DAN LINETZKY WAITZBERG
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Gastroenterologia, Faculdade de Medicina - Docente
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/35 - Laboratório de Nutrição e Cirurgia Metabólica do Aparelho Digestivo, Hospital das Clínicas, Faculdade de Medicina - Líder
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/35 - Laboratório de Nutrição e Cirurgia Metabólica do Aparelho Digestivo, Hospital das Clínicas, Faculdade de Medicina - Líder
12 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 12
- Global Leadership Initiative on Malnutrition (GLIM): Guidance on validation of the operational criteria for the diagnosis of protein-energy malnutrition in adults(2020) SCHUEREN, M. A. E. de van der; KELLER, H.; CEDERHOLM, T.; BARAZZONI, R.; COMPHER, C.; CORREIA, M. I. T. D.; GONZALEZ, M. C.; JAGER-WITTENAAR, H.; PIRLICH, M.; STEIBER, A.; WAITZBERG, D.; JENSEN, G. L.Background: The Global Leadership Initiative on Malnutrition (GLIM) created a consensus-based framework consisting of phenotypic and etiologic criteria to record the occurrence of malnutrition in adults. This is a minimum set of practicable indicators for use in characterizing a patient/client as malnourished, considering the global variations in screening and nutrition assessment, and to be used across different health care settings. As with other consensus-based frameworks for diagnosing disease states, these operational criteria require validation and reliability testing as they are currently based solely on expert opinion. Methods: Several forms of validation and reliability are reviewed in the context of GLIM, providing guidance on how to conduct retrospective and prospective studies for criterion and construct validity. Findings: There are some aspects of GLIM criteria which require refinement; research using large data bases can be employed to reach this goal. Machine learning is also introduced as a potential method to support identification of the best cut-points and combinations of operational criteria for use with the different forms of malnutrition, which the GLIM criteria were created to denote. It is noted as well that the validation and reliability testing need to occur in a variety of sectors, populations and with diverse persons completing the criteria. Conclusion: The guidance presented supports the conduct and publication of quality validation and reliability studies for GLIM.
- ESPEN practical guideline: Clinical nutrition in surgery(2021) WEIMANN, Arved; BRAGA, Marco; CARLI, Franco; HIGASHIGUCHI, Takashi; HUBNER, Martin; KLEK, Stanislaw; LAVIANO, Alessandro; LJUNGQVIST, Olle; LOBO, Dileep N.; MARTINDALE, Robert; WAITZBERG, Dan L.; BISCHOFF, Stephan C.; SINGER, PierreEarly oral feeding is the preferred mode of nutrition for surgical patients. Avoidance of any nutritional therapy bears the risk of underfeeding during the postoperative course after major surgery. Considering that malnutrition and underfeeding are risk factors for postoperative complications, early enteral feeding is especially relevant for any surgical patient at nutritional risk, especially for those undergoing upper gastrointestinal surgery. The focus of this guideline is to cover both nutritional aspects of the Enhanced Recovery After Surgery (ERAS) concept and the special nutritional needs of patients undergoing major surgery, e.g. for cancer, and of those developing severe complications despite best perioperative care. From a metabolic and nutritional point of view, the key aspects of perioperative care include the inte-gration of nutrition into the overall management of the patient, avoidance of long periods of preoperative fasting, re-establishment of oral feeding as early as possible after surgery, the start of nutritional therapy immediately if a nutritional risk becomes apparent, metabolic control e.g. of blood glucose, reduction of factors which exacerbate stress-related catabolism or impaired gastrointestinal function, minimized time on paralytic agents for ventilator management in the postoperative period, and early mobilization to facilitate protein synthesis and muscle function.
- Health insurance or subsidy has universal advantage for management of hospital malnutrition unrelated to GDP(2017) KLEK, Stanislaw; CHOURDAKIS, Michael; ABOSALEH, Dima Abdulqudos; AMESTOY, Alejandra; BAIK, Hyun Wook; BAPTISTA, Gertrudis; BARAZZONI, Rocco; FUKUSHIMA, Ryoji; HARTONO, Josef; JAYAWARDENA, Ranil; GARCIA, Rafael Jimenez; KRZNARIC, Zeljko; NYULASI, Ibolya; PARALLADA, Gabriela; FRANCISCO, Eliza Mei Perez; PANISIC-SEKELJIC, Marina; PERMAN, Mario; PRINS, Anna; REQUEJO, Isabel Martinez del Rio; REDDY, Ravinder; SINGER, Pierre; SIOSON, Marianna; UKLEJA, Andrew; VARTANIAN, Carla; FUENTES, Nicolas Velasco; WAITZBERG, Dan Linetzky; ZOUNGRANA, Steve Leonce; GALAS, AleksanderBackground and Objectives: Protein-energy and micronutrient malnutrition are global public health problems which, when not prevented and severe, require medical management by clinicians with nutrition expertise, preferably as a collectively skilled team, especially when disease-related. This study aimed to investigate barriers and facilitators of clinical nutrition services (CNS), especially the use of oral, enteral (EN) and parenteral (PN) nutrition in institutional and home settings. Methods and Study Design: An international survey was performed between January and December 2014 in twenty-six countries from all continents. Electronic questionnaires were distributed to 28 representatives of clinical nutrition (PEN) societies, 27 of whom responded. The questionnaire comprised questions regarding a country's economy, reimbursement for CNS, education about and the use of EN and PN. Results: The prevalence of malnutrition was not related to gross domestic product (GDP) at purchasing power parity (PPP) per capita (p=0.186). EN and PN were used in all countries surveyed (100%), but to different extents. Reimbursement of neither EN nor PN use depended on GDP, but was associated with increased use of EN and PN in hospitals (p=0.035), although not evident for home or chronic care facilities. The size of GDP did not affect the use of EN (p=0.256), but it mattered for PN (p=0.019). Conclusions: A worldwide survey by nutrition support societies did not find a link between national economic performance and the implementation of medical nutrition services. Reimbursement for CNS, available through health insurance systems, is a factor in effective nutrition management.
- GLIM criteria for the diagnosis of malnutrition - A consensus report from the global clinical nutrition community(2019) CEDERHOLM, T.; JENSEN, G. L.; CORREIA, M. I. T. D.; GONZALEZ, M. C.; FUKUSHIMA, R.; HIGASHIGUCHI, T.; BAPTISTA, G.; BARAZZONI, R.; BLAAUW, R.; COATS, A. J. S.; CRIVELLI, A. N.; EVANS, D. C.; GRAMLICH, L.; FUCHS-TARLOVSKY, V.; KELLER, H.; LLIDO, L.; MALONE, A.; MOGENSEN, K. M.; MORLEY, J. E.; MUSCARITOLI, M.; NYULASI, I.; PIRLICH, M.; PISPRASERT, V.; SCHUEREN, M. A. E. de van der; SILTHARM, S.; SINGER, P.; TAPPENDEN, K.; VELASCO, N.; WAITZBERG, D.; YAMWONG, P.; YU, J.; GOSSUM, A. Van; COMPHER, C.Rationale This initiative is focused on building a global consensus around core diagnostic criteria for malnutrition in adults in clinical settings. Methods In January 2016, the Global Leadership Initiative on Malnutrition (GLIM) was convened by several of the major global clinical nutrition societies. GLIM appointed a core leadership committee and a supporting working group with representatives bringing additional global diversity and expertise. Empirical consensus was reached through a series of face-to-face meetings, telephone conferences, and e-mail communications. Results A two-step approach for the malnutrition diagnosis was selected, i.e., first screening to identify ""at risk"" status by the use of any validated screening tool, and second, assessment for diagnosis and grading the severity of malnutrition. The malnutrition criteria for consideration were retrieved from existing approaches for screening and assessment. Potential criteria were subjected to a ballot among the GLIM core and supporting working group members. The top five ranked criteria included three phenotypic criteria (weight loss, low body mass index, and reduced muscle mass) and two etiologic criteria (reduced food intake or assimilation, and inflammation or disease burden). To diagnose malnutrition at least one phenotypic criterion and one etiologic criterion should be present. Phenotypic metrics for grading severity as Stage 1 (moderate) and Stage 2 (severe) malnutrition are proposed. It is recommended that the etiologic criteria be used to guide intervention and anticipated outcomes. The recommended approach supports classification of malnutrition into four etiology-related diagnosis categories. Conclusion A consensus scheme for diagnosing malnutrition in adults in clinical settings on a global scale is proposed. Next steps are to secure further collaboration and endorsements from leading nutrition professional societies, to identify overlaps with syndromes like cachexia and sarcopenia, and to promote dissemination, validation studies, and feedback. The diagnostic construct should be re-considered every 3-5 years.
- GLIM criteria for the diagnosis of malnutrition - A consensus report from the global clinical nutrition community(2019) CEDERHOLM, T.; JENSEN, G. L.; CORREIA, M. I. T. D.; GONZALEZ, M. C.; FUKUSHIMA, R.; HIGASHIGUCHI, T.; BAPTISTA, G.; BARAZZONI, R.; BLAAUW, R.; COATS, A.; CRIVELLI, A.; EVANS, D. C.; GRAMLICH, L.; FUCHS-TARLOVSKY, V.; KELLER, H.; LLIDO, L.; MALONE, A.; MOGENSEN, K. M.; MORLEY, J. E.; MUSCARITOLI, M.; NYULASI, I.; PIRLICH, M.; PISPRASERT, V.; SCHUEREN, M. A. E. de van der; SILTHARM, S.; SINGER, P.; TAPPENDEN, K.; VELASCO, N.; WAITZBERG, D.; YAMWONG, P.; YU, J.; GOSSUM, A. Van; COMPHER, C.Rationale: This initiative is focused on building a global consensus around core diagnostic criteria for malnutrition in adults in clinical settings. Methods: In January 2016, the Global Leadership Initiative on Malnutrition (GLIM) was convened by several of the major global clinical nutrition societies. GLIM appointed a core leadership committee and a supporting working group with representatives bringing additional global diversity and expertise. Empirical consensus was reached through a series of face-to-face meetings, telephone conferences, and e-mail communications. Results: A two-step approach for the malnutrition diagnosis was selected, i.e., first screening to identify ""at risk"" status by the use of any validated screening tool, and second, assessment for diagnosis and grading the severity of malnutrition. The malnutrition criteria for consideration were retrieved from existing approaches for screening and assessment. Potential criteria were subjected to a ballot among the GLIM core and supporting working group members. The top five ranked criteria included three phenotypic criteria (non-volitional weight loss, low body mass index, and reduced muscle mass) and two etiologic criteria (reduced food intake or assimilation, and inflammation or disease burden). To diagnose malnutrition at least one phenotypic criterion and one etiologic criterion should be present. Phenotypic metrics for grading severity as Stage 1 (moderate) and Stage 2 (severe) malnutrition are proposed. It is recommended that the etiologic criteria be used to guide intervention and anticipated outcomes. The recommended approach supports classification of malnutrition into four etiology-related diagnosis categories. Conclusion: A consensus scheme for diagnosing malnutrition in adults in clinical settings on a global scale is proposed. Next steps are to secure further collaboration and endorsements from leading nutrition professional societies, to identify overlaps with syndromes like cachexia and sarcopenia, and to promote dissemination, validation studies, and feedback. The diagnostic construct should be re-considered every 3-5 years.
- Global Leadership Initiative on Malnutrition (GLIM): Guidance on Validation of the Operational Criteria for the Diagnosis of Protein-Energy Malnutrition in Adults(2020) KELLER, Heather; SCHUEREN, Marian A. E. de van der; JENSEN, Gordon L.; BARAZZONI, Rocco; COMPHER, Charlene; CORREIA, M. Isabel T. D.; GONZALEZ, M. Cristina; JAGER-WITTENAAR, Harriet; PIRLICH, Matthias; STEIBER, Alison; WAITZBERG, Dan; CEDERHOLM, TommyBackground The Global Leadership Initiative on Malnutrition (GLIM) created a consensus-based framework consisting of phenotypic and etiologic criteria to record the occurrence of malnutrition in adults. This is a minimum set of practicable indicators for use in characterizing a patient/client as malnourished, considering the global variations in screening and nutrition assessment, and to be used across different healthcare settings. As with other consensus-based frameworks for diagnosing disease states, these operational criteria require validation and reliability testing, as they are currently based solely on expert opinion. Methods Several forms of validation and reliability are reviewed in the context of GLIM, providing guidance on how to conduct retrospective and prospective studies for criterion and construct validity. Results There are some aspects of GLIM that require refinement; research using large databases can be employed to reach this goal. Machine learning is also introduced as a potential method to support identification of the best cut points and combinations of indicators for use with the different forms of malnutrition, which the GLIM criteria were created to denote. It is noted as well that validation and reliability testing need to occur in a variety of sectors and populations and with diverse persons using GLIM criteria. Conclusion The guidance presented supports the conduct and publication of quality validation and reliability studies for GLIM.
- Economic burden of hospital malnutrition and the cost-benefit of supplemental parenteral nutrition in critically ill patients in Latin America(2018) CORREIA, Maria Isabel Toulson Davisson; PERMAN, Mario Ignacio; PRADELLI, Lorenzo; OMARALSALEH, Abdul Jabbar; WAITZBERG, Dan LinetzkyAim: Disease-related malnutrition (DRM) is a prevalent condition that significantly increases the risk of adverse outcomes in hospitalized patients, particularly those with critical illness. Limited data is available on the economic burden of DRM and the cost-benefit of nutrition therapy in high-risk populations in Latin America. The aims of the present study were to estimate the economic burden of DRM and evaluate the cost-benefit of supplemental parenteral nutrition (SPN) in critically ill patients who fail to receive adequate nutrient intake from enteral nutrition (EN) in Latin America. Methods: Country-specific cost and prevalence data from eight Latin American countries and clinical data from studies evaluating outcomes in patients with DRM were used to estimate the costs associated with DRM in public hospitals. A deterministic decision model based on clinical outcomes from a randomized controlled study and country-specific cost data were developed to examine the cost-benefit of administering SPN to critically ill adults who fail to reach >= 60% of the calculated energy target with EN. Results: The estimated annual economic burden of DRM in public hospitals in Latin America is $10.19 billion (range, $8.44 billion-$11.72 billion). Critically ill patients account for a disproportionate share of the costs, with a 6.5-fold higher average cost per patient compared with those in the ward ($5488.35 vs. $839.76). Model-derived estimates for clinical outcomes and resource utilization showed that administration of SPN to critically ill patients who fail to receive the targeted energy delivery with EN would result in an annual cost reduction of $10.2 million compared with continued administration of EN alone. Limitations: The cost calculation was limited to the average daily cost of stay and antibiotic use. The costs associated with other common complications of DRM, such as prolonged duration of mechanical ventilation or more frequent readmission, are unknown. Conclusions: DRM imposes a substantial economic burden on Latin American countries, with critically ill patients accounting for a disproportionate share of costs. Cost-benefit analysis suggests that both improved clinical outcomes and significant cost savings can be achieved through the adoption of SPN as a therapeutic strategy in critically ill patients who fail to receive adequate nutrient intake from EN.
- ESPEN guideline: Clinical nutrition in surgery(2017) WEIMANN, Arved; BRAGA, Marco; CARLI, Franco; HIGASHIGUCHI, Takashi; HUEBNER, Martin; KLEK, Stanislaw; LAVIANO, Alessandro; LJUNGQVIST, Olle; LOBO, Dileep N.; MARTINDALE, Robert; WAITZBERG, Dan L.; BISCHOFF, Stephan C.; SINGER, PierreEarly oral feeding is the preferred mode of nutrition for surgical patients. Avoidanc'e of any nutritional therapy bears the risk of underfeeding during the postoperative course after major surgery. Considering that malnutrition and underfeeding are risk factors for postoperative complications, early enteral feeding is especially relevant for any surgical patient at nutritional risk, especially for those undergoing upper gastrointestinal surgery. The focus of this guideline is to cover nutritional aspects of the Enhanced Recovery After Surgery (ERAS) concept and the special nutritional needs of patients undergoing major surgery, e.g. for cancer, and of those developing severe complications despite best perioperative care. From a metabolic and nutritional point of view, the key aspects of perioperative care include: integration of nutrition into the overall management of the patient avoidance of long periods of preoperative fasting re-establishment of oral feeding as early as possible after surgery start of nutritional therapy early, as soon as a nutritional risk becomes apparent metabolic control e.g. of blood glucose reduction of factors which exacerbate stress-related catabolism or impair gastrointestinal function minimized time on paralytic agents for ventilator management in the postoperative period early mobilisation to facilitate protein synthesis and muscle function The guideline presents 37 recommendations for clinical practice.
- GLIM Criteria for the Diagnosis of Malnutrition: A Consensus Report From the Global Clinical Nutrition Community(2019) JENSEN, Gordon L.; CEDERHOLM, Tommy; CORREIA, M. Isabel T. D.; GONZALEZ, M. Christina; FUKUSHIMA, Ryoji; HIGASHIGUCHI, Takashi; BAPTISTA, Gertrudis Adrianza de; BARAZZONI, Rocco; BLAAUW, Renee; COATS, Andrew J. S.; CRIVELLI, Adriana; EVANS, David C.; GRAMLICH, Leah; FUCHS-TARLOVSKY, Vanessa; KELLER, Heather; LLIDO, Luisito; MALONE, Ainsley; MOGENSEN, Kris M.; MORLEY, John E.; MUSCARITOLI, Maurizio; NYULASI, Ibolya; PIRLICH, Matthias; PISPRASERT, Veeradej; SCHUEREN, Marian de van der; SILTHARM, Soranit; SINGER, Pierre; TAPPENDEN, Kelly A.; VELASCO, Nicolas; WAITZBERG, Dan L.; YAMWONG, Preyanuj; YU, Jianchun; COMPHER, Charlene; GOSSUM, Andre VanBackground This initiative aims to build a global consensus around core diagnostic criteria for malnutrition in adults in clinical settings. Methods The Global Leadership Initiative on Malnutrition (GLIM) was convened by several of the major global clinical nutrition societies. Empirical consensus was reached through a series of face-to-face meetings, telephone conferences, and e-mail communications. Results A 2-step approach for the malnutrition diagnosis was selected, that is, first screening to identify at risk status by the use of any validated screening tool, and second, assessment for diagnosis and grading the severity of malnutrition. The malnutrition criteria for consideration were retrieved from existing approaches for screening and assessment. Potential criteria were subjected to a ballot among GLIM participants that selected 3 phenotypic criteria (non-volitional weight loss, low body mass index, and reduced muscle mass) and 2 etiologic criteria (reduced food intake or assimilation, and inflammation or disease burden). To diagnose malnutrition at least 1 phenotypic criterion and 1 etiologic criterion should be present. Phenotypic metrics for grading severity are proposed. It is recommended that the etiologic criteria be used to guide intervention and anticipated outcomes. The recommended approach supports classification of malnutrition into four etiology-related diagnosis categories. Conclusions A consensus scheme for diagnosing malnutrition in adults in clinical settings on a global scale is proposed. Next steps are to secure endorsements from leading nutrition professional societies, to identify overlaps with syndromes like cachexia and sarcopenia, and to promote dissemination, validation studies, and feedback. The construct should be re-considered every 3-5 years.
- Summary of Proceedings and Expert Consensus Statements From the International Summit ""Lipids in Parenteral Nutrition""(2020) MARTINDALE, Robert G.; BERLANA, David; I, Joseph Boullata; CAI, Wei; CALDER, Philip C.; DESHPANDE, Girish H.; EVANS, David; GARCIA-DE-LORENZO, Abelardo; GOULET, Olivier J.; LI, Ang; MAYER, Konstantin; MUNDI, Manpreet S.; MUSCARITOLI, Maurizio; PRADELLI, Lorenzo; ROSENTHAL, Martin; SEO, Jeong-Meen; WAITZBERG, Dan L.; KLEK, StanislawBackground The 2018 Lipids in Parenteral Nutrition summit involved a panel of experts in clinical nutrition, lipid metabolism, and pharmacology, to assess the current state of knowledge and develop expert consensus statements regarding the use of intravenous lipid emulsions in various patient populations and clinical settings. The main purpose of the consensus statements is to assist healthcare professionals by providing practical guidance on common clinical questions related to the provision of lipid emulsions as part of parenteral nutrition (PN). Methods The summit was designed to allow interactive discussion and consensus development. The resulting consensus statements represent the collective opinion of the members of the expert panel, which was informed and supported by scientific evidence and clinical experience. Results The current article summarizes the key discussion topics from the summit and provides a set of consensus statements designed to complement existing evidence-based guidelines. Lipid emulsions are a major component of PN, serving as a condensed source of energy and essential fatty acids. In addition, lipids modulate a variety of biologic functions, including inflammatory and immune responses, coagulation, and cell signaling. A growing body of evidence suggests that lipid emulsions containing omega-3 fatty acids from fish oil confer important clinical benefits via suppression of inflammatory mediators and activation of pathways involved in the resolution of inflammation. Conclusions This article provides a set of expert consensus statements to complement formal PN guideline recommendations.