Year 2018 / Volume 110 / Number 5
Original
Nutritional deficiency during colonoscopy preparation: the forgotten iatrogeny

285-291

DOI: 10.17235/reed.2018.5140/2017

Gonçalo Nunes, Ana Teresa Barata, Carla Adriana Santos, Marta Patita, Jorge Fonseca,

Abstract
Background and aims: bowel preparation for colonoscopy induces a semi-fasting state, with a potential negative impact on fragile patients. The present study aims to quantify nutritional deficiency during colonoscopy preparation. Methods: this was an observational and cross-sectional study. A convenience sample was obtained that included adults that underwent colonoscopy after bowel preparation with Klean-Prep® according to the center protocol. Anthropometric evaluation was performed and nutritional deficiency was calculated via the quantification of energy and protein intake during the 48 hours prior to the examination which was compared with the individuals’ needs. The association between nutritional deficiency with the quality of bowel preparation, age and status (hospitalized/ambulatory) was evaluated. Results: the study included 131 patients aged 21-91 years (mean 63.6 ± 13.2 years); 73 cases were male. Malnutrition reached 67.2% using specific anthropometric tools. A median preparation quality of six points was found when the Boston Bowel Preparation Scale was considered. The mean intake 48 hours prior to the procedure was 1,795 kcal and 100 g of protein. A daily energy intake of less than 50% of the individual needs was observed in 88 patients and less than 25% in 29 cases. The mean energy and protein deficiency were 59% (p < 0.01) and 45% (p < 0.01), and there was no correlation with preparation quality (p > 0.05). Nutritional defiency is similar in hospitalized and ambulatory patients (p > 0.05), but higher in older individuals (p = 0.04). Conclusions: nutritional deficiency during colonoscopy preparation was significant, more so in older patients, and there was no correlation with the quality of bowel preparation. We conclude that bowel preparation regimens should be reformulated with an improved nutritional intake and the inclusion of nutritional supplements without residues.
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References
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24) Laur CV, McNicholl T, Valaitis R, Keller HH. Malnutrition or frailty? Overlap and evidence gaps in the diagnosis and treatment of frailty and malnutrition. Appl Physiol Nutr Metab. 2017; 42(5):449-458. doi: 10.1139/apnm-2016-0652.
25) Landi F, Cruz-Jentoft AJ, Liperoti R, Russo A, Giovannini S, Tosato M et al. Sarcopenia and mortality risk in frail older persons aged 80 years and older: results from ilSIRENTE study. Age Ageing. 2013; 42(2):203-9. doi: 10.1093/ageing/afs194.
1) Cederholm T, Bosaeus I, Barazzoni R, et al. Diagnostic criteria for malnutrition - An ESPEN Consensus Statement. Clin Nutr. 2015;34(3):335-40. doi: 10.1016/j.clnu.2015.03.001
2) Toulson Davisson Correia MI. Addressing the Hidden Burden of Malnutrition for Hospitalized Patients. J Acad Nutr Diet. 2017. pii: S2212-2672(17)30233-2. doi: 10.1016/j.jand.2017.03.009.
3) Martín Palmero Á, Serrano Pérez A, Chinchetru Ranedo MJ, et al. Malnutrition in hospitalized patients: results from La Rioja. Nutr Hosp. 2017; 34(2):402-406. doi: 10.20960/nh.458.
4) Konturek PC, Herrmann HJ, Schink K, et al. Malnutrition in Hospitals: It Was, Is Now, and Must Not Remain a Problem! Med Sci Monit. 2015;21:2969-75. doi: 10.12659/MSM.894238.
5) Matthew L. Bechtold, Fazia Mir, et al. Optimizing bowel preparation for colonoscopy: a guide to enhance quality of visualization. Ann Gastroenterol. 2016; 29(2): 137–146. doi: 10.20524/aog.2016.0005
6) Douglas K. Rex, Philip S. Schoenfeld, Jonathan Cohen, et al. Quality indicators for colonoscopy. Gastrointest Endosc. 2015; 81(1): 31-53. doi: 10.1016/j.gie.2014.07.058
7) Hassan C, Bretthauer M, Kaminski MF, et al. Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy. 2013;45(2):142-50. doi: 10.1055/s-0032-1326186.
8) ASGE Standards of Practice Committee, Saltzman JR, Cash BD, Pasha SF, et al. Bowel preparation before colonoscopy. Gastrointest Endosc. 2015; 81(4):781-94. doi: 10.1016/j.gie.2014.09.048.
9) Johnson DA, Barkun AN, Cohen LB, et al. Optimizing adequacy of bowel cleansing for colonoscopy: recommendations from the US multi-society task force on colorectal cancer. Gastroenterology. 2014; 147(4):903-24. doi: 10.1053/j.gastro.2014.07.002.
10) American Society of Anesthesiologists Committee. Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: an updated report by the American Society of Anesthesiologists Committee on Standards and Practice Parameters. Anesthesiology. 2011; 114(3):495-511. doi: 10.1097/ALN.0b013e3181fcbfd9.
11) Smith I, Kranke P, Murat I, et al. Perioperative fasting in adults and children: guidelines from the European Society of Anaesthesiology. Eur J Anaesthesiol. 2011;28(8):556-69. doi: 10.1097/EJA.0b013e3283495ba1.
12) Wright JE, Willis GJ, Edwards MS. Nutritional content of hospital diets. JAMA. 2004;291(18):2194-6. doi: 10.1001/jama.291.18.2194.
13) Edwin J. Lai, Audrey H. Calderwood, et al. The Boston Bowel Preparation Scale: A valid and reliable instrument for colonoscopy-oriented research. Gastrointest Endosc. 2009; 69: 620–625. doi: 10.1016/j.gie.2008.05.057.
14) Stewart A, Marfell-Jones M, Olds T, et al. International standards for anthropometric assessment. Lower Hutt: International Society for the Advancement of Kinanthropometry; 2011.
15) American Academy of Family Physicians, American Dietetic Association, National Council on the aging. Nutrition Intervention Manual for Professionals Caring for Older Americans. Washington DC: Nutritional Screening Initiative: s.n., 1992.
16) McDowell M, Fryar C, Ogden C, et al. Anthropometric reference data for children and adults: United States, 2003-2006. Natl Health Stat Report. 2008;(10):1-48.
17) Frisancho AR. New standards of weight and body composition by frame size and height for assessment of nutritional status of adults and the elderly. Am J Clin Nutr. 1984;40: 808-19.
18) Fonseca J, Santos CA. Clinical anatomy: anthropometry for nutritional assessment of 367 adults who underwent endoscopic gastrostomy. Acta Med Port. 2013;26(3):212-8.
19) Goios A, Liz Martins M, Oliveira AC, et al. Pesos e Porções de Alimentos. 1st ed. Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, Porto; 2014. 120p.
20) Instituto Nacional de Saúde Doutor Ricardo Jorge. Tabela de Composição de Alimentos. 1st Ed. Centro de Segurança Alimentar e Nutrição. Lisboa; 2007. 355 p.
21) Tae JW, Lee JC, Hong SJ, et al. Impact of patient education with cartoon visual aids on the quality of bowel preparation for colonoscopy. Gastrointest Endosc. 2012; 76(4):804-11. doi: 10.1016/j.gie.2012.05.026.
22) Spiegel BM, Talley J, Shekelle P, et al. Development and validation of a novel patient educational booklet to enhance colonoscopy preparation. Am J Gastroenterol. 2011; 106(5):875-83. doi: 10.1038/ajg.2011.75.
23) Rothman KJ. BMI-related errors in the measurement of obesity. Int J Obes (Lond). 2008; 32 Suppl 3:S56-9. doi: 10.1038/ijo.2008.87.
24) Laur CV, McNicholl T, Valaitis R, et al. Malnutrition or frailty? Overlap and evidence gaps in the diagnosis and treatment of frailty and malnutrition. Appl Physiol Nutr Metab. 2017; 42(5):449-458. doi: 10.1139/apnm-2016-0652.
25) Landi F, Cruz-Jentoft AJ, Liperoti R, et al. Sarcopenia and mortality risk in frail older persons aged 80 years and older: results from ilSIRENTE study. Age Ageing. 2013; 42(2):203-9. doi: 10.1093/ageing/afs194.
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Nunes G, Barata A, Santos C, Patita M, Fonseca J. Nutritional deficiency during colonoscopy preparation: the forgotten iatrogeny. 5140/2017


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Publication history

Received: 23/06/2017

Accepted: 23/11/2017

Online First: 15/01/2018

Published: 27/04/2018

Article revision time: 149 days

Article Online First time: 206 days

Article editing time: 308 days


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