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Advisor(s)
Abstract(s)
A deterioração do estado nutricional quando presente, colabora para um declínio progressivo do estado de saúde e do aumento do grau de dependência, conduzindo à institucionalização em unidades geriátricas e muitas vezes, hospitalizações prolongadas. Um suprimento deficiente da necessidade energética e proteica aponta para um risco aumentado de desenvolver doenças como sarcopenia, osteoporose e resposta imunológica diminuída. A avaliação periódica do estado nutricional como procedimento de rotina, em conjunto com a avaliação da presença de sarcopenia e da desnutrição calórico-proteica em ambiente de assistência ao idoso merece ênfase ao se traçar estratégicas diretivas de intervenção. Trata-se de um estudo retrospetivo, analítico, baseado em dados obtidos em instituições hospitalares e em residências geriátricas portuguesas. A aplicação do MNA®, IMC e do questionário alimentar ocorreu no momento da coleção dos dados. Buscou-se também aplicar os critérios do GLIM (modificado para os dados disponíveis - mGLIM) e classificação energético-proteica. Assim, utilizou-se as informações de ingestão calórica e proteica de modo a se permitir o uso do mGLIM e a se realizar a classificação energético-proteica. Foram avaliados 117 indivíduos com idade média de 78 ± 7,1 anos, dos quais 94 (80,3%) estavam hospitalizados e 23 (19,7%) estavam em instituições geriátricas. Verificou-se uma prevalência de desnutrição nos idosos hospitalizados e institucionalizados pelo IMC de 21,3% e 17,4%, pelo MNA® de 13,8% e 17,4% e pelo mGLIM de 17% e 13%, respetivamente. Os coeficientes de associação entre as ferramentas utilizadas para diagnóstico nutricional MNA® x mGLIM e MNA® x IMC são elevados e estatisticamente significativos (p= 0,613 e 0,867). Verificou-se que 91,5% dos idosos como um todo, tinham uma ingestão energética abaixo da recomendação atual (≥ 30 kcal/g/dia) e 68,4% dos indivíduos tinham uma ingestão proteica abaixo do que recomendado para idosos (≥ 1 g/kg/dia). Este estudo reforça a necessidade de investigar a prevalência da desnutrição e da sarcopenia na senescência e os fatores a ela associados, que podem ajudar na identificação e intervenção precoce. Também permite analisar a prevalência do comprometimento do estado nutricional e da ingestão de energia e proteínas, que muitas vezes está associado à vulnerabilidade dos idosos frente os problemas nutricionais, no intuito de aumentar o cuidado no âmbito da assistência hospitalar e instituições geriátricas.
ABSTRACT - Deterioration in nutritional status, when present, contributes to a progressive decline in health status and an increase in dependence, leading to institutionalization in geriatric units and often prolonged hospitalizations. A deficient supply of energy and protein needs points to an increased risk of developing diseases such as sarcopenia, osteoporosis, and reduced immune response. Periodic assessment of nutritional status as a routine procedure, together with assessment of the presence of sarcopenia and protein-calorie malnutrition in an elderly care environment deserves prominence when outlining strategic intervention directives. This is a retrospective, analytical study based on data obtained in Portuguese hospitals and geriatric residences. The evaluation using MNA®, the evaluation of the BMI, and the application of the 24 hours recall occurred at the time of data collection. We also sought to apply the GLIM criteria (modified according to the data available - mGLIM) and protein-energy classification. In that sense, information on caloric and protein intake was used in order to allow the usage of mGLIM and perform the protein-energy classification. 117 individuals with a mean age of 78 ± 7.1 years were evaluated, of which 94 (80.3%) were hospitalized and 23 (19.7%) were in geriatric institutions. There was a prevalence of malnutrition in hospitalized and institutionalized elderly people by the BMI criteria of 21.3% and 17.4%, by the MNA® criteria of 13.8% and 17.4%, and by the mGLIM criteria of 17% and 13%, respectively. The association coefficients between the tools used for nutritional diagnosis MNA® x mGLIM and MNA® x BMI are high and statistically significant (p= 0.613 and 0.867). It was found that 91.5% of the elderly had an energy intake below the current recommendation (≥ 30 kcal/g/day) and 68.4% of the individuals had a protein intake below the recommendation for the elderly (≥ 1 g/kg/day). This study reinforces the need to investigate the prevalence of malnutrition and sarcopenia in senescence and the factors associated with it, which can help in early identification and intervention. It also allows to analysis of the prevalence of compromised nutritional status and energy and protein intake, which is often associated with the vulnerability of the elderly when faced to nutritional problems, in order to increase care in the context of hospital care and geriatric institutions.
ABSTRACT - Deterioration in nutritional status, when present, contributes to a progressive decline in health status and an increase in dependence, leading to institutionalization in geriatric units and often prolonged hospitalizations. A deficient supply of energy and protein needs points to an increased risk of developing diseases such as sarcopenia, osteoporosis, and reduced immune response. Periodic assessment of nutritional status as a routine procedure, together with assessment of the presence of sarcopenia and protein-calorie malnutrition in an elderly care environment deserves prominence when outlining strategic intervention directives. This is a retrospective, analytical study based on data obtained in Portuguese hospitals and geriatric residences. The evaluation using MNA®, the evaluation of the BMI, and the application of the 24 hours recall occurred at the time of data collection. We also sought to apply the GLIM criteria (modified according to the data available - mGLIM) and protein-energy classification. In that sense, information on caloric and protein intake was used in order to allow the usage of mGLIM and perform the protein-energy classification. 117 individuals with a mean age of 78 ± 7.1 years were evaluated, of which 94 (80.3%) were hospitalized and 23 (19.7%) were in geriatric institutions. There was a prevalence of malnutrition in hospitalized and institutionalized elderly people by the BMI criteria of 21.3% and 17.4%, by the MNA® criteria of 13.8% and 17.4%, and by the mGLIM criteria of 17% and 13%, respectively. The association coefficients between the tools used for nutritional diagnosis MNA® x mGLIM and MNA® x BMI are high and statistically significant (p= 0.613 and 0.867). It was found that 91.5% of the elderly had an energy intake below the current recommendation (≥ 30 kcal/g/day) and 68.4% of the individuals had a protein intake below the recommendation for the elderly (≥ 1 g/kg/day). This study reinforces the need to investigate the prevalence of malnutrition and sarcopenia in senescence and the factors associated with it, which can help in early identification and intervention. It also allows to analysis of the prevalence of compromised nutritional status and energy and protein intake, which is often associated with the vulnerability of the elderly when faced to nutritional problems, in order to increase care in the context of hospital care and geriatric institutions.
Description
Mestrado em Nutrição Clínica
Keywords
Nutrição Desnutrição Idosos Estado nutricional Ingestão calórica Ingestão proteica Sarcopenia Nutrition Malnutrition Elderly Nutritional status Calorie intake Protein intake
Citation
Costa DG. Prevalência da malnutrição, sarcopenia e fragilidade de uma população idosa admitida numa instituição hospitalar [dissertation]. Lisboa: Faculdade de Medicina da Universidade de Lisboa; Escola Superior de Tecnologia da Saúde de Lisboa/Instituto Politécnico de Lisboa; 2021.