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      Risk of malnutrition and oral nutritional support in a cohort of hospital inpatients Translated title: Riesgo de desnutrición y soporte nutricional oral en una cohorte de pacientes hospitalizados

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          Abstract

          Abstract Introduction: The disease-related malnutrition is considered a serious problem since it is strongly related to higher mortality rates, longer hospital stays, and increased costs for medical care. A highly associated risk factor has been the decreased oral intake during the hospital stay; however, the use of oral nutritional supplements allows to heal the malnutrition burden having positive results. Objective: To evaluate the hospital malnutrition risk and the oral nutritional supplements effect for 4 days in anthropometric variables, energy, and protein intake in hospital inpatients. Methodology: A cohort study, in a third-level hospital in which within the first 24 hours of the admission, the malnutrition risk was assessed (NRS-2002), the prescribed oral nutritional supplements, its follow-up during a 4-day consumption and its impact on weight, body mass index and muscle strength estimated by dynamometry were analyzed; additionally, the nutritional intake (energy and proteins) was assessed. Results: A total of 290 patients (167W/123M) were assessed, with an average age of 54.7±17.3 years. The malnutrition risk prevalence at hospital admission was 50.3% and from the total patients, 10.3% (n=30) received oral nutritional supplements. After the consumption of oral nutritional supplements, an increased energy consumption was shown in those with a >50% adherence during the 4 days; we found an increased energy adequacy percentage of 73.6±33 to 101±32 (p=0.003) and protein adequacy 75.8±45 to 108±58 (p=0.016), with appropriate tolerance. No differences were documented in anthropometric and arm strength variables. Conclusions: The use of oral nutritional supplements during the hospital stay increases considerably the energy and protein consumption in patients with a >50% adherence with appropriate tolerance.

          Translated abstract

          Resumen Introducción: La desnutrición relacionada con la enfermedad está relacionada con mayores tasas de mortalidad, estadías hospitalarias y costos de atención. Un factor de riesgo altamente asociado es la disminución de la ingesta oral durante la estancia hospitalaria; sin embargo, el uso de suplementos nutricionales orales es una opción para mejorarla. Objetivo: Evaluar el riesgo de desnutrición hospitalaria y el efecto de los suplementos nutricionales orales durante 4 días en variables antropométricas, ingesta energética y proteica en pacientes hospitalizados. Metodología: Estudio de cohorte en un hospital de tercer nivel, en el que dentro de las primeras 24 horas del ingreso se evaluó el riesgo de desnutrición (NRS-2002), los suplementos nutricionales orales prescritos a los pacientes y su seguimiento durante 4 días, se analizó el consumo diario y su impacto en el peso, índice de masa corporal y fuerza muscular estimados por dinamometría; además, se evaluó el aporte nutricional (energía y proteínas). Resultados: Un total de 290 pacientes (167M/123H) fueron evaluados, con edad promedio 54,7±17,3 años. La prevalencia del riesgo de desnutrición al ingreso hospitalario fue del 50,3% y del total de pacientes, el 10,3% (n=30) recibieron suplementos nutricionales orales. Tras el consumo de suplementos nutricionales orales, se evidenció un mayor consumo energético en aquellos con una adherencia >50% durante los 4 días; encontramos un porcentaje de adecuación energética incrementado de 73,6±33 a 101±32 (p=0,003) y adecuación proteica de 75,8±45 a 108±58 (p=0,016), con tolerancia adecuada. No se documentaron diferencias en las variables antropométricas y de fuerza de brazo. Conclusiones: El uso de suplementos nutricionales orales durante la estancia hospitalaria aumenta considerablemente el consumo de energía y proteínas en pacientes con una adherencia >50% con tolerancia adecuada.

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          Most cited references26

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          ESPEN guidelines on definitions and terminology of clinical nutrition.

          A lack of agreement on definitions and terminology used for nutrition-related concepts and procedures limits the development of clinical nutrition practice and research.
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            The relationship between nutritional intake and clinical outcomes in critically ill patients: results of an international multicenter observational study.

            The objective of this study was to examine the relationship between the amount of energy and protein administered and clinical outcomes, and the extent to which pre-morbid nutritional status influenced this relationship. We conducted an observational cohort study of nutrition practices in 167 intensive care units (ICUs) across 21 [corrected] countries. Patient demographics were collected, and the type and amount of nutrition received were recorded daily for a maximum of 12 days. Patients were followed prospectively to determine 60-day mortality and ventilator-free days (VFDs). We used body mass index (BMI, kg/m2) as a marker of nutritional status prior to ICU admission. Regression models were developed to evaluate the relationship between nutrition received and 60-day mortality and VFDs, and to examine how BMI modifies this relationship. Data were collected on 2,772 mechanically ventilated patients who received an average of 1,034 kcal/day and 47 g protein/day. An increase of 1,000 cal per day was associated with reduced mortality [odds ratio for 60-day mortality 0.76; 95% confidence intervals (CI) 0.61-0.95, p = 0.014] and an increased number of VFDs (3.5 VFD, 95% CI 1.2-5.9, p = 0.003). The effect of increased calories associated with lower mortality was observed in patients with a BMI or =35 with no benefit for patients with a BMI 25 to or =35.
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              ESPEN guidelines for nutrition screening 2002.

              To provide guidelines for nutrition risk screening applicable to different settings (community, hospital, elderly) based on published and validated evidence available until June 2002. NOTE: These guidelines deliberately make reference to the year 2002 in their title to indicate that this version is based on the evidence available until 2002 and that they need to be updated and adapted to current state of knowledge in the future. In order to reach this goal the Education and Clinical Practice Committee invites and welcomes all criticism and suggestions (button for mail to ECPC chairman).
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                Author and article information

                Journal
                renhyd
                Revista Española de Nutrición Humana y Dietética
                Rev Esp Nutr Hum Diet
                Academia Española de Nutrición y Dietética (Pamplona, Navarra, Spain )
                2173-1292
                2174-5145
                June 2022
                : 26
                : 2
                : 147-155
                Affiliations
                [1] Ciudad de México orgnameInstituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán orgdiv1Clinical Nutrition Service México
                [2] Ciudad de México orgnameInstituto Nacional de Pediatría orgdiv1Departamento de Metodología de la Investigación México
                Article
                S2174-51452022000200147 S2174-5145(22)02600200147
                10.14306/renhyd.26.2.1635
                8a89184e-a4d3-4e31-8f69-39f36cdf1e33

                This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

                History
                : 22 February 2022
                : 04 April 2022
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 26, Pages: 9
                Product

                SciELO Spain

                Categories
                Research Articles

                Adecuación Nutricional,Desnutrición,Pacientes Hospitalizados,Suplementos Nutricionales Orales,Soporte nutricional,Malnutrition,Hospital Inpatients,Oral Nutrition Supplement,Nutritional Adequacy,Nutrition support

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