Nutritional profile of cancer patients treated at an outpatient oncology center in the south region of Brazil

To evaluate the nutritional profile of cancer patients treated at an oncology center in South Brazil.This is a descriptive, exploratory and sectional study that was developed in a process that involved 100 patients aged between 18 and 75 years old, suffering from cancer.The anthropometric variables studied were weight, height, Body Mass Index (BMI), arm circumference (AC), arm muscle circumference (AMC),triceps skinfold (TSF) and corrected arm muscle area (cAMA). For subjective nutritional assessment, we used the Patient-Generated Subjective Global Assessment (PG-SGA). Nearly half of the patients evaluated had a critical need for nutritional intervention. There was a statistically significant association between cAMA and marital status, age and gender; between AC and age, gender and staging; between AMC and staging; between BMI and marital status and age; and between TSF and marital status. Patients diagnosed with IV stage had the lowest values for nutritional variables. There was no significant association between nutritional status of patients obtained by the PG-SGA instrument and sociodemographic characteristics. Malnutrition should be diagnosed as soon as possible,aiming at early intervention and improving survival and quality of life. Therefore, early nutritional assessment in cancer patients is required, combining subjective and objective methods.

Programa Nutricional: Informe de la situación nutricional de población atendida en centros de salud nivel 1: año 2021 / Status report nutritional population attended in Level 1 Health Centres: Year 2021

En este informe se presenta la situación nutricional de la población menor de 19 años, adultos/as y embarazadas atendidas en los Centros de Salud Nivel 1 (CESACs) durante el período 2021. Esta sistematización ha sido elaborada a partir de los datos brindados por la Gerencia Operativa de Gestión de Información y Estadísticas de Salud (Dirección General de Sistemas de Información Sanitaria) de la Sub-Secretaría de Planificación Sanitaria del Ministerio de Salud del GCBA. El propósito de este Informe es facilitar el acceso a datos consolidados sobre la situación nutricional de la población atendida en el primer nivel de atención, de manera que los equipos de salud puedan disponer y compartir información correspondiente a sus áreas de trabajo y al conjunto de la Ciudad, y planificar acciones acordes al perfil epidemiológico-nutricional. (AU)

Diagnóstico nutricional de pessoas que vivem com HIV/AIDS: revisão de protocolos nacionais e internacionais / Nutritional diagnosis of people living with HIV/AIDS: a review of national and international protocols

Resumo A infecção pelo HIV é preditora de diversas alterações metabólicas e de composição corporal, além de quadro de desnutrição, anemia e hipovitaminoses. Existem assim, especificidades de diagnóstico e tratamento conforme o estágio da doença e o ambiente ambulatorial ou hospitalar. O objetivo desse trabalho é apresentar arcabouço teórico e conceitual sobre a realização do diagnóstico nutricional em pessoas que vivem com HIV/AIDS. Buscou-se evidências científicas atuais nacionais e internacionais publicadas em artigos científicos, livros recentes, protocolos, consensos e diretrizes. O diagnóstico nutricional engloba vários aspectos e habilidades clínicas e conhecimentos específicos sobre essa morbidade. Assim, devido sua complexidade e abrangência, compreende: história clínica e situação clínica atual, consumo alimentar, dados antropométricos, composição corporal, bioquímicos, pressão arterial e exame físico. Foi demonstrado o processo de diagnóstico nutricional de forma a fornecer subsídios para as equipes de saúde na identificação de parâmetros que possibilitem instituir um plano de cuidado nutricional que promova, previna e recupere as alterações detectadas nas pessoas que vivem com HIV/AIDS.

Abstract HIV infection is a predictor of several metabolic and body composition alterations, in addition to malnutrition, anemia, and hypovitaminosis. There are thus specificities of diagnosis and treatment depending on the stage of the disease and the outpatient or hospital environment. The scope of this narrative review was to update the conceptual and theoretical framework regarding the nutritional diagnosis of people living with HIV/AIDS. Current national and international scientific evidence published in scientific articles, recent books, protocols, consensuses, and guidelines were analyzed. The nutritional diagnosis encompasses several clinical aspects and abilities and specific knowledge about HIV/AIDS, such as: clinical history and current clinical situation, food consumption, anthropometric data, body composition, and biochemistry, blood pressure and physical examination. The nutritional diagnosis process was demonstrated in order to provide subsidies for the health teams in the identification of parameters that make it possible to establish a plan for nutritional care to promote, prevent and recuperate the alterations detected in people living with HIV/AIDS.

Discriminative power of an adapted version of Nutritional Risk Screening 2002 applied to Brazilian older adults / Poder diagnóstico discriminativo da versão adaptada do Nutritional Risk Screening 2002 administrada em idosos brasileiros

ABSTRACT Objective: To investigate the discriminative power of Nutritional Risk Screening 2002. Methods: A cross sectional study involving one hundred participants aged ≥60 years. The original and adapted versions of Nutritional Risk Screening 2002 and the Mini Nutritional Assessment were used. Nutritional Risk Screening 2002 adaptation consisted of a lower age cutoff (60 years or older) for addition of one extra point to the final score. Results: Screening using Nutritional Risk Screening 2002 revealed higher nutritional risk among patients aged ≥70 years (p=0.009), whereas screening using the adapted version of Nutritional Risk Screening 2002 revealed similar nutritional risk in both age groups (60-69 years and ≥70 years; p=0.117). Frequency of nutritional risk was highest when the Mini Nutritional Assessment was administered (52.7%), followed by the adapted and original versions of Nutritional Risk Screening 2002 (35.5% and 29.1%, respectively). Conclusion: The adapted version of Nutritional Risk Screening 2002 was more effective than the original version. However, further studies are needed to confirm these findings.

RESUMO Objetivo: Avaliar o poder de discriminação diagnóstica da ferramenta Nutritional Risk Screening 2002. Métodos: Estudo transversal com cem participantes com idade ≥60 anos. Foram aplicados o Nutritional Risk Screening 2002 original, o Nutritional Risk Screening 2002 adaptado e o Mini Nutritional Assessment. A adaptação do Nutritional Risk Screening 2002 consistiu em diminuir o critério de idade, incluindo pontuação adicional para 60 anos de idade ou mais. Resultados: Maior risco nutricional ocorreu nos ≥70 anos quando aplicado o Nutritional Risk Screening 2002 original (p=0,009), enquanto o Nutritional Risk Screening 2002 adaptado apresentou risco nutricional semelhante em ambos os grupos (60-69 anos e ≥70 anos; p=0,117). A frequência de risco nutricional foi maior no Mini Nutritional Assessment (52,7%), seguido do Nutritional Risk Screening 2002 adaptado (35,5%) e do Nutritional Risk Screening 2002 original (29,1%). Conclusão: A adaptação do Nutritional Risk Screening 2002 mostrou-se descritivamente mais eficaz do que a original, porém mais estudos devem ser realizados para confirmar os achados.

Informe de la situación nutricional de población atendida en Centros de Salud Nivel 1: Año 2019 / Status report nutritional population attended in Level 1 Health Centres Year 2019

Se presenta información referida a la situación nutricional de la población menor de 19 años, adultos/as y embarazadas atendidas en los Centros de Salud Nivel 1 (CESACs) durante el período 2019. El propósito de este Informe es facilitar el acceso a datos consolidados sobre la situación nutricional de la población atendida en el primer nivel de atención, de manera que los equipos de salud puedan disponer y compartir información correspondiente a sus áreas de trabajo y al conjunto de la Ciudad, y planificar acciones acordes al perfil epidemiológico-nutricional. (AU)

Determinación del estado nutricional mediante el ángulo de fase en pacientes en hemodiálisis / Determination of nutritional status by phase angle in hemodialysis patients

Resumen Introducción: La bioimpedancia eléctrica multifrecuencia (BIE) evalúa con precisión la composición corporal. Objetivo: Investigar el estado nutricional y su relación con el índice de masa corporal (IMC) o el ángulo fase obtenido por BIE en pacientes con enfermedad renal terminal (ERT) en hemodiálisis. Método: En 99 pacientes en hemodiálisis (43.6 ± 17.2 años, 58.8 % varones) se evaluó IMC, BIE y puntuación de desnutrición (DMS, Dialysis Malnutrition Score). La independencia de las asociaciones del IMC y el ángulo fase con el DMS se determinó con regresión lineal múltiple. Resultados: El riesgo de desnutrición (DMS > 13) se incrementó gradualmente entre los sujetos con IMC y ángulo fase normales (44.4 %), IMC bajo (45.8 %), ángulo fase bajo (64.0 %) y en aquellos con ambos parámetros anormales (68.0 %). El ángulo fase fue la única variable asociada independientemente con el estado nutricional de los pacientes (coeficiente beta estandarizado −0.372, p < 0.001), lo que explicó 13.8 % de la variación en el DMS. Conclusiones: El ángulo fase se asocia inversa e independientemente con el riesgo de desnutrición en pacientes con ERT, lo que sugiere que la composición corporal evaluada por BIE pudiera ser mejor que el IMC en la valoración clínica de pacientes con esta enfermedad.

Abstract Introduction: Multi-frequency bio-impedance analysis (BIA) accurately evaluates body composition. Objective: To assess nutritional status and its relationship with body mass index (BMI) or with BIA-obtained phase angle in patients with end-stage renal disease (ESRD) on hemodialysis. Method: BMI, BIA and dialysis malnutrition score (DMS) were assessed in 99 patients on hemodialysis (43.6 ± 17.2 years of age, 58.8% males). Multivariate linear regression analysis was used to determine BMI and phase angle independent associations with DMS. Results: Malnutrition risk (DMS > 13) showed a gradual increase among patients with normal BMI and phase angle (44.4%), low BMI (45.8%), low phase angle (64.0%), and in those with both parameters at abnormal ranges (68.0%). The phase angle was the only variable that was independently associated with patient nutritional status (standardized coefficient beta −0.372, p < 0.001), accounting for 13.8% of DMS variation. Conclusion: Phase angle is inversely and independently associated with malnutrition risk in patients with ESRD, which suggests that BIA-assessed body composition might be better than BMI in the clinical assessment of patients with ESRD.

Estudio comparativo del estado nutricional de niños y niñas residentes en cuatro partidos de la provincia de Buenos Aires (Argentina), en el marco de la transición nutricional / Comparative study of the nutritional status of children living in four counties of the province of Buenos Aires (Argentina), in the context of nutrition transition

RESUMEN El objetivo fue evaluar y comparar el estado nutricional en poblaciones infanto-juveniles residentes en cuatro partidos de la provincia de Buenos Aires y observar si existen diferencias vinculadas a los contextos ambientales y socioeconómicos particulares, en el marco de la transición nutricional. Entre los ciclos lectivos 2008-2012, se relevó el peso y la talla y se calculó el índice de masa corporal de 7.873 escolares, entre 4 y 12 años de edad, residentes en los partidos de La Plata, Brandsen, Magdalena y Punta Indio. La información acerca del contexto de residencia se obtuvo mediante encuesta estructurada y autoadministrada. Alrededor del 40% de los escolares presentó malnutrición, y prevalecieron el sobrepeso en La Plata, la obesidad en Punta Indio y la desnutrición en Magdalena. El estado nutricional se vinculó con las condiciones socioambientales de residencia y dio cuenta de que estas poblaciones se ubican en distintas etapas del proceso de transición nutricional.

ABSTRACT The aim of this study was to evaluate and compare the nutritional status of child populations living in four counties of the province of Buenos Aires to observe differences related to particular environmental and socioeconomic contexts in the framework of the nutrition transition. During the school years corresponding to the 2008-2012 period, weight and height were measured and body mass index was calculated for 7,873 school children between the ages of 4 and 12 years from the counties of La Plata, Brandsen, Magdalena and Punta Indio. Information about the contexts of residence was obtained using self-administered structured surveys. About 40% of schoolchildren presented malnutrition, with a prevalence of overweight in La Plata, obesity in Punta Indio and undernutrition in Magdalena. The nutritional status of the study populations was associated with the socioenvironmental conditions of residence, indicating that these populations are at different stages of the nutrition transition process.

The importance of dysphagia screening and nutritional assessment in hospitalized patients / Importância do rastreamento de disfagia e da avaliação nutricional em pacientes hospitalizados

ABSTRACT Objective: To determine frequency of dysphagia risk and associated factors in hospitalized patients as well as to evaluate nutritional status by using different methods and correlate the status with scores of the Eating Assessment Tool (EAT-10). Methods: This was a cross-sectional study including 909 inpatients of a philanthropic hospital. For the diagnosis of dysphagia we used an adapted and validated Brazilian version of the Eating Assessment Tool (EAT-10). The nutritional status was evaluated through the subjective global assessment, and anthropometric measurements included weight, calf and arm circumference, and knee height. The Mann-Whitney test, associations using the Pearson's χ2 and Spearman's correlation were used to verify differences between the groups. Results: The prevalence of dysphagia risk was 10.5%, and aging was the associated factor with this condition. Patients at risk presented lower values of arm and calf circumference, variables that correlated inversely with the Eating Assessment Tool (EAT-10) score. Malnutrition was observed in 13.2% of patients based on the subjective global assessment and in 15.2% based on the Body Mass Index. Conclusion: Screening for dysphagia and malnutrition should be introduced in hospitals routine to avoid or minimize damages caused by dysphagia or malnutrition, especially among older people.

RESUMO Objetivo: Verificar a prevalência do risco de disfagia e seus fatores associados em pacientes hospitalizados, bem como avaliar o estado nutricional por diferentes métodos e correlacioná-los à pontuação do Eating Assessment Tool (EAT-10). Métodos: Estudo de delineamento transversal, realizado com 909 pacientes internados em um hospital filantrópico. Para o rastreamento de disfagia, foi aplicado o Eating Assessment Tool (EAT-10) em sua versão adaptada para o Brasil. O diagnóstico nutricional foi realizado por meio da avaliação global subjetiva e pela aferição de medidas antropométicas. A diferença entre os grupos foi verificada pelo teste de Mann-Whitney e as associações, pelo χ2 de Pearson e correlação de Spearman. Resultados: A prevalência do risco de disfagia foi de 10,5%, sendo a faixa etária idosa um fator associado a esta condição. Pacientes em risco apresentaram valores inferiores de perímetro do braço e panturrilha, variáveis que se correlacionaram de forma inversa à pontuação do Eating Assessment Tool (EAT-10). A desnutrição foi identificada em 13,2% dos avaliados, segundo a avaliação global subjetiva, e em 15,2%, quando utilizado o índice de massa corporal. Conclusão: O rastreamento da disfagia e da desnutrição devem ser incorporados à rotina hospitalar, com o objetivo de evitar ou minimizar os prejuízos provocados por estas condições, especialmente nos idosos.

Diagnóstico nutricional en lactantes menores con cardiopatía congénita: comparación de dos clasificaciones antropométricas / Nutritional assessment in infants with congenital heart disease: comparison of two anthropometric classifications

INTRODUCCIÓN: Los niños con cardiopatía congénita (CC) presentan alto porcentaje de malnutrición por déficit, siendo difícil la interpretación de su estado nutricional. OBJETIVO: Describir el estado nutricional de lactantes con CC utilizando dos clasificaciones antropométricas y realizar una comparación entre ellas. PACIENTES Y MÉTODO: Estudio de cohorte no concurrente. Se estudiaron menores de 12 meses sometidos a cirugía de CC. Se excluyeron prematuros, pequeños para la edad gestacional, portadores de síndrome genético u otra enfermedad con compromiso nutricional. Se registraron datos demográficos, diagnóstico de CC, peso y talla de ingreso. Se realizó evaluación nutricional comparando estándares OMS según clasificación norma ministerial (CNM) y una Clasificación Antropométrica Integrada (CAI) que define desnutrición si (ZT/E)≤-2 y/o (ZP/T)≤-2, riesgo de desnutrición ZP/T entre -1 a -1,9, eutrofia ZP/T entre -0,9 a +0,9, sobrepeso entre +1 a +1,9 y obesidad ZP/T≥+2. RESULTADOS: Se incluyeron 387 intervenciones, 219 (56,6%) varones, mediana de edad 3,1 meses (RIC:0,4;6,4). Un 26,4% tenían talla baja. Utilizando CNM 55 sujetos presentaron dos diagnósticos por superposición de ZP/E y ZP/T, con CAI no hubo superposición. Al comparar CNM con CAI se encontró diferencia en desnutrición 28,9% versus 38,5%(p = 0,001), riesgo de des nutrición 27,4% versus 16,3%(p = 0,01) y obesidad 4,9% versus 3,3%(p = 0,03) respectivamente. Se encontró correlación entre ZP/E y ZP/T, r = 0,6(p < 0,001) y entre ZP/E y ZT/E, r = 0,6(p < 0,001). Conclusiones: Los niños con CC presentan alto porcentaje de desnutrición y talla baja. Utilizando las mismas mediciones antropométricas CAI no presentó superposición de diagnósticos y detectó más desnutrición. El P/E es útil como tamizaje, pero insuficiente en malnutrición crónica.

INTRODUCTION: Children with congenital heart disease (CHD) present a high percentage of undern utrition and the interpretation of their nutritional assessment is difficult. OBJECTIVE: To describe the nutritional status of infants with CHD using two anthropometric classifications and compare them. PATIENTS AND METHOD: Non-concurrent cohort study. We studied children under 12 months under going cardiac surgery. We excluded preterm infants, small for gestational age, carriers of genetic syndrome or other disease with nutritional compromise. Demographic data, type of CHD, weight and height were recorded. Nutritional assessment was performed using WHO standards per health ministry criteria (HMC) and per an Integrated Anthropometric Classification (IAC), which defines undernutrition if height-for-age Z-score (ZT/E)≤-2 and/or weight-for-height (ZP/T)≤-2, risk of un dernutrition as ZP/T between -1 to -1,9, normal as ZP/T between -0.9 to +0.9, overweight as ZP/T between +1 to +1.9 and obesity as ZP/T≥+2. RESULTS: 387 interventions were included, 219 (56.6%) were males, median age 3.1 months (IQR:0.4;6.4). A 26.4% presented short stature. Using HMC classification 55 subjects presented two diagnoses by overlap of ZP/E and ZP/T, although with IAC there was no overlap. Comparing HMC with IAC, a difference was found in undernutrition, 28.9% versus 38.5% (p = 0.001), risk of undernutrition 27.4% versus 16.3%(p = 0.01) and obesity 4.9% ver sus 3.3% (p = 0.03) respectively. Correlation was found between ZP/E and ZP/T, r = 0.6(p < 0.001) and between ZP/E and ZT/E, r = 0.6 (p < 0.001). CONCLUSIONS: Children with CHD have a high per centage of undernutrition and short stature. Using the same anthropometric measurements IAC did not present overlapping diagnoses and detected more undernutrition. P/E is useful as screening, but insufficient in chronic undernutrition.

Frecuencia de riesgo de desnutrición según la Escala de Tamizado para Desnutrición (MST) en un servicio de Medicina Interna / Screening for malnutrition among hospitalized patients in a Colombian University Hospital

Background: On admission, 30 to 50% of hospitalized patients have some degree of malnutrition, which is associated with longer length of stay, higher rates of complications, mortality and greater costs. Aim: To determine the frequency of screening for risk of malnutrition in medical records and assess the usefulness of the Malnutrition Screening Tool (MST). Material and Methods: In a cross-sectional study, we searched for malnutrition screening in medical records, and we applied the MST tool to hospitalized patients at the Internal Medicine Wards of San Ignacio University Hospital. Results: Of 295 patients included, none had been screened for malnutrition since hospital admission. Sixty one percent were at nutritional risk, with a higher prevalence among patients with HIV (85.7%), cancer (77.5%) and pneumonia. A positive MST result was associated with a 3.2 days increase in length of hospital stay (p = 0.024). Conclusions: The prevalence of malnutrition risk in hospitalized patients is high, but its screening is inadequate and it is underdiagnosed. The MST tool is simple, fast, low-cost, and has a good diagnostic performance.

Morbimortalidad asociada al estado nutricional y vía de alimentación en niños con parálisis cerebral / Morbimortality associated to nutritional status and feeding path in children with cerebral palsy

Introducción: Los niños y adolescentes con Parálisis Cerebral (PC) tienen elevada prevalencia de desnutrición, asociada a peor pronóstico. Para la adecuada evaluación nutricional existen nuevas curvas de crecimiento (Brooks y Col) que han planteado puntos de corte del índice Peso/Edad asociados a mayor morbimortalidad. Objetivo: Evaluar si pacientes con PC, en dicha categoría de riesgo nutricional (RN), presentan mayor riesgo de hospitalización y muerte. Pacientes y Método: Estudio observacional y prospectivo de una cohorte de pacientes con PC, controlados en un centro ambulatorio de referencia. Se registró: datos demográficos, socioeconómicos, evaluación funcional motora y nutricional basal. En seguimiento durante un año se constataron hospitalizaciones y mortalidad. Investigación aprobada por la comisión de ética. Resultados: Se reclutaron 81 niños con PC, edad 131,6 ± 60,4 meses (25-313), 60% de sexo masculino, 77,5% no se movilizaba por sí mismo. Los 23 pacientes con RN (28,4%), presentaban menor masa muscular y masa grasa (p = 0,000). Durante el año de seguimiento, 29 pacientes requirieron hospitalización (35,8%) y 4 fallecieron (4,9%). El grupo con RN no tuvo mayor morbilidad ni mortalidad que los sin RN. Sin embargo, ambos riesgos fueron mayores en los pacientes gastrostomizados versus los alimentados por vía oral (RR: 2,98 IC 95%: 1.32-6.75 al combinar ambas variables). Conclusiones: En esta cohorte de niños y adolescentes con PC seguidos durante un año, aquellos definidos como de riesgo nutricional según nuevas curvas, tuvieron similar morbimortalidad a los que tenían estado nutricional aceptable. La morbimortalidad fue mayor en los gastrostomizados.

Introduction: Children and adolescents with cerebral palsy (CP) have a high prevalence of malnutrition associated to poor prognosis. For an adequate nutritional assessment, new growth curves (Brooks, 2011) are available, in which precise cut-off points in Weight/Age index correlate to increased morbidity and mortality rate. Objective: To evaluate risk of hospitalization and death in patients with CP, according to nutritional risk (NR). Patients and Method: Observational and prospective cohort study of patients with CP in an outpatient referral center. We registered demographic, socioeconomic data and nutritional assessment. During a one-year follow-up, hospitalizations and mortality were recorded. The correspondent committee extended an ethical approval. Results: 81 CP patients were recruit, age 131.6 ± 60.4 months (25-313), 60 % male, 77.5 % without independent mobility. The 23 NR patients (28.4%) had lower muscle and fat mass (p = 0.000). During the follow-up, 29/81 patients required hospitalization (35.8%) and 4/81 died (4.9%). There was not an increased risk of hospitalization and/or mortality in NR group, but both were significantly higher in gastrostomy-fed children (RR: 2,98 CI 95%: 1.32-6.75 combining both variables). Conclusions: In this study, children and adolescents with severe CP and nutritional risk had similar morbidity and mortality during a one-year follow-up, compared to those with acceptable nutritional status. Both risks were higher in gastrostomy-fed than the orally fed children.

Prevalence of malnutrition in children with chronic hepatitis b infection

ABSTRACT Background - There have been limited studies investigating the impact of chronic hepatitis B virus infection on the growth of children. Objective - Our objective was to investigate the prevalence of malnutrition in children with chronic hepatitis B infection. Methods - The nutritional status of patients was retrospectively evaluated in the outpatient Clinic of Pediatric Gastroenterology between February and November 2014. During the study, biochemical laboratory parameters, duration of disease, liver biopsy scores, and medication were evaluated. Additionally body mass index and body mass index centiles were calculated. Results - Of the 96 patients in this study, 68 were male and 28 were female, and the mean age was 144.7±43.9 months and 146.1±47.3 months, respectively. According to body mass index centiles five (5.2%) patients were underweight, seven (7.3%) patients were overweight, and seven (7.3%) patients were obese. Conclusions - Moderate rates of malnutrition (including obesity) were found in chronic hepatitis B infection. Additional nutritional status information of healthy and sick children should be assessed in the infection's early period, and timely interventions should be initiated.

RESUMO Contexto - Há limitados estudos investigando o impacto da infecção crônica pelo vírus da hepatite B no crescimento das crianças. Objetivo - O objetivo deste estudo foi investigar a prevalência de desnutrição em crianças com infecção crônica da hepatite B. Métodos - O estado nutricional dos pacientes foi avaliado retrospectivamente em ambulatório de gastroenterologia clínica pediátrica, entre fevereiro e novembro de 2014. Durante o estudo, parâmetros bioquímicos do laboratório, duração da doença, classificação de biópsias hepáticas e medicação foram avaliadas. Além disso, o índice de massa corporal e suas porcentagens foram calculados. Resultados - Dos 96 pacientes, 68 eram do sexo masculino e 28 eram do sexo feminino e idade média era 144.7±43.9 e de 146.1±47.3 meses, respectivamente. De acordo com as porcentagens de índice de massa corporal, cinco (5,2%) pacientes estavam abaixo do peso, sete (7,3%) pacientes estavam com sobrepeso, e sete (7.3%) estavam obesos. Conclusão - Taxas moderadas de desnutrição (incluindo obesidade) foram encontradas em infecção crônica da hepatite B. Informação sobre o estado nutricional das crianças infectadas deve ser colhida inicialmente para que intervenções oportunas sejam tomadas.

Prevalencia y factores asociados a malnutrición en adultos mayores hospitalizados en el Servicio Agudos del Hospital Geriátrico San José PNP / Prevalence and factors associated with malnutrition in older adults hospitalized in the Acute Service of the Geriatric Hospital San Jose PNP

Objetivos: Determinar la prevalencia de malnutrición utilizando el Mini Nutritional Assesment (MNA) e identificar los factores asociados a su presencia en los pacientes que ingresen a la unidad de agudos del servicio de Geriatría del Hospital Geriátrico San José PNP en el periodo comprendido de marzo a mayo del 2014. Material y métodos: Se realizó un estudio observacional, descriptivo, de casos. Se revisaron 80 historias clínicas de pacientes que ingresaron a la unidad de agudos del servicio de Geriatría del Hospital Geriátrico San José PNP, de forma urgente o programada en el periodo que correspondió al estudio. Resultados: La media de la edad global fue de 80,9+/-6,6 años, siendo la mínima edad de 65 años y la máxima de 91 años. El 60 por ciento fueron varones y el 40 por ciento mujeres. La prevalencia de malnutrición fue del 75 por ciento, observando riesgo de desnutrición en el 5 por ciento de los casos. El 100 por ciento de los pacientes desnutridos fueron varones, y de los pacientes con riesgo nutricional el 60 por ciento fueron varones. La media de la edad de los pacientes desnutridos fue de 75+/-4,3 años, y de los pacientes con riesgo de desnutrición fue de 81,2+/-6,5 años. Los pacientes con desnutrición se caracterizaron por haber sido hospitalizados por EPID infectado, demencia (100 por ciento), con valoración social buena (100 por ciento), con valoración funcional G (100 por ciento). Los pacientes con desnutrición presentaron un IMC entre 21 a 23 (100 por ciento), perímetro braquial mayor de 22 (100 por ciento), y perímetro de la pantorrilla menor de 31 (100 por ciento). Conclusiones: La prevalencia de malnutrición utilizando el Mini Nutritional Assesment (MNA) fue del 75 por ciento. Los factores clínico-patológicos asociados a la presencia de malnutrición fueron el haber sido hospitalizados por EPID infectado, demencia, valoración social buena, con valoración funcional G. Los factores socio-demo gráficos asociados a la presencia de malnutrición en...

La doble carga de desnutrición y obesidad en venezuela / The double burden of undernutrition and obesity in venezuela

La doble carga nutricional, la coexistencia del déficit y del exceso nutricional es el resultado de la Transición Alimentaria y Nutricional acelerada en los países en vías de desarrollo que no habrían resuelto sus problemas de déficit nutricional antes de que les alcanzaran el sobrepeso, la obesidad y las enfermedades crónicas relacionadas con la nutrición. Los cambios en el estilo de vida del venezolano como resultado de la rápida urbanización y la migración masiva hacia las ciudades es el fenómeno más relevante; se discuten los aspectos relacionados con el crecimiento prenatal y posnatal temprano y su asociación con las enfermedades crónicas relacionadas con la nutrición. Factores demográficos perfilan a Venezuela como de alto riesgo: el embarazo de adolescentes con tasas altas en la Región Latinoamericana, el peso bajo al nacer, el aumento de la mortalidad materna y de la mortalidad infantil, la lactancia materna exclusiva que disminuye con la edad del recién nacido. En el primer estudio de sobrepeso y obesidad en la población venezolana, del INN, entre los 7 a los 17 años de edad, 21-28% presentaban exceso y 15- 17% déficit, un reflejo de la “doble carga”, cuya distribución resulta heterogénea en el país, el déficit en los niños parece ser mayor que el exceso en estados rurales como Apure así como en los estratos más bajos. En los adultos el sobrepeso y la obesidad aumentan con la edad. Se presenta una aproximación a la prevención de la “doble carga” y de los problemas de salud pública derivados de esta(AU)

The double burden of malnutrition, the coexistence of nutritional deficit and excess is the result of the Food and Nutrition Transition accelerated in developing countries that would had not have solved their problems of nutritional deficiency before they were reached by overweight, obesity and chronic diseases related to nutrition. Changes in the lifestyle of the Venezuelan population as a result of rapid urbanization and migration to the cities, is the most important phenomenon; aspects of prenatal and early postnatal growth and its association with chronic diseases related to nutrition are discussed. Demographic factors outline the Venezuelan population as high risk: teenage pregnancy prevalence is among the highest in the Latin American region, low birth weight, increased maternal mortality and infant mortality; exclusive breastfeeding decreasing's the with age of the newborn. In the first study of overweight and obesity in the Venezuelan population, INN, in ages 7 to 17 years olds 21-28% were overweight and 15-17% were undernourished, a reflection of the “double burden”, whose distribution is heterogeneous in the country, the deficit in children appears to be larger than the excess overweight in rural states like Apure and in the lower socioeconomic strata. In adults, overweight and obesity increase with age. An approach to the prevention of the “double burden” and the public health problems resulting from this is presented(AU)

Aplicabilidade da avaliação global subjetiva e malnutrition inflammation score na avaliação do estado nutricional na doença renal crônica / Applicability of subjective global assessment and malnutrition inflammation score in the assessment of nutritional status on chronic kidney disease

Até o momento, não há um método único capaz de diagnosticar com fidedignidade a condição nutricional do paciente com doença renal crônica (DRC). Por essa razão, tem se recomendado o emprego de vários marcadores nutricionais. A avaliação global subjetiva (AGS) se baseia na história física e no exame clínico do paciente e, desde sua criação, novas versões foram elaboradas. A partir da AGS, foi criado o malnutrition inflammation score (MIS), composto por 70% das questões comuns à AGS acrescido de questões objetivas do estado nutricional. Como muitas modificações foram feitas na forma original da AGS e o emprego tanto da AGS quanto do MIS em pacientes com DRC aumentou significativamente na prática clínica, este trabalho tem como objetivo fazer uma revisão sobre a aplicabilidade desses métodos para avaliação do estado nutricional em pacientes com DRC.

Up to now, there is no single method that provides complete and unambiguous assessment of the nutritional status in chronic kidney disease (CKD). Therefore, it has been recommended the use of many nutritional markers. The subjective global assessment (SGA) contains questions regarding the clinical history and physical examination. Subsequently, other versions of the SGA were developed. The malnutrition inflammation score (MIS) was also developed from the original version of the SGA and consists of 70% of the items common to SGA in addition to objective questions. Since many modifications were proposed in the original form of SGA, the use of these questionnaires in CKD patients has increased substantially in clinical practice. Therefore, this paper aims to review the applicability of the SGA and MIS when applied to assess the nutritional status of CKD patients.

ComparaþÒo da forþa do aperto de mÒo com parÔmetros antropométricos e subjetivos na avaliaþÒo nutricional de hepatopatas / [Comparison of strength of the handshake with anthropometric and subjective parameters at the patients' nutritional assessment with liver diseas].

OBJECTIVE: We aimed to assess the nutritional status of patients with chronic liver disease by evaluating the strength of grip of non-dominant hand (SGNDH), correlating it with other methods and analyzing their contribution to this assessment. METHODS: This study was conducted with patients having chronic chronic disease at the outpatient hepatology service of the Instituto de Medicina Integral Professor Fernando Figueira--IMIP, Recife-PE, from February to October 2010. Clinical and demographic variables were collected. The evaluation was performed according to anthropometric, subjective and functional parameters. RESULTS: There were evaluated 49 individuals and 65.3

of them were men. The mean age was 51.3 years and individuals over 60 year predominated. The patients presented non-alcoholic liver disease in 61.2

of cases, MELD < or = 10 in 67.3

, some gastroenteropathy in 67.4

, jaundice in 66.7

and ascites in 63

. The global average SGNDH was higher among men with higher prevalence of malnutrition by arm muscle area (AMA), followed by arm muscle circumference (AMC) and SGNDH, and lower prevalence by body mass index (BMI) and adapted subjective global assessment (SGA). There were not statistically significant differences between the prevalence of malnutrition by SGNDH and arm circumference (AC), triceps skinfold (TS), AMC, AMA and Mendenhall score. The diagnosis of malnutrition by SGND was higher among men and 100

among elderly (P < 0.05). There was strong correlation between SGNDH and AMC, regular between SGNDU and height, and weak between SGDNH and AC (P < 0.05). CONCLUSIONS: It is noted that the SGNDH showed similar contribution than AMA and AMC and higher than BMI and adapted SGA. The strong correlation between SGNDH and AMC indicates a major relationship with muscle reserves. Thus, more studies are needed to clarify the application of SGNDH in this nutritional assessment. We point out that an association of different methods is necessary.

Nutritional markers in patients undergoing chronic haemodialysis in Jamaica / Marcadores nutricionales en pacientes en hemodiálisis crónica en Jamaica

OBJECTIVES: The main objective of the study is to assess the nutritional status in patients on chronic haemodialysis in Jamaica using the Subjective Global Assessment tool and to correlate this with measured serum nutritional biomarkers, and also to identify nutritional biomarkers that can be used to assess nutritional status of patients with end-stage renal disease (ESRD). SUBJECT AND METHODS: Two hundred and nine consecutive patients on haemodialysis were selected from dialysis centres in Kingston, the capital of Jamaica, St Catherine and Manchester, Jamaica. The nutritional status of each participant was assessed using the Subjective Global Assessment tool in an interview performed by the researcher. Serum albumin, blood urea nitrogen and creatinine, highly sensitive complement reactive protein (hsCRP) and total fasting cholesterol were determined from a single serum sample. Only patients with ESRD were selected. Patients with acute renal failure or those with ESRD who were admitted in the previous two weeks were excluded from the study. Informed consent was obtained prior to interview and obtaining blood samples. RESULTS: Of the total participants, 54.5% (n = 114) were male and 45.5% (n = 95) female. The mean age for males was 51.9 years and females 47.6 years. Diabetes was documented as the most common cause of chronic renal disease and was found in 29.7%, hypertension in 24.4% and chronic glomerulonephritis in 22% of the participants. Approximately 80% of the study population had moderate malnutrition. There was a significant association between moderate malnutrition and a diagnosis of ESRD secondary to diabetes mellitus, p = 0.03. Being on haemodialysis for < six months was significantly associated with moderate malnutrition p = 0.002. Also associated with moderate malnutrition were presence of an arteriovenous (AV) fistula (p = 0.01), serum albumin of < 40 g/L (OR 3.68, p = 0.001), pre-dialysis creatinine of < 880 jumol/L (p = 0.02) and cholesterol < 3.9 mmol/L (p = 0.04). Highly sensitive complement reactive protein levels of >10 mg/L was associated with moderate malnutrition, though statistical signifance was not met (p = 0.39). CONCLUSION: Factors associated with malnutrition in patients on dialysis were having ESRD secondary to diabetes mellitus, dialysis duration for < six months, low serum albumin, pre-dialysis serum creatinine of 880 umol/L, low total cholesterol and presence of AV fistula access.

OBJETIVOS: El objetivo principal del estudio es, por una parte, evaluar el estado nutricional en pacientes en hemodiálisis crónica en Jamaica, usando como herramienta la Valoración Global Subjetiva (VGS), y por otra parte, poner en correlación los datos con la medición de los biomarcadores nutricionales séricos, identificando a la par los biomarcadores nutricionales que pueden usarse para evaluar el estado nutricional de pacientes con enfermedad renal en etapa terminal. SUJETOS Y MÉTODOS: Se seleccionaron doscientos nueve pacientes consecutivos en hemodiálisis de los centros de diálisis en Kingston, la capital de Jamaica. El estado nutricional de cada participante fue evaluado usando la Valoración Global Subjetiva como herramienta, en una entrevista realizada por el investigador. La albúmina en suero, el nitrógeno ureico y la creatinina en sangre, la proteína C-reactiva altamente sensible (hsCRP), y el colesterol total en ayunas, fueron determinados a partir de una sola muestra de suero. Sólo se escogieron pacientes con la enfermedad renal en etapa terminal (ERET). Los pacientes con insuficiencia renal aguda o aquellos con ERET ingresados en las dos semanas previas, fueron excluidos del estudio. Se obtuvo consentimiento informado antes de la entrevista y la toma de muestras de sangres. RESULTADOS: Del total de participantes, 54.5% (n = 114) fueron varones y 45.5% (n = 95) fueron hembras. La edadpromedio de los varones fue 51.9 anos y la de las hembras 47.6 anos. La diabetes se documentó como la causa más común de la enfermedad renal crónica, y se halló en 29.7%. Asimismo, se evidenció hipertensión en 24.4% y glomerulonefritis crónica en 22% de los participantes. Aproximadamente el 80% de la población en estudio presentaba desnutrición moderada. Hubo una asociación significativa entre la desnutrición moderada y un diagnóstico de ERET secundario de diabetes mellitus, p = 0.03. El hallarse en hemodiálisis por < seis meses estuvo significativamente ...

Investigation of nutritional risk factors using anthropometric indicators in hospitalized surgery patients / Investigação de fatores de risco nutricional por meio de indicadores antropométricos em pacientes cirúrgicos hospitalizados

CONTEXT: The investigation of risk factors associated with nutritional status could contribute for better knowledge of the malnutrition. OBJECTIVE: To investigate the incidence of malnutrition and its possible association with many parameters that assess nutritional status and to identify the associated risk factors. METHODS: The nutritional status was assessed in 235 hospitalized patients. Malnutrition was defined as present when the patient presented at least two anthropometric criteria below the normal range and habitual energy intake below 75% of the energy requirement (HEI/ER<75%). Gender, age, type of disease, recent weight change and dental problems were investigated as possible associated risk factors. The chi-square and Mann-Whitney tests were used to compare the data and univariate and multiple logistic regressions were used to identify the factors associated with malnutrition. The odds ratio (OR) and confidence interval (CI) of 95% were calculated with the significance level set at 5% (P<0.05). RESULTS: One-fifth (20%) of the patients were malnourished on admission to the hospital and 27.5% reported recent weight loss. Malnutrition (P<0.0001) was greater in patients with malignant diseases. The only variables significantly associated with malnutrition according to univariate logistic regression were recent weight loss (P = 0.0058; OR = 2.909; IC95% = 1.362; 6.212) and malignant disease (P = 0.0001; OR = 3.847; IC95% = 1.948; 7.597). When multiple regression was used in the model which included type of disease, malignant disease was shown to increase the chance of malnutrition fourfold (P = 0.0002; OR = 3.855; IC95% = 1.914; 7.766). When disease was excluded, recent weight loss also increased malnutrition fourfold (P = 0.0012; OR = 3.716; IC95% = 1.677; 8.236). CONCLUSION: Patients with a history of recent weight loss and those with malignant diseases are more susceptible to malnutrition.

CONTEXTO: A investigação de fatores de risco associados ao estado nutricional pode contribuir para o melhor conhecimento da desnutrição. OBJETIVO: Investigar a incidência de risco nutricional com a associação de vários parâmetros de avaliação nutricional e identificar os fatores de risco relacionados. MÉTODO: Foi avaliado o risco nutricional em 235 pacientes hospitalizados com doenças benignas e malignas, sendo o sexo, a faixa etária, o tipo de doença, a alteração de peso recente e os problemas dentários, investigados como possíveis fatores de risco associados. Para a comparação dos dados, foi utilizado o teste Qui ao quadrado e Mann-Whitney e para identificar os fatores associados ao risco nutricional foi utilizada a análise de regressão logística univariada e múltipla, sendo calculado o odds ratio (OR) e o intervalo de confiança (IC) de 95%, com P<0,05. RESULTADOS: Verificou-se 20% dos pacientes com risco nutricional na admissão hospitalar e 27,5% referiram perda de peso recente, com diferença significativa entre os grupos nos parâmetros avaliados e para o risco nutricional de desnutrição (P<0,0001), maior naqueles com doenças malignas. Na regressão logística univariada, as únicas variáveis significativas para o risco nutricional foram a perda de peso recente (P = 0,0058; OR = 2,909; IC95% = 1,362; 6,212) e a doença maligna (P = 0,0001; OR = 3,847; IC95% =1 ,948; 7,597). Posteriormente, na regressão múltipla, no modelo com o tipo de doença, foi comprovado que a doença maligna elevou a chance de risco nutricional em 4 vezes (P = 0,0002; OR = 3,855; IC95% = 1,914; 7,766). Excluindo-se a doença, comprovou-se que a perda de peso recente elevou o risco nutricional também em quase 4 vezes (P = 0,0012; OR = 3,716; IC95% = 1,677; 8,236). CONCLUSÃO: Pacientes que perderam peso recentemente e aqueles com doença maligna apresentaram mais chances de desenvolver risco nutricional.

Nutritional evaluation of stage 5 chronic kidney disease patients on dialysis / Avaliação nutricional de pacientes portadores de doença renal crônica estágio 5 em diálise

CONTEXT AND OBJECTIVE: Patients with chronic kidney failure undergoing dialysis have high prevalence of protein-energy malnutrition. There is still no uniform method for assessing these patients' nutritional status. It is recommended that a set of subjective and objective methods should be applied so that an adequate nutritional diagnosis can be reached. The aim of this study was to evaluate the nutritional profile of patients undergoing hemodialysis. DESIGN AND SETTING: Cross-sectional study conducted in the Dialysis Treatment Unit, Araraquara, São Paulo, Brazil, in 2008. METHODS: Anthropometric and biochemical indicators were characterized for 48 patients who also gave responses to the modified Subjective Global Assessment questionnaire (SGAm), and possible correlations between these indicators were investigated. RESULTS: The frequency of moderate or severe malnutrition ranged from 22% to 54%, according to the parameter used. Regarding the patients' conformity with the ideal weight, 29% of them weighed less than 75% of the ideal, and thus were classified as having moderate or severe malnutrition. The most significant correlations were observed between body mass index (BMI) and the idealness of triceps skinfold (TSF), upper arm circumference (UAC) and upper arm muscle circumference (UAMC); and between SGAm and the idealness of UAC and UAMC. CONCLUSION: The frequency of malnutrition showed great variability among the patients, according to the evaluation criterion chosen. Routine nutritional monitoring and validation of methods for assessing body composition among such patients are extremely important for diagnosing malnutrition early on, thus preventing complications and reducing the morbidity and mortality rates in this population.

CONTEXTO E OBJETIVO: Portadores de insuficiência renal crônica em diálise apresentam alta prevalência de desnutrição proteico-energética. Não existe ainda um método uniforme para avaliar o estado nutricional desses pacientes. Recomenda-se a aplicação de um conjunto de métodos subjetivos e objetivos para se chegar aos diagnósticos nutricionais adequados. O objetivo deste estudo é traçar o perfil nutricional de pacientes submetidos a hemodiálise. TIPO DE ESTUDO E LOCAL: Estudo transversal descritivo realizado na Unidade de Tratamento Dialítico de Araraquara, São Paulo, Brasil, em 2008. MÉTODOS: 48 pacientes tiveram seus indicadores antropométricos e bioquímicos caracterizados, sendo também submetidos ao questionário Avaliação Global Subjetiva modificada (SGAm), verificando-se possíveis correlações entre esses indicadores. RESULTADOS: A frequência de desnutrição moderada e grave variou de 22% a 54%, de acordo com o parâmetro utilizado. Com relação à adequação do peso ideal, 29% da amostra estavam com porcentagem de adequação abaixo do percentil 75, classificados como portadores de desnutrição moderada e grave. As correlações mais significativas foram observadas entre índice de massa corporal (IMC) e adequações de prega triciptal (PCT), circunferência do braço (CB) e circunferência muscular do braço (CMB); e entre o SGAm e adequações de CB e CMB. CONCLUSÃO: A desnutrição apresentou grande variabilidade de frequência entre os pacientes de acordo com o critério escolhido para avaliação. O acompanhamento nutricional de rotina e a validação de métodos que avaliem a composição corporal desses pacientes são de extrema importância para diagnosticar precocemente a desnutrição e assim prevenir complicações e reduzir as taxas de morbimortalidade nesta população.

Utilidad de la evaluación del estado nutricional en pacientes hospitalizados / Assessment of nutritional status of hospitalized patients

Introducción: La desnutrición hospitalaria incrementa las complicaciones infecciosas y no infecciosas, así como la morbilidad y mortalidad. La evaluación del estado nutricional debe ser la primera intervención para planificar una asistencia nutricional temprana y eficiente. Objetivo: Determinar el estado nutricional de pacientes hospitalizados. Materiales y métodos: Se realizó un estudio prospectivo, descriptivo y observacional, encuestándose 116 pacientes a las 48 horas de internación en el Servicio de Clínica Médica del Hospital Central de Formosa, desde el 1 de mayo al 30 de junio de 2010, elegidos según criterios de inclusión y exclusión. Análisis de datos: Un 33.62% (n = 39) de los encuestados presentó desnutrición moderada y un 15.51% (n = 18) desnutrición grave. El 41.37% (n = 48) disminuyó la ingesta previa a la internación. El 56% (n = 65) presentó pérdida de peso en los últimos 6 meses previos a la internación. Según su IMC, el 13.81% (n = 16) de los pacientes presentó bajo peso, el 47.41% (n = 55) peso normal, y el 23.41% (n = 26) sobrepeso. El 33.3% (n = 6) de los pacientes con desnutrición grave tuvo peso adecuado según su IMC, el 11.1% (n = 2) sobrepeso; el 61.5% (n = 24) con desnutrición moderada presentó peso normal y el 23.1% (n = 9), sobrepeso. El 52.59% (n = 61) del total de pacientes tuvo niveles de albúmina disminuidos. El 41% (n = 16) de los pacientes con desnutrición moderada presentó niveles de albúmina entre 3.4 y 3 g/dl y el 28.2% (n = 11), albúmina entre 2.9 y 2.1 g/dl. El 66.7% (n = 12) con desnutrición grave tuvo valores de albúmina por debajo del límite de normalidad. El 33.3% (n = 6) con desnutrición grave presentó conteo de linfocitos entre 1 499 y 1 200 y un 38.9% (n = 7), < 1 200 mm3. Conclusión: El tamizaje nutricional permitió diagnosticar precozmente desnutrición en el 49.12% de los pacientes. Estos hallazgos apoyan la necesidad de incluir la evaluación nutricional en la historia clínica.