Procedimento operacional padrão na assistência nutricional ao paciente com covid 19: relato de experiência / Standard operational procedure in nutritional assistance to patients with covid 19: experience report / Procedimiento operativo estándar en asistencia nutricional a pacientes con covid 19: informe de experiência

Introdução:Vivencia-se na atualidade uma pandemia causada pelo novo Coronavírus,o qual é transmitido por meio de gotículas de saliva, espirro e tosse, fazendo-se necessário mudanças na assistência ao paciente. Objetivo:Descrever a experiência com a construção de um Procedimento Operacional Padrão para assistência nutricional em pacientes acometidos pelo Coronavírus. Metodologia:Trata-se de um estudo descritivo, do tipo relato de experiência,vivenciado pela equipe de residentes multiprofissionais em nutrição do Hospital Universitário Onofre Lopes,da Universidade Federal do Rio Grande do Norte. Resultados:Baseado nas recomendações da Organização Mundial de Saúde e do Conselho Federal de Nutrição e, com a participação dos profissionais do serviço, foi construído o referido procedimento que descreve as boas práticas na triagem, avaliação e conduta nutricional. Conclusão:A implantação e implementação do POP oportunizou a interação de conhecimentos e novas condutas assistenciais, mesmo diante das limitações estruturais, de equipamentos de proteção individual e de medidas de contingenciamento implementadas no serviço (AU).

Introduction:We are currently experiencing a pandemic caused by the new Coronavirus, which is transmitted through droplets of saliva, sneezing and coughing, making changes in patient care necessary. Objective:To describe the experience with the construction of a Standard Operating Procedure for nutritional assistance in patients affected by the Coronavirus. Methodology:This is a descriptive study, an experience report, experienced by the team of multiprofessional residents in nutrition at the Hospital Universitário Onofre Lopes, at the Federal University of Rio Grande do Norte. Results:Based on the recommendations of the World Health Organization and the Federal Nutrition Council and, with the participation of service professionals, the referred procedure was developed, which describes good practices in screening, assessment and nutritional conduct. Conclusion: The implementation and implementation of SOP provided an opportunity for the interaction of knowledge and new care behaviors, even in the face of structural limitations, personal protective equipment and contingency measures implemented in the service (AU).

Introducción:Actualmenteestamos experimentando una pandemia causada por el nuevo Coronavirus, que se transmite a través de gotas de saliva, estornudos y tos, lo que hace que sea necesario realizar cambios en la atención del paciente. Objetivo:Describir la experiencia con la construcción de un Procedimiento Operativo Estándar para asistencia nutricional en pacientes afectados por el Coronavirus. Metodología:Este es un estudio descriptivo, un informe de experiencia, experimentado por el equipo de residentes multiprofesionales en nutrición del Hospital Universitário Onofre Lopes, de la Universidad Federal de Río Grande del Norte. Resultados:Basado en las recomendaciones de la Organización Mundial de la Salud y el Consejo Federal de Nutrición y, con la participación de profesionales de servicio, se desarrolló el procedimiento referido, que describe buenas prácticas en la detección, evaluación y conducta nutricional. Conclusión:La implementación e implementación de SOP brindó una oportunidad para la interacción del conocimiento y los nuevos comportamientos de atención, incluso frente a limitaciones estructurales, equipos de protección individual y medidas de contingencia implementadas en el servicio (AU).

Evaluation of factors that may influence in the insufficient weight loss in patients after two years of Roux-en-Y gastric bypass.

INTRODUCTION: bariatric surgery is a favorable option for the treatment of obesity, resulting in long-term weight loss. OBJECTIVES: to analyze whether feeding behavior, evaluated by caloric intake, dietary preferences and tolerance, can be considered as a determinant factor for weight loss in obese patients submitted to Roux-en-Y gastric bypass (RYGB). METHODS: cross-sectional study of 105 patients with at least two years post-RYGB surgery with a preoperative body mass index (BMI) of ≥ 35 kg/m². Caloric intake was evaluated by 24-hour dietary recall and 3-day dietary intake record; dietary habits, by a qualitative dietary frequency questionnaire; and food tolerance, with a validated questionnaire. Multiple logistic regression was used for statistical analysis. RESULTS: the majority of the 105 participants were female (84%). The mean age was 43.3 ± 11.4 years in the success group (n = 64) and 43.4 ± 10.7 years in the failure group (n = 41). Preoperative BMI was not associated with the outcome. Mean caloric intake did not show significant differences between groups: 24 hours recall, p = 0.27; 3-day record, p = 0.95. The frequency of weekly consumption of desserts was twice as high in the success group. Only two patients in the success group presented daily vomiting. CONCLUSION: the factors that determine the failure of weight loss have not yet been fully elucidated. Caloric intake was not a determining factor of failure, and insufficient weight loss was more prevalent in patients who ceased to lose weight earlier.

Evaluation of factors that may influence in the insufficient weight loss in patients after two years of roux-en-y gastric bypass / Evaluación de factores que pueden influenciar en la pérdida de peso insuficiente en pacientes después de dos años de bypass gástrico en Y de Roux

Introduction: bariatric surgery is a favorable option for the treatment of obesity, resulting in long-term weight loss. Objectives: to analyze whether feeding behavior, evaluated by caloric intake, dietary preferences and tolerance, can be considered as a determinant factor for weight loss in obese patients submitted to Roux-en-Y gastric bypass (RYGB). Methods: cross-sectional study of 105 patients with at least two years post-RYGB surgery with a preoperative body mass index (BMI) of ≥ 35 kg/m². Caloric intake was evaluated by 24-hour dietary recall and 3-day dietary intake record; dietary habits, by a qualitative dietary frequency questionnaire; and food tolerance, with a validated questionnaire. Multiple logistic regression was used for statistical analysis. Results: the majority of the 105 participants were female (84%). The mean age was 43.3 ± 11.4 years in the success group (n = 64) and 43.4 ± 10.7 years in the failure group (n = 41). Preoperative BMI was not associated with the outcome. Mean caloric intake did not show significant differences between groups: 24 hours recall, p = 0.27; 3-day record, p = 0.95. The frequency of weekly consumption of desserts was twice as high in the success group. Only two patients in the success group presented daily vomiting. Conclusion: the factors that determine the failure of weight loss have not yet been fully elucidated. Caloric intake was not a determining factor of failure, and insufficient weight loss was more prevalent in patients who ceased to lose weight earlier

Introducción: la cirugía bariátrica es una opción favorable para el tratamiento de la obesidad, resultando a largo plazo en pérdida de peso. Objetivos: analizar si el comportamiento alimentario, evaluado por la ingesta calórica, las preferencias y las tolerancias alimentarias, puede ser considerado un factor determinante de los resultados de pérdida de peso en pacientes obesos sometidos a bypass gástrico en Y de Roux (BPGYR). Métodos: se realizó un estudio de cohorte retrospectivo con 105 pacientes sometidos a cirugía de BPGYR, con índice de masa corporal (IMC) preoperatorio ≥ 35 kg/m² y, como mínimo, dos años de postoperatorio. La ingesta calórica fue evaluada por el recordatorio alimentario de 24 horas y el registro alimentario de tres días. Para la evaluación de los hábitos alimentarios se empleó un cuestionario cualitativo de frecuencia alimentaria y para la tolerancia alimentaria, un cuestionario validado. Resultados: la mayoría de los participantes eran del sexo femenino (84%). La edad promedio fue de 43,30 ± 11,39 años en el grupo éxito y de 43,39 ± 10,73 años en el grupo sin éxito. El IMC preoperatorio no presentó influencia sobre el resultado final. El promedio de ingesta calórica no mostró diferencia significativa entre los grupos estudiados (R 24 h, p = 0,27; registro del diario alimentario, p = 0,95). La frecuencia del consumo semanal de dulces fue dos veces mayor en el grupo éxito. Apenas dos pacientes del grupo éxito presentaban vómitos diarios. Conclusión: los factores que determinan la falta de éxito en la pérdida de peso aún no están bien esclarecidos. La ingesta calórica no fue un factor determinante para no obtener éxito y la pérdida de peso insuficiente fue más prevalente en los pacientes que dejaron de perder peso más temprano

Phase Angle and Onodera's Prognostic Nutritional Index in critically ill patients.

INTRODUCTION: Assessing severity and nutritional prognosis in critical patients has become increasingly important in recent years, since these parameters are related to morbidity/mortality and used to guide therapeutic options. OBJECTIVE: Determine nutritional prognosis through the Phase Angle (PA) and Onodera's Prognostic Nutritional Index (OPNI) and its relationship with severity, hospitalization time and mortality of critically ill patients. METHODS: Descriptive cross-sectional study, involving adult patients hospitalized in an Intensive Care Unit (ICU). Data were collected from the patients' medical records to calculate severity indicators (APACHE II, SOFA and SAPS 3) and determine the length of hospitalization and outcome. Bioimpedance was conducted to calculate the PA, using resistance and reactance data. RESULTS: A total of 35 patients (26% men and 74% women), with mean age of 55.5 ± 16.7 years, were included. The mortality rate (17%) was similar to that expected by APACHE II and SOFA, but higher than that predicted by SAPS 3. The mean values for the PA (4.2 ± 1.0) and OPNI (38.7 ± 8.3) were lower than the reference values adopted. Individuals with PA < 5.1 exhibited significantly lower reactance and albumin and higher APACHE II and SOFA values, in addition to longer hospitalization time and higher mortality. The PA was inversely correlated with all the severity indicators under study (APACHE II, SOFA and SAPS 3), and the length of hospitalization. By contrast, there was no correlation between OPNI and these parameters, or between PA and OPNI. CONCLUSION: The PA proved to be a good tool in assessing nutritional prognosis in critically ill patients. By contrast, more studies using the OPNI with this type of patients are needed.

Phase Angle and Onodera’s Prognostic Nutritional Index in critically ill patients / Ángulo de fase e índice de Onodera en pacientes críticamente enfermos

Introduction: Assessing severity and nutritional prognosis in critical patients has become increasingly important in recent years, since these parameters are related to morbidity/mortality and used to guide therapeutic options. Objective: Determine nutritional prognosis through the Phase Angle (PA) and Onodera’s Prognostic Nutritional Index (OPNI) and its relationship with severity, hospitalization time and mortality of critically ill patients. Methods: Descriptive cross-sectional study, involving adult patients hospitalized in an Intensive Care Unit (ICU). Data were collected from the patients’ medical records to calculate severity indicators (APACHE II, SOFA and SAPS 3) and determine the length of hospitalization and outcome. Bioimpedance was conducted to calculate the PA, using resistance and reactance data. Results: A total of 35 patients (26% men and 74% women), with mean age of 55.5 ± 16.7 years, were included. The mortality rate (17%) was similar to that expected by APACHE II and SOFA, but higher than that predicted by SAPS 3. The mean values for the PA (4.2 ± 1.0) and OPNI (38.7 ± 8.3) were lower than the reference values adopted. Individuals with PA < 5.1 exhibited significantly lower reactance and albumin and higher APACHE II and SOFA values, in addition to longer hospitalization time and higher mortality. The PA was inversely correlated with all the severity indicators under study (APACHE II, SOFA and SAPS 3), and the length of hospitalization. By contrast, there was no correlation between OPNI and these parameters, or between PA and OPNI. Conclusion: The PA proved to be a good tool in assessing nutritional prognosis in critically ill patients. By contrast, more studies using the OPNI with this type of patients are needed (AU)

Introducción: en los últimos años se ha valorado la evaluación de la gravedad y del pronóstico nutricional en pacientes críticos, por ser parámetros relacionados a la morbimortalidad y porteadores de conductas terapéuticas. Objetivo: verificar el pronóstico nutricional mediante el Ángulo de Fase (AF) y el Índice de Pronóstico Nutricional de Onodera (OPNI) y su relación con la gravedad, con el tiempo de internación y con la mortalidad de pacientes críticos. Métodos: estudio transversal descriptivo, incluyendo pacientes adultos, internados en Unidad de Terapia Intensiva (UTI). Fueron recabados datos en la historia clínica de los pacientes para cálculo de los indicadores de gravedad (APACHE II, SOFA y SAPS 3), y verificación del tiempo de internación y desenlace. Fue realizada la bioimpedancia para cálculo del AF, mediante datos de resistencia y reactancia. Resultados: se incluyeron 35 pacientes, con edad promedio de 55,5 ± 16,7 años, siendo 26% del sexo masculino y 74% del femenino. La tasa de mortalidad encontrada en el estudio (17%) fue semejante a aquella esperada por los indicadores de gravedad APACHE II y SOFA, pero superior a aquella esperada por el SAPS 3. Los valores promedios encontrados para el AF (4,2 ± 1,0) y el OPNI (38,7 ± 8,3) fueron inferiores a los valores de referencia adoptados. Aquellos con AF < 5,1 presentaron significativamente menores valores de reactancia y albumina, mayores valores del APACHE II y del SOFA, y tuvieron mayor tiempo de internación y mortalidad. El AF se correlacionó inversamente con todos los indicadores de gravedad, pero lo contrario fue observado con el OPNI, no habiendo correlación entre estos dos indicadores de pronóstico nutricional. Conclusión: el AF es una herramienta confiable para evaluación del pronóstico nutricional en pacientes críticos. Por el contrario, se necesitan más estudios utilizando el OPNI con este tipo de pacientes (AU)

Perfil dos obesos sem remissão do diabete melito tipo 2 e/ou perda insuficiente de peso após bypass gástrico em Y-de-roux / Profile of the obese patients submitted to Roux-en-Y gastric bypass whithout diabetes melittus type 2 remission and/or insufficient weight loss

RACIONAL: A literatura mostra que a derivação gastrojejunal em Y-de-Roux apresenta grande eficiência no controle do peso como também na resolução do diabete melito tipo 2, porém estudos após o bypass gástrico em Y-de-Roux tem mostrado piora do controle glicêmico em porcentagem considerável e os fatores associados não são completamente conhecidos. OBJETIVO: Estudar o perfil dos pacientes obesos, que apresentaram ausência de remissão do diabete e/ou perda insuficiente de peso, submetidos ao bypass gástrico em Y-de-Roux. MÉTODO: Estudo caso-controle, incluindo 32 pacientes submetidos à esta operação há pelo menos dois anos com resultados insatisfatórios relacionados à perda de peso ou ausência de remissão completa do diabete. Um grupo controle foi constituído por outros 32 pacientes submetidos à mesma operação e no mesmo serviço, pareados por idade e tempo de operação. Um questionário estruturado foi aplicado com e dados clínicos e laboratoriais colhidos e analisados. RESULTADOS: Dos casos e controles avaliados, o IMC médio foi de 38,9 kg/m² e 29,5 kg/m²; a perda do excesso de peso foi de 56,10% e 77,23%; o percentual de reganho de peso, do peso inicial perdido, foi de 20,22% e 7,67%. Os antecedentes familiares para diabete e hipertensão arterial mostraram relação significativa entre casos e controles, com razão de chances de 9,00 para diabete, 5,44 para hipertensão e intolerância alimentar mostrou relação significativa entre casos e controles. CONCLUSÃO: Intolerância alimentar persistente e antecedentes familiares para diabete e hipertensão mostraram-se associados à menor perda e reganho de peso, ou menor chance de remissão completa do diabete após o bypass gástrico.

BACKGROUND: The literature reports that gastrojejunal derivation with Roux-en-Y gastric bypass is highly efficient in controlling weight and resolving; but studies have shown worsened glycemic control in a considerable number of patients and associated factors that have not been fully elucidated. AIM: To analyze the profile of patients submitted to gastric bypass that did not achieve satisfactory weight loss or complete diabetes remission. METHODS: Case-control study of 32 patients submitted to gastric bypass with at least two years postoperative time, unsatisfactory results in terms of weight loss or absence of complete diabetes remission. The control group was composed of another 32 patients submitted to the same operation at the same facility, matched for age and postoperative time. A structured questionnaire was applied and clinical and laboratory data were analyzed. RESULTS: Among the cases and controls, BMI was 38.9 kg/m² and 29.5 kg/m2, excess weight loss was 56.1% and 77.2%, % excess weight regain of initial excess weight loss, was 20.2% and 7.7%, respectively. Family history of type 2 diabetes mellitus, hypertension and food intolerance showed a significant relationship between cases and controls. CONCLUSION: Food intolerance and family history of hypertension and diabetes were associated to lower loss and weight regain or less likelihood of complete diabetes remission after gastric bypass.

[Insufficient loss of weight and/or absence of DM2 remission after Roux-en-Y gastric bypass: factors that may influence the unsatisfactory results]. / Perda insuficiente de peso e ou ausência de remissão da diabete melito tipo 2 após a derivação gástrica em Y-de-Roux: fatores que podem influenciar os resultados insatisfatórios.

BACKGROUND: Roux-en-Y gastric by-pass is considered one of the most effective treatments for maintaining long-term weight loss. However, it is associated to failures manifested by the inability to maintain weight loss, weight gain or poor glycemic control. OBJECTIVE: Study the possible factors that influence weight loss failure and/or DM2 remission. METHODS: Case-control study of 159 patients submitted to gastric by-pass two or more years postoperatively. Twenty-four individuals with unsatisfactory weight loss and/or DM2 remission were selected as cases and 24 with satisfactory weight loss and/or absence of DM2 remission as controls, matched for age and postoperative time. RESULTS: Of the 24 cases and controls evaluated, the percentage weight gain was 19.32% and 8.68%, percentage DM2 remission 26.6% and 87.5% and percentage DM2 recurrence 6.6% and 0.0%, respectively. Cases and controls exhibited mean maximum preoperative BMI of 53.50±12.24 kg/m2 and 48.77±5.19 kg/m2, respectively. These values were statistically significant in terms of poor weight management or failed surgery. CONCLUSION: Patients with elevated initial maximum BMI (≥ 50kg/m2) displayed higher weight loss failure rates. Food intolerance and socioeconomic differences are considered factors in weight gain.

Perda insuficiente de peso e ou ausência de remissão da diabete melito tipo 2 após a derivação gástrica em Y-de-Roux: fatores que podem influenciar os resultados insatisfatórios / Insufficient loss of weight and/or absence of DM2 remission after Roux-en-Y gastric bypass: factors that may influence the unsatisfactory results

RACIONAL: A derivação gastrojejunal em Y-de-Roux é considerada um dos tratamentos mais eficientes para a manutenção de peso a longo prazo; porém, está associada à falhas manifestadas por impossibilidade de manutenção ou reganho de peso e descontrole glicêmico. OBJETIVO: Estudar os possíveis fatores que influenciam na falha do controle de peso e ou remissão da DM2. MÉTODOS: Estudo do tipo caso-controle, com 159 pacientes submetidos ao bypass gástrico com dois anos ou mais de pós-operatório, sendo selecionados para casos 24 pacientes com perda ponderal insatisfatória e ou ausência de remissão da DM2 e para controle 24 pacientes com perda ponderal satisfatória e ou remissão do DM2, pareados por idade e tempo de pós-operatório. RESULTADOS: Dos 24 casos e 24 controles avaliados, o percentual de reganho de peso foi de 19,32% e 8,68% e o percentual de remissão da DM2 foi de 26,6% e 87,5% assim como o percentual de recorrência da DM2 foi de 6,6% e 0,0% para casos e controles. Observando o IMC máximo pré-operatório, os casos apresentaram em média 53,50±12,24 kg/m2 e controles 48,77±5,19 kg/m2 sendo que o IMC máximo anterior ao bypass gástrico foi estatisticamente significativo no que se refere à falha no controle de peso ou insucesso da operação. CONCLUSÃO: Pacientes com IMC máximo inicial elevado (≥ 50kg/m2) apresentaram maior índice de falha na perda ponderal. A intolerância alimentar e diferenças socioeconômicas são consideradas fatores de reganho de peso.

BACKGROUND: Roux-en-Y gastric by-pass is considered one of the most effective treatments for maintaining long-term weight loss. However, it is associated to failures manifested by the inability to maintain weight loss, weight gain or poor glycemic control. OBJETIVE: Study the possible factors that influence weight loss failure and/or DM2 remission. METHODS: Case-control study of 159 patients submitted to gastric by-pass two or more years postoperatively. Twenty-four individuals with unsatisfactory weight loss and/or DM2 remission were selected as cases and 24 with satisfactory weight loss and/or absence of DM2 remission as controls, matched for age and postoperative time. RESULTS: Of the 24 cases and controls evaluated, the percentage weight gain was 19.32% and 8.68%, percentage DM2 remission 26.6% and 87.5% and percentage DM2 recurrence 6.6% and 0.0%, respectively. Cases and controls exhibited mean maximum preoperative BMI of 53.50±12.24 kg/m2 and 48.77±5.19 kg/m2, respectively. These values were statistically significant in terms of poor weight management or failed surgery. CONCLUSION: Patients with elevated initial maximum BMI (≥ 50kg/m2) displayed higher weight loss failure rates. Food intolerance and socioeconomic differences are considered factors in weight gain.

Profile of the obese patients submitted to Roux-en-Y gastric bypass whithout diabetes melittus type 2 remission and/or insufficient weight loss.

BACKGROUND: The literature reports that gastrojejunal derivation with Roux-en-Y gastric bypass is highly efficient in controlling weight and resolving; but studies have shown worsened glycemic control in a considerable number of patients and associated factors that have not been fully elucidated. AIM: To analyze the profile of patients submitted to gastric bypass that did not achieve satisfactory weight loss or complete diabetes remission. METHODS: Case-control study of 32 patients submitted to gastric bypass with at least two years postoperative time, unsatisfactory results in terms of weight loss or absence of complete diabetes remission. The control group was composed of another 32 patients submitted to the same operation at the same facility, matched for age and postoperative time. A structured questionnaire was applied and clinical and laboratory data were analyzed. RESULTS: Among the cases and controls, BMI was 38.9 kg/m² and 29.5 kg/m2, excess weight loss was 56.1% and 77.2%, % excess weight regain of initial excess weight loss, was 20.2% and 7.7%, respectively. Family history of type 2 diabetes mellitus, hypertension and food intolerance showed a significant relationship between cases and controls. CONCLUSION: Food intolerance and family history of hypertension and diabetes were associated to lower loss and weight regain or less likelihood of complete diabetes remission after gastric bypass.