Consequencias do estado nutricional na força muscular respiratória de idosos hospitalizados assistidos pela fisioterapia
Consequences of the nutritional status in the respiratory muscle force in hospitalized elderly treated with physiotherapy
Eliane Regina Ferreira Sernache de Freitas, Caroline Mari Oyama, Priscila Silva Oliveira, Leila Donária, Antonio Fernando Brunetto
Resumo
Introdução: O estado nutricional pode afetar as necessidades fisiológicas, determinando alterações na função respiratória de idosos hospitalizados. Objetivo: Avaliar os efeitos do estado nutricional na força muscular respiratória em idosos hospitalizados assistidos pela fisioterapia. Métodos: Foram estudados 30 indivíduos com idade igual ou acima de 60 anos internados no Hospital Santa Casa de Londrina pelo sistema único de saúde (SUS) e divididos em dois grupos: grupo 1 (G1) - pacientes com até 12 horas de solicitação médica para assistência de fisioterapia e grupo 2 (G2) - pacientes que não tinham solicitação médica de acompanhamento fisioterapêutico. Foi realizado o teste de força muscular respiratória e avaliação das variáveis do estado nutricional considerando-se parâmetros antropométricos, laboratoriais e determinação da competência imune. Resultado: O sobrepeso predominou nos dois grupos em especial no G1 (p=0,0272). Idosos do G1 apresentaram um menor percentual do valor predito de força muscular respiratória (PImax 58 ± 26,4 e PEmax 62 ± 21,1). O diagnóstico predominante foi de insuficiência cardíaca congestiva (40%) nos dois grupos, sendo que no G1 foi de 23,3% e no G2 16,7%. O G1 apresentou um número maior de idosos com diminuição de hemoglobina e aumento dos leucócitos totais. Conclusão: Não foi evidenciada a depleção do estado nutricional nos idosos estudados, mas sim o sobrepeso. Contudo, a diferença clínica encontrada, com diminuição da PImax e PEmax no G1, reforça a necessidade de uma intervenção fisioterapêutica precoce em pacientes idosos hospitalizados no sentido de otimizar sua força muscular respiratória, prevenindo maiores complicações pulmonares com conseqüente diminuição do tempo de permanência hospitalar e custos com os cuidados à saúde.
Palavras-chave
Abstract
Introduction: The nutritional status can affect the physiological needs, determining changes in lung function in elderly patients. Objective: To evaluate the effects of nutritional status in the respiratory muscle force in elderly subjects treated with physiotherapy. Methods: We studied 30 subjects over 60 years old hospitalized at the Hospital Santa Casa in Londrina by the Public Health System and divided into two groups: group 1 (G1) - patients until 12 hours of medical solicitation for physiotherapy attendance and group 2 (G2) – patients who did not have medical solicitation for physiotherapy. Respiratory muscle force and nutritional status were assessed. Immune competence was also evaluated. Results: Overweight prevailed in the two groups especially in G1 (p=0.0272). The elderly in G1 had lower values of respiratory muscle force (MIP 58 ± 26.4 % predicted and MEP 62 ± 21.1 % predicted). The most predominant diagnosis was chronic heart failure (40%) in the two groups, and in G1 was of 23.3% whereas in G2 16.7%. G1 presented a larger number of elderly with hemoglobin decrease and total leukocytes increase. Conclusion: There was no significant depletion in these elderly hospitalized subjects, but overweight instead. However, the decreased MIP and MEP in G1 increases the need for an early physical therapy intervention in hospitalized elderly patients in order to optimize their respiratory muscle force, preventing major pulmonary complications with consequent reduction in length of hospital stay and healthcare costs.
Keywords
References
1. Dehoog S. Avaliação do estado nutricional. In: Mahan KL, Escott-Stump S. Krause: alimentos, nutrição & dietoterapia. 9. ed. São Paulo: Roca; 1998. p. 371-413.
2. Smith LC, Mullen JL. Nutritional assessment and indications for nutritional support. Surg Clin North Am. 1991 Jun;71(3):449-57.
3. Jeejeebhoy KN. Nutritional assessment. Gastroenterol Clin North Am. 1998 Jun;27(2):347-69.
4. Baxter YC, Waitzberg DL, Peres G. Métodos não-convencionais; estudo dietético e medida da qualidade de vida. In: Waitzberg DL, editor. Nutrição oral, enteral e parenteral na prática clínica. 3. ed. São Paulo: Atheneu; 2000. p. 305-19.
5. Waitzberg DL, Ferrini MT. Exame físico e antropometria. In: Waitzberg DL, editor. Nutrição oral, enteral e parenteral na prática clínica. 3. ed. São Paulo: Atheneu; 2000. p. 255-78.
6. Bottoni A, Oliveira GPC, Ferrini MT, Waitzberg DL. Avaliação nutricional: exames laboratoriais. In: Waitzberg DL, editor. Nutrição oral, enteral e parenteral na prática clínica. São Paulo: Atheneu; 2000. p. 279- 94.
7. Mcwhirter JP, Pennington CR. Incidence and recognition of malnutrition in hospital. BMJ. 1994 Apr 9;308(6934):945-8.
8. Jensen GL, Friedmann JM, Coleman CD, Smiciklas-Wright H. Screening for hospitalization and nutritional risks among community-dwelling older persons. Am J Clin Nutr. 2001 Aug;74(2):201-5.
9. Organização Mundial da Saúde. Manejo da desnutrição grave: um manual para profissionais de saúde de nível superior e suas equipes auxiliares. OMS, Genebra: OMS; 2000.
10. World Health Organization. Physical status: the use and interpretation of anthropometry. Geneva: WHO; 1995.
11. Tockman MS. Aging of the respiratory system. In: Hazzard WR, Bierman EL, Blass JP, Ettinger WH Jr, Halter JB, editors. Principles of geriatric medicine and gerontology. New York: McGraw Hill; 1994. p. 499-507.
12. Beaty TH, Newill CA, Cohen BH, Tockman MS, Bryant SH, Spurgeon HA. Effects of pulmonary function on mortality. J Chronic Dis. 1985;38(8):703-10.
13. Janssens JP, Pache JC, Nicod LP. Physiological changes in respiratory function associated with ageing. Eur Respir J. 1999 Jan;13(1):197-205.
14.Ravasco P, Camilo ME, Gouveia-Oliveira A, Adam S, Brum G. Critical approach to nutritional assessment in critically ill patients. Clin Nutr. 2002 Feb;21(1):73-7.
15. Oliveira CPMS, Pucci N. Avaliação nutricional em gastroenterologia. Rev Gastroenterol da FUGEST. [Internet] 2002 maio-jun [citado 2099 nov 12]. Disponível em: http://www.fugesp.org.br/nutricao_e_saude_conteudo.asp?id_publicacao=1&edicao_numero=18&menu_ordem=4
16. Santana H, Zoico E, Turcato E, Tosoni P, Bissoli L, Olivieri M et al. Relation between body composition, fat distribution, and lung function in elderly men. Am J Clin Nutr. 2001 Apr;73(4):827-31.
17. Jelliffe DB, Jelliffe EFP. Community nutritional assessment – With special reference to less technically developed countries. New York: Oxford University Press; 1989. p. 56-550.
18. World Health Organization. Population ageing: a public health challenge. Geneva: WHO; 1998.
19. Sousa RB. Pressões respiratórias estáticas máximas. J Penumol. 2002 out;28 (Supl 3):S155-65.
20. Volianitis S, McConnell AK, Jones DA. Assessment of maximum inspiratory pressure. Prior submaximal respiratory muscle activity (‘warm-up’) enhances maximum inspiratory activity and attenuates the learning effect of repeated measurement. Respiration. 2001;68(1):22-7.
21. Brunetto AF, Alves LA. Comparing peak and sustained values of maximal respiratory pressures in healthy subjects and chronic pulmonary disease patients. J Penumol. 2003 Jul-Aug;29(4):208-12.
22. Neder JA, Andreoni S, Peres C, Nery LE. Reference values for lung function tests. II. Maximal respiratory pressures and voluntary ventilation. Braz J Med Biol Res. 1999 Jun;32(6):719-727.
23. Chiavone PA, Sens YA. Evaluation of APACHE II system among intensive care patients at a teaching hospital. São Paulo Med J. 2003 Mar 5;121(2):53-7. Epub 2003 Jul 14.
24. Leandro-Merhi VA. Garcia RWD, Tafner B, Florentino MC, Casteli R, Aquino JLB. The relationship between the nutritional status of surgical patints and their clinical characteristics. Rev Ciên, Méd. 2000 setdez;9(3):105-14. Portuguese.
25. Jackson AS, Beard EF, Wier LT, Ross RM, Stuteville JE, Blair SN. Changes in aerobic power of men, ages 25-70 yr. Med Sci Sports Exerc. 1995 Jan;27(1):113-20.
26. Fiatarone-Sigh M. Body composition and weight control in older adults. In: Lamb DR, Murray R, editors. Perspectives in exercicses science and sports medicine: exercise, nutrition and weight control. Carmel: Cooper, 1998. Vol. 2, p. 243-288.
27. Pietro DB, Leandro-Merhi VA, Mônaco DV, Lazarini ALG. Routine nutritional intervention for patients of a private hospital. Rev Bras Nutr Clin 2006;21(3):181-7. Portuguese.
28.Sales FM, Santos I. Profile of elderly people hospitalized and dependence levels of nursing care: identification of necessities. Texto & Contexto Enferm. 2007 Jul-Sep;16(3):495-502. Portuguese.
29.mWannamethee SG, Shaper AG, Whincup PH, Walker M. Characteristics of older men who lose weight intentionally or unintentionally. Am J Epidemiol. 2000 Apr 1;151(7):667-75.
30.mHughes PD, Polkey MI, Harrus ML, Coats AJ, Moxham J, Green M. Diaphagm strength in chronic heart failure. Am J Resp Crit Care Med. 1999 Aug;160(2):529-34.
31. Evans SA, Watson L, Hawkins M, Cowley AJ, Johnston IDA, Kinnear W. Respiratory muscle strength in chronic heart failure. Thorax. 1995 Jun;50(6):625-8.
32. Ershler WB, Sheng S, McKelvey J, Artz AS, Denduluri N, Tecson J, et al. Serum erythropoietin and aging: a longitudinal analysis. J Am Geriatr Soc. 2005 Aug;53(8):1360-5.
33. Schaan MDA, Schwanke CHA, Bauer M, Luz C, Cruz IM. Hematological and nutritional parameters in apparently health elderly individuals. Rev Bras Hematol Hemoter. 2007 Apr-Jun;29(2):136-143.
34. Ble A, Fink JC, Woodman RC, Klausner MA, Windham BG, Guralnik JM, et al. Renal function, erythropoietin, and anemia of older persons: the InCHIANTI study. Arch Intern Med. 2005 Oct 24;165(19):2222-7.
35. Woodman R, Ferrucci L, Guralnik J. Anemia in older adults. Curr Opin Hematol. 2005 Mar;12(2):123-8.
36. Maraldi C, Volpato S, Cesari M, Onder G, Pedone C, Woodman RC, et al. Anemia, physical disability, and survival in older patients with heart failure. J Card Fail. 2006 Sep;12(7):533-9.
37. Rink L, Cakman I, Kirchner H. Altered cytokine production in elderly. Mech Ageing Dev. 1998 May 15;102(2-3):199-209.
38. Grimble RF. Inflammatory response in the elderly. Curr Opin Clin Nutr Metab Care, 2003 Jan;6(1):21-9