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1.
Medicine (Baltimore) ; 99(1): e18506, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895785

RESUMO

BACKGROUND: Whether the occurrence of refeeding syndrome (RFS), a metabolic condition characterized by electrolyte shifts after initiation of nutritional therapy, has a negative impact on clinical outcomes remains ill-defined. We prospectively investigated a subgroup of patients included in a multicentre, nutritional trial (EFFORT) for the occurrence of RFS. METHODS: In this secondary analysis of a randomized-controlled trial investigating the effects of nutritional support in malnourished medical inpatients, we prospectively screened patients for RFS and classified them as "RFS confirmed" and "RFS not confirmed" based on predefined criteria (i.e. electrolyte shifts, clinical symptoms, clinical context, and patient history). We assessed associations of RFS and mortality within 180 days (primary endpoint) and other secondary endpoints using multivariable regression analysis. RESULTS: Among 967 included patients, RFS was confirmed in 141 (14.6%) patients. Compared to patients with no evidence for RFS, patients with confirmed RFS had significantly increased 180-days mortality rates (42/141 (29.8%) vs 181/826 (21.9%), adjusted odds ratio (OR) 1.53 (95% CI 1.02 to 2.29), P < .05). Patients with RFS also had an increased risk for ICU admission (6/141 (4.3%) vs 13/826 (1.6%), adjusted OR 2.71 (95% CI 1.01 to 7.27), P < .05) and longer mean length of hospital stays (10.5 ±â€Š6.9 vs 9.0 ±â€Š6.6 days, adjusted difference 1.57 days (95% CI 0.38-2.75), P = .01). CONCLUSION: A relevant proportion of medical inpatients with malnutrition develop features of RFS upon hospital admission, which is associated with long-term mortality and other adverse clinical outcomes. Further studies are needed to develop preventive strategies for RFS in this patient population.


Assuntos
Pacientes Internados/estatística & dados numéricos , Desnutrição/mortalidade , Apoio Nutricional/efeitos adversos , Síndrome da Realimentação/mortalidade , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Desnutrição/terapia , Pessoa de Meia-Idade , Razão de Chances , Estudos Prospectivos , Síndrome da Realimentação/etiologia , Fatores de Risco , Taxa de Sobrevida
3.
Rev Med Suisse ; 15(670): 2046-2051, 2019 Nov 06.
Artigo em Francês | MEDLINE | ID: mdl-31696680

RESUMO

Stroke is the most common acute neurological disease in the world. Approximately 16 000 strokes occur each year in Switzerland. In the older population, the stroke outcomes are related to high risk of malnutrition due to neurological deficits impacting oral feeding. Therefore, systematic screening of malnutrition is required upon admission to hospital. Then, assessment of the nutritional status by a specialist should be initiated before deciding on individualised nutritional strategy. Rehabilitation is complex and must be done in multidisciplinary team to provide optimal care to the patients.


Assuntos
Desnutrição/etiologia , Desnutrição/terapia , Avaliação Nutricional , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral/complicações , Idoso , Hospitalização , Humanos , Desnutrição/diagnóstico , Estado Nutricional , Acidente Vascular Cerebral/epidemiologia , Suíça/epidemiologia
4.
Surg Clin North Am ; 99(6): 1083-1094, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31676049

RESUMO

Patients with ulcerative colitis and Crohn's disease often present to surgery malnourished and on combination immunosuppression. These factors affect operation selection and postoperative outcomes. Corticosteroids have a well-established detrimental effect on postoperative outcomes, whereas the impact of biologic agents is more controversial. In a patient exposed to these medications, and in the presence of other risk factors, temporary intestinal diversion is likely the best choice. Enteral nutrition may help optimize malnourished patients at high risk of adverse postoperative outcomes.


Assuntos
Corticosteroides/uso terapêutico , Produtos Biológicos/uso terapêutico , Colectomia/métodos , Colite Ulcerativa/tratamento farmacológico , Doença de Crohn/tratamento farmacológico , Progressão da Doença , Tomada de Decisão Clínica , Colite Ulcerativa/diagnóstico , Colite Ulcerativa/cirurgia , Doença de Crohn/diagnóstico , Doença de Crohn/cirurgia , Nutrição Enteral/métodos , Feminino , Humanos , Imunossupressores/uso terapêutico , Doenças Inflamatórias Intestinais/tratamento farmacológico , Doenças Inflamatórias Intestinais/cirurgia , Masculino , Desnutrição/terapia , Período Pré-Operatório , Prognóstico , Resultado do Tratamento
5.
Endocrinol. diabetes nutr. (Ed. impr.) ; 66(9): 555-562, nov. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-184378

RESUMO

Introducción: La prevalencia de la desnutrición relacionada con la enfermedad en el hospital varía del 20 al 50%. La utilización de herramientas de cribado debe ser el primer paso en la prevención y el tratamiento de los pacientes en riesgo de desnutrición o desnutridos. Objetivos: Implantar un método de cribado nutricional al ingreso en el ámbito de un hospital terciario. Métodos: La Unidad de Nutrición elaboró un protocolo de detección precoz del riesgo nutricional y eligió el NRS 2002 como herramienta de cribado. El protocolo fue aprobado por la Comisión de Protocolos y Procedimientos del hospital y difundido en la intranet. El NRS 2002 se incluyó en el programa de prescripción de dietas para su realización por parte del personal de enfermería de las unidades de hospitalización y como sistema de comunicación directo con la Unidad de Nutrición. Se diseñaron 3 fases para la implantación: fase de pilotaje, fase de implantación y fase de consolidación. Resultados: En la fase de pilotaje se implantó el NRS 2002 en 2 unidades de hospitalización para monitorizar el software. La fase de implantación se realizó en las mismas unidades y se verificaron todos los protocolos de actuación relacionados con el mismo. La fase de consolidación consistió en ir ampliando sucesivamente las unidades de hospitalización con el protocolo implantado. Conclusiones: La implantación de un cribado nutricional al ingreso hospitalario es un proceso largo y complejo, con la implicación de muchos estamentos. El programa informático ha posibilitado que la realización del mismo sea rápido, sencillo y automatizado, y que el resultado del cribado llegue inmediatamente al personal de enfermería de la unidad de Nutrición y se activen los protocolos de actuación de la misma


Introduction: Prevalence of disease-related malnutrition in hospitals ranges from 20%-50%. Use of nutritional screening tools should be the first step in the prevention and treatment of patients at risk of malnutrition and/or undernourished. Aims: To implement a nutritional screening tool at admission to a tertiary hospital. Methods: The nutrition unit prepared a protocol for early detection of nutritional risk and selected the NRS 2002 as screening tool. The protocol was approved by the hospital committee of protocols and procedures and disseminated through the intranet. NRS 2002 was included in the diet prescription software to be implemented by the nursing staff of the hospital wards and as a direct communication system with the nutrition unit. Three phases were designed: pilot phase, implementation phase, and consolidation phase. Results: The pilot phase, NRS 2002 was implemented in 2 hospital units to monitor software. The implementation phase was carried out in the same units, and all action protocols related to it were verified. The consolidation phase consisted of sequential extension of the protocol to the other hospital units. Conclusions: Implementation of nutritional screening at hospital admission is a long and complex process that requires involvement of many stakeholders. Computer software has allowed for a rapid, simple, and automatic process, so that the results of the screening are immediately available to the nursing staff of the nutrition unit and activate the nutritional protocols when required


Assuntos
Humanos , Idoso , Desnutrição/prevenção & controle , Desnutrição/terapia , Diagnóstico Precoce , Hospitais Universitários , Desnutrição/diagnóstico , Programas de Triagem Diagnóstica/normas , Indicadores de Morbimortalidade , Tempo de Internação
6.
Rev Lat Am Enfermagem ; 27: e3198, 2019 Oct 14.
Artigo em Português, Inglês, Espanhol | MEDLINE | ID: mdl-31618391

RESUMO

OBJECTIVE: to evaluate the clinical and nutritional evolution of elderly patients receiving home enteral nutritional therapy. METHOD: retrospective cohort observational study. Data collection was performed through the analysis of clinical and nutritional records. The demographic, nutritional and clinical variables were analyzed. The sample consisted of elderly patients using home enteral nutritional therapy via the probe or the stomach. For the statistical analysis, the Statistical Package for the Social Sciences program was used, adopting the level of significance of 5%. RESULTS: the sample was 218 participants, with a mean age of 76 ± 10.12 years, of which 54.1% were female. The main morbidity was the stroke sequelae. Malnutrition was the nutritional diagnosis and the overall subjective assessment, the main instrument of nutritional evaluation. The route of administration of the most prevalent diet was the nasoenteric/nasogastric tube, however, after one year of follow-up, gastrostomy became the main route. It was observed the predominance of general condition maintenance and the most prevalent clinical outcome was death. CONCLUSION: the majority of patients in home enteral nutrition therapy presented maintenance and / or improvement of clinical and nutritional status. Therefore, this therapy may contribute to a better clinical and nutritional evolution.


Assuntos
Nutrição Enteral/estatística & dados numéricos , Serviços de Assistência Domiciliar/estatística & dados numéricos , Estado Nutricional , Acidente Vascular Cerebral/terapia , Idoso , Idoso de 80 Anos ou mais , Feminino , Gastrostomia/estatística & dados numéricos , Avaliação Geriátrica/estatística & dados numéricos , Humanos , Intubação Gastrointestinal/estatística & dados numéricos , Masculino , Desnutrição/terapia , Estudos Retrospectivos , Resultado do Tratamento
7.
Ned Tijdschr Geneeskd ; 1632019 09 13.
Artigo em Holandês | MEDLINE | ID: mdl-31556503

RESUMO

Optimal nutrition is an important condition for optimal recovery from illness, both in and outside the hospital setting. In addition, in developed countries hospital-related malnutrition remains a major problem which can lead to complications, longer hospital stays and increased costs. The EFFORT study investigated if individualised nutritional support targeted at reaching protein and caloric goals, would reduce the risk of adverse outcomes. Achieving optimal nutrition is difficult due to illness-induced anorexia, inadequate education of medical doctors and little financial incentive. Guidelines focus on protein and energy, negating those illness-induced anorexia and individual patient aspects such as taste, portion size and eating habits. Although the EFFORT study showed benefit on the composite and individual endpoints, we should point out that the intervention group received standard care. Malnutrition needs multidisciplinary and transmural care including physiotherapy/exercise. As such, a more holistic approach is needed; optimal care as described by the EFFORT study should be the standard.


Assuntos
Hospitalização , Desnutrição/terapia , Apoio Nutricional , Proteínas na Dieta/administração & dosagem , Ingestão de Energia , Humanos , Desnutrição/complicações , Desnutrição/etiologia , Estado Nutricional , Apoio Nutricional/métodos , Assistência Centrada no Paciente
9.
Zhen Ci Yan Jiu ; 44(6): 451-3, 2019 Jun 25.
Artigo em Chinês | MEDLINE | ID: mdl-31368271

RESUMO

OBJECTIVE: To investigate the clinical effect of acupuncture at Sifeng (EX-UE10) combined with Wang's Baochi Pills in the treatment of pediatric malnutrition, so as to provide a more effective method for pediatric malnutrition. METHODS: A total of 201 children with malnutrition were randomly divided into combined treatment group (n=102) and control (Baochi Pill) group (n=99). The children in the combined treatment group were treated by acupuncture stimulation of Sifeng (EX-UE10, till no more yellowish-white effusion out) and oral administration of Wang's Baochi Pills, and those in the control group treated by oral administration of Wang's Baochi Pills only. The course of treatment was one month for both groups. The integral score of symptom was assessed according to the main symptoms as body weight and height and food-intake, and to the secondary symptoms including mentality, agitation, sleep, hair gloss, susceptibility to cold, hydrosis, abdominal distension, and susceptibility to diarrhea or constipation. The therapeutic effect was assessed by consulting the "Criteria for Diagnosis and Therapeutic Effect Evaluation of Syndromes/Illnesses of Traditional Chinese Medicine (TCM)" and "TCM Professional Criteria of the People's Republic of China for Diagnosis and Therapeutic Effect Evaluation of Syndromes/Diseases of TCM Pediatric". RESULTS: After the treatment, the total symptom scores of both groups were significantly decreased in comparison with their own pre-treatment (P<0.05), and the scores of total symptom after the treatment and the 1st, 2nd and 3rd follow-up surveys were obviously lower in the combined treatment group than in the control group (P<0.05). Of the 99 and 102 cases in the control and combined treatment groups, 47 and 59 were cured, 39 and 37 experienced improvement in their symptoms, and 13 and 6 failed, with the effective rate being 86.87% (86/99) and 94.11%(96/102), respectively. The effective rate of the combined treatment was evidently higher than that of the simple medication (P<0.05). CONCLUSION: Acupuncture of Sifeng (EX-UE10) combined with Wang's Baochi Pills is better than administration of Wang's Baochi Pills alone in the therapeutic effect for pediatric malnutrition.


Assuntos
Terapia por Acupuntura , Desnutrição , Administração Oral , Criança , China , Humanos , Desnutrição/terapia , Medicina Tradicional Chinesa
10.
BMC Public Health ; 19(1): 962, 2019 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-31319828

RESUMO

BACKGROUND: India faces a high burden of child undernutrition. We evaluated the effects of two community strategies to reduce undernutrition among children under 3 years in rural Jharkhand and Odisha, eastern India: (1) monthly Participatory Learning and Action (PLA) meetings with women's groups followed by home visits; (2) crèches for children aged 6 months to 3 years combined with monthly PLA meetings and home visits. METHODS: We tested these strategies in a non-randomised, controlled study with baseline and endline cross-sectional surveys. We purposively selected five blocks of Jharkhand and Odisha, and divided each block into three areas. Area 1 served as control. In Area 2, trained local female workers facilitated PLA meetings and offered counselling to mothers of children under three at home. In Area 3, workers facilitated PLA meetings, did home visits, and crèches with food and growth monitoring were opened for children aged 6 months to 3 years. We did a census across all study areas and randomly sampled 4668 children under three and their mothers for interview and anthropometry at baseline and endline. The evaluation's primary outcome was wasting among children under three in areas 2 and 3 compared with area 1, adjusted for baseline differences between areas. Other outcomes included underweight, stunting, preventive and care-seeking practices for children. RESULTS: We interviewed 83% (3868/4668) of mothers of children under three sampled at baseline, and 76% (3563/4668) at endline. In area 2 (PLA and home visits), wasting among children under three was reduced by 34% (adjusted Odds Ratio [aOR]: 0.66, 95%: 0.51-0.88) and underweight by 25% (aOR: 0.75, 95% CI: 0.59-0.95), with no change in stunting (aOR: 1.23, 95% CI: 0.96-1.57). In area 3, (PLA, home visits, crèches), wasting was reduced by 27% (aOR: 0.73, 95% CI: 0.55-0.97), underweight by 40% (aOR: 0.60, 95% CI: 0.47-0.75), and stunting by 27% (aOR: 0.73, 95% CI: 0.57-0.93). CONCLUSIONS: Crèches, PLA meetings and home visits reduced undernutrition among children under three in rural eastern India. These interventions could be scaled up through government plans to strengthen home visits and community mobilisation with Accredited Social Health Activists, and through efforts to promote crèches. TRIAL REGISTRATION: The evaluation was registered retrospectively with Current Controlled Trials as ISCRTN89911047 on 30/01/2019.


Assuntos
Transtornos da Nutrição Infantil/terapia , Aconselhamento/métodos , Desnutrição/terapia , Educação de Pacientes como Assunto/métodos , Mulheres/psicologia , Adulto , Transtornos da Nutrição Infantil/epidemiologia , Transtornos da Nutrição Infantil/psicologia , Pré-Escolar , Estudos Transversais , Feminino , Visita Domiciliar , Humanos , Índia/epidemiologia , Lactente , Masculino , Desnutrição/epidemiologia , Desnutrição/psicologia , Mães/psicologia , Ensaios Clínicos Controlados não Aleatórios como Assunto , Aceitação pelo Paciente de Cuidados de Saúde , População Rural
11.
Medicine (Baltimore) ; 98(27): e16290, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31277161

RESUMO

Patients who become malnourished during hospitalization because of illness or treatment often receive intervention from a nutrition support team (NST). The NST intervention not only enhances the nutritional status but also decreases medical expenses and catheter-related complications. However, the impact of the NST intervention on the home discharge of hospitalized community-dwelling older adults remains unclear. Hence, this study aims to investigate factors related to home discharge in malnourished community-dwelling older adults.In this retrospective longitudinal cohort study, examined 191 community-dwelling older adults aged ≥65 years (108 males; mean age: 80.9 ±â€Š7.8 years) who received the NST intervention. All participants were categorized into two groups based on whether they were home discharged or not (home discharge group and non-home discharge group). We performed intergroup comparisons using serum albumin (Alb) as an index of the nutritional status and functional independence measure (FIM: motor and cognitive items) as an index of activities of daily living (ADL). Furthermore, we constructed a prognostic model of home discharge using the logistic regression analysis.The home discharge group had 94 participants, with a home discharge rate of 50.8%. Baseline body mass index (BMI), motor-FIM score, and cognitive-FIM score were significantly higher in the home discharge group compared with the non-home discharge group (P = .002, P < .001, P < .001, respectively). In the home discharge group, BMI declined significantly, Alb elevated significantly, and both motor-FIM and cognitive-FIM score enhanced significantly by the completion of the NST intervention (P < .001, P < .001, P < .001, P = .005, respectively). The adjusted logistic regression analysis extracted the baseline BMI (odds ratio [OR], 1.146; 95% confidence interval [CI]: 1.034-1.270), baseline motor-FIM score (OR, 1.070; 95% CI: 1.036-1.105), and extent of change in the motor-FIM score (OR, 1.061; 95% CI: 1.026-1.098) as independent factors that predict home discharge.This study highlights the significance of higher baseline BMI, higher baseline ADL level, ADL enhancements, and improvements in the nutritional status by the NST intervention in malnourished community-dwelling older adults considering home discharge.


Assuntos
Atividades Cotidianas , Desnutrição/terapia , Estado Nutricional , Apoio Nutricional/métodos , Alta do Paciente/tendências , Recuperação de Função Fisiológica/fisiologia , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Masculino , Desnutrição/fisiopatologia , Prognóstico , Estudos Retrospectivos
12.
Bone Joint J ; 101-B(7_Supple_C): 17-21, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31256648

RESUMO

AIMS: To date, no study has demonstrated an improvement in postoperative outcomes following elective joint arthroplasty with a focus on nutritional intervention for patients with preoperative hypoalbuminaemia. In this prospective study, we evaluated differences in the hospital length of stay (LOS), rate of re-admission, and total patient charges for a malnourished patient study population who received a specific nutrition protocol before surgery. PATIENTS AND METHODS: An analytical report was extracted from the electronic medical record (EMR; Epic, Verona, Wisconsin) of a five-hospital network joint arthroplasty patient data set between 2014 and 2017. A total of 4733 patients underwent joint arthroplasty and had preoperative measurement of albumin levels: 2220 at four hospitals and 2513 at the study hospital. Albumin ≤ 3.4 g/l, designated as malnutrition, was found in 543 patients (11.5%). A nutritional intervention programme focusing on a high-protein, anti-inflammatory diet was initiated in January 2017 at one study hospital. Hospital LOS, re-admission rate, and 90-day charges were compared for differential change between patients in study and control hospitals for all elective hip and knee arthroplasty patients, and for malnourished patients over time as the nutrition intervention was implemented. RESULTS: Malnourished patients with nutritional intervention at the study hospital had shorter hospital LOS beginning in 2017 than malnourished patients at control hospitals during the same period (p = 0.04). Similarly, this cohort had significantly lower primary hospitalization charges, charges associated with hospital re-admissions, and 90-day total charges (p < 0.001). Inclusion of covariant potential confounders (age, anaemia, diabetes, and obesity) did not alter the conclusions of the primary statistical analysis. CONCLUSION: Joint arthroplasty outcomes were positively affected in study patients with low albumin when a high-protein, anti-inflammatory diet was encouraged. Elective surgery was neither cancelled nor delayed with a malnutrition designation. While the entire network population experienced improved postoperative outcomes, malnourished control patients did not experience this improvement. This study demonstrated that education on malnutrition can benefit patients. Cite this article: Bone Joint J 2019;101-B(7 Supple C):17-21.


Assuntos
Artroplastia de Quadril/métodos , Artroplastia do Joelho/métodos , Procedimentos Cirúrgicos Eletivos/métodos , Desnutrição/complicações , Estado Nutricional , Apoio Nutricional/métodos , Osteoartrite/cirurgia , Idoso , Feminino , Seguimentos , Humanos , Tempo de Internação/tendências , Masculino , Desnutrição/terapia , Pessoa de Meia-Idade , Osteoartrite/complicações , Alta do Paciente/tendências , Período Pós-Operatório , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
13.
Nutrients ; 11(7)2019 Jun 27.
Artigo em Inglês | MEDLINE | ID: mdl-31252674

RESUMO

Modulation of the human gut microbiota through probiotics, prebiotics and dietary fibre are recognised strategies to improve health and prevent disease. Yet we are only beginning to understand the impact of these interventions on the gut microbiota and the physiological consequences for the human host, thus forging the way towards evidence-based scientific validation. However, in many studies a percentage of participants can be defined as 'non-responders' and scientists are beginning to unravel what differentiates these from 'responders;' and it is now clear that an individual's baseline microbiota can influence an individual's response. Thus, microbiome composition can potentially serve as a biomarker to predict responsiveness to interventions, diets and dietary components enabling greater opportunities for its use towards disease prevention and health promotion. In Part I of this two-part review, we reviewed the current state of the science in terms of the gut microbiota and the role of diet and dietary components in shaping it and subsequent consequences for human health. In Part II, we examine the efficacy of gut-microbiota modulating therapies at different life stages and their potential to aid in the management of undernutrition and overnutrition. Given the significance of an individual's gut microbiota, we investigate the feasibility of microbiome testing and we discuss guidelines for evaluating the scientific validity of evidence for providing personalised microbiome-based dietary advice. Overall, this review highlights the potential value of the microbiome to prevent disease and maintain or promote health and in doing so, paves the pathway towards commercialisation.


Assuntos
Bactérias/crescimento & desenvolvimento , Microbioma Gastrointestinal , Intestinos/microbiologia , Desnutrição/microbiologia , Estado Nutricional , Hipernutrição/microbiologia , Fatores Etários , Animais , Bactérias/metabolismo , Fibras na Dieta/administração & dosagem , Feminino , Interações Hospedeiro-Patógeno , Humanos , Expectativa de Vida , Masculino , Desnutrição/fisiopatologia , Desnutrição/terapia , Hipernutrição/fisiopatologia , Hipernutrição/terapia , Prebióticos/administração & dosagem , Probióticos/administração & dosagem
14.
Afr Health Sci ; 19(1): 1566-1573, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31148985

RESUMO

Background: Nationwide studies have focused only on prevalence of malnutrition in hospitalized children, while medical nutrition therapies and assessing nutritional interventions is neglected. Methods: This research was conducted in tertiary level children hospitals in the NorthEastern region of Iran for 1 year from 2016 to 2017. Five questions were included in the initial assessment form and, if there was even one positive response, nutritional interventions were prescribed for the patients. Results: A total of 65 children aged ≥ 5 years and hospitalized for ≥ two days were included. 24.6% of patients had 2 >BMI Z-score>-2 at time of admission. At the beginning of the study, weight loss more than 10%, and appetite loss or decreased food intake was observed in 10.8% and 20% of the study population, respectively. Median BMI percentile of patients with nutritional intervention was 8.9 (0.1-98.7) at the beginning of the study and 12.7 (0.1-98.4) at discharge time which shows a significant difference (P=0.01). Conclusion: Medical nutrition therapy employed in this study prevented deterioration of nutritional status of children during hospitalization and was effective in stabilizing indices of nutritional status.


Assuntos
Desnutrição/diagnóstico , Desnutrição/terapia , Programas de Rastreamento/métodos , Terapia Nutricional/métodos , Adolescente , Índice de Massa Corporal , Criança , Pré-Escolar , Estudos Transversais , Feminino , Hospitalização , Humanos , Irã (Geográfico)/epidemiologia , Tempo de Internação , Masculino , Desnutrição/epidemiologia , Avaliação Nutricional , Estado Nutricional
15.
Nutrients ; 11(6)2019 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-31146408

RESUMO

Those with peripheral arterial disease (PAD) require important considerations with respect to food and nutrition, owing to advanced age, poor diet behaviours and immobility associated with the disease process and co-morbid state. These considerations, coupled with the economic effectiveness of medical nutrition therapy, mandate that dietetic care plays a vital role in the management of PAD. Despite this, optimising dietetic care in PAD remains poorly understood. This narrative review considers the role of medical nutrition therapy in every stage of the PAD process, ranging from the onset and initiation of disease to well established and advanced disease. In each case, the potential benefits of traditional and novel medical nutrition therapy are discussed.


Assuntos
Desnutrição/terapia , Terapia Nutricional/métodos , Doença Arterial Periférica/terapia , Comportamento de Redução do Risco , Humanos , Desnutrição/diagnóstico , Desnutrição/epidemiologia , Desnutrição/fisiopatologia , Estado Nutricional , Valor Nutritivo , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/epidemiologia , Doença Arterial Periférica/fisiopatologia , Fatores de Proteção , Recomendações Nutricionais , Medição de Risco , Fatores de Risco , Resultado do Tratamento
16.
Nutr Hosp ; 36(Spec No2): 38-43, 2019 Jul 01.
Artigo em Espanhol | MEDLINE | ID: mdl-31189320

RESUMO

Introduction: Heart failure (HF), chronic obstructive pulmonary disease (COPD), and most chronic diseases are associated with mild to moderate chronic or recurrent inflammation. This inflammation contributes to malnutrition through different mechanisms: anorexia, decreased intake, alteration of metabolism with increased energy expenditure at rest and increased muscle catabolism. The decrease in lean mass has been included as a phenotypic criterion in the recently coined definition of malnutrition. In addition, a greater importance is given to the evaluation of the function, together with that of the morphological parameters. The grip strength, measured with a manual dynamometer and compared to reference populations, is a simple measure of muscle strength and correlates with the strength of the legs. On the other hand, the so-called "paradox of obesity" occurs in both patients with HF and COPD, since overweight and obese patients have lower overall mortality than patients with normal or low body mass index (BMI). The nutritional treatment, with an adequate contribution of macro and micronutrients and a contribution of proteins of fast absorption, with a higher content of leucine or its metabolite ß-hydroxy-ß-methylbutyrate, seems to offer a benefit in the preservation of muscle mass and its functionality in the patient with cardiorespiratory pathology. Nutritional treatment, associated with a pulmonary or cardiac rehabilitation regimen, is essential to obtain good morphological and functional results.


Assuntos
Insuficiência Cardíaca/terapia , Doença Pulmonar Obstrutiva Crônica/terapia , Adulto , Idoso , Insuficiência Cardíaca/fisiopatologia , Humanos , Desnutrição/complicações , Desnutrição/terapia , Pessoa de Meia-Idade , Força Muscular , Terapia Nutricional , Estado Nutricional , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Recuperação de Função Fisiológica
17.
Nutr Hosp ; 36(Spec No2): 44-49, 2019 Jul 01.
Artigo em Espanhol | MEDLINE | ID: mdl-31189321

RESUMO

Introduction: The efficient management of health services requires obtaining the highest level of health possible with the available resources. The health economy has developed in recent years under the pressure of a more demanding population, older and with more comorbidities, in an environment of limited resources and greater financing difficulties. The Economics of Nutrition was born as a new discipline that addresses aspects related to the role of economics and nutrition in the health of healthy and sick populations. The economic analyzes are part of the evaluation tools for health interventions. Cost-effectiveness studies are the most frequently used. Cost-effectiveness studies have shown that the use of oral nutritional supplements offer clinical advantages for undernourished patients (reduction of morbidity and mortality) and economic benefits for the system (reduction of hospital stay, lower re-entry rates and cost savings). Oral nutritional supplementation in the integral recovery of the patient with malnutrition related to the disease is cost effective.


Assuntos
Desnutrição/economia , Desnutrição/terapia , Neoplasia Residual/terapia , Terapia Nutricional/economia , Adulto , Idoso , Idoso de 80 Anos ou mais , Redução de Custos , Análise Custo-Benefício , Suplementos Nutricionais , Humanos , Desnutrição/complicações , Pessoa de Meia-Idade , Apoio Nutricional
18.
Gerokomos (Madr., Ed. impr.) ; 30(2): 67-71, jun. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-183944

RESUMO

Objetivos: Mejorar el estado nutricional del paciente institucionalizado y evaluar la intervención de un soporte nutricional adecuado. Metodología: Estudio cuasi experimental, con diseño pre-post en un único grupo de residentes en la Residencia San Llorenç de Vila-real (Castellón). Para determinar el estado nutricional del residente se utilizaron la escala Mini-Nutritional Assessment II y los parámetros antropométricos y analíticos medidos antes y después de la aplicación de la guía de práctica clínica. Resultados: En el presente estudio se confirma que existen diferentes factores de riesgo para la desnutrición en las personas mayores y que esta puede ser tratada de forma precoz y efectiva si se lleva a cabo una buena valoración nutricional detectando estos factores de riesgo. Conclusiones: Podemos afirmar que los suplementos nutricionales orales son la mejor medida frente a la desnutrición, ya que los parámetros analíticos y antropométricos mejoran de forma favorable, por lo que se trata de una medida justificada y efectiva


Objetive: Improving the nutritional status of the institutionalized patient and evaluate the intervention of adequate nutritional support. Methodology: A quasi experimental study with pre-post design in a unique group of residents in the Residencia San Llorenç of Vila-real (Castellón). Using to determine the nutritional status of the resident the Mini Nutritional Assessment II scale and and the analytical and anthropometric parameters measured before and after the application of the practical guideline. Results: In the present study confirmed that different risk factors exist for the malnutrition in the elderly and it can be treated early and effectively if it takes place a good nutritional assessment detecting this risk factors. Conclusions: We can say that oral nutritional supplements are the best measure front malnutrition since analytical and anthropometric parameters improve favorably, therefore, it's a justified and effective measure


Assuntos
Humanos , Idoso , Saúde do Idoso Institucionalizado , Desnutrição/terapia , Estado Nutricional , Fatores de Risco , Disfunção Cognitiva , Apoio Nutricional , Análise de Dados , Antropometria
19.
PLoS One ; 14(5): e0216415, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31048884

RESUMO

BACKGROUND AND AIMS: Malnutrition and inflammation are closely linked to vascular calcification (VC), the severity of which correlate with adverse outcome. However, there were few studies on the interplay between malnutrition, inflammation and VC progression, rather than VC presence per se. We aimed to determine the relationship of malnutrition, inflammation, abdominal aortic calcification (AAC) progression with survival in hemodialysis (HD) patients. METHODS: Malnutrition and inflammation were defined as low serum albumin (< 40 g/L) and high hs-CRP (≥ 28.57 nmol/L), respectively. We defined AAC progression as an increase in AAC score using lateral lumbar radiography at both baseline and one year later. Patients were followed up to investigate the impact of AAC progression on all-cause and cardiovascular mortality. RESULTS: AAC progressed in 54.6% of 97 patients (mean age 58.2±11.7 years, 41.2% men) at 1-year follow-up. Hypoalbuminemia (Odds ratio 3.296; 95% confidence interval 1.178-9.222), hs-CRP (1.561; 1.038-2.348), low LDL-cholesterol (0.976; 0.955-0.996), and the presence of baseline AAC (10.136; 3.173-32.386) were significant risk factors for AAC progression. During the mean follow-up period of 5.9 years, 38(39.2%) patients died and 27(71.0%) of them died of cardiovascular disease. Multivariate Cox regression analysis adjusted for old age, diabetes, cardiovascular history, and hypoalbuminemia determined that AAC progression was an independent predictor of all-cause mortality (2.294; 1.054-4.994). CONCLUSIONS: Malnutrition and inflammation were significantly associated with AAC progression. AAC progression is more informative than AAC presence at a given time-point as a predictor of all-cause mortality in patients on maintenance HD.


Assuntos
Aorta Abdominal/diagnóstico por imagem , Desnutrição , Diálise Renal , Calcificação Vascular , Adulto , Idoso , Idoso de 80 Anos ou mais , Progressão da Doença , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Inflamação/diagnóstico por imagem , Inflamação/mortalidade , Inflamação/terapia , Masculino , Desnutrição/complicações , Desnutrição/diagnóstico por imagem , Desnutrição/mortalidade , Desnutrição/terapia , Pessoa de Meia-Idade , Estudos Prospectivos , Taxa de Sobrevida , Calcificação Vascular/diagnóstico por imagem , Calcificação Vascular/etiologia , Calcificação Vascular/mortalidade , Calcificação Vascular/terapia
20.
Zhonghua Wai Ke Za Zhi ; 57(5): 331-336, 2019 May 01.
Artigo em Chinês | MEDLINE | ID: mdl-31091586

RESUMO

It is well known that parenteral and enteral nutrition support is helpful to improve clinical outcomes in patients with malnutrition or nutritional risk, and surgical nutrition has been used in China for 40 years. However, there is still insufficient awareness of malnutrition among clinical workers. There were different opinions from many experts after the publications of the European Society for Parenteral and Enteral Nutrition (ESPEN) consensus of malnutrition assessment 2015 and ESPEN guidelines on definitions and terminology of clinical nutrition 2017. Global Leadership Initiative on Malnutrition (GLIM) criteria for the diagnosis of malnutrition has also been published in 2018. Though it is lack of clinical validation, it is a big step forward. In order to achieve better prevention and treatment of malnutrition in clinical work, this present paper analyzes and compares the core contents of malnutrition assessment (diagnosis) in recent years, proposes current practical strategy for Chinese clinical workers, emphasizes that GLIM criteria cannot replace the three steps named "screening-assessment-intervention" .


Assuntos
Desnutrição/diagnóstico , Desnutrição/terapia , Avaliação Nutricional , China , Pessoal de Saúde , Humanos , Estado Nutricional
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