RESUMEN
BACKGROUND & AIMS: Malnutrition in cancer is an independent factor associated with negative clinical outcomes. The aim was to evaluate the prevalence and independent risk factors for malnutrition in hospitalized cancer patients using the Patient-Generated Subjective Global Assessment (PG-SGA). METHODS: We evaluated 4783 cancer patients, aged ≥20 years, in a hospital-based, multicenter, cross-sectional study. Patients were classified as well-nourished (PG-SGA Stage A), moderate/suspected malnutrition (PG-SGA Stage B), or severely malnourished (PG-SGA Stage C), and provided a score to define required nutritional interventions. Multivariate analysis was composed of the odds ratio (OR) estimated by ordinal polytomous logistic regression. RESULTS: 45.3% were classified as Stage B and 11.8% as Stage C. Moreover, 45.3% of the patients presented a need for nutritional intervention. The variables that presented the highest ORs for Stage B or Stage C were: problems with swallowing (OR 2.8, 95% confidence interval (CI) 2.2-3.4, p < 0.001), loss of appetite (OR 1.9, 95% CI 1.6-2.3, p < 0.001), vomiting (OR 1.8, 95% CI 1.5-2.3, p < 0.001), presence of more than 3 nutrition impact symptoms (OR 8.3, 95% CI 5.8-12, p < 0.001), and cancer site: lung (OR 4.6, 95% CI 3.2-6.6, p < 0.001), upper digestive cancer (OR 3.7, 95% CI 2.7-5.2, p < 0.001), and head and neck cancer (OR 3.7, 95% CI 2.7-5.2, p < 0.001). The score for Worksheet 4 on the PG-SGA had a higher association with malnutrition (OR 7.3, 95% CI 6.6-8.2, p < 0.001). CONCLUSIONS: Malnutrition is highly prevalent in cancer patients in Brazil, and is associated with nutritional impact symptoms, cancer site and age ≥65 years.
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Desnutrición , Neoplasias , Estado Nutricional/fisiología , Adulto , Anciano , Anorexia/complicaciones , Anorexia/epidemiología , Brasil , Estudios Transversales , Trastornos de Deglución/complicaciones , Trastornos de Deglución/epidemiología , Diarrea/complicaciones , Diarrea/epidemiología , Femenino , Hospitalización , Humanos , Masculino , Desnutrición/epidemiología , Desnutrición/etiología , Desnutrición/fisiopatología , Persona de Mediana Edad , Neoplasias/complicaciones , Neoplasias/epidemiología , Evaluación Nutricional , Vómitos/complicaciones , Vómitos/epidemiologíaRESUMEN
OBJECTIVE: Vitamin A antioxidant role has an important relationship with the metabolic processes of aging and cardiovascular disease (CVD). This study aimed at assessing the liver store of retinol in elderly individuals who died from cardiovascular disease and its relationship with liver weight and body weight. METHODS AND RESULTS: This is a cross-sectional study conducted in necropsied individuals, aged 60 years or over, until 48 hours postmortem. The study assessed 65 elderly individuals who died from ischemic heart diseases (G1), cerebrovascular diseases (G2), other forms of heart disease (G3), or infectious heart diseases (G4). Twenty percent had inadequate liver store of retinol. G1 showed lower median of liver store of retinol when compared to G3 (p < 0.001), and G3 showed the highest median when compared to G2 (p = 0.007). A significant association was observed between inadequate liver store of retinol and death by ischemic CVD (G1) (p = 0.001) with an odds ratio of 10.38. It was observed that individuals with higher body weight and liver weight showed lower liver store of retinol with significant differences (p = 0.027 and p = 0.026). CONCLUSION: Ischemic CVD and increased body weight and liver weight are related to a greater impairment of the liver store of retinol.
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Enfermedades Cardiovasculares/patología , Hígado/metabolismo , Vitamina A/análisis , Anciano , Anciano de 80 o más Años , Enfermedades Cardiovasculares/metabolismo , Causas de Muerte , Estudios Transversales , Femenino , Cardiopatías/metabolismo , Cardiopatías/patología , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Oportunidad RelativaRESUMEN
To assess perioperative care in patients undergoing abdominal surgery for gynaecological tumours and how it relates to post-operative (PO) complications and oral PO feeding. Ninety-one women undergoing major abdominal surgery for gynaecological tumours were enrolled. Data included mechanical bowel preparation (MBP), prescribed diet, length of fast, start date of oral diet and progression of food consistency, anaesthetic technique, use of opioids and intravenous hydration (IH). Outcomes evaluated were nausea, vomiting and abdominal distension. The median pre-operative length of fast was 11.4 h. PO digestive complications occurred in 46.2% of the patients. Median intraoperative total IH and crystalloids were significantly higher in patients with abdominal distension during the first and second PO day. MBP with mannitol implied greater intraoperative IH and was significantly associated with a higher incidence of immediate PO nausea. Post-operative IH was also associated with gastrointestinal complications. The best cut-off point for the cumulative fluid load PO for determining a longer PO hospital stay was 4 L. Performing MBP before surgery and excessive IH are factors related to major digestive complications in our study population. Changes in pre-operative fasting time and PO refeeding should be considered to reduce the gastrointestinal complications and PO recovery time.
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Fluidoterapia/métodos , Enfermedades Gastrointestinales/epidemiología , Neoplasias de los Genitales Femeninos/cirugía , Procedimientos Quirúrgicos Ginecológicos , Atención Perioperativa/métodos , Náusea y Vómito Posoperatorios/epidemiología , Abdomen , Adulto , Anciano , Anciano de 80 o más Años , Anestesia/métodos , Estudios de Cohortes , Conización , Soluciones Cristaloides , Ayuno , Conducta Alimentaria , Femenino , Humanos , Histerectomía , Histerectomía Vaginal , Incidencia , Soluciones Isotónicas/uso terapéutico , Laparoscopía , Tiempo de Internación , Escisión del Ganglio Linfático , Persona de Mediana Edad , Ovariectomía , Pelvis , Complicaciones Posoperatorias/epidemiología , Recuperación de la Función , Factores de TiempoRESUMEN
INTRODUCTION: Malnutrition is commonly and frequently under-diagnosed in clinical settings in patients with chronic liver disease (CLD) due to the limitations of nutritional evaluation methods in this population. We hypothesized that the bioelectrical impedance analysis derived phase angle (BIA-derived PhA) might be considered as a nutritional indicator in CLD since it represents either cell death or malnutrition characterized by changes in cellular membrane integrity. OBJECTIVE: The aim of this study was to evaluate the BIA-derived PhA as a nutritional evaluation tool in all stages of CLD, including chronic hepatitis, liver cirrhosis and hepatocellular carcinoma (HCC). Liver-related death and survival were evaluated. METHODS: A total of 66 patients were enrolled in a cross-sectional study. For the nutritional diagnosis, mid-arm circumference (MAC), triceps skinfold thickness (TST), mid-arm muscle circumference (MAMC) and Subject Global Assessment (SGA) were evaluated. Biochemical and clinical evaluations were performed. RESULTS: Our results showed that PhA was higher in well-nourished patients, according to SGA and in the patients without hepatic encephalopathy. PhA correlated significantly with MAMC, MAC and albumin and was inversely correlated with age. No correlation was found between PhA values and the Child-Pugh score and ascites. PhA was strongly associated with survival and PhA ≤ 5.18º with relative risk increase of 2.5 for death. CONCLUSIONS: We conclude that the BIA-derived PhA is a relevant nutritional evaluation tool in chronic hepatitis, liver cirrhosis and HCC and the role of PhA in the prediction of survival in CLD should be examined further in a controlled study.
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Impedancia Eléctrica , Enfermedad Hepática en Estado Terminal/diagnóstico , Desnutrición/diagnóstico , Adulto , Anciano , Antropometría , Brazo/anatomía & histología , Estudios Transversales , Enfermedad Hepática en Estado Terminal/etiología , Femenino , Estudios de Seguimiento , Hepatitis/complicaciones , Humanos , Masculino , Desnutrición/complicaciones , Persona de Mediana Edad , Evaluación Nutricional , Estado Nutricional , Reacción en Cadena de la Polimerasa , Grosor de los Pliegues Cutáneos , SobrevidaRESUMEN
Hepatitis C virus (HCV) infection is associated with oxidative stress and vitamin A possesses antioxidant activity. The objective of the present study was to investigate vitamin A nutritional status in chronic hepatitis, liver cirrhosis and hepatocellular carcinoma (HCC), according to biochemical, functional and dietetic indicators correlating these findings with liver function, liver damage and death. Vitamin A nutritional status was analysed by serum retinol levels, dietetic indicators and functional indicators. A total of 140 patients with HCV-related liver disease were enrolled. Vitamin A deficiency was detected in 54·3 % of all patients, and there was a progressive drop in serum retinol levels from chronic hepatitis C patients towards cirrhosis and HCC patients. Increased total bilirubin, liver transaminases and prothrombin time, presence of hepatic encephalopathy and ascites were related to reduced serum retinol levels, and values ≤ 0·78 µmol/l of serum retinol were associated with liver-related death. A high prevalence of inadequate intake of vitamin A was observed in all stages of chronic liver disease. The functional indicator was not an adequate parameter for evaluating the vitamin A nutritional status. Therefore, serum retinol concentration is related to severity of the disease, liver complications and mortality. The effectiveness of nutritional counselling and measures of intervention in this group in improving vitamin A nutritional status should be examined further in a controlled study.