Mid-arm muscle circumference cutoff points in patients with cirrhosis: Low muscle mass related to malnutrition predicts mortality.

OBJECTIVES: Muscle loss is one of the phenotypic criteria of malnutrition, is highly prevalent in patients with cirrhosis, and is associated with adverse outcomes. Mid-arm muscle circumference (MAMC) estimates the skeletal muscle mass and is especially helpful in cases of fluid overload. This study aimed to propose MAMC cutoff points for patients with cirrhosis and demonstrate its association with 1-year mortality. METHODS: This is an analysis of cohort databases from five reference centers in Brazil that included inpatients and outpatients with cirrhosis aged ≥18 y. The nutritional variables obtained were the MAMC (n = 1075) and the subjective global assessment (n = 629). We established the MAMC cutoff points stratified by sex based on the subjective global assessment as a reference standard for malnutrition diagnosis, considering the sensitivity, specificity, and Youden index. An adjusted Cox regression model was used to test the association of MAMC cutoff points and 1-year mortality. RESULTS: We included 1075 patients with cirrhosis, with a mean age of 54.8 ± 11.3 y; 70.4% (n = 757) male. Most patients had alcoholic cirrhosis (47.1%, n = 506) and were classified as Child-Pugh B (44.7%, n = 480). The MAMC cutoff points for moderate and severe depletion were ≤21.5 cm and ≤24.2 cm; ≤20.9 cm and ≤22.9 cm for women and men, respectively. According to these cutoff points, 13.8% (n = 148) and 35.1% (n = 377) of the patients had moderate or severe MAMC depletion, respectively. The 1-year mortality rate was 17.3% (n = 186). In the multivariate analysis adjusted for sex, age, MELD-Na, and Child-Pugh scores, a severe depletion in MAMC was an independent increased risk factor for 1-year mortality (HR: 1.71, 95% CI: 1.24-2.35, P < 0.001). Each increase of 1 cm in MAMC values was associated with an 11% reduction in 1-year mortality risk (HR: 0.89, 95% CI: 0.85-0.94, P < 0.001). CONCLUSIONS: Low MAMC classified according to the new cutoff points predicts mortality risk in patients with cirrhosis and could be used in clinical practice.

Nonalcoholic fatty liver disease in adolescents with phenylketonuria

Abstract Objective: This study aimed to investigate non-alcoholic fatty liver disease (NAFLD) occurrence and factors associated with the disease in phenylketonuria (PKU) patients undergoing exclusive dietary treatment. Method: This cross-sectional study included 101 adolescents 10 to < 20 years of age with PKU, who were undergoing exclusive dietary treatment and monitored since early diagnosis at a single reference service. Anthropometric and biochemical assessments were performed and food intake was documented, and an ultrasound diagnosis of NAFLD was established. Data were evaluated using the Student's t-test for continuous variables, the chi-square for categorical variables, and logistic regression using the Wald chi-squared test; differences with p < 0.05 were considered to be statistically significant. Results: NAFLD was detected in 26 (25.7%) teenagers. There was no difference in prevalence between the sexes or nutritional status. The final logistic regression model revealed low sensitivity (26.1%) and high specificity (94.7%). The specificity suggested a lower likelihood of NAFLD in older adolescents, in the presence of normal or high levels of alkaline phosphatase, lower carbohydrate intake, and adequate protein and lipid intake. Conclusions: The prevalence of NAFLD in adolescents with PKU was higher than that found in healthy Brazilian adolescents and similar to that found in obese Brazilian children, suggesting a higher risk for NAFLD in patients with PKU treated exclusively by dietary modification.

Constipation in patients with myofascial pain syndrome as important aspect for clinical and nutritional treatment: A case-control study / Constipação em pacientes com síndrome dolorosa miofascial como importante aspecto para o tratamento clínico e nutricional: um estudo caso-controle

ABSTRACT Objective To identify the occurrence of constipation in patients with myofascial pain syndrome and to correlate these disorders with the clinical and nutritional variables. Methods This report describes a case-control study performed with 98 adults of both sexs, including 49 patients and 49 individuals without pain. The intensity of the reported pain was evaluated using the Pain Visual Analog Scale, which provided a simple and efficient measurement of pain intensity consisting of a 10cm horizontal line with the ends marked "absence of pain" and "worst possible pain". The occurrence of constipation was evaluated using the Rome III criteria. A multivariate linear regression was proposed to investigate risk factors between the frequency of bowel movements per week and independent variables this study. Results The mean ages of the patients and controls were 45.9 (7.6) years and 41.2 (12.2) years, respectively. The intensity of the reported pain showed a mean of 7.3 (1.6) points. The likelihood of exhibiting constipation was 4.5 times higher in the patients than in the controls (p=0.001). The number of stools per week was negatively correlated with the intensity of the reported pain (r=-0.613, p<0.001). The use of benzodiazepines was negatively correlated with the frequency of bowel movements per week, while the use of muscle relaxants appeared to increase the frequency of defecation when combined with the use of benzodiazepines and adjusted for the intake of fiber, water and sexs (p=0.037). Conclusion Constipation was a frequent nosological entity in this patient population and the persistence of a change in intestinal motility showed a significant correlation with the pain intensity and low water intake. The reduction of the number of stools per week seems to be associated with the use of benzodiazepines.

RESUMO Objetivo Identificar a ocorrência de constipação em pacientes com síndrome dolorosa miofascial e correlacionar essa desordem da motilidade intestinal com variáveis clínicas e nutricionais. Métodos Trata-se de um estudo de caso-controle, realizado com 98 indivíduos adultos de ambos os sexos, sendo 49 pacientes e 49 indivíduos sem dor. A intensidade da dor foi avaliada usando a Escala Visual Analógica de Dor, que forneceu uma medida simples e eficaz de intensidade da dor, e consiste em uma linha horizontal de 10cm com as extremidades marcadas "ausência de dor" e "pior dor possível". A ocorrência de constipação foi avaliada utilizando os critérios de Roma III. Uma regressão linear multivariada foi proposta para investigar fatores de risco entre a frequência de dejeções por semana e demais variáveis independentes do estudo. Resultados A média da idade dos pacientes e controles foi de 45,9 anos ± 7,6 DP e 41,2 anos ± 12,2 DP, respectivamente. A intensidade da dor referida mostrou uma média de 7,3 pontos ± 1,6 DP. A probabilidade de exibir a constipação foi 4,5 vezes maior nos pacientes com dor miofascial que nos indivíduos do grupo controle (p=0,001). A frequência de dejeções semanais relatada pelos pacientes apresentou correlação negativa com a intensidade da dor (r=-0,613, p<0,001). O uso de benzodiazepínicos foi negativamente correlacionado com a frequência de dejeções por semana, enquanto que o uso de relaxantes musculares aumentou a frequência de dejeções quando combinado com o uso de benzodiazepínicos, e ajustado pela ingestão de fibras, água e sexo (p=0.037). Conclusão A constipação foi uma entidade nosológica frequente no grupo de pacientes com dor miofascial. A alteração na motilidade intestinal mostrou uma correlação significativa com a intensidade da dor e a baixa ingestão hídrica. A redução do número de dejeções por semana parece estar associada ao uso de benzodiazepínicos.

Selenium and Zinc Status in Chronic Myofascial Pain: Serum and Erythrocyte Concentrations and Food Intake.

INTRODUCTION: Nutritional disorders have been reported to be important causal factors that can intensify or cause a painful response in individuals with chronic musculoskeletal pain. AIM: To assess the habitual intake of and the serum and erythrocyte levels of selenium and zinc in patients with chronic myofascial pain. MATERIALS AND METHODS: A case-control study of 31 patients with chronic myofascial pain (group I) and 31 subjects without pain (group II). Dietary record in five days for assessing food intake were used. The serum and erythrocyte concentrations of selenium and zinc were analyzed using an atomic absorption spectrophotometry. Pain intensity was assessed using a visual analog scale. RESULTS: The group of patients with chronic myofascial pain, compared with the control group, showed a lower erythrocyte concentration of selenium (79.46 ± 19.79 µg/L vs. 90.80 ± 23.12 µg/L; p = 0.041) and zinc (30.56 ± 7.74 µgZn/gHb vs. 38.48 ± 14.86 µgZn/gHb, respectively; p = 0.004). In this study, a compromised food intake of zinc was observed in the majority of the subjects in both groups. The selenium intake was considered to be safe in 80% of the subjects in both groups; however, the likelihood of inadequate intake of this mineral was twice as high in group I (49.5% vs. 24.4%, respectively). In the logistic regression analysis, the erythrocyte concentration of zinc was associated with the presence of pain. In each additional 1 mg of Zn2+ per gram of hemoglobin, a reduction of 12.5% was observed in the risk of the individual having chronic myofascial pain (B = -0.133; adjusted OR = 0.875, 95% CI = 0.803 to 0.954, Wald = 9.187, standard error = 0.044, p = 0.002). Physical inactivity and obesity were noted more commonly in group I compared with the control group. CONCLUSION: In this study, patients with chronic myofascial pain showed lower intracellular stores of zinc and selenium and inadequate food intake of these nutrients.

Uso de terapêutica com ácidos graxos ômega-3 em pacientes com dor crônica e sintomas ansiosos e depressivos / Therapy with omega-3 fatty acids for patients with chronic pain and anxious and depressive symptoms

JUSTIFICATIVA E OBJETIVOS: Desordens ansiosas e depressivas muitas vezes ocorrem simultaneamente com condições dolorosas crônicas e são associadas à uma gama de desfechos negativos. Apesar desta associação, tanto a dor quanto essas desordens são frequentemente tratadas de forma inadequada, causando incapacidade laboral, redução da saúde, da qualidade de vida e aumento dos custos com a saúde. Foi realizada uma revisão das ações terapêuticas dos ácidos graxos ômega-3 (w-3) no tratamento de pacientes com dor crônica que apresentam sintomas ansiosos e depressivos. CONTEÚDO: Estudos vêm demonstrando que sintomas ansiosos e depressivos contribuem para exacerbar o quadro álgico e que a presença de dor crônica contribui para o surgimento destes transtornos. É possível que o emprego de substâncias capazes de reduzir os sintomas álgicos possa aliviar os sintomas ansiosos e depressivos. O ácido graxo (w-3) pode atuar na neuroproteção e estabilização do humor, e na redução do estado inflamatório, comum na dor crônica. Ensaios clínicos evidenciaram a eficácia do ácido graxo em pacientes com sintomas ansiosos e depressivos, e com dor crônica. CONCLUSÃO: A suplementação com ácidos graxos w-3 em pacientes com dor crônica que apresentam sintomas ansiosos e depressivos pode ser uma estratégia efetiva tanto para a melhoria destes sintomas quanto do quadro álgico.

BACKGROUND AND OBJECTIVES: Anxious and depressive disorders very often follow with chronic painful conditions and are associated to a range of negative outcomes. In spite of this association, both pain and these disorders are often inadequately managed, leading to labor incapacity, worsening of health and quality of life and increased health costs. A review was carried out of therapeutic actions of omega-3 (w-3) fatty acids to treat chronic pain patients with anxious and depressive symptoms. CONTENTS: Studies are showing that anxious and depressive symptoms contribute to worsen pain and that chronic pain contributes for such disorders. It is possible that substances able to decrease pain may also relieve anxious and depressive symptoms. Omega-3 fatty acids may act on neuroprotection and mood stabilization, and may even decrease the inflammatory status common in chronic pain. Clinical trials have shown the effectiveness of fatty acids in patients with anxious and depressive symptoms and chronic pain. CONCLUSION: Supplementation with w-3 fatty acids for chronic pain patients with anxious and depressive symptoms may be an effective strategy to improve both such symptoms and pain.

Reflexões sobre o adoecer e mudanças dietéticas durante a assistência nutricional em pacientes com hepatite C / Reflections about getting sick and dietetic changes during nutritional assistance with hepatitis C patients

Trata-se de investigar os significados atribuídos por pacientes portadores do vírus da hepatite C sobre a doença e o tratamento dietético. Para tanto, adota-se a metodologia da pesquisa qualitativa em que o sujeito interage com sua narrativa sobre o objeto de estudo e os pesquisadores analisam cuidadosamente seus enunciados. As acepções sobre o adoecer e as mudanças dos hábitos alimentares e de vida dos pacientes foram analisadas por meio da obtenção de entrevistas em profundidade. Ao trazer os sentidos expressos sobre a doença, cria-se a possibilidade de compreensão dos aspectos culturais sobre a alimentação, a nutrição e a dietética; um desafio para os profissionais de saúde e nutrição, que precisam relatar a seus pacientes a necessidade de seguir hábitos alimentares mais saudáveis, implicando alterações nem sempre simples de serem realizadas. Consideram-se hábitos e representações do ato da alimentação, como parte da identidade cultural do sujeito. Justifica-se este estudo pela necessidade de situar maior interação entre profissionais, estudantes de saúde e pacientes de modo a ampliar a compreensão dos fenômenos que cercam a experiência da doença pelos pacientes. Conclui-se que os pacientes de hepatite C atendidos no ambulatório do Hospital Universitário da cidade de Salvador e o profissional podem atingir os objetivos de aconselhamentos nutricionais, se trilharem direções dialógicas. Com isso, observou-se a adesão à orientação dietética sem rupturas bruscas e sofrimentos dos pacientes.

This paper investigates the meanings attributed by patients to hepatitis C on disease and dietary treatment. To this end, we adopt the methodology of qualitative research in which the individual interacts with his narrative on the subject of study and the researchers carefully examine their statements. The meanings of the illness and changes in dietary habits and life of the patients were analyzed by obtaining in-depth interviews. By bringing the senses expressed about the disease, it creates the possibility of understanding cultural factors on diet, nutrition and dietetics - a challenge for health professionals and nutrition, which need to report their patients the need to follow dietary healthier, involving changes not always simple to perform. Habits and representations of the act of feeding are considered part of the cultural identity of the subject. This study is justified by the need to place greater interaction among professionals, students, patients and health so as to broaden the understanding of the phenomena that surround the experience of illness by patients. We conclude that outpatients with hepatitis C at the University Hospital in the city of Salvador and the professional can achieve the goals of nutritional advice, if they follow dialogic lines. Thus, there was compliance with dietary counseling without sudden breaks and suffering of patients.

Perfil de utilización de medicamentos administrados por sonda enteral en el hospital universitario / Profile of the use of drugs administered via enteral feeding tube in a university hospital

The objective of this study was to evaluate the conditions of use of medicines in patients receiving enteral nutrition at units of University Hospital. The data collection was done using a structured questionnaire, based on patient's clinical files and observation of the nurse aides' routine in the period between January and April of 2009. Results demonstrated that 16.7 percent of the patients needed a feeding tube replacement because of obstructions. Approximately 52 percent of prescribed medicines were in solid form and at least eight medicines administered via feeding tube were recognized to be capable of drug-nutrient interaction in enteral feeding and affected at least one patient each. A conclusion can be drawn that there were prescription errors and inadequacy in techniques of administration of medicines to patients using probes of enteral nutrition.

El presente estudio tuvo como objetivo describir el perfil general de utilización de fármacos en pacientes que usan una sonda de nutrición enteral en un hospital universitario. La recolección de información fue hecha por medio de un formulario estructurado a partir de las fichas clínicas de pacientes internados en el hospital y de la observación de la rutina de los auxiliares de enfermería, en el periodo de enero a abril de 2009. Los resultados demuestran que 16,7 por ciento de los pacientes necesitaron cambio de catéter para nutrición enteral, debido a obstrucción. Aproximadamente 52,0 por ciento de los medicamentos prescritos estaban en la forma farmacéutica sólida y por lo menos ocho medicamentos administrados por sonda fueron reconocidos como capaces de provocar interacción fármaco-nutrición enteral, afectando por lo menos a un paciente. Se concluye que hay errores en la medicación y en las técnicas de administración de medicamentos para la sonda enteral.