Development of a nutritional risk screening tool for cancer patients undergoing outpatient treatment.

INTRODUCTION: Malnutrition is a common reality in many hospitals, especially in cancer patients. In order to avoid its late diagnosis, there are screening instruments that help professionals detect nutritional risk early, thus avoiding further damage to the nutritional status. OBJECTIVE: To develop a nutritional screening tool for cancer patients undergoing outpatient treatment. MATERIAL AND METHODS: This cross-sectional, observational study was carried out in cancer patients assisted at an outpatient clinic for nutritional care. Data were collected from nutritional care records, including bioelectrical and body composition data (by electrical bioimpedance spectroscopy), anthropometry (adductor pollicis muscle thickness, circumferences, and body mass index), routine clinical biochemical tests, and dynamometry. Malnourished patients were identified through screening using the NRS-2002 method, and all participants were classified according to the GLIM criterion as the control group (no risk and no malnutrition) and the malnourished group. The logistic regression method was used to select the variables that were more sensitive to nutritional risk, thus composing the final screening instrument. RESULTS: The study sample consisted of 72 patients, 58% male, with a mean age of 63 years (±13.3). The malnourished group had a higher frequency of sarcopenia, worse Karnofsky Performance Status (KPS), and lower values for weight, adductor pollicis muscle thickness (APMT), body mass index (BMI), calf circumference (CC), dynamometry (HAND), and fat mass index (FMI) than the control group. After multivariate analyses and analysis of covariance, the final model was devised in the form of an equation containing two variables, which were more associated with malnutrition, the BMI and the KPS. CONCLUSION: The screening instrument developed in this study resulted in an equation for screening nutritional risk, which included the variables KPS and BMI with 84% assertiveness.

Brazilian Nutritional Consensus in Hematopoietic Stem Cell Transplantation: Adults.

The nutritional status of patients submitted to hematopoietic stem cell transplant is considered an independent risk factor, which may influence on quality of life and tolerance to the proposed treatment. The impairment of nutritional status during hematopoietic stem cell transplant occurs mainly due to the adverse effects resulting from conditioning to which the patient is subjected. Therefore, adequate nutritional evaluation and follow-up during hematopoietic stem cell transplant are essential. To emphasize the importance of nutritional status and body composition during treatment, as well as the main characteristics related to the nutritional assessment of the patient, the Brazilian Consensus on Nutrition in Hematopoietic Stem Cell Transplant: Adults was prepared, aiming to standardize and update Nutritional Therapy in this area. Dietitians, nutrition physicians and hematologists from 15 Brazilian centers thar are references in hematopoietic stem cell transplant took part.

[Anthropometric evolution and gastrointestinal complaints in oral nutritional supplementation and enteral nutritional therapy]. / Evolução antropométrica e sintomas gastrointestinais em pacientes que receberam suplementos nutricionais ou nutrição enteral.

OBJECTIVE: To compare the evolution of anthropometric variables and the occurrence of adverse effects related to the ingestion of nutritional food supplements and enteral diet administration in hospitalized patients. METHODS: The study was performed in the Clinical Medicine wards of the Hospital of the School of Medicine of Ribeirão Preto, USP, with 10 patients receiving nutrition supplements, and 20 patients under enteral nutrition therapy, paired by gender, age (50 +/- 21 vs 49 +/- 23 years) and basic afflictions. All were volunteers submitted to anthropometric evaluation at the beginning and end of nutritional therapy, utilizing standard techniques. A semi-structured questionnaire was applied daily referring to gastrointestinal complaints. Statistical differences between onset and final results (t-test for dependent samples) and between-group differences (t-test for independent samples) were estimated. RESULTS: Arm muscle circumference increased in patients receiving enteral nutrition therapy (80 +/- 15 vs 85 +/- 15% adequacy, p = 0.009) and decreased in those receiving nutritional supplements (96 +/- 14 vs 92 +/- 14% adequacy, p = 0.04). Nausea and vomiting were more frequent in the latter (60 vs 10%, p = 0.01); complaints about taste of the products were reported by 30% of the cases. CONCLUSION: Patients who received oral nutrition supplements reported gastrointestinal complaints and had a less favorable anthropometric evolution. Study data did not disclose the benefit of routine nutrition supplements for hospitalized patients.

Evolução antropométrica e sintomas gastrointestinais em pacientes que receberam suplementos nutricionais ou nutrição enteral / Anthropometric evolution and gastrointestinal complaints in oral nutritional supplementation and enteral nutritional therapy

OBJETIVO: Em pacientes hospitalizados, comparar a evolução de variáveis antropométricas e a ocorrência de efeitos adversos relacionados ao consumo de suplementos nutricionais e infusão de nutrição enteral. MÉTODOS: 10 pacientes que recebiam suplementos nutricionais (Grupo SN) e 20 em nutrição enteral (Grupo NE), pareados para o gênero, idade (50 ± 21 vs 49 ± 23 anos) e afecções de base foram submetidos à avaliação antropométrica ao início e término da terapêutica. Diariamente, foi aplicado um questionário semi-estruturado referente às queixas gastrointestinais. Determinaram-se as diferenças estatísticas obtidas entre o início e o final da terapêutica (teste t para amostras dependentes) e entre os grupos de estudo (teste t para amostras independentes). RESULTADOS: A circunferência muscular do braço aumentou nos pacientes do Grupo NE (80 ± 15 vs 85 ± 15 por cento de adequação, p = 0,009) e diminuiu no Grupo SN (96 ± 14 vs 92 ± 14 por cento de adequação, p = 0,04). Náuseas e vômitos foram mais frequentes no Grupo SN (60 vs 10 por cento, p = 0,01) e as queixas relacionadas ao sabor dos produtos ocorreram em 30 por cento dos casos. CONCLUSÃO: Os pacientes que receberam suplementos nutricionais apresentaram maior ocorrência de queixas gastrointestinais e evolução desfavorável dos parâmetros antropométricos. Os dados obtidos no estudo não evidenciam o benefício da suplementação nutricional de rotina em pacientes hospitalizados.

OBJECTIVE: To compare the evolution of anthropometric variables and the occurrence of adverse effects related to the ingestion of nutritional food supplements and enteral diet administration in hospitalized patients. METHODS: The study was performed in the Clinical Medicine wards of the Hospital of the School of Medicine of Ribeirão Preto, USP, with 10 patients receiving nutrition supplements, and 20 patients under enteral nutrition therapy, paired by gender, age (50 ± 21 vs 49 ± 23 years) and basic afflictions. All were volunteers submitted to anthropometric evaluation at the beginning and end of nutritional therapy, utilizing standard techniques. A semi-structured questionnaire was applied daily referring to gastrointestinal complaints. Statistical differences between onset and final results (t-test for dependent samples) and between-group differences (t-test for independent samples) were estimated. RESULTS: Arm muscle circumference increased in patients receiving enteral nutrition therapy (80 ± 15 vs 85 ± 15 percent adequacy, p = 0.009) and decreased in those receiving nutritional supplements (96 ± 14 vs 92 ± 14 percent adequacy, p = 0.04). Nausea and vomiting were more frequent in the latter (60 vs 10 percent, p = 0.01); complaints about taste of the products were reported by 30 percent of the cases. CONCLUSION: Patients who received oral nutrition supplements reported gastrointestinal complaints and had a less favorable anthropometric evolution. Study data did not disclose the benefit of routine nutrition supplements for hospitalized patients.

Manejo nutricional nos transtornos alimentares / The nutricional therapy in eating disorders

Os portadores de transtornos alimentares caracterizam-se por apresentarem quadros graves, desafiadores e sempre exigem muita dedicação do profissional de saúde. O objetivo desse relato foi explorar o manejo de portadores de distúrbios da conduta alimentar, salientando as dificuldades em se reabilitar esse paciente para se alimentar de forma equilibrada. Há muito que se progredir nas abordagens de doenças psiquiátricas como essas que envolvem complicaçães nutricionais de ampla complexidade, porém o trabalho interdisciplinar desenvolvido por equipe é a melhor alternativa para se tratar esses doentes e suas famílias, que demandam tantos cuidados da equipe.

Patients with eating disorders present severe and challenging conditions andalways require a lot of nutritional care. The objective of this study aims to explore ways to handle patients with eating disorders, enhancing the difficulties in rehabilitating such patients in order for them to adopt balanced eating habits. The methodology used was a description procedure and approaches when assisting these patients. In conclusion there is still a lot to be done in terms of approaches in cases involving patients with eating disorders, so the only alternative to address such cases is a team work involving several health professionals so as to support these patients and their families