RESUMO
Chronic kidney disease (CKD) is considered a public health problem and part of the growing burden of noncommunicable diseases. Many studies have searched for ways to reduce the risk of complications and death. One possible approach to modify the course of this disease is the adoption of healthy dietary habits. Previous studies have suggested that healthy dietary patterns, such as the Dietary Approaches to Stop Hypertension (DASH), the Mediterranean diet, the vegetarian diet, and a diet adhering to the Healthy Eating Index, are associated with improved renal health. In this chapter, we reviewed the scientific literature and presented the potential role of dietary patterns in the prevention of CKD, contributing to dietary strategies for promoting kidney health. We found that nutritional planning plays an important role in kidney health maintenance and in the protection of kidneys from further damage. The DASH, Mediterranean, and vegetarian dietary patterns can be viable strategies for CKD prevention. However, individualized nutritional monitoring is necessary for individuals with overt kidney disease. Randomized, controlled, and prospective studies focusing on nutritional interventions applied to renal patients undergoing conservative and dialytic treatment and to the general population are necessary to assess habits that can prevent the occurrence and worsening of kidney disease.
Assuntos
Abordagens Dietéticas para Conter a Hipertensão , Insuficiência Renal Crônica , Humanos , Rim , Estudos Prospectivos , Diálise Renal , Insuficiência Renal Crônica/prevenção & controleRESUMO
O câncer de cabeça e pescoço corresponde a cerca de 6% das neoplasias malignas, sendo mais frequente em países em desenvolvimento. Os tipos de tratamentos aos quais os pacientes são submetidos incluem quimioterapia e/ou radioterapia e cirurgia. A quimioterapia e a radioterapia podem causar efeitos colaterais como: mucosite, anorexia, náuseas, vômitos, xerostomia, estomatite, diarréia, constipação, plenitude, azia, ou seja, sintomas gastrintestinais contribuindo para o comprometimento do estado nutricional. Diante desse quadro alguns pacientes necessitam de suporte nutricional adequado por via alternativa, incluindo sonda nasoenteral ou gastrostomia endoscópica percutânea, que podem contribuir para uma melhora do quadro clínico e propiciar melhores condições para que o paciente tolere melhor o tratamento. Porém, o uso de suporte nutricional pode causar complicações para o paciente. O objetivo desse estudo foi realizar uma análise comparativa entre o uso de sonda nasoenteral (SNE) e gastrostomia endoscópica percutânea (PEG) em pacientes com câncer de cabeça e pescoço tratados com radioterapia e quimioterapia. O estudo foi retrospectivo, onde foram coletados dados de 232 pacientes adultos, diagnosticados com carcinoma epidermóide de orofaringe, hipofaringe e laringe, que foram submetidos a tratamento radioterápico e quimioterápico. Foram coletadas informações sobre o uso de suporte nutricional por via alternativa, assim como dados relevantes sobre a história clínica e dados antropométricos. A maioria dos pacientes era do sexo masculino (83,2%) e o local de acometimento do tumor mais frequente foi a laringe representando 43,1% dos pacientes, com 81,8% dos pacientes com doença localmente avançada (T3 e T4). Quanto ao tratamento realizado, 90,5% foram submetidos à radioterapia concomitante a quimioterapia. Encontrou-se uma perda ponderal média de 6 quilos, representando um percentual de perda de peso corporal de 5-10%. O uso de suporte nutricional por via alternativa foi utilizado por 61,6% dos pacientes (31,9% SNE; 29,7% PEG). Com relação a indicação desse suporte, 31,9% realizou de forma profilática e 22,4% de forma reativa. Foi encontrada uma maior média de perda de peso nos pacientes que utilizaram SNE de forma reativa. O tempo de uso do suporte nutricional em geral foi de 6,56 meses (SNE 4,54 meses; PEG 8,72 meses). Seu uso esteve associado ao percentual de perda de peso pré-tratamento (p<0,0002), ao IMC pré-tratamento (p<0,01) e ao uso de radioterapia por IMRT (p<0,0175). Nenhum paciente apresentou complicação grave, e as complicações menores foram mais frequentes nos pacientes que fizeram uso de PEG (p=0,029), sendo as mais relatadas com o uso de SNE a perda/recolocação e obstrução, e naqueles que fizeram o uso de PEG infecção/abscesso no local de inserção, dor e laceração superficial do esôfago. Houve uma frequência maior de interrupção do tratamento em pacientes que perderam > 10% do peso e nos pacientes que fizeram uso de SNE de forma reativa, apesar de não ser estatisticamente significante. Esse estudo sugere que este grupo de pacientes pode se beneficiar com o uso de suporte nutricional, principalmente nos indivíduos que apresenta em perda de peso pré-tratamento de até 10% do peso corporal e aqueles que perdem peso durante o tratamento. O uso de PEG de forma profilática sugere ser mais efetivo, com menor chance de interrupção do tratamento, porém com maior número de complicações consideradas menores.
The head and neck cancer represents approximately 6% of malignancies are more common in developing countries. The types of treatments which include patients undergo chemotherapy and / or radiotherapy and surgery. Chemotherapy and radiation can cause side effects such as mucositis, anorexia, nausea, vomiting, dry mouth, stomatitis, diarrhea, constipation, fullness, heartburn, or gastrointestinal symptoms contributing to the compromised nutritional status. Given this situation some patients must nutritional support for alternative pathway, including nasogastric tube or percutaneous endoscopic gastrostomy, which may contribute to clinical improvement and provide better conditions for the patient to tolerate the treatment better. However, the use of nutritional support should be cause complications for the patient. The goal of this study was to perform a comparative analysis between the use of a nasogastric tube (SNE) and percutaneous endoscopic gastrostomy (PEG) in patients with head and neck cancer treated with radiotherapy and chemotherapy. The study was retrospective, where data were collected from 232 adults patients diagnosed with squamous cell carcinoma of the oropharynx, hypopharynx and larynx who suffered radiotherapy and chemotherapy. Information was collected on the use of nutritional support for alternative pathway, as well as relevant files on the clinical history and demographics. Most patients were male (83.2%) and location of tumor involvement was the most frequent laryngeal representing 43.1% of patients, with 81.8% of patients with locally advanced disease (T3 and T4). Regarding the treatment performed, 90.5% did the use of concomitant chemotherapy radiation. We found a mean weight loss of 6 pounds, a percentage of body weight loss of 5-10%. The use of nutritional support for alternative route was used for 61.6% of the patients (31.9% SNE, 29.7% PEG). Regarding the indication of support, 31.9% performed prophylactically and 22.4% reactively. We found higher mean weight loss in patients who used SNE reactively. The time of use of nutritional support in general was 6.56 months (SNE 4.54 months; PEG 8.72 months). Its use was associated with percentage weight loss pre-treatment (p <0.0002), pretreatment with BMI (p <0.01) and the use of radiotherapy by IMRT (p <0.0175). No patient had serious complications, and minor complications were more recurrent in patients using PEG (p = 0.029), the most reported with the use of SNE loss / replacement and obstruction, and those who made use of PEG infection / abscess at the site of insertion, pain and superficial laceration of the esophagus. There was a higher frequency of treatment discontinuation in patients who lost > 10% by weight and in patients who used SNE reactively, although not statistically significant. This study suggests that this group of patients can benefit from the use of nutritional support, especially in individuals who presents weight loss pretreatment of up to 10% of body weight and those who lose weight during treatment. The use of PEG as a prophylactic suggested being more effective, with less chance of stopping treatment, but with more complications considered minor.