Malnutrice je častým jevem u pokročilého chronického jaterního onemocnění negativně ovlivňující prognózu pacientů stran morbidity i mortality. Etiopatogeneze je multifaktoriální a zahrnuje nedostatečný příjem potravy, malabsorpci, alteraci metabolismu směrem ke katabolismu a zvýšený energetický výdej. V diagnostice se užívají pečlivý odběr anamnézy, fyzikální vyšetření, laboratorní odběry, základní biometrická měření, funkční svalové testy a stále častěji též CT vyšetření stanovující množství svalové hmoty. V terapii hrají roli dostatečný příjem základních živin, minerálů a mikronutrientů, kterého lze dostáhnout úpravou diety, perorálními nutričními suplementy či sondovou enterální výživou. Ve vybraných případech může být nutná parenterální nutriční podpora. Cílem tohoto článku je shrnout současné poznatky o patogenezi malnutrice u populace pacientů s chronickým jaterním onemocněním a poskytnout přehled doporučených metod diagnostiky a léčby.
Malnutrition is common in advanced chronic liver disease (ACLD) negatively affecting both patient morbidity and mortality. Etiopathogenesis is multifactorial and includes insufficient food intake, malabsorption, metabolism alteration towards catabolism and increased energy expenditure. The diagnostic process involves conscientious history taking, basic biometric measurements, functional muscle tests, and with increasing significance also core muscle mass assessment using CT scan. Therapy consists of sufficient nutrients, minerals and micronutrients intake which can be achieved by increased oral intake or using enteral or parenteral nutrition. The aim of this article is to summarize the current knowledge regarding pathogenesis, diagnostics and therapy methods of malnutrition in the specific population of patients with chronic liver disease.
- MeSH
- chronická nemoc MeSH
- lidé MeSH
- malabsorpční syndromy etiologie MeSH
- nemoci jater komplikace MeSH
- nemoci výživy a metabolismu diagnóza prevence a kontrola terapie MeSH
- nutriční podpora MeSH
- nutriční terapie MeSH
- podvýživa * diagnóza komplikace prevence a kontrola terapie MeSH
- poruchy metabolismu glukózy etiologie komplikace MeSH
- poruchy metabolismu lipidů diagnóza etiologie MeSH
- přijímání potravy MeSH
- živiny metabolismus MeSH
- Check Tag
- lidé MeSH
AIMS AND OBJECTIVES: The aim of this study was to find tools for screening the risk of malnutrition in adult hospitalised patients, evaluate their key characteristics including selected psychometric properties and propose the most appropriate tools for nursing practice. BACKGROUND: A large number of existing tools for nutritional screening make it difficult to be aware of all the possibilities and especially to select the optimal tool. DESIGN: The research methodology was designed as secondary research using a scoping review search to map and compare existing tools for assessing the risk of malnutrition in hospitalised adults. METHODS: The analysis focused on the selected psychometric properties of the instruments (sensitivity, specificity, positive and negative predictive value) and key characteristics relevant to the selection of an appropriate instrument. This study follows the PRISMA-ScR Checklist. RESULTS: The review included 27 publications containing 17 tools. The best sensitivity (57%-100%) and specificity (76%-96%) were achieved by the Malnutrition Universal Screening Tool (MUST) and the Nutritional Risk Screening 2002 (NRS 2002). Minimal Eating Observation and Nutrition Form-Version II (MEONF-II) has solid sensitivity (up to 73%), specificity (88%) and high positive predictive values (81%-82%). CONCLUSIONS: The MUST, NRS 2002 and MEONF-II showed satisfactory psychometric properties. MEONF-II and MUST are able to assess risk without weighing the patient. The Hand Grip Strength (HGS) assessment can be recommended to detect reductions in muscle strength. RELEVANCE TO CLINICAL PRACTICE: We recommend the MUST, NRS 2002 and MEONF-II tools for use in clinical practice, as they have the best psychometric properties and are user-friendly. The HGS, which proved to be related to the length of hospital stay (LOS) and used as an indicator of protein-energy malnutrition in obese patients, may be a useful complementary tool. For nursing practice, we recommend selecting a tool with respect to the specifics of a particular workplace.
- MeSH
- délka pobytu MeSH
- dospělí MeSH
- hodnocení rizik MeSH
- hodnocení stavu výživy MeSH
- lidé MeSH
- nutriční stav * MeSH
- podvýživa * diagnóza MeSH
- síla ruky MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
Udržať dobrý výživový status by malo byť neoddeliteľnou súčasťou starostlivosti od prvého kontaktu s onkologicky chorým. Intervencie by mali obsahovať zhodnotenie výživového stavu, zistenie rizika malnutrície, identifikáciu malnutrície, sarkopénie, naplánovanie intervencii na ich zabránenie resp. elimináciu. Dobrý nutričný stav je jedným z hlavných podmienok úspešnej liečby väčšiny závažných ochorení, ku ktorým patria aj onkologické ochorenia. Zahájenie skorej nutričnej starostlivosti, pred operačným výkonom, chemoterapiou, rádioterapiou, môže ovplyvniť celkový priebeh liečby, eliminovať vznik komplikácii, resp. ich oddialiť. V konečnom dôsledku to má aj ekonomický benefit, eliminujú sa náklady na liečbu. Cieľom príspevku je poukázať na význam skorej nutričnej podpory u pacientov s nádormi hlavy a krku, ktoré sú hodnotené ako najrizikovejšie z hľadiska vzniku malnutrície. Metódou výskumu bola prípadová štúdia (case study), doplňujúcimi metódami boli analýza zdravotnej dokumentácie, rozhovor, pozorovanie, hodnotiace nástroje- MNA, Kritéria hodnotenia ťažkostí MDU podľa WHO, Kritéria hodnotení komplikácii v ústnej dutine, VAS, Karnofského index. Súborom boli dvaja hospitalizovaní pacienti s diagnostikovaným onkologickým ochorením, ktorým bola aplikovaná rádioterapia a chemoterapia. Výskumom sme zistili, že zahájenie skorej nutričnej podpory ešte pred začatím onkostatickej liečby významne ovplyvňuje vznik komplikácii. U prvého respondenta sme zaznamenali skorý nástup komplikácii- postradiačná mukozitída, úbytok hmotnosti, znížený príjem stravy, znížené biochemické parametre- B, Al, zvýšené CRP. U druhého respondenta so zahájenou skorou nutričnou podporou sa objavili komplikácie až v závere liečby. Výsledky sú súčasťou projektu KEGA 009 KU-4-2022.
Maintaining a good nutritional status should be an integral part of care from the first contact with an oncological patient. Interventions should include assessment of nutritional status, detection of the risk of malnutrition, identification of malnutrition, sarcopenia, planning of interventions to prevent them or elimination. Good nutritional status is one of the main conditions for the successful treatment of most serious diseases, including oncological diseases. The initiation of early nutritional care, before surgery, chemotherapy, radiotherapy, can influence the overall course of treatment, eliminate the occurrence of complications, or delay the onset of complications. In the end, it also has an economic benefit, the costs of treating the complication are eliminated. The aim of the article is to point out the importance of early nutritional support in patients with head and neck cancer, who are assessed as the most at-risk in terms of developing malnutrition. Methods the research method was a case study, additional methods were the analysis of health documentation, interview, observation, evaluation tools- MNA, Criteria for evaluating the difficulties of MDU according to WHO, Criteria for evaluating complications in the oral cavity, VAS, Karnofsky index. The group consisted of two hospitalized patients diagnosed with oncological disease who were applied radiotherapy and chemotherapy. Through research, we have found that the initiation of early nutritional support even before the start of oncostatic treatment significantly affects the occurrence of complications. In the first respondent, we noticed an early onset of complications - postradiation mucositis, weight loss, reduced food intake, reduced biochemical parameters - B, Al, increased CR. In the second respondent with early nutritional support, complications appeared only at the end of the treatment. The results are part of the KEGA 009 KU-4-2022 project.
- MeSH
- fyziologie výživy MeSH
- hmotnostní úbytek MeSH
- hodnocení stavu výživy MeSH
- nádory hlavy a krku dietoterapie MeSH
- nutriční podpora MeSH
- nutriční stav MeSH
- nutriční terapie MeSH
- plošný screening MeSH
- podvýživa diagnóza epidemiologie prevence a kontrola terapie MeSH
- průzkumy a dotazníky MeSH
- NLK Publikační typ
- studie
Úvod: U pacientov s onkologickým ochorením sú poruchy výživy rizikovým faktorom, ktoré komplikujú protinádorovú liečbu a výrazne skracujú prežívanie pacientov. V praxi je kľúčovou podmienkou úspechu posúdenie stavu výživy a včasná nutričná intervencia. Cieľ: Hlavným cieľom príspevku je objasniť postupy ošetrovateľských intervencií pri zabezpečení výživy pacienta s malnutríciou. Metódy: Hlavnou metódou je prípadová štúdia (case study). Výber respondenta bol zámerný. Kritériami výberu boli: pacient s onkologickou diagnózou a malnutríciou, ochotný spolupracovať. Do štúdie sme zaradili 68 ročného pacienta s karcinómom pažeráka. Pacient nám poskytol informácie o svojom zdravotnom stave dobrovoľne a súhlasil s ich spracovaním. Výsledky: Na základe nutričnej anamnézy, antropometrických meraní a laboratórnych vyšetrení bol nutričný stav pacienta vyhodnotený ako malnutrícia. V priebehu štyroch mesiacov sme ordinovanými nutričnými intervenciami - podávaním diéty č.1, tekutín, a nutridrinkov 6 až 8 denne cez perkutánnu endoskopickú gastrostómiu zabezpečovali uspokojovanie potreby výživy u pacienta. Telesnú hmotnosť pacienta sa nám podarilo stabilizovať na hodnote 65-62kg za sledované obdobie 4 mesiacov. Záver: Malnutrícia je najčastejšou sprievodnou diagnózou u onkologických pacientov. Napriek nutričným intervenciám sa stav výživy pacienta zhoršil a po 4 mesiacoch javil známky nádorovej kachexie, čo potvrdili laboratórne parametre.
Introduction: In patients with oncological disease are nutritional disorders a risk factor, which complicate anti-tumor treatment and significantly shorten the survival of patients. In practice, the key condition for success is the assessment of the nutritional status and early nutritional intervention. Objective: The main objective of the paper is explain the procedures of nursing interventions in ensuring the nutrition of a malnourished patient. Methods: The main method is a case study. The choice of the respondent was deliberate. These lection criteria were: a patient with an oncological diagnosis and malnutrition, willing to cooperate. We included a 68-year-old patient with esophageal cancer in the study. The patient provided us with information about his health condition voluntarily and agreed to its processing. Results: Based on nutritional anamnesis, anthropometric measurements and laboratory tests, the patient's nutritional status was evaluated as malnutrition. Over thecourse of five months, we ensured that the patient's nutritional needs were met through a percutaneous endoscopic gastrostomy through prescribed nutritional interventions - administration of diet No. 1 and, liquids, 6 to 8 nutridrinks per day. We managed to measure the patient's body weight stabilize at a value of 65-62kg for the monitored period of 4 months. Conclusion: Malnutrition is the most common accompanying diagnosis in oncology patients. Despite nutritional interventions with the nutritional status of the patient worsened and after 4 months showed signs of tumor cachexia, which was confirmed by laboratory parameters.
- Klíčová slova
- Perkutánní endoskopická gastrostomie (PEG),
- MeSH
- enterální výživa MeSH
- gastrostomie metody MeSH
- hodnocení stavu výživy MeSH
- metody výživy MeSH
- miniinvazivní chirurgické výkony MeSH
- nádory klasifikace MeSH
- nutriční podpora MeSH
- nutriční stav MeSH
- nutriční terapie MeSH
- podvýživa diagnostické zobrazování diagnóza ošetřování terapie MeSH
- protein-energetická malnutrice diagnostické zobrazování diagnóza ošetřování terapie MeSH
- MeSH
- hodnocení stavu výživy MeSH
- index tělesné hmotnosti MeSH
- komorbidita MeSH
- lidé MeSH
- multimorbidita * MeSH
- nutriční podpora metody MeSH
- obezita komplikace prevence a kontrola MeSH
- podvýživa diagnóza komplikace prevence a kontrola MeSH
- poruchy výživy diagnóza etiologie prevence a kontrola MeSH
- potrava speciální MeSH
- strava, jídlo, výživa MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
PURPOSE: To obtain information on characteristics, management, current objective nutritional status and perception of nutritional status of children with cerebral palsy (CP) from healthcare professionals (HCPs) and caregivers. MATERIALS AND METHODS: A detailed survey of several items on eight main topics (general characteristics, motor function, comorbidities, therapies, anthropometry, feeding mode and problems and perceived nutritional status) was developed and tested for the study. Correlation between nutritional status and Gross Motor Function Classification System (GMFCS) levels was assessed using continuous variables (Z-scores for weight-for-age, height-for-age, weight-for-height, and body mass index-for-age), and categorical variables (being malnourished, stunted, or wasted). HCP and caregiver perceptions of the child's nutritional status as well as agreement between perceived and objective nutritional status and agreement between perceived nutritional status and concerns about the nutritional status were analyzed. RESULTS: Data were available for 497 participants from eight European countries. Poorer nutritional status was associated with higher (more severe) GMFCS levels. There was minimal agreement between perceived and objective nutritional status, both for HCPs and caregivers. Agreement between HCP and caregiver perceptions of the child's nutritional status was weak (weighted kappa 0.56). However, the concerns about the nutritional status of the child were in line with the perceived nutritional status. CONCLUSIONS: The risk of poor nutritional status is associated with more severe disability in children and adolescents with CP. There is a mismatch between HCP and caregiver perceptions of participants' nutritional status as well as between subjective and objective nutritional status. Our data warrant the use of a simple and objective screening tool in daily practice to determine nutritional status in children and adolescents with CP. Clinical trial registration: ClinicalTrials.gov Identifier: NCT03499288 (https://clinicaltrials.gov/ct2/show/NCT03499288). IMPLICATIONS FOR REHABILITATIONUse of the ESPGHAN recommendations and simple screening tools in daily practice is needed to improve nutritional care for individuals with CP.Attention should be paid to the differences in the perception of nutritional status of individuals with CP between professionals and caregivers to improve appropriate referral for nutritional support.Objective measures rather than the professional's perception need to be used to define the nutritional status of individuals with CP.
- MeSH
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- mozková obrna * MeSH
- nutriční stav MeSH
- osoby pečující o pacienty MeSH
- podvýživa * diagnóza MeSH
- průzkumy a dotazníky MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
BACKGROUND: Malnutrition and dehydration are widespread in older people, and obesity is an increasing problem. In clinical practice, it is often unclear which strategies are suitable and effective in counteracting these key health threats. AIM: To provide evidence-based recommendations for clinical nutrition and hydration in older persons in order to prevent and/or treat malnutrition and dehydration. Further, to address whether weight-reducing interventions are appropriate for overweight or obese older persons. METHODS: This guideline was developed according to the standard operating procedure for ESPEN guidelines and consensus papers. A systematic literature search for systematic reviews and primary studies was performed based on 33 clinical questions in PICO format. Existing evidence was graded according to the SIGN grading system. Recommendations were developed and agreed in a multistage consensus process. RESULTS: We provide eighty-two evidence-based recommendations for nutritional care in older persons, covering four main topics: Basic questions and general principles, recommendations for older persons with malnutrition or at risk of malnutrition, recommendations for older patients with specific diseases, and recommendations to prevent, identify and treat dehydration. Overall, we recommend that all older persons shall routinely be screened for malnutrition in order to identify an existing risk early. Oral nutrition can be supported by nursing interventions, education, nutritional counselling, food modification and oral nutritional supplements. Enteral nutrition should be initiated if oral, and parenteral if enteral nutrition is insufficient or impossible and the general prognosis is altogether favorable. Dietary restrictions should generally be avoided, and weight-reducing diets shall only be considered in obese older persons with weight-related health problems and combined with physical exercise. All older persons should be considered to be at risk of low-intake dehydration and encouraged to consume adequate amounts of drinks. Generally, interventions shall be individualized, comprehensive and part of a multimodal and multidisciplinary team approach. CONCLUSION: A range of effective interventions is available to support adequate nutrition and hydration in older persons in order to maintain or improve nutritional status and improve clinical course and quality of life. These interventions should be implemented in clinical practice and routinely used.
12letý chlapec s mnohočetnými komorbiditami byl přijat pro výraznou slabost, apatii, bledost. V krevním obraze dominovala pancytopenie - makrocytární anémie s těžkým poklesem hemoglobinu, leukopenie a trombocytopenie se zvýšenými markery hemolýzy. Kostní dřeň byla hypocelulární s dyserytropoetickými a myelodysplastickými rysy s absencí megakaryocytů. Současně byly přítomné velmi nízké sérové hladiny vitaminu B12 a kyseliny listové, spolu s nízkými hladinami dalších vitaminů a nutričních parametrů. Léčba parenterálně podávaným vitaminem B12 vedla rychle k postupnému obnovení funkce kostní dřeně a spolu s léčbou přidružené malabsorpce a karence dalších vitaminů k úpravě celkového stavu.
12-years-old boy with multiple comorbidities was admitted to the hospital for major weakness, lethargy and palor. There was pancytopenia in the blood count - macrocytic anemia with deep decrease of hemoglobin, leucocytopenia and trombocytopenia and higher level of hemolysis parameters. Bone marrow was hypocellular with marks of dyserythropoesis and myelopoesis and with no megakaryocytes. There were also low levels of vitamin B12 and folate and also low levels of other vitamins and nutritional parameters in the serum. After parenteral vitamin B12, other vitamins and makronutrients delivery quick improvement of clinical status and bone marrow function was reached.
- MeSH
- apatie MeSH
- dítě MeSH
- lidé MeSH
- makrocytární anemie etiologie MeSH
- nedostatek vitaminu B12 diagnóza komplikace terapie MeSH
- pancytopenie * diagnóza etiologie terapie MeSH
- podvýživa diagnóza etiologie MeSH
- vitamin B 12 aplikace a dávkování terapeutické užití MeSH
- výsledek terapie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- MeSH
- hodnocení stavu výživy MeSH
- lidé MeSH
- nutriční stav * MeSH
- podvýživa diagnóza etiologie patofyziologie terapie MeSH
- sarkopenie diagnóza terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
