Excessive interdialytic weight gain and associated factors

ABSTRACT Excessive interdialytic weight gain (IDWG) may be associated with numerous factors that are discussed little in the literature. The aim of the present study was to evaluate factors associated with excessive IDWG in patients on hemodialysis. A cross-sectional study was conducted with 197 adults on hemodialysis at a satellite clinic in the city of Jaboatão dos Guararapes, Brazil. We calculated %IDWG by the mean difference among 12 hemodialysis sessions, with >4.5% considered excessive. The conceptual model considered socioeconomic, demographic, clinical, anthropometric and laboratorial variables. Excessive IDWG was found in 28.4% of the sample. In the final adjusted Poisson regression model, three variables remained independently associated with excessive IDWG: age between 20 and 59 years (adjusted prevalence ratio [PRadjusted]= 1.87, 95% CI: 1.21-2.88), household income between one and two times the minimum monthly salary (PRadjusted=2.14, 95% CI: 1.36-3.44) and

RESUMEN El aumento de peso interdiálisis (APID) excesivo puede asociarse a numerosos factores, pero todavía es poco discutido en la literatura. El objetivo fue evaluar los factores asociados al APID excesivo de pacientes en hemodiálisis (HD). Estudio transversal, que incluyó a 197 pacientes adultos en HD, y fue realizado en una clínica satélite ubicada en Jaboatão dos Guararapes/PE. Para el análisis del % APID, se calculó el promedio de la diferencia de peso de 12 sesiones de hemodiálisis, considerándose excesivo el valor >4,5%. El modelo conceptual consideró variables socioeconómicas, demográficas, clínicas, antropométricas y de laboratorio. El APID excesivo estuvo presente en el 28,4% de la muestra y, tras el ajuste para el modelo final obtenido por la regresión de Poisson, tres variables permanecieron independientemente asociadas al APID excesivo: edad entre 20 y 59 años (razón de prevalencia ajustada - RPajustada= 1,87 IC95% 1,21-2,88), renta familiar entre 1 y 2 sueldos mínimos (RPajustada= 2,14 IC95% 1,36-3,44) y nivel educacional <9 años de estudio (RPajustada= 1,78 IC95% 1,15-2,76). Los resultados mostraron una asociación entre APID excesivo con algunos factores, siendo la renta familiar baja la más fuertemente asociada, seguida por la edad adulta no-anciana y el bajo nivel educacional.

Associations between nutritional risk at hospital admission and incidence of complications, hospitalization time and mortality

ABSTRACT The early identification of nutritional risk is essential for the earliest possible implementation of nutritional therapy. The aim of the present study was to evaluate the association between nutritional risk and the incidence of clinical complications. An observational study was conducted at the internal medicine infirmary of a Brazilian public hospital involving patients admitted between January 2016 and December 2017. The NRS-2002, anthropometrics and laboratory exams (initial and final) were used for the evaluation of nutritional risk. The prevalence of nutritional risk was 63.6%. Nutritional risk upon admission to hospital was associated with the occurrence of complications, a longer hospitalization time and death. In correlation analysis, considering anthropometrics and laboratory exams compared to hospitalization time and time elapsed prior to the onset of the diet, serum albumin was inversely correlated with both hospitalization time and nutritional risk. Based on the present findings, knowledge on the nutritional status of patients and adequate nutritional therapy can lead to fewer complications during hospitalization.

RESUMEN La identificación del riesgo nutricional precoz es esencial para que un procedimiento nutricional sea implementado. El objetivo fue evaluar la asociación entre el riesgo nutricional con incidencia de complicaciones clínicas. Estudio observacional, realizado en la enfermería de una clínica médica de un hospital público brasileño, con pacientes admitidos entre enero de 2016 y diciembre de 2017. Para evaluación nutricional, se utilizaron la NRS-2002, antropometría y análisis laboratoriales inicial y final. La frecuencia de riesgo nutricional fue del 63,6%. El riesgo nutricional en la admisión se mostró asociado a incidencia de complicaciones, mayor tiempo de hospitalización y muerte. La albúmina sérica mostró una correlación inversa con el tiempo de internamiento y riesgo nutricional. Se concluye que el conocer el estado nutricional de los pacientes y el acompañamiento nutricional adecuado minimizará las complicaciones durante el internamiento.

Qualidade da dieta e fatores relacionados ao desenvolvimento de Diabetes mellitus gestacional em gestantes de alto risco de um hospital público do Nordeste brasileiro / Quality of diet and factors related to the development of gestational diabetes mellitus in high-risk pregnant women in a public hospital in Northeastern Brazil

Introdução: a qualidade da dieta de gestantes está associada a complicações na gestação, dentre as quais o Diabetes mellitus Gestacional. Conhecer o padrão alimentar dessa população, por métodos que avaliem a qualidade global da dieta é importante, pois permite o ajuste da ingestão alimentar, pode evitar distúrbios associados para mãe e filho e contribuir na definição de estratégias de intervenção. Objetivo: avaliar a qualidade da dieta de gestantes de alto risco, inclusive com Diabetes mellitus Gestacional, e a presença de fatores relacionados ao desenvolvimento da patologia. Metodologia: estudo transversal, conduzido em um hospital do Nordeste. Foram coletadas variáveis clínicas, socioeconômicas, demográficas, de estilo de vida, antropométricas e dietéticas. A qualidade da dieta foi avaliada pelo HEIP-B. Resultados: o Diabetes mellitus Gestacional foi a patologia mais comum na gestação (n = 31; 70,4%), seguida pela hipertensão (n = 27; 61,4%). As frequências de excesso de peso materno pré e gestacional foram expressivas, sobretudo nas grávidas com Diabetes mellitus Gestacional (93,6% e 96,7%, respectivamente). Nenhuma paciente consumia dieta de má qualidade e a proporção de dieta de boa qualidade e precisando de melhorias foi similar. Mas observou-se que a maioria das grávidas diabéticas consomem dieta de boa qualidade (p = 0,046). Discussão: os percentuais de hipertensão e excesso de peso podem ter levado ao desenvolvimento de Diabetes mellitus Gestacional pelas gestantes, pois são fatores de risco para a doença. A qualidade da dieta acompanha a preocupante tendência mostrada por outros estudos. O maior consumo de dieta de boa qualidade por gestantes diabéticas é animador, tendo em vista a importância da dieta no tratamento da patologia. Conclusão: gestantes diabéticas parecem se preocupar com a alimentação e, em sua maioria, consomem dieta de boa qualidade. Mas o HEIP-B mostrou alto percentual de gestantes adeptas de dietas precisando de melhorias e que não seguem plano alimentar orientado. Não apenas a qualidade da dieta, mas também as expressivas freqüências de hipertensão e excesso de peso são preocupantes e falam a favor da alta prevalência de Diabetes mellitus Gestacional observada. Estes resultados reforçam a necessidade de melhoria na qualidade da alimentação desse público, fazendo-se necessário incentivar práticas alimentares saudáveis, além do acompanhamento pré-natal para o diagnóstico das patologias e sua intervenção precoce (AU)

Introduction: the quality of the diet of pregnant women is associated with complications during pregnancy, such as Gestational Diabetes Mellitus. Knowing the dietary pattern of this population, by methods that evaluate the overall quality of the diet is important, since it allows the adjustment of food intake, can avoid associated disorders for mother and child and contribute to the definition of intervention strategies. Objective: to evaluate the quality of the diet of high-risk pregnant women, including Gestational Diabetes Mellitus, and the presence of factors related to the development of the pathology. Methodology: a cross-sectional study conducted at a hospital in the Northeast. Clinical, socioeconomic, demographic, lifestyle, anthropometric and dietary variables were collected. The quality of the diet was evaluated by HEIP-B. Results: Gestational Diabetes mellitus was the most common pathology in pregnancy (n = 31, 70.4%), followed by hypertension (n = 27, 61.4%). The frequencies of pre and gestational maternal overweight were significant, especially in pregnant women with Gestational Diabetes mellitus (93.6% and 96.7%, respectively). No patient consumed poor diet and the proportion of good quality diet and needing improvement was similar. But it was observed that the majority of diabetic pregnant women consume a good quality diet (p = 0.046). Discussion: Percentages of hypertension and overweight may have led to the development of Gestational Diabetes Mellitus by pregnant women, as they are risk factors for the disease. The quality of the diet accompanies the worrying trend shown by other studies. The higher consumption of good quality diet by pregnant diabetics is encouraging, considering the importance of diet in the treatment of pathology. Conclusion: Diabetic pregnant women seem to worry about eating and, for the most part, consume good quality diet. But HEIP-B showed a high percentage of pregnant women who were diets in need of improvement and did not follow a food oriented plan. Not only the quality of the diet, but also the expressive frequencies of hypertension and overweight are worrisome and speak in favor of the high prevalence of observed Gestational Diabetes Mellitus. These results reinforce the need to improve the quality of food for this public, making it necessary to encourage healthy eating practices, as well as prenatal care to diagnose pathologies and their early intervention (AU)

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)