Terapia nutricional enteral e parenteral em pacientes hospitalizados: estado nutricional, adequação calórica e proteica e desfechos clínicos

Abstract

Estimates of the prevalence of malnutrition in hospitalized adults around the world vary between 20 and 50%. Despite being one of the biggest public health problems in the world, it is still highly underdiagnosed and undertreated. Malnutrition causes nutritional decline, increasing the risk of complications and hospital readmissions. Given this context, nutritional support (NS) has been widely used as a strategy to prevent and treat malnutrition and other clinical conditions. The benefits associated with NS are diverse, however this practice is not without problems, and understanding its complications is vital to meet the demands, maintaining the safety and effectiveness of the therapy. This study aimed to evaluate the practice of enteral and parenteral nutritional therapy, nutritional status, adequacy of caloric and protein intake and clinical outcomes of hospitalized patients using NS. This is a prospective observational study with secondary data obtained from the electronic medical records of patients admitted to the Hospital das Clínicas of UFMG from December 14, 2021 to May 14, 2023. All nutritional assessments were carried out by the hospital's nutritionists and data were collected in electronic forms and later analyzed using SPSS software. Data from 300 patients using NS were included. The median age was 61.0 (49.0 - 69.75) years, in relation to nutritional status, 39.5% were severely malnourished, according to the assessment contained in the medical records. In the analysis of the variation in muscle mass during hospitalization, measured using estimation equations with anthropometric data, three of the four equations indicated a significant reduction (p=0.016, p=0.014 and p=0.006). Regression analyzes showed that higher protein intake can increase lean soft tissue (p = 0.036). Furthermore, the greater the number of infections (r=0.085; p=0.039), the greater the chance of being in the group in which there was loss of muscle mass. Regarding adequacy of intake, the median was 75.8% (58.0-87.0) for caloric adequacy and 71.6% (51.2–86.9) for protein adequacy. The median calories per kg of body weight was 20.0 kcal (15.7–24.4), and the median protein intake per kg was 1.0 grams (0.9–1.2). The mortality rate was 30.3% and patients with higher caloric and protein infusion were associated with a longer length of stay, with higher protein intake per kg being protective for death and was a predictor of the risk of referral to intensive treatment. (p=0.014). Finally, it was observed that 83.3% of patients started NS after more than 48 hours and 71.7% of patients had their diet interrupted at some point during hospitalization. Late onset of NS was associated with higher mortality, longer hospital stay and lower risk of refeeding syndrome (p<0.001). Expected interruptions were associated with worse outcomes. The findings of this study highlight the association of problems in the administration of NS with worse clinical outcomes and decline in nutritional status.