Low skeletal muscle radiodensity is the best predictor for short-term major surgical complications in gastrointestinal surgical cancer: A cohort study.

The aim of this study was to evaluate whether body composition, muscle function, and their association are predictive factors for short-term postoperative complications in patients with gastric and colorectal cancer. A prospective cohort study was conducted with patients undergoing resection of gastric and colorectal tumors. Nutritional status was assessed using Patient-Generated Subjective Global Assessment (PG-SGA) and anthropometric techniques. Low handgrip strength (HGS) was observed when <16kg for women, and <27kg for men. Computed tomography images were used to measure visceral adipose tissue, skeletal muscle index (SMI), and skeletal muscle radiodensity (SMD). Complications of grade II or above (according to Clavien-Dindo's classification) were considered in a follow-up period of up to 30 days after surgery. Major complications were defined when they reached grade III or above. A total of 84 patients were analyzed (57.1% female, 59.7 ± 12.6 years) and 19% were diagnosed with low HGS + low SMI or SMD. Postoperative complications occurred in 51.2%, and these patients presented significantly longer duration of surgery and hospital stay. Major complications were observed in 16.7% of the total number of patients. Binary logistic regression adjusted by age, sex, and tumor staging showed that low SMD, low HGS + low SMI or SMD, and obesity were independent risk factors for postoperative complications, but only low SMD was an independent risk factor for major postoperative complications. Low SMD is an independent risk factor for short-term major complications following surgery in patients with gastric and colorectal cancer.

Is perioperative fasting associated with complications, length of hospital stay and mortality among gastric and colorectal cancer patients? A cohort study.

BACKGROUND: During a surgical procedure, patients are often subjected to fasting for times that are more prolonged than the ideal, which may lead to complications. OBJECTIVE: To evaluate the duration of perioperative fasting and its association with postoperative complications, length of hospital stay (LOS) and mortality among gastric and colorectal cancer patients. DESIGN AND SETTING: Cohort study developed in a surgical oncology hospital in the city of Natal (Rio Grande do Norte, Brazil). METHODS: Patients aged over 18 years were included. The Clavien-Dindo surgical complication scale was used to evaluate occurrences of postoperative complications. LOS was defined as the number of days for which patients stayed in the hospital after surgery, or until the day of death. RESULTS: Seventy-seven patients participated (59.8 ± 11.8 years; 54.5% females; 70.1% with bowel tumor). The incidences of postoperative complications and death were 59.7% and 3.9%, respectively. The duration of perioperative fasting was 59.0 ± 21.4 hours, and it was higher among non-survivors and among patients with prolonged hospital stay (≥ 6 days). For each one-hour increase in the durations of perioperative and postoperative fasting, the odds of prolonged hospitalization increased by 12% (odds ratio, OR = 1.12; 95% confidence interval, CI 1.04-1.20) and 5% (OR = 1.05; 95% CI 1.02-1.08), respectively. CONCLUSION: Prolonged perioperative fasting, especially in the postoperative period, was observed in a sample of patients with gastric and colorectal cancer, and this was an independent predictor of LOS.

Estado Nutricional de Pacientes Pediátricos Recém-Diagnosticados com Leucemia Linfoblástica Aguda em um Instituto de Referência em Oncologia do Rio de Janeiro / Nutritional Status of Pediatric Patients Newly Diagnosed with Acute Lymphoblastic Leukemia at an Institute of Reference in Oncology of Rio de Janeiro / Estado Nutricional de Pacientes Pediátricos Recién diagnosticados con leucemia linfoblástica Aguda en un Instituto de Referencia en Oncología de Río de Janeiro

Introdução: a leucemia linfoblástica aguda (lla) constitui a neoplasia mais comum em pediatria e a avaliação nutricional é um instrumento essencial para conhecer as condições de saúde dos pacientes. o presente estudo teve como objetivo avaliar e descrever o estado nutricional de pacientes pediátricos recém-diagnosticados com lla e verificar a relação do índice de massa corporal para idade (iMc/i) com as demais medidas antropométricas. Método: estudo observacional, transversal, realizado com pacientes de 1 a 18 anos, recém- -diagnosticados com lla, no período de janeiro/2004 a dezembro/2009. os dados coletados foram idade, peso corporal, estatura, prega cutânea tricipital (Pct), circunferência do braço (cB) e circunferência muscular do braço (cMB). o iMc foi calculado e a classificação iMc/i utilizada na análise. o teste Qui-quadrado de Pearson e exato de Fisher foram utilizados para analisar a associação entre os parâmetros antropométricos. Resultados: Foram incluídos no estudo 54 pacientes. a classificação do "estado nutricional adequado" foi a mais frequente em todos os parâmetros antropométricos. em adição, observou-se que a associação do estado nutricional pela cMB com o iMc/i (p=0,001) demonstra que este último pode ser adequado para classificação dos pacientes pediátricos com lla ao diagnóstico. e a concordância da cB com a cMB (p=0,01) de 43% (p=0,001) também ratifica a utilização da cB frente à cMB, por ser uma medida mais simples. Conclusão: na população estudada, o estado nutricional encontrava-se preservado. assim como a associação da cMB com o iMc/i, a cB demonstrou ser um parâmetro sensível para classificar eutrofia.

Introduction: acute lymphoblastic leukemia (all) is the most common neoplasm in pediatrics, and nutritional assessment is an essential tool for understanding patients' health conditions. The present study aimed to evaluate and describe the nutritional status of pediatric patients newly diagnosed with all and to verify the relation between body mass index for age (BMi-for-age) and other anthropometric measurements. Method: a cross-sectional, observational study was performed with patients from 1 to 18 years of age, newly diagnosed with all, from January 2004 to december 2009. The data collected were age, body weight, height, triceps skinfold (ts), arm circumference (ac) and arm muscle circumference (aMc). The BMi was calculated and the BMi-for-age classification used in the analysis. Pearson's chi-square test and Fisher's exact test were used to analyze the association between anthropometric parameters. Results: 54 patients were included in the study. The classification of "adequate nutritional status" was the most frequent in all anthropometric parameters. in addition, we observed that the association of nutritional status by aMc with BMi-for-age (p=0.001) shows that the BMi-for-age may be adequate for classification of pediatric patients with all at diagnosis. in addition, ac agreement with aMc (p=0.01) of 43% (p=0.001) also confirmed the use of ac versus aMc, as it is a simpler measure. Conclusion: in the studied population the nutritional status was preserved. Just as the association of aMc with BMi-for-age, ac has been shown to be a sensitive parameter for classifying eutrophy

Introducción: la leucemia linfoblástica aguda (lla) constituye la neoplasia más común en pediatría y la evaluación nutricional es un instrumento esencial para conocer las condiciones de salud de los pacientes. el presente estudio tuvo como objetivo evaluar y describir el estado nutricional de pacientes pediátricos recién diagnosticados con lla y verificar la relación del Índice de masa corporal por edad (iMc/i) con las demás medidas antropométricas. Método: estudio observacional, transversal, realizado con pacientes de 1 a 18 años recién diagnosticados con lla en el período de enero / 2004 a diciembre / 2009. los datos recogidos fueron edad, peso corporal, estatura, pliegue cutáneo tricipital (Pct), circunferencia del brazo (cB) y circunferencia muscular del brazo (cMB). el iMc fue calculado y la clasificación iMc/i utilizada en el análisis. la prueba chi-cuadrado de Pearson y exacto de Fisher se utilizaron para analizar la asociación entre los parámetros antropométricos. Resultados: se incluyeron en el estudio 54 pacientes. la clasificación del "estado nutricional adecuado", fue la más frecuente, en todos los parámetros antropométricos. en adición, se observo que la asociación del estado nutricional por la cMB con el iMc/i(p=0,001) demuestra que este último puede ser adecuado para clasificación de los pacientes pediátricos con lla al diagnóstico. Y la concordancia de la cB con la cMB (p=0,01) del 43% (p=0,001), también ratifica la utilización de la cB frente a la cMB, por ser una medida más simple. Conclusión: en la población estudiada el estado nutricional se encontraba preservado. así como la asociación de la cMB con el iMc/i, la cB demostró ser un parámetro sensible para clasificar eutrofia.

Estado nutricional e desfechos clínicos em pacientes pediátricos com leucemia linfoblástica aguda / Nutritional status and clinical outcomes in pediatric patients with acute lymphoblastic leukemia / Estado nutricional y los resultados clínicos en pacientes pediátricos con leucemia linfoblástica aguda

Introdução: A leucemia linfoblástica aguda é a neoplasia mais comum na população pediátrica, e estudos apontam o estado nutricional como um fator prognóstico importante. Objetivo: Avaliar o estado nutricional de uma coorte de crianças e adolescentes durante o tratamento para leucemia linfoblástica aguda, determinar a sua associação com o risco de recaída e com a sobrevida em cinco anos de seguimento. Método: Estudo observacional, retrospectivo, com 54 pacientes de 1 a 18 anos com leucemia linfoblástica aguda, tratados em um hospital de referência em oncologia, entre janeiro de 2004 e dezembro de 2009. Os dados antropométricos foram coletados pela equipe de pesquisadores, nos prontuários, no período de junho a outubro de 2015. Verificaram-se a incidência de recaída e o óbito nos pacientes estudados em cinco anos de seguimento. Resultados: Houve predomínio do sexo masculino (55,6%) e a mediana de idade foi de 7,0 anos no início do seguimento. Observou-se um aumento significativo no escore-z médio do índice de massa corporal para idade durante o tratamento de 0,13±1,19 ao diagnóstico para 0,72±1,07 no início da fase de manutenção (p=0,000). No presente estudo, o estado nutricional ao diagnóstico não foi determinante para o risco de recaída. As curvas de sobrevida não foram diferentes entre os pacientes com ou sem excesso de peso ao diagnóstico. Conclusão: Na população estudada, observou-se um ganho ponderal significativo durante o tratamento, porém não foi encontrada associação entre estado nutricional ao diagnóstico e risco de recaída, e não se verificou influência do excesso de peso na sobrevida.

Introduction: Acute Lymphoblastic Leukemia is the most common neoplasm in the pediatric population, and studies point to nutritional status as an important prognostic factor. Objective: To evaluate the nutritional status of a cohort of children and adolescents during treatment for acute lymphoblastic leukemia, to determine its association with risk of relapse and survival at five years of follow-up Method: Observational retrospective study of 54 patients aged 1 to 18 years old with acute lymphoblastic leukemia treated at an oncology reference hospital, between January 2004 and December 2009. The anthropometric data were collected by the team of researchers from the medical records, from June to October 2015. The incidence of relapse and death was verified in the patients studied at five years of follow-up. Results: There was a predominance of males (55.6%) and the median age was 7.0 years at the beginning of followup. A significant increase was observed in the mean z-score of the Body Mass Index for age during treatment, from 0.13±1.19 at diagnosis to 0.72±1.07 at the beginning of the maintenance phase (p=0.000). In the present study, the nutritional status at diagnosis was not decisive for the risk of relapse. Survival curves did not differ between patients who were and were not overweight at diagnosis. Conclusion: In the studied population, a significant weight gain was observed during treatment, but no association was found between nutritional status at diagnosis and risk of relapse, and no influence of overweight on survival was observed.

Introducción: La leucemia linfoblástica aguda es el cáncer más común en los pacientes pediátricos, y los estudios indican el estado nutricional como un factor pronóstico importante. Objetivo: Evaluar el estado nutricional de una cohorte de niños y adolescentes durante el tratamiento para la leucemia linfoblástica aguda, determinar su asociación con el riesgo de recaídas y la supervivencia a los cinco años de seguimiento. Método: estudio observacional, retrospectivo con 54 pacientes de 1 a 18 años con leucemia linfoblástica aguda tratados en un hospital de referencia en oncología, entre enero de 2004 y diciembre de 2009. Los datos antropométricos fueron recogidos por el equipo de investigadores, en los prontuarios, en el período de junio a octubre de 2015. Se verificó la incidencia de recaída y muerte en los pacientes en cinco años de seguimiento. Resultado: Hubo un predominio del sexo masculino (55,6%) y la edad mediana fue de 7,0 años al inicio del estudio. Se observó un aumento significativo en el escore-z medio del índice de masa corporal para la edad durante el tratamiento, de 0,13±1,19 en el diagnóstico para 0,72±1,07 en el período de mantenimiento (p=0,000). En este estudio, el estado nutricional al momento del diagnóstico no fue decisivo para el riesgo de recaída. Las curvas de supervivencia no fueron diferentes entre los pacientes con o sin exceso de peso al momento del diagnóstico. Conclusión: En la población estudiada, hubo un aumento significativo de peso durante el tratamiento, pero no se encontró asociación entre el estado nutricional al momento del diagnóstico y el riesgo de recaída y no hubo influencia del exceso de peso en la supervivencia.ncia, basándose en los estudios de las necesidades físicas, emocionales, sociales y económicos de este creciente grupo.