Resumo Objetivo Investigar o comprometimento do apetite em pessoas idosas hospitalizadas com câncer e sua associação com estado nutricional e presença de caquexia. Métodos Estudo transversal realizado com pessoas idosas de ambos os sexos, diagnosticadas com neoplasia maligna, de julho de 2017 a março de 2019 em um hospital universitário. A amostra final foi composta por 90 pacientes. O comprometimento do apetite foi identificado pelo Questionário de Apetite e Sintomas para Pacientes com Câncer (CASQ) e o estado nutricional pela Avaliação Subjetiva Global Produzida pelo Próprio Paciente (ASG-PPP). A presença de caquexia foi avaliada pela perda de peso >5% nos últimos 6 meses; ou índice de massa corporal (IMC) <20 kg/m2 e perda de peso >2%; ou índice de músculo esquelético apendicular consistente com sarcopenia e perda de peso >2%. Resultados Houve predomínio de indivíduos do sexo masculino (56,7%), autodeclarados não brancos (56,7%), com tumores localizados no trato gastrointestinal (75,6%) e mediana de idade de 67 anos. 75,6% dos indivíduos apresentaram comprometimento do apetite, 57,8% suspeita de desnutrição ou desnutrição de algum grau, 54,4% caquexia e 92,2% necessidade de intervenção nutricional. Houve associação entre as categorias do CASQ com estado nutricional (p=0,001) e presença de caquexia (p=0,050). Após análise de regressão logística, a desnutrição permaneceu associada ao comprometimento do apetite [OR: 4,68 (IC 95%: 1,50–14,56), p=0,008]. Conclusão A presença de desnutrição aumentou as chances de comprometimento do apetite, o que reforça a necessidade da triagem e intervenção nutricional precoces, a fim de reduzir e/ou evitar os agravos nutricionais.

Abstract Objective To investigate appetite impairment in older adults hospitalized with cancer and its association with nutritional status and cachexia. Method A cross-sectional study, conducted with older adults men and women diagnosed with malignant neoplasia from July 2017 to March 2019 at a university hospital. The final sample consisted of 90 patients. Appetite was evaluated using the Cancer Appetite and Symptom Questionnaire (CASQ) and nutritional status was determined using the Patient-Generated Subjective Global Assessment (PG-SGA). Presence of cachexia was assessed by weight loss >5% in the last 6 months; or body mass index (BMI) <20 kg/m2 and weight loss >2%; or appendicular skeletal muscle index consistent with sarcopenia and weight loss >2%. Results There was a predominance of male (56.7%) self-declared non-white individuals (56.7%), with tumors in the gastrointestinal tract (75.6%) and median age of 67.0 years. 75.6% of the individuals have impaired appetite, 57.8% suspected malnutrition or malnutrition of some degree, 54.4% cachexia and 92.2% needed nutritional intervention. There was significant association between CASQ categories with nutritional status (p= 0.001) and presence of cachexia (p=0.050). After logistic regression analysis, malnutrition remained associated with impaired appetite assessed by CASQ score [OR: 4.68 (CI 95%: 1.50-14.56), p=0.008] Conclusion The presence of malnutrition increased the chances of appetite impairment, which reinforces the need for early nutritional screening and intervention, in order to reduce and/or avoid nutritional problems.

Resumo Objetivo Rastrear o risco de sarcopenia em indivíduos hospitalizados por meio dos instrumentos SARC-F e SARC-Calf e verificar a associação entre o risco de sarcopenia com as variáveis sociodemográficas, clínicas e as variáveis que compõem o fenótipo de sarcopenia. Métodos Trata-se de um estudo transversal. Características sociodemográficas, clínicas e todas as variáveis que compõem o fenótipo de sarcopenia (força de prensão palmar, massa muscular e velocidade de marcha) foram investigadas. Para o rastreamento e diagnóstico da sarcopenia adotou-se o algoritmo e critérios propostos pelo European Working Group on Sarcopenia in Older People (EWGSOP2). Resultados Participaram 90 indivíduos. A maioria encontrava-se sem sinais sugestivos de sarcopenia, tanto pelo SARC-F (58,9%) quanto pelo SARC-Calf (68,9%), com força de preensão palmar (FPP) (28,59±9,21;26,74±10,60) e índice de massa muscular esquelética apendicular (IMMEA) (9,31±1,78;9,58±1,62) normais e com baixa velocidade de marcha (VM) (0,69±0,26; 0,68±0,44), respectivamente. O SARC-F apresentou associação significativa com as variáveis sexo (p=0,032), FPP (p<0,001), VM (p=0,001) e sarcopenia (p<0,001). Quando da adição da circunferência da panturrilha (CP), foi encontrado associação com as variáveis grupo etário (p=0,029), atividade laboral (p=0,008), FPP (p<0,001), IMMEA (p=0,033), VM (p=0,019) e sarcopenia (p<0,001). Conclusão O risco de sarcopenia foi observado em aproximadamente um terço dos pacientes avaliados. Sugere-se o uso rotineiro nos hospitais da ferramenta de rastreamento de sarcopenia SARC-Calf, uma vez que apresentou associação com os três fatores preditivos da sarcopenia, além de ser um instrumento de aplicação ágil, baixo custo e não invasivo. A investigação do diagnóstico da sarcopenia deve ser encorajada na prática clínica.

Abstract Objective To screen the risk of sarcopenia in hospitalized individuals using the SARC-F and SARC-Calf instruments and verify the association between the risk of sarcopenia with the sociodemographic and clinical variables and those that make up the sarcopenia phenotype. Methods This is a cross-sectional study. Sociodemographic, clinical characteristics, and all variables (handgrip strength, muscle mass and gait speed) that construct the sarcopenia phenotype were investigated. For the screening and diagnosis of sarcopenia, the algorithm, and criteria proposed by the European Working Group on Sarcopenia in Older People (EWGSOP2). Results A total of 90 individuals participated. Most were without risk of sarcopenia, both by SARC-F (58.9%) and by SARC-Calf (68.9%), with normal handgrip strength (HGS) (28.6±9.2; 26.7±10.6) and appendicular skeletal muscle mass index (ASMI) (9.3±1.78; 9.6±1.6) and with low gait speed (GS) (0.69±0.26; 0.68±0.4), respectively. SARC-F showed a significant association with the variables gender (p=0.032), HGS (p<0.001), GS (p=0.001) and sarcopenia (p<0.001). When adding the calf circumference (CC), an association was found with the variables age group (p=0.029), work activity (p=0.008), HGS (p<0.001), ASMI (p=0.033), GS (p=0.019) and the sarcopenia (p<0.001). Conclusion The risk of sarcopenia was observed in approximately one-third of the evaluated patients. It is suggested the routine use in hospitals of the sarcopenia screening tool SARC-Calf, since it was associated with the three predictive factors of sarcopenia, in addition,it is an instrument of agile application, low cost and non-invasive. When a possible, investigation of the diagnosis of sarcopenia should be encouraged in clinical practice.

Abstract Introduction: sarcopenia is considered a risk factor for cancer patients, as it increases mortality and post-surgical complications, and reduces response to treatment and quality of life. Objective: to identify the risk of sarcopenia by SARC-CalF, as well as the factors associated with this outcome in patients with cancer of the gastrointestinal tract (GIT) and adnexal glands. Methods: this cross-sectional study included patients with cancer of the GIT and adnexal glands, without edema or ascites, of both sexes and aged ≥ 20 years. Conventional anthropometric variables and handgrip strength (HGS) were measured. The risk of sarcopenia was assessed through the SARC-CalF questionnaire, and nutritional status by the Patient-Generated Subjective Global Assessment (PG-SGA). The data analysis was performed using the SPSS® software, 22.0, with a significance of 5 %. Results: seventy patients took part in the study. Of these, 55.7 % were female, 52.9 % were aged over 60 years, and 64.3 % were non-white. PG-SGA identified 50.0 % of patients as well-nourished and 50.0 % as having some degree of malnutrition. The prevalence of risk of sarcopenia was 28.6 %. There were different correlations between the SARC-CalF score and anthropometric variables (p < 0.05) according to life stage (adults and elderly). After a linear regression analysis the measures that most influenced the SARC-CalF score were arm circumference (AC) and adductor pollicis muscle thickness in the dominant hand (DAPMT) for adults, while for the elderly current weight and DAPTM (p < 0.05) were more relevant. Conclusion: SARC-CalF identified 28.6 % of patients at risk for sarcopenia and was associated with body weight and anthropometric variables indicative of muscle reserve in adults and the elderly.

Resumen Introducción: se considera la sarcopenia un factor de riesgo, especialmente para los pacientes con cáncer, ya que aumenta la mortalidad y las complicaciones posquirúrgicas, reduciendo la respuesta al tratamiento y la calidad de vida. Objetivo: identificar el riesgo de sarcopenia por el SARC-CalF y los factores asociados en pacientes con cáncer del tracto gastrointestinal (TGI) y las glándulas anexas. Métodos: estudio transversal descriptivo. Se incluyeron pacientes con cáncer del TGI y glándulas anexas, sin edema o ascitis, de ambos sexos y de edad ≥ 20 años. Se midieron las variables antropométricas convencionales y la fuerza de presión manual (FPM). El riesgo de sarcopenia se obtuvo mediante el cuestionario SARC-CalF y el estado nutricional mediante la valoración global subjetiva generada por el propio paciente (VGS-GP). El análisis de los datos se realizó con el software SPSS®, versión 22.0, con una significancia del 5 %. Resultados: participaron 70 pacientes. De estos, el 55,7 % eran mujeres, el 52,9 % eran mayores de 60 años y el 64,3 % eran de etnia no caucásica (64,3 %). La VGS-GP identificó un 50,0 % de pacientes bien alimentados y un 50,0 % con algún grado de desnutrición. El riesgo de sarcopenia fue del 28,6 %. Hubo diferentes correlaciones entre el puntaje SARC-CalF y las variables antropométricas (p < 0,05) según la etapa de la vida (adultos y ancianos). Después del análisis de regresión lineal, las medidas que más influyeron en el puntaje SARC-CalF fueron la circunferencia muscular del brazo (CMB) y el espesor del músculo aductor del pulgar de la mano dominante (EMAPD) en los adultos, mientras que en los ancianos fueron el peso actual y elEMAPD (p < 0,05). Conclusión: el SARC-CalF identificó al 28,6 % de los pacientes con riesgo de sarcopenia y se asoció con el peso corporal y las variables antropométricas indicativas de reserva muscular en adultos y ancianos.

Abstract Background: it is essential for an early nutritional intervention that utilizes effective and practical nutritional screening and evaluation tools to diagnose nutritional status, increasing the patient's survival. Objective: to evaluate the agreement of the Graz Malnutrition Screening (GMS) with subjective methods of nutritional evaluation in hospitalized patients. Methods: descriptive cross-sectional study with adults and elderly of both sexes evaluated within 48 hours of hospital admission. Nutritional status in cancer patients was identified by the Patient-Generated Subjective Global Assessment (PG-SGA(r)) and in the elderly by the Mini Nutritional Assessment Short-Form (MNA-SF(r)). GMS was applied in both groups and its efficiency was compared with that of PG-SGA(r) and MNA-SF(r). The agreement between the methods was evaluated by the kappa test, followed by assessment of diagnostic performance and correlation test. Results: of the 87 patients evaluated, 64.4% (56) presented nutritional risk according to GMS, while 49.4% (43) and 47.1% (41) indicated nutritional risk and malnutrition according to MNA-SF(r) and PG-SGA(r), respectively. GMS presented moderate agreement with PG-SGA(r) (p < 0.001) and MNA-SF(r) (p < 0.001), with high sensitivity, specificity, positive predictive value, and negative predictive value. Correlations were observed between the GMS score and both the PG-SGA(r) (p < 0.001) and MNA-SF(r) scores (p < 0.001). Conclusion: GMS was effective in detecting nutritional risk in hospitalized patients when compared to classic tools in the evaluation of nutritional status in hospitalized patients.

Resumen Introducción: el uso de herramientas de clasificación y evaluación nutricional eficaces, además de prácticas para diagnosticar el estado nutricional con el fin de aumentar la supervivencia del paciente, es imprescindible para una intervención nutricional temprana. Objetivo: evaluar la concordancia del Graz Malnutrition Screening (GMS) con métodos subjetivos de evaluación nutricional en pacientes hospitalizados. Metodología: estudio descriptivo transversal con adultos y ancianos de ambos sexos, evaluados hasta 48 horas después de la admisión hospitalaria. El estado nutricional de los pacientes con cáncer fue identificado mediante la Valoración Global Subjetiva Generada por el Paciente (VGS-GP(r)) y el de los ancianos, mediante el test Mini Nutritional Assesment (MNA(r)). El GMS fue aplicado en ambos grupos y se comparó su eficiencia con la VGS-GP(r) y el MNA-SF(r). La concordancia entre los métodos fue evaluada por el test de kappa. Resultados: de los 87 pacientes evaluados, el 64,4% presentó riesgo nutricional según el GMS, mientras que el 49,4% y el 47,1% indicaron riesgo nutricional y desnutrición de acuerdo con el MNA-SF(r) y la VGS-GP(r), respectivamente. El GMS presentó una concordancia moderada con la VGS-GP(r) (p < 0,001) y el MNA-SF(r) (p < 0,001), con alta sensibilidad, especificidad, valor predictivo positivo y valor predictivo negativo. Se observaron correlaciones entre la puntuación del GMS con las puntuaciones de la VGS-GP (p < 0,001) y de la MNA-SF (p < 0,001). Conclusión: el GMS fue eficaz en la detección del riesgo nutricional en pacientes hospitalizados, en comparación con las herramientas clásicas en la evaluación del estado nutricional de pacientes hospitalizados.

RESUMO Objetivo Avaliar a correlação entre a medida da espessura do músculo adutor do polegar com medidas antropométricas, índice de massa corporal e Avaliação Subjetiva Global no diagnóstico nutricional de pacientes cirúrgicos. Métodos Participaram do estudo pacientes internados em uma unidade de cirurgia geral e reparadora de um hospital universitário de Vitória (ES), Brasil. Os critérios de inclusão foram pacientes avaliados nas primeiras 48 horas de internação, idade ≥20 anos hemodinamicamente estáveis, sem edema ou ascite. A análise dos dados foi realizada pelo softwareStatistical Package for Social Science, versão 21.0, com nível de significância de 5%. Resultados Compuseram a amostra 150 pacientes candidatos à cirurgia, com média de idade de 42,7±12,0 anos. Os motivos de internação mais comuns foram procedimentos cirúrgicos, doenças do trato gastrointestinal e neoplasias. Observou-se associação significativa entre a espessura do músculo adutor do polegar com a Avaliação Subjetiva Global (p=0,021) e com o índice de massa corporal para risco nutricional (p=0,008). Foram encontradas correlações significativas entre a espessura do músculo adutor do polegar com circunferência muscular do braço, área muscular do braço corrigida, circunferência da panturrilha e índice de massa corporal. Não foram encontradas correlações significativas entre a espessura do músculo adutor do polegar com prega cutânea triciptal e idade. Conclusão O uso da espessura do músculo adutor do polegar mostrou-se um método eficiente na detecção de desnutrição em pacientes cirúrgicos e deve ser acrescentado ao processo de triagem de pacientes hospitalizados, uma vez que é de fácil execução, baixo custo e não invasivo.

ABSTRACT Objective To evaluate the correlation between thickness of the muscle adductor pollicis and anthropometric measurements, body mass index and Subjective Global Assessment in the nutritional assessment of surgical patients. Methods The study population comprised patients admitted to the general and reconstructive surgery unit of a university hospital in the city of Vitória (ES), Brazil. The inclusion criteria were patients evaluated in the first 48 hours of admission, aged ≥20 years, hemodynamically stable, with no edema or ascites. Data analysis was performed using the software Statistical Package for Social Science 21.0, significance level of 5%. Results The sample consisted of 150 patients that were candidates to surgery, mean age of 42.7±12.0 years. The most common reasons for hospitalization were surgical procedures, gastrintestinal diseases and neoplasm. Significant association was observed between thickness of adductor pollicis muscle and Subjective Global Assessment (p=0.021) and body mass index (p=0.008) for nutritional risk. Significant correlation was found between thickness of adductor pollicis muscle and arm muscle circumference, corrected arm muscle area, calf circumference and body mass index. There were no significant correlations between thickness of adductor pollicis muscle and triceps skinfold and age. Conclusion The use of thickness of adductor pollicis muscle proved to be an efficient method to detect malnutrition in surgical patients and it should be added to the screening process of hospitalized patients, since it is easy to perform, inexpensive and noninvasive.