Avaliação nutricional dos pacientes com narcolepsia segundo os níveis de hipocretina-1 no líquido cefalorraquiano
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Data
2024-03-26
Autores
Reis, Maria Júlia Figueiró [UNIFESP]
Orientadores
Coelho, Fernando Morgadinho Santos [UNIFESP]
Tipo
Dissertação de mestrado
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INTRODUÇÃO: Muito além da sonolência excessiva diurna ligada à narcolepsia, estudos recentes vêm indicando novos alvos para o manejo da qualidade de vida nessa população. Avanços importantes foram feitos em crononutrição, especialmente evidenciando-se uma tendência ao ganho ponderal e provavelmente à rarefação óssea. O objetivo do nosso estudo foi avaliar esse espectro adicional de sintomas, correlacionando-o com o tipo de narcolepsia, com a dosagem de hipocretina-1 no líquido cefalorraquiano (LCR) e com características cronobiológicas. MÉTODOS: Foram selecionados pacientes adultos com narcolepsia do tipo 1 (NT1) e do tipo 2 (NT2), os quais foram submetidos a medições antropométricas padronizadas (índice de massa corporal e relação cintura-quadril, respectivamente IMC e RCQ), análise de impedância bioelétrica (BIA) e avaliação nutricional por meio de um recordatório alimentar de 24 horas (24HR). O percentual de massa mineral óssea (%MMO) foi obtido por meio da divisão da massa mineral óssea pelo peso, ambos medidos via BIA. Indivíduos que consumiram uma quantidade maior de calorias antes das 15:00 foram classificados como matutinos, enquanto os demais foram classificados como vespertinos. As medições antropométricas e o %MMO foram então analisados em função do tipo de narcolepsia, dos níveis de hipocretina-1 e do perfil nutricional de matutinidade-vespertinidade. Valores de p inferiores a 0,05 e um intervalo de confiança de 95% foram adotados como condições de significância estatística. RESULTADOS: Foi avaliado um total de 49 pacientes (31 com NT1 e 18 com NT2). Os pacientes com NT1 demonstraram maior grau de obesidade que aqueles com NT2, além de uma tendência à rarefação óssea (IMC: 32,04±6,95 vs. 25,38±4,26 Kg/m2, p<0,01; RCQ: 0,89±0,09 vs. 0,83±0,09, p=0,02 e %MMO: 4,1±1,02 vs. 4,89±0,59%, p<0,01). Tais achados parecem estar ligados às dosagens de hipocretina-1, já que elas tiveram correlação negativa com o ganho de peso (IMC: r=-0,54, p<0,01 e RCQ: r=-0,37, p=0,01) e correlação positiva com o %MMO (r=+0,48, p<0,01). O perfil de matutinidade-vespertinidade não se associou a uma modificação nas medidas antropométricas ou na massa mineral óssea. Entretanto, de forma interessante, pacientes vespertinos realmente tiveram uma maior ingestão de calorias durante o dia (2700,00±834,23 vs. 2237,82±550,73 kcal, p=0,03), e as análises globais mostraram uma correlação positiva entre a ingesta calórica diária e a RCQ (r=+0,42, p<0,01). Em contraste com estudos prévios, a modafinila não modificou o %MMO (4,51±0,75 vs. 4,16±1,27%, p=0,54). Também não foram observadas diferenças no padrão de uso da medicação entre NT1 e NT2 ou entre matutinos e vespertinos. CONCLUSÕES: O perfil de morbidade inerente à narcolepsia pode incluir fatores que vão além da sonolência excessiva necessária ao seu diagnóstico. Embora os dados sejam incipientes e haja a necessidade de novos estudos para a confirmação, os profissionais de saúde devem prestar especial atenção ao ganho de peso e a uma possível rarefação óssea, com vistas a permitir uma detecção precoce de doença, seguida do correto manejo clínico.
INTRODUCTION: Far beyond the excessive daytime sleepiness linked to narcolepsy, recent studies are pointing out new targets for managing the quality of life in this population. Significant advances have been made in chrononutrition, especially highlighting a tendency for weight gain and probably bone rarefaction. This study aims to assess this additional symptom spectrum and evaluate its correlation with the type of narcolepsy, hypocretin-1 dosage in cerebrospinal fluid (CSF), and chronobiologic features. METHODS: We have selected adult patients diagnosed with narcolepsy type 1 (NT1) and type 2 (NT2) and proceeded to standardized anthropometric measurements (body mass index and waist to hip ratio, respectively BMI and WHR), bioelectrical impedance analysis (BIA) and nutritional evaluation using a 24-hour dietary recall (24HR). The percentage of bone mineral content (%BMC) was obtained by dividing bone mineral content by body mass, measured by BIA. Individuals who consumed more calories before 3:00 PM were classified as a morning type, and the others as an evening type. Anthropometric measurements and %BMC were then analyzed as a function of the narcolepsy type, hypocretin-1 levels, and morningness-eveningness nutritional profile. Values of p lower than 0.05 and a confidence interval of 95% were adopted as conditions for statistical significance. RESULTS: 49 patients were included (31 with NT1 and 18 with NT2). Patients with NT1 were fatter than those with NT2 and presented with a tendency for bone rarefaction (BMI: 32.04±6.95 vs. 25.38±4.26 Kg/m2, p<0.01; WHR: 0.89±0.09 vs. 0.83±0.09, p=0.02 and %BMC: 4.1±1.02% vs. 4.89±0.59%, p<0.01). These findings seemed to be linked to hypocretin-1 measurements, as they had a negative correlation with weight gain (BMI: r=-0.54, p<0.01 and WHR: r=-0.37, p=0.01) and a positive correlation with %BMC (r=+0.48, p<0.01). The morningness-eveningness profile was not associated with anthropometric measurements or bone mineral content changes. Interestingly, however, patients with an evening type did have a higher intake of calories during the day (2700.00±834.23 vs. 2237.82±550.73 kcal, p=0.03), and the overall analysis showed that diary caloric intake was positively correlated with WHR (r=+0.42, p<0.01). Contradicting previous data, treatment with modafinil did not influence %BMC (4.51±0.75% vs. 4.16±1.27%, p=0.54). Also, we did not observe different medication use patterns between NT1 and NT2 or between morning and evening types. CONCLUSION: The morbidity profile inherent to narcolepsy might include factors that go beyond the excessive sleepiness necessary for its diagnosis. Although data is developing and more studies are needed for confirmation, healthcare providers should pay special attention to weight gain and possible bone rarefaction to allow an intelligent detection of disease and correct clinical management.
INTRODUCTION: Far beyond the excessive daytime sleepiness linked to narcolepsy, recent studies are pointing out new targets for managing the quality of life in this population. Significant advances have been made in chrononutrition, especially highlighting a tendency for weight gain and probably bone rarefaction. This study aims to assess this additional symptom spectrum and evaluate its correlation with the type of narcolepsy, hypocretin-1 dosage in cerebrospinal fluid (CSF), and chronobiologic features. METHODS: We have selected adult patients diagnosed with narcolepsy type 1 (NT1) and type 2 (NT2) and proceeded to standardized anthropometric measurements (body mass index and waist to hip ratio, respectively BMI and WHR), bioelectrical impedance analysis (BIA) and nutritional evaluation using a 24-hour dietary recall (24HR). The percentage of bone mineral content (%BMC) was obtained by dividing bone mineral content by body mass, measured by BIA. Individuals who consumed more calories before 3:00 PM were classified as a morning type, and the others as an evening type. Anthropometric measurements and %BMC were then analyzed as a function of the narcolepsy type, hypocretin-1 levels, and morningness-eveningness nutritional profile. Values of p lower than 0.05 and a confidence interval of 95% were adopted as conditions for statistical significance. RESULTS: 49 patients were included (31 with NT1 and 18 with NT2). Patients with NT1 were fatter than those with NT2 and presented with a tendency for bone rarefaction (BMI: 32.04±6.95 vs. 25.38±4.26 Kg/m2, p<0.01; WHR: 0.89±0.09 vs. 0.83±0.09, p=0.02 and %BMC: 4.1±1.02% vs. 4.89±0.59%, p<0.01). These findings seemed to be linked to hypocretin-1 measurements, as they had a negative correlation with weight gain (BMI: r=-0.54, p<0.01 and WHR: r=-0.37, p=0.01) and a positive correlation with %BMC (r=+0.48, p<0.01). The morningness-eveningness profile was not associated with anthropometric measurements or bone mineral content changes. Interestingly, however, patients with an evening type did have a higher intake of calories during the day (2700.00±834.23 vs. 2237.82±550.73 kcal, p=0.03), and the overall analysis showed that diary caloric intake was positively correlated with WHR (r=+0.42, p<0.01). Contradicting previous data, treatment with modafinil did not influence %BMC (4.51±0.75% vs. 4.16±1.27%, p=0.54). Also, we did not observe different medication use patterns between NT1 and NT2 or between morning and evening types. CONCLUSION: The morbidity profile inherent to narcolepsy might include factors that go beyond the excessive sleepiness necessary for its diagnosis. Although data is developing and more studies are needed for confirmation, healthcare providers should pay special attention to weight gain and possible bone rarefaction to allow an intelligent detection of disease and correct clinical management.
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Citação
REIS, Maria Júlia Figueiró. Avaliação nutricional dos pacientes com narcolepsia segundo os níveis de hipocretina-1 no líquido cefalorraquiano. 2024. 61 f. Dissertação (Mestrado em Psicobiologia) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP). São Paulo, 2024.