A Malnutrição Associada à Doença e as suas Repercussões em Portugal
DOI:
https://doi.org/10.24950/rspmi/revisao/91/1/2019Palavras-chave:
Avaliação Nutricional, Custos Hospitalares, Estado Nutricional, Malnutrição, Perturbações da NutriçãoResumo
A malnutrição associada à doença é frequente do ponto de
vista clínico, apresentando elevada morbilidade, mortalidade e impacto na qualidade de vida, em especialidades
como a medicina interna, a oncologia, a neurologia, a gastroenterologia e a pediatria, entre outras. Estudos realizados
em Portugal estimam existirem cerca de 40% de doentes em
risco nutricional à data da admissão hospitalar, dependendo
do estadio da doença e do grau/severidade. O custo da hospitalização destes doentes, é cerca de 20% superior ao dos
doentes com o mesmo grupo de diagnóstico homogéneo,
mas sem risco nutricional associado. No nosso país, o acesso dos doentes malnutridos a avaliação, aconselhamento e
tratamento nutricional adequados ainda é limitado, mesmo
em ambiente hospitalar. Um conhecimento detalhado da
malnutrição associada à doença nas referidas especialidades, permitiria uma melhor caracterização da situação em
Portugal, e permitiria estabelecer uma estratégia de intervenção clínica e terapêutica, para melhorar este panorama
e as suas consequências no nosso país.
Downloads
Referências
Benkovic V, Kolcic I, Ivicevic Uhernik A, Vranesic Bender D, Oreb I, Stevanovic R, et al. The economic burden of disease-related undernutrition in selected chronic diseases. Clin Nutr. 2014;33:689-93. doi: 10.1016/j. clnu.2013.09.006.
Barker LA, Gout BS, Crowe TC. Hospital malnutrition: prevalence, identification and impact on patients and the healthcare system. Int J Environ Res Public Health. 2011;8:514-27. doi: 10.3390/ijerph8020514.
Elia M, Normand C, Laviano A, Norman K. A systematic review of the cost and cost effectiveness of using standard oral nutritional supplements in community and care home settings. Clin Nutr. 2016;35:125-37. doi: 10.1016/j.clnu.2015.07.012.
Alvarez-Hernandez J, Planas Vila M, Leon-Sanz M, Garcia de Lorenzo A, Celaya-Perez S, Garcia-Lorda P, et al. Prevalence and costs of malnutrition in hospitalized patients; the PREDyCES Study. Nutr Hosp. 2012;27:1049-59. doi: 10.3305/nh.2012.27.4.5986.
Cederholm T, Bosaeus I, Barazzoni R, Bauer J, Van Gossum A, Klek S, et al. Diagnostic criteria for malnutrition - An ESPEN Consensus Statement. Clin Nutr. 2015;34:335-40. doi: 10.1016/j.clnu.2015.03.001
Gastalver-Martin C, Alarcon-Payer C, Leon-Sanz M. Individualized measurement of disease-related malnutrition´s costs. Clin Nutr. 2015;34:951- 5. doi: 10.1016/j.clnu.2014.10.005.
Leon-Sanz M, Brosa M, Planas M, Garcia-de-Lorenzo A, Celaya-Perez S, Hernandez JA, et al. PREDyCES study: The cost of hospital malnutrition in Spain. Nutrition. 2015;31:1096-102. doi: 10.1016/j.nut.2015.03.009.
Norman K, Pichard C, Lochs H, Pirlich M. Prognostic impact of disease- -related malnutrition. Clin Nutr. 2008;27:5-15.
Ray S, Laur C, Golubic R. Malnutrition in healthcare institutions: a review of the prevalence of under-nutrition in hospitals and care homes since 1994 in England. Clin Nutr. 2014;33:829-35. doi: 10.1016/j.clnu.2013.10.017.
Cederholm T, Barazzoni R, Austin P, Ballmer P, Biolo G, Bischoff SC, et al. ESPEN guidelines on definitions and terminology of clinical nutrition. Clin Nutr. 2017;36:49-64. doi: 10.1016/j.clnu.2016.09.004.
Cederholm T, Jensen GL. To create a consensus on malnutrition diagnostic criteria. JPEN J Parenter Enteral Nutr. 2017;41:311-4. doi: 10.1177/0148607116686293.
Guerra RS, Fonseca I, Sousa AS, Jesus A, Pichel F, Amaral TF. ESPEN diagnostic criteria for malnutrition - A validation study in hospitalized patients. Clin Nutr. 2017;36:1326-32. doi: 10.1016/j.clnu.2016.08.022.
Lim SL, Ong KC, Chan YH, Loke WC, Ferguson M, Daniels L. Malnutrition and its impact on cost of hospitalization, length of stay, readmission and 3-year mortality. Clin Nutr. 2012;31:345-50. doi: 10.1016/j. clnu.2011.11.001.
Norman C, Kirchner H, Lochs H, Pirlich M. Malnutrition affects quality of life in gastroenterology patients. World J Gastroenterol. 2006;12:3380-5.
Almeida AI, Correia M, Camilo M, Ravasco P. Length of stay in surgical patients: nutritional predictive parameters revisited. Br J Nutr. 2013;109(2):322-8.
Amaral TF, Matos LC, Tavares MM, Subtil A, Martins R, Nazare M, et al. The economic impact of disease-related malnutrition at hospital admission. Clin Nutr. 2007;26:778-84.
Amaral TF, Matos LC, Teixeira MA, Tavares MM, Alvares L, Antunes A. Undernutrition and associated factors among hospitalized patients. Clin Nutr. 2010;29:580-5. doi: 10.1016/j.clnu.2010.02.004.
National Alliance for Infusion Therapy and the American Society for Parenteral and Enteral Nutrition Public Policy Committee and Board of Directors. Disease-related malnutrition and enteral nutrition therapy: a significant problem with a cost-effective solution. Nutr Clin Pract. 2010;25:548-54. doi: 10.1177/0884533610378524.
Khalatbari-Soltani S, Marques-Vidal P. Impact of nutritional risk screening in hospitalized patients on management, outcome and costs: A retrospective study. Clin Nutr. 2016;35:1340-6. doi: 10.1016/j.clnu.2016.02.012.
Mahakalkar C, Modi S, Yeola M, Kaple M, Patwardhan M, Laddha P. Malnutrition in hospitalised patients; a real concern in surgical outcomes. Intl J Res Med Sci. 2014;2:250.
Schindler K, Pernicka E, Laviano A, Howard P, Schutz T, Bauer P, et al. How nutritional risk is assessed and managed in European hospitals: a survey of 21,007 patients findings from the 2007-2008 cross- -sectional nutritionDay survey. Clin Nutr. 2010;29:552-9. doi: 10.1016/j. clnu.2010.04.001.
Shpata V, Prendushi X, Kreka M, Kola I, Kurti F, Ohri I. Malnutrition at the time of surgery affects negatively the clinical outcome of critically ill patients with gastrointestinal cancer. Med Arch. 2014;68:263-7. doi: 10.5455/medarh.2014.68.263-267.
Sorensen J, Kondrup J, Prokopowicz J, Schiesser M, Krahenbuhl L, Meier R, et al. EuroOOPS: an international, multicentre study to implement nutritional risk screening and evaluate clinical outcome. Clin Nutr. 2008;27:340-9. doi: 10.1016/j.clnu.2008.03.012.
Sousa AS, Guerra RS, Fonseca I, Pichel F, Amaral TF. Sarcopenia among hospitalized patients - A cross-sectional study. Clin Nutr. 2015;34:1239- 44. doi: 10.1016/j.clnu.2014.12.015.
Planas M, Alvarez-Hernandez J, Leon-Sanz M, Celaya-Perez S, Araujo K, Garcia de Lorenzo A, et al. Prevalence of hospital malnutrition in cancer patients: a sub-analysis of the PREDyCES(R) study. Support Care Cancer. 2016;24:429-35. doi: 10.1007/s00520-015-2813-7
Arends J, Bodoky G, Bozzetti F, Fearon K, Muscaritoli M, Selga G, et al. ESPEN Guidelines on Enteral Nutrition: Non-surgical oncology. Clin Nutr. 2006;25:245-59. doi: 10.1016/j.clnu.2009.04.011.
Hebuterne X, Lemarie E, Michallet M, de Montreuil CB, Schneider SM, Goldwasser F. Prevalence of malnutrition and current use of nutrition support in patients with cancer. JPEN J Parenter Enteral Nutr. 2014;38:196- 204. doi: 10.1177/0148607113502674.
Jensen KC, Bellini SG, Derrick JW, Fullmer S, Eggett D. Handgrip strength and malnutrition (undernutrition) in hospitalized versus nonhospitalized children aged 6-14 years. Nutr Clin Pract. 2017;32:687-93. doi: 10.1177/0884533617698098.
Ravasco P, Monteiro-Grillo I, Vidal PM, Camilo ME. Nutritional deterioration in cancer: the role of disease and diet. Clin Oncol. 2003;15:443-50.
J. Arends, V. Baracos, H. Bertz, F. Bozzetti, Calder PC, et al. ESPEN expert group recommendations for action against cancer-related malnutrition. Clin Nutr. 2017;36:1187-96. doi: 10.1016/j.clnu.2017.06.017.
Fonseca J, Santos C, Brito J. Malnutrition and clinical outcome of 234 head and neck cancer patients who underwent percutaneous endoscopic gastrostomy. Nutr Cancer. 2016;68:589-97. doi: 10.1080/01635581.2016.1158297.
Dias do Prado C, Alvares D. Malnutrition in patients with gastrointestinal cancer: effectiveness of different diagnostic methods. Nutr Hosp. 2015; 32:182-8. doi: 10.3305/nh.2015.32.1.8657.
Gärtner S KJ, Aghdassi AA, Steveling A, Simon P, Lerch MM, Mayerle J. Nutrition in pancreatic cancer: a review. Gastrointest Tumors. 2016; 2:195-202. doi: 10.1159/000442873.
Vomero ND, Colpo E. Nutritional care in peptic ulcer. Arq Bras Cir Dig. 2014; 27:298-302. doi: 10.1590/S0102-67202014000400017.
Lucendo A, De Rezende L. Importance of nutrition in inflammatory bowel disease. World J Gastroenterol. 2009; 15:2081-8.
Rasmussen H, Irtun O, Olesen S, Drewes A, Holst M. Nutrition in chronic pancreatitis. World J Gastroenterol. 2013; 19:7267-75.
Nunes G, Santos C, Barosa R, Fonseca C, Barata A, Fonseca J. Outcome and nutritional assessment of chronic liver disease patients using anthropometry and subjective global assessment. Arq Gastroenterol. 2017;54:225-31.
Sato T, Shiobara M, Nishizawa M, Shimohata T. Nutritional status and changes in body weight in patients with multiple system atrophy. Eur Neurol. 2017;77:41-4. doi: 10.1159/000453395.
Volkert D, Chourdakis M, Faxen-Irving G, Fruhwald T, Landi F, Suominen MH, et al. ESPEN guidelines on nutrition in dementia. Clin Nutr. 2015;34:1052-73. doi: 10.1016/j.clnu.2015.09.004.
Tombini M, Sicari M, Pellegrino G, Ursini F, Insarda P, Di Lazzaro V. Nutritional Status of Patients with Alzheimer´s Disease and Their Caregivers. J Alzheimers Dis. 2016;54:1619-27.
Sheard J, Ash S, Silburn P, Kerr G. Prevalence of malnutrition in Parkinson´s disease: a systematic review. Nutr Rev. 2011; 69:520-32. doi: 10.1111/j.1753-4887.2011.00413.x.
Markus HS, Tomkins AM, Stern GM. Increased prevalence of undernutrition in Parkinson´s disease and its relationship to clinical disease parameters J Neural Transm Park Dis Dement Sect. 1993;5:117-25.
Desport JC PP, Truong TC, Vallat JM, Sautereau D, Couratier P. Nutritional status is a prognostic factor for survival in ALS patients. Neurology. 1999; 53:1059.
Wills AM, Hubbard J, Macklin EA, Glass J, Tandan R, Simpson EP, et al. Hypercaloric enteral nutrition in patients with amyotrophic lateral sclerosis: a randomised, double-blind, placebo-controlled phase 2 trial. Lancet. 2014;383:2065-72. doi: 10.1016/S0140-6736(14)60222-1.
Beal MF. Mitochondrial dysfunction in neurodegenerative diseases. Biochim Biophys Acta. 1998;1366:211-23.
Esposito S, Bonavita S, Sparaco M, Gallo A, Tedeschi G. The role of diet in multiple sclerosis: A review. Nutr Neurosci. 2017:1-14. doi: 10.1080/1028415X.2017.1303016.
Sorgun MH, Yucesan C, Tegin C. Is malnutrition a problem for multiple sclerosis patients? J Clin Neurosci. 2014;21:1603-5.
Joosten KF, Hulst JM. Prevalence of malnutrition in pediatric hospital patients. Curr Opin Pediatr. 2008;20:590-6.
Shaughnessy EE, Kirkland LL. Malnutrition in hospitalized children: a responsibility and opportunity for pediatric hospitalists. Hosp Pediatr. 2016;6:37-41. doi: 10.1542/hpeds.2015-0144.
Dura Trave T, San Martin Garcia I, Gonzalez Benavides A, Vaquero Inigo I, Herranz Aguirre M, Iceta Elizaga A. Situacion nutricional en el momento del ingreso en un hospital pediatrico terciario. Nutr Hosp. 2015;31:2465- 71. doi: 10.3305/nh.2015.31.6.8863.
Dura-Trave T, San Martin-Garcia I, Gallinas-Victoriano F, Vaquero Inigo I, Gonzalez-Benavides A. Prevalence of malnutrition in hospitalised children: retrospective study in a Spanish tertiary-level hospital. JRSM Open. 2016;7:2054270416643889. doi: 10.1177/2054270416643889.
Trave TD. Malnutrition in hospitalized children. J Obes Weight Loss Ther. 2016;06:1.
Elia M, Normand C, Norman K, Laviano A. A systematic review of the cost and cost effectiveness of using standard oral nutritional supplements in the hospital setting. Clin Nutr. 2016;35:370-80. doi: 10.1016/j. clnu.2015.05.010.
Qualife+. Estudo conclui que a avaliação na admissão hospitalar reduz risco de desnutrição. 2016 [consultado em Julho 2018] Disponível em: http://portal-chsj.min-saude.pt/frontoffice/pages/616?news_id=324.
UP65 N. 44% dos idosos portugueses têm excesso de peso. 2016 [consultado em Julho 2018] Disponível em: https://nutritionup65. up.pt/2016/10/19/nutrition-up-65-nas-noticias-44-dos-idosos-portugueses-tem-excesso-de-peso/.
Amaral TF, Santos A, Guerra RS, Sousa AS, Álvares L, Valdiviesso R, et al. Nutritional strategies facing an older demographic: the Nutrition UP65 study protocol. JMIR Res Protoc. 2016;5:e184. doi: 10.2196/resprot.6037.
Guerra RS, Sousa AS, Fonseca I, Pichel F, Restivo MT, Ferreira S, et al. Comparative analysis of undernutrition screening and diagnostic tools as predictors of hospitalisation costs. J Hum Nutr Diet. 2016;29:165-73. doi: 10.1111/jhn.12288
Freijer K, Bours MJ, Nuijten MJ, Poley MJ, Meijers JM, Halfens RJ, et al. The economic value of enteral medical nutrition in the management of disease-related malnutrition: a systematic review. J Am Med Dir Assoc. 2014;15:17-29. doi: 10.1016/j.jamda.2013.09.005.
Ljungqvist O, Man F. Under nutrition: a major health problem in Europe. Nutr Hosp. 2009;24:369-70.
Matos LC, Teixeira MA, Henriques A, Tavares MM, Álvares L, Antunes A, et al. Menções sobre o estado nutricional nos registos clínicos de doentes hospitalizados. Acta Med Port 2007;20:503-10.
Direção Geral da Saúde. Portugal IDADE MAIOR em números, 2014: a saúde da população Portuguesa com 65 ou mais anos de idade. Direção-Geral da Saúde Direção de Serviços de Informação e Análise Portugal. 2014 [consultado em Agosto 2017] Disponível em: http://www.dgs. pt.
Downloads
Publicado
Como Citar
Edição
Secção
Licença
Este trabalho encontra-se publicado com a Licença Internacional Creative Commons Atribuição 4.0.
Direitos de Autor (c) 2023 Medicina Interna
Acesso livre
