Nutritional factors and pressure injury risk in hospitalised patients post-stroke.

OBJECTIVE: This study aimed to analyse the nutritional factors and pressure injury (PI) risk in hospitalised patients post-stroke. METHOD: The research employed a descriptive observational method in which patients ≥18 years of age were followed for six days. Nutritional evaluation was based on anthropometric and dietary factors. The nutritional risk was assessed via anthropometric measurements, Braden nutrition subscale and daily dietary intake. PI risk was evaluated through the Braden Scale. The Wilcoxon test, paired t-test, and Kruskal-Wallis test were applied and corrected with Bonferroni correction or analysis of variance, followed by the post hoc Tukey test. RESULTS: During their hospital stays, the participating 59 patients had an increase in sensory perception (p=0.02) and nutrition (p=0.005) scores. It was observed that patients at high risk of PI did not meet daily nutritional recommendations for calories, proteins, carbohydrates, lipids and micronutrients (zinc, selenium and copper) compared with patients at low-to-moderate risk. Weight (p<0.001), body mass index (p<0.001), calf (p=0.01) and arm (p=0.04) circumferences, and subscapular (p=0.003) and triceps (p<0.001) skinfolds decreased during the six days of hospitalisation. CONCLUSION: From the findings of this study, it was concluded that nutritional factors, such as unmet recommended daily nutritional requirements of macronutrients and micronutrients, and nutritional status are associated with a higher risk of developing a PI.

Night fasting as an alternative to improve nutritional support and glycaemic control in hospitalised patients with exclusive enteral nutrition.

BACKGROUND: Enteral nutrition (EN) assists in the nutritional status of hospitalised patients unable to feed orally. The aim of this study was to determine which method-continuous EN or discontinuous EN, a diet in which the infusion is discontinued for 4h during the night,-is more effective in meeting nutrient recommendations and improving glycaemic control and biochemical parameters related to protein anabolism. METHODS: Patients were divided into two groups: discontinuous (EN administered in mL/h, 18h/day, 4-h night fasting) and continuous (EN administered in mL/h, 22h/day). All patients with EN receive the diet over a 22-h daily period, in which the diet is suspended for two hours/day for daily hospital routines such as bathing, and physiotherapy, and followed for seven days. Evaluated data: prescribed and administered volume, calories, protein, and fibre; capillary blood glucose; erythrogram; serum albumin. RESULTS: 52 patients were followed-up, with 23 (44.2%) in the discontinuous group and 29 (55.8%) in the continuous group. Compared with the continuous group, the discontinuous group received volumes closer to those prescribed, equal or higher calories, and more protein. The capillary glucose values were within the reference range in the discontinuous group, while the continuous group presented elevated values. Both groups presented hypoalbuminaemia, haemoglobin, and haematocrit below the reference values; however, in the discontinuous group, the serum albumin values improved during hospitalisation relative to the continuous. CONCLUSIONS: The method involving discontinuation of EN for 4h was more effective in meeting nutrient recommendations compared with the continuous method. Additionally, in the discontinuous group, we observed a better control of glycaemia when compared to that of the continuous group.

Low Food Consumption Interferes with the Nutritional Status of Surgical Patients with Neoplasia of the Gastrointestinal Tract.

Nutritional support strongly influence the nutritional status of the surgical neoplastic patients. This study aimed to evaluate the influence of food consumption on the perioperative nutritional status of hospitalized patients with neoplasia of the upper (UGIT) and lower (LGIT) gastrointestinal tract. METHOD: Observational, longitudinal, and prospective study. Data collected: food consumption, Subjective Global Assessment, anthropometry, laboratory tests. RESULTS: Eighty patients were followed up: 43 (54%) in the UGIT and 37 (46%) in the LGIT. The consumption in the perioperative period was lower than the usual consumption in the UGIT and LGIT groups, respectively, of energy (14.2 ± 6.5; 22.8 ± 11.2 Kcal/kg/d, p < 0.001; 13.6 ± 1.2; 19.0 ± 2.0 Kcal/kg/d; p = 0.014), protein (1.1 ± 0.7; 0.6 ± 0.3 g/kg/d, p < 0.001; 0.8 ± 0.1; 0.5 ± 0.1 g/kg/d; p = 0.058), selenium, zinc and copper. Most patients presented in the UGIT and LGIT groups, respectively, worsening malnutrition and muscle depletion according to the Subjective Global Assessment (61.9%; 51.4%) and hypoalbuminemia, mainly in the UGIT in the postoperative. CONCLUSION: Low food consumption during the perioperative period associated with prolongation of the postoperative fasting period worsens the nutritional status of patients undergoing surgery of the gastrointestinal tract for neoplasia, especially in the UGIT group.

Dysphagia, Immobility, and Diet Acceptance: Main Factors Associated with Increased Risk of Pressure Injury in Patients Hospitalized after Stroke.

OBJECTIVE: To determine the predisposing factors for PI in patients hospitalized after stroke. METHODS: This 7-day longitudinal study followed up with patients hospitalized after stroke. Assessments included mobility, nutrition, and the presence of dysphagia and anemia. The nutrition evaluation was based on anthropometric, biochemical, and dietary determinants. Pressure injury (PI) risk was assessed via the Braden Scale. Mann-Whitney and Kruskal-Wallis tests were applied. RESULTS: Patients who were bedridden showed a greater risk of PI development upon admission (P = .004) and 7 days later (P < .001) compared with patients who could ambulate. Patients who were not dysphagic presented a lower risk of PI development in relation to patients who were dysphagic on admission (P = .047) and 7 days later (P < .001). On admission, patients with good and average diet acceptance had a lower PI risk (P = .002; P = .034) compared with those with a low acceptance. Body mass index was lower in patients at a high risk of developing PI compared with those at moderate risk (P = .02). Hemoglobin and hematocrit were statistically lower among patients who were at high risk of PI compared with patients who were low risk. CONCLUSIONS: Predisposing factors such as immobility, dysphagia, low diet acceptance, nutrition risk, and anemia are associated with a greater risk of PI development.

Biochemical and nutritional profile of patients with exclusive enteral nutrition during hospitalization / Perfil bioquímico y nutricional de pacientes con nutrición enteral exclusiva durante hospitalización

BACKGROUND: Enteral nutrition therapy (ENT) is intended to restore the nutritional status of patients. OBJECTIVE: The objective of this study was to evaluate the biochemical and nutritional profile of hospitalized patients with exclusive enteral nutrition. METHODS: It is a longitudinal study, with a sample of 42 hospitalized young and elder adults, with exclusive ENT, for at least seven days. The patients were submitted to nutritional, anthropometric (Body Mass Index, corrected arm muscle area and arm muscle circumference) and biochemical evaluation as albumin, hemoglobin, C-reactive protein, vitamin C, Iron, Zinc and Copper serum. Results and DISCUSSION: It was observed that anthropometric parameters such as weight, BMI, muscle area and circumference increased during hospitalization time only in the elderly (P= 0.016; P=0.018; P = 0.021; P = 0.020). The percentage of adequacy in energy, protein and micronutrients with vitamin C, iron, zinc and copper were adequate during hospitalization for both age groups, according to the estimated average needs. Serum levels of these micronutrients were within normal values for both age groups, with the exception of zinc, which decreased during hospitalization in the elderly. This may be associated with the greater need for this mineral in this age group or with a implicate in its absorption. CONCLUSION: The ENT influence the weight and muscle mass gain in hospitalized elderly patients and, although the appropriate administration of micronutrients, the absorption of zinc was affected. Therefore, monitoring of enteral nutrition is essential in order to avoid worsening nutritional status during hospitalization

INTRODUCCIÓN: La terapia de nutrición enteral (TNE) tiene la finalidad de recuperar el estado nutricional de los pacientes. Objectivo: Se evaluó el perfil bioquímico y nutricional de pacientes hospitalizados con nutrición enteral exclusiva. MÉTODOS: Estudio longitudinal, con muestra compuesta por 42 adultos y ancianos hospitalizados, con TNE exclusiva, por lo menos siete días. Los pacientes fueron sometidos a evaluación nutricional, antropométrica (Índice de Masa Corporal, área muscular del brazo corregida y circunferencia del brazo) y bioquímica como albúmina, proteína C-reactiva, vitamina C, hierro zinc y cobre sérico. Resultados y DISCUSIÓN: Se observó que los parámetros antropométricos como el peso, IMC, área y circunferencia muscular del brazo aumentaron durante el tiempo de internación solo en los ancianos (P= 0.016; P=0.018; P = 0.021; P = 0.020). El porcentaje de adecuación de energía, proteica y micronutrientes como vitamina C, hierro, zinc y cobre fueron adecuados durante el tiempo de internación para ambos grupos de edad, de acuerdo con las necesidades medias estimadas. Los niveles séricos de estos micronutrientes se mantuvieron dentro de los valores normales para ambos grupos de edad, a excepción del zinc, que disminuyó durante la hospitalización en ancianos. Esto puede asociarse a la mayor necesidad de este mineral en este grupo de edad o a un deterioro en su absorción. CONCLUSIÓN: La TNE influye en el aumento de peso y la masa muscular en ancianos y, apesar de la administración adecuada de micronutrientes, se observó un deterioro en la absorción de zinc. Por lo tanto, el monitoreo de la nutrición enteral es esencial para evitar el empeoramiento del estado nutricional durante la hospitalización

Association of anemia and malnutrition in hospitalized patients with exclusive enteral nutrition.

INTRODUCTION: enteral nutrition therapy maintains and/or regains the nutritional status of the common patient in hospital settings, where anemia and malnutrition are food related and are very common diseases. OBJECTIVE: to determine and associate the presence of anemia and malnutrition in hospitalized patients with exclusive enteral nutrition. METHODS: a prospective, cross-sectional study with patients receiving exclusive enteral nutrition up to 72 hours after hospitalization. A nutritional evaluation was performed, consisting of anthropometric data, such as weight, circumferences, and skinfolds; dietary evaluation (data were collected through an electronic medical record) and biochemistry data (hemogram, albumin, C-reactive protein, capillary glucose monitoring). RESULTS: the population consists of 77 individuals. As the patients presented greater severity of anemia, corrected arm muscle area, calf circumference and serum albumin levels were reduced while C-reactive protein increased significantly (p < 0.05). In relation to the low weight classification according to the body mass index (BMI), it was observed that the anthropometric parameters such as corrected arm muscle area (R = 0.74, p < 0.001), adductor pollicis muscle thickness (R = 0.23, p = 0.046) and calf circumference (R = 0.81, p < 0.001) decreased as did biochemical parameters albumin (R = 0.26; p = 0.048) and capillary blood glucose (R = 0.34, p = 0.018). CONCLUSION: anemia has an important relation with anthropometric markers that evaluate the depletion of lean mass; the BMI has a strong association with all the anthropometric parameters evaluated, as well as the albumin and capillary blood glucose, except with the values of hemoglobin.