STRONGkids nutrition screening tool in pediatrics: An analysis of cutoff points in Brazil.

BACKGROUND: Studies have indicated the Screening Tool for Risk on Nutritional Status and Growth (STRONGkids) as a method of pediatric nutrition screening with good validity in the hospital setting. However, we need to analyze whether the cutoff values originally proposed are suitable for use in Brazil. METHODS: A cross-sectional study was performed in patients admitted to the pediatric ward of a public hospital. STRONGkids was used to assess nutrition risk (low risk, 0 points; moderate risk, 1-3 points; and high risk, 4-5 points). The indexes weight/height or body mass index/age were used to indicate acute malnutrition, and length or height/age was used to indicate chronic malnutrition. Receiver operating characteristic curves were constructed and the areas under the curve were calculated, with respective 95% confidence intervals, to assess the ability of STRONGkids to predict malnutrition and longer hospital stay. RESULTS: The study included 599 patients, with a median age of 2.6 years. The frequency of nutrition risk (medium or high) was 83.6%. In comparison with anthropometric indexes, STRONGkids was the only scoring system with the discriminatory capacity to identify patients with longer hospital stays. The comparative analysis of the means of hospital stay according to STRONGkids showed that patients with a score equal to 3 behaved similarly to those classified as high nutrition risk (4-5 points). CONCLUSIONS: Considering the best cutoff point to predict prolonged hospitalization, STRONGkids used in Brazil should consider patients with 3 points as having high nutrition risk, as well those scoring 4 and 5.

Association of dietary total antioxidant capacity with anthropometric indicators, C-reactive protein, and clinical outcomes in hospitalized oncologic patients.

OBJECTIVE: Many studies have shown an inverse association between higher dietary total antioxidant capacity (DTAC) and chronic non-communicable diseases, including cancer. The aim of this study was to evaluate the association of the DTAC with anthropometric and biochemical indicators and clinical outcomes in hospitalized patients with cancer. METHODS: A cross-sectional study was carried out with 196 hospitalized patients diagnosed with cancer. The DTAC, determined by the ferric-reducing antioxidant power method, was calculated using a validated standard spreadsheet. Multivariate linear regression was used to assess the association, identifying anthropometric indicators that were associated with DTAC and the variables of interest. P < 0.05 was statistically significant. RESULTS: The individuals included in the last tertile of DTAC presented lower occurrences of death (P = 0.032), constipation (P = 0.010), dysphagia (P = 0.010), painful swallowing and chewing (P = 0.019), and dehydration (P = 0.032) than individuals in the first tertile. The C-reactive protein values were significantly lower (P = 0.010) and handgrip strength values were higher (P = 0.037) in individuals in the third tertile than in the other participants. CONCLUSIONS: DTAC was associated with a better prognosis of hospitalized cancer patients, considering signs and symptoms of nutritional impact, as well as the inflammatory state of the patients. These factors may influence the length of hospital stay and mortality. The findings of this research provide important information for a preventive and nutritional management perspective in this population.

Usefulness of the StrongKids Screening Tool in Detecting Anemia and Inflammation in Hospitalized Pediatric Patients.

Objective: To assess whether the nutritional risk classified by StrongKids is associated with anemia and inflammation (total leukocytes and C-reactive protein (CRP)), as well as to compare the ability of StrongKids with anthropometry in identifying these changes in hospitalized pediatric patients.Methods: Cross-sectional study with patients admitted to the pediatric ward of a public hospital in Brazil, from 2014 to 2018. The experimental protocol included: nutritional risk screening by StrongKids; weight and height measurements; and biochemical tests (complete blood count and C-reactive protein - CRP). Sensitivity, specificity, positive predictive value and negative predictive value were calculated to assess the ability of StrongKids and anthropometry to identify patients with the biochemical changes.Results: The study included 482 patients (54.2% male), with a median age of 2.7 years. The frequency of nutritional risk (medium or high) was 85.9% and the prevalence of malnutrition (acute and/or chronic) was 20.2%. Overall, of the patients evaluated, 40.2% had anemia, 28.2% leukocytosis, and 78.0% high CRP. Children and adolescents classified as at nutritional risk (moderate/high) had lower levels of hemoglobin and higher levels of CRP and total leukocytes, as well as a higher frequency of leukocytosis, high CRP and the three alterations combined when compared with individuals at low risk. No association was found between anthropometric variables and biochemical alterations. The sensitivity of nutritional screening was high to detect all biochemical alterations and was superior to the anthropometric assessment.Conclusion: StrongKids was associated with alterations in biochemical parameters with a better performance than anthropometry.

StrongKids for pediatric nutritional risk screening in Brazil: a validation study.

OBJECTIVES: To evaluate the validity and reproducibility of StrongKids as a pediatric nutritional screening tool in Brazil, which has no validated method for this purpose. METHODS: A cross-sectional study was conducted with 641 patients admitted to the pediatric care unit of a public hospital from 2014 to 2018. The concurrent validity was assessed by evaluating the sensitivity, specificity, and the positive and negative predictive values of StrongKids in detecting acute, chronic, and overall malnutrition. Predictive validity was determined by calculating the same indices to identify longer than median hospital stay, need of enteral nutrition, 30-day hospital readmission, transfer to hospitals with more complex procedures, and death. StrongKids was reapplied to a subsample to evaluate the inter-rater reproducibility. RESULTS: Prevalence of low risk was 15.6%, moderate risk was 63.7%, and high nutritional risk was 20.7%. A positive test, corresponding to the moderate or high risk category, identified all those with acute malnutrition and showed sensitivity of 89.4% (95% CI: 76.9-96.4) and 94.0% (95% CI: 86.6-98.0) for the detection of chronic and overall malnutrition, respectively. Regarding its predictive capacity, 100% of the patients who needed enteral nutrition, who were transferred, died, or were readmitted to hospital within 30 days after discharge were considered in risk by StrongKids, and the sensitivity to identify those with prolonged hospital stays was 89.2 (95% CI: 84.6-92.7). The inter-rater agreement was excellent (PABAK: 0.87). CONCLUSIONS: StrongKids had satisfactory validity and reproducibility and successfully identified nutritional deficits and predict unfavorable health outcomes. Our results support the use of StrongKids as a pediatric nutritional risk screening method in Brazil.

The importance of dysphagia screening and nutritional assessment in hospitalized patients.

OBJECTIVE: To determine frequency of dysphagia risk and associated factors in hospitalized patients as well as to evaluate nutritional status by using different methods and correlate the status with scores of the Eating Assessment Tool (EAT-10). METHODS: This was a cross-sectional study including 909 inpatients of a philanthropic hospital. For the diagnosis of dysphagia we used an adapted and validated Brazilian version of the Eating Assessment Tool (EAT-10). The nutritional status was evaluated through the subjective global assessment, and anthropometric measurements included weight, calf and arm circumference, and knee height. The Mann-Whitney test, associations using the Pearson's χ2 and Spearman's correlation were used to verify differences between the groups. RESULTS: The prevalence of dysphagia risk was 10.5%, and aging was the associated factor with this condition. Patients at risk presented lower values of arm and calf circumference, variables that correlated inversely with the Eating Assessment Tool (EAT-10) score. Malnutrition was observed in 13.2% of patients based on the subjective global assessment and in 15.2% based on the Body Mass Index. CONCLUSION: Screening for dysphagia and malnutrition should be introduced in hospitals routine to avoid or minimize damages caused by dysphagia or malnutrition, especially among older people.

The importance of dysphagia screening and nutritional assessment in hospitalized patients / Importância do rastreamento de disfagia e da avaliação nutricional em pacientes hospitalizados

ABSTRACT Objective: To determine frequency of dysphagia risk and associated factors in hospitalized patients as well as to evaluate nutritional status by using different methods and correlate the status with scores of the Eating Assessment Tool (EAT-10). Methods: This was a cross-sectional study including 909 inpatients of a philanthropic hospital. For the diagnosis of dysphagia we used an adapted and validated Brazilian version of the Eating Assessment Tool (EAT-10). The nutritional status was evaluated through the subjective global assessment, and anthropometric measurements included weight, calf and arm circumference, and knee height. The Mann-Whitney test, associations using the Pearson's χ2 and Spearman's correlation were used to verify differences between the groups. Results: The prevalence of dysphagia risk was 10.5%, and aging was the associated factor with this condition. Patients at risk presented lower values of arm and calf circumference, variables that correlated inversely with the Eating Assessment Tool (EAT-10) score. Malnutrition was observed in 13.2% of patients based on the subjective global assessment and in 15.2% based on the Body Mass Index. Conclusion: Screening for dysphagia and malnutrition should be introduced in hospitals routine to avoid or minimize damages caused by dysphagia or malnutrition, especially among older people.

RESUMO Objetivo: Verificar a prevalência do risco de disfagia e seus fatores associados em pacientes hospitalizados, bem como avaliar o estado nutricional por diferentes métodos e correlacioná-los à pontuação do Eating Assessment Tool (EAT-10). Métodos: Estudo de delineamento transversal, realizado com 909 pacientes internados em um hospital filantrópico. Para o rastreamento de disfagia, foi aplicado o Eating Assessment Tool (EAT-10) em sua versão adaptada para o Brasil. O diagnóstico nutricional foi realizado por meio da avaliação global subjetiva e pela aferição de medidas antropométicas. A diferença entre os grupos foi verificada pelo teste de Mann-Whitney e as associações, pelo χ2 de Pearson e correlação de Spearman. Resultados: A prevalência do risco de disfagia foi de 10,5%, sendo a faixa etária idosa um fator associado a esta condição. Pacientes em risco apresentaram valores inferiores de perímetro do braço e panturrilha, variáveis que se correlacionaram de forma inversa à pontuação do Eating Assessment Tool (EAT-10). A desnutrição foi identificada em 13,2% dos avaliados, segundo a avaliação global subjetiva, e em 15,2%, quando utilizado o índice de massa corporal. Conclusão: O rastreamento da disfagia e da desnutrição devem ser incorporados à rotina hospitalar, com o objetivo de evitar ou minimizar os prejuízos provocados por estas condições, especialmente nos idosos.

Perfil nutricional e fatores associados à desnutrição e ao óbito em pacientes com indicação de terapia nutricional / Nutritional profile and associated factors with malnutrition and death in patients with nutritional support indication

Objetivo: Analisar o perfil nutricional, demográfico e clínico de indivíduos hospitalizados com indicação de terapia nutricional, assim como verificar as variáveis que se relacionam à ocorrência de desnutrição e óbito. Método: Estudo transversal retrospectivo, realizado em um hospital filantrópico de Minas Gerais, com os dados dos pacientes adultos e idosos que receberam terapia nutricional enteral e/ou parenteral entre 2011 e 2014. Resultados: Foram analisados os dados de 688 indivíduos, com idade média de 69 anos (DP=17,5 anos). Dos pacientes avaliados, 55,5% apresentavam algum grau de desnutrição, segundo a Avaliação Subjetiva Global, sendo 22,5% desnutridos graves. A maioria (81,5%) atingiu a meta nutricional e 56,6% foram a óbito. Ter 60 anos ou mais, estar em Unidade de Terapia Intensiva (UTI) e o atendimento pelo Sistema Único de Saúde foram fatores que se associaram à maior frequência de desnutrição e ao óbito. Conclusão: É preocupante a frequência de indivíduos que já iniciam a terapia nutricional com algum grau de desnutrição, ressaltando-se a necessidade da intervenção nutricional precoce. Idosos e pacientes em UTI foram grupos potencialmente mais vulneráveis à desnutrição e ao óbito e, requerem, portanto, atenção especial.(AU)

Objective: To analyze the nutritional status, demographic and clinical profile of hospitalized patients with nutritional support indication, as well as check the variables that relate to the occurrence of malnutrition and death. Methods: A retrospective cross-sectional study in a philanthropic hospital in Minas Gerais, with data from adults and elderly patients who received enteral and/or parenteral nutrition between the years 2011 to 2014. Results: Data of 688 individuals were analyzed, with mean age of 69 years (SD: 17.5 years). Among the patients, 55.5% had some degree of malnutrition according to the Subjective Global Assessment, and 22.5% were severely malnourished. Most of patients (81.5%) reached the nutritional goal and 56.6% died. Be 60 years or older, be in the Intensive Care Unit (ICU) and the attendance by the Unified Health System were factors that were associated with higher frequency of malnutrition and death. Conclusion: It is worrying the high frequency of individuals who already begin to nutritional support with some degree of malnutrition, emphasizing the need for early nutritional intervention. Elderly and patients in ICU were potentially most vulnerable to malnutrition and death, and therefore require special attention.(AU)

Perfil nutricional e fatores associados ao baixopeso e à redução do consumo alimentar emcrianças hospitalizadas / Nutritional profile and factors associaed with low body weight andreduction of food intake in hospitalized children

A avaliação do estado nutricional de crianças hospitalizadas assume um papel fundamental na identificação precocede riscos nutricionais. Assim, é de grande relevância identificar variáveis que exercem impacto no estado nutricional ena aceitação dos alimentos no ambiente hospitalar. O objetivo do trabalho foi avaliar o perfil nutricional de criançasinternadas em um hospital e analisar as variáveis que exercem influência no diagnóstico nutricional e no consumoalimentar durante a hospitalização. O estado nutricional foi avaliado por meio da aferição de peso, comprimento/estatura,cálculo do Índice de Massa Corporal e avaliação dos índices antropométricos. A avaliação bioquímica foi realizadaa partir das informações disponíveis no prontuário clínico. Os dados socioeconômicos, alimentares, de aleitamentomaterno e avaliação da aceitação das refeições oferecidas foram coletados por meio de aplicação de um questionárioao responsável pela criança. Participaram do estudo 208 crianças, sendo 61,5% do sexo masculino e mediana deidade de 21,5(6-59) meses. Quanto ao estado nutricional, 80% das crianças foram classificadas como eutróficas, 10%apresentavam magreza e 10% excesso de peso. As crianças com baixo peso tiveram mais linfocitopenia (p=0,038)e também foram as que apresentaram menor tempo de aleitamento materno exclusivo (p=0,015). As crianças queapresentaram concentrações elevadas de PCR e leucócitos apresentaram baixa aceitação da dieta oferecida (p=0,034e p=0,040, respectivamente). Foram identificados fatores que se associaram ao baixo peso e a menor aceitação dasrefeições pelas crianças. Assim, atenção específica deve ser dada àquelas com alteração do estado inflamatório e commenor tempo de aleitamento materno exclusivo.

The evaluation of nutritional status in hospitalized children plays a critical role in the early identification of nutritionalrisk. Thus, it is of great importance to identify variables that have an impact on nutritional status and acceptance of foodin the hospital environment. The objective of this work to evaluate the nutritional status of hospitalized children, thevariables that influence the nutritional diagnosis and food intake during hospitalization. Nutritional status was evaluatedby measurement of weight, length / height, body mass index and anthropometric indices. The biochemical evaluationwas performed based on the information available in the medical record. Socioeconomic, dietary and breastfeedingdata and, evaluation of the acceptance of meals offered were obtained through a questionnaire to the responsable forthe children. The study included 208 children, predominantly male (61.5%) and median age of 21.5 (6-59) months. Inrelation to nutritional status, 80% of children were classified eutrophic, 10% were thinness and 10% overweight. Childrenwith low weight had more cases of lymphocytopenia (p = 0.038) and were also those who had shorter time of exclusivebreastfeeding (p = 0.015). Children with elevated concentrations of PCR and leukocytes showed low acceptance of theoffered diet (p = 0.034 and p = 0.040, respectively). Factors associated with low weight and lower acceptance of mealsby children were identified. Particular attention should be given to children with altered inflammatory status and shortertime of exclusive breastfeeding.

Farinha de banana verde não altera perfillipídico e inflamatório de mulheres comexcesso de peso / Green banana flour does not alter lipid and inflammatory profile of womenoverweight

A prevalência de doenças crônicas não transmissíveis, como as dislipidemias, o excesso de peso e as complicações relacionadasao estado inflamatório têm aumentado em todo o mundo. Neste cenário, produtos alimentícios com alegaçõesbenéficas no tratamento e/ou prevenção destas condições surgem como promessas, muitas vezes, sem respaldo científico.A farinha de banana verde (FBV) tem ganhado espaço na mídia como uma possível promotora de efeitos positivos àsaúde, mas não existem estudos controlados sobre seus reais efeitos em humanos. O objetivo deste trabalho foi analisaros impactos do consumo da FBV no peso corporal, perfil lipídico, parâmetros inflamatórios e no consumo alimentar demulheres adultas com excesso de peso. Foi realizado um estudo de intervenção no qual 25 mulheres adultas com excessode peso consumiram, diariamente, 20g de FBV, durante 45 dias. O protocolo do estudo incluiu avaliações antropométricas,de composição corporal, consumo alimentar, perfil lipídico e determinação de parâmetros inflamatórios séricos. A idademédia das participantes foi 34 anos, com Índice de Massa Corporal médio de 27,7 kg/m². O consumo da FBV não alterouo peso, a composição corporal, o perfil lipídico e os parâmetros inflamatórios. Houve aumento na ingestão de fibras (varia-ção no consumo mediano de 12,72g para 14,16g; p=0,031), embora a necessidade nutricional deste nutriente não tenhasido alcançada (25g/dia). O consumo isolado da FBV não promoveu alterações corporais e metabólicas significativas. Aadoção de medidas isoladas oferece efeitos limitados e deve ser desencorajada como única forma de melhora da saúde.

The prevalence of chronic diseases such as dyslipidemia, overweight and complications related to the inflammatory statehave increased worldwide. In this scenario, food products which claim to be beneficial in the treatment and/or preventionof these conditions arise as promises often having no scientific support. The green banana flour (GBF) has gained mediaattention as a possible promoter of beneficial health effects. However, there are no controlled studies on their real effectsin human studies. The objective of this study was to analyze the effects of consumption of GBF in body weight, lipid profile,inflammatory parameters and food consumption in adult overweight women. An intervention study in which 25 adultoverweight women consumed daily 20g of GBF during 45 days was carried out. The study protocol included anthropometricmeasurements, body composition, food intake, lipid profile and determination of serum inflammatory parameters. The meanage of participants was 34 years, with Body Mass Index of 27.7 kg/m². The consumption of FBV did not alter weight, bodycomposition, lipid profile and inflammatory parameters. There was an increase in fiber intake (variation in median intakeof 12,72g to 14,16g; p=0,031), although it has not achieved the needs of this nutrient (25g/day). Isolated consumption ofFBV did not cause significant bodily and metabolic changes. The adoption of individual measures offer limited effects andshould be discouraged as the only way of improving health.

Depressão, déficit cognitivo e fatores associados à desnutrição em idosos com câncer / Depression, cognitive deficit and factors associated with malnutrition in elderly people with cancer

Objetiva-se analisar a presença de depressão, a função cognitiva, o estado nutricional e os fatores associados à desnutrição em idosos em tratamento para o câncer. Foi realizado um estudo transversal em um centro oncológico em Minas Gerais que incluiu a aplicação de um questionário sociodemográfico e de saúde, a avaliação de sintomas depressivos, da função cognitiva e do estado nutricional. Foram avaliados 96 idosos, 50% do sexo feminino e com idade média de 70,6 anos. O déficit cognitivo foi identificado em 39,6% e a presença de depressão em 17,7% dos avaliados, com um maior número de sintomas depressivos sexo feminino (p = 0,017). Foi diagnosticada desnutrição moderada ou suspeita de desnutrição em 29,2% dos avaliados, desnutrição grave em 14,6% e 47,9% apresentou necessidade de intervenção nutricional crítica. Na análise multivariada foram condições independentemente associadas à desnutrição o déficit funcional (RP: 3,40; IC: 1,23-9,45), a presença de dois ou mais sintomas de impacto nutricional (RP: 3,22; IC: 1,03-10,10) e o tratamento atual por quimioterapia (RP: 2,96; IC: 1,16-7,56). Idosos com câncer apresentaram elevada prevalência de desnutrição e de necessidade de intervenção nutricional. A avaliação da depressão e do déficit cognitivo também devem ser partes integrantes na abordagem deste grupo.

The study sought to analyze the presence of depression, cognitive function, nutritional status and factors associated with malnutrition in the elderly undergoing treatment for cancer. A cross-sectional study was conducted in a cancer clinic in Minas Gerais, which included the application of a sociodemographic and health questionnaire, assessment of depressive symptoms, cognitive function and nutritional status. 96 elderly people were evaluated, 50% of which were female and the mean age was 70.6 years. Cognitive impairment was identified in 39.6% and the presence of depression in 17.7%, with a higher number of depressive symptoms in females (p = 0,017). Moderate malnutrition or suspected malnutrition was diagnosed in 29.2%, severe malnutrition in 14.6% and 47.9% had a critical need for nutritional intervention. In multivariate analysis, functional impairment was independently associated with malnutrition (PR: 3.40; CI: 1.23-9.45), the presence of two or more symptoms of nutritional impact (PR: 3.22; CI: 10.03-10.10) and current treatment by chemotherapy (PR: 2.96; CI: 1.16-7.56). The elderly with cancer showed a high prevalence of malnutrition and a need for nutritional intervention. The assessment of depression and cognitive impairment should also be an integral part in addressing this group.

Influência do gênero e do tipo de tratamento nos parâmetros nutricionais de idosos em Oncologia / Elderly influence of gender and type of treatment on nutritional parameters in oncology

Introdução: A avaliação dos fatores que exercem influência nos parâmetros nutricionais é um importante aspecto a ser considerado em indivíduos com câncer. Objetivo: Analisar o perfil clínico, sociodemográfico e nutricional de idosos em tratamento oncológico, com ênfase nas diferenças nos indicadores nutricionais relacionados ao tipo de tratamento e ao gênero. Método: Estudo transversal com 96 idosos em tratamento oncológico, que incluiu a aplicação de um questionário sociodemográfico e de saúde, avaliação do estado nutricional pela Avaliação Subjetiva Global Produzida pelo Paciente (ASG-PPP) e pelo Índice de Massa Corporal (IMC), avaliação do consumo alimentar e aferição demedidas antropométricas. Resultados: A amostra apresentou idade média de 70,6 anos e predomínio da doença emestágio avançado. A ASG-PPP identificou desnutrição moderada ou grave em 43,8% dos avaliados. Segundo o IMC, 29,1% estavam com baixo peso e 35,4% com excesso de peso. Idosos em quimioterapia, quando comparados aos em hormonioterapia, apresentaram valores inferiores para a quase totalidade parâmetros antropométricos e maior pontuação na ASG-PPP. Foram identificados valores de medidas antropométricas inferiores no gênero masculino, independente do tipo de tratamento. Conclusão: O tipo de tratamento e o gênero parecem exercer influência nas medidas antropométricas, sugerindo-se, em idosos, maior depleção nutricional no tratamento por quimioterapia, especialmente entre os homens. O excesso de peso foi observado na mesma frequência que a eutrofia e esteve igualmente distribuído entre os tipos de tratamento. A identificação de desvios nutricionais é parte essencial na abordagem dopaciente idoso com câncer.

Introduction: The evaluation of the factors that influence on nutritional parameters is an important aspect to beconsidered in individuals with cancer. Objective: To analyze the clinical, sociodemographic and nutritional status ofelderly undergoing cancer treatment, with emphasis on differences in the nutritional indicators, related to the type oftreatment and gender. Method: We performed a cross-sectional study with 96 elderly undergoing cancer treatment,which included the application of a sociodemographic and health questionnaire, assessment of nutritional statusby Patient-Generated Subjective Global Assessment (PG-SGA) and the Body Mass Index (BMI), assessment foodconsumption and anthropometric measures. Results: The sample had a mean age of 70,6 years and a predominanceof advanced stage disease. The PG-SGA identified moderate or severe malnutrition in 43,8%. According to BMI,29,1% were underweight and 35,4% overweight. Elderly undergoing chemotherapy compared to those in hormonetherapy, showed lower values for almost all anthropometric parameters and higher scores on the PG-SGA. Quantitativevalues of anthropometric measurements were lower in males, regardless of type of treatment. Conclusion: The typeof treatment and gender seem to exert influence on anthropometric measurements, suggesting, in the elderly, highernutritional depletion in chemotherapy, especially among men. Overweight was observed in the same frequency asnormal weight and was equally distributed between treatment types. The identification of nutritional problems is anessential part in addressing the elderly cancer patient.