Patricia Stanich

Nutritional care in motor neurone disease/ amyotrophic lateral sclerosis.

Patients with amyotrophic lateral sclerosis (ALS) often present changes in nutritional status. Based on weight loss and on difficulty in nutritional management, this study aims to review the different possibilities and to present guidelines concerning nutritional treatment to such patients. Diet characteristics, types of treatment and nutritional therapy indicating administration routes and discussing the details of the disease are described herein. Nutritional therapy has been a substantial therapeutic resource for ALS development.

Nurse to Bed Ratio and Nutrition Support in Critically Ill Patients

BACKGROUND Inadequate nutrition support is common among critically ill patients, and identification of risk factors for such inadequacy might help in improving nutrition support. OBJECTIVE To determine how often daily calorie goals are met and the factors responsible for inadequate nutrition support. Methods A single-center prospective cohort study. Each patients demographic and clinical characteristics, the need for ventilatory support, the use and dosage of medications, the number of nursing staff per bed, the time elapsed from admission to the intensive care unit until the effective start of enteral feeding, and the causes for nonadministration were recorded. Achievement of daily calorie goals was determined and correlated with risk factors. RESULTS A total of 262 daily evaluations were done in 40 patients. Daily calorie goal was achieved in only 46.2% of the evaluations (n = 121), with a mean of 74.8% of the prescribed volume of enteral nutrition infused daily. Risk factors for inadequate nutrition support were the use of midazolam (odds ratio, 1.58; 95% CI, 1.18-2.11) and fewer nursing professionals per bed (odds ratio, 2.56; 95% CI, 1.43-4.57). Conclusion Achievement of daily calorie goals was inadequate, and the main factors associated with this failure were the use and dosage of midazolam and the number of nurses available.

Anthropometry of arm: nutritional risk indicator in amyotrophic lateral sclerosis

The aim of the paper is to examine the correlation between clinical data, nutritional, respiratory and functional parameters in amyotrophic lateral sclerosis (ALS). This is a descriptive study of 111 ALS patients [91 spinal onset (GS) and 20 bulbar onset (GB)] carried on using nutritional and respiratory parameters and amyotrophic lateral sclerosis functional rating scale (ALSFRS). ALSFRS was analyzed in the main domains (D1, D2 and D3). Forced vital capacity and anthropometric measurements, there was significant association for GS and GB, and in GS there was positive correlation with midarm circumference (MAC) (r=0.30; P=0.020), midarm muscle circumference (r=0.29; P=0.026), arm muscle area (r=0.28; P=0.033) and protein-caloric malnutrition score (r=0.27; P=0.039), while for GB only with body weight (r=0.64; P=0.024). On correlation of nutritional parameters and ALSFRS for GS patients we observed that MAC and %MAC presented positive association with both issues of D1 and D2. For GB, the total score in addition to correlate positively with anthropometric parameters related to lean body mass also presented negative association with a parameter associated with body fat. In summary, it is suggested that the application of anthropometry of arm could be useful in routine monitoring of ALS patients.

Nutrition and Survival in Patients with Amyotrophic Lateral Sclerosis

Amyotrophic lateral sclerosis (ALS) is characterized by alterations in nutritional state, energy intake, and energy expenditure. Maintaining an appropriate energy balance prevents malnutrition and its complications, and may improve physical functioning, quality of life, and survival. Worsening nutritional state as reflected by a decrease of body mass index (BMI) or weight has been associated with decreased survival. Enteral feeding can maintain BMI and weight and should be considered as a means to increase survival. Percutaneous endoscopic gastrostomy (PEG) is a standard procedure for feeding dysphagic ALS patients. Nevertheless, the effects of prognostic factors that influence survival after PEG remain unclear. Therefore, the purpose of this chapter is to evaluate the effects of nutrition on survival.

Nutrition and Amyotrophic Lateral Sclerosis

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder characterized by a loss of motor neurons in the cerebral cortex, brainstem, and spinal cord, leading to skeletal muscle atrophy, paralysis, and death. The clinical onset can be bulbar, affecting swallowing and phonation, or spinal, presenting as skeletal muscle atrophy. Dysphagia is a condition that leads to decreased food intake and body mass, malnutrition, and dehydration. Weight and muscle loss are related to the disease progression. In this chapter, we will discuss the importance of nutritional therapy in the multidisciplinary treatment of ALS.

Importância do atendimento multidisciplinar a pacientes com doença do neurônio motor/esclerose lateral amiotrófica DOI:10.5585/conssaude.v8i2.1584

Amyotrophic Lateral Sclerosis (ALS) is a progressive and degenerative disease, causing progressive weakness and loss of muscular strength of superior and inferior members. This article presents the results of the multdisciplinary care in patients with ALS, by means of retrospective study with 33 patients in regular treatment. The results show that 84,84 % made use of Riluzol; tamoxifen was associated to 30,30%; 39,39% to vitamins E and C, and B Complex was used in 6,0%. In spite of the nutritional orientations, 18,18% presented malnutrition. The majority did not present change in the food consistency, 42,4% ingested creamy diet, and 6,06% received exclusive nutrition by Percutaneus Endoscopic Gastrostomy (PEG). It was observed significant difference only for food consistency. It was concluded that the multdisciplinary care promotes an acceptance of the ALS treatment. However, the application of the orientations depends on the availability of the patient and the caregiver.