Avaliação de métodos para identificar desnutrição energético-protéica de pacientes em hemodiálise / Assessment of methods to identify protein-energy wasting in patients on hemodialysis

INTRODUÇÃO: O método capaz de melhor identificar desnutrição energético-protéica (DEP) em pacientes em hemodiálise (HD) ainda se mantém em debate. Logo, avaliamos o estado nutricional de pacientes em HD por diferentes métodos e verificamos qual deles identificava o maior número de pacientes com DEP. MÉTODOS: Quinze pacientes em HD (52,7 ± 10 anos; 33,3 por cento Masculino). O estado nutricional foi avaliado por medidas antropométricas, pela avaliação subjetiva global (ASG), por albumina plasmática e pelo consumo alimentar (recordatório de 24 horas). A gordura corporal foi avaliada por antropometria. O critério de diagnóstico de DEP preconizado pela International Society of Renal Nutrition and Metabolism (ISRNM) foi empregado. RESULTADOS: Observou-se que o índice de massa corporal esteve dentro da normalidade (24,2 ± 4,4 kg/m²). Ao avaliar a condição nutricional pela adequação da circunferência muscular do braço CMB) e da prega cutânea de tríceps (PCT) notou-se que a adequação da CMB esteve dentro dos parâmetros de normalidade (102,6 ± 13 por cento), ao passo que a adequação da PCT esteve abaixo da normalidade (Feminino: 75,3 ± 40,4 por cento; Masculino: 73,5 ± 20,6 por cento). Contudo, o percentual de gordura corporal esteve elevado (Feminino: 34,5 ± 7,3 por cento; Masculino: 23,6 ± 4,2 por cento). Com relação à ASG, a maioria dos pacientes (n = 12) apresentou algum grau de desnutrição e este constituiu o método que identificou o maior número de pacientes com DEP. Ao empregar os critérios da ISRNM, notou-se que apenas dois pacientes apresentaram DEP. CONCLUSÃO: Todos os pacientes avaliados encontravam-se com DEP por algum dos métodos utilizados. A ASG foi o método que, isoladamente, conseguiu detectar o maior número de pacientes com DEP.

INTRODUCTION: The method capable of best identifying protein-energy wasting (PEW) in hemodialysis (HD) patients is controversial. Thus, we assessed the nutritional status of HD patients by use of different methods and verified which one identified the highest number of patients with PEW. METHODS: The study assessed the nutritional status of 15 HD patients (age: 52.7 ± 10.1 years; males: 33.3 percent) by use of anthropometric measurements, subjective global assessment (SGA), serum albumin, and dietary intake (24-hour food recall). Body fat was assessed by use of anthropometry. The International Society of Renal Nutrition and Metabolism (ISRNM) criteria were used to diagnose PEW. RESULTS: The body mass index (24.2 ± 4.4 kg/m²) and the percentage of standard value for mid-arm muscle circumference were within the normal limits (102.6 ± 13 percent). Nevertheless, the percentage of standard value for triceps skinfold was below the normal limits (females, 75.3 ± 40.4 percent; and males, 73.5 ± 20.6 percent), although a high body fat percentage was observed (females, 34.5 ± 7.3 percent; males, 23.6 ± 4.2 percent). When assessing the nutritional status by use of SGA, most patients (80 percent, n = 12) were malnourished, and SGA was the method that identified the highest number of patients with PEW. By using the ISRNM criteria, PEW was diagnosed in only two patients. CONCLUSION: All patients were diagnosed with PEW by use of one of the methods studied. The SGA was the method that, in isolation, could detect the greatest number of patients with PEW.

Dietary counseling on long-term weight loss in overweight hypertensive patients

OBJECTIVE: This study aimed to evaluate long-term weight loss in overweight hypertensive patients receiving dietary counseling. METHODS: Longitudinal study included overweight hypertensive patients who had an initial individual consultation with a nutritionist between January 2002 and December 2005 and were followed for four years in a hypertension clinic. Patients who had at least four consultations during the follow-up period were included in the dietary counseling group. Those who scheduled their first consultation but missed that appointment or had fewer than four consultations during the follow-up period were allocated to the control group. Target Energy intake was calculated at 20-25 kcal/kg actual body weight/day. RESULTS: The study included 102 patients aged 55 + 1 years old (58 in the dietary counseling group). As compared with the control group, patients in the dietary counseling group showed a significantly greater reduction in body weight (-3.6 + 0.8 vs. 0.8 + 0.7 kg), which remained significant after controlling for age, gender, baseline body mass index, and the use of different antihypertensive and antidiabetic drugs. Weight loss between 5.0 percent and 9.9 percent was observed in a significantly higher percentage of patients in the dietary counseling group (28 percent vs. 11 percent). A weight loss of at least 10 percent was only observed in dietary counseling group patients, who had a significantly lower odds ratio for increasing the number and/or dosage of antihypertensive agents, even after controlling for age, gender, and baseline body mass index. CONCLUSIONS: Dietary counseling may be associated with long-term weight loss in overweight hypertensive patients.