Carla de Oliveira Barbosa Rosa

Patient-generated subjective global assessment and classic anthropometry: comparison between the methods in detection of malnutrition among elderly with cancer.

INTRODUCTION A comparative study of the various methods of nutritional assessment currently available in oncology are necessary to identify the most appropriate one, as well as the relationships that exist among the different instruments. OBJECTIVE To compare the nutritional diagnosis obtained by the Patient-Generated Subjective Global Assessment (PG-SGA) with the objective anthropometric measurements in the elderly undergoing oncology treatment and to assess the concordance between the methods used in detecting malnutrition. METHODS A cross-sectional study of the elderly, older than or equal to 60 years in age undergoing oncology treatment. The PG-SGA was performed and the anthropometric parameters including weight, height, Body Mass Index (BMI), arm circumference, arm muscle circumference, corrected arm muscle area, arm fat area, calf circumference, waist circumference, hip circumference, waist-hip ratio and triceps skinfold were evaluated. From a 24-hour recall the energy and macronutrient intakes were estimated. RESULTS A total of 96 elderly patients were evaluated. The PG-SGA identified 29.2% with moderate malnutrition or suspected malnutrition and 14.6% with severe malnutrition. From among the elderly evaluated, 47.9% required critical nutritional intervention. The anthropometric parameters and the consumption of energy and macronutrients revealed significant differences based on the subjective PG-SGA classification. The prevalence of malnutrition ranged from 43.8% to 61.4%, depending upon the instrument used. The method most consistent with the diagnosis of malnutrition provided by the PGSGA was the BMI (kappa = 0.54; CI: 0.347-0.648). CONCLUSIONS The PG-SGA showed a significant correlation with the anthropometric measurements and with food consumption for both the categorical classification, as well as for the scoring system. Diagnosis of malnutrition showed variable prevalence depending upon the method used, and none were found equivalent to the PG-SGA.

Impact of Nutrients and Food Components on Dyslipidemias: What Is the Evidence?

Dyslipidemias have been shown to bear a close association with an increased risk of cardiovascular diseases, atherosclerosis in particular. As efforts are being made to find alternative therapies and ways to prevent disease, there is a corresponding rise in public interest in food and/or active food components that contribute to an improved lipid profile and, thus, to better health. Besides supplying the basic nutrients necessary for well-being, some foods add further physiologic benefits. In fact, specific foods and bioactive components could be beneficial in controlling dyslipidemias. From a review of the literature on foods and bioactive compounds, their recommended quantities, and expected effects, we found that the following nutrients and food components could positively impact the lipid profile: monounsaturated and polyunsaturated fatty acids, soluble fiber, vegetable proteins, phytosterols, and polyphenols. Therefore, incorporating these components into the regular diets of individuals is justified, because they contribute additional positive effects. This suggests that they also be recommended in clinical practice.

Depressão, déficit cognitivo e fatores associados à desnutrição em idosos com câncer

The study sought to analyze the presence of depression, cognitive function, nutritional status and factors associated with malnutrition in the elderly undergoing treatment for cancer. A cross-sectional study was conducted in a cancer clinic in Minas Gerais, which included the application of a sociodemographic and health questionnaire, assessment of depressive symptoms, cognitive function and nutritional status. 96 elderly people were evaluated, 50% of which were female and the mean age was 70.6 years. Cognitive impairment was identified in 39.6% and the presence of depression in 17.7%, with a higher number of depressive symptoms in females (p = 0,017). Moderate malnutrition or suspected malnutrition was diagnosed in 29.2%, severe malnutrition in 14.6% and 47.9% had a critical need for nutritional intervention. In multivariate analysis, functional impairment was independently associated with malnutrition (PR: 3.40; CI: 1.23-9.45), the presence of two or more symptoms of nutritional impact (PR: 3.22; CI: 10.03-10.10) and current treatment by chemotherapy (PR: 2.96; CI: 1.16-7.56). The elderly with cancer showed a high prevalence of malnutrition and a need for nutritional intervention. The assessment of depression and cognitive impairment should also be an integral part in addressing this group.The study sought to analyze the presence of depression, cognitive function, nutritional status and factors associated with malnutrition in the elderly undergoing treatment for cancer. A cross-sectional study was conducted in a cancer clinic in Minas Gerais, which included the application of a sociodemographic and health questionnaire, assessment of depressive symptoms, cognitive function and nutritional status. 96 elderly people were evaluated, 50% of which were female and the mean age was 70.6 years. Cognitive impairment was identified in 39.6% and the presence of depression in 17.7%, with a higher number of depressive symptoms in females (p = 0,017). Moderate malnutrition or suspected malnutrition was diagnosed in 29.2%, severe malnutrition in 14.6% and 47.9% had a critical need for nutritional intervention. In multivariate analysis, functional impairment was independently associated with malnutrition (PR: 3.40; CI: 1.23-9.45), the presence of two or more symptoms of nutritional impact (PR: 3.22; CI: 10.03-10.10) and current treatment by chemotherapy (PR: 2.96; CI: 1.16-7.56). The elderly with cancer showed a high prevalence of malnutrition and a need for nutritional intervention. The assessment of depression and cognitive impairment should also be an integral part in addressing this group.

Cognitive capacity in individuals with chronic kidney disease: relation to demographic and clinical characteristics

INTRODUCTION The life expectancy of individuals with Chronic Kidney Disease (CKD) on hemodialysis has increased, however, with over years in treatment, there is impairment of cognitive function that affect adherence to therapy and dialysis. OBJECTIVE To evaluate the cognitive ability of individuals on hemodialysis through the Mini Mental State Examination (MMSE) and the relation to sociodemographic and clinical characteristics of these individuals. METHODS We obtained demographic and clinical information of 75 individuals. To assess memory and cognition MMSE was applied, which was analyzed according to the different cutoff points proposed in the literature. After classifying the participants according to proposal of different studies, the causes of CKD and sociodemographic characteristics, individuals were divided into groups with and without cognitive impairment in an attempt to identify differences between them. RESULTS Most participants were men with a mean age of 59.2 years. The mean MMSE score was 24.16 points and there was no difference (p < 0.05) in MMSE results between the different causes of CKD. MMSE scores were correlated (p < 0.05) positively with years of schooling and income and inversely with age. According to the different cutoff points, six to 34 participants showed cognitive impairment and memory, and only three of these were classified with cognitive impairment for all cutoff points evaluated. CONCLUSION The average MMSE score declined with increasing age and increased with years of schooling and income per capita. No relationships were found to justify the harmful effects of dialysis process on cognition and memory.

Nutritional risk in pediatrics by StrongKids: a systematic review

Background/objectiveThe nutritional risk in hospitalized children and adolescents is a frequent and under-diagnosed reality. There is still no consensus regarding the best nutritional screening method in pediatrics, with StrongKids being one of the existing proposals. A systematic review was performed to evaluate the scientific evidence about StrongKids, with emphasis on the world frequency of nutritional risk, associations of interest in health, validation and reproducibility studies.MethodsDatabases Pubmed, Lilacs, Scielo, ScienceDirect, Web of Science, Scopus and Cochrane Library were searched, using keyword “StrongKids,” without limit on the year of publication, in English, Spanish, and Portuguese.ResultsFrom 125 papers initially identified, 22 original were included in analysis. The sample size ranged from 43 to 2874, with a maximum of 44 hospitals. The frequency of nutritional risk (medium or high) ranged from 35.7 to 100%. The nutritional risk was mainly associated with acute and/or chronic malnutrition already installed, lower anthropometric indexes and longer length of hospital stay. The method presented satisfactory inter-rater and intra-rater agreements and was validated in the three studies performed with this proposal.ConclusionsThe prevalence of nutritional risk in hospitalized children and adolescents is high. StrongKids is a valid, easy-to-use, and reproducible method, with significant associations of interest in health.

Importância do rastreamento de disfagia e da avaliação nutricional em pacientes hospitalizados

ABSTRACT Objective: To determine frequency of dysphagia risk and associated factors in hospitalized patients as well as to evaluate nutritional status by using different methods and correlate the status with scores of the Eating Assessment Tool (EAT-10). Methods: This was a cross-sectional study including 909 inpatients of a philanthropic hospital. For the diagnosis of dysphagia we used an adapted and validated Brazilian version of the Eating Assessment Tool (EAT-10). The nutritional status was evaluated through the subjective global assessment, and anthropometric measurements included weight, calf and arm circumference, and knee height. The Mann-Whitney test, associations using the Pearson’s χ2 and Spearman’s correlation were used to verify differences between the groups. Results: The prevalence of dysphagia risk was 10.5%, and aging was the associated factor with this condition. Patients at risk presented lower values of arm and calf circumference, variables that correlated inversely with the Eating Assessment Tool (EAT-10) score. Malnutrition was observed in 13.2% of patients based on the subjective global assessment and in 15.2% based on the Body Mass Index. Conclusion: Screening for dysphagia and malnutrition should be introduced in hospitals routine to avoid or minimize damages caused by dysphagia or malnutrition, especially among older people.

Dietary pattern and macronutrients profile on the variation of inflammatory biomarkers: scientific update

It is known that the dietary pattern and macronutrients profile may influence the expression and secretion of inflammatory biomarkers, and the low-grade inflammation is associated with the manifestation of noncommunicable chronic diseases. Therefore, this review aimed to present and discuss the role of dietary patterns and macronutrients on the variation of inflammatory markers related to NCD risk. Scientific evidences within the last five years based on clinical trials, case-controls, cohorts, and cross-sectional studies indicate that normocaloric, carbohydrate-moderated, low-glycemic index, protein-moderated, monounsaturated and polyunsaturated fatty acid-rich, omega-3, and low-saturated fat diets display positive effects on the inflammatory state, both in healthy individuals and in those with cardiovascular risk, although the second group seems to benefit more from changes in the dietary profile.

Gordura Corporal e Ácido Úrico Estão Relacionados com Escores de Risco Cardiovascular? Análise Transversal no Programa de Intervenção PROCADIO-UFV

Fundamentos: Os escores de risco sao ferramentas utilizadas para indicar a probabilidade de ocorrencia de certo evento cardiovascular e identificar previamente os individuos com baixo, medio e alto risco para desenvolvimento de doencas cardiovasculares. Objetivo: Estabelecer o risco cardiovascular dos usuarios de um programa de atencao a saude cardiovascular de uma universidade, bem como avaliar a relacao dos mesmos com estilo de vida, dados clinicos, sociodemograficos e outros marcadores de risco cardiometabolico. Metodos: Estudo transversal com amostra de 197 participantes, dos quais foram coletados dados demograficos, antropometricos, clinico-metabolicos, habitos alimentares e do estilo de vida por meio do Escore de Risco Global e do Escore de Risco de Framingham. Valor de p < 0,05 foi considerado estatisticamente significante. Resultados: De acordo com o Escore de Risco de Framingham, 84% da populacao analisada foi considerada baixo risco e 16% de risco intermediario/alto, enquanto que, de acordo com Escore de Risco Global, 18% foram baixo risco, 45% de risco intermediario e 37% de alto risco para infarto ou morte por doenca coronaria em 10 anos. Conclusao: O excesso de peso corporal e os valores sericos de acido urico se demonstraram importantes marcadores de risco cardiovascular, alem daqueles dos escores, de modo que deveriam ser considerados na pratica clinica.

Assessment of different detection methods of chronic kidney disease and their importance for an early diagnosis

AimThe prevalence of chronic kidney disease (CKD) has been increasing worldwide. In practice, the glomerular filtration rate (GFR) can be assessed by the dosage of creatinine serum, its clearance through the kidneys and estimation formulae. However, there is no existing consensus about the best method of assessment; therefore, the aim of the present study is to assess the different methods of detecting CKD.Subjects and methodsA total of 293 hypertensive patients participated in the research. Creatinine serum and clearance were assessed to analyze kidney function. The GFR was estimated using the following formulae: Cockcroft and Gault (CG); CG-corrected; Modification of Diet in Renal Disease (MDRD)-6; MDRD-4 and The Chronic Kidney Disease Epidemiology Collaboration Equation (CKD-EPI). The following tests were used: weighted Kappa coefficient; Pearson’s correlation (r) and Bland-Altman graph analysis.ResultsThe greatest agreement found using the weighted Kappa was for the CKD-EPI formula (k = 0.362). The greatest correlation was found for the CKD-EPI formula (r = 0.612). The CKD-EPI formula exhibited the lowest number of individuals below the lowest limit of agreement in the Bland-Altman analysis.ConclusionsThe CKD-EPI formula should be used to estimate the GFR, given that it exhibited the greatest correlation and agreement with creatinine clearance; thus, it is possible to implement low-cost activities focusing on early detection and diagnosis, as well as the prevention of CKD.

Tratamento conservador: influência sobre parâmetros clínicos de indivíduos em hemodiálise

O diagnostico precoce da Doenca Renal Cronica (DRC) possibilita a implementacao de medidas que adiam a entrada emhemodialise (HD) e melhoram parâmetros clinicos. O objetivo deste estudo foi analisar as caracteristicas epidemiologicase clinicas dos individuos com DRC em HD que realizaram ou nao tratamento conservador (TC). Foram coletados dadosde prontuarios medicos de 65 participantes, os quais foram entrevistados sobre diagnostico e tratamento da DRC. Paraanalise dos dados, os individuos foram divididos entre os que realizaram TC ou nao e, quanto ao tempo de TC, menor,igual ou maior que seis meses. A hipertensao arterial e o diabetes mellitus foram as principais causas da DRC, a qual foidiagnosticada, na maioria dos casos, por um nefrologista. A maior parte dos individuos que nao realizaram tratamentoconservador teve diagnostico da DRC realizado em um hospital. Individuos que realizaram TC apresentaram melhoresparâmetros bioquimicos, especialmente aqueles que o fizeram por mais de seis meses. O TC, sobretudo, realizado porequipes multidisciplinares, pode contribuir para melhoria dos desfechos da DRC tanto no periodo pre-dialitico quantodurante o tratamento de HD.(AU) Early diagnosis of Chronic Kidney Disease (CKD) leads to the implementation of measures that are delaying undergoinghemodialysis (HD) and improve clinical parameters. The aim of this study was to analyze the epidemiological and clinicalcharacteristics of individuals with CKD who underwent HD or not conservative treatment (CT). Data were collected frommedical records of 65 participants who were interviewed about the diagnosis and treatment of CKD. For data analysis,subjects were divided between those who underwent CT or not and as to the time of CT less than, equal to or greater thansix months. Hypertension and diabetes mellitus were the main causes of CRD, which were diagnosed, in most cases, by anephrologist. Most individuals which did not receive a conservative treatment were diagnosed as having CRD in a hospitalsettting. Individuals who underwent CT showed better biochemical parameters, especially those who did so for more thansix months. The TC mainly conducted by multidisciplinary teams, can contribute to improving the outcomes of CKD inboth pre-dialysis and during HD treatment.(AU)