Mapa de Evidências: Má Nutrição e Intervenções na APS

O mapa apresenta uma síntese gráfica das evidências sobre as intervenções para o manejo, prevenção e tratamento da má nutrição (desnutrição, obesidade e deficiência de micronutrientes) no âmbito da Atenção Primária (APS). A partir de uma ampla busca bibliográfica (PubMed e BVS) foram incluídos no mapa 61 estudos de revisão sistemática. Todos os estudos foram avaliados, caracterizados e categorizados por tipo de intervenção e por desfechos.

Ciência da disseminação em DOHaD para a promoção da saúde nas futuras gerações / Dissemination Science in DOHaD for health promotion in future generations

Após o reconhecimento de princípios evolutivos e da epigenética associada à plasticidade do desenvolvimento, a ciência de DOHaD (Origens Desenvolvimentistas da Saúde e Doença) floresceu. Segundo DOHaD, a exposição a condições adversas no início da vida, como a subnutrição, leva a respostas adaptativas para aumentar as chances de sobrevivência imediata e posterior, as quais podem aumentar o risco de doenças crônicas não transmissíveis (DCNT) no curso da vida. Outros insultos como obesidade (materna e paterna) na preconcepção e gestação, diabetes gestacional, aleitamento e a alimentação inadequada na infância podem induzir respostas não adaptativas e aumentar o risco de doenças, independentemente do ambiente posterior. A exposição à desreguladores endócrinos, substâncias tóxicas e poluentes também podem ter efeitos de longo prazo. Esses efeitos são mediados por alterações epigenéticas, as quais se tornam mais sensíveis nesse período crítico de desenvolvimento de intensa reorganização. Diante da transição nutricional e coexistência das diferentes formas de desnutrição nos países de baixa e média renda (PBMR); do aumento global das DCNT, cujo impacto social e econômico é maior nesses países; da fraca contribuição de fatores genéticos fixos na etiologia dessas doenças; e da ineficácia das atuais intervenções, a implementação de DOHaD representa uma estratégia potencial para beneficiar as futuras gerações. Considerando que a disseminação de DOHaD não têm acompanhado seu florescimento científico, esse trabalho teve como objetivo o desenvolvimento de um ebook direcionado para nutricionistas e um artigo relativo aos impactos da pandemia de COVID-19 na perspectiva de DOHaD, a fim de aproximar a ciência destes profissionais e fomentar sua implementação. Trata-se de uma revisão narrativa de literatura a partir artigos científicos em inglês e português, publicados nas bases de dados SciELO, PubMed e BVS, sem limite de data. O trabalho evidenciou que o desafio da dupla carga de doenças e das diferentes formas de desnutrição nos PBMR, foi agravado pela pandemia, tornando imperativo medidas de intervenção por seu provável impacto no ciclo intergeracional de DCNT e desenvolvimento dos países. A aproximação dessa ciência do nutricionista, propicia uma formação mais ampla e integrativa, através de capacitação técnica e habilidades interpessoais, capazes de acionar as fragilidades biopsicossociais, e melhor intervir, equacionando resultados de curto e longo prazo, a fim de interromper o ciclo intergeracional de DCNT, assim como otimizar o capital humano, a capacidade de produção e renda da futura geração. Conclui-se que o material desenvolvido é de grande valia, dado que a disseminação desse conhecimento deve se estender aos nutricionistas de todas as áreas e ser multiplicado

After evolutionary and epigenetics principles associated with the plasticity of development were recognized, DOHaD (Developmental Origins of Health and Disease) science flourished. According to DOHaD, the exposure to adverse conditions at the beginning of life, like undernutrition, leads to adaptive responses to increased immediate and later odds of survival, which may increase the risk of noncommunicable diseases (NCD) during life. Other conditions such as obesity (maternal and paternal) in preconception and pregnancy, gestational diabetes, lactation, and inadequate nourishment during infancy can induce non-adaptive responses and increased risk of diseases, regardless of the upcoming environment. The exposure to endocrine disruptors, and toxic and pollutant substances can also have long-term effects. Those effects are mediated by epigenetic changes, which become more sensitive during this critical period of development under intense reorganization. Considering the nutritional transition and coexistence of the different forms of undernutrition in the low- and middle-income countries (LMIC); the global increase of NCDs, with a higher social and economic impact in those countries; the weak contribution of fixed genetic factors in the etiology of those diseases; and the inefficacy of current interventions, the implementation of DOHaD represents a potential strategy to benefit future generations. Considering that the dissemination of DOHaD have not followed its scientific progress, the goal of the present work was to develop an e-book targeting nutritionists and an article about the impacts of the COVID-19 pandemic in the perspective of DOHaD, intended to drive the science closer to those professionals and foster its implementation. It is a narrative review of the literature regarding scientific articles published in English and Portuguese on the data bases SciELO, PubMed and BVS, with no date limit. The work has highlighted that the challenge of the double burden of the diseases and the several forms of undernutrition in the LMIC, was aggravated by the pandemic, making intervention measures imperative due to its likely impact on the intergenerational cycle of NCD and the development of countries. By inching closer to nutritionists this science provides larger and more integrative education through technical training and interpersonal abilities that help activate biopsychosocial fragilities, and better intervention; providing short- and long-term results aiming to interrupt the NCD intergenerational cycle, as well as optimize the human capital, the work and income capacity of the future generation. It is concluded that the material developed is of great value, given that the dissemination of this knowledge should reach all nutritionists from all areas and be multiplied

Nutritional status in young children prior to the malaria transmission season in Burkina Faso and Mali, and its impact on the incidence of clinical malaria.

BACKGROUND: Malaria and malnutrition remain major problems in Sahel countries, especially in young children. The direct effect of malnutrition on malaria remains poorly understood, and may have important implications for malaria control. In this study, nutritional status and the association between malnutrition and subsequent incidence of symptomatic malaria were examined in children in Burkina Faso and Mali who received either azithromycin or placebo, alongside seasonal malaria chemoprevention. METHODS: Mid-upper arm circumference (MUAC) was measured in all 20,185 children who attended a screening visit prior to the malaria transmission season in 2015. Prior to the 2016 malaria season, weight, height and MUAC were measured among 4149 randomly selected children. Height-for-age, weight-for-age, weight-for-height, and MUAC-for-age were calculated as indicators of nutritional status. Malaria incidence was measured during the following rainy seasons. Multivariable random effects Poisson models were created for each nutritional indicator to study the effect of malnutrition on clinical malaria incidence for each country. RESULTS: In both 2015 and 2016, nutritional status prior to the malaria season was poor. The most prevalent form of malnutrition in Burkina Faso was being underweight (30.5%; 95% CI 28.6-32.6), whereas in Mali stunting was most prevalent (27.5%; 95% CI 25.6-29.5). In 2016, clinical malaria incidence was 675 per 1000 person-years (95% CI 613-744) in Burkina Faso, and 1245 per 1000 person-years (95% CI 1152-1347) in Mali. There was some evidence that severe stunting was associated with lower incidence of malaria in Mali (RR 0.81; 95% CI 0.64-1.02; p = 0.08), but this association was not seen in Burkina Faso. Being moderately underweight tended to be associated with higher incidence of clinical malaria in Burkina Faso (RR 1.27; 95% CI 0.98-1.64; p = 0.07), while this was the case in Mali for moderate wasting (RR 1.27; 95% CI 0.98-1.64; p = 0.07). However, these associations were not observed in severely affected children, nor consistent between countries. MUAC-for-age was not associated with malaria risk. CONCLUSIONS: Both malnutrition and malaria were common in the study areas, high despite high coverage of seasonal malaria chemoprevention and long-lasting insecticidal nets. However, no strong or consistent evidence was found for an association between any of the nutritional indicators and the subsequent incidence of clinical malaria.

The prognostic impact of the controlling nutritional status (CONUT) score in patients undergoing cardiovascular surgery.

BACKGROUND: Various postoperative predictive markers following cardiovascular surgery have been examined for use in the current aging population. The controlling nutritional status (CONUT) score, which is advocated not only as a screening tool for poor nutritional status, but also as an immunonutritional assessment, has started to attract attention in several clinical settings, such as in cancer and heart failure patients. The aim of this study was to evaluate the value of the CONUT score as a postoperative prognostic marker in patients who underwent cardiovascular surgery. METHODS: A total of 75 patients who underwent elective cardiovascular surgery between January 2015 and October 2017 were retrospectively analyzed. The patients were divided into two groups according to their preoperative CONUT score (i.e., CONUT < 2 or CONUT ≥ 2), and their clinicopathological characteristics, surgical outcomes, and overall survival were compared. The median follow-up period was 23 months (range 0-43 months) after surgery. RESULTS: The high CONUT group (CONUT ≥ 2), which consisted of 30 (40.0%) patients, had a significantly worse prognosis than the low CONUT group with regard to overall survival (p = 0.0007). On multivariate analyses, the CONUT score was identified as the only independent prognostic factor for overall survival (hazard ratio 1.47 per 1 CONUT score increase, 95% confidence interval 1.05-2.06, p < 0.026). CONCLUSIONS: The CONUT score is a reliable and independent preoperative predictor of overall survival after cardiovascular surgery.

Malnutrition definitions in clinical practice: To be E43 or not to be?

Malnutrition is a disease that imposes a significant healthcare cost burden in the United States, especially when left undiagnosed and untreated for an extended period of time. This article discusses traditional malnutrition diagnostic criteria for adults and why registered dietitian nutritionists and physicians should no longer use these criteria to determine nutrition status. It concludes with the malnutrition clinical characteristics currently accepted in the United States and globally, with implications for practice. Clinical documentation specialists and medical coders can use this information to better interpret medical record documentation and assign the correct International Classification of Diseases, 10th Revision, Clinical Modification codes to the coding abstract.

Malnutrition Status and Associated Factors in Cardiac Patients Admitted to Heart Hospital, in the North of Iran.

The objective of study was to evaluate the prevalence of malnutrition and associated factors in cardiac patients in the north of Iran. This cross-sectional study was done on 430 cardiac patients, who were admitted to the only heart hospital in the north of Iran. The malnutrition status was assessed based on "Malnutrition Universal Screening Tool" (MUST). The data was analyzed using SPSS software. The mean age of patients was 63.5 ± 12.67 years. The commonest cause of hospitalization was acute coronary syndrome. 31.4% patients had history of admission in the past 12 months. The prevalence of malnutrition was 14%, 7.7%, and 6.3% had medium and high risk of malnutrition, respectively. Patients with history of one time admission were 2.7 times more likely to be malnourished. The odds ratio for more than one time of hospital admission was 3.54. Malnutrition is likely to be present when the cardiac patients are admitted to hospital in Gilan province, in northern Iran.

Medical Nutrition Terminology and Regulations in the United States and Europe-A Scoping Review: Report of the ISPOR Nutrition Economics Special Interest Group.

BACKGROUND: The term medical nutrition (MN) refers to nutritional products used under medical supervision to manage disease- or condition-related dietary needs. Standardized MN definitions, aligned with regulatory definitions, are needed to facilitate outcomes research and economic evaluation of interventions with MN. OBJECTIVES: Ascertain how MN terms are defined, relevant regulations are applied, and to what extent MN is valued. METHODS: ISPOR's Nutrition Economics Special Interest Group conducted a scoping review of scientific literature on European and US MN terminology and regulations, published between January 2000 and August 2015, and pertinent professional and regulatory Web sites. Data were extracted, reviewed, and reconciled using two-person teams in a two-step process. The literature search was updated before manuscript completion. RESULTS: Of the initial 1687 literature abstracts and 222 Web sites identified, 459 records were included in the analysis, of which 308 used MN terms and 100 provided definitions. More than 13 primary disease groups as per International Classification of Disease, Revision 10 categories were included. The most frequently mentioned and defined terms were enteral nutrition and malnutrition. Less than 5% of the records referenced any MN regulation. The health economic impact of MN was rarely and insufficiently (n = 19 [4.1%]) assessed, although an increase in economic analyses was observed. CONCLUSIONS: MN terminology is not consistently defined, relevant European and US regulations are rarely cited, and economic evaluations are infrequently conducted. We recommend adopting consensus MN terms and definitions, for example, the European Society for Clinical Nutrition and Metabolism consensus guideline 2017, as a foundation for developing reliable and standardized medical nutrition economic methodologies.

Is phase angle an appropriate indicator of malnutrition in different disease states? A systematic review.

BACKGROUND & AIMS: Subjective Global Assessment (SGA) classifies malnutrition severity via a simple bedside assessment. Phase angle (PhA) is an indicator of cell integrity and has been suggested to be indicator of nutritional status. OBJECTIVE: To explore the relationship between PhA and SGA. METHODS: Relevant studies published through October 31, 2017 were identified using 7 electronic databases. Articles were included for review if they included comparison data between SGA and PhA within adult disease populations. Evidence quality was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) guidelines and methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. RESULTS: 33 articles within four disease states (liver, hospitalization, oncology and renal) met inclusion criteria for review. Results were limited by restricting the database search to articles published in English only, and by the inherent difficulty of comparing 2 methods which are both influenced by the operator. CONCLUSION: Based on GRADE guidelines, evidence quality received a grade of Low. Based on QUADAS-2, 61% of studies had high risk of bias in the index test (PhA), while all other domains had low risk. It is not possible to conclude that PhA is an accurate independent indicator of malnutrition. PROSPERO no. CRD42016050876.

Development and application of a scoring system to rate malnutrition screening tools used in older adults in community and healthcare settings - A MaNuEL study.

RATIONALE: Many malnutrition screening tools are used to screen for risk of malnutrition in older adults. An aim of the Joint Programming Initiative (JPI) 'A Healthy Diet for a Healthy Life' (HDHL) MalNutrition in the ELderly Knowledge hub (MaNuEL) is to devise recommendations on the best tools to screen for risk of malnutrition in older adults in community and healthcare settings across Europe. The aim of this paper was to develop and apply a scoring system to rate malnutrition screening tools. METHODS: Using a targeted literature search strategy, 48 malnutrition screening tools used to screen for risk of malnutrition in older adults were identified across community, rehabilitation, residential care and hospital settings. Criteria to rate each tool were developed; these were based on published evidence and expert opinion. These criteria were translated into a scoring system. RESULTS: The scoring system had three equally weighted sections; validation, parameters and practicability, and was applied to all 48 tools. Overall, the highest scoring tools per setting for screening for risk of malnutrition in older adults were i) DETERMINE your health checklist for the community setting; ii) the Nutritional Form for the Elderly (NUFFE) for the rehabilitation setting; iii) the Short Nutritional Assessment Questionnaire-Residential Care (SNAQRC) for residential care and iv) both the Malnutrition Screening Tool (MST) and the Mini Nutritional Assessment Short Form Version 1 (MNA-SF-V1) for the hospital setting. CONCLUSION: Setting-specific tools are more appropriate for use with older adults. These findings will inform recommendations for the optimal screening of geriatric malnutrition across Europe.

Are Dietitians Documenting Malnutrition Based on Subjective Global Assessment Category?

Purpose: This study reports on dietitian use of the Nutrition Care Process Terminology (NCPT) diagnosis of malnutrition based on Subjective Global Assessment (SGA). Methods: Nutrition assessment reports for adults in medical, surgical, and cardiac units in 13 Canadian hospitals were retrospectively examined for a 6-week period in 2014. Reports with a SGA and NCPT diagnosis were included regardless of why the patient was seen by the dietitian. Results: Of the 932 nutrition assessment reports, 857 (92%) included an SGA. Based on SGA, the prevalence of mild to moderate malnutrition (SGA B) and severe malnutrition (SGA C) was 53.4% (n = 458) and 10.0% (n = 86), respectively. When categorized as severely malnourished, the most common NCPT diagnoses were "malnutrition" (n = 55, 72.4%), "inadequate oral intake" (n = 11, 14.5%), and "inadequate protein-energy intake" (n = 10,13.1%). Among those with SGA B and C, the assignment of the NCPT malnutrition diagnosis was 19.8% (n = 95). Conclusions: Dietitians play a key role in the prevention, identification, and treatment of malnutrition in the hospitalized patient and are well positioned to take a leadership role in improving its documentation. Ongoing audits, staff support, and training regarding NCPT use may improve the application of the malnutrition diagnosis. Future research examining dietitian barriers to using the malnutrition diagnosis would be valuable.

Transthyretin for the routine assessment of malnutrition: A clinical dilemma highlighted by an international survey of experts in the field.

The value of transthyretin (TTR) measurement for assessing malnutrition is under debate due to its sensitivity to inflammation and frequent confusion over its meaning (i.e. as a marker of diagnosis, prognosis, or efficacy of refeeding). Moreover, there is still no ESPEN/ASPEN guideline on its use and cut-off values. Here the aim was to evaluate the overall perception of the value of this parameter and its utilization worldwide. A panel of international experts in the field were surveyed on the use of TTR in clinical practice in their country, on the guidelines issued by their national health authorities, and on the cut-off values used to diagnose malnutrition. A total of 31 experts (nutrition [n = 9], surgery [n = 8], critical care [n = 4], geriatrics [n = 4], biology [n = 3], pediatrics [n = 1], internal medicine [n = 1] and gastroenterology [n = 1]) from 16 countries participated. TTR only appears in Italian, Polish, British and French national guidelines giving cut-off values for mild/moderate/severe malnutrition. TTR is frequently used in research yet rarely if ever in clinical practice in most countries, the reasons cited being lack of evidence for its usefulness, lack of specificity, or its high cost/effectiveness ratio. Given the difficulty of finding a consensus tool for the diagnosis of malnutrition, there is every reason to consider such a simple and inexpensive marker as TTR. However, further studies are needed to define and unify international guidelines on the use of TTR in terms of inflammation level and the associated cut-off values.

Malnutrition Diagnosis during Adult Inpatient Hospitalizations: Analysis of a Multi-Institutional Collaborative Database of Academic Medical Centers.

BACKGROUND: Malnutrition is a significant problem for hospitalized patients. However, the true prevalence of reported malnutrition diagnosis in real-world clinical practice is largely unknown. Using a large collaborative multi-institutional database, the rate of malnutrition diagnosis was assessed and used to assess institutional variables associated with higher rates of malnutrition diagnosis. OBJECTIVE: The aim of this study was to define the prevalence of malnutrition diagnosis reported among inpatient hospitalizations. DESIGN: The University Health System Consortium (Vizient) database was retrospectively reviewed for reported rates of malnutrition diagnosis. PARTICIPANTS/SETTING: All adult inpatient hospitalization at 105 member institutions during fiscal years 2014 and 2015 were evaluated. MAIN OUTCOME MEASURES: Malnutrition diagnosis based on the presence of an International Classification of Diseases-Ninth Revision diagnosis code. STATISTICAL ANALYSIS: Hospital volume and publicly available hospital rankings and patient satisfaction scores were obtained. Multiple regression analysis was performed to assess the association between these variables and reported rates of malnutrition. RESULTS: A total of 5,896,792 hospitalizations were identified from 105 institutions during the 2-year period. It was found that 292,754 patients (5.0%) had a malnutrition diagnosis during their hospital stay. By institution, median rate of malnutrition diagnosis during hospitalization was 4.0%, whereas the rate of severe malnutrition diagnosis was 0.9%. There was a statistically significant increase in malnutrition diagnosis from 4.0% to 4.9% between 2014 and 2015 (P<0.01). Institutional factors associated with increased diagnosis of malnutrition were higher hospital volume, hospital ranking, and patient satisfaction scores (P<0.01). CONCLUSIONS: Missing a malnutrition diagnosis appears to be a universal issue because the rate of malnutrition diagnosis was consistently low across academic medical centers. Institutional variables were associated with the prevalence of malnutrition diagnosis, which suggests that institutional culture influences malnutrition diagnosis. Quality improvement efforts aimed at improved structure and process appear to be needed to improve the identification of malnutrition.

Evolución del estado nutricional en niños menores de 5 años beneficiarios de un programa alimentario, al ingreso, a los 3 y 6 meses de tratamiento que acuden al Hospital distrital de la ciudad de Coronel Bogado / Evolution of nutritional status in children under 5 years of age who are beneficiaries of a food program, on admission, at 3 and 6 months of treatment, who come to the District Hospital of the city of Coronel Bogado

Introducción: la desnutrición es un problema de salud pública a nivel nacional. Objetivo: Evaluar la evolución nutricional de los niños menores de 5 años beneficiarios de un programa alimentario, al ingreso, a los 3 y 6 meses de tratamiento que acuden al Hospital Distrital de la Ciudad de Coronel Bogado. Metodología: estudio de cohorte retrospectivo, observacional, descriptivo con componente analítico de casos consecutivos, evaluados durante setiembre de 2016 a marzo de 2017. Resultados: fueron evaluados 40 pacientes. El 52,50% (n=21) corresponde al sexo masculino y 47,50% (n=19) al femenino. La edad promedio fue de 13.606 ± 14.52 meses. El 37.50% (n=15) provino de una zona rural y el 62.50% (n=21) de zona urbana. Se encontró desnutrición al ingreso 15%, a los 3 meses 10% y a los 6 meses no se detectaron casos de desnutrición. Riesgo de desnutrición al ingreso 85%, a los 3 meses 45% y finalmente a los 6 meses 16%. Por último, 45% presentaron peso adecuado a los 3 meses y 84% a los 6 meses. El aumento total de peso promedio durante los meses de tratamiento fue :2,81 ±1,16 kg. El 85 % tiene un ingreso menor al sueldo mínimo, 58% accedió solo a la educación primaria, 53% no tiene acceso a agua potable, 38% no cuenta con baño moderno, 27% no cumplió los 6 meses de lactancia materna exclusiva, 27% presento bajo peso al nacer. No se observó relación significativa de los factores en relación al estado nutricional a los 3 meses. Conclusiones: Se observó una tendencia hacia la mejoría del estado nutricional a través de un Programa alimentario que brinda apoyo nutricional

Evolución del Estado Nutricional de Niños/as del 1ro. a 6to. grado de las Escuelas de Asentamientos del Distrito de Edelira beneficiados con la Alimentación Escolar, periodo 2016 / Evolution of the Nutritional State of Children from 1st to 6th Grade of the Edelira District Basic Schools of Settlements benefited from School Feeding, Period 2016

El Programa de Alimentación Escolar del Paraguay trabaja para combatir el hambre, la desnutrición infantil e incentivar a la permanencia de los niños/as en las escuelas. Objetivo: Describir la evolución del estado nutricional de niños/as del 1ro a 6to grado de las escuelas básicas de asentamientos del Distrito de Edelira beneficiados con la alimentación escolar, periodo 2016. Métodos: Estudio observacional descriptivo, longitudinal. Se utilizó el Manual Básico de Evaluación Nutricional Antropométrica del INAN-2015 para diagnosticar el estado nutricional por IMC/Edad y Talla/Edad. Resultados: Se analizó la planilla de valoración nutricional de 47 niños/as, el 66% (n= 31) de la población estudiada corresponde al sexo femenino y el 34% (n=16) al sexo masculino. La mediana encontrada fue de 8,45 ± 1,69 años. Antes de la alimentación escolar, el estado nutricional según el IMC/E resultaron peso adecuado (A) 60 % (n= 28), (RD) del 19 % (n=9), sobre peso ( S) 13% (n=6), (DM) 2% (n=1), obesidad (O) 6% (n=3).Talla para la edad ( T/E); fue sin talla baja en un 89% (n= 42), (RTB) 9 % (n=4), (TB) 2% (n=1). Después de iniciado la alimentación escolar, el estado nutricional según el IMC/E resultaron peso adecuado (A) 74 % (n= 35), (RD) 15 % (n=7), sobre peso (S) 9 % (n= 4), (DM) 0% (n=0), y obesidad (O) 2% (n=1). Sin talla baja se mantuvo en 89% (n=42), (RTB) 9% y (TB) 2% (n=1). Conclusiones: 4 meses iniciado el programa de alimentación escolar, los hallazgos indican una evolución favorable en cuanto al IMC/E en un 14%, un descenso del (RD) 4%, sobre peso (S) 4%, obesidad (O) 4% , no se evidenció (DM). En cuanto a la T/E no se evidenció cambio importante por el crecimiento lento, propio de la edad

The School Feeding Program of Paraguay works to combat hunger, child malnutrition and encourage children to stay in school. Objective: To describe the evolution of the nutritional status of children from the 1st to the 6th grade of the basic schools of settlements of the District of Edelira beneficiaries with school education, 2016 period. Methods: Descriptive, longitudinal observational study. The Basic Manual of Nutritional Anthropometric Evaluation of the INAN-2015 was used to diagnose the nutritional status by BMI / Age and Size / Age. Results: The nutritional assessment form of 47 children was analyzed, 66% (n = 31) of the studied population corresponds to the female sex and 34% (n = 16) to the male sex. The median found was 8.45 ± 1.69 years. Before school feeding, nutritional status according to BMI / E resulted in adequate weight (A): 60% (n = 28), (RD) of 19% (n = 9), overweight (S) 13% ( n = 6), (DM) 2% (n= 1), obesity (O) 6% (n= 3) .Talk for age (T / E); it was without a low stature in 89% (n = 42), (RTB) 9% (n = 4), (TB) 2% (n = 1). After starting school feeding, the nutritional status according to BMI / E resulted in adequate weight (A): 74% (n = 35), (RD) 15% (n = 7), overweight (S) 9% (n = 4), (DM) 0% (n = 0), and obesity (O) 2% (n = 1). No short stature remained at 89% (n = 42), (RTB) 9% and (TB) 2% (n = 1). Conclusions: 4 months into the school feeding program, the findings indicate a favorable evolution in terms of BMI / E in 14%, a decrease in (RD) 4%, overweight (S) 4%, obesity (O) 4 %, was not evidenced (DM). Regarding T / E, there was no significant change due to the slow growth, typical of age

Comparação de métodos de detecção da desnutrição no ambiente hospitalar / Comparison of methods for detection of malnutrition in hospital environment

Objetivo: Comparar o diagnóstico de desnutrição em pacientes hospitalizados por meio da Avaliação Subjetiva Global (ASG) e o consenso de desnutrição proposto pela American Society for Parenteral and Enteral Nutrition (ASPEN). Método: Estudo retrospectivo, observacional, sendo a amostra composta de pacientes com idade superior a 18 anos internados no período de 2011 a 2014 nas clinicas médicas e cirúrgica de um Hospital Público terciário. Foram incluídos pacientes identificados como risco nutricional por meio da Triagem de Risco Nutricional (NRS-2002). Os diagnósticos de desnutrição foram estabelecidos com base nos dados das fichas de acompanhamento nutricional e a classificação realizada conforme a proposta da Avaliação Subjetiva Global (ASG) e do consenso de desnutrição da American Society for Parenteral and Enteral Nutrition (ASPEN). Para verificar a concordância entre as ferramentas foi aplicado o Coeficiente de Kappa. Resultados: A amostra totalizou em 963 pacientes, na maioria adultos (52,6%) e do sexo masculino (56,2%). Ao verificar a concordância entre as ferramentas obteve-se o valor de kappa=0,392 mostrando assim que não houve concordância entre as classificações de desnutrição. Melhor concordância foi encontrada ao comparar os instrumentos considerando a presença ou ausência da desnutrição (kappa=0,513). Conclusão: As ferramentas analisadas não apresentaram concordância na identificação dos graus de desnutrição. Ressalta-se, porém, a importância da análise de métodos diagnósticos para que sejam utilizados instrumentos sensíveis na identificação de pacientes desnutridos, para que a intervenção nutricional precoce possa ser realizada

Objective: Compare the diagnosis of malnutrition in hospitalized patients by means of the Subjective Global Assessment (ASG) and the consensus of malnutrition proposed by American Society for Parenteral and Enteral Nutrition (ASPEN). Methods: Retrospective study, observational, the sample consisted of patients with age above 18 years admitted in the period 2011 to 2014 in medical and surgical clinics of a tertiary public hospital. Patients included were identified as nutritional risk by means of screening of nutritional risk (NRS- 2002). To verify the concordance between the tools were applied the Kappa Coefficient. Results: The sample totaled in 963 patientes, in most adults (52,6%) and male (56,2%). To check the concordance between the tools it was obtained the kappa value=0,392 thus showing that there was no concordance between the classifications of malnutrition. Best concordance was found when comparing the instruments considering the presence or absence of malnutrition (kappa=0,513). Conclusions: The tools analyzed didn't agree in the identification of degrees of malnutrition. It must be highlighted the importance of analysis of diagnostics methods to be used sensitive instruments in the identification of malnourished patients for which the early nutritional intervention can be performed

No disponible

[Not Available]. / Impacto de una adecuada codificación de la desnutrición relacionada con la enfermedad en los índices hospitalarios.

Introducción: la desnutrición relacionada con la enfermedad (DRE) afecta al menos a una cuarta parte de los pacientes hospitalizados, aumentando la morbimortalidad del paciente durante su hospitalización y al alta. Sin embargo, su repercusión en la actividad hospitalaria no está bien cuantificada. Objetivo: determinar el impacto de una adecuada codificación de la DRE y los procedimientos empleados para revertirla en el peso medio del hospital y otros índices hospitalarios. Material y métodos: estudio comparativo realizado en todos los pacientes subsidiarios de soporte nutricional artificial seguidos por la Unidad de Nutrición Clínica y Dietética de la Sección de Endocrinología y Nutrición (UNCyD-SEyN) del Complejo Asistencial Universitario de León durante los años 2008 y 2013. Se realizó un informe de codificación nutricional del diagnóstico, el tratamiento nutricional y la vía de acceso según la CIE-9-MC. Se comparó el peso medio depurado del hospital, el índice de estancia media ajustada (IEMA), la casuística e índice de funcionamiento previo a la codificación nutricional y tras la misma. Resultados: el peso medio depurado del hospital se incrementó tras la codificación, tanto en 2008 (+ 4,1%) como en 2013 (+1,7%) y especialmente en aquellos servicios en los que se realiza cribado nutricional (Hematología, +10,5%). El IEMA se redujo por debajo de 1 (-5,7% y -0,2% en 2008 y 2013), indicando un mejor funcionamiento, y también disminuyó el índice funcional (-5,6% y -0,4% en 2008 y 2013), lo que supondría una mayor eficiencia. Conclusión: la correcta codificación del diagnóstico y el tratamiento nutricional del paciente con desnutrición aumenta el peso medio depurado de un hospital de tercer nivel, y mejora el IEMA y el índice de funcionamiento.

Impacto de la adecuada codificación de la desnutrición y procesos asociados sobre el índice case-mix en patologías médicas y quirúrgicas / Impact of adequate coding of undernutrition and nutritional procedures on case-mix index in medical and surgical pathologies

Introducción: la clasificación por procesos según el sistema de los grupos relacionados con el diagnóstico permite clasificar los diferentes procesos acorde a un consumo de recursos equivalentes. La complejidad de los procesos según el índice case-mix permite solicitar un mayor o menor presupuesto para la atención de los pacientes. La desnutrición tiene capacidad para aumentar el índice case-mix si bien en muchos casos este diagnóstico y el de los procesos nutricionales no se realizan de forma adecuada. Objetivo: determinar si la adecuada codificación de la desnutrición es capaz de aumentar el índice case-mix y si este aumento es dependiente de la documentación del mismo por un médico especialista, el tipo de proceso o el servicio de ingreso. Resultados: en una serie aleatorizada de 100 pacientes, la documentación de desnutrición y procesos asociados por parte de un médico especialista en Endocrinología y Nutrición produjo un aumento de 0,68 puntos en el índice case-mix (IC95: 0,48-0,88). El impacto fue mayor en procesos médicos que en quirúrgicos (0,42 puntos [IC95:0,03-0,81]). Por servicios, el impacto fue positivo en Medicina Interna y Cirugía General. El tamaño muestral para el cálculo del resto de servicios no alcanzó tamaño muestral suficiente. Conclusión: el aumento de recursos humanos (médicos especialistas en Endocrinología y Nutrición) es viable en términos de gestión por el aumento del índice case-mix dependiente de su presencia en un contexto de práctica clínica habitual, no de investigación (AU)

Introduction: Group-related diagnosis classification system allows ordering medical and surgical procedures following a similar expenditure of economical resources. Complexity of procedures according to the case-mix index permits asking for a minor o major economical reimbursement of the expenditure in patients’ attention. Undernutrition documentation can increase case-mix index, but it is barely detected and documented. Aim: Determine if proper documentation of undernutrition is able to enhance the case-mix index and establish if it is dependent on documentation by a specialist on clinical nutrition, the type of procedure or the service where the patient is admitted. Results: In a randomized simple of 100 procedures, documentation of undernutrition and nutritional support procedures by a specialist in Clinical Nutrition increased the case-mix index in 0.68 points (IC95:0.48-0.88). Impact of documentation was higher on medical than surgical procedures (0.42 points [IC95: 0.03-0.81]). Impact was also positive on patients admitted at general surgery and internal medicine. Sample size for other services was not high enough to establish differences. Conclusion: Investment on human resources (specialists in Clinical Nutrition) is feasible in terms of economic management due to the increase of the case-mix index dependent on specialist’s documentation in a real clinical practice, not in a research environment (AU)

Impacto de una adecuada codificación de la desnutrición relacionada con la enfermedad en los índices hospitalarios / Influence of an appropriate coding of disease-related malnutrition in clinical indexes

Introducción: la desnutrición relacionada con la enfermedad (DRE) afecta al menos a una cuarta parte de los pacientes hospitalizados, aumentando la morbimortalidad del paciente durante su hospitalización y al alta. Sin embargo, su repercusión en la actividad hospitalaria no está bien cuantificada. Objetivo: determinar el impacto de una adecuada codificación de la DRE y los procedimientos empleados para revertirla en el peso medio del hospital y otros índices hospitalarios. Material y métodos: estudio comparativo realizado en todos los pacientes subsidiarios de soporte nutricional artificial seguidos por la Unidad de Nutrición Clínica y Dietética de la Sección de Endocrinología y Nutrición (UNCyD-SEyN) del Complejo Asistencial Universitario de León durante los años 2008 y 2013. Se realizó un informe de codificación nutricional del diagnóstico, el tratamiento nutricional y la vía de acceso según la CIE-9-MC. Se comparó el peso medio depurado del hospital, el índice de estancia media ajustada (IEMA), la casuística e índice de funcionamiento previo a la codificación nutricional y tras la misma. Resultados: el peso medio depurado del hospital se incrementó tras la codificación, tanto en 2008 (+ 4,1%) como en 2013 (+1,7%) y especialmente en aquellos servicios en los que se realiza cribado nutricional (Hematología, +10,5%). El IEMA se redujo por debajo de 1 (-5,7% y -0,2% en 2008 y 2013), indicando un mejor funcionamiento, y también disminuyó el índice funcional (-5,6% y -0,4% en 2008 y 2013), lo que supondría una mayor eficiencia. Conclusión: la correcta codificación del diagnóstico y el tratamiento nutricional del paciente con desnutrición aumenta el peso medio depurado de un hospital de tercer nivel, y mejora el IEMA y el índice de funcionamiento (AU)

Introduction: Disease related malnutrition (DRM) affects at least one in four inpatients, increasing both morbidity and mortality during admission and after discharge. Nevertheless, its repercussion on hospital activity is not properly quantified. Objective: To determine the impact of an adequate coding of DRM and procedures employed to reverse it in the hospital average weight and other hospital indicators. Methods: Comparative study carried out in every patients requiring nutritional support and followed up by the Clinical Nutrition and Dietetics Unit of the Endocrinology and Nutrition Department in Complejo Asistencial Universitario de León (Spain) in 2008 and 2013. A nutritional coding report at discharge including diagnosis, nutritional treatment and access was performed following ICD-9-MC.Average weight, average length of stay adjusted by case-mix and case-mix index were compared before and after coding. Results: Hospital average weight increased after coding, both in 2008 (+4.1%) and 2013 (+1.7%) and especially in those departments in which nutritional screening is performed (Hematology, +10.5%). Average length of stay adjusted by case-mix was reduced under 1 (-5.7% and -0.2% in 2008 y 2013), pointing out to better functioning, and functioning index also decreased (-5.6% y -0.4% in 2008 and 2013), what means a higher efficiency. Conclusion: Adequate coding of nutritional diagnosis and treatment of patients with DRM increases the average weight of our hospital and improves average length of stay adjusted by case-mix and functioning index (AU)

Malnutrition in Hospitalized Pediatric Patients: Assessment, Prevalence, and Association to Adverse Outcomes.

Malnutrition is a frequent finding in pediatric health care settings in the form of undernutrition or excess body weight. Its increasing prevalence and impact on overall health status, which is reflected in the adverse outcomes, renders imperative the application of commonly accepted and evidence-based practices and tools by health care providers. Nutrition risk screening on admission and nutrition status evaluation are key points during clinical management of hospitalized pediatric patients, in order to prevent health deterioration that can lead to serious complications and growth consequences. In addition, anthropometric data based on commonly accepted universal growth standards can give accurate results for nutrition status. Both nutrition risk screening and nutrition status assessment are techniques that should be routinely implemented, based on commonly accepted growth standards and methodology, and linked to clinical outcomes. The aim of the present review was to address the issue of hospital malnutrition in pediatric settings in terms of prevalence, outline nutrition status evaluation and nutrition screening process using different criteria and available tools, and present its relationship with outcome measures. Key teaching points • Malnutrition-underweight or excess body weight-is a frequent imbalance in pediatric settings that affects physical growth and results in undesirable clinical outcomes. • Anthropometry interpretation through growth charts and nutrition screening are cornerstones for the assessment of malnutrition.To date no commonly accepted anthropometric criteria or nutrition screening tools are used in hospitalized pediatric patients. • Commonly accepted nutrition status and screening processes based on the World Health Organization's growth standards can contribute to the overall hospital nutrition care of pediatric patients.