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El envejecimiento es un proceso natural en el ser humano que trae consigo cambios fisiológicos, morfológicos, bioquímicos y psicológicos. A medida que van aumentando los años, estas modificaciones se traducen en una mayor vulnerabilidad para el desarrollo de enfermedades como la sarcopenia, que implican una disminución de la capacidad funcional, pérdida de masa y fuerza muscular, y mayor fragilidad. Los procedimientos quirúrgicos, cada vez más comunes en la población geriátrica, representan un gran desafío para el personal médico en la medida en que esta población requiere de cuidados individualizados y de una atención multidimensional enfocada en diferentes aspectos, que van desde la salud física y emocional hasta aspectos económicos, sociales y culturales. En los pacientes sarcopénicos candidatos a procedimientos quirúrgicos son necesarias intervenciones preoperatorias que optimicen su salud y aceleren su recuperación posoperatoria, y disminuyan el riesgo de complicaciones y mortalidad. Esta revisión examina cómo la prehabilitación representa una oportunidad para mejorar la capacidad funcional de los pacientes y para prepararlos para soportar un evento estresante como lo es una cirugía, haciendo más digno su curso posoperatorio y mejorando su calidad de vida a corto y largo plazo.

The ACERTO project is a multimodal peri-operative care program. The set of routines and prescriptions of the ACERTO project is based on evidence-based medicine as opposed to traditional care, often empirical and taught in the same routine by successive generations of surgeons. Traditional care such as the use of nasogastric tube, abdominal drainage, preoperative colonic preparation, preoperative fasting of 6-8 hours are modified in the project based on evidence from randomized studies and meta-analysis. In addition, the project reinforces the restriction of intravenous fluids and the use of nutritional therapy in the peri-operative. The application of the ACERTO project since 2005 has been modifying results, showing significant reduction of hospitalization days and postoperative morbidity in successive clinical studies. The ACERTO project is free to use.

Justificación: La brecha entre la educación nutricional proporcionada a los estudiantes de medicina y las competencias y actitudes nutricionales necesarias para que los médicos brinden una atención nutricional eficaz es una preocupación mundial. El objetivo de este estudio fue investigar el contenido curricular sobre educación nutricional en las facultades de medicina de América Latina y evaluar los conocimientos, las actitudes y las barreras autopercibidas para la práctica de la nutrición de los estudiantes de último año de medicina. Métodos: Se invitó a participar en el estudio a 85 facultades de medicina públicas y privadas de 17 países de América Latina. Se enviaron dos cuestionarios en línea cerrados que constaban de 25 y 43 preguntas a los directores de las facultades de medicina. Las variables cuantitativas se expresaron como frecuencias, porcentajes, media ± desviación estándar, medianas y rangos. Resultados: Respondieron un total de 22 (26%) directores de escuelas de medicina, de los cuales 11 escuelas (50%) ofrecían cursos de nutrición obligatorios independientes en años preclínicos y 8 (36%) en años clínicos. La media de horas dedicadas a la educación nutricional fue de 47 (rango: 0-150). Respondieron un total de 1530 de 1630 (94%) estudiantes de 12 países. La edad promedio de los estudiantes fue de 25 ± 3 años y el 59% eran mujeres. La mayoría de los estudiantes estuvo de acuerdo en que mejorar la salud de los pacientes a través de la nutrición (91 %) es importante y que el asesoramiento y la evaluación nutricional deben ser parte de la atención de rutina brindada por todos los médicos (89 %), pero carecen del nivel de educación y capacitación necesarios para abordar la nutrición. -asuntos relacionados. Conclusiones: La actitud positiva y el interés por la nutrición entre los estudiantes de último año de medicina es alto, pero la educación en nutrición no se percibe como suficiente para preparar adecuadamente a los médicos en el campo de la nutrición. Rationale: The gap between the nutrition education provided to medical students and the nutrition competences and attitudes needed for doctors to provide effective nutrition care is a global concern. The goal of this study was to investigate the curricular content on nutrition education in Latin American medical schools and to evaluate the self-perceived knowledge, attitudes, and barriers to nutrition practice of final-year medical students. Methods: Eighty-five public and private medical schools from 17 Latin American countries were invited to participate in the study. Two close-ended online questionnaires consisting of 25 and 43 questions were sent to medical school directors. Quantitative variables were expressed as frequencies, percentages, mean ± standard deviation, medians, and ranges. Results: A total of 22 (26%) medical school directors responded, of which 11 schools (50%) offered stand-alone mandatory nutrition courses in preclinical and 8 (36%) in clinical years. The mean hours dedicated to nutrition education was 47 (range: 0–150). A total of 1530 of 1630 (94%) students from 12 countries responded. Students’ average age was 25 ± 3 years, and 59% were female. Most students agreed that improving patients’ health through nutrition (91%) is important and that nutrition counseling and assessment should be part of routine care provided by all physicians (89%), but they lack the level of education and training required to address nutrition-related issues. Conclusions: Positive attitude and interest in nutrition among final-year medical students is high, but nutrition education is not perceived as sufficient to adequately prepare doctors in the field of nutrition.

Objective: to evaluate the impact of probable sarcopenia (PS) on the survival of oncological patients submitted to major surgeries. Method: prospective cohort bicentrical study enrolling adult oncological patients submitted to major surgeries at Cancer Hospital and Santa Casa de Misericordia in Cuiabá-MT. The main endpoint was the verification of postoperative death. Demographic and clinical data was collected. PS was defined as the presence of 1) sarcopenia risk assessed by SARC-F questionnaire and 2) low muscle strength measured by dynamometry. The cumulative mortality rate was calculated for patients with either PS or non PS using Kaplan Meier curve. The univariate and multivariate Cox regression model was used to evaluate the association of mortality with various investigated confounding variables. Results: a total of 220 patients with a mean (SD) age of 58.7±14.0 years old, 60.5% males participated of the study. Patients with PS had higher risk to postoperative death (RR=5.35 95%CI 1.95-14.66; p=0,001) and for infectious complications (RR=2.45 95%CI 1.12-5.33; p=0.036). The 60 days mean survival was shorter for patients with PS: 44 (IQR=32-37) vs 58 (IQR=56-59) days (log rank

Objectives : to investigate the impact of oncological surgical procedures on the muscle function of patients with and without nutritional risk. Methods: cross-sectional study conducted with cancer patients undergoing major operations between July 2018 to March 2019 in Cuiabá, Mato Grosso, Brazil. Patients were assessed preoperatively for the nutritional risk by the Nutricional Risk Screening-2002, and handgrip strength (FPP) was assessed both on the pre- and 2nd and 5th postoperative days (PO). Results: 92 patients were evaluated, of whom 55.4% were men and 44.6% women, with a mean age (SD) of 64 (10.81) for patients at risk and 51 (12.99) for patients without nutritional risk. The preoperative nutritional risk evaluation indicated that 34.8% of the patients had no risk and 65.2% had a nutritional risk. The FPP was lower (p = 0.008) in the group with nutritional risk in the preoperative period. In both groups, there was a significant drop in FPP on the 2nd PO day. The preoperative FPP compared with the 2nd PO FPP was more pronounced in patients without nutritional risk (p = 0.039). Patients with nutritional risk had a longer hospital stay (p = 0.049). Conclusion: surgical trauma causes loss of muscle function in the early PO. Patients without nutritional risk have a more significant decrease in muscle strength after surgical oncological procedures than those with nutritional risk. These results may infer the need to implement pre-habilitation in all patients who will undergo major oncological procedures.