Variables de la desnutrición en pacientes en diálisis / Variables of malnutrition in dialysis patients

Introducción: El paciente en diálisis va a sufrir una desnutrición proteico-calórica, con diferentes factores implicados en su aparición, lo cual se asocia con una elevadísima morbilidad cardiovascular y mortalidad. Se ha estimado una prevalencia de desnutrición en la población en hemodiálisis del 18-75%, siendo por tanto, un problema de especial relevancia en este tipo de pacientes. Objetivo: Realizar una revisión bibliográfica de los artículos científicos existentes sobre las variables que intervienen en la desnutrición del paciente en diálisis. Metodología: Se ha realizado una revisión bibliográfica mediante las bases de datos PubMed, Scielo, Pro-Quest. La búsqueda se ha realizado con términos Mesh, con una antigüedad no mayor de 5 años y con distintas palabras clave. Resultados: Se han revisado 19 artículos. La mayoría de los artículos fueron estudios observacionales y de revisión. Los factores que se asocian con desnutrición son la edad, pérdida de masa muscular, baja actividad física y dieta pobre en micronutrientes. Otro factor muy importante, es la inflamación. En cuanto a los métodos diagnósticos, son variados y diferentes, debido a la gran cantidad de variables que influyen en la desnutrición. Conclusiones: La desnutrición en pacientes en diálisis depende de distintas variables y no solamente de la dieta. Los factores que se asocian con desnutrición son mayor edad, pérdida de masa muscular, baja actividad física y dieta pobre en micronutrientes. Además, habría que añadir el doble papel que juega la inflamación en este proceso, pues puede ser tanto consecuencia como factor predisponente a la desnutrición (AU)

Introduction: The patient on dialysis will suffer from protein-caloric malnutrition, with different factors involved in its onset, which is associated with very high cardiovascular morbidity and mortality. A prevalence of malnutrition in the hemodialysis population of 18- 75% has been estimated, being therefore a problem of special relevance in this type of patients. Objective: A literature review of the existing scientific articles on the variables involved in malnutrition of patients on dialysis was carried out. Methods: A bibliographic review has been done using the PubMed, Scielo, ProQuest databases. The search used Mesh terms, with an age of no more than 5 years and with different keywords. Results: Nineteen articles were reviewed. Most articles were observational and review studies. The factors that are associated with malnutrition are age, loss of muscle mass, low physical activity and diet deficient in micronutrients. Another very important factor is inflammation. Regarding the diagnostic methods are varied and different, due to the large number of variables that influence malnutrition. Conclusions: Malnutrition in dialysis patients depends on different variables and not only on the diet. The factors that are associated with malnutrition are older age, loss of muscle mass, low physical activity and diet deficient in micronutrients. In addition, we should add the dual role of inflammation in this process as it can be both a consequence and a predisposing factor to malnutrition (AU)

[Treating the somatic complications of anorexia]. / Traiter les complications somatiques de l'anorexie.

Anorexia can cause serious somatic complications, linked to undernutrition or associated pathological behaviours. The care pathway drawn up by a multi-discipline team is a real therapeutic challenge. Oral nutritional supplements, enteral nutrition and parenteral nutrition are three possible forms of nutritional assistance.

[Between intent and inability-management of malnutrition on medical wards of a centre hospital in Switzerland: patients' experience and perceptions]. / Wollen und nicht können. Malnutritionsmanagement in medizinischen Kliniken eines schweizerischen Zentrumsspitals: Erleben und Sichtweisen von Patient(inn)en.

BACKGROUND: Malnutrition is a common phenomenon in acute care institutions accounting for many negative health consequences for the patient. In many hospitals, therefore, malnutrition risk screening and nutrition management programs were established; however, programs were commonly developed without integrating the patients' perspective. It is unknown if the program covers the patients' needs and if the interventions are worthwhile. AIM: Because patient experience is known solely from everyday conversations, the aim of the study was to explore affected patients' experience regarding nutrition management. METHOD: The study has a qualitative, inductive approach. From September 2011 till May 2012, seven women and one man were interviewed. To analyse the guided interviews, content analysis was used. RESULTS: The analysis shows that patients find themselves between 'to want but not be able to eat'. Patients at risk encounter barriers due to their physical condition, such as swallowing- and chewing pain, nausea and dysgeusia and barriers associated with the system when ordering meals, such as fixed mealtimes, a limited variety of the menu and non-tasting supplements. To overcome these barriers patients are left to develop self-management strategies and to be in charge of their nutrition. CONCLUSIONS: Therefore, targeted training for caregivers is a key, enabling them to support patients individually in their nutrition management. At the same time, institutional barriers must be removed.

Improving Nutrition in Mechanically Ventilated Patients.

BACKGROUND: Although proper diet has been found to play an important role in patient outcomes, studies have shown that intensive care unit patients often receive inadequate nutrition. Moreover, it has been found that critically ill patients who are mechanically ventilated regularly receive even less nutrition. Inadequate nutrition has been associated with impaired immune response, increased susceptibility to infection, poor wound healing, and neuromuscular impairment. These factors lead to prolonged dependence on ventilators, protracted length of stay, and increased morbidity and mortality. This study investigates the use of an enteral nutrition (EN) protocol and its ability to prompt earlier initiation of feedings and more complete nutrition in mechanically ventilated patients to minimize such complications. METHODS: In a sample of 51 mechanically ventilated patients admitted to an intensive care unit, percentage of prescribed calories received and percentage of feedings initiated with 24-48 hours of intubation were calculated before and after the initiation of an EN protocol. RESULTS: In the postintervention group (n = 18), 83.3% received EN with the first 24-48 hours after intubation, compared with 54.5% in the preintervention group (n = 33). In the postintervention group, 77.8% received at least 60% of their prescribed feeding goal compared with 63.6% of the preintervention group. CONCLUSION: Findings show that the use of an EN protocol when caring for mechanically ventilated patients leads to earlier initiation of feedings as well as more complete nutrition.

Valoración del estado nutricional y consumo alimentario de los pacientes en terapia renal sustitutiva mediante hemodiálisis / Assessment of nutritional status and food intake of patients in renal replacement therapy with hemodialysis

Introducción: La malnutrición proteico-energética es un hecho frecuente entre los pacientes en tratamiento sustitutivo renal con hemodiálisis y a ello contribuye, además de la propia técnica dialítica, la dieta inadecuada. Objetivos: Valorar la evolución del estado nutricional y la ingesta alimentaria de los pacientes de 3 unidades de hemodiálisis extrahospitalaria, tras una intervención enfermera educativa. Pacientes y métodos: Hemos realizado un estudio transversal en 66 pacientes de 3 unidades extrahospitalarias (44 hombres y 23 mujeres) con dosis de diálisis medida por KT/V > 1,3 .Se hizo una determinación del estado nutricional por métodos convencionales y del consumo alimentario mediante encuesta dietética, determinándose mediante soporte informático el índice de alimentación saludable, identificando los déficits y/o excesos de nutrientes en cada paciente. Se llevaron a cabo intervenciones educativas personalizadas dirigidas a corregir los excesos o déficits de nutrientes detectados en los pacientes, y se volvieron a hacer las mismas valoraciones a los seis meses. Resultados: La prevalencia de desnutrición es leve en el 41% de hombres y 43% de las mujeres y moderada en el 34% de los hombres y 21% de las mujeres. El índice de alimentación saludable era inadecuado en el 37,31% de los pacientes en el análisis basal y postintervención educativa paso al 18,8%. La ingesta media energética es elevada (1398.86 Kcal/paciente/día) con alto consumo de colesterol y déficit de aminoácidos. Se detectó un alto consumo de hidratos de carbono simples (> 20%) y un elevado uso de proteínas de origen animal. El contenido mineral y vitamínico de la dieta es muy deficiente, destacando el bajo consumo de Vitamina D (1.45±2.55 ng) y elevado de fósforo (1052.28±356.23 m/día). Conclusion: Tras una intervención educativa sobre nuestros pacientes, corrigiendo hábitos dietéticos no saludables, hemos conseguido mejorar su estado nutricional, reduciendo la prevalencia de desnutrición en nuestras unidades (AU)

Introduction: Protein-energy malnutrition is a common occurrence among patients on renal replacement therapy with hemodialysis and this in addition to the dialysis technique itself, improper diet contributes. Objective: Assess the evolution of nutritional status and food intake of patients from 3 outpatient hemodialysis units, after an educational nurse intervention. Methods: We conducted a cross-sectional study in 66 outpatient units from 3 patients (44 men and 23 women) with dialysis dose measured by Kt / V> 1.3. It was made a determination of nutritional status by conventional methods and food consumption by a diet questionnaire, determining by computer support the healthy eating index, identifying deficits and / or excess nutrients in each patient.Customized educational interventions designed to correct the excesses or deficiencies of nutrients detected in patients were carried out. The same assessments were made at six months. Results: The prevalence of malnutrition was mild in 41% of men and 43% of women and moderate in 34% of men and 21% of women. The healthy eating index was inadequate in 37.31% of patients at baseline but after the educational intervention was 18.8%. The average energy intake was high (1398.86 Kcal / patient / day) with high intake of cholesterol and amino acid deficiency. A high intake of simple carbohydrates (> 20%) and a high use of animal protein were detected. The mineral and vitamin content of the diet was very poor, highlighting the low consumption of vitamin D (1.45 ± 2.55 ng) and high phosphorus (1052.28 ± 356.23 m / day). Conclusion: After an educational intervention on our patients, correcting unhealthy dietary habits, we managed to improve their nutritional status, reducing the prevalence of malnutrition in our units (AU)

Weight reduction after severe brain injury: a challenge during the rehabilitation course.

BACKGROUND: There is a paucity of studies, which have described malnutrition in patients with acquired brain injury (ABI) across etiology. This study describes weight change, malnutrition, and potential associations in patients with ABI at a subacute inpatient rehabilitation hospital. METHOD: This is a descriptive cohort study. Ninety-eight patients were admitted in a 3-month period, of whom n = 76 met inclusion criteria. The Malnutrition Universal Screening Tool was used for categorizing patients according to risk of malnutrition. RESULTS: Patients had experienced weight loss of 5.59% ± 5.89% (p < .001) at admission at the rehabilitation hospital, and patients with traumatic brain injury had experienced a greater weight loss than patients with stroke (p < .01). Thirty percent of patients were at high risk for malnutrition, and 52% of these patients received enteral or parenteral nutrition at admission at the rehabilitation hospital. No association was found between risk of malnutrition and severity of injury, complications, functional outcome, or length of stay. CONCLUSION: RESULTS underline the importance that nurses, especially in acute care, adhere to clinical guidelines to minimize weight loss. Special attention should be on patients with traumatic brain injury. Weight gain in the following course of rehabilitation may facilitate positive rehabilitation outcomes.

[Comparison of the nutritional status of residents in shared-housing arrangements and nursing homes: a secondary data analysis]. / Vergleich der Ernährungssituation von Bewohnern ambulant betreuter Wohngemeinschaften und einer stationären Pflegeeinrichtung: Eine Sekundärdatenanalyse.

Malnutrition and weight loss are special challenges in the care of older people particularly with dementia. In Germany, shared-housing arrangements (SHA) for older care-dependent people evolved in the last years. SHA are an alternative to traditional nursing homes. Despite of the increase of SHA in number it remains unclear if this setting is especially beneficial in terms of (mal-)nutrition. Therefore the nutritional status of older people with and without dementia living in SHA and traditional nursing homes will be compared. From 2010 to 2011 data was collected in various SHA in Berlin and in a nursing home in Schkeuditz/Saxony using standardized face-to-face interviews with nurses. In addition to socio-demographic data the nutritional status using the Mini Nutritional Assessment (MNA) and the cognitive capacities usingthe Mini Mental State Examination (MMSE) were examined. In the secondary data analysis, data from 129 residents (60 residents from 29 SHA and 69 from a nursing home) were included in the analysis. The residents of both settings were mostly female (76.7%) and on average 80.4 years old and with a moderate to severe cognitive decline (MMSE: 13.2). The average MNA score of residents from both settings is 19.7, indicating a risk for malnutrition. Residents of SHA have a significantly higher (and therefore better) MNA score (21.2) on average than residents in the nursing home (18.3; t-Test p<0.001). The present study shows that residents in SHA show a better nutritional status than residents in the nursing home even when taking into account differences concerning age, gender, care dependency, a medical diagnosis of dementia and the MMSE. Further studies should evaluate the concept of food intake in both settings and evaluate differences.

[Calories, proteins - what does the intensive care patient need?]. / Kalorien, Proteine - was braucht der Intensivpatient?

It is increasingly recognized that the nutrition of critically ill patients is a highly complex activity with many unanswered questions. Much research has been performed showing that early enteral nutrition helps to avoid complications. In addition, it has already been shown that the calorie goal as the sole diet goal rather plays a minor role, if one pays attention to sufficient supply of proteins. The diet of the different patient groups with their very individual physiological conditions and their very different diseases are another difficile question in nutritional therapy. The question about the best access path currently appears clearly to be the way of enteral nutrition. Although there seems to be no clear advantage to the gastric or jejunal route, the gastric tube is apparently used more often in clinical practice due to the ease of placement. Reflux control is also currently controversially discussed. To assess the intestinal transport capacity, control of reflux is inevitable, but the amount of reflux that should be considered as cut-off criteria is still unclear. The field of immunonutrition or the substitution of selenium, glutamine, and other substances requires further research. The goal of this article is to provide the reader with a review of the current literature concerning nutritional needs of intensive care patients.