Influência da composição corporal e do estado nutricional na evolução da Esclerose Lateral Amiotrófica/ Doença do Neurônio Motor
Data
2021-05-21
Autores
Salvioni, Cristina Cleide dos Santos [UNIFESP]
Orientadores
Oliveira, Acary Souza Bulle [UNIFESP]
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Objetivo: Avaliar o impacto da evolução dos parâmetros de composição corporal e do estado nutricional em pacientes com Esclerose Lateral Amiotrófica/ Doença do Neurônio Motor (ELA). Métodos: Estudo longitudinal e observacional, com amostra de conveniência onde os participantes foram divididos em dois grupos: Grupo Apendicular (GA) e Grupo Bulbar (GB). O protocolo deste estudo incluiu a avaliação nutricional e dos aspectos da deglutição e respiração realizados trimestralmente, durante um ano e compreendeu: (1) análise da composição corporal por bioimpedância segmentar multi-frequência, (2) diagnóstico nutricional por índice de massa corporal (IMC), (3) análise da ingestão alimentar e orientação nutricional, (4) teste de força máxima da língua e lábios utilizando o Iowa Oral Pressure Instrument, (5) análise da deglutição pelas escalas Functional Oral Intake Score (FOIS) e Swallowing Rating Scale of the American Speech-Language-Hearing Association (ASHA), (6) avaliação da inteligibilidade da fala, (7) avaliação da capacidade vital forçada na posição sentada e supino (CVF sentada e supino), (8) medidas do pico de fluxo de tosse (PFT) e (9) escala de funcionalidade ALSFRS-R. Resultados: Os resultados não demonstraram diferenças significativas na análise da composição corporal entre os grupos e a desnutrição, no momento da avaliação, não era uma característica marcante da população. A ingestão de macronutrientes se relacionaram diretamente à composição corporal. O consumo de gordura parece preservar a massa muscular esquelética, (r = 0,39, p<0,01), (r = 0,47, p < 0,05) para o GA e GB, respectivamente. Os aminoácidos de cadeia ramificada, consumidos através de fontes alimentares, relacionaram-se à melhora dos aspectos de funcionalidade. Associações positivas foram encontradas entre os compartimentos corporais e a análise da deglutição. O ângulo de fase apresentou forte correlação entre as escalas FOIS (r = 0,74, p<0.01), ASHA (r = 0,77, p<0.01) e a análise da pressão da língua (r = 0,66, p < 0,01), para o GB. Para a função respiratória, associações positivas foram encontradas na análise dos compartimentos corporais: para o GA, o peso (P) se associou com o PFT (r = 0,4, p<0,01) e o IMC com CVF sentada e supino (r=0,3, p<0,01) e a massa livre de gordura com o PFT (r = 0,54, p <0,01); para o GB, o P se associou com a CVF sentada (r = 0,55, p <0,05) e supino (r = 0,59, p <0,05) e o IMC com os mesmos parâmetros (r = 0,59, p <0,01) e (r = 0,63, p <0,01), respectivamente. Para ambos os grupos, o ângulo de fase se associou positivamente com todos os parâmetros analisados. Conclusões: As alterações dos compartimentos corporais relacionaram-se à funcionalidade da deglutição, à inteligibilidade da fala e ao comprometimento respiratório em pacientes com ELA, ressaltando-se a importância da análise dos compartimentos corporais para a tomada de decisão da equipe interdisciplinar.
Objective: To evaluate the impact of the evolution of body composition parameters and nutritional status in patients with Amyotrophic Lateral Sclerosis / Motor Neuron Disease (ALS). Methods: Longitudinal and observational study, with a convenience sample where the participants were divided into two groups: Appendicular Group (AG) and Bulbar Group (BG). The protocol of this study included nutritional assessment and aspects of swallowing and breathing performed quarterly, for one year and included:(1) analysis of body composition using multi-frequency segmental bioimpedance, (2) nutritional diagnosis by body mass index (BMI), (3) analysis of food intake and nutritional guidance, (4) test of maximum strength of the tongue and lips using the Iowa Oral Pressure Instrument, (5) swallowing analysis using the Functional Oral Intake Score (FOIS) and Swallowing Rating Scale of the American Speech-Language-Hearing Association (ASHA), (6) speech intelligibility assessment, (7) assessment of forced vital capacity in the sitting and supine position (FVC sitting and supine), (8) peak cough flow measurements (PCF) and (9) ALSFRS-R functionality scale. Results: The results showed no significant differences in body composition analysis between groups and malnutrition at the time of evaluation, therefore, it was not a prominent characteristic of the population. Intake of macronutrients was directly related to body composition. Fat consumption appears to preserve skeletal muscle mass, (r = 0.39, p <0.01), (r = 0.47, p <0.05) for GA and GB, respectively. The branched-chain amino acids, consumed through food sources, were related to the improvement of aspects of functionality. Positive associations were found between body compartments and swallowing analysis. The phase angle showed a strong correlation between the FOIS scales (r = 0.74, p <0.01), ASHA (r = 0.77, p <0.01) and the tongue pressure analysis (r = 0.66, p <0.01), for the GB. For respiratory function, positive associations were found in the analysis of body compartments: for GA, weight (W) was associated with PCF (r = 0.4, p <0.01) and BMI with seated and supine FCV (r = 0.3, p <0.01) and the fat-free mass with the PCF (r = 0.54, p <0.01); for GB, the W was associated with FVC sitting (r = 0.55, p <0.05) and supine (r = 0.59, p <0.05) and BMI with the same parameters (r = 0.59, p <0.01) and (r = 0.63, p <0.01), respectively. For both groups, the phase angle was positively associated with all analyzed parameters. Conclusions: Changes in body compartments were related to swallowing functionality, speech intelligibility and respiratory impairment in patients with ALS, stressing the importance of analyzing body compartments for the decision making of the interdisciplinary team.
Objective: To evaluate the impact of the evolution of body composition parameters and nutritional status in patients with Amyotrophic Lateral Sclerosis / Motor Neuron Disease (ALS). Methods: Longitudinal and observational study, with a convenience sample where the participants were divided into two groups: Appendicular Group (AG) and Bulbar Group (BG). The protocol of this study included nutritional assessment and aspects of swallowing and breathing performed quarterly, for one year and included:(1) analysis of body composition using multi-frequency segmental bioimpedance, (2) nutritional diagnosis by body mass index (BMI), (3) analysis of food intake and nutritional guidance, (4) test of maximum strength of the tongue and lips using the Iowa Oral Pressure Instrument, (5) swallowing analysis using the Functional Oral Intake Score (FOIS) and Swallowing Rating Scale of the American Speech-Language-Hearing Association (ASHA), (6) speech intelligibility assessment, (7) assessment of forced vital capacity in the sitting and supine position (FVC sitting and supine), (8) peak cough flow measurements (PCF) and (9) ALSFRS-R functionality scale. Results: The results showed no significant differences in body composition analysis between groups and malnutrition at the time of evaluation, therefore, it was not a prominent characteristic of the population. Intake of macronutrients was directly related to body composition. Fat consumption appears to preserve skeletal muscle mass, (r = 0.39, p <0.01), (r = 0.47, p <0.05) for GA and GB, respectively. The branched-chain amino acids, consumed through food sources, were related to the improvement of aspects of functionality. Positive associations were found between body compartments and swallowing analysis. The phase angle showed a strong correlation between the FOIS scales (r = 0.74, p <0.01), ASHA (r = 0.77, p <0.01) and the tongue pressure analysis (r = 0.66, p <0.01), for the GB. For respiratory function, positive associations were found in the analysis of body compartments: for GA, weight (W) was associated with PCF (r = 0.4, p <0.01) and BMI with seated and supine FCV (r = 0.3, p <0.01) and the fat-free mass with the PCF (r = 0.54, p <0.01); for GB, the W was associated with FVC sitting (r = 0.55, p <0.05) and supine (r = 0.59, p <0.05) and BMI with the same parameters (r = 0.59, p <0.01) and (r = 0.63, p <0.01), respectively. For both groups, the phase angle was positively associated with all analyzed parameters. Conclusions: Changes in body compartments were related to swallowing functionality, speech intelligibility and respiratory impairment in patients with ALS, stressing the importance of analyzing body compartments for the decision making of the interdisciplinary team.
Descrição
Citação
SALVIONI, C. C. S. Influência da composição corporal e do estado nutricional na evolução da Esclerose Lateral Amiotrófica/ Doença do Neurônio Motor. São Paulo, 2021. 169 f. Tese (Doutorado em Neurologia e Neurociências) – Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, 2021.