Estado nutricional de pacientes com neoplasia do trato digestivo no estágio pré-cirúrgico

Abstract

Cancer is currently a public health problem worldwide, with a view to increasing its incidence according to a recent epidemiological transition, characterized by the change in mortality profile with the decrease of the infectious disease rate and concomitant increase of the chronic-degenerative disease rate. Cancer is a genetic disease, characterized by the local uncontrolled proliferation of abnormal cells, with the invasion of adjacent normal structures and distant dissemination. The impairment of the nutritional status is an important problem associated with cancer, particularly in those located in the digestive tract. In general, individuals with these neoplasias present reduction of the dietary intake and consequent malnutrition. This work aims to know the nutritional status of patients with digestive tract cancer in pre-surgical stage through the use of different methods of nutritional evaluation. It was performed a transversal descriptive study, from January to June in 2012, with patients hospitalized in João de Barros Barreto University Hospital and Ophir Loyola Hospital in Belém-Pa, that included individuals of both gender and age equal or superior to 19 years old. To determine the nutritional status, it was utilized anthropometric parameters (BMI, TST, %WLP, AC, AMC, CAMA), biochemical indicators (serum albumin, hemoglobin, hematocrit and TLC) and clinical indicators (alterations in skin, nail, mouth and hair, loss of subcutaneous fat and muscle tissue), besides the patient-generated subjective global assessment and the nutritional risk index. It was also applied the food frequency questionnaire to verify the eating habits of these patients. It was evaluated 70 patients with average age of 58 ±12 years old, in which 62.9% were man, 60% had stomach neoplasia, 31.4% had intestine neoplasia and 8.6% had esophageal cancer (p-value < 0.005). According to the results, 40% e 41.4% were eutrophic when evaluated by the BMI and AMC, respectively. According to %WLP and TST, 57.1% and 60% had severe malnutrition, respectively, while based in AC, there was a trend to a mild malnutrition (40%). The PG-SGA showed that 73.1% of these patients presented some malnutrition degree, while by the NRI, 71.4% were malnourished predominantly with the severe form (64.3%). The most frequent clinical signs were loss of subcutaneous fat (64.3%) and muscle depletion (52.8%). In the biochemical evaluation, it was found that 47.1% of patients prevalently presented appropriate values of serum albumin, and for the hematocrit and hemoglobin results, it was observed that the values tended to be below the reference (61.4% and 70%, respectively), revealing the presence of anemia in most of the individuals. Based on the TLC analysis, values were within the normal range in 37.1% and depletion in approximately 63% of the sample. It stood out among the studied population`s eating pattern high consumption of food group of cereals, tubers and roots, and low consumption of fruits and vegetables. It was found that cancer patients presented relevant impairment of its nutritional status in the anthropometric, biochemical and clicnical aspects, according to several parameters utilized, and they had inappropriate eating habits, which yields to a relevant reduction of food with nutrient sources that may protect against carcinogenesis.