Survival of patients with advanced cancer in Enteral Nutritional Therapy: a comparison between caloric estimates / Sobrevida de pacientes com câncer avançado em Terapia Nutricional Enteral: um comparativo entre estimativas calóricas

ABSTRACT Objective To assess factors related to the achievement of the caloric estimates of enteral nutritional therapy and the survival of patients with advanced cancer in exclusively palliative care. Methods Retrospective study, where patients using enteral nutrition admitted from March 2019 to February 2020 were divided into two groups: Group 1 included patients who reached 75% of the estimated caloric goals, and Group 2 included those who did not. The data were extracted from the patients' electronic medical records. Logistic regression analyzes were performed to assess associations between the studied sociodemographic, clinical, and nutritional variables, and the Kaplan-Meier curve and Cox regression were used to assess the survival of the groups. Results A total of 158 patients participated in the study, with a median age of 63 (IIQ: 55-70) years. 57% reached the caloric goal (Group 1). In the logistic regression, the functional capacity (OR: 5.82; CI: 2.28-14.84; p<0.001) and symptoms of nausea or vomiting (OR: 0.050; CI: 0.005-0.455; p=0.008) were independent variables for achieving the caloric goal. Cox regression showed Karnofsky Performance Status as an independent predictor for survival (HR: 1.85; CI: 1.13-3.04). Conclusion Patients with better functionality have longer survival and are potential candidates for reaching the caloric goals proposed by national and international guidelines for cancer patients.

RESUMO Objetivo Avaliar os fatores relacionados ao alcance das estimativas calóricas da terapia nutricional enteral e a sobrevida dos pacientes com câncer avançado em cuidados paliativos exclusivos. Métodos Estudo retrospectivo no qual pacientes em uso de nutrição enteral internados no período de março de 2019 a fevereiro de 2020 foram divididos em dois grupos: Grupo 1, composto por pacientes que atingiram 75% das metas calóricas estimadas, e Grupo 2, composto por aqueles que não atingiram. Os dados foram extraídos do prontuário eletrônico dos pacientes. Análises de regressão logística foram realizadas para avaliar associações entre as variáveis sociodemográficas, clínicas e nutricionais estudadas, e a curva de Kaplan-Meier e regressão de Cox foram usadas para avaliar a sobrevida dos grupos. Resultados Participaram do estudo 158 pacientes, com mediana de idade de 63 (IIQ:55-70) anos. Cinquenta e sete por cento dos pacientes atingiram a meta calórica (Grupo 1). Na regressão logística, a capacidade funcional (OR:5,82; IC: 2,28-14,84; p<0,001) e os sintomas náuseas ou vômitos (OR:0,050; IC:0,005-0,455; p=0,008) se mostraram variáveis independentes para o alcance da meta calórica. A regressão de Cox mostrou o Karnofsky Performance Status como preditor independente para sobrevida (HR: 1,85; IC: 1,13-3,04) Conclusão Pacientes com melhor funcionalidade possuem sobrevida maior e são potenciais candidatos ao alcance das metas calóricas propostas por diretrizes nacionais e internacionais para pacientes com câncer em terapia nutricional enteral.

Elderly patients on hemodialysis have worse dietary quality and higher consumption of ultraprocessed food than elderly without chronic kidney disease.

OBJECTIVES: The multiple dietary restrictions recommended to patients on hemodialysis (HD), coupled with conditions imposed by aging, may lead to poor dietary quality in these patients. The aim of this study was to investigate the dietary quality and consumption of ultraprocessed food by elderly patients on HD and those without chronic kidney disease (CKD). Additionally, diets on the day of dialysis and on nondialysis days were evaluated. METHODS: This was a cross-sectional study conducted with 153 noninstitutionalized elderly patients on HD (Elder-HD) and 47 non-CKD elderly (Elder-Healthy) aged ≥60 y. From a 3-d food record, the dietary quality was assessed using the Brazilian Healthy Eating Index Revised (BHEI-R) and the energy contribution of food-processing groups. RESULTS: Compared with the Elder-Healthy group, the Elder-HD group showed a lower total BHEI-R score (P < 0.05). On the weekdays, the Elder-HD group showed lower scores (P < 0.05) of whole fruit, dark green vegetables and legumes, meat, eggs, and legumes, whereas total cereals showed a higher score (P < 0.05). When furthering the analysis on the Elder-HD group, although the total BHEI-R score did not differ among the days assessed, the components whole fruit, dark green vegetables, and legumes had lower scores (P < 0.05) on the day of dialysis, and the opposite was observed for milk and dairy products. Moreover, the Elder-HD showed a higher (P < 0.05) contribution of processed and ultraprocessed foods and lower (P < 0.05) contribution of natural or minimally processed foods. CONCLUSION: The Elder-HD group showed poorer dietary quality and higher consumption of processed and ultraprocessed foods than the Elder-Healthy group. Moreover, when compared with the nondialysis day, these patients exhibited worse dietary quality, on the day of dialysis.