Grupo de Patologia Médica, Nutrição e Estudos Clínicos (PaMNEC) of Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Caparica, 2829-511 Almada, Portugal.
GENE-Artificial Feeding Team, Gastroenterology Department, Hospital Garcia de Orta, 2805-267 Almada, Portugal.
Nutrients. 2023 Jun 15;15(12):2753. doi: 10.3390/nu15122753.
Dementia is a rising public health concern. Feeding and nutritional problems increase as the disease progresses, affecting the clinical course and caregiver burden. While some guidelines advise against percutaneous endoscopic gastrostomy (PEG) and tube feeding in advanced dementia, conflicting evidence exists. This study aims to evaluate the nutritional status and influence of PEG feeding on the outcome and evolution of nutritional/prognosis markers of patients with severe dementia (PWSD) who underwent gastrostomy for nutritional support. We conducted a 16-year retrospective study on 100 PEG-fed PWSD with strong familial support. We evaluated the survival PEG-feeding period, safety, and objective nutritional/prognosis data on the gastrostomy day and after 3 months: Body Mass Index (BMI), Mid Upper Arm Circumference, Tricipital Skinfold, Mid-Arm Muscle Circumference, albumin, transferrin, total cholesterol, and hemoglobin. Most patients presented low values in these nutritional/prognosis parameters. No major life-threatening PEG complications were reported. The mean survival time after gastrostomy was 27.9 months (median of 17 months). Female sex, BMI recovery at 3 months, and higher baseline hemoglobin levels were associated with a reduced risk of death and increased survival time. The study concluded that, in carefully selected PWSD with strong familial support, PEG feeding can improve nutritional status and have a positive impact on survival.
痴呆是一个日益严重的公共卫生问题。随着疾病的进展,喂养和营养问题会增加,影响临床病程和照顾者负担。虽然一些指南建议在晚期痴呆症中避免经皮内镜下胃造口术(PEG)和管饲,但存在相互矛盾的证据。本研究旨在评估严重痴呆症(PWSD)患者接受胃造口术进行营养支持的营养状况,以及 PEG 喂养对其结局和营养/预后标志物演变的影响。我们对 100 例接受 PEG 喂养的具有强烈家族支持的 PWSD 进行了 16 年的回顾性研究。我们评估了胃造口当天和 3 个月后的生存 PEG 喂养期、安全性和客观营养/预后数据:体重指数(BMI)、上臂中部周长、三头肌皮褶厚度、上臂中部肌肉周长、白蛋白、转铁蛋白、总胆固醇和血红蛋白。大多数患者这些营养/预后参数值较低。未报告 PEG 严重的危及生命并发症。胃造口术后的平均生存时间为 27.9 个月(中位数为 17 个月)。女性、3 个月时 BMI 恢复以及较高的基线血红蛋白水平与降低死亡风险和延长生存时间相关。研究结论是,在经过精心挑选、具有强烈家族支持的 PWSD 中,PEG 喂养可以改善营养状况,并对生存产生积极影响。