Role of enteral nutrition and pharmaconutrients in conditions of splanchnic hypoperfusion.

In critically ill patients there is consistent evidence that significant benefits are achieved if nutrients are delivered within the gut compared with the parenteral route. However, in conditions related to gut hypoflux, enteral nutrition may play a double role in counterbalancing the installed low-flow state. On the one hand, enteral-induced postprandial hyperemia may preserve the mucosal barrier and ameliorate immune competence; on the other hand, feeding by the gut may pose a theoretical risk of intestinal ischemia. Despite limited investigation, a strategic temporary minimal enteral nutrition with hypocaloric content has been recommended recently aiming to avoid the overfeeding syndrome and the menace of gut hypoperfusion. Under these conditions, the early luminal delivery of key nutrients such as arginine, glutamine dipeptides, antioxidants, and butyrate are an attractive option for this subset of patients. Arginine may prevent intestinal injury due to hypoperfusion but may harm the gut if ischemia is established. In contrast, glutamine may promote benefits in both conditions. Further investigations by randomized trials in this field are necessary.

[Adductor pollicis muscle thickness: a fast and reliable method for nutritional assessment in surgical patients]. / Espessura do músculo adutor do polegar: um método rápido e confiável na avaliação nutricional de pacientes cirúrgicos.

OBJECTIVE: Investigate whether the right adductor pollicis muscle thickness is a reliable method to evaluate the nutritional status of surgical patients and whether it correlates or not correlate to other anthropometric, biochemical, and clinical parameters. METHODS: Cross-sectional study evaluating 87 patients candidates to major operations of the gastrointestinal tract. All were submitted to global subjective evaluation, traditional anthropometry (arm circumpherence ; triceps skin fold; and arm muscle circumpherence, serum albumin, lymphocytes and measurement of in both hands. RESULTS: The mean right adductor pollicis muscle thickness in dominant hand was 12,64 +/- 3,19 mm and in non-dominant hand (EMAPND) 12,23 +/- 2,9 mm. Sensitivity was 72,37% for left adductor pollicis muscle and 77,33% for left adductor pollicis muscle thickness being the cut-offs given by the ROC curve (13,4 and 13,1mm respectively). Specificity was 100% for both hands. There was a significantly correlation (P<0.01) for right adductor pollicis muscle thickness with all anthropometric parameters. The mean value for normal individuals was significantly greater (P<0.001) than for mild malnourished which was greater (p<0.05) when compared to patients with severe malnutrition. CONCLUSION: right adductor pollicis muscle thickness is a low-cost, reliable, and trustworthy method to assess nutritional status that can be easily and safety used in clinical practice for surgical patients.

Espessura do músculo adutor do polegar: um método rápido e confiável na avaliação nutricional de pacientes cirúrgicos / Adductor pollicis muscle thickness: a fast and reliable method for nutritional assessment in surgical patients

OBJETIVO: Determinar se a medida da espessura do músculo adutor do polegar é confiável para avaliação nutricional de pacientes cirúrgicos e se correlaciona bem com outros parâmetros antropométricos, bioquímicos e clínicos. MÉTODOS: Estudo de corte transversal, com avaliação de 87 pacientes candidatos à procedimento cirúrgico de grande porte no trato gastrointestinal. Eles foram submetidos à avaliação nutricional através da avaliação subjetiva global, antropometria (circunferência do braço, prega cutânea triciptal, e circunferência muscular do braço), albumina sérica, linfocitometria e pela medida da espessura do músculo adutor do polegar em ambas as mãos. RESULTADOS: A média da espessura da mão dominante (direita) foi de 12,64 ± 3,19 mm e da mão não dominante 12,23 ± 2,9 mm. Para desnutrição, a sensibilidade da espessura do músculo adutor do polegar direita foi de 72,37 por cento e da esquerda de 77,33 por cento para os pontos de cortes encontrados com a curva Receiver Operating Characteristic (13,4 e 13,1 mm respectivamente). Para ambas as mãos a especificidade foi de 100 por cento. Encontrou-se correlação significativa (p<0,01) da espessura do músculo adutor do polegar com todas as outras técnicas antropométricas de avaliação nutricional. Os seus valores médios nos pacientes eutróficos segundo a avaliação subjetiva global foram significativamente maiores (P<0.001) que dos desnutridos leves, e estes também maiores (P<0,05) que os desnutridos graves (avaliação subjetiva global-C). CONCLUSÃO: a espessura do músculo adutor do polegar é um método de fácil execução, baixo custo, confiável e transmite segurança na avaliação do estado nutricional, podendo ser usado na prática clínica em pacientes cirúrgicos.

OBJECTIVE: Investigate whether the right adductor pollicis muscle thickness is a reliable method to evaluate the nutritional status of surgical patients and whether it correlates or not correlate to other anthropometric, biochemical, and clinical parameters. METHODS: Cross-sectional study evaluating 87 patients candidates to major operations of the gastrointestinal tract. All were submitted to global subjective evaluation, traditional anthropometry (arm circumpherence ; triceps skin fold; and arm muscle circumpherence, serum albumin, lymphocytes and measurement of in both hands. RESULTS: The mean right adductor pollicis muscle thickness in dominant hand was 12,64 ± 3,19 mm and in non-dominant hand (EMAPND) 12,23 ± 2,9 mm. Sensitivity was 72,37 percent for left adductor pollicis muscle and 77,33 percent for left adductor pollicis muscle thickness being the cut-offs given by the ROC curve (13,4 and 13,1mm respectively). Specificity was 100 percent for both hands. There was a significantly correlation (P<0.01) for right adductor pollicis muscle thickness with all anthropometric parameters. The mean value for normal individuals was significantly greater (P<0.001) than for mild malnourished which was greater (p<0.05) when compared to patients with severe malnutrition. CONCLUSION: right adductor pollicis muscle thickness is a low-cost, reliable, and trustworthy method to assess nutritional status that can be easily and safety used in clinical practice for surgical patients.