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      ¿Son las herramientas recomendadas por la ASPEN y la ESPEN equiparables en la valoración del estado nutricional? Translated title: Are the tools recommended by ASPEN and ESPEN comparable for assessing the nutritional status?

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          Abstract

          Introducción: No existe un método de valoración nutricional universalmente aceptado. Los expertos de ASPEN (2002) sugieren utilizar la valoración subjetiva global (VSG), mientras que los de ESPEN (2002) recomiendan el sistema NRS-2002. Objetivos y ámbito: Este estudio transversal tiene como objetivos: 1) conocer la prevalencia de malnutrición al ingreso hospitalario en un hospital terciario y 2) conocer el grado de asociación entre dos herramientas utilizadas para valorar el estado de nutrición: la VSG y el sistema NRS-2002. Material y métodos: Se estudian 135 pacientes (42,2 % mujeres y 58,8 % varones, edad 62,1 ± 14,5 años) en los tres primeros días del ingreso hospitalario, ingresados en camas de Medicina Interna y Cirugía. Se analizan diferentes variables del estado nutricional. Se compara las necesidades calóricas (Harris Benedict x factor de agresión) y la ingesta calórica del día anterior al ingreso, mediante recordatorio de 24 horas. Se calcula la prevalencia de malnutrición al ingreso con dos herramientas de screening: VSG y el sistema NRS-2002. Resultados: El 42,2 % de los pacientes reconocen haber perdido peso y el 39,3 % ingieren una dieta inferior a sus necesidades al ingreso en el hospital. Según el método utilizado de valoración nutricional, la prevalencia de malnutrición es del 40,7 y del 45,1/100 pacientes ingresados con el VSG y el NRS-2002, respectivamente. Existe una asociación significativa entre los resultados obtenidos con ambas herramientas (p = 0,000). Los niveles de albúmina sérica y linfocitos totales son inferiores en los pacientes malnutridos. Conclusiones: La prevalencia de malnutrición al ingreso hospitalario es elevada. Existe una asociación estrecha entre los resultados obtenidos con la VSG y el sistema NRS-2002. Aunque en la práctica clínica cualquiera de los dos métodos puede ser utilizado para valorar el estado de nutrición, consideramos que el sistema NRS-2002, aunque más complejo, es menos subjetivo.

          Translated abstract

          Introducion: There is no "gold standar" for identification of malnutrition. The ASPEN board of directors (2002) suggest the subjective global assessment (SGA) and ESPEN (2002) recommend the nutritional risk screening-2002 (NRS-2002) to detect the prevalence of malnutrition. Aims: This cross-sectional study aims 1) to assess the prevalence of malnutrition on admission and 2) to know association between two tools used to evaluate nutritional risk. Material and methods: 135 patients (42.2% women and 58.8% men, 62.1 ± 14.4 years) are studied at admission. Different parameters are assessed to evaluate nutritional state. Patient's energy requirements (Harris Benedict x Long's factor) and energy intake, calculated as 24 h-recall, are compared. The prevalence of malnutrition is assessed with two screening tools: SGA and NRS-2002. Results: 42.2% of the patients had lost more than 5% body weight and 39.3% had an intake lower than required at admission. The prevalence of malnutrition is 40.7 and 45.1/100 patients admitted at hospital, if SGA or NRS-2002 are used, respectivility. There is strong agreement between results of two nutritional assessment methods (p = 0.000). Serum albumin and protein concentrations and linfocytes count are less in the malnourished patients. Conclusions: The prevalence of malnutrition is elevated. In clinical practice, both methods could be used to identify patients at nutritional risk, but the NRS-2002 is a less subjective method.

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          Most cited references 23

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          Incidence of nutritional risk and causes of inadequate nutritional care in hospitals.

          Many patients in hospitals are undernourished and nutritional care is inadequate in most hospitals. The aim of this investigation was to gain insight into how this situation could be improved. Seven hundred and fifty randomly selected patients were screened at admission in three hospitals and surveyed during their entire hospitalization. Each time a patient was not treated according to a clearly defined nutritional standard, the nurse responsible for the patient was interviewed about possible reasons according to preformed questionnaires. The investigators found that 22% of the patients were nutritionally at-risk, and that only 25% of these patients received an adequate amount of energy and protein. The departments had only screened for nutritional problems in 60% of the cases. Only 47% of the patients, who the departments judged to be at-risk patients, had a nutrition plan worked out, and only about 30% of the at-risk patients were monitored by the departments by recording of dietary intake and/or body weight. The main causes for inadequate nutritional care were lack of instructions to deal with these problems, and lack of basic knowledge with respect to dietary requirements and practical aspects of the hospital's food provision. Patient-related aspects and the system of food provision also contributed, but only to a small degree. These findings form the basis of the strategy to improve nutritional care in these hospitals.
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            The methodology of nutritional screening and assessment tools.

            The aim of this paper was to give a critical appraisal of the methodology of nutritional screening and assessment tools. A literature search identified 44 tools. Each tool was assessed in relation to details of its application, method of derivation and evaluation of its performance. The findings indicate that tools were published with insufficient details regarding their intended use and method of derivation, and with an inadequate assessment of their effectiveness. An appraisal of these features judged that no one tool satisfied a set of criteria regarding scientific merit. There is thus a need to ensure that nutritional screening and assessment tools are developed using procedures based on good design and sound statistical practice. This paper suggests that a unified approach using multivariate techniques could make a significant contribution to this process.
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              Nutritional status at submission for dietetic services and screening for malnutrition at admission to hospital

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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                nh
                Nutrición Hospitalaria
                Nutr. Hosp.
                Grupo Arán (Madrid, Madrid, Spain )
                0212-1611
                1699-5198
                August 2005
                : 20
                : 4
                : 259-267
                Affiliations
                Madrid orgnameHospital 12 de Octubre orgdiv1Unidad de Nutrición Clínica
                Article
                S0212-16112005000600005

                This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 International License.

                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 24, Pages: 9
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