Navegando por Palavras-chave "nutritional assessment"
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- ItemAcesso aberto (Open Access)Acompanhamento nutricional de cirróticos com história pregressa de alcoolismo(Pontifícia Universidade Católica de Campinas, 1998-12-01) Reis, Nelzir Trindade; Cople, Cláudia Dos Santos [UNIFESP]; Universidade Gama Filho; Universidade Federal de São Paulo (UNIFESP)The protein-calorie malnutrition is very common in the cirrhotic patients and it represents a risk in the morbidity and mortality rates increase. Independently of the etiologic factor, its prevalence is high and has repercussions in both sexes. This cases study had the objective of verifying the impact of alcoholic cirrhosis in the nutritional status and the efficacy of the diet therapy in the reversion of malnutrition. Fifty patients (47 men and 3 women) were studied. They were attended at the Nutrition Ambulatory, where an objective nutritional assessment was carried out wish anthropometric, biochemical and clinical parameters and dietetic history in three distinct moments (beginning, 8th and 18th month of treatment). The first results revealed that 96% of the cirrhotic patients presented some level of malnutrition and in the 18th month the nutritional parameters were normalized.
- ItemAcesso aberto (Open Access)Avaliação nutricional de crianças com doença renal crônica(Sociedade de Pediatria de São Paulo, 2009-06-01) Brecheret, Ana Paula [UNIFESP]; Fagundes, Ulysses [UNIFESP]; Lazaretti-Castro, Marise [UNIFESP]; Andrade, Maria Cristina de [UNIFESP]; Carvalhaes, João Tomás de Abreu [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE:Malnutrition is a frequent complication among children with renal diseases. Short stature is the main clinical sign. The aim of this study is to analyze the nutritional status of children with renal disease using anthropometry. METHODS: This cross sectional study enrolled 21 (43%) boys and 28 (57%) girls with age ranging from 5.3 to 19.5 years. They were divided in three groups based on their creatinine clearance (mL/min/1.73m²): Group 1, >37 (n=19); Group 2, between 15 and 37 (n=9) and Group 3, <15 (n=21). Weight and height were obtained in order to calculate the following indexes: Weight/age (W/A), height/age (H/A) and body mass index (BMI); then, Z scores were obtained. Malnutrition was defined as Z scores below -2. ANOVA test was used to compare groups. RESULTS: There were no differences among the groups for anthropometric data. 19 patients (38.8%) presented short-stature and 22 (44.8%) low-weight. Z scores were similar among groups relative to W/A, H/A and BMI values. W/A Z score values were: Group 1: -1.9±1.8; Group 2: -2.6±3.1 and Group 3: -2.5±1.4 (p=0.47). H/A Z scores values were: Group 1: -1.5±1.2; Group 2: -2.3±1.8 and Group 3: -2.1±1.1 (p=0.18). The calculated BMI Z scores were: Group 1: -1.2±1.4; Group 2: -1.7±3.9 and Group 3: -1.6±1.3 (p=0.82). 19 children presented short stature and 22 presented low weight. There were no differences between the studied groups. CONCLUSIONS: The sample presented high prevalence of malnutrition. Even considering the disease stage, there were no nutritional differences between the studied groups.
- ItemSomente MetadadadosBody composition in patients with chronic obstructive pulmonary disease: which method to use in clinical practice?(Cambridge Univ Press, 2006-07-01) Lerario, Maria Cristina [UNIFESP]; Sachs, Anita [UNIFESP]; Lazaretti-Castro, Marise [UNIFESP]; Saraiva, L. G. [UNIFESP]; Jardim, José Roberto [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)The objective of the present study was to compare anthropometry with bioelectrical impedance (BIA) in relation to densitometry (dual-energy X-ray absorptiometry; DEXA) as methods of nutritional assessment and body composition in out-patients with chronic pulmonary obstructive disease (COPD). We conducted a cross-sectional clinical study with sixty-one patients with COPD (forty-two men and nineteen women), mean age of 66 center dot 5 (sd 7 center dot 9) years and forced expiratory volume in 1 s of 1 center dot 3 (sd 0 center dot 6) litres (52 center dot 2 (sd 19 center dot 8) % predicted), referred to the Pulmonary Rehabilitation Center. the patients were evaluated regarding nutrition status and body composition as determined by anthropometry, BIA and DEXA. in the results, 34 center dot 4 % showed mild obstruction, 31 center dot 2 %, moderate and 34 center dot 4 %, severe obstruction. According to the BMI (mean 24 center dot 5 (sd 4 center dot 5) kg/m(2)), 45 center dot 9 % of the patients exhibited normal weight, while 27 center dot 9 % were underweight and 26 center dot 2 % were obese. Related to fat-free mass (FFM), anthropometry and BIA compared with DEXA presented high correlations (r 0 center dot 96 and 0 center dot 95 respectively; P < 0 center dot 001) and high reliability between the methods (alpha 0 center dot 98; P < 0 center dot 001). Agreement analysis between the methods shows that anthropometry overestimates (0 center dot 62 (sd of the difference 2 center dot 89) kg) while BIA underestimates FFM (0 center dot 61 (sd of the difference 2 center dot 82) kg) compared with DEXA. We concluded that according to the nutritional diagnosis, half of our population of patients with COPD showed normal weight, while the other half comprised equal parts obese and underweight patients. Body composition estimated by BIA and anthropometry presented good reliability and correlation with DEXA; the three methods presented satisfactory clinical accuracy despite the great disparity of the limits of agreement.
- ItemSomente MetadadadosChallenges of nutritional assessment in pediatric ICU(Lippincott Williams & Wilkins, 2009-05-01) Feferbaum, Rubens; Delgado, Artur F.; Zamberlan, Patricia; Leone, Claudio; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)Purpose of reviewThe nutritional assessment of children in the pediatric ICU is unique in view of the metabolic changes of the underlying disease. This review addresses the use and limitations of anthropometry and laboratorial and body composition markers in the diagnosis of the nutritional status of such patients.Recent findingsThe presence of inflammatory activity leads to body composition changes (lean mass reduction) and undernutrition. Nutritional assessment in pediatric ICU must prioritize anthropometric and laboratory markers that can differentiate body composition to detect specific macronutrient and micronutrient deficiencies and assessment of the inflammatory activity.SummaryNutritional assessment is one of the main aspects of the pediatric intensive care patient and is the most important tool to avoid hospital undernutrition. There is currently no gold standard for nutritional assessment in the pediatric ICU. the results of anthropometric and laboratory markers must be jointly analyzed, but individually interpreted according to disease and metabolic changes, in order to reach a correct diagnosis of the nutritional status and to plan and monitor the nutritional treatment.
- ItemAcesso aberto (Open Access)Espessura do músculo adutor do polegar como preditor da força de preensão manual nos pacientes em hemodiálise(Sociedade Brasileira de Nefrologia, 2013-09-01) Pereira, Raíssa Antunes [UNIFESP]; Caetano, Alex Lopes [UNIFESP]; Cuppari, Lilian [UNIFESP]; Kamimura, Maria Ayako [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)INTRODUCTION: Recently, the adductor pollicis muscle thickness (APMT) has been suggested as a new nutritional marker in several population. OBJECTIVE: In view of the scarce data regarding the use of this marker in CKD patients, we aimed to evaluate APMT and its association with nutritional parameters in patients on hemodialysis. METHODS: We evaluated 73 hemodialysis patients (52.3 ± 17 years, without residual renal function). The APMT was assessed in the non vascular access arm by means of skinfold caliper. Body composition (bioelectrical impedance), handgrip strength (HGS, dynamometer), nutritional status (subjective global assessment), and laboratory parameters (creatinine, total protein and albumin) were also evaluated. RESULTS: Subjects with APMT values above the median were in greater proportion black/ brown, younger and had higher HGS. The APMT correlated positively with HGS, albumin and body cell mass (%), and negatively with age. In the linear regression analysis adjusted for sex, age and length on hemodialysis, APMT was independently associated with HGS. CONCLUSION: APMT was able to predict HGS in hemodialysis patients, suggesting APMT as a promising nutritional marker in this population.
- ItemSomente MetadadadosNutritional assessment of elderly patients on dialysis: pitfalls and potentials for practice(Oxford Univ Press, 2017) Rodrigues, Juliana; Cuppari, Lilian [UNIFESP]; Campbell, Katrina L.; Avesani, Carla MariaThe chronic kidney disease (CKD) population is aging. Currently a high percentage of patients treated on dialysis are older than 65 years. As patients get older, several conditions contribute to the development of malnutrition, namely protein energy wasting (PEW), which may be compounded by nutritional disturbances associated with CKD and from the dialysis procedure. Therefore, elderly patients on dialysis are vulnerable to the development of PEW and awareness of the identification and subsequent management of nutritional status is of importance. In clinical practice, the nutritional assessment of patients on dialysis usually includes methods to assess PEW, such as the subjective global assessment, themalnutrition inflammation score, and anthropometric and laboratory parameters. Studies investigatingmeasures of nutritional status specifically tailored to the elderly on dialysis are scarce. Therefore, the same methods and cutoffs used for the general adult population on dialysis are applied to the elderly. Considering this scenario, the aim of this review is to discuss specific considerations for nutritional assessment of elderly patients on dialysis addressing specific shortcomings on the interpretation of markers, in addition to providing clinical practice guidance to assess the nutritional status of elderly patients on dialysis.
- ItemAcesso aberto (Open Access)Nutritional care in motor neurone disease/ amyotrophic lateral sclerosis(Academia Brasileira de Neurologia - ABNEURO, 2014-02-01) Salvioni, Cristina Cleide dos Santos; Stanich, Patricia [UNIFESP]; Almeida, Claudinéa S.; Oliveira, Acary Souza Bulle [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Hospital Santa Marcelina Ambulatório Médico EspecialidadesPatients 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.
- ItemAcesso aberto (Open Access)Nutritional status of hemodialysis patients with secondary hyperparathyroidism(Associação Brasileira de Divulgação Científica, 2000-11-01) Rezende, Luciana Trindade Teixeira [UNIFESP]; Cuppari, Lilian [UNIFESP]; Carvalho, A.b. [UNIFESP]; Canziani, Maria Eugênia Fernandes [UNIFESP]; Manfredi, Sílvia Regina [UNIFESP]; Cendoroglo Neto, Miguel [UNIFESP]; Sigulem, Dirce Maria [UNIFESP]; Draibe, Sergio Antonio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)The repercussions of secondary hyperparathyroidism on the nutritional status of chronic renal failure patients have not been well established. Therefore, the aim of this study was to compare the nutritional indices of hemodialysis patients with and without secondary hyperparathyroidism. Sixteen hemodialysis patients with serum parathyroid hormone (PTH) levels higher than 420 pg/ml (hyperparathyroidism group) were matched for gender, age and length of dialysis treatment to 16 patients with serum PTH between 64 and 290 pg/ml (control group). The following parameters were assessed: anthropometric indices (body mass index, skinfold thickness, midarm muscle circumference and body fat), 4-day food diaries, protein catabolic rate, biochemical indices (blood urea nitrogen, serum creatinine, albumin, ionized calcium, inorganic phosphorus, serum alkaline phosphatase, PTH, pH and HCO3) and dialysis efficiency. We did not observe differences in the anthropometric indices between the two groups. Only calcium intake was significantly different between groups (307.9 mg/day for the hyperparathyroidism group vs 475.8 mg/day for the control group). Protein catabolic rate tended to be higher in the hyperparathyroidism group compared to the control group (1.3 vs 0.9 g kg-1 day-1; P = 0.08). Except for blood urea nitrogen (86.4 vs 75.7 mg/dl), alkaline phosphatase (175 vs 65 U/l) and PTH (898 vs 155 pg/ml), no other differences were found between groups in the biochemical indices studied. PTH was directly correlated with protein catabolic rate (r = 0.61; P<0.05) and length of dialysis (r = 0.53; P<0.05) only in the hyperparathyroidism group. Considering the indices used, we could not demonstrate the deleterious effect of high PTH levels on the nutritional status of hemodialysis patients. Indirect evidence, however, suggests an action of PTH on protein metabolism.
- ItemSomente MetadadadosSerum albumin and clinical outcome in pediatric cardiac surgery(Elsevier B.V., 2005-05-01) Leite, H. P.; Fisberg, M.; Carvalho, W. B. de; Carvalho, A. C.; Universidade Federal de São Paulo (UNIFESP)Objective: We evaluated the behavior of serum albumin concentrations in response to metabolic stress that is associated with cardiac surgery and the role of this protein as a predictor of clinical outcome in children at high surgical risk who undergo operative correction of congenital heart defects.Methods: Serum albumin concentrations were measured in 30 children who had heart disease and were at high surgical risk. Analyses were performed before surgery, on the second postoperative day, and on discharge from the intensive care unit. Preoperative serum concentrations of albumin were compared with those of a control group that consisted of 20 healthy and well-nourished children.Results: Preoperative albumin concentrations of patients were lower than those of the control group (3.4 0.25 g/dL versus 4.0 0.18 g/dL, P < 0.05). Serum levels decreased on the second postoperative day and at discharge from the intensive care unit (3.1 0.65 g/dL and 3.2 0.44 g/dL, P < 0.05) compared with preoperative concentrations. Preoperative concentrations lower than 3.0 g/dL were associated with increased postsurgical infection (P = 0.0026) and with increased mortality (P = 0.0138). Patients whose postoperative levels were lower than 3.0 g/dL had longer hospital stays compared with those whose concentrations were higher than 3.0 g/dL (14.5 1.3 d versus 10 2.2 d, P < 0.05).Conclusion: the results suggest that hypoalbuminemia is common among children who have heart disease and are at high surgical risk, and serum albumin concentrations lower than 3 g/dL may be related to outcome in the period after cardiac surgery. 2005 Elsevier Inc. All rights reserved.