STRONGkids validation: tool accuracy / Validação do STRONGkids: acurácia do instrumento

Abstract Objective: Validate the accuracy of the Screening Tool for Risk on Nutritional status and Growth (STRONGkids) and estimate the prevalence of malnutrition and nutritional risk in hospitalized children. Methods: Cross-sectional study of a representative sample of children admitted to ten public pediatric emergency rooms. The sample was randomly estimated in stages, including children older than 30 days and younger than 10 years of age, of both sexes, excluding syndromic children and those in whom it was impossible to directly measure anthropometry. Weight, height, and arm circumference were measured, as well as the Z-scores of the anthropometric indices weight-for-age, height-for-age, weight-for-height, body mass index for age, and arm circumference for age, classified according to the reference curves of the World Health Organization. After the tool was applied, its accuracy tests were performed in comparison with the anthropometric data, with the evaluation of sensitivity, specificity, and positive and negative predictive values. Results: A total of 271 children were evaluated, 56.46% males and 41.70% younger than 2 years of age. The prevalence rates of malnutrition, nutritional risk assessed by anthropometric measurements, and nutritional risk assessed by the tool were 12.18%, 33.95%, and 78.60%, respectively. Accuracy showed sensitivity of 84.8%, specificity of 26.7%, positive predictive value of 49.8%, and negative predictive value of 67.2%, when the patients at nutritional risk were identified by anthropometry. Conclusion: Validation of the accuracy of STRONGkids was performed, showing high sensitivity, allowing the early identification of nutritional risk in similar populations.

Resumo Objetivo: Validar a acurácia do instrumento de triagem nutricional Screening Tool for Risk on Nutritional status and Growth (STRONGkids) e estimar as prevalências de desnutrição e risco nutricional em crianças hospitalizadas. Métodos: Estudo transversal, em amostra representativa de crianças admitidas em 10 prontos-socorros infantis públicos. A amostra foi estimada aleatoriamente, por etapas, foram incluídas crianças com idade superior a 30 dias e inferior a 10 anos, de ambos os sexos, e excluídas as sindrômicas e impossibilitadas de aferição direta da antropometria. Foram aferidos peso, estatura e circunferência do braço, calculados os Z-scores dos índices antropométricos peso para idade, estatura para idade, peso para estatura, índice de massa corporal para idade e circunferência do braço para idade, classificados de acordo com as curvas de referência da Organização Mundial da Saúde. Após a aplicação do instrumento foram realizados os testes de acurácia do instrumento em comparação a antropometria, foram avaliados sensibilidade, especificidade e valores preditivos positivo e negativo. Resultados: Foram avaliadas 271 crianças, 56,46% meninos e 41,70% menores de dois anos. As prevalências de desnutrição, risco nutricional pela antropometria e pelo instrumento foram de 12,18%, 33,95% e 78,60%, respectivamente. A acurácia mostrou 84,8% de sensibilidade, 26,7% de especificidade, 49,8% de valor preditivo positivo e 67,2%, negativo, quando identificados os pacientes em risco nutricional pela antropometria. Conclusão: A validação da acurácia do STRONGkids foi feita com verificação de alta sensibilidade, permitiu a identificação precoce de risco nutricional em populações semelhantes.

STRONGkids validation: tool accuracy.

OBJECTIVE: Validate the accuracy of the Screening Tool for Risk on Nutritional status and Growth (STRONGkids) and estimate the prevalence of malnutrition and nutritional risk in hospitalized children. METHODS: Cross-sectional study of a representative sample of children admitted to ten public pediatric emergency rooms. The sample was randomly estimated in stages, including children older than 30 days and younger than 10 years of age, of both sexes, excluding syndromic children and those in whom it was impossible to directly measure anthropometry. Weight, height, and arm circumference were measured, as well as the Z-scores of the anthropometric indices weight-for-age, height-for-age, weight-for-height, body mass index for age, and arm circumference for age, classified according to the reference curves of the World Health Organization. After the tool was applied, its accuracy tests were performed in comparison with the anthropometric data, with the evaluation of sensitivity, specificity, and positive and negative predictive values. RESULTS: A total of 271 children were evaluated, 56.46% males and 41.70% younger than 2 years of age. The prevalence rates of malnutrition, nutritional risk assessed by anthropometric measurements, and nutritional risk assessed by the tool were 12.18%, 33.95%, and 78.60%, respectively. Accuracy showed sensitivity of 84.8%, specificity of 26.7%, positive predictive value of 49.8%, and negative predictive value of 67.2%, when the patients at nutritional risk were identified by anthropometry. CONCLUSION: Validation of the accuracy of STRONGkids was performed, showing high sensitivity, allowing the early identification of nutritional risk in similar populations.

Assessment of Malnutrition Risk in Canadian Pediatric Hospitals: A Multicenter Prospective Cohort Study.

OBJECTIVE: To assess the prevalence, causes, and consequences of malnutrition, as well as the evolution of nutritional status, in Canadian pediatric health care institutions. STUDY DESIGN: In this multicenter prospective cohort study, a total of 371 patients were recruited from pediatric hospitals in 5 Canadian provinces. Subjects were aged 1 month to 18 years; admitted to a medical, surgical, or oncology ward; and had a planned hospital stay of >48 hours. Data on demographics, medical condition, anthropometric measures, and dietary intake were collected. The Screening Tool Risk on Nutritional Status and Growth (STRONGkids) and Subjective Global Nutritional Assessment (SGNA) were applied at admission. Malnutrition was defined as a weight-for-age, height-for-age, body mass index-for-age, or weight-for-length/height z score <-2 SD. RESULTS: Among 307 subjects (median age, 5.3 years; median length of stay, 5 days), 19.5% were malnourished on admission. Both STRONGkids and SGNA classifications were associated with baseline nutritional status. Mean weight-for-age z score was lower at discharge compared with admission (-0.14 vs -0.09; P < .01), and nearly one-half of all patients lost weight during their hospital stay. Only one-half of the children who were malnourished or screened as high risk of malnutrition were visited by a dietitian during their stay. The percentage of patients who lost weight during hospitalization was significantly greater in the group not visited by a dietitian (76.5 vs 23.5%; P < .01). CONCLUSION: Nutritional status deterioration and malnutrition are common in hospitalized Canadian children. Screening tools, anthropometric measurements, and dietitian consultation should be used to establish adequate nutritional support.

Nutrition screening in public hospital emergency rooms: Malnutrition Universal Screening Tool and Nutritional Risk Screening-2002 can be applied.

OBJECTIVE: To evaluate the agreement between two nutritional screening tools (Malnutrition Universal Screening Tool [MUST] and Nutritional Risk Screening-2002 [NRS-2002]) and Subjective Global Assessment (SGA) to identify nutritional risk in patients admitted to public emergency rooms. STUDY DESIGN: Cross-sectional study. METHODS: Patients aged ≥18 years who were admitted to an emergency room of a tertiary public hospital were evaluated. A nutritional risk assessment was performed in the first 48 h following hospital admission, through MUST, NRS-2002, and SGA. The Cohen's kappa coefficient was calculated. RESULTS: The study included 577 patients, with an average age of 53.9 ± 15.8 years; 56% of whom were women. Prevalence of nutritional risk was 35.3% and 28.5% according to MUST and NRS-2002, respectively, and malnutrition prevalence was equal to 32.9% according to SGA. The Cohen's kappa coefficient between SGA and MUST was 0.67 and between SGA and NRS-2002 was 0.62. CONCLUSION: MUST and NRS-2002 showed good agreement with SGA in identification of nutritional risk, suggesting that both tools have similar applicability for nutritional screening in adults or older patients admitted to public emergency rooms.

Evaluación nutricional en niños hospitalizados en un Servicio de Pediatría / Nutritional assessment in hospitalized children in a Paediatric service

Introducción: En niños hospitalizados la malnutrición está asociada a mayor morbimortalidad. Objetivo: Evaluar el estado nutricional de niños hospitalizados en el servicio de pediatría y su asociación con algunos factores. Pacientes y método: Estudio transversal retrospectivo. Se evaluaron menores de 17 años, hospitalizados entre noviembre de 2010 y abril de 2011. Se obtuvieron los datos demográficos, motivo de ingreso, exámenes (albuminemia, hemoglobina, hematocrito), estancia hospitalaria y antropometría. El diagnóstico nutricional se expresó en desviaciones estándar (DS) de peso para la talla según la OMS en menores de 5 años e índice de masa corporal (IMC) de acuerdo a CDC-NCH en los mayores. Se consideró una talla baja con un valor de T/E < -2 desviaciones estándar según el sexo. Resultados: Se evaluaron 365 niños, 201 hombres (55,1%), con una mediana de edad de 3,35 (RIC: 1,2-8,2) años. El principal motivo de ingreso fue por cardiopatías (30,4%). La estancia hospitalaria tuvo una mediana de 2,0 (RIC: 2,0-4,0) días. Se observó una desnutrición en el 3,3%; riesgo de desnutrición en un 8%; sobrepeso en un 15% y obesidad en un 10,9%. Se encontró una talla baja en un 12,9%. Las enfermedades cardiológicas fueron más frecuentes en los menores de 2 años, y las enfermedades neurológicas y gastrointestinales en niños mayores, mostrando una asociación significativa. Mediante regresión logística ordinal por cada año de edad, el ZP/T aumenta en un 6,9% (OR = 1,07). Los exámenes bioquímicos y el tiempo hospitalizado no se asociaron con el estado nutricional. Conclusiones: Se encontró un porcentaje importante de niños con riesgo de desnutrición. El exceso de peso observado fue similar a la población pediátrica chilena. La detección precoz de malnutrición permitiría una pronta intervención y seguimiento nutricional al alta.

Introduction: Malnutrition in hospitalized children is associated with increased morbidity and mortality. Objective: To determine the nutritional status in children admitted to the Hospital Clínico de la Universidad Católica de Chile. Patients and method: A retrospective, cross-sectional study was conducted on hospital patients less than 17 years old within the period from November 2010 to April 2011. A record was made of the demographic data, admission diagnosis, biochemistry results (albumin, haemoglobin, haematocrit), hospital stay, and anthropometry data. Nutritional diagnosis was expressed as standard deviation (SD) for weight-for-height (WFH) by WHO in children younger than 5 y, and body mass index (BMI) by CDC-NCHS in older children. Height-for-age (HFA) ≤ -2 SD indicated stunted growth. Results: A total of 365 children, including 201 boys (55.1%), were evaluated. The median age was 3.35 years (IQR: 1.2-8.2). The most frequent reason for admission was heart disease (30.4%). The median hospital stay was 2 days (IQR: 2.0-4.0). Undernutrition was observed in 3.3% of the children, 8% were nutritionally at risk, 15% were overweight, and 10.9% were obese. As regards HFA, short stature was reported in 12.9%. There was a significant relationship between lower age and heart disease, and higher age with gastrointestinal and neurological diseases. By ordinal logistic regression for each year of age, the weight/height ratio (ZP/T) increases by 6.9% (OR = 1.07). The biochemistry results (albumin, haemoglobin and haematocrit levels) were not associated with nutritional status. Conclusions: A high percentage of children at risk of undernutrition was found. The percentage overweight was similar to the general Chilean paediatric population. Early detection will allow an opportune intervention, and nutritional monitoring at discharge.

[Nutritional assessment in hospitalized children in a Paediatric service]. / Evaluación nutricional en niños hospitalizados en un Servicio de Pediatría.

INTRODUCTION: Malnutrition in hospitalized children is associated with increased morbidity and mortality. OBJECTIVE: To determine the nutritional status in children admitted to the Hospital Clínico de la Universidad Católica de Chile. PATIENTS AND METHOD: A retrospective, cross-sectional study was conducted on hospital patients less than 17 years old within the period from November 2010 to April 2011. A record was made of the demographic data, admission diagnosis, biochemistry results (albumin, haemoglobin, haematocrit), hospital stay, and anthropometry data. Nutritional diagnosis was expressed as standard deviation (SD) for weight-for-height (WFH) by WHO in children younger than 5 y, and body mass index (BMI) by CDC-NCHS in older children. Height-for-age (HFA) ≤-2SD indicated stunted growth. RESULTS: A total of 365 children, including 201 boys (55.1%), were evaluated. The median age was 3.35 years (IQR: 1.2-8.2). The most frequent reason for admission was heart disease (30.4%). The median hospital stay was 2 days (IQR: 2.0-4.0). Undernutrition was observed in 3.3% of the children, 8% were nutritionally at risk, 15% were overweight, and 10.9% were obese. As regards HFA, short stature was reported in 12.9%. There was a significant relationship between lower age and heart disease, and higher age with gastrointestinal and neurological diseases. By ordinal logistic regression for each year of age, the weight/height ratio (ZP/T) increases by 6.9% (OR=1.07). The biochemistry results (albumin, haemoglobin and haematocrit levels) were not associated with nutritional status. CONCLUSIONS: A high percentage of children at risk of undernutrition was found. The percentage overweight was similar to the general Chilean paediatric population. Early detection will allow an opportune intervention, and nutritional monitoring at discharge.

Desnutrición en pacientes adultos internados del Hospital Regional de Encarnación, Paraguay

Introducción la desnutrición hospitalaria es un problema de Salud Pública de alto impacto en todo el mundo, particularmente en Latinoamérica, genera mayor morbimortalidad, peor respuesta al tratamiento, mayor estancia y costo hospitalario. Es frecuentemente subestimada por el equipo de salud. Objetivo: determinar la desnutrición en pacientes adultos internados en el Servicio de Clínica Médica del Hospital Regional de Encarnación del 2014 al 2015. Métodos: estudio observacional, descriptivo, de corte transverso con componente analítico, realizado en 420 pacientes en quienes se realizó una valoración nutricional a través de indicadores bioquímicos y antropométricos al ingreso y al quinto día de internación se aplicó la escala de Valoración Global Subjetiva (VGS). Se comparó el estado nutricional mediante la VGS, índice de masa corporal (IMC) y la depleción de albúmina. Resultados: según el IMC al ingreso, sólo 6,67% presentaba desnutrición. Según la VGS al egreso, 51,2% presentaba con riesgo de malnutrición y 14,5% estaba con malnutrición grave. El 48,33% se encontraba con hipoalbuminemia 10 días). La tasa de letalidad fue 14% en los desnutridos. Conclusiones: la desnutrición hospitalaria es un hallazgo frecuente en la sala de internados con una letalidad considerable. Confiamos en que este trabajo, aparte de obtener una mejora en la asistencia sanitaria, facilitará la toma de conciencia por parte del personal médico y responsable de la Sanidad Pública, por la magnitud de las consecuencias derivadas de la desnutrición en los enfermos hospitalizados y al egreso.

Introduction: Hospital malnutrition is a Public Health problem of high impact worldwide, particularly in Latin America. It generates higher morbimortality, worst response to treatment, longer stay at hospitals and higher hospital cost. It is frequently underestimated by health teams. Objective: To determine the malnutrition in adult patients admitted to the Service of Medical Clinic of the Regional Hospital of Encarnación from 2014 to 2015. Methods: This was a cross-sectional descriptive observational study with an analytical component performed in 420 patients in whom a nutritional assessment was made using biochemical and anthropometric indicators at the admittance and at the fifth day of their stay. The nutritional state was compared using the Subjective Global Assessment (SGA), body mass index (BMI) and albumin depletion. Results: According to the BMI at admittance, only 6.67% of the patients had malnutrition while according to the SGA at discharge, 51.2% had malnutrition risk and 14.5% had severe malnutrition and 48.33% had hypoalbuminemia 10 days). Lethality rate was 14% in the malnourished patients. Conclusions: Hospital malnutrition is a frequent finding in hospitalization rooms with a considerable lethality. We believe that this work, apart from obtaining an improvement of health assistance, will facilitate the awareness of medical staff and people responsible of Public Health because of the magnitude derived from malnutrition in hospitalized patients and at discharge.

Evolución de la desnutrición hospitalaria / Progression of the in-hospital malnutrition

Introducción: la desnutrición hospitalaria se asocia a un incremento de la morbilidad y mortalidad que repercute en una peor calidad asistencial, con aumento de la tasa media de estadía y tasa de rehospitalización. Objetivo: evaluar la evolución de la desnutrición hospitalaria pediátrica usando como herramienta metodológica la Encuesta de Desnutrición Hospitalaria Pediátrica y la Encuesta de Riesgo Nutricional Pediátrico, en el Hospital Pediátrico Universitario Juan Manuel Márquez, durante los años 2008, 2010 y 2012. Métodos: se realizó un estudio descriptivo transversal en 3 oportunidades que involucró a todos los niños (edades entre 0,1 y 19 años), ingresados en el citado hospital. La muestra estuvo constituida por 157 niños en el estudio de 2008, 188 en el de 2010 y 158 en el de 2012. A todos se les practicó una evaluación antropométrica que incluyó la mensuración del peso y la longitud/talla. Al mismo tiempo, se aplicó la Encuesta de Riesgo Nutricional Pediátrico a todos los niños encuestados, para determinar el riesgo de desnutrición al momento del ingreso. Resultados: se observó un incremento de la desnutrición aguda (peso para la longitud/talla inferior al 3er. percentil) de 9,4 por ciento y de la crónica de 6,1 por ciento respectivamente, desde 2008 a 2012. La obesidad como figura de morbilidad nutricional se incrementó en un 3,1 por ciento en igual periodo. Existió una disminución del riesgo grave de desnutrición al ingreso de 6,0 por ciento, con un incremento del leve de 5,3 por ciento. Conclusiones: la desnutrición hospitalaria pediátrica continúa siendo un problema importante de salud, al que los administradores de salud deben prestarle especial atención, al mismo tiempo que incrementar el esfuerzo el Grupo de Apoyo Nutricional en relación con su función educativa, para mejorar las prestaciones de los servicios nutricionales(AU)

Introduction: in-hospital malnutrition is associated to increased morbidity and mortality that affect medical assistance quality, with higher average rates of hospital stay and readmission. Objective: to evaluate the progression of in-hospital pediatric malnutrition by using the methodological tool called Survey of In-hospital Pediatric Malnutrition and the Survey of Pediatric Nutritional Risk at Juan Manuel Marquez university pediatric hospital in 2008, 2010 and 2012. Methods: a cross-sectional descriptive study was conducted three times and involved all the children aged 0.1 to 19 years who were admitted to this hospital. The sample was made up of 157 children in the 2008, 188 in the 2010 and 158 in 2012 studies, respectively. Anthropometric assessments were made including weight and length/size measurement. At the same time, the Survey of Pediatric Nutritional Risk was applied to all the children to determine the risk of malnutrition at the time of admission. Results: there was an increase of acute malnutrition (weight for length/size lower than 3rd percentile) of 9.4 percent and of chronic malnutrition of 6.1 percent, from 2008 to 2012. Obesity, as marker of nutritional morbidity, increased by 3.1 percent in the same period. Severe malnutrition risk on admission was reduced by 6.0 percent whereas the mild risk increased by 5.3 percent. Conclusions: in-hospital pediatric malnutrition remains a significant health problem, so the health managers must pay a special attention to it. At the same time the Nutritional Support Group should increase its efforts for education in order to improve the nutritional services(AU)

Evolución de la desnutrición hospitalaria / Progression of the in-hospital malnutrition

INTRODUCCIÓN: la desnutrición hospitalaria se asocia a un incremento de la morbilidad y mortalidad que repercute en una peor calidad asistencial, con aumento de la tasa media de estadía y tasa de rehospitalización. OBJETIVO: evaluar la evolución de la desnutrición hospitalaria pediátrica usando como herramienta metodológica la Encuesta de Desnutrición Hospitalaria Pediátrica y la Encuesta de Riesgo Nutricional Pediátrico, en el Hospital Pediátrico Universitario "Juan Manuel Márquez", durante los años 2008, 2010 y 2012. MÉTODOS: se realizó un estudio descriptivo transversal en 3 oportunidades que involucró a todos los niños (edades entre 0,1 y 19 años), ingresados en el citado hospital. La muestra estuvo constituida por 157 niños en el estudio de 2008, 188 en el de 2010 y 158 en el de 2012. A todos se les practicó una evaluación antropométrica que incluyó la mensuración del peso y la longitud/talla. Al mismo tiempo, se aplicó la Encuesta de Riesgo Nutricional Pediátrico a todos los niños encuestados, para determinar el riesgo de desnutrición al momento del ingreso. RESULTADOS: se observó un incremento de la desnutrición aguda (peso para la longitud/talla inferior al 3er. percentil) de 9,4 % y de la crónica de 6,1 % respectivamente, desde 2008 a 2012. La obesidad como figura de morbilidad nutricional se incrementó en un 3,1 % en igual periodo. Existió una disminución del riesgo grave de desnutrición al ingreso de 6,0 %, con un incremento del leve de 5,3 %. CONCLUSIONES: la desnutrición hospitalaria pediátrica continúa siendo un problema importante de salud, al que los administradores de salud deben prestarle especial atención, al mismo tiempo que incrementar el esfuerzo el Grupo de Apoyo Nutricional en relación con su función educativa, para mejorar las prestaciones de los servicios nutricionales.

INTRODUCTION: in-hospital malnutrition is associated to increased morbidity and mortality that affect medical assistance quality, with higher average rates of hospital stay and readmission. OBJECTIVE: to evaluate the progression of in-hospital pediatric malnutrition by using the methodological tool called Survey of In-hospital Pediatric Malnutrition and the Survey of Pediatric Nutritional Risk at "Juan Manuel Marquez" university pediatric hospital in 2008, 2010 and 2012. METHODS: a cross-sectional descriptive study was conducted three times and involved all the children aged 0.1 to 19 years who were admitted to this hospital. The sample was made up of 157 children in the 2008, 188 in the 2010 and 158 in 2012 studies, respectively. Anthropometric assessments were made including weight and length/size measurement. At the same time, the Survey of Pediatric Nutritional Risk was applied to all the children to determine the risk of malnutrition at the time of admission. RESULTS: there was an increase of acute malnutrition (weight for length/size lower than 3rd percentile) of 9.4 % and of chronic malnutrition of 6.1 %, from 2008 to 2012. Obesity, as marker of nutritional morbidity, increased by 3.1 % in the same period. Severe malnutrition risk on admission was reduced by 6.0 % whereas the mild risk increased by 5.3 %. CONCLUSIONS: in-hospital pediatric malnutrition remains a significant health problem, so the health managers must pay a special attention to it. At the same time the Nutritional Support Group should increase its efforts for education in order to improve the nutritional services.

Clinical outcome of protein-energy malnourished patients in a Brazilian university hospital

Protein-energy malnutrition (PEM) is a treatable disease with high prevalence among hospitalized patients. It can cause significant increases in the duration of hospitalization and costs. PEM is especially important for health systems since malnourished patients present higher morbidity and mortality. The objective of the present study was to assess the evolution of nutritional status (NS) and the effect of malnutrition on clinical outcome of patients at a public university hospital of high complexity in Brazil. Patients hospitalized in internal medicine (n = 54), oncology (n = 43), and infectious diseases (n = 12) wards were included. NS was evaluated using subjective global assessment up to 48 h after admission, and thereafter at intervals of 4-6 days. On admission, patients (n = 109) were classified as well-nourished (n = 73), moderately malnourished or at risk of malnutrition (n = 28), and severely malnourished (n = 8). During hospitalization, malnutrition developed or worsened in 11 patients. Malnutrition was included in the clinical diagnosis of only 5/36 records (13.9% of the cases, P = 0.000). Nutritional therapy was administered to only 22/36 of the malnourished patients; however, unexpectedly, 6/73 well-nourished patients also received commercial enteral diets. Complications were diagnosed in 28/36 malnourished and 9/73 well-nourished patients (P = 0.000). Death occurred in 12/36 malnourished and 3/73 well-nourished patients (P = 0.001). A total of 24/36 malnourished patients were discharged regardless of NS. In summary, malnutrition remains a real problem, often unrecognized, unappreciated, and only sporadically treated, even though its effects can be detrimental to the clinical course and prognosis of patients. The amount of public and private funds unnecessarily dispersed because of hospital malnutrition is significant.

Avaliação e monitoramento do estado nutricional de pacientes hospitalizados: uma proposta apoiada na opinião da comunidade científica / Assessment and monitoring of the nutritional status of hospitalized patients: a proposal based on the opinion of the scientific community

OBJETIVO: A desnutrição pode afetar adversamente a evolução clínica de pacientes hospitalizados e aumentar o tempo de permanência hospitalar. O objetivo deste estudo foi certificar critérios para avaliação e acompanhamento do estado nutricional de pacientes hospitalizados aceitos pela comunidade de pesquisadores, docentes e profissionais da área de nutrição clínica. MÉTODOS: Com este propósito aplicou-se um questionário via Internet, à comunidade científica, cadastrada na Plataforma Lattes - sistema nacional de cadastro curricular unificado on-line -, para apoiar atividades de fomento de agencias federais e estaduais. O questionário é composto de recomendações acompanhadas por uma escala Likert e espaços para justificativas dos participantes em relação à opção de aceitação parcial ou discordância do procedimento proposto. Foi considerado aprovado o procedimento que teve concordância total ou parcial maior ou igual a 70,0 por cento. RESULTADOS: Responderam ao questionário 35,2 por cento dos profissionais contatados. A maioria (84,0 por cento) era professor universitário, sendo 62,0 por cento de universidade pública; 67,0 por cento eram doutores; 63,0 por cento tinha mais de 20 anos de formado; 74,0 por cento eram nutricionistas e 25,0 por cento médicos. Os procedimentos propostos versam sobre as seguintes necessidades: triagem para definição de complexidade da atenção nutricional, indicadores de avaliação e monitoramento nutricional durante a internação e equipamentos e protocolos para o atendimento nutricional. Todos os procedimentos foram aceitos pelos entrevistados. Foi proposto pelos autores um modelo de triagem para definição da complexidade do atendimento nutricional, considerando os procedimentos aceitos. CONCLUSÃO: A aceitação dos procedimentos propostos fortalece o reconhecimento da necessidade de implantação de padrões para a avaliação e monitoramento nutricional nas instituições hospitalares.

OBJECTIVE: Malnutrition can adversely affect the clinical course of hospitalized patients and increase the length of hospital stay. The objective of this study was to certify procedures for assessing and following the nutritional status of hospitalized patients accepted by the clinical nutrition research community, professors and professionals. METHODS: For this purpose, a questionnaire was administered via the Internet to the scientific community registered in the Lattes Platform - national system of online, unified curriculum database to support the activities of the state and federal research funding agencies. The questionnaire consists of recommendations together with a Likert scale and space for the participants to justify their reasons for partial acceptance or rejection of the procedure proposed. The procedure that obtained total agreement or partial agreement >70.0 percent was approved. RESULTS: Roughly one-third (35.2 percent) of the professionals who received the questionnaire answered it. Most of them (84.0 percent) were university professors; 62.0 percent were of public universities; 67.0 percent had a PhD; 63.0 percent had twenty years or more of professional experience; 74.0 percent were dietitians and 25.0 percent were physicians. The proposed procedures cover the following needs: screening for defining the complexity of nutritional care, indicators of nutritional assessment and monitoring during hospital stay and equipment and protocols for nutritional care. All the procedures were accepted by the interviewees. A screening model to define the complexity of nutritional care was proposed based on the accepted procedures. CONCLUSION: Acceptance of the proposed procedures strengthens the acknowledgement of the need to implement standards for nutritional assessment and monitoring in hospitals.

Malnutrición en pacientes con patología quirúrgica en cirugía general: Hospital de San José, marzo 2009 a agosto 2009 / Malnutrition in surgical patients at the general surgery department

Introducción: la malnutrición es un proceso mórbido serio con múltiples causas de índole clínica y socioeconómica. Tiene desenlaces desde el punto de vista de morbimortalidad, estancia hospitalaria prolongada así como de costos de atención en salud. Existen múltiples métodos directos e indirectos que pueden ser útiles en la detección temprana. La valoración global subjetiva (VGS) es uno simple y fácil de aplicar a los pacientes hospitalizados y es válida en la práctica clínica. Objetivo: determinar la frecuencia de malnutrición de los pacientes con patología quirúrgica hospitalizados en el servicio de cirugía general del Hospital de San José a través de la VGS. Métodos: se realizó un estudio descriptivo. Los criterios de inclusión fueron pacientes hospitalizados mayores de 18 años con una estancia mínima de 24 horas en el servicio de cirugía general, que no tuvieran asistencia del grupo de soporte nutricional, a los cuales se les aplicó la VGS. El análisis se realizó en STATA 10. Resultados: se estudiaron 281 casos. La frecuencia de malnutrición fue de 45,2%, siendo el 12,8% severa. La mediana de la edad fue 45 años. El 70% de los desnutridos tuvieron cirugía abdominal. La estancia fue más prolongada en los pacientes malnutridos. Conclusi ón: en este estudio se analizaron 281 pacientes durante seis meses, con una prevalencia de malnutrición del 45,2%, que es alta, pero se encuentra cerca de lo reportado en la literatura médica latinoamericana. La mayoría de los pacientes malnutridos fueron los posquirúrgicos dado por el aumento de su catabolismo.

Introduction: malnutrition is a serious morbid process caused by multiple clinical, social/economic factors. From the morbidity/ mortality point of view, it contributes to clinical outcomes, a longer hospital stay, as well as to health care costs. There are many direct and indirect useful methods for early detection. The Subjective Global Assessment (SGA) is a simple and easy method to apply on hospitalized patients and is valid in clinical practice. Objective: to determine the frequency of malnutrition on surgical patients hospitalized at the General Surgery Department at Hospital de San José using the SGA method. Methods: a descriptive study was performed. Inclusion criteria were: hospitalized patients, =18 years old, with at least a 24-hour hospital stay at the General Surgery Department, who did not receive assistance by the nutrition support group, who completed the SGA method survey. Data analysis was made by STATA 10. Results: 281 cases were studied. The frequency of malnutrition was 45.2%, and 12.8% were rated as severe. The mean age was 45 years. Seventy percent (70%) of malnourished patients had abdominal surgery. Hospital stay was longer in malnourished patients. Conclusion: 281 patients were analyzed during six months. The prevalence of malnutrition was 45.2%, which is high. However, this result is close to that reported in Latin American medical literature. Malnourishment resulting from increased catabolism was found mostly in post-operative patients.

Terapia nutricional enteral em pacientes oncológicos: uma revisão da literatura / Enteral nutrition therapy in oncology patients: a review of the literature

Objetivo: Avaliar o impacto da terapia nutricional enteral sobre o estado nutricional de pacientes oncológicos hospitalizados. Métodos: Pesquisa nas bases de dados Medline, Lilacs, NCBI, Capes, Scielo, Google scholar e Cochrane, com ênfase nos últimos 10 anos, nos idiomas inglês e português, referente à terapia nutricional enteral empacientes com câncer, utilizando-se os descritores: desnutrição hospitalar, estado nutricional, terapia nutricional enteral, anorexia-caquexia e câncer. Foram selecionados ensaios clínicos randomizados e controlados, seguidos de tratamento estatístico com significância de p ≤ 0,05. Resultados: Observou-se, por meio da literatura, que a terapia nutricional enteral, utilizada com o intuito de recuperar o estado nutricional de indivíduos debilitados, pode ser determinante na melhora do prognóstico de pacientes oncológicos hospitalizados, visto que a desnutrição é um achado comum, o que acarreta maior tempo de internação, maior incidência de complicações pré e pós-operatórias e elevada mortalidade. Conclusão: Os estudos analisados demonstraram que a terapia nutricional enteral é capaz de melhorar significativamente o estado nutricional de pacientes oncológicos e, conseqüentemente, o prognóstico dos mesmos.

Objective: To evaluate the impact of enteral nutrition therapy on the nutritional state of hospitalized cancer patients. Methods: Research in the Medline, Lilacs, NCBI, Capes, Scielo, Google scholar and Cochrane databases, with emphasis on the last 10 years, in English and Portuguese, on the enteral nutrition therapy in patients with cancer, by using the following descriptors: hospital malnutrition, nutritional state, enteral nutrition therapy, anorexia, cachexia and cancer. It selected randomized and controlled clinical experiments, followed by treatment with statistical significance of p ≤ 0.05. Results: We observed, through literature, that enteral nutrition therapy, used in order to recover the nutritional state of individuals debilitated, can be crucial on improving the prognostic of cancer patients hospitalized considering that malnutrition is a common finding, resulting in increased time of hospitalization, higher incidence of pre and postoperative complications and high mortality rates. Conclusion: Studies examined showed that enteral nutrition therapy is able to significantly improve the nutritional state of cancer patients and, therefore, their prognostic.