Nutrición Hospitalaria 00721 / http://dx.doi.org/10.20960/nh.721

Resumen| PDF (ENGLISH)

Trabajo Original

Quality control of enteral nutrition therapy in cancer patients at nutritional risk

Ariana Lee, Ronaldo Sousa Oliveira Filho, Thais De Campos Cardenas, Gislaine Aparecida Ozório, Juliana Pereira Lima Gropp, Dan Linetzky Waitzberg

VOLUMEN 34, NÚM. 2, marzo-abril (2017), PAG. 264-270

Logo Descargas Número de descargas: 22205 Logo Visitas Número de visitas: 10061 Citas Citas: 9

Compártelo:

Introduction: Quality indicators in nutritional therapy (QINTs) allow for the practical assessment of quality in the management of enteral nutrition therapy (ENT) among hospitalized patients.Objective: To control ENT quality in cancer patients at nutritional risk.Methods: A prospective, observational study was performed with cancer patients over 19 years of age who had undergone exclusive ENT for at least 72 h. Nutritional Risk Screening was used to assess nutritional risk; in the presence of nutritional risk, the Subjective Global Assessment (SGA) was used. Six QINTs were applied.Results: Our study included 211 patients (mean age: 59 ± 10 years, 67.3% men). Most common cancer diagnoses were head and neck (68.2%) and gastrointestinal (18%). Nutritional risk was identified in 93.3% (n = 197) of patients; SGA identified malnutrition in 84.2% of patients (n = 166). ENT was used for 9.7 ± 7 days, presenting a daily deficit of -243.1 ± 141 ml of dietary volume, -363.3 ± 214.1 kcal, and -14.2 ± 8.41 g of protein. Three of the six QINTs were in accordance with the proposed goal: frequency of SGA application, calculations of nutritional needs, and frequency of diarrhea. Three of the six QINTs were in disagreement with the proposed goal: ENT infused volume exceeding 70% of prescribed volume, frequency of digestive fasting exceeding 24 h, and frequency of constipation. Prescriptions for anticholinergic drugs (p = 0.023) and diuretics (p = 0.007) were associated with diarrhea.Conclusion: Nutritional risk and malnutrition are frequent among ENT cancer patients. Quality control in ENT was moderately impaired by episodes of fasting and intestinal motility disorders.

Palabras Clave: Cancer. Quality indicators. Enteral nutrition. Malnutrition. Diarrhea. Constipation.

Descargar PDF (ENGLISH)

Citas
Bibliografía

Almeida, Hákylla Rayanne Mota de, Arruda, Ilma Kruze Grande de, Diniz, Alcides da Silva, Cabral, Edla Karina, Santos, Stefanny Viana dos (2023) NUTRISCORE as a tool to predict greater weight loss and longer hospital stay in cancer patients. Nutrición Hospitalaria

Mezzomo, Thais Regina, Sampaio, Isabella Ruckl, Fiori, Lize Stangarlin, Schieferdecker, Maria Eliana Madalozzo (2019) Content of Poorly Absorbed Short‐Chain Carbohydrates (FODMAP) in Enteral Homemade Diets. Nutrition in Clinical Practice

Pedrazzoli, Paolo, Caccialanza, Riccardo, Cotogni, Paolo, Degli Esposti, Luca, Perrone, Valentina, Sangiorgi, Diego, Di Costanzo, Francesco, Gavazzi, Cecilia, Santoro, Armando, Pinto, Carmine (2020) The Advantages of Clinical Nutrition Use in Oncologic Patients in Italy: Real World Insights. Healthcare

Andaloro, Adriana, Caliri, Santina, Corallo, Francesco, Bramanti, Placido, Rifici, Carmela, De Cola, Maria Cristina (2021) Is the natural feed the better nutritional therapy in patients with severe acquired brain injury? A retrospective study. Clinical Nutrition Open Science

Nogueira, Daiane Aparecida, Ferreira, Lara Princia, Andrade de Lúcia, Renata Paniago, Pena, Geórgia das Graças (2020) High frequency of non-compliance with quality indicators during oral nutrition support in hospitalized patients. Clinical Nutrition ESPEN

WANDERLEY, Brenda Domingues, SANTOS, Rosane de Souza, COSTA, Mariana Fernandes (2022) Survival of patients with advanced cancer in Enteral Nutritional Therapy: a comparison between caloric estimates. Revista de Nutrição

Caliri, Santina, Andaloro, Adriana, Corallo, Francesco, Donato, Antonina, Marino, Silvia, Mantarro, Carmela, Terranova, Aurelio, Bramanti, Placido, Caminiti, Fabrizia, Rifici, Carmela (2019) Recovery of malnutrition in a patient with severe brain injury outcomes. Medicine

ZHAO, Meilin, ZHAN, Qingqing (2021) Rehabilitation treatment of enteral nutrition whey protein in lung cancer patients in southern China. Food Science and Technology

Souza, Micheline Tereza Pires, Singer, Pierre, Ozorio, Gislaine Aparecida, Rosa, Vitor Modesto, Alves, Maria Manuela Ferreira, Mendoza López, Rossana Verónica, Waitzberg, Dan L. (2018) Resting energy expenditure and body composition in patients with head and neck cancer: An observational study leading to a new predictive equation. Nutrition

Correia MI, Perman MI, Waitzberg DL. Hospital malnutrition in Latin America: A systematic review. Clin Nutr. 2016;S0261-5614(16)30160-1.

Brasil. Ministério da Saúde. Inquérito Brasileiro de Nutrição Oncologica / Instituto Nacional do Câncer Jose de Alencar Gomes da Silva; organização Cristiane Aline D’Almeida, Nivaldo Barroso de Pinho. Rio de Janeiro: INCA, 2013.

Sánchez RE, García-Galbis MR. Enteral nutrition on the nutritional status of cancer. Nutr Hosp. 2015;1;32(4):1408-16.

Chima C S, Barco K, Dewitt J L A, Maeda M, Teran J C, Mullen K D. Relationship of nutritional status to length of stay, hospital costs, and discharge status of patients hospitalized in the medicine service. Aliment Pharmacol Ther. 1997;11:975-978.
DOI: 10.1016/S0002-8223(97)00235-6

McClave SA, DiBaise JK, Mullin GE, Martindale RG. ACG Clinical Guideline: Nutrition Therapy in the Adult Hospitalized Patient. Am J Gastroenterol. 2016;111(3):315-34.
DOI: 10.1038/ajg.2016.28

Gramlich L, Kichian K, Pinilla J, Rodych NJ, Dhaliwal R, Heyland DK. Does enteral nutrition compared to parenteral nutrition result in better outcomes in critically ill adult patients? A systematic review of the literature. Nutrition. 2004;20(10):843-8.
DOI: 10.1016/j.nut.2004.06.003

Waitzberg DL. Indicadores de Qualidade em Terapia Nutricional. São Paulo: ILSI Brasil; 2008.

Shiroma GM, Horie LM, Castro MG, Martins JR, Bittencourt AF, Logullo L et al. Nutrition quality control in the prescription and administration of parenteral nutrition therapy for hospitalized patients. Nutr Clin Pract. 2015;30(3):406-13.
DOI: 10.1177/0884533614567540

Verotti CC, Torrinhas RS, Cecconello I, Waitzberg DL. Selection of top 10 quality indicators for nutrition therapy. Nutr Clin Pract. 2012;27(2):261-7.
DOI: 10.1177/0884533611432317

Verotti CCG, Torrinhas RSM, Corona LP, Waitzberg DL. Design of quality indicators for oral nutritional therapy. Nutr Hosp. 2015; 1;31(6):2692-5.

Waitzberg DL, Enck CR, Miyahira NS, Mourão JRP, Faim MMR, Oliseski M, et al. Terapia Nutricional: Indicadores de Qualidade Projeto Diretrizes. São Paulo: Associação Médica Brasileira e Conselho Federal de Medicina; 2011.

Oliveira Filho RS, Ribeiro LMK, Caruso L, Lima PA, Damasceno NRT, Soriano FG. Quality indicators for enteral and parenteral nutrition therapy: application in critically ill patients “at nutritional risk”. Nutr Hosp. 2016; 20;33(5):563

Oliveira Filho RS, Vianna SN, Almeida MMFA, Trevisani VS, Cardenas TC. Quality Indicators in Nutrition Therapy: Results at an Oncology Reference Hospital in São Paulo – Brazil. Clin Nutr 2014;33 (suppl. 1): 59.

Kondrup J, Rasmussen HH, Hamberg O, Satanga Z, ESPEN Working Group. Nutritional risk screening (NRS 2002): a new method base don a analysis of controlled clinical trials. Clin Nutr. 2003; 22(3):321-336.
DOI: 10.1016/S0261-5614(02)00214-5

Detsky AS, Mclaughlin JR, Baker JP, Johnston N, Whittaker S, Mendelson RA, et al. What is subjective global assessment of nutritional status? J Parenter Enteral Nutr.1987;11:8-13.

Brasil. Ministério da Saúde. Instituto Nacional de Câncer. Consenso nacional de nutrição oncológica. / Instituto Nacional de Câncer. – Rio de Janeiro: INCA, 2009.

Isosaki M, Gandolfo AS, Jorge AL, Evazian D, Castanheira FA, Bittar OJN. Indicadores de Nutrição Hospitalar. São Paulo: Editora Atheneu, 2015.

Langius JA, van Dijk AM, Doornaert P, Kruizenga HM, Langendijk JA, Leemans CR, et al. More than 10% weight loss in head and neck cancer patients during radiotherapy is independently associated with deterioration in quality of life. Nutr Cancer. 2013;65(1):76-83.
DOI: 10.1080/01635581.2013.741749

Silander E, Nyman J, Hammerlid E. An exploration of factors predicting malnutrition in patients with advanced head and neck cancer. Laryngoscope. 2013;123(10):2428-34.
DOI: 10.1002/lary.23877

Zhang Z, Zhu Y, Ling Y, Zhang L, Wan H. Comparative effects of different enteral feeding methods in head and neck cancer patients receiving radiotherapy or chemoradiotherapy: a network meta-analysis. Onco Targets Ther. 2016;18;9:2897-909.

Chapple LS, Deane AM, Heyland DK, Lange K, Kranz AJ, Williams LT, et al. Energy and protein deficits throughout hospitalization in patients admitted with a traumatic brain injury. Clin Nutr. 2016;23:S0261-5614(16)00066-2.

Ventura AM, Waitzberg DL. Enteral nutrition protocols for critically ill patients: are they necessary? Nutr Clin Pract. 2015;30(3):351-62.
DOI: 10.1177/0884533614547765

Raslan M, Gonzalez MC, Torrinhas RS, Ravacci GR, Pereira JC, Waitzberg DL. Complementarity of Subjective Global Assessment (SGA) and Nutritional Risk Screening 2002 (NRS 2002) for predicting poor clinical outcomes in hospitalized patients. Clin Nutr. 2011;30(1):49-53.
DOI: 10.1016/j.clnu.2010.07.002

Martins JR, Horie LM, Shiroma GM, Ortolani MC, Lugollo L, Bittencourt AF, et al. Quality control indicators in enteral nutrition: the compliance rates in a general hospital in Brazil. Clin Nutr Suppl 2009;4 (suppl. 2).

McClave SA, Martindale RG, Vanek VW, McCarthy M, Roberts P, Taylor B, et al. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr. 2009;33(3):277-316.
DOI: 10.1177/0148607109335234

Kreymann KG, Berger MM, Deutz NE, Hiesmayr M, Jolliet P, Kazandjiev G, et al; DGEM (German Society for Nutrition Medicine); ESPEN (European Society for Parenteral and Enteral Nutrition). ESPEN Guidelines on Enteral Nutrition: Intensive care. Clin Nutr 2006;25(2):210-23.
DOI: 10.1016/j.clnu.2006.01.021

Heyland DK, Cahill NE, Dhaliwal R, Sun X, Day AG, McClave SA. Impact of enteral feeding protocols on enteral nutrition delivery: results of a multicenter observational study. JPEN J Parenter Enteral Nutr 2010;34(6):675-84
DOI: 10.1177/0148607110364843

Oliveiro Filho RS, Tamburrino AC, Trevisani VS, Rosa VM. Main Barriers in Control of Energy-Protein Deficit in Critical Oncologic Patient at Nutritional Risk. J Integr Oncol 2016;5:156.
DOI: 10.4172/2329-6771.1000156

Martins JR, Shiroma GM, Horie LM, Logullo L, Silva MdeL, Waitzberg DL. Factors leading to discrepancies between prescription and intake of enteral nutrition therapy in hospitalized patients. Nutrition. 2012;28(9):864-7.
DOI: 10.1016/j.nut.2011.07.025

Ribeiro LMK, Oliveira Filho RS, Caruso L, Lima PA, Damasceno NRT, Soriano FG. Adequacy of energy and protein balance of enteral nutrition in intensive care: what are the limiting factors? Rev Bras Ter Intensiva 2014;26(2):155-162.

Faisy C, Lerolle N, Dachraoui F, Savard JF, Abboud I, Tadie JM, et al. Impact of energy deficit calculated by a predictive method on outcome in medical patients requiring prolonged acute mechanical ventilation. Br J Nutr. 2009;101:1079-1087.
DOI: 10.1017/S0007114508055669

Heyland DK, Dhaliwal R, Wang M, Day AG. The prevalence of iatrogenic underfeeding in the nutritionally ‘at-risk’ critically ill patient: Results of an international, multicenter, prospective study. Clin Nutr 2015;34:659-66
DOI: 10.1016/j.clnu.2014.07.008

Wang K, McIlroy K, Plank LD, Petrov MS, Windsor JA. Prevalence, Outcomes, and Management of Enteral Tube Feeding Intolerance: A Retrospective Cohort Study in a Tertiary Center. JPEN J Parenter Enteral Nutr. 2016 Feb 5. pii: 0148607115627142

Bittencourt AF, Martins JR, Logullo L, Shiroma G, Horie L, Ortolani MC, et al. Constipation is more frequent than diarrhea in patients fed exclusively by enteral nutrition: results of an observational study. Nutr Clin Pract. 2012;27(4):533-9.
DOI: 10.1177/0884533612449488

Benson AB, Ajani JA, Catalano RB, Engelking C, Kornblau SM, Martenson JAJR et al. Recomended guidelines for the treatment of cancer treatment-induced diarrhea. J Clin Oncol. 2004;15;22(14):2918-26.

Machado RRC, Caruso L, Lima PA, Damasceno NRT, Soriano FG.

Nutrition therapy in sepsis: characterization and implications for clinical prognosis. Nutr Hosp 2015; 32: 1281-1288.

Nassar APJ, Silva FMQ, Cleva R. Constipation in intensive care unit: Incidence and risk factors. J Crit Care. 2009;24(4):630.9-12.

Martín FT, Álvarez HJ, Burgos PR, Celaya PS, Calvo HMV, García LA. et al. Analysis of the relevance and feasibility of quality indicators in nutrition support. Nutr Hosp 2012;27(1):198-204

Waitzberg DL, Correia MI. Strategies for High-Quality Nutrition

Therapy in Brazil. JPEN J Parenter Enteral Nutr. 2016;40:73-82.

Joint Commission on Accreditation of Healthcare Organizations (JCIHO); 1996.