Concordância entre medidas de avaliação nutricional, composição corporal e força muscular em pacientes com doença hepática crônica

Abstract

The liver performs fundamental functions for human homeostasis. Chronic liver disease (CLD) arises from liver injuries that, during the healing process, cause changes in the normal architecture of the liver, which can lead to loss of function of this organ, with liver transplantation (LTx) being one of the therapies used in patients with DHC in advanced stage. As a consequence of metabolic changes, it is common to find patients suffering from malnutrition, sarcopenia and frailty, situations that increase the risk of mortality in these individuals. However, due to the complications common to CLD, nutritional assessment in these patients becomes a challenge. In this context, the present study aimed to identify the agreement between measures commonly used in nutritional assessment, muscle strength and diagnosis of sarcopenia, with the nutritional risk status identifiedby the Royal Free Hospital Nutrition Prioritizing Tool (RFH-NPT) in patients with CLD treated at the clinic of the hepatology service of the University Hospital of Maceió-AL. This is a cross-sectional, study, in which socioeconomic, clinical, anthropometric, muscular strength (through dynamometry), subjective (RFH-NPT) and body composition data were collected through Dual-energy X-ray absorptiometry (DEXA). Bioimpedance was also performed to determine the phase angle (PA), in addition to screening for the risk of sarcopenia using the SARC-F and SARC-Calf questionnaires. Frailty was determined using the Liver Fragility Index (LFI). To compare frequencies, the chi-square test or Fischer's exact test with Bonferroni adjustment was performed. To evaluate the agreement between the instruments, the kappa (ÿ) agreement test was used and classified as poor, mild, regular, moderate, substantial and almost perfect. Data were analyzed using the Statistical Package for Social Science SPSS® version 26.0 software. The sample included 41 patients, with a mean age of 46.68 ±14.26 years, 35 adults and 6 elderly and mostly male (68.3%, n=68.3). When evaluating the agreement between the analyzed variables and the RFH-NPT, the only measure that showed moderate agreement with this subjective survey was the adequacy of the arm circumference (AC), (p= 0,001; y= 0,502). These results suggest that AC associated with RFH-NPT can contribute to a better assessment of liver patients and should be incorporated into the routine of health professionals who monitor these patients.