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Sarcopenia e malnutrição nos doentes pré-cirúrgicos com cancro colorretal
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Abstract(s)
Introdução: O cancro colorretal (CCR) é o segundo cancro mais comum em Portugal e os doentes com esta condição clínica têm elevada probabilidade de desenvolver malnutrição e sarcopenia. O objetivo deste estudo foi determinar a prevalência destas condições nos doentes pré-cirúrgicos com CCR e estudar a associação destas e outros parâmetros nutricionais e corporais com o outcome clínico. Métodos: Trata-se de um estudo longitudinal e observacional, constituído por uma amostra de 106 doentes pré-cirúrgicos com CCR seguidos no Hospital Santa Maria em Lisboa. A avaliação nutricional foi realizada através da ferramenta Patient-Generated Subjective Global Assessment (PG-SGA) e para análise do risco nutricional utilizou-se o Nutrition Risk Screening 2002 (NRS 2002). Recorreu-se também ao método Bioimpedância elétrica (BIA) tetrapolar para análise de parâmetros corporais, e, a análise do outcome clínico teve em consideração as complicações pós-operatórias e os dias de internamento. Resultados: Neste estudo 37,7% da população apresentou malnutrição e 5,7% sarcopenia, sendo que doentes com malnutrição, bem como os doentes em risco nutricional apresentaram um aumento de 3,7 (p value=0,001) e 5,1 (p value=0,014) dias de internamento, respetivamente, em relação aos grupos em comparação. Quanto às complicações pós-cirúrgicas, os doentes com o índice de massa muscular esquelética apendicular (IMMEA) reduzida, demonstraram ter maior risco de a desenvolverem, (OR: 7,5; IC95%:1,494-37,656, p value= 0,014). Contudo, mediante a análise multivariada, o risco nutricional foi o único que demonstrou ser um fator preditor independente das complicações pós-cirúrgicas (OR: 8,326; IC95%: 1,317-52,642; p value= 0,024). Não foram verificadas associações significativas entre a sarcopenia/sarcopenia provável e o outcome clínico, porém, o ângulo fase (AF) demonstrou associação significativa com este último e revelou-se como um fator preditor independente da malnutrição, (OR:0,377; IC95%: 0,147-0,965; P value=0,042). Conclusão: A avaliação do estado nutricional e funcional dos doentes demonstram ser fatores importantes a serem considerados no pré-cirúrgico, devido à influência destes sobre o desfecho clínico. É importante procurar estratégias que diminuam a taxa de malnutrição no pré-cirúrgico, e implementar as ferramentas adequadas para a sua deteção.
ABSTRACT: Introduction: Colorectal cancer (CRC) is the second most common cancer in Portugal, and patients affected by this condition have a high tendency to develop malnutrition and sarcopenia. The objective of this study is to determine the prevalence of these conditions in pre-surgical patients with CRC and to investigate the association of these and other nutritional and body parameters with clinical outcomes. Methods: This is a longitudinal and observational study, consisting of a sample of 106 pre-surgical individuals with CRC from Hospital Santa Maria in Lisbon. Nutritional assessment was performed using the Patient-Generated Subjective Global Assessment (PG-SGA) tool, and for the nutritional risk analysis, the Nutrition Risk Screening 2002 (NRS 2002) was used. The tetrapolar BIA method was also employed for the analysis of body parameters, and for the clinical outcome analysis, the postoperative complications and length of hospital stay were considered. Results: In this study, 37.7% of the population presented malnutrition, and 5.7% had sarcopenia. Patients with malnutrition and those at nutritional risk had an increase of 3.7 (p value=0.001) and 5.1 (p value=0.014) days of hospitalization, respectively, compared to the comparison groups. Patients with reduced appendicular skeletal muscle mass index (ASMI) were found to have a higher risk of developing postoperative complications (OR: 7.5; 95% CI: 1.494-37.656, p value= 0.014). However, in a multivariate analysis, the nutritional risk was the only factor demonstrated to be an independent predictor of postsurgical complications (OR: 8.326; 95% CI: 1.317-52.642; p-value: 0.024). No significant associations were found between sarcopenia/probable sarcopenia and clinical outcomes. However, phase angle showed significant associations with the latter and proved to be an independent predictor of malnutrition (OR: 0.377; 95% CI: 0.147-0.965; P value=0.042). Conclusion: The assessment of nutritional and functional status in patients proves to be important factors to be considered in the pre-surgical period, given the influence they can exert on clinical outcomes. It is also crucial to seek strategies that reduce the rate of malnutrition preoperatively and to implement adequate tools that assist in its detection.
ABSTRACT: Introduction: Colorectal cancer (CRC) is the second most common cancer in Portugal, and patients affected by this condition have a high tendency to develop malnutrition and sarcopenia. The objective of this study is to determine the prevalence of these conditions in pre-surgical patients with CRC and to investigate the association of these and other nutritional and body parameters with clinical outcomes. Methods: This is a longitudinal and observational study, consisting of a sample of 106 pre-surgical individuals with CRC from Hospital Santa Maria in Lisbon. Nutritional assessment was performed using the Patient-Generated Subjective Global Assessment (PG-SGA) tool, and for the nutritional risk analysis, the Nutrition Risk Screening 2002 (NRS 2002) was used. The tetrapolar BIA method was also employed for the analysis of body parameters, and for the clinical outcome analysis, the postoperative complications and length of hospital stay were considered. Results: In this study, 37.7% of the population presented malnutrition, and 5.7% had sarcopenia. Patients with malnutrition and those at nutritional risk had an increase of 3.7 (p value=0.001) and 5.1 (p value=0.014) days of hospitalization, respectively, compared to the comparison groups. Patients with reduced appendicular skeletal muscle mass index (ASMI) were found to have a higher risk of developing postoperative complications (OR: 7.5; 95% CI: 1.494-37.656, p value= 0.014). However, in a multivariate analysis, the nutritional risk was the only factor demonstrated to be an independent predictor of postsurgical complications (OR: 8.326; 95% CI: 1.317-52.642; p-value: 0.024). No significant associations were found between sarcopenia/probable sarcopenia and clinical outcomes. However, phase angle showed significant associations with the latter and proved to be an independent predictor of malnutrition (OR: 0.377; 95% CI: 0.147-0.965; P value=0.042). Conclusion: The assessment of nutritional and functional status in patients proves to be important factors to be considered in the pre-surgical period, given the influence they can exert on clinical outcomes. It is also crucial to seek strategies that reduce the rate of malnutrition preoperatively and to implement adequate tools that assist in its detection.
Description
Mestrado em Nutrição Clínica
Keywords
Cancro colorretal Cirurgia Malnutrição Risco nutricional Ângulo fase Outcome clínico Sarcopenia Colorectal cancer Surgery Malnutrition Nutritional risk Phase angle Clinical outcome MNC