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1.
Curr Opin Clin Nutr Metab Care ; 27(2): 192-199, 2024 03 01.
Article in English | MEDLINE | ID: mdl-38190340

ABSTRACT

PURPOSE OF REVIEW: The prevalence of overweight and obesity in our society is a pressing concern that has demanded immediate attention. Traditional treatments have proven ineffective for many individuals, leading to a surge in bariatric surgery as a last resort. While the rate of early and late postoperative complications may be low, when they occur, they place these patients at higher risk of requiring intensive care treatment. Therefore, it is our aim to discuss the nutritional care of these individuals. RECENT FINDINGS: Nutritional management of critically ill postbariatric surgical patients is related to the difficulty of providing an adequate nutritional assessment, calculating the macro and micronutrient requirements, choosing the right therapy, and defining the timely moment to initiate it. The anatomic changes related to the bariatric operation pose a high risk for a nonfunctional gastrointestinal tract both in the early postoperative and late postoperative. Therefore, the route of nutrition will greatly rely on the absorptive capacity, as well as on the nutritional status, with parenteral nutrition being an early option, especially for those with high critical care severity scores. Also, these patients are known to have an altered microbiota which may influence the absorptive capacity. Immunonutrition, prebiotics, probiotics, and symbiotics may represent potential options, but there is currently little support for 'one size fits all'. SUMMARY: The nutritional care of critically ill patients postbariatric surgery is a complex and nuanced process requiring a multifaceted precision approach. The distinct nutritional challenges of early and late postoperative patients necessitate a thorough nutritional assessment and a highly individualized nutritional care plan.


Subject(s)
Bariatric Surgery , Critical Illness , Humans , Nutritional Requirements , Nutritional Support , Obesity , Critical Care
2.
Nutrition ; 119: 112324, 2024 Mar.
Article in English | MEDLINE | ID: mdl-38215671

ABSTRACT

OBJECTIVES: To assess the concurrent and predictive validity of different combinations of Global Leadership Initiative on Malnutrition (GLIM) criteria in patients with colorectal cancer considering different indicators of reduced muscle mass (MM) and the effects of the disease. METHODS: A secondary analysis with patients with colorectal cancer. The reduced MM was assessed by arm muscle area, arm muscle circumference, calf circumference, fat-free mass index, skeletal muscle index (SMI) and skeletal muscle. Cancer diagnosis or disease staging (TNM) was considered for the etiologic criterion referred to as the effect of the disease. The other phenotypic and etiologic criteria were also evaluated, and we analyzed 13 GLIM combinations. Concurrent validity between GLIM criteria and Patient-Generated Subjective Global Assessment was evaluated. Logistic and Cox regression were used in the predictive validation. RESULTS: For concurrent validity (n = 208), most GLIM combinations (n = 6; 54.5%) presented a moderate agreement with Patient-Generated Subjective Global Assessment and none showed satisfactory sensitivity and specificity (>80%). Reduced MM evaluated by SMI and SMI were present in the GLIM combinations associated with postoperative complications (odds ratio, ≥2.0), independent of other phenotypic and etiologic criteria. The combinations with reduced MM considering any method and fixed phenotypic criteria and TNM were associated with mortality (hazard ratio, ≥2.0). CONCLUSIONS: Satisfactory concurrent validity was not verified. The GLIM diagnosis of malnutrition was associated with postoperative complications and mortality.


Subject(s)
Colorectal Neoplasms , Malnutrition , Humans , Leadership , Patient Acuity , Malnutrition/complications , Malnutrition/diagnosis , Muscle, Skeletal , Postoperative Complications , Colorectal Neoplasms/complications , Colorectal Neoplasms/diagnosis , Nutrition Assessment , Nutritional Status
3.
Nutrition ; 118: 112260, 2024 Feb.
Article in English | MEDLINE | ID: mdl-37980778

ABSTRACT

OBJECTIVES: Patients undergoing hematopoietic stem cell transplantation may present with metabolic alterations that can have an effect on their energy expenditure and nutritional status. This project aimed to compare the pre- and posttransplant energy expenditures of patients undergoing hematopoietic stem cell transplantation as well as related factors. METHODS: This prospective study was conducted at a single center. Patients, undergoing autograft or allograft, were evaluated before transplantation and on the 10th and 17th d posttransplantation. Energy expenditure was measured by indirect calorimetry. Diet intake was assessed by a 24-h dietary recall. Infectious and noninfectious complications were analyzed between days 1 to 10 after transplantation and days 11 to 17 after transplantation. Paired model analyses were carried out to identify the pretransplantation and posttransplantation periods. RESULTS: Twenty patients were evaluated with a mean age of 45.6 ± 17.2 y; a majority were male sex (65%), and the most frequent diagnoses were chronic myeloid leukemia (25%) and multiple myeloma (25%). Energy expenditure increased by 15% posttransplantation, and the energy requirement per kilogram of weight was 23 kcal/kg at day 10 after transplantation. Throughout the posttransplantation period, 45% of the patients required nutritional therapy. Negative energy and negative protein balance were observed at all analyzed times. Phase angle (P = 0.018), fever (P = 0.014), mucositis grades I to II (P = 0.018), and the total number of infectious and noninfectious events (P = 0.043) were associated with an increase in energy expenditure at day 10 after transplantation. CONCLUSIONS: Energy expenditure increased after transplantation compared with pretransplantation in 50% of patients. Phase angle, fever, grades I to II mucositis, and infectious and noninfectious events were associated with increased energy expenditure at day 10 after transplantation.


Subject(s)
Hematopoietic Stem Cell Transplantation , Mucositis , Humans , Male , Female , Adult , Middle Aged , Prospective Studies , Nutritional Status , Energy Metabolism , Hematopoietic Stem Cell Transplantation/adverse effects , Calorimetry, Indirect
4.
Nutrition ; 116: 112195, 2023 Dec.
Article in English | MEDLINE | ID: mdl-37678014

ABSTRACT

OBJECTIVES: The Global Leadership Initiative on Malnutrition (GLIM) criteria establish a diagnosis of malnutrition based on the presence of at least one phenotypic and one etiologic criterion. This study aimed to assess the concurrent and predictive validity of the GLIM criteria in hospitalized cancer patients. METHODS: This is an observational retrospective study, including 885 cancer patients, ages >18 y, admitted to a medical oncology inpatient unit between 2019 and 2020. All patients at risk for malnutrition according to the Nutritional Risk Screening 2002 score were assessed by the subjective global assessment (SGA) and 14 different combinations of the GLIM criteria. The SGA was considered the gold standard for assessing the concurrent validity of the GLIM combinations. For a subsample of patients with data available on inflammatory markers (n = 198), the serum albumin and C-reactive protein were included in the combinations as etiologic criteria. The predictive validity of the different combinations was tested using the occurrence of surgical complications as the clinical outcome. The sensitivity and specificity values were calculated to assess the concurrent validity, univariate and multivariate logistic regression models were used to test predictive validity. Adequate concurrent and predictive validity were determined as sensitivity and specificity values >80% and odds ratio values ≥2.0, respectively. RESULTS: The median age of the patients was 61.0 y (interquartile range = 51.0-70.0). Head and neck cancer was the prevailing diagnosis and 375 patients were at nutritional risk. According to the SGA, 173 (26.1%) patients were malnourished (SGA categories B or C) and the prevalence of malnutrition ranged from 3.9% to 30.0%, according to the GLIM combinations. None of the tested combinations reached adequate concurrent validity; however, the presence of malnutrition according to four combinations independently predicted surgical complications. CONCLUSIONS: The predictive validity of the GLIM was satisfactory in surgical cancer patients.


Subject(s)
Malnutrition , Neoplasms , Humans , Inpatients , Leadership , Retrospective Studies , Neoplasms/complications , Malnutrition/complications , Malnutrition/diagnosis , Malnutrition/epidemiology , Nutrition Assessment , Nutritional Status
5.
Nutrition ; 114: 112093, 2023 10.
Article in English | MEDLINE | ID: mdl-37437417

ABSTRACT

OBJECTIVES: The Global Leadership Initiative on Malnutrition (GLIM) is a framework aiming to standardize malnutrition diagnosis. However, it still needs to be validated, in particular for patients with chronic liver disease. This study aimed to validate the GLIM criteria in patients with liver cirrhosis awaiting liver transplant (LTx). METHODS: This was a retrospective observational study carried out with adult patients on the waiting list for LTx, consecutively evaluated between 2006 and 2021. The phenotypic criteria were unintentional weight loss, low body mass index, and reduced muscle mass (midarm muscle circumference [MAMC]). The etiologic criteria were high Model for End-Stage Liver Disease (MELD) and MELD adjusted for serum sodium (MELD-Na) scores, the Child-Pugh score, low serum albumin, and low food intake and/or assimilation. Forty-three GLIM combinations were tested. Sensitivity (SE), specificity (SP), positive and negative predictive values, and machine learning (ML) techniques were used. Survival analysis with Cox regression was carried out. RESULTS: A total of 419 patients with advanced liver cirrhosis were included (median age, 52.0 y [46-59 y]; 69.2% male; 68.8% malnourished according to the Subjective Global Assessment [SGA]). The prevalence of malnutrition by the GLIM criteria ranged from 3.1% to 58.2%, and five combinations had SE or SP >80%. The MAMC as a phenotypic criterion with MELD and MELD-Na as etiologic criteria were predictors of mortality. The MAMC and the presence of any phenotypic criteria associated with liver disease parameters and low food intake or assimilation were associated with malnutrition prediction in ML analysis. CONCLUSIONS: The MAMC and liver disease parameters were associated with malnutrition diagnosis by SGA and were also predictors of 1-y mortality in patients with liver cirrhosis awaiting LTx.


Subject(s)
End Stage Liver Disease , Liver Transplantation , Malnutrition , Adult , Humans , Male , Middle Aged , Female , End Stage Liver Disease/complications , End Stage Liver Disease/surgery , Leadership , Severity of Illness Index , Liver Cirrhosis/complications , Liver Cirrhosis/surgery , Malnutrition/diagnosis
6.
Appl Physiol Nutr Metab ; 48(9): 710-717, 2023 Sep 01.
Article in English | MEDLINE | ID: mdl-37229778

ABSTRACT

This commentary represents a dialogue on key aspects of disease-related malnutrition (DRM) from leaders and experts from academia, health across disciplines, and several countries across the world. The dialogue illuminates the problem of DRM, what impact it has on outcomes, nutrition care as a human right, and practice, implementation, and policy approaches to address DRM. The dialogue allowed the germination of an idea to register a commitment through the Canadian Nutrition Society and the Canadian Malnutrition Task Force in the UN/WHO Decade of Action on Nutrition to advance policy-based approaches for DRM. This commitment was successfully registered in October 2022 and is entitled CAN DReaM (Creating Alliances Nationally for Policy in Disease-Related Malnutrition). This commitment details five goals that will be pursued in the Decade of Action on Nutrition. The intent of this commentary is to record the proceedings of the workshop as a stepping stone to establishing a policy-based approach to DRM that is relevant in Canada and abroad.


Subject(s)
Malnutrition , Nutrition Therapy , Humans , Canada , Malnutrition/diagnosis , Nutritional Status , Food
7.
Nutr Cancer ; 75(4): 1109-1115, 2023.
Article in English | MEDLINE | ID: mdl-36895156

ABSTRACT

BACKGROUND: Cancer patients often have altered nutritional status and periodically undergo imaging tests. We hypothesized that standard uptake values (SUV) by positron emission tomography-computed tomography (PET/CT) with 18 F-fluorodeoxyglucose (18F-FDG) could be associated with the nutritional status of cancer patients. MATERIALS AND METHODS: Adult cancer patients who underwent clinical evaluation and PET/CT with 18 F-FDG on the same day were included in a cross-sectional pilot study. The focus was on evaluating 18 F-FDG findings with regard to nutritional status, with an emphasis on liver SUVmean and tumor SUVmax. RESULTS: A total of 179 patients were evaluated. One hundred and three (57.5%) were classified as well-nourished, 54 (30.1%) as suspected/moderately malnourished, and 22 (12.2%) as severely malnourished. The median hepatic SUVmean was 2.29, with 1.87 corresponding to the 10th percentile. There was a significant difference between the severely malnourished (2.02) and well-nourished or suspected/moderately malnourished (2.36) patients. Severely malnourished patients were more likely to have a SUVmean < 1.87 (p = .035). The tumor SUVmax also was significantly higher in severely malnourished patients (p = .003). CONCLUSION: Cancer patients with severe malnutrition have lower values of hepatic SUVmean and higher values of tumor SUVmax in PET/CT with 18F-FDG when compared to well-nourished patients.


Subject(s)
Neoplasms , Positron Emission Tomography Computed Tomography , Adult , Humans , Positron Emission Tomography Computed Tomography/methods , Fluorodeoxyglucose F18 , Pilot Projects , Nutritional Status , Cross-Sectional Studies , Neoplasms/complications , Neoplasms/diagnostic imaging , Radiopharmaceuticals
8.
Rev Col Bras Cir ; 49: e20213256EDIT01, 2022.
Article in English, Portuguese | MEDLINE | ID: mdl-35239849
9.
Clin Nutr ESPEN ; 48: 63-67, 2022 04.
Article in English | MEDLINE | ID: mdl-35331535

ABSTRACT

BACKGROUND: Green tea (Camellia sinensis L.) has an effect on energy metabolism, but little is known about its infusion intake impact on satiety responses. OBJECTIVE: This paper aimed at analyzing the effect of green tea on energy expenditure, satiety response, and food intake in humans. METHODS: The study involved 21 individuals (11 women, 10 men), and consisted of an open-label, crossover, randomized clinical trial (RBR-928HCW). Evaluation of subjects was performed as an acute study on two different days, after having a standardized breakfast accompanied by water or green tea. Indirect calorimetry was used to evaluate resting energy expenditure (REE), and a visual analogue scale to assess satiety. Food records were used to assess food intake along the day of the trial. RESULTS: Acute ingestion of green tea infusion with the standardized breakfast increased REE (p = 0.014) by 7.2 ± 11.7% at 240min compared to fasting (mean difference of REE between the time of 240min and fasting: +91 ± 157.6 kcal). No significant alterations were observed for substrate oxidation and respiratory quotient compared to the water treatment. A greater feeling of hunger was observed when volunteers ingested green tea (water -828.75 ± 494.2  cm min; green tea -549.8 ± 545.6  cm min; p = 0.026). No significant differences were observed regarding food intake energy and macronutrients between treatments. CONCLUSIONS: Green tea increased energy expenditure and the subjective response of hunger in healthy individuals. This study is registered in the ReBEC Platform of the Brazilian Clinical Trials Registry (RBR-928HCW).


Subject(s)
Energy Metabolism , Tea , Cross-Over Studies , Eating , Female , Humans , Male , Sensation
10.
JPEN J Parenter Enteral Nutr ; 46(3): 635-645, 2022 03.
Article in English | MEDLINE | ID: mdl-34117790

ABSTRACT

BACKGROUND: The gap between the nutrition education provided to medical students and the nutrition competencies and attitudes needed for physicians to provide adequate nutrition care is a global concern. There is no universally accepted benchmark on nutrition competencies for doctors. The objective of this study was to establish, by expert consensus, the objectives of undergraduate nutrition medial education, the nutrition core competencies, and strategies for curriculum development in medical nutrition education. METHODS: We administered a Delphi survey to systematically gather the opinion of a panel of Latin American experts in nutrition. The survey questionnaire was constructed considering scientific literature by using a 5-point Likert scale. Consensus was defined as >70% agreement on the importance of an item (Likert scale 4 and 5). RESULTS: A four-round Delphi survey was conducted for this research. In the second, third, and fourth rounds, we validated a total of 130 competencies by consensus, which were distributed into four different thematic areas: (1) basic nutrition concepts, (2) public nutrition and nutrition prevention throughout the life cycle, (3) nutrition status and disease, and (4) nutrition care process. CONCLUSION: The curricula for general physician education in medical school must include health promotion, prevention, and treatment of diseases related to nutrition. This goal can be reached by integrating ≤130 competencies into four different fundamental areas.


Subject(s)
Education, Medical, Undergraduate , Clinical Competence , Consensus , Curriculum , Delphi Technique , Humans , Nutritional Status
11.
Clin Nutr ; 41(1): 97-104, 2022 01.
Article in English | MEDLINE | ID: mdl-34864459

ABSTRACT

BACKGROUND & AIMS: Studies using the Global Leadership Initiative on Malnutrition (GLIM) criteria for patients with liver cirrhosis are limited. This study aimed to assess the impact of malnutrition according to the GLIM criteria on the outcomes of patients awaiting a liver transplant (LTx) and compare these criteria with Subjective Global Assessment (SGA). METHODS: This retrospective observational study included adult patients awaiting LTx. Patient clinical data, nutritional status according to various tools including SGA, and resting energy expenditure were assessed. The distinct phenotypic and etiologic criteria provided 36 different GLIM combinations. The GLIM criteria and SGA were compared using the kappa coefficient. The variables associated with mortality before and after the LTx and with a longer length of stay (LOS) after LTx (≥18 days) were assessed by Cox regression and logistic regression analyses, respectively. RESULTS: A total of 152 patients were included [median age 52.0 (interquartile range: 46.5-59.5) years; 66.4% men; 63.2% malnourished according to SGA]. The prevalence of malnutrition according to the GLIM criteria ranged from 0.7% to 30.9%. The majority of the GLIM combinations exhibited poor agreement with SGA. Independent predictors of mortality before and after LTx were presence of ascites or edema (p = 0.011; HR:2.58; CI95%:1.24-5.36), GLIM 32 (PA-phase angle + MELD) (p = 0.026; HR:2.08; CI95%:1.09-3.97), GLIM 33 (PA + MELD-Na≥12) (p = 0.018; HR:2.17; CI95%:1.14-4.13), and GLIM 34 (PA + Child-Pugh) (p = 0.043; HR:1.96; CI95%:1.02-3.77). Malnutrition according to GLIM 28 (handgrip strength + Child-Pugh) was independently associated with a longer LOS (p = 0.029; OR:7.21; CI95%:1.22-42.50). CONCLUSION: The majority of GLIM combinations had poor agreement with SGA, and 4 of the 36 GLIM combinations were independently associated with adverse outcomes.


Subject(s)
Liver Cirrhosis/physiopathology , Malnutrition/diagnosis , Nutrition Assessment , Risk Assessment/methods , Waiting Lists/mortality , Adult , Female , Hand Strength , Humans , Liver Cirrhosis/complications , Liver Cirrhosis/surgery , Liver Transplantation/mortality , Male , Malnutrition/etiology , Middle Aged , Nutritional Status , Prevalence , Prognosis , Reproducibility of Results , Retrospective Studies
12.
Appl Physiol Nutr Metab ; 47(4): 429-438, 2022 Apr.
Article in English | MEDLINE | ID: mdl-34370964

ABSTRACT

The aim of this study was to investigate the effect of Hibiscus sabdariffa tea on energy expenditure, satiety response and food intake. This is an open-label, crossover, randomized clinical trial that comprised 21 subjects (11 women, 10 men). The individuals were evaluated at acute moments (fasting and after eating standardized breakfast accompanied by water or H. sabdariffa tea). Resting energy expenditure was measured by indirect calorimetry, subjective satiety responses were evaluated with a visual analogue scale and food intake was assessed by using food records. The volunteers who drank the H. sabdariffa tea had lower perception of hunger (p = 0.002) and greater feeling of satiety (p = 0.01) and fullness (p = 0.009) compared to control. Men who ingested the H. sabdariffa tea had an increase in nitrogen energy expenditure (water: 1501 ± 290.7 kcal, H. sabdariffa tea: 1619 ± 288.9 kcal; p = 0.029). In comparison to control, men presented less perception of hunger (p = 0.003) and desire to eat (p = 0.016), increased satiety (p = 0.021) and fullness (p = 0.01), and women oxidized more fat (p = 0.034) when they drank H. sabdariffa tea. There was no difference between treatments regarding the energy and macronutrient intake from the first meal and throughout the day (p > 0.05) for all participants. The H. sabdariffa tea only affected energy expenditure and satiety responses in men. Clinical trial registry: ReBEC Platform of the Brazilian Clinical Trials Registry (https://ensaiosclinicos.gov.br/) - RBR-5HZ86T. Novelty: H. sabdariffa tea promoted an increase in energy expenditure and caused less perception of hunger/desire to eat in men. H. sabdariffa tea intake increased postprandial fat oxidation in women.


Subject(s)
Hibiscus , Satiety Response , Cross-Over Studies , Energy Intake , Female , Hibiscus/chemistry , Humans , Male , Meals , Tea , Thermogenesis
13.
Nutrition ; 94: 111528, 2022 02.
Article in English | MEDLINE | ID: mdl-34891107

ABSTRACT

OBJECTIVES: The aim of this study was to assess patients on the waiting list for liver transplant (LTx) according to bioelectrical impedance vector analysis (BIVA), as well as to verify the association between the placement of the vectors on the graph with clinical outcomes and identify the predictors to vector placement in quadrant 4 (Q4; indicating more hydration and less cellularity). METHODS: This was a retrospective observational study including 129 patients ≥20 y of age awaiting LTx. Patients' nutritional status was assessed by using different tools, including single-frequency bioelectrical impedance analysis and the Subjective Global Assessment (SGA). Clinical data were registered. The BIVA was evaluated by comparing the individual vectors plotted for all patients to the tolerance ellipses of 50%, 75%, and 95% of the reference healthy population. The quadrant of the vector for each patient was registered. RESULTS: The majority of the vectors were placed in Q1 (n = 54; 41.9%) and Q4 (n = 39; 30.2%). The presence of ascites or edema (hazard ratio [HR], 2.43; 95% confidence interval [CI], 1.15-5.12; P = 0.019) and the BIVA vector placed in Q4 in any ellipse (HR, 2.10; 95% CI, 1.07-4.09; P = 0.029) were independent predictors for mortality on the waiting list or ≤1 y after LTx. BIVA was not associated with longer hospital length of stay. The predictors of vector placement in Q4 were higher age, malnutrition according to SGA, and presence of ascites or edema. CONCLUSION: Patients on the waiting list for LTx with BIVA vectors placed in Q4, in the 50%, 75%, or 95% tolerance ellipses, presented a worse prognosis.


Subject(s)
Liver Transplantation , Malnutrition , Body Composition , Electric Impedance , Humans , Malnutrition/diagnosis , Prognosis , Waiting Lists
15.
Arq Bras Cir Dig ; 34(2): e1596, 2021.
Article in English, Portuguese | MEDLINE | ID: mdl-34669886

ABSTRACT

BACKGROUND: Chronic liver disease is associated with malnutrition that negatively impacts a patient's health-related quality of life (HRQoL). AIM: To evaluate the short-term effect of whey protein supplementation on the HRQoL and nutritional and functional status of patients waiting for liver transplantation. METHODS: This was a double-blind randomized clinical trial with patients waiting for liver transplantation who were randomized into two groups: WP (whey protein supplementation) and the control (casein supplementation). Both groups received 40 g (20 g in the morning and 20 g in the evening) for 15 days. Nutritional and functional status were evaluated. Energy balance was calculated as the difference between energy intake (24-hour recall) and total energy expenditure (assessed by indirect calorimetry). The chronic liver disease questionnaire was used to assess HRQoL. All measurements were performed before and after the intervention. RESULTS: Fifty-six patients were evaluated. Malnutrition was present in 56.9%, and it was directly associated with a poor HRQoL (p<0.05). No improvement on the nutritional and functional status was observed, in either group after protein supplementation. HRQoL improved after WP and casein supplementation, with no differences between groups (p>0.05). Patients who met protein requirements and had a positive energy balance demonstrated a higher HRQoL score (4.9, p<0.05), without between-group differences. CONCLUSION: Malnutrition substantially reduces HRQoL. Short-term WP or casein supplementation improved similarly the HRQoL.


Subject(s)
Liver Transplantation , Malnutrition , Dietary Supplements , Humans , Quality of Life , Whey Proteins
17.
Clin Nutr ESPEN ; 44: 397-401, 2021 08.
Article in English | MEDLINE | ID: mdl-34330496

ABSTRACT

BACKGROUND: Nutrition therapy (NT), defined as the provision of oral, enteral, or parenteral nutrition, should be considered a part of the holistic approach to patient care, while quality assessment of its practices is crucial. The present study aimed to identify variables capable of explaining the reason behind compliance of NTTs with the regulatory requirements. METHODS: A cross-sectional study focused on assessing the quality of nutritional therapy practices among NTTs who previously stated to be able to comply with requirements of the Brazilian law versus those who were not able to meet these demands. Hospitals were classified as A (teams that had previously reported to be able to meet the requirements) and B (those unable to comply with them). The study was approved by the ethics committees of all participant institutions. RESULTS: Twenty six hospitals met the inclusion criteria. The main hospital features, such as size, classification, service type, and percentage of hospitals providing NT were similar. Hospitals differed on the median number of patients undergoing NT per week: in group B (41.0; IR = 28.0-58.0) and group A (11.0; IR = 5.0-48.0) (p < 0.05), but there were no differences regarding personnel expertise. Both hospital groups had low quality control of the NT processes. CONCLUSION: Lack of quality assurance is responsible for the inadequate services in both type of institutions.


Subject(s)
Enteral Nutrition , Nutritional Support , Brazil , Cross-Sectional Studies , Humans , Parenteral Nutrition
18.
Nutr Clin Pract ; 36(3): 534-544, 2021 Jun.
Article in English | MEDLINE | ID: mdl-34013590

ABSTRACT

The International Working Group for Patients' Right to Nutritional Care presents its position paper regarding nutritional care as a human right intrinsically linked to the right to food and the right to health. All people should have access to food and evidence-based medical nutrition therapy including artificial nutrition and hydration. In this regard, the hospitalized malnourished ill should mandatorily have access to screening, diagnosis, nutritional assessment, with optimal and timely nutritional therapy in order to overcome malnutrition associated morbidity and mortality, while reducing the rates of disease-related malnutrition. This right does not imply there is an obligation to feed all patients at any stage of life and at any cost. On the contrary, this right implies, from an ethical point of view, that the best decision for the patient must be taken and this may include, under certain circumstances, the decision not to feed. Application of the human rights-based approach to the field of clinical nutrition will contribute to the construction of a moral, political, and legal focus to the concept of nutritional care. Moreover, it will be the cornerstone to the rationale of political and legal instruments in the field of clinical nutrition.


Subject(s)
Malnutrition , Nutrition Therapy , Human Rights , Humans , Malnutrition/diagnosis , Malnutrition/etiology , Malnutrition/prevention & control , Nutrition Assessment , Nutritional Support
19.
Clin Nutr ; 40(6): 4029-4036, 2021 06.
Article in English | MEDLINE | ID: mdl-34023070

ABSTRACT

The International Working Group for Patients' Right to Nutritional Care presents its position paper regarding nutritional care as a human right intrinsically linked to the right to food and the right to health. All people should have access to food and evidence-based medical nutrition therapy including artificial nutrition and hydration. In this regard, the hospitalized malnourished ill should mandatorily have access to screening, diagnosis, nutritional assessment, with optimal and timely nutritional therapy in order to overcome malnutrition associated morbidity and mortality, while reducing the rates of disease-related malnutrition. This right does not imply there is an obligation to feed all patients at any stage of life and at any cost. On the contrary, this right implies, from an ethical point of view, that the best decision for the patient must be taken and this may include, under certain circumstances, the decision not to feed. Application of the human rights-based approach to the field of clinical nutrition will contribute to the construction of a moral, political and legal focus to the concept of nutritional care. Moreover, it will be the cornerstone to the rationale of political and legal instruments in the field of clinical nutrition.


Subject(s)
Human Rights , Malnutrition , Nutrition Therapy/ethics , Patient Rights , Right to Health , Health Services Accessibility/ethics , Humans
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