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Background This study aims to evaluate the use of ultrasonography (US) as an instrument to assess the quadriceps muscles in patients admitted to intensive care units (ICUs), comparing the evolution of US-assessed mass muscle to other nutrition methods. Methods We conducted a prospective observational study of adult patients aged ≥18 years admitted to an ICU of the Hospital das Clinicas in Brazil. Quadriceps muscle measurements were performed by US, and adductor pollicis muscle thickness and arm, calf, and thigh circumferences were measured at admission and every 2 days within the first week. Nutrition status was assessed at baseline by using the Subjective Global Assessment and the Global Leadership Initiative on Malnutrition criteria. Mechanical ventilation time, length of hospital and ICU stay, and mortality were recorded. Results Sixty patients were included. Reductions in quadriceps thickness and rectus femoris cross-sectional area were observed at landmarks two-thirds reduction of both measurements from days 1 and 3 to days 5 and 7 (P = .017 and P = .000, respectively). The mid arm circumference (MAC) was reduced. Malnourished patients had lower initial muscle mass. However, muscle mass loss was similar between nourished and malnourished individuals (P > .005). Clinical outcomes were not impacted by muscle loss. Conclusions US muscle mass assessment was able to detect short-term changes in critically ill patients but must be used with caution. MAC was also identified as a useful follow-up tool.

CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior A ultrassonografia tem emergido como método promissor para acompanhamento nutricional de pacientes internados em Unidades de Terapia Intensiva, contudo há certas questões a respeito da aplicabilidade neste público que devem ser consideradas. Assim, o objetivo do trabalho foi avaliar o uso da ultrassonografia como instrumento de avaliação da musculatura do quadríceps em pacientes internados em unidades de terapia intensiva. Métodos: Foram incluídos enfermos admitidos na Unidade de Terapia Intensiva (UTI) do Hospital das Clínicas da Universidade Federal de Minas Gerais (HC-UFMG). Os dados demográficos, clínicos e de balanço hídrico foram coletados em prontuário clínico. A avaliação nutricional global subjetiva foi realizada no momento inicial. Medidas da massa muscular realizadas por ultrassonografia nos pontos de ½ e 2/3 entre a crista ilíaca e a borda superior da patela, a espessura muscular do polegar, as circunferências do braço, panturrilha e coxa foram realizadas no momento inicial e a cada 2 dias de internação na unidade, na primeira semana, e a cada 7 dias após este período. A adequação calórica e proteica foi avaliada diariamente. Desfechos como tempo de ventilação mecânica, tempo de internação hospitalar e na UTI foram registrados e, o acompanhamento dos desfechos após 1 mês e 3 meses da alta da UTI foi feito por meio de contato telefônico. Resultados: Foram incluídos 60 pacientes. Redução da espessura do quadríceps (EQ) e da área transversal do reto femoral (ATRF) foram observadas principalmente para as medidas realizadas no ponto de 2/3 (redução de ambas medidas, dos dias 1 e 3 para os dias 5 e 7; p=0,017 e p=0,000, respectivamente). Das demais medidas antropométricas realizadas, a circunferência do braço foi a que mais teve redução durante o seguimento (Do dia 1 para dia 3, 5 e 7; p=0,000). Pacientes desnutridos apresentaram menor massa muscular inicial, no entanto a perda de massa muscular foi semelhante entre nutridos e desnutridos (p>0,005). Pacientes com maior alteração do volume de líquidos entre os dias 1 e 3 foram aqueles que tiveram menor área transversal do reto femoral em ambos os dias e pacientes cirúrgicos perderam mais massa muscular entre o dia 1 e 5, respectivamente. O percentual de óbitos foi maior entre àqueles que perderam mais de 2% da ATRF entre os dias 1 e 3. Não houve diferença entre as perdas musculares e oferta calórica e proteica, bem como tempo de ventilação mecânica, tempo de internação e acompanhamento após 1 e 3 meses. Conclusão: A avaliação de massa muscular por ultrassonografia foi capaz de detectar alterações em curto prazo. A perda de massa muscular avaliada por ultrassonografia não foi associada com a oferta nutricional e a maioria dos desfechos. Ultrasonography (US) has emerged as a promising method for nutritional follow-up of patients admitted to intensive care units, however there are certain questions regarding its use with this population that should be considered. Thus, the objective of this study was to evaluate the use of ultrasound as an instrument to assess the quadricep muscle in patients admitted to the intensive care units. Methods: Patients admitted to the Intensive Care Unit (ICU) of the Hospital das Clínicas Federal University of Minas Gerais (HC-UFMG) were included. Demographic, clinical data and fluid balance were collected from medical records. Subjective global assessment was performed at baseline, as part of the nutrition diagnosis. Quadriceps muscle measurements were performed by US at the iliac crest and the superior line patella landmarks, adductor pollicis muscle thickness, arm, calf and thigh circumferences were carried out at admission and every 2 days within the first week, and every 7 days thereafter. Caloric and protein adequacy was evaluated daily. Outcomes (mechanical ventilation time, length of hospital and ICU stay) were recorded and follow-up of outcomes after 1 month and 3 months of ICU discharge were made by telephone contact. Results: A total of 60 patients were included. Reduction of quadriceps thickness (EQ) and transverse rectus femoris area (ATRF) were observed mainly for measurements at landmarks 2/3 at follow up (reduction of both measurements from days 1 and 3 to days 5 and 7; p = 0.017 and p = 0.000, respectively). The mid arm circumference was the other anthropometric measurements that more was reduced between days (From day 1 to day 3, 5 and 7; p = 0.000). Malnourished patients had lower initial muscle mass, however muscle mass loss was similar between nourished and malnourished individuals (p>0,005). Patients with greater fluid alterations between days 1 and 3 were those who presented smaller transverse area of the rectus femoris in both days, and surgical patients had more muscle loss between day 1 and 5, respectively. The percentage of deaths was higher among those who lost more than 2% of the ATRF between days 1 and 3. There was no difference between muscle loss and caloric and protein intake, as well as mechanical ventilation time, length of stay and follow-up after 1 and 3 months. Conclusions: Ultrasonography muscle mass assessment was able to detect short-term changes. Muscle mass measurements loss assessed by US was not associated with nutritional supply and most outcomes.

Objective The aim of this study was to evaluate the relevance of ultrasonography training by non-experts carrying out quadriceps muscle mass assessment. Methods Two non-expert evaluators were trained by two radiologists on the basic principles of ultrasonography and quadriceps muscle measurements. Afterward, they performed assessments on 30 healthy volunteers to determine interobserver agreement, considering two landmarks (two-thirds of the femoral distance, and 10 cm above the patella), which were tested by the intraclass correlation coefficient (ICC). Results In all, 342 measurements were acquired. Better ICC data were seen for the muscle at two-thirds (ICC = 0.74–0.86) of the landmark than at the 10-cm landmark (ICC = 0.63–0.91). However, the thickness measurements indicated inadequate agreement (ICC = 0.71). The ICC values for both the rectus femoris area and thickness progressively increased when comparing the first 10 measurements with the last 10 for the two-thirds landmark. For the 10-cm landmark, worse data were observed in the last measurements, perhaps due to the increased number of obese volunteers. Conclusions Measurements at the 10-cm landmark are more difficult to acquire, especially in the obese. Intensive training for non-expert examiners is mandatory.

Introducao: A resistencia a insulina (RI) e frequentemente associada ao diabetes tipo 2 (DM2), quese apresenta como uma morbidade de importante impacto devido as suas possiveis complicacoes.Objetivos: Identificar individuos com RI e DM2 e avaliar as possiveis diferencas em suas caracteristicassociodemograficas, antropometricas e de composicao corporal, clinicas e de comportamento alimentar.Materiais e metodos: Trata-se de um estudo transversal observacional. Participaram do estudo 68pacientes atendidos em um programa de intervencao nutricional visando a prevencao e ao tratamentode doencas cardiovasculares. Os dados foram coletados de prontuarios referentes a primeira consulta.Para identificacao de individuos com RI utilizou-se o indice HOMA-IR>2,7. Resultados: Vinte e seteindividuos foram classificados como grupo controle, 21 com RI e nao diabeticos e 20 com DM2. Tanto osresistentes a insulina quanto os diabeticos tiveram maiores valores de IMC (p=00001), gordura corporal(p=0,001), perimetro da cintura (p=0,001) e do quadril (p=0,002) quando comparados ao grupo controle.Foi observada maior prevalencia de hipertensao arterial (70%) nos diabeticos. Os resistentes a insulinativeram menores valores de HDL (p=0,009) e maiores de acido urico (p=0,033), em comparacao ao grupocontrole, e maiores de LDL (p=0,031), quando comparados aos diabeticos. Esses tambem relatarammaior uso de banha animal (15,8%) e mudancas de habitos alimentares nos finais de semana (84,2%).Conclusoes: Os resultados deste estudo ressaltam a importância da deteccao precoce da RI e de programasde intervencao nutricional, visando ao controle de peso corporal e combate a hipertensao arterial tanto emdiabeticos como em resistentes a insulina.