RESUMO

Background: Bladder cancer (BC) is an aggressive disease that begins in the cells lining the bladder, which grows abnormally due to mutations. One of the aggravating factors during treatment is the nutritional risk, contributing to increased morbidity and mortality. Nutritional screening can be extremely important for these patients since the nutritional condition can deteriorate during treatment and due to the progression of the disease. Objectives: This cross-sectional observational study aimed to compare the results of using the Mini Nutritional Assessment (MNA) nutritional screening tool obtained by urologists and nutritionists at our center. Methods: The target audience were adult patients diagnosed with BC. They were followed up at the urology outpatient clinic and were asked to answer the questions in the short version of MAN during a nutritional screening conducted by a medical team, and later answer the questions contained in the full version of the instrument during a nutritional consultation by nutritionists. The data were analyzed and organized by employing a RedCap database. Statistical analysis of data was performed using the SPSS software package. For comparison between continuous variables, the Mann-Whitney U-test and Student's t-test were utilized. For analyses of the categorical variables, the Wilcoxon Matched Pairs test and the Cohen Kappa test were used. A significance level of 5% (P ≤ 0.05) with a confidence level of 95% was set for all statistical tests. Results: A total of 46 patients were evaluated. The medical team identified 18 (39.1%) with normal nutritional status, while the nutrition team identified 13 (28.3%). In comparison, the use of the full version of the MNA administered by the nutrition team found that 32 (69.6%) patients were at nutritional risk. Individual questions of the short-version MNA were also compared between the two groups and the Wilcoxon Matched Pairs test was performed. The short-version MNA was found to be an excellent screening tool. When applied by a urologist, it yielded a sensitivity of 87.5% (P = 0.87) and a sensitivity of 93.7% (P = 0.76) when used by the nutritionist. A raw match rate was 71.7% achieved by both questionnaires, and the Cohen Kappa test showed that the agreement was moderate, with an agreement rate of 77.9% (k = 0.50). Conclusion: The application of short-version MNA has a high sensitivity. However, the full-version MNA is necessary for nutritional screening to improve the sensitivity of the assessment and to serve as a guide for nutritionists and the multidisciplinary care team.

RESUMO

OBJECTIVE: To propose and evaluate the clinical utility of a new nutrition screening algorithm, NutriPal, to detect the degree of nutritional risk in patients with incurable cancer receiving palliative care. METHODS: It is a prospective cohort conducted in an oncology palliative care unit. The NutriPal algorithm was used in a three-step process: (i) administration of the Patient-Generated Subjective Global Assessment short form; (ii) calculation of the Glasgow Prognostic Score; and (iii) application of the algorithm to classify patients into four degrees of nutritional risk. The higher the degrees of NutriPal, the worse the nutritional risk, comparing nutritional measures, laboratory data, and overall survival (OS). RESULTS: The study included 451 patients that were classified using the NutriPal. They were allocated to the degrees: 1 (31.26%), 2 (27.49%), 3 (21.73%), and 4 (19.71%). Statistically significant differences were found in most of the nutritional and laboratory parameters and in OS with each increment in the NutriPal degrees, and OS was reduced (log-rank <0.001). In addition, NutriPal was able to predict a 120-day mortality: there was a significantly higher risk of death in the patients classified as degrees 4 (hazard ratio [HR], 3.03; 95% confidence interval [95% CI], 2.18-4.19), 3 (HR, 2.01; 95% CI, 1.46-2.78), and 2 (HR, 1.42; 95% CI; 1.04-1.95) than in those classified as degree 1. It also showed good predictive accuracy (concordance statistic, 0.76). CONCLUSION: The NutriPal is associated to nutritional and laboratory parameters and can predict survival. It could therefore be incorporated into clinical practice for patients with incurable cancer receiving palliative care.

Assuntos

Neoplasias , Cuidados Paliativos , Humanos , Estudos Prospectivos , Detecção Precoce de Câncer , Estado Nutricional , Neoplasias/terapia , Prognóstico , Avaliação Nutricional

RESUMO

Objective: To analyze the agreement between body mass index (BMI) and waist-to-height Ratio (WHtR) to identify preschool and school children with cardiovascular risk factors (CRFs). Methods: Three-hundred-twenty-one kids were divided into preschool (3-5 years) and school children (6-10 years). BMI was used to classify children as overweight or obese. Abdominal obesity was defined with a WHtR ≥0.50. Fasting blood lipids, glucose and insulin were measured, and the homeostasis model assessment of insulin resistance (HOMA-IR) was calculated. The presence of CRFs and multiple non-waist circumference (non-WC) metabolic syndrome factors (MetS-Factors) [high HOMA-IR, high triglycerides and low high-density lipoprotein cholesterol (HDL-C)] were analyzed. Results: One-hundred-twelve preschool and 209 school children were evaluated. WHtR ≥0.50 classified abdominal obesity in more than half of the preschool children, exceeding those classified with overweight+obesity by BMI (59.5% vs. 9.8%; p<0.001). There was no agreement between WHtR and BMI to identify preschool kids with CRFs and multiple non-WC MetS-Factors (kappa: 0.0 to 0.23, p>0.05). There were similar proportions of school children classified with abdominal obesity by the WHtR and overweight+obesity by the BMI (18.7% vs. 24.9%; p>0.05). There was substantial agreement between WHtR and BMI to identify school children with high total cholesterol values, low-density lipoprotein cholesterol (LDL-C), triglycerides, non-HDL-C, insulin, HOMA-IR, low HDL-C values, and the presence of multiple non-WC MetS-Factors (kappa: 0.616 to 0.857, p<0.001). Conclusion: In preschool children WHtR ≥0.5 disagree with BMI results, but in school kids, it has good agreement with the BMI to classify the children´s nutritional status and to identify those with CRFs.

---

Objetivo: Analizar el grado de acuerdo entre el índice de masa corporal (IMC) y la relación/cintura estatura (rCE) para identificar niños con factores de riesgo cardiovascular (FRC). Métodos: Estudio transversal analítico con 112 niños preescolares (3-5 años) y 209 escolares (6-10 años). El sobrepeso y la obesidad se clasificaron con el IMC y la obesidad abdominal con la rCE ≥0.50. Se tomaron muestras sanguíneas en ayuno para análisis de glucosa, insulina, lípidos y cálculo del índice HOMA-IR. Se analizó la presencia de FRC y de múltiples factores del síndrome metabólico (Factores-SinMet) diferentes a la cintura [HOMA-IR elevado, triglicéridos elevados y colesterol de alta densidad (HDL-C) bajo]. Resultados: rCE ≥0.50 clasificó con obesidad abdominal a más de la mitad de los niños preescolares, excediendo el número de niños clasificados con sobrepeso+obesidad por IMC (59.5% vs 9.8%; p<0.001). No hubo acuerdo entre el IMC y la rCE para identificar niños preescolares con FRC o múltiples Factores-SinMet diferentes a la cintura (kappa: 0.0 a 0.23, p>0.05). Fueron similares las proporciones de niños escolares clasificados con obesidad abdominal por la rCE o con sobrepeso+obesidad por el IMC (18.7% vs. 24.9%; p>0.05). Hubo acuerdo sustancial entre la rCE y el IMC para identificar niños escolares con valores elevados de colesterol total, colesterol de baja densidad, triglicéridos, colesterol no-HDL, insulina, HOMA-IR, valores bajos de HDL-C y la presencia de múltiples Factores-SinMet diferentes a la cintura (kappa: 0.616 a 0.857, p<0.001). Conclusión: En niños preescolares la aplicación de rCE ≥0.5 no presenta acuerdo con el IMC, pero en escolares presenta un acuerdo sustancial con el IMC en la clasificación del estado nutricional y en la identificación de niños con FRC.

Assuntos

Doenças Cardiovasculares , Insulinas , Humanos , Pré-Escolar , Criança , Índice de Massa Corporal , Sobrepeso/epidemiologia , Sobrepeso/complicações , Fatores de Risco , Obesidade Abdominal/epidemiologia , Obesidade Abdominal/complicações , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Colômbia/epidemiologia , Razão Cintura-Estatura , Obesidade/complicações , Triglicerídeos , Colesterol , Fatores de Risco de Doenças Cardíacas

RESUMO

OBJECTIVE: The aim of this study was to investigate the complementarity of five nutritional risk screening tools (Nutritional Risk Screening 2002 [NRS-2002], Malnutrition Screening Tool [MST], Malnutrition Universal Screening Tool [MUST], Mini-Nutritional Assessment-Short Form [MNA-SF], and Patient-Generated Subjective Global Assessment SF [PG-SGA SF]) combined with three malnutrition diagnostic tools (SGA, PG-SGA, and Global Leadership Initiative on Malnutrition [GLIM]) and their ability to predict poor clinical outcomes in older patients with cancer. METHODS: Using data collected within 48 h of hospital admission, we conducted a prospective cohort study on nutritional risk (NRS-2002, MST, MUST, MNA-SF, and PG-SGA SF) and the presence of malnutrition (SGA, PG-SGA, and GLIM). Patients were grouped according to their nutritional risk and malnutrition status. Accuracy tests and logistic regression analysis were used to evaluate the ability of the combined tools to predict hospital length of stay and readmission. We evaluated 248 older patients (69.7 ± 7.2 y of age, 59.7% men; 27.4% with gastrointestinal tumors). The median length of stay was 4 d (3-9 d), and 65.3% of patients remained hospitalized for ≥ 4 d. RESULTS: The NRS-2002 combined with SGA and MST combined with SGA and GLIM had the highest specificity (> 80%) for predicting hospitalization. Nutritional risk assessed by MNA-SF and malnutrition assessed by PG-SGA were associated with 2.48- and 6.04-fold increased likelihood of hospitalization (≥ 4 d) and readmission (60 d), respectively. CONCLUSION: Concomitant application of MNA-SF (specific for older patients) with PG-SGA (specific for patients with cancer) might enhance the ability to predict length of stay and readmission in hospitalized older patients with solid tumors.

Assuntos

Desnutrição , Neoplasias , Masculino , Humanos , Idoso , Pessoa de Meia-Idade , Feminino , Avaliação Nutricional , Tempo de Internação , Estado Nutricional , Estudos de Coortes , Estudos Prospectivos , Readmissão do Paciente , Desnutrição/diagnóstico , Desnutrição/epidemiologia , Desnutrição/etiologia , Neoplasias/complicações

RESUMO

Objective: To analyze the agreement between body mass index (BMI) and waist-to-height Ratio (WHtR) to identify preschool and school children with cardiovascular risk factors (CRFs). Methods: Three-hundred-twenty-one kids were divided into preschool (3-5 years) and school children (6-10 years). BMI was used to classify children as overweight or obese. Abdominal obesity was defined with a WHtR ≥0.50. Fasting blood lipids, glucose and insulin were measured, and the homeostasis model assessment of insulin resistance (HOMA-IR) was calculated. The presence of CRFs and multiple non-waist circumference (non-WC) metabolic syndrome factors (MetS-Factors) [high HOMA-IR, high triglycerides and low high-density lipoprotein cholesterol (HDL-C)] were analyzed. Results: One-hundred-twelve preschool and 209 school children were evaluated. WHtR ≥0.50 classified abdominal obesity in more than half of the preschool children, exceeding those classified with overweight+obesity by BMI (59.5% vs. 9.8%; p0.05). There were similar proportions of school children classified with abdominal obesity by the WHtR and overweight+obesity by the BMI (18.7% vs. 24.9%; p>0.05). There was substantial agreement between WHtR and BMI to identify school children with high total cholesterol values, low-density lipoprotein cholesterol (LDL-C), triglycerides, non-HDL-C, insulin, HOMA-IR, low HDL-C values, and the presence of multiple non-WC MetS-Factors (kappa: 0.616 to 0.857, p<0.001). Conclusion: In preschool children WHtR ≥0.5 disagree with BMI results, but in school kids, it has good agreement with the BMI to classify the children´s nutritional status and to identify those with CRFs.

---

Objetivo: Analizar el grado de acuerdo entre el índice de masa corporal (IMC) y la relación/cintura estatura (rCE) para identificar niños con factores de riesgo cardiovascular (FRC). Métodos: Estudio transversal analítico con 112 niños preescolares (3-5 años) y 209 escolares (6-10 años). El sobrepeso y la obesidad se clasificaron con el IMC y la obesidad abdominal con la rCE ≥0.50. Se tomaron muestras sanguíneas en ayuno para análisis de glucosa, insulina, lípidos y cálculo del índice HOMA-IR. Se analizó la presencia de FRC y de múltiples factores del síndrome metabólico (Factores-SinMet) diferentes a la cintura [HOMA-IR elevado, triglicéridos elevados y colesterol de alta densidad (HDL-C) bajo]. Resultados: rCE ≥0.50 clasificó con obesidad abdominal a más de la mitad de los niños preescolares, excediendo el número de niños clasificados con sobrepeso+obesidad por IMC (59.5% vs 9.8%; p0.05). Fueron similares las proporciones de niños escolares clasificados con obesidad abdominal por la rCE o con sobrepeso+obesidad por el IMC (18.7% vs. 24.9%; p>0.05). Hubo acuerdo sustancial entre la rCE y el IMC para identificar niños escolares con valores elevados de colesterol total, colesterol de baja densidad, triglicéridos, colesterol no-HDL, insulina, HOMA-IR, valores bajos de HDL-C y la presencia de múltiples Factores-SinMet diferentes a la cintura (kappa: 0.616 a 0.857, p<0.001). Conclusión: En niños preescolares la aplicación de rCE ≥0.5 no presenta acuerdo con el IMC, pero en escolares presenta un acuerdo sustancial con el IMC en la clasificación del estado nutricional y en la identificación de niños con FRC.

RESUMO

ABSTRACT Background: Nutritional screening is defined by American Society for Parenteral and Enteral Nutrition (ASPEN) as a process to identify individuals at risk of malnutrition. Malnutrition is a prevalent condition in cirrhotic patients, and it results in important prognostic implications. Most of the commonly used instruments fail in considering the particularities of cirrhotic patients. The Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT) is a nutritional screening tool developed and validated to identify malnutrition risk in patients with liver disease. Objective The study's aim was to conduct the transcultural adaptation (translation and adaptation) of RFH-NPT tool to Portuguese (Brazil). Methods: The process of cultural translation and adaptation followed the Beaton et al. methodology. The process involved the steps of initial translation, synthesis translation, back translation pretest of the final version with 40 nutritionists and a specialists committee. The internal consistency was calculated with the Cronbach coefficient and the content validation was verified with the content validation index. Results: Forty clinical nutritionists with experience in treatment of adult patients participated in the step of cross-cultural adaptation. The alpha Cronbach coefficient was 0.84, which means high reliability. In the specialists analyzes all the tool's questions achieved a validation content index higher than 0.8, showing high agreement. Conclusion: The NFH-NPT tool was translated and adapted to Portuguese (Brazil) and showed high reliability.

---

RESUMO Contexto: A triagem nutricional é definida pela Sociedade Americana de Nutrição Parenteral e Enteral (ASPEN) como um processo para identificar indivíduos em risco de desnutrição. A desnutrição é uma condição prevalente em pacientes cirróticos e resulta em importantes implicações prognósticas. A maioria dos instrumentos comumente utilizados falha em considerar as particularidades dos pacientes com cirrose. A Royal Free Hospital-Nutritional Prioritizing Tool (RFH NPT) é uma ferramenta de triagem nutricional desenvolvida e validada para identificar o risco de desnutrição em pacientes com doença hepática. Objetivo: O objetivo do estudo foi realizar a adaptação transcultural (tradução e adaptação cultural) da ferramenta RFH-NPT para o português (Brasil). Métodos: O processo de tradução e adaptação cultural seguiu a metodologia de Beaton et al. O processo envolveu as etapas de tradução inicial, síntese das traduções, retrotradução, pré-teste da versão final em uma amostra de 40 nutricionistas e comitê de especialistas. A consistência interna foi calculada pelo coeficiente de Cronbach e a validação de conteúdo foi verificada por meio do índice de validação de conteúdo. Resultados: Quarenta nutricionistas clínicos com experiência no tratamento de pacientes adultos participaram da etapa de adaptação cultural. O coeficiente alfa de Cronbach foi de 0,84, que expressa alta confiabilidade. Na análise dos especialistas, todas as questões da ferramenta obtiveram índice de validação de conteúdo superior a 0,8, apresentando alta concordância. Conclusão: A ferramenta RFH-NPT foi traduzida e adaptada para a língua portuguesa do Brasil apresentando alta confiabilidade.

RESUMO

ABSTRACT Background The prevalence of hospitalized elderly patients has grown substantially and has impacted the hospital health services. Thus, it is believed that an investigation of the nutritional status associated with different clinical situations in elderly patients could contribute to multidisciplinary hospital intervention and nutritional care actions suitable for this population. Objective To investigate the relationship between two nutritional screening instruments in hospitalized older patients and to compare clinical variables between these two instruments. Methods Retrospective study with hospitalized older patients (n=277), investigating the agreement between two nutritional screening instruments. The data were analyzed using the McNemar, chi-square, Fisher, Mann-Whitney tests and the kappa coefficient for the agreement assessment. Results There was a significant difference (P=0.0002) between the nutritional risk classifications of the two nutritional screening instruments and moderate agreement (k=0.5430) between them. The association between nutritional risk screening and age (P=0.0255), length of hospital stay (P<0.0001), gender (P=0.0365) and illness (P=0.0001) were assessed. There was an association between Mini Nutritional Assessment and length of stay (P<0.0001), illness (P=0.0001) and body weight evolution (P=0.0479). Conclusion The nutritional risk screening and Mini Nutritional Assessment showed moderate agreement in the assessment of elderly patients.

---

RESUMO Contexto A prevalência de pacientes idosos hospitalizados tem crescido substancialmente e impactado os serviços de saúde hospitalar. Desta forma, acredita-se que uma investigação do estado nutricional, associado a situações clínicas variadas em pacientes idosos, poderia contribuir para ações de intervenção hospitalar multidisciplinares e de cuidado nutricional adequadas para esta população. Objetivo Investigar a relação entre dois instrumentos de triagem nutricional em pacientes idosos hospitalizados e comparar variáveis clínicas entre estes dois instrumentos. Métodos Estudo retrospectivo com pacientes idosos hospitalizados (n=277), sendo investigado a concordância entre dois instrumentos de triagem nutricional. Os dados foram analisados pelos testes McNemar, qui-quadrado, Fisher, Mann-Whitney e o coeficiente kappa para a avaliação de concordância. Resultados Houve diferença significativa (P=0,0002) entre as classificações de risco nutricional pelos dois instrumentos de triagem nutricional e concordância moderada (k=0,5430) entre eles. Verificou-se associação entre triagem de risco nutricional e idade (P=0,0255), tempo de internação (P<,0001), sexo (P=0,0365) e doenças (P=0,0001). Houve associação entre a Mini Avaliação Nutricional e tempo de internação (P<0,0001), doenças (P=0,0001) e evolução do peso corporal (P=0,0479). Conclusão Triagem de risco nutricional e a Mini Avaliação Nutricional apresentam concordância moderada para a avaliação de pacientes idosos.

RESUMO

PURPOSE: Malnutrition is a common problem among pancreatic cancer (PC) patients that negatively impacts on their quality of life (QoL) and clinical outcomes. The main objective of this consensus is to address the role of Medical Nutrition Therapy (MNT) into the comprehensive therapeutic management of PC patients. METHODS: A Spanish multidisciplinary group of specialists from the areas of Medical Oncology; Radiation Oncology; Endocrinology and Nutrition; and General Surgery agreed to assess the role of MNT as part of the best therapeutic management of PC patients. RESULTS: The panel established different recommendations focused on nutritional screening and nutritional screening tools, MNT strategies according to PC status, and MNT in palliative treatment. CONCLUSIONS: There is an unmet need to integrate nutritional therapy as a crucial part of the multimodal care process in PC patients. Health authorities, health care professionals, cancer patients, and their families should be aware of the relevance of nutritional status and MNT on clinical outcomes and QoL of PC patients.

Assuntos

Desnutrição/dietoterapia , Desnutrição/etiologia , Terapia Nutricional , Neoplasias Pancreáticas/complicações , Procedimentos Clínicos , Humanos , Estado Nutricional

RESUMO

CONTEXT: Malnutrition has a negative impact on patients with cancer. Identifying risk, nutritional status, and functional capacity can contribute to adequate and early nutritional therapy, which can reduce unfavorable clinical outcomes. OBJECTIVE: To evaluate and summarize the main instruments of nutritional assessment and functional capacity and associate their results with clinical outcomes in hospitalized patients with cancer. DATA SOURCES: A systematic search was performed in the PubMed/MEDLINE, Embase, SciELO, and LILACS databases. Studies in which researchers evaluated and compared screening, nutritional assessment, and functional capacity instruments and their associations with clinical outcomes were included. DATA EXTRACTION: The data were extracted by 2 independent reviewers. RESULTS: A total of 29 studies met the inclusion criteria (n = 20 441 individuals). The Nutritional Risk Screening-2002 (NRS-2002) and Patient-Generated Subjective Global Assessment (PG-SGA) were the most common tools used for nutritional assessment. High nutritional risk according to the NRS-2202 and worse nutritional status according to the PG-SGA and Subjective Global Assessment were positively associated with a longer hospital stay and mortality. Low functional capacity, according to handgrip strength, was associated with longer hospital stay and nutrition impact symptoms. CONCLUSIONS: Tools such as the NRS-2002, PG-SGA, Subjective Global Assessment, and handgrip strength assessment are efficacious for assessing unfavorable clinical outcomes in hospitalized patients with cancer.

Assuntos

Desnutrição , Neoplasias , Força da Mão , Humanos , Desnutrição/complicações , Neoplasias/terapia , Avaliação Nutricional , Estado Nutricional

RESUMO

Resumen Introducción: la desnutrición hospitalaria, vinculada principalmente a la enfermedad o injuria, tiene una alta prevalencia a nivel mundial. Está asociada negativamente con resultados clínicos y económicos. Objetivo: Determinar si existe asociación entre el estado nutricional al ingreso hospitalario y el tiempo de internación. Materiales y método: se realizó un estudio observacional, descriptivo y retrospectivo, en pacientes adultos ingresados al Hospital Interzonal General de Agudos "San Roque" durante el año 2019. Para el tamizaje nutricional se utilizó el Malnutrition Screening Tool (MST) y para la evaluación nutricional la Valoración Global Subjetiva. Se calculó la estancia hospitalaria como la diferencia entre la fecha de ingreso y egreso. Resultados: se evaluaron 2296 pacientes. La prevalencia global de desnutrición fue del 25,4%. Se encontraron diferencias estadísticamente significativas entre estancia hospitalaria prolongada y estado nutricional; tanto en pacientes con desnutrición moderada [OR crudo 2,75 (IC 95% 2,1-3,4; p < 0,0001)] como en pacientes con desnutrición severa [OR crudo 5 (IC 95% 3,5 - 7,0; p < 0,0001)]. Conclusión: este estudio refleja la alta prevalencia de desnutrición que padecen los pacientes al ingreso hospitalario, como así también el mayor riesgo de tener estancias más prolongadas cuando existe desnutrición.

---

Abstract Introduction: hospital malnutrition, mainly linked to illness or injury, has a high prevalence worldwide. It is negatively associated with clinical and economic outcomes. Objective: to determine if there is an association between nutritional status and length of hospital stay. Materials and method: observational, descriptive and retrospective study was carried out in adult patients admitted to the Hospital Interzonal General de Agudos "San Roque" during 2019. For nutritional screening, the Malnutrition Screening Tool was used and for nutritional assessment, the Subjective Global Assessment. Length of hospital stay was calculated as the difference between the date of admission and discharge. Results: 2296 patients were assessed. The global prevalence of malnutrition was 25,4%. Statistically significant differences were found between prolonged hospital stay and nutritional status; both in patients with moderate malnutrition [crude OR 2,75 (95% CI 2,1-3,4; p<0.0001)] and in patients with severe malnutrition [crude OR 5 (95% CI 3,5 - 7,0; p<0,0001)]. Conclusion: this study reflects the high prevalence of malnutrition suffered by patients at hospital admission, as well as the increased risk of having longer stays when malnutrition exists.

Assuntos

Desnutrição , Hospitalização

RESUMO

Objective: To assess whether the nutritional risk classified by StrongKids is associated with anemia and inflammation (total leukocytes and C-reactive protein (CRP)), as well as to compare the ability of StrongKids with anthropometry in identifying these changes in hospitalized pediatric patients.Methods: Cross-sectional study with patients admitted to the pediatric ward of a public hospital in Brazil, from 2014 to 2018. The experimental protocol included: nutritional risk screening by StrongKids; weight and height measurements; and biochemical tests (complete blood count and C-reactive protein - CRP). Sensitivity, specificity, positive predictive value and negative predictive value were calculated to assess the ability of StrongKids and anthropometry to identify patients with the biochemical changes.Results: The study included 482 patients (54.2% male), with a median age of 2.7 years. The frequency of nutritional risk (medium or high) was 85.9% and the prevalence of malnutrition (acute and/or chronic) was 20.2%. Overall, of the patients evaluated, 40.2% had anemia, 28.2% leukocytosis, and 78.0% high CRP. Children and adolescents classified as at nutritional risk (moderate/high) had lower levels of hemoglobin and higher levels of CRP and total leukocytes, as well as a higher frequency of leukocytosis, high CRP and the three alterations combined when compared with individuals at low risk. No association was found between anthropometric variables and biochemical alterations. The sensitivity of nutritional screening was high to detect all biochemical alterations and was superior to the anthropometric assessment.Conclusion: StrongKids was associated with alterations in biochemical parameters with a better performance than anthropometry.

Assuntos

Anemia , Desnutrição , Adolescente , Anemia/diagnóstico , Anemia/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Inflamação/diagnóstico , Masculino , Desnutrição/diagnóstico , Desnutrição/epidemiologia , Programas de Rastreamento , Avaliação Nutricional , Estado Nutricional

RESUMO

Coronavirus disease 2019 (COVID-19) is associated with high risk of malnutrition, primarily in older people; assessing nutritional risk using appropriate screening tools is critical. This systematic review identified applicable tools and assessed their measurement properties. Literature was searched in the MEDLINE, Embase, and LILACS databases. Four studies conducted in China met the eligibility criteria. Sample sizes ranged from six to 182, and participants' ages from 65 to 87 years. Seven nutritional screening and assessment tools were used: the Nutritional Risk Screening 2002 (NRS-2002), the Mini Nutritional Assessment (MNA), the MNA-short form (MNA-sf), the Malnutrition Universal Screening Tool (MUST), the Nutritional Risk Index (NRI), the Geriatric NRI (GNRI), and modified Nutrition Risk in the Critically ill (mNUTRIC) score. Nutritional risk was identified in 27.5% to 100% of participants. The NRS-2002, MNA, MNA-sf, NRI, and MUST demonstrated high sensitivity; the MUST had better specificity. The MNA and MUST demonstrated better criterion validity. The MNA-sf demonstrated better predictive validity for poor appetite and weight loss; the NRS-2002 demonstrated better predictive validity for prolonged hospitalization. mNUTRIC score demonstrated good predictive validity for hospital mortality. Most instruments demonstrate high sensitivity for identifying nutritional risk, but none are acknowledged as the best for nutritional screening in older adults with COVID-19.

Assuntos

Betacoronavirus , Infecções por Coronavirus/complicações , Avaliação Geriátrica , Desnutrição/diagnóstico , Avaliação Nutricional , Pneumonia Viral/complicações , Idoso , Idoso de 80 Anos ou mais , COVID-19 , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/virologia , Feminino , Humanos , Masculino , Desnutrição/virologia , Pessoa de Meia-Idade , Estado Nutricional , Pandemias , Pneumonia Viral/fisiopatologia , Pneumonia Viral/virologia , Reprodutibilidade dos Testes , Medição de Risco , SARS-CoV-2 , Sensibilidade e Especificidade

RESUMO

OBJECTIVE: To determine if a global mid-upper arm circumference (MUAC) cut-off can be established to classify underweight in adults (men and non-pregnant women). DESIGN: We conducted an individual participant data meta-analysis (IPDMA) to explore the sensitivity (SENS) and specificity (SPEC) of various MUAC cut-offs for identifying underweight among adults (defined as BMI < 18·5 kg/m2). Measures of diagnostic accuracy were determined every 0·5 cm across MUAC values from 19·0 to 26·5 cm. A bivariate random effects model was used to jointly estimate SENS and SPEC while accounting for heterogeneity between studies. Various subgroup analyses were performed. SETTING: Twenty datasets from Africa, South Asia, Southeast Asia, North America and South America were included. PARTICIPANTS: All eligible participants from the original datasets were included. RESULTS: The total sample size was 13 835. Mean age was 32·6 years and 65 % of participants were female. Mean MUAC was 25·7 cm, and 28 % of all participants had low BMI (<18·5 kg/m2). The area under the receiver operating characteristic curve for the pooled dataset was 0·91 (range across studies 0·61-0·98). Results showed that MUAC cut-offs in the range of ≤23·5 to ≤25·0 cm could serve as an appropriate screening indicator for underweight. CONCLUSIONS: MUAC is highly discriminatory in its ability to distinguish adults with BMI above and below 18·5 kg/m2. This IPDMA is the first step towards determining a global MUAC cut-off for adults. Validation studies are needed to determine whether the proposed MUAC cut-off of 24 cm is associated with poor functional outcomes.

Assuntos

Braço , Magreza , Adulto , África , Antropometria , Braço/anatomia & histologia , Ásia , Índice de Massa Corporal , Estudos Transversais , Feminino , Humanos , Masculino , América do Norte , América do Sul

RESUMO

BACKGROUND: Different nutritional screening instruments can be used to identify the risk of malnutrition in advanced chronic liver disease patients. The present study aimed to evaluate and compare two nutrition screening tools with the Global Leadership Initiative on Malnutrition (GLIM) diagnostic criteria for malnutrition in patients with advanced chronic liver disease. METHODS: Two nutritional screening tools, Nutritional Risk Screening 2002 (NRS-2002) and Royal Free Hospital Nutritional Prioritizing Tool (RFH-NPT), were assessed for 166 patients with liver cirrhosis. We compared medium/high nutritional risk screening with the diagnosis of malnutrition, using the GLIM criteria as the reference standard. RESULTS: According to the GLIM criteria, 57.3% of the patients were malnourished. NRS and RFH-NPT identified, respectively, 36.1% and 52.4% of patients with nutritional risk. RFH-NPT presented better agreement with the diagnosis according to GLIM criteria (k = 0.64; 95% confidence interval = 0.52-0.75), higher sensitivity (80%), higher negative predictive value (79%) and larger area under the curve (82.3%) compared to the NRS. CONCLUSIONS: RFH-NPT, when compared with the GLIM method, has substantial agreement in identifying nutritional risk, good sensitivity and good value for diagnosing malnutrition in patients with advanced chronic liver disease.

Assuntos

Doença Hepática Terminal/classificação , Desnutrição/diagnóstico , Programas de Rastreamento/métodos , Avaliação Nutricional , Medição de Risco/métodos , Idoso , Estudos Transversais , Doença Hepática Terminal/complicações , Doença Hepática Terminal/fisiopatologia , Feminino , Humanos , Masculino , Desnutrição/etiologia , Pessoa de Meia-Idade , Estado Nutricional , Índice de Gravidade de Doença

RESUMO

Although pressure injury (PI) is preventable, the number of patients developing this type of injury is still high. In this prospective cohort study, we aimed to assess whether high risk for undernutrition was a risk factor for PI in 1937 patients aged ≥18 at six hospitals in Sao Paulo, Brazil. Patients' risk for undernutrition was assessed using three unique screening tools. Risk for PI was assessed using the Braden Scale. Data were analysed using Poisson regression with robust variance (95% CI, P ≤ .05). While 57.1% of patients were at risk for undernutrition in the Nutritional Risk Screening (NRS 2002), only 36.8% and 2.6% were at risk in the Braden Scale Nutrition Subscale (BSNS) and Subjective Global Assessment of Nutritional Status (SGANS), respectively. The cumulative incidence rate was 5.9%. Of those who developed PI, 91.2%, 56.2%, and 18.4% were at risk for undernutrition in the NRS 2002, BSNS, and SGANS scales, respectively. We found a significantly higher risk for PI in patients who were at risk for undernutrition compared with those who were not at risk, supporting previous evidence about the role of undernutrition as a key risk factor for PI in hospitalised patients.

Assuntos

Previsões/métodos , Pacientes Internados/estatística & dados numéricos , Desnutrição/diagnóstico , Desnutrição/fisiopatologia , Úlcera por Pressão/diagnóstico , Úlcera por Pressão/fisiopatologia , Medição de Risco/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Estudos Prospectivos , Fatores de Risco , Adulto Jovem

RESUMO

BACKGROUND: Malnutrition in cancer is an independent factor associated with negative clinical outcomes. The objective of this study was to evaluate the prevalence of malnutrition across different age groups in patients with cancer in Brazil and to identify associations with nutrition impact symptoms (NIS). METHODS: In this observational, cross-sectional, multicenter study, the authors evaluated 4783 patients with cancer aged ≥20 years who were admitted to 45 public hospitals in Brazil. Nutritional status, nutritional risk, and NIS were evaluated using the Patient-Generated Subjective Global Assessment. RESULTS: More than one-fourth (25.5%) of all participants were aged ≥65 years. In patients aged ≥65 years, the prevalence of moderate/suspected and severe malnutrition was 55%, it was 45.4% in those aged 51 to 64 years, and it was 36.1% in those aged ≤50 years. Among the NIS with a higher risk of occurrence in patients aged ≥65 years were no appetite (odds ratio [OR], 1.90; 95% CI, 1.62-2.22; P < .05) and dry mouth (OR, 1.40; 95% CI, 1.1-1.67; P < .05). In patients between ages 51 and 64 years, compared with those aged ≤50 years, the NIS with a higher risk of occurrence were no appetite (OR, 1.45; 95% CI, 1.23-1.69; P < .05), dry mouth (OR, 1.22; 95% CI, 1.02-1.45; P < .05), and problems with swallowing (OR, 1.56; 95% CI, 1.25-1.96; P < .05). CONCLUSIONS: The prevalence of malnutrition and the occurrence of NIS are high in hospitalized Brazilian patients aged ≥65 years who have cancer. The occurrence of NIS was higher in the population aged >50 years than in those aged ≤50 years. Nutritional screening and assessment should be performed immediately after hospitalization to enable early diagnosis and multidisciplinary or interdisciplinary intervention(s).

Assuntos

Desnutrição/epidemiologia , Neoplasias/epidemiologia , Estado Nutricional , Adulto , Idoso , Idoso de 80 Anos ou mais , Apetite/fisiologia , Índice de Massa Corporal , Brasil/epidemiologia , Feminino , Hospitalização , Humanos , Tempo de Internação , Masculino , Desnutrição/complicações , Desnutrição/patologia , Pessoa de Meia-Idade , Neoplasias/complicações , Neoplasias/patologia , Avaliação Nutricional

RESUMO

BACKGROUND: Considering the difficulty in obtaining weight and height measurements of patients at hospital admission, the Malnutrition Universal Screening Tool (MUST) proposes the use of mid-upper arm circumference (MUAC) instead of body mass index (BMI) as an alternative for screening of malnutrition risk. The present study aimed to evaluate the performance of MUST with MUAC in place of BMI to identify nutritional risk and predict prolonged hospitalisation and mortality in hospitalised patients. METHODS: The prospective cohort study involved ambulant patients aged ≥18 years who were admitted to the emergency department of a public hospital. A questionnaire concerning clinical and socio-demographic data was applied and anthropometric measurements were performed (weight, height, BMI and MUAC). Nutritional risk screening was performed using the original MUST (BMI) and MUST-MUAC tools. The outcomes were length of hospital stay and death. RESULTS: Seven hundred and fifty-two patients were included and followed-up for 13.5 (interquartile range 3.00-19.00) days. The frequency of patients at nutritional risk was higher according to MUST-MUAC (48.9%) compared to the original MUST (37.1%). MUST-MUAC showed concurrent validity, demonstrating good agreement with the original MUST (k = 0.690), high sensitivity (95.3%) and accuracy (area under the curve = 0.868; 95% confidence interval = 0.841-0.895) with respect to identifying nutritional risk. The presence of nutritional risk detected by the MUST-MUAC increased the chance of prolonged hospital stay by 1.9 (95% CI. 1.4-2.7)-fold and mortality by 3.2 (95% CI. 1.1-9.4)-fold. CONCLUSIONS: MUST-MUAC showed satisfactory concurrent and predictive validity. Considering that MUAC measurement is easier to perform than BMI, the MUST-MUAC should be used for screening of nutritional risk in hospitalised patients.

Assuntos

Antropometria/métodos , Braço/anatomia & histologia , Índice de Massa Corporal , Programas de Rastreamento/métodos , Adulto , Idoso , Estudos de Coortes , Serviço Hospitalar de Emergência , Feminino , Hospitalização , Humanos , Tempo de Internação , Masculino , Desnutrição/diagnóstico , Pessoa de Meia-Idade , Admissão do Paciente , Estudos Prospectivos , Fatores de Risco , Sensibilidade e Especificidade

RESUMO

OBJECTIVE: To assess the prevalence, causes, and consequences of malnutrition, as well as the evolution of nutritional status, in Canadian pediatric health care institutions. STUDY DESIGN: In this multicenter prospective cohort study, a total of 371 patients were recruited from pediatric hospitals in 5 Canadian provinces. Subjects were aged 1 month to 18 years; admitted to a medical, surgical, or oncology ward; and had a planned hospital stay of >48 hours. Data on demographics, medical condition, anthropometric measures, and dietary intake were collected. The Screening Tool Risk on Nutritional Status and Growth (STRONGkids) and Subjective Global Nutritional Assessment (SGNA) were applied at admission. Malnutrition was defined as a weight-for-age, height-for-age, body mass index-for-age, or weight-for-length/height z score <-2 SD. RESULTS: Among 307 subjects (median age, 5.3 years; median length of stay, 5 days), 19.5% were malnourished on admission. Both STRONGkids and SGNA classifications were associated with baseline nutritional status. Mean weight-for-age z score was lower at discharge compared with admission (-0.14 vs -0.09; P < .01), and nearly one-half of all patients lost weight during their hospital stay. Only one-half of the children who were malnourished or screened as high risk of malnutrition were visited by a dietitian during their stay. The percentage of patients who lost weight during hospitalization was significantly greater in the group not visited by a dietitian (76.5 vs 23.5%; P < .01). CONCLUSION: Nutritional status deterioration and malnutrition are common in hospitalized Canadian children. Screening tools, anthropometric measurements, and dietitian consultation should be used to establish adequate nutritional support.

Assuntos

Hospitais Pediátricos/estatística & dados numéricos , Desnutrição/epidemiologia , Inquéritos Nutricionais/métodos , Estado Nutricional , Medição de Risco/métodos , Adolescente , Índice de Massa Corporal , Canadá/epidemiologia , Criança , Criança Hospitalizada/estatística & dados numéricos , Pré-Escolar , Feminino , Seguimentos , Humanos , Tempo de Internação/tendências , Masculino , Desnutrição/diagnóstico , Prevalência , Estudos Prospectivos , Fatores de Risco

RESUMO

OBJECTIVE: To evaluate the agreement between two nutritional screening tools (Malnutrition Universal Screening Tool [MUST] and Nutritional Risk Screening-2002 [NRS-2002]) and Subjective Global Assessment (SGA) to identify nutritional risk in patients admitted to public emergency rooms. STUDY DESIGN: Cross-sectional study. METHODS: Patients aged ≥18 years who were admitted to an emergency room of a tertiary public hospital were evaluated. A nutritional risk assessment was performed in the first 48 h following hospital admission, through MUST, NRS-2002, and SGA. The Cohen's kappa coefficient was calculated. RESULTS: The study included 577 patients, with an average age of 53.9 ± 15.8 years; 56% of whom were women. Prevalence of nutritional risk was 35.3% and 28.5% according to MUST and NRS-2002, respectively, and malnutrition prevalence was equal to 32.9% according to SGA. The Cohen's kappa coefficient between SGA and MUST was 0.67 and between SGA and NRS-2002 was 0.62. CONCLUSION: MUST and NRS-2002 showed good agreement with SGA in identification of nutritional risk, suggesting that both tools have similar applicability for nutritional screening in adults or older patients admitted to public emergency rooms.

Assuntos

Serviço Hospitalar de Emergência , Hospitais Públicos , Desnutrição/diagnóstico , Programas de Rastreamento/instrumentação , Avaliação Nutricional , Adolescente , Adulto , Idoso , Brasil/epidemiologia , Estudos Transversais , Feminino , Hospitalização , Humanos , Masculino , Desnutrição/epidemiologia , Pessoa de Meia-Idade , Prevalência , Reprodutibilidade dos Testes , Medição de Risco , Centros de Atenção Terciária , Adulto Jovem

RESUMO

Introducción: la prevalencia de malnutrición clínica se encuentra entre el 20% al 50% de los pacientes hospitalizados. El tamizaje nutricional es esencial para poder identificar aquellos pacientes en riesgo de malnutrición y es el primer paso del proceso de atención nutricional. Objetivo: realizar una revisión bibliográfica de las diferentes herramientas validadas de tamizaje nutricional para pacientes hospitalizados. Materiales y método: se realizó una búsqueda bibliográfica de trabajos de comparación de herramientas de tamizaje nutricional en las bases de datos de Pubmed, Scielo y Lilacs desde 2007 a 2017, más los artículos originales de los métodos. Las palabras claves fueron: herramientas de tamizaje nutricional, evaluación nutricional, malnutrición, pacientes hospitalizados. Se incluyeron todos aquellos artículos en idioma español e inglés. Se identificaron 82 artículos de los cuales se seleccionaron 11 que incluyeron población mayor de 18 años de edad y los estudios originales y de comparación de las herramientas de tamizaje nutricional validadas. Se excluyeron todas aquellas publicaciones de estudios con una muestra menor a 60 y evaluación de tamizaje nutricional para grupos de riesgo específicos. Desarrollo: se analizaron 11 estudios que comparan métodos de tamizaje nutricional. Las herramientas incluidas fueron: VGS, MNA, MNA-SF, MST, NRS-2002, MUST, SNAQ y CONUT. Los estudios resultaron ser heterogéneos en cuanto a las características de la población evaluada, número de pacientes, análisis estadístico, herramientas empleadas y patrones de comparación. Conclusión: es importante contar con una herramienta de tamizaje para detectar aquellos pacientes que se encuentren en riesgo de malnutrición y realizar una intervención temprana. El tamizaje nutricional es una estrategia de priorización que busca determinar la importancia y/o la urgencia de la intervención nutricional. La aplicación de procesos sistemáticos de detección de riesgo nutricional es esencial para poder realizar una intervención oportuna, tanto para disminuir la morbilidad, la mortalidad del paciente y mejorar su calidad de vida como para disminuir los costos que ésta genera(AU).

---

Introduction: the prevalence of clinical malnutrition among hospitalized patients ranges between 20% and 50%. Nutritional screening is essential to identify those patients at risk of malnutrition and constitutes the first step towards nutrition care process. Aim: to carry out a literature review of the different validated nutritional screening tools for hospitalized patients. Materials and Methods: a review of nutritional screening tools in the databases Pubmed, Scielo and Lilacs from 2007 to 2017, plus the original articles of the screening tools methods. The key words were: nutritional screening tools, nutritional assessment, malnutrition, hospitalized patients. All articles in Spanish and English were included. 82 particles were identified, out of which 11 included a population over 18 years old, plus the original works, and those of comparison of the nutritional screening tools that were validated. It were excluded studies with sample number under 60 and with nutritional screening tools for specific risk groups. Results: 11 studies that compare nutritional screening tools were identified. The tools included were: SGA, MNA, MNA-SF, MST, NRS-2002, MUST, SNAQ and CONUT. The studies turned out to be heterogeneous regarding characteristics of the population assessed, number of patients, statistical analysis, tools used and comparison patterns. Conclusion: It is important to count on a malnutrition screening tool to detect those patients at risk of malnutrition, in order to do early intervention. Nutritional screening is a strategy to prioritize the importance and/ or urgency of nutritional intervention. The application of systematic processes for the detection of nutritional risk is essential to carry out a timely intervention, so as to decrease the patient's morbidity and mortality, to improve his/her quality of life, and to diminish the costs generated(AU).

Assuntos

Avaliação Nutricional , Pacientes , Grupos de Risco