Adequacy of energy and micronutrient supply and progression of enteral diet in hospitalized adult patients
Keywords:
Adult, Diet therapy, Enteral nutrition, Nutrition therapyAbstract
Objective
To asses the adequacy of enteral diet, in terms of micronutrients and energy and to identify factors that interfere in the progression of enteral diets prescribed to adults hospitalized in a high complexity general hospital.
Methods
From June 2004 to May 2005, adult patients hospitalized in a high complexity hospital, in Southern Brazil, were assessed in terms of enteral diet prescription and clinical characteristics. The characteristics of the enteral nutrition were assessed and compared with the recommended daily intakes, obtaining percentages of nutrient adequacy of the enteral diet. Factors associated with energy prescription were identified by multiple linear regression.
Results
Two hundred and thirty tube-fed patients were followed. The dietary reference intakes were satisfatory met for water-soluble vitamins (except for folic acid), fat-soluble vitamins (except for vitamin D) and minerals (except for calcium). The mean initial energy prescription was 24.0 kcal/kg/day (standard deviation=10.8, minimum and maximum values ranging from 4.3 to 69.2kcal/kg/day) and progressed to 28.4kcal/kg/day (standard deviation=11.8, minimum and maximum values ranging from 1.4 to 69.2kcal/kg/day).The recommendation of 25 to 35kcal/kg/day was prescribed to 32.6% of patients. Forty or more kcal/kg/day was
presuibed to 15.7% of the patients. Only body mass index and the number of hospital stay days, adjusted to the energy prescribed at the beginning, were independently associated with the final energy prescription.
Conclusion
A small proportion of the prescriptions were adequate in terms of Kcal/kg/day, and the progression of enteral diet occurs regardless of the clinical characteristics of the patients.
References
Waitzberg DL, Caiaffa WT, Correia MI. Hospital malnutrition: the Brazilian national survey (IBRANUTRI): a study of 4000 patients. Nutrition. 2001; 17(7-8):573-80.
Mello ED, Beghetto MG, Teixeira LB, Luft VC. Desnutrição hospitalar: cinco anos após o IBRANUTRI. Rev Bras Nutr Clin. 2003; 18(2):65-9.
Naber TH, Schermer T, Bree A, Nusteling K, Eggink L, Kruimel JW, et al. Prevalence of malnutrition in nonsurgical hospitalized patients and its association with disease complications. Am J Clin Nutr. 1997; 66(5):1232-9.
Heymsfield SB, Bethel RA, Ansley JD, Gibbs DM, Felner JM, Nutter DO. Cardiac abnormalities in cachectic patients before and during nutritional repletion. Am Heart J. 1978; 95(5):584-94.
Arora NS, Rochester DF. Respiratory muscle strength and maximal voluntary ventilation in undernourished patients. Am Rev Respir Dis. 1982; 126(1):5-8.
Anderson CF, Moxness K, Meister J, Burritt MF. The sensitivity and specificity of nutrition-related variables in relationship to the duration of hospital stay and the rate of complications. Mayo Clin Proc. 1984; 59(7):477-83.
Reilly JJ, Hull SF, Albert N, Waller A, Bringardener S. Economic impact of malnutrition: a model system for hospitalized patients. JPEN J Parenter Enteral Nutr. 1988; 12(4):371-6.
Peter JV, Moran JL, Phillips-Hughes J. A metaanalysis of treatment outcomes of early enteral versus early parenteral nutrition in hospitalized patients. Crit Care Med. 2005; 33(1): 213-20.
Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Portaria nº 31, de 8 de março de 2005.
Define unidades de assistência de alta complexidade em terapia nutricional e centros de referência de alta complexidade em terapia nutricional e suas aptidões e qualidades. Diário Oficial da União. 2005 11 março.
Vinken AG, Bathalon GP, Sawaya AL, Dallal GE, Tucker KL, Roberts SB. Equations for predicting the energy requirements of healthy adults aged 18-81 y. Am J Clin Nutr. 1999; 69(5):920-6.
Stroud M, Duncan H, Nightingale J. Guidelines for enteral feeding in adult hospital patients. Gut. 2003; 52(Suppl 7):1-12.
ASPEN Board of Directors and the Clinical Guidelines Task Force. Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients. JPEN J Parenter Enteral Nutr. 2002; 26(Suppl 1):1-138.
Klein CJ, Stanek GS, Wiles CE. Overfeeding macronutrients to critically ill adults: metabolic complications. J Am Diet Assoc. 1998; 98(7): 795-806.
De Jonghe B, Appere-De-Vechi C, Fournier M, Tran B, Merrer J, Melchior JC, et al. A prospective survey of nutritional support practices in intensive care unit patients: what is prescribed? What is delivered? Crit Care Med. 2001; 29(1):8-12.
Engel JM, Muhling J, Junger A, Menges T, Karcher B, Hempelmann G. Enteral nutrition practice in a surgical intensive care unit: what proportion of energy expenditure is delivered enterally? Clin Nutr. 2003; 22(2):187-92.
Elpern EH, Stutz L, Peterson S, Gurka DP, Skipper A. Outcomes associated with enteral tube feedings in a medical intensive care unit. Am J Crit Care. 2004; 13(3):221-7.
O’Leary-Kelley CM, Puntillo KA, Barr J, Stotts N, Douglas MK. Nutritional adequacy in patients receiving mechanical ventilation who are fed enterally. Am J Crit Care. 2005; 14(3):222-31.
Institute of Medicine. Food and Nutrition Board: Dietary Reference Intakes: calcium, phosphorus, magnesium, vitamin D, and fluoride. Washington (DC): National Academy Press; 1997.
Institute of Medicine. Food and Nutrition Board. Dietary reference intakes: thiamin, riboflavin, niacin, vitamin B6, folate, vitamin B12, panthotenic acid, biotin, and choline. Washington (DC): National Academy Press; 1998.
Institute of Medicine. Food and Nutrition Board. Dietary reference intakes: vitamin C, vitamin E, selenium, and carotenoids. Washington (DC): National Academy Press; 2000.
Institute of Medicine. Food and Nutrition Board. Dietary reference intakes: vitamin A, vitamin K, arsenic, boron, chromium, copper, iodine, iron, manganese, molybdenum, nickel, silicon, vanadium, and zinc. Washington (DC): National Academy Press; 2001.
Institute of Medicine. Food and Nutrition Board. Dietary reference intakes: energy, carbohydrates, fiber, fat, fatty acids, cholesterol, protein, and amino acids. Washington (DC): National Academy Press; 2002.
Brasil. Ministério da Saúde. Secretaria de Vigilância Sanitária. Resolução RDC nº 63, de 6 de julho de 2000. Aprova o Regulamento Técnico para fixar os requisitos mínimos exigidos para a Terapia de Nutrição Enteral. Diário Oficial da União. 2000.
Detsky AS, McLaughlin J, Baker JP, Johnston N, Whittaker S, Mendelson RA, et al. What is subjective global assessment of nutritional status? JPEN J Parenter Enteral Nutr. 1987; 11(1):8-13.
Kirkwood B, Sterne J. Essential medical statistics. 2nd ed. Oxford: Blackwell Science; 2003.
Harris JA, Benedict FG. A biometric study of basal metabolism in man. Washington (DC): Carnegie Institution of Washington; 1919.
Crook MA, Hally V, Panteli JV. The importance of the refeeding syndrome. Nutrition. 2001; 17(7-8): 632-7.
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Copyright (c) 2023 Vivian Cristine LUFT, Diego de Matos VIEIRA, Mariur Gomes BEGHETTO, Carísi Anne POLANCZYK, Elza Daniel de MELLO
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