Terapia nutricional de paciente com ataxia-telangiectasia: relato de caso / Nutrition therapy of a patient with ataxia-telangiectasia: case report

Neste artigo relatamos a terapia nutricional de um paciente com ataxia-telangiectasia (A-T) utilizando a gastrostomia (GTM) como via alternativa para alimentação. Paciente do sexo masculino, 13 anos de idade, com diagnóstico clínico de A-T aos 6 anos. Aos 8 anos e 7 meses o paciente foi identificado com risco nutricional (ZIMC/I: -1,67). Após 1 ano, evoluiu de forma desfavorável (ZIMC/I: -2,51) apesar da intervenção nutricional, sendo indicada a GTM aos 9 anos e 11 meses. No entanto, em decorrência da dificuldade de aceitação dos pais, o procedimento foi realizado somente quando o adolescente completou 11 anos e 7 meses. Inicialmente foi prescrita para oferta pela GTM dieta enteral normocalórica e normoproteica, correspondendo a 45,8% da necessidade energética diária. Após um mês, com estabilidade metabólica, houve a transição para uma dieta enteral hipercalórica e hiperproteica, fornecendo 91,6% da necessidade energética diária. Após 6 meses com a GTM, verificou-se ganho de peso total de 3,3 Kg (ZIMC/I -2,97), após 1 ano de 4,7 Kg (ZIMC/I -2,59), e após 1 ano e 9 meses de 6,7 Kg (ZIMC/I -2,63). Apesar da desnutrição nos pacientes com A-T ter origem multifatorial, o uso da GTM como via alternativa para alimentação por esse paciente resultou em uma evolução favorável dos seus indicadores antropométricos, sendo relatadas poucas intercorrências com a sua utilização. Portanto, sugere-se que pacientes com A-T devam ser monitorados periodicamente por equipe multiprofissional visando à identificação precoce de potenciais agravos.

In this article we report the nutritional therapy of a patient with ataxia-telangiectasia (A-T) using percutaneous endoscopic gastrostomy (PEG) as an alternative way of feeding. The patient was a 13-year-old male diagnosed with A-T at the age of 6 years. At 8 years and 7 months, the patient was at nutritional risk (body mass index z-score [BMIZ]: -1.67). After 1 year, he had an unfavorable evolution (BMIZ: -2.51), despite nutritional intervention; then, a PEG was indicated when he was 9 years and 11 months. However, due to the difficulty of parental acceptance, the procedure was performed when the adolescent was 11 years and 7 months. At first, a standard energy and protein enteral formula was prescribed, reaching 45.8% of his daily energy requirement. After 1 month, with metabolic stability, there was a transition to a high-energy and protein enteral formula providing 91.6% of his daily energy requirement. After 6 months of PEG placement, the patient had a total body weight gain of 3.3 kg (BMIZ: -2.97); subsequently, body weight increased by 4.7 kg (BMIZ: -2.59) after 1 year, and by 6.7 kg (BMIZ: -2.63) after 1 year and 9 months. Despite the multifactorial origin of malnutrition in A-T patients, PEG placement as an alternative way of feeding for this patient resulted in favorable evolution of his anthropometric indicators, and only a few complications were reported with its use. Therefore, it is suggested that patients with A-T should be monitored periodically by a multidisciplinary team for early identification of potential damages.

Validación de un cuestionario corto de frecuencia de consumo alimentario en niños pequeños / Validation of a short food frequency questionnaire in small children

Introducción: los cuestionarios de frecuencia de consumo alimentario validados en la edad infantil son escasos, principalmente largos y solo aportan datos del consumo alimentario. Objetivos: nuestro objetivo fue evaluar la reproducibilidad y validez de un cuestionario de frecuencia corto que estimara la frecuencia del consumo de alimentos y la ingesta energética y nutricional en edades de 3 a 6 años. Material y métodos: en 49 niños y niñas (57% varones) se valoró la reproducibilidad y la validez de un cuestionario de frecuencia de 41 ítems mediante los coeficientes de correlación de Spearman e intraclase, ajustados y sin ajustar por la energía. Se usó como método de referencia un registro alimentario de 6 días. Resultados: se obtuvo una reproducibilidad elevada en los alimentos con correlaciones > 0,70 para la mayoría de alimentos, y entre 0,5 y 0,7 para carnes, pescados, patatas, dulces-refrescos y aceite; para la energía y los nutrientes, las correlaciones fueron > 0,9 y > 0,7, respectivamente. Se obtuvo una validez fuerte o moderada en los alimentos, con correlaciones > 0,7 para lácteos y leche, y entre 0,4 y 0,7 para embutidos, huevos, yogur/queso, verduras y aceite, y en los nutrientes, con correlaciones > 0,5 para lípidos, AGS, AGP, fósforo, calcio, vitamina E y vitamina C, y entre 0,3 y 0,5 para energía, almidones, fibra, AGMI, colesterol, sodio, magnesio, potasio, retinol, rivoflabina, niacina, ácido pantoténico, vitamina B6 y folatos. Las correlaciones fueron significativas y se incrementaron al ajustar la energía. Conclusiones: el cuestionario de frecuencia de consumo alimentario corto para niños de 3-6 años de edad resultó tener una reproducibilidad elevada y buena validez, con resultados tan buenos como los de un cuestionario largo

Introduction: validated food frequency questionnaires in children are scarce, mostly long, and only provide data about food consumption. Objective: the aim of this study was to evaluate the reproducibility and validity of a short food frequency questionnaire that estimates energy, nutritional intake, and the frequency of food consumption in children aged between 3 and 6 years. Material and methods: in 49 children (57 % boys), the reproducibility and validity of a frequency questionnaire with 41 items was assessed using Spearman's and intraclass correlations, both adjusted and not adjusted for energy. A 6-day record was used as a reference method. Results: reproducibility was high in food groups with correlations > 0.70 for most of them and between 0.5 and 0.7 for meat, fish, potatoes, sweets/soft drinks, and oil. For energy and nutrients correlations were > 0.9 and > 0.7, respectively. Validity was strong to moderate for foods with correlations > 0.7 (dairy and milk) and between 0.4 and 0.7 (sausages, eggs, yogur/cheese, vegetables and oil), and for nutrients with correlations > 0.5 (lipids, AGS, AGP, phosphorus, calcium, vitamin E and vitamin C) and between 0.3 and 0.5 (energy, starches, fiber, MUFA, cholesterol, sodium, magnesium, potassium, retinol, riboflavin, niacin, pantothenic acid, vitamin B6 and folates). All correlations were significant and increased after they had been adjusted for energy. Conclusions: the short food frequency questionnaire for children between 3 and 6 years old has high reproducibility and good validity with results that are as good as those of long food frequency questionnaires

Effects of high altitude mountaineering on body composition: a systematic review / Efectos del alpinismo de altitud en la composición corporal: revisión sistemática

High altitude mountaineering is characterized by high energetic requirements due to the environment in which the activity is developed: negative energy balance, extreme cold, high altitude and the assumption of potential risks can be found during the practice of this sport. High altitude mountaineering, as a result of the previous factors, induces changes in body composition which have never been studied previously in a systematic review. A search within four different databases (PubMed, SportDiscus, Scopus and Medline) was performed using the thesaurus terms "Mountaineering" and "Body composition". A second search was performed using the following terms "Altitude" and "Body composition". The selection criteria included studies with healthy adults which evaluated the effects of at least 14 days of uninterrupted stays at altitudes above 4,000 m. The studies included in the review assessed body composition through different methods such as anthropometry, bioimpedance, dual energy x-ray absorptiometry, hydrostatic weighing and air displacement plethysmography. The search was performed up to and including December 1st 2018. Eleven observational studies met the inclusion criteria. All studies reported weight loss, of which five reported significant reductions in lean mass and six reported reductions in fat mass. Also, three studies reported reductions in both fat mass and lean mass. Current evidence is limited to observational studies with important confounding factors affecting the final conclusions. Longitudinal studies with a better methodological design and control groups are needed in order to verify these results

El alpinismo a grandes altitudes se caracteriza por elevados requerimientos energéticos debido al ambiente en el que se desarrolla la actividad: los balances energéticos negativos, el frío extremo, la exposición a la altitud o niveles de estrés elevados se pueden observar en la práctica de este deporte. Debido a estos factores, el alpinismo de altitud induce cambios en la composición corporal que no se han estudiado previamente en una revisión sistemática. Se realizó una búsqueda en cuatro bases de datos (PubMed, SportDiscus, Scopus and Medline) con los términos Mesh "Mountaineering" y "Body composition". Una segunda búsqueda se realizó usando los términos "Altitude" y "Body composition". Los criterios de selección incluyeron estudios con adultos sanos que evaluaron los efectos de estancias de al menos 14 días ininterrumpidos en altitudes superiores a los 4.000 m. La composición corporal se analizó con diferentes métodos como antropometría, bioimpedancia, absorciometría dual de rayos x, pesada hidrostática y pletismografía por desplazamiento de aire. La búsqueda se realizó incluyendo estudios fechados hasta el 1 de diciembre de 2018. Once estudios observacionales cumplieron con los criterios de inclusión. Todos los estudios reportaron pérdida de peso, de los cuales cinco reportaron reducciones en masa magra; seis, reducciones en masa grasa; y tres, reducciones en ambas. La evidencia actual se limita a estudios observacionales con factores de confusión importantes que afectan a los resultados finales. Se necesitan estudios longitudinales con mejor diseño metodológico y grupo control para verificar estos resultados

O Uso de Métodos de Avaliação do Estado Nutricional e Cálculo de Necessidade Energética por Nutricionistas em Dois Hospitais Públicos do Rio de Janeiro / The Use of Nutritional Status Evaluation and Energy Needs Calculation Methods by Nutritionists in Two Public Hospitals of Rio de Janeiro

Introdução: O estado nutricional e a avaliação do gasto metabólico têm impacto significativo na evolução clínica dos pacientes. Objetivo: Identificar quais métodos de avaliação do estado nutricional e o cálculo da necessidade energética têm sido eleitos na prática clínica de nutricionistas, conhecendo os motivos que influenciaram suas escolhas. Metodologia: Aplicou- -se um questionário semiestruturado, com perguntas quanti e qualitativas, por meio do autopreenchimento. Resultados: A maioria dos entrevistados era do gênero feminino, formados em instituições públicas, com formação complementar. O principal local de atuação foi a internação e o único equipamento comum a todos foi a balança. Os métodos escolhidos por 100% dos profissionais foram o IMC e o método Kcal/Kg de peso. Conclusão: Apesar do conhecimento teórico-prático de diferentes métodos de avaliação nutricional e do cálculo da necessidade energética houve preferência pelos de maior facilidade e praticidade, havendo pouco reconhecimento de suas limitações. Entre os motivos para tais escolhas destacam-se a falta de equipamentos e o número de profissionais por enfermaria. (AU)

Introduction: Nutritional status and the evaluation of metabolic expenditure have a significant impact on the clinical evolution of patients. Objective: To identify which nutritional status and energy need assessment methods have been chosen in the clinical practice of nutritionists, knowing the possible reasons that influenced their choices. Methodology: For the study, a semi-structured questionnaire was developed, with quanti and qualitative questions and the data was collected through self-completion. Results: Most of the interviewees were female, graduated in public institutions and all of them had made complementary studies. The main place of work of the professionals was the hospitalization and the only equipment present common to all nutritionists was the scale. The chosen methods by 100% were the BMI and the Kcal/Kg body weight method. Conclusion: Despite the theoretical and practical knowledge of different methods of nutritional assessment and calculation of the energy requirement, there was a preference for the easiest and most practical methods, with little recognition of their limitations. Other reasons include the lack of equipment and the number of professionals per ward. (AU)

Balance energético en adolescentes deportistas del Cantón Manta (Manabí, Ecuador) / Energy energetic balance in adolescent athletes of the Manta Canton (Manabí, Ecuador)

Introducción: El Balance Energético es un proceso interactivo y dinámico con reflejo en la masa corporal de los sujetos y, como objeto funcional susceptible de cambio, requiere de seguimiento en adolescentes practicantes sistemáticos de actividad física. Objetivo: Evaluar el Balance energético en adolescentes deportistas del Cantón Manta (Manabí, Ecuador). Metodología: Estudio descriptivo de corte transversal sobre 94 adolescentes masculinos en la categoría Fútbol Sub16. Se recopila información sobre ingesta energética nutrimental y gasto energético mediante recordatorio de 24 horas y encuesta tiempo/movimiento, así como de rasgos antropométricos. Resultados: La incorporación de energía alimentaria alcanza 1847,45±351,87 kcal/d, con valor promedio sobre peso total de 33,72±2,05 kcal y 35,81±1,76 kcal respecto a masa muscular. Los valores de ingesta proteica son aceptables. El gasto energético es de 3433,17±121,76 kcal, los mayores niveles en la práctica deportiva y las de carácter sedentario. Mientras que los compartimentos graso y muscular se sitúan en 3,22±0,57 y 51,70±0,15 kg. Discusión: Se determina una depresión en la incorporación de energía alimentaria respecto a recomendaciones de consumo reportadas por organismos internacionales con diferencias estadísticamente significativas entre los adolescentes (t=44,405; p-valor=0,00; p<0,05) reflejo de la insuficiente incorporación de macronutrientes, no así en relación con la Masa Libre de Grasa y revela un balance energético negativo con repercusión en el estado nutricional. Conclusiones: El balance energético alimentario es de carácter negativo y limita el establecimiento de reservas energéticas corporales, condicionando un compartimento graso restringido y potenciales respuestas adaptativas no deseables

Introduction: The Energy Balance is an interactive and dynamic process that reflects body mass and as a functional object susceptible to change, it requires follow-up particularly in adolescents who practice systematic physical activity. Objective: To evaluate the energy balance in adolescent athletes of the Manta Canton (Manabí, Ecuador). Methodology: Descriptive cross-sectional study on 94 male adolescents in the Sub16 Soccer category. Information on nutrimental energy intake and energy expenditure is collected through a 24-hour reminder and time / movement survey, as well as anthropometric traits. Results: The incorporation of food energy reaches 1847.45 ± 351.87 kcal / d, with average value over total weight of 33.72 ± 2.05 kcal and 35.81 ± 1.76 kcal with respect to muscle mass. The values of protein intake are acceptable. The energy expenditure is 3433,17 ± 121,76 kcal, the highest levels in sports practice and those of sedentary nature. While the fatty and muscular compartments are 3.22 ± 0.57 and 51.70 ± 0.15 kg. Discussion: Depression was determined in the incorporation of dietary energy with respect to consumption recommendations reported by international organizations with statistically significant differences between them (t = 44.405, p-value = 0.00, p <0.05), reflecting the insufficient incorporation of macronutrients, but not in relation to Fat Free Mass and reveals a negative energy balance with repercussion on nutritional status. Conclusions: The energy energetic balance is negative and limits the establishment of body energy reserves, conditioning a restricted fat compartment and potential undesirable adaptive responses

Comparación entre ecuaciones para estimar el requerimiento energético en mujeres antioqueñas con exceso de peso (Colombia) / Comparision between equations to estimate the energetic requeriment in antioquia's women overweight (Colombia)

El gasto energético (GE) es la suma de la tasa metabólica basal (TMB), la termogénesis endógena (TE) y la actividad física (AF). La Calorimetría indirecta (CI) es uno de los métodos que se utiliza para medir el GE en los seres humanos, no obstante, existen más de 200 ecuaciones para estimarlo. Objetivo: comparar el GE mediante CI vs algunas de las ecuaciones más usadas para estimar el GE en reposo. Materiales y métodos: se seleccionaron 1178 mujeres entre 18 y 73 años, con exceso de peso, quienes asistieron durante 9 años (2006-2015) a consulta médica particular. Análisis estadístico: se efectuó un análisis descriptivo comparativo de tipo multidimensional de corte transversal. Para el análisis estadístico se empleó el MODELO LINEAL GENERAL, adicionalmente se efectuó estadística descriptiva de tipo unidimensional. Se utilizó el paquete estadístico SAS University. Resultados: En la presente investigación se evidenció que a medida que aumenta la edad, disminuye la estatura y aumenta el peso promedio y el IMC. Al efectuar el análisis estadístico, no se detectó diferencia significativa en el GE determinado por CI en los grupos analizados (p>0.05). Se detectó diferencia significativa (p<0.05) en el GE según la ecuación de Harris y Benedict (HB) entre las personas de menor edad. Conclusión: al hacer el análisis general de todos los grupos, se encontró que la ecuación de Mifflin-St.Jeor determinó de manera significativa un menor GE, mientras que el GE obtenido por las fórmulas empíricas P2 y P3 (25 y 30 kcal/kg/día respectivamente) fue significativamente mayor en todos los grupos; no obstante el comportamiento del GE fue similar con las ecuaciones FAO-OMS, HB, P1 (20 kcals/kg/día) y CI

The Energy Expenditure (EE) is the sum of Basal Metabolic Rate (BMR), Endogenous Thermogenesis (ET) and the Physical Activity (PA). The indirect calorimetric (IC) is one of the methods used to measure the EE in the human beings; however, there are more than 200 equations to estimate it. Objective: To compare the EE using the IC with some of the most used equations to estimate the EE at rest. Materials and Methods: There were selected 1,178 women between 18 and 73, with overweight, who assisted during 9 years (2006-2015) to private medical consultation. Statistical Analysis: It was carried out a descriptive-comparative analysis of cross-section multidimensional type. For the statistical analysis, it was used the GENERALIZED LINEAR MODEL, furthermore, it was applied unidimensional descriptive statistics. SAS University program was employed. Results: In the current investigation it was proven that as the age increases the height decreases and the average weight and BMI increases. By carrying out the statistical analysis, it was not detected any significant difference in the EE determined by the IC between the analyzed groups (p>0.05). It was detected a significant difference (p<0.05) in the EE, according to the Harris Benedict (HB) equation, among young people. Conclusion: After the general analysis of all the groups was carriedout, it was found that the Mifflin-St.Jeor equation significantly determined a lower EE, while the EE obtained by the Empirical formulas P2 and P3 (25 and 30 kcal / kg / day respectively) were significantly higher in all groups; however the behavior of the EE was similar with the equations FAOOMS, HB, P1 (20 kcals / kg / day) and CI

Impacto da terapia nutricional enteral precoce sob o tempo em uso de ventilação mecânica invasiva de pacientes críticos / Impact of early enteral nutrition therapy under time in use of invasive mechanical ventilation of critical patients

Introdução: É comum que pacientes em estado grave admitidos devido quadro de insuficiência respiratória e necessidade de uso de ventilador mecânico evoluam com quadro de subnutrição que causa dificuldade regenerativa do epitélio pulmonar e desfecho clinico desfavorável. Assim, a terapia nutricional precoce possui potencial significativo em prevenir a subnutrição e melhorar o desfecho clínico. Objetivo: Verificar a correlação entre a infusão da terapia nutricional enteral em período precoce com o tempo em uso de ventilação mecânica do tipo invasiva em pacientes graves. Métodos: Estudo observacional analítico de corte transversal, realizado o ano de 2016, incluindo indivíduos de ambos os sexos com idade superior a 18 anos, admitidos na unidade com necessidade de ventilação mecânica invasiva e que iniciaram a terapia nutricional em período precoce até seu desfecho clínico. Foi utilizado questionário previamente elaborado e os dados foram arquivados no programa EXCEL para Windows, versão 2013 e a análise estatística foi realizada no programa SPSS, versão 13.0 (Chicago, IL, USA). Resultados e Discussão: Foram incluídos 41 pacientes, de ambos os sexos, desde a intubação até seu desfecho clínico, com idade média de 51,3±17,6 anos (18-82 anos), sendo 60,9 % do sexo feminino. Durante o período de internamento os pacientes receberam em média 68% do valor energético prescrito e 56% do proteico. Observou-se maior tempo de ventilação mecânica em pacientes que foram submetidos a maior período de jejum (8,94±3,19 dias) em comparação com os pacientes que iniciaram dieta precoce (7,24±4,71 dias, p=0,21). Conclusão: Os resultados obtidos demonstraram uma tendência estatística relevante de que o menor período de jejum impacta de forma benéfica sob período em uso de VMI, levando ao desmame, entretanto há necessidade de pesquisas futuras com um grupo amostral maior

Introduction: It is common for patients in severe condition admitted due to respiratory failure and need for mechanical ventilator to evolve with malnutrition that causes regenerative difficulty of the pulmonary epithelium and unfavorable clinical outcome. Thus, early nutritional therapy has significant potential in preventing malnutrition and improving clinical outcome. Objective: To verify the correlation between the infusion of enteral nutritional therapy in an early period and the time in use of mechanical ventilation of the invasive type in severe patients. Methods: A cross-sectional, observational, cross-sectional study was carried out in 2016, including individuals of both sexes over 18 years of age, admitted to the unit requiring invasive mechanical ventilation and who began nutritional therapy in an early period until their clinical outcome. A previously prepared questionnaire was used and the data were archived in the EXCEL program for Windows, version 2013 and statistical analysis was performed in the SPSS program, version 13.0 (Chicago, IL, USA). Results and Discussion: A total of 41 patients, from both intubation to clinical outcome, were included, with a mean age of 51.3 ± 17.6 years (18-82 years), 60.9% female. During the hospitalization period the patients received, on average, 68% of the prescribed energy value and 56% of the protein. Longer mechanical ventilation time was observed in patients who underwent a longer fasting period (8.94 ± 3.19 days) compared to patients who started an early diet (7.24 ± 4.71 days, p = 0, twenty-one). Conclusion: The results showed a statistically significant trend that the shortest fasting period has the potential to positively impact the period in use of IMV, that is, facilitating weaning, however, there is a need for future research with a larger sample group

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Actividad física: algo más que gasto energético / Physical activity is more than energy expenditure

Tradicionalmente, se ha considerado el balance energético como la diferencia entre consumo y gasto calórico, asociando resultados positivos a un incremento del índice de masa corporal, que puede conducir hacia sobrepeso u obesidad en casos extremos. En la actualidad, se conocen diversos factores genéticos, metabólicos y ambientales (regulación del apetito, intensidad del ejercicio, sedentarismo), que afectan al balance energético y están induciendo hacia una pandemia de enfermedades crónicas, como la obesidad. El avance del conocimiento científico viene indicando que el ejercicio físico planificado que cumpla con las recomendaciones de actividad física, hace aumentar el nivel de condición física, reduce el sedentarismo y provoca una disminución del índice de masa corporal con un descenso asociado del porcentaje de masa grasa, factores que inducen sobre el bienestar físico, psicológico y socio-emocional (AU)

Traditionally, energy balance has only been shown as result between energy intake and energy expenditure, associating positive results with increase of body mass index and with overweight and obesity in extreme cases. Recently, several environmental, metabolic and genetic factors have been identified, such as regulation of appetite, exercise intensity and sedentary lifestyle, all of them affecting energy balance and inducing a pandemic of chronic diseases, including obesity. There is scientific evidence that physical activity, better if systematically planned, at recommended levels, reduces body mass index and fat mass levels, improves physical fitness and has consequently physical, social, emotional and cognitive benefits (AU)

Energy expenditure and intake comparisons in Chilean children 4-5 years attending day-care centres / Comparación entre el gasto y el consumo de energía en niños chilenos de 4-5 años asistentes a jardines infantiles

Introduction: the doubly labelled water (DLW) method has an accuracy of 1% and within-subject precision of 5-8%, depending on subject’s age and environments issues. Energy intake assessment is prone to errors (>15- 20%) depending in the method utilized. Objective: to quantify DLW methodology errors in four to five year olds that could affect the comparison with energy intake. Methods: energy expenditure (TEE, by DLW), was assessed during 14 days in 18 preschool children, who attended eight hours daily to day-care centres. Energy intake was determined by a combined method: food weighing during weekdays and recall after leaving the Centre (17h to sleep time) plus 24 h recall, during the weekend. Several assumptions affecting DLW total error were assessed to determine their influence in the comparison to energy intake (i.e. background variability, space ratio, proportion of water subject to fractionation, food quotient value). Results: the individual mean energy expenditure was 1 373 ± 177 kcal and the energy intake (1 409 ± 161 kcal). The overall difference between intake and expenditure was 42.9 kcal/day (limits of agreement + 259.1 to -112.3 kcal/day). TEE measurement error only explained a minor quantity (2.4%), between both measurements, and the observed mean isotope dilution space was 1.030 ± 0.010 confirming the value utilized in adults studies. Conclusions: energy expenditure data is similar to other studies in preschool children. The small difference found between energy intake and expenditure may be attributed to the applied energy intake methodology, the homogeneous diet at care centres during the week-days and the lower DLW methodology error (AU)

Introducción: el método del agua doblemente marcada (ADM) tiene una precisión del 1% y en un mismo sujeto es de 5-8%, dependiendo de la edad y el entorno del sujeto. La evaluación de la ingesta energética es propensa a errores (> 15-20%), dependiendo del método utilizado. Objetivo: cuantificar los errores metodológicos del ADM en niños de 4-5 años que podrían afectar la comparación con la ingesta de energía. Métodos: el gasto de energía (GTE, por ADM), se evaluó durante 14 días en 18 preescolares, asistentes a guarderías infantiles. La ingesta energética se determinó mediante un método combinado: pesaje de alimentos durante los días de la semana y registro después de salir del centro (17 horas en adelante), además de un recordatorio de 24 horas, durante un día del fin de semana. Resultados: el promedio individual del gasto energético total fue 1373 ± 177 kcal y la ingesta de energía (1.409 ± 161 kcal). La diferencia global entre la ingesta y el gasto fue 42,9 kcal/día. El error de medición del GET explicó una variación del 2,4%, entre ambas mediciones, y el espacio de dilución de isótopos fue 1030 ± 0.010, confirmando el valor utilizado en los estudios de adultos. Conclusiones: los datos de GET fueron similares a otros estudios realizados en niños en edad preescolar. La pequeña diferencia encontrada entre la ingesta y el gasto energético se puede atribuir a la metodología de la ingesta de energía aplicada, la dieta homogénea en los centros de atención, durante los días de la semana, y el bajo error metodológico del ADM (AU)

Protocolo para el manejo de nutrición parenteral periférica lista para usar en paciente quirúrgico / Protocol for peripheral parenteral nutrition management ready to use in surgical patients

Introducción: Los pacientes sometidos a cirugía electiva, requieren de un tratamiento clínico integral que propenda por mantener o evitar el deterioro del estado nutricional y favorecer los resultados clínicos, y a su vez mejorar la seguridad de la terapia nutricional parenteral mediante la optimización de la tecnología, como una opción enfocada a la minimización de riesgo y la disminución de los costos operativos en las instituciones de prestación de servicios de salud. Objetivo: Realizar una revisión de la literatura con el fin de estudiar las indicaciones y recomendaciones del soporte nutricional parenteral periférico y/o complementario listo para usar en personas sometidas a una intervención quirúrgica. Métodos: Síntesis de datos tras la revisión de la bibliografía pertinente, que permitiera el diseño del protocolo. Se realizó la búsqueda en las siguientes bases de datos: PubMed, Medline, ScienceDirect y Embase. Conclusiones: La nutrición parenteral periférica lista para usar es una alternativa de soporte nutricional, que permite mejorar el aporte Proteico-Energético así como demostrar mejoras en la seguridad del paciente, disminución de los costos y aumentar la satisfacción del paciente (AU)

Introduction: Patients undergoing elective surgery, require a comprehensive clinical treatment that tends to maintain or prevent deterioration of nutritional status and promote clinical outcomes, and in turn improve the safety of parenteral nutrition therapy through optimization of technology, as a option aimed at minimizing risk and lower operating costs in institutions providing health services. Aim: To review the literature in order to study the requirements and recommendations of peripheral parenteral nutritional support and / or complementary ready to use in people undergoing surgery. Methods: Data synthesis after reviewing the relevant literature, to allow the protocol design. The search was conducted in the following databases: PubMed, Medline, Embase and ScienceDirect. Conclusions: Peripheral parenteral nutrition is a ready to use alternative nutritional support that improves the contribution Protein-Energy and demonstrate improvements in patient safety, decrease costs and increase patient satisfaction (AU)

La obesidad infantil como consecuencia de la interacción entre firmicutes y el consumo de alimentos con alto contenido energético / Childhood obesity is associated to the interaction between firmicutes and high energy food consumption

Introducción: La obesidad es un grave problema de salud pública en México, la Encuesta Nacional de Salud y Nutrición (ENSANUT 2012) reporta una prevalencia de sobrepeso y obesidad en niños de 5 a 11 años de 34.4%, siendo el país con mayor prevalencia a nivel mundial. Investigaciones recientes han sugerido que la microbiota intestinal puede ser factor de riesgo de la obesidad por su influencia en el metabolismo humano. Objetivo: Evaluar si existe asociación entre el perfil de la microbiota intestinal y la obesidad infantil y si esta asociación se modifica dependiendo del patrón de alimentación de una muestra de niños de edad escolar de la Ciudad de México. Metodología y Resultados: Estudio transversal en 1042 niños de 6 a 14 años, a todos se les aplicó cuestionario de actividad física, antecedentes patológicos personales y heredofamiliares de obesidad y diabetes tipo 2. La definición de los patrones de alimentación se realizó por análisis de componentes principales (ACP). La asociación entre microbiota intestinal y sobrepeso/obesidad dependiendo de la dieta se evaluó con modelos de regresión logística, ajustados por factores de confusión. Encontramos que un perfil de abundancia relativa alta de Firmicutes y una abundancia relativa baja de Bacteroidetes aunado a un consumo elevado de dietas ricas en carbohidratos y grasas saturadas se asocia con un mayor riesgo de obesidad. Conclusión: La interacción entre la microbiota intestinal y la dieta, particularmente con alto contenido de grasas y carbohidratos simples incrementa las posibilidades de presentar obesidad (AU)

Introductión: Obesity is a serious public health problem in Mexico, the National Health and Nutrition Survey (ENSANUT 2012) reported a 34.4% prevalence of overweight, and obesity in children aged 5-11. Recent research has suggested that the gut microbiota may be a risk factor of obesity through its influence on human metabolism. Aim of the study: To evaluate association between the intestinal microbiota profile and obesity among children and whether this association is modified depending on the feeding pattern of a sample of schoolchildren from Mexico City. Metodology and Results: Cross-sectional study on 1042 children aged 6-14 years; physical activity questionnaire, personal medical history and heredofamilial of obesity and type 2 diabetes were administered to all the children. Eating patterns was performed by principal component analysis (PCA). The association between intestinal microbiota and overweight / obesity depending on diet was assessed with logistic regression models. Conclusion: Our results shows that the interaction between the intestinal microbiota and diet, particularly high in fats and simple carbohydrates increases the chance of developing obesity (AU)

Consideraciones y recomendaciones en el caso de estudios nutricionales realizados en adultos mayores / Special considerations for nutritional studies in elderly

La población de edad avanzada va en aumento y puede presentar problemas de salud relacionados con la alimentación. Los ancianos presentan alteraciones mentales, físicas y funcionales que precisan de adaptaciones específicas en los métodos de evaluación dietética. Todas las evaulaciones auto-referidas presentan errores sistemáticos, y es frecuente que refieran una menor ingesta energética. Los biomarcadores de ingesta proteica, como el Nitrógeno urinario de 24 horas, pueden ser difíciles de determinar debido a la incontinencia urinaria. Ciertos micronutrientes, como la vitamina B12, tienen una importancia especial en la población de edad avanzada. Igualmente, la medición de la ingesta de líquidos es importante, ya que están más predispuestos a sufrir deshidratación. En la evaluación geriátrica debería incluirse una evaluación de la malnutrición. El índice de masa corporal (IMC) no es muy útil en el anciano, y es mejor evaluar la situación funcional. Pueden medirse la velocidad de la marcha, y la fuerza de prensión, medida con dinamómetro. El Índice de Forma Corporal parece ser una medición fiable de la adiposidad y se asocia de forma significactiva con la mortalidad. Son necesarios más estudios para aclarar cuál es el mejor método para estimar de forma fiable la ingesta de comida y bebida en la población anciana y para evaluar el estado nutricional (AU)

The elderly population is increasing and it is well documented that may present some health problems related to nutritional intake. Both mental and physical impairments in the elderly may need specific adaptations to dietary assessment methods. But all self-report approaches include systematic and random errors, and under-reporting of dietary energy intake is common. Biomarkers of protein intake, as 24 hours urinary Nitrogen, may not be useful in elderly patients because of incontinence problems. Some micronutrients, like vitamin B12, have special importance in the elderly population. Also, measurement of fluid intake is also critical because elderly population is prone to dehydration. A detailed malnutrition status assessment should be included in the geriatric dietary history, and assessment. Body Mass Index (BMI) is not useful in the elderly, and it is important to evaluate functional status. Gait speed, handgrip strength using hand dynamometry can be used. Body Shape Index (ABSI) appears to be an accurate measure of adiposity, and is associated with total mortality. Further research is needed to clarify the best and simple methods to accurately estimate food and beverage fluid intake in the elderly population, and to evaluate nutritional and hidration status (AU)

Efectos de una dieta hipocalórica y de un programa de ejercicio físico de corta duración en el perfil lipídico y en la composición corporal de mujeres menopáusicas con sobrepeso / Effects of a short-term physical exercise program and a hypocaloric diet in lipid profile and body composition of overweight post-menopausal women

Objetivo. Analizar los cambios producidos en la composición corporal y, a nivel bioquímico, sobre el colesterol y los triglicéridos, por un programa de ejercicio físico aeróbico y de fuerza de 6 semanas de duración, acompañado de una dieta hipocalórica, en un grupo de mujeres menopáusicas con sobrepeso. Método. La muestra estaba formada por 18 mujeres en la etapa de la menopausia, 9 de las cuales fueron asignadas aleatoriamente al grupo experimental y las otras 9 al grupo control. Todas presentaban más de 12 meses de amenorrea y tenían una edad comprendida entre 46 y 62 años. No realizaban ninguna actividad física. Resultados. Se han encontrado diferencias significativas entre el grupo experimental y el de control en las variaciones experimentadas en la masa, en el componente graso y en el componente muscular. No se han encontrado diferencias significativas en las variaciones experimentadas en el perfil lipídico, si bien el tamaño del efecto producido en el grupo experimental frente al de control fue moderado para la disminución del colesterol total y de las lipoproteínas de baja densidad (LDL). Conclusión. Los resultados obtenidos sugieren que la combinación de un programa de ejercicio físico aeróbico y de fuerza de 6 semanas de duración y una dieta hipocalórica en mujeres menopáusicas con sobrepeso, provoca mejoras significativas en la composición corporal y una tendencia hacia la mejora del perfil lipídico, lo que puede repercutir positivamente en la calidad de vida (AU)

Objective. The purpose of this paper is to assess the changes in the body composition and the cholesterol and triglycerides caused by a 6 weeks aerobic and resistance training program and a hypocaloric diet in a group of overweight post-menopausal women. Method. The sample population was made up of 18 post-menopausal women, 9 of them were randomly assigned to the experimental group and the other 9 to the control group. All the women presented more than 12 months of amenorrhea and had an age between 46 and 62 years old. None of them were involved in any physical activity. Results. Significant differences between experimental and control group were found in the variations of the body weight, the body fat mass and the muscle mass. No significant differences were found in the lipid profile. However, the effect size produced in the experimental group related to the control group was moderate for the decrease of the total cholesterol and the low density lipoproteins (LDL). Conclusion. These data suggest that a short-term (6 weeks) aerobic and resistance training program and a hypocaloric diet in overweight postmenopausal women produces substantial improvements in the body composition and a trend to improve the lipid profile. These changes can have a positive impact in the quality of life (AU)

Patrón de consumo e ingestas recomendadas de azúcar / Consumption pattern and recommended intakes of sugar

Los azúcares son hidratos de carbono con sabor dulce que proveen energía al organismo. El cerebro adulto utiliza aproximadamente 140 g de glucosa al día, cantidad que puede representar hasta el 50% del total de hidratos de carbono que se consumen. En nuestro país el patrón de consumo de azúcar en alimentos permanece constante, mientras que el consumo de bebidas refrescantes presenta un aumento en los últimos cuatro años. Según la Encuesta Nacional de Ingesta Dietética de España (ENIDE) (AESAN, 2011) un 20% de la ingesta de los hidratos de carbono proviene de los denominados azúcares (azúcar, chocolate y derivados, bebidas no lácteas y miscelánea). Se ha asociado el consumo de azúcar con diversas patologías (diabetes, obesidad, caries, cardiovasculares) si bien estas relaciones no presentan consistencia en las evidencias encontradas. La información alimentaria a través del etiquetado nutricional, incluida la relativa a los azúcares presentes en los alimentos, facilitada al consumidor persigue proteger la salud de los mismos y garantizar su derecho a la información para que puedan tomar decisiones con criterio. A la vista de las distintas valoraciones y estudios existentes y sobre todo, en ausencia de una evidencia científica sólida que arroje datos concretos sobre los que realizar recomendaciones, el mejor consejo nutricional para la población general podría ser llevar una dieta variada y equilibrada con alimentos y nutrientes procedentes de diversas fuentes, combinando dicha dieta con el ejercicio y la actividad física. De manera más concreta, un consumo moderado de azúcar (< 10% de la energía total) en el anterior contexto de dieta variada y equilibrada, es compatible (AU)

Sugars are sweet-flavored carbohydrates that provide energy to the body. The adult brain uses about 140 g of glucose per day, amount which can represent up to 50 of the total number of carbohydrates consumed. In our country the sugar in food consumption pattern remains constant, while the consumption of soft drinks has increased in the past four years. According to the national survey of dietary intake of Spain (ENIDE)(AESAN, 2011) 20% carbohydrate intake comes from the so-called sugar (sugar, chocolate and derivatives, nondairy beverages and miscellaneous).Sugar consumption has been associated with various pathologies (diabetes, obesity, tooth decay, cardiovascular disease) but these relationships are not consistent enough. Food information through nutritional labeling, including sugars present in food, pretend to protect the consumer health and to guarantee their right to information so they can make their own decisions with criterion. In view of different appraisals and existing studies, and above all, in the absence of a solid scientific evidence that concrete data on which make recommendations, the best nutritional advice for the general population could be a diet varied and balanced with food and nutrients from different sources, combining such a diet with exercise and physical activity. More specifically in terms of moderate consumption of sugar in the previous context of varied and balanced dietis perfectly compatible (AU)

El azúcar en los distintos ciclos de la vida: desde la infancia hasta la vejez / Sugar role through the life cycle: from infancy to the elderly

Se revisa la importancia que tienen los diferentes tipos de azúcares consumidos a través de la dieta y en diferentes fuentes alimentarias en las etapas de la vida y situaciones fisiológicas especiales, y como el consumo moderado de azúcar es compatible con una dieta equilibrada y estilos de vida activos. Se describe también su función en el disfrute y placer de comer, como uno de los pilares básicos también de una alimentación equilibrada. Al mismo tiempo, se evalúan los riesgos del consumo muy insuficiente, principalmente en lo referido a un bajo aporte de glucosa en etapas críticas de la vida, así como las potenciales consecuencias negativas sobre el estado de salud en el ciclo vital cuando la ingesta es excesiva, y la asociación con factores de riesgo en enfermedades crónico-degenerativas, o con complicaciones en el embarazo. Finalmente, se aportan recomendaciones para un correcto consumo desde el punto de vista nutricional que constituyan, finalmente, herramientas válidas para una evaluación beneficio/riesgo a nivel individual o desde el punto de vista de la salud pública (AU)

The chapter reviews and updates the role of the different types of sugar along the life cycle, mainly during infancy and aging, but also for physiological situations such as pregnancy and breastfeeding. Moreover, several examples from infancy to the elderly illustrate that a moderate consumption may be considered as adequate within the context of a healthy diet and active life. In addition, the importance of sugar to provide palatability to the diet is also revised and attempted. The consequences of low sugar consumption (e.g. glucose) are also evaluated, but also the potential hazard effects of high and prolonged intakes at the different ages or pregnancy, aswell as its association with risk factors for chronic diseases. Finally, recommendations are given for adequate consumption to serve as tools for a benefit/risk evaluation at individual level and for public health strategies (AU)

La densidad energética y la calidad nutricional de la dieta en función de su contenido en azúcares / The energy density and the nutritional quality of diet depending on their sugar content

El azúcar contenido de forma natural en los alimentos no se puede distinguir del añadido, aunque lo cierto es que este azúcar de adición aporta fundamentalmente energía y no otros nutrientes esenciales. Por otro lado, en el contexto de la dieta, el azúcar contribuye a hacerla más variada y apetecible permitiendo incluir alimentos que quizá de otra manera no se consumirían, contribuyendo pues indirectamente a la ingesta de otros nutrientes. Habiendo interés en conocer la posible relación entre una elevada ingesta de azúcares y la disminución de la de micronutrientes, se ha observado que la densidad nutritiva de la dieta podría estar influida por factores como la presencia elevada de azúcar añadido en los alimentos. Parece ser que esta dilución nutricional producida al añadir azúcar a los alimentos es, en general, poco significativa y, a menudo, contrarrestada por la fortificación en micronutrientes que frecuentemente encontramos en numerosos productos azucarados. Tras el análisis en detalle de los estudios publicados al respecto, se ha comprobado que no existe una evidencia clara de la hipotética dilución de micronutrientes que se produciría al añadir azúcares a la dieta. Por otra parte, dado que la adición de azúcar a la dieta no parece reportar ninguna ventaja destacable desde el punto de vista de la ingesta de micronutrientes; parece razonable que se promueva un consumo moderado de alimentos y bebidas azucaradas, para de ese modo, evitar que se conviertan en una importante fuente energética extra. Finalmente, se concluye sobre la necesidad de profundizar en la investigación acerca de los mecanismos subyacentes a ese, hasta ahora no demostrado, posible desplazamiento de micronutrientes y otros alimentos componentes de la dieta que podría ocurrir en casos de consumo de alimentos con un elevado contenido en azúcares, así como su repercusión desde un punto de vista clínico (AU)

Sugar content in foods cannot be distinguished from added sugar, although it is true that this added sugar brings mainly energy and no other essential nutrients. On the other hand, in the context of diet, sugar helps make it more varied and palatable allowing including foods that may otherwise not be would consume, thus indirectly contributing to the intake of other nutrients. Having interest in knowing the possible relationship between a high intake of sugars and the decrease in micronutrients intake, we noted that the nutrient density of the diet might be influenced by factors such as the high presence of sugar added to food. It seems that this nutritional dilution produced by adding sugar to food is, in general, not very significant and, often, offset by the fortification in micronutrients that we usually can find in many sugary products. After a detailed analysis of the published studies on the subject, it has been found that there is no a clear evidence of the hypothetical micronutrient dilution that would occur by adding sugar to the diet. On the other hand, given that the addition of sugar to the diet doesn't seem to report any remarkable advantages from the point of view of the intake of micronutrients; It seems reasonable to promote a moderate consumption of foods and sugary drinks, so in that way, they become an important extra energy source. It should also be borne in mind that the addition of sugar to the diet does not seem remarkable report any advantage in terms of intake of micronutrients. For this reason, it seems logical that the consumption of sugary food and sweet drinks will be moderate given the ease of consumption and the likelihood of their becoming a major source of energy. Finally, it is concluded on the need for further research on the mechanisms underlying that, up to now showed no, possible displacement of micronutrients and other food components of the diet that could occur in cases of consumption of foods with a high sugar content, as well as their impact from a clinical point of view (AU)

Obesidad y azúcar: aliados o enemigos / Obesity and sugar: allies or enemies

En las últimas tres décadas, la prevalencia de obesidad en los países desarrollados ha alcanzado dimensiones epidémicas y continua en aumento 1. Existen múltiples factores que influyen en la incidencia de obesidad, y junto con el descenso de actividad física ,el exceso de ingesta, juega un papel preponderante en la aparición de este problema de salud pública 2. Aunque existe una clara relación entre la ingesta de grasas y la ganancia de peso, el papel de los carbohidratos y más concretamente el de la sacarosa en el desarrollo de obesidad es más controvertido. Gran parte de esta controversia se debe a la creciente demanda de bebidas azucaradas y al posible incremento calórico en la dieta asociado a su consumo. A pesar de la publicación de múltiples estudios y comunicaciones a este respecto en los últimos años, siguen existiendo numerosas incógnitas acerca del papel que juegan las dietas ricas en azúcares en el incremento de incidencia y prevalencia de obesidad en los últimos años (AU)

In the last three decades, the prevalence of obesity in developed countries has reached epidemic proportions, and continues rising. Many factors have influence on the incidence of obesity, and with the decline of physical activity, overeating plays a role in the emergence of this public health problem. Although a clear relationship between fat intake and weight gain has been established, the role of carbohydrates and more specifically from sucrose and the development of obesity is more controversial. Much of this controversy is due to the growing demand for sweetened drinks and caloric increase posed by these in the diet. Despite multiple studies and communication son this subject in recent years, there are still many areas of uncertainty about the role played by diets rich in sugars over the increase in obesity in last years (AU)

Estimativa das necessidades energéticas em pacientes com doença renal crônica / Estimating the energy requirement of chronic kidney disease patients

Estabelecer as necessidades energéticas de pacientes com doença renal crônica é importante para que se possam tratar os distúrbios nutricionais encontrados nessa população. Segundo os guias de condutas voltados ao cuidado nutricional de pacientes com essa doença, a recomendação energética pode variar entre 30 e 40kcal/kg/dia. Contudo, trabalhos que avaliaram os componentes do gasto energético nos pacientes com doença renal crônica sugerem que as necessidades energéticas dessa população podem diferir do valor recomendado acima, a depender da condição clínica (presença de comorbidades), da modalidade de tratamento empregado e do nível de atividade física. Dessa forma, o presente trabalho tem como objetivo fazer uma revisão dos estudos sobre o gasto energético de pacientes com doença renal crônica, com o intuito de abordar as seguintes questões: (1) as atuais recomendações de energia para pacientes com doença renal crônica estão adequadas? (2) qual equação de predição poderia ser empregada para estimar as necessidades energéticas desse grupo de pacientes? Assim, esta revisão busca auxiliar o nutricionista ao estimar as necessidades energéticas de pacientes com doença renal crônica.

Estimating the energy requirement of patients with chronic kidney disease is highly important for treating the nutritional disorders often seen in this population. According to the specific guidelines for patients with chronic kidney disease, the currently recommended daily energy intake varies from 30 to 40kcal/kg/day. However, studies that investigated energy expenditure components of patients with chronic kidney disease suggested that the energy requirement may differ from the one proposed earlier, depending on overall clinical condition (i.e. presence of comorbidities), treatment modality and level of physical activity. With this perspective in mind, the present study aims to review the studies assessing energy expenditure focusing on two themes: (1) is the current energy recommendation for patients with chronic kidney disease adequate? (2) which predictive equation can be used when estimating the energy requirements of this population? Therefore, this review aims to help dietitians to estimate the energy needs of chronic kidney disease patients.

Terapia nutricional enteral em politraumatizados sob ventilação mecânica e oferta energética / Enteral nutritional therapy in mechanically-ventilated multiple-trauma patients and energy intake

OBJETIVO: O objetivo deste estudo foi avaliar a adequação energética dos pacientes politraumatizados em suporte ventilatório internados na unidade de terapia intensiva de um hospital público de Porto Alegre (RS), por meio da comparação entre as calorias prescritas e as efetivamente administradas, assim como entre as calorias estimadas pela equação de Harris-Benedict e a prescrição energética de cada paciente. MÉTODOS: Estudo de coorte prospectivo de pacientes politraumatizados, simultaneamente sob ventilação mecânica e terapia nutricional enteral. Verificou-se o tempo de permanência sob ventilação mecânica e a oferta energética durante o período de terapia nutricional enteral. A associação entre as variáveis quantitativas foi avaliada através do teste de correlação de Spearman devido à assimetria das variáveis. RESULTADOS: Foram acompanhados 60 pacientes, na faixa etária de 18 a 78 anos, sendo 81,7% do sexo masculino. Os tempos medianos de internação hospitalar, permanência na unidade de terapia intensiva e ventilação mecânica foram de 29, 14 e 6 dias, respectivamente. A média do percentual de dieta administrada foi de 68,6% (DP=18,3%). Da amostra total, 16 (26,7%) pacientes receberam no mínimo 80% de suas necessidades diárias. Não houve associação estatisticamente significativa entre o valor energético total administrado e os tempos de ventilação mecânica (r s=0,130; p=0,321), de unidade de terapia intensiva (r s=-0,117; p=0,372) e de internação hospitalar (r s=-0,152; p=0,246). CONCLUSÃO: Os pacientes incluídos neste estudo não receberam com precisão o aporte energético prescrito, ficando expostos aos riscos da desnutrição e seus desfechos clínicos desfavoráveis.

OBJECTIVE: The objective of this study was to asssess the adequacy of energy intake of multiple trauma patients in the intensive care unit of a public hospital in the city of Porto Alegre, Southern Brazil, who require ventilatory support, by comparing prescribed energy intake with effectively administered energy, and energy requirement estimated by the Harris-Benedict equation with the energy prescription of each patient. METHODS: This is a prospective cohort study of patients with multiple trauma simultaneously on mechanical ventilation and enteral nutrition. Duration of mechanical ventilation and energy intake during enteral nutrition were verified. The association between quantitative variables was assessed by the Spearman correlation test due to variable asymmetry. RESULTS: Sixty patients aged 18 to 78 years were studied, 81.7% of them males. Median length of hospital stay, intensive care unit stay, and duration of mechanical ventilation was 29, 14, and 6 days, respectively. The mean percentage of administered calories was 68.6% (SD=18.3%). Of the entire sample, 16 (26.7%) patients received at least 80% of their daily energy requirement. There was no significant association between total energy administered and duration of mechanical ventilation (r s=0.130; p=0.321), length of intensive care unit stay (r s=-0.117; p=0.372) and length of hospital stay (r s=-0.152; p=0.246). CONCLUSION: The study patients did not receive the prescribed energy. Therefore, they were at risk of malnutrition and its adverse clinical outcomes.