Evaluación nutricional de pacientes cirróticos compensados

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Abstract

Introducción: la malnutrición proteico-energética es la complicación más frecuente en pacientes cirróticos, la valoración nutricional es difícil y la atención en este sentido es deficiente. Objetivo: evaluar el estado nutricional de los pacientes con cirrosis hepática. Métodos: se realizó un estudio observacional descriptivo de 19 pacientes, de ambos sexos, entre 15 y 60 años de edad, con diagnóstico de cirrosis hepática compensada, atendidos en el Hospital Clinicoquirúrgico "10 de Octubre", desde enero de 2008 a enero de 2009, para evaluar el estado nutricional. Se utilizaron variables como: edad y sexo, antropométricas (peso, talla, circunferencia del brazo e Índice de masa corporal), de laboratorio y dietéticas. Resultados: predominó el sexo masculino y el grupo de 45 a 54 años de edad. El mayor número de pacientes estuvo entre 6 meses y un año del diagnóstico. Se encontró un porcentaje elevado de desnutrición, según índice de masa corporal, la circunferencia del brazo fue el indicador antropométrico menos afectado. La anemia se presentó en más del 50 % y el 26 % tuvo linfopenia. Se evidenció que al disminuir la frecuencia de comidas al día, aumentó la frecuencia e intensidad de la malnutrición. Conclusiones: la frecuencia de malnutrición proteico-energética en la población cirrótica estudiada fue elevada, con mayor índice de malnutrición en casos de origen alcohólico, además se comprobó que el estado nutricional del paciente cirrótico no puede ser valorado al margen de factores dietéticos.

Translated abstract

Introduction: protein-energy malnutrition is the most common complication in cirrhotic patients. Nutritional assessment is difficult and care is deficient. Objective: evaluate the nutritional status of patients with liver cirrhosis. Methods: an observational descriptive study was conducted of 19 patients of both sexes aged 15-60 diagnosed with compensated liver cirrhosis, cared for at 10 de Octubre Clinical Surgical Hospital from January 2008 to January 2009, with the purpose of evaluating their nutritional status. The variables studied were age and sex, anthropometric measurements (weight, height, arm circumference and body mass index), laboratory data and dietary information. Results: there was a prevalence of the male sex and the 45-54 age group. Most patients were between 6 months and one year from diagnosis. Malnutrition was found to be high, based on body mass index. Arm circumference was the least affected anthropometric indicator. Anemia was present in more than 50 %, and 26 % had lymphopenia. It was found that as the frequency of meals a day decreased, there was an increase in the frequency and intensity of malnutrition. Conclusions: protein-energy malnutrition was high in the cirrhotic population studied, with higher malnutrition rates in cases of alcoholic origin. It was also found that the nutritional status of cirrhotic patients can only be assessed with reference to dietary factors.

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Most cited references 23

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State of malnutrition in Cuban hospitals.

J Barreto Penié, (2005)

We assessed the current state of undernutrition as observed in 1905 patients hospitalized in 12 Cuban health care institutions, as part of a Latin American, multinational survey similar in design and goals. We surveyed 1905 randomly selected patients from 12 Cuban hospitals in a two-phase study. Patients' clinical charts were audited in phase 1, the Subjective Global Assessment was used to assess patients' nutritional status in phase 2. The study was locally conducted by a properly trained team. The frequency of undernutrition in Cuban hospitals was 41.2% (95% confidence interval = 38.9 to 43.4), and 11.1% of patients were considered severely undernourished. Statistically significant (P < 0.05) univariate relations were identified between undernutrition and patient's age and sex. Nutritional status was a dependent of the patient's instruction level (P < 0.05). Patients' nutritional status was statistically associated with the presence of cancer and infection. Undernutrition was highly prevalent among cancer patients, no matter the stage of medical or surgical treatment. Undernutrition became extremely frequent after surgical treatment in non-cancer patients. High nutritional risks hospital services/specialties were identified: geriatrics (56.3%), critical care (54.8%), nephrology (54.3%), internal medicine (48.6%), gastroenterology (46.5%), and cardiovascular surgery (44.8%). Malnutrition rates increased progressively with prolonged length of stay. A high malnutrition rate was observed among participating hospitals. The design and inception of policies that foster intervention programs focusing on early identification of hospital malnutrition and its timely management is suggested to decrease its deleterious effects on outcomes of health care in the participating hospitals.