Clinical and nutritional evaluation indicators of patients on waiting list for liver transplantation
Palavras-chave:
Nutritional assessment, Anthropometry, Liver transplantationResumo
Objective: Comparing different methods of clinical and anthropometric assessment of pre-liver transplant patients. Methods: This was a cross-sectional study with quantitative approach. We analyzed data from the medical records of pre-transplant patients older than 18 who received care at a Nutrition outpatient clinic of a Liver Transplant Center in Fortaleza-CE. We collected data regarding patient identification, clinical diagnosis, nutritional assessment and diagnosis. This study was approved by the Ethics Committee in Research of Walter Cantídio University Hospital of the Federal University of Ceará. Data were analyzed in the statistical program SPSSTM version 17.0 Results: The sample consisted of 71 patients, with 46 men (64.8%) and 25 women (35.2%), with a mean age of 53.7 years. The average BMI was 27.2 kg/m2; most women were healthy (60.0%) and most men were with excess of body weight (69.0%). As for the nutritional diagnosis according to the percentage of adequacy of the mid-upper arm circumference, we noted that 52.4% and 43.6% of female and male patients, respectively, showed some level of protein-calorie malnutrition. For the triceps skin fold, we noticed that most male patients (54.5%) were diagnosed as being overweight or obese. When assessing the percentage of adequacy of the mid-upper arm muscle area, most patients of both sexes had some level of malnutrition (62.3%). No significant correlation was observed between the MELD and Child-Pugh severity score (indices that encompass biochemical and clinical parameters for the prognostic evaluation of end-stage liver disease) and anthropometric variables. Conclusion: The severity indicators of the disease were not related to the anthropometric indices, but most patients who are eligible for a liver transplant were overweight according to BMI, although suffer from muscle mass depletion according to mid-upper arm muscle are, which shows the necessity of the combined use of several nutritional assessment methods in order to achieve a diagnosis of their body composition and, consequently, a faithful nutritional diagnosis.Downloads
Referências
Halliday DN, Westbrook DRH. Liver transplantation: need, indications, patient selection and pre-transplant care. British Journal of Hospital Medicine. 2017; 78(5): 252-9.
Farkas S, Hackl C, Schlitt HJ. Overview of the indications and contraindications for liver transplantation. Cold Spring Harb Perspect Med. 2014; 4(5): a015602.
Freire de Aguiar MI, Batista Braga VA, de Almeida PC, Parente Garcia, JH, Azevedo de Lima, C. Gravidade da doença hepática e qualidade de vida no transplante de fígado. Acta Paulista de Enfermagem. 2016; 29(1): 107-114.
Vintro AD, Krasnoff JB, Painter P. Roles of nutrition and physical activity in musculoskeletal complications before and after liver transplantation. AACN Clin Issues. 2002; 13: 333-347.
Zhao VM, Ziegler TR. Nutrition support in end-stage liver disease. Crit Care Nurs Clin North Am. 2010; 22(3): 369-80.
Plauth M, Cabré E, Riggio O, Assis-Camilo M, Pirlich M, Kondrup J. ESPEN Guidelines on Enteral Nutrition: Liver disease. Clin Nutr. 2006; 25: 285-294.
Sociedade Brasileira de Nutrição Parenteral e Enteral, Colégio Brasileiro de Cirurgiões, Associação Brasileira de Nutrologia. Projeto Diretrizes: Terapia nutricional nas doenças hepáticas crônicas e insuficiência hepática. São Paulo: 2011. [cited 2019 Jun 13]. Available from: URL: https://diretrizes.amb.org.br/_BibliotecaAntiga/terapia_nutricional_nas_doencas_hepaticas_cronicas_e_insuficiencia_hepatica.pdf.
Leitão AVA, Castro CLN, Basile TM, Souza THS, Braulio VB. Avaliação da capacidade física e do estado nutricional em candidatos ao transplante hepático. Rev Assoc Med Bras. 2003; 49(4): 424-428.
Kim HJ, Lee HW. Important predictor of mortality in patients with end-stage liver disease. Clin Mol Hepatol. 2013; 19(2):105-115.
Wedd JP, Harper AM, Biggins SW. MELD sore, allocation, and distribution in the United States. Clinical Liver Disease. 2013; 2(4):148-151.
World Health Organization (WHO). Expert Committee on Physical Status: the use and interpretation of anthropometry. Geneva: 1995. [cited 2014 Jan 04]. Available from: URL: http://apps.who.int/iris/bitstream/10665/37003/1/WHO_TRS_854.pdf
World Health Organization (WHO). Obesity – Preventing and managing the global epidemic. Geneva: 1997. [cited 2014 Jan 05]. Available from: URL: http://apps.who.int/iris/bitstream/10665/42330/1/WHO_TRS_894.pdf
Blackburn GL, Harvey KB. Nutritional assessment as a routine in clinical medicine. Postgrad Med. 1982; 71:46-63.
James R. Nutritional support in alcoholic liver disease: a review. J Hum Nutr Diet. 1989; 2: 315-323.
Brasil. Resolução Nº 466, de 12 de dezembro de 2012. Diretrizes e normas regulamentadoras de pesquisas envolvendo seres humanos. Ministério da Saúde: Conselho Nacional de Saúde. 2012. [cited 2014 Jan 13]. Available from: URL: http://bvsms.saude.gov.br/bvs/saudelegis/cns/2013/res0466_12_12_2012.html
Anastácio LR, Ferreira LG, Ribeiro HS, Lima AS, Vilela EG, Correia MITD. Weight loss during cirrhosis is related to the etiology of liver disease. Arq Gastroenterol. 2012; 49(3): 195-198.
Nunes FF. Consumo alimentar de pacientes cirróticos, comparação com o estado nutricional e com o estadiamento da doença. Rio Grande do Sul: Porto Alegre: Universidade Federal de Ciências da Saúde de Porto Alegre – Programa de Pós-Graduação em Medicina: Hepatologia, 2012.
Mendes KD, Lopes NL, Fabbris MA, Castro-e-Silva Júnior O, Galvão CM. Caracterização sociodemográfica e clínica de candidatos a transplante de fígado. Acta Paulista de Enfermagem. 2016; 29(2): 128-135.
Campillo B, Richardet JP, Borries PN. Validation of body mass index for the diagnosis of malnutrition in patients with liver cirrhosis. Gastroenterol Clin Biol. 2006; 30: 1137-1143.
do Nascimento, SC, da Silva Pinto, IC, Pereira da Silva, C. Comparação da força do aperto de mão com parâmetros antropométricos e subjetivos na avaliação nutricional de hepatopatas. Acta Gastroenterológica Latinoamericana. 2013; 43(3): 218-226.
Fernandes SA, Bassani L, Nunes FF, Aydos MED, Alves AV, Marroni CA. Nutritional assessment in patients with cirrhosis. Arq Gastroenterol. 2012; 49(1): 19- 27.
Carvalho L, Parise ER. Evaluation of nutritional status of nonhospitalized patients with liver cirrhosis. Arq Gastroenterol. 2006; 43(4): 269-274.
Reis NT, Cople CS. Acompanhamento nutricional de cirróticos com história pregressa de alcoolismo. Rev Nutr. 1998; 11(2): 139-148.
Maio R, Dichi JB, Burini RC. Sensibilidade de indicadores da desnutrição proteico-energética em cirróticos com vários graus de disfunção hepatocelular. Arq Gastroenterol. 2004; 41(2): 93-99.
Gottschall CBA, Álvares-da-Silva MR, Camargo ACR, Burtett RM, Silveira TR. Avaliação nutricional de pacientes com cirrose pelo vírus da hepatite C: a aplicação da calorimetria indireta. Arq Gastroenterol. 2004; 41(4): 220-224.
Johnson TM, Overgard EB, Cohen AE, DiBaise JK. Nutrition assessment and management in advanced liver disease. Nutr Clin Pract. 2013; 28(1): 15–29.
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