Exploração e comparação de métodos para avaliação de risco nutricional em pacientes com insuficiência cardíaca crônica.
Data
2022
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Objetivo: Explorar e comparar os diferentes métodos para avaliar o
diagnóstico de risco nutricional nos pacientes com Insuficiência Cardíaca Crônica
(ICC). Métodos: Estudo de coorte transversal, com abordagem quantitativa, onde
foram incluídos 79 pacientes adultos atendidos no ambulatório de Insuficiência
Cardíaca da Universidade Federal de São Paulo (UNIFESP). Os pacientes
passaram em consulta onde foi realizado medidas antropométricas, de composição
corporal (bioimpedância elétrica), exames laboratoriais e avaliações subjetivas
(Avaliação Subjetiva Global - AGS e o Escore de Desnutrição e Inflamação - MIS).
Regressões lineares univariadas foram utilizadas para avaliar a relação entre
espessura do músculo adutor do polegar (EMAP), ângulo de fase (AF), MIS e as
variáveis de avaliação nutricional. Regressões binárias logísticas foram utilizadas
para avaliar a chance de desnutrição para cada uma das métricas de desnutrição
(EMAP / MIS / AF), usando como padrão-ouro o AGS compatível com desnutrição.
Também foi avaliada a capacidade discriminatória dos modelos (EMAP / MIS / AF)
usando a área sob a curva característica operacional do receptor. Resultados: A
média de idade encontrada foi 51,72 ±11,4 anos, com predominância do sexo
masculino e IMC de 29 ± 4 kg/m2
. De acordo com o AGS 20,3% estavam
desnutridos e, segundo o MIS, 7,6%. As médias do EMAP da mão dominante e do
ângulo de fase foram 8,0 ± 2,4mm e 6,7o ± 1,9, respectivamente. A cada aumento na
medida do EMAP o risco de desnutrição pela AGS cai 20,3% (p= 0,049; OR=0,797).
O EMAP também apresentou boa sensibilidade e especificidade para indicar
desnutrição com o ponto de corte <9mm. A cada ponto aumentado do MIS o risco de
desnutrição aumenta 2,312 (p= <0.001; OR= 2,312), com expressivos valores de
sensibilidade, especificidade, e boa acurácia para desnutrição com o ponto de corte
< 4 pontos. O AF apenas mostrou bons resultados para as mulheres. Conclusões:
Essas ferramentas isoladamente não foram capazes de avaliar o risco nutricional
nos pacientes com ICC. Porém, quando associadas ao método padrão ouro, AGS,
podem predizer o risco nutricional na população em questão.
Objective: To assess and compare the different methods for diagnosis of Nutritional Risk in patients with Chronic Heart Failure (CHF). Methods: Crosssectional cohort study, with a quantitative approach, which included 79 adult patients seen at the Heart Failure Outpatient Clinic of the Federal University of São Paulo (UNIFESP). The patients underwent a consultation, where anthropometric measurements, body composition measurements (bioelectrical impedance), laboratory tests and subjective evaluations (Subjective Global Assessment - SGA and the Malnutrition and Inflammation Score - MIS) were carried out. Univariate linear regressions were used to assess the relationship between adductor pollicis muscle thickness (APMT), phase angle (PA), MIS and nutritional assessment variables. Logistic binary regressions were used to assess the chance of malnutrition for each of the malnutrition metrics (APMT / MIS / PA), using SGA compatible with malnutrition as the gold standard. The discriminatory capacity of the models (APMT / MIS / PA) was also evaluated using the area under the operational characteristic curve of the receiver. Results: The mean age found was 51.72 ± 11.4 years, with a predominance of males and a BMI of 29 ± 4 kg/m2. According to the SGA, 20.3% were malnourished and, according to the MIS, 7.6%. The mean APMT of the dominant hand and the mean PA was 8.0 ± 2.4 mm and 6.7o ± 1.9, respectively. With each increase in the APMT measurement, the risk of malnutrition by the AGS drops 20.3% (p=0.049; OR=0.797). APMT also showed good sensitivity and specificity to indicate malnutrition with a cutoff point of <9mm. At each MIS point increased, the risk of malnutrition increases 2.312 (p= <0.001; OR= 2.312), with expressive values for sensitivity, specificity, and good accuracy for malnutrition with a cut-off point of < 4 points. The PA only showed good results for women. Conclusions: These tools alone were not able to assess nutritional risk in patients with CHF. However, when associated with the gold standard method, SGA, they can predict nutritional risk in the population in question. Descriptors: Nutritional assessment, nutritional risk, add
Objective: To assess and compare the different methods for diagnosis of Nutritional Risk in patients with Chronic Heart Failure (CHF). Methods: Crosssectional cohort study, with a quantitative approach, which included 79 adult patients seen at the Heart Failure Outpatient Clinic of the Federal University of São Paulo (UNIFESP). The patients underwent a consultation, where anthropometric measurements, body composition measurements (bioelectrical impedance), laboratory tests and subjective evaluations (Subjective Global Assessment - SGA and the Malnutrition and Inflammation Score - MIS) were carried out. Univariate linear regressions were used to assess the relationship between adductor pollicis muscle thickness (APMT), phase angle (PA), MIS and nutritional assessment variables. Logistic binary regressions were used to assess the chance of malnutrition for each of the malnutrition metrics (APMT / MIS / PA), using SGA compatible with malnutrition as the gold standard. The discriminatory capacity of the models (APMT / MIS / PA) was also evaluated using the area under the operational characteristic curve of the receiver. Results: The mean age found was 51.72 ± 11.4 years, with a predominance of males and a BMI of 29 ± 4 kg/m2. According to the SGA, 20.3% were malnourished and, according to the MIS, 7.6%. The mean APMT of the dominant hand and the mean PA was 8.0 ± 2.4 mm and 6.7o ± 1.9, respectively. With each increase in the APMT measurement, the risk of malnutrition by the AGS drops 20.3% (p=0.049; OR=0.797). APMT also showed good sensitivity and specificity to indicate malnutrition with a cutoff point of <9mm. At each MIS point increased, the risk of malnutrition increases 2.312 (p= <0.001; OR= 2.312), with expressive values for sensitivity, specificity, and good accuracy for malnutrition with a cut-off point of < 4 points. The PA only showed good results for women. Conclusions: These tools alone were not able to assess nutritional risk in patients with CHF. However, when associated with the gold standard method, SGA, they can predict nutritional risk in the population in question. Descriptors: Nutritional assessment, nutritional risk, add
Descrição
Citação
BEZERRA, L.T.C. Exploração e comparação de métodos para avaliação de risco nutricional em pacientes com insuficiência cardíaca crônica. São Paulo, 2022. 79 f. Dissertação (Mestrado em Cardiologia) - Escola Paulista de Medicina (EPM), Univiversidade Federal de São Paulo (UNIFESP). São Paulo, 2022.