Natália Sanchez Oliveira

Impacto da adequação da oferta energética sobre a mortalidade em pacientes de UTI recebendo nutrição enteral

OBJECTIVE: To investigate the relationship between adequacy of energy intake and intensive care unit mortality in patients receiving exclusive enteral nutrition therapy. METHODS: Observational and prospective study conducted during 2008 and 2009. Patients above 18 years with exclusive enteral nutrition therapy for at least 72 hours were included. The adequacy of energy intake was estimated by the administered/prescribed ratio. Non-conditional logistic regression was used to assess the relationship between predictive variables (adequacy of energy intake, APACHE II, gender, age, and intensive care unit length of stay) and intensive care unit mortality. RESULTS: Sixty-three patients (mean 58 years, 27% mortality) were included, 47.6% of whom received more than 90% of the energy prescribed (mean adequacy 88.2%). Mean energy balance was -190 kcal/day. Significant associations between death in the intensive care unit and the variables age and intensive care unit length of stay were observed, after removing the variables adequacy of energy intake, APACHE II, gender and age during the modeling process. CONCLUSION: In our study, adequacy of energy intake did not affect intensive care unit mortality. Carefully followed enteral nutrition protocols, resulting in an administered/prescribed ratio above 70%, are apparently not sufficient to impact the mortality rates in the intensive care unit. Therefore, it may not be necessary to achieve 100% of the targeted energy, considering the high frequency of enteral feeding interruptions due to gastrointestinal intolerance and fasting for tests and procedures. Additional research is needed to identify the optimal energy intake for improved outcomes and reduced costs.

Concentrações de vitamina A no leite humano e características socioeconômicas e nutricionais maternas: resultados de estudos brasileiros

OBJECTIVES: to compile the results of Brazilian studies that investigated the vitamin A content of human milk. SOURCES: the searches were performed at LILACS, Banco de Teses da Capes, SciELO (Scientific Electronic Library), and Plataforma Lattes databases. The search strategy was: pregnant, lactating, human milk vitamin A concentration, Brazil. The searches were done in 2006 and updated in March 2008. SUMMARY OF THE FINDINGS: fourteen studies published between 1988 and 2008 were located. These studies were heterogeneous in terms of sample size, milk phase, time of collection and method for determining vitamin A concentrations. The study outcomes described average vitamin A concentrations in human milk ranging from 0.62 to 4.50 µmol/L. CONCLUSIONS: there was no consensus as to the relationship between the vitamin A content of human milk and a diet with a suitable vitamin A content, maternal nutritional status, maternal obstetric and demographical characteristics and duration of pregnancy. The review indicates that future studies should use casual samples of mature milk, and use high performance liquid chromatography - HPLC - as the laboratory technique in order to quantify vitamin A.