Perfil nutricional e qualidade de vida de pacientes cirróticos internados em um hospital de ensino

• Autor(a) principal: Barros, Iara Marcato Petean
• Data de Publicação: 2015
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Biblioteca Digital de Teses e Dissertações da FAMERP
• Texto Completo: http://bdtd.famerp.br/handle/tede/522
• topic: Estado Nutricional; Qualidade de Vida; Desnutrição; Cirrose Hepática; Nutritional Status; Quality of Life; Malnutrition; Liver Cirrhosis; CIENCIAS DA SAUDE

The nutritional diagnosis by traditional parameters of anthropometric assessment is considered difficult in decompensated cirrhotic patients due to complications such as edema and ascites. Aims: To evaluate the nutritional status and Quality of Life (QoL) of hospitalized cirrhotic patients, admitted to the ward Gastro-Hepatology of São José do Rio Preto, Hospital de Base, between September/2014 and September/2015. Methods: anthropometric parameters, with body mass index (BMI), triceps skinfold thickness (TST), mid-upper arm circumference (MAC), mid-arm muscle circumference (MAMC), corrected arm muscle area (CAMA); hand-grip strength (HGS) dynamometer measurement and of the adductor pollicis muscle thickness (APMT); subjective global assessment (SGA) and QoL assessment. Cirrhosis status was classified by Child-Pugh score and MELD (The model end-stage liver disease) score. Dietary intake was assessed by 24-hour recall: calculated total energy intake and macronutrients. Statistical analysis included ANOVA, Kruskal-Wallis and chi-square test, Mann-Whitney; p <0.05 was considered significant. Results: We included 92 patients with an average age of 56.7±10 years and 77.2% male. The most common causes of cirrhosis were alcohol (52.2%) and hepatitis C (18.5%). The median serum albumin was 2.9g/dL(1.63-4.56), creatinine 0.9mg/dl (0.5-4.3), bilirubin 1,89mg/dL (1.10-27,9) and INR 1.48 (1.19-3.91). Child-Pugh A, B and C: 11%, 43% and 46%, respectively; MELD 14 (7-32). Malnutrition prevalence according to the following parameters: HGS 90%, SGA 85%, APMT 79%, TST 61%, MAC 56%, CAMA 53%, MAMC 48%, BMI DW (dry body weight) 33%, BMI proposed for cirrhotic patients 30% and CW (current weight)BMI 11%. Sensitivity DW BMI 38%, BMI proposed for cirrhotic patients 33% and CW BMI 13% for diagnosis of malnutrition with reference to the SGA. Comparative analysis: there were no differences among the SGA groups (well nourished, moderately malnourished and severely malnourished) regarding the Child-Pugh score (p=0.16); age (p=0.87); albumin (p=0.16), creatinine (p=0.56), bilirubin (p=0.37), INR (p=0.77) and MELD (p=0.99). The calculation of the 24-hour recall for inpatients resulted in an average of 844kcal ±427 and protein consumption 55% less than recommended. Domains that did better on average QoL scores were the general state of health 64.1±22.6, followed by mental health 56.7±24.2. Worst result was obtained in the physical role functioning (PRF) 19.9±34.4 and emotional role functioning (ERF) 30.4±43.3. Compared QoL through the scores of the SF-36 in patients classified by SGA in ‘well nourished’, ‘moderately malnourished’, ‘severely malnourished’, there was a significant difference in the field PRF (p=0.018) and ERF (p=0.002). Conclusions: the malnutrition rate among hospitalized cirrhotic patients was very high and variable according to several parameters, nutritional assessment methods that best identified malnutrition was HGS, SGA and APMT; the sensitivity of DW BMI in detecting malnutrition was low; the food intake during hospital stay was below the recommended; QoL in all domains was impaired and there was a significant association between low QoL in the areas PRF and ERF and malnutrition.