RESUMO
INTRODUCTION:: Protein-energy malnutrition in Crohn's disease (CD) has been reported in 20 to 92% of patients, and is associated with increased morbidity and mortality and higher costs for the health system. Anti-TNF drugs are a landmark in the clinical management, promoting prolonged remission in patients with CD. It is believed that the remission of this disease leads to nutritional recovery. The effect of biological therapy on body composition and nutritional status is unclear. METHOD:: Prospective study of body assessment by bioelectrical impedance method in patients with moderate to severe CD undergoing treatment with infliximab. The main outcome was the body composition before and after 6 months of anti-TNF therapy. RESULTS:: There was a predominance of females (52%) with a mean age of 42±12 years. Most patients were eutrophic at baseline and remained so. There was an increase in all parameters of body composition after anti-TNF treatment: BMI (22.9±3.2 versus 25±3.8; p=0.005), waist circumference (88.1±6.7 versus 93.9±7.7; p=0.002), lean mass index (17.5±2.2 versus 18.2±2.3; p=0.000) and fat mass index (5.5±2.3 versus 6.8±2.3; p=0.000). Phase angle remained unchanged (6.2 versus 6.8; p=0.94). CONCLUSION:: After therapy with IFX, all components of body composition increased, except for phase angle. The substantial increase in fat mass index and waist circumference led to concern regarding cardiovascular risk and, thus, to the need for further studies.
Assuntos
Composição Corporal/efeitos dos fármacos , Doença de Crohn/tratamento farmacológico , Fármacos Gastrointestinais/uso terapêutico , Infliximab/uso terapêutico , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Adulto , Antropometria , Doença de Crohn/fisiopatologia , Impedância Elétrica , Exercício Físico/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Estudos Prospectivos , Desnutrição Proteico-Calórica/prevenção & controle , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Inquéritos e Questionários , Fatores de Tempo , Resultado do TratamentoRESUMO
Summary Introduction: Protein-energy malnutrition in Crohn's disease (CD) has been reported in 20 to 92% of patients, and is associated with increased morbidity and mortality and higher costs for the health system. Anti-TNF drugs are a landmark in the clinical management, promoting prolonged remission in patients with CD. It is believed that the remission of this disease leads to nutritional recovery. The effect of biological therapy on body composition and nutritional status is unclear. Method: Prospective study of body assessment by bioelectrical impedance method in patients with moderate to severe CD undergoing treatment with infliximab. The main outcome was the body composition before and after 6 months of anti-TNF therapy. Results: There was a predominance of females (52%) with a mean age of 42±12 years. Most patients were eutrophic at baseline and remained so. There was an increase in all parameters of body composition after anti-TNF treatment: BMI (22.9±3.2 versus 25±3.8; p=0.005), waist circumference (88.1±6.7 versus 93.9±7.7; p=0.002), lean mass index (17.5±2.2 versus 18.2±2.3; p=0.000) and fat mass index (5.5±2.3 versus 6.8±2.3; p=0.000). Phase angle remained unchanged (6.2 versus 6.8; p=0.94). Conclusion: After therapy with IFX, all components of body composition increased, except for phase angle. The substantial increase in fat mass index and waist circumference led to concern regarding cardiovascular risk and, thus, to the need for further studies.
Resumo Introdução: Desnutrição proteico-calórica em pacientes de doença de Crohn (DC) tem sido relatada em 20 a 92% dos casos associando-se a maior morbimortalidade e maiores custos para o sistema de saúde. Agentes anti-TNF são um marco no controle clínico, promovendo remissão prolongada em portadores de DC. Acredita-se que a remissão da doença leve à recuperação nutricional desses pacientes. O efeito da terapia biológica na composição corporal e no estado nutricional é pouco conhecido. Método: Estudo prospectivo de avaliação corporal por método de bioimpedância em portadores de DC moderada a grave submetidos a terapia com infliximabe (IFX). O desfecho principal foi a composição corporal antes e após 6 meses de terapia anti-TNF. Resultados: Houve predomínio do sexo feminino (52%), com média de idades de 42±12 anos. A maioria dos pacientes era eutrófica na inclusão do estudo e assim permaneceu. Houve aumento de todos os parâmetros da composição corporal após o tratamento anti-TNF: IMC (22,9±3,2 versus 25±3,8; p=0,005), circunferência abdominal (88,1±6,7 versus 93,9±7,7; p=0,002), índice de massa magra (17,5±2,2 versus 18,2±2,3; p=0,000) e índice de massa gorda (5,5±2,3 versus 6,8±2,3; p=0,000). O ângulo de fase manteve-se inalterado (6,2 versus 6,8; p=0,94). Conclusão: Após terapia com IFX, observou-se aumento de todos os componentes da composição corporal, exceto no ângulo de fase. O aumento substancial do índice de massa gorda e da circunferência abdominal levantam a preocupação de aumento nos riscos cardiovasculares e necessidade de estudos complementares.