Nutritional assessment of heart failure patients after listing for cardiac transplantation / Avaliação nutricional de pacientes portadores de insuficiência cardíaca no período pré-transplante cardíaco

AUTOR(ES)
DATA DE PUBLICAÇÃO

2008

RESUMO

Malnutrition is frequently present in patients with heart failure (HF) and is associated with an increase in morbidity and mortality. The objective of this study was to evaluate nutritional status of patients with refractory HF waiting for cardiac transplantation. Nutritional evaluation was done with the use of subjective global assessment, complete anthropometric measurements (body mass index (BMI), mid-arm circumference (MAC), triceps skinfold thickness (TSF), mid-arm muscle circumference (MAMC) and arm fat area), laboratory evaluation and food intake assessment in two moments: at the admission to the cardiac transplantation waiting list (1st evaluation) and after 4 months (2nd evaluation). On the 1st evaluation, we studied 56 patients, mean age 46±12 years, 67.8% were men, and 33.9% had Chagas disease. Analyzing anthropometric measurements, we found that, based on BMI 73.2% of patients were normal and 5.3% had underweight; MAMC revealed 66% with depletion. There was a negative and significant correlation between BMI and tumor necrosis factor-a (r= - 0.305; p<0.022). Laboratory evaluation showed that based on albumin levels, 50% of patients had some degree of depletion, based on transferrin 40% and on lymphocyte count 80%. There were negative and significant correlations between albumin and interleukin-6 (r= - 0.464; p<0.001), transferrin and interleukin-6 (r= -0.269; p<0.047) and lymphocyte count and interleukin-6 (r= -0.394; p<0.003). On the 2nd evaluation 18 patients were studied. There were no significant differences in the studied parameters between the 1st and 2nd evaluations. Based on the food intake assessment, percentage of adequacy of calories intake was 85% and 84% on 1st and 2nd evaluations, and more than 70% of patients had adequate protein intake on both evaluations. Low intake of calcium, potassium, magnesium, zinc, folate and vitamin E was detected. Daily sodium intake was found to be above the recommended levels. Fourteen patients were submitted to cardiac transplantation, mean age 44±21 years, 57.1% were men. Four patients died in post operative period. No relation was observed between anthropometric, laboratory, alimentary adequacy and age variables between patients transplanted that survive (n=9) and that died (n=4). We concluded that malnutrition is common in patients with refractory HF listed for cardiac transplantation. Nutritional assessment based on BMI did not show to be a good index to detect nutritional disorders and need to be used together with MAC, TSF, MAMC and arm fat area. Laboratory evaluation permitted the detection of compromised nutritional status. The participation of inflammatory cytokines in the process of malnutrition was evidenced in our population. Therefore, a complete nutritional evaluation should be part of routine care of patients with chronic HF, particularly in those with refractory HF waiting for cardiac transplantation

ASSUNTO(S)

cachexia nutrition assessment heart failure heart transplantation insuficiência cardíaca avaliação nutricional caquexia transplante de coração

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