal University of Juiz de Fora (HU-UFJF/Ebserh). To identify the nutritional risk, a nutritional screening instrument (NRS-2002) was applied on hospital admission, in addition to checking weight, height, data demographic (gender, age, race/color), clinical (medical diagnosis, type and number of comorbidities, hospital length of stay and clinical outcome) and nutritional (nutritional risk, use and time in nutritional therapy). For statistical associations, the chi-square test or Fisher's exact test (depending on the sample size) were used for categorical variables and the Mann-Witney test for continuous variables. In all the analyzes considered a significance level of 0,05. Results: In the end, 147 patients were evaluated, 74 (50,34%) females, 94 (63,95%) white and 91 (61,90%) adults. Only 15,65% of this population presented nutritional risk and this parameter was associated with individuals with hematological (p= 0,02) and pulmonary (p= 0,02) diseases, those using nutritional therapy (p<0,01), longer hospital lengths of stay (p<0,01) and lower Body Mass Index (BMI) (p= 0,02). Patients at risk who used nutritional therapy spent more days in hospital. Conclusion: This study revealed that nutritional risk, determined by NRS-2002, was significantly associated with the presence of hematological and pulmonary diseases, as well as the use of nutritional therapy, number of days using nutritional therapy, longer hospital stay and lower BMI, agreeing with other studies. The results may contribute to improving the service and treatment of hospitalized patients.

The geriatric nutritional risk index predicts complications after nephrectomy for renal cancer

ABSTRACT Purpose: We examined if malnutrition, as defined by the Geriatric Nutritional Risk Index (GNRI), is independently associated with 30-day postoperative complications in patients undergoing nephrectomy for the treatment of renal cancer. Materials and methods: Using the American College of Surgeons National Surgical Quality Improvement Program database from 2006-2019, we identified patients ≥65 years old who underwent nephrectomy for renal cancer. The following formula for GNRI was used to define preoperative nutritional status: 1.489 x serum albumin (g/L) + 41.7 x (current body weight [kg]/ ideal body weight [kg]). Based on the GNRI, patients were classified as having no (> 98), moderate (92-98), or severe malnutrition (< 92). After adjusting for potential confounders, multivariable logistic regression analyses were performed to assess the association between GNRI and 30-day postoperative complications. Odds ratios (OR) with 95% confidence intervals (CI) were reported. Results: A total of 7,683 patients were identified, of which 1,241 (16.2%) and 872 (11.3%) had moderate and severe malnutrition, respectively. Compared to normal nutrition, moderate and severe malnutrition were significantly associated with a greater odds of superficial surgical site infection, progressive renal insufficiency, readmission, extended length of stay, and non-home discharge. Severe malnutrition was also associated with urinary tract infection (OR 2.10, 95% CI 1.31-3.35) and septic shock (OR 2.93, 95% CI 1.21-7.07). Conclusion: Malnutrition, as defined by a GNRI ≤ 98, is an independent predictor of 30-day complications following nephrectomy. The GNRI could be used to counsel elderly patients with renal cancer prior to nephrectomy.

Risk assessment and nutritional prognosis of clinical outcome in critically ill patients / Avaliação do risco e prognóstico nutricional com relação ao desfecho clínico de pacientes críticos

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.

INTRODUÇÃO: A avaliação do estado nutricional de pacientes críticos é um desafio, mas faz parte da rotina da nutrição clínica hospitalar. OBJETIVO: Avaliar o risco e o prognóstico nutricional, e suas relações, em pacientes críticos admitidos na unidade de terapia intensiva (UTI) de um hospital universitário em Natal, Brasil. MÉTODOS: Estudo transversal, desenvolvido com pacientes adultos e idosos entre fevereiro de 2017 e fevereiro de 2020. O risco nutricional foi detectado pelo Nutrition Risk in Critically ill score modificado (mNUTRIC-score). O prognóstico nutricional foi avaliado mediante o ângulo de fase (AF). O teste de Mann-Whitney foi usado para verificar a associação do mNUTRIC-score e do AF com os desfechos (alta da UTI ou óbito). A correlação de Spearman foi usada para verificar a correlação entre o mNUTRIC-score e o AF. RESULTADOS: Ao total, 55 indivíduos foram incluídos no estudo. O valor médio do mNUTRIC-score foi de 3,13 ± 2,35 e do AF foi de 4,19 ± 1,21. A maioria dos pacientes apresentaram baixo risco nutricional (76,4%) e tiveram alta da UTI (81,8%). Tanto o mNUTRIC-score (p<0,0001) como o AF (p=0,04) estiveram associados com o desfecho clínico. Esses dois parâmetros se correlacionaram negativamente (r= -0,3804; p=0,0059). CONCLUSÃO: A maioria dos pacientes críticos estudados apresentaram baixo risco nutricional determinado pelo mNUTRIC-score. Aqueles com alto risco nutricional tiveram pior desfecho (óbito). Observou-se correlação negativa entre o mNUTRIC-score e o AF, demostrando que quanto maior o risco nutricional, pior o prognóstico clínico e nutricional em pacientes críticos.

Estado nutricional e consumo alimentar de idosos residentes em uma instituição asilar de Feira de Santana- Bahia / Nutritional status and food intake of elderly residents of a nursing home in Feira de Santana - Bahia

O Estado Nutricional (EN) exerce grande influência na morbimortalidade de idosos institucionalizados, e a sua avaliação permite definir uma intervenção nutricional individualizada. Esse estudo objetivou avaliar o estado nutricional e o consumo alimentar de idosos residentes de uma instituição de longa permanência. Trata-se de um estudo transversal, realizado com 37 idosos institucionalizados residentes, no ano de 2019. O EN foi avaliado pelo questionário da Mini Avaliação Nutricional (MAN). O consumo alimentar foi obtido através da pesagem total dos alimentos, verificando sua adequação de acordo com as recomendações para idade. As diferenças entre variáveis foram testadas por meio do teste t de Student e o teste de Mann-Whitney. As associações entre variáveis foram investigadas com auxílio dos coeficientes de correlação de Pearson e Spearman. As prevalências de desnutrição e risco de desnutrição nos idosos foram de 21,6% e 73%, respectivamente. O Índice de Massa Corporal (IMC) demonstrou predominância de baixo peso nos homens (38,9%) e sobrepeso nas mulheres (47,4%). Foi encontrado consumo excessivo de carboidratos e proteínas na população, sendo que, a ingestão de energia, proteínas e lipídios foi superior entre o grupo masculino. A circunferência do braço (p= 0,007), necessidade energética estimada (p= 0,049) e IMC (p <0,001) foram associados positivamente com a MAN. Os resultados demonstraram que, esses idosos são caracterizados por alto risco nutricional associado a alterações na composição corporal, e inadequações nutricionais. Sugerindo que, independente do consumo alimentar estar adequado em quantidade, não foi suficiente para prevenir o quadro de desnutrição nos idosos institucionalizados.(AU)

The Nutritional Status (NS) has a great influence on the morbidity and mortality of institutionalized elderly, and its evaluation allows to define of an individualized nutritional intervention. This study aimed to assess the nutritional status and food consumption of elderly residents of a long-term institution. This is a cross-sectional study carried out with 37 institutionalized elderly residents in 2019. The NS was assessed by the Mini Nutritional Assessment (MNA) questionnaire. Dietary intake was obtained through total weighing of the food, checking its adequacy according to the recommendations for age. Differences between variables were tested using the Student's t-test and the Mann-Whitney test. Associations between variables were investigated with the aid of Pearson and Spearman correlation coefficients. The prevalence of malnutrition and risk of malnutrition in the elderly was 21.6% and 73%, respectively. The Body Mass Index (BMI) showed a predominance of low weight in men (38.9%) and overweight in women (47.4%). Excessive consumption of carbohydrates and proteins was found in the population, and the intake of energy, proteins, and lipids was higher among the male group. Arm circumference (p = 0.007), estimated energy requirement (p = 0.049) and BMI (p <0.001) were positively associated with MAN. The results demonstrate that these elderly people are characterized by the high nutritional risk associated with changes in body composition, and nutritional inadequacies. Suggesting that, regardless of whether food intake was adequate in quantity, it was not enough to prevent malnutrition in institutionalized elderly.(AU)

Evaluation of malnutrition frequency and related factors of geriatric patients in need of home healthcare

SUMMARY OBJECTIVE: The nutritional status of frail elderly people receiving home health services should be evaluated. This study aimed to determine the nutritional status of patients aged ≥65 years registered in the Home Healthcare Services unit and investigate the factors that may be associated with malnutrition. METHODS: This cross-sectional descriptive study was conducted during routine visits to patients and their caregivers. A total of 161 patients were asked to fill in surveys asking about sociodemographic characteristics, patient history, and clinical status. Anthropometric measurements were taken from all patients. The Mini Nutritional Assessment Short Form was applied to the patients for screening purposes. Patients who scored ≤11 on the Mini Nutritional Assessment Short Form were then asked to complete the full Mini Nutritional Assessment form. RESULTS: According to the Mini Nutritional Assessment Short Form and Mini Nutritional Assessment tests, almost half of the elderly patients included in the study (49.7%, n=161) were malnourished or at risk of malnutrition. Analyses showed that those who had COVID-19 [odds ratio (OR): 9.423, 95%CI 2.448-36.273) and those diagnosed with dementia/depression (OR: 8.688, 95%CI 3.246-23.255) were more likely to be malnourished, whereas those with diabetes (OR: 0.235, 95%CI 0.084-0.657) were less likely to have malnutrition. Strikingly, those who were fed by caregivers (OR: 15.061, 95%CI 3.617-62.710) were also more likely to be malnourished than those with self-feeding ability. CONCLUSION: Malnutrition or the risk of malnutrition is common in elderly patients receiving home care services. Many factors can have an impact on malnutrition.

Construction of a nutritional assessment tool for the pediatric cancer population (ANPEDCancer): content validation using the Delphi method / Construção de um instrumento de avaliação nutricional para a população pediátrica com câncer (ANPEDCancer): validação de conteúdo pelo método Delphi

ABSTRACT Objective: To develop and establish content validation of a nutritional assessment tool for pediatric cancer patients using the Delphi method. Methods: A literature review was performed and the nutritional assessment in pediatrics and cancer construct was discussed with experts. Forty-six nutrition experts from Brazil with experience in oncology participated in the panel. Rounds were held to discuss and judge the items that should be included in this tool. With the aid of an algorithm, it was possible to simultaneously consider the adequacy, relevance and measurement of the items. The consensus was reached with an agreement equal to or greater than 80% among the experts. Results: From the 7 domains suggested by the literature, the first round generated 81 items, which were assessed for adequacy, relevance and the possibility of being measured in the routine of nutritional assessment, by specialists in the following two rounds. The percentage of specialists who responded to each round was high (above 90%) and the dropout rate between the stages was relatively low. After applying the algorithm, the ANPEDCancer tool had 36 items considered appropriate by specialists from the five different geographical regions of Brazil. Conclusions: The Delphi method allowed the construction and content validation of the nutritional assessment tool for children and adolescents with cancer, providing the first stage for use in the Brazilian hospital setting.

RESUMO Objetivo: Desenvolver e estabelecer a construção, a validação de conteúdo e a elaboração de um plano de ação para cada diagnóstico nutricional de um instrumento de avaliação nutricional para pacientes pediátricos com câncer por meio do método Delphi. Métodos: Foi realizada uma revisão da literatura e discutido com especialistas o constructo avaliação nutricional em pediatria em câncer. Participaram do painel 46 especialistas nutricionistas do Brasil com experiência em oncologia. Rodadas ocorreram, para discutir e julgar os itens que deveriam constar do instrumento. Com o auxílio de um algoritmo, foi possível ponderar simultaneamente a adequação, relevância e mensuração dos itens. O consenso foi atingido com concordância igual ou superior a 80% entre os especialistas. Resultados: Com base nos sete domínios sugeridos pela literatura científica, a primeira rodada gerou 81 itens, que foram avaliados quanto à adequação, relevância e possibilidade de ser medido na rotina de avaliação nutricional pelos especialistas nas duas rodadas seguintes. O percentual de especialistas que responderam a cada rodada foi alto (acima de 90%), e a desistência entre as etapas, relativamente baixa. Após aplicação do algoritmo, o instrumento ANPEDCancer contou com 36 itens considerados apropriados pelos especialistas das cinco distintas regiões geográficas do Brasil. Conclusões: O método Delphi permitiu a construção e validação de conteúdo do instrumento de avaliação nutricional para crianças e adolescentes com câncer, fornecendo uma primeira versão a ser aplicada e avaliada no cenário hospitalar brasileiro.

Utilização da Razão Cintura-Estatura na avaliação nutricional na primeira fase da adolescência / The use of Waist-to-Height Ratio for nutritional assessment in the first phase of adolescence

Objetivo: Este estudo visou avaliar o desempenho da razão cintura-estatura (RCE) como indicador complementar do estado nutricional na primeira fase da adolescência. Métodos: Trata-se de estudo transversal com 148 adolescentes (10 a 13 anos de idade) de duas escolas de Macaé, RJ, realizado em 2016/2017. Foram coletadas informações de maturação sexual, peso, estatura e perímetro da cintura (PC). Para verificar como as classificações do índice de massa corporal-para-idade (IMC/I), PC e RCE dialogam em termos de triagem de risco em saúde, foi feito o teste Kappa. Os limites máximos de sensibilidade e especificidade da RCE segundo o IMC/I foram analisados pela curva ROC (Receiver Operating Characteristics). Resultados: Dentre os avaliados, 51,4% eram meninas e mais de 60% encontravam-se nos dois primeiros estágios de maturação sexual. A prevalência de excesso de peso (sobrepeso+obesidade) foi 31,8%, obesidade 17,6% e RCE elevada 20,3%, sem diferença segundo sexo e maturação sexual. A RCE apresentou boa concordância com excesso de peso (Kappa=0,707) e obesidade (Kappa=0,780). Já a concordância entre IMC/I e PC foi pobre. O valor de 0,45 da RCE foi o ponto de corte mais adequado para identificar os adolescentes com excesso de peso. Conclusões: Este trabalho sugere que a RCE apresenta melhor desempenho que o PC como indicador complementar do estado nutricional no início da adolescência. A RCE agrega informação sobre a gordura central ponderada pela estatura, não requer curva de comparação e apresenta ponto de corte, o que facilita ações de triagem nos serviços de saúde e em estudos epidemiológicos.

Objective: This study evaluated the performance of the Waist-to-Height Ratio (WHR) as an additional indicator of nutritional status in the first phase of adolescence. Methods: This is a cross-sectional study, developed in 2016/2017, with 148 adolescents (10 to 13 years old) from two public schools of Macaé, a municipality in Rio de Janeiro, Southeast Brazil. We collected information on sexual maturation, weight, height, and waist circumference (WC). The Kappa Test was performed to verify the accordance among Body Mass Index-for-Age (BMI/A), WC, and WHR in relation to health risk screening. The maximum limits of sensitivity and specificity of WHR according to BMI/A were analyzed by ROC curve (Receiver Operating Characteristics). Results: Among the participants, 51.4% were girls, and more than 60% were in the first two stages of sexual maturation. The prevalence of excess weight (overweight+obesity) was 31.8%, obesity 17.6%, and high WHR 20.3%, with no difference according to sex and sexual maturation. WHR showed good agreement with excess weight (Kappa=0.707) and obesity (Kappa=0.780). The agreement between BMI/A and WC was poor. The value 0.45 was the most appropriate WHR cutoff point to identify adolescents with excess weight. Conclusions: This study suggests that WHR performs better than WC as an additional indicator of nutritional status in early adolescence. WHR brings information on central adiposity weighted by height, does not require a comparison curve, and has a cutoff point, which may facilitate screening in health services and epidemiological studies.

Estado nutricional avaliado pela mini avaliação nutricional como fator prognóstico de mortalidade em pacientes idosos com câncer / Nutritional status assessed by the mini nutritional assessment as a prognostic factor for mortality in elderly patients with cancer

Introdução: A desnutrição em pacientes idosos com câncer pode aumentar a mortalidade, o tempo de internação hospitalar, piorar a qualidade de vida, bem como reduzir tolerância à terapia oncológica e aumento da toxicidade relacionada à terapia. A ferramenta mini avaliação nutricional (MAN) é prática e não invasiva, permitindo avaliação rápida do estado nutricional de idosos. Na versão reduzida da MAN (MAN-VR), quando há ausência do índice de massa corporal (IMC), utiliza-se a circunferência da panturrilha (CP < 31 cm). No Brasil, a circunferência da panturrilha (CPBR) possui ponto de corte para homens (CPBR ≤ 34 cm) e para mulheres (CPBR e ≤33 cm). Objetivo: Avaliar a MAN-VR como preditora de risco de morte em idosos com câncer. Métodos: Trata-se de um estudo multicêntrico, descritivo e prospectivo, em que foram incluídos todos os pacientes idosos do sexo feminino ou masculino, com 60 anos ou mais, portadores de tumores malignos, independentemente de localização ou estadiamento da doença, internados nas instituições brasileiras e portuguesas durante o período de setembro a dezembro de 2014. Resultados: Foram avaliados 2677 pacientes idosos com câncer, sendo 56,4% do sexo masculino. A média da idade foi de 73 ± 6,7 anos. Os pacientes apresentaram como principais localizações do tumor o aparelho digestório, próstata e pele (56,9%) e 9% foram ao óbito durante o tempo de internação e acompanhamento do estudo. Foram testados quatro modelos de MAN-VR para predizer mortalidade na população idosa com câncer. As áreas dos modelos sobre a curva ROC variaram de 0,79 a 0,80, sendo que a referência foi o modelo original (MAN-VRIMC/CP). A análise estatística mostrou curvas semelhantes, mas com diferença significativa para o modelo MAN-VRIMC/CPBR (classificação da MAN-VR, em que se utilizou a pontuação do IMC ou da CPBR). No modelo ajustado, houve maior chance de óbito entre os pacientes idosos com "perda de apetite grave", "mobilidade reduzida" (sendo maior naquele "restrito ao leito") e com "problemas neuropsicológicos". Ao considerar o escore da MAN-VR, pacientes com escore inferior a 8 em sua versão original (MAN-VRIMC/CP) ou com o uso MAN-VRIMC/CPBR, apresentaram maior risco de morte. Mostrou, também, que a MAN-VR pode ser usada para identificar risco de mortalidade com o escore menor que 6, sem considerar a pontuação para antropometria (IMC ou CP). Conclusão: O modelo MAN-VRIMC/CPBR proposto se mostrou como melhor preditor para mortalidade em idosos com câncer. A MAN-VR foi capaz de predizer risco de óbito, mesmo não mensurando IMC ou CP, enquanto a adição de antropometria não melhorou o reconhecimento de desnutrição ou risco de mortalidade em pacientes idosos com câncer.

Introduction: Malnutrition in older patients can increase mortality, length of hospital stay, worsen quality of life, as well as reduce tolerance to oncologic therapy and increase therapyrelated toxicity. The mini nutritional assessment (MNA) tool is practical and non-invasive, allowing a quick assessment of the nutritional status of the older patients. The mini nutritional assessment (MNA) tool is practical and non-invasive, allowing a quick assessment of the nutritional status of the elderly. In the short form of the MNA (MNA-SF), when there is no body mass index (BMI), calf compression is used (CC < 31 cm). In Brazil, the calf circumference (CCBR) has a cutoff point for men (CCBR ≤ 34 cm) and for women (CCBR e ≤33 cm). Objective: To evaluate MNA-SF as a predictor of risk of death in older patients with cancer. Methods: This is a multicenter, descriptive, and prospective study, which included all older female or male patients, aged 60 years or older, with malignant tumors, regardless of location or stage of the disease, hospitalized in Brazilian/Portuguese institutions from September to December 2014. Results: We evaluated 2677 older patients with cancer, 56.4% of whom were male. The mean age was 73 ± 6.7 years. The patients had the digestive system, prostate and skin as the main tumor locations (56.9%) and 9% died during the period of hospitalization and follow-up of the study. Four MNA-SF models were tested to predict mortality in the older patients with cancer. The areas of the models on the ROC analyzes ranged from 0.79 to 0.80, with the reference being the original model (MNA-SFBMI/CC). Statistical analysis showed similar curves, but with a significant difference for the MNA-SFIMC/CCBR model (MNA-SF classification, where BMI or CCBR scores were used). In the adjusted model, there was a greater chance of death among older patients with "severe loss of appetite", "reduced mobility" (being greater in those "restricted to bed") and with "neuropsychological problems". When considering the MNA-SF scores, patients with a score lower than eight in its original version (MNA-SFBMI/CC) or using MNA-SFBMI/CCBR, had a higher risk of death. It also showed that the MNA-SF could be used to identify risk of mortality with a score lower than six, without considering the score for anthropometry (BMI or CC). Conclusion: The proposed MNA-SFBMI/CCBR model proved to be the best predictor of mortality in older patients with cancer. The MNA-SF was able to predict risk of death, even without measuring BMI or CC, while the addition of anthropometry did not improve the recognition of malnutrition or mortality risk in older patients with cancer.

Nutritional risk and clinical outcomes of COVID-19 in hospitalized children and adolescents: a multicenter cohort

Abstract Objective: To verify the association between nutritional risk on admission and clinical outcomes of COVID-19 in hospitalized children and adolescents. Methods: Multicenter cohort study was conducted in two cities in the northeastern region of Brazil, with children under 18 years of age laboratory diagnosed with COVID-19. Sociodemographic data and nutritional risk screening by STRONGKids (low, medium and high risk) were collected remotely and in hospital records, respectively. The outcomes assessed were the need for ICU admission, length of stay (< 10 days or ≥ 10 days), critical cases, and death. Multivariable logistic regression models were used to evaluate the effects of high nutritional risk on COVID-19 clinical outcomes. Results: 103 individuals were evaluated, of these 35 (34.0%) had low risk, 44 (42.7%) medium risk, and 24 (23.3%) had high risk of malnutrition. In multivariate analysis, ICU bed admission (OR: 4.57; 95%CI, 1.39-4.97; p = 0.01), hospitalization longer than or equal to ten days (OR: 3.96; 95%CI, 1.22-2.83; p = 0.02) and critical cases (OR: 4.35; 95%CI, 1.08-7.55; p = 0.04) were associated with high nutritional risk. Death was not associated with high nutritional risk. Conclusions: Children and adolescents with high nutritional risk by STRONGkids at hospital admission were more likely to be admitted to the ICU, have hospitalization longer than or equal to ten days, and have critical cases when infected with SARS-CoV-2.

Comparison of four different nutritional risk screening tools in hospitalized children / Comparação de quatro ferramentas diferentes de triagem de risco nutricional em crianças hospitalizadas

ABSTRACT Objective: Early detection of malnutrition risk in hospitalized children can improve health outcomes and quality of life; however, the number of studies where the pediatric screening tool is appropriate for Turkish children is limited. Therefore, this article aims to determine the prevalence of malnutrition risk in pediatric patients evaluated with Screening Tool for Risk on Nutritional Status and Growth, Screening Tool for the Assessment of Malnutrition in Pediatrics, Pediatric Yorkhill Malnutrition Score, and Simple Pediatric Nutrition Screening Tool with original and adjusted cutoffs and to evaluate which pediatric screening tool is appropriate for Turkish children. Methods: In this cross-sectional study, four published nutritional risk screening tools (Screening Tool for Risk on Nutritional Status and Growth, Screening Tool for the Assessment of Malnutrition in Pediatrics, Pediatric Yorkhill Malnutrition Score, Pediatric Nutrition Screening Tool) were applied to pediatric inpatients (n=604) aged 1 month to 17 years, admitted to a pediatric ward for at least 24 hours. Results: Pediatric Nutrition Screening Tool with adjusted cutoffs had the greatest recognition rate (94.2%) of acute malnutrition. Having a high nutritional risk by Pediatric Yorkhill Malnutrition Score was associated with an increased risk of acute (OR: 6.57 for Screening Tool for Risk on Nutritional Status and Growth, 5.84 for Screening Tool for the Assessment of Malnutrition in Pediatrics, and 20.35 for Pediatric Yorkhill Malnutrition Score) and chronic malnutrition (OR: 1.27 for Screening Tool for Risk on Nutritional Status and Growth, 3.28 for Screening Tool for the Assessment of Malnutrition in Pediatrics, and 1.72 for Pediatric Yorkhill Malnutrition Score). Classifying the at-risk category by the Pediatric Nutrition Screening Tool was related to raised odds of malnutrition (OR: 2.64 for original and 5.24 for adjusted cutoffs). This positive association was also observed for acute (OR: 4.07 for original cutoffs, and 28.01 for adjusted cutoffs) and chronic malnutrition (OR: 1.14 for original cutoffs, and 1.67 for adjusted cutoffs). Conclusion: Pediatric Nutrition Screening Tool with adjusted cutoffs and Pediatric Yorkhill Malnutrition Score have higher diagnostic accuracy than other screening tools in assessing the nutritional status of hospitalized Turkish children and detecting children, particularly with acute malnutrition.

RESUMO Objetivo: A detecção precoce do risco de desnutrição em crianças hospitalizadas pode melhorar a saúde e a qualidade de vida, porém o número de estudos em que a ferramenta de triagem pediátrica é apropriada para crianças turcas é limitado. O objetivo deste estudo foi determinar a prevalência do risco de desnutrição em pacientes pediátricos avaliados com Ferramenta de Triagem para Risco no Estado Nutricional e Crescimento, Ferramenta de Triagem para Avaliação de Desnutrição em Pediatria, Escore de Malnutrição Pediátrica de Yorkhill e Ferramenta de Triagem de Nutrição Pediátrica Simples com pontos de corte originais e ajustados para avaliar qual ferramenta de triagem pediátrica é apropriada para crianças turcas. Métodos: Neste estudo transversal, quatro ferramentas de triagem de risco nutricional publicadas (Ferramenta de Triagem para Risco no Estado Nutricional e Crescimento, Ferramenta de Triagem para Avaliação de Desnutrição em Pediatria, Escore de Malnutrição Pediátrica de Yorkhill, Ferramenta de Triagem de Nutrição Pediátrica) foram aplicadas a pacientes pediátricos (n=604) com idades entre 1 mês e 17 anos, internados em uma enfermaria pediátrica por pelo menos 24 horas. Resultados: A Ferramenta de Triagem de Nutrição Pediátrica com pontos de corte ajustados obteve a maior taxa de reconhecimento de desnutrição aguda (94,2%), enquanto a Ferramenta de Triagem para Avaliação de Desnutrição em Pediatria teve a maior taxa na identificação da desnutrição crônica (67,4%). Essas associações positivas foram mais notáveis para desnutrição aguda (OR: 6,57 para Ferramenta de Triagem para Risco no Estado Nutricional e Crescimento, 5,84 para Ferramenta de Triagem para Avaliação de Desnutrição em Pediatria e 20,35 para Escore de Malnutrição Pediátrica de Yorkhill) do que para desnutrição crônica (OR: 1,27 para Ferramenta de Triagem para Risco no Estado Nutricional e Crescimento, 3,28 para Ferramenta de Triagem para Avaliação de Desnutrição em Pediatria e 1,72 para Escore de Malnutrição Pediátrica de Yorkhill). A classificação da categoria de risco pela Ferramenta de Triagem de Nutrição Pediátrica foi relacionada a maiores chances de desnutrição (OR: 2,64 para pontos de corte originais e 5,24 para pontos de corte ajustados). Essa associação positiva também foi observada para desnutrição aguda (OR: 4,07 para pontos de corte originais e 28,01 para pontos de corte ajustados) e crônica (OR: 1,14 para pontos de corte originais e 1,67 para pontos de corte ajustados). Conclusão: A Ferramenta de Triagem de Nutrição Pediátrica com pontos de corte ajustados e Escore de Malnutrição Pediátrica de Yorkhill têm maior precisão diagnóstica do que outras ferramentas de triagem na avaliação do estado nutricional de crianças turcas hospitalizadas e na detecção da desnutrição aguda em particular.

The Relationship Between Mitral Annular Calcification and Controlling Nutritional Status Score

ABSTRACT Introduction: The relationship between mitral annular calcification (MAC) and the controlling nutritional status (CONUT) score has not been previously studied. In this study, we investigated the relationship between MAC and CONUT score to evaluate the nutritional status of patients with MAC. Methods: A total of 275 patients, including 150 patients with MAC and 125 patients without MAC, who presented to a cardiology outpatient clinic were enrolled in the study. Results: There was no difference in the CONUT score between the two groups. Correlation analysis indicated that CONUT score was positively correlated with left atrial (LA) diameter (r=0.190, P=0.020) and interventricular septum thickness (r=0.179, P=0.028) in the MAC+ group. In multivariate regression analysis, only LA diameter (odds ratio 95% confidence interval = 1,054-1,189, P=0.0001) was independently associated with MAC. Conclusion: The present study investigated the relationship between CONUT score and MAC for the first time in the literature. We demonstrated that CONUT score was not significantly higher in patients with MAC without chronic diseases. However, CONUT score was correlated with LA diameter in patients with MAC. We therefore conclude that, for patients admitted with MAC and high LA diameter, CONUT is a valuable nutritional and inflammatory status index.

Effects of sodium-glucose cotransporter-2 inhibitors on nutritional status in heart failure with reduced ejection fraction

SUMMARY OBJECTIVE: This study aimed to evaluate the effects of sodium-glucose cotransporter-2 inhibitors on nutritional status in patients with heart failure with reduced ejection fraction. METHODS: The sodium-glucose cotransporter-2 inhibitor treatment was initiated in 153 patients with heart failure with reduced ejection fraction who were symptomatic despite optimal medical treatment and were followed up for 6 months. The Minnesota Living With Heart Failure Questionnaire scores, New York Heart Association functional class, NT-pro-BNP levels, and nutritional index scores of the patients were evaluated before sodium-glucose cotransporter-2 inhibitor treatment and at the 6-month follow-up. The nutritional status of the patients was evaluated with the COntrolling NUTritional Status score, Geriatric Nutritional Risk Index, and Prognostic Nutritional Index. RESULTS: After sodium-glucose cotransporter-2 inhibitor treatment, significant changes were observed in the mean scores of the three different nutritional indexes: COntrolling NUTritional Status (before: 2.76±2.43 vs. after: 1.12±1.23, p<0.001), Geriatric Nutritional Risk Index (before: 98.2±9.63 vs. after: 104.4±5.83, p<0.001), and Prognostic Nutritional Index (before: 37.9±4.63 vs. after: 42.9±3.83, p<0.001) scores. A significant decrease in the number of patients with malnutrition was observed according to the COntrolling NUTritional Status (before: 46.4% vs. after: 9.7%, p<0.001), Geriatric Nutritional Risk Index (before: 41.8% vs. after: 18.9%, p=0.006), and Prognostic Nutritional Index (before: 36.6% vs. after: 13.7%, p=0.007) scores. A significant functional improvement was observed in patients after sodium-glucose cotransporter-2 treatment: Minnesota Living With Heart Failure Questionnaire scores (before: 39.2±7.2 vs. after: 20.4±7.4, p<0.001), NT-pro-BNP levels (before: 2989±681 vs. after: 1236±760, p<0.001), and New York Heart Association class (before: class II-III: 95.5%; class IV: 4.5% vs. after: class II-III: 78%; class IV: 0%, p<0.001). CONCLUSION: In patients with heart failure with reduced ejection fraction who are symptomatic despite optimal medical treatment, the addition of an sodium-glucose cotransporter-2 inhibitor to treatment can significantly improve both the nutritional and functional statuses.

Concordancia entre criterios de clasificación nutricional en adultos mayores, Colombia / Accordance between different nutritional classification criteria in older adults, Colombia

Introducción: El envejecimiento es un proceso irreversible que genera aumento permanente de la población de 60 o más años. Esta población vulnerable, vive en condiciones de discapacidad, abandono, falta de atención y presenta enfermedades asociadas con su estado nutricional, esto hace necesario determinarlo de forma adecuada. Objetivo: Analizar la concordancia entre diferentes criterios de clasificación nutricional según el Índice de Masa Corporal, a partir de una encuesta poblacional de envejecimiento, Colombia 2015. Material y métodos: Se utilizaron cuatro criterios y la concordancia entre las categorías del estado nutricional. Se calculó con los índices de Kappa directo y ponderado. Resultados: Las concordancias fueron moderadas y buenas, la menor proporción de bajo peso (3,4%) se obtuvo utilizando el criterio Organización Mundial de la Salud y la más alta (22,6%) con Organización Panamericana de Salud (p<0,05). El bajo peso se incrementa a medida que aumenta la edad, mientras el exceso de peso disminuye. Conclusiones: La clasificación nutricional cambia según el criterio y puntos de corte, el de la Sociedad Española de Nutrición Parenteral y Enteral, tuvo la mayor concordancia comparado con el de la Organización Mundial de la Salud y mejor capacidad para detectar deficiencia nutricional en la población adulta mayor.

Introduction: Aging is an irreversible process that generates a permanent increase in the 60 and older population. This vulnerable population lives in conditions of disability, neglect, lack of attention, and they present with illnesses related to their nutritional status, which is why it is necessary to understand it fully. Objective: To analyze the accordance between different criteria of nutritional classification according to the Body Mass Index, using an aging population survey, Colombia 2015. Materials and methods: Four criteria were used as well as accordance between categories of nutritional status. Direct and weighted Kappa indices were calculated. Results: The accordance was moderate and good, the lowest proportion of low weight (3.4%) was obtained using the World Health Organization criteria and the highest (22.6%) with the Pan American Health Organization (p<0.05). Low weight is increased as one ages, while excessive weight decreases. Conclusions: Nutritional classification changes depending on the criteria and cut-off points. The criteria of the Spanish Society of Parenteral and Enteral Nutrition had the highest accordance with the World Health Organization and the best capacity in detecting nutritional deficiency in the older adult population.