ANÁLISIS DE LA ADECUACIÓN DEL APORTE NUTRICIONAL A LA META CALÓRICA Y PROTEICA EN PACIENTES CON NUTRICIÓN ENTERAL EXCLUSIVA INTERNADOS EN UN HOSPITAL PÚBLICO PEDIÁTRICO DE ALTA COMPLEJIDAD / ANALYSIS OF ADEQUACY OF THE NUTRITIONAL CONTRIBUTION TO THE CALORIE GOAL AND PROTEIN IN PATIENTS WITH ENTERAL NUTRITION EXCLUSIVE BOARDING SCHOOLS IN A PUBLIC HOSPITAL PEDIATRIC HIGH COMPLEXITY

La malnutrición en los pacientes hospitalizados representa un importante problema sanitario asociado a una mayor tasa de complicaciones con un incremento de la morbimortalidad

Malnutrition in hospitalized patients represents a significant health problem associated with an increased rate of complications and higher morbidity and mortality

Incidencia de desnutrición crónica y factores asociados en una cohorte de niños menores de 5 años / Incidence of chronic malnutrition and associated factors in a cohort of children under 5 years of age: A multicenter observational study

Introducción: La desnutrición crónica es un problema de difícil erradicación con grandes repercusiones en la población infantil. En el Ecuador 1 de cada 5 niños menor de cinco años, presenta desnutrición crónica. El objetivo del presente estudio fue determinar incidencia y factores asociados al desarrollo de desnutrición crónica en una cohorte de niños menores de 5 años durante un periodo de seguimiento de un año, en la provincia de Chimborazo, 2018-2019. Métodos: Se realizó un estudio de cohorte prospectivo, con seguimiento de 2018-2019. La población estuvo conformada por 1228 niños, de los cuales se tomó una muestra de 138 niños. Se tuvieron en cuenta variables como la edad, sexo, ubicación geográfica, nivel socioeconómico, acceso a servicios de salud, servicios básicos y tierras, prácticas de alimentación, antropometría, desnutrición crónica, talla de la madre, infecciones, y parasitosis. Se calculó el Riesgo Relativo (RR) y sus respectivos intervalos de confianza al 95% usando modelos lineales generalizados (familia binomial). Resultados: La incidencia de desnutrición crónica fue de 20,3%. Los factores asociados fueron: dificultad para acceder a los servicios de salud [RR: 4.87; IC 95%: 1.89-12.55]; y LME < 6 meses [RR: 3.44, IC 95%: 2.14-5.55]. Conclusiones: La incidencia de desnutrición crónica en menores de cinco años en la provincia Chimborazo es elevada; por lo que se precisa de intervenciones que garanticen el acceso a los servicios de salud y educación nutricional para eliminar este problema de salud.

Introduction: Chronic malnutrition is a problem that is difficult to eradicate with significant repercussions on the child population. In Ecuador, 1 in 5 children under five have chronic malnutrition. This trial aimed to determine the incidence and factors associated with the development of chronic malnutrition in a cohort of children under five years of age during a one-year follow-up period in the province of Chimborazo, 2018-2019. Methods: A prospective cohort study was conducted with a 2018-2019 follow-up. The population consisted of 1,228 children, from which a sample of 138 children was taken. Variables such as age, gender, geographic location, socioeconomic level, access to health services, essential services and land, feeding practices, anthropometry, chronic malnutrition, mother's height, infections, and parasitosis were taken into account. The Relative Risk (RR) and their respective 95% confidence intervals were calculated using generalized linear models (binomial family). Results: The incidence of chronic malnutrition was 20.3%. The associated factors were: difficulty in accessing health services [RR: 4.87; 95% CI: 1.89-12.55]; and EBF <6 months [RR: 3.44, 95% CI: 2.14-5.55]. Conclusions: The incidence of chronic malnutrition in children under five years of age in the Chimborazo province is high; therefore, interventions are needed to guarantee access to health services and nutritional education to eliminate this health problem.

Adequação calórico proteica da terapia nutricional enteral em pacientes críticos / Caloric-protein adequacy of enteral nutritional therapy in critical patients

A doença crítica promove um estado hipercatabólico associado a uma resposta inflamatória intensa. Admite-se que essas alterações contribuem para o aumento do gasto de energia e para a elevação do catabolismo proteico. Objetivo: analisar a adequação calórico-proteica da terapia de nutrição enteral e o seu impacto no desfecho clínico de pacientes críticos. Método: Trata-se de um estudo longitudinal prospectivo realizado com 36 pacientes internados em unidades de terapia intensiva. A adequação da oferta calórico-proteica foi obtida pela relação percentual a partir do quarto dia de implementação da terapia nutricional. Realizou-se o teste de Shapiro Wilk para averiguar a normalidade dos dados e a partir disso, foi aplicado o teste de Mann-Whitney ou de t-Student não pareado. Foi realizada a análise de regressão logística com estimativa de seu coeficiente. Para a regressão estimou-se o intervalo de confiança de 95% e nível de significância de 5%. Foi utilizado o software STATA® versão 14.0 nesta análise. Resultados: Ao avaliar 36 pacientes verificou-se que a sobrevida foi menor entre os indivíduos que apresentaram o menor percentual de adequação calórica (p=0,010) e proteica (p=<0,001). Observou-se que oferta proteica impactou mais expressivamente os desfechos clínicos, ao aumento de 1% na média de adequação proteica as chances de óbito diminuíram 21%. Conclusão: O menor percentual de adequação calórico-proteica foi associado a menor sobrevida de pacientes críticos. Ainda, observou-se que o percentual de adequação proteica se associou mais expressivamente aos desfechos clínicos nessa amostra

The critical illness promotes a hypercatabolic state associated with an intense inflammatory response. It is recognized that those changes contribute to the rise of consumption of energy expenditure and to protein metabolism rise. Objective: to analyze the adequacy caloric-protein of enteral nutrition therapy and its impact on the clinical outcome of critical patients. Method: This is a prospective longitudinal study conducted with 36 hospitalized patients in intensive care units. The caloric-protein adequacy was acquired by percent ratio from the fourth day of nutritional therapy implementation. The Shapiro Wilk test was performed to check the data normality and based on that the Mann-Whitney test or unpaired Student t test was applied. The logistic regression analysis was performed with an estimate of its coefficient. For regression, it was estimated the confidence interval of 95% and significance level of 5%. In this analysis was utilized the STATA® software version 14.0. Results: In the evaluation of 36 patients, it was found that survival was lower among the individuals who had the lower percentage of caloric adequacy (p=0,010) and protein (p=<0,001). It was observed that the protein supply impacted expressively the clinical outcome with an increase of 1% in the average protein adequacy, the chances of death decreased by 21%. Conclusion: The lower percentage of caloric-protein adequacy was associated with lower mortality of critical patients. In addition, in this sampling, it was observed that the protein adequacy percentual joined expressively in the clinical outcome

Patients in public hospitals received insufficient food to meet daily protein and energy requirements: Cape Town Metropole, South Africa

Objectives: This study aimed to determine the energy and protein content of meals served and consumed by hospitalised patients compared with their needs, to assess patients' food satisfaction and investigate associations with energy and protein intake. Design: This was an exploratory quantitative cross-sectional study. Setting: Three public hospitals within the Cape Town metropole were recruited; a central hospital (945 beds), large district hospital (372 beds) and a medium district hospital (172 beds). Subjects: Adult inpatients 18+ years admitted to medical or surgical wards, on a non-therapeutic/normal hospital diet were recruited by purposive sampling method between 2018 and 2019.Outcomes measures: Each participant's weight and height were measured to calculate body mass index (BMI) and to determine energy/protein requirements. The Acute Care Hospital Foodservice Patient Satisfaction Questionnaire was administered. Meals were weighed before and after consumption to calculate energy and protein intake per patient/day. Results: A total of 128 patients (males = 71) participated. Total protein served did not meet patient requirements in any of the hospitals. Consumed energy and protein were significantly below requirements in all hospitals (p < 0.002). Perceived food quality (r = 0.38, p = 0.039) and staff/service issues (r = 0.39; p = 0.035) were significantly positively correlated with protein intake, while appetite correlated positively (r = 0.42, p = 0.006; r = 0.41, p = 0.008) and length of stay (LOS) correlated negatively (r = −0.46, p = 0.002; r = −0.42, p = 0.008) with energy and protein intake, respectively. Conclusion: Energy and protein served was significantly lower than participants' requirements in all three hospitals and none achieved the official ration scale amounts. Nearly 40% reported having a normal appetite and did not receive additional food from family or friends, which may lead to hospital-acquired malnutrition and increased hospital length of stay (LOS). Improved hospital food quality, quantity, mealtimes and staff training should be a focus to improve patient energy and protein intake

Avaliação do estado nutricional em relação à presença de cárie dentária em crianças de 4 a 6 anos do município de Cajamar - São Paulo / Evaluation of the nutritional status in relation to the presence of dental caries in children aged 4 to 6 years in the city of Cajamar - São Paulo

Este artigo tem como objetivo avaliar o estado nutricional em relação à presença de cáries dentárias em crianças de 4 a 6 anos de idade, do município de Cajamar, São Paulo. Trata-se de estudo transversal com crianças entre 4 a 6 anos (n=1642), acompanhadas pelo Programa Saúde na Escola (PSE) do Município de Cajamar, São Paulo. A classificação do estado nutricional foi baseada no Índice de Massa Corporal (IMC) e a avaliação das condições bucais, por meio do índice ceo-d e critério para Risco de Cárie. A análise do estado nutricional, faixa etária e sexo conforme o número de cáries, foi feita por meio dos testes Mann-Whitney U e Kruskal-Wallis (p<0,05). Observou-se maior prevalência de meninos entre 4 a 6 anos. Em todas as faixas etárias a prevalência de excesso de peso foi de aproximadamente 30% e eutrofia em torno de 70%. 65% (n=1068) das crianças não apresentavam risco de cárie (A) e 28,8% (n=475), alto risco (D, E e F). Das 1162 crianças sem cáries, 0,2% eram magras (n=2), 67,2% (n=781) eutróficas e 32,7% (n=380) possuíam excesso de peso. A frequência de 1 a 5 cáries maior entre meninas e de 6 ou mais cáries, entre meninos. Segundo estado nutricional, o número médio do número de cáries foi de 2,17 para magreza, 0,93 para eutrofia e 0,65 para excesso de peso (p<0,010). Conclui-se que houve diferença entre número cáries e estado nutricional, na qual crianças com déficit nutricional apresentavam maior número de cáries dentárias comparadas às eutróficas ou com excesso de peso, sugerindo-se a inclusão do estado nutricional na avaliação odontológica.

This article aims at evaluating the nutritional status in relation to the presence of dental caries in children aged 4 to 6 years in the city of Cajamar, in the state of São Paulo. It is a cross-sectional study with children aged 4 to 6 years (n=1642) accompanied by the School Health Program of the City of Cajamar, São Paulo. The nutritional status classification was based on the Body Mass Index (BMI) and the evaluation of oral conditions, through the ceo-d index, and criteria for risk for caries. The analysis of the nutritional status, age, and sex according to the number of caries was made through the Mann-Whitney U and Kruskal-Wallis tests (p<0.05). A higher prevalence was observed among boys aged 4 to 6 years. In all age groups, there was a prevalence of 30% of overweight children, and eutrophy of approximately 70%. A total of 65% (n=1068) of the children presented no risk of caries (A), whereas 28.8% (n=475) showed high risk (D, E, and F). Among the 1162 children with no caries, 0.2% were thin (n=2); 67.2% (n=781) eutrophic; and 32.7% (n=380) were overweight. Girls presented a higher frequency of 1 to 5 caries while boys presented frequency of having 6 or more caries. According to the nutritional status, the average number of caries was 2.17 for thin individuals; 0.93 for eutrophic individuals; and 0.65 for overweight individuals (p<0.010). It could be concluded that there was a difference between the number of caries and the nutritional status, in which children with nutritional deficit presented a higher number of dental caries when compared to eutrophic or overweight ones, suggesting the inclusion of the nutritional status in the dental evaluation.

Desnutrição na cirrose: associação com a etiologia e disfunção hepatocelular / Malnutrition in cirrhosis: association with etiology and hepatocellular dysfunction

ABSTRACT BACKGROUND: The protein-energy malnutrition alters the prognosis of patients with cirrhosis. Its prevalence may vary according to the etiology of liver disease, it´s severity and the evaluation of the method applied. The infection by the hepatitis C virus (HCV) and alcoholism are the main etiologies of cirrhosis and result in a significant morbidity and mortality. OBJECTIVE: To evaluate the nutritional status of patients with cirrhosis according the liver disease etiology and severity. METHODS: It is a prospective study, in which the sample was for convenience and consisted of patients with cirrhosis, infected by HCV or alcoholic etiology. The nutritional status evaluation was carried out through anthropometry, food consumption, bioelectrical impedance (BIA) and subjective global assessment (SGA). The anthropometric data evaluated were weight, height, body mass index (BMI), triceps skinfold (TSF), circumference of the arm (CA), non-dominant handshake strength (FAM) and the adductor pollicis muscle thickness (APM). Patients were classified according to the severity of liver disease, using the Child-Pugh and Model for End-stage Liver Diseases (MELD) scores. RESULTS: Ninety patients with cirrhosis were evaluated, 47 with HCV and 43 with alcoholic etiology. The prevalence of protein-calorie malnutrition ranged from 10.9% to 54.3% in the HCV group and from 4.7% to 20.9% in the alcoholic group, depending on the method used for evaluation. The group with HCV infection presented a higher malnutrition prevalence in comparison to the alcoholic in the following evaluations: TSF (P<0.001), phase angle (PA) (P=0.016) and SGA (P=0.010). PA values were lower in patients with viral cirrhosis (5.68±1.05) when compared to those with alcoholic etiology (6.61±2.31) (P=0.016). When all patients were analyzed, regardless of etiology, an inversely correlation was observed among Child-Pugh score and PA values (P=0.018). CONCLUSION: HCV cirrhosis showed worse nutritional parameters in comparison to alcoholic etiology; however, the PA was associated with worse liver function in both etiologies.

RESUMO CONTEXTO: A desnutrição proteico-calórica altera o prognóstico dos pacientes com cirrose. Sua prevalência pode variar de acordo com a etiologia da hepatopatia, gravidade da doença e o método de avaliação empregado. A infeção pelo vírus da hepatite C (VHC) e o alcoolismo, estão entre as principais etiologias da cirrose e acarretam significativa morbidade e mortalidade. OBJETIVO: Avaliar o estado nutricional do paciente com cirrose de acordo com a etiologia e gravidade da hepatopatia. MÉTODOS: Estudo prospectivo, em que a amostra foi por conveniência constituída de pacientes com cirrose, infectados pelo vírus da hepatite C (VHC) ou etiologia alcoólica. A avaliação do estado nutricional foi realizada através da antropometria, consumo alimentar, bioimpedância elétrica (BIA) e da avaliação subjetiva global (ASG). Os dados antropométricos avaliados foram: peso, altura, índice de massa corporal (IMC), prega cutânea triciptal (PCT), circunferências do braço (CB), força do aperto de mão não dominante (FAM) e a espessura do músculo adutor do polegar (MAP). Os pacientes foram classificados de acordo com a gravidade da hepatopatia, através do escore Child-Pugh e Model for End-stage Liver Diseases (MELD). RESULTADOS: Foram avaliados 90 pacientes com cirrose, 47 com etiologia pelo VHC e 43 com etiologia alcoólica. A prevalência de desnutrição proteico-calórica variou de 10,9% a 54,3% no grupo do VHC e de 4,7% a 20,9% no grupo dos alcoolistas, dependendo do método utilizado para avaliação. O grupo com infecção pelo VHC apresentou maior prevalência de desnutrição em relação ao de etiologia alcoólica nas seguintes avaliações: PCT (P<0,001), ângulo de fase (AF) (P=0,016) e ASG (P=0,010). Os valores do AF foram menores nos pacientes com cirrose viral (5,68±1,05) quando comparados aos com etiologia alcoólica (6,61±2,31) (P=0,016). Quando analisados todos os pacientes, independente da etiologia da hepatopatia, observou-se uma correlação inversamente proporcional entre a classificação de Child-Pugh e os valores de AF (P=0,018). CONCLUSÃO: A cirrose pelo VHC demonstrou piores parâmetros nutricionais em relação à etiologia alcoólica; entretanto, em ambas etiologias o AF foi associado com pior função hepática em ambas etiologias.

Riesgo de desnutrición y factores asociados en una muestra de adultos mayores en la comunidad e institucionalizados de Yucatán, México / Malnutrition risk and associated factors in a sample of older adults in the community and institutionalized in Yucatan, Mexico

Evaluar la prevalencia de riesgo de desnutrición (RD) en adultos mayores de dos municipios de Yucatán, México, e identificar algunos factores asociados. Estudio transversal con muestreo intencional no probabilístico en 6 centros de atención geriátrica, una clínica universitaria y visitas domiciliares. Noventa y seis adultos mayores de 60 años (76% mujeres), 42 residentes de estancias geriátricas y 54 no institucionalizados. Se evaluó el RD con la escala de Valoración Mínima del Estado de Nutrición (VMEN), junto con variables demográficas, de funcionalidad, comorbilidades, depresión y apetito. La composición corporal se evaluó con ecuaciones basadas en antropometría e impedancia bioeléctrica. Se realizaron análisis descriptivos, t de Student, Kolmogorov-Smirnov, chi cuadrado, análisis univariado y análisis de regresión múltiple. El 47,9 % (46 sujetos; 37 mujeres y 9 varones) presentaron RD de acuerdo con la VMEN y 52,1% de los participantes fueron clasificados con estado nutricio normal de acuerdo con dicha escala. Los valores promedio de la masa corporal libre de grasa y la masa muscular esquelética en extremidades de sujetos con RD, fueron más bajos que en aquellos con estado de nutrición normal (p< 0,05). El análisis de regresión logístico múltiple ajustado por género indicó que la edad (OR=1,08, p=0,005) y la depresión (OR=3,79, p=0,017) fueron factores predictores asociados con RD. El 47,9 % de los participantes presentaron RD. Se requieren acciones para diagnosticar y atender el RD y evitar que progrese a desnutrición. La edad y la depresión se debieran incluir como posibles marcadores tempranos de desnutrición en futuros estudios poblacionales e intervenciones nutricionales en adultos mayores en comunidad e institucionalizados en Yucatán(AU)

To assess the prevalence of Malnutrition Risk (MR) in older adults from two municipalities of Yucatan, Mexico, and to identify some associated factors. Cross-sectional study, using non-probabilistic sample in six geriatric care centers, a university clinic, and home visits. Ninety-six adults over 60 years (76% women), 42 residents of geriatric care homes, and 54 non-institutionalized. The MR was assessed by the Mini Nutritional Assessment scale (MNA), along with demographic, functionality, comorbidities, depression, and appetite variables. Body composition was also assessed by bioelectrical impedance analysis. Descriptive analyzes, Student's t, Kolmogorov-Smirnov, chi-square, univariate, and multiple regression analysis were performed. Of the total sample, 47.9% (46 subjects; 37 women and 9 men) presented RD according to the VMEN and 52.1% of the participants were classified with normal nutritional status according to the scale. Mean values of fat-free mass and appendicular skeletal muscle mass were lower in subjects with MR than in those with normal nutritional status (p <0.05). The multiple logistic regression analysis adjusted by gender indicated that age (OR = 1.08, p = 0.005) and depression (OR = 3.79, p = 0.017) were predictor associated factors with MR. Almost forty eight percent of the participants present MR. Actions are required to diagnose and treat MR, avoiding progressing to malnutrition. Age and depression should be included as possible early markers of malnutrition in future population studies and nutritional interventions, in the community and institutionalized older adults in Yucatan(AU)

Centros de recuperación nutricional: 1984-2011 / Nutritional Recovery Centers: 1984-2011

Los centros de recuperación nutricional (CRN) fueron creados por el Dr. José María Bengoa en Venezuela. En el presente estudio se realizó una revisión sistemática cualitativa, de 1984 al 2011, que permitió analizar las modalidades de funcionamiento de los diferentes CRN en el mundo, mediante indicadores de: criterios de admisión, parámetros utilizados en estos centros, así como las modalidades de tratamiento, tiempo de estancia y criterios de alta. Se encontraron diecisiete artículos que describen algunos o todos estos indicadores. El uso de los CRN se encontró en cuatro países de África (Etiopía, Kenia, Malawi y Nigeria), cuatro de América (Bolivia, Brasil, Chile y Nicaragua) y dos en Asia (India y Nepal). Los resultados reflejan la importancia de los CRN en el tratamiento de la desnutrición, sobre todo si se acompaña con la educación de las madres sobre la alimentación, prácticas higiénicas, etc., para un mejor cuidado en el hogar. Nuevas evidencias en el tratamiento de la desnutrición han motivado la evolución de los centros, pero aún así, sus limitaciones persisten. No obstante, las ventajas de su uso son excepcionales. Se propone, de acuerdo con los diferentes tipos de centros, y en base a las deficiencias o limitaciones observadas en su conceptualización y designación, redefinir las NRC bajo el concepto de Centros Globales de Nutrición (GloNuCen) basados en la comunidad y la personalización nutricional, los cuales podrían ser centros fijos en el caso de hospitales y servicios ambulatorios, e instalaciones móviles para situaciones de emergencia que, si duran con el tiempo, puedan convertirse en centros fijos(AU)

The Nutritional Recovery Centers (NRC) were created by Dr. Jose María Bengoa in Venezuela. In the present study a qualitative systematic review was carried out, from 1984 to 2011, allowing us to analyze the operating modalities of the different CRNs in the world, by means of indicators of: admission criteria, parameters used in these centers, as well as their treatment modalities, time of stay and discharge criteria. Seventeen articles have been found that describe some or all of these indicators. The use of NRCs was found in four African countries (Ethiopia, Kenya, Malawi and Nigeria), four in America (Bolivia, Brazil, Chile and Nicaragua) and two in Asia (India and Nepal). The results reflect the importance of NRC in the treatment of malnutrition, especially if it is reinforced with mothers' education about food, hygiene practices, etc., for better home care. New evidence in the treatment of malnutrition has motivated the evolution of the centers, but still, their limitations persist. Nonetheless, the advantages of their use are exceptional. It is proposed, according to the different types of centers, and based on the deficiencies or limitations observed in their conceptualization and designation, to redefine the NRCs under the concept of Global Nutrition Centers (GloNuCen) based on the community and nutritional customization, which could be fixed centers in the case of hospitals and outpatient services, and mobile facilities for emergency situations that, if they last over time, could turn into fixed centers(AU)

Severe malnutrition after bariatric surgery and clinic manifestations of infection

SUMMARY This report describes the post-bariatric-surgery evolution of an obese patient who had low adherence to the diet and micronutrient supplementation. Four years after two bariatric surgeries, the patient was admitted due to transient loss of consciousness, slow thinking, anasarca, severe hypoalbuminemia, in addition to vitamin and mineral deficiencies. She had subcutaneous foot abscess but did not present fever. Received antibiotics, vitamins A, D, B12, thiamine, calcium, and parenteral nutrition. After hospitalization (twenty-eight days), there was a significant body weight reduction probably due to the disappearance of clinical anasarca. Parenteral nutrition was suspended after twenty-five days, and the oral diet was kept fractional. After hospitalization (weekly outpatient care), there was a gradual laboratory data improvement, which was now close to the reference values. Such outcome shows the need for specialized care in preventing and treating nutritional complications after bariatric surgeries as well as clinical manifestations of infection in previously undernourished patients.

RESUMO Este relato descreve a evolução pós-cirurgia bariátrica de uma paciente obesa que apresentou baixa adesão à dieta e suplementação de micronutrientes. Quatro anos após duas cirurgias bariátricas, a paciente foi internada por perda transitória de consciência, raciocínio lento, anasarca, hipoalbuminemia grave, além de deficiências vitamínicas e minerais. Apresentava abscesso subcutâneo no pé, mas não apresentava febre. Recebeu antibióticos, vitaminas A, D, B12, tiamina, cálcio e nutrição parenteral. Após a internação (28 dias) houve redução significativa do peso corporal, provavelmente devido ao desaparecimento clínico da anasarca. A nutrição parenteral foi suspensa após 25 dias e a dieta oral foi mantida fracionada. Após a internação (atendimento ambulatorial semanal) houve uma melhora gradativa dos dados laboratoriais, que estavam próximos dos valores de referência. Tal desfecho mostra a necessidade de cuidados especializados na prevenção e tratamento de complicações nutricionais após cirurgias bariátricas, bem como manifestações clínicas de infecção em pacientes previamente desnutridos.

Requerimientos ajustados a la Desnutrición del Paciente Oncológico / Requirements adjusted to the Malnutrition of the Oncological Patient

Propósito de la revisión: Este artículo explica las causas de desnutrición en el paciente con cáncer y los requerimientos de energía y nutrientes específicos para esta población. Recientes Hallazgos: En la caquexia cancerosa del paciente tumoral existe una incrementada lipólisis, favorecida por una disminución de la actividad de la Lipoproteína Lipasa (LPL) del Tejido Adiposo Blanco (TAB) y que propicia un aumento de niveles de Triacilgliceroles (TAG) circulantes. No existe evidencia de que el soporte nutricional incremente el crecimiento tumoral. Extracto: La desnutrición en los pacientes con cáncer se debe a tres grandes grupos, el primero relacionado a nutrientes (su déficit, metabolismo, alteraciones de absorción), el segundo grupo por la presencia de la Caquexia Cancerosa y el tercer grupo relacionado con el tumor, el paciente y los tratamientos recibidos. De acuerdo a las Guías de la Sociedad Europea de Nutrición para pacientes con cáncer, se recomienda que si el gasto de energía en pacientes oncológicos no es medido específicamente a cada paciente se haga un cálculo de 25 - 30 Kcal/Kg de peso/día.

Purpose of the Review: This article explains the causes of malnutrition in the cancer patient and the specific energy and nutrient requirements for this population. Recent Findings: In the cancerous cachexia of the tumor patient there is an increased lipolysis, favored by a decrease in the activity of the White Adipose Tissue Lipoprotein (LPL) and that promotes an increase in circulating Triacylglycerols (TAG) levels. There is no evidence that nutritional support increases tumor growth. Excerpt: Malnutrition in cancer patients is due to three large groups, the first related to nutrients (their deficit, metabolism, absorption disorders), the second group due to the presence of Cancerous Cachexia and the third group related to the tumor, the patient and the treatments received. According to the Guidelines of the European Nutrition Society for cancer patients, it is recommended that if the energy expenditure in cancer patients is not measured specifically for each patient an estimate of 25 - 30 Kcal / Kg of weight / day.

Comunicar para el desarrollo: una propuesta de divulgación radiofónica en la lucha contra el hambre y la malnutrición en Nicaragua / Communicating for development: a proposal for radio broadcasting to deal with hunger and malnutrition in Nicaragua

Nicaragua presenta altos niveles de inseguridad alimentaria y nutricional. Predomina la deficiencia proteico-energética y la carencia de nutrientes específicos y al mismo tiempo presenta la superposición epidemiológica-nutricional y la doble carga de riesgos para la salud. Faltan conocimientos para optimizar los escasos recursos para adquirir productos de mayor valor nutricional. El objetivo fue contribuir a reducir el hambre y la desnutrición y mejorar la alimentación y el estado nutricional de la población del municipio nicaragüense de Somotillo, a través de estrategias educativas difundidas por el medio radiofónico. Se ejecutó el programa "Por una mejor nutrición" en la radio (1 junio al 29 de julio, 2016) y se abordaron cuatro temas: conocimientos sobre alimentación saludable, higiene alimentaria, enfermedades asociadas a la malnutrición y alimentación del escolar y se acompañaron de tres cápsulas informativas cada uno, transmitidas 1v/s y 5v/s (8v/día), respectivamente, más una sesión 1v/s de respuesta a los oyentes (maestros y niños escolares). Además, se hizo una evaluación cualitativa (grupo de discusión con maestros y promotores de salud) y se aplicó un cuestionario de 5 preguntas pre y post intervención a 600 escolares seleccionados al azar en 20 escuelas rurales. Se encontró dominio parcial del tema de higiene pre-intervención y fallas en las acciones para prevenir las enfermedades que afectan el estado nutricional de los escolares (post intervención). El programa benefició a 2.349 estudiantes y familias. Esta experiencia puede mejorar el empoderamiento de las familias y la comunidad frente a los problemas de alimentación y prácticas higiénicas peligrosas existentes, pero requieren por parte de las comunidades garantizar la sostenibilidad y replicabilidad del mismo(AU)

Nicaragua has high levels of food and nutritional insecurity. Protein-energy deficiency and lack of specific nutrients predominate, while epidemiological-nutritional deficiencies and excess overlap and the double burden of health risks. There is a lack of knowledge in order to optimize scarce resources and to acquire products of greater nutritional value. The aim was to contribute to the reduction of hunger and malnutrition and to improve the diet and nutritional status of the population of the Nicaraguan municipality of Somotillo, through educational strategies broadcasted by radio. The program "For better nutrition" was carried out on the radio (1 June to 29 July 2016) and addressed four topics: knowledge of healthy eating, food hygiene, diseases associated with malnutrition and school feeding, and was accompanied by three information capsules, each transmitted 1/s and 5/s (8v/day), respectively, plus a 1/s response session for listeners (teachers and school children). In addition, a qualitative evaluation (discussion group with teachers and health promoters) and a questionnaire of 5 pre and post intervention questions were applied to 600 randomly selected schoolchildren in 20 rural schools. Partial mastery was found of the issue of pre-intervention hygiene and failures in actions to prevent diseases that affect the nutritional status of schoolchildren (post-intervention). The program benefited 2,349 students and families. This experience can improve the empowerment of families and the community in the face of existing food problems and dangerous hygiene practices(AU)

Protocolo del Sistema Nacional de Vigilancia Epidemiológica: desnutrición aguda. No. 09 / Protocol of the National Epidemiological Surveillance System: acute malnutrition. No. 09

Estos protocolos están dirigido a personal médico, paramédico y otros profesionales que realizan acciones gerenciales y operativas de vigilancia epidemiológica en los servicios de salud del país, y están divididos en varios tomos para dar a conocer y actualizar la identificación y medidas de control para diversos padecimientos a fin de continuar con el mejoramiento de las capacidades técnicas de los trabajadores de salud, que permita planificar la prestación de servicios con decisiones partiendo de un enfoque epidemiológico comprobado, para responder a los cambios de tendencias epidemiológicas y con ello contribuir al fortalecimiento de prácticas asertivas de la salud pública de nuestro país.

Caracterización clinicoepidemiológica de niños con desnutrición proteicoenergética / Clinical and epidemiological characterization of children with protein-energetic malnutrition

Se realizó un estudio descriptivo, longitudinal y prospectivo de 76 niños desnutridos atendidos en consulta de nutrición del Policlínico Jimmy Hirzel de Bayamo, provincia de Granma, en el período 2014-2016, con vistas a caracterizarles según variables relacionadas con las madres, los niños y las familias, para lo cual se emplearon métodos teóricos, empíricos y estadísticos. En la casuística predominaron los niños con las características siguientes: nacidos con bajo peso (71,1 por ciento), con alimentación complementaria inadecuada (61,8 por ciento), con infecciones agudas reiteradas (75,0 por ciento), hijos de madres con enfermedades asociadas con el embarazo (90,8 por ciento), con bajo nivel de conocimiento sobre la enfermedad (67,1 por ciento), así como procedentes de familias con ingreso económico medio (81,6 por ciento) y con hacinamiento (55,3 por ciento). Se concluyó que la mayoría de los niños desnutridos presentaron antecedentes prenatales, natales y posnatales a tener en cuenta para el desarrollo de la desnutrición, los cuales pueden ser prevenibles o modificables.

A descriptive, longitudinal and prospective study of 76 undernourished children assisted in the Nutrition Service of Jimmy Hirzel Polyclinic in Bayamo, Granma province was carried out in the period 2014-2016, with the aim of characterizing them according to variables related to the mothers, the children and the families, for which theoretical, empiric and statistical methods were used. The children with the following characteristics: born underweight (71.1 percent), inadequate complementary feeding (61.8 percent), repeated acute infections (75.0 percent), children which mothers had associated diseases with pregnancy (90.8 percent), with low level of knowledge on the disease (67.1 percent), as well as coming from families with middle economic incomes (81.6 percent) and crowding (55.3 percent) prevailed in the case material. It was concluded that most of the undernourished children presented prenatal, natal and postnatal history to kept in mind for the development of malnutrition, which can be preventable or modifiable.

Perfil Sociodemográfico e Nutricional de Pacientes Oncológicos em Terapia Nutricional Enteral / Sociodemographic and Nutritional Profile of Oncological Patients in Enteral Nutritional Therapy / Perfil Sociodemográfico y Nutricional de Pacientes Oncológicos en Terapia Nutricional Enteral

Introdução: Os pacientes oncológicos apresentam alto risco nutricional, sendo a desnutrição e a caquexia comumente observadas nesses indivíduos. A terapia nutricional enteral (TNE) é uma terapêutica que pode oferecer inúmeros benefícios. Objetivo: Identificar o perfil sociodemográfico e nutricional de pacientes oncológicos relacionando-os aos efeitos da TNE com estado nutricional e à evolução clínica desses pacientes. Método: Estudo clínico retrospectivo com revisão de prontuários eletrônicos de pacientes admitidos, no período de setembro de 2016 a abril de 2017, em um hospital oncológico público e privado, no município de Juiz de Fora - MG. As análises estatísticas foram por meio de frequências e proporções e média e desvio-padrão a depender das variáveis, sendo p<0,05. Resultados: Entre os 96 prontuários analisados, 68,75% eram do gênero masculino, 54,16% idosos, 52,1% ex-tabagistas, 39,6% ex-etilistas e 46,9% apresentavam câncer de cabeça e pescoço. Destes, 44,8% apresentavam suspeita de desnutrição e 39,6% estavam desnutridos. A média do índice de massa corporal (IMC) foi de 19,44±4,83 kg/m² e o peso 52,91±12,97 kg antes da TNE, e 18,76±4,47 kg/m² e 51,01±12,69 kg após sete dias em TNE, não apresentando diferença significativa entre os valores obtidos antes e após a TNE. A classificação do percentual da perda de peso no início da TNE evidenciou 88,5% com perda de peso grave e, após sete dias de terapia, houve uma redução nesse percentual para 46,9%. Conclusões: A maioria dos pacientes oncológicos apresenta um comprometimento progressivo do estado nutricional. A TNE contribuiu de modo positivo para o retardo da perda de peso desses pacientes.

Introduction:Cancer patients are at high nutritional risk, with malnutrition and cachexia being commonly observed in these individuals. Enteral nutritional therapy (ENT) is a therapy that can offer numerous benefits for these. Objective: To identify the sociodemographic and nutritional profile of cancer patients, relating to the effects of ENT with nutritional status and clinical evolution of these patients. Method: Retrospective clinical study with review of electronic medical records of patients admitted from September 2016 to April 2017 at a public and private oncology hospital in the city of Juiz de Fora - MG. Statistical analyzes were by means of frequencies and proportions and means and standard deviations depending on the variables, being p <0.05. Results: Among 96 charts analyzed, 68.75% were males, 54.16% were elderly, 52.1% were former smokers, 39.6% were ex- and 46.9% had head and neck cancer. Of these, 44.8% were suspected of malnutrition and 39.6% were malnourished. The mean BMI was 19.44 ± 4.83 kg / m² and the weight was 52.91 ± 12.97 kg before the ENT and 18.76 ± 4.47 kg / m² and 51.01 ± 12.69 kg after seven days in ENT, showing no significant difference between the values obtained before and after ENT. The classification of the percentage of weight loss at the beginning of ENT showed 88.5% with severe weight loss and after seven days of therapy there was a reduction in this percentage to 46.9%. Conclusions: Most cancer patients present with progressive impairment of nutritional status. ENT was a therapy that contributed positively to the delay of weight loss in these patients

Introducción: Los pacientes oncológicos presentan alto riesgo nutricional, siendo la desnutrición y la caquexia comúnmente observadas en esos individuos. La terapia nutricional enteral (TNE) es una terapéutica que puede ofrecer innumerables beneficios para estos. Objetivo:Identificar el perfil sociodemográfico y nutricional de pacientes oncológicos relacionando a los efectos de la TNE con estado nutricional y evolución clínica de esos pacientes. Método: Estudio clínico retrospectivo con revisión de prontuarios electrónicos de pacientes admitidos en el período de septiembre de 2016 a abril de 2017 en un hospital oncológico público y privado en el municipio de Juiz de Fora - MG. Los análisis estadísticos fueron a través de frecuencias y proporciones y medias y desviaciones estándar a depender de las variables, siendo p <0,05. Resultados: Entre 96 prontuarios analizados, el 68,75% eran del género masculino, 54,16% ancianos, 52,1% ex tabaquistas, el 39,6% etilistas y el 46,9% tenían cáncer de cabeza y cuello. De estos 44,8% presentaban sospechosos de desnutrición y 39,6% desnutridos. El promedio de IMC fue de 19,44 ± 4,83 kg / m² y el peso 52,91 ± 12,97 kilogramos antes de la TNE y 18,76 ± 4,47 kg / m² y 51,01 ± 12,69 kilogramos después de siete días en TNE, no presentando diferencia significativa entre los valores obtenidos antes y después de la TNE. La clasificación del porcentaje de la pérdida de peso al inicio de la TNE evidenció un 88,5% con pérdida de peso grave y después de siete días de terapia hubo una reducción en este porcentual para el 46,9%. Conclusiones: La mayoría de los pacientes oncológicos presentan un compromiso progresivo del estado nutricional. La TNE fue una terapia que contribuyó positivamente al retraso de la pérdida de peso de estos pacientes.

Prevalence of underweight and wasting in Iranian children aged below 5 years: a systematic review and meta-analysis / 소아과

PURPOSE: Wasting and underweight are the 2 main indicators of children’s undernutrition. We aimed to estimate the prevalence of undernutrition at the national level in Iran. METHODS: We performed a search for original articles published in international and Iranian databases including MEDLINE, Web of Science, Google Scholar, Scopus, CINHAL (Cumulative Index to Nursing and Allied Health Literature), Scientific Information Database, Irandoc, Iranmedex, and Magiran during January 1989–August 2017. Seven keywords, in English and Persian, including malnutrition, protein energy malnutrition, growth disorders, underweight wasting, weight loss, children below 5 years old, and children, were used to search the databases. RESULTS: Finally, 17 articles were included in the meta-analysis, based on which the prevalence of underweight and wasting in Iranian children were estimated to be 11% and 5%, respectively. The prevalence rates of underweight among children in the central, western, southern, and northern parts of Iran and at the national level were 24%, 5%, 20%, 17%, and 6%, respectively. The prevalence rates of wasting in the central, western, southern, and northern parts of Iran and at the national level were 9%, 4%, 11%, 5%, and 4%, respectively. CONCLUSION: Although the prevalence of underweight and wasting in Iran was low, some parts of the country showed high prevalence. The main reason behind this difference in the prevalence of malnutrition may be due to the level of development in different regions.

Estado nutricional de pacientes diagnosticados con cáncer, Hospital General San Felipe, Honduras / Nutritional assessment of cancer patients at Hospital General San Felipe, Honduras

Los pacientes diagnosticados con cáncer están en riesgo de malnutrición debido al efecto físico o metabólico de la enfermedad y a las terapias utilizadas en su manejo. La pérdida de peso y la malnutrición, son problemas frecuentes que afectan del 40% al 80% de los pacientes con cáncer, prolongando la estadía hospitalaria, disminuyendo la tolerancia y respuesta a la terapia, encareciendo los costos, afectando la calidad y sobrevida global. Objetivo: evaluar el estado nutricional y el riesgo de desnutrirse en pacientes diagnosticados con cáncer en el Hospital General San Felipe. Material y Métodos: estudio descriptivo, transversal, no aleatorizado, en 100 pacientes oncológicos adultos en los que se determinó los datos generales, sintomatología, hábitos tóxicos, comorbilidades, medidas antropométricas, índice de masa corporal y rendimiento físico. Se aplicó el instrumento de la Valoración Global Subjetiva Generada por el Paciente. Resultados: de los 100 casos estudiados 80 fueron mujeres y 20 hombres, los tipos de cáncer más frecuentes fueron: de mama, genital femenino, esófago-gástrico y colo-rectal; la mayoría presentaron síntomas de impacto nutricional. El uso de alcohol y tabaco fue 18% y 11% respectivamente. La hipertensión arterial y la diabetes mellitus fueron las comorbilidades más frecuentes; 48% presentaron índice de masa corporal en rango normal, 14% bajo peso y 38% sobrepeso. Según la Escala del Grupo Oncológico Cooperativo del Este 47% presentaron estado funcional normal y el 53% se encontró cierto grado de afectación. Al aplicarse el instrumento para Valoración Global Subjetiva, 55% de los 100 casos perdieron peso en los últimos 6 meses y 63% en el último mes. De acuerdo a la escala de reconocimiento físico global 59 pacientes mostraron déficit de peso, la evaluación del tejido graso y muscular mostró déficit en más de la mitad de los casos, 60% de los pacientes estaban moderada a severamente malnutridos y el riesgo de desnutrirse fue del 90%. Conclusión: la condición nutricional está afectada en más de la mitad de los casos y el riesgo de desnutrirse está presente en la mayoría de los pacientes oncológicos.

Situación nutricional de los pacientes que consultan a los servicios médicos del área Metropolitana de Caracas. Estudio multicéntrico / Nutritional status of patients who consult medical services in the metropolitan area of Caracas. Multicentric study

La ingesta alimentaria y los hábitos nutricionales han sufrido un cambio muy importante en Venezuela en los últimos 18 meses aproximadamente. Objetivo: Describir la condición nutricional de las personas que acuden a hospitales del área metropolitana de Caracas. Métodos: estudio de casos, descriptivo y prospectivo. La muestra fué no probabilística de selección intencional, de pacientes de cualquier género y mayores de 18 años, atendidos en los hospitales HGO, HDL, HUC y HV durante un día escogido acordado y simultáneo: el 25 de mayo de 2018. Se procedió a atender el motivo de consulta y luego se aplicó una encuesta, incorporando, además en ella, el diagnóstico principal y el Índice de Masa Corporal (IMC). Resultados: Se evaluaron 322 pacientes, 130 del HV, 93 del HGO, 54 del HUC y 45 del HDL. El promedio de edad fue 48,63 años ±19,11 años DE, con 55,22% de mujeres. Refirieron un promedio de comidas de 2,90 ± 0,88 veces al día y en la semana consumían 2,17 ± 2,10 veces proteínas y 4,15 ± 2,51 veces vegetales. EL IMC promedio fue de 21,48 ± 9,93. Hubo 139 personas con desgaste orgánico (SDO) y en ellos la patología principal no justificaba este su presencia en 76 pacientes. Conclusiones: La calidad de la ingesta referida es inadecuada y existe un porcentaje alto de SDO en pacientes sin razones médicas para ello(AU)

Food intake and nutritional habits have experienced an important change in Venezuela in the last 18 months, approximately. Objective: To evaluate the nutritional status of the people who attended four hospitals of the metropolitan area of Caracas. Methods: case study, descriptive and prospective design. The sample was non-probabilistic and of intentional selection; the patients were of any gender over 18 years-old and came to HGO, HDL, HUC and HV hospitals. One accorded and simultaneous day was chosen: may 25,2018. The cause of consultation was assessed and afterwards, a survey was applied to evaluate the reason for consultation and then a survey was applied. It also included the main diagnoses and the Body Mass Index (BMI) was measured. Results: 322 patients were evaluated, 130 of the HV, 93 of the HGO, 54 of the HUC and 45 of the HDL. The average age was 48.63 years ± 19.11 years -old age, with 55.22% of women. They reported an average of 2.90 ± 0.88 meals a day and during the week they consumed proteins 2.17 ± 2.10 and 4.15 ± 2.51 times vegetables. The average BMI was 21.48 ± 9.93. Wasting Syndrome (WS) was found in 139 patients whose basic illness did not explain it 76. Conclusions: The quality and quantity of the food intake is inadequate and there is a high percentage of SDO in patients without a medical justification for this(AU)

Level of Nutrition Knowledge, Diet Practice and Education Demands in Dialysis Patients with Chronic Renal Failure

The number of patients is increasing and their mean age is also increasing. Proper dietary adjustments are necessary to prevent protein-calorie malnutrition or complications but it is difficult for dialysis patients to adapt to diet therapy due to stress or anorexia. Education does not consider the individual characteristics, knowledge, dietary inhabit education demands, and initial education. The purpose of this study was to identify dialysis patient's nutrition knowledge and, dietary practice and compare those with nutrition education or counseling demands for providing basic data of desirable nutrition management. The data were collected by a survey consisting of the general characteristics, disease related characteristics, nutrition education and counsel characteristics, level of nutrition knowledge, diet therapy, and nutrition education and counsel demands from the 28th March to 22th July 2017. The total number of subjects were 33 patients among dialysis patients at two tertiary medical institutions and an artificial kidney room at a private hospital in Incheon·Gyeonggi. The data collected were analyzed statistically using the SPSS program 23.0, followed by further analyses using frequency analysis, one-way ANOVA, cross analysis, and correlation analysis. The results of the dialysis patients showed that younger (P < 0.05), female (P < 0.05), abnormal high school diploma (P < 0.001) groups had high nutrition scores. In addition, dietary practice and nutrition education and counsel demands showed a positive correlation (P < 0.05, P < 0.01). In particular, females were higher than males in nutrition knowledge, dietary practice, nutrition education, and counseling demand scores.

Percepción de un grupo de adultos mayores con presbifagia sobre el fenómeno de la alimentación y las propiedades organolépticas de los alimentos / Perception of feeding phenomenon and organoleptic properties of food by a group of elderly people with presbyphagia

El envejecimiento conlleva cambios fisiológicos y no fisiológicos que afectan la percepción del adulto mayor sobre el fenómeno de la alimentación, sin embargo, las investigaciones internacionales podrían no representar a la población chilena, existiendo escasa información acerca de la percepción del adulto mayor con presbifagia y los factores que influyen en su alimentación. El objetivo del presente estudio cualitativo y de diseño fenomenológico es conocer la percepción de los adultos mayores con presbifagia sobre el fenómeno de la alimentación, abarcando factores fisiológicos y no fisiológicos, junto a las propiedades organolépticas de los alimentos que prefieren. Para ello se aplicó una entrevista semiestructurada a ocho adultos mayores con presbifagia asistentes a un Centro de Actividades Prácticas (muestreo por saturación). El discurso se procesó mediante codificación axial en dos niveles: formación de códigos (a través de citas del entrevistado), memos (conceptos de los investigadores) y la codificación selectiva, mediante la integración de los códigos en familias, aplicando el método de comparaciones constantes, utilizando Atlas.ti 6. Los resultados indican que en la alimentación intervienen factores sociales y psicológicos. Las propiedades organolépticas que influyen en la percepción del adulto mayor son: tamaño, consistencia, sabor, temperatura e intensidad del color, las cuales afectan la elección de los alimentos. En conclusión la percepción del adulto mayor con presbifagia sobre la alimentación, está influenciada por factores fisiológicos y no fisiológicos, los cuales determinan la preferencia de propiedades organolépticas y elección de alimentos. Además de encontrarse influenciada por hábitos alimentarios adquiridos y ubicación geográfica(AU)

Aging involves physiological and non-physiological changes that affect the perception of the elderly on the phenomenon of food, however, international investigations could not represent the Chilean population, because of the little information about the perception of the elderly with presbyphagia and the factors that influence their diet. The purpose of this qualitative study with phenomenological design is to know the perception of older adults with presbyphagia about food phenomenon, considering physiological and non-physiological factors along with the organoleptic properties of foods that they prefer. For this, a semistructured interview was applied to eight older adults with presbyphagia attending at the Practical Activities Center (sampling by saturation). The speech was processed through axial coding in two levels: formation of codes (through appointments of the interviewee), memos (concepts of researchers) and selective coding, through the integration of family codes, applying the method of constant comparisons, using Atlas.ti 6. The results indicate that social and psychological factors are involved in feeding. Organoleptic properties that influence the perception of the elderly are: size, consistency, taste, temperature and intensity of the color, which affect the choice of food. In conclusion the perception of the elderly with presbyphagia food, is influenced by physiological and non-physiological factors which determine the preference of organoleptic properties and food choices. In addition to being influenced by acquired habits and geographic location(AU)

Sindrome de Cotard: Monicete, el haitiano / Cotard's syndrome: Monicete, the Haitian

Paciente NN de sexo masculino, de edad media, es traído por carabineros al Servicio de Urgencia del Instituto, luego de haber realizado intento suicida por ahorcamiento. El paciente no aporta mayor información respecto de sus datos demográficos ni cuenta con identificación. Existe falta de cooperación y aparentes dificultades con el manejo del idioma. Paciente de raza negra, muy enflaquecido, de unos 40 a 50 años de edad, desaseado. Lúcido y orientado. Juicio de realidad alterado. Hipótesis Diagnóstica: Síndrome Suicidal. Psicosis Lúcida. Desnutrición Calórico-Proteica. Social: Situación de identidad y documentación. Red de apoyo. No se ha logrado contactar familiares. Debido a la situación de indocumentación, se dificulta el realizar varios estudios médicos. Idioma criollo haitiano (creol). Migración: Es conocido el aumento de la población migrante en nuestro país. El desafío de la competencia cultural.

NN male patient, middle age, is brought by police to the Institute's Emergency Department, after having committed a suicide attempt by hanging. The patient does not provide more information regarding his / her demographic data or has identification. There is a lack of cooperation and apparent difficulties with language management. Black patient, very emaciated, about 40 to 50 years of age, dirty. Lucid and oriented. Altered judgment of reality. Diagnostic Hypothesis: Suicidal Syndrome. Lucid Psychosis. Caloric-Protein Malnutrition. Social: Status of identity and documentation. Supporting net. Family members could not be reached. Due to the undocumented situation, it is difficult to perform several medical studies. Haitian Creole language. Migration: It is known the increase of the migrant population in our country. The challenge of cultural competence.