Avaliação dos benefícios do aconselhamento nutricional em pacientes portadores de doença renal crônica
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Data
2020-04-23
Autores
Presti, Paula Torres [UNESP]
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Universidade Estadual Paulista (Unesp)
Resumo
Introdução: Doença renal crônica (DRC) é uma enfermidade de relevância para a saúde pública, cursando com prevalência crescente. Estudos confirmam associação da hipertensão arterial, diabetes mellitus e proteinúria com desenvolvimento da DRC, progressão e mortalidade. Intervenções nutricionais podem prevenir ou atenuar essas complicações da doença, além de manter o estado nutricional e levar à maior sobrevida e qualidade de vida aos pacientes. Objetivo: Avaliar os benefícios do aconselhamento nutricional em pacientes portadores de DRC. Metodologia: Estudo quase-experimental, controlado e em dois momentos (inicial e após três meses), com indivíduos nos estadios 3 e 4 da doença, divididos em dois grupos: controle, composto por indivíduos que nunca receberam aconselhamento nutricional por recusa, e intervenção, caracterizado por pacientes em acompanhamento com nutricionista. Foi realizada a comparação entre os parâmetros: antropometria, exames bioquímicos e avaliação do consumo alimentar através da análise dos R24h através do programa Nutrition Data System for Research. Para análise estatística, ANOVA seguido do teste de Tukey ou teste de Wald de acordo com a distribuição dos dados, adotando nível de significância de 5%. Resultados: Foram incluídos 50 pacientes, sendo: controle (n=23) e intervenção (n=27). Os grupos foram homogêneos. Observou-se diferenças em relação à pressão arterial, reduzida após aconselhamento nutricional. Não ocorreram alterações consideráveis nos bioquímicos, porém na avaliação de consumo alimentar após intervenção, foi encontrada resposta favorável em relação ao controle proteico, e nas restrições dos minerais: fósforo, sódio e potássio. Em relação à presença anemia, foi observada diminuição no consumo dos micronutrientes: ferro, folato e vitamina B12. Também houve redução no consumo de fibras, carboidratos, lipídeos e energia total. Apesar disso, não houve alteração no peso dos pacientes. Não houve menor ingestão de cálcio e vitamina D, fatores que poderiam agravar alterações do metabolismo mineral e ósseo. Conclusão: O aconselhamento nutricional foi benéfico na prevenção alterações no estado nutricional e proporcionou consumo alimentar adequado às recomendações propostas na DRC.
Introduction: Chronic kidney disease (CKD) is a condition of increasing prevalence, considered relevant to public health. Studies confirm an association of arterial hypertension, diabetes mellitus and proteinuria with the development of CKD, progression and mortality. Dietary interventions can prevent or mitigate these complications of the disease, in addition to maintaining nutritional status and leading to greater survival and quality of life for patients. Objective: To evaluate the benefits of nutritional counseling in patients with CKD. Methodology: Quasi-experimental study, controlled and two-stage (initial and after three months), with individuals in stages 3 and 4 of the disease, separated into two groups: control, composed of individuals who never received nutritional advice for refusal, and intervention, characterized by patients being followed up with a nutritionist. A comparison was between the parameters: anthropometry, biochemical tests and evaluation of food consumption by the analysis of R24h using the Nutrition Data System for Research program. For statistical analysis, ANOVA followed by the Tukey test or Wald test according to the data distribution, adopting a significance level of 5%. Results: 50 patients were included in the groups control (n = 23) and intervention (n = 27). The groups were homogeneous. Differences were observed in blood pressure that reduced after nutritional counseling. There were no changes in biochemicals exams, however in the evaluation of food consumption after intervention, a favorable response was found in relation to protein control, and in the restrictions of minerals: phosphorus, sodium and potassium. Regarding the presence of anemia, a decrease in the consumption of micronutrients was observed: iron, folate and vitamin B12. There was also a reduction in the consumption of fiber, carbohydrates, lipids and total energy. Despite this, there was no change in the patients weight. There was no lower intake of calcium and vitamin D, factors that could aggravate changes in bone and mineral metabolism. Conclusion: Nutritional counseling was beneficial in preventing changes in nutritional status and provided adequate food consumption to the recommendations proposed in CKD.
Introduction: Chronic kidney disease (CKD) is a condition of increasing prevalence, considered relevant to public health. Studies confirm an association of arterial hypertension, diabetes mellitus and proteinuria with the development of CKD, progression and mortality. Dietary interventions can prevent or mitigate these complications of the disease, in addition to maintaining nutritional status and leading to greater survival and quality of life for patients. Objective: To evaluate the benefits of nutritional counseling in patients with CKD. Methodology: Quasi-experimental study, controlled and two-stage (initial and after three months), with individuals in stages 3 and 4 of the disease, separated into two groups: control, composed of individuals who never received nutritional advice for refusal, and intervention, characterized by patients being followed up with a nutritionist. A comparison was between the parameters: anthropometry, biochemical tests and evaluation of food consumption by the analysis of R24h using the Nutrition Data System for Research program. For statistical analysis, ANOVA followed by the Tukey test or Wald test according to the data distribution, adopting a significance level of 5%. Results: 50 patients were included in the groups control (n = 23) and intervention (n = 27). The groups were homogeneous. Differences were observed in blood pressure that reduced after nutritional counseling. There were no changes in biochemicals exams, however in the evaluation of food consumption after intervention, a favorable response was found in relation to protein control, and in the restrictions of minerals: phosphorus, sodium and potassium. Regarding the presence of anemia, a decrease in the consumption of micronutrients was observed: iron, folate and vitamin B12. There was also a reduction in the consumption of fiber, carbohydrates, lipids and total energy. Despite this, there was no change in the patients weight. There was no lower intake of calcium and vitamin D, factors that could aggravate changes in bone and mineral metabolism. Conclusion: Nutritional counseling was beneficial in preventing changes in nutritional status and provided adequate food consumption to the recommendations proposed in CKD.
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Palavras-chave
Aconselhamento em nutrição, Insuficiência renal crônica, Nutrição, Saúde pública, Nutrition, Nutritional counseling, Chronic kidney disease