Comparison between GLIM and PG-SGA methods in the nutritional assessment of hospitalized oncological patients / Comparação entre os métodos GLIM e ASG-PPP na avaliação nutricional de pacientes oncológicos hospitalizados

ABSTRACT Objective The aim of this study was to compare the Global Leadership Initiative on Malnutrition and Subjective Global Assessment methods produced by the patient in the nutritional assessment of cancer in-patients. Methods Cross-sectional study with a prospective variable, conducted with patients admitted to a public hospital in Pernambuco, Brazil. The application of these tools and the diagnosis of malnutrition were performed within the first 48 hours of admission. Sociodemographic, clinical and laboratory data were obtained from the medical records and weight, height, arm circumference, triceps skinfold and handgrip strength data were collected. Results The 82 patients evaluated included mostly men aged ≥ 60 years with less than 8 years education. Malnutrition frequency was 93.7% according to the Subjective Global Assessment and including 23.2% severe malnutrition while, according to the Global Leadership Initiative on Malnutrition, 50% of the patients were considered severely malnourished. Malnutrition by the Global Leadership Initiative on Malnutrition showed a sensitivity of 82.9% and when associated with handgrip strength sensitivity was 90.8%, considering the Subjective global assessment produced by the patient as a reference; on the other hand, the specificity was 16.7% independently of adding handgrip strength. None of the anthropometric variables was associated with the reference tool. Conclusion The Global Leadership Initiative on Malnutrition proved to be a very sensitive tool for diagnosing malnutrition when compared to the gold standard, particularly for severe malnutrition, but with little specificity. The need for a comprehensive nutritional assessment in the clinical practice was confirmed, using the parameters available and not interpreting them separately.

RESUMO Objetivo O objetivo deste estudo foi comparar os métodos Global Leadership Initiativeon Malnutrition e Avaliação Subjetiva Global Produzida pelo Próprio Paciente na avaliação nutricional de pacientes oncológicos hospitalizados. Métodos Estudo transversal com uma variável prospectiva, realizado com pacientes internados em um hospital público de Pernambuco. A aplicação dessas ferramentas e o diagnóstico de desnutrição foram realizados nas primeiras 48 horas de admissão. Dados sociodemográficos, clínicos e laboratoriais foram obtidos do prontuário, e dados com peso, altura, circunferência do braço, prega cutânea tricipital e força de preensão palmar foram coletados. Resultados Dos 82 pacientes avaliados, a maioria eram homens com idade ≥60 anos com menos de 8 anos de estudo. A frequência de desnutrição foi de 93,7% pela Avaliação Subjetiva Global; destes, 23,2% com desnutrição grave. Já pela Global Leadership Initiative on Malnutrition, 50% dos pacientes foram considerados desnutridos graves. A desnutrição pela Global Leadership Initiative on Malnutrition apresentou uma sensibilidade de 82,9% e de 90,8% quando associada à força de preensão palmar considerando a Avaliação Subjetiva Global Produzida pelo Próprio Paciente como referência. Por sua vez, a especificidade foi de 16,7% independentemente de adicionar a força de preensão palmar. Nenhuma das variáveis antropométricas apresentou associação com a ferramenta de referência. Conclusão A Global Leadership Initiative on Malnutrition mostrou-se uma ferramenta bastante sensível para diagnosticar desnutrição quando comparada ao padrão ouro, principalmente para desnutrição grave, porém pouco específica. Ratificou-se a necessidade de uma avaliação nutricional ampla na prática clínica, utilizando os parâmetros disponíveis e não os interpretando de forma isolada.

Phase angle, muscle mass, and functionality in patients with Parkinson's disease.

OBJECTIVE: To evaluate the association of phase angle (PA) with clinical and nutritional aspects in patients with Parkinson's disease (PD) treated in an outpatient clinic in northeastern Brazil. METHODS: This is a case series study involving adults and the elderly with PD of both genders. We collected data such as stage, severity, and time of diagnosis of the disease, muscle strength, gait speed, and level of physical activity. We evaluated the nutritional status using body mass index, calf circumference, skeletal appendicular muscle mass index, and the presence of sarcopenia. We obtained the PA through the analysis by electrical bioimpedance. After obtaining the result of the division between reactance and resistance, with later transformation into degrees, we multiplied the result by 180/π. RESULTS: We evaluated 77 individuals with a mean age of 65.4 ± 8.9 years. 63.6% of them had reduced PA values and 19.7% of them had sarcopenia. Age (rho = - 0.423; p = < 0.001) was inversely correlated with PA. Skeletal appendicular muscle mass index (rho = 0.251; p = 0.028), pressure force (rho = 0.240; p = 0.035), and gait speed (rho = 0.323; p = 0.005) showed a direct correlation with age. When adjusted for confounding factors, only age remained associated with PA (p = 0.012). CONCLUSION: Most individuals had reduced PA, and only age was associated with this result. Aging is a risk factor for reducing muscle mass and physical disability in PD. Although this study indicates a relationship between PA, age, muscle mass, and functionality, further prospective studies are needed to confirm these findings.

Nutritional status and dynapenia in people living with Parkinson's disease: a cross-sectional study.

OBJECTIVE: This study aimed to evaluate the nutritional status and handgrip strength (HS) in patients with Parkinson's disease (PD). METHODOLOGY: This is a cross-sectional study with outpatients in two treatment centers in the state of Pernambuco. Sociodemographic data, body mass index (BMI), waist circumference (WC), and calf circumference (CC) were collected. Body fat (BF) was assessed using electrical bioimpedance. Dynapenia was assessed using HS and dynapenic obesity was defined as very high WC associated with low HS. The Hoehn-Yahr scale was used for the staging of PD and the disease's severity was assessed by the Unified Parkinson's Disease Rating Scale (UPDRS). RESULTS: The results showed that 77.2% were elderly, which were at II and III stages of UPDRS scale. Overweight and obesity were present in 44.3% and 27.8%. Dynapenia was found in 50.6%. A negative correlation was observed between HS with age, UPDRS II and III, and BF percentage. Dynapenic obesity in men was lower 37.5% compared to women 63.6%. CONCLUSION: It is relevant to identify the functional capacity such as dynapenia and also the nutritional status in people living with neurodegenerative diseases of early onset, such as PD, so it is possible to develop strategies in prevention and treatment that can improve these conditions, considering its negative impact in PD.

Determinant factors of sarcopenia in individuals with Parkinson's disease.

OBJECTIVE: Evaluate the occurrence of sarcopenia and determinant factors in individuals with Parkinson's disease (PD) in a city in northeastern Brazil. METHODS: Case series with 77 men and women (adults and older adults) with PD. The risk of sarcopenia was determined using the SARC-F and SARC-CalF screening tools. The diagnosis of sarcopenia was based on the new consensus published by the European Working Group on Sarcopenia in Older People (EWGSOP2). Sarcopenic obesity was diagnosed based on the criteria proposed by Stenholm. Disease stage and severity were determined using the Hoehn and Yahr scale and the Unified Parkinson Disease Rating Scale, respectively. RESULTS: The prevalence of sarcopenia was 19.5% and was associated with age, poor performance on activities of daily living and poor nutritional status. No significant association was found between the SARC-F score and the diagnosis of sarcopenia. The main factors that determined the variation in the parameters for the diagnosis of sarcopenia in the present sample were age, disease severity, body weight, and SARCF score. CONCLUSION: Despite the low prevalence in the present study, sarcopenia progresses with the worsening of the nutritional status and functional capacity of individuals with PD. Further studies are needed on the factors involved in the genesis of sarcopenia. The SARC-F questionnaire is related to parameters for the diagnosis and severity of sarcopenia as well as the severity of PD.

SARC-F and SARC-CalF in screening for sarcopenia in older adults with Parkinson's disease.

INTRODUCTION: Few studies have investigated the performance of screening tools in truly sarcopenic individuals, especially subgroups of this population, or in comparison to previous and current criteria for the definition of sarcopenia. OBJECTIVES: Evaluate the performance of SARC-F and SARC-CalF in screening for sarcopenia in patients with Parkinson's disease (PD) in comparison to the diagnostic criteria proposed by the 2010 (1) and 2019 (2) European Working Group on Sarcopenia in Older People (EWGSOP). METHODS: A methodological, cross-sectional study was conducted involving male and female patients ≥60 years of age diagnosed with PD in outpatient care. The risk of sarcopenia was assessed using the SARC-F and SARC-CalF questionnaires, the latter of which includes the calf circumference as an additional item. RESULTS: Sixty patients were evaluated (mean age: 68.9 ± 6.5 years). The prevalence of sarcopenia was 21.7% according to EWGSOP-2 and 55.0% according to EWGSOP-1. Positive screening for sarcopenia was 30% according to the SARC-F and 36.7% according to SARC-CalF. The sensitivity of the SARC-F for the detection of sarcopenia was 27.2% and 23.1% using the criteria of the 2010 and 2019 consensuses, respectively. The comparative analysis of the SARC-CalF revealed a better performance in the diagnostic discrimination with the addition of calf circumference, with sensitivity ranging from 53.8 to 54.5%. Higher sensitivity was found on items addressing the ability to stand up from a chair and climb stairs (69.2%) and the occurrence of falls (76.9%) compared to the use of the complete questionnaire. CONCLUSION: Relatively low sensitivity and an underestimation of sarcopenia were found in the analysis of the SARC-F as a screening tool for sarcopenia. Thus, a significant number of sarcopenic patients would not be identified using this screening tool alone. The SARC-CalF performed better than the SARC-F.