Efeito positivo da perda moderada de peso por intervenção nutricional nos componentes do domínio de frequência em pacientes de alto risco cardiovascular e regime multimedicamentoso
Data
2024-09-12
Autores
Moreira, Priscila 
Orientadores
Franco, Maria do Carmo Pinho
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Objetivo: Avaliar a efetividade de um programa de reeducação alimentar e melhoria de qualidade de vida sobre os indicadores de adesão às orientações dietéticas, o estilo de vida, variáveis bioquímicas e antropométricas e a função autonômica do coração. Métodos: Pacientes com obesidade de ambos os sexos, encaminhados ao ambulatório de nutrição do Instituto Dante Pazzanese de Cardiologia para emagrecimento, foram acompanhados mensalmente, durante 3 meses. Foram aplicados dois questionários para avaliar as mudanças no estilo de vida (IPAQ-versão reduzida e PHQ-9), e foi realizado o eletrocardiograma para avaliação da Variabilidade da Frequência Cardíaca (VFC), antes e após o período de acompanhamento, e os exames laboratoriais foram consultados em prontuário. Resultados: Foram avaliados 24 pacientes com obesidade (IMC > 30kg/m2), com idade média de 62 anos (min – máx: 42 – 80 anos, DP: 10 anos), sendo 45,8% eram adultos (5 homens e 6 mulheres) e 54,2% idosos (7 homens e 6 mulheres). A adesão aos hábitos alimentares saudáveis teve aumento médio de 21,3% para 66,5% (P< 0,001). O IPAQ demonstrou que, ao final do estudo 88% dos pacientes foram classificados como fisicamente ativos quando comparados a 58% no período basal (P=0,023), e houve redução significativa no escore de PHQ-9 após a intervenção (Basal: 8,87 ± 1,15; Pós-intervenção: 5,15 ± 1,20; P=0,022), indicando melhora na saúde mental dos pacientes. Foram ainda observadas reduções significativas dos níveis de glicemia, hemoglobina glicada, colesterol total e da fração LDLc, e triglicerídeos, em modelos ajustados para o uso de medicação (P<0,05). O IMC, que antes da intervenção apresentava média de 34,8 Kg/m2, variando de 30,0 – 47,4 Kg/m2, após a intervenção nutricional apresentou média de 32,6 Kg/m2, variando de 27,7 – 44,8 Kg/m2. Notou-se que o programa de intervenção foi eficaz em reduzir significativamente o IMC (P=0,029) e a circunferência da cintura (P=0,031). Foi identificada existência de associação entre a variação de perda de peso e de diminuição do IMC com as variabilidades observadas nos componentes do domínio da frequência, tanto entre os indivíduos adultos (P=0,003), quanto entre indivíduos idosos (P=0,034). Conclusões: A intervenção em qualidade de vida e reeducação alimentar utilizada no presente estudo foi capaz de promover a melhora tanto na saúde mental quanto o aumento da atividade física dos pacientes, redução dos parâmetros antropométricos e de marcadores do perfil glicêmico e lipídico e a melhora na VFC, especificamente nos componentes do domínio da frequência.
Objective: To evaluate the effectiveness of a nutritional re-education and quality of life improvement program on indicators of adherence to dietary guidelines, lifestyle, biochemical and anthropometric variables, and the autonomic function of the heart. Methods: Obesity patients of both sexes, referred to the nutrition outpatient clinic of the Instituto Dante Pazzanese de Cardiologia for weight loss, were monitored monthly for 3 months. Two questionnaires were applied to evaluate changes in lifestyle (IPAQ-reduced version and PHQ-9), and an electrocardiogram was performed to evaluate Heart Rate Variability (HRV), before and after the follow-up period, and exams laboratory data were consulted in the medical records. Results: 24 patients with obesity (BMI > 30kg/m2) were evaluated, with a mean age of 62 years (min – max: 42 – 80 years, SD: 10 years), 45.8% of whom were adults (5 men and 6 women) and 54.2% elderly (7 men and 6 women). Adherence to healthy eating habits increased on average from 21.3% to 66.5% (P< 0.001). The IPAQ demonstrated that, at the end of the study, 88% of patients were classified as physically active when compared to 58% in the baseline period (P=0.023), and there was a significant reduction in the PHQ-9 score after the intervention (Baseline: 8. 87 ± 1.15; Post-intervention: 5.15 ± 1.20; P=0.022), indicating improvement in patients' mental health. Significant reductions in blood glucose levels, glycated hemoglobin, total cholesterol and the LDLc fraction, and triglycerides were also observed in models adjusted for medication use (P<0.05). The BMI, which before the intervention had an average of 34.8 kg/m2, ranging from 30.0 – 47.4 kg/m2, after the nutritional intervention had an average of 32.6 kg/m2, ranging from 27.7 – 44.8 kg/m2. It was noted that the intervention program was effective in significantly reducing BMI (P=0.029) and waist circumference (P=0.031). An association was identified between the variation in weight loss and decrease in BMI with the variability observed in the components of the frequency domain, both among adult individuals (P=0.003) and among elderly individuals (P=0.034). Conclusions: The intervention in quality of life and nutritional re-education used in the present study was able to promote improvements in both mental health and increased physical activity of patients, reduction in anthropometric parameters and markers of the glycemic and lipid profile and improvement in HRV, specifically in the frequency domain components.
Objective: To evaluate the effectiveness of a nutritional re-education and quality of life improvement program on indicators of adherence to dietary guidelines, lifestyle, biochemical and anthropometric variables, and the autonomic function of the heart. Methods: Obesity patients of both sexes, referred to the nutrition outpatient clinic of the Instituto Dante Pazzanese de Cardiologia for weight loss, were monitored monthly for 3 months. Two questionnaires were applied to evaluate changes in lifestyle (IPAQ-reduced version and PHQ-9), and an electrocardiogram was performed to evaluate Heart Rate Variability (HRV), before and after the follow-up period, and exams laboratory data were consulted in the medical records. Results: 24 patients with obesity (BMI > 30kg/m2) were evaluated, with a mean age of 62 years (min – max: 42 – 80 years, SD: 10 years), 45.8% of whom were adults (5 men and 6 women) and 54.2% elderly (7 men and 6 women). Adherence to healthy eating habits increased on average from 21.3% to 66.5% (P< 0.001). The IPAQ demonstrated that, at the end of the study, 88% of patients were classified as physically active when compared to 58% in the baseline period (P=0.023), and there was a significant reduction in the PHQ-9 score after the intervention (Baseline: 8. 87 ± 1.15; Post-intervention: 5.15 ± 1.20; P=0.022), indicating improvement in patients' mental health. Significant reductions in blood glucose levels, glycated hemoglobin, total cholesterol and the LDLc fraction, and triglycerides were also observed in models adjusted for medication use (P<0.05). The BMI, which before the intervention had an average of 34.8 kg/m2, ranging from 30.0 – 47.4 kg/m2, after the nutritional intervention had an average of 32.6 kg/m2, ranging from 27.7 – 44.8 kg/m2. It was noted that the intervention program was effective in significantly reducing BMI (P=0.029) and waist circumference (P=0.031). An association was identified between the variation in weight loss and decrease in BMI with the variability observed in the components of the frequency domain, both among adult individuals (P=0.003) and among elderly individuals (P=0.034). Conclusions: The intervention in quality of life and nutritional re-education used in the present study was able to promote improvements in both mental health and increased physical activity of patients, reduction in anthropometric parameters and markers of the glycemic and lipid profile and improvement in HRV, specifically in the frequency domain components.
Descrição
Citação
MOREIRA, Priscila. Efeito positivo da perda moderada de peso por intervenção nutricional nos componentes do domínio de frequência em pacientes de alto risco cardiovascular e regime multimedicamentoso. 2024. 91 f. Dissertação (Mestrado em Medicina Translacional ) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP). São Paulo, 2024.