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.

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.

SUMMARY OBJECTIVE: The aim of this study was to describe the medical nutritional therapy (MNT) of adult non-critically ill hospitalization patients. METHODS: In a retrospective study, adults hospitalized for more than 48 h in non-intensive care unit medical and surgical areas that were classified as being at nutritional risk were included. Malnutrition was defined according to Global Leadership Initiative on Malnutrition (GLIM) criteria. RESULTS: A total of 255 patients, aged 54.13±18.4 years, who were at risk of malnutrition were included in this study. Of these, 50% were males. Notably, 52.5% received oral nutrition supplementation (ONS), 23.5% enteral nutrition (EN), 15% parenteral nutrition (PN), and 9% received enteral and parenteral nutrition (EPN). Patients with EPN presented the highest frequency of malnutrition (52%), and therefore they received more than 100% of energy and protein requirements. The median length of stay was 25 days. Among patients with nutritional risk receiving EPN, no deaths occurred. Patients, identified at nutritional risk, but without malnutrition according to GLIM, and receiving ONS had significantly lower mortality than patients receiving other MNT. CONCLUSIONS: Oral nutrition supplementation was the more frequent MNT prescribed. The frequency of malnutrition and percentage of prescribed energy and protein were higher in patients receiving PN and EPN compared with those receiving ONS.

Abstract Introduction: nutritional therapy is essential for the treatment of critically ill patients, although its right application fails frequently, which increases the risk for undernutrition and complications. Objective: to evaluate the nutritional adequacy of patients with enteral nutritional support in an intensive care unit (ICU). Methods: a cohort study was conducted including adults admitted to the ICU with enteral support and stay ≥ 7 days. Demographic data, severity of the disease, and clinical and nutritional scores, including IL-6 levels and body composition, were evaluated at admission. Nutritional intake was recorded daily in relation to the target intake according to international guidelines, for calculation of caloric and protein deficiencies. Results: in all, 26 from 132 admitted patients were included. Their probability of mortality was 20-25 % due to disease severity by APACHE (16.6 ± 6.02) and SOFA (8 ± 4.4). Undernutrition risk was 5.6 ± 1.09 by NRS-2002 and 4.3 ± 1.2 by angle phase. Caloric deficiency was - 674 kcal/day, with 13 % proteins (28 ± 11.5 g/d) and 42 % lipids, including 17.5 % of non-nutrient calories from propofol. NUTRIC was significantly associated with percentages of the caloric prescription at days 3 and 7 (R2 = 0.21, p = 0.01). Conclusion: patients had a caloric/protein deficit with critical protein deficit of -85.2 g/day, and an inadequate proportion between protein calories and non-protein calories, increasing their risk of complications.

Resumen Introducción: la terapia nutricional es esencial para tratar a pacientes críticos pero, si no es la adecuada, aumenta el riesgo de desnutrición y complica la evolución. Objetivo: evaluar la adecuación de la terapia nutricional enteral en una unidad de cuidados intensivos (UCI). Métodos: se evaluó una cohorte adulta ingresada a una UCI con nutrición enteral y estancia ≥ 7 días. Al ingreso se registraron la severidad de la enfermedad y los datos socio-demográficos, clínicos y nutricionales, con cribados que incluyeron la IL-6 y la composición corporal. Diariamente se evaluó el aporte de nutrientes con respecto al 70 % óptimo de lo prescrito por las guías internacionales, para estimar el déficit energético-proteico. Resultados: se incluyeron 26 de 132 pacientes ingresados. Su probabilidad de mortalidad era del 20-25 % debido a la severidad de su enfermedad por los sistemas APACHE (16,6 ± 6,0) y SOFA (8 ± 4,4); su riesgo de desnutrición era de 5,6 ± 1,09 puntos por el NRS-2002, con 4,3 ± 1,2 de ángulo de fase. El déficit energético promedio era de -674 kcal/día, con un 13 % en aporte proteico (28 ± 11,5 g/d) y un 42 % en lípidos, y con el 17,5 % proveniente del propofol. El NUTRIC se asoció significativamente con los porcentajes de prescripción calórica alcanzados los días 3 y 7 (R2 = 0,21, p = 0,01). Conclusión: los pacientes sufrieron déficit calórico/proteico, con déficit proteico crítico de > 85,2 g/día e inadecuada relación entre calorías proteicas y no proteicas, aumentando su riesgo de complicaciones.

SUMMARY OBJECTIVE The aim was to evaluate the prevalence of oropharyngeal dysphagia (OD) and its association with body composition by bioelectrical impedance analysis (BIA) and functionality among institutionalized older adults. METHODS A cross-sectional study was conducted. The swallowing function and diagnosis of OD were evaluated with a volume-viscosity swallow test. Activities of daily living were evaluated by the Barthel Index. Body composition was evaluated by BIA, and phase angle (PhA) was determined. RESULTS Eighty institutionalized older adults were evaluated. The mean age of the study population was 82±9.5 years, and 65% were females. The OD prevalence was 30%, dependence was 30%, and sarcopenia was 16%. In the multivariate analysis, a low PhA (<3.5°) was independently associated with the presence of OD adjusted by sex and age (OR: 2.60, 95%CI 2.41–2.90, p=0.01). CONCLUSIONS A higher prevalence of OD was found. Significant and independent associations were found between low PhA, dependence, and sarcopenia with the presence of OD among institutionalized older persons.

Introduction: Superior mesenteric artery syndrome (SMAS) is a rare condition characterized by vascular compression of the duodenum. There is controversy regarding the optimal treatment. Case report: In case 1, we describe the case of a 21-year-old woman (body mass index [BMI] 16.9 kg/m²) with high-level obstructive symptoms three months prior, with computed tomography scan (TC) showing a superior mesenteric artery aorta angle (SMAA) of 13º and compression of the third portion of the duodenum (D3), for this reason a nasojejunal tube was placed for enteral feeding. In case 2, enteral nutrition was initiated for feeding a 17-year-old female with anorexia nervosa (BMI 8.3 kg/m²). She presented macrohematuria, vomiting, epigastralgia, abdominal distension and acute abdomen when oral feeding was reinitiated. TC reported a SMAA of 15º, in addition to compression of the left renal vein (Nutcracker syndrome) and gastro duodenal expansion, surgical management was necessary. Discussion: Both cases had favorable evolution, being the nutritional support fundamental. SMAS should be suspected in all people with high-level obstructive symptoms and recent weight loss.

Introducción: el síndrome de la arteria mesentérica superior (SAMS) es una condición rara caracterizada por la compresión vascular del duodeno, y existe controversia acerca de su tratamiento. Caso clínico: en el caso 1, presentamos a una mujer de 21 años (índice de masa corporal [IMC] 16,9 kg/m²) con datos de obstrucción alta y epigastralgia durante los tres meses previos, con tomografía computarizada (TC) que reporta ángulo de la arteria mesentérica superior (AAMS) de 13º y compresión de D3. Se colocó sonda nasoyeyunal para alimentarla. En el caso 2, se inició alimentación enteral por sonda nasogástrica en una mujer de 17 años con anorexia nerviosa (IMC 8,3 kg/m²). Al reiniciar la vía oral presentó hematuria, vómito, epigastralgia, distensión abdominal y abdomen agudo. La TC reportó AAMS 15º, compresión de la vena renal izquierda (síndrome de Nutcracker) y distensión gastroduodenal. Requirió tratamiento quirúrgico. Discusión: ambas pacientes tuvieron evolución favorable, siendo fundamental el soporte nutricional. Se debe sospechar el SAMS en los pacientes con datos de obstrucción intestinal alta y pérdida de peso reciente.

Introduction: Body weight measurement is of critical importance when evaluating the nutritional status of patients entering a hospital. In some situations, such as the case of patients who are bedridden or in wheelchairs, these measurements cannot be obtained using standardized methods. We have designed and validated a formula for predicting body weight. Objectives: To design and validate a formula for predicting body weight using circumference-based equations. Methods: The following anthropometric measurements were taken for a sample of 76 patients: weight (kg), calf circumference, average arm circumference, waist circumference, hip circumference, wrist circumference and demispan. All circumferences were taken in centimeters (cm), and gender and age were taken into account. This equation was validated in 85 individuals from a different population. The correlation with the new equation was analyzed and compared to a previously validated method. Results: The equation for weight prediction was the following: Weight = 0.524 (WC) - 0.176 (age) + 0.484 (HC) + 0.613 (DS) + 0.704 (CC) + 2.75 (WrC) - 3.330 (if female) -140.87. The correlation coefficient was 0.96 for the total group of patients, 0.971 for men and 0.961 for women (p < 0.0001 for all measurements). Conclusion: The equation we developed is accurate and can be used to estimate body weight in overweight and/or obese patients with mobility problems, such as bedridden patients or patients in wheelchairs.

Introducción: La medición del peso corporal resulta de suma importancia en la evaluación del estado nutricional de los pacientes que ingresan a una institución hospitalaria. En algunas situaciones, estas mediciones no pueden obtenerse por los métodos estandarizados, como es el caso de los pacientes encamados o en silla de ruedas. Nosotros diseñamos y validamos una fórmula de predicción del peso corporal. Objetivos: Diseñar y validar una fórmula de predicción del peso corporal utilizando circunferencias. Métodos: Se realizaron las siguientes medidas antropométricas en una muestra de 76 pacientes: peso en kg (P), circunferencia de pantorrilla (CP), circunferencia media de brazo (CMB), cintura (CC), cadera (CCad), circunferencia de muñeca (CM) y media envergadura (ME) todas las circunferencias fueron tomadas en cm y así mismo se tomó en cuenta el género y la edad. De estas mediciones obtuvimos una ecuación de predicción del peso corporal. Esta ecuación se validó en 85 individuos de una población diferente. Se realizó un análisis de la correlación de la nueva ecuación contra un método previamente validado. Resultados: La ecuación de predicción de peso fue la siguiente: Peso = 0,524 (CC) - 0,176 (edad) + 0,484 (CCad) + 0,613 (ME) + 0,704 (CP) + 2,75 (CM) - 3,330 (si es mujer) -140,87. El coeficiente de correlación fue de 0,96 para el grupo de pacientes totales y de 0,971 para hombres y 0,961 para mujeres (todos p < 0,0001). Conclusión: La ecuación desarrollada en nuestro trabajo, es precisa, y puede emplearse para estimar el peso corporal en pacientes con sobrepeso y/o obesidad que tengan problemas de movilidad como pacientes encamados, o en sillas de ruedas.