- Email: [email protected]
Efficacy of enteral nutritional replenishment during radiotherapy
658
ABSTRACTS
FROM THE 1lTH BRAZILIAN
CONGRESS
Nutritional Followup of Uremic Patients in Haemodialysis Prqram at Silo Joiio Bath Hospital, Viqw~ (MC, Brazil) J.B.R. MONTEIRO, PP. OLIVEIRA, E.L. ROSADG Departamento de Nutri@o e hide. Universidade Federal de Qosa, 36571.00 - &o.sa city - MC state, Brazil.
Differents studies of body composition appear to suggest fat and lean body mass reduction in uremic patients. The causes are multifactorial and they include inadequate nutrients intake, loss of nutrients into dialysate, intercurrent illnesses, uremic toxins, and metabolic or endocrine disorders associated with the uremic syndrome. Patients (48) were studied from May/94 to June195 and separated into 4 groups, according to maintenance haemodialysis (HD): Cl1 (O-6 months), GII (7-30), GIII (31-60) e GIV (> 60). Urea, creatinin, potassium, haemoglobm (Hb) and haematocrit (Htc) were investigated during every month. The weight was performed alter I-ID. when the patient was with dry weight (DW), height, arm circumference (AC), arm muscle circumference (AMC), total body fat (%TBF, FutrexR) were determined on five assessments. Statiscal analysis was performed by Student’s t tests using appropriately paired or non-paired analysis and ANOVA II. Patients (645% males and 35.5% females), mean age 47,9 ( 14.9 years average were grouped at GI (4,3%), GII (40,495). GIII (34%) and GIV (21.3%). It was registered higher values for urea (109,9 mg/dL) and creatinin (9.46 mg/dL), normal values for potassium (5.0 mEq/L), while Hb and Htc showed lower values (9.21 g% e 26.2%. respectively), and it did not show statistically significant group differences. The dry weight, body mass index, AC, AMC, and TBF were statistically significant when compared among groups and both sexes and were not significant when these parameters were compared among assessments. The period of time appears to have no influence on the biochemical level, which were statistically significant in both sexes. The high concentration for creatinin and urea indicated a lacking control of the dietary protein intake. As expected, the degree of anemia was acceptable for the groups. The body composition, different in both sexes, was affected by the time of haemodialysis therapy and it was stable during the assessment, indicating the preservation of the body compartment. This work was supported by FAPEMIG and CNPq (Brazil).
Early Enteral Nutrition Improves Survival in Hospitalized Elderly Patients M.L. TEIXEIRA DA SILVA. D.L. WAITZBERG; V. CHAER BORGES; SS. CIOSAK; L.Z. COPPINI; R. ARAB-FADUL GANEP-Grupo de Apoio de Nutri@o Enteral e Parenteral Paulo-Sp-Brasil
- Sio
Due to the progressive increase of the elderly patients (%5 years) in the hospital it is of interest to assess their nutritional status and follow-up after EN were performed by routine parameters used in clinical practice. Anthropometric measures were correlated to albuminemia QK 0,05). Malnutrition diagnosed by Seltzer index, was found en 56.8%. Early (5 < days) or late EN with polymeric diet were used for 18,5 +/- 17,4 days, adequate in 89.7 for the estimated caloric requirements. EN complications occurred in 77.5% related to access route (49%) and digestive complications (47%). Diarrhea was prevalent (35%). Severe hypoalbuminemia was associated to diarrhea (p c 0.05). Patients with early EN had significantly less hypoalbuminemia, diarrhea and mortality. At conclusion - 1) Malnutrition is prevalent is hospitalized elderly patients. 2) EN is efficient but not innocuous for nutritional support. 3) Early EN ameliorates morbymortality rates.
OF PARENTERAL
AND ENTERAL NUTRITION
Efficacy of Enteral Nutritional Replenishment During Radiotherapy M.C.G. DIAS, R.D.; Y.C. BAXTER, R.D.; J. MACULEVICIUS, R.D.; W. NADALIN,M.D.; J. FAlNTUCH,M.D. Division of Nutrition and Dietetics and Service of Experimental Surgery. Hospital ah Clinicas, sdo Paula, Brazil
Advanced head and neck cancer is frequently associated with alimentation troubles, and these tend to be compounded in the course of radiation therapy. Aiming at the results of an 0raUenteral therapeutic program, a prospective investigation was done with 128 patients in these conditions already suffering from protein-calorie malnutrition. Mean age was 55.6 f 12.1 years with a majority of males (109:19), and radiotherapy was applied during 69.4 f 22.6 days. Nutritional support, in the proportion of 40 Kcal and 1.5 g protein/Kg/day, was started simultaneously and proceeded for 83.9 f 37.2 days. A complete polymeric commercial diet was prescribed as a supplement (n = 42). as the exclusive oral diet (n = 5.5).or in the form of tube feeding (n = 31). Efficacy of the procedure was assessed by anthropometric and nutritional parameters (table):
Description calories (Kcal) protein (s) body mass in&x (Kg/q) serum albumin (g/dl) hemoglobin (g/dl)
Initial 1354 i 798 51.4t 30.5 21.2 f 3.9 4.1 jzO.6 12.4 i 1.8
Final 1719*574 73.7 f 26.3 21.1 f 3.6 4.2+ 0.5 12.4 f 1.8
Sigtdf. @ * 0.05) * * ns ns ns
At the end of the treatment, 47 patients ate at least 90% of theii needs, 23 ingested 75-90% and the remaining 58 stayed below that value. It is concluded that: 1) Gral and enteral assistance of head and neck cancer patients undergoing radiotherapy is feasible and should be tried, 2) Objective improvement of calorie and protein input could be demonstrated; 3) More than half of the population achieved recovery or at least stabilization of the nutritional status.
The Effect of TPN Versus en in Critical Care Patients D.V. AANHOLT R.D.; D.L. WAITZBERG M.D.; G.C. ULIANA M.D.; M.L. TEMEIRA DA SILVA M.D.; MFR. OLIVBIRA R.N. Enteral and Parentera Nutritional Team-GANEP - Sdo Paula-SP Brasil.
New data concerning EN advantages make an argument against the routine use of TPN in ICU. To compare the nutritional-metabolic effect of EN versus TPN, a retrospective, paired case by case (age, sex, diagnosis, surgery) study was done in 50 coronary heart disease patients submitted to open heart surgery for coronary artery bypass with complicated post-operative course at the ICU. EN (25) was given as a polimeric diet (1,l kcal/ml;0,04 prot./ml) and TPN (25) as a elicidic regimen (1.1 KcaUml. 0.05e as/ml). EN x TPN shown no 2ifferences-m estimated caloric ~re&&ments (Kcahday) (1998 +/- 349 x 1998 +/- 328), caloric balance (kcal/day) (-680 +/- 427 x - 756 +/375). nitrogen intake (g/day) (7.9 +/- 2.6 x 9.1 +/- 3.0). nitrogen balance (g/day) (-5.8 +/- 0.4 x -3.1 +/- 6.1) and BUN, and seric cmatinine, both at the begining and at end of nutritional support @IS). Final albuminemia (g/dl) increased with BN (3,7 +/- 0.3 x 2,8 +/- 0,8) p < 0.05). Days of NS (20 +/- 14 x 16 +I- 11). metabolic complications (7/25 x 4/25) and mortality were not different with EN or TPN. Diarrhoea occurred twice withe EN. At conclusion: 1) Caloric requirements in ICU patients are only partially fullfiled by NS; 2) EN use is associated with seric albumin recovery. It is suggested to prefer EN in ICU heart surgery patients whenewere Possible.
ABSTRACTS
FROM THE 1lTH BRAZILIAN
CONGRESS
Nutritional Followup of Uremic Patients in Haemodialysis Prqram at Silo Joiio Bath Hospital, Viqw~ (MC, Brazil) J.B.R. MONTEIRO, PP. OLIVEIRA, E.L. ROSADG Departamento de Nutri@o e hide. Universidade Federal de Qosa, 36571.00 - &o.sa city - MC state, Brazil.
Differents studies of body composition appear to suggest fat and lean body mass reduction in uremic patients. The causes are multifactorial and they include inadequate nutrients intake, loss of nutrients into dialysate, intercurrent illnesses, uremic toxins, and metabolic or endocrine disorders associated with the uremic syndrome. Patients (48) were studied from May/94 to June195 and separated into 4 groups, according to maintenance haemodialysis (HD): Cl1 (O-6 months), GII (7-30), GIII (31-60) e GIV (> 60). Urea, creatinin, potassium, haemoglobm (Hb) and haematocrit (Htc) were investigated during every month. The weight was performed alter I-ID. when the patient was with dry weight (DW), height, arm circumference (AC), arm muscle circumference (AMC), total body fat (%TBF, FutrexR) were determined on five assessments. Statiscal analysis was performed by Student’s t tests using appropriately paired or non-paired analysis and ANOVA II. Patients (645% males and 35.5% females), mean age 47,9 ( 14.9 years average were grouped at GI (4,3%), GII (40,495). GIII (34%) and GIV (21.3%). It was registered higher values for urea (109,9 mg/dL) and creatinin (9.46 mg/dL), normal values for potassium (5.0 mEq/L), while Hb and Htc showed lower values (9.21 g% e 26.2%. respectively), and it did not show statistically significant group differences. The dry weight, body mass index, AC, AMC, and TBF were statistically significant when compared among groups and both sexes and were not significant when these parameters were compared among assessments. The period of time appears to have no influence on the biochemical level, which were statistically significant in both sexes. The high concentration for creatinin and urea indicated a lacking control of the dietary protein intake. As expected, the degree of anemia was acceptable for the groups. The body composition, different in both sexes, was affected by the time of haemodialysis therapy and it was stable during the assessment, indicating the preservation of the body compartment. This work was supported by FAPEMIG and CNPq (Brazil).
Early Enteral Nutrition Improves Survival in Hospitalized Elderly Patients M.L. TEIXEIRA DA SILVA. D.L. WAITZBERG; V. CHAER BORGES; SS. CIOSAK; L.Z. COPPINI; R. ARAB-FADUL GANEP-Grupo de Apoio de Nutri@o Enteral e Parenteral Paulo-Sp-Brasil
- Sio
Due to the progressive increase of the elderly patients (%5 years) in the hospital it is of interest to assess their nutritional status and follow-up after EN were performed by routine parameters used in clinical practice. Anthropometric measures were correlated to albuminemia QK 0,05). Malnutrition diagnosed by Seltzer index, was found en 56.8%. Early (5 < days) or late EN with polymeric diet were used for 18,5 +/- 17,4 days, adequate in 89.7 for the estimated caloric requirements. EN complications occurred in 77.5% related to access route (49%) and digestive complications (47%). Diarrhea was prevalent (35%). Severe hypoalbuminemia was associated to diarrhea (p c 0.05). Patients with early EN had significantly less hypoalbuminemia, diarrhea and mortality. At conclusion - 1) Malnutrition is prevalent is hospitalized elderly patients. 2) EN is efficient but not innocuous for nutritional support. 3) Early EN ameliorates morbymortality rates.
OF PARENTERAL
AND ENTERAL NUTRITION
Efficacy of Enteral Nutritional Replenishment During Radiotherapy M.C.G. DIAS, R.D.; Y.C. BAXTER, R.D.; J. MACULEVICIUS, R.D.; W. NADALIN,M.D.; J. FAlNTUCH,M.D. Division of Nutrition and Dietetics and Service of Experimental Surgery. Hospital ah Clinicas, sdo Paula, Brazil
Advanced head and neck cancer is frequently associated with alimentation troubles, and these tend to be compounded in the course of radiation therapy. Aiming at the results of an 0raUenteral therapeutic program, a prospective investigation was done with 128 patients in these conditions already suffering from protein-calorie malnutrition. Mean age was 55.6 f 12.1 years with a majority of males (109:19), and radiotherapy was applied during 69.4 f 22.6 days. Nutritional support, in the proportion of 40 Kcal and 1.5 g protein/Kg/day, was started simultaneously and proceeded for 83.9 f 37.2 days. A complete polymeric commercial diet was prescribed as a supplement (n = 42). as the exclusive oral diet (n = 5.5).or in the form of tube feeding (n = 31). Efficacy of the procedure was assessed by anthropometric and nutritional parameters (table):
Description calories (Kcal) protein (s) body mass in&x (Kg/q) serum albumin (g/dl) hemoglobin (g/dl)
Initial 1354 i 798 51.4t 30.5 21.2 f 3.9 4.1 jzO.6 12.4 i 1.8
Final 1719*574 73.7 f 26.3 21.1 f 3.6 4.2+ 0.5 12.4 f 1.8
Sigtdf. @ * 0.05) * * ns ns ns
At the end of the treatment, 47 patients ate at least 90% of theii needs, 23 ingested 75-90% and the remaining 58 stayed below that value. It is concluded that: 1) Gral and enteral assistance of head and neck cancer patients undergoing radiotherapy is feasible and should be tried, 2) Objective improvement of calorie and protein input could be demonstrated; 3) More than half of the population achieved recovery or at least stabilization of the nutritional status.
The Effect of TPN Versus en in Critical Care Patients D.V. AANHOLT R.D.; D.L. WAITZBERG M.D.; G.C. ULIANA M.D.; M.L. TEMEIRA DA SILVA M.D.; MFR. OLIVBIRA R.N. Enteral and Parentera Nutritional Team-GANEP - Sdo Paula-SP Brasil.
New data concerning EN advantages make an argument against the routine use of TPN in ICU. To compare the nutritional-metabolic effect of EN versus TPN, a retrospective, paired case by case (age, sex, diagnosis, surgery) study was done in 50 coronary heart disease patients submitted to open heart surgery for coronary artery bypass with complicated post-operative course at the ICU. EN (25) was given as a polimeric diet (1,l kcal/ml;0,04 prot./ml) and TPN (25) as a elicidic regimen (1.1 KcaUml. 0.05e as/ml). EN x TPN shown no 2ifferences-m estimated caloric ~re&&ments (Kcahday) (1998 +/- 349 x 1998 +/- 328), caloric balance (kcal/day) (-680 +/- 427 x - 756 +/375). nitrogen intake (g/day) (7.9 +/- 2.6 x 9.1 +/- 3.0). nitrogen balance (g/day) (-5.8 +/- 0.4 x -3.1 +/- 6.1) and BUN, and seric cmatinine, both at the begining and at end of nutritional support @IS). Final albuminemia (g/dl) increased with BN (3,7 +/- 0.3 x 2,8 +/- 0,8) p < 0.05). Days of NS (20 +/- 14 x 16 +I- 11). metabolic complications (7/25 x 4/25) and mortality were not different with EN or TPN. Diarrhoea occurred twice withe EN. At conclusion: 1) Caloric requirements in ICU patients are only partially fullfiled by NS; 2) EN use is associated with seric albumin recovery. It is suggested to prefer EN in ICU heart surgery patients whenewere Possible.