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1.
Nutr Hosp ; 36(5): 1027-1036, 2019 Oct 17.
Artigo em Inglês | MEDLINE | ID: mdl-31545065

RESUMO

Introduction: Objective: to investigate whether the caloric and protein deficits, the diagnosis and the NUTRIC score, behaved as risk factors associated to the survival time. Methods: prospective study with 82 critically ill patients in intensive care unit (ICU), with exclusive enteral nutritional therapy (EENT). We investigated the calorie and protein deficiencies of EENT, the NUTRIC score, and the inflammatory-nutritional index by the C-reactive protein-CRP/albumin. The data were analyzed using the Chi-square, Fisher, Mann-Whitney, Kruskal-Wallis, univariate and multiple Cox regressions and the Kaplan-Meyer method. Results: in the univariate Cox regression, one-year increase in age increased the risk of death by 4.1% (p=0.0009; HR=1.041) and one-day increase with intercurrent events, by 1.8% (p = 0.0485; HR = 1.018). In the multiple Cox regression, the clinical diagnosis (p = 0.0462, HR = 2.091) and the NUTRIC score ≥ 5 (p < 0.0001; HR = 5.740) were the variables that together were associated with the survival time. The critical caloric and protein deficits did not behave as death risk factors in this population. Kaplan-Meier curves showed that the probability of survival in 40 days was 28.1% with clinical diagnosis and 40.2% with surgical diagnosis. The mean survival time with NUTRIC score ≥ 5 was 17.4 days. The probability of survival at 40 days was 72.8% with NUTRIC score < 5 and 6.4% with NUTRIC score ≥ 5. Conclusion: caloric and protein deficits are not risk factors for mortality. Only the diagnosis and the NUTRIC score were considered risk factors associated with the survival time.


Assuntos
Nutrição Enteral , Unidades de Terapia Intensiva , Desnutrição Proteico-Calórica/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estado Terminal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Taxa de Sobrevida , Fatores de Tempo
2.
Nutr Hosp ; 36(Spec No3): 63-69, 2019 Aug 27.
Artigo em Espanhol | MEDLINE | ID: mdl-31368337

RESUMO

Introduction: 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
Desnutrição/etiologia , Nutrição Parenteral , Diálise Renal , Insuficiência Renal Crônica/complicações , Humanos , Desnutrição/diagnóstico , Desnutrição/metabolismo , Desnutrição/prevenção & controle , Necessidades Nutricionais , Desnutrição Proteico-Calórica/etiologia , Desnutrição Proteico-Calórica/metabolismo , Desnutrição Proteico-Calórica/terapia , Diálise Renal/efeitos adversos , Insuficiência Renal Crônica/metabolismo , Síndrome de Emaciação/etiologia , Síndrome de Emaciação/metabolismo
3.
Obes Surg ; 29(10): 3095-3102, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31264177

RESUMO

BACKGROUND: Severe protein malnutrition, with a serum albumin < 25 g/L, is one of the complications that may develop after bariatric surgery. It is associated with increased morbidity and mortality and requires timely diagnosis and appropriate treatment to prevent rapid clinical deterioration. However, evidence-based recommendations for a specific treatment approach are currently not available. The present study describes the efficacy of a newly developed treatment regimen for post-bariatric patients presenting with severe hypoalbuminemia. METHODS: A single-centre, retrospective analysis of eleven post-bariatric patients presenting with severe hypoalbuminemia, treated with continuous 24 h nasal-jejunal tube feeding of a medium chain triglyceride (MCT) formulation in combination with pancreatic enzyme supplementation every 3 h. RESULTS: Duration of tube feeding ranged from 25 to 156 days (median 64 days) and pancreatic enzyme was supplemented for 22-195 days (median 75 days). An increase in serum albumin levels of 5 g/L and 10 g/L was achieved after a median period of 20 (range 6-26 days) and 36 days (range 21-57 days), respectively. Albumin levels were > 35 g/L after a median period of 58 days (range 44-171 days). CONCLUSION: In this case series, a continuous 24-h nasal-jejunal MCT tube feed combined with frequent pancreatic enzyme supplementation was effective in all patients presenting with severe post-bariatric hypoalbuminemia and was not associated with adverse effects.


Assuntos
Cirurgia Bariátrica/efeitos adversos , Nutrição Enteral , Fármacos Gastrointestinais/uso terapêutico , Pancreatina/uso terapêutico , Desnutrição Proteico-Calórica/terapia , Adulto , Idoso , Terapia de Reposição de Enzimas , Feminino , Humanos , Hipoalbuminemia/etiologia , Hipoalbuminemia/terapia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Desnutrição Proteico-Calórica/etiologia , Estudos Retrospectivos
4.
Nephrol Ther ; 15(3): 136-142, 2019 Jun.
Artigo em Francês | MEDLINE | ID: mdl-31053553

RESUMO

Protein energy wasting (PEW) is frequent among hemodialysis patients. Published international recommendations in this field are sometimes difficult to implement in daily practices. We evaluated daily practices of PEW screening and treatment in French hemodialysis centers using an online computerized questionnaire sent by email (1 answer required per center). Eighty-six centers returned the questionnaire filled by a nephrologist (43%), nurse (14%) or dietician (43%). The mean number of patients per center was 112±64 patients. PEW screening was performed at least once/month in 56% of centers, once/3 months in 36%, and less frequently in 8%. PEW screening frequency and tools were in agreement with recommendations. Regarding treatment, dietitian interviews were proposed in 98% of units. Hundred percent of units prescribed home oral nutrition supplements (ONS), and 90% ONS during hemodialysis. Ninety-seven percent of centers practiced intradialytic parenteral nutrition, 34% enteral nutrition with feeding tube and 41% with gastrostomy. 14% of centers had no dietician or only on call. A dietician was present≤1 day per week in 44% of centers, 1 to 2.5 days per week in 27%, and>2.5 days per week in 15%. After adjustment for the number of patients, private practice units had significantly less time of presence of the dietician than nonprofit associations or public healthcare centers. In all, 36% of centers offered physical activity during hemodialysis sessions - cycling in almost all centers - and only 12.8% proposed physical activity programs apart from dialysis sessions. In summary, in majority of French hemodialysis centers, PEW screening was consistent with recommendations but the dietician time was insufficient to screen for PEW causes and elaborate a treatment program. Only one third of centers perform enteral nutrition, the most recommended artificial nutrition therapy. Nutritional treatment could be improved in hemodialysis centers in France.


Assuntos
Pesquisas sobre Serviços de Saúde , Desnutrição Proteico-Calórica/diagnóstico , Desnutrição Proteico-Calórica/terapia , Diálise Renal , França , Humanos
5.
Am J Cardiol ; 123(6): 929-935, 2019 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-30612726

RESUMO

Chronically elevated cytokines from un-abating low-grade inflammation in heart failure (HF) results in Protein-Energy Malnutrition (PEM). However, the impact of PEM on clinical outcomes of admissions for HF exacerbations has not been evaluated in a national data. From the 2012 to 2014 Nationwide Inpatient Sample (NIS) patient's discharge records for primary HF admissions, we identified patients with concomitant PEM, and their demographic and comorbid factors. We propensity-matched PEM cohorts (32,771) to no-PEM controls (1:1) using a greedy algorithm-based methodology and estimated the effect of different clinical outcomes (SAS 9.4). There were 32,771 (∼163,885) cases of PEM among the 541,679 (∼2,708,395) primary admissions for HF between 2012 and 2014 in the US. PEM cases were older (PEM:76 vs no-PEM:72 years), Whites (70.75% vs 67.30%), and had higher comorbid burden, with Deyo-comorbidity index >3 (31.61% vs 26.30%). However, PEM cases had lower rates of obesity, hyperlipidemia and diabetes. After propensity-matching, PEM was associated with higher mortality (AOR:2.48 [2.31 to 2.66]), cardiogenic shock (3.11[2.79 to 3.46]), cardiac arrest (2.30[1.96 to 2.70]), acute kidney failure (1.49[1.44 to 1.54]), acute respiratory failure (1.57[1.51 to 1.64]), mechanical ventilation (2.72[2.50 to 2.97]). PEM also resulted in higher non-routine discharges (2.24[2.17 to 2.31]), hospital cost ($80,534[78,496 to 82,625] vs $43,226[42,376 to 44,093]) and longer duration of admission (8.6[8.5 to 8.7] vs 5.3[5.2 to 5.3] days). In conclusion, PEM is a prevailing comorbidity among hospitalized HF subjects, and results in devastating health outcomes. Early identification and prevention of PEM in HF subjects during clinic visits and prompt treatment of PEM both in the clinic and during hospitalization are essential to decrease the excess burden of PEM.


Assuntos
Insuficiência Cardíaca/epidemiologia , Hospitalização/estatística & dados numéricos , Desnutrição Proteico-Calórica/epidemiologia , Medição de Risco/métodos , Idoso , Comorbidade , Feminino , Seguimentos , Insuficiência Cardíaca/terapia , Custos Hospitalares , Mortalidade Hospitalar/tendências , Humanos , Tempo de Internação/tendências , Masculino , Prognóstico , Desnutrição Proteico-Calórica/terapia , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências , Fatores de Tempo
6.
Minerva Chir ; 74(2): 126-136, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30019880

RESUMO

INTRODUCTION: One anastomosis gastric bypass (OAGB) is now a recognized mainstream bariatric procedure being adopted by an increasing number of surgeons. The purpose of this review was to present an evidence-based summary of its key technical aspects and prevention and management of its specific complications. EVIDENCE ACQUISITION: We examined PubMed for all published articles on OAGB, including the ones published under one of its various other names. EVIDENCE SYNTHESIS: An ideal OAGB procedure has a long, narrow pouch constructed carefully to avoid going too close to the greater curvature of the stomach especially at the bottom of the pouch and maintains a safe distance from the angle of His. A bilio-pancreatic limb length of 150 cm appears to be safest and a limb length of >200 cm is associated with a significantly increased incidence of protein-calorie malnutrition. We recommend routine closure of Petersen's space to prevent Petersen's hernia and suggest a protocol for micronutrient supplementation. This review also presents evidence-based algorithms for prevention and management of marginal ulcers, protein-calorie malnutrition, and gastroesophageal reflux disease after OAGB. We suggest lifelong supplementation with two multivitamin/mineral supplements (each containing at least 1.0 mg copper and 15 mg zinc) daily, 1.5 mg vitamin B12 orally daily or 3-monthly injection with 1 mg vitamin B12, 120 mg elemental iron daily, 1500 mg elemental calcium daily, and 3000 international units of vitamin D daily. CONCLUSIONS: This review examines key technical steps of OAGB. We also discuss how to prevent and manage its specific complications.


Assuntos
Derivação Gástrica/efeitos adversos , Derivação Gástrica/métodos , Complicações Pós-Operatórias/terapia , Algoritmos , Anastomose Cirúrgica/métodos , Fístula Anastomótica/prevenção & controle , Fístula Anastomótica/terapia , Suplementos Nutricionais , Combinação de Medicamentos , Dilatação Gástrica/prevenção & controle , Dilatação Gástrica/terapia , Refluxo Gastroesofágico/prevenção & controle , Refluxo Gastroesofágico/terapia , Humanos , Micronutrientes/deficiência , Cuidados Pós-Operatórios , Complicações Pós-Operatórias/prevenção & controle , Desnutrição Proteico-Calórica/prevenção & controle , Desnutrição Proteico-Calórica/terapia , Úlcera Gástrica/prevenção & controle , Úlcera Gástrica/terapia , Vitaminas/administração & dosagem
8.
BMJ Open ; 8(12): e022775, 2018 12 14.
Artigo em Inglês | MEDLINE | ID: mdl-30552255

RESUMO

INTRODUCTION: Oropharyngeal dysphagia (OD) is a major disorder following stroke. OD can produce alterations in both the efficacy and safety of deglutition and may result in malnutrition, dehydration, frailty, respiratory infections and pneumonia. These complications can be avoided by early detection and treatment of OD in poststroke patients, and hospital stays, medication and mortality rates can be reduced. In addition to acute in-hospital costs from OD complications, there are other costs related to poststroke OD such as direct non-healthcare costs or indirect costs. The objective of this systematic review is to assess and summarise literature on the costs related to OD in poststroke patients. METHODS AND ANALYSIS: A systematic review of studies on the cost of OD and its complications (aspiration, malnutrition, dehydration, aspiration pneumonia and death) in patients who had a stroke will be performed from the perspectives of the hospital, the healthcare system and/or the society. The main outcomes of interest are the costs related to poststroke OD. We will search MEDLINE, Embase and the National Health Service Economic Evaluation Database. Studies will be included if they are partial economic evaluation studies, studies that provide information on costs in adult (>17 years) poststroke patients with OD and/or its complications (malnutrition, dehydration, frailty, respiratory infections and pneumonia) or economic evaluation studies in which the cost of this condition has been estimated. Studies will be excluded if they refer to oesophageal dysphagia or OD caused by causes other than stroke. Main study information will be presented and summarised in tables, separately for studies that provide incremental costs attributable to OD or its complications and studies that report the effect of OD or its complications on total costs of stroke, and according to the perspective from which costs were measured. ETHICS AND DISSEMINATION: The results of this systematic review will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42018099977.


Assuntos
Transtornos de Deglutição/economia , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/economia , Custos e Análise de Custo , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/terapia , Desidratação/diagnóstico , Desidratação/economia , Desidratação/terapia , Assistência à Saúde/economia , Diagnóstico Precoce , Intervenção Médica Precoce , Humanos , Desnutrição Proteico-Calórica/diagnóstico , Desnutrição Proteico-Calórica/economia , Desnutrição Proteico-Calórica/terapia
9.
Am J Med Sci ; 356(3): 234-243, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30286818

RESUMO

BACKGROUND: High mortality in dialysis patients may be associated with protein-energy wasting (PEW) syndrome characterized by progressively depleted protein and energy stores. While early diagnosis and treatment of PEW can reduce mortality, clinically practical measures for its detection are lacking. Poor dietary protein intake (DPI) is associated with risk of malnutrition and PEW. However, the impact of DPI on mortality is unclear. The purpose of this study is to examine the ability of DPI to predict 1-year mortality in dialysis patients. METHODS: This prospective, secondary study using data from the Comprehensive Dialysis Study and United States Renal Data System examined risk factors associated with 1-year mortality in dialysis patients. RESULTS: Seventeen (7.5%) of the 227 subjects died within 1 year following baseline data collection. One year survivors were significantly younger (60 ± 13.6 versus 71 ± 12.8; P = 0.0043), had a lower Charlson Comorbidity Index score (1.6 ± 2.3 versus 4.0 ± 3.6; P = 0.0157), higher serum albumin level (3.5 ± 0.5 versus 3.3 ± 0.4; P = 0.0173) and had higher DPI (63 ± 33.7 versus 49.5 ± 21.5 g/day; P = 0.0386) than those who died. In multivariable Cox proportional hazards model analyses, only the Charlson Comorbidity Index adjusted hazard ratio for death (1.24) was significantly associated with increased mortality. The Comprehensive Dialysis Study data showed no association between DPI and 1-year mortality in dialysis patients. CONCLUSIONS: Future studies using more precise measures should further examine the impact of DPI on mortality given the known association of DPI with PEW syndrome and the definitive link between PEW syndrome and survival in dialysis patients.


Assuntos
Proteínas na Dieta , Ingestão de Alimentos , Desnutrição Proteico-Calórica , Diálise Renal/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Prospectivos , Desnutrição Proteico-Calórica/etiologia , Desnutrição Proteico-Calórica/mortalidade , Desnutrição Proteico-Calórica/fisiopatologia , Desnutrição Proteico-Calórica/terapia , Fatores de Risco
10.
Strahlenther Onkol ; 194(11): 1049-1059, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30182247

RESUMO

PURPOSE: The nutritional status of inpatients influences the therapeutic outcome. Malnutrition is a common comorbidity in oncological patients. Both radio- and radiochemotherapy may contribute to the additional deterioration of the nutritional status. The aim of this study was to evaluate the impact of specialized treatment of malnutrition as a clinical routine. METHODS: The nutritional status of inpatients was assessed by the Nutritional risk screening (NRS-2002) on the day of admission to the University Department of Radiation Oncology. In case of significantly elevated NRS-2002 (NRS ≥ 3), a guideline-compliant, individual nutritional treatment was initiated by a specialized nutrition support team. The influence of the nutritional status and nutritional treatment on length of stay and complication rate was assessed. RESULTS: Of 840 included patients, 344 patients (40.95%) were at risk for malnutrition. Malnutrition was a significant, independent risk factor for both prolonged hospital stay, represented by the deviation between the actual length of stay and the DRG-associated mean length of stay (dLOS at risk: 0.88 days, dLOS not at risk: -0.88 days, p = 0.0047), as well as for the occurrence of complications (OR: 1.758 CI: [1.286-2.402], p = 0.0006). In the group of 337 (40.12%) rehospitalized patients the nutritional management was able to assimilate the values of length of stay as well as the complication rates to standard values. CONCLUSIONS: The high risk for malnutrition and the negative consequences for patients and hospitals underline the urgent need for malnutrition screening on admission and treatment of malnutrition. A specialized, interdisciplinary nutrition support team positively influences patient outcome and should be established routinely in all oncological disciplines.


Assuntos
Tempo de Internação , Neoplasias/radioterapia , Serviço Hospitalar de Oncologia , Desnutrição Proteico-Calórica/terapia , Radioterapia (Especialidade) , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Quimiorradioterapia/efeitos adversos , Estudos Transversais , Feminino , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/tratamento farmacológico , Terapia Nutricional , Estado Nutricional , Desnutrição Proteico-Calórica/diagnóstico , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
11.
Nutr Clin Pract ; 33(6): 767-771, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30207411

RESUMO

Intradialytic parenteral nutrition (IDPN) is a form of supplemental nutrition used to treat patients with malnutrition who receive hemodialysis. Once the diagnosis of malnutrition is made in such patients, encouragement of oral intake is the first-line treatment. If this fails, then enteral or parenteral nutrition may be needed. This review examines the literature on the use of IDPN and summarizes the current recommendations. There is considerable controversy over indications and benefits of IDPN, and well-controlled, long-term studies are needed to help tease out these issues. In the interim, clinical judgment should be used when considering IDPN for individual patients.


Assuntos
Falência Renal Crônica/terapia , Terapia Nutricional , Estado Nutricional , Nutrição Parenteral , Desnutrição Proteico-Calórica/terapia , Diálise Renal , Suplementos Nutricionais , Nutrição Enteral , Humanos , Falência Renal Crônica/complicações , Desnutrição Proteico-Calórica/etiologia
12.
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
13.
BMC Pregnancy Childbirth ; 18(1): 286, 2018 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-29973170

RESUMO

BACKGROUND: Prenatal balanced protein energy supplementation consumed by undernourished women improves mid-upper arm circumference in early infancy. This study aimed to identify whether locally produced maternal food-based supplementation improved anthropometric measures at birth and early infancy. METHODS: A village-matched evaluation, applying principles of a cluster randomised controlled trial, of a locally produced supplemental food to 87 undernourished pregnant women. 12 villages (intervention: n = 8; control: n = 4) in Pirganj sub-district, Rangpur District, northern Bangladesh. Daily supplements were provided. RESULTS: Anthropometric data at birth were available for 77 mother-infant dyads and longer-term infant growth data for 75 infants. Mid-upper arm circumference (MUAC) was significantly larger in infants of mothers in the intervention group compared with the control group at 6 months (p < 0.05). The mean birth weight in babies of supplemented mothers (mean: 2·91 kg; SD: 0·19) was higher than in babies of mothers in the control group (mean: 2·72 kg; SD: 0·13), and these changes persisted until 6 months. Also, the proportion of low birth weight babies in the intervention group was much lower (event rate = 0.04) than in the control group (event rate = 0.16). However, none of these differences were statistically significant (p > 0·05; most likely due to small sample size). The intervention reduced the risk of wasting at 6 months by 63.38% (RRR = 0.6338), and of low birth weight by 88·58% (RRR = 0.8858), with NNT of 2.22 and 6.32, respectively. Only three pregnant women require this intervention in order to prevent wasting at 6 months in one child, and seven need the intervention to prevent low birth weight of one child. CONCLUSIONS: Locally produced food-based balanced protein energy supplementation in undernourished pregnant women in northern Bangladesh resulted in larger MUAC in infants at 6 months. Further research, with larger sample sizes, is required to confirm the role of locally produced supplementation for undernourished pregnant women on weight and linear growth in newborns and infants. TRIAL REGISTRATION: This research was registered with the ISRCTN registry (ISRCTN97447076). This project had human research ethical approval from the James Cook University (Australia) Ethics committee (H4498) and the Bangladesh Medical Research Council (BMRC/NREC/2010-2013/58).


Assuntos
Peso ao Nascer , Proteínas na Dieta/administração & dosagem , Suplementos Nutricionais , Ingestão de Energia , Complicações na Gravidez , Desnutrição Proteico-Calórica , Adulto , Antropometria/métodos , Bangladesh/epidemiologia , Feminino , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Avaliação de Resultados em Cuidados de Saúde , Gravidez , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/terapia , Desnutrição Proteico-Calórica/epidemiologia , Desnutrição Proteico-Calórica/terapia
14.
Semin Dial ; 31(6): 583-591, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-29909606

RESUMO

Protein energy wasting (PEW) is a condition commonly occurring among patients with ESRD on hemodialysis. PEW is characterized by depletion of protein and energy stores and is caused by multiple factors related to chronic kidney disease, acute and chronic comorbidities and by renal replacement therapy itself. Anorexia is central in the pathogenesis of PEW; it is frequently observed in these patients whose protein and energy intakes are typically lower than guidelines recommendations. If untreated, PEW invariably leads to major complications, and may activate a vicious circle with further worsening of nutritional status. Dietary counseling and nutritional status monitoring play a key role in the prevention and treatment of PEW, since they allow an early identification of high risk patients, as well as the assessment of the response to nutritional intervention. Different nutritional approaches can be implemented following thorough nutritional counseling. These are chosen on the basis of patients' spontaneous dietary intake, severity of PEW and acute comorbidities. Initially, regular encounters with the dietitian allow patients to clarify doubts and strengthen basic concepts on nutrition to improve dietary intake and prevent PEW. When PEW is present or the patient is at high risk, the clinician may opt for the administration of oral intradialytic or daily supplements, aiming at increasing energy and protein intake, while in selected cases intradialytic parenteral nutrition may be used. This review addresses the main issues of nutritional status in ESRD patients on hemodialysis-its evaluation and monitoring, as well as at describing the available nutritional interventions.


Assuntos
Proteínas na Dieta/administração & dosagem , Falência Renal Crônica/terapia , Desnutrição Proteico-Calórica/etiologia , Diálise Renal/efeitos adversos , Suplementos Nutricionais , Humanos , Falência Renal Crônica/complicações , Estado Nutricional , Desnutrição Proteico-Calórica/terapia
16.
Clin Nutr ESPEN ; 25: 163-165, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29779813

RESUMO

It is generally acknowledged that malnutrition is a propensity factor for secondary infections in different clinical situations (malnutrition-associated infections in hospitalized patients and malnourished children in developing countries). However, it is not clear how malnutrition might facilitate the development of opportunistic infections in human immunodeficiency virus (HIV)-negative patients without a definite etiology (disease or treatment) of impaired cell-mediated immune response. We report here on a case of Pneumocystis jirovecii pneumonia in an HIV-negative patient suffering from anorexia nervosa with extreme malnutrition, which had a favorable outcome despite the severity of her respiratory failure. This report indicates the need for the early screening of nutritional status and rapid treatment initiation in patients with malnutrition, as well as the determination of opportunistic infections in the event of a low lymphocyte count.


Assuntos
Anorexia Nervosa/imunologia , Imunidade Celular , Hospedeiro Imunocomprometido , Estado Nutricional , Infecções Oportunistas/imunologia , Pneumocystis carinii/imunologia , Pneumonia por Pneumocystis/imunologia , Desnutrição Proteico-Calórica/imunologia , Anorexia Nervosa/diagnóstico , Anorexia Nervosa/fisiopatologia , Anorexia Nervosa/terapia , Feminino , Interações Hospedeiro-Patógeno , Humanos , Pessoa de Meia-Idade , Avaliação Nutricional , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/microbiologia , Infecções Oportunistas/terapia , Pneumocystis carinii/patogenicidade , Pneumonia por Pneumocystis/diagnóstico , Pneumonia por Pneumocystis/microbiologia , Pneumonia por Pneumocystis/terapia , Desnutrição Proteico-Calórica/diagnóstico , Desnutrição Proteico-Calórica/fisiopatologia , Desnutrição Proteico-Calórica/terapia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
17.
Nutr Clin Pract ; 33(3): 419-425, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29665145

RESUMO

BACKGROUND: Serum albumin and prealbumin levels, may be more strongly associated with inflammation than with nutrient delivery. Their predictive value has not been extensively described in surgical intensive care unit (ICU) patients. METHODS: We analyzed a registry of adult surgical ICU patients receiving enteral nutrition. Subjects with at least 1 serum albumin, prealbumin, or C-reactive protein (CRP) level were included. Demographic, nutrition, and clinical outcome data were collected. RESULTS: A total 252 subjects were included. A subset had serial measurements: albumin (n = 194), prealbumin (n = 13), CRP (n = 9), white blood cell (WBC) (n = 131), and neutrophil-lymphocyte ratio (NLR) (n = 86). Serum albumin level was inversely correlated with all 3 inflammatory biomarkers (CRP, ρ = -0.24, P <0.02; WBC, ρ = -0.15, P <0.001; and NLR, ρ = -0.26, P < 0.001). Change in serum albumin level was inversely correlated with change in NLR (ρ = -0.22, P = 0.044) but not with CRP or WBC. Admission serum albumin level was significantly higher in nourished vs. moderately and/or severely malnourished patients (3.2 [2.7-3.7] vs. 2.7 [2.3-3.0], P = 0.004). Admission serum prealbumin level was significantly higher in nourished vs. moderately and/or severely malnourished patients (9 [7-12] vs. 4 [3-5], P = 0.001). Serum albumin level was inversely correlated with Charlson Comorbidity Index (ρ = 0.20, P = 0.001). Calorie and/or protein delivery in the ICU was not correlated with changes in serum albumin or prealbumin levels. CONCLUSIONS: In the ICU, initial serum albumin levels and serial trends are inversely correlated with inflammation. Although initial serum albumin levels are reflective of baseline nutrition status, neither serum albumin level nor serum prealbumin level trends correlate with calorie or protein deficits and should not be used to assess adequacy of nutrition delivery.


Assuntos
Cuidados Críticos , Unidades de Terapia Intensiva , Pré-Albumina/metabolismo , Albumina Sérica/metabolismo , Adulto , Idoso , Biomarcadores/sangue , Proteína C-Reativa/metabolismo , Proteínas na Dieta/administração & dosagem , Nutrição Enteral , Feminino , Humanos , Inflamação/sangue , Leucócitos/metabolismo , Masculino , Pessoa de Meia-Idade , Neutrófilos/metabolismo , Estado Nutricional , Desnutrição Proteico-Calórica/sangue , Desnutrição Proteico-Calórica/terapia , Estudos Retrospectivos , Fatores de Risco
18.
BMC Res Notes ; 11(1): 68, 2018 Jan 24.
Artigo em Inglês | MEDLINE | ID: mdl-29361980

RESUMO

OBJECTIVE: We aimed to assess outcomes [rates of recovery, default, case fatality; rate of weight gain and rate of Mean Upper Arm Circumference (MUAC) gain] of children aged 6-59 months with severe acute malnutrition (SAM) at the Outpatient Therapeutic Center at Gado Refugee Camp, Cameroon, in relation to international standards. We retrospectively analysed files of 254 children with SAM aged 6-59 months admitted from April 2015 to August 2016. RESULTS: 72.8% got discharged as recovered, 0.8% died and none defaulted. 26.8% got referred to stabilization center, mostly for poor weight gain (44.1%). Mean rate of weight gain was 4.4 g/kg/day and MUAC gain 0.3 mm/cm/day; median duration of treatment 44.5 days. Amongst those with marasmus, kwashiorkor and marasmic kwashiorkor, median duration of stay was 48, 24.5 and 36.3 days (p = 0.002); recovery rates were similar 73, 71.4, 71.4% respectively (p = 0.7); Median rates of weight gain, 4.4, 6.7 and 8.1 g/kg/day (p = 0.05). 49 children had been incorrectly diagnosed and treated as SAM. International Standards were met in terms of case fatality rate and default rate but not rates of recovery and weight gain. Separate gender charts must be used to calculate weight for height z scores as combined charts cause significant errors.


Assuntos
Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Pacientes Ambulatoriais/estatística & dados numéricos , Desnutrição Aguda Grave/terapia , Ganho de Peso , Camarões , Pré-Escolar , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Tempo de Internação/estatística & dados numéricos , Masculino , Avaliação de Resultados em Cuidados de Saúde/métodos , Alta do Paciente/estatística & dados numéricos , Desnutrição Proteico-Calórica/fisiopatologia , Desnutrição Proteico-Calórica/terapia , Estudos Retrospectivos , Desnutrição Aguda Grave/fisiopatologia
19.
Z Gerontol Geriatr ; 51(2): 237-245, 2018 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-29349584

RESUMO

The technique of percutaneous endoscopic gastrostomy (PEG) was introduced in 1979 as a semi-invasive approach for children with the need for a gastric fistula in order to avoid an operative intervention. The suture pull-through method was rapidly established and is now omnipresent. Because scientific evidence is broadly missing, there is some uncertainty about the indications in geriatric medicine. Guidelines do not recommend the insertion of a PEG in patients with severe dementia and malnutrition. Tube feeding is mainly recommended as a temporary method for patients who cannot take oral nutrition for more than 3 days or for whom the energy intake for more than 10 days presumably covers less than 50% of their needs, assuming that the overall prognosis is reasonable. Insertion of a PEG is only recommended if artificial nutrition is expected to be necessary for more than 3-4 weeks or if a nasogastric tube is not tolerated.


Assuntos
Doença de Alzheimer/terapia , Nutrição Enteral/métodos , Gastrostomia/métodos , Desnutrição Proteico-Calórica/terapia , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/mortalidade , Nutrição Enteral/efeitos adversos , Gastrostomia/efeitos adversos , Fidelidade a Diretrizes , Humanos , Cuidados Paliativos/métodos , Desnutrição Proteico-Calórica/mortalidade , Medição de Risco , Análise de Sobrevida
20.
Pril (Makedon Akad Nauk Umet Odd Med Nauki) ; 39(2-3): 51-61, 2018 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-30864357

RESUMO

BACKGROUND: Protein-energy wasting (PEW) is common in patients with chronic kidney disease (CKD), and is associated with high morbidity and mortality. Malnutrition-Inflammation Score (MIS) has significant correlations with prospective hospitalization and mortality, as well as measures of anemia, inflammation, and nutrition in dialysis patients. MATERIAL AND METHODS: The study was conducted on 100 adult patients of CKD selected from K&D clinic PGIMS, Rohtak. All the patients went under detailed socioeconomic, clinical, biochemical and radiological examination. The average of three measurements of body weight, height, triceps skin fold thickness (TST), and mid-arm muscle circumference (MAMC) were measured in all patients. MIS was calculated for all the patients. RESULTS: Out of total 100 patients, 64 were male and 36 were female. Overall, the prevalence of malnutrition was 60%. A total of 42%, 16% and 2% patients had mild, moderate and severe malnutrition respectively. Our study also shows significant association between staging of CKD (3 to 5-D) and MIS. A significant negative correlation was found between MIS and factors such as BMI, eGFR, serum calcium and hemoglobin levels. A significant positive correlation of this score was found with blood urea serum creatinine, serum uric acid, serum potassium and serum phosphate. Multivariate analysis showed significant association between MIS and serum albumin, TIBC, BMI, family income and hs-CRP. CONCLUSION: Assessment of key components of malnutrition and inflammation early in disease course will help to identify high risk subjects in whom modifying these predictors will help in providing active and healthy life for CKD patients.


Assuntos
Inflamação/etiologia , Desnutrição Proteico-Calórica/complicações , Insuficiência Renal Crônica/complicações , Adulto , Idoso , Antropometria , Índice de Massa Corporal , Estudos Transversais , Feminino , Humanos , Inflamação/imunologia , Inflamação/fisiopatologia , Inflamação/terapia , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Valor Preditivo dos Testes , Desnutrição Proteico-Calórica/imunologia , Desnutrição Proteico-Calórica/fisiopatologia , Desnutrição Proteico-Calórica/terapia , Diálise Renal , Insuficiência Renal Crônica/imunologia , Insuficiência Renal Crônica/fisiopatologia , Insuficiência Renal Crônica/terapia , Índice de Gravidade de Doença
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