Vivian Cristine Luft

Accuracy of nutritional assessment tools for predicting adverse hospital outcomes

Objective: To investigate the prevalence of trematode Aspidogastrea in the freshwater mussels in the Yangtze River basin within Anhui province, China. Methods: We initially harvested the freshwater mussels living in the Yangtze River running through Anhui area, and labeled them with corresponding number. Then the samples were dissected for isolating the flukes, which were identified by conventional staining. Results: Infection rate of trematode Aspidogastrea in freshwater mussels in the Yangtze River basin within the territory of Anhui province was 30.38℅(103/339)in general, and a total of 912 flukes of Aspidogastrea were detected in the 103 mussels, with average infection rate of 8.85 for each mussel. Conclusion: Trematode Aspdogastrea is prevalent in the freshwater bivalves living in the Yangtze River basin running through Anhui area, and the treamatode was identified as Aspidogaster sp. belong to Aspidogaste under Aspidogastridae of Aspidogastrea.Objective: to assess the use of oral nutritional supplements analyzing the reason for prescription and its implication in caloric-protein intake. Setting: study performed at a university hospital of 350 beds with medical and surgical specialties. Subjects, patients: Patients inclusion was done by selecting all starting oral nutritional supplement prescription. Exclusion criteria were being younger than 18 years, being admitted to the Intensive Care Unit, having cognition or communication impairments, being on concomitant parenteral nutrition or requiring complete enteral diet, and/or using nasogastric tube for feeding. We also excluded special enteral diets, specifically designed for certain conditions. Interventions: One-year long prospective study on prescription of oral nutritional supplements. Through clinical chart review and personal interview, we recorded demographic data, nutritional parameters, characteristics of the diet and supplement, and caloricprotein intake prescribed and ingested. The data were introduced in an Access97 database and processed by means of SPSS software for Windows®. We performed a descriptive study of quantitative and qualitative variables, a χ2 analysis between qualitative variables, and a comparative analysis between means of all paired data by means of the student’s t test, and variance analysis between quantitative variables. The significance level was set at p < 0.05. Results: we were only able to analyze 77 out of 130 prescriptions for nutritional supplements since we could not adequately interview the remaining patients, mainly due to neurological impairments. Mean age was 74.8 years (SD = 12) and 50.6% were women. The departments prescribing the highest number of supplements were hematology (22.1%) and internal medicine (20.8%). GI neoplasm was the most frequent diagnosis at admission (27.3%). The most frequent indication was kwashiorkor (45.5%), with 15.6% of patients being well nourished. Mean therapy duration was 11 days (SD = 11.1), and the main reason for termination was hospital discharge (70.1%). The supplement was concomitantly prescribed with the meals in 70.6% of the cases, and more than halfMaterial y metodos: Estudio retrospectivo de 55 pacientes de 65,4 ± 14,7 anos, 35,7% mujeres y 64,3% varones con un IMC 27,87 ± 5,56 kg/m (0% con IMC 30 kg/m ) en tratamiento con NPT con una duracion de 28 ± 5 dias (mas de 20 dias en el 75% de los casos). El 16,1% presentaba Diabetes Mellitus previa al inicio de NPT. En el 64,3% de los pacientes, la fistula ocurria tras cirugia reciente: en un 38.8% tras reseccion de colon, 16,6% de intestino delgado y 13,9% de estomago. La NPT se planificaba para aportar diariamente 1,5 × Gasto Energetico Basal, 1,5 g/kg/dia de proteinas, 6 mg de vitamina B 12 y 414 μg de acido folico. Ninguna solucion contenia hierro.Objective. To assess the impact of weight loss in clinical progression of the comorbidities in a group of morbid obese patients submitted to surgical treatment with the duodenal switch technique. Study setting. Between 2001-2006, we have operated by the duodenal crossing technique a total of 118 morbid obese patients (97 women and 21 men), mean age 42.6 years. Average pre-surgical BMI was 49.7, with average overweight of 69.1 kg. After surgical intervention, we have prospectively assessed the progression of the main comorbidities (arterial hypertension, diabetes, OSAS, osteoarticular pathology, dyslipidemia), according to the subscale of the BAROS scoring system. Postsurgical controls are done at months 3, 6, 12, 18, and 24 and annually thereafter. We have followed-up 110 patients, of whom 90 presented comorbidities, being the ones studied. Results. At 3 months post-surgery, we observed a decrease in the mean value of %WL to 31%, and a mean BMI value of 41.3, the percentage of lost BMI being 40.3%. Most of the weight loss occurred within 2 years, with %WL of 74.8% and a percentage of lost BMI of 97.7%. In 68 patients (75.5%) there was resolution of their comorbidities, 14.4% having improvement, and 10% with no improvement in spite of the surgery. Of patients achieving complete resolution, almost all of them achieved it within two years after surgery. Cure rates correlate with weight loss, so that at 3 months, with a mean weight loss of 25 kg (BMI decrease of 8.4 points) the comorbidity resolution rate is 45.5%. At 12 months, with a mean decrease in BMI of 16.4 points, %WL of 61.6% and % of lost BMI of 70.4%, the comorbidity resolution rate is 89.7%. At two years, by the time most of the main comorbidities resolved (68 patients), the BMI decreased by 22.4 points, the %WL 74.8% and the % of lost BMI 97.9%. Conclusion. The aim of bariatric surgery is weight loss and overweight-associated comorbidities improvement. In our study, most of the comorbidities improvement started at the third month, with the highest improvement rate occurring within two years, verifying that there is a direct relationship between post-surgical weight loss comorbidities improvement and resolution in most of the cases.Objective: To investigate the breeding rate and breeding density of Carpoglyphus lactis in stored Fructus Jujubae in Anhui, China in order to provide a scientific basis for prevention of Carpoglyphus lactis(C. lactis) from spoiling the dried fruit of such category. Methods： By the breeding nature of C. lactis, we collected samples of Fructus Jujubae, which were kept over 6 months in general, from the dried fruit shop and (or) Chinese herbal medicine warehouse, and isolated C. lactis from those samples. The mite specimens were prepared, and microscopically and morphologically identified. Species classification was done in accordance with Hughes (1976). Result:C. lactis was identified in 19 of the 300 samples, with breeding density and breeding rate of 6.52 heads/g and 6.33%. Constitute ratio at distinct developmental phase was associated with adult (including nymph, 85.71%), larva(12.27%), hypopus (0.56%) and egg(1.45%), respectively. The richness index, diversity index and evenness index was1.644, 1.644 and 0.923, respectively. Conclusion： Carpoglyphus lactis appears infesting in large quantity in the Fructus Jujubae stored in the above places in Anhui province, and the density is higher. Therefore, it is urgent to take effective measures to prevent C. lactis from spreading over other dried products stored in the same room and potential human intestinal acariasis as a result of the biological contamination.Objective: To determine possible associations between the risk of breast cancer in Brazilian women and demographic, social and economical variables, and past dietary intake. Methods: A case-control study was conducted in Joinville, Santa Catarina, Brazil, between june and november 2003 involving a group of 33 women recently diagnosed with breast cancer and a control group of 33 healthy women volunteers. Personal details, health history and past dietary intake were obtained via questionnaires and interviews. Data between groups were compared using χ2, Fisher, and Student’s t test, whilst associations were evaluated using a non-conditional logistic regression method and odds ratio (OR). Results: Statistically significant differences between the two groups were revealed with respect to age distribution (P = 0.007), family income level (P = 0.02), educational level (P 45 years), low family income (<

Chronic inflammation role in the obesity-diabetes association: a case-cohort study

520/month), poor educational level (primary school level or lower) and past regular consumption of pork fat and fatty meat may be factors associated with an increased risk of breast cancer.A case of peritoneal mucinous carcinomatosis in a patient who suffered a Hirschsprung disease 30 year before is presented. TH present condition caused an irreversible intestinal obstruction and the patients received home parenteral nutrition without unremarkable complications longer than two years.Introduction: Clinical nutrition is an activity realized in most of Health Centres of France, Canada, Great Britain and USA. The aim of our work was to determine activity and resources of Nutrition Units of Hospitals in the Community of Castilla y Leon. Material and methods: A questionnaire was send to all Hospitals of Castilla y Leon (SACYL); Hospital UniMaterial y método: Se estudió una población de pacientes postquirúrgicos (n = 22; 12 hombres y 10 mujeres) de 72,9 años de promedio (DE = 13,5) que fueron apareados en razón de edad y además un 40% de ellos por sexo, en dos grupos: A) con gastrectomía total (73%) o parcial (23%) por neoplasia y B) control, presencia de íleo paralítico postquirúrgico de causa no neoplásica. La duración media de la NPT fue de 14 días (DE = 2) y 13 días (DE = 2) respectivamente siendo la composición estándar de 12 g/N2, 100 kcal no proteicas/g N2, carbohidratos/lípidos: 63/38; volumen: 1.550-2.250 mL. Se realizaron controles basales habituales antes de la cirugía y al final de la NPT. Se analizaron los niveles de: Hb, Hto, contaje de linfocitos, contaje de neutrófilos y bioquímicos: glucosa, urea, creatinina, proteínas y albúmina. Análisis estadístico: test no paramétrico U de Mann Whitney y correlación de Pearson.El Órgano Oficial de SENPE, Nutrición Hospitalaria, no ha parado de crecer y prosperar a lo largo de sus 26 años de existencia. La revista se ha ido haciendo un hueco merecido en las bases de datos electrónicas y repositorios, alcanzando a los lectores interesados en su temática, no solo en España e Iberoamérica, sino también en países de ámbito sajón y en otros muy lejanos. El éxito ha traído parejo un incremento de originales, que en 2006 permitió alcanzar la cifra de 1.000 páginas publicadas. La creciente exigencia de los revisores, rechazando un treinta por ciento de los artículos recibidos, no ha sido impedimento para esta progresión, de lo que nos congratulamos. Otro de los éxitos positivos de este éxito editorial ha sido el aumento de números suplementarios de NUTR HOSP, documentos monográficos relativos a congresos, cursos, eventos o conclusiones de grupos de trabajo. La proliferación de los suplementos, muy halagüeña al comienzo, empezó a preocuparnos por las posibles desviaciones de la esencia de la revista. Vaya por delante que todos los suplementos han cumplido siempre las pautas éticas exigibles por la revista y por la SENPE, pero lo que escapaba al ámbito del comité editorial era la garantía de originalidad de todas las contribuciones, la homogeneidad en su estructura de acuerdo con las normas de publicación de la revista y, lo que es más importante, la falta de revisión por pares de sus contenidos. Esto último contradice formalmente la esencia de una revista científica. Por ello, Nutrición Hospitalaria y su comité editorial se encontraron ante un dilema: si se renuncia a la edición de suplementos que apoyan acciones especiales de la SENPE, se deja de prestar un servicio muy importante a la sociedad. Si se continua, incumplimos la normativa de revisión por pares. Hemos consultado los entornos científicos internacionales y rápidamente encontramos la solución, que colegas como Clin Nutr vienen aplicando desde hace uno o dos años: los suplementos deben aparecer bajo la cobertura de un ISSN diferente, llevando su propia paginación correlativa, en volúmenes independientes. Esta solución, que nos ha parecido la idónea, ha sido refrendada por el Comité Científico y la Junta Directiva de la Sociedad, y empezará a implementarse a partir de mayo de 2008. Así, el lector recibirá, a lo largo de los próximos meses, suplementos de Nutr Hosp ligeramente distintos. Los contenidos científicos de esta nueva línea editorial vendrán avalados por el Comité Científico Educacional y la Junta Directiva de SENPE. Creemos que con esta nueva fórmula que, como decimos, está ampliamente implantada en otras revistas científicas, se propiciará la multiplicación de los suplementos científicos de diversa índole que, en definitiva, redundará en beneficio de los miembros de SENPE y de nuestros lectores en general, sin menoscabo de las características referentes a originalidad y control que se exigen a los artículos que se publiquen en Nutrición Hospitalaria.OBJECTIVES: To analyze the complications related to enteral nutritional support in patients with lateral amyotrophic sclerosis included in our home-based mechanical ventilation program (HMVP), with a special emphasis on gastrointestinal complications. METHOD: Retrospective, descriptive study of the patients included in our HMVP directed by intensive care physicians, by means of systematic review of the medical records (included in a Microsoft Access database) during the period 2004-2011. RESULTS: In the period 2004-2011, 73 patients with a diagnosis of lateral amyotrophic sclerosis were followed: 34 (46.6%) refused nutritional support through gastrostomy or nasogastric tube, whereas 39 (53.4%) accepted. Twenty (51.3%) of the 39 patients with (home-based nutritional support) were females. The mean age of the patients was 60.6 + 13.4 years (95% CI 56.4-64.8). Diagnoses at the time of inclusion in the HMVP were: LAS, 21 cases (53.8%), and LAS with bulbar impairment 18 (43.1%). 34 patients (87.2%) were fed through percutaneous endoscopic gastrostomy (PEG), 3 (7.7%) through surgical gastrostomy, and 3 (7.7%). PEG was performed at the time of inclusion of the patients in the program, with a mean duration of 222.7 + 356.6 days (95% CI: 110.8-334.7). In patients with LAS, the mean duration was 271.4 + 449.5 days (95% CI: 130.3-412.1), and with LAS and bulbar impairment of 126.4 + 131.3 days (95% CI: 90-172.6). The mean duration of the nasogastric tube was 7.3 + 4.8 months (95% CI: 4-10.6). The mean duration of enteral nutrition was 578.6 + 872.9 days (95% CI: 304.7-852.6). There were complications in 35 patients (89.7%), and no complications occurred in only 4 patients (10.3%) (See table 2). Constipation occurred after initiating EN in 30 patients (76.9%); however, it was already present in 18 of them (60%). The remaining gastrointestinal complications observed were: abdominal bloating (9 patients; 23.1%); abdominal pain (6; 15,.4%); nausea and vomiting (5; 12.8%); diarrhea (3; 7.7%). CONCLUSIONS: Gastrointestinal complications are the most common ones; constipation stands out as the main problem in patients with LAS and HEN. However it may not be considered as a complication exclusively due to nutritional support since it is also a manifestation in the disease course. The occurrence of granulomas is also common.Obesity combined with breast cancer is a public health problem, given the high incidence and prevalence of both diseases. The aim of this review is to determine the current status of research on the relationship between the body weight of breast cancer patients and their prognosis. Overweight and obesity at the time of diagnosis are associated with a worse prognosis in breast cancer survivors. Observational studies show that breast cancer mortality is 33% higher in obese than in non-obese survivors. Furthermore, weight gain after diagnosis is common in these patients and is even greater in those receiving chemotherapy. Weight gains of 2-8 kg are observed in 68% of patients 3 years after diagnosis. Each 5 kg increase in body weight is associated with a 13% increase in breast cancer specific mortality. The mechanisms that cause this weight gain are not totally known. A higher weight gain is also associated with higher the risk of co-morbid cardiometabolic diseases, which worsen the quality of life and shorten overall survival. On the other hand, excess adipose tissue is an indirect promoter of tumor cell proliferation and releases circulating estrogens. Hence, preventing excess weight is important in these patients. An important limitation is the small number of randomised controlled trials investigating the type of diet that could be recommended specifically to breast cancer survivors. The evidence from current studies suggests that a healthy diet, low in fat and simple sugars and with a high proportion of fruit, vegetables and wholegrain products, has the potential to reduce morbidity and the risk of recurrence significantly, thus improving prognosis and quality of life in the long term.Objective To investigate the species and breeding density of acaroid mites in the stored rhizomatic traditional Chinese medicinal materials in Anhui province, China, in order to supply evidences for control and prevention of such species. Methods The stored traditional Chinese medicinal materials of root-stock origins were collected in 30 herb stores and warehouses in 17 cities across Anhui province. Mites were collected by using Tullgren funnel and directicopy, and identified under microscopy. Results 22 species of acaroid mites, belonging to 15 genera under 5 families, were identified from the total 47 stored samples, in which Tyrophagus putrescentiae，Acarus farinae, Carpoglyphus lactis, and Cologlyplus berlesei were predominant. Conclusion Breeding density of acaroid mites was high in the stored rhizomatic traditional Chinese medicinal materials in Anhui province. This indicates that the traditional Chinese medicinal herbs of root-stock origins in storage are seriously contaminated by the acaroid mites, and such infestation should be positively controlled to reduce the potential harm to public health.INTRODUCTION For critically patients, enteral immunonutrition results in notable reductions in infections and in length of stay in hospital, but not on mortality, raising the question as to whether this relate to the heterogeneous nature of critically ill patients or to the absence of the altered absorption of specific nutrients within the immunonutrient mix (e.g. iron). Immune-associated functional iron deficiency (FID) is not only one of the many causes or anaemia in the critically ill, but also a cause of inappropriate immune response, leading to a longer duration of episodes of systemic inflammatory response syndrome and poor outcome. OBJECTIVE This prospective cross-sectional study was undertaken to assess the prevalence of FID in critically ill patients during their stay in intensive care (ICU) in order to find the more appropriate population of patients that can benefit from iron therapy. METHOD Full blood cell counts, including reticulocytes (RETIC), serum iron (SI), transferring levels (TRF) and saturation (satTRF), serum TFR receptor (sTfR), ferritin (FRT) and C-reactive protein (CRP) were measured in venous blood samples from 131 random patients admitted to the ICU for at least 24 h (Length of ICU stay, LIS; min: 1 day; max: 38 days). RESULTS Anaemia (Hb < 12 g/dL) was present in 76% of the patients (Hb < 10 g/dL in 33%), hypoferremia (SI < 45 microg/dl) in 69%; satTRF < 20% in 53%; FRT < 100 ng/mL in 23%; sTfR > 2.3 mg/dL in 13%; and CRP > 0.5 mg/dL in 88%. Statistically significant correlations (r of Pearson; *p < 0.05, **p < 0.01) were obtained for serum CRP levels and WBC**, Hb*, TRF**, satTRF*, and FRT**. There was also a strong correlation between TRF and FRT (-0.650**), but not between FRT and satTRF or SI. LIS correlated with Hb*, CRP**, TRF*, satTRF* and FRT**. CONCLUSIONS A large proportion of critically ill patients admitted to the ICU presented the typical functional iron deficiency (FID) of acute inflammation-related anaemia (AIRA). This FID correlates with the inflammatory status and the length of stay at the ICU. However, 21% of the ICU patients with AIRA had an associated real iron deficiency (satTRF < 20; FRT < 100 and sTfR > 2.3). Since oral supplementation of iron seems to be ineffective, all these patients might benefit of iv iron therapy for correction of real or functional iron deficiency, which in turn might help to ameliorate their inflammatory status.In August 1976, a young man named LeRoy fell from a ledge, fracturing his femur. Major internal bleeding was suspected. During a laparotomy, the trauma team ensured that all internal organs were intact and the orthopedic team set his fracture. Thirty days later, LeRoy died. He had eaten little; each day he only received three liters of glucose, the equivalent of 510 calories, intravenously. The glucose was insufficient to meet his nutritional needs, and he lost over 20% of his body weight during his hospital stay. The cause of death was due to “physicianinduced” malnutrition. Meanwhile, a paper around the same time documented that the prevalence of malnutrition in Boston hospitals was 44% and that malnutrition itself was a predictor of higher complication and death rates. As a result, like-minded physicians formed a society that created training programs and encouraged formation of hospital nutrition teams. Industry produced nutrition formulas and catheters. Complications in sick hospitalized patients plummeted while survival rates rose, and California passed legislation to mandate nutritional support. Though the health care industry recognized the importance of nutrition in patient care, Congress failed to pass fiscal support for nutrition teams. As a result, hospitals disbanded their newly created nutrition teams, nutrition education and skills declined, and hospital complications and death rates have risen again.Some bioethicists consider older age as a limiting factor for receiving special medical care. Older adults comprise the majority of home enteral nutrition patients (neoplams of the head, neck, and upper gastrointestinal tract neuromuscular swallowing disorders, dementia, etc) On the contrary, there are very few data on Home Parenteral Nutrition (HPN) in the elderly. We report these of a 75 years old man affected from a severe short bowel syndrome due to mesenteric thrombosis. After a hospital stay of two months he was sent home on HPN. His current caregiver was her wife, a 72 year old woman suffering from incipient Parkinson’s disease. HPN lasted for 11 years and was stopped because of clinical deterioration. During this time he presented 5 catheter- related infections (1.3 episodes/1,000 days). 5 catheters were used (average length 788 days). He was hospitalized four times because of HPN complications. Functional status was maintained along almost all the length of HPN. Conclusions: The rate of complications in this patient was similar to other groups of age receiving HPN. The technique was not burdensome for the family. Older age cannot be consider, by itself a limiting factor when receiving long term nutritional support.Patients submitted to hematopoietic stem cells transplantation (HSCT) have an increased risk for having hyponutrition, both in the phase prior to transplantation and after this one. The indication of specialized nutritional support is common in allogenic HSCT, whereas patients submitted to auto-HSCT need it in the presence of complications that compromise an adequate nutrients intake. Enteral nutrition through a nasogastric tube has difficulties in these patients; the presence of mucositis delays the indication for enteral nutrition, which usually is poorly tolerated. Thus, frequently parenteral nutrition needs to be used as the route for nutritional support. The use of specific substrates, such as glutamine, is a controversial issue.La edad media fue 4,29 anos (0,1-14,4); el 48% de los ninos tenian menos de 3,5 anos. En el 70% de los casos, el motivo de la indicacion fue la disminucion de la ingesta. La duracion media fue 116,16 dias (4-1.165), manteniendose durante menos de 100 dias en el 79% de los pacientes. El porcentaje calorico medio administrado fue del 68%, precisando el 48% de la serie un aporte < 50%. El tipo de acceso inicial fue la sonda nasogastrica en el 92% de los ninos, la gastrostomia en el 5% y la sonda nasoyeyunal en el 3%. El modo de alimentacion mas frecuentemente utilizado fue la administracion exclusivamente nocturna en el 39% de los casos. El soporte de modo continuo se realizo en el 32%. La dieta polimerica pediatrica se empleo en el 70% de los pacientes. Los datos antropometricos, a excepcion de la talla, mejoraron de forma significativa tras la aplicacion del soporte. El 33% de los pacientes mostraban un indice de Waterlow inicial ≥ 90%.Metodo: Se realizo una busqueda de GPC disponibles en Internet en New Zeland Guidelines Group, Nacional Institute for Clinical Excellence, Scottish Intercollegiate Guidelines Network, Canadian Medical Association Infobase, Health Services/Technology Assesment, Fisterra y Medline. Se incluyeron ademas las direcciones de la ASPEN y la SENPE. Se recuperaron todas aquellas guias editadas o actualizadas en los ultimos cinco anos, en idioma ingles o castellano.Resumen es: Las enfermedades cardiovasculares representan la primera causa de muerte en Venezuela desde el ano 1967. Existen evidencias que demuestran que la lesion ...Material y metodo: Estudio retrospectivo. Cuando existe indicacion de administrar nutricion enteral en intestino, las enfermeras de nuestra Unidad colocan este tipo de sonda en la misma habitacion del enfermo, segun tecnica descrita por el fabricante. Despues de 24 horas de su colocacion, y sin fijarla en el ala de la nariz durante este tiempo, se realiza una radiografia de abdomen en decubito supino para valorar la situacion de la punta de la sonda (gastrica vs intestinal). Si no progresa a intestino, se reajusta la longitud introducida de la sonda y se repite la radiografia en las siguientes 24 horas. Ninguno de los pacientes tenian ventilacion asistida o sedo-relajacion. El exito en la colocacion se expresa como porcentaje de paso a traves del piloro.Introduction: Significant malnutrition exists in a high percentage of patients with head and neck cancer. Malnutrition is associated with defects in immune function that may impair the host response to malignancy. Malnutrition and immunosupression make patients highly susceptible to postoperative infections and complications. Objectives: Compare two immunoenhanced enteral nutritions with a control diet, and evaluate the effect in postoperative infections, length of stay and inflammatory markers. Patients: A population of 44 patients with oral and laryngeal cancer was enrolled in a randomized trial. At surgery, patients were randomly allocated to three groups: (group I); patients receiving an arginine-enhanced formula (group II); patients receiving a standard polymeric formula, and (group III) patients receiving an arginine, RNA and omega-3 fatty acids enhanced formula, in an isonitrogenous way. Results: The duration of enteral nutrition in the three groups was similar with an average duration of 14,5 ± 8 days. The length of postoperative stay was similar, with an average of 19,8 ± 8,5 days. Wound infections and general infections were more frequent in the control group. Fistula rates were not improved in the enhanced diet groups. No significant intergroup differences in the trend of the two plasma proteins (albumin, transferrin), lymphocytes, weight, IL-6, CPR and TNFα were detected. The control group showed the highest levels of TNFα at the fourteenth postoperative day. Gastrointestinal tolerance and diarrhoea rate were similar in all the patients. Conclusions: Immunoenhanced enteral nutrition formulas improved the infection rate in the postoperative of head and neck cancer patients. In the fistula rates, we observed that technical problems and nutritional status might have played an equally important role, and therefore the positive effect of immunonutrition in this parameter might have been overestimated.Introduction: Due to the high prevalence of overweight and obesity, new strategies are needed for its prevention and treatment. Nutritional Coaching (NC) has been shown to be effective in weight reduction, even though the innovation of this concept, it’s not always used properly. Objective: To verify if NC, added to dietary assessment, is an effective approach for weight loss in overweight or obese population, compared with only technical dietary assessment. Methodology: We performed a search for papers related to NC to establish quality parameters for this intervention. A systematic review was conducted, including randomized controlled trials that apply CN according to the selected parameters and comparing it with technical dietary assessment. Results: Eight high quality studies were included in the analysis. Among these, six revealed statistical differences on behalf of the group that received NC. Conclusion: Nutritional Coaching is an effective approach for weight reduction. Future nutritional coaching intervention research would benefit from clear definitions of this new model.Introducción: El control de calidad es fundamental en cualquier intervención de enfermería clínico-asistencial y más aun en el paciente crítico. El protocolo de Enfermería de Nutrición Parenteral Total (NPT), que incluye el cambio de bolsa de nutrición, equipo de perfusión y cuidado del catéter venoso central (CVC) define unas actividades básicas. Fundamentamos el seguimiento en dos aspectos principales: 1. El paciente tiene un potencial de complicaciones relacionadas con la inserción del CVC y su manipulación, y 2. las repetidas manipulaciones de la conexión del CVC al equipo durante el tratamiento puede incidir en las infecciones del mismo.Material y metodo: Se estudiaron 27 pacientes (16 hombres y 11 mujeres) con carcinoma de colon y una edad media de 62,1 anos ? 11,2 (M?DE), de los cuales un 59% estaban en un estadio III de la enfermedad. De los pacientes incluidos, 11 habian recibido tratamiento quimioterapico previo y 16 no. El protocolo de Oncologia supuso la administracion aislada de 5fluoracilo en el 80% de los pacientes combinado con Oxaliplatino en un 17%. En todos los casos se registraron parametros antropometricos y analiticos (hemograma completo, glucosa, creatinina, bilirrubina, ALAT, ASAT, fosfatasa alcalina, albumina y marcadores tumorales) determinados antes de la cirugia y al final de la nutricion parenteral. Para evaluar la posible influencia del soporte nutricional los pacientes fueron divididos en dos grupos, en funcion de si habian o no recibido tratamiento citostatico previo a la intervencion. El analisis estadistico se realizo con el test ?2 y el de Wilcoxon (SPSS 10.0), aceptandose un nivel de significacion estadistica para p < 0,05.

Role of enteral nutrition in the incidence of diarrhea among hospitalized adult patients

BackgroundChronic inflammation is related to both obesity and diabetes. Our aim was to investigate to what extent this inflammation contributes to the association between obesity and diabetes.MethodsUsing a case-cohort design, we followed 567 middle-aged individuals who developed diabetes and 554 who did not over 9 years within the ARIC Study. Weighted Cox proportional hazards analyses permitted statistical inference to the entire cohort.ResultsObese individuals (BMI≥30 kg/m2), compared to those with BMI<25 kg/m2, presented a large increased risk of developing diabetes (HR[obesity]=6.4, 95%CI 4.5–9.2), as did those in the highest (compared to the lowest) quartile of waist circumference (HR[waist]=8.3, 95%CI 5.6–12.3), in analyses adjusted for age, gender, ethnicity, study center, and parental history of diabetes. Notably, further adjustment for adiponectin and inflammation markers halved the magnitude of these associations (HR[obesity]=3.2, 95%CI 2.1–4.7; and HR[waist]=4.2, 95%CI 2.8–6.5). In similar modeling, attenuation obtained by adding fasting insulin, instead of these markers, was only slightly more pronounced HR[obesity]=2.7, 95%CI 1.7–4.1; and HR[waist]=3.6, 95%CI 2.3–5.8).ConclusionsThe marked decrease in the obesity-diabetes association after taking into account inflammation markers and adipokines indicates their major role in the pathways leading to adult onset of diabetes in obese individuals.

Estratégias e desenvolvimento de garantia e controle de qualidade no ELSA-Brasil

OBJECTIVE This study examined the risk of diarrhea as a result of providing enteral nutrition in the hospital setting, adjusting for other clinical and therapeutic factors. METHODS Adults admitted to a general tertiary care university hospital, in clinical or surgical units, were enrolled in the study between June 2004 and May 2005 and prospectively followed during their hospital stay. For each patient treated with enteral nutrition (n = 302), a comparable non-treated patient from the same ward (who also received antibiotics previously) and was similarly cared for by the same hospital staff was included in the study (n = 302), constituting a double-cohort study. All patients were seen three times per week, on alternating days, until the occurrence of diarrhea or hospital discharge. Coxs regression analyses were applied for adjustments. RESULTS The incidence of diarrhea was 18% for patients receiving enteral nutrition and 6% for non-treated patients (P < 0.01). In multivariate analyses, enteral nutrition was independently associated with diarrhea (hazard ratio 2.7, 95% confidence interval 1.6-4.7), even adjusting for age (hazard ratio 1.02, 95% confidence interval 1.00-1.03) and hospitalization during the summer months (hazard ratio 2.4, 95% confidence interval 1.5-3.9). Patients for whom strict adherence to delivery-set washing-and-changing procedures was observed (on >75% of days) presented a lower incidence of diarrhea (6.5% versus 20.3%, P = 0.02; and 5.9% versus 19.8%, P = 0.05, respectively). CONCLUSION Providing enteral nutrition to the hospitalized elderly during the summer months is associated with a higher risk of diarrhea. Strategies aimed toward improvement in the quality of enteral nutrition practices should be evaluated to minimize this deleterious clinical outcome.

Validation of a New Method Developed to Measure the Height of Adult Patients in Bed

The ELSA-Brasil (Estudo Longitudinal de Saude do Adulto - Brazilian Longitudinal Study for Adult Health) is a cohort study composed of 15,105 adults followed up in order to assess the development of chronic diseases, especially diabetes and cardiovascular disease. Its size, multicenter nature and the diversity of measurements required effective and efficient mechanisms of quality assurance and control. The main quality assurance activities (those developed before data collection) were: careful selection of research instruments, centralized training and certification, pretesting and pilot studies, and preparation of operation manuals for the procedures. Quality control activities (developed during data collection and processing) were performed more intensively at the beginning, when routines had not been established yet. The main quality control activities were: periodic observation of technicians, test-retest studies, data monitoring, network of supervisors, and cross visits. Data that estimate the reliability of the obtained information attest that the quality goals have been achieved.

Avaliação nutricional: descrição da concordância entre avaliadores

UNLABELLED We present the performance of a new instrument developed to measure the height of patients in bed (Luft Ruler). METHODS Standing height was the gold standard measured in 116 hospitalized adults with a stadiometer, compared with measurements from the Luft Ruler and calculated estimates. RESULTS Using the Luft Ruler in women, men, <60 years old, and >60 years old, the mean difference from the gold standard was, respectively, 1.5 cm (P= .02), 1.3 cm (P= .06), 1.2 cm (P= .07), and 1.6 cm (P= .02); total arm span: 6.7 cm, 7.7 cm, 5.4 cm, and 9.0 cm (P< .01 for all strata); 2x half arm span: 7.8 cm, 10.2 cm, 7.7 cm, and 10.3 cm (P< .01 for all); World Health Organization (WHO) equation: 5.5 cm, 6.2 cm, 4.7 cm, and 6.9 cm (P< .01 for all); and the Hospital de Clínicas de Porto Alegre equation: 1.9 cm (P< .01), 2.5 cm (P< .01), 1.1 cm (P= .12), and 3.3 cm (P< .01). The proportion of differences >5 cm was 0.9% (n=1) using the Luft Ruler, 62.9% using total arm span, 71.6% using 2x half arm span, 64.7% using the WHO equation, and 27.6% using the Hospital de Clínicas de Porto Alegre equation. CONCLUSIONS The Luft Ruler was the only method that presented minor mean differences in relation to the gold standard in both gender and age strata. The other estimates are not recommended because of high frequency of relevant errors.

Omega-3 fatty acids' supplementation in Alzheimer's disease: A systematic review

Este estudo objetivou avaliar a concordância interobservadores de medidas antropometricas e avaliacao subjetiva do estado nutricional em adultos hospitalizados. Pacientes internados em um hospital geral universitario tiveram peso atual, peso usual, altura, circunferencia do braco, prega cutânea tricipital, percentual de perda de peso, Indice de Massa Corporal, circunferencia muscular do braco e Avaliacao Nutricional Subjetiva Global obtidos por avaliadores independentes. A concordância foi avaliada pelo coeficiente kappa, teste t pareado e coeficiente de correlacao intraclasse (ICC). Foram avaliados 102 pacientes, com idade de 53±15 anos. Foi obtida boa correlacao entre observadores para todos os metodos antropometricos (ICC>0,86) e diferencas medias de pequena magnitude. As variaveis categorizadas mostraram concordância otima para o Indice de Massa Corporal (kappa=0,98; IC95%: 0,95-1,0), fraca para a Avaliacao Nutricional Subjetiva Global (kappa=0,46; IC95%: 0,31-0,60) e moderada para os percentis 5 e 10 da circunferencia do braco (kappa=0,78; IC95%: 0,65-0,91), circunferencia muscular do braco (kappa=0,73; IC95%: 0,54-0,92) e prega cutânea tricipital (kappa=0,65; IC95%: 0,48-0,82). Para muitos pacientes houve discrepâncias clinicamente relevantes no percentual de perda de peso, circunferencia do braco, prega cutânea tricipital e circunferencia muscular do braco. Embora estatisticamente a reprodutibilidade dos metodos antropometricos tenha sido boa, deve-se ser prudente ao emprega-los no contexto hospitalar, visto as diferencas encontradas, em especial na antropometria do braco e na Avaliacao Nutricional Subjetiva Global.

Estratégias de identificação, investigação e classificação de desfechos incidentes no ELSA-Brasil

Introduction: Alzheimers disease (AD) is a neurodegeneration disorder characterized by progressive impairments of memory, language, reasoning, and other cognitive functions. Evidence suggests that omega-3 fatty acids may act as a possible protection factor in AD. Objective: To evaluate the results available in the literature involving omega-3 fatty acids supplementation and its effect on cognitive function in AD patients. Methods: A systematic review of MEDLINE (from PubMed), Excerpta Medica Database, and Cochrane Library databases was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria consisted in original intervention studies, controlled by placebo, that assessed the impact of supplementation or dietary intake of omega-3 fatty acids on cognitive function, in humans with AD, without limitation for prime date of publication. Results: Initial search resulted in 361 articles. Seven studies fully met the inclusion criteria. Most studies did not find statistically significant results for the omega-3 fatty acids supplementation compared to placebo, and those who show some benefit do it only in a few cognitive assessment scales. However, the effects of omega-3 fatty acids appear to be most effectively demonstrated in patients with very mild AD. Conclusion: The effects of omega-3 fatty acids supplementation in mild AD corroborate epidemiological observational studies showing that omega-3 fatty acids may be beneficial in disease onset, when there is slight impairment of brain function. Although some studies have shown changes in scales of cognitive function in more severe cases, they are not enough to support omega-3 fatty acids supplementation in the treatment of AD.

Retinol binding protein 4 and incident diabetes – the Atherosclerosis Risk in Communities Study (ARIC Study)

OBJETIVO: O artigo descreve as estrategias do Estudo Longitudinal de Saude do Adulto (ELSA-Brasil) para a manutencao da adesao dos participantes ao longo do tempo e seu seguimento adequado. Isto e fundamental para garantir a validade interna de estudos longitudinais e identificar, investigar e classificar os desfechos incidentes de interesse. METODOS: A metodologia de seguimento da coorte combina contatos telefonicos anuais com re-exames e entrevistas a cada tres ou quatro anos. O objetivo e identificar desfechos incidentes de natureza transitoria, reversiveis ou nao; desfechos finais, de natureza irreversivel; bem como complicacoes relacionadas a evolucao das doencas cardiovasculares e diabetes, principais doencas estudadas. RESULTADOS: As entrevistas telefonicas visam monitorar a saude dos participantes e identificar possiveis eventos ocorridos, como internacoes hospitalares, exames ou procedimentos especializados definidos previamente. O participante tambem e incentivado a comunicar a ocorrencia de algum evento de saude ao Centro de Pesquisa. A partir da identificacao de um potencial evento, e iniciado um processo de investigacao, que inclui acesso a prontuarios medicos para verificacao de datas e informacoes detalhadas sobre aquele evento. Os documentos obtidos sao analisados sem identificacao do paciente, profissional ou servico de saude e classificados por um comite de especialistas medicos. A classificacao de desfechos incidentes adotada baseia-se em criterios internacionais consagrados, garantindo comparabilidade e reduzindo o erro de classificacao deles. Alem dessas estrategias, a ocorrencia de desfechos podera ser investigada por meio do relacionamento de dados com bases secundarias do Ministerio da Saude, como as de mortalidade e internacoes. CONCLUSOES: A correta identificacao de desfechos permitira estimar sua incidencia na coorte e investigar o efeito das exposicoes estudadas no ELSA-Brasil em sua linha de base e nas ondas posteriores.

Timing and Type of Alcohol Consumption and the Metabolic Syndrome - ELSA-Brasil.

BACKGROUND Retinol binding protein 4 (RBP4) has been described as a link between impaired glucose uptake in adipocytes and systemic insulin sensitivity. OBJECTIVE To determine whether RBP4 fasting levels predict the development of type 2 diabetes. METHODS Using a case-cohort design, we followed 543 middle-aged individuals who developed diabetes and 537 who did not over ~9 years within the population-based Atherosclerosis Risk in Communities Study. Weighted Cox proportional hazards analyses permitted statistical inference of the RBP4 - incident diabetes associations to the entire cohort. RESULTS Women in the highest tertile of RBP4 presented greater risk of developing diabetes (HR = 1.74; 95%CI 1.03 - 2.94) in analyses adjusted for age, ethnicity, study center, parental history of diabetes, hypertension, glomerular filtration rate, body mass index, waist-hip ratio, nonesterified fatty acids, adiponectin, leptin, triglycerides and HDL-C. When additionally adjusted for fasting insulin, this associations significance became borderline (HR = 1.68; 95%CI 1.00 - 2.82). No association between RBP4 levels and incident diabetes was found in men. CONCLUSION These findings suggest that RBP4 levels may be directly involved in the pathogenesis of type 2 diabetes in women.