Estado nutricional e estilo de vida em pacientes com hepatite C crônica

Abstract

Introduction: Chronic infection associated with hepatitis C virus (HCV) is a severe public health problem and is considered a significant cause of cirrhosis and hepatocellular carcinoma (HCC). Scientific evidence indicates that liver disease, especially advanced, results in great nutritional impact. However, the diagnosis and classification of nutritional disorders in patients with chronic hepatitis C (CHC), the relationship between nutritional status with the development of liver disease were not yet fully understood. Aim: To assess the nutritional status and risk factors related to lifestyle of patients with HCC. Methods: We included transversely patients with confirmed diagnosis of CHC (n = 128) and control group (n = 58), asymptomatic blood donors, matched for sex and age. Body composition data, dietary intake and lifestyle were analyzed. Sociodemographic, clinical and biochemical data were also collected. The presence of metabolic syndrome (MS) was observed by the criteria of the International Diabetes Federation - IDF. International Physical Activity Questionnaire (IPAQ) was used to assess physical activity. Results: Obesity/overweight [body mass index (BMI) 25 kg / m2] was observed in 72.4% and 60.0% of asymptomatic individuals and CHC patients, respectively. Excess body fat, estimated by bioelectrical impedance analysis (BIA), was observed in 77.6% and 74.5% control subjects and patients with CHC, respectively. Among the males, patients with CHC had reduced muscle mass compared to controls, even in the absence of cirrhosis. The severity of liver disease was also associated with reduced muscle mass. In the linear regression model, adjusted for age and sex, MS and sedentary lifestyle were associated with reduction in the percentage of lean body mass. In the first logistic model, AST to Platelet Ratio Index (APRI) score (OR = 0.24, 95% CI 0.08 to 0.72 =, p = 0.01), female gender (OR = 5.97, CI 95% = 2.14 to 16.61, p = 0.001), SM (OR = 5.97, CI 95% = 1.40 to 20.19, p = 0.008) and physical activity grade (OR = 0. 51, CI 95% = 0.26 to 0.99, p = 0.05) remained significantly associated with excess body fat assessed by BIA. In the second logistic model adjusted for age and sex, cirrhosis was associated with MS (OR = 2.85, 95% CI 1.09 to 7.44 =, p = 0.03) and lower level of physical activity (OR = 0.33, 95% CI = .13-.81, p = 0.02). The Homeostatic Model Assessment (HOMA) 2.7 correlated with cirrhosis and APRI score. Conclusion: The results of this study demonstrate that both malnutrition and excess body fat may be present in patients with CHC. In this context, the assessment of nutritional status of patients chronically infected with HCV becomes essential. Integrated approach (medical / nutritional / guidance and education for physical activity) should be glimpsed in the daily care of patients with HCC.