Avaliação antropométrica e sua associação com variáveis clínicas em pacientes pediátricos com fibrose cística de um centro no Nordeste brasileiro / Anthropometric assessment and its association with clinical variables in pediatric patients with cystic fibrosis from a center in the northeast of Brazil

RESUMO

Introdução: a avaliação e o acompanhamento nutricional fazem parte do cuidado integral dos pacientes com fibrose cística (FC), possibilitando intervenção precoce e tratamento mais efetivo da doença. Objetivo: avaliar o estado antropométrico de crianças e adolescentes com FC e pesquisar sua associação com variáveis clínicas e demográficas. Metodologia: estudo descritivo, incluindo-se indivíduos entre 1-19 anos de idade. Foram registradas medidas de peso, estatura, circunferência do braço (CB) e da prega cutânea tricipital (PCT) e calculados indicadores antropométricos (Peso/Idade- P/I, Altura idade -A/I e IMC/idade-IMC/I) e Circunferência Muscular do Braço (CMB). Comparou-se o indicador CMB com variáveis clínicas e demográficas através do cálculo de razões de prevalência (RP). Resultados: foram incluídos 41 pacientes, 53,6% do sexo masculino, mediana de idade de 78 meses. Quinze (36,6%) pacientes foram classificados como desnutridos pela avaliação da CMB (indicador IMC/I, apenas um (2,4%) apresentava magreza. Trinta (73,1%) pacientes tinha insuficiência pancreática (IP), determinada pela terapia de reposição enzimática (TRE) e/ou níveis da elastase fecal. Todos os pacientes realizaram pesquisas de mutações no gene CFTR e 38 (92,8%) tiveram duas variantes patológicas identificadas, dos quais 25 (65,8%) tinham pelo menos um alelo para a variante F508del. Dezesseis (39%) crianças cursavam com infecções respiratórias recorrentes. A desnutrição (CMBassociação positiva com as seguintes variáveis idade do diagnóstico, sexo masculino, PCT >P15, TRE, mutação F508/del e A/I<-2, observando-se maior associação com as três últimas, RP de 6,25, 3,12; e 2,06; respectivamente.

Conclusão:

o IMC pode não ser suficiente para a avaliação do estado nutricional na FC, pois subestima a prevalência de desnutrição. Com exceção das infecções respiratórias recorrentes, as demais variáveis tiveram associação com o indicador CMB

ABSTRACT

Introduction: the assessment and nutritional follow-up are part of the comprehensive care of cystic fibrosis (CF) patients enabling an early intervention and a more effective disease treatment. Objective: to assess the anthropometric status of children and adolescents with cystic fibrosis (CF) and to investigate its association with clinical and demographic variables. Methodology: descriptive study, including individuals between 1-19 years of age. Weight, height, arm circumference (AC) and tricipital skinfold (TSF) measurements were recorded and anthropometric indicators were calculated (Weight/Age-W/A, Height age -H/A and BMI/age-BMI/A) and Muscle Circumference of the Arm (AMC). The AMC indicator was compared with clinical and demographic variables by calculating prevalence ratios (PR). Results: 41 patients were included, 53.6% male, median age 78 months. Fifteen (36.6%) patients were classified as malnourished by the AMC assessment (indicator, only one (2,4%) was thin. Thirty (73.1%) patients had pancreatic insufficiency (PI), determined by enzyme replacement therapy (ERT) and/or fecal elastase levels. All patients underwent research for mutations in the CFTR gene and 38 (92.8%) had two pathological variants identified, of which 25 (65.8%) had at least one allele for the F508del mutation. Sixteen (39%) children had recurrent respiratory infections. Malnutrition (AMC association with the following variables age of diagnosis, male gender, TSF > P15, TRE, F508del variant and H/A <-2, with a greater association with the last three, PR of 6.25, 3.12; and 2.06; respectively.

Conclusions:

BMI may not be sufficient to assess nutritional status in CF since it underestimates the prevalence of malnutrition. Except for recurrent respiratory infections, the other variables were associated with the AMC indicator

Subject(s)

Humans; Male; Female; Infant; Child, Preschool; Child; Adolescent; Body Composition; Body Height; Body Weight; Anthropometry; Cystic Fibrosis; Cross-Sectional Studies

Anthropometry; Antropometria; Body composition; Composição corporal; Mucoviscidose; Mucoviscidosis

ABSTRACT

Introduction: the assessment and nutritional follow-up are part of the comprehensive care of cystic fibrosis (CF) patients enabling an early intervention and a more effective disease treatment. Objective: to assess the anthropometric status of children and adolescents with cystic fibrosis (CF) and to investigate its association with clinical and demographic variables. Methodology: descriptive study, including individuals between 1-19 years of age. Weight, height, arm circumference (AC) and tricipital skinfold (TSF) measurements were recorded and anthropometric indicators were calculated (Weight/Age-W/A, Height age -H/A and BMI/age-BMI/A) and Muscle Circumference of the Arm (AMC). The AMC indicator was compared with clinical and demographic variables by calculating prevalence ratios (PR). Results: 41 patients were included, 53.6% male, median age 78 months. Fifteen (36.6%) patients were classified as malnourished by the AMC assessment (indicator, only one (2,4%) was thin. Thirty (73.1%) patients had pancreatic insufficiency (PI), determined by enzyme replacement therapy (ERT) and/or fecal elastase levels. All patients underwent research for mutations in the CFTR gene and 38 (92.8%) had two pathological variants identified, of which 25 (65.8%) had at least one allele for the F508del mutation. Sixteen (39%) children had recurrent respiratory infections. Malnutrition (AMC association with the following variables age of diagnosis, male gender, TSF > P15, TRE, F508del variant and H/A <-2, with a greater association with the last three, PR of 6.25, 3.12; and 2.06; respectively.

Conclusions:

BMI may not be sufficient to assess nutritional status in CF since it underestimates the prevalence of malnutrition. Except for recurrent respiratory infections, the other variables were associated with the AMC indicator