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Avaliação do estado nutricional em indivíduos com imunodeficiência comum variável (IDCV)
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Introdução: A Imunodeficiência comum variável (IDCV) constitui um distúrbio de imunodeficiência primária heterogéneo. No que diz respeito ao estado nutricional (EN), estes indivíduos são um grupo vulnerável a estados de desnutrição devido ao estado infecioso recorrente, à diarreia e mal absorção característica.
Objetivo: Avaliar o estado nutricional, a adesão à Dieta mediterrânica (DM), a sintomatologia gastrointestinal (GI) e a qualidade de vida de um grupo de doentes adultos com IDCV.
Metodologia: Estudo analítico descritivo e exploratório, observacional, longitudinal, que incluiu 39 doentes com diagnóstico de IDCV em ambulatório. Recolheram-se dados sociodemográficos, de caracterização da doença, complicações decorrentes da IDCV, terapêutica com impacto nutricional e parâmetros analíticos. A avaliação nutricional incluiu medidas antropométricas - peso corporal, altura e Índice de Massa Corporal IMC - e parâmetros de composição corporal - Bioimpedância elétrica (BIA), prega cutânea tricipital (PCT), perímetro da cintura (PC), perímetro da anca (PA) e perímetro do braço (PB). A ingestão alimentar foi analisada recorrendo a recall 24h e diário alimentar realizado durante 3 dias não consecutivos. A avaliação da adesão à DM foi realizada pela aplicação do questionário Prevención com dieta Mediterránea (PREDIMED). A qualidade de vida foi avaliada por aplicação do questionário “CVID_QoL” validado e traduzido em português. A sintomatologia GI foi avaliada através do questionário Gastrointestinal Symptom Rating Scale (GSRS) validado em português do Brasil. Todos os procedimentos de avaliação do estado nutricional e questionários foram repetidos em dois momentos de avaliação – baseline e 2º momento de avaliação após 3 meses da intervenção nutricional, tendo sido avaliados 34 indivíduos no baseline e 30 no 2º momento. A análise estatística foi efetuada recorrendo ao software IBM®SPPS® Statistics versão 28.0.
Resultados: Apesar da maioria dos indivíduos (64,7%) ter apresentado inicialmente peso normal (de acordo com o IMC), a avaliação do seu estado nutricional (de acordo com os valores de adequação do PB e de adequação da circunferência muscular do braço corrigida - CMBc) mostrou desnutrição na maioria dos casos (ligeira e grave em 13 e 17 dos indivíduos, respectivamente). No sexo feminino houve diminuição significativa da massa gorda (MG) (kg) (p=0,012). O IMC diminuiu de forma significativa (p=0,008). A adesão à DM aumentou de forma significativa (p=0,006). O score ao componente da diarreia diminuiu significativamente a entre os dois momentos (p=0,02).
Conclusão: A intervenção alimentar e nutricional pode ter efeitos benéficos na redução de MG e aumento de massa muscular destes indivíduos, bem como na diminuição de sintomas GI como a diarreia, melhorando a qualidade de vida.
Introduction: Common variable immunodeficiency (CVID) represents a heterogeneous primary immunodeficiency disorder. Regarding the nutritional status (EN), these patients are vulnerable to malnutrition due to recurrent infections, diarrhea and characteristic malabsorption. Purpose: To evaluate the nutritional status, compliance to the Mediterranean Diet (MD), gastrointestinal (GI) symptoms and quality of life of a group of adult patients with CVID. Methodology: Descriptive and exploratory, observational, longitudinal analytical study, which included 39 patients diagnosed with CVID in an outpatient context. Sociodemographic data, disease characterization, complications resulting from CVID, therapeutics with nutritional impact and analytical parameters were collected. The nutritional assessment included anthropometric measurements - body weight, height and Body Mass Index (BMI) - and body composition parameters - Bioelectrical impedance analysis (BIA), tricipital skinfold (TSF), waist circumference (WC), hip circumference (HC) and arm perimeter (AP). Food intake was analyzed using a 24-hours recall and a food diary carried out for 3 non-consecutive days. The assessment of the compliance to the MD was carried out by applying the Prevención com diet Mediterránea (PREDIMED) questionnaire. The quality of life was assessed by applying the “CVID_QoL” questionnaire, validated and translated to Portuguese. The GI symptoms were assessed using the Gastrointestinal Symptom Rating Scale (GSRS) questionnaire validated in Brazilian Portuguese. All nutritional status assessment procedures and questionnaires were repeated at two assessment moments – baseline and 2nd assessment moment 3 months after the nutritional intervention, with 34 patients being evaluated at baseline and 30 at the 2nd moment. Statistical analysis was carried out using IBM®SPPS® Statistics version 28.0 software. Results: Although the majority of individuals (64.7%) initially presented a normal weight (according to BMI), the assessment of their nutritional status (according to the adequacy values of AP and adequacy of corrected arm muscle circumference - CMBc) showed malnutrition in most cases (mild and severe in 13 and 17 of the individuals, respectively). In females, there was a significant decrease in fat mass (FM) (kg) (p=0.012). The BMI decreased significantly (p=0.008). The compliance to the MD increased significantly (p=0.006). The diarrhea component score significantly decreased between the two moments (p=0.02). Conclusion: Food and nutritional intervention can have beneficial effects on reducing FM and increasing muscle mass in these patients, as well as on reducing GI symptoms such as diarrhea, improving quality of life.
Introduction: Common variable immunodeficiency (CVID) represents a heterogeneous primary immunodeficiency disorder. Regarding the nutritional status (EN), these patients are vulnerable to malnutrition due to recurrent infections, diarrhea and characteristic malabsorption. Purpose: To evaluate the nutritional status, compliance to the Mediterranean Diet (MD), gastrointestinal (GI) symptoms and quality of life of a group of adult patients with CVID. Methodology: Descriptive and exploratory, observational, longitudinal analytical study, which included 39 patients diagnosed with CVID in an outpatient context. Sociodemographic data, disease characterization, complications resulting from CVID, therapeutics with nutritional impact and analytical parameters were collected. The nutritional assessment included anthropometric measurements - body weight, height and Body Mass Index (BMI) - and body composition parameters - Bioelectrical impedance analysis (BIA), tricipital skinfold (TSF), waist circumference (WC), hip circumference (HC) and arm perimeter (AP). Food intake was analyzed using a 24-hours recall and a food diary carried out for 3 non-consecutive days. The assessment of the compliance to the MD was carried out by applying the Prevención com diet Mediterránea (PREDIMED) questionnaire. The quality of life was assessed by applying the “CVID_QoL” questionnaire, validated and translated to Portuguese. The GI symptoms were assessed using the Gastrointestinal Symptom Rating Scale (GSRS) questionnaire validated in Brazilian Portuguese. All nutritional status assessment procedures and questionnaires were repeated at two assessment moments – baseline and 2nd assessment moment 3 months after the nutritional intervention, with 34 patients being evaluated at baseline and 30 at the 2nd moment. Statistical analysis was carried out using IBM®SPPS® Statistics version 28.0 software. Results: Although the majority of individuals (64.7%) initially presented a normal weight (according to BMI), the assessment of their nutritional status (according to the adequacy values of AP and adequacy of corrected arm muscle circumference - CMBc) showed malnutrition in most cases (mild and severe in 13 and 17 of the individuals, respectively). In females, there was a significant decrease in fat mass (FM) (kg) (p=0.012). The BMI decreased significantly (p=0.008). The compliance to the MD increased significantly (p=0.006). The diarrhea component score significantly decreased between the two moments (p=0.02). Conclusion: Food and nutritional intervention can have beneficial effects on reducing FM and increasing muscle mass in these patients, as well as on reducing GI symptoms such as diarrhea, improving quality of life.
Descrição
Tese de mestrado, Nutrição Clínica, Universidade de Lisboa, Faculdade de Medicina, 2024
Palavras-chave
Estado nutricional Imunodeficiência comum variável Qualidade de vida Dieta mediterrânica Sintomas gastrointestinais Teses de mestrado - 2024