Avaliação nutricional do paciente com doença hepática crônica
Autor(a) principal: | |
---|---|
Data de Publicação: | 2009 |
Tipo de documento: | Dissertação |
Idioma: | por |
Título da fonte: | Biblioteca Digital de Teses e Dissertações da UERJ |
Texto Completo: | http://www.bdtd.uerj.br/handle/1/8694 |
Resumo: | Malnutrition is often present and under diagnosed in patients with chronic liver diseases. Many of the traditional methods used to evaluate nutritional status may be altered by edema, ascites, and protein deficit caused by liver disfunction. To compare different methods to assess nutritional status; to correlate nutritional status with severity of liver dysfunction, and to determine the role of handgrip strength to nutritional assessment in patients with chronic liver disease. This prospective, cross-sectional study evaluated 305 consecutive outpatients adults with chronic liver disease. The severity of liver dysfunction was assessed by Child`s classification and Meld score. The nutritional assessment was evaluated by subjective global assessment (SGA), anthropometry, handgrip strength, Mendenhall score, and a new malnutrition score (defined by alteration in any nutritional parameter). The anormality of all parameters was considered when the adequation percentage was under 90%. Fifty-three percent of patients were male, 43% had liver cirrhosis, 80% had viral etiology, with a mean age of 54 ± 12 years. There was a significative relationship between the severity of liver dysfunction and SGA, Mendenhall score, and the new malnutrition score. The isolated assessment of anthropometry had no relationship with the severity of liver dysfunction. According to SGA, the prevalence of malnutrition was 10% for non-cirrhotic hepatic disease, 16% for compensated cirrhosis, and 94% for descompensated cirrhosis. According to Mendenhall score, the rates were 31%, 38%, and 56%, respectively. According to the new malnutrition score, the rates were 52%, 60%, and 96%, respectively. Although there had had a significant reduction in handgrip strength with the severity of malnutrition, we can t establish a cut-off value. The performance of handgrip strength adequation percentage as a criteria for diagnosing malnutrition showed 56% of false-positive and 24% of false-negative results. The prevalence of malnutrition is variable in patients with chronic liver diseases. It depends on the method used to evaluate nutritional status and the severity of liver dysfunction. Not surprisingly, the scores who combined multiple parameters of nutritional assessment showed the higher prevalence of malnutrition. There was a significant association between nutritional status and severity of liver dysfunction. If we add the measurement of handgrip strength to nutritional assessment, the prevalence rates of malnutrition will increase because of false-positive results. |
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Figueiredo, Fátima Aparecida Ferreirahttp://lattes.cnpq.br/8542709624481505Perez, Renata de Mellohttp://lattes.cnpq.br/0870986021644250Carneiro, Antonio José de Vasconcelloshttp://lattes.cnpq.br/4997381018969813Terra Filho, Carlos Antonio Rodrigueshttp://lattes.cnpq.br/3843065600926479http://lattes.cnpq.br/4002241460118522Castro, Tatiana Mazza de2021-01-05T19:40:44Z2011-04-282009-01-07CASTRO, Tatiana Mazza de. Avaliação nutricional do paciente com doença hepática crônica. 2009. 106 f. Dissertação (Mestrado em Ciências Médicas) - Universidade do Estado do Rio de Janeiro, Rio de Janeiro, 2009.http://www.bdtd.uerj.br/handle/1/8694Malnutrition is often present and under diagnosed in patients with chronic liver diseases. Many of the traditional methods used to evaluate nutritional status may be altered by edema, ascites, and protein deficit caused by liver disfunction. To compare different methods to assess nutritional status; to correlate nutritional status with severity of liver dysfunction, and to determine the role of handgrip strength to nutritional assessment in patients with chronic liver disease. This prospective, cross-sectional study evaluated 305 consecutive outpatients adults with chronic liver disease. The severity of liver dysfunction was assessed by Child`s classification and Meld score. The nutritional assessment was evaluated by subjective global assessment (SGA), anthropometry, handgrip strength, Mendenhall score, and a new malnutrition score (defined by alteration in any nutritional parameter). The anormality of all parameters was considered when the adequation percentage was under 90%. Fifty-three percent of patients were male, 43% had liver cirrhosis, 80% had viral etiology, with a mean age of 54 ± 12 years. There was a significative relationship between the severity of liver dysfunction and SGA, Mendenhall score, and the new malnutrition score. The isolated assessment of anthropometry had no relationship with the severity of liver dysfunction. According to SGA, the prevalence of malnutrition was 10% for non-cirrhotic hepatic disease, 16% for compensated cirrhosis, and 94% for descompensated cirrhosis. According to Mendenhall score, the rates were 31%, 38%, and 56%, respectively. According to the new malnutrition score, the rates were 52%, 60%, and 96%, respectively. Although there had had a significant reduction in handgrip strength with the severity of malnutrition, we can t establish a cut-off value. The performance of handgrip strength adequation percentage as a criteria for diagnosing malnutrition showed 56% of false-positive and 24% of false-negative results. The prevalence of malnutrition is variable in patients with chronic liver diseases. It depends on the method used to evaluate nutritional status and the severity of liver dysfunction. Not surprisingly, the scores who combined multiple parameters of nutritional assessment showed the higher prevalence of malnutrition. There was a significant association between nutritional status and severity of liver dysfunction. If we add the measurement of handgrip strength to nutritional assessment, the prevalence rates of malnutrition will increase because of false-positive results.Além de muito freqüente, a desnutrição associa-se a morbi/mortalidade em pacientes com doenças hepáticas crônicas. A avaliação do estado nutricional em hepatopatas é difícil pela sobrecarga hídrica e pela alteração na síntese protéica, fatores que alteram os parâmetros tradicionalmente usados na avaliação nutricional. Os objetivos são:a)avaliar o estado nutricional, através da AGS, antropometria, do escore de Mendenhall e da combinação de todos os instrumentos, em pacientes com doença hepática crônica; b)correlacionar o estado nutricional com a gravidade de doença hepática crônica; c)determinar a contribuição da dinamometria do aperto de mão para a avaliação do estado nutricional. Foram incluídos 305 pacientes portadores de doenças hepáticas crônicas, com idade de 18-80 anos, atendidos no ambulatório de doenças hepatobiliares do Hospital Universitátio Pedro Ernesto. A gravidade da doença hepática foi avaliada pela classificação de Child-Pugh e escore de Meld. Foram aferidos parâmetros antropométricos (peso, altura, índice de massa corporal, prega cutânea triciptal, circunferência do braço, circunferência muscular do braço), parâmetros bioquímicos (albumina e contagem total de linfócitos), Avaliação Global Subjetiva, escore de Mendenhall e força do aperto de mão pela dinamometria. Os valores da porcentagem de adequação dos parâmetros foram utilizados para a classificação da desnutrição. Consideramos todos os pacientes com porcentagens de adequação abaixo de 90% como desnutridos. Foi criado o escore risco de desnutrição que se caracterizou pela alteração em qualquer um dos parâmetros da avaliação nutricional. Cerca de 53% dos pacientes eram do sexo masculino, 43% portadores de cirrose hepática, 80% com etiologia viral e média de idade de 54 ± 12 anos. Houve relação estatisticamente significativa entre a classificação funcional da doença hepática e a AGS, o escore de Mendenhall e o de risco de desnutrição. A avaliação isolada da antropometria não se correlacionou com a classificação funcional. Segundo a AGS, a prevalência de desnutrição foi de 10% na hepatopatia não cirrótica, 16% na cirrose compensada e 94% na cirrose descompensada. Segundo o escore de Mendenhall, as cifras foram de 31%, 38% e 56%, respectivamente. Segundo o novo escore, as cifras foram de 52%, 60% e 96%, respectivamente. Embora tenha havido uma redução estatisticamente significativa da força muscular com o agravamento do estado nutricional, não foi possível estabelecer um ponto de corte para os valores da dinamometria. A análise do desempenho do percentual de adequação da força muscular como critério diagnóstico de pacientes sob risco de desnutrição revelou provavelmente 56% de falso-positivos e 24% de falso-negativos. A grande variação na prevalência de desnutrição em pacientes com doença hepática depende do instrumento de avaliação nutricional usado e da classificação funcional da doença hepática. Não surpreendentemente, os escores combinados detectaram as maiores taxas de prevalência de desnutrição. Houve associação significativa entre o estado nutricional e a gravidade da doença hepática. O aumento das taxas de prevalência de desnutrição trazido pela dinamometria ocorreu às custas de resultados falso-positivos.Submitted by Boris Flegr (boris@uerj.br) on 2021-01-05T19:40:44Z No. of bitstreams: 1 Tatiana Mazza de Castro Dissertacao completa.pdf: 683473 bytes, checksum: e43ec2d64fdc237267ef9136191f543b (MD5)Made available in DSpace on 2021-01-05T19:40:44Z (GMT). No. of bitstreams: 1 Tatiana Mazza de Castro Dissertacao completa.pdf: 683473 bytes, checksum: e43ec2d64fdc237267ef9136191f543b (MD5) Previous issue date: 2009-01-07application/pdfporUniversidade do Estado do Rio de JaneiroPrograma de Pós-Graduação em Ciências MédicasUERJBRCentro Biomédico::Faculdade de Ciências MédicasChronic liver diseaseNutritional statusSubjective global assessmentAnthropomethyDynamometryHandgrip strengthDoença hepática crônicaEstado nutricionalAvaliação global subjetivaAntropometriaDinamometriaForça muscularCNPQ::CIENCIAS DA SAUDE::NUTRICAOAvaliação nutricional do paciente com doença hepática crônicaNutritional status in patients with chronic liver diseaseinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/masterThesisinfo:eu-repo/semantics/openAccessreponame:Biblioteca Digital de Teses e Dissertações da UERJinstname:Universidade do Estado do Rio de Janeiro (UERJ)instacron:UERJORIGINALTatiana Mazza de Castro Dissertacao completa.pdfapplication/pdf683473http://www.bdtd.uerj.br/bitstream/1/8694/1/Tatiana+Mazza+de+Castro+Dissertacao+completa.pdfe43ec2d64fdc237267ef9136191f543bMD511/86942024-02-26 16:00:04.117oai:www.bdtd.uerj.br:1/8694Biblioteca Digital de Teses e Dissertaçõeshttp://www.bdtd.uerj.br/PUBhttps://www.bdtd.uerj.br:8443/oai/requestbdtd.suporte@uerj.bropendoar:29032024-02-26T19:00:04Biblioteca Digital de Teses e Dissertações da UERJ - Universidade do Estado do Rio de Janeiro (UERJ)false |
dc.title.por.fl_str_mv |
Avaliação nutricional do paciente com doença hepática crônica |
dc.title.alternative.eng.fl_str_mv |
Nutritional status in patients with chronic liver disease |
title |
Avaliação nutricional do paciente com doença hepática crônica |
spellingShingle |
Avaliação nutricional do paciente com doença hepática crônica Castro, Tatiana Mazza de Chronic liver disease Nutritional status Subjective global assessment Anthropomethy Dynamometry Handgrip strength Doença hepática crônica Estado nutricional Avaliação global subjetiva Antropometria Dinamometria Força muscular CNPQ::CIENCIAS DA SAUDE::NUTRICAO |
title_short |
Avaliação nutricional do paciente com doença hepática crônica |
title_full |
Avaliação nutricional do paciente com doença hepática crônica |
title_fullStr |
Avaliação nutricional do paciente com doença hepática crônica |
title_full_unstemmed |
Avaliação nutricional do paciente com doença hepática crônica |
title_sort |
Avaliação nutricional do paciente com doença hepática crônica |
author |
Castro, Tatiana Mazza de |
author_facet |
Castro, Tatiana Mazza de |
author_role |
author |
dc.contributor.advisor1.fl_str_mv |
Figueiredo, Fátima Aparecida Ferreira |
dc.contributor.advisor1Lattes.fl_str_mv |
http://lattes.cnpq.br/8542709624481505 |
dc.contributor.referee1.fl_str_mv |
Perez, Renata de Mello |
dc.contributor.referee1Lattes.fl_str_mv |
http://lattes.cnpq.br/0870986021644250 |
dc.contributor.referee2.fl_str_mv |
Carneiro, Antonio José de Vasconcellos |
dc.contributor.referee2Lattes.fl_str_mv |
http://lattes.cnpq.br/4997381018969813 |
dc.contributor.referee3.fl_str_mv |
Terra Filho, Carlos Antonio Rodrigues |
dc.contributor.referee3Lattes.fl_str_mv |
http://lattes.cnpq.br/3843065600926479 |
dc.contributor.authorLattes.fl_str_mv |
http://lattes.cnpq.br/4002241460118522 |
dc.contributor.author.fl_str_mv |
Castro, Tatiana Mazza de |
contributor_str_mv |
Figueiredo, Fátima Aparecida Ferreira Perez, Renata de Mello Carneiro, Antonio José de Vasconcellos Terra Filho, Carlos Antonio Rodrigues |
dc.subject.eng.fl_str_mv |
Chronic liver disease Nutritional status Subjective global assessment Anthropomethy Dynamometry Handgrip strength |
topic |
Chronic liver disease Nutritional status Subjective global assessment Anthropomethy Dynamometry Handgrip strength Doença hepática crônica Estado nutricional Avaliação global subjetiva Antropometria Dinamometria Força muscular CNPQ::CIENCIAS DA SAUDE::NUTRICAO |
dc.subject.por.fl_str_mv |
Doença hepática crônica Estado nutricional Avaliação global subjetiva Antropometria Dinamometria Força muscular |
dc.subject.cnpq.fl_str_mv |
CNPQ::CIENCIAS DA SAUDE::NUTRICAO |
description |
Malnutrition is often present and under diagnosed in patients with chronic liver diseases. Many of the traditional methods used to evaluate nutritional status may be altered by edema, ascites, and protein deficit caused by liver disfunction. To compare different methods to assess nutritional status; to correlate nutritional status with severity of liver dysfunction, and to determine the role of handgrip strength to nutritional assessment in patients with chronic liver disease. This prospective, cross-sectional study evaluated 305 consecutive outpatients adults with chronic liver disease. The severity of liver dysfunction was assessed by Child`s classification and Meld score. The nutritional assessment was evaluated by subjective global assessment (SGA), anthropometry, handgrip strength, Mendenhall score, and a new malnutrition score (defined by alteration in any nutritional parameter). The anormality of all parameters was considered when the adequation percentage was under 90%. Fifty-three percent of patients were male, 43% had liver cirrhosis, 80% had viral etiology, with a mean age of 54 ± 12 years. There was a significative relationship between the severity of liver dysfunction and SGA, Mendenhall score, and the new malnutrition score. The isolated assessment of anthropometry had no relationship with the severity of liver dysfunction. According to SGA, the prevalence of malnutrition was 10% for non-cirrhotic hepatic disease, 16% for compensated cirrhosis, and 94% for descompensated cirrhosis. According to Mendenhall score, the rates were 31%, 38%, and 56%, respectively. According to the new malnutrition score, the rates were 52%, 60%, and 96%, respectively. Although there had had a significant reduction in handgrip strength with the severity of malnutrition, we can t establish a cut-off value. The performance of handgrip strength adequation percentage as a criteria for diagnosing malnutrition showed 56% of false-positive and 24% of false-negative results. The prevalence of malnutrition is variable in patients with chronic liver diseases. It depends on the method used to evaluate nutritional status and the severity of liver dysfunction. Not surprisingly, the scores who combined multiple parameters of nutritional assessment showed the higher prevalence of malnutrition. There was a significant association between nutritional status and severity of liver dysfunction. If we add the measurement of handgrip strength to nutritional assessment, the prevalence rates of malnutrition will increase because of false-positive results. |
publishDate |
2009 |
dc.date.issued.fl_str_mv |
2009-01-07 |
dc.date.available.fl_str_mv |
2011-04-28 |
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2021-01-05T19:40:44Z |
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info:eu-repo/semantics/masterThesis |
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masterThesis |
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publishedVersion |
dc.identifier.citation.fl_str_mv |
CASTRO, Tatiana Mazza de. Avaliação nutricional do paciente com doença hepática crônica. 2009. 106 f. Dissertação (Mestrado em Ciências Médicas) - Universidade do Estado do Rio de Janeiro, Rio de Janeiro, 2009. |
dc.identifier.uri.fl_str_mv |
http://www.bdtd.uerj.br/handle/1/8694 |
identifier_str_mv |
CASTRO, Tatiana Mazza de. Avaliação nutricional do paciente com doença hepática crônica. 2009. 106 f. Dissertação (Mestrado em Ciências Médicas) - Universidade do Estado do Rio de Janeiro, Rio de Janeiro, 2009. |
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http://www.bdtd.uerj.br/handle/1/8694 |
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Universidade do Estado do Rio de Janeiro |
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UERJ |
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BR |
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Centro Biomédico::Faculdade de Ciências Médicas |
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Universidade do Estado do Rio de Janeiro |
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