Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.542
Filtrar
1.
Rev Assoc Med Bras (1992) ; 65(9): 1151-1155, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31618329

RESUMO

This report describes the post-bariatric-surgery evolution of an obese patient who had low adherence to the diet and micronutrient supplementation. Four years after two bariatric surgeries, the patient was admitted due to transient loss of consciousness, slow thinking, anasarca, severe hypoalbuminemia, in addition to vitamin and mineral deficiencies. She had subcutaneous foot abscess but did not present fever. Received antibiotics, vitamins A, D, B12, thiamine, calcium, and parenteral nutrition. After hospitalization (twenty-eight days), there was a significant body weight reduction probably due to the disappearance of clinical anasarca. Parenteral nutrition was suspended after twenty-five days, and the oral diet was kept fractional. After hospitalization (weekly outpatient care), there was a gradual laboratory data improvement, which was now close to the reference values. Such outcome shows the need for specialized care in preventing and treating nutritional complications after bariatric surgeries as well as clinical manifestations of infection in previously undernourished patients.


Assuntos
Cirurgia Bariátrica , Desnutrição Proteico-Calórica/complicações , Infecções Estreptocócicas/complicações , Adulto , Deficiência de Vitaminas/complicações , Deficiência de Vitaminas/terapia , Cirurgia Bariátrica/efeitos adversos , Feminino , Humanos , Nutrição Parenteral , Complicações Pós-Operatórias , Desnutrição Aguda Grave/complicações , Desnutrição Aguda Grave/etiologia , Desnutrição Aguda Grave/terapia , Cooperação e Adesão ao Tratamento
2.
Nutr. hosp ; 36(extr.3): 63-69, jul. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-184438

RESUMO

Los pacientes con insuficiencia renal crónica presentan frecuentemente malnutrición calórico-proteica, y esta situación es un predictor de morbilidad y mortalidad. En este artículo, se resumen las causas de la desnutrición y las diferentes aproximaciones terapéuticas para revertirla, entre las que se incluyen la suplementación nutricional oral o parenteral, especialmente durante la diálisis


Chronic kidney disease patients often also present protein-calorie malnutrition, and it is a powerful predictor of morbidity and mortality. In this article, causes and management are shown, highlighting oral and parenteral nutritional supplementation, especially during dialysis process


Assuntos
Humanos , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/dietoterapia , Desnutrição Proteico-Calórica/complicações , Suplementos Nutricionais , Indicadores de Morbimortalidade , Diálise , Desnutrição Proteico-Calórica/etiologia , Nutrição Enteral/métodos , Nutrição Parenteral/métodos , Apoio Nutricional
3.
Nutr. hosp ; 36(3): 743-747, mayo-jun. 2019. tab, ilus
Artigo em Inglês | IBECS | ID: ibc-184577

RESUMO

Case report: we present the case of a 44-year-old male who presented with uncontrollable diarrhea, severe protein-calorie malnutrition and multiple vitamin deficiencies, along with peripheral neuropathy ten years after classic biliopancreatic diversion (BPD). He underwent nutritional support and had the surgery converted to a Roux-en-Y gastric bypass, with an uneventful outcome. The histopathology of the resected bowel revealed lipofuscinosis of the muscular layer compatible with brown bowel syndrome. Discussion: brown bowel syndrome is a rare complication of malnutrition that can be observed after BPD. It is associated with vitamin E deficiency. After recovery with nutritional support, a reoperation that elongates the common channel, and thus minimizes the degree of malabsorption, should be indicated in these cases


Caso clínico: presentamos el caso de un paciente varón de 44 años que presentó diarrea incontrolable, desnutrición proteica-calórica severa y deficiencias de múltiples vitaminas, junto con neuropatía periférica diez años después de derivación biliopancreatica clásica (DBP). Se sometió a soporte nutricional y la cirugía se convirtió en un bypass gástrico en Y de Roux, con un resultado sin complicaciones. La histopatología del intestino resecado reveló una lipofuscinosis de la capa muscular compatible con el síndrome del intestino marrón. Discusión: el síndrome de intestino marrón es una complicación rara de la desnutrición que se puede observar después de la DBP. Se asocia a deficiencia de vitamina E. Después de la recuperación con soporte nutricional, se debe indicar una reoperación que alargue el canal común y, por lo tanto, minimice el grado de malabsorción en estos casos


Assuntos
Humanos , Masculino , Adulto , Cirurgia Bariátrica/efeitos adversos , Desnutrição Proteico-Calórica/complicações , Desnutrição/complicações , Síndromes de Malabsorção/complicações , Apoio Nutricional , Deficiência de Vitamina E/complicações , Enteropatias/etiologia , Intestino Delgado/diagnóstico por imagem , Intestino Delgado/patologia , Transtornos da Pigmentação/complicações , Enteropatias/patologia , Enteropatias/complicações
4.
JAMA Netw Open ; 2(3): e191054, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30901050

RESUMO

Importance: Mortality among African children hospitalized with severe malnutrition remains high, with sudden, unexpected deaths leading to speculation about potential cardiac causes. Malnutrition is considered high risk for cardiac failure, but evidence is limited. Objective: To investigate the role of cardiovascular dysfunction in African children with severe, acute malnutrition (SAM). Design, Setting, and Participants: A prospective, matched case-control study, the Cardiac Physiology in Malnutrition (CAPMAL) study, of 88 children with SAM (exposed) vs 22 severity-matched patients without SAM (unexposed) was conducted between March 7, 2011, and February 20, 2012; data analysis was performed from October 1, 2012, to March 1, 2016. Exposures: Echocardiographic and electrocardiographic (ECG) recordings (including 7-day Holter monitoring) at admission, day 7, and day 28. Main Outcomes and Measures: Findings in children with (cases) and without (controls) SAM and in marasmus and kwashiorkor phenotypes were compared. Results: Eighty-eight children (52 with marasmus and 36 with kwashiorkor) of the 418 admitted with SAM and 22 severity-matched controls were studied. A total of 63 children (57%) were boys; median age at admission was 19 months (range, 12-39 months). On admission, abnormalities more common in cases vs controls included severe hypokalemia (potassium <2.5 mEq/L) (18 of 81 [22%] vs 0%), hypoalbuminemia (albumin level <3.4 g/dL) (66 of 88 [75%] vs 4 of 22 [18%]), and hypothyroidism (free thyroxine level <0.70 ng/dL or thyrotropin level >4.2 mU/L) (18 of 74 [24%] vs 1 of 21 [5%]) and were associated with typical electrocardiographic changes (T-wave inversion: odds ratio, 7.3; 95% CI, 1.9-28.0; P = .001), which corrected as potassium levels improved. Fourteen children with SAM (16%) but no controls died. Myocardial mass was lower in cases on admission but not by day 7. Results of the Tei Index, a measure of global cardiac function, were within the reference range and similar in cases (median, 0.37; interquartile range [IQR], 0.26-0.45) and controls (median, 0.36; IQR, 0.28-0.42). Echocardiography detected no evidence of cardiac failure among children with SAM, including those receiving intravenous fluids to correct hypovolemia. Cardiac dysfunction was generally associated with comorbidity and typical of hypovolemia, with low cardiac index (median, 4.9 L/min/m2; IQR, 3.9-6.1 L/min/m2), high systemic vascular resistance index (median, 1333 dyne seconds/cm5/m2; IQR, 1133-1752 dyne seconds/cm5/m2), and with few differences between the marasmus and kwashiorkor manifestations of malnutrition. Seven-day continuous ECG Holter monitoring during the high-risk initial refeeding period demonstrated self-limiting significant ventricular arrhythmias in 33 of 55 cases (60%) and 6 of 18 controls (33%) (P = .049); none were temporally related to adverse events, including fatalities. Conclusions and Relevance: There is little evidence that African children with SAM are at greater risk of cardiac dysfunction or clinically significant arrhythmias than those without SAM or that marasmus and kwashiorkor differed in cardiovascular profile. These findings should prompt a review of current guidelines.


Assuntos
Cardiopatias , Coração/fisiopatologia , Kwashiorkor , Desnutrição Proteico-Calórica , Estudos de Casos e Controles , Pré-Escolar , Eletrocardiografia Ambulatorial , Feminino , Cardiopatias/complicações , Cardiopatias/diagnóstico , Cardiopatias/epidemiologia , Humanos , Lactente , Quênia , Kwashiorkor/complicações , Kwashiorkor/epidemiologia , Masculino , Estudos Prospectivos , Desnutrição Proteico-Calórica/complicações , Desnutrição Proteico-Calórica/epidemiologia
5.
Ann Afr Med ; 18(1): 17-22, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30729928

RESUMO

Background: Noma (cancrum oris) remains the scourge of children and the "face of poverty" in Sub-Saharan Africa. Recent data on the burden of noma and its risk factors are needed for evaluating and redesigning interventions for its prevention and control. Objectives: This study aimed to determine the pattern of noma and its risk factors in Northwestern Nigeria. Materials and Methods: It was a retrospective study that looked into cases of noma (cancrum oris) admitted into the Noma Children Hospital, Sokoto, Nigeria, between January 1999 and December 2011. Information on patients' bio-data, the site and severity of lesions, and presence of trismus and its severity were extracted from the patients' case files and analyzed using descriptive statistics. Results: One hundred and fifty-nine (8.3%) of the 1923 patients admitted to the hospital from January 1999 to December 2011 were diagnosed with fresh noma. The mean age of the patients was 3.0 ± 1.4 years, and majority of them, 139 (87.4%) were aged 1-5 years. The soft-tissue lesions essentially involved multiple sites but most commonly the outer and inner cheeks (84.3%). The most common risk factors identified were measles (47.2%) and protein-energy malnutrition (42.1%). There were rises and falls in the prevalence of noma in the period studied. Conclusion: This study showed a high burden of noma in Northwestern Nigeria, mostly among children aged 1-5 years, and with soft-tissue lesions involving multiple sites. Measles and malnutrition were the major risk factors identified, and the disease trend showed a wave-like pattern. There is an urgent need to eliminate the disease in Nigeria through prevention and control of infectious diseases and malnutrition.


Assuntos
Sarampo/complicações , Noma/diagnóstico , Noma/epidemiologia , Desnutrição Proteico-Calórica/complicações , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Sarampo/epidemiologia , Nigéria/epidemiologia , Noma/etiologia , Desnutrição Proteico-Calórica/epidemiologia , Estudos Retrospectivos , Fatores de Risco
6.
Nutrients ; 11(1)2019 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-30626166

RESUMO

Studies on the effect of dietary protein intake (DPI) on chronic kidney disease (CKD) progression, along with the potential hazard of protein-energy wasting (PEW), are scarce. We evaluated the association between DPI and kidney function both cross-sectionally and longitudinally, particularly emphasizing the role of PEW, in a large-scale, observational, multicenter, prospective study. We enrolled 1572 patients with non-dialysis CKD between 2011 and 2016. CKD progression was defined by a >50% estimated glomerular filtration rate (eGFR) decrease, serum creatinine doubling, or dialysis initiation. A Cox proportional hazard regression analysis was conducted. During the mean follow-up period of 41.6 months, CKD progression was observed in 296 patients. Cross-sectionally, increased DPI was significantly associated with increased eGFR. Similarly, increased DPI tertile was significantly associated with increased renal survival in a Kaplan⁻Meier curve analysis. In the multivariate Cox proportional hazard regression analysis, the statistical significance of the DPI tertile group in CKD progression was lost when PEW-related variables were added as covariates. In penalized spline curve analysis, the adjusted odds ratio of PEW significantly increased as DPI decreased. DPI, per se was not a major determinant of CKD progression. An intimate association between reduced DPI and PEW may be a more important predictor of CKD progression than DPI.


Assuntos
Dieta , Proteínas na Dieta/administração & dosagem , Comportamento Alimentar , Rim/patologia , Desnutrição Proteico-Calórica/complicações , Diálise Renal , Insuficiência Renal Crônica/fisiopatologia , Creatinina/sangue , Estudos Transversais , Progressão da Doença , Feminino , Taxa de Filtração Glomerular , Humanos , Estimativa de Kaplan-Meier , Rim/fisiopatologia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Razão de Chances , Modelos de Riscos Proporcionais , Estudos Prospectivos , Insuficiência Renal , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/terapia
8.
Nutrition ; 57: 231-236, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30184517

RESUMO

OBJECTIVES: Protein-energy wasting (PEW) is highly prevalent in patients on hemodialysis (HD). Oral nutritional supplementation (ONS) is recommended for malnourished patients on HD. The aim of this study was to evaluate ONS on plasma amino acid in HD patients with PEW. METHODS: Thirty-two HD patients with a mean age 59.1 ± 9.5 y with PEW were enrolled into the study. Patients were prescribed ONS (125 mL twice a day for 3 mo) together with dietary advice. The nutritional status was evaluated by means of body mass index, Subjective Global Assessment, and serum albumin and prealbumin levels. The percentages of body fat and lean body mass were measured by means of the near-infrared method. The lean body mass-to-body weight ratios were calculated. Tumor necrosis factor, interleukin-6 and high-sensitivity C-reactive protein, were measured by the enzyme-linked immunosorbent assay method. Serum concentrations of amino acids were measured by the high-performance liquid chromatography method. RESULTS: After 3 mo of ONS, a significant increase of both serum prealbumin and albumin was observed. The concentration of most of the amino acids increased independently on inflammation. CONCLUSIONS: Dietary advice, combined with ONS, is effective in HD patients with PEW. Both dietary advice and ONS are needed to be sure that patients consume an adequate daily amount of calories and protein.


Assuntos
Aminoácidos/sangue , Suplementos Nutricionais , Nutrientes/uso terapêutico , Estado Nutricional , Desnutrição Proteico-Calórica/tratamento farmacológico , Diálise Renal , Síndrome de Emaciação/tratamento farmacológico , Idoso , Feminino , Humanos , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Avaliação Nutricional , Pré-Albumina/metabolismo , Desnutrição Proteico-Calórica/complicações , Diálise Renal/efeitos adversos , Albumina Sérica/metabolismo , Síndrome de Emaciação/etiologia
9.
Osteoporos Int ; 30(3): 611-620, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30456573

RESUMO

Chronic inflammation and protein energy wasting (PEW) syndrome are common in kidney transplant recipients (KTR). The presence of inflammation and PEW syndrome can directly affect bone resorption and bone formation, leading to bone loss and fractures. We showed PEW is independently associated with new clinically detected bone fractures in prevalent KTR. INTRODUCTION: Kidney transplant recipients (KTR) have a 4-fold higher risk of fracture compared to the general population. Chronic inflammation and PEW syndrome are common in KTR and are associated with poor outcomes. We hypothesized that the Malnutrition-Inflammation Score (MIS), a validated measure of PEW, is associated with higher risk of bone fractures in KTR. METHODS: This prospective cohort study included 839 prevalent KTR from a Central European academic center. MIS, a semiquantitative instrument of PEW, was calculated at the study entry. Self-reported history of fractures was recorded during the 2-year follow-up period. The association between MIS and bone fractures was examined in logistic regression analyses with adjustment for age, gender, eGFR, smoking habits, history of pre-transplant bone fractures, and acute rejection. RESULTS: Mean age was 51 ± 13 years, and 56% of patients were males with median (interquartile range) transplant vintage 69 (38-112) months, estimated glomerular filtration rate 55 ± 21 ml/min/1.73 m2, and calculated MIS 3 (2-4) at enrollment. Fifty-five (7%) patients experienced self-reported bone fractures during the 2-year follow-up period. Higher MIS score showed linear association with increased risk of fracture. Each one-point higher MIS was associated with 23% higher risk of bone fractures (odds ratio (OR) and 95% CI 1.23, 1.12-1.34), which remained significant after multivariable adjustments (OR 1.17, 95% CI 1.06-1.29). CONCLUSION: The MIS is independently associated with new clinically detected bone fractures in prevalent KTR.


Assuntos
Inflamação/complicações , Transplante de Rim/efeitos adversos , Fraturas por Osteoporose/etiologia , Desnutrição Proteico-Calórica/complicações , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Fatores de Risco , Autorrelato , Índice de Gravidade de Doença
10.
Kidney Blood Press Res ; 43(6): 1878-1889, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30566933

RESUMO

BACKGROUND/AIMS: Geriatric nutritional risk index (GNRI) was developed as a "nutrition-related" risk index and was reported in different populations as associated with the risk of all-cause and cardiovascular morbidity and mortality. Therefore, GNRI can be used to classify patients according to a risk of complications in relation to conditions associated with protein-energy wasting (PEW). However, not all reports pointed to the prognostic ability of the GNRI. The purpose of this study was to assess the associations of GNRI with mortality in chronic hemodialysis patients. METHODS: We electronically searched original articles published in peer-reviewed journals from their inception to September 2018 in The PubMed, Embase, and the Cochrane Library databases. The primary outcome was all-cause and cardiovascular mortality. We pooled unadjusted and adjusted odds ratios (ORs) with 95% confidence intervals (95% CIs) using Review Manager 5.3 software. RESULTS: A total of 10,739 patients from 19 cohort studies published from 2010 to 2018 were included. A significant negative association was found between the GNRI and all-cause mortality in patients with chronic hemodialysis (OR, 0.90; 95% CI, 0.84-0.97, p=0.004) (per unit increase) and (OR, 2.15; 95% CI, 1.88-2.46, p<0.00001) (low vs. high GNRI). Moreover, there was also a significant negative association between the GNRI (per unit increase) and cardiovascular events (OR, 0.98; 95% CI, 0.97-1.00, p=0.01), as well as cardiovascular mortality (OR, 0.89; 95% CI, 0.80-0.99, p=0.03). CONCLUSION: Our findings supported the hypothesis that the low GNRI is associated with an increased risk of all-cause and cardiovascular mortality in chronic hemodialysis patients. Based on our literature review, GNRI has been found to be an effective tool for identifying patients with nutrition-related risk of all-cause and cardiovascular disease.


Assuntos
Avaliação Geriátrica/métodos , Falência Renal Crônica/etiologia , Estado Nutricional , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/mortalidade , Humanos , Falência Renal Crônica/mortalidade , Desnutrição Proteico-Calórica/complicações , Medição de Risco
11.
JCI Insight ; 3(21)2018 11 02.
Artigo em Inglês | MEDLINE | ID: mdl-30385711

RESUMO

Maternal malnutrition, which causes prenatal exposure to excessive glucocorticoid, induces adverse metabolic programming, leading to hypertension in offspring. In offspring of pregnant rats receiving a low-protein diet or dexamethasone, a synthetic glucocorticoid, mRNA expression of angiotensin receptor type 1a (Agtr1a) in the paraventricular nucleus (PVN) of the hypothalamus was upregulated, concurrent with reduced expression of DNA methyltransferase 3a (Dnmt3a), reduced binding of DNMT3a to the Agtr1a gene, and DNA demethylation. Salt loading increased BP in both types of offspring, suggesting that elevated hypothalamic Agtr1a expression is epigenetically modulated by excessive glucocorticoid and leads to adult-onset salt-sensitive hypertension. Consistent with this, dexamethasone treatment of PVN cells upregulated Agtr1a, while downregulating Dnmt3a, and decreased DNMT3a binding and DNA demethylation at the Agtr1a locus. In addition, Dnmt3a knockdown upregulated Agtr1a independently of dexamethasone. Hypothalamic neuron-specific Dnmt3a-deficient mice exhibited upregulation of Agtr1a in the PVN and salt-induced BP elevation without dexamethasone treatment. By contrast, dexamethasone-treated Agtr1a-deficient mice failed to show salt-induced BP elevation, despite reduced expression of Dnmt3a. Thus, epigenetic modulation of hypothalamic angiotensin signaling contributes to salt-sensitive hypertension induced by prenatal glucocorticoid excess in offspring of mothers that are malnourished during pregnancy.


Assuntos
Metilação de DNA/genética , Hipertensão/genética , Núcleo Hipotalâmico Paraventricular/metabolismo , Receptor Tipo 1 de Angiotensina/metabolismo , Animais , Animais Recém-Nascidos , DNA (Citosina-5-)-Metiltransferases/metabolismo , Dexametasona/provisão & distribução , Epigenômica , Feminino , Glucocorticoides/provisão & distribução , Hipertensão/metabolismo , Masculino , Camundongos , Gravidez , Efeitos Tardios da Exposição Pré-Natal , Desnutrição Proteico-Calórica/complicações , RNA Mensageiro/genética , Ratos , Ratos Sprague-Dawley , Regulação para Cima/fisiologia
12.
Clin Interv Aging ; 13: 2097-2106, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30425464

RESUMO

Background: Both low skeletal muscle mass (LSMM) and delirium are frequently seen in elderly patients. This study aimed to investigate the association between preoperative LSMM and postoperative delirium (POD) in elderly patients undergoing colorectal cancer (CRC) surgery and to design a model to predict POD. Patients and methods: This is a retrospective observational cohort study. Patients aged 70 years or older undergoing CRC surgery from January 2013 to October 2015 were included in this study. The cross-sectional skeletal muscle area at the level of the third lumbar vertebra using computed tomography was adjusted for patients' height, resulting in the skeletal muscle index. The lowest quartile per sex was defined as LSMM. Short Nutritional Assessment Questionnaire for Residential Care and KATZ-Activities of Daily Living were used to define malnourishment and physical dependency, respectively. POD was diagnosed using the Delirium Observational Screening Scale and geriatricians' notes. Results: Median age of the 251 included patients was 76 years (IQR, 73-80 years), of whom 56% of patients were males, 24% malnourished, and 15% physically impaired. LSMM and POD were diagnosed in 65 and 33 (13%) patients, respectively. POD occurred significantly more in patients with LSMM (25%) compared with patients without LSMM (10%), P=0.006. In the multivariate analysis, age, history of delirium, and LSMM were significantly associated with POD. In addition, this effect increased in patients with LSMM and malnourishment (P=0.019) or physical dependency (P=0.017). Conclusion: Age, history of delirium, LSMM, and malnourishment or physical dependency were independently associated with POD. Our nomogram could be used to identify patients at an increased risk for delirium. These patients may benefit from intensive monitoring to prevent POD.


Assuntos
Neoplasias Colorretais/cirurgia , Delírio/etiologia , Força Muscular , Complicações Pós-Operatórias/etiologia , Sarcopenia/complicações , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Correlação de Dados , Delírio/epidemiologia , Avaliação da Deficiência , Feminino , Humanos , Masculino , Países Baixos , Desnutrição Proteico-Calórica/complicações , Desnutrição Proteico-Calórica/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Sarcopenia/epidemiologia
13.
J Nutr Health Aging ; 22(7): 811-818, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30080225

RESUMO

BACKGROUND: Parenteral nutrition (PN)-dependent adults and elderly individuals who are admitted to hospital treatment are potentially susceptible to mineral disorder complications due to depleted physiological reserves, loss of lean body mass, and increased fat mass, thus worsening inflammation. AIM: The purpose of this study is to evaluate the prevalence of hypophosphatemia, hypokalemia, and hypomagnesaemia prior and within the first 7 days of PN infusion. Furthermore, whether malnutrition and old age are associated with these disorders was also investigated. METHODS: This study included a historical cohort of adult patients, and 1,040 patients whose information was prospectively entered in the database were evaluated. RESULTS: Of the 781 patients, 27.3% were ≥65 years, 80.9% had undergone surgical treatment, 74.3% were in the intensive care unit, and 17.9% died during the hospitalization period. About 17.1% patients were malnourished. Protein energy malnutrition (PEM) was observed in 31.9% of the elderly patients and 27.1% of adults in general. Hypophosphatemia, hypokalemia, and hypomagnesemia were more prevalent before the start of PN infusion (D0: 214 [18.4%]), and new events were more common during the first 2 days of PN infusion (D1: 283 [23.1%]; D2: 243 [20.1%]. Elderly patients were more susceptible to developing hypophosphatemia (odds ratio [OR]: 1.69; 95% confidence interval [CI]: 1.29-2.19; p<0.001). Patients with PEM were also more susceptible to hypophosphatemia (OR: 3.75; 95% CI: 1.13-12.47; p=0.036). CONCLUSION: Hypophosphatemia, hypokalemia, and hypomagnesemia were frequently observed in hospitalized adults and elderly patients before and particularly during the first 2 days of PN infusion. Elderly patients and patients with PEM are more susceptible to developing hypophosphatemia.


Assuntos
Hipercalciúria/epidemiologia , Hipopotassemia/epidemiologia , Hipofosfatemia/epidemiologia , Nefrocalcinose/epidemiologia , Nutrição Parenteral Total/efeitos adversos , Erros Inatos do Transporte Tubular Renal/epidemiologia , Adulto , Idoso , Brasil/epidemiologia , Feminino , Hospitalização , Humanos , Pacientes Internados , Magnésio/metabolismo , Masculino , Pessoa de Meia-Idade , Minerais/metabolismo , Estado Nutricional , Prevalência , Desnutrição Proteico-Calórica/complicações , Desnutrição Proteico-Calórica/patologia
14.
J Ren Nutr ; 28(6): 428-434, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-29983232

RESUMO

OBJECTIVE: To study whether the score proposed by the International Society of Renal Nutrition and Metabolism to define the protein energy wasting (PEW) syndrome has diagnostic validity in patients undergoing dialysis. DESIGN AND METHODS: Cross-sectional study including 468 prevalent hemodialysis patients from Canary Islands, Spain. Individual PEW syndrome criteria and the number of PEW syndrome categories were related to other objective markers of PEW using linear and logistic regression analyses: subjective global assessment, handgrip strength, bioimpedance-assessed body composition, and levels of high-sensitivity C-reactive protein. RESULTS: Study participants (34% women) had a median age of 66 years, 37 months of maintenance dialysis, and 50% were diabetics. About 23% of patients had PEW (≥3 PEW categories), and 68% were at risk of PEW (1-2 PEW categories). Low prealbumin was the most frequently found derangement (52% of cases), followed by low albumin (46%), and low protein intake (35%). Across higher number of PEW syndrome categories, patients showed a longer dialysis vintage and had lower creatinine, triglycerides, and transferrin (P for trend <.001 for all). All nutritional assessments not included in the PEW definition worsened across higher number of PEW categories. In multivariable regression analyses, there was a linear inverse relationship between muscle and fat mass as well as handgrip strength with the number of PEW syndrome categories. Likewise, the proportion of subjective global assessment-defined malnutrition and serum concentration of C-reactive protein gradually increased despite adjustment for confounders (P for trend <.05 for all). CONCLUSION: The PEW score reflects systemic inflammation, malnutrition and wasting among dialysis patients and may thus be used for diagnostic purposes.


Assuntos
Desnutrição Proteico-Calórica/complicações , Desnutrição Proteico-Calórica/diagnóstico , Desnutrição Proteico-Calórica/fisiopatologia , Diálise Renal , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/terapia , Idoso , Proteína C-Reativa , Estudos Transversais , Impedância Elétrica , Feminino , Força da Mão/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Espanha
15.
J Ren Nutr ; 28(6): 369-379, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30057212

RESUMO

Protein-energy wasting (PEW), which essentially refers to decreased body protein mass and fuel (energy) reserves, is common in advanced chronic kidney disease (CKD) patients and end-stage kidney disease patients undergoing chronic dialysis. The term PEW is used rather than protein-energy malnutrition because many causes of PEW in CKD and end-stage kidney disease patients does not involve reduced nutrient intake (e.g., catabolic illness, oxidants, biologicals lost in urine and dialysate, acidemia). The prevalence of PEW in CKD increases as glomerular filtration rate declines and is highest in chronic dialysis patients. PEW in CKD is important because it is associated with substantially increased morbidity and mortality and reduced quality of life. Many signs of PEW can be improved with nutritional therapy. It is not known whether amelioration or eradication of PEW by treatment of underlying illnesses, nutritional therapy, and/or other measures will reduce morbidity and mortality or improve quality of life. Clinical trials are indicated to answer these questions.


Assuntos
Estado Nutricional , Apoio Nutricional/métodos , Desnutrição Proteico-Calórica/complicações , Desnutrição Proteico-Calórica/terapia , Diálise Renal , Insuficiência Renal Crônica/complicações , Humanos , Insuficiência Renal Crônica/terapia
16.
PLoS One ; 13(7): e0199916, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29965973

RESUMO

Early postnatal-life malnutrition remains prevalent globally, and about 45% of all child deaths are linked to malnutrition. It is not clear whether survivors of childhood malnutrition suffer from long-term metabolic effects, especially when they are later in life exposed to a fat and carbohydrate rich obesogenic diet. The lack of knowledge around this dietary "double burden" warrants studies to understand the long-term consequences of children previously exposed to malnutrition. We hypothesized that an early-life nutritional insult of low protein consumption in mice would lead to long-term metabolic disturbances that would exacerbate the development of diet-induced insulin resistance and non-alcoholic fatty liver disease (NAFLD). We investigated the effects of feeding a low protein diet (4% wt/wt) immediately after weaning for four weeks and subsequent feeding of a high carbohydrate high fat feeding for 16 weeks on metabolic function and development of NAFLD. Mice exposed to early-life protein restriction demonstrated a transient glucose intolerance upon recovery by regular chow diet feeding. However, protein restriction after weaning in mice did not exacerbate an obesogenic diet-induced insulin resistance or progression to NAFLD. These data suggest that transient protein restriction in early-life does not exacerbate an obesogenic diet-induced NAFLD and insulin resistance.


Assuntos
Dieta com Restrição de Proteínas/efeitos adversos , Intolerância à Glucose/metabolismo , Glucose/metabolismo , Resistência à Insulina , Hepatopatia Gordurosa não Alcoólica/metabolismo , Desnutrição Proteico-Calórica/complicações , Animais , Feminino , Intolerância à Glucose/etiologia , Intolerância à Glucose/patologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Hepatopatia Gordurosa não Alcoólica/etiologia , Hepatopatia Gordurosa não Alcoólica/patologia , Desnutrição Proteico-Calórica/fisiopatologia
17.
Am J Clin Nutr ; 107(4): 626-634, 2018 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-29635501

RESUMO

Background: Goals of treating childhood severe acute malnutrition (SAM), in addition to anthropometric recovery and preventing short-term mortality, include reducing the risks of subsequent serious infections. How quickly and how much the risk of serious illness changes during rehabilitation are unknown but could inform improving the design and scope of interventions. Objective: The aim of this study was to investigate changes in the risk of life-threatening events (LTEs) in relation to anthropometric recovery from SAM. Design: This was a secondary analysis of a clinical trial including 1778 HIV-uninfected Kenyan children aged 2-59 mo with complicated SAM, enrolled after the inpatient stabilization phase of treatment, and followed for 12 mo. The main outcome was LTEs, defined as infections requiring rehospitalization or causing death. We examined anthropometric variables measured at months 1, 3, and 6 after enrollment in relation to LTEs occurring during the 6 mo after each of these time points. Results: Over 12 mo, there were 823 LTEs (257 fatal), predominantly severe pneumonia and diarrhea. At months 1, 3, and 6, 557 (34%), 764 (49%), and 842 (56%) children had a weight-for-height or -length z score (WHZ) ≥-2, respectively, which, compared with a WHZ <-3, was associated with lower risks of subsequent LTEs [adjusted HRs (95% CIs): 0.50 (0.40, 0.64), 0.30 (0.23, 0.39), and 0.23 (0.16, 0.32), respectively]. However, children with a WHZ ≥-2 at 1, 3, and 6 mo still had 39 (95% CI: 32, 47), 26 (95% CI: 22, 32), and 15 (95% CI: 12, 20) LTEs/100 child-years of observation during the following 6 mo. WHZ at study enrollment predicted subsequent WHZ but not the risk of LTEs. Changes in height-for-age z score did not predict LTEs. Conclusions: Anthropometric response was associated with a rapid and substantial reduction in risk of LTEs. However, reduction in susceptibility lagged behind anthropometric improvement. Disease events, together with anthropometric assessment, may provide a clearer picture of the effectiveness of interventions. Robust protocols for detecting and treating poor anthropometric recovery and addressing broader vulnerabilities that complicated SAM indicates may save lives. This trial was registered at www.clinicaltrials.gov as NCT00934492.


Assuntos
Transtornos da Nutrição do Lactente/complicações , Infecções/complicações , Desnutrição Proteico-Calórica/complicações , Desnutrição Proteico-Calórica/dietoterapia , Desnutrição Aguda Grave/complicações , Desnutrição Aguda Grave/dietoterapia , Pré-Escolar , Estudos de Coortes , Suscetibilidade a Doenças , Feminino , Humanos , Lactente , Infecções/mortalidade , Quênia/epidemiologia , Masculino , Estado Nutricional , Fatores de Risco , Desnutrição Aguda Grave/mortalidade
18.
J Ren Nutr ; 28(5): 324-332, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29691162

RESUMO

OBJECTIVES: To evaluate whether body composition monitor (BCM) could be a practical instrument for nephrologists to assess nutritional status in patients on hemodialysis (HD) and whether it is more effective in identifying patients at highest risk of developing protein-energy wasting (PEW) alone or in combination with other tools currently used for that purpose. DESIGN: Observational cross-sectional study in 91 HD patients (60 ± 14 years, 70.3% male, 24 ± 4.1 kg/m2 body mass index) from 2 different locations. METHODS: Nutritional status was evaluated by anthropometric methods (biceps and triceps skinfold thickness, waist circumference, and arm muscular circumference), biochemical nutritional markers, malnutrition-inflammation score (MIS), and BCM. The patients were grouped into those with and without PEW by using classical criteria and then classified as being adequately or inadequately nourished according to a BCM flow chart to detect those requiring preferential nutritional intervention. A multivariate approach was used to calculate the risk of developing PEW. RESULTS: Anthropometric measurements revealed significantly lower body mass index (<23 kg/m2; odds ratios [OR] = 13.3 and P = 0.001) and arm muscular circumference < p10 (OR = 34, P < 0.001) in the PEW group. MIS was above 5 in all the patients classified as having PEW. BCM showed that fat tissue index < p10 was significantly lower in this group (OR = 1.52), and a decision tree using the lean tissue index < p10, fat tissue index < p10, and extracellular water > 15% revealed that 42.9% of the patients would need nutritional monitoring. On multivariate analysis, insufficient nutritional status detected by BCM decision tree was an independent prognostic factor for developing PEW. About 9.89% of the patients were classified as PEW, with MIS > 5, and insufficient nutritional status detected by BCM required preferential nutritional intervention. CONCLUSION: BCM is a practical instrument for nephrologists to assess nutritional status in patients on HD and is useful for the early prevention and detection of PEW, as is able to identify differences in body composition, predict clinically important outcomes, and classify patients requiring preferential nutritional intervention.


Assuntos
Impedância Elétrica , Falência Renal Crônica/complicações , Avaliação Nutricional , Desnutrição Proteico-Calórica/complicações , Desnutrição Proteico-Calórica/diagnóstico , Diálise Renal , Composição Corporal , Estudos Transversais , Feminino , Humanos , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Desnutrição Proteico-Calórica/prevenção & controle , Análise Espectral
19.
PLoS One ; 13(4): e0195585, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29702682

RESUMO

BACKGROUND: Cardiovascular disease (CVD), protein-energy wasting (PEW), and inflammation are common interrelated features of chronic kidney disease (CKD). Less is known about lung dysfunction in CKD and its possible role in this context. We evaluated lung function and its association with estimated glomerular filtration rate (GFR), CVD, PEW, and inflammation in individuals with normal to severely reduced GFR. METHODS: In 404 individuals with GFR category G1 (n = 31; GFR >90mL/min/1.73 m2), G2 (n = 46), G3 (n = 33), G4 (n = 49) and G5 (n = 245; GFR<15mL/min/1.73 m2), pulmonary function was assessed by spirometry. Obstructive (OLD) and restrictive (RLD) lung dysfunction was defined based on forced vital capacity (FVC), forced expiratory volume in the first second (FEV1) and peak expiratory flow (PEF), expressed as percentages of predicted values (%FEV1, %FVC and %PEF, respectively). PEW was evaluated by subjective global assessment, handgrip strength (HGS) and lean body mass index (LBMI), and inflammation by interleukin-6 and high sensitivity C-reactive protein. RESULTS: RLD (defined as FEV1/FVC ≥ 0.70 and %FVC<80) associated with GFR and was present in 36% of G5 and 14% of G1-4 individuals. OLD (FEV1/FVC<0.70) was less common with similar prevalence among G1-4 (9%) and G5 (11%) individuals. Notably, 64% of those with concomitant presence of PEW, inflammation and clinical signs of CVD had RLD while 79% of those lacking these complications had normal lung function. In multivariate logistic regression analysis, RLD associated with CVD, PEW and inflammation, after adjusting for Framingham's CVD risk score, serum albumin, and GFR category. CONCLUSIONS: RLD is a common complication in patients with advanced CKD, especially in those with concomitant presence of CVD, inflammation and PEW. RLD appears to be an integral albeit scarcely explored consequence of pulmonary-renal interactions in CKD patients.


Assuntos
Doenças Cardiovasculares/complicações , Inflamação/complicações , Pneumopatias/complicações , Desnutrição Proteico-Calórica/complicações , Insuficiência Renal/complicações , Adulto , Idoso , Biomarcadores/sangue , Índice de Massa Corporal , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/fisiopatologia , Feminino , Taxa de Filtração Glomerular , Humanos , Inflamação/epidemiologia , Inflamação/fisiopatologia , Rim/fisiopatologia , Modelos Logísticos , Pulmão/fisiopatologia , Pneumopatias/epidemiologia , Pneumopatias/fisiopatologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prevalência , Desnutrição Proteico-Calórica/epidemiologia , Desnutrição Proteico-Calórica/fisiopatologia , Insuficiência Renal/epidemiologia , Insuficiência Renal/fisiopatologia , Testes de Função Respiratória
20.
Medicine (Baltimore) ; 97(17): e0538, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29703031

RESUMO

BACKGROUND: Episodes of malnutrition in early childhood can produces alterations in the salivary glands. The investigation of mechanisms that can reduce the impact of malnutrition on the defenses of the organism is of the utmost important and interest to public health. The aim of this study is to evaluate the effect of low-level laser on the saliva of children aged 1 to 5 years with energy-protein malnutrition. METHODS: Mandatory inclusion criteria are diagnosis of malnutrition. The sample will consist of 50 men and women malnourished children aged 12 to 71 months. Saliva will be collected and the volume of saliva will be measured and the salivary flow rate will be determined (mL/min). Concentrations of salivary IgA in all samples will be measured using a commercial Enzyme-Linked Immunosorbent Assay (ELISA) kit. Low-level laser (laser diode) will be administered in the region of the parotid glands bilaterally as well as in the regions of the submandibular and sublingual glands. DISCUSSION: This study will be the first that investigate the effects of local laser therapy on the salivary glands of malnourished children. TRIAL REGISTRATION: Clinical.trials.gov as NCT03355313, first received in 21 November 2017.


Assuntos
Transtornos da Nutrição Infantil/complicações , Lasers Semicondutores/uso terapêutico , Terapia com Luz de Baixa Intensidade/métodos , Desnutrição Proteico-Calórica/complicações , Saliva/efeitos da radiação , Glândulas Salivares/efeitos da radiação , Pré-Escolar , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Imunoglobulina A Secretora/análise , Lactente , Masculino , Estado Nutricional , Glândula Parótida/efeitos da radiação , Saliva/imunologia , Saliva/metabolismo , Glândula Sublingual/efeitos da radiação , Glândula Submandibular/efeitos da radiação , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA