RESUMO
BACKGROUND: Among the anthropometric measurements, calf circumference has been widely used as a simple and practical method to diagnose low muscle mass and sarcopenia. However, the association between this measurement and clinical outcomes in people receiving home enteral nutrition is still unknown. Therefore, this study aimed to investigate the association of calf circumference with mortality, discharge from home enteral nutrition, continuity in home enteral nutrition, and new hospitalizations in adult and older adult people. METHODS: This retrospective cohort study used secondary data, including people aged ≥18 years receiving home enteral nutrition. The association between calf circumference and the outcomes of mortality, discharge from home enteral nutrition, and continuity in home enteral nutrition was analyzed using multinomial logistic regression. The association between calf circumference and the occurrence of new hospitalizations was investigated using binary logistic regression. RESULTS: Among the 899 people included in the study, 470 were men (52.3%), the median age was 72 years (interquartile range, 56.5-82), and 850 had inadequate calf circumference (94.5%). As calf circumference increased, the odds of mortality decreased and the probability of discharge from home enteral nutrition and continuity in home enteral nutrition increased. Furthermore, in people with oncologic diagnoses, the odds of new hospitalizations were reduced by 71.9% for each additional centimeter in calf circumference. CONCLUSION: These findings underline the importance of using calf circumference as part of the nutrition assessment because it is a simple, easy, and cost-effective method that can also be used as a tool to predict clinical outcomes.
Assuntos
Nutrição Enteral , Serviços de Assistência Domiciliar , Perna (Membro) , Humanos , Estudos Retrospectivos , Masculino , Feminino , Idoso , Pessoa de Meia-Idade , Nutrição Enteral/métodos , Idoso de 80 Anos ou mais , Serviços de Assistência Domiciliar/estatística & dados numéricos , Sarcopenia/mortalidade , Hospitalização/estatística & dados numéricos , Antropometria , Alta do Paciente/estatística & dados numéricosRESUMO
BACKGROUND & AIMS: Home enteral nutrition is a nutritional intervention that can help in the recovery of health after hospital discharge. The objectives of this study were to evaluate the nutritional composition of different categories of enteral nutrition administered to patients at home, the relationship with their nutritional status, and to compare the nutritional recommendations to the nutritional content provided by the different categories of enteral nutrition. METHODS: 111 samples of homemade enteral preparations (HEP), blended enteral preparations (BEP) and commercial enteral formulas (CEF) were collected from patients' homes. Physicochemical analyses were performed on the enteral formulations, and anthropometric and body composition evaluations were performed on the patients. Comparisons between the infused and prescribed nutritional content were performed. Shapiro-Wilk, Wilcoxon, and Kruskal-Wallis tests with post hoc DMS were conducted. RESULTS: The enteral nutrition categories demonstrated adequacy in relation to the physical analyses. The energy content was similar among the evaluated categories. The BEP and CEF presented higher levels of total solids, proteins, lipids, caloric density and non-protein calories; they also had a lower volume of infused/day content, and both were classified as normocaloric. The HEP were classified as hypocaloric. Regarding the infused content in relation to the recommended content, the HEP presented lower levels of protein and lipids; the CEF showed lower lipid and carbohydrate content, and the BEP presented adequacy in all nutrients. Most of the evaluated anthropometric parameters did not differ between the enteral nutrition categories. The anthropometric indicator of arm circumference (cm and %) was higher in patients receiving CEF and BEP, and the triceps skin fold (mm) was higher in patients receiving CEF and HEP. CONCLUSIONS: It is recommended to review the macronutrient content in nutritional prescriptions, regardless of the enteral nutrition category used. Most anthropometric parameters did not differ between the categories of enteral nutrition administered, especially those that were indicative of lean body mass.
Assuntos
Nutrição Enteral , Estado Nutricional , Ingestão de Energia , Humanos , Lipídeos , Apoio NutricionalRESUMO
Resumen: El uso de apoyo nutricional ambulatorio, enteral o parenteral, ha sido un paso necesario en la opti mización del soporte nutricional en pacientes, que, por diversas patologías, no logran cumplir con sus requerimientos por vía oral (VO). En el presente artículo se presentan las recomendaciones de la Rama de Nutrición, dirigidas a los equipos de salud que atienden pacientes pediátricos, que requieran alimentación enteral por un tiempo prolongado. Su objetivo general es entregar pautas para un co rrecto manejo en estos pacientes. Se describe la conformación ideal del equipo de salud para atención y seguimiento de dichos pacientes, los criterios de ingreso al programa y su forma de evaluación en el tiempo. Además, se describen características generales de la alimentación enteral, vías de admi nistración, fórmulas enterales disponibles, complicaciones de este soporte nutricional y por último monitorización y seguimiento del paciente.
Abstract The use of home enteral or parenteral nutrition has been a necessary step in the optimization of nu tritional support in patients who, due to several diseases, fail to meet their nutritional requirements by oral feeding. This article presents the recommendations of the Chilean Pediatric Society Nutritio nal Branch, aimed at health teams that treat pediatric patients who require enteral feeding for a long time. The general objective is to provide guidelines for the proper management of these patients. It describes the ideal conformation of the health team for the care and follow-up of those patients, the program admission criteria, and its evaluation method over time. In addition, it describes general characteristics of enteral feeding, routes of administration, available enteral formulas, complications, and patient follow-up.
Assuntos
Humanos , Criança , Adolescente , Nutrição Enteral/normas , Serviços de Assistência Domiciliar/normas , Pediatria , Sociedades Médicas , Chile , Doença Crônica , Nutrição Enteral/efeitos adversos , Nutrição Enteral/métodos , Assistência ao Convalescente/métodos , Assistência ao Convalescente/normasRESUMO
Introducción: la nutrición enteral domiciliaria se realiza en la casa del paciente, y permite que disminuyan los costos hospitalarios como consecuencia de largas estadías para lograr la recuperación o mejorar el estado nutricional y su reingreso al medio familiar. Objetivo: mostrar una metodología para la implementación del soporte nutricional enteral personalizado en el hogar con recursos centralizados, como una alternativa para la nutrición domiciliaria en pediatría. Métodos: a partir del diseño de la metodología para las Unidades de Nutrición Enteral Pediátrica con objetivos de actuación de los Grupos de Apoyo Nutricional Hospitalarios, se diseñó una metodología, que, a través de acciones concretas, logra la integración entre los niveles clínico-facultativos y gerenciales. Resultados: la metodología diseñada está basada en la integración de la atención primaria de salud con la secundaria, en una relación de carácter recíproco (desde y hacia), en la que el control centralizado de los recursos permite, no solo economizarlos, sino, a la vez, su registro para organizar la demanda por la estructura administrativa. El diseño metodológico crea, a su vez, un espacio para las funciones educativas de los padres y el control sistemático del soporte, lo cual, a su vez, le da una connotación preventiva acorde con los objetivos de la medicina comunitaria. Conclusiones: la metodología propuesta por nuestro grupo de trabajo constituye una alternativa en pediatría para el desarrollo de la nutrición enteral domiciliaria, como prestación de los servicios nutricionales, con una mayor integración entre los niveles primario y secundario de salud.
Introduction: home enteral nutrition is provided at the patient's house and allows reducing the hospital costs derived from long lengths of stay at hospital to attain the recovery or the improvement of the nutritional status of the patient and his/her return to the family environment. Objective: to show a methodology for the implementation of the personalized enteral nutritional support at home with centralized resources, as an alternative for home nutrition for pediatric patients. Methods: on the basis of the design of the methodology for pediatric enteral nutrition units involving the performance of the hospital nutritional support groups, a methodology was designed that, through concrete actions, manages to integrate the clinical-medical levels and the management levels. Results: this methodology is based on the integration of the primary health care and the secondary health care, in a reciprocal way, in which the centralized control of resources allows both economizing them and organizing them according to the demands on the part of the managing structures. At the same time, the methodological design creates a space for the education of parents and the systematic control of the nutritional support, all of which grants it preventive connotation in line with the objectives of the community-based medicine. Conclusions: the methodology submitted by our working group is a pediatric alternative for the development of home enteral nutrition, as a way of providing nutritional service, with more integration between the primary and the secondary health care levels.
RESUMO
Introdução: A terapia nutricional enteral domiciliar (TNED) é a continuação da administração hospitalar de fórmulas enterais via sonda no ambiente domiciliar. o retorno para o domicílio implica em mudanças na vida cotidiana da família que podem interferir na qualidade de vida (QV) do doente e do cuidador. Objetivo: Fazer uma revisão da literatura sobre a QV de pacientes e cuidadores em TNED, visto o grande aumento deste tipo de terapia nos últimos anos. Resultados: Alguns estudos sugerem que a QV dos pacientes em TNED esteja prejudicada, porém há alguns aspectos clínicos e psicológicos que podem melhorar com o uso prolongado da mesma. Em relação aos cuidadores, a demanda de cuidados, a sobrecarga e o estresse vivido por eles sugerem que a QV esteja comprometida. É indispensável o treinamento e o acompanhamento dos pacientes e cuidadores para o sucesso da terapia, bem como a criação de instrumentos específicos que avaliem a QV em TNED, para melhor compreensão dos fatores envolvidos na mesma.
Introduction: home enteral nutrition therapy (TNED) is the continuation of hospital administration of enteral formulas via tube in the home environment. return to the home involves changes in the daily life of family that can interfere with quality of life (QOL) of the patient and caregiver. Objective: To review the literature on QOL of patients and caregivers TNED since the big increase in this type of therapy in recent years. Results: Some studies suggest that QOL of patients in TNED is impaired, but there are some clinical and psychological aspects that may improve with prolonged use of it. As for caregivers, the demand for care, the burden and stress experienced by them suggest that QOL is compromised. It is essential to the training and monitoring of patients and caregivers for successful therapy, as well as the creation of specific instruments to assess QOL in TNED to better understand the factors involved in it.
Introducción: La terapia de nutrición enteral domiciliaria (TNED) es la continuación de la administración del hospital de fórmulas enterales través de una sonda en el ambiente del hogar. volver a la casa implica cambios en la vida cotidiana de la familia que pueden interferir con la calidad de vida (CDV) del paciente y el cuidador. Objetivo: Revisar la literatura sobre la calidad de vida de los pacientes y cuidadores TNED ya que el gran incremento en este tipo de terapia en los últimos años. Resultados: Algunos estudios sugieren que calidad de vida de los pacientes en TNED se vea afectado, pero hay algunos aspectos clínicos y psicológicos que pueden mejorar con el uso prolongado de la misma. En cuanto a los cuidadores, la demanda de atención, la carga y el estrés experimentado por ellos sugieren que la calidad de vida se ve comprometida. Es fundamental la capacitación y seguimiento de los pacientes y cuidadores para una terapia exitosa, así como la creación de instrumentos específicos para evaluar la calidad de vida en TNED para comprender mejor los factores que intervienen en ella.