Emprego da Avaliação global subjetiva e do Malnutrition Inflammation Score para acompanhamento do estado nutricional em pacientes idosos em tratamento crônico de hemodiálise

• Ano de defesa: 2014
• Autor(a) principal: Oliveira, Fernanda Galvão Pasculli de
• Orientador(a): Avesani, Carla Maria
• Banca de defesa: Valle, Lilian Cuppari , Martucci, Renata Brum
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade do Estado do Rio de Janeiro
• Programa de Pós-Graduação: Programa de Pós-Graduação em Alimentação, Nutrição e Saúde
• Departamento: Centro Biomédico::Instituto de Nutrição
• País: BR
• Palavras-chave em Português: Doença renal crônica; Estado nutricional; Avaliação global subjetiva; Malnutrition inflammation score; Nutrição; Idosos; Hemodiálise
• Palavras-chave em Inglês: Chronic kidney disease; Elderly; Hemodialysis; Nutritional status; Subjective global assessment; Malnutrition inflammation score
• Área do conhecimento CNPq: CNPQ::CIENCIAS DA SAUDE::NUTRICAO
• Link de acesso: http://www.bdtd.uerj.br/handle/1/7321

The 7 point subjective global assessment (7p-SGA) and the malnutrition inflammation score (MIS) are nutrition screening tools commonly applied in patients on chronic hemodialysis (HD). However, little is known about its ability to detect changes in nutritional status, which impairs its use as a tool for monitoring nutritional status. This limitation might be enhanced in elderly patients. Thus, this study aims to evaluate whether changes in nutritional status assessed by 7p-SGA and the MIS are associated with changes in objective parameters, in elderly patients on HD. This is an observational, longitudinal and prospective study, encompassed by 126 HD patients aged ≥ 60 years (70.4% male, mean age 70.5 ±7.4 years). Nutritional status was assessed by objective (anthropometry, bioelectrical impedance, handgrip strength - HGS, 3-day food records, serum albumin and creatinine) and subjective methods (7p-SGA and MIS). After 11 to 13 months from baseline, patients were reassessed using the same protocol applied at baseline. The statistical package SPSS version 18.0 was used and a P-value <0.05 was considered of statistical significance. Out of 126 patients evaluated at baseline, 77 were reassessed after 11 to 13 months (72.7% male, age: 70.5 ± 6.9 years). In the second assessment, it was observed a significant reduction in body fat (%) and calf circumference in males and females, body cell mass and phase angle in males, while HGS increased in males. Concerning females, body cell mass and phase angle tended to decrease and HGS increase. In addition, changes (final value - initial) in nutritional status assessed by 7p-SGA was significantly and positively associated with changes in body weight, BMI and calf circumference. The changes in MIS were significantly and negatively associated with changes of body fat (%), total iron binding capacity (TIBIC), albumin and creatinine. In the multiple linear regression analysis adjusted for sex, age, HD length and baseline score of 7p-SGA or MIS (depending on the tool tested in the statistical model), it was observed that 1-unit change in 7p-SGA was significantly associated with appropriate changes in body weight (=0.102), BMI (=0.197) and calf circumference (=0.284). For MIS, 1-unit change was significantly associated with appropriate changes in body weight (= -0.317), BMI (= -0.468) body fat (%; = -0.203), calf circumference (=0.725), albumin (= -1.467; P=0.054) and creatinine (= -0.471). In conclusion, longitudinal changes in 7p-SGA and MIS were associated with changes in some of the objective parameters tested, when applied to monitor the nutritional status in a sample of elderly on HD. Thus, 7p-SGA and MIS can be applied to monitor nutritional changes, but should be complemented by objective parameters to enhance precision