Publication: Palyatif bakım servisinde yatan ve tüplü enteral beslenme desteği alan hastaların beslenme durumunun değerlendirilmesi
Abstract
Palyatif bakım servisinde yatan ve tüplü enteral beslenme desteği alan hastaların beslenme durumunun değerlendirilmesi Amaç: Bu çalışmanın amacı, palyatif bakımda tüplü enteral beslenen hastaların beslenme durumunu antropometrik ölçümler, tarama araçları ve biyokimyasal bulgularla değerlendirmek; enteral nütrisyon (EN) uygulamalarını ve bunları etkileyen faktörlerle ilişkisini incelemektir. Gereç ve Yöntem: Bir devlet hastanesinin palyatif bakım servisinde 132 hasta ile yürütülen çalışmada, demografik, klinik, antropometrik ve biyokimyasal veriler toplanmıştır. Hastaların beslenme durumu tarama araçları ile değerlendirilmiş; diyetle alınan enerji ve protein gereksinimlerinin karşılanma düzeyleri araştırmacı tarafından hesaplanmıştır. Ayrıca, EN’ye bağlı gelişen komplikasyonlar sistematik olarak kaydedilmiştir. Bulgular: Beslenme Risk Tarama Aracı 2002’ye göre hastaların %75,8’i malnütrisyon riski altındayken, Malnütrisyonun Küresel Liderlik İnisiyatifi’ne (Global Leadership Initiative on Malnutrition, GLIM) göre %89,4’ünde malnütrisyon saptanmıştır. GLIM’de malnütrisyonu olanlarda Baldır Çevresi (BÇ) ve Triseps Deri Kıvrım Kalınlığı (TDKK) düşük bulunmuştur. Geriatrik Beslenme Risk İndeksi grupları arasında Vücut Ağırlığı (VA), boy uzunluğu, Beden Kütle İndeksi (BKİ), BÇ, Üst Orta Kol Çevresi (ÜOKÇ) ve TDKK; hematokrit, kalsiyum, C-reaktif protein (CRP), CRP/ Albümin Oranı (CAR) ve Nötrofil/ Lenfosit Oranı (NLR) anlamlı farklılık göstermiştir. Beslenme Risk İndeksi gruplarında albümin, klor, kalsiyum ve hemoglobin farklı bulunmuştur. Enerji gereksinimini ≥%90 karşılayanlarda VA ve ÜOKÇ; protein yeterliliğinde VA, BKİ ve ÜOKÇ daha yüksek saptanmıştır. Perkütan endoskopik gastrostomi/ perkütan endoskopik jejunostomi ile beslenenlerde enerji karşılanma oranı nazogastrik tuple beslenenlere göre daha yüksek bulunmuştur. Katılımcıların %78,8’inde komplikasyon gelişmiş, en sık diyare gözlenmiştir. Sonuç Palyatif bakımda tüple EN alan bireylerde bireyselleştirilmiş beslenme tedavisine rağmen enerji-protein yeterliliği düşük, komplikasyon oranı yüksektir. Bulgular, mevcut enteral formülasyonların yetersizliğini, tarama araçlarının kombine kullanımının önemini ve palyatif bakım için daha özgün araç ve yaklaşımların geliştirilmesi gerekliliğini göstermektedir.
Assessment of the nutritional status of patients receiving tube enteral nutrition support in the palliative care unit Objective: This study aims to evaluate the nutritional status of palliative care patients receiving tube enteral nutrition using anthropometric measurements, screening tools, and biochemical findings, and to examine enteral nutrition (EN) practices and associated factors. Materials and Methods: The study, conducted with 132 patients in the palliative care unit of a state hospital, collected demographic, clinical, anthropometric, and biochemical data. Patients’ nutritional status was assessed using screening tools, while dietary energy and protein requirement coverage was calculated by the researcher. In addition, complications related to enteral nutrition (EN) were systematically recorded. Results: According to the Nutritional Risk Screening 2002 (NRS-2002), 75.8% of the patients were at risk of malnutrition, while malnutrition was identified in 89.4% according to the Global Leadership Initiative on Malnutrition (GLIM). In those with malnutrition by GLIM, calf circumference (CC) and triceps skinfold thickness (TSF) were found to be low. Among Geriatric Nutritional Risk Index groups, body weight (BW), height, body mass index (BMI), CC, mid-upper arm circumference (MUAC), and TSF; hematocrit, calcium, C-reactive protein (CRP), CRP/ albümin ratio (CAR), and neutrophil/ lymphocyte ratio (NLR) showed significant differences. In Nutritional Risk Index groups, albümin, chloride, calcium, and hemoglobin were found to differ. In those meeting ≥90% of energy requirements, BW and MUAC, and in protein adequacy, BW, BMI, and MUAC were found to be higher. The rate of energy adequacy was higher in patients fed by percutaneous endoscopic gastrostomy/ percutaneous endoscopic jejunostomy compared to those fed by nasogastric tube. Complications developed in 78.8% of participants, with diarrhea being the most common. Conclusion: In palliative care patients receiving tube EN, energy–protein adequacy was low and complication rates were high despite individualized nutritional therapy. The findings highlight the insufficiency of current enteral formulations, the importance of combined use of screening tools, and the need to develop more specific tools and approaches for palliative care.
Assessment of the nutritional status of patients receiving tube enteral nutrition support in the palliative care unit Objective: This study aims to evaluate the nutritional status of palliative care patients receiving tube enteral nutrition using anthropometric measurements, screening tools, and biochemical findings, and to examine enteral nutrition (EN) practices and associated factors. Materials and Methods: The study, conducted with 132 patients in the palliative care unit of a state hospital, collected demographic, clinical, anthropometric, and biochemical data. Patients’ nutritional status was assessed using screening tools, while dietary energy and protein requirement coverage was calculated by the researcher. In addition, complications related to enteral nutrition (EN) were systematically recorded. Results: According to the Nutritional Risk Screening 2002 (NRS-2002), 75.8% of the patients were at risk of malnutrition, while malnutrition was identified in 89.4% according to the Global Leadership Initiative on Malnutrition (GLIM). In those with malnutrition by GLIM, calf circumference (CC) and triceps skinfold thickness (TSF) were found to be low. Among Geriatric Nutritional Risk Index groups, body weight (BW), height, body mass index (BMI), CC, mid-upper arm circumference (MUAC), and TSF; hematocrit, calcium, C-reactive protein (CRP), CRP/ albümin ratio (CAR), and neutrophil/ lymphocyte ratio (NLR) showed significant differences. In Nutritional Risk Index groups, albümin, chloride, calcium, and hemoglobin were found to differ. In those meeting ≥90% of energy requirements, BW and MUAC, and in protein adequacy, BW, BMI, and MUAC were found to be higher. The rate of energy adequacy was higher in patients fed by percutaneous endoscopic gastrostomy/ percutaneous endoscopic jejunostomy compared to those fed by nasogastric tube. Complications developed in 78.8% of participants, with diarrhea being the most common. Conclusion: In palliative care patients receiving tube EN, energy–protein adequacy was low and complication rates were high despite individualized nutritional therapy. The findings highlight the insufficiency of current enteral formulations, the importance of combined use of screening tools, and the need to develop more specific tools and approaches for palliative care.