A CIRCUNFERÊNCIA DA PANTURRILHA ESTÁ ASSOCIADA AO DESFECHO CLÍNICO E NUTRICIONAL EM PACIENTES IDOSOS?

MAZZINI, Lucas Rosasco; AQUINO, José Luis Braga de; CAMARGO, José Gonzaga Teixeira de; LEANDRO-MERHI, Vania Aparecida

doi:10.1590/0102-672020230055e1773

Brazil

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Original Article • ABCD, arq. bras. cir. dig. 36 • 2023 • https://doi.org/10.1590/0102-672020230055e1773 linkcopiar

A CIRCUNFERÊNCIA DA PANTURRILHA ESTÁ ASSOCIADA AO DESFECHO CLÍNICO E NUTRICIONAL EM PACIENTES IDOSOS?

Autoria SCIMAGO INSTITUTIONS RANKINGS

RESUMO

RACIONAL: Estudos anteriores mostraram uma relação entre a circunferência da panturrilha (CP) e desfechos em pacientes hospitalizados.

OBJETIVOS: Investigar a relação entre CP e desfecho clínico e nutricional em pacientes idosos hospitalizados (PIH) em uma enfermaria cirúrgica.

MÉTODOS: Este foi um estudo transversal com 417 PIH em uma enfermaria de cirurgia. Variáveis clínicas, antropometria e instrumentos de triagem nutricional como avaliação subjetiva global (ASG), mini avaliação nutricional (MAN) e triagem de risco nutricional (NRS) foram utilizados na investigação. Qui-quadrado, Mann-Whitney, Kruskal-Wallis, coeficiente de Spearman e análise de regressão linear múltipla foram usados para analisar os fatores associados a CP.

RESULTADOS: Menores valores de CP foram encontrados na faixa etária de 80 anos (p<0,0001), complicações (p=0,0269), risco nutricional pelo NRS (p<0,0001), ASG (p<0,0001) e MAN (p<0,0001). Sexo (p=0,0011; R2 parcial=0,01151), idade (p=0,0002; R2 parcial=0,06032), IMC (p≤0,0001; R2 parcial=0,40820) e circunferência do braço (CB) (p≤0,0001; R2 parcial=0,11890) foram variáveis que juntas estiveram associadas com a CP. Também houve relação entre ASG (p=0,0166; R2 parcial=0,00605) e ausência de complicações durante a internação (p=0,0047; R2= 0,01154) com a CP.

CONCLUSÕES: Sexo, idade, IMC e CB associaram-se conjuntamente com CP, ASG e ausência de complicações. CP é um indicador relevante em PIH na prática clínica.

DESCRITORES:
Estado nutricional; Antropometria; Pacientes internados; Idoso

Variables	Category	n	%
Age group (years)	65–79	308	73.9
Age group (years)	≥80	109	26.1
Gender	Female	149	35.7
Gender	Male	268	64.3
Reason for hospitalization	Digestive tract disease	52	12.5
	Kidney disease	42	10.1
	Respiratory disease	19	4.6
	Vascular disease	68	16.3
	Oncological digestive disease	151	36.2
	Orthopedic disease	28	6.7
	Thoracic disease	57	13.7
Body mass index	Overweight	131	34.2
	Adequate	152	39.7
	Low weight	100	26.1
Comorbidity	Yes	309	98.1
Comorbidity	No	6	1.9
Mini nutritional assessment	Malnourished	61	14.6
	Eutrophic	148	35.5
	Malnutrition risk	208	49.9
Subjective global assessment	Well nourished	318	76.3
Subjective global assessment	Malnourished	99	23.7
Nutritional risk screening	At risk	202	48.4
Nutritional risk screening	Without risk	215	51.6
Death	No	401	96.2
Death	Yes	16	3.8
Complications	No	357	85.6
Complications	Yes	60	14.4
Surgery	No	137	32.9
Surgery	Yes	280	67.1

Variables	Measure	Mean±SD	Median
Age	years	73.99±6.92	72.0
Length of hospital stay	days	8.94±8.11	6.0
Body mass index	kg/m²	25.28±5.19	24.90
Arm circumference	cm	27.77±4.41	27.50
Calf circumference	cm	32.49±4.36	32.10
Triceps skinfold	mm	16.70±8.15	15.00
Lymphocytes	cel/mm³	1,519.33±948.70	1,355.00
Arm muscle circumference	cm	225.72±34.52	224.35

Variables	Coefficient (r)^* * Spearman correlation coefficient; †p<0.05.	p-value^† * Spearman correlation coefficient; †p<0.05.
Calf circumference vs age	-0.24848	<0.0001
Calf circumference vs length of hospital stay	-0.02028	0.6797
Calf circumference vs body mass index	0.66943	<0.0001
Calf circumference vs arm circumference	0.70746	<0.0001
Calf circumference vs triceps skinfold	0.38119	<0.0001
Calf circumference vs arm muscle circumference	0.59757	<0.0001
Calf circumference vs lymphocytes	0.10103	0.0827

Variables	Mean ± SD	Median	p-value
Age group (years)
65–79 (n=308)	33.13±4.19	33.00	<0.0001^* * Mann-Whitney; †Kruskal Wallis. SGA: subjective global assessment; NRS: nutritional risk screening; MNA: mini nutritional assessment; M+MR: malnutrition plus malnutrition risk.
≥80 (n=109)	30.69±4.35	30.50
Total (n=417)	32.49±4.36	32.10
Gender
Female (n=149)	31.97±4.73	32.00	0.0689^* * Mann-Whitney; †Kruskal Wallis. SGA: subjective global assessment; NRS: nutritional risk screening; MNA: mini nutritional assessment; M+MR: malnutrition plus malnutrition risk.
Male (n=268)	32.78±4.12	32.50
Total (n=417)	32.49±4.36	32.10
Diseases
Digestive (n=52)	33.43±5.04	32.15	0.4076^† * Mann-Whitney; †Kruskal Wallis. SGA: subjective global assessment; NRS: nutritional risk screening; MNA: mini nutritional assessment; M+MR: malnutrition plus malnutrition risk.
Renal (n=42)	32.66±4.21	32.75
Respiratory (n=19)	30.45±4.10	31.50
Vascular (n=68)	32.27±4.45	32.25
Digestive neoplasms (n=151)	32.32±4.37	32.50
Orthopedics (n=28)	32.79±4.70	33.50
Thoracic (n=57)	32.78±3.42	32.00
Surgery
No (n=137)	32.37±4.14	32.00	0.5406^* * Mann-Whitney; †Kruskal Wallis. SGA: subjective global assessment; NRS: nutritional risk screening; MNA: mini nutritional assessment; M+MR: malnutrition plus malnutrition risk.
Yes (n=280)	32.56±4.47	32.50
Complications
No (n=357)	32.66±4.45	33.00	0.0269^* * Mann-Whitney; †Kruskal Wallis. SGA: subjective global assessment; NRS: nutritional risk screening; MNA: mini nutritional assessment; M+MR: malnutrition plus malnutrition risk.
Yes (n=60)	31.47±3.66	31.50
SGA
Well nourished (n=318)	33.15±4.10	33.00	<0.0001^* * Mann-Whitney; †Kruskal Wallis. SGA: subjective global assessment; NRS: nutritional risk screening; MNA: mini nutritional assessment; M+MR: malnutrition plus malnutrition risk.
Malnourished (n=99)	30.38±4.52	30.00
NRS
At risk (n=202)	31.21±4.36	31.00	<0.0001^* * Mann-Whitney; †Kruskal Wallis. SGA: subjective global assessment; NRS: nutritional risk screening; MNA: mini nutritional assessment; M+MR: malnutrition plus malnutrition risk.
Without risk (n=215)	33.70±4.01	34.00
MNA
M+MR (n=269)	31.49±4.44	31.00	<0.0001^* * Mann-Whitney; †Kruskal Wallis. SGA: subjective global assessment; NRS: nutritional risk screening; MNA: mini nutritional assessment; M+MR: malnutrition plus malnutrition risk.
Eutrophic (n=148)	34.32±3.56	34.00
Death
No (n=401)	32.52±4.36	32.30	0.4377^* * Mann-Whitney; †Kruskal Wallis. SGA: subjective global assessment; NRS: nutritional risk screening; MNA: mini nutritional assessment; M+MR: malnutrition plus malnutrition risk.
Yes (n=16)	31.83±4.40	30.50

Variable	Estimated parameter^* R2 model = 0.6165. *Estimated value; R2: coefficient of determination: partial; R2: proportion of response variability explained exclusively by the variable in question; R2 model: proportion of explanation of the dependent variable by the variation of the independent variables that remained in the model. Stepwise criterion used for selecting variables; AC: arm circumference; BMI: body mass index; M: male; F: female.	p-value	Partial R²
Age	-0.13231	0.0002	0.06032	age ¯calf circumference
Body mass index	0.27155	<0.0001	0.40820	BMI calf circumference
Arm circumference	0.52190	<0.0001	0.11890	AC calf circumference
Gender (M vs F)	27.20215	0.0011	0.01151	male calf circumference
Complications (no vs yes)	32.64815	0.0047	0.01154	uncomplicated calf circumference
Subjective global assessment (well-nourished vs malnourished)	23.41684	0.0166	0.00605	Well-nourished calf circumference

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[1] SD: standard deviation.