Estado nutricional e composição corporal em pacientes com hepatite B crônica

Abstract

Sarcopenia has been considered a relevant topic in clinical hepatology settings. However, the interface between skeletal muscle loss and chronic hepatitis B (CHB) is poorly understood. Thus, the aim of this study was to evaluate associations between skeletal muscle mass loss and demographic, liver disease severity, antiviral treatment status, nutritional assessment, body composition components and lifestyle variables in patients with CHB. This cross-sectional study prospectively enrolled 134 outpatients with CHB followed at the tertiary care ambulatory centre (mean age, 48.2 ± 11.8 years; 66.0%, males; 77.6%, without cirrhosis; 22.4%, with compensated cirrhosis) and 58 age- and body mass index (BMI)-matched healthy individuals (mean age, 46.8 ± 5.9 years; 58.6%, males). Cirrhosis was diagnosed using clinical, biochemical, histological, and radiological methods. Bioelectrical impedance analysis (BIA) measured skeletal muscle mass (SM) and phase angle (PhA). The skeletal mass index (SMI) was calculated by dividing SM by height squared. The subjective global assessment (SGA) and the International Physical Activity Questionnaire (IPAQ) were used to assess the nutritional status and physical activity level, respectively. Compared with controls, patients with CHB and significant liver fibrosis were more likely to have lower SMI (20.5% vs 1.7%, P = 0.001). All patients chronically infected with HBV (n = 21) who had low SMI were men. Multivariate model showed that compensated cirrhosis (odds ratio [OR] = 4.18; 95% confidence interval [CI] = 1.29 - 13.58; P = 0.02), low PhA (OR = 4.83; 95%CI = 1.44 - 16.24; P = 0.01) and higher BMI (OR = 0.74; 95%CI = 0.62 - 0.88; P = 0.02) were independently associated with low SMI in men chronically infected with HBV. In the linear regression analysis, male sex, older age, and low SMI were independently associated with PhA. Compensated liver cirrhosis was associated with low SMI in male patients chronically infected with HBV. Additionally, low PhA, a nutritional indicator of cell membrane integrity, showed a positive association with low SMI in male patients chronically infected with HBV.