Vivian Marques Miguel Suen

Weight and height prediction of immobilized patients

OBJECTIVE: To confirm the adequacy of the formula suggested in the literature and/or to develop appropriate equations for the Brazilian population of immobilized patients based on simple anthropometric measurements. METHODS: Hospitalized patients were submitted to anthropometry and methods to estimate weight and height of bedridden patients were developed by multiple linear regression. RESULTS: Three hundred sixty eight persons were evaluated at two hospital centers and five weight-predicting and two height-predicting equations were developed from the measurements obtained. Among the new equations developed, the simplest one for weight estimate was: Weight (kg) = 0.5759 x (arm circumference, cm) + 0.5263 x (abdominal circumference, cm) + 1.2452 x (calf circumference, cm) -4.8689 x (Sex, male = 1 and female = 2) -32.9241 (r = 0.94); and the one for height estimate was: Height (cm) = 58.6940 - 2.9740 x (Sex) -0.0736 x (age, years) + 0.4958 x (arm length, cm) + 1.1320 x (half- span, cm) (r = 0.88). The estimates thus calculated did not differ significantly from actual measurements, with p = 0.94 and 0.89 and a mean error of 6.0 and 2.1% for weight and height, respectively. CONCLUSION: We suggest that these equations can be used to estimate the weight and height of bedridden patients when necessary or when these parameters cannot be measured with a scale and a stadiometer.

Evidence of zinc deficiency in competitive swimmers.

OBJECTIVE The aim of this study was to assess the nutritional zinc (Zn) status of elite swimmers during different training periods. METHODS A longitudinal paired study was performed at the University of Sao Paulo in eight male swimmers 18 to 25 y old who had been swimming competitively at the state and national levels for at least 5 y. The swimmers were evaluated over a total period of 14 wk: before the basic and specific preparatory period (BSPP-baseline), at the end of the basic and specific preparatory period (post-BSPP), and at the end of the polishing period (PP). Levels of Zn were determined in the plasma, erythrocyte, urine, and saliva by atomic absorption spectrophotometry. Anthropometric measurements and a 3-d food record were also evaluated. RESULTS The median plasma Zn concentration was below the reference value in all training periods (BSPP-baseline 59 μg/dL, post-BSPP 55.9 μg/dL, after PP 58.8 μg/dL, P > 0.05), as were threshold values for erythrocytes (BSPP-baseline 36.5 μg of Zn/g of hemoglobin, post-BSPP 42 μg of Zn/g of hemoglobin, after PP 40.7 μg of Zn/g of hemoglobin, P > 0.05), urinary Zn (BSPP-baseline 280 μg/24 h, post-BSPP 337 μg/24 h, after PP 284 μg/24 h, P > 0.05), and salivary Zn (BSPP-baseline 66.1 μg/L, post-BSPP 54.1 μg/L, after PP 79.7 μg/L, P > 0.05). Salivary Zn did not correlate with plasma and erythrocyte Zn levels. CONCLUSION The results suggest that the elite swimmers studied presented a possible Zn deficiency and that salivary Zn was not adequate to evaluate the Zn nutritional status.

Effect of hypocaloric meals with different macronutrient compositions on energy metabolism and lung function in obese women

OBJECTIVE We investigated the effect of hypocaloric mixed diets with different proportions of carbohydrate, protein, and fat on resting metabolic rate and the thermic effect of food in obese women. METHODS Three mixed hypocaloric diets were consumed in random order during separate periods lasting 7 d each. Between each dietary period there was a washout period of 10 d. Diet 1 had a higher proportion of energy from carbohydrate (72%), diet 2 had a higher proportion of energy from protein (43%), and diet 3 had a higher proportion of energy from fat (68%). Indirect calorimetry and lung function tests were done after the completion of each 7-d diet. Seven obese women, ages 22 to 45 y and with body mass indexes of 32 to 59 kg/m(2), participated in the study. Oxygen consumption, carbon dioxide production, resting metabolic rate, and the thermic effect of food by indirect calorimetry were measured. Lung function tests included spirometry in the seated and upright positions, arterial blood gas analysis, and maximal inspiratory and expiratory pressures. RESULTS There were no statistically significant differences in the resting metabolic rate and the thermic effect of food resulting from the three diets. The mean resting metabolic rates (kJ/d) were 7453 +/- 1446 for diet 1, 7461 +/- 1965 for diet 2, and 7076 +/- 2048 for diet 3. The mean thermic effects of food (kcal/min) were -0.02 +/- 0.07 for diet 1, -0.01 +/- 0.25 for diet 2, and 0.05 +/- 0.13 for diet 3. Lung function tests were normal before and after the hypocaloic diets: partial pressure of oxygen (mmHg) values were 81 +/- 13, 77 +/- 8, and 78 +/- 11 for diets 1 to 3, respectively; and partial pressure of carbon dioxide (mmHg) were 37 +/- 4, 37 +/- 3, and 37 +/- 4 for diets 1 to 3, respectively. CONCLUSIONS Obese women with normal lung function tests and consuming mixed hypocaloric diets showed no alteration in resting metabolic rate and a reduced or absent thermic effect of food independently of the macronutrient composition.

Uso de cateteres venosos totalmente implantados para nutrição parenteral: cuidados, tempo de permanência e ocorrência de complicações infecciosas

Cateteres venosos totalmente implantados sao utilizados em pacientes com sindrome do intestino curto, pararealizar o suporte nutricional parenteral, o qual mantem estes pacientes vivos, pois fornece-lhes nutrientesque sao absorvidos pela via digestiva. No entanto, estes cateteres nao sao isentos de complicacoes. Asinfeccoes relacionadas aos cateteres venosos sao as complicacoes mais temidas e sua incidencia varia de 3%a 20%, aumentando em pacientes mais graves. O objetivo do presente estudo e descrever as complicacoesinfecciosas em pacientes recebendo nutricao parenteral por meio de cateteres venosos totalmente implantados.Tais cateteres sao utilizados pela Divisao de Nutricao Clinica do Hospital das Clinicas da Faculdade de Medicinade Ribeirao Preto, Universidade de Sao Paulo, para realizar o suporte nutricional parenteral em pacientessubmetidos a resseccoes extensas de intestino delgado. Foram avaliadas as complicacoes infecciosas ocorridascom 21 cateteres, implantados em 16 pacientes. O tempo de permanencia dos cateteres foi de 768±664,3dias (mediana 529 dias) e a taxa de infeccao foi de 0,029 infeccoes/paciente/ano, resultados que se comparamas taxas de infeccao observadas em paises desenvolvidos. Concluiu-se que os cuidados observados no manuseiodestes cateteres foram de fundamental importância para diminuir a incidencia de infeccao nestes pacientes.

Refeeding syndrome, an undiagnosed and forgotten potentially fatal condition.

Refeeding syndrome (RFS) has been well described but is also a frequently forgotten and undiagnosed complication in clinical practice, which, if untreated, may lead to death. Patients who are more prone to developing RFS are those with at least one of the following conditions: BMI <16 kg/m2, a recent unintentional weight loss >15%, very little nutritional intake for >10 days, and/or low plasma concentrations of potassium, phosphate or magnesium before feeding; and those with at least two of the following conditions: BMI <18.5 kg/m2, a recent weight loss >10%, very little nutritional intake for >5 day, and/or a history of alcohol abuse or drug use, including insulin, chemotherapy or diuretics. We report here a patient who, after undergoing intestinal resection (short gut syndrome), presented diarrhoea, weight loss and protein–energy malnutrition. After nutritional assessment, the nutritional support team decided to feed the patient by the parenteral route. After 16 h of parenteral nutrition, the patient developed supraventricular tachycardia, hypomagnesaemia and hypocalcaemia, and RFS was diagnosed and managed. After intestinal adaptation, the patient is currently able to maintain his nutritional status with nutrition therapy by the oral route.

What is the best equation to estimate the basal energy expenditure of climacteric women

Objectives The methods currently available for the measurement of energy expenditure in patients, such as indirect calorimetry and double-labelled water, are expensive and are limited in Brazil to research projects. Thus, equations for the prediction of resting metabolic rate appear to be a viable alternative for clinical practice. However, there are no specific equations for the Brazilian population and few studies have been conducted on Brazilian women in the climacteric period using existing and commonly applied equations. On this basis, the objective of the present study was to investigate the concordance between the predictive equations most frequently used and indirect calorimetry for the measurement of resting metabolic rate. Methods We calculated the St. Laurent concordance correlation coefficient between the equations and resting metabolic rate calculated by indirect calorimetry in 46 climacteric women. Results The equation showing the best concordance was that of the FAO//WHO//UNU formula ((0.63)), which proved to be better than the Harris & Benedict equation ((0.55)) for the sample studied. Conclusions On the basis of the results of the present study, we conclude that the FAO//WHO//UNU formula can be used to predict better the resting metabolic rate of climacteric women. Further studies using more homogeneous and larger samples are needed to permit the use of the FAO//WHO//UNU formula for this population group with greater accuracy.

Muscle mass gain observed in patients with short bowel syndrome subjected to resistance training.

Few studies are available about the evaluation of resistance training in patients with protein-energy malnutrition. To assess the effects of resistance training on the recovery of nutritional status of patients with short bowel syndrome, with a small bowel remnant of less than 100 cm, 9 patients of both sexes with protein-energy malnutrition after extensive resection of the small bowel were submitted to resistance training of progressive intensity consisting of concentric and eccentric work exercises for the upper limbs, trunk, and lower limbs, with the individuality and limitations of each patients being respected. Food consumption was monitored by 24-hour food recall performed during the initial phase of the study, before and 7 and 14 weeks after physical training, and by a dietary record for a period of 3 days of oral feeding. The nutrients administered by the enteral and parenteral route were recorded. A significant increase in total arm area (P < or = .01) and fat-free mass (P < or = .01) was observed as determined by computed tomography. An increase in total energy ingestion and carbohydrate consumption (P < or = .01) was also observed. In addition, the activity of the enzyme carnosinase was increased after resistance training (P < or = .01). The present results show that resistance training in patients with short bowel syndrome and protein-energy malnutrition can be considered to be a part of the nonmedicamentous treatment of these patients, leading to better nutrient use and to a gain of lean mass.

Cyclic parenteral nutrition does not change the intestinal microbiota in patients with short bowel syndrome

PURPOSE To characterize of the intestinal microbiota of patients with short bowel syndrome (SBS) admitted to the Metabolic Unit of a University Hospital. METHODS Fecal samples were evaluated, and biochemical tests were conducted only in the case of SBS patients. The nutritional status was assessed via anthropometric measurements and evaluation of food intake by means of a food questionnaire. The pathogenic strains were detected with the aid of cultures and specific biochemical tests in aerobic medium, for determination of species belonging to the Family enterobacteriaceae. Anti-sera were applied to each isolated E. coli strain, for determination of their possible pathogenicity. Molecular methodology was employed for establishment of the intestinal bacterial microbiota profile RESULTS A lower amount of microorganisms of the family enterobacteriaceae per gram of stool was observed in the case of patients with SBS. However, molecular analysis showed maintenance of the bacterial species ratio, which is equivalent to a healthy intestinal microbiota. CONCLUSION Despite the massive removal of the small bowel, frequent use of antibiotics, immune system depression, presence of non-digested food in the gastrointestinal tract, and accelerated intestinal transit, the ratio between intestinal bacterial species remain similar to normality.

Energy expenditure after 2- to 3-hour elective surgical operations

UNLABELLED Energy expenditure was measured by indirect calorimetry in 17 adult patients (8 women and 9 men) before surgery, 4 hours immediately after surgery, and 24 hours late after surgery in patients undergoing elective surgery of small-to-medium scope. MATERIAL AND METHODS The total duration of surgery ranged from 2 to 3 hours. Repeated measures were performed on the same patient, so that each patient was considered to be his/her own control. All patients received a 5% dextrose solution (2000 mL/day) throughout the postoperative period. RESULTS Men showed a reduction in CO2 production during the immediately after surgery period (257+/-42 mL/min) compared to before surgery (306+/-48 mL/min) and late after surgery (301+/-45 mL/min); this reduction was not observed in women. Energy expenditure was also lower in men during immediately after surgery (6.6 kJ/min). None of the other measurements, including substrate oxidation, showed significant differences. CONCLUSION Therefore, elective surgery itself cannot be considered an important trauma that would result in increased energy expenditure. According to this study, it is not necessary to prescribe an energy supply exceeding basal expenditure during the immediate after-surgery period. The present results suggest that the energy supply prescribed during the postoperative period after elective surgery of small-to-medium scope should not exceed 5-7 kJ/min, so the patient does not receive a carbohydrate overload from energy supplementation.

Anthropometric, food intake differences and aplicability of low-cost instruments for the measurement of body composition in two distinct groups of individuals with short bowel syndrome

INTRODUCTION Short bowel syndrome is associated with weight loss due to nutrient, electrolyte and fluid malabsorption. In view of the pathophysiology of SBS, all patients would be expected to exhibit similar clinical signs and symptoms, whereas many variations occur probably due to the adaptive capacity of the remaining small intestine in order to compensate for the resected area. OBJECTIVE To determine whether there is a difference in nutritional status and food intake between patients receiving PNT, patients who do not receive PNT but are monitored on an ambulatory basis, and control subjects, and 2) to determine body composition by two different methods, i.e., electrical bioimpedance and skin fold measurement. METHODS This was a case-control study where the subjects were divided into three groups: parenteral group (PG) - adults with a history of SBS intermittently using PNT; ambulatory group (AG) - adults with a history of SBS who do not receive PNT; control group (CG) - adults with no history of intestinal resections and/or use of PNT. The volunteers were submitted to measurements of body weight, height, body composition by bioimpedance analysis and assessment of food intake using a food frequency questionnaire. Univariate analysis of variance (ANOVA) with the aid of the SAS® 9.2. software, using the PROC GLM feature. The Student t-test was used to compare the instruments for the assessment of body composition, with the aid of the PROC TTEST feature of the SAS® 9.2 software. RESULTS Thirty-two volunteers, 19 women and 13 men, participated in the study. The PNT group consisted of 9 volunteers, 4 women and 5 men, with a mean (± SD) age of 57 ± 9 years. The nutrition status and food intake were different between the groups. There was no difference in percent body fat measured by anthropometry and bioimpedance analysis. DISCUSSION AND CONCLUSION Large resections, as well as the resected portions, explain the greater nutritional impairment of PG compared to AG and CG, although no significant difference in food consumption was detected between these three groups. Since the use of PNT can lead to a state of hyperhydration, the results of BIA should be interpreted with caution, in view of the fact that the lean mass determined by this method varies positively with the hydration state of an individual.