Nutritional status and nutritional therapy in pediatric and adolescent patients submitted to autologous hematopoietic stem cell transplantation

Introduction: To assess the use of nutritional support in children and adolescents submitted to autologous hematopoietic stem cell transplantation (HSCT), and analyze changes in nutritional status at hospital discharge after HSCT. Methods: A retrospective observational study was conducted on pediatric oncology patients hospitalized for autologous HSCT between 2010 and 2017. Nutritional therapy was evaluated based on the duration of enteral tube feeding (ETF) and parenteral nutrition (PN), either alone or in combination. The length of hospital stay was measured in days. Nutritional status was assessed at admission and discharge, and classified according to World Health Organization criteria. Results: The sample consisted of 68 patients, 54.4% of whom were boys. Most participants (89.7%) had solid tumors. Nutritional therapy was required in over half (52.9%) of cases, with PN being the most common indication. There was a reduction in the percentage of overweight patients and an increase in the percentage of underweight patients at discharge relative to admission. Conclusions: The use of nutritional therapy is highly prevalent in this population, and HSCT has a negative impact on nutritional status at discharge

Descrição do Tempo de Jejum Pré-Procedimentos em um Serviço de Oncologia Pediátrica

Introduction: Shortening the duration of preoperative fasting is one of the current nutritional cares related to surgical patients. The metabolic response to surgical trauma may be enhanced by fasting. The description of the actual time of pre-procedure fasting allows us to review old paradigms. Therefore, the aim of this study was to describe the practices in relation to the pre-procedure fasting time in a Pediatric Oncology Unit. Methods: Retrospective descriptive study, consultation of medical records, including patients aged between zero and 18 years who were admitted to the Pediatric Oncology Unit, diagnosed with cancer, who started fasting for tests or elective surgical procedures between July and September of 2014. Results: A total of 30 patients, 57% female, with an average age of 9 years (± 5 years) were included. The most common diagnoses were leukemia (40%), lymphoma (13%) and osteosarcoma (13%) and neuroblastoma (13%). The most common procedures performed were: placement of totally implantable catheter, bone marrow biopsy and intrathecal chemotherapy. All patients had a preprocedure fasting time greater than or equal to 6 hours; 66% of these patients fasted for 10h or more hours, and 23% had to fast for 12 hours or more. Conclusion: No patient had their pre-procedure fasting according to current guidelines. Our expectation is that abbreviation of preoperative fasting be considered and that it reduce physical symptoms and metabolic changes

Estado Nutricional de Crianças e Adolescentes com Neoplasias Malignas Durante o Primeiro Ano Após o Diagnóstico

Introdução: O tratamento antineoplásico causa, frequentemente, complicações gastrintestinais que, juntamente com alterações metabólicas, podem interferir no estado nutricional.Objetivo: Analisar a evolução do estado nutricional de crianças e adolescentes com neoplasias, durante o primeiro ano após o diagnóstico.Métodos: Estudo de coorte retrospectivo realizado no Serviço de Oncologia Pediátrica do Hospital de Clínicas de Porto Alegre com pacientes admitidos entre janeiro de 2001 e agosto de 2005, que possuíam registros de peso e estatura ao diagnóstico, ao terceiro, ao sexto e ao décimo segundo mês após o diagnóstico. Para classificar o estado nutricional utilizou-se o escore-Z do índice peso/estatura para as crianças e o índice de massa corporal para os adolescentes.Resultados: Foram avaliados 140 pacientes com mediana de idade ao diagnóstico de 4,75 anos (3,08 – 10,31), sendo 77 (55%) pacientes do sexo masculino. Dos pacientes pesquisados, 86 (61%) apresentavam doenças hematológicas e 54 (39%) tumores sólidos. Os adolescentes, comparados às crianças, apresentaram maior prevalência de desnutrição e risco nutricional ao sexto (P =0,02) e ao décimo segundo mês (P =0,001). O comportamento das médias do escore-Z e do percentil do índice de massa corporal ao longo do primeiro ano foi diferente entre os grupos de pacientes com tumores sólidos e com doenças hematológicas, tanto para as crianças (P <0,001) como para os adolescentes (P =0,012).Conclusão: Os adolescentes, comparados às crianças, apresentaram prevalências maiores de desnutrição e risco nutricional. Os pacientes com tumores sólidos tiveram seu estado nutricional mais afetado do que aqueles com doenças hematológicas

Subjective global nutritional assessment : applicability in children and adolescents with malignant tumors

Introduction: This study investigated the applicability of the Subjective Global Nutritional Assessment (SGNA) tool to evaluate the nutritional status of pediatric cancer patients. Methods: This was a multicenter, observational cohort study of infants, children, and adolescents diagnosed with malignant tumors. Participants were evaluated at the moment they were diagnosed with a malignant tumor (EV1) and at the third month of treatment (EV2). Objective data were collected and the SGNA questionnaire was applied. Correlation between the methods was performed using the Kendall test. Results: We evaluated 216 patients at EV1 and 172 patients at EV2. During EV1, 7% of patients presented with some degree of malnutrition, according to objective measures, and 35.7% according to the SGNA. During EV2, they presented 6.4% and 26.8%, respectively. The SGNA showed ability to diagnose more malnutrition than objective indicators and the agreement found between both methods was moderate and weak. We observed a significant correlation between the SGNA and the nutritional indicators (p = <0.002), thus proving its efficacy in assessing nutritional status. Conclusion: The SGNA was applicable for evaluating the nutritional status of children and adolescents diagnosed with malignant tumors, and effective in tracking malnutrition prevalence when compared to objective nutritional assessment methods

Subjective Global Nutritional Assessment: Applicability in children and adolescents with malignant tumors

Introduction: This study investigated the applicability of the Subjective Global NutritionalAssessment (SGNA) tool to evaluate the nutritional status of pediatric cancer patients.Methods: This was a multicenter, observational cohort study of infants, children,and adolescents diagnosed with malignant tumors. Participants were evaluated at themoment they were diagnosed with a malignant tumor (EV1) and at the third monthof treatment (EV2). Objective data were collected and the SGNA questionnaire wasapplied. Correlation between the methods was performed using the Kendall test.Results: We evaluated 216 patients at EV1 and 172 patients at EV2. During EV1,7% of patients presented with some degree of malnutrition, according to objectivemeasures, and 35.7% according to the SGNA. During EV2, they presented 6.4% and26.8%, respectively. The SGNA showed ability to diagnose more malnutrition thanobjective indicators and the agreement found between both methods was moderateand weak. We observed a significant correlation between the SGNA and the nutritionalindicators (p = &lt;0.002), thus proving its efficacy in assessing nutritional status.Conclusion: The SGNA was applicable for evaluating the nutritional status of childrenand adolescents diagnosed with malignant tumors, and effective in tracking malnutritionprevalence when compared to objective nutritional assessment methods

Perfil antropométrico dos pacientes internados em um hospital universitário

Introdução: Identificar precocemente o perfil antropométrico dos pacientes possibilita o conhecimento do estado nutricional e o planejamento de uma terapia nutricional adequada podendo reduzir o número e a gravidade das complicações e acelerar a sua recuperação.Objetivo: Identificar o perfil antropométrico dos pacientes na internação hospitalarMétodos: Estudo observacional descritivo, com pacientes adultos e idosos, que internaram no Hospital de Clínicas de Porto Alegre no período de julho de 2008 a dezembro de 2009.Resultados: Foram arrolados para o estudo 460 indivíduos com média de idade de 52 anos (± 16,14), sendo 164 (35,7%) idosos. Dos pacientes estudados, 152 (33%) chegaram ao hospital eutróficos, 216 (47%) com sobrepeso ou obesidade e 92 (20%) desnutridos. Entre os pacientes com sobrepeso e obesidade, 10 (4,6%) estavam com obesidade mórbida (IMC &gt; 40 kg/m²); e entre os desnutridos, 14 (15,2%) estavam com desnutrição grave (IMC &lt; 16 kg/m²). Os níveis assistenciais (NA) foram determinados conforme o diagnóstico nutricional, considerando percentual de perda de peso e IMC. Dos pacientes analisados, 12 (2,6%) foram classificados como NA 1, seguido por 325 (70,7%) como NA 2,  88 (19,1%) como NA 3 e 35 (7,6%) como NA 4. Pacientes idosos apresentaram maior percentual de desnutrição (26,2% vs 16,6%) quando comparados com os pacientes &lt; de 60 anos (p&lt; 0,014).Conclusão: A prevalência de risco e/ou desnutrição é elevada no ambiente hospitalar e demanda atenção dos profissionais da saúde responsáveis pela assistência do paciente, principalmente nos indivíduos com idade acima de 60 anos