Avaliação nutricional de pacientes submetidos à cirurgia do trato gatrointestinal: associação entre avaliação subjetiva global, ferramentas de triagem nutricional e métodos objetivos

EnglishIntroduction: The presence of malnutrition in the preoperative period increases the frequency of infectious and non-infectious complications after surgery. Thus a careful assessment of nutritional status is required for the adoption of strategies to maintain or restore health. Objective: To investigate the association between Subjective Global Assessment (SGA) and nutritional screening tools and classic anthropometry. Methods: Cross-sectional study conducted from February to July 2011, candidates for major surgery of the gastrointestinal tract, 18 years, of both sexes. The following data were collected: Nutritional Risk Score (NRS) and Nutritional Risk Index (NRI), SGA, weight, height and body mass index (BMI), arm circumference, triceps skin fold thickness, arm muscle circumference, adductor pollicis muscle thickness, albumin, total lymphocyte count, hematocrit and hemoglobin. Data were tabulated using the software Excel 2007 and statistical analyzes were performed using SPSS version 13.0 (SPSS® Inc., Chicago, IL, USA). Continuous variables were tested for normal distribution using the KolmogorovSmirnov test and, once all of them showed normal distribution, they were expressed as mean and standard deviation. To verify the existence of association between categorical variables, the chi square of Pearson and the Fisher exact test were used. For comparison between two groups, the Student t test was applied. The significance level of 5% (p Results: 46 patients were evaluated, aged 56.24 ± 14.38 years, 67.4% (n = 31) female. Approximately 61% and 21.7% were classified as malnourished by SGA and BMI, respectively. Hypoalbuminemia was present in 41% of patients. The NRS tool has classified 65.2% of patients in moderate to severe nutritional risk while only 32.5% have had this classification according to the NRI. There was a significant association between SGA and weight loss percentage, NRS and NRI. Conclusion: Weight loss percentage, NRS and NRI can be used as nutritional screening tools in surgical patients, since these screening tools have showed significant association with SGA, which is considered the gold standard tool in assessing the nutritional status of these patients. portuguesIntroducao: A presenca de desnutricao no periodo pre-cirurgico aumenta a frequencia de complicacoes infecciosas e nao-infecciosas no pos-operatorio. Dessa forma, uma avaliacao do estado nutricional criteriosa e necessaria para a adocao de estrategias que visem a manutencao ou recuperacao da saude. Objetivo: Verificar a associacao entre a Avaliacao Subjetiva Global (ASG) e ferramentas de triagem nutricional e metodos objetivos. Metodos: Estudo transversal, realizado no periodo de fevereiro a julho de 2011, com candidatos a grandes cirurgias do trato gastrointestinal, maiores de 18 anos, de ambos os sexos. Foram coletados os seguintes dados: Nutritional Risk Score (NRS) e Nutritional Risk Index (NRI), ASG, peso e altura para o calculo do indice de massa corporal (IMC), circunferencia braquial, prega cutânea tricipital, circunferencia muscular do braco, espessura do musculo adutor do polegar, albumina, contagem total de linfocitos, hematocrito e hemoglobina. Os dados foram tabulados utilizando o Software Excel 2007 e realizadas as analises estatisticas no SPSS versao 13.0 (SPSS® Inc., Chicago, IL, USA). As variaveis continuas foram testadas quanto a normalidade da distribuicao pelo teste de Kolmogorov Smirnov e todas apresentaram distribuicao normal, sendo entao expressas na forma de media e desvio padrao. Para verificar a existencia de associacao entre as variaveis categoricas foi utilizado o teste do Qui quadrado de Pearson e o teste exato de Fisher e, para comparacao entre dois grupos, utilizou-se o Teste t Student. Foi utilizado o nivel de significância de 5% (p Resultados: Foram avaliados 46 pacientes com idade de 56,24 ± 14,38 anos, sendo 67,4% (n=31) do sexo feminino. Aproximadamente 61% e 21,7% foram classificados como desnutridos pela ASG e IMC, respectivamente. A hipoalbuminemia esteve presente em 41% dos pacientes. O NRS classificou 65,2% dos pacientes em risco nutricional moderado a grave en quanto o NRI classificou apenas 32,5%. Houve associa- cao significativa entre ASG e percentual de perda de peso, NRS e NRI. Conclusao: O percentual de perda de peso, o NRS e o NRI podem ser utilizados como ferramenta de triagem nutricional desses pacientes, visto que foi observada associacao significativa com ASG, ferramenta considerada padrao-ouro na avaliacao do estado nutricional de pacientes cirurgicos.