Banca de DEFESA: IASMIN MATIAS SOUSA

Uma banca de DEFESA de DOUTORADO foi cadastrada pelo programa.
STUDENT : IASMIN MATIAS SOUSA
DATE: 23/11/2023
TIME: 14:00
LOCAL: REMOTA - https://meet.google.com/bcn-farw-agk
TITLE:

EVALUATION OF NUTRITIONAL STATUS IN HOSPITALIZED AND NON-HOSPITALIZED PATIENTS AND ASSOCIATIONS WITH ADVERSE CLINICAL OUTCOMES

KEY WORDS:

nutritional status; malnutrition; sarcopenia; length of hospital stay; mortality; frailty

PAGES: 116
BIG AREA: Ciências da Saúde
AREA: Nutrição
SUMMARY:

The assessment of nutritional status, both in outpatient and hospital settings, allows for directing the therapeutic approach and monitoring the evolution of the treatments proposed to these patients. Although there are different methods, the conclusions are still conflicting regarding which is most appropriate for the evaluation of this population in terms of validity in predicting adverse clinical outcomes. This doctoral thesis aimed to investigate the validity of different methods for assessing the nutritional status of hospitalized and non-hospitalized patients based on the association between the diagnoses and adverse clinical outcomes (length of hospital stay, hospital readmission, and mortality). The thesis is composed of four independent cohort studies: 1) a study involving adult and elderly patients with gastric and colorectal cancer undergoing treatment, which aimed to evaluate the accuracy of isolated nutritional indicators (BMI, handgrip strength - HGS, calf circumference - CC) for the diagnosis of malnutrition (using the subjective global assessment patient generated - SGA-PG as a reference method) and its association with mortality; 2) a study including hospitalized adults and older adults evaluated in the first 72 hours after hospital admission to five hospitals in a hospital complex in the South of the country, which aimed to test the predictive validity of BMI-adjusted CC (CCbmi), with the outcomes of interest being prolonged hospital stay, hospital readmission, and mortality. Weight, height, and CC were measured and BMI calculated, and adjustments were applied to the crude CC values prior to classification as normal or reduced; 3) in the same sample of hospitalized patients, malnutrition and sarcopenia were diagnosed, and the association of these isolated and overlapping conditions with clinical outcomes was evaluated; 4) a study with elderly patients with gastrointestinal cancer evaluating the association between the diagnosis of isolated and overlapping sarcopenia and frailty and mortality. According to the results obtained in the first study, the nutritional indicators BMI, HGS, and CC were not accurate for the diagnosis of malnutrition (SGA-PG as a reference). However, SGA-PG and CC were independent predictors of mortality in patients with gastric and colorectal cancer (n = 178, HR= 2.9 [95%CI 1.5 - 5.9] and HR = 2.4 [95%CI 1.1 - 5.2], respectively). The results of study 2 (n = 550 patients) demonstrated that the risk or presence of sarcopenia increases the risk of in-hospital mortality by 4.0 times [95% CI 1.1 - 13.9], while the overlap of sarcopenia-malnutrition was associated with longer hospital stay (OR = 2.7; 95%CI 1.4 - 5.3), hospital readmission (OR = 7.6, 95%CI 3.1 - 19.6) and mortality (OR = 1.2, 95%CI 1.1 - 1.2) six months after hospital discharge in hospitalized patients with different pathologies. In study 3, reduced CCbmi values were identified in more than 60% of the 554 hospitalized patients evaluated and were an independent predictor of prolonged length of hospital stay (OR = 1.7; 95%CI 1.2 - 2.4). In study 4, we identified that the coexistence of sarcopenia and frailty was associated with a higher risk of death (HR = 3.0; 95%CI 1.5 - 6.1) in elderly patients with gastrointestinal cancer (n = 179) when compared to isolated parameters. The findings of this doctoral thesis reinforce the importance of assessing and diagnosing the different situations that impair nutritional status, such as malnutrition, sarcopenia, and frailty, both in hospitalized and outpatient patients. In addition, we found the clinical applicability of the measurement of reduced CC in both cancer patients and general patients and warned of the need to consider the influence of adiposity when classifying low CC.

COMMITTEE MEMBERS:
Externo à Instituição - ALEXANDRE COELHO SERQUIZ - UFPB
Externa à Instituição - ALINE MARCADENTI DE OLIVEIRA - HC
Presidente - 1879430 - ANA PAULA TRUSSARDI FAYH
Externa ao Programa - 2306763 - KARINE CAVALCANTI MAURICIO DE SENA EVANGELISTA - nullExterna ao Programa - 2315640 - MARCIA MARILIA GOMES DANTAS LOPES - null