Efeitos da suplementação com fibra alimentar na constipação intestinal de pacientes com Doença Renal Crônica Pré-Dialítica
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2023-02-27
Autores
Thomazi, Ana Luiza Leite Silva
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Universidade Estadual Paulista (Unesp)
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Introdução: A Doença Renal Crônica (DRC) é considerada um importante problema de saúde pública mundial em decorrência do expressivo aumento nas taxas de incidência e prevalência, associado a um custo social e econômico elevadíssimo e risco 10 vezes maior de morte prematura por doença cardiovascular (DCV). Além da HAS e do DM, a alteração da microbiota intestinal normal (disbiose), a inflamação, a toxicidade urêmica e o estresse oxidativo também desempenham um papel na patogênese da DRC, assim como nas complicações associadas à doença. Dentre os diversos sintomas clínicos que podem desencadear com sua evolução, a constipação intestinal é uma delas, e pode estar relacionada ao quadro de disbiose encontrado nesses indivíduos. Considerando que nos estágios mais avançados da DRC o tempo de trânsito intestinal é aumentado, um maior consumo de fibras alimentares poderia beneficiar essa população. Considerando os efeitos positivos das fibras dietéticas na melhora da constipação intestinal e na composição de adequado metabolismo da microbiota intestinal, conhecer seus efeitos na população com DRC em estágio terminal, bem como as quantidades suficientes para desencadear melhora do trânsito intestinal podem proporcionar benefícios interessantes e vantajosos. Objetivo: Avaliar o efeito da suplementação com fibra alimentar em pacientes com DRC estágio V não dialítico, na melhora da constipação intestinal. Pacientes e Métodos: Trata-se de ensaio clínico analítico experimental com controle histórico, que avaliou pacientes com DRC estágio V (fase pré-dialítica) acompanhados ambulatorialmente. O estudo foi conduzido ao longo de 60 dias consecutivos, sendo incluídos 22 pacientes. Todos receberam 10g de fibra alimentar, contendo goma guar e inulina, uma vez ao dia pela manhã, durante 60 dias consecutivos. Antes e após a intervenção, foi aplicado protocolo de avaliação nutricional, composto por protocolo de avaliação nutricional e constipação intestinal, antropometria, ingestão, anamnese alimentar e exames bioquímicos. Durante todo o acompanhamento, os pacientes foram contactados para checar a adesão ao uso das fibras alimentares. Resultados: Foram avaliados 22 pacientes, com média de 60,2 ± 13,8 anos e média de TFGe de 13,2mL/min/1.73 m². No momento da inclusão, em torno de 30% dos pacientes apresentaram constipação intestinal. A suplementação com fibra alimentar reduziu a prevalência de constipação intestinal avaliada pela escala de Bristol (31,5% versus 0%; p=0,0076). Ao longo do período de acompanhamento, não foi observada alteração do apetite. Houve redução da Proteína C-reativa (PCR) quando comparado antes e após a suplementação, sendo respectivamente 1,5mg/dL + 1,8 versus 0,7mg/dL + 0,2 (p=0,0406). Em relação aos parâmetros nutricionais, houve aumento do peso corporal (80,2kg + 17 versus 81,4kg + 16,5; p=0,0201) e Índice de Massa Corpórea (IMC) (29,4kg/m² + 4,5 versus 29,8kg/m² + 4,4; p=0,0286). Dos parâmetros avaliados pela bioimpedância, foi observado um aumento nas quantidades de água corporal total (40,7L + 8,0 versus 42,6L + 7,6; p< 0,0001), água intracelular (22,0L ± 4,8 versus 22,8 ± 4,6; p=0,0249) e água extracelular (18,7L ± 3,9 versus 19,8L ± 3,9; p=0,0004). Conclusão: A suplementação com fibras sintéticas em pacientes portadores de DRC na fase pré dialítica, foi capaz de reduzir a prevalência da constipação intestinal sem interferir na piora do apetite. Além disso, apresentou efeito adicional na manutenção da função renal e redução da inflamação.
Introduction: Chronic Kidney Disease (CKD) is considered an important global public health problem due to the significant increase in incidence and prevalence rates, associated with a very high social and economic cost and a 10-fold greater risk of premature death from cardiovascular disease (CVD). In addition to Hypertension and Diabetes, alteration of the normal intestinal microbiota (dysbiosis), inflammation, uremic toxicity and oxidative stress also play a role in the pathogenesis of CKD, as well as in the complications associated with the disease. Among the various clinical symptoms that may trigger its evolution, constipation is one of them, and may be related to the dysbiosis found in these individuals. Considering that in the more advanced stages of CKD, the intestinal transit time is increased, a higher consumption of dietary fiber could benefit this population. Considering the positive effects of dietary fibers in the improvement of intestinal constipation and in the composition of adequate metabolism of the intestinal microbiota, knowing its effects in the population with end-stage CKD, as well as the amounts sufficient to improvement in intestinal transit can provide interesting and advantageous benefits. Objective: To evaluate the effect of dietary fiber supplementation in patients non-dialytic with CKD stage V, in improving constipation. Patients and Methods: This is an experimental analytical clinical trial with historical control, that evaluated patients with CKD stage V (pre-dialysis phase) followed on an outpatient basis. The study was conducted over 60 consecutive days, including 22 patients. All received 10g of dietary fiber, containing guar gum and inulin, 1x daily in the morning, for 60 consecutive days. Before and after the intervention, a nutritional assessment protocol was applied, consisting of a nutritional assessment protocol and intestinal constipation, anthropometry, intake, anamnesis and biochemical tests. During this period, patients were contacted to check adherence to the use of dietary fibers. Results: 22 patients were evaluated. The patients have a mean of 60.2 ± 13.8 years and mean eGFR of 13.2mL/min/1.73 m². At the time of inclusion, around 30% of patients had intestinal constipation. Dietary fiber supplementation reduced the prevalence of constipation assessed by the Bristol scale (31.5% versus 0%; p=0.0076). During the follow-up period, there was no change in apetite. There was a reduction in Creactive protein (CRP) when compared before and after supplementation, Abstract 6 respectively 1.5mg/dL + 1.8 versus 0.7mg/dL + 0.2 (p=0.0406). Regarding the nutritional parameters, there was an increase in body weight (80.2kg + 17 versus 81.4kg + 16.5; p=0.0201) and Body Mass Index (BMI) (29.4kg/m² + 4.5 versus 29.8kg/m² + 4.4; p=0.0286). The nutritional parameters evaluated by bioimpedance, an increase in the amounts of total body water (40.7L + 8.0 versus 42.6L + 7.6; p< 0.0001), intracellular water (22.0L ± 4.8 versus 22.8 ± 4.6; p=0.0249) and extracellular water (18.7L ± 3.9 versus 19.8L ± 3.9; p=0.0004) was observed. Conclusion: Supplementation with synthetic fibers in patients with CKD in the pre-dialysis phase was able to reduce the prevalence of constipation without interfering with the worsening of appetite. In addition, it had an additional effect on maintaining renal function and reducing inflammation.
Introduction: Chronic Kidney Disease (CKD) is considered an important global public health problem due to the significant increase in incidence and prevalence rates, associated with a very high social and economic cost and a 10-fold greater risk of premature death from cardiovascular disease (CVD). In addition to Hypertension and Diabetes, alteration of the normal intestinal microbiota (dysbiosis), inflammation, uremic toxicity and oxidative stress also play a role in the pathogenesis of CKD, as well as in the complications associated with the disease. Among the various clinical symptoms that may trigger its evolution, constipation is one of them, and may be related to the dysbiosis found in these individuals. Considering that in the more advanced stages of CKD, the intestinal transit time is increased, a higher consumption of dietary fiber could benefit this population. Considering the positive effects of dietary fibers in the improvement of intestinal constipation and in the composition of adequate metabolism of the intestinal microbiota, knowing its effects in the population with end-stage CKD, as well as the amounts sufficient to improvement in intestinal transit can provide interesting and advantageous benefits. Objective: To evaluate the effect of dietary fiber supplementation in patients non-dialytic with CKD stage V, in improving constipation. Patients and Methods: This is an experimental analytical clinical trial with historical control, that evaluated patients with CKD stage V (pre-dialysis phase) followed on an outpatient basis. The study was conducted over 60 consecutive days, including 22 patients. All received 10g of dietary fiber, containing guar gum and inulin, 1x daily in the morning, for 60 consecutive days. Before and after the intervention, a nutritional assessment protocol was applied, consisting of a nutritional assessment protocol and intestinal constipation, anthropometry, intake, anamnesis and biochemical tests. During this period, patients were contacted to check adherence to the use of dietary fibers. Results: 22 patients were evaluated. The patients have a mean of 60.2 ± 13.8 years and mean eGFR of 13.2mL/min/1.73 m². At the time of inclusion, around 30% of patients had intestinal constipation. Dietary fiber supplementation reduced the prevalence of constipation assessed by the Bristol scale (31.5% versus 0%; p=0.0076). During the follow-up period, there was no change in apetite. There was a reduction in Creactive protein (CRP) when compared before and after supplementation, Abstract 6 respectively 1.5mg/dL + 1.8 versus 0.7mg/dL + 0.2 (p=0.0406). Regarding the nutritional parameters, there was an increase in body weight (80.2kg + 17 versus 81.4kg + 16.5; p=0.0201) and Body Mass Index (BMI) (29.4kg/m² + 4.5 versus 29.8kg/m² + 4.4; p=0.0286). The nutritional parameters evaluated by bioimpedance, an increase in the amounts of total body water (40.7L + 8.0 versus 42.6L + 7.6; p< 0.0001), intracellular water (22.0L ± 4.8 versus 22.8 ± 4.6; p=0.0249) and extracellular water (18.7L ± 3.9 versus 19.8L ± 3.9; p=0.0004) was observed. Conclusion: Supplementation with synthetic fibers in patients with CKD in the pre-dialysis phase was able to reduce the prevalence of constipation without interfering with the worsening of appetite. In addition, it had an additional effect on maintaining renal function and reducing inflammation.
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Palavras-chave
Prebióticos, Fibras dietéticas, Constipação intestinal, Doença renal crônica, Insuficiência renal crônica, Fibras na dieta