Vânia Aparecida Leandro-Merhi

Nutrition Status and Risk Factors Associated With Length of Hospital Stay for Surgical Patients

OBJECTIVE To diagnose the nutrition status of hospitalized patients and identify the risk factors associated with hospital length of stay (LOS). METHODS The subjective approach and the body mass index (BMI) were used to classify the nutrition status, and other indicators (anthropometry, biochemistry, and energy intake) were analyzed regarding their association with length of hospital stay of 350 patients. The chi-square test was used to compare proportions, and the Mann-Whitney or Kruskal-Wallis test was used to compare continuous measures. Linear association was verified using Spearmans rank correlation coefficient. Coxs regression model was used to investigate factors associated with LOS. RESULTS Disease was the factor that influenced LOS the most in the studied population. Longer LOS prevailed in males (P < .0001), patients aged ≥60 years (P = .0008), patients with neoplasms (P < .0001), patients who lost weight during their hospital stay (P < .0001), and malnourished patients (P = .0034). There was a negative and significant, but weak, correlation between LOS and nutrition indicators (calf circumference, arm circumference, triceps skinfold thickness, subscapular skinfold thickness, arm fat area, lymphocyte count, and hemoglobin). Among adults, well-nourished patients were 3 times more likely to be discharged sooner (P = .0002, RR = 3.3 [1.7-6.2]) than those who had some degree of malnutrition. Well-nourished patients with digestive tract diseases (DTD) were also discharged sooner than malnourished patients with the same condition (P = .02, RR = 2.5 [1.1-5.8]). In patients with neoplasms, arm circumference was an independent risk factor to assess LOS (P = .009, RR = 1.1 [1.0-1.1]). CONCLUSIONS LOS was associated with disease and nutrition status. Among the more common diseases, nutrition status according to the subjective approach determined the LOS for patients with DTD and nutrition status according to arm circumference determined the LOS for patients with neoplasms.

Agreement between body mass index, calf circumference, arm circumference, habitual energy intake and the MNA in hospitalized elderly

ObjectivesThis study aimed to assess the agreement between body mass index, calf circumference, arm circumference, habitual energy intake and the mini nutritional assessment (MNA) and then assess the accuracy of these parameters in relation to the MNA.MethodThe nutritional status of 132 hospitalized elderly was assessed with the MNA, body mass index (BMI), calf circumference (CC) and arm circumference (AC). Their habitual energy intake (HEI) was also determined. The chi-square and the Mann-Whitney tests were used. The agreement between the nutritional risk criteria and the MNA was determined by the Kappa coefficient. The ROC curve was used to determine the accuracy of the parameters in relation to the MNA and to determine the cut-off values. The significance level was set at 5% (p<0.05).ResultsA little more than half the sample (54.5%) was well nourished, 34.9% were at risk of malnutrition and 10.6% were malnourished. There was good agreement only for BMI<22 (Kappa=0.44), with an accuracy (AUC) of 0.78. No agreement was found for the other parameters, their sensitivities were shown to be low. However, CC and AC were very specific for determining the well nourished patients: the CC specificity was 86.1% and AC specificity was 94.4%. The cutoff values determined by the ROC curve were ≤23.2 for BMI, ≤26.2 for AC and ≤32.2 for CC.ConclusionThe best parameters to determine nutritional risk in relation to the MNA were AC, BMI and CC. However, these nutritional assessment parameters should be used to replace the MNA for the assessment of hospitalized elderly patients with their current cut-off points.

Evolution of nutritional status of infants infected with the human immunodeficiency virus

CONTEXT There are today only a limited number of studies defining growth parameters and nutritional status for HIV children. OBJECTIVE To study the nutritional status of infants infected with the human immunodeficiency virus. TYPE OF STUDY Longitudinal study. SETTING Department of Pediatrics, Faculty of Medical Sciences, UNICAMP, Campinas, Brazil. PARTICIPANTS One hundred and twenty-four children born to HIV infected mothers were evaluated from birth until the age of two years. They were subdivided into two groups: 71 infected children and 53 non-infected children. MAIN MEASUREMENTS Growth was evaluated in both groups by comparing Z-scores for weight/age (w/a), length/age (H/a) and weight/length (w/H) (using the NCHS curves as reference). RESULTS The Z-score analyses showed that there was a significant difference between the two groups for all the variables studied, except for the H/a value at 3 months of age and the W/H value at 21 months of age, which showed P > 0.05. CONCLUSIONS The growth of infected infants was observed to be severely affected in comparison with that of seroreversed infants in the same age groups. Although clinical manifestations may take time to appear, the onset of growth changes begin soon after birth.

Clinical and nutritional status of surgical patients with and without malignant diseases: cross-sectional study

CONTEXT Malnutrition is frequently observed in inpatients with malignant diseases and may contribute to longer hospital stays. OBJECTIVE To compare the nutritional status, lymphocyte count, hemoglobin values and length of hospital stay of patients with and without malignant diseases. METHODS This comparative study assessed indicators of nutritional status, namely body mass index, recent weight loss, lymphocyte count, hemoglobin and length of hospital stay, of 928 surgical patients with and without malignant diseases (50.2% females and 49.8% males). The chi-square test was used to compare proportions and the Mann-Whitney test was used to compare continuous measurements between two groups. The significance level was set at 5%. RESULTS Patients with malignant diseases had longer hospital stays (P<0.0001), furthermore, a higher percentage of patients with malignant diseases had body mass index <18.5 (P<0.0001) and experienced recent weight changes (P<0.0002). Lymphocyte count also differed statistically between the groups (P = 0.0131), which lower levels were identified among patients with malignant diseases. CONCLUSION The lymphocyte count, hemoglobin values and weight loss are important findings of nutritional depletion in patients with malignant diseases.

Association between indicators of dementia and nutritional status in institutionalised older people

BACKGROUND AND AIMS Dementia weakens older people and can lead to malnutrition; therefore, the objective of this study was to assess the association between indicators of dementia and biochemical indicators, anthropometric indicators and food intake in institutionalised older people. METHODS A total of 150 older people of both genders participated in this study. Nutritional status was determined by body mass index and other anthropometric variables, and biochemical indicators were used to analyse the differences between individuals with and without dementia. Energy and nutrient intakes were determined by food records, and dementia was investigated with the Mini-Mental State Examination. The data were analysed by the chi-square test, Students t-test and Mann-Whitney tests. RESULTS Of the 150 individuals studied, 48% were men with a mean age of 73 ± 10 years and 52% were women with a mean age of 80 ± 9 years. Thirty-six per cent had some degree of malnutrition and 48% presented dementia, which was more prevalent in women (59%). The nutritional status of men and women individuals with and without dementia differed significantly (P < 0.001 for men and women). The only variables that presented a significant difference between individuals with and without dementia were those associated with muscle mass in men. There were no differences in energy and nutrient intakes between individuals with and without dementia except for vitamin C intake, which differed among women (P = 0.032). CONCLUSION In the conditions of the present study, dementia was associated with nutritional status, but not with energy and nutrient intakes, suggesting that older people with dementia may have higher nutritional requirements. Implications for practice.  Investigation of dementia may contribute to the nutritional status assessment of older people and energy expenditure and immobility should be investigated for a more complete assessment.

Food intake and nutritional status of hospitalised older people

BACKGROUND AND AIMS Disease is influenced by the nutritional status of the individual. We have assessed the relationship between nutritional status and food intake among recently hospitalised older people. METHODS A cross-sectional study was undertaken with 240 older people in a hospital that provides care for the public and private healthcare systems. Nutritional status was classified by the MNA (Mini Nutritional Assessment) into: malnourished, risk of malnutrition and without malnutrition. Food intake was estimated by the reported food intake during a typical day. The Kruskal-Wallis test was used to compare the medians and the correlation coefficient of Spearman to verify the relationship between the consumption of energy, protein and vitamin C and MNA scores. RESULTS 33.8% were classified as adequate regarding nutritional status; 37.1% were classified as being at risk of malnutrition and 29.1% were classified as malnourished. The malnourished individuals reported significantly less energy and nutrient intake than those at risk of malnutrition or those without malnutrition (P = 0.001). Not all nutrient intake, just some (iron, cholesterol and fibre), were lower in malnourished people. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Deterioration of the nutritional status of older people is accompanied by a reduction in energy and some nutrient intake. The investigation of food intake in older people could provide important information about nutritional risk.

Comparison of nutritional diagnosis methods and prediction of clinical outcomes in patients with neoplasms and digestive tract diseases

BACKGROUND & AIMS Nowadays studies are advised to compare nutritional risk assessed by different instruments with clinical outcomes. This study compared nutritional diagnosis methods and identified the best predictor of clinical outcomes. METHODS This cross-sectional study included 500 hospitalized patients with neoplasms and digestive tract diseases (DTD). Their nutritional status was determined by nutritional risk screening (NRS), subjective global assessment (SGA), and anthropometry, and compared with the clinical outcomes. The Kappa coefficient measured the agreement between the methods. Associations between risk factors and clinical outcomes were investigated by Cox, univariate logistic, and multiple logistic regression analyses at a significance level of 5%. RESULTS In DTD and cancer patients, SGA and NRS presented good agreement, but agreement of either with anthropometry was poor. According to Cox regression, both SGA and NRS predicted complications in DTD patients. However, none of the instruments was capable of predicting complications in cancer patients or death in DTD patients. In cancer patients, SGA and age were considered risk factors for death. In DTD patients, age, SGA, and NRS predicted a long hospital stay. In cancer patients, long stays were associated with age and SGA. CONCLUSION SGA and NRS are highly sensitive for predicting complications in DTD patients. Old age and SGA predicted death in cancer patients. Advanced age and SGA also predicted long hospital stays for DTD and cancer patients, but NRS predicted long hospital stays only for DTD patients.

Evaluation of urgent esophagectomy in esophageal perforation

Background Esophageal trauma is considered one of the most severe lesions of the digestive tract. There is still much controversy in choosing the best treatment for cases of esophageal perforation since that decision involves many variables. The readiness of medical care, the patients clinical status, the local conditions of the perforated segment, and the severity of the associated injuries must be considered for the most adequate therapeutic choice. Aim To demonstrate and to analyze the results of urgent esophagectomy in a series of patients with esophageal perforation. Methods A retrospective study of 31 patients with confirmed esophageal perforation. Most injuries were due to endoscopic dilatation of benign esophageal disorders, which had evolved with stenosis. The diagnosis of perforation was based on clinical parameters, laboratory tests, and endoscopic images. ‪The main surgical technique used was transmediastinal esophagectomy followed by reconstruction of the digestive tract in a second surgical procedure. Patients were evaluated for the development of systemic and local complications, especially for the dehiscence or stricture of the anastomosis of the cervical esophagus with either the stomach or the transposed colon. Results Early postoperative evaluation showed a survival rate of 77.1% in relation to the proposed surgery, and 45% of these patients presented no further complications. The other patients had one or more complications, being pulmonary infection and anastomotic fistula the most frequent. The seven patients (22.9%) who underwent esophageal resection 48 hours after the diagnosis died of sepsis. At medium and long-term assessments, most patients reported a good quality of life and full satisfaction regarding the surgery outcomes. Conclusions Despite the morbidity, emergency esophagectomy has its validity, especially in well indicated cases of esophageal perforation subsequent to endoscopic dilation for benign strictures.

Risco nutricional no período pré-operatório

BACKGROUND: Bad nutricional status in preoperative period - mainly associated to weight loss -, may lead to grater number of postoperative complications. AIM: To investigate the nutritional risk indicators in preoperative period, stratified by disease groups treated at the site. METHODS: A total of 512 patients with the following conditions were assessed: acute abdomen, digestive tract diseases, biliary diseases, gynecological diseases, vascular diseases, hernias and traumas. The following data were analyzed: body mass index, recent weight loss, habitual energy intake, lymphocyte count and length of hospital stay. The data were compared among the disease groups. The chi-square test or Fishers exact test when necessary was used to compare proportions. The significance level was set at 5%. RESULTS: Trauma patients followed by those with digestive tract diseases and acute abdomen had significantly lower body mass index (P=0.0222), and the ones with acute abdomen presented recent weight loss at hospital admittance (P=0.0048). A greater percentage of severe and moderate immune depletion was seen in patients with acute abdomen (P<0.0001) and those with vascular diseases had a greater percentage of patients with energy intake below 1000 kcalories (P=0.0311). Trauma patients presented longer hospital stays (P<0.0001). CONCLUSION: Trauma and acute abdomen patients had greater nutritional risk during the preoperative period. Thus, nutritional care strategies should be oriented towards them since the hospital admittance.

Neoplasia digestiva, baixo índice de massa corporal e perda de peso como indicadores do tempo de internação em pacientes portadores de neoplasias

RACIONAL: O estado de pacientes portadores de neoplasias pode influenciar o tempo de internacao. OBJETIVO: Investigar as alteracoes nutricionais e estudar os fatores de risco associados ao tempo de internacao em pacientes portadores de neoplasias. METODOS: Foi investigado em um estudo transversal o estado nutricional por antropometria classica, consumo energetico, alteracoes gastrointestinais, indicadores de risco nutricional e tempo de internacao em 93 pacientes portadores de neoplasias. Posteriormente foram estimados os fatores de risco associados ao tempo de internacao prolongado. RESULTADOS: Verificou-se diferenca significativa quanto ao tempo de internacao, para os pacientes com neoplasias digestivas que apresentaram 26 vezes mais chance de ficar internado sete dias ou mais do que pacientes com neoplasia ginecologica. Aqueles com IMC<18,5 apresentaram oito vezes mais chance de ficar internado sete dias ou mais. Os pacientes que apresentaram perda de peso recente, apresentaram 4,5 vezes mais chance de ficar internado sete dias ou mais do que aqueles que nao apresentaram perda de peso. CONCLUSAO: Pacientes portadores de neoplasias digestivas, com baixo IMC e perda de peso sao considerados fatores de risco para maior tempo de internacao.