Estado nutricional e fatores associados à desnutrição em idosos em tratamento oncológico

• Ano de defesa: 2013
• Autor(a) principal: Santos, Carolina Araújo dos
• Orientador(a): Ribeiro, Rita de Cássia Lanes
• Banca de defesa: Bevilacqua, Paula Dias
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de Viçosa
• Programa de Pós-Graduação: Mestrado em Ciência da Nutrição
• Departamento: Valor nutricional de alimentos e de dietas; Nutrição nas enfermidades agudas e crônicas não transmis
• País: BR
• Palavras-chave em Português: Estado nutricional; Idoso; Neoplasia
• Palavras-chave em Inglês: Nutritional status; Elderly; Neoplasia
• Área do conhecimento CNPq: CNPQ::CIENCIAS DA SAUDE::NUTRICAO
• Link de acesso: http://locus.ufv.br/handle/123456789/2775

Introduction: Elderly patients with cancer are at high risk of malnutrition. The Patient Generated Subjective Global Assessment (PG-SGA) has been considered the most suitable method for cancer patients, although anthropometry is still widely used in clinical practice. Because it is a subjective method, recently validated for the Brazilian population, comparative studies between different methods are needed. Besides the nutritional diagnosis, the identification of factors associated with malnutrition is an important aspect in the management of elderly patients with cancer, including the investigation of the presence of depression and cognitive impairment. Objectives: To analyze the clinical, sociodemographic and nutritional profile, the factors associated with malnutrition and compare the nutritional diagnosis by PG-SGA with objective anthropometric measures in elderly patients undergoing cancer treatment. Methods: A cross-sectional study was carried out with 96 elderly patients undergoing cancer treatment. The procedures included the application of a sociodemographic and health questionnaire, assessment of nutritional status by PG-SGA and determination of measures and anthropometric indices: weight, height, Body Mass Index, mid-upper arm circumference, arm muscle circumference, arm muscle area, corrected arm muscle area, arm fat area, calf circumference, waist circumference, hip circumference, waist to hip ratio and triceps skinfold. The current food consumption was investigated by a 24-Hour Recall, the presence of depression was assessed by the Geriatric Depression Scale with 15 items (GDS-15) and cognitive function by the Mini Mental State Examination (MMSE). Statistical analysis involved descriptive measures, univariate and multivariate analysis. The Poisson regression with robust variance adjustment was used to identify the factors independently associated with malnutrition. Comparison between methods of nutritional evaluation was performed by Spearman correlation and Kappa coefficient adjusted prevalence. In all statistical tests, the significance level for rejection of the null hypothesis was α = 0,05. Results: The sample was equitable in relation to gender, with a mean age of 70,6 years (SD = 7,8 years) and predominance of individuals with advanced disease. The PG-SGA identified 56,2% of elderly normal weight, 29,2% moderately malnourished or suspected malnutrition and 14,6% with severe malnutrition. Of elderly evaluated, 47,9% needed critical nutritional intervention. Anthropometric parameters differ according to the subjective classification of PG-SGA, with significant correlation between subjective and objective methods. The prevalence of malnutrition ranged from 43,8% to 61,4%, depending on the method used, with greater agreement between the diagnosis provided by PG-SGA with the Body Mass Index (kappa = 0,54, CI: 0,347-0,648) Cognitive impairment was identified in 39,6% and the presence of depression in 17,7%, with higher scores for females on the GDS-15 (p = 0,017). In the multivariate analysis were independently associated with malnutrition the functional impairment (PR: 3,40, CI: 1,23-9,45), the presence of two or more symptoms with nutritional impact (PR: 3,22 CI: 1,03-10,10 ) and current treatment by chemotherapy (PR: 2,96, CI: 1,16-7,56). Conclusions: Elderly patients in cancer treatment showed high prevalence of malnutrition and need for critical nutritional intervention, reiterating the importance of nutrition as central action in the management of these patients. The ASG-PPP significantly correlated with anthropometric and food intake variables, confirming his recomendation as the preferred method for the nutritional assessment of elderly patients with cancer. About two to five assessed had cognitive impairment and depression was identified in a every six elderly, with higher scores on the depression scale for females. The functional impairment, the presence of two or more symptoms with nutritional impact and current treatment by chemotherapy were independently associated with malnutrition. These conditions must be investigated effectively in the evaluation and intervention in these individuals.