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Identificação do risco nutricional em crianças com paralisia cerebral
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Abstract(s)
A Paralisia Cerebral (PC) é a principal causa de incapacidade na infância. A malnutrição afeta o desenvolvimento físico e cognitivo destas crianças. A identificação de risco nutricional (IRN) com recurso a ferramentas validadas e práticas é fundamental para o rastreio das crianças que necessitarão de uma avaliação nutricional completa e intervenção nutricional subsequentes. O objetivo deste estudo consistiu em comparar os resultados obtidos com a aplicação de diferentes ferramentas de IRN em crianças com PC. A amostra, recolhida entre fevereiro e dezembro de 2020, incluiu um total de 30 participantes observados no Hospital Divino Espírito Santo, EPER e na Associação de Paralisia Cerebral de São Miguel. Para cada participante foram recolhidos os dados clínicos e sociodemográficos, avaliação antropométrica, avaliação da ingestão alimentar e hídrica, e a aplicação indireta de cinco ferramentas de IRN (STRONGkids, Bell et al. (2019), CP-MST, Bushell (2014) e Malnutrition Risk Score) e dois instrumentos de classificação do estado nutricional (Organização Mundial de Saúde e Subjective Global Nutrition Assessment). O Malnutrition Risk Score mostrou elevada sensibilidade (>87%) e especificidade (>71%), assim como os valores preditivos positivo e negativo mais elevados (77,8% e >83%, respetivamente) e um Kappa superior a 0,59, em comparação com as restantes ferramentas e independentemente do método de avaliação do estado nutricional. Para além disso, este estudo também revelou que a gordura e a água são os macronutrientes que necessitam de otimização na terapêutica nutricional das crianças com PC. Em suma, o Malnutrition Risk Score demonstrou ser o instrumento mais eficiente para a IRN em crianças com PC.
Cerebral Palsy (CP) is the main cause of disability in childhood. Malnutrition affect the physical and cognitive development of these children. Validated and practical tools for the identification of nutritional risk are essential for screening children who will need a complete nutritional assessment and subsequent nutritional intervention. The aim of this study was to compare the results obtained with the application of different tools used to identify nutritional risk in children with CP. The sample, collected between February and December 2020, included a total of 30 participants assisted at Divino Espírito Santo Hospital, EPER and at the São Miguel Cerebral Palsy Association. For each participant, their clinical and sociodemographic data were collected, anthropometric and food intake assessment was done, as well as the indirect application of five nutritional risk identification tools (STRONGkids, Bell et al. (2019), CP MST, Bushell (2014) and Malnutrition Risk Score) and two nutritional status classification instruments (World Health Organization and Subjective Global Nutrition Assessment). The results of this study revealed that Malnutrition Risk Score seems to be the most appropriate tool for detecting nutritional risk in children with CP, since this tool showed high sensitivity (>87%) and specificity (>71%), as well as the highest positive and negative predictive values (77.8% and >83%, respectively) and a Kappa statistic value higher than 0.59, compared to the other tools and regardless of the method for assessing nutritional status. In addition, this study also revealed that the macronutrients that need more attention in the nutritional therapy of children with CP are fat and water. In conclusion, Malnutrition Risk Score has proven to be an efficient tool for identifying nutritional risk in children with CP.
Cerebral Palsy (CP) is the main cause of disability in childhood. Malnutrition affect the physical and cognitive development of these children. Validated and practical tools for the identification of nutritional risk are essential for screening children who will need a complete nutritional assessment and subsequent nutritional intervention. The aim of this study was to compare the results obtained with the application of different tools used to identify nutritional risk in children with CP. The sample, collected between February and December 2020, included a total of 30 participants assisted at Divino Espírito Santo Hospital, EPER and at the São Miguel Cerebral Palsy Association. For each participant, their clinical and sociodemographic data were collected, anthropometric and food intake assessment was done, as well as the indirect application of five nutritional risk identification tools (STRONGkids, Bell et al. (2019), CP MST, Bushell (2014) and Malnutrition Risk Score) and two nutritional status classification instruments (World Health Organization and Subjective Global Nutrition Assessment). The results of this study revealed that Malnutrition Risk Score seems to be the most appropriate tool for detecting nutritional risk in children with CP, since this tool showed high sensitivity (>87%) and specificity (>71%), as well as the highest positive and negative predictive values (77.8% and >83%, respectively) and a Kappa statistic value higher than 0.59, compared to the other tools and regardless of the method for assessing nutritional status. In addition, this study also revealed that the macronutrients that need more attention in the nutritional therapy of children with CP are fat and water. In conclusion, Malnutrition Risk Score has proven to be an efficient tool for identifying nutritional risk in children with CP.
Description
Tese de mestrado, Nutrição Clínica, Universidade de Lisboa, Faculdade de Medicina, 2021
Keywords
Paralisia cerebral Desnutrição Rastreio Sensibilidade Especificidade Teses de mestrado - 2021