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Estado nutricional, atividade física e qualidade de vida em crianças e adolescentes com doença de Crohn : um estudo caso-controlo
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Introdução: A Doença de Crohn (DC) em idade pediátrica está reconhecidamente associada a elevada prevalência de desnutrição, tendo sido reportada entre 23% na doença remissiva e 85% na doença ativa. Por outro lado, o curso imprevisível da doença torna-a disruptiva do ponto de vista psicológico, social e familiar, condicionando a absentismo escolar e a diminuição da prática regular de atividade física (AF) e da qualidade de vida (QV).
Objetivos: Avaliação do estado nutricional, das necessidades energéticas, da atividade física e da qualidade de vida em crianças e adolescentes com DC e comparação com um grupo de controlos “saudáveis”.
Metodologia: Estudo caso-controlo, transversal e observacional. Foram avaliadas, 30 crianças/adolescentes com DC e 50 controlos “saudáveis”. A avaliação de ambos os grupos contemplou a ingestão alimentar (registo alimentar de 3 dias), antropometria: peso, altura, índice de massa corporal (IMC), perímetro braquial (PB) e prega cutânea tricipital (PCT) (expressos em z-score e percentil); composição corporal obtida por Bioimpedância elétrica e expressa em massa gorda (MG) e massa isenta em gordura (MIG); AF (questionário de Baecke e colaboradores) e QV (IMPACT III® ou KIDSCREEN-27®). No grupo de estudo, foram ainda avaliadas variáveis clinicas relacionadas com a doença, nomeadamente localização, extensão e atividade da mesma, bem como alguns parâmetros bioquímicos. O tratamento estatístico foi efetuado com recurso ao software SPSS for Windows versão 22.
Discussão/conclusão: Os resultados do presente estudo, refletem que estes doentes apesar de bem nutridos segundo o IMC exibem importantes alterações na composição corporal, caracterizadas por um excesso de MG e um défice de MIG. Além disso, estes doentes praticavam significativamente menos exercício do que o grupo de controlos “saudáveis”, podendo este fator contribuir para os desequilíbrios ao nível da composição corporal. O presente estudo evidencia que os doentes apresentam défices de ingestão de macro e micronutrientes específicos, dados estes que reforçam a importância de um acompanhamento nutricional a longo termo, independentemente da fase da doença. As crianças e adolescentes com DC apresentaram níveis de QV semelhantes ao grupo de controlo.
Introduction: Crohn’s disease (CD) in paediatric patients has been associated with high prevalence of malnutrition. Due to its unpredictable course, the disease is psychologically, socially and familiarly disruptive, leading to school absenteeism and to the decrease of regular physical activity (PA) and quality of life (QoL). Objective: To assess nutritional status, through anthropometric measures and electric bioimpedance, PA levels and QoL, in CD patients and to compare the obtained data with a healthy control group. Methodology: Case-control, cross-sectional observational study. Thirty children/adolescents with CD and 50 "healthy" controls were evaluated. The assessment in both groups included food intake (food record of 3 days), anthropometry: weight, height, body mass index (BMI), arm circumference and triceps skinfold (expressed as z-score and percentile); body composition obtained by electrical bioimpedance and expressed as fat mass (FM) and fat-free mass (FFM); PA (Baecke et al) and QoL (IMPACT III® or KIDSCREEN®). In the study group, clinical variables related to the disease, such as location, extent and activity of the same and some biochemical parameters were also evaluated. Statistical analysis was conducted with IMB® SPSS® v.22. Discussion/conclusion: The results of this study showed that patients exhibit significant changes in body composition, characterized by an excess of FM and a deficit of FFM, even though the BMI showed they were eutrophic. In addition, in our sample the PA practice was significantly lower than in the "healthy" control group, which might also contribute to the imbalance in body composition. Furthermore CD patients had specific macro and micronutrients intake deficits. These data highlight the importance of nutritional counseling, regardless of the disease activity. Finally, this study showed that QoL levels were similar in children and adolescents with CD, as compared to the control group.
Introduction: Crohn’s disease (CD) in paediatric patients has been associated with high prevalence of malnutrition. Due to its unpredictable course, the disease is psychologically, socially and familiarly disruptive, leading to school absenteeism and to the decrease of regular physical activity (PA) and quality of life (QoL). Objective: To assess nutritional status, through anthropometric measures and electric bioimpedance, PA levels and QoL, in CD patients and to compare the obtained data with a healthy control group. Methodology: Case-control, cross-sectional observational study. Thirty children/adolescents with CD and 50 "healthy" controls were evaluated. The assessment in both groups included food intake (food record of 3 days), anthropometry: weight, height, body mass index (BMI), arm circumference and triceps skinfold (expressed as z-score and percentile); body composition obtained by electrical bioimpedance and expressed as fat mass (FM) and fat-free mass (FFM); PA (Baecke et al) and QoL (IMPACT III® or KIDSCREEN®). In the study group, clinical variables related to the disease, such as location, extent and activity of the same and some biochemical parameters were also evaluated. Statistical analysis was conducted with IMB® SPSS® v.22. Discussion/conclusion: The results of this study showed that patients exhibit significant changes in body composition, characterized by an excess of FM and a deficit of FFM, even though the BMI showed they were eutrophic. In addition, in our sample the PA practice was significantly lower than in the "healthy" control group, which might also contribute to the imbalance in body composition. Furthermore CD patients had specific macro and micronutrients intake deficits. These data highlight the importance of nutritional counseling, regardless of the disease activity. Finally, this study showed that QoL levels were similar in children and adolescents with CD, as compared to the control group.
Descrição
Tese de mestrado, Nutrição Clínica, Faculdade de Medicina, Universidade de Lisboa, 2015
Palavras-chave
Estado nutricional Atividade física Doença de Crohn Crianças Adolescentes Teses de mestrado - 2015