Avaliação da síndrome metabólica em mulheres com câncer de mama: uma coorte prospectiva
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2021-05-21
Autores
Prado, Vanildo
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Universidade Estadual Paulista (Unesp)
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Introdução: Pacientes com câncer de mama apresentam maior risco de ganho de peso e síndrome metabólica (SM), com piora da sobrevida global e específica. A intervenção com equipe interdisciplinar pode influenciar no prognóstico. Objetivo: Avaliar a ocorrência da síndrome metabólica e seus componentes em mulheres durante o primeiro ano após o diagnóstico do câncer de mama. Métodos: Estudo clínico prospectivo, de centro único, que incluiu mulheres com diagnóstico recente de câncer de mama, idade ≥ 40 anos, diagnóstico histológico de câncer de mama, sem doença metastática e sem doença cardiovascular (DCV) estabelecida. Dados clínicos e antropométricos (pressão arterial, índice de massa corporal/IMC e circunferência da cintura) foram coletados por meio de entrevista e exame físico. Para análise bioquímica foram solicitados HDL, triglicerídeos (TG) e glicose. Foram consideradas com SM, mulheres que apresentaram três ou mais critérios diagnósticos: circunferência da cintura (CC) > 88 cm; TG 150 mg/dL; HDL < 50 mg/dL; pressão arterial 130/85 mmHg; glicose 100 mg/dL. As medidas foram realizadas em três momentos: primeira consulta oncológica (T0m), seis meses (T6m) e 12 meses (T12m). As pacientes foram submetidas a avaliação e acompanhamento interdisciplinar (nutricional e psicológico) conforme a rotina do serviço. Para análise estatística foram empregados o teste de McNemar na comparação entre os momentos e teste Qui-quadrado de tendência. Resultados: Foram incluídas 72 mulheres com câncer de mama, com média de idade de 58,4 10,7 anos e 83,3% na pós-menopausa. O perfil oncológico das pacientes foi de doença em estádio inicial (94,4% estádio I e II) com perfil imunohistoquímico favorável (79,1% receptor de estrogênio positivo, 72,2% receptor de progesterona positivo e 86,1% HER2 negativo). Na avaliação da SM não foi observada diferenças na ocorrência entre os três momentos, com 37.5% das pacientes com SM no diagnóstico, 43% aos 6 meses e 44,4% aos 12 meses (p=0.332). Foi observada diferença significativa na ocorrência da hipertrigliceridemia (TG 150 mg/dL) de 25% em T0m, 36,1% em T6m e 44,4% em T12m (p<0.05). Não se identificou aumento nos critérios de obesidade (IMC30mg/m2 e circunferência da cintura/CC > 88cm) no período estudado, com IMC médios de 28.9kg/m2, 28.8kg/m2 e 28.8kg/m2 e de CC de 97.2cm, 97.2cm e 96.7cm, nos momentos T0, T6 e T12, respectivamente (p>0.05). Na comparação dos critérios individuais da SM entre os três momentos de avaliação, observou-se apenas diferença estatística nos critérios triglicerídeos e glicemia. A análise da glicemia demonstrou diminuição dos valores médios, de 106.6 mg/dL em T0m, 100.4 mg/dL em T6m e 98.9mg/dL em T12m (p=0.004). Em relação aos TG observou-se aumento dos valores médios, de 121mg/dL em T0m, 139.4 mg/dL em T6m e 148.4 mg/dL em T12m (p=0.003). Conclusão: Mulheres com câncer de mama submetidas a avaliação interdisciplinar não apresentaram aumento na ocorrência de SM durante o primeiro ano após o diagnóstico do câncer. Entre os componentes da SM, observou-se redução nos valores de glicemia e aumento nos valores de triglicerídeos.
Introduction: Patients with breast cancer have a higher risk of weight gain and metabolic syndrome (MS), with worsening overall and specific survival. Intervention with an interdisciplinary team can influence the prognosis. Objective: To evaluate the occurrence of the metabolic syndrome and its components in women during the first year after the diagnosis of breast cancer. Methods: Prospective, single-center clinical study that included women with a recent diagnosis of breast cancer, age ≥ 40 years, histological diagnosis of breast cancer, without metastatic disease and without established cardiovascular disease (CVD). Clinical and anthropometric data (blood pressure, body mass index / BMI and waist circumference) were collected through interviews and physical examination. For biochemical analysis, HDL, triglycerides (TG) and glucose were requested. Women with MS were considered to have three or more diagnostic criteria: waist circumference (WC)> 88 cm; TG 150 mg/dL; HDL <50 mg/dL; blood pressure 130/85 mmHg; glucose 100 mg/dL. The measurements were carried out in three moments: first cancer consultation (T0m), six months (T6m) and 12 months (T12m). The patients underwent interdisciplinary evaluation and monitoring (nutritional and psychological) according to the service's routine. For statistical analysis, the McNemar test was used to compare the moments and the Chi-square test of trend. Results: 72 women with breast cancer were included, with a mean age of 58.4 10.7 years and 83.3% in the post-menopause. The cancer profile of the patients was that of an early-stage disease (94.4% stage I and II) with a favorable immunohistochemical profile (79.1% positive estrogen receptor, 72.2% positive progesterone receptor and 86.1% HER2 negative). In the assessment of MS, no differences were observed in the occurrence between the three moments, with 37.5% of patients with MS at diagnosis, 43% at 6 months and 44.4% at 12 months (p = 0.332). A significant difference was observed in the occurrence of hypertriglyceridemia (TG 150 mg/dL) of 25% in T0m, 36.1% in T6m and 44.4% in T12m (p <0.05). There was no increase in the obesity criteria (BMI 30mg/m2 and waist circumference / WC > 88cm) in the studied period, with mean BMI of 28.9kg/m2, 28.8kg/m2 and 28.8kg/m2 and WC of 97.2 cm, 97.2cm and 96.7cm, at moments T0, T6 and T12, respectively (p> 0.05). When comparing the individual MS criteria between the three assessment moments, there was only a statistical difference in the triglyceride and glycemia criteria. The analysis of glycemia showed a decrease in mean values, from 106.6mg/dL in T0m, 100.4 mg/dL in T6m and 98.9mg/dL in T12m (p = 0.004). Regarding TG, an increase in mean values was observed, from 121mg/dL in T0m, 139.4mg/dL in T6m and 148.4 mg/dL in T12m (p = 0.003). Conclusion: Women with breast cancer submitted to interdisciplinary evaluation did not show an increase in the occurrence of MS during the first year after the cancer diagnosis. Among the components of MS, there was a reduction in blood glucose values and an increase in triglyceride values.
Introduction: Patients with breast cancer have a higher risk of weight gain and metabolic syndrome (MS), with worsening overall and specific survival. Intervention with an interdisciplinary team can influence the prognosis. Objective: To evaluate the occurrence of the metabolic syndrome and its components in women during the first year after the diagnosis of breast cancer. Methods: Prospective, single-center clinical study that included women with a recent diagnosis of breast cancer, age ≥ 40 years, histological diagnosis of breast cancer, without metastatic disease and without established cardiovascular disease (CVD). Clinical and anthropometric data (blood pressure, body mass index / BMI and waist circumference) were collected through interviews and physical examination. For biochemical analysis, HDL, triglycerides (TG) and glucose were requested. Women with MS were considered to have three or more diagnostic criteria: waist circumference (WC)> 88 cm; TG 150 mg/dL; HDL <50 mg/dL; blood pressure 130/85 mmHg; glucose 100 mg/dL. The measurements were carried out in three moments: first cancer consultation (T0m), six months (T6m) and 12 months (T12m). The patients underwent interdisciplinary evaluation and monitoring (nutritional and psychological) according to the service's routine. For statistical analysis, the McNemar test was used to compare the moments and the Chi-square test of trend. Results: 72 women with breast cancer were included, with a mean age of 58.4 10.7 years and 83.3% in the post-menopause. The cancer profile of the patients was that of an early-stage disease (94.4% stage I and II) with a favorable immunohistochemical profile (79.1% positive estrogen receptor, 72.2% positive progesterone receptor and 86.1% HER2 negative). In the assessment of MS, no differences were observed in the occurrence between the three moments, with 37.5% of patients with MS at diagnosis, 43% at 6 months and 44.4% at 12 months (p = 0.332). A significant difference was observed in the occurrence of hypertriglyceridemia (TG 150 mg/dL) of 25% in T0m, 36.1% in T6m and 44.4% in T12m (p <0.05). There was no increase in the obesity criteria (BMI 30mg/m2 and waist circumference / WC > 88cm) in the studied period, with mean BMI of 28.9kg/m2, 28.8kg/m2 and 28.8kg/m2 and WC of 97.2 cm, 97.2cm and 96.7cm, at moments T0, T6 and T12, respectively (p> 0.05). When comparing the individual MS criteria between the three assessment moments, there was only a statistical difference in the triglyceride and glycemia criteria. The analysis of glycemia showed a decrease in mean values, from 106.6mg/dL in T0m, 100.4 mg/dL in T6m and 98.9mg/dL in T12m (p = 0.004). Regarding TG, an increase in mean values was observed, from 121mg/dL in T0m, 139.4mg/dL in T6m and 148.4 mg/dL in T12m (p = 0.003). Conclusion: Women with breast cancer submitted to interdisciplinary evaluation did not show an increase in the occurrence of MS during the first year after the cancer diagnosis. Among the components of MS, there was a reduction in blood glucose values and an increase in triglyceride values.
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Palavras-chave
Cancêr de mama, Obesidade, Síndrome metabólica, Equipe interdisciplinar, Breast cancer, Obesity, Metabolic syndrome, Estudo clínico, Equipe de assistência ao paciente, Pesquisa interdisciplinar