Context Nutritional risk (NR) screening is the first step of nutrition care process. Few data are available in literature about its prevalence, nor, to our knowledge, is a universally accepted reference method for the intensive care unit (ICU). Objective The aim for this systematic review was to summarize evidence regarding the prevalence of NR and the predictive validity of different tools applied for NR screening of critically ill patients. Data Sources The PubMed, Embase, and Scopus databases were searched up to December 2019 using the subject headings related to critically ill patients and NR screening. The current systematic review is registered with PROSPERO (identifier: CRD42019129668). Data Extraction Data on NR prevalence, predictive validity of nutritional screening tools, and interaction between caloric-protein balance and NR in outcome prediction were collected. Data Analysis Results were summarized qualitatively in text and tables, considering the outcomes of interest. Results From 15 669 articles initially identified, 36 fulfilled the inclusion criteria, providing data from 8 nutritional screening tools: modified Nutrition Risk in the Critically Ill (mNUTRIC; n = 26 studies) and Nutritional Risk Screening–2002 (NRS-2002; n = 7 studies) were the most frequent; the NR prevalence was 55.9% (range, 16.0% to 99.5%). Nutritional risk was a predictor of 28-day and ICU mortality in 8 studies. Interactions between caloric-protein balance and NR on outcome prediction presented were scarcely tested and presented heterogeneous results (n = 8). Conclusions Prevalence of NR in patients in the ICU varies widely; a satisfactory predictive validity was observed, especially when mNUTRIC or NRS-2002 were applied.

Com o objetivo de analisar o perfil nutricional de pacientes oncológicos submetidos à quimioterapia, foi realizado um estudo descritivo aplicado em 50 pacientes com câncer em um ambulatório de quimioterapia. O estado nutricional foi avaliado por medidas antropométricas: índice de massa corporal; dobra cutânea triciptal; circunferência do braço e circunferência muscular do braço; e dietéticas, através de recordatório alimentar de 24 horas. O tempo médio de tratamento foi de 4,5 meses. Observou-se um índice de massa corporal médio de 25+-4,0 Kg/m², 10% dos pacientes em desnutrição, 44% eutróficos, 32% com sobrepeso e 14% obesos. A média de circunferência do braço foi de 28+-4,2 cm, a de circunferência muscular do braço de 21,2+-2,9 mm e a prega cutânea triciptal de 21,2 mm+-8 mm. Dos eutróficos e os que estavam com excesso de peso, 35,3% e 34,7% apresentaram depleção proteica, respectivamente. Considerando a alteração de peso, 33% tiveram perda de peso significativa durante o tratamento. A média do consumo energético foi de 1.875+-200,2 kcal/dia, e o consumo médio de ingestão de fibras foi de 14+- 3g/dia. Em relação aos micronutrientes, o consumo de cálcio foi de 612,1+-200,2 mg/dia, ferro 13,9+-3,9 mg/dia e vitamina C99+-60,9 mg/dia. Apesar da prevalência de excesso de peso, as necessidades energéticas não foram atingidas. Somado a isso, grande parte dos pacientes eutróficos e acima do peso encontrava-se em déficit de massa magra, indicando risco nutricional e a importância de uma interpretação adequada da avaliação nutricional.

Overall survival (OS) varies widely in patients with stage IV non-small cell lung cancer (NSCLC). Strong prognostic factors are still needed to improve decision-making regarding standard treatment options, to stratify patients for inclusion in innovative therapeutic trials and to identify patients who would be best treated with palliative care rather than with systemic chemotherapy. Mid-arm muscle circumference (MAMC) is a bedside anthropometric measurement that estimates somatic protein reserve, an early indicator of nutritional depletion. This measurement is simple, non-invasive, objective and inexpensive to perform. We evaluated MAMC as a potential prognostic factor in patients with stage IV NSCLC. A total of 56 non-selected consecutive patients with stage IV NSCLC were evaluated. The MAMC measurement results for these patients were expressed as a percentage of the expected reference values, adjusted for gender and age. Patients were categorized as normal (MAMC ≥90%) or depleted (MAMC <90%). The mean age of patients was 63 years (range 47–80), and the mean MAMC was 89 (range 66–122), with 55% of patients classified as depleted. The median OS was 6.2 months (95% CI, 5.1–7.3). In the subgroup with normal MAMC, the median OS was 10.2 months (95% CI, 9.2–11.1). In patients classified as depleted, the median OS was 5.0 months (95% CI, 4.2–5.8). The difference in OS between these two subgroups was highly significant (p<0.001 by the log-rank test; HR=0.21; 95% CI, 0.09–0.5 for patients with normal MAMC). In a multivariate analysis with Karnofsky status, age and gender as covariates, the difference in OS between the MAMC groups remained statistically significant (p<0.001, according to the Cox proportional hazards model). MAMC is a strong independent prognostic factor in stage IV NSCLC patients. Patients with MAMC <90% of the expected value had poor OS.

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