Estágio de investigação em nutrição: relevância para a prática clínica em medicina.

Abstract

In oncology, early and individualized nutritional intervention for each patient is essential to improve nutritional intake and status, to reduce morbidity during treatment, enhance tolerance to treatment and improve Quality of Life.For medical students to evaluate nutritional risk and status, analyse the prevalence of undernutrition in a population of patients with diverse types of tumours. We aimed to identify difficulties regarding the use of the MUST tool (Malnutrition Universal Screening Tool) for nutritional risk by the students.This study included 35 cancer patients consecutively referenced for Radiotherapy (RT) in the Radiotherapy Department of the University Hospital of Santa Maria. Nutritional risk was evaluated by MUST; nutritional status by Patient Generated-Subjective Global Assessment (PG-SGA) validated and specific for oncology.Students identified 13 patients (36%) at moderate/high risk of undernutrition. According to PG-SGA, 31,5% (11/35) of patients presented moderate or severe undernutrition, of which 77% of patients needed individualized nutritional counselling. Students successfully detected undernourished patients using these specific methods.Risk of undernutrition and undernutrition are common in oncology, therefore indicating the critical need to educate all health professionals for risk screening and for the relevance of nutritional intervention in the multidisciplinary context. MUST is a simple and quick tool, that demonstrated to be adequate when applied by medical students, well accepted by these health professionals and effectively used. Nutritional risk evaluation can and must be performed by health professionals such as the medical team, as long as they are involved in patient's treatment. Our methodology may be used as a model allowing for early guidance to individualized intervention, human resources' optimization and education for the importance of nutrition care.

Effects of Sarcopenia on Post-Operative Complications in Patients Undergoing Gastrectomy for Gastric Cancer: An Integrative Review

“…One way in which cancer can cause sarcopenia is through the generation of inflammatory cytokines by monocytes, leading to muscle atrophy, decreased walking speed, and reduced appetite [4,6] . Metabolic disruptions also contribute to the alterations in body composition.…”

The influence of chemotherapy on nutritional status and oncological fatigue in cancer patients: Cross-sectional study

“…The adverse effects of chemotherapy are very variable and can contribute to the nutritional impairment of the cancer patient, since symptoms that imply daily nutritional intake such as anorexia, nausea, vomiting, diarrhea, constipation, mucositis, xerostomia and dysgeusia, increase the tendency to the appearance of cachexia and malnutrition, which, in turn, intensify the adverse effects of treatment, generating a vicious cycle [6][7][8] .…”

Associação da composição corporal e índices inflamatórios na sobrevida de pacientes com câncer gástrico metastático que receberam quimioterapia de primeira linha

“…Adicionalmente, fatores associados ao tumor como características invasivas e metastáticas também participam na promoção da desnutrição (10). Os principais fatores determinantes da desnutrição nesses indivíduos são as alterações metabólicas provocadas pelo tumor, aumento da demanda calórica pelo crescimento do tumor e a redução na ingestão total de alimentos causado pela própria doença e tratamento (11) , que irão refletir diretamente na composição corporal, levando a uma perda de peso progressiva e involuntária do paciente, especialmente em tumores sólidos (12). Alta demanda metabólica para renovação celular e consumo de energia inerentes ao estágio avançado pode representar maior tamanho tumoral, comportamento biológico tumoral mais agressivo assim como o aumento e liberação de mediadores biológicos, como citocinas pró-inflamatórias (13), comprometendo o estado nutricional (14,15).…”