Maria Eliana Madalozzo Schieferdecker

Nutritional status influences the length of stay and clinical outcomes in hospitalized patients in internal medicine wards

OBJECTIVE The aim of this study was to investigate the relationship between the nutritional status (NS) and clinical outcome and length of stay (LOS) among patients admitted to the internal medicine ward. METHODS This is a retrospective observational study performed with the data of clinical patients collected during a one year period. The NS was assessed using: subjective global assessment (SGA), body mass index (BMI), triceps skinfold thickness (TST), muscle arm circumference (MAC) and combined tools. Statistical analysis was performed with a confidence interval of 95% (p < 0.05). For categories comparison the chi-square test was used. To examine the association between length of stay and variables related to the NS Mann-Whitney and Kruskal-Wallis tests was used with multiple comparisons. RESULTS 396 patients were included in the study, 42.2% were over 60 years of age, what was associated with the presence of hypertension (p < 0.001), diabetes mellitus (p = 0.003) and required diet with modifications consistency (p = 0.003). According to combined diagnostic tools, 45.7% of patients were malnourished. Decreased food intake (p = 0.01), malnutrition according to SGA (p = 0.02) and MAC (p = 0.03) were associated with increased mortality. Patients with tertiary level of care (p = 0.01), decreased food intake (p = 0.001), who died (p = 0.004) and diagnosed with malnutrition by SGA (p = 0.001) and by the combined tools (p = 0.001) had a longer LOS. CONCLUSIONS Patients who were malnourished by SGA and who presented decrease food intake at admission had longer LOS and poorer clinical outcomes (highest number of deaths). The diagnosis of malnutrition by MAC was also related to higher mortality.

Ingestão alimentar em pacientes com doença inflamatória intestinal

BACKGROUND: Patients with inflammatory bowel disease may have nutritional deficiencies. AIM: To verify the adequacy of dietary intake of patients with Crohns disease and ulcerative colitis. METHODS: To assess food intake of 55 patients, 28 with Crohns disease and 27 with ulcerative colitis treated in the gastroenterology clinic, was used the 24-Hour Food Recall and Food Frequency Questionnaire. The inflammatory activity of the disease was evaluated by serum C-reactive protein and Harvey and Bradshaw Index. For comparison of means t test was used, and the average on non-parametric, the Mann-Whitney test, with level of significance p <0.05. RESULTS: The patients were aged between 19 and 63 years and time since diagnosis was 7.9 years (1 to 22). According to the food intake was identified deficiency in energy intake, fiber, iron, potassium, sodium, magnesium, calcium, menadione, riboflavin, niacin, folate, pantothenic acid, tocopherol and cholecalciferol in Crohns disease and ulcerative colitis, active or in remission. The intake of vegetables, fruits, dairy products and beans were low, and intake of fats and sweets was higher than the recommendations. CONCLUSION: There was a deficiency in food intake both in Crohns disease and in ulcerative colitis, in activity and in remission. These deficiencies can adversely affect the disease course, and justify the need for nutritional intervention with these patients.

Relação entre estado nutricional e atividade inflamatória em pacientes com doença inflamatória intestinal

RESUMO – Racional – As doencas inflamatorias intestinais caracterizam-se por diversos sintomas que afetam o aparelho digestorio e, consequentemente, podem interferir sobre o estado nutricional. Objetivo - Avaliar o estado nutricional de pacientes com doenca inflamatoria intestinal em diferentes estagios de atividade inflamatoria. Metodos – Foram avaliados 55 pacientes com doenca inflamatoria intestinal, por meio de dados antropometricos, com afericao de peso, altura, circunferencia do braco e prega cutânea do triceps e tiveram sua composicao corporal determinada por impedância bioeletrica. Para determinacao de atividade inflamatoria da doenca foram utilizados os niveis sericos de proteina C reativa e o indice de Harvey e Bradshaw. Para comparacao de medias foi usado o teste t nao pareado, e para as medias nao parametricas, o teste de Mann-Whitney, considerando nivel de significância valor de p<0,05. Resultados – Entre os pacientes avaliados, 28 apresentavam doenca de Crohn e 27 retocolite ulcerativa inespecifica, com idade entre 19 e 63 anos e tempo de diagnostico de 1 a 22 anos. Nao houve diferenca nas medidas antropometricas e na composicao corporal dos pacientes cuja doenca inflamatoria estava em atividade ou em remissao. Os que usaram glicocorticoides nos seis meses anteriores a avaliacao apresentaram percentual de gordura corporal de 23,4±8,2%, enquanto para os que nao usaram o percentual foi de 30,7±11,3 (p<0,0199). Os sintomas gastrintestinais mais comuns foram distensao abdominal (41%), diarreia (18%), nausea (13%), obstipacao (12%), inapetencia (11%) e vomito (5%). Todos os sintomas foram mais frequentes nos pacientes com maior indice de massa corporal e de gordura corporal. Conclusao – Houve maior numero de pacientes com excesso de peso e de gordura corporal, sendo que esses pacientes foram mais sintomaticos e apresentaram maiores valores de proteina C reativa.ABSTRACT - Background - The inflammatory bowel diseases are characterized by multiple digestive tract symptoms and therefore may interfere with nutritional status. Aim - To assess the nutritional status of patients with inflammatory bowel disease in different stages of inflammatory activity. Methods – Fifty five patients with inflammatory bowel disease were demographically evaluated with weight measurement, height, arm circumference and triceps skinfold and had their body composition determined by bioelectrical impedance. For determination of inflammatory activity of the disease were used serum C-reactive protein and the index of Harvey and Bradshaw. To compare means it was used the unpaired t test, and the average non-parametric, the Mann-Whitney test, level of significance p <0.05. Results - Among the patients, 28 had Crohn’s disease and 27 ulcerative colitis, aged between 19 and 63 years and time since diagnosis 1-22 years. There was no difference in anthropometric measurements and body composition of patients whose disease was inflammatory activity or in remission. Patients who used glucocorticoids in the six months preceding the assessment showed body fat percentage of 23.4 ± 8.2% whilst those who did not use the percentage was 30.7 ± 11.3 (p <0.0199). The most common gastrointestinal symptoms were abdominal distension (41%), diarrhea (18%), nausea (13%), constipation (12%), anorexia (11%) and vomiting (5%). All symptoms were more common in patients with higher body mass index and body fat. Conclusion - There were more patients with excess weight and body fat, and these patients were more symptomatic and had higher values of C-reactive protein.

The reality of the surgical fasting time in the era of the ERAS protocol

Multimodal protocols to optimize perioperative care and to accelerate postoperative recovery include abbreviated pre-and postoperative fasting. The aim of this study was to investigate the pre and postoperative fasting period and the factors that influence it in patients who underwent elective operations. We included patients who underwent surgery of the digestive tract and abdominal wall. Data were collected from the patients and from their personal health records. We included 135 patients between 19 and 89 years old. Most were adults (75.55%), female (60.74%) and the most common procedures were hernioplasty (42.96%) and cholecystectomy (34.81%). The preoperative fasting periods for solids and liquids were similar, median 16.50 (5.50-56.92) and 15.75 (2.50- 56.92) hours, respectively. The preoperative fasting period was influenced by the instruction received and surgery time. Postoperative fasting period was 15.67 (1.67-90.42) hours and was influenced by type of surgery and lack of synchrony between the clinical meeting and the nutrition and dietetics service schedules.

Características físico-químicas y nutricionales de las dietas enterales caseras

Introduction: There is an increasing use of enteral therapy at home, which reduces costs and improves patients’ quality of life. Homemade food diets are being commonly used in the households of undeveloped countries, but those diets vary in composition and characteristics depending on the ingredients and preparation procedures adopted in its preparation, which influences the quality of the diet to satisfy the nutritional needs of patients. Objective: This study aimed to formulate and determine the quality of homemade enteral diets. Methods: An enteral diet plan was prepared by using conventional food, consisting of 6 meals, totalizing 2 liters per day, and it was adopted a proportion of 25% of solid food. The diets were analyzed for stability, viscosity, flow, pH, chemical and nutritional composition. Results and discussion: The enteral diet plan was adequate in its physical-chemical aspects, however, it presented low percentages of adequacy, 20-53%, between the estimated and real content of macronutrients in the soup, formula used for lunch and dinner, which impaired the nutritional quality of the enteral diet plan. Conclusions: The results showed the difficulty of establishing the nutritional content of these diets, especially when made of meat and vegetables. Therefore, it is suggested a mixed enteral therapy by using commercial diets to achieve part of the nutritional needs of the patient together with enteral diets of homemade food to supplement it and also to redeem the psychosocial values of the feeding process. (Nutr Hosp. 2014;29:568-574) DOI:10.3305/NH.2014.29.3.7083Introduccion: Existe un creciente uso de la terapia enteral domiciliaria, lo que reduce los costes y mejora la calidad de vida para los pacientes. Las dietas elaboradas con alimentos caseros estan siendo usadas comunmente en los domicilios de los paises subdesarrollados, pero estos varian en composicion y caracteristicas dependiendo de los ingredientes y procedimientos adoptados en su preparacion, lo que influye la calidad de estas dietas para satisfacer las necesidades nutricionales de los pacientes. Objetivo: Desarrollar y determinar la calidad de las dietas enterales caseras. Metodos: Se elaboro un plan de dieta enteral casera, con alimentos naturales, consistente en 6 comidas, con un total de 2 litros por dia, utilizando una proporcion de 25% de solidos. Las dietas se analizaron para determinar la estabilidad de su composicion, viscosidad, flujo, pH, composicion quimica y nutricional. Resultados y discusion: Las dietas eran adecuadas en sus aspectos fisico-quimicos, sin embargo, presentaron bajos porcentajes de adecuacion, 20 a 53%, entre el contenido estimado y real de macronutrientes en la sopa, formula usada en el almuerzo y la cena, que afecto a la calidad nutricional del plan de dieta enteral. Conclusiones: Los resultados muestran las dificultades de establecer el contenido nutricional de estas dietas, sobre todo cuando son a base de carne y verduras. Por lo tanto, se sugiere una mezcla de terapia enteral casera e industrial, mediante el uso de dietas comerciales para lograr parte de las necesidades nutricionales del paciente, junto con dietas caseras para complementar y compensar tambien los valores psicosociales del proceso de alimentacion.Introduction: There is an increasing use of enteral therapy at home, which reduces costs and improves patients’ quality of life. Homemade food diets are being commonly used in the households of undeveloped countries, but those diets vary in composition and characteristics depending on the ingredients and preparation procedures adopted in its preparation, which influences the quality of the diet to satisfy the nutritional needs of patients. Objective: This study aimed to formulate and determine the quality of homemade enteral diets. Methods: An enteral diet plan was prepared by using conventional food, consisting of 6 meals, totalizing 2 liters per day, and it was adopted a proportion of 25% of solid food. The diets were analyzed for stability, viscosity, flow, pH, chemical and nutritional composition. Results and discussion: The enteral diet plan was adequate in its physical-chemical aspects, however, it presented low percentages of adequacy, 20-53%, between the estimated and real content of macronutrients in the soup, formula used for lunch and dinner, which impaired the nutritional quality of the enteral diet plan. Conclusions: The results showed the difficulty of establishing the nutritional content of these diets, especially when made of meat and vegetables. Therefore, it is suggested a mixed enteral therapy by using commercial diets to achieve part of the nutritional needs of the patient together with enteral diets of homemade food to supplement it and also to redeem the psychosocial values of the feeding process.

Criação de protocolo eletrônico para terapia nutricional enteral domiciliar

BACKGROUND Informatics can help the development of home enteral nutrition therapy (HENT). By using an electronic protocol with an electronic database it is possible to organize, structure and manage, information. AIM To develop an electronic protocol for data collection on treatment of patients with home enteral nutrition. METHOD After a review in theoretical material about home enteral nutrition therapy, 1793 data collection items were selected and grouped into nine categories: patient identification, nutritional assessment, dietetics prescription, indications for enteral nutrition, access to enteral nutrition options, composition of enteral nutrition, administration system, complications, and readmission. Was used the Electronic Integrated Computerized Procotols System (SINPE©) to organize that knowledge and the database that attends this research was named Informatized Master Protocol of HENT. The last step was the creation of a specific protocol to collect data by using informations from this database. RESULTS After installing the program, the system recognizes the user by identifying a pre-defined security authorization and also provides a screen to select a master protocol which the user can access. Items that arrange the specific protocol are contained in the Master Protocol and the information for this protocol are displayed. CONCLUSION It was possible to create an electronic protocol for HENT patients care with safety data based on research in enteral nutrition support.

Food intake assessment and quality of life in women with fibromyalgia

OBJECTIVE To compare the food intake of women with and without fibromyalgia and verify if the food intake of patients with fibromyalgia interferes with the pain and quality of life. METHODS Study participants were women with fibromyalgia (FM) seen in Fibromyalgia Outpatient Clinic, Hospital das Clínicas/UFPR and a control group (CT) with healthy women. Data collection was conducted from March to October 2012. For the assessment of food intake we used the Food Registration and the analyzed items were total calories, carbohydrates, proteins, lipids, vitamins (A, C, B12, D and E) and minerals (folate, selenium, zinc, iron, calcium and magnesium). The software used was Avanutri Online(®). To evaluate the quality of life, the Fibromyalgia Impact Questionnaire (FIQ) and pain threshold were used. RESULTS 43 patients with FM and 44 healthy women were evaluated. CT group showed a mean consumption of nutrients greater than FM group except for iron. However, only caloric intake, carbohydrates, proteins and lipids in grams and percentage of lipids, vitamin A, E, B12, folate, selenium and calcium were statistically significant. In FM group, there was a negative correlation between vitamin E and FIQ and a positive correlation between percentage of protein and pain threshold. CONCLUSION Women with FM showed a lower qualitative and quantitative intake in comparison with CT group. Only vitamin E correlated with quality of life and percentage of protein in the diet with sensation of pain.

Composição corporal por absorciometria radiológica de dupla energia de mulheres com fibromialgia

OBJECTIVES To assess body composition in women with fibromyalgia (FM) comparing to the reference value for healthy women. PATIENTS AND METHODS Cross-sectional observational analytical study, with 52 women selected with Fibromyalgia, according American College of Rheumatology (ACR, 1990) criteria. The patients were selected in Hospital de Clínicas da Universidade Federal do Paraná (HC-UFPR) and divided into two groups, 28 patients with a BMI (Body Mass Index) equal or higher (≥) than 25kg/m2 and 24 patients with BMI less or equal (≤) 24.99 kg/m2, subjected to physical examination for the count of tender points (TP) and completing the fibromyalgia impact questionnaire (FIQ). The assessment of body composition was performed by the Dual-Energy X-Ray Absorptiometry (DXA). The values of the fat mass percentage (MG %) found in the two groups were compared to the average percentage of MG by age and sex, described by Heward (2004). RESULTS The mean age of the study groups was 47.8 ± 8.6 years, the FIQ score was 70.5 ± 18.6 and TP 16.2 ± 2.0. The mean BMI was 26.4 ± 4.1 kg/m2, and the amount of MG was 25.2 ± 7.8 kg and 39.5 ± 6.8%, and lean mass (LM) was 37 2 ± 3.7 kg and 60.4 ± 7.3%. In the group with BMI ≤ 25 kg/m2, the MG % was 33.8% (21.5 -42.4) and in the group with BMI ≥ 25 kg/m2 of the MG was 44.4% (37.6 -56.2). CONCLUSION Both groups women with FM eutrophic as the overweight and obese group, presented higher reference MG% levels comparing with the standard levels for healthy women.

Utilization of the Apriori Data Mining method in a research software with electronic protocol in Enteral Nutrition

The aims this paper is to display the apriori data mining method results implanted in SINPE© (Electronic Protocols Integrated System) in an Enteral Nutrition research. We developed the data mining in the SINPE and later the items body mass index (BMI or IMC) and Enteral diet were selected from the database of the Homecare Enteral Nutrition Research. The parameters used were 10% support and 50% confidence. The Apriori generated a rule showing that patients with BMI ¿ 22 kg/m2 implied the intake of a homemade diet. The application of the apriori data mining method shows itself more dynamic, allowing the data intersection, and helping on decisions and on the elaboration of diagnostics as well as on diet prescriptions, checking the possible relationships between the analyzed items.

Indicators of sarcopenia and their relation to intrinsic and extrinsic factors relating to falls among active elderly women

Introduction: Musculoskeletal aging can impair functional performance increasing the risk of falls. Objective: To analyze the correlation between sarcopenia and the intrinsic and extrinsic factors involved in falls among community-dwelling elderly women. Method: A cross-sectional study evaluated the number of falls of 85 active community-dwelling elderly women in the previous year and then divided them into two groups: non-fallers (n=61) and fallers (n=24). The sarcopenia indicators assessed were gait speed (GS, 10m); handgrip strength (HS); calf circumference; appendicular muscle mass index (DXA). Intrinsic factors: Mental State Examination (MSE); visual acuity; depression (GDS-30); hip , knee (Lequesne) and ankle/foot (FAOS) pain/function; vestibular function (Fukuda test); functional mobility and risk of falls (TUG); power (sitting and standing five times); gait (treadmill); fear of falling (FES-I-Brazil). Extrinsic factors: risk/security features in homes. The independent t test was applied for comparisons between groups and the Pearson and Spearman tests were used for correlations (p<0.05). Results: There was a moderate correlation between HS and GS in non-fallers (r=0.47; p=0.001) and fallers (r= 0.54; p=0.03). There was a moderate negative correlation (r= -0.52; p=0.03) between FES-I-Brazil and gait cadence in fallers. There was a greater presence of stairs (p=0.001) and throw rugs (p=0.03) in the homes of fallers than non-fallers. Conclusion: The elderly women were not sarcopenic. Elderly fallers presented inferior gait cadence and a greater fear of falling. Residential risks were determining factors for falls, and were more relevant than intrinsic factors in the evaluation of falls among active community-dwelling elders.