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Fagundes GBP, Rodrigues AMDS, Martins LB, Monteze NM, Correia MITD, Teixeira AL, Ferreira AVM. Acute effects of dry extract of ginger on energy expenditure in eutrophic women: A randomized clinical trial. Clin Nutr ESPEN 2021; 41:168-174. [PMID: 33487261 DOI: 10.1016/j.clnesp.2020.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 09/23/2020] [Accepted: 10/01/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND & AIMS The thermic effect of food (TEF) is one of the components of total energy expenditure (TEE). Some bioactive compounds present in food could be useful to increase TEE. In this context, ginger has been extensively used as a thermogenic food despite no clear effect has been demonstrated yet. Herein, we evaluated the acute thermogenic effect of gingerol, a bioactive compound present in ginger, in healthy women. METHODS We carried out a randomized double-masked, cross-over and placebo-controlled clinical trial with 20 healthy eutrophic women. Anthropometric, body composition, indirect calorimetry and clinical variables were collected at baseline and throughout the intervention phase. A standardized breakfast was offered together with two dry extract of ginger capsules (5% gingerol) or a placebo (cellulose). Indirect calorimetry, blood pressure, heart rate, axillary temperature and blood collection were assessed at baseline and thereafter, at 30, 60, 120, 180 and 240 min postprandial. The analyses were repeated with a minimum of seven days' washout period. RESULTS Ginger intake did not increase the TEF of a standardized breakfast compared to the placebo. Oxygen consumption, respiratory quotient, blood pressure, heart rate, axillary temperature and metabolic profile were not different as well. CONCLUSIONS Our data show that gingerol did not modify the acute TEF in healthy women. More studies in human subjects, using different concentrations of gingerol, administration methods and intervention type (chronic effect) are necessary to clarify the putative thermogenic effect of ginger. Registered at ClinicalTrials.gov (Thermogenic Effect of Ginger - NCT03089593).
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DE-Aguilar-Nascimento JE, SalomÃo AB, Caporossi C, Dock-Nascimento DB, Eder Portari-Filho P, Campos ACL, Imbelloni LE, Silva-Jr JM, Waitzberg DL, Correia MITD. ACERTO Project - 15 years changing perioperative care in Brazil. Rev Col Bras Cir 2021; 48:e20202832. [PMID: 33503143 PMCID: PMC10846405 DOI: 10.1590/0100-6991e-20202832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 09/18/2020] [Indexed: 12/14/2022] Open
Abstract
The ACERTO project is a multimodal perioperative care protocol. Implemented in 2005, the project in the last 15 years has disseminated the idea of a modern perioperative care protocol, based on evidence and with interdisciplinary team work. Dozens of published studies, using the protocol, have shown benefits such as reduced hospital stay, postoperative complications and hospital costs. Disseminated in Brazil, the project is supported by the Brazilian College of Surgeons and the Brazilian Society of Parenteral and Enteral Nutrition, among others. This article compiles publications by the authors who belong to the CNPq research group "Acerto em Nutrição e Cirurgia", refers to the experience of other national authors in various surgical specialties, and finally outlines the evolution of the ACERTO project in the timeline.
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Toulson Davisson Correia MI, Castro M, Oliveira Toledo D, Farah D, Sansone D, Morais Andrade TR, Tannus Branco de Araújo G, Fonseca MCM. Nutrition Therapy Cost‐Effectiveness Model Indicating How Nutrition May Contribute to the Efficiency and Financial Sustainability of the Health Systems. JPEN J Parenter Enteral Nutr 2020; 45:1542-1550. [PMID: 33241592 PMCID: PMC8697995 DOI: 10.1002/jpen.2052] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/16/2020] [Indexed: 12/11/2022]
Abstract
Background Method Results Conclusion
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Henrique JR, Pereira RG, Ferreira RS, Keller H, de Van der Schueren M, Gonzalez MC, Meira W, Correia MITD. Pilot study GLIM criteria for categorization of a malnutrition diagnosis of patients undergoing elective gastrointestinal operations: A pilot study of applicability and validation. Nutrition 2020; 79-80:110961. [DOI: 10.1016/j.nut.2020.110961] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/25/2020] [Accepted: 07/06/2020] [Indexed: 01/07/2023]
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Santos BC, Correia MITD, Anastácio LR. Energy Expenditure and Liver Transplantation: What We Know and Where We Are. JPEN J Parenter Enteral Nutr 2020; 45:456-464. [DOI: 10.1002/jpen.1985] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/24/2020] [Accepted: 07/27/2020] [Indexed: 12/17/2022]
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Rodrigues CN, Ribeiro Henrique J, Ferreira ÁRSI, Correia MITD. Ultrasonography and Other Nutrition Assessment Methods to Monitor the Nutrition Status of Critically Ill Patients. JPEN J Parenter Enteral Nutr 2020; 45:982-990. [PMID: 32700339 DOI: 10.1002/jpen.1966] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 07/14/2020] [Accepted: 07/16/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND This study aims to evaluate the use of ultrasonography (US) as an instrument to assess the quadriceps muscles in patients admitted to intensive care units (ICUs), comparing the evolution of US-assessed mass muscle to other nutrition methods. METHODS We conducted a prospective observational study of adult patients aged ≥18 years admitted to an ICU of the Hospital das Clínicas in Brazil. Quadriceps muscle measurements were performed by US, and adductor pollicis muscle thickness and arm, calf, and thigh circumferences were measured at admission and every 2 days within the first week. Nutrition status was assessed at baseline by using the Subjective Global Assessment and the Global Leadership Initiative on Malnutrition criteria. Mechanical ventilation time, length of hospital and ICU stay, and mortality were recorded. RESULTS Sixty patients were included. Reductions in quadriceps thickness and rectus femoris cross-sectional area were observed at landmarks two-thirds reduction of both measurements from days 1 and 3 to days 5 and 7 (P = .017 and P = .000, respectively). The mid arm circumference (MAC) was reduced. Malnourished patients had lower initial muscle mass. However, muscle mass loss was similar between nourished and malnourished individuals (P > .005). Clinical outcomes were not impacted by muscle loss. CONCLUSIONS US muscle mass assessment was able to detect short-term changes in critically ill patients but must be used with caution. MAC was also identified as a useful follow-up tool.
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Tomasich F, Oliveira AVDE, Oliveira ADEJ, Correia MITD. The history of quality and safety of the surgical patient: from the initial standards to the present day. Rev Col Bras Cir 2020; 47:e20202650. [PMID: 32638915 DOI: 10.1590/0100-6991e-20202650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 06/08/2020] [Indexed: 11/22/2022] Open
Abstract
There are currently various concepts related to quality, which have been implemented by many hospitals and other healthcare institutions. The search for continuous improvement, the implementation of a quality culture and hospital accreditation have also been common, in these institutions. However, the history of hospital audits and accreditation is complex and full of dynamic concepts. The American College of Surgeons was pioneer in publishing, more than a century ago, the first document pertaining quality standards. After that, various programs and concepts have been developed and remodeled by distinct entities. In this article, we briefly review the history of quality in the world and Brazil. We also discuss related concepts regarding its assessment in healthcare.
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Correia MITD. A series of editorials regarding the question: why is my paper rejected? Rev Col Bras Cir 2020; 47:e2020EDIT01. [PMID: 32638912 DOI: 10.1590/0100-6991e-2020edit01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 06/15/2020] [Indexed: 11/21/2022] Open
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Maia FDCP, Silva TA, Generoso SDV, Correia MITD. Malnutrition is associated with poor health-related quality of life in surgical patients with gastrointestinal cancer. Nutrition 2020; 75-76:110769. [DOI: 10.1016/j.nut.2020.110769] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 01/12/2020] [Accepted: 01/14/2020] [Indexed: 02/06/2023]
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Silva TA, Maia FDCP, Zocrato MCA, Mauricio SF, Correia MITD, Generoso SDV. Preoperative and Postoperative Resting Energy Expenditure of Patients Undergoing Major Abdominal Operations. JPEN J Parenter Enteral Nutr 2020; 45:152-157. [DOI: 10.1002/jpen.1825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 02/03/2020] [Accepted: 02/25/2020] [Indexed: 12/26/2022]
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Correia MITD. A tribute to Stanley John Dudrick. Rev Col Bras Cir 2020. [DOI: 10.1590/0100-6991e-20202517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Ferreira TMR, Albuquerque A, Cancela Penna FG, Macedo Rosa R, Correia MITD, Barbosa AJA, Salles Cunha A, Ferrari MDLA. Effect of Oral Nutrition Supplements and TGF-β2 on Nutrition and Inflammatory Patterns in Patients With Active Crohn's Disease. Nutr Clin Pract 2019; 35:885-893. [PMID: 31840323 DOI: 10.1002/ncp.10448] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Crohn's disease (CD) is often associated with nutrition disorders. Many nutrition therapeutic alternatives have been studied. Nevertheless, the actual role of nutrition therapy is still controversial. The objective of this study was to assess the effects of nutrition supplementation with and without transforming growth factor-beta 2 (TGF-β2) on inflammatory, endoscopic, histopathologic, and nutrition parameters in active CD. MATERIALS AND METHODS Thirty-eight patients were allocated into 3 groups: group 1 (patients who received only nutrition orientation), group 2 (nutrition orientation and a normoproteic, normocaloric nutrition supplement), and group 3 (nutrition orientation and the nutritional supplement with TGF-β2). Clinical and nutrition evaluation, C-reactive protein (CRP) levels, and assessment of endoscopic and histologic parameters in the intestinal mucosa were performed before and after nutrition intervention. RESULTS The mean follow-up period was 3 months. In the beginning of the study, groups were homogeneous regarding age, gender, CD behavior and localization, and medication in use. In the end of the study, the Clinical Disease Activity Index score was reduced in groups 2 and 3; in group 3, a reduction in CRP levels and an improvement in histologic findings were observed. Among patients who received nutritional supplement, some anthropometric patterns were improved. CONCLUSION The results of the study indicate that nutritional supplementation improved nutrition and inflammatory patterns in patients with active CD. However, only patients receiving TGF-β2-enriched formula showed improvement in histologic parameters and significant reduction in CRP levels.
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Ferreira SC, de Oliveira Penaforte FR, Cardoso A, da Silva MVT, Lima AS, Correia MITD, Anastácio LR. Association of food cravings with weight gain, overweight, and obesity in patients after liver transplantation. Nutrition 2019; 69:110573. [PMID: 31585257 DOI: 10.1016/j.nut.2019.110573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 08/13/2019] [Accepted: 08/18/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE After liver transplantation (LTx), patients often gain weight and many become overweight or obese; however, the association between LTx and food craving (FC) is unknown. The aim of this study was to describe FC among patients after LTx and verify its association with weight gain and obesity. METHODS This was a cross-sectional study that assessed 301 patients who underwent LTx (55.1 ± 12.7 y of age; time since LTx 6.6 ± 4.4 y; 64.1% men). Pregnant or nursing women were excluded. Patients were interviewed once either in the outpatient clinic or by completing the online questionnaire, from August 2016 to February 2017. RESULTS The median weight variation after Ltx was 8 kg (ranging from -16 to +41 kg). At evaluation, 62.5% (n = 188) of the patients presented excessive weight and 22.3% (n = 67) presented with obesity. The average score on the Food Craving Questionnaire-State (FCQ-S) was 33.4 ± 9 and for the Food Craving Questionnaire-Trait (FCQ-T) the median score was 68 (39-163). The FCQ-T dimensions of lack of control, preoccupation, emotion, environmental triggers/stimuli, and guilt correlated positively with weight gain (P < 0.05). The desire dimension on the FCQ-S was significantly associated with overweight in post-LTx patients (P < 0.05) and the FCQ-T dimensions [negative reinforcement (P = 0.013), lack of control (P = 0.016), emotion (P = 0.009), environmental triggers/stimuli (P = 0.029), and guilt (P = 0.007)] were associated with obesity. CONCLUSION Lack of control, preoccupation, emotion, trigger, and guilt were positively correlated with weight gain. Desire was significantly associated with overweight. Negative reinforcement, lack of control, emotion, environmental triggers/stimuli, and guilt were associated with obesity.
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Correia MITD, Tomasich FDS, de-Castro Filho HF, Portari Filho PE, Colleoni Neto R. Safety and quality in surgery: surgeons' perception in Brazil. Rev Col Bras Cir 2019; 46:e2146. [PMID: 31508733 DOI: 10.1590/0100-6991e-20192146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 06/20/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to evaluate the perception of surgeons, members of the Brazilian College of Surgeons (CBC), on safety and quality issues in surgery, based on projects of Brazilian Ministry of Health (MS), CBC, World Health Organization (WHO), and American College of Surgeons (ACS). METHODS a questionnaire based on WHO, CBC, and ACS initiatives was sent to all active and non-active CBC members, using Survey Monkey, in March 2018. RESULTS out of 7,100 members, 171 professionals answered the questionnaire. Out of these, the majority (63.2%) declared to perform general surgery, 88.9% indicated knowing the project called Safe Surgery developed by MS, 73.1%, the CBC manual, and 14.6%, the ACS Strong for Surgery. Among those who indicated knowing the MS project, 73.1% said that they were accustomed to use it as a routine, and, among those who indicated knowing the CBC manual, 46.2% said that they were accustomed to use it. Most of the surgeons (81.3%) indicated that they had experienced severe surgical failures, being failures related to surgical material (49.7%) and presence of foreign bodies (8.2%) the most common ones. There were distinct opinions on who was responsible for checking over the checklist. CONCLUSION the importance of safety and quality in surgery is well known by surgeons, but the practice is varied. Serious adverse events had been experienced by many surgeons, mainly related to surgical material and foreign bodies. The concept of interdisciplinarity did not seem to be common practice. Data indicated the need to develop education projects and the obligation of audits.
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Moreira GR, Rodrigues MAG, Correia MITD. Fístulas Digestivas. REVISTA CIÊNCIAS EM SAÚDE 2019. [DOI: 10.21876/rcshci.v9i2.780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Fístulas digestivas são comunicações anormais entre qualquer parte do trato gastrointestinal e outro órgão interno ou a pele. Podem causar desequilíbrio hidroeletrolítico, déficits nutricionais, formação de abscesso, infecção, sepse ou sangramentos. Existem várias maneiras de se classificar uma fístula gastrointestinal de acordo com sua anatomia, débito, tempo de aparecimento, etiologia, entre outros. Os fatores de risco associados ao surgimento de fístulas digestivas são muitos e ainda em descoberta, sejam eles locais ou sistêmicos. Sua fisiopatologia é complexa e as complicações de maior morbidade e mortalidade estão relacionadas à desnutrição e infecção. O tratamento deve ser multidisciplinar e adaptado a cada caso, envolvendo medidas nutricionais, antimicrobianos, cuidados com a pele e, por vezes, cirurgia. Como o cirurgião desempenha papel fundamental na prevenção e tratamento das fístulas digestivas, este artigo pretende fazer revisão de conceitos fundamentais sobre o tema, discutindo classificação, etiologia, fisiopatologia, complicações, diagnóstico e principais aspectos no manejo clínico, nutricional e cirúrgico.
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Ribeiro HS, Coury NC, de Vasconcelos Generoso S, Lima AS, Correia MITD. Energy Balance and Nutrition Status: A Prospective Assessment of Patients Undergoing Liver Transplantation. Nutr Clin Pract 2019; 35:126-132. [DOI: 10.1002/ncp.10323] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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Gomes MMA, Silva JM, Silva Ferreira ÁR, Vasconcelos Generoso S, Correia MITD. Implementing Quality Assessment Is Fundamental to Guarantee Optimal Nutrition Therapy. JPEN J Parenter Enteral Nutr 2019; 44:274-281. [DOI: 10.1002/jpen.1600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 04/22/2019] [Indexed: 11/08/2022]
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Rodrigues DF, Monteze NM, Fagundes GBP, Monteiro BL, Lima AS, Correia MITD, Generoso SDV, Ferreira AVM. Hypometabolism as a potential risk factor for overweight and obesity in liver recipients. Nutrition 2019; 61:16-20. [DOI: 10.1016/j.nut.2018.10.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/07/2018] [Accepted: 10/14/2018] [Indexed: 12/24/2022]
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Cederholm T, Compher C, Correia MITD, Gonzalez MC, Fukushima R, Higashiguchi T, Van Gossum A, Jensen GL. Response to the letter: Comment on "GLIM criteria for the diagnosis of malnutrition - A consensus report from the global clinical nutrition community". Some considerations about the GLIM criteria - A consensus report for the diagnosis of malnutrition by Drs. LB da Silva Passos and DA De-Souza. Clin Nutr 2019; 38:1480-1481. [PMID: 30904187 DOI: 10.1016/j.clnu.2019.02.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Accepted: 02/16/2019] [Indexed: 10/27/2022]
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Maurício SF, de Vasconcelos Generoso S, Leandro Marciano Vieira É, Xiao J, Prado CM, Gonzalez MC, Correia MITD. Relationship between Sarcopenia and mTOR Pathway in Patients with Colorectal Cancer: Preliminary Report. Nutr Cancer 2019; 71:172-177. [PMID: 30663406 DOI: 10.1080/01635581.2018.1540716] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Sarcopenia is a syndrome characterized by loss of muscle mass and strength that impacts clinical outcomes and mortality in cancer patients. Although the molecular pathways involved in sarcopenia are not fully elucidated, the decrease in protein synthesis rate appears to be one of the most important events. The objective of this study was to investigate the relationship between sarcopenia and mTOR signaling pathway in patients undergoing colorectal resection surgery. Three groups of patients were assessed: 1) the control group (no cancer, no sarcopenia), 2) the cancer non-sarcopenic group and 3) the cancer sarcopenic group. All individuals were evaluated in relation to presence of sarcopenia and mTOR signaling pathway. Sarcopenia was evaluated by the combination of low muscle mass and low muscle strength, measured using computerized tomography images, and hand grip strength, respectively. Rectus abdominis muscle biopsy was performed at the time of surgery. mTOR pathway was analyzed by MILLIPLEX Map Kit Phospho/total mTOR 2-Plex Magnetic Bead Panel. Results were presented by phosphor/total mTOR ratio. Independent T test, Kruskal-Wallis test, and Dunn-Bonferroni post hoc were performed for statistical analysis and P < 0.05 was considered. Thirty-six patients and five controls were evaluated. A total of 13 cancer patients (36.1%) had sarcopenia. The phospho/total mTOR ratio was different between the control group (0.167 MFI) and the cancer non-sarcopenic group (0.055 MFI) (P = 0.026) as well as between the control group (0.167 MFI) and the cancer sarcopenic group (0.0049 MFI) (P = 0.041). No difference was observed on the median phospho/total mTOR ratio between the cancer groups (P > 0.05). More research is needed to extrapolate these results.
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da-Fonseca LM, Buzatti KCDLR, Castro LL, Lacerda Filho A, Correia MITD, da-Silva RG. Factors preventing restoration of bowel continuity in patients with rectal cancer submitted to anterior rectal resection and protective ileostomy. Rev Col Bras Cir 2019; 45:e1998. [PMID: 30624520 DOI: 10.1590/0100-6991e-20181998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 10/25/2018] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE to evaluate the factors associated with non-closure of protective ileostomy after anterior resection of the rectum with total mesorectum excision for rectal cancer, the morbidity associated with the closure of ileostomies and the rate of permanent ileostomy in patients with rectal adenocarcinoma. METHODS we conducted a retrospective study with 174 consecutive patients diagnosed with rectal tumors, of whom 92 underwent anterior resection of the rectum with coloanal or colorectal anastomosis and protective ileostomy, with curative intent. We carried out a multivariate analysis to determine the factors associated with definite permanence of the stoma, as well as studied the morbidity of patients who underwent bowel continuity restoration. RESULTS In the 84-month follow-up period, 54 of the 92 patients evaluated (58.7%) had the ileostomy closed and 38 (41.3%) remained with the stoma. Among the 62 patients who had the ileostomy closed, 11 (17.7%) presented some type of postoperative complication: three had ileal anastomosis dehiscence, five had intestinal obstruction, two had surgical wound infection, and one, pneumonia. Eight of these patients required a new stoma. CONCLUSION according to the multivariate analysis, the factors associated with stoma permanence were anastomotic fistula, presence of metastases and closure of the ileostomy during chemotherapy.
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Correia MITD, Perman MI, Pradelli L, Omaralsaleh AJ, Waitzberg DL. Economic burden of hospital malnutrition and the cost-benefit of supplemental parenteral nutrition in critically ill patients in Latin America. J Med Econ 2018; 21:1047-1056. [PMID: 30001667 DOI: 10.1080/13696998.2018.1500371] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
AIM Disease-related malnutrition (DRM) is a prevalent condition that significantly increases the risk of adverse outcomes in hospitalized patients, particularly those with critical illness. Limited data is available on the economic burden of DRM and the cost-benefit of nutrition therapy in high-risk populations in Latin America. The aims of the present study were to estimate the economic burden of DRM and evaluate the cost-benefit of supplemental parenteral nutrition (SPN) in critically ill patients who fail to receive adequate nutrient intake from enteral nutrition (EN) in Latin America. METHODS Country-specific cost and prevalence data from eight Latin American countries and clinical data from studies evaluating outcomes in patients with DRM were used to estimate the costs associated with DRM in public hospitals. A deterministic decision model based on clinical outcomes from a randomized controlled study and country-specific cost data were developed to examine the cost-benefit of administering SPN to critically ill adults who fail to reach ≥60% of the calculated energy target with EN. RESULTS The estimated annual economic burden of DRM in public hospitals in Latin America is $10.19 billion (range, $8.44 billion-$11.72 billion). Critically ill patients account for a disproportionate share of the costs, with a 6.5-fold higher average cost per patient compared with those in the ward ($5488.35 vs. $839.76). Model-derived estimates for clinical outcomes and resource utilization showed that administration of SPN to critically ill patients who fail to receive the targeted energy delivery with EN would result in an annual cost reduction of $10.2 million compared with continued administration of EN alone. LIMITATIONS The cost calculation was limited to the average daily cost of stay and antibiotic use. The costs associated with other common complications of DRM, such as prolonged duration of mechanical ventilation or more frequent readmission, are unknown. CONCLUSIONS DRM imposes a substantial economic burden on Latin American countries, with critically ill patients accounting for a disproportionate share of costs. Cost-benefit analysis suggests that both improved clinical outcomes and significant cost savings can be achieved through the adoption of SPN as a therapeutic strategy in critically ill patients who fail to receive adequate nutrient intake from EN.
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Cederholm T, Jensen GL, Correia MITD, Gonzalez MC, Fukushima R, Higashiguchi T, Baptista G, Barazzoni R, Blaauw R, Coats A, Crivelli A, Evans DC, Gramlich L, Fuchs-Tarlovsky V, Keller H, Llido L, Malone A, Mogensen KM, Morley JE, Muscaritoli M, Nyulasi I, Pirlich M, Pisprasert V, de van der Schueren MAE, Siltharm S, Singer P, Tappenden K, Velasco N, Waitzberg D, Yamwong P, Yu J, Van Gossum A, Compher C, Cederholm T, Van Gossum A, Correia MIT, Gonzalez MC, Fukushima R, Higashiguchi T, Baptista G, Barazzoni R, Blaauw R, Coats A, Crivelli A, Evans D, Gramlich L, Fuchs V, Keller H, Llido L, Malone A, Mogensen K, Morley J, Muscaritoli M, Nyulasi I, Pirlich M, Pisprasert V, de van der Schueren M, Siltharm S, Singer P, Tappenden K, Velasco N, Waitzberg D, Yamwong P, Yu J. GLIM criteria for the diagnosis of malnutrition - A consensus report from the global clinical nutrition community. Clin Nutr 2018; 38:1-9. [PMID: 30181091 DOI: 10.1016/j.clnu.2018.08.002] [Citation(s) in RCA: 1240] [Impact Index Per Article: 206.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 08/02/2018] [Indexed: 12/12/2022]
Abstract
RATIONALE This initiative is focused on building a global consensus around core diagnostic criteria for malnutrition in adults in clinical settings. METHODS In January 2016, the Global Leadership Initiative on Malnutrition (GLIM) was convened by several of the major global clinical nutrition societies. GLIM appointed a core leadership committee and a supporting working group with representatives bringing additional global diversity and expertise. Empirical consensus was reached through a series of face-to-face meetings, telephone conferences, and e-mail communications. RESULTS A two-step approach for the malnutrition diagnosis was selected, i.e., first screening to identify "at risk" status by the use of any validated screening tool, and second, assessment for diagnosis and grading the severity of malnutrition. The malnutrition criteria for consideration were retrieved from existing approaches for screening and assessment. Potential criteria were subjected to a ballot among the GLIM core and supporting working group members. The top five ranked criteria included three phenotypic criteria (non-volitional weight loss, low body mass index, and reduced muscle mass) and two etiologic criteria (reduced food intake or assimilation, and inflammation or disease burden). To diagnose malnutrition at least one phenotypic criterion and one etiologic criterion should be present. Phenotypic metrics for grading severity as Stage 1 (moderate) and Stage 2 (severe) malnutrition are proposed. It is recommended that the etiologic criteria be used to guide intervention and anticipated outcomes. The recommended approach supports classification of malnutrition into four etiology-related diagnosis categories. CONCLUSION A consensus scheme for diagnosing malnutrition in adults in clinical settings on a global scale is proposed. Next steps are to secure further collaboration and endorsements from leading nutrition professional societies, to identify overlaps with syndromes like cachexia and sarcopenia, and to promote dissemination, validation studies, and feedback. The diagnostic construct should be re-considered every 3-5 years.
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Correia MITD. Response to Comment on ‘Nutrition Screening vs Nutrition Assessment: What's the Difference?’. Nutr Clin Pract 2018; 33:307-308. [DOI: 10.1002/ncp.10010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Correia MITD. Patient Empowerment on the Fight Against Malnutrition. JPEN J Parenter Enteral Nutr 2018; 42:672-674. [DOI: 10.1002/jpen.1161] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 02/13/2018] [Indexed: 12/26/2022]
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