Theoretical Construction and Expert Validation of a Nutritional Protocol for Hematopoietic Stem Cell Transplantation: Early Enteral Nutrition Therapy
DOI:
https://doi.org/10.32635/2176-9745.RBC.2025v71n4.5354Keywords:
Clinical Protocols/standards, Enteral Nutrition/standards, Hematopoietic Stem Cell Transplantation, Hematologic Neoplasms/diet therapyAbstract
Introduction: This study addresses the development and validation of a nutritional protocol aiming to systematize early enteral nutritional therapy for patients of the Bone Marrow Transplant Service at a university hospital in Fortaleza, Ceará. Objective: To develop and validate, based on evidence and expert opinions, a nutritional protocol focused on early enteral therapy in hematopoietic stem cell transplantation. Method: Methodological study divided into two phases. The first consisted of gathering scientific evidence through an integrative literature review, conducted in the PubMed and LILACS databases, using Portuguese and English descriptors combined with the Boolean operators AND and OR. After applying the eligibility criteria, 27 articles were selected to support the protocol construction. In the second phase, the protocol was submitted to evaluation by 11 specialists with experience in clinical nutrition, onco-hematology, oncology, and/or enteral nutritional therapy, through a structured questionnaire with a Likert-type scale. Agreement among judges was analyzed using the Content Validity Index (CVI), considering 0.80 as the minimum acceptable value. Results: The protocol obtained a global CVI of 0.87, indicating good content validity. Conclusion: The protocol presents content validated by experts, representing a potential tool for clinical practice. However, the need for validation with end users to confirm its applicability is emphasized.
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Zama D, Gori D, Muratore E, et al. Enteral versus parenteral nutrition as nutritional support after allogeneic hematopoietic stem cell transplantation: a systematic review and meta-analysis. Transplant Cell Ther. 2021;27(2):180.e1-8. doi: https://doi.org/10.1016/j.jtct.2020.11.006 DOI: https://doi.org/10.1016/j.jtct.2020.11.006
Lemal R, Cabrespine A, Pereira B, et al. Could enteral nutrition improve the outcome of patients with haematological malignancies undergoing allogeneic haematopoietic stem cell transplantation? A study protocol for a randomized controlled trial (the NEPHA study). Trials. 2015;16:136. doi: https://doi.org/10.1186/s13063-015-0663-8 DOI: https://doi.org/10.1186/s13063-015-0663-8
Chaudhry HM, Bruce AJ, Wolf RC, et al. The incidence and severity of oral mucositis among allogeneic hematopoietic stem cell transplantation patients: a systematic review. Biol Blood Marrow Transplant. 2016;22(4):605-16. doi: https://doi.org/10.1016/j.bbmt.2015.09.014 DOI: https://doi.org/10.1016/j.bbmt.2015.09.014
Fuji S, Einsele H, Savani BN, et al. Systematic nutritional support in allogeneic hematopoietic stem cell transplant recipients. Biol Blood Marrow Transplant. 2015;21(10):1707-13. doi: https://doi.org/10.1016/j.bbmt.2015.07.003 DOI: https://doi.org/10.1016/j.bbmt.2015.07.003
Andersen S, Brown T, Kennedy G, et al. Implementation of an evidenced based nutrition support pathway for haematopoietic progenitor cell transplant patients. Clin Nutr. 2015;34(3):536-40. doi: https://doi.org/10.1016/j.clnu.2014.06.006 DOI: https://doi.org/10.1016/j.clnu.2014.06.006
Gómez-Candela C, Luengo LM, Cos AI, et al. Valoración global subjetiva en el paciente neoplásico. Nutr Hosp [Internet]. 2003 [acesso 2025 fev 15];18(6):353-7. Disponível em: https://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S0212-16112003000600006
Sociedade Brasileira de Nutrição Oncológica. I Consenso brasileiro de nutrição oncológica da SBNO[Internet]. Rio de Janeiro: Edite; 2021 [acesso 2025 fev 15]. 164 p. Disponível em: https://institutolg.com.br/wp-content/uploads/2025/05/I_Consenso_brasileiro_de_nutriA7A3o_oncolB3gica_da_SBNO_low.pdf
Muscaritoli M, Arends J, Bachmann P, et al. ESPEN practical guideline: clinical nutrition in cancer. Clin Nutr. 2021;40(5):2898-913. doi: https://doi.org/10.1016/j.clnu.2021.02.005 DOI: https://doi.org/10.1016/j.clnu.2021.02.005
Barban JB, Simões BP, Moraes BD, et al. Consenso Brasileiro de Nutrição em Transplante de Células-Tronco Hematopoiéticas: adultos. Einstein (São Paulo). 2020;18:eAE4530. doi: https://dx.doi.org/10.31744/einstein_journal/2020AE4530 DOI: https://doi.org/10.31744/einstein_journal/2020AE4530
Andersen S, Kennedy G, Banks M. A randomised controlled comparison of enteral versus parenteral nutritional support post allogeneic haematopoietic cell transplantation. Clin Nutr ESPEN. 2015;10(3):e102-6. doi: https://doi.org/10.1016/j.clnesp.2015.04.001 DOI: https://doi.org/10.1016/j.clnesp.2015.04.001
Horie LM, Barrére APN, Castro MG, et al. Diretriz BRASPEN de terapia nutricional no paciente com câncer. Braspen J [Internet]. 2019 [acesso 2025 fev 15];34(1):2-32. Disponível em: https://www.braspenjournal.org/journal/braspen/article/6537d09ea95395083b1a5db3
August DA, Huhmann MB. American Society for Parenteral and Enteral Nutrition Board of Directors. A.S.P.E.N. clinical guidelines: nutrition support therapy during adult anticancer treatment and in hematopoietic cell transplantation. JPEN J Parenter Enteral Nutr. 2009;33(5):472-500. doi: https://doi.org/10.1177/0148607109341804 DOI: https://doi.org/10.1177/0148607109341804
Iyama S, Tatsumi H, Shiraishi T, et al. Possible clinical outcomes using early enteral nutrition in individuals with allogeneic hematopoietic stem cell transplantation: a single-center retrospective study. Nutrition. 2021;83:111093. doi: https://doi.org/10.1016/j.nut.2020.111093 DOI: https://doi.org/10.1016/j.nut.2020.111093
Andersen S, Fichera R, Banks M, et al. Proactive enteral nutrition for patients undergoing allogeneic stem cell transplantation: implementation and clinical outcomes. Eur J Clin Nutr. 2024;78(3):251-6. doi: https://doi.org/10.1038/s41430-023-01367-8 DOI: https://doi.org/10.1038/s41430-023-01367-8
Akbulut G, Yesildemir O. Overview of nutritional approach in hematopoietic stem cell transplantation: COVID-19 update. World J Stem Cells. 2021;13(10):1530-48. doi: https://doi.org/10.4252/wjsc.v13.i10.1530 DOI: https://doi.org/10.4252/wjsc.v13.i10.1530
Vinuto J. A amostragem em bola de neve na pesquisa qualitativa: um debate em aberto. Temáticas. 2014;22(44):203-20. doi: http://dx.doi.org/10.20396/tematicas.v22i44.10977 DOI: https://doi.org/10.20396/tematicas.v22i44.10977
Fehring RJ. The Fehring model. In: Carrol-Johnson RM, Paquette M, editores. Classification of the nursing diagnosis: proceeding of tenth conference. Philadelphia: Lippincott; 1994. p. 55-62.
Alexandre NMC, Coluci MZO. Validade de conteúdo nos processos de construção e adaptação de instrumentos de medidas. Ciênc Saúde Colet. 2011;16(7):3061-8. doi: https://doi.org/10.1590/S1413-81232011000800006 DOI: https://doi.org/10.1590/S1413-81232011000800006
Conselho Nacional de Saúde (BR). Resolução n° 466, de 12 de dezembro de 2012. Aprova as diretrizes e normas regulamentadoras de pesquisas envolvendo seres humanos [Internet]. Diário Oficial da União, Brasília, DF. 2013 jun 13 [acesso 2025 mar 14]; Seção 1:59. Disponível em: https://bvsms.saude.gov.br/bvs/saudelegis/cns/2013/res0466_12_12_2012.html
Kondrup J, Rasmussen HH, Hamberg O, et al. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr. 2003;22(3):321-36. doi: https://doi.org/10.1016/s0261-5614(02)00214-5 DOI: https://doi.org/10.1016/S0261-5614(02)00214-5
Gonzalez MC, Borges LR, Silveira DH, et al. Validação da versão em português da avaliação subjetiva global produzida pelo paciente. Rev Bras Nutr Clín [Internet]. 2010 [acesso 2025 fev 15];25(2):102-8. Disponível em: http://www.braspen.com.br/home/wp-content/uploads/2016/12/02-Valida%C3%A7%C3%A3o-da-vers%C3%A3o-em-portugu%C3%AAs-da-avalia%C3%A7%C3%A3o-subjetiva-global-produzida-pelo-paciente.pdf
Arends J, Bachmann P, Baracos V, et al. ESPEN guidelines on nutrition in cancer patients. Clin Nutr. 2017;36(1):11-48. doi: https://doi.org/10.1016/j.clnu.2016.07.015 DOI: https://doi.org/10.1016/j.clnu.2016.07.015
Roeland EJ, Bohlke K, Baracos VE, et al. Management of cancer cachexia: ASCO guideline. J Clin Oncol. 2020;38(21):2438-53. doi: https://doi.org/10.1200/jco.20.00611 DOI: https://doi.org/10.1200/JCO.20.00611
Barbosa-Silva TG, Menezes AM, Bielemann RM, et al. Enhancing SARC-F: improving sarcopenia screening in clinical practice. J Am Med Dir Assoc. 2016;17(12):1136-41. doi: https://doi.org/10.1016/j.jamda.2016.08.004 DOI: https://doi.org/10.1016/j.jamda.2016.08.004
Roberts HC, Denison HJ, Martin HJ, et al. A review of the measurement of grip strength in clinical and epidemiological studies: towards a standardized approach. Age Ageing. 2011;40(4):423-9. doi: https://doi.org/10.1093/ageing/afr051 DOI: https://doi.org/10.1093/ageing/afr051
Viana L, Gazal C, Loss S, et al. Avaliação nutricional. In: Xavier RM, Dora JM, Barros E, organizadores. Laboratório na prática clínica: consulta rápida. 3 ed. Porto Alegre: Artmed; 2016. p. 240-50.
Agência Nacional de Vigilância Sanitária (BR), Diretoria Colegiada. Resolução RDC nº 503, de 27 de maio de 2021. Dispõe sobre os requisitos mínimos exigidos para a Terapia de Nutrição Enteral. Diário Oficial da União, Brasília, DF. 2021 maio 31 [acesso 2025 abr 17]; Edição 1001; Seção I:113. Disponível em: https://www.in.gov.br/web/dou/-/resolucao-rdc-n-503-de-27-de-maio-de-2021-322985331
Bielemann RM, Gigante DP, Horta BL. Birth weight, intrauterine growth restriction and nutritional status in childhood in relation to grip strength in adults: from the 1982 Pelotas (Brazil) birth cohort. Nutrition. 2016;32(2):228-35. doi: https://doi.org/10.1016/j.nut.2015.08.014 DOI: https://doi.org/10.1016/j.nut.2015.08.014
Gonzalez MC, Mehrnezhad A, Razaviarab N, at al. Calf circumference: cutoff values from the NHANES 1999–2006. Am J Clin Nutr. 2021;113(6):1679-87. doi: https://doi.org/10.1093/ajcn/nqab029 DOI: https://doi.org/10.1093/ajcn/nqab029
Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48(1):16-31. doi https://doi.org/10.1093/ageing/afy169 DOI: https://doi.org/10.1093/ageing/afz046
Matsuba CST, Serpa LF, Pereira SRM, et al. Diretriz BRASPEN de enfermagem em terapia nutricional oral, enteral e parenteral. Diretrizes. 2021;36(3):2-62. doi: http://dx.doi.org/10.37111/braspenj.diretrizENF2021 DOI: https://doi.org/10.37111/braspenj.diretrizENF2021
Faramarzi E, Mahdavi R, Mohammad-Zadeh M, et al. Validation of nutritional risk index method against patient-generated subjective global assessment in screening malnutrition in colorectal cancer patients. Chin J Cancer Res. 2013;25(5):544-8. doi: https://doi.org/10.3978/j.issn.1000-9604.2013.10.04
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