Vitamin D in dysphagic patients who have undergone endoscopic gastrostomy for long-term enteral feeding.

OBJECTIVE: Vitamin D plays a major role in biological processes. Its deficiency is associated with increased morbidity and mortality. Patients who have undergone endoscopic gastrostomy (PEG) present with protein-energy malnutrition, and may be at risk for Vitamin D deficiency, due to their age, less sunlight exposure and lower dietary intake. We aimed to determine the prevalence of hypovitaminosis D in PEG-patients, its change under PEG-feeding, and its relationship with serum proteins and risk factors for Vitamin D deficiency. METHODS: This was a prospective observational study, over 4 weeks, after gastrostomy. Data were collected at the initial PEG procedure (T0), and after 4 weeks (T1). Initial evaluation included age, gender, underlying disorder, NRS-2002, BMI, serum albumin, transferrin and Vitamin D. At T1 we assessed Vit. D, albumin, and transferrin. Vitamin D was performed with Electrochemiluminescence through Elecsys 2010 assay. Patients were fed with blended homemade meals. RESULTS: 200 patients (118 males), 22-92 years of age, were studied. There were initial low values for Vit. D (181), albumin (96), transferrin (121), and BMI (124). A correlation was found between Vit. D and serum albumin (r=0.49, p=0.005) but not with transferrin (r=0.26, p=0.195). At T1 the subgroup who had Vit. D levels assessed (n=48) was part of the initial study group maintained low levels of Vitamin D despite nutritional intervention. CONCLUSION: We recommend systematic Vitamin D supplementation of PEG fed patients using homemade meals or at least screening for hypovitaminosis D as a routine part of their care.

Clinical use of metal and plastic calipers for nutritional assessment of patients under long-term enteral feeding through endoscopic gastrostomy.

BACKGROUND: Endoscopic gastrostomy (PEG) fed patients, including those with neurologic disorders (ND) or head and neck cancer (HNC) present high malnutrition risk and speech difficulties. Teams taking care of these patients need to rely on anthropometric data. Skinfold thickness (TSF) is used to assess nutritional status, but the use of heavy, large and expensive metal calipers may become a limitation. This study aimed to compare and correlate TSF measurements using a metal caliper and a plastic caliper in PEG fed patients. METHODS: Prospective observational study on adult PEG fed patients. TSF was measured using plastic Ross and Lange metal calipers. Paired measurements were compared and correlated. RESULTS: Fifty-one patients, 37 men (72.5%), 14 women (27.5%): 28 (54.9%) ND patients; 23 (45.1%) with HNC. In total, 94 TSF measurements were performed using both plastic and metal calipers. Significant association was found between TSF measurements with the two equipments (rs = 0.94; p < 0.001). High correlation was observed between TSF measurements using both calipers for both genders (men: rs = 0.93; p < 0.001; women: rs = 0.96; p < 0.001), age (< 65 years: rs = 0.98; p < 0.001; ≥ 65 years: rs = 0.88; p < 0.001), underlying condition (ND: rs = 0.91; p < 0.001; HNC: rs = 0.95; p < 0.001) and time of TSF evaluation (before PEG: rs = 0.95; p < 0,001; after PEG: rs = 0.92; p < 0.001). CONCLUSIONS: TSF measurements obtained with small, light and cheap plastic Ross caliper were equivalent to those obtained with larger, heavier and more expensive metal caliper. For everyday clinical practice, plastic calipers may be suitable for teams taking care of PEG fed patients in hospital wards, outpatient clinic and home visits.

Clinical use of metal and plastic calipers for nutritional assessment of patients under long-term enteral feeding through endoscopic gastrostomy / Utilización clínica de adipómetros metálicos y plásticos para la evaluación nutricional de pacientes en nutrición enteral de larga duración por gastrostomía endoscópica

Background: Endoscopic gastrostomy (PEG) fed patients, including those with neurologic disorders (ND) or head and neck cancer (HNC) present high malnutrition risk and speech difficulties. Teams taking care of these patients need to rely on anthropometric data. Skinfold thickness (TSF) is used to assess nutritional status, but the use of heavy, large and expensive metal calipers may become a limitation. This study aimed to compare and correlate TSF measurements using a metal caliper and a plastic caliper in PEG fed patients. Methods: Prospective observational study on adult PEG fed patients. TSF was measured using plastic Ross and Lange metal calipers. Paired measurements were compared and correlated. Results: Fifty-one patients, 37 men (72.5%), 14 women (27.5%): 28 (54.9%) ND patients; 23 (45.1%) with HNC. In total, 94 TSF measurements were performed using both plastic and metal calipers. Significant association was found between TSF measurements with the two equipments (rs = 0.94; p < 0.001). High correlation was observed between TSF measurements using both calipers for both genders (men: rs = 0.93; p < 0.001; women: rs = 0.96; p < 0.001), age (< 65 years: rs = 0.98; p < 0.001; ≥ 65 years: rs = 0.88; p < 0.001), underlying condition (ND: rs = 0.91; p < 0.001; HNC: rs = 0.95; p < 0.001) and time of TSF evaluation (before PEG: rs = 0.95; p < 0,001; after PEG: rs = 0.92; p < 0.001). Conclusions: TSF measurements obtained with small, light and cheap plastic Ross caliper were equivalent to those obtained with larger, heavier and more expensive metal caliper. For everyday clinical practice, plastic calipers may be suitable for teams taking care of PEG fed patients in hospital wards, outpatient clinic and home visits (AU)

Introducción: los pacientes alimentados por gastrostomía endoscópica (PEG), incluyendo aquellos con enfermedades neurológicas o cáncer de cabeza y cuello, presentan un riesgo elevado de desnutrición. Los equipos que cuidan a estos pacientes se basan frecuentemente en datos antropométricos. El pliegue cutáneo del tríceps (TSF) se utiliza para evaluar el estado nutricional, pero la utilización de adipómetros metálicos pesados, grandes y costosos puede convertirse en una limitación. El presente estudio pretende comparar y correlacionar las mediciones de la TSF usando un adipómetro metálico y de plástico en pacientes alimentados por PEG. Métodos: estudio observacional prospectivo en pacientes alimentados por PEG. La TSF se midió utilizando el adipómetro metálico de Lange y el adipómetro plástico de Ross. Las mediciones emparejadas se compararon y correlacionaron. Resultados: cincuenta y un pacientes, 37 hombres (72,5%), 14 mujeres (27,5%): 28 (54,9%) pacientes neurológicos; 23 (45,1%) con cáncer de cabeza y cuello. En total, se efectuaron 94 mediciones utilizando ambos los adipómetros (de plástico y metálico). Se encontró una asociación significativa entre las mediciones de TSF con los dos tipos de adipómetros (rs = 0,94; p < 0,001). Se observó también una correlación fuerte entre las mediciones de TSF utilizando ambos adipómetros para ambos los géneros (hombres: rs = 0,93; p < 0,001; mujeres: rs = 0,96; p < 0,001), edad (< 65 años: rs = 0,98; p < 0,001; ≥ 65 años: rs = 0,88; p < 0,001), enfermedad de base (neurológicos: rs = 0,91; p < 0,001, cáncer: rs = 0,95; p < 0,001) y tiempo de evaluación (antes de PEG: rs = 0,95; p < 0,001; después de PEG: rs = 0,92; p < 0,001). Conclusiones: las mediciones de TSF obtenidas con adipómetros de plástico Ross, pequeños, ligeros y menos costosos, fueron equivalentes aquellos en que se utilizaron adipómetros metálicos grandes, pesados y más caros. Los adipómetros de plástico pueden ser más adecuados para la práctica clínica diaria de los equipos que abordan pacientes alimentados por PEG en régimen de ambulatorio o internamiento (AU)