Neonatos críticos recebem a terapia nutricional parenteral em volume conforme suas necessidades prescritas? Estudo clínico observacional

Introduction: Monitoring of parenteral nutrition therapy (NPT) in critical neonates is essential for clinical outcome, and it is indispensable to quantify the infused NPT compared to the prescribed and prepared amount. The purpose of this study is to account for monetary losses due to unmanaged NPT disposal. Methods: Neonates were stratified into two groups. Group A (n = 6): low birth weight preterm infants; Group B (n = 6): preterm infants of very low weight and extreme low weight <1,000 g, followed by 167 days of NPT, compared to the percentage differences in volumes, calories and average monetary losses of the despised volumes. Results: The percentage difference between volume prescribed and prepared for group A was 42.49 ± 18.27% and for group B it was 86.82 ± 63.52% (p = 0.003). Between volume prepared and infused, the difference was 63.15 ± 15.11% for group A and 47.98 ± 17.25% for group B (p = 0.003). Among prescribed and infused calories, the difference was 22.61 ± 8.69% for group A and 13.92 ± 3.45% for group B (p = 0.04). The average monetary losses of the despised volumes were R$ 992.68 and R$ 1,296.81 (p = 0.0129), respectively. Conclusion: Infused NPT was lower than prescribed, resulting in lower caloric intake for neonates and significant financial losses associated with NPT disposal.

A espessura do músculo adutor do polegar não está associada a Proteína C Reativa em pacientes com câncer hospitalizados

Objective: To evaluate the association between blood of C-reactive protein concentrations and an indicator of muscle mass in hospitalized cancer patients. Methods: A cross-sectional study carried out with 110 patients of both sexes, aged ≥18 years, with solid and/or liquid cancer undergoing clinical and/or surgical treatment. Clinical and socioeconomic data were obtained from medical records. The adductor pollicis muscle thickness was obtained using skinfold caliper. Patients were divided into two groups: altered adductor pollicis muscle thickness (<13.4 mm) and normal adductor pollicis muscle thickness (≥13.4 mm). Logistic regression was performed to verify the association between adductor pollicis muscle thickness and C-reactive protein. Results: It was observed that 90% (n = 100) of the patients were classified with reduced adductor pollicis muscle thickness, higher prevalence of the solid tumor, low usual weight, current weight, and body mass index. The logistic regression analysis showed no association between the adductor pollicis muscle thickness and C-reactive protein concentrations, in any of models used: model without adjustment (OR: 1.01; 95% CI [0.94-1.09], p = 0.65); adjusted for sex and age (OR: 1.01; 95% CI [0.94-1.09], p = 0.61); and adjusted model for sex, age and body mass index (BMI) (OR: 1.04; 95% CI [0.96-1.13], p = 0.29). Conclusion: Although adductor pollicis muscle thickness is validated method for nutritional assessment, we did not find an association with the inflammation marker (C-reactive protein).

Fisiopatologia e desenvolvimento do diabetes mellitus tipo 3 e sua relação com a doença de Alzheimer

Introduction: Alzheimer’s disease (AD) is characterized by a progressive and persistent deterioration of the whole cognitive function, which results in an impaired cortical function. Some years ago, the connection between AD and type 2 diabetes has been studied, resulting in the term type 3 diabetes (T3D). Methods: This is a literature review, a search for articles published in the last 5 years in the Medline and PubMed databases was performed, using the descriptor: Alzheimer disease, diabetes, insulin resistance. Results: For analysis, 12 articles were selected, with 10 literature reviews and 2 original studies. Among those who explored the cellular and molecular relationship between AD and insulin resistance, possible pathogenic mechanisms, the role of insulin in the brain, environmental factors linked to AD and dietary interventions to prevent neurodegeneration. Conclusion: The relation between AD and type 2 diabetes is due several mechanisms such as lipid metabolism, insulin metabolism and agents related to its functioning, like the ApoEε4, C-peptide, the glycogen synthase kinase 3β (GSK-3β) and the amyloid-beta (Aβ). It is suggested that several changes, mainly in insulin metabolism, can impair neurocognitive function and trigger AD. Future studies are needed to analyze the context of T3D and find possible treatments that attenuate the AD progression and promote quality of life for the patients.

Métodos para avaliação da sarcopenia em pacientes hospitalizados com câncer do trato gastrointestinal

Introduction: Sarcopenia is characterized by the association of loss of lean mass and functionality, and in cancer patients it is a frequent situation. Thus, the study aims to assess the presence of sarcopenia in hospitalized patients with cancer of the gastrointestinal tract using alternative assessments to analyse the patient’s strength and functionality. Methods: To assess sarcopenia in cancer patients, the thickness of the adductor pollicis muscle (APM), dynamometry to assess handgrip strength and the Barthel Scale to analyse functionality were collected, associating APM and dynamometer and MAP. with Barthel scale in cancer patients. Results: Twenty patients participated in the study, with moderately malnourished patients showing greater strength in the dynamometer in relation to the well-nourished ones and that obese individuals had greater APM in relation to other nutritional states. Regarding functionality, most patients 80% were classified as independent. Patients with esophageal cancer had MAP inferior to the other locations of the body evaluated, but compared with the dynamometer they presented better results. Conclusions: There was no high prevalence of sarcopenia among patients with cancer of the gastrointestinal tract using the methods used APM, dynamometer and Barthel Scale.

Indicadores de qualidade da terapia nutricional enteral são ferramentas úteis para o monitoramento em pacientes com câncer avançado em cuidados paliativos?

Introduction: Enteral nutritional therapy (ENT) in patients with advanced cancer in palliative care should be directed towards a better quality of life, being important its monitoring so that the patient has access to the best that the therapy can offer. The objective of this study was to apply the quality indicators of ENT in patients with advanced cancer in palliative care. Methods: Descriptive, observational study with a quantitative approach. Seven ENT quality indicators proposed by the International Life Sciences Institute in Brazil were applied and the reasons for the suspension or interruption of the enteral diet during hospitalization were quantified. Results: 51 patients admitted from May to November 2019 participated in the study. The frequencies of inadvertent exit of enteral nutrition tube (0.02%), the days of adequate administration of the prescribed volume versus infused volume (92.6%) and diarrhea (2%) are within the goal used. The administration of protein (25.5%) and energy (57.4%), the frequency of episodes of abdominal distension (33.3%) and constipation (86.3%) were inadequate. The diet was interrupted or suspended mainly due to the occurrence of vomiting, end-of-life care or tube obstruction. Conclusion: The use of quality indicators of nutritional therapy proved to be viable in this group of patients. Some inadequacies found in this population may be associated with the change in the objective of nutritional therapy in patients with shorter life expectancy. Adaptations based on the prognosis may be necessary, in addition to the application of new indicators, or adjustments to the proposed goals.

Planejamento nutricional da alta hospitalar: breve revisão da literatura e proposta de instrumento de avaliação

Introduction: Due to its frequency and potential consequences, malnutrition is a worrisome condition in the hospital environment, especially in the case of adults admitted to intensive care units and others at high risk; malnutrition is associated with a higher risk of morbidity and mortality, prolonged hospital stay, higher frequency of readmissions, and increased costs. Although the absence of a planning for hospital discharge can aggravate these consequences, there are no guidelines for nutritional planning for hospital discharge that can be widely adopted in Brazil. Methods: A panel of experts was convened to assess the most relevant topics in the literature related to hospital discharge planning, discuss their experience in this regard, and propose an instrument that could guide and justify the importance of planned and safe nutrition discharge. Results: An organized and explicit discharge plan brings clinical and nutritional benefits to the patient, as well as advantages for family members and the health-care service. Nutritional care and better communication and guidance from the multiprofessional team prepare the patient and family members to reduce length of hospital stay and may avoid readmissions. Discharge planning requires the development of an individualized plan, as well as the education of the patient, family and caregivers; the nutritional care plan is inserted in the discharge plan. Based on these considerations, we propose an instrument that aims to systematize the nutritional discharge through the collection of the most relevant information related to the nutritional risk and the therapeutic approach to this risk, standardizing the communication with the patient, their caregivers, and the health-care team. Conclusions: The instrument presented here should be tested in clinical practice, and it is hoped that it can allow a better follow-up of the patient’s journey, leading to a more successful hospital discharge.

Prevalência de risco de sarcopenia e obesidade sarcopênica entre idosos não-institucionalizados do interior do Ceará

Introduction: The loss of muscle mass is an expected consequence of aging, but excess adiposity has also been increasing in this age group. Both in isolation compromise health and quality of life, but a greater impact happens when they associate. Objective: To verify the prevalence of risk for sarcopenia and sarcopenic obesity among elderly in the municipality of Morada Nova-CE. Methods: Quantitative, transversal, descriptive and analytical study. Simple Questionnaire to Rapidly Diagnosed Sarcopenia (SARC-F) was applied. After, weight, height, calf circumference (CP) and triceps skinfolds (DCT), bicipital, subscapular and supra iliac were collected for diagnoses of nutritional status, sarcopenia and sarcopenic obesity. In descriptive statistics, mean and standard deviation were calculated. In inferential statistics, Pearson’s correlation tests, ANOVA and chisquare were applied. Results: A total of 121 elderly people aged 60 or over and of both sexes participated in the study. The majority of the elderly people (72%, n = 87) were female, with a mean age of 68.8 ± 6.18 years, ranging from 60 to 86 years. The main findings were: predominance of BMI eutrophy, obesity due to DCT adequacy and percentage of fat (% GC), absence of muscle mass depletion, sarcopenia and sarcopenic obesity. Conclusions: Most elderly people did not have sarcopenia or sarcopenic obesity. No association was found between these two diagnoses, nor between the results of SARC-F and CP. Women were more likely to have sarcopenia than men. We suggest studies that allow the establishment of consensus bridges for the diagnosis of sarcopenia and sarcopenic obesity, as well as studies involving the use of SARC-F for its diffusion and evaluation of its sensitivity for the diagnosis of sarcopenia.

Estado nutricional de portadoras de síndrome dos ovários policísticos segundo os diferentes índices antropométricos

Introduction: Women with polycystic ovary syndrome have several hormonal and metabolic changes in common, among which peripheral insulin resistance stands out, which manifests itself more frequently in those with overweight or obesity. The objective of this study was to evaluate the nutritional status of patients with polycystic ovary syndrome and to correlate the most recent anthropometric indexes proposed with traditional ones. Methods: The research had a quantitative, transversal and analytical approach. The participants were 40 women, aged 20 to 59 years, from the city of Jaguaruana - Ceará. A questionnaire was applied in order to obtain information about cultural and socioeconomic history, clinical history, history of the current disease and revision of the body systems pertinent to the disease. The body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR), body adiposity index (ABSI), body shape index and body shape index, which is an indicator of premature mortality and excess abdominal adiposity and body roundness index (BRI), which is a great predictor of the percentage of body fat and visceral adipose tissue. Results: When assessing BMI, it was seen that eutrophy was the predominant category (40%). However, 55% of the participants had some degree of excess weight (pre-obesity or obesity). Most participants were not at risk for cardiovascular disease in relation to the diagnoses of WC and WHR. As for the new indices, it was inferred that the predominant body shape in the sample is slightly rounded. Conclusions: It was found that the participants within the largest ABSI tertiles were also shown to have higher WHR values. As for the BRI, a directly proportional relationship was observed among the averages of its tertiles and those of the traditional indices/measures. The association between traditional and the most recently proposed anthropometric indices/measures allows for a better and more complete interpretation of nutritional status, especially if performed in a serial manner