Alessandra Campani Pizzato

Associações entre ingestão energética, proteica e de fósforo em pacientes portadores de doença renal crônica em tratamento hemodialítico

INTRODUCAO: A nutricao desempenha papel fundamental nas doencas renais. A recomendacao nutricional deve ofertar uma dieta hiperproteica, adequada em energia e fosforo segundo o Kidney Disease Outcomes Quality Initiative (K/DOQI). E necessario controlar e/ou prevenir as complicacoes da Doenca Renal Cronica (DRC), pois ela impoe desafios clinicos diretamente ligados ao estado nutricional. OBJETIVO: Investigar as associacoes entre a ingestao energetica, proteica e de fosforo em pacientes em hemodialise (HD). PACIENTES E METODOS: Estudo observacional envolvendo 72 pacientes em HD, em dois hospitais de Porto Alegre/RS/Brasil. Foram coletados dados referentes ao perfil antropometrico (peso, altura e indice de massa corporal - IMC) e do registro alimentar de tres dias (ingestao de energia, proteina e fosforo). O teste de correlacao de Spearman foi utilizado para avaliar as associacoes entre as variaveis do registro alimentar (p < 0,05). RESULTADOS: A ingestao energetica, proteica e de fosforo foi, respectivamente, de: 28 ± 10,0 kcal/kg, 1,1 ± 0,4 g ptn/kg, 958 ± 374 mg/dia, estando os niveis de energia e proteina abaixo das recomendacoes do K/DOQI. Observou-se correlacao positiva forte entre as variaveis. DISCUSSAO: O perfil no tratamento nutricional e fundamental, pois houve correlacoes entre os nutrientes. E importante salientar que as recomendacoes do K/DOQI nao conseguem ser atingidas pelos pacientes. CONCLUSAO: Ha associacao positiva entre a ingestao de energia, proteina e fosforo na alimentacao de pacientes em HD. O controle desses nutrientes na dieta e essencial, pois auxilia no controle das complicacoes relacionadas com a DRC. Assim, a avaliacao nutricional e importante nas unidades de dialise para definir o perfil dietetico dos pacientes e que seja feito o ajuste de suas prescricoes.

The Influence of Glucose Exposure Load and Peritoneal Membrane Transport on Body Composition and Nutritional Status Changes after 1 Year on Peritoneal Dialysis

Background: The characteristics of peritoneal membrane transport differ among patients, affecting the prescription of peritoneal dialysis (PD) modality and glucose exposure in order to achieve an effective dialysis. This study aims to verify the influence of glucose exposure load and peritoneal membrane transport on body composition and nutritional status changes after the first year of PD. Methods: We examined a cohort of 85 incident PD patients during the first year of treatment. We established a cut-off of 5% to define changes in dry weight (DW), lean tissue mass (LTM), and fat mass (FM). Results: In total, 50.6% of the patients presented DW gain, 41.2% showed LTM loss, and 65.9% presented FM gain. Over the time (T0 – T12), we found significant differences in DW, body mass index (BMI), adipose tissue mass (ATM), FM and fat tissue index (FTI). Patients with lower dialysate-to-plasma creatinine ratio showed DW and FM gain. We observed a higher percentage of nonfast transporters in DW gain when comparing with DW no gain. As for glucose exposure load, no body composition changes were seen. Conclusions: Most patients presented DW gain, FM gain, and LTM loss. The characteristics of peritoneal membrane transport affected DW during the first year, changes being greater in nonfast than in fast transporters.

Evaluation of body composition and fluid volume using a body composition monitor: does intraperitoneal fluid matter?

Fluid overload is a common finding in patients on peritoneal dialysis (PD) and this condition has been linked to adverse cardiovascular effects and increased mortality (1). The variation of body weight and blood pressure, usually used for clinical evaluation of volume, may not be sufficient for the adjustment of volemia; therefore, regular and precise measurement of hydration and body composition is needed (2). It is believed that volume control in PD patients is harder to achieve compared to hemodialysis patients, as they receive home treatment with monthly monitoring only, and have greater autonomy in their care (3). Bioimpedance spectroscopy (BIS) is a tool for detecting longitudinal changes in the hydration status of this population. The body composition monitor (BCM) (Fresenius Medical Care, Germany) is a validated and non-invasive method that combines BIS with a physiological tissue model developed for dialysis patients (4). Describing the body composition and hydration profile of PD patients is essential for clinical evaluation; however, the possible interference of dialysate in the intraperitoneal cavity on BCM results is an underexplored question in the literature. Therefore, the aim of this study was to compare body composition and volume variables with the dialysis fluid in the peritoneal cavity and also after its drainage, using BCM methodology.

Imunonutrição e o tratamento do câncer

Introducao: O binomio dieta e nutricao tem relacao com causas e consequencias do câncer. O estado nutricional e afetado diretamente tanto pelo tumor, quanto pelo tratamento administrado, exigindo manejo especial. Quando ha deplecao do estado nutricional, associa-se diminuicao da funcao imune, o que favorece o avanco da doenca. Para isso a imunonutricao poderia colaborar com a diminuicao da taxa de infeccoes e do tempo de hospitalizacao no tratamento de pacientes com câncer. Objetivo: Revisar o papel da imunonutricao na melhora da resposta ao tratamento do câncer. Materiais e Metodos: Realizou-se estudo exploratorio do tipo revisao bibliografica a partir das bases de dados PubMed e LILACS, datados a partir de 1998, com os termos de indexacao: imunomoduladores, câncer, terapia nutricional. Foram incluidas obras bibliograficas do tema em questao e outros artigos de relevância. Resultados: Foi realizada a revisao com sete estudos. Foram incluidos nesta revisao cinco capitulos de obras bibliograficas e outros tres artigos de relevância do assunto. Os resultados foram organizados em uma categoria e tres temas: imunonutricao no tratamento ao câncer, abrangendo conceito e caracteristicas, tempo de administracao de dietas imunomoduladoras e as neoplasias nas quais imunonutricao esta mais envolvida. Conclusoes: Poucas pesquisas com resultados significativos sao encontradas quando comparadas a dietas-padrao, nao sendo possivel afirmar com seguranca sobre os beneficios da imunonutricao no tratamento dos pacientes oncologicos em relacao ao tempo de administracao de formulas enriquecidas com esses imunomoduladores. Contudo, os beneficios relacionados a diminuicao da taxa de infeccoes e ao tempo de hospitalizacao estao associados ao tipo de tratamento cirurgico do câncer.

A comparative between the supply and energy needs of hospitalized patients under enteral nutritional therapy

Introduction : Patients who are at risk of malnutrition are potential candidates for the use of enteral nutritional therapy (ENT), since it allows a more effective control of the patient’s nutrition. When oral food intake is impossible or insufficient, enteral nutrition is the most appropriate physiological option aiming at the maintenance of gastrointestinal trophism. Studies show us that the protein-caloric needs of the hospitalized patients are seldom reached in the feeding tube supply, staying routinely between 70% and 80% of their needs. Methods: A descriptive study was conducted based on secondary data collected by the Multidisciplinary Team of Nutritional Therapy of a university hospital in Brazil to compare the caloric intake received by the hospitalized patients when in enteral nutritional therapy with their real needs. Results: A total of 43 adult inpatients who were in exclusive enteral nutrition were assessed. It was observed that the mean caloric intake received by the patients was 1,767±271kcal/day, reaching 94% of the estimated caloric needs, which were 321kcal/day. In relation to the nutritional status of the analyzed patients, it was found that 38% were at nutritional risk. Conclusion: The creation of protocols of nutritional support is of great importance to guide professionals in the prescription of ENT, aiming to improve the nutritional intake offered to hospitalized patients. Keywords: Enteral nutrition; malnutrition; caloric intake; caloric needs