NUTrISCorE as a tool to predict greater weight loss and longer hospital stay in cancer patients / NUTRISCORE como herramienta para predecir mayor pérdida de peso y mayor estancia hospitalaria en pacientes oncológicos

Introduction: malnutrition in cancer patients is quite common and can cause various types of harm such as reduced tolerance to therapeuticmeasures and increased hospital stay. Identification of nutritional risk for these patients may minimize these problems. NUTRISCORE screeninghas been associated with Global Subjective Assessment Produced by Patient (ASG-PPP) screening, which is considered as the gold standardin cancer patients. No study has evaluated its predictive value in relation to weight loss and length of hospital stay in Brazil. Thus, the presentstudy aims to analyze the NUTRISCORE tool, translated and adapted to the Brazilian population, as a predictor of longer hospital stays, as wellas greater hospital weight loss.Methods: first, the NUTRISCORE tool was translated and adapted to the Brazilian population and subsequently applied to patients of both sexes,over 20 years old, admitted to the Cancer Hospital of Pernambuco. The patients were screened and classified as nutritionally “at risk” or “not atrisk”, their weight was measured at the time of admission and time of discharge from the hospital, and they were followed up throughout theirstay to assess their weight loss and length of hospital stay.Results: one hundred and one patients participated in the study, with a higher prevalence of adults and males. The NUTRISCORE showed thatpatients “at nutritional risk” had a higher risk of greater weight loss (p = 0.001) and longer hospital stay (p = 0.007).Conclusion: NUTRISCORE proved to be a good predictor of longer hospital stay and greater weight loss among hospitalized patien.(AU)

Introducción: la desnutrición en pacientes con cáncer es bastante común y puede causar diversos daños, como la reducción de la toleranciaa las medidas terapéuticas y el aumento de la estancia hospitalaria. Por tanto, es fundamental identificar a los pacientes con riesgo nutricionalpara minimizar estos problemas. El tamizaje NUTRISCORE tiene una buena asociación con el tamizaje Global Subjective Assessment Producedby Patient (ASG-PPP), que se considera el estándar de oro en pacientes con cáncer, y ningún estudio evaluó su valor predictivo en relacióncon la pérdida de peso y la duración de la estancia hospitalaria en Brasil. Así, el presente estudio tiene como objetivo analizar la herramientaNUTRISCORE, traducida y adaptada a la población brasileña, como predictor de estancias hospitalarias más prolongadas, así como de mayorpérdida de peso hospitalario.Métodos: primero, la herramienta NUTRISCORE fue traducida y adaptada a la población brasileña y posteriormente aplicada a pacientes deambos sexos, mayores de 20 años, internados en el Hospital del Cáncer de Pernambuco. Los pacientes fueron tamizados y clasificados comonutricionalmente “de riesgo” o “sin riesgo”, se midió su peso al momento del ingreso y el alta del hospital y se les hizo seguimiento durante todasu estadía para evaluar su pérdida de peso y el tiempo de estancia hospitalaria.Resultados: participaron en el estudio 101 pacientes, con mayor prevalencia de adultos y de sexo masculino. El NUTRISCORE mostró que lospacientes “en riesgo nutricional” tenían mayor riesgo de mayor pérdida de peso (p = 0,001) y mayor estancia hospitalaria (p = 0,007).Conclusión: NUTRISCORE demostró ser un buen predictor de mayor estancia hospitalaria y mayor pérdida de peso entre los pacientes hospitalizados.(AU)

NUTRISCORE as a tool to predict greater weight loss and longer hospital stay in cancer patients.

Introduction: Introduction: malnutrition in cancer patients is quite common and can cause various types of harm such as reduced tolerance to therapeutic measures and increased hospital stay. Identification of nutritional risk for these patients may minimize these problems. NUTRISCORE screening has been associated with Global Subjective Assessment Produced by Patient (ASG-PPP) screening, which is considered as the gold standard in cancer patients. No study has evaluated its predictive value in relation to weight loss and length of hospital stay in Brazil. Thus, the present study aims to analyze the NUTRISCORE tool, translated and adapted to the Brazilian population, as a predictor of longer hospital stays, as well as greater hospital weight loss. Methods: first, the NUTRISCORE tool was translated and adapted to the Brazilian population and subsequently applied to patients of both sexes, over 20 years old, admitted to the Cancer Hospital of Pernambuco. The patients were screened and classified as nutritionally "at risk" or "not at risk", their weight was measured at the time of admission and time of discharge from the hospital, and they were followed up throughout their stay to assess their weight loss and length of hospital stay. Results: one hundred and one patients participated in the study, with a higher prevalence of adults and males. The NUTRISCORE showed that patients "at nutritional risk" had a higher risk of greater weight loss (p = 0.001) and longer hospital stay (p = 0.007). Conclusion: NUTRISCORE proved to be a good predictor of longer hospital stay and greater weight loss among hospitalized patients.

Introducción: Introducción: la desnutrición en pacientes con cáncer es bastante común y puede causar diversos daños, como la reducción de la tolerancia a las medidas terapéuticas y el aumento de la estancia hospitalaria. Por tanto, es fundamental identificar a los pacientes con riesgo nutricional para minimizar estos problemas. El tamizaje NUTRISCORE tiene una buena asociación con el tamizaje Global Subjective Assessment Produced by Patient (ASG-PPP), que se considera el estándar de oro en pacientes con cáncer, y ningún estudio evaluó su valor predictivo en relación con la pérdida de peso y la duración de la estancia hospitalaria en Brasil. Así, el presente estudio tiene como objetivo analizar la herramienta NUTRISCORE, traducida y adaptada a la población brasileña, como predictor de estancias hospitalarias más prolongadas, así como de mayor pérdida de peso hospitalario. Métodos: primero, la herramienta NUTRISCORE fue traducida y adaptada a la población brasileña y posteriormente aplicada a pacientes de ambos sexos, mayores de 20 años, internados en el Hospital del Cáncer de Pernambuco. Los pacientes fueron tamizados y clasificados como nutricionalmente "de riesgo" o "sin riesgo", se midió su peso al momento del ingreso y el alta del hospital y se les hizo seguimiento durante toda su estadía para evaluar su pérdida de peso y el tiempo de estancia hospitalaria. Resultados: participaron en el estudio 101 pacientes, con mayor prevalencia de adultos y de sexo masculino. El NUTRISCORE mostró que los pacientes "en riesgo nutricional" tenían mayor riesgo de mayor pérdida de peso (p = 0,001) y mayor estancia hospitalaria (p = 0,007). Conclusión: NUTRISCORE demostró ser un buen predictor de mayor estancia hospitalaria y mayor pérdida de peso entre los pacientes hospitalizados.

Malnutrition associated with inflammation in the chronic renal patient on hemodialysis

SUMMARY INTRODUCTION Malnutrition-Inflammation-Atherosclerosis Syndrome is very frequent in patients with chronic kidney disease on haemodialysis. In these patients, the inflammation associated with malnutrition is observed by the Malnutrition-Inflammation Score. OBJECTIVE To analyse the relationship between malnutrition-inflammation-atherosclerosis syndrome and anthropometric and biochemical parameters of patients on haemodialysis. METHODS A cross - sectional study was performed at the Haemodialysis Clinic of the Barão de Lucena Hospital, Recife, Brazil, between July and August 2016, with patients cared at the clinic for at least six months. Patients with amputees, hospitalized, visually impaired, HIV positive, with catheters in the neck, ascites and/or oedema, and those who were unable to provide information at the time of the interview were excluded. The patients were submitted to anthropometric evaluation for the classification of the nutritional status by waist circumference, neck circumference, body mass index, waist-to-hip ratio and waist-to-height ratio. Nutritional status related to inflammation was measured by the Malnutrition-Inflammation Score and nutritional status assessment using biochemical indicators that used urea, creatinine and albumin. RESULTS Twenty-seven individuals of both genders, adults and elderly, aged 51.3 ± 13.3 years old participated in the study. The anthropometric evaluation showed that most of the population presented cardiovascular risk. The biochemical evaluation reported low frequencies of malnutrition. Malnutrition-Inflammation-Atherosclerosis syndrome was evidenced in 3.7% of the patients. The Malnutrition-Inflammation Score had a moderate negative correlation with body mass index, waist circumference, neck circumference, waist-to-height ratio and creatinine. CONCLUSION The correlation seen among the parameters suggests that most of the parameters evaluated can be used as an indirect indicator of malnutrition-inflammation-atherosclerosis syndrome.

RESUMO INTRODUÇÃO A síndrome Desnutrição-Inflamação-Aterosclerose é frequente nos pacientes com doença renal crônica em hemodiálise, acarretando perda de proteínas corporais e produção de citocinas pró-inflamatórias. OBJETIVO Verificar, entre os indicadores nutricionais estudados, aqueles que melhor se correlacionam com a síndrome Desnutrição-Inflamação-Aterosclerose em pacientes submetidos à hemodiálise. MÉTODOS O estudo foi transversal, realizado na Clínica de Hemodiálise do Hospital Barão de Lucena, no Recife (PE), entre julho e agosto de 2016, com pacientes atendidos há pelo menos seis meses. Foram excluídos pacientes amputados, internados, com deficiência visual, cateter no pescoço, HIV positivo, ascite e/ou edema e aqueles incapazes de prestar informações no momento da entrevista. Os pacientes foram submetidos à avaliação antropométrica para a classificação do estado nutricional pela circunferência da cintura, perímetro do pescoço, índice de massa corporal, relação cintura-quadril e relação cintura-estatura. O estado nutricional relacionado à inflamação foi mensurado pelo escore Desnutrição-Inflamação e a avaliação do estado nutricional pelos indicadores bioquímicos: ureia, creatinina e albumina. RESULTADOS Participaram do estudo 27 indivíduos de ambos os sexos, adultos e idosos, com idade de 51,3 ± 13,3 anos. A avaliação antropométrica mostrou que a maior parte da população apresentava risco cardiovascular. A avaliação bioquímica relatou baixas frequências de desnutrição. Foi evidenciada síndrome Desnutrição-Inflamação-Aterosclerose em 3,7% dos pacientes. O escore Desnutrição-Inflamação apresentou correlação moderada negativa com o índice de massa corporal, circunferência da cintura, perímetro do pescoço, relação cintura-estatura e creatinina. CONCLUSÃO A correlação observada entre os parâmetros sugere que a maioria dos parâmetros avaliados pode ser utilizada como indicador indireto da síndrome Desnutrição-Inflamação-Aterosclerose.

Malnutrition associated with inflammation in the chronic renal patient on hemodialysis.

INTRODUCTION: Malnutrition-Inflammation-Atherosclerosis Syndrome is very frequent in patients with chronic kidney disease on haemodialysis. In these patients, the inflammation associated with malnutrition is observed by the Malnutrition-Inflammation Score. OBJECTIVE: To analyse the relationship between malnutrition-inflammation-atherosclerosis syndrome and anthropometric and biochemical parameters of patients on haemodialysis. METHODS: A cross - sectional study was performed at the Haemodialysis Clinic of the Barão de Lucena Hospital, Recife, Brazil, between July and August 2016, with patients cared at the clinic for at least six months. Patients with amputees, hospitalized, visually impaired, HIV positive, with catheters in the neck, ascites and/or oedema, and those who were unable to provide information at the time of the interview were excluded. The patients were submitted to anthropometric evaluation for the classification of the nutritional status by waist circumference, neck circumference, body mass index, waist-to-hip ratio and waist-to-height ratio. Nutritional status related to inflammation was measured by the Malnutrition-Inflammation Score and nutritional status assessment using biochemical indicators that used urea, creatinine and albumin. RESULTS: Twenty-seven individuals of both genders, adults and elderly, aged 51.3 ± 13.3 years old participated in the study. The anthropometric evaluation showed that most of the population presented cardiovascular risk. The biochemical evaluation reported low frequencies of malnutrition. Malnutrition-Inflammation-Atherosclerosis syndrome was evidenced in 3.7% of the patients. The Malnutrition-Inflammation Score had a moderate negative correlation with body mass index, waist circumference, neck circumference, waist-to-height ratio and creatinine. CONCLUSION: The correlation seen among the parameters suggests that most of the parameters evaluated can be used as an indirect indicator of malnutrition-inflammation-atherosclerosis syndrome.

Comparação entre diferentes métodos de triagem nutricional em pacientes oncológicos ambulatoriais / Comparison between different nutritional screnning tools in cancer outpatients

Introdução: A caquexia é uma condição que ocorre frequentemente nos pacientes oncológicos, sendo de suma importância avaliar o estado e o risco nutricional desses indivíduos. Existem diversas triagens nutricionais que identificam esse risco, dentre elas: Malnutrition Universal Screening Tool (MST) Nutritional Risk Screening 2002 (NRS 2002), Mini Avaliação Nutricional Simplificada (MAN-SF), NutriScore e Avaliação Subjetiva Global Produzida Pelo Paciente (ASG-PPP), sendo essa última padrão ouro para pacientes oncológicos. Objetivo: Comparar diferentes métodos de triagem nutricional em pacientes oncológicos atendidos ambulatorialmente em um hospital público do Recife-PE. Metodologia: Estudo transversal com pacientes portadores de câncer, adultos e idosos, de ambos os sexos. Foram obtidos dados demográficos, socioeconômicos, do estilo de vida, clínicos e antropométricos. Foi realizada a associação entre 5 protocolos de triagem nutricional, sendo adotado o nível de significância de 5%. Resultados: A amostra compreendeu 65 pacientes, a maioria do sexo feminino (n=51; 78,5%). O tipo de neoplasia mais observada foi o câncer de mama (52,3%), seguido por tumores localizados no trato gastrointestinal (23,1%) e no sistema reprodutor (21,6%). A quimioterapia foi o tratamento antineoplásico mais utilizado (84,6%). No que diz respeito aos dados nutricionais, a maior parcela da amostra apresentou-se sem risco nutricional. As triagens NRS 2002 e a NutriScore demonstraram associação estatisticamente significante com a ASG-PPP (p<0,05). Discussão: Assim como no presente estudo, o câncer de mama é a neoplasia mais frequente no sexo feminino. Nos estudos de Gomes e Maio e de Khoshnevis et al. a quimioterapia foi o tratamento mais utilizado também. De acordo com a pesquisa de Bozetti et al. a maioria dos pacientes não apresentava risco nutricional, enquanto que Shaw identificou mais pacientes com risco. Quanto a associação entre as triagens nutricionais, a NRS 2002 e a NutriScore foram as únicas que apresentaram associação com a ASG-PPP provavelmente por conterem questões relativas ao catabolismo da doença. Conclusão: As triagens nutricionais aplicadas no presente estudo identificaram maior proporção de pacientes sem risco nutricional. A NutriScore e a NRS 2002 apresentaram associação estatisticamente significante com a ASG-PPP, podendo ser recomendadas como alternativas mais práticas e rápidas à ASG-PPP (AU)

Introduction: Cachexia is a condition that often occurs in oncology patients and it is imperative to assess the nutritional status and risk of these diseases. There are several nutritional screenings that identify this risk, among them: the Malnutrition Universal Screening Tool (MST) Nutritional Risk Screening 2002 (NRS 2002), Mini Simplified Nutrition Assessment (MAN-SF), NutriScore and Patient Produced Subjective Global Assessment, which is the gold standard for cancer patients. Objective: To compare different methods of nutritional risk screening in oncology outpatients attended in a public hospital in Recife-PE. Methodology: Cross-sectional study with patients with cancer, adults and elderly, of both sexes. It was obtained demographic, socioeconomic, lifestyle, clinical and anthropometric data. The association between 5 nutritional screening protocols was performed and the significance level of 5% was adopted. Results: The sample comprised 65 patients, most of whom were female (n=51, 78.5%). The most observed neoplasia was breast cancer (52.3%), followed by tumors located in the gastrointestinal tract (23.1%) and the reproductive system (21.6%). Chemotherapy was the most used antineoplastic treatment (84.6%). Concerning nutritional data, the largest portion of the sample was presented without nutritional risk. The NRS 2002 and NutriScore showed a statistically significant association with ASG-PPP (p<0.05). Discussion: As in the present study, breast cancer is the most frequent neoplasm in females. In the studies by Gomes and Maio and Khoshnevis et al. Chemotherapy was the most commonly used treatment as well. According to the research of Bozetti et al. The majority of patients did not present nutritional risk, while Shaw identified more patients at risk. As for the association between nutritional screenings, NRS 2002 and NutriScore were the only ones that were associated with ASG-PPP probably because they contained questions regarding the catabolism of the disease. Conclusion: The nutritional screening applied in the present study identified a higher proportion of patients without nutritional risk. NutriScore and NRS 2002 showed a statistically significant association with ASG-PPP and could be used (AU)