RESUMO
The high prevalence of malnutrition in the growing population of older adults makes malnutrition screening critical, especially in hospitalized elderly patients. The aim of our study was to evaluate the use of the MNA® Mini Nutritional Assessment in hospitalized older adults for rapid evaluation of nutritional risk. A prospective cohort study was made of 106 patients 65 years old or older admitted to an internal medicine ward of a tertiary-care teaching hospital to evaluate the use of the short form, or screening phase, of the MNA-SF. In the first 48 hours of admission, the full MNA questionnaire was administered and laboratory tests and a dermatologic evaluation were made. The MNA score showed that 77% of the patients were at risk of malnutrition or were frankly malnourished. Low blood levels of albumin, cholesterol and vitamins A and D showed a statistically significant association with malnutrition or risk of malnutrition. Separate evaluation of the MNA-SF showed that it was accurate, sensitive and had predictive value for the screening process. Routine use of the MNA-SF questionnaire by admission nurses to screen patients is recommended. Patients with MNA-SF scores of 11 or lower should be specifically assessed by the nutritional intervention team (AU)
El envejecimiento de la población y la elevada prevalencia de desnutrición en este colectivo hacen que el cribaje de desnutrición sea fundamental, especialmente en ancianos ingresados. Realizamos un estudio prospectivo sobre una población de 106 pacientes mayores de 65 años, ingresados en plantas de Medicina Interna de un hospital terciario, en el que se ha seguido la aplicación sistemática de Minimal Nutritional Assessment (MNA) en las primeras 48 horas de ingreso, así como una evaluación hematológica y dermatológica. Hemos detectado situación nutricional de riesgo (RM) o malnutrición (MN) en el 77% de los casos. Los marcadores biológicos que resultaron asociados estadísticamente a la MN o RM fueron la hipoalbuminemia, hipocolesterolemia, así como la hipovitaminosis A y D. Proponemos el empleo rutinario de la fase de cribaje del MNA por la enfermera de hospitalización, y la valoración específica por equipo especializado (Unidad de Nutrición) en caso de puntuación igual o inferior a 11 (AU)
Assuntos
Humanos , Avaliação Nutricional , Nutrição do Idoso , Distúrbios Nutricionais/epidemiologia , Programas de Rastreamento/métodos , Fatores de Risco , Desnutrição/epidemiologia , Hospitalização/estatística & dados numéricosRESUMO
The high prevalence of malnutrition in the growing population of older adults makes malnutrition screening critical, especially in hospitalized elderly patients. The aim of our study was to evaluate the use of the MNA® Mini Nutritional Assessment in hospitalized older adults for rapid evaluation of nutritional risk. A prospective cohort study was made of 106 patients 65 years old or older admitted to an internal medicine ward of a tertiary-care teaching hospital to evaluate the use of the short form, or screening phase, of the MNA-SF. In the first 48 hours of admission, the full MNA questionnaire was administered and laboratory tests and a dermatologic evaluation were made. The MNA score showed that 77% of the patients were at risk of malnutrition or were frankly malnourished. Low blood levels of albumin, cholesterol and vitamins A and D showed a statistically significant association with malnutrition or risk of malnutrition. Separate evaluation of the MNA-SF showed that it was accurate, sensitive and had predictive value for the screening process. Routine use of the MNA-SF questionnaire by admission nurses to screen patients is recommended. Patients with MNA-SF scores of 11 or lower should be specifically assessed by the nutritional intervention team.
Assuntos
Desnutrição/tratamento farmacológico , Avaliação Nutricional , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Hospitalização , Humanos , Masculino , Desnutrição/sangue , Estado Nutricional , Valor Preditivo dos Testes , Estudos Prospectivos , Reprodutibilidade dos Testes , Risco , Inquéritos e QuestionáriosRESUMO
Objetivo: Estudiar la relación entre episodios neurológicos graves (traumatismo craneoencefálico, hemorragia subaracnoidea o accidente cerebrovascular) y déficit en la función hipofisaria, así como establecer parámetros en el momento agudo del episodio neurológico que permitan predecir la función hipofisaria posteriormente. Material y métodos: Estudio descriptivo y transversal, realizado en pacientes de la Unidad de Cuidados Intensivos del Hospital Universitario de Getafe (Madrid), durante los años 2001 y 2002, que habían sufrido traumatismo craneoencefálico grave, hemorragia subaracnoidea o accidente cerebrovascular. De 65 pacientes ingresados, se reclutó solamente a 11. Se contactó con ellos transcurridos de 3 a 24 meses del episodio neurológico para realización de historia clínica endocrinológica, exploración física y determinaciones hormonales. A 8 pacientes estudiados se les tomaron muestras basales de hormonas hipofisarias y se les realizaron pruebas de estimulación. En los 3 restantes se realizaron pruebas de estimulación cuando las basales extraídas hacían sospechar déficit. Retrospectivamente, se revisaron las historias para obtener parámetros del momento del ingreso que pudiesen predecir el déficit. Resultados: En los pacientes que sufrieron un episodio neurológico grave que precisó cuidados intensivos inicialmente, existe una prevalencia de déficit de un 36,4%. Se encuentra un 18,2% de déficit en los ejes gonadal y somatotropo. La presencia de hipertensión intracraneal en el momento agudo se relaciona con la aparición de déficit mediante una relación estadísticamente significativa. Conclusión: En este estudio preliminar aparece un alto porcentaje de afección hipofisaria en la evolución de pacientes que sufren un episodio neurológico grave. La hipertensión intracraneal se asocia a la aparición del déficit (AU)
Objective: To determine the relationship between severe neurological events [traumatic brain injury (TBI), subarachnoid hemorrhage (SAH) or stroke] and pituitary dysfunction, as well as to establish parameters at the acute moment of the neurological event that could help to predict subsequent pituitary function. Material and methods: We performed a descriptive, cross-sectional study in patients with a severe TBI, SAH or stroke in the Intensive Care Unit of the Getafe University Hospital in Madrid (Spain) between 2001 and 2002. Of the 65 patients who were admitted, only 11 were recruited. Contact was made with these patients between 3 and 24 months after the neurological event to take a medical history and perform a physical examination and hormone determinations. Basal samples of pituitary hormones and stimulation tests were performed in eight patients. In the remaining three patients, the stimulation tests were only performed when the basal samples were suspicious for pituitary deficiency. Medical records were retrospectively reviewed to obtain admission parameters that could predict deficiency. Results: In patients who experienced a severe neurological event that initially required intensive care, the prevalence of hormone deficiency was 36.4%; gonadal and somatotropic deficiency was found in 18.2%. The presence of intracranial hypertension in the acute phase was statistically significantly related to the development of hormone deficiency. Conclusion: In this preliminary study a high percentage of pituitary involvement was found in the follow-up of patients who experienced a severe neurological event. Intracranial hypertension was associated with the development of hormone deficiency (AU)
