ABSTRACT
La incidencia de cáncer aumenta a medida que avanza la edad. Con el envejecimiento, y con una enfermedad crónica como el cáncer, crece la prevalencia de desnutrición relacionada con la enfermedad (DRE), de sarcopenia, de caquexia y de fragilidad. Estas se asocian a mortalidad, a toxicidad por tratamiento antineoplásico y a complicaciones posquirúrgicas. En este artículo se repasan, de forma diferencial en mayores, la prevalencia de DRE, sarcopenia y caquexia, la manera de diagnosticar estas situaciones en la clínica diaria, su fisiopatología, su relación con el pronóstico clínico y las evidencias sobre la eficacia del tratamiento médico nutricional y multimodal, con el ejercicio físico como principal aliado. Por el momento, son escasas las guías que se refieren únicamente al paciente mayor y, hasta que se generen más estudios en este grupo de enfermos, las actuaciones en materia de nutrición deberán basarse en las ya publicadas de forma general en oncología. Si el paciente mayor presenta desnutrición, y esta puede condicionar la calidad de vida o el pronóstico clínico, el tratamiento médico nutricional debe progresar, de forma individualizada, desde el consejo dietético hasta las formas más complejas de tratamiento como la suplementación oral, la nutrición enteral o la nutrición parenteral
The incidence of cancer increases as age progresses. With aging, and with a chronic disease such as cancer, the prevalence of disease-related malnutrition (DRE), sarcopenia, cachexia and frailty increases. These are associated with mortality, toxicity due to antineoplastic treatment and post-surgical complications. In this article, the prevalence of DRE, sarcopenia and cachexia, the way to diagnose these situations in the daily clinic, their pathophysiology, their relationship with clinical prognosis, and the evidence on the effectiveness of medical nutrition treatment and multimodal therapy, with physical exercise as the main ally, are reviewed differentially in older patients. At the moment, there are few guidelines that refer only to the elderly patient, and until more studies are generated in this group of patients, the actions, in matters of nutrition, should be based on those already published in general oncology. If the elderly patient has malnutrition, and this can condition quality of life or clinical prognosis, medical nutrition therapy should progress, individually, from dietary advice to more complex forms of treatment such as oral supplementation, enteral nutrition or parenteral nutrition
Subject(s)
Humans , Aged , Aged, 80 and over , Nutritive Value , Enteral Nutrition/methods , Parenteral Nutrition , Malnutrition/epidemiology , Chronic Disease/epidemiology , Neoplasms/epidemiology , Combined Modality Therapy , Quality of Life , Cachexia/epidemiology , Neoplasms/diagnosis , Frail ElderlyABSTRACT
BACKGROUND: Enteral nutrition (EN) is an effective nutritional intervention for patients at risk of malnutrition or malnourished. However, complications such as gastrointestinal intolerance, hyperglycemia or refeeding syndrome can be triggered by EN. AIM: To investigate the effects of a tube feeding formula (TFF) on patients' nutritional status, biochemical status, bowel habits and safety. METHODOLOGY: Observational, prospective and multicenter study. Patients ≥ 18 years, undernourished or at nutritional risk, who were prescribed a high-calorie, high-protein, fiber-fortified TFF were included. Patients were evaluated over a period of eight weeks (baseline [V1], four weeks [V2] and eight weeks [V3]). RESULTS: A statistically significant increase in weight (1.5 kg), body mass index (0.6 kg/m2) and nutritional intake (59.7 kcal/day) was observed between V1 and V2. Between V1 and V3, there was a statistically significant decrease in the percentage of individuals with abnormal biochemical markers for glucose, potassium, total protein and albumin. The number of patients' bowel movements remained stable throughout the study with a mean of 1.1 daily bowel movements. CONCLUSION: The TFF was safe and well tolerated, improving patients' nutritional status without altering patients' bowel habits.
Subject(s)
Dietary Fiber , Energy Intake , Enteral Nutrition/methods , Food, Formulated , Aged , Aged, 80 and over , Defecation , Enteral Nutrition/adverse effects , Female , Food, Formulated/adverse effects , Humans , Male , Nutritional Status , Oligosaccharides , Prospective Studies , SpainABSTRACT
La desnutrición calórico-proteica es frecuente en el anciano hospitalizado. La presencia de este diagnóstico condiciona el pronóstico clínico, así que su detección y tratamiento parecen prioritarios en el plan terapéutico del paciente. Todos los hospitales deberían implantar sistemas de cribado sistemático de desnutrición asociado a un plan de cuidados. Algunas estrategias útiles para mejorar la situación nutricional del anciano son: la modificación de la dieta hospitalaria, incluidas las comidas de alta densidad calórico-proteica, y la utilización de medidas de soporte nutricional, como el suplemento oral o enteral, la nutrición enteral y la nutrición parenteral. En el artículo se repasa desde la evidencia disponible hasta los beneficios que pueden esperarse de todas estas alternativas. Son necesarios más estudios de calidad para responder a los interrogantes del efecto sobre episodios importantes, como capacidad funcional y calidad de vida. Las evidencias en diagnósticos específicos llevan a concretar en mayor medida las ventajas atribuibles a cada posibilidad nutricional
Protein-caloric malnutrition is common in hospitalized elderly patients. The presence of this diagnosis affects clinical prognosis and consequently its detection and treatment are a priority. All hospitals should implement systematic malnutrition screening systems associated with a care plan. Useful strategies to improve nutritional status in the elderly are modifying the hospital diet by including meals with a high protein-caloric density, and the use of nutritional support measures such as oral or enteral supplementation and enteral and parenteral nutrition. Based on the available evidence, the present article reviews the benefits that can be expected from all these alternatives. Further, high-quality studies are required to answer questions on the effect of these measures on significant events such as functional capacity and quality of life. The evidence on specific diagnoses allows the advantages of each nutritional modality to be evaluated more precisely