Prevalência de desnutrição em pacientes adultos que ingressam na emergência de um hospital público / Malnutrition prevalence in adult patients that entered in a public hospital emergency

Introdução: Visto que a desnutrição aumenta o risco de complicações adversas para os pacientes e acarreta custos excessivos para os sistemas de saúde, o rastreio de todos os pacientes na admissão ou no início do atendimento hospitalar, pode melhorar os resultados clínicos e reduzir assim os custos de saúde. Embora as repercussões no estado nutricional em pacientes hospitalizados sejam bem conhecidas há mais de 30 anos, ainda não há um consenso sobre a melhor forma ou instrumento para sua avaliação. Objetivo: Avaliar a prevalência de desnutrição em pacientes admitidos na Emergência de um Hospital Público a partir de diferentes ferramentas. Métodos: Estudo observacional transversal realizado com dados secundários obtidos de uma amostra de pacientes que participaram de estudo de coorte prospectivo sobre risco nutricional em pacientes admitidos na Emergência de um hospital público. A coleta de dados do estudo original foi realizada nas primeiras 48 horas após a admissão dos pacientes na Emergência e compreendeu avaliação sócio demográfica, clínica e nutricional. Foram utilizados os dados antropométricos, através da aferição do peso corporal e estatura para cálculo do índice de massa corporal, circunferência do braço e da panturrilha, além da avaliação subjetiva global para avaliação nutricional dos pacientes. Resultados: De acordo com a avaliação subjetiva global, a desnutrição moderada foi observada em 24,6% dos pacientes, enquanto que 8,4% dos pacientes foram classificados como desnutridos graves. De acordo com o percentual de adequação da circunferência do braço, dentre os pacientes com diagnóstico de desnutrição, a maioria apresentou desnutrição leve (17,4%), enquanto que 10,6% apresentaram desnutrição moderada e 4,3% desnutrição grave. Quando avaliados a partir do índice de massa corporal, 6,5% dos pacientes foram diagnosticados com desnutrição leve, 6,5% com desnutrição moderada e 0,7% com desnutrição grave. Discussão e Conclusão: A prevalência de desnutrição conforme grau de gravidade encontrada neste trabalho diagnosticada por diferentes métodos de avaliação do estado nutricional e a relação com variáveis como idade e motivo de internação dos pacientes mostram-se em consonância com os dados descritos na literatura. A prevalência de desnutrição avaliada através de quatro diferentes ferramentas se mostrou elevada, obtendo maior concordância no diagnóstico entre a avaliação subjetiva global e o percentual de adequação da circunferência do braço (AU)

Introduction: Since malnutrition increases the risk of adverse complications for the patients and entails expensive costs for the healthcare systems, to track all the patients at the moment of the admission or in the beginning of the hospital treatment, can improve the clinical results and decrease thus the health costs. Although the repercussions at the nutritional status in hospitalized patients are well known for more than 30 years, still there is not a consensus about the better way or instrument for its evaluation. Objective: To evaluate the malnutrition prevalence in admitted patients at the Emergency of a Public Hospital as from different tools. Methods: Cross-sectional observational study performed with secondary data obtained from a sample of patients that participated in a prospective cohort study about the nutritional risk in admitted patients at the Emergency of a public hospital. The data collection from the original study was performed in the first 48 hours after the patients admission at the Emergency and comprehended sociodemographic evaluation, clinical and nutritional. It was used the anthropometric data, trough body weight measurement and stature to calculate the body mass index, arm and calf circumference, in addition to the subjective global assessment for the patients nutritional evaluation. Results: According to the subjective global assessment, moderate malnutrition was observed in 24,6% of the patients, while 8,4% of the patients were classified as severe undernourished. According to the suitability percentage of arm circumference, among the patients with malnutrition diagnosis, the majority presented slight malnutrition (17,4%), while 10,6% presented moderate malnutrition and 4,3% severe malnutrition. When evaluated from the body mass index, 6,5% of the patients were diagnosed with slight malnutrition, 6,5% with moderate malnutrition and 0,7% with severe malnutrition. Discussion and Conclusion: The malnutrition prevalence according to the severity grade found in this study diagnosed by different methods of nutritional state evaluation and the relation with the variables as age and the patients hospitalization motive were shown in consonance with the data described in the literature. The malnutrition prevalence evaluated through four different tools showed elevated, obtaining greater agreement in diagnosis between the subjective global assessment and the suitability percentage of arm circumference (AU)

Positive association between waist-to-height ratio and hypertension in adolescents. / Associação positiva entre razão cintura-estatura e presença de hipertensão em adolescentes.

INTRODUCTION: The obesity and overweight epidemic, together with increasing cardiovascular disease, represent a major public health problem worldwide, and their occurrence in childhood and adolescence has increased in recent decades. The objective of this study was to assess the association between waist-to-height ratio (WHR) and the incidence of hypertension in adolescents. METHODS: We performed a cross-sectional study of adolescents aged 10-17 years of both sexes attending municipal schools in inland Rio Grande do Sul, Brazil. Using a secondary database, weight and height measurements, blood pressure, and waist circumference (WC) were analyzed and body mass index (BMI) and WHR were calculated. Blood pressure was classified according to the Brazilian hypertension guidelines, BMI according to the curves of the World Health Organization, and WC according to Taylor et al. The cutoff used for WHR was 0.50 for both sexes. RESULTS: Of the 1030 adolescents studied, 29.6% (305) presented overweight/obesity and 30.4% (313) had hypertension; 24% (247) had high WC and 18.3% (189) presented high WHR. Participants with WHR ≥0.50 were 2.4 times more likely to have hypertension than those with WHR <0.50 (OR 2.39; 95% CI 1.73-3.32; p<0.001). CONCLUSION: A positive association was found between WHR and the presence of hypertension in adolescents.

Lunch energy density and the metabolic syndrome in patients with type 2 diabetes mellitus.

The aim of the present study was to investigate the possible associations between dietary energy density (ED) and the metabolic syndrome (MetS) in patients with type 2 diabetes. In the present case-control study, the dietary ED of 125 patients with type 2 diabetes (seventy-eight with (cases) the MetS and forty-seven without (controls) the MetS; mean age 62·0 (SD 9·4) years, mean diabetes duration 12·5 (SD 8·4) years and mean glycated Hb 7·2 (SD 1·3) %) was assessed by weighed diet records. The MetS was defined according to the 2009 Joint Interim Statement and ED by the amount of energy (kJ) in a given weight of food. Data are expressed as means (standard deviations) or medians (interquartile ranges). Patients with the MetS reported lower intakes of total energy and fibre, and a higher total food amount than the controls; the total ED did not differ, but the cases had a higher ED at lunch (mean 6·3 (SD 1·3) v. 5·9 (SD 0·8) kJ/g; P= 0·017). In this meal, patients with the MetS had lower intakes of beans (median 0·7 (interquartile range 0·4-1·1) v. 1·1 (interquartile range 0·6-1·6) g/kg; P= 0·020), vegetables (median 1·2 (interquartile range 0·6-1·7) v. 1·4 (interquartile range 1·0-2·0) g/kg; P= 0·046) and total meat (median 1·3 (interquartile range 1·0-1·6) v. 1·4 (interquartile range 1·2-1·8) g/kg; P= 0·034) than patients without the MetS. The associations between lunch ED (kJ/g) and food groups (g/kg) were confirmed for vegetables (r - 0·584; P< 0·001), fruits (r - 0·233; P= 0·070), beans (r - 0·189; P= 0·037) and oils (r 0·323; P< 0·001). In a multivariate logistic regression model, a high lunch ED was associated with the MetS (OR 6·89, 95 % CI 1·35, 35·15; P =0·020) after adjusting for confounders. In conclusion, a high ED at lunch increased the odds of the presence of the MetS in patients with type 2 diabetes. Beans and vegetables may be the major contributors to this association and their consumption might be considered to decrease ED.