Desnutrição de pacientes em terapia nutricional enteral domiciliar: prevalência, variáveis associadas e comparação de métodos

Abstract

The home care patient may already be malnourished or may become malnourished during home care. The aim of the study was to determine the prevalence of malnutrition and to verify its association with patient, caregiver and dietary characteristics, as well as to compare different methods of nutritional assessment of enteral nutrition therapy (ENT) users in home care in the city from Lavras-MG. Data collection was performed at the patients' homes. Nutritional status was determined by Subjective Global Assessment (SGA), Mini Nutritional Assessment (MAN), anthropometric measurements [body mass index (BMI), arm circumference (AC) and calf circumference (CC)] and by bioimpedance [lean mass index (LMI) and phase angle (PA)]. Clinical data regarding underlying disease, complications, characteristics of the diet and caregivers were also researched. Sixty-six patients/caregivers were evaluated, most of them elderly (97.0%), female (71.2%), patients with neurological diseases (81.8%), and bedridden (83.3%). Malnutrition was universal, affecting 100% of patients by SGA and MAN, with 39.4% being severely malnourished by SGA. Severe malnutrition was associated with male gender (p = 0.024; OR = 4.0) and patients with partners (p = 0.021; OR = 3.5). The median number of caregivers was 2 (0-4), most of whom were family members (51.5%) and did not receive training before starting ENT home care (71.2%). Caregiver characteristics were not associated with severe malnutrition (p> 0.05). The preferred route of administration was gastrostomy (54.5%), protein and caloric inadequacy were 72.4% and 57.6%, respectively, and intake was lower than required (p <0.05). Severe malnourished patients ingested higher amounts of calories and protein (p <0.05). Regarding the other nutritional assessment methods, the percentage of malnutrition ranged from 35.6% by LMI to 95% by CC. Severe malnutrition was associated with lower values of estimated BMI, IMM, CB, CP (p <0.05), but not with PA. After multivariate analysis, male gender along with AC (p<0.001; OR:0.337) or CC (p<0.001; OR: 0.692), were the independent variables associated with severe malnutrition.