RESUMEN
ABSTRACT Objective: To develop a graphical representation in the form of a food pyramid for a ketogenic diet for dietary treatment in children and adolescents with refractory epilepsy. Methods: The pyramid was constructed based on: the estimation of energy requirements for different age groups, macronutrient distribution, food groups, and the number of servings and respective amounts of food according to the ketogenic diet. Serving sizes were based on the calculation of energy and macronutrient requirements according to age and nutritional status. Results: The pyramid was divided into three tiers and 5 food groups (fats, proteins, type 1 vegetables, type 2 vegetables, and fruits). Four portion size lists were defined for the following age groups: 1-3 years, 4-6 years, 7-10 years, and 11-19 years. Conclusion: The ketogenic diet food pyramid can be used as nutritional guidance for patients undergoing this dietary therapy by illustrating the variety of foods that can be eaten during the treatment, optimizing adherence to the treatment, and guaranteeing beneficial effects on seizure control.
RESUMO Objetivo: Desenvolver uma representação gráfica sob a forma de pirâmide alimentar para a dieta cetogênica destinada a crianças e adolescentes com indicação de tratamento dietético da epilepsia refratária. Métodos: A construção foi baseada na estimativa da necessidade energética por faixa etária, na distribuição de macronutrientes, nos grupos alimentares, no número de porções e nas respectivas quantidades de alimentos a serem ofertados de forma a atender as recomendações da dieta cetogênica. O porcionamento dos alimentos foi feito baseado no cálculo da necessidade energética e na distribuição de macronutriente segundo a faixa etária e estado nutricional. Resultados: A pirâmide foi dividida em três estratos e em cinco grupos alimentares (gorduras, proteínas, hortaliças tipo 1, hortaliças tipo 2 e frutas). Foram elaboradas quatro listas de porcionamento para as seguintes faixas etárias 1 a 3 anos, 4 a 6 anos, 7 a 10 anos e 11 a 19 anos. Conclusão: A utilização da pirâmide alimentar da dieta cetogênica facilitará a orientação inicial dos pacientes submetidos a essa terapia nutricional, ilustrando a diversidade de alimentos que podem ser ofertados durante o tratamento e otimizando, assim, a aderência ao mesmo e a manutenção dos efeitos benéficos de controle de crises.
Asunto(s)
Humanos , Masculino , Femenino , Preescolar , Niño , Adolescente , Dieta Cetogénica , Educación Alimentaria y Nutricional , Epilepsia/dietoterapiaRESUMEN
Introduction: the inflammatory response caused by sepsis leads to metabolic changes, which may result in significant lean mass loss in septic patient. Because of this, when digestive tract is functional, nutritional therapy (NT) must be initiated within 48 hours of intensive treatment to reduce protein loss. Objective: to evaluate enteral nutritional therapy (ENT) in adult septic patients with exclusive ENT for ≥ 72 hours and length of stay ≥7 days in Intensive Care Unit and its relationship with clinical prognosis. Methods: we prospectively analyzed the adequacy of enteral nutrition administered, factors associated with non-conformity, gastrointestinal tolerance and outcome. Statistical tests of chi-square and Students t as well as Mann-Whitney and Spearman and Pearson correlations (p < 0.05) were used. A multiple logistic regression model has been done by using the stepwise method to evaluate the association between predictors of clinical outcome. Results: 53 patients, 67.9% male and 52.8% elderly were enrolled in this study. The average time for starting ENT was 30 (23.5) hours, and 88.7% of patients achieved nutritional goal in 48 hours. The mean volume delivered in relation to prescribed was 78.9%. When the sample was stratified according to administered/ prescribed calories, patients who received < 80% had a higher mortality rate (p = 0.001) and the caloric intake ≥ 80% was the determining factor in patients clinical prognosis (p = 0.021). Conclusion: septic patients received early enteral nutrition. The nutritional goal and the mean volume delivered in relation to the prescribed volume meet the intensive care guidelines. The nutritional support was associated with clinical outcome, and caloric intake ≥ 80% determining the clinical prognosis. The pauses caused by reflux were significant in the group of patients who died and it may be related to disease severity (AU)
Introducción: la respuesta inflamatoria causada por sepsis provoca cambios metabolicos que pueden provocar una perdida de masa magra significativa en pacientes septicos. Debido a ello, cuando el tracto digestivo es funcional la terapia nutricional (NT) debe iniciarse dentro de las 48 horas de tratamiento intensivo para reducir la perdida de proteina. Objetivo: evaluar la terapia nutricional enteral (TNE) en pacientes septicos adultos con TNE exclusivo para ≥ 72 horas y duracion de ≥ 7 dias de estancia en la Unidad de Cuidados Intensivos y su relacion con el pronostico clinico. Métodos: se analizaron prospectivamente la adecuacion de la nutricion enteral administrada, los factores asociados con la falta de conformidad, la tolerancia gastrointestinal y el resultado. Se utilizaron pruebas estadisticas de chi-cuadrado y la t de Student, asi como las correlaciones de Mann-Whitney y Spearman y Pearson (p < 0,05). Se ha realizado un modelo de regresion logistica multiple mediante el metodo paso a paso para evaluar la asociacion entre factores de prediccion de la evolucion clinica. Resultados: 53 pacientes, 67,9% hombres y 52,8% ancianos se inscribieron en este estudio. El tiempo promedio para el inicio de ENT fue de 30 (23,5) horas, y el 88,7% de los pacientes alcanzaron el objetivo nutricional en 48 horas. El volumen medio entregado en relacion con el prescrito fue 78,9%. Cuando la muestra se estratifico segun calorias prescritas/administradas, los pacientes que recibieron < 80% tenian una tasa de mortalidad mas alta (p = 0,001) y el consumo de calorias ≥ 80% fue el factor determinante en el pronostico clinico de los pacientes (p = 0,021). Conclusión: los pacientes septicos recibieron nutricion enteral precoz. El objetivo nutricional y el volumen medio entregado en relacion con el volumen prescrito cumplen las directrices de cuidados intensivos. El soporte nutricional se asocio con el resultado clinico y la ingesta calorica ≥ 80% para determinar el pronostico clinico. Las pausas causadas por el reflujo fueron significativas en el grupo de pacientes que murieron y que pueden estar relacionadas con la gravedad de la enfermedad (AU)
Asunto(s)
Humanos , Nutrición Enteral , Apoyo Nutricional/métodos , Terapia Nutricional/métodos , Sepsis/dietoterapia , Cuidados Críticos/métodos , Ingestión de Energía/fisiologíaRESUMEN
INTRODUCTION: the inflammatory response caused by sepsis leads to metabolic changes, which may result in significant lean mass loss in septic patient. Because of this, when digestive tract is functional, nutritional therapy (NT) must be initiated within 48 hours of intensive treatment to reduce protein loss. OBJECTIVE: to evaluate enteral nutritional therapy (ENT) in adult septic patients with exclusive ENT for ≥ 72 hours and length of stay ≥7 days in Intensive Care Unit and its relationship with clinical prognosis. METHODS: we prospectively analyzed the adequacy of enteral nutrition administered, factors associated with non-conformity, gastrointestinal tolerance and outcome. Statistical tests of chi-square and Student's t as well as Mann-Whitney and Spearman and Pearson correlations (p < 0.05) were used. A multiple logistic regression model has been done by using the stepwise method to evaluate the association between predictors of clinical outcome. RESULTS: 53 patients, 67.9% male and 52.8% elderly were enrolled in this study. The average time for starting ENT was 30 (23.5) hours, and 88.7% of patients achieved nutritional goal in 48 hours. The mean volume delivered in relation to prescribed was 78.9%. When the sample was stratified according to administered/ prescribed calories, patients who received < 80% had a higher mortality rate (p = 0.001) and the caloric intake ≥ 80% was the determining factor in patients' clinical prognosis (p = 0.021). CONCLUSION: septic patients received early enteral nutrition. The nutritional goal and the mean volume delivered in relation to the prescribed volume meet the intensive care guidelines. The nutritional support was associated with clinical outcome, and caloric intake ≥ 80% determining the clinical prognosis. The pauses caused by reflux were significant in the group of patients who died and it may be related to disease severity.
Introducción: la respuesta inflamatoria causada por sepsis provoca cambios metabolicos que pueden provocar una perdida de masa magra significativa en pacientes septicos. Debido a ello, cuando el tracto digestivo es funcional la terapia nutricional (NT) debe iniciarse dentro de las 48 horas de tratamiento intensivo para reducir la perdida de proteina. Objetivo: evaluar la terapia nutricional enteral (TNE) en pacientes septicos adultos con TNE exclusivo para ≥ 72 horas y duracion de ≥ 7 dias de estancia en la Unidad de Cuidados Intensivos y su relacion con el pronostico clinico. Métodos: se analizaron prospectivamente la adecuacion de la nutricion enteral administrada, los factores asociados con la falta de conformidad, la tolerancia gastrointestinal y el resultado. Se utilizaron pruebas estadisticas de chi-cuadrado y la t de Student, asi como las correlaciones de Mann-Whitney y Spearman y Pearson (p < 0,05). Se ha realizado un modelo de regresion logistica multiple mediante el metodo paso a paso para evaluar la asociacion entre factores de prediccion de la evolucion clinica. Resultados: 53 pacientes, 67,9% hombres y 52,8% ancianos se inscribieron en este estudio. El tiempo promedio para el inicio de ENT fue de 30 (23,5) horas, y el 88,7% de los pacientes alcanzaron el objetivo nutricional en 48 horas. El volumen medio entregado en relacion con el prescrito fue 78,9%. Cuando la muestra se estratifico segun calorias prescritas/administradas, los pacientes que recibieron < 80% tenian una tasa de mortalidad mas alta (p = 0,001) y el consumo de calorias ≥ 80% fue el factor determinante en el pronostico clinico de los pacientes (p = 0,021). Conclusión: los pacientes septicos recibieron nutricion enteral precoz. El objetivo nutricional y el volumen medio entregado en relacion con el volumen prescrito cumplen las directrices de cuidados intensivos. El soporte nutricional se asocio con el resultado clinico y la ingesta calorica ≥ 80% para determinar el pronostico clinico. Las pausas causadas por el reflujo fueron significativas en el grupo de pacientes que murieron y que pueden estar relacionadas con la gravedad de la enfermedad.