Adequate calorie and protein administration via enteral nutrition may contribute to improved 30-day survival in patients with solid tumors at nutritional risk.

BACKGROUND: Patients with cancer receiving adequate enteral nutrition (EN) have improved clinical outcomes. Unfortunately, discrepancies may exist between the amounts prescribed and received. This study aimed to investigate: (1) the receiving exclusive EN, (2) the relationship between inadequacy and unfavorable outcomes, and (3) the impact of inadequate EN administration on the survival of patients with cancer. METHODS: This study included hospitalized patients with solid tumors who exclusively received EN and were evaluated using data extracted from electronic medical records. Nutritional risk was evaluated using Nutritional Risk Screening (NRS - 2002). EN adequacy was assessed from days 3-7 of hospitalization. Calorie and protein delivery by EN was classified as adequate (≥80 % of EN administration) or inadequate (<80 % of EN administration). Data were analyzed using dispersion and Bland-Altman plots, Pearson's chi-square and Fisher's exact tests, and Kaplan-Meier survival curves. RESULTS: A total of 114 patients were evaluated (63.9 ± 13.1 years of age, 67.5 % male, 32.5 % with head and neck cancer, and 86.8 % at nutritional risk). During the 5-day evaluation period, only 14 % of the patients received the mean volume, proteins, and calories according to the EN prescription. A relationship was observed between inadequate EN (<80 %) and 30-day in-hospital mortality. This result was confirmed by Kaplan-Meier survival analysis (p = 0.020), which showed a survival benefit in patients at nutritional risk who received adequate calories and protein. CONCLUSION: This study demonstrated significant caloric and protein deficits related with EN. Furthermore, adequate calorie and protein administration could contribute to improved survival in patients with cancer who are at a risk of malnutrition, however, randomized controlled trials are required to confirm whether adequate calorie administration could contribute to improved survival.

Prolonged hospitalization and 1-year mortality are associated with sarcopenia and malnutrition in older patients with type 2 diabetes: A prospective cohort study.

AIM: To assess the relationship of the presence of sarcopenia and malnutrition with unfavorable clinical outcomes: prolonged length of hospital stay (LOS), readmission, and one-year mortality in older patients with type 2 diabetes (T2D). METHODS: Were included 319 patients with ≥ 60 years of age with T2D hospitalized at a university hospital in Southern Brazil. Sarcopenia was diagnosed according to handgrip strength (HGS), calf circumference (CC), and the timed up and go (TUG) walking test, and malnutrition according to the subjective global assessment (SGA) and the mini nutritional assessment long form (MNA-LF). Multivariate analyses, adjusted for confounders, were performed to assess the association of sarcopenia and malnutrition with clinical outcomes. One-year survival was compared using Kaplan-Meier analysis. RESULTS: The association between sarcopenia and malnutrition increased by 2.42 times (95 %CI 1.35-4.36) the probability of LOS ≥ 14 days and by 2.01 times (95 %CI 1.09-3.72) the risk of one-year mortality. Older patients with malnutrition and sarcopenia have a higher risk of one-year mortality (log-rank p < 0.05) compared with well-nourished patients without sarcopenia. CONCLUSION: In older patients with type 2 diabetes, those with sarcopenia, and malnutrition have higher odds of prolonged hospitalization and risk of mortality within one year after hospital discharge.

Complementarity of nutritional assessment tools to predict prolonged hospital stay and readmission in older patients with solid tumors: A secondary analysis of a cohort study.

OBJECTIVE: The aim of this study was to investigate the complementarity of five nutritional risk screening tools (Nutritional Risk Screening 2002 [NRS-2002], Malnutrition Screening Tool [MST], Malnutrition Universal Screening Tool [MUST], Mini-Nutritional Assessment-Short Form [MNA-SF], and Patient-Generated Subjective Global Assessment SF [PG-SGA SF]) combined with three malnutrition diagnostic tools (SGA, PG-SGA, and Global Leadership Initiative on Malnutrition [GLIM]) and their ability to predict poor clinical outcomes in older patients with cancer. METHODS: Using data collected within 48 h of hospital admission, we conducted a prospective cohort study on nutritional risk (NRS-2002, MST, MUST, MNA-SF, and PG-SGA SF) and the presence of malnutrition (SGA, PG-SGA, and GLIM). Patients were grouped according to their nutritional risk and malnutrition status. Accuracy tests and logistic regression analysis were used to evaluate the ability of the combined tools to predict hospital length of stay and readmission. We evaluated 248 older patients (69.7 ± 7.2 y of age, 59.7% men; 27.4% with gastrointestinal tumors). The median length of stay was 4 d (3-9 d), and 65.3% of patients remained hospitalized for ≥ 4 d. RESULTS: The NRS-2002 combined with SGA and MST combined with SGA and GLIM had the highest specificity (> 80%) for predicting hospitalization. Nutritional risk assessed by MNA-SF and malnutrition assessed by PG-SGA were associated with 2.48- and 6.04-fold increased likelihood of hospitalization (≥ 4 d) and readmission (60 d), respectively. CONCLUSION: Concomitant application of MNA-SF (specific for older patients) with PG-SGA (specific for patients with cancer) might enhance the ability to predict length of stay and readmission in hospitalized older patients with solid tumors.

Validity of the Global Leadership Initiative on Malnutrition criteria using calf circumference in the prediction of in-hospital mortality in older surgical patients: A secondary analysis of a cohort study.

BACKGROUND: Malnutrition is a prevalent condition among older patients and is associated with worse clinical outcomes. Methods such as the Subjective Global Assessment (SGA), the Mini Nutritional Assessment Long Form (MNA-LF), and the Global Leadership Initiative on Malnutrition (GLIM) diagnose malnutrition early. This study aimed to evaluate the performance and validity of these instruments to predict the length of hospital stay (LOS) and in-hospital mortality in older surgical patients. METHODS: This prospective cohort study was performed in hospitalized older surgical patients. In the first 48 h of admission, general data were collected, and patients were evaluated by SGA, MNA-LF, and GLIM using calf circumference (CC) and mid-upper arm circumference (MUAC) as phenotypic criteria for nutrition diagnoses. Accuracy tests and regression analysis adjusted for sex, type of surgery, and the Charlson Comorbidity Index adjusted for age were performed to assess the criterion validity of instruments to predict LOS and mortality. RESULTS: A total of 214 patients (age 75.4 ± 6.6 years, 57.3% men, and 71.1% admitted to elective surgery) were evaluated. Malnutrition was diagnosed in 39.7% (SGA), 63% (MNA-LF), 41.6% (GLIMCC ), and 32.1% (GLIMMUAC ) of patients. GLIMCC had the best accuracy (AUC = 0.70; 95% CI, 0.63-0.79) and sensitivity (95.8%) to predict in-hospital mortality. In the adjusted analysis, malnutrition, according to SGA, MNA-LF, and GLIMCC , increased the risk of in-hospital mortality by 3.12 (95% CI, 1.08-11.34), 4.51 (95% CI, 1.29-17.61), and 4.83 (95% CI, 1.52-15.22), respectively. CONCLUSION: GLIMCC had the best performance and satisfactory criterion validity to predict in-hospital mortality in older surgical patients.

Accuracy of the GLIM Criteria and SGA Compared to PG-SGA for the Diagnosis of Malnutrition and Its Impact on Prolonged Hospitalization: A Prospective Study in Patients with Cancer.

BACKGROUND: Early assessment of malnutrition in cancer patients is essential. This study analyzed the accuracy of the Global Leadership Initiative on Malnutrition (GLIM) and the Subjective Global Assessment (SGA), in diagnosing malnutrition, considering the Patient Generated-SGA (PG-SGA) as a reference, and the impact of malnutrition on hospital days. METHODS: We conducted a prospective cohort study in 183 patients with gastrointestinal, head and neck, and lung cancer. Malnutrition was assessed within 48 h, of hospital admission according to the SGA, PG-SGA, and GLIM. Accuracy tests and regression analysis were performed to assess the criterion validity of the GLIM and SGA for diagnosing malnutrition. RESULTS: Malnutrition was diagnosed in 57.3% (SGA), 86.3% (PG-SGA), and 74.9% (GLIM) of the inpatients. The median of hospitalization was 6 (3-11) days, with 47% hospitalized > 6 day. The SGA presented the best accuracy (AUC = 0.832) than the GLIM (AUC = 0.632) compared to PG-SGA. Patients diagnosed with malnutrition by SGA, GLIM, and PG-SGA remained hospitalized for 2.13, 3.19, and 4.56 day more than well-nourished patients, respectively. CONCLUSION: Compared to PG-SGA, the SGA presents good accuracy and adequate specificity (>80%). Malnutrition evaluated by SGA, PG-SGA, and GLIM was associated with more days of hospitalization.

Methods of nutritional assessment and functional capacity in the identification of unfavorable clinical outcomes in hospitalized patients with cancer: a systematic review.

CONTEXT: Malnutrition has a negative impact on patients with cancer. Identifying risk, nutritional status, and functional capacity can contribute to adequate and early nutritional therapy, which can reduce unfavorable clinical outcomes. OBJECTIVE: To evaluate and summarize the main instruments of nutritional assessment and functional capacity and associate their results with clinical outcomes in hospitalized patients with cancer. DATA SOURCES: A systematic search was performed in the PubMed/MEDLINE, Embase, SciELO, and LILACS databases. Studies in which researchers evaluated and compared screening, nutritional assessment, and functional capacity instruments and their associations with clinical outcomes were included. DATA EXTRACTION: The data were extracted by 2 independent reviewers. RESULTS: A total of 29 studies met the inclusion criteria (n = 20 441 individuals). The Nutritional Risk Screening-2002 (NRS-2002) and Patient-Generated Subjective Global Assessment (PG-SGA) were the most common tools used for nutritional assessment. High nutritional risk according to the NRS-2202 and worse nutritional status according to the PG-SGA and Subjective Global Assessment were positively associated with a longer hospital stay and mortality. Low functional capacity, according to handgrip strength, was associated with longer hospital stay and nutrition impact symptoms. CONCLUSIONS: Tools such as the NRS-2002, PG-SGA, Subjective Global Assessment, and handgrip strength assessment are efficacious for assessing unfavorable clinical outcomes in hospitalized patients with cancer.

Relationship between the FTO Genotype and Early Chronic Kidney Disease in Type 2 Diabetes: The Mediating Role of Central Obesity, Hypertension, and High Albuminuria.

INTRODUCTION: Single nucleotide polymorphisms (SNP) in the fat mass and obesity-associated (FTO) gene have been associated with type 2 diabetes (T2D) and its complications. The aim of the present research was to investigate which and how (directly or indirectly) clinical and metabolic variables mediate the association between fat mass and the FTO gene and early chronic kidney disease (CKD) in individuals with T2D. METHODS: This cross-sectional study was conducted in a sample of 236 participants with T2D (53.4% women, mean age 60 ± 10 years). DNA samples were genotyped for the rs7204609 polymorphism (C/T) in the FTO gene. Clinical, anthropometric, and metabolic data were collected. Path analysis was used to evaluate the associations. RESULTS: Of the sample, 78 individuals with T2D had CKD (33%). Presence of the risk allele (C) was higher among participants with CKD (21.8 vs. 10.8%; p = 0.023). This polymorphism was positively associated with higher waist circumference, which in turn was associated with higher glycated hemoglobin and higher blood pressure. A higher blood-pressure level was associated with higher urinary albumin excretion (UAE) and as expected, higher UAE was associated with CKD. Path analysis showed an indirect relationship between the FTO gene and early CKD, mediated by waist circumference, blood-pressure levels, and UAE. CONCLUSIONS: These findings suggest that the C allele may contribute to genetic susceptibility to CKD in individuals with T2D through the presence of central obesity, hypertension, and high albuminuria.

Influence of thickening agents on rheological properties and sensory attributes of dysphagic diet.

Dysphagia is the difficulty during the progression of the bolus from the mouth to the stomach. Modifying the texture of the food is a fundamental factor for safe swallowing in patients with dysphagia since inadequate consistency can result in complications. To personalize and develop diets for dysphagia, understanding, and controlling the rheological and sensory properties of thickeners is useful. This review examines the different types of thickeners used to modify the texture of foods, as well as their influence on rheological properties and sensory attributes to efficiently manage the diet in dysphagia. The study discusses characteristics such as: hardness, viscosity, viscoelasticity, as well as sensory attributes related to rheology. The thickeners xanthan gum, methylcellulose, carboxymethylcellulose, guar gum, linseed, and chia, carboxymethylated curdlan, and konjac glucomannan were reviewed in this work. Sensory evaluations of different foods have already been carried out on some products such as: meats, carrots, soups, pates, and timbales with their modified textures. The sensory attributes measured among hydrocolloids are strongly correlated with rheological parameters. Dysphagic diets should have less hardness and adherence, but with adequate cohesiveness to facilitate chewing, swallowing to protect from aspiration and reduction of residues in the oropharynx. The use of a single type of thickener may not be ideal, their mixtures and synergistic effect can improve the viscous and elastic characteristics of foods, to obtain safe food to swallow and to improve the sensory interest of dysphagic patients. Personalized recommendations with follow-up on swallowing approaches, respecting patient's individuality, explaining thickening agents' differences would be pertinent.

Efficacy of single-dose cholecalciferol in the blood pressure of patients with type 2 diabetes, hypertension and hypovitaminoses D.

Observational and experimental data reinforce the concept that vitamin D is associated with the pathogenesis of arterial hypertension. We investigated the effect of a single dose of 100,000 IU of cholecalciferol, in office blood pressure (BP), and 24-h ambulatory blood pressure monitoring (ABPM) in patients with type 2 diabetes mellitus (DM), hypertension, and hypovitaminosis D. Forty-three patients were randomized to a placebo or cholecalciferol group. BP was assessed by office measurements and 24-h ABPM, before and after intervention. At week 8, a greater decrease in median ABPM values was observed in cholecalciferol supplementation than in the placebo group for systolic 24-h (- 7.5 vs. - 1; P = 0.02), systolic daytime (- 7 vs. - 1; P = 0.007), systolic nighttime (- 7.0 vs. 3; P = 0.009), diastolic 24-h (- 3.5 vs. - 1; P = 0.037), and daytime DBP (- 5 vs. 0; P = 0.01). Office DBP was also reduced after vitamin D supplementation. A single dose of vitamin D3 improves BP in patients with type 2 diabetes, hypertension, and vitamin D insufficiency, regardless of vitamin D normalization. Vitamin D supplementation could be a valuable tool to treat patients with type 2 DM, hypertension, and hypovitaminosis D.Trial registration: Clinicaltrials.gov NCT02204527.

Predictive equations for evaluation for resting energy expenditure in Brazilian patients with type 2 diabetes: what can we use?

BACKGROUND: Evaluation of the resting energy expenditure (REE) is essential to ensure an appropriate dietary prescription for patients with type 2 diabetes. The aim of this record was to evaluate the accuracy of predictive equations for REE estimation in patients with type 2 diabetes, considering indirect calorimetry (IC) as the reference method. METHODS: A cross-sectional study was performed in outpatients with type 2 diabetes. Clinical, body composition by electrical bioimpedance and laboratory variables were evaluated. The REE was measured by IC (QUARK RMR, Cosmed, Rome, Italy) and estimated by eleven predictive equations. Data were analyzed using Bland-Altman plots, paired t-tests, and Pearson's correlation coefficients. RESULTS: Sixty-two patients were evaluated [50% female; mean age 63.1 ± 5.2 years; diabetes duration of 11 (1-36) years, and mean A1C of 7.6 ± 1.2%]. There was a wide variation in the accuracy of REE values predicted by equations when compared to IC REE measurement. In all patients, Ikeda and Mifflin St-Jeor equations were that most underestimated REE. And, the equations that overestimated the REE were proposed by Dietary Reference Intakes and Huang. The most accurate equations were FAO/WHO/UNO in women (- 1.8% difference) and Oxford in men (- 1.3% difference). CONCLUSION: In patients with type 2 diabetes, in the absence of IC, FAO/WHO/UNO and Oxford equations provide the best REE prediction in comparison to measured REE for women and men, respectively.

NUTRIC Score: Isolated and Combined Use With the NRS-2002 to Predict Hospital Mortality in Critically Ill Patients.

BACKGROUND: Identification of nutritional risk in critically ill patients is a challenge because each nutritional screening tool has its specific characteristics. The objective was to evaluate the performance of the modified Nutrition Risk in Critically ill (mNUTRIC) score, used alone or in combination with the Nutritional Risk Screening 2002 (NRS-2002) score, to predict hospital mortality in critically ill patients. METHODS: A prospective study was performed with patients admitted to the intensive care unit (ICU) from October 2017 to April 2018. Multiple logistic regression analysis was used to test for complementarity between the mNUTRIC and NRS-2002. A receiver operating characteristic (ROC) curve was used to identify the performance of the instruments to predict mortality. This study was conducted in accordance with the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) statement. RESULTS: 384 patients were evaluated (51.8% female mean age 59.6 ± 16.7 years). High nutritional risk was detected in 54.4% by the NRS-2002 and 48.4% by mNUTRIC. The overall mortality rate was 36.5% (n = 140). Patients in whom nutritional risk was identified both by mNUTRIC and by NRS-2002 (score ≥5) had a twofold greater risk of in-hospital mortality (RR = 2.29; 95%CI: 1.42-3.68; p = 0.001). The area under the ROC curve to predict mortality was 0.693 for mNUTRIC; 0.645 for NRS-2002; and 0.666 for mNUTRIC and NRS-2002 combined. CONCLUSIONS: The mNUTRIC and NRS-2002 scores had similar performance in predicting hospital mortality. The mNUTRIC has better discriminant ability to quantify the risk of mortality in critically ill patients.

Two variants of the Nutritional Risk in the Critically Ill Score as predictors of mortality in Intensive Care Unit patients at a Brazilian University Hospital / Duas variantes do Escore de Risco Nutricional em Pacientes Críticos como preditoras de mortalidade em pacientes admitidos em uma Unidade de Terapia Intensiva de um Hospital Universitário Brasileiro

ABSTRACT Objective To evaluate the agreement between the modified version of the Nutritional Risk in the Critically Ill Score (without Interleukin-6) and a variant composed of C-Reactive Protein as well as its capacity to predict mortality. Methods A prospective cohort study was carried out with 315 patients in an Intensive Care Unit of a university hospital from October 2017 to April 2018. The agreement between the instruments was evaluated using the Kappa test. The predictive capacity for estimating mortality was assessed with the Receiver Operating Characteristic curve. Results The critical patients involved in the study had a mean age of 60.8±16.3 years and 53.5% were female. Most patients had C-Reactive Protein levels ?10mg/dL (n=263, 83.5%) and their admission in the Intensive Care Unit was medical (n=219, 69.5%). The prevalence of mortality was observed in 41.0% of the evaluated patients. The proportions at high nutritional risk according to Nutritional Risk in the Critically Ill without Interleukin-6 and with C-Reactive Protein were 57.5% and 55.6%, respectively. The tools showed strong and significant agreement(Kappa=0.935; p=0.020) and satisfactory performances in predicting mortality (area under the curve 0.695 [0.636-0.754] and 0.699 [0.640-0.758]). Conclusion Both versions of the Nutritional Risk in the Critically Ill tool show a satisfactory agreement and performance as predictors of mortality in critically ill patients. Further analysis of this variant and the association between nutrition adequacy and mortality is needed.

RESUMO Objetivo Avaliar a concordância entre a versão modificada do Escore de Risco Nutricional em Pacientes Críticos (sem Interleucina-6) e uma variante composta de Proteína C-Reativa, bem como a capacidade de ambas as versões para predizer mortalidade em pacientes críticos. Métodos Trata-se de um estudo de coorte prospectivo em 315 pacientes admitidos em uma Unidade de Tratamento Intensivo de um hospital universitário brasileiro no período de outubro de 2017 a abril de 2018. A concordância entre os instrumentos foi avaliada pelo teste Kappa. A capacidade preditiva de mortalidade foi avaliada pela curva Receiver Operating Characteristic. Resultados Os pacientes apresentaram idade média de 60,8±16,3 anos, dos quais 53,5% eram mulheres. A maioria dos pacientes apresentou níveis de Proteína C-Reativa ?10mg/dL (n=263; 83,5%). O tipo de admissão na Unidade de Terepia Intensiva foi clínica (n=219; 69,5%), sendo que a prevalência da mortalidade foi observada em41,0% dos pacientes avaliados. O alto risco nutricional, avaliado pelo Nutritional Risk in the Critically Ill sem Interleucina-6 e pela variante com Proteína C-Reativa, foi demonstrado em 57,5% e 55,6% dos pacientes críticos, respectivamente. Os instrumentos demostraram concordância forte e significativa (Kappa=0,935; p=0,020) e desempenho satisfatório para predizer mortalidade (área sob a curva 0,695 [0,636-0,774] e 0,699 [0,640-0,758]). Conclusão Ambas as versões do Escore de Risco Nutricional em Pacientes Críticos apresentam boa concordância e desempenho satisfatório como preditores de mortalidade em pacientes críticos. É ainda necessária uma análise mais aprofundada desta variante, bem como da associação entre adequação nutricional e mortalidade.

High nutritional risk is associated with unfavorable outcomes in patients admitted to an intensive care unit. / O elevado risco nutricional está associado a desfechos desfavoráveis em pacientes internados na unidade de terapia intensiva.

OBJECTIVE: To evaluate possible associations between nutritional risk and the clinical outcomes of critical patients admitted to an intensive care unit. METHODS: A prospective study was carried out with a cohort comprising 200 patients admitted to a university hospital intensive care unit. Nutritional risk was assessed with the NRS-2002 and NUTRIC scores. Patients with scores ≥ 5 were considered at high nutritional risk. Clinical data and outcome measures were obtained from patients' medical records. Multiple logistic regression analysis was used to calculate odds ratios and their respective 95% confidence intervals (for clinical outcomes). RESULTS: This sample of critical patients had a mean age of 59.4 ± 16.5 years and 53.5% were female. The proportions at high nutritional risk according to NRS-2002 and NUTRIC were 55% and 36.5%, respectively. Multiple logistic regression models adjusted for gender and type of admission indicated that high nutritional risk assessed by the NRS-2002 was positively associated with use of mechanical ventilation (OR = 2.34; 95%CI 1.31 - 4.19; p = 0.004); presence of infection (OR = 2.21; 95%CI 1.24 - 3.94; p = 0.007), and death (OR = 1.86; 95%CI 1.01 - 3.41; p = 0.045). When evaluated by NUTRIC, nutritional risk was associated with renal replacement therapy (OR = 2.10; 95%CI 1.02 - 4.15; p = 0.040) and death (OR = 3.48; 95%CI 1.88 - 6.44; p < 0.001). CONCLUSION: In critically ill patients, high nutritional risk was positively associated with an increased risk of clinical outcomes including hospital death.

OBJETIVO: Avaliar possíveis associações do risco nutricional com os desfechos clínicos desfavoráveis em pacientes críticos internados na unidade de terapia intensiva. MÉTODOS: Estudo de coorte, prospectivo, realizado em 200 pacientes em unidade de terapia intensiva de hospital universitário. O risco nutricional foi avaliado pelos escores NRS-2002 e NUTRIC. Pacientes com escore ≥ 5 foram considerados de alto risco nutricional. Os dados e desfechos clínicos foram obtidos de registros clínicos dos pacientes. Utilizou-se análise de regressão logística múltipla para calcular os riscos relativos e seus respectivos intervalos de confiança de 95% para os desfechos clínicos. RESULTADOS: Os pacientes críticos apresentaram idade de 59,4 ± 16,5 anos, e 53,5% eram do sexo feminino. O alto risco nutricional, segundo NRS-2002 e NUTRIC, foi de 55% e 36,5%, respectivamente. Em modelos de regressão logística múltipla, ajustados por sexo e motivo de internação, o alto risco nutricional avaliado pelo NRS-2002 associou-se positivamente ao uso de ventilação mecânica (RR = 2,34; IC95% 1,31 - 4,19; p = 0,004); presença de infecção (RR = 2,21; IC95% 1,24 - 3,94; p = 0,007) e óbito (RR = 1,86; IC95% 1,01 - 3,41; p = 0,045). Quando avaliado pelo NUTRIC, o risco nutricional foi associado à terapia de substituição renal (RR = 2,10; IC95% 1,02 - 4,15; p = 0,040) e óbito (RR = 3,48; IC95% 1,88 - 6,44; p < 0,001). CONCLUSÃO: Em pacientes gravemente doentes, o alto risco nutricional foi positivamente associado a um maior risco de desfechos clínicos desfavoráveis, incluindo óbito hospitalar.

O elevado risco nutricional está associado a desfechos desfavoráveis em pacientes internados na unidade de terapia intensiva / High nutritional risk is associated with unfavorable outcomes in patients admitted to an intensive care unit

RESUMO Objetivo: Avaliar possíveis associações do risco nutricional com os desfechos clínicos desfavoráveis em pacientes críticos internados na unidade de terapia intensiva. Métodos: Estudo de coorte, prospectivo, realizado em 200 pacientes em unidade de terapia intensiva de hospital universitário. O risco nutricional foi avaliado pelos escores NRS-2002 e NUTRIC. Pacientes com escore ≥ 5 foram considerados de alto risco nutricional. Os dados e desfechos clínicos foram obtidos de registros clínicos dos pacientes. Utilizou-se análise de regressão logística múltipla para calcular os riscos relativos e seus respectivos intervalos de confiança de 95% para os desfechos clínicos. Resultados: Os pacientes críticos apresentaram idade de 59,4 ± 16,5 anos, e 53,5% eram do sexo feminino. O alto risco nutricional, segundo NRS-2002 e NUTRIC, foi de 55% e 36,5%, respectivamente. Em modelos de regressão logística múltipla, ajustados por sexo e motivo de internação, o alto risco nutricional avaliado pelo NRS-2002 associou-se positivamente ao uso de ventilação mecânica (RR = 2,34; IC95% 1,31 - 4,19; p = 0,004); presença de infecção (RR = 2,21; IC95% 1,24 - 3,94; p = 0,007) e óbito (RR = 1,86; IC95% 1,01 - 3,41; p = 0,045). Quando avaliado pelo NUTRIC, o risco nutricional foi associado à terapia de substituição renal (RR = 2,10; IC95% 1,02 - 4,15; p = 0,040) e óbito (RR = 3,48; IC95% 1,88 - 6,44; p < 0,001). Conclusão: Em pacientes gravemente doentes, o alto risco nutricional foi positivamente associado a um maior risco de desfechos clínicos desfavoráveis, incluindo óbito hospitalar.

ABSTRACT Objective: To evaluate possible associations between nutritional risk and the clinical outcomes of critical patients admitted to an intensive care unit. Methods: A prospective study was carried out with a cohort comprising 200 patients admitted to a university hospital intensive care unit. Nutritional risk was assessed with the NRS-2002 and NUTRIC scores. Patients with scores ≥ 5 were considered at high nutritional risk. Clinical data and outcome measures were obtained from patients' medical records. Multiple logistic regression analysis was used to calculate odds ratios and their respective 95% confidence intervals (for clinical outcomes). Results: This sample of critical patients had a mean age of 59.4 ± 16.5 years and 53.5% were female. The proportions at high nutritional risk according to NRS-2002 and NUTRIC were 55% and 36.5%, respectively. Multiple logistic regression models adjusted for gender and type of admission indicated that high nutritional risk assessed by the NRS-2002 was positively associated with use of mechanical ventilation (OR = 2.34; 95%CI 1.31 - 4.19; p = 0.004); presence of infection (OR = 2.21; 95%CI 1.24 - 3.94; p = 0.007), and death (OR = 1.86; 95%CI 1.01 - 3.41; p = 0.045). When evaluated by NUTRIC, nutritional risk was associated with renal replacement therapy (OR = 2.10; 95%CI 1.02 - 4.15; p = 0.040) and death (OR = 3.48; 95%CI 1.88 - 6.44; p < 0.001). Conclusion: In critically ill patients, high nutritional risk was positively associated with an increased risk of clinical outcomes including hospital death.

Basal metabolic rate in Brazilian patients with type 2 diabetes: comparison between measured and estimated values.

OBJECTIVES: The aims of this study are to investigate which of the seven selected predictive equation for estimating basal metabolic rate (BMR) is the best alternative to indirect calorimetry (IC) and to evaluate the dietary energy intake in patients with type 2 diabetes. SUBJECTS AND METHODS: Twenty-one patients with type 2 diabetes participated in this diagnostic test study. Clinical and laboratorial variables were evaluated as well as body composition by absorptiometry dual X-ray emission (DXA) and BMR measured by IC and estimated by prediction equations. Dietary intake was evaluated by a quantitative food frequency questionnaire. Data were analyzed using Bland-Altman plots, paired t-tests, and Pearson's correlation coefficients. RESULTS: Patients were 62 (48-70) years old, have had diabetes for 8 (2-36) yeas, and 52.4% were females. The mean body composition comprised a fat-free mass of 49.8 ± 9.4 kg and a fat mass of 28.3 ± 7.2 kg. The energy intake was 2134.3 ± 730.2 kcal/day and the BMR by IC was 1745 ± 315 kcal/day. There was a wide variation in the accuracy of BMR values predicted by equations when compared to IC BMR measurement. Harris-Benedict, Oxford, FAO/WHO/UNO equations produced the smallest differences to IC, with a general bias of < 8%. The FAO/WHO/UNO equation provided the best BMR prediction in comparison to measured BMR. CONCLUSION: In patients with type 2 diabetes, the equation of the FAO/WHO/UNO was the one closest to the BMR values as measured by IC.

Basal metabolic rate in Brazilian patients with type 2 diabetes: comparison between measured and estimated values

ABSTRACT Objectives: The aims of this study are to investigate which of the seven selected predictive equation for estimating basal metabolic rate (BMR) is the best alternative to indirect calorimetry (IC) and to evaluate the dietary energy intake in patients with type 2 diabetes. Subjects and methods: Twenty-one patients with type 2 diabetes participated in this diagnostic test study. Clinical and laboratorial variables were evaluated as well as body composition by absorptiometry dual X-ray emission (DXA) and BMR measured by IC and estimated by prediction equations. Dietary intake was evaluated by a quantitative food frequency questionnaire. Data were analyzed using Bland-Altman plots, paired t-tests, and Pearson's correlation coefficients. Results: Patients were 62 (48-70) years old, have had diabetes for 8 (2-36) yeas, and 52.4% were females. The mean body composition comprised a fat-free mass of 49.8 ± 9.4 kg and a fat mass of 28.3 ± 7.2 kg. The energy intake was 2134.3 ± 730.2 kcal/day and the BMR by IC was 1745 ± 315 kcal/day. There was a wide variation in the accuracy of BMR values predicted by equations when compared to IC BMR measurement. Harris-Benedict, Oxford, FAO/WHO/UNO equations produced the smallest differences to IC, with a general bias of < 8%. The FAO/WHO/UNO equation provided the best BMR prediction in comparison to measured BMR. Conclusion: In patients with type 2 diabetes, the equation of the FAO/WHO/UNO was the one closest to the BMR values as measured by IC.

Hand Grip Strength and nutritional status in hospitalized oncological patients / Força de Preensão Manual e estado nutricional em pacientes oncológicos hospitalizados

ABSTRACT Objective To evaluate the nutritional status and functional capacity of hospitalized adult patients. Methods Cross-sectional study of adult oncology patients at Hospital de Clínicas de Porto Alegre. Patients were evaluated according to Solid Tumors and Hematologic Tumors. The nutritional status was obtained using Patient Generated Subjective Global Assessment, and the functional capacity was evaluated by Handgrip Strength using a Jamar® dynamometer - and the Performance Index of the Eastern Cooperative Oncology Group. Results This study evaluated 76 patients (56±17 years old, 35.5% female), 63.2% with Solid Tumors and 36.8% with Hematologic Tumors. According to the Patient Generated Subjective Global Assessment, 53.9% of the patients were moderately and severely malnourished and demonstrated functional capacity, according to the Handgrip Strength and Performance Index of the Eastern Cooperative Oncology Group, of 47.9% and 32.2%, respectively. The functional capacity instruments showed a moderate agreement (Kappa=0.427, p<0.001) and positive correlation (r=0.136, p=0.028). Severely malnourished patients had a lower Handgrip Strength when compared to well nourished (24.0±10.4 vs. 34.2±16.6kg, p=0.015). The results were confirmed among moderately and severely malnourished patients, who were rated at the 40 percentile, considered low functional capacity. Conclusion In this study, hospitalized oncological patients presented poor nutritional status and low functional capacity. The Patient Generated Subjective Global Assessment identifies the nutritional specification earlier. In addition, Handgrip Strength dynamometry can be a useful tool to evaluate the low functional capacity and nutritional status. It can be included in cancer patient's evaluation, along with other nutritional assessment tools.

RESUMO Objetivo Avaliar o estado nutricional e capacidade funcional de pacientes adultos oncológicos hospitalizados. Métodos Estudo transversal em pacientes oncológicos adultos do Hospital de Clínicas de Porto Alegre. Os pacientes foram divididos de acordo com a presença de Tumores Sólidos e Tumores Hematológicos. O estado nutricional foi identificado pela Avaliação Subjetiva Global Produzida pelo Paciente e a capacidade funcional pela Força do Aperto de Mão - medida por dinamometria - e pelo Índice de Desempenho do Eastern Cooperative Oncology Group. Resultados Foram avaliados 76 pacientes (56±17 anos, 35,5% do sexo feminino), 63,2% apresentaram Tumores Sólidos e 36,8% Tumores Hematológicos. De acordo com a Avaliação Subjetiva Global Produzida pelo Paciente, 53,9% dos pacientes estavam moderadamente e gravemente desnutridos e demonstraram baixa capacidade funcional de acordo com a Força do Aperto de Mão e Índice de Desempenho do Eastern Cooperative Oncology Group, 47,9% e 32,2%, respectivamente. Os instrumentos de capacidade funcional demonstraram uma concordância moderada (Kappa=0,427; p<0,001) e correlação positiva (r=0,136; p=0,028). Pacientes gravemente desnutridos demonstraram ter uma menor Força do Aperto de Mão quando comparados aos bem nutridos (24,0±10,4 vs. 34,2±16,6kg; p=0,015). Resultados foram confirmados entre pacientes moderadamente e gravemente desnutridos que apresentaram Força do Aperto de Mão abaixo do percentil 40, considerado uma baixa capacidade funcional. Conclusão Neste estudo, os pacientes oncológicos hospitalizados, independentes do tipo de tumor, apresentaram comprometimento do estado nutricional e baixa capacidade funcional. A Avaliação Subjetiva Global Produzida pelo Paciente identifica de forma mais precoce a necessidade de uma intervenção nutricional especifica. Ainda, a Força do Aperto de Mão deve ser considerada para complementar a avaliação nutricional neste grupo de pacientes.

Higher fiber intake is associated with lower blood pressure levels in patients with type 1 diabetes.

Objective The present investigation sought to evaluate the potential association between dietary fiber intake and blood pressure (BP) in adult patients with type 1 diabetes (T1D). Subjects and methods A cross-sectional study was carried out in 111 outpatients with T1D from Porto Alegre, Brazil. Patients were predominantly male (56%) and white (88%), with a mean age of 40 ± 10 years, diabetes duration of 18 ± 9 years, BMI 24.8 ± 3.85 kg/m2, and HbA1c 9.0 ± 2.0%. After clinical and laboratory evaluation, dietary intake was evaluated by 3-day weighed-diet records, whose reliability was confirmed by 24-h urinary nitrogen output. Patients were stratified into two groups according to adequacy of fiber intake in relation to American Diabetes Association (ADA) recommendations: below recommended daily intake (< 14g fiber/1000 kcal) or at/above recommended intake (≥ 14g/1000 kcal). Results Patients in the higher fiber intake group exhibited significantly lower systolic (SBP) (115.9 ± 12.2 vs 125.1 ± 25.0 mmHg, p = 0.016) and diastolic blood pressure (DBP) (72.9 ± 9.2 vs 78.5 ± 9.3 mmHg, p = 0.009), higher energy intake (2164.0 ± 626.0 vs 1632.8 ± 502.0 kcal, p < 0.001), and lower BMI (24.4 ± 3.5 vs 26.2 ± 4.8, p = 0.044). Linear regression modelling, adjusted for age, energy intake, sodium intake, and BMI, indicated that higher fiber intake was associated with lower SBP and DBP levels. No significant between-group differences were observed with regard to duration of diabetes, glycemic control, insulin dosage, or presence of hypertension, nephropathy, or retinopathy. Conclusion We conclude that fiber consumption meeting or exceeding current ADA recommendations is associated with lower SBP and DBP in patients with T1D.

Higher fiber intake is associated with lower blood pressure levels in patients with type 1 diabetes

ABSTRACT Objective The present investigation sought to evaluate the potential association between dietary fiber intake and blood pressure (BP) in adult patients with type 1 diabetes (T1D). Subjects and methods A cross-sectional study was carried out in 111 outpatients with T1D from Porto Alegre, Brazil. Patients were predominantly male (56%) and white (88%), with a mean age of 40 ± 10 years, diabetes duration of 18 ± 9 years, BMI 24.8 ± 3.85 kg/m2, and HbA1c 9.0 ± 2.0%. After clinical and laboratory evaluation, dietary intake was evaluated by 3-day weighed-diet records, whose reliability was confirmed by 24-h urinary nitrogen output. Patients were stratified into two groups according to adequacy of fiber intake in relation to American Diabetes Association (ADA) recommendations: below recommended daily intake (< 14g fiber/1000 kcal) or at/above recommended intake (≥ 14g/1000 kcal). Results Patients in the higher fiber intake group exhibited significantly lower systolic (SBP) (115.9 ± 12.2 vs 125.1 ± 25.0 mmHg, p = 0.016) and diastolic blood pressure (DBP) (72.9 ± 9.2 vs 78.5 ± 9.3 mmHg, p = 0.009), higher energy intake (2164.0 ± 626.0 vs 1632.8 ± 502.0 kcal, p < 0.001), and lower BMI (24.4 ± 3.5 vs 26.2 ± 4.8, p = 0.044). Linear regression modelling, adjusted for age, energy intake, sodium intake, and BMI, indicated that higher fiber intake was associated with lower SBP and DBP levels. No significant between-group differences were observed with regard to duration of diabetes, glycemic control, insulin dosage, or presence of hypertension, nephropathy, or retinopathy. Conclusion We conclude that fiber consumption meeting or exceeding current ADA recommendations is associated with lower SBP and DBP in patients with T1D.

Estado nutricional e tempo de internação de pacientes adultos hospitalizados com diferentes tipos de câncer / Nutritional status and length of stay of adult hospitalized patients with different types of cancer

Introdução: O câncer é uma doença crônica não transmissível e afeta, de modo crescente, a população mundial. A presença da desnutrição é elevada e o estado nutricional tem um papel importante no desfecho clínico e na qualidade de vida de pacientes com câncer. O objetivo desse estudo foi identificar a prevalência dos tipos de câncer, alterações do estado nutricional e tempo de internação de pacientes adultos hospitalizados. Método: Estudo retrospectivo observacional com análise de 354 prontuários de pacientes (idade 60,6±13,8 anos; 34,2% do sexo feminino) com qualquer tipo de câncer, internados no Hospital de Clínicas de Porto Alegre. Resultados: Foi observada maior prevalência de quatro tipos de cânceres: próstata (48,8%), tireoide (26%), digestivo (19%) e ovário e mama (6,2%). Pacientes com câncer digestivo apresentaram maior tempo de internação (aproximadamente 10 dias), menor índice de massa corporal (IMC) (24,8±5,3 kg/ m²), maior prevalência de desnutrição (75%) e associação aos principais sintomas vinculados ao estado nutricional quando comparados aos pacientes com outros tipos de câncer. Indicadores do estado nutricional (IMC, presença da desnutrição, perda de peso e percentual de perda de peso em 6 meses) foram associados a um maior período de internação (p≤0,001). Conclusão: Pacientes com câncer digestivo demonstraram ter pior estado nutricional durante o seu período de internação, apresentando maior risco nutricional associado à presença da desnutrição e maior perda de peso, o que refletiu em maior tempo de permanência hospitalar.(AU)

Introduction: Cancer is a chronic disease and affect, increasingly, the world population. The presence of malnutrition is high and nutritional status plays an important role in clinical outcome and quality of life of cancer patients. The aim of this study was to identify the prevalence of cancers, nutritional status changes and length of stay of hospitalized adult patients. Methods: An observational retrospective study with analysis of 354 records of patients (age 60.6±13.8 years; 34.2% female) with any type of cancer, admitted to the Hospital de Clínicas de Porto Alegre. Results: Was observed a higher prevalence of four types of cancers: prostate (48.8%), thyroid (26%), digestive (19%) and ovarian and breast (6.2%). Patients with digestive cancer had longer hospital stay (about 10 days), lower body mass index (BMI) (24.8±5.3 kg/m²), a higher prevalence of malnutrition (75%) and association with the main symptoms linked nutritional status when compared to patients with other cancers. The indicators of nutritional status (BMI, presence of malnutrition, weight loss and percentage of weight loss at 6 months) were associated with increased hospital stay (p≤0.001). Conclusion: The patients with digestive cancer showed a poor nutritional status during their hospital stay, showing a higher nutritional risk associated with the presence of malnutrition and increased weight loss which resulted in a longer hospital stay time.(AU)