Associação entre ângulo de fase, avaliação subjetiva global e métodos objetivos de avaliação nutricional em pacientes com câncer do trato gastrointestinal superior

Abstract

Malnutrition is the most common complication in cancer. Tumors of the upper gastrointestinal tract lead to a worse nutritional prognosis. This thesis includes a literature review that evaluates the use of the patient-generated subjective global assessment (PG-SGA) method in patients with upper gastrointestinal tract cancer, and an observational and crosssectional study that describes the nutritional status and verifies the association between phase angle, PG-SGA and anthropometry (% of weight loss, body mass index- BMI, arm circumference- AC, arm muscle circumference- AMC and the calf- CC, and triceps skinfold-TSF), biochemical (blood count, total protein, albumin and total lymphocyte count) and bioelectrical impedance analysis - BIA (% water, fat and fat-free mass) in these patients. Among the main findings of the literature review, it was observed that PG-SGA presents a possibility to be repeated in short intervals of time, and is indicated as a method of patient evolution in nutritional therapy. However, of the 21 studies surveyed, the majority limit themselves to assessing only the nutritional profile. The importance of evaluating the effectiveness of nutritional therapy was demonstrated, although only two studies included this approach. It was observed that there exists a high prevalence of malnutrition in elderly patients with cancer. It was also observed that tumors of the gastrointestinal tract are three times more likely to cause malnutrition. It is important to periodically re-evaluate these patients according to PG-SGA to optimize nutritional therapy and the results of the treatment, and minimize the effects of the disease. Regarding the cross-sectional study, the main results were observed as follows: PG-SGA indicated malnutrition in 88.5%. In the biochemical assessment, the total lymphocyte count and albumin depletion showed 73.1% and 48.6%, respectively. According to the anthropometry: weight loss reached 96%; the BMI showed malnutrition in 36%, the depletion of fat in the patient reached 84%; according to the AC and AMC: malnutrition in 85.7% and 64%, respectively. The elderly had a 50% depletion of the CC. The BIA showed 56% with depleted fat-free mass. The phase angle (PA) was <5º in 42.8% of patients, while 86.7% were considered severely malnourished by the PG-SGA, and of these 76.9% were elderly. The associations found between PA, PG-SGA and other variables allowed to identify the most appropriate nutritional indicators for the detection of malnutrition in these patients.