Perfil nutricional e qualidade de vida de pacientes cirróticos internados em um hospital de ensino

Abstract

The nutritional diagnosis by traditional parameters of anthropometric assessment is considered difficult in decompensated cirrhotic patients due to complications such as edema and ascites. Aims: To evaluate the nutritional status and Quality of Life (QoL) of hospitalized cirrhotic patients, admitted to the ward Gastro-Hepatology of São José do Rio Preto, Hospital de Base, between September/2014 and September/2015. Methods: anthropometric parameters, with body mass index (BMI), triceps skinfold thickness (TST), mid-upper arm circumference (MAC), mid-arm muscle circumference (MAMC), corrected arm muscle area (CAMA); hand-grip strength (HGS) dynamometer measurement and of the adductor pollicis muscle thickness (APMT); subjective global assessment (SGA) and QoL assessment. Cirrhosis status was classified by Child-Pugh score and MELD (The model end-stage liver disease) score. Dietary intake was assessed by 24-hour recall: calculated total energy intake and macronutrients. Statistical analysis included ANOVA, Kruskal-Wallis and chi-square test, Mann-Whitney; p <0.05 was considered significant. Results: We included 92 patients with an average age of 56.7±10 years and 77.2% male. The most common causes of cirrhosis were alcohol (52.2%) and hepatitis C (18.5%). The median serum albumin was 2.9g/dL(1.63-4.56), creatinine 0.9mg/dl (0.5-4.3), bilirubin 1,89mg/dL (1.10-27,9) and INR 1.48 (1.19-3.91). Child-Pugh A, B and C: 11%, 43% and 46%, respectively; MELD 14 (7-32). Malnutrition prevalence according to the following parameters: HGS 90%, SGA 85%, APMT 79%, TST 61%, MAC 56%, CAMA 53%, MAMC 48%, BMI DW (dry body weight) 33%, BMI proposed for cirrhotic patients 30% and CW (current weight)BMI 11%. Sensitivity DW BMI 38%, BMI proposed for cirrhotic patients 33% and CW BMI 13% for diagnosis of malnutrition with reference to the SGA. Comparative analysis: there were no differences among the SGA groups (well nourished, moderately malnourished and severely malnourished) regarding the Child-Pugh score (p=0.16); age (p=0.87); albumin (p=0.16), creatinine (p=0.56), bilirubin (p=0.37), INR (p=0.77) and MELD (p=0.99). The calculation of the 24-hour recall for inpatients resulted in an average of 844kcal ±427 and protein consumption 55% less than recommended. Domains that did better on average QoL scores were the general state of health 64.1±22.6, followed by mental health 56.7±24.2. Worst result was obtained in the physical role functioning (PRF) 19.9±34.4 and emotional role functioning (ERF) 30.4±43.3. Compared QoL through the scores of the SF-36 in patients classified by SGA in ‘well nourished’, ‘moderately malnourished’, ‘severely malnourished’, there was a significant difference in the field PRF (p=0.018) and ERF (p=0.002). Conclusions: the malnutrition rate among hospitalized cirrhotic patients was very high and variable according to several parameters, nutritional assessment methods that best identified malnutrition was HGS, SGA and APMT; the sensitivity of DW BMI in detecting malnutrition was low; the food intake during hospital stay was below the recommended; QoL in all domains was impaired and there was a significant association between low QoL in the areas PRF and ERF and malnutrition.