Navegando por Autor "Gonzalez, Maria Cristina"

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Agreement between muscle mass assessments by computed tomography and calf circumference in patients with cancer: a cross-sectional study
(Clinical Nutrition Espen, 2022-02) Fayh, Ana Paula Trussardi; Sousa, Iasmin Matias; Gonzalez, Maria Cristina; Bielemann, Renata Moraes; Rocha, Ilanna Marques Gomes; Barbalho, Erica Roberta; Carvalho, Ana Lúcia Miranda; Medeiros, Galtieri Otávio Cunha; Silva, Flávia Moraes
Background & aims: Cancer influences body composition, including a loss of muscle mass (MM), associated with worse outcomes. The study aimed to evaluate the agreement between MM estimated by calf circumference (CC) and computed tomography (CT) image as a reference method. Methods: A cross-sectional study including patients (>20 years) diagnosed with cancer attending a reference center of oncology. Spearman's correlation was performed to verify the correlation between CC and MM by CT, including skeletal muscle area - SMA and skeletal muscle index - SMI. ROC curves, Kappa coefficient, sensitivity, specificity, positive and negative predictive values were obtained. Results: The study included 219 patients, age 62.9 ± 13.1 years (mean ± standard deviation). Low CC was observed in 43.8% of the patients, and 29.2% had low SMI. CC positively correlated with SMA (rho ¼ 0.333) and SMI (rho ¼ 0.329), and fair agreements (K ¼ 0.268) were observed between CC and SMI, with higher and significant values for males (K ¼ 0.332) and patients below 60 years (K ¼ 0.419). The area under the curve (AUC) for low CC to identifying low SMI was equal to 0.685 (CI 95% 0.606 e0.765). Low CC presented fair agreement to identify low SMI in the sample; however, the negative predictive value was almost 80% for all analyses. Conclusions: Low CC is not a surrogate for low SMI in patients with cancer, but it could be an alternative, non-invasive, easy-to-perform method to pre-screen patients with cancer with adequate SMI
Alterações antropométricas e bioelétricas em decorrência da sarcopenia em idosos: International Mobility in Aging Study IMIAS Brasil
(Universidade Federal do Rio Grande do Norte, 2020-09-09) Morais, Marcely Araújo de; Lyra, Clélia de Oliveira; Lopes, Márcia Marilia Gomes Dantas; ; ; ; http://lattes.cnpq.br/8457538057453833; Gonzalez, Maria Cristina; ; Vale, Sancha Helena de Lima;
A sarcopenia é uma síndrome caracterizada pela redução da massa muscular, força muscular e desempenho físico. É considerada uma das principais causas de incapacidade no idoso, o que implica em prejuízos na capacidade funcional e na qualidade de vida. Fatores como diminuição da síntese protéica, proteólise, alterações na integridade neuromuscular e conteúdo de gordura podem estar envolvidos em sua gênese. O objetivo deste estudo foi avaliar a sarcopenia em idosos relacionando-os com parâmetros antropométricos e bioelétricos. Trata-se de um estudo transversal aninhado a uma coorte, da 3ª onda do projeto International Mobility in Aging Study – IMIAS Brasil no ano de 2016, com participação de 169 idosos. Para a avaliação do estado nutricional foram coletados dados antropométricos e bioelétricos. Tais dados foram utilizados para calcular o índice de massa corporal (IMC) e o índice de massa muscular esquelética (IMME), relacionados com baixa massa muscular, força e desempenho físico para obter o diagnóstico de sarcopenia; o ângulo de fase (AF) para a análise vetorial de impedância bioelétrica (BIVA). Dentre os idosos participantes, 14,8% tinham sarcopenia. Em relação ao estado nutricional antropométrico, 7,1% estavam com magreza e 69,8% com excesso de peso. Os idosos com sarcopenia tiveram valores de IMC e de perímetros do braço, da panturrilha e muscular do braço inferiores aos que não tinham estas condições (p<0,05). Os valores de AF foram menores para os homens com sarcopenia (p<0,003). Na análise estratificada por sexo, de acordo com a BIVA, os grupos dos idosos com sarcopenia possuíam vetores mais longos quando comparados aos demais (p<0,0001). Ao plotarmos os vetores individuais, foi observado massa celular reduzida em 71% das mulheres com sarcopenia. Para os homens, detectamos massa celular reduzida em 36% daqueles com sarcopenia. Em conclusão, os indivíduos com sarcopenia apresentaram menores valores de parâmetros antropométricos relacionados à muscularidade e um perfil nutricional bioelétrico com comprometimento na celularidade.
Avaliação do ângulo de fase padronizado como preditor de eventos cardiovasculares adversos de curto e longo prazo em pacientes com infarto agudo do miocárdio: um estudo de coorte
(Universidade Federal do Rio Grande do Norte, 2021-10-28) Queiroz, Sandra Azevedo; Fayh, Ana Paula Trussardi; Gonzalez, Maria Cristina; https://orcid.org/0000-0002-9130-9630; http://lattes.cnpq.br/0049770583345803; http://lattes.cnpq.br/6821738457005091; Oliveira, Aline Marcadenti de; Silva, Flávia Moraes
As doenças cardiovasculares (DCV) se destacam como a principal causa de morte no mundo, e incluem as doenças coronarianas. Dentre as doenças coronarianas, o infarto agudo do miocárdio (IAM) é definido como necrose miocárdica em uma condição clínica consistente com isquemia miocárdica. Ele é em evento cardíaco agudo, com impacto sobre o estado de saúde, e seus fatores de risco geralmente são uma combinação de uso de tabaco, dietas inadequadas, obesidade e sedentarismo, além de comorbidades pré- existentes. Estes fatores de risco podem comprometer a integridade celular, impactando sobre componentes fisiológicos e nutricionais. Nessa abordagem, o ângulo de fase (AF), medido através da bioimpedância elétrica (BIA), identifica a qualidade da membrana celular e a distribuição de fluidos corporais. Existem evidências prévias de que esse marcador possui alto poder preditivo de desfecho clínico adverso, como mortalidade e readmissão hospitalar, em diversas situações clínicas. No entanto, ainda não foi avaliada a associação do AF com eventos adversos em pacientes que foram recentemente acometidos por IAM. Assim, este trabalho tem como objetivo verificar se o ângulo de fase é preditor de eventos adversos cardiovasculares de curto e longo prazo em pacientes recentemente acometidos por infarto agudo do miocárdio. Foi realizado um estudo de coorte com seguimento de 12 meses. Foram incluídos pacientes adultos e idosos, de ambos os sexos, que internaram no Hospital Universitário Onofre Lopes (HUOL) com diagnóstico de IAM. Os pacientes foram avaliados durante a internação hospitalar, e foram coletados dados demográficos, clínicos e nutricionais. Massa corporal, estatura e circunferência da panturrilha foram medidas pela técnica antropométrica. O AF foi calculado através das medidas de resistência (R) e reactância (Xc) da bioimpedância, e foi ajustado com base no sexo e idade, apresentando o AF Padronizado (AFP). Eventos cardíacos adversos maiores (ECAM) foram observados durante o acompanhamento, e todos os pacientes foram seguidos durante os 12 meses. A amostra foi composta por 153 pacientes, com idade média de 61,2 ± 12,6 anos, sendo 57,5% idosos. Pacientes que apresentaram o AFP abaixo do percentil 10 tiveram um menor tempo para a ocorrência de morte cardiovascular (p= 0,024). Na análise univariada o AFP foi preditor de mortalidade (p= 0,036), porém esta significância estatística não foi observada quando a Regressão de Cox foi ajustada para o fator de confusão (número de fatores de risco cardiovascular). Em conclusão, pacientes recentemente acometidos por IAM e que tinham baixo AFP apresentaram maior incidência de mortalidade em 12 meses. No entanto, quando ajustado para fatores de risco cardiovascular, não observamos associação entre o AFP e ECAM e mortalidade.
Bioelectrical impedance vector analysis is different according to the comorbidity burden in post–acute myocardial infarction
(Nutrition In Clinical Practice, 2023-09) Fayh, Ana Paula Trussardi; Lopes, Márcia Marília Gomes Dantas; Sousa, Iasmin Matias; Queiroz, Sandra Azevedo; Bezerra, Mara Rubia de Oliveira; Gonzalez, Maria Cristina
Background: The prevalence of a high comorbidity burden in patients who suffered an acute myocardial infarction (AMI) is increasing with the aging population, and the nutrition status also may be a predictor of clinical outcomes for these patients. This study aimed to investigate the relationship between the comorbidity burden and the characteristics of the bioelectrical impedance vector analysis (BIVA) in patients post‐AMI. Methods: This prospective observational cohort study was conducted with adult patients who were hospitalized with AMI. Pre‐existing comorbidities were assessed by the Charlson comorbidity index (CCI) adjusted by age, and anthropometric and BIVA characteristics were evaluated after the hemodynamic stabilization. All patients were followed‐up until hospital discharge, and their length of stay was observed. Results: A total of 184 patients (75% were males; mean age, 60.2 ± 12.3 years) were included. The most common comorbidities were dyslipidemia (73.9%), hypertension (62%), and type 2 diabetes (34.2%). A higher CCI (≥3) was associated with sex (P = 0.008) and age (P < 0.001). Regarding BIVA, statistically significant differences were detected between sex (P < 0.001), age (P < 0.001), and CCI (P = 0.003), with longer vectors in female, older adults, and those with CCI ≥ 3. Conclusion: Finding a relationship between BIVA and CCI suggests the first identified coherent differences, potentially correlated with diseases, representing a first contribution to support this type of assessment. Therefore, with BIVA, healthcare professionals may monitor abnormalities and adopt preventive nutrition care measures on patients post‐AMI to improve their clinical status
Comparative assessment of abdominal and thigh muscle characteristics using CT-derived images
(Nutrition, 2022-07) Fayh, Ana Paula Trussardi; Medeiros, Galtieri Otávio Cunha de; Sousa, Iasmin Matias de; Chaves, Gabriela Villaça; Gonzalez, Maria Cristina; Prado, Carla M.
Objectives: The aim of this study was to compare the assessment of skeletal muscle area (SMA in cm2 ), skeletal muscle index (SMI in cm2 /m2 ), and skeletal muscle density (SMD in HU) between third lumbar vertebra (L3) and thigh landmarks, and the agreement in diagnosing low muscle mass and low SMD (L3 as the reference method). Methods: This was a multicenter, cross-sectional study including healthy individuals (18 y of age) of both sexes, who had an elective computed tomography exam including abdominal and pelvic regions. Computed tomography images were analyzed to evaluate SMA, SMI, and SMD. Muscle abnormalities (low SMA, SMI, and SMD) were defined as values below the fifth percentile from a subsample of healthy young individuals (n = 111; 1839 y of age; 55.9% women). Correlation coefficients, BlandAltman graphs, and receiver operating characteristic (ROC) curves were calculated for the total sample and stratified by sex and age. Results: In all, 268 individuals (44.3 § 15.2 y of age) were evaluated (53% women). Significant (P < 0.001 for all analysis) and strong correlations between SMA (r = 0.896), SMI (r= 0.853), and SMD (r= 0.864) compared with L3 and thigh landmarks were observed. For the ROC curves, similar areas under the curve values were obtained for men (0.981), women (0.895), younger (0.902), and older adults (0.894). Conclusions: Muscle characteristics between L3and thigh landmarks have a strong correlation. This suggests that images of the thigh can be used to characterize muscle characteristics. Image acquisition and analysis of thigh region is simpler, with less radiation exposure, and consequently more appropriate for longitudinal analysis
Complementaridade de diferentes ferramentas de triagem de risco nutricional aos critérios GLIM para diagnóstico de desnutrição em pacientes com câncer
(Universidade Federal do Rio Grande do Norte, 2024-03-27) Miranda, Bruna Luisa Gomes de; Fayh, Ana Paula Trussardi; Silva, Flávia Moraes; https://orcid.org/0000-0002-9130-9630; http://lattes.cnpq.br/0049770583345803; https://orcid.org/0000-0002-8219-7235; http://lattes.cnpq.br/9755054763329683; Lima, Severina Carla Vieira Cunha; Gonzalez, Maria Cristina
Introdução: O câncer é a segunda causa de morte mundial e o curso da doença aumenta o risco de desnutrição. Aproximadamente 20% dos pacientes morre por desnutrição e complicações associadas, não pela doença propriamente dita. Portanto, a correta identificação da desnutrição favorece intervenção precoce naqueles que necessitam. Ferramentas de triagem de risco nutricional (TRN) e diagnóstico nutricional se tornam indispensáveis nesse processo. Objetivos: Avaliar a complementaridade de diferentes ferramentas de TRN aos critérios GLIM para diagnóstico de desnutrição em pacientes com câncer. Métodos: O estudo representa uma análise secundária de uma coorte prospectiva, que avaliou pacientes com câncer em ambiente hospitalar. A TRN foi feita por meio das ferramentas Protocol for Nutritional Risk in Oncology (PRONTO), Avaliação Subjetiva Global Produzida pelo Próprio Paciente (ASG-PPP), Nutritional Risk Screening (NRS-2002), Malnutrition Screening Tool (MST), Malnutrition Universal Screening Tool (MUST) e Nutriscore. A avaliação do estado nutricional foi feita pelo critério proposto pelo GLIM, considerando critérios fenotípicos de perda ponderal, Índice de Massa Corporal reduzido e baixa massa muscular (via circunferência da panturrilha e índice de massa livre de gordura avaliado pela impedância bioelétrica), combinados com critério etiológico de redução da ingestão alimentar e inflamação, considerado presente em todos os pacientes devido ao diagnóstico de câncer. Pacientes foram avaliados até 12 meses após alta hospitalar para avaliar o desfecho de interesse (óbito). Para verificar a complementaridade das ferramentas de TRN aos critérios GLIM para diagnóstico de desnutrição, foram calculadas métricas de acurácia e conduzida análise de regressão de Cox para verificar associação entre mortalidade e presença de risco nutricional combinado com diagnóstico de desnutrição, considerando-se as diferentes ferramentas de TRN. Resultados: Foram avaliados 290 pacientes, sendo a maioria idosos (60,3%), do sexo feminino (53,1%) e com tumores sólidos (89,7%). Do total, 118 (40,7%) indivíduos morreram. A ferramenta PRONTO identificou mais indivíduos (n = 240, 82,8%) em risco nutricional. Entretanto, como as demais, apresentou complementaridade aos critérios GLIM reduzida, levando em conta a especificidade (68,6%) e valor preditivo negativo (48,0%) obtidos. Sobre risco de mortalidade, após ajuste para variáveis de confusão, a presença de desnutrição pelo GLIM, sem aplicação prévia de triagem, foi associada à mortalidade (HR: 5,15; IC95% 1,62 – 16,36; p < 0,001). O risco nutricional também foi preditor de óbito, independente da ferramenta de TRN empregada (HR entre 1,70 e 10,07). Ainda, a presença de risco nutricional e desnutrição, independentemente da ferramenta de TRN empregada, aumentou o risco de morte entre 1,90 e 7,70 vezes. Conclusão: A prevalência de desnutrição de acordo com os critérios GLIM é dependente da ferramenta aplicada para TRN previamente à avaliação da presença dos critérios etiológicos e fenotípicos, e foi mais elevada quando aplicada a ASG-PPP. Nenhuma ferramenta de TRN apresentou valores satisfatórios de especificidade e valor preditivo negativo. Risco nutricional e desnutrição, isolados ou combinados, independente da ferramenta aplicada, foram preditores de óbito em pacientes com câncer. Tais resultados sugerem que, independentemente da ferramenta de TRN empregada e do resultado, o diagnóstico de desnutrição pelos critérios GLIM deve ser realizado em todos os pacientes com câncer.
Is cachexia associated with chemotherapy toxicities in gastrointestinal cancer patients? a prospective study
(Journal of Cachexia, Sarcopenia and Muscle, 2019-03) Fayh, Ana Paula Trussardi; Rocha, Ilanna Marques Gomes da; Marcadenti, Aline; Medeiros, Galtieri Otávio Cunha de; Bezerra, Ricardo Andrade; Rego, Juliana Florinda de Mendonça; Gonzalez, Maria Cristina
BackgroundChemotherapy is an effective treatment with good clinical response in patients with cancer. However, it cancause exacerbated toxicities in patients and consequently change the course of treatment. Some factors may interfere withthis toxicity such as body composition, especially in gastrointestinal cancer. The aim of this study was to evaluate the effectsof body composition, nutritional status, and functional capacity scale in predicting the occurrence of toxicities in gastrointes-tinal cancer patients during chemotherapy treatment.MethodsThis is a prospective study with gastrointestinal cancer patients at the beginning of chemotherapy treatment.Sarcopenia and muscle attenuation were assessed using the skeletal muscle index from computerized tomography by measur-ing cross-sectional areas of the L3tissue (cm2/m2). Cachexia was graded according to involuntary weight loss associated withsarcopenia. Nutritional status was assessed by using anthropometric evaluation and Patient-Generated Subjective Global As-sessment. Functional capacity was evaluated by handgrip strength and Eastern Cooperative Oncology Group (ECOG) Perfor-mance Status scale. Haematological gastrointestinal and dose-limiting toxicities (DLTs) were defined according to NationalCancer Institute Common Toxicity Criteria. The associations among sarcopenia, cachexia, nutritional status, and functional ca-pacity with DLT were assessed by univariate and multivariate Cox regression model.ResultsA total of60patients were evaluated (55% male,60.9±14.0years) and followed up for a mean of55days. Mostpatients had normal weight (44.2%) and good ECOG Performance Status (≤1) at baseline (78%). During the chemotherapy pe-riod, the most prevalent toxicities were diarrhoea, nausea, and anorexia, but the presence of DLT was similar between cycles(P>0.05). Cachexia was associated with a higher toxicity manifested by diarrhoea (P=0.02), nausea (P=0.02), and anorexia(P<0.01andP=0.03at Cycles1and2, respectively). Sarcopenic and cachetic individuals experienced more toxicities and DLTduring chemotherapy. The only factors associated with DLT in the multivariate Cox regression analyses including the presenceof metastasis and the chemotherapy protocol were cachexia and the ECOG scale (P<0.001for both).ConclusionsCachexia and ECOG score may identify patients with an increased risk for developing severe toxicity events dur-ing chemotherapy treatment for gastrointestinal cancer
Is skeletal muscle radiodensity able to indicate physical function impairment in older adults with gastrointestinal cancer?
(Experimental Gerontology, 2019-10) Fayh, Ana Paula Trussardi; Barbalho, Erica Roberta; Gonzalez, Maria Cristina; Bielemann, Renata Moraes; Rocha, Ilanna Marques Gomes da; Sousa, Iasmin Matias de; Bezerra, Ricardo Andrade; Medeiros, Galtieri Otávio Cunha de
Background: Worsening nutritional status in older adult cancer patients can lead to sarcopenia, a condition that occurs with low quantity or quality of muscle mass associated with low physical function. However, most of the studies with cancer patients have only analyzed the quantity of muscle mass for diagnostic of sarcopenia, without exploring muscle characteristics and physical function. The purpose of the present study is to explore the associations between muscle mass characteristics and physical function in older adult patients with cancer. Methods: Gastric older cancer patients were enrolled in a cross-sectional study. Computed tomography images of the abdominal region evaluated skeletal muscle mass using the Slice-O-Matic version 5.0 Software program (Tomovision, Montreal, Canada) to determine the parameters of skeletal muscle index (SMI, muscle quantity) and skeletal muscle radiodensity (SMD). The physical function was evaluated through handgrip strength and gait speed test. Four musculature phenotypes were identified: normal SMI and SMD, only low SMI, only low SMD, and low SMI and SMD. Linear regression analyses adjusted by age and tumor stage verified the associations between SMI, SMD and physical function. A One-Way Covariance Analysis with Bonferroni post hoc test was used to compare the physical function variables among the four different phenotypes. Results: In total, 167 patients were evaluated (58.1% males; mean age 69.17 ± 7.97 years). The results showed that muscle mass characteristics explains, at least partially, the variability in handgrip strength and gait speed in a direct relationship. The phenotypes with low muscular SMI and/or SMD presented worse performances in handgrip strength and gait speed tests. When stratified for sexes, the significant difference occurs only in males. Conclusions: Low SMD has negatively impacted physical function in older adults with gastrointestinal cancer, especially in males
Is the standardized phase angle a predictor of short- and long-term adverse cardiovascular events in patients with acute myocardial infarction? a cohort study
(Nutrition, 2022-11) Fayh, Ana Paula Trussardi; Queiroz, Sandra Azevedo; Gonzalez, Maria Cristina; Silva, Alana Monteiro Bispo da; Costa, Jálissa Karla de Araújo; Oliveira, Carlos Diego Ramos de; Sousa, Iasmin Matias de
Objectives: Acute myocardial infarction (AMI) is myocardial necrosis resulting from myocardial ischemia, and its risk factors are usually a combination of the consumption of tobacco, inadequate diet, obesity, and a sedentary lifestyle, in addition to preexisting comorbidities. These risk factors may compromise cellular integrity, affecting physiologic and nutritional components. The phase angle (PhA) has been measured by bioelectrical impedance analysis (BIA) to identify the quality of the cell membrane and the distribution of body fluids. The aim of this study was to verify if the standardized PhA (SPhA) is a predictor of short- and long-term adverse cardiovascular events in patients after AMI. Methods: This was a prospective cohort study including hospitalized adult patients with a diagnosis of AMI. Demographic, clinical, and nutritional data were collected. The PhA was calculated through the measuring of the resistance (R) and reactance (Xc) from BIA, and it was adjusted based on reference values for sex and age, presenting, therefore, the SPhA. Low SPhA was defined as that <10th percentile of distribution. Hospital length of stay (LOS) and major adverse cardiac events (MACE), such as new hospital admission for unstable angina, new MI, and cardiovascular mortality, were observed. The sample comprised 153 patients, with a mean age of 61.2 § 12.6 y, with 57.5% being older adults. Results: Fifteen patients with low SPhA (values <3.10) had a longer LOS compared with those with normal SPhA (median 14 versus 8 d, P = 0.007), and shorter time for the occurrence of death (320 versus 354 d, P = 0.024). In the multivariate analysis, an association was observed between SPhA and longer LOS (hazard ratio, 9.25; P = 0.005), but not with mortality and MACE (P > 0.05 for all). Conclusion: SPhA was a predictor of longer LOS, but not of long-term adverse cardiac events in patients following AMI
Is there a difference in the parameters of the bioelectrical impedance obtained from devices from different manufacturers? a cross-sectional study in hospitalized cancer patients
(Clinical Nutrition Espen, 2023-08) Fayh, Ana Paula Trussardi; Guedes, Francisco Felipe de Oliveira; Sousa, Iasmin Matias de; Medeiros, Galtieri Otávio Cunha de; Gonzalez, Maria Cristina
Background: Cancer is a disease with high and increasing incidence rates in the world and its course tends to harm the body composition. Monitoring these body changes is very important. Therefore, it is essential to have reliable, accessible, and practical methods for evaluating body compartments. This study aims to evaluate the correlation and agreement of results for the bioelectrical impedance analysis (BIA) obtained from devices from different manufacturers. Methods: This is a single-center cross-sectional study including hospitalized patients with cancer. Two devices from different brands used for obtaining the BIA were used; both with a tetrapolar model and a single frequency (50 kHz). The results were evaluated for resistance (R) and reactance (Xc) and used to calculate the phase angle (PhA) and fat-free mass (FFM) indicators. Pearson and Spearman correlation tests and BlandeAltman plots were performed, with results expressed as bias and limits of agreement at 95% confidence intervals (95%CI). Results: We have included 116 patients, with a mean age of 60.8 ± 14.8, 51.7% were women. We have found very strong correlations between the measurements of R (rho ¼ 0.971) and FFM (r ¼ 0.979), and strong correlations for Xc (rho ¼ 0.784) and PhA (rho ¼ 0.768). However, the measurements did not agree between the methods. Conclusions: Commercial brands of devices used for the BIA influence the results generated, a factor that must be considered when choosing the most appropriate method for this analysis
Low calf circumference adjusted for body mass index is associated with prolonged hospital stay
(The American Journal Of Clinical Nutrition, 2023-02) Fayh, Ana Paula Trussardi; Sousa, Iasmin Matias de; Lima, Júlia; Gonzalez, Maria Cristina; Prado, Carla M.; Silva, Flávia Moraes
Background: Calf circumference (CC) is of emerging importance because of its practicality, high correlation with skeletal muscle, and potential predictive value for adverse outcomes. However, the accuracy of CC is influenced by adiposity. CC adjusted for BMI (BMI-adjusted CC) has been proposed to counteract this problem. However, its accuracy to predict outcomes is unknown. Objectives: To evaluate the predictive validity of BMI-adjusted CC in hospital settings. Methods: A secondary analysis of a prospective cohort study in hospitalized adult patients was conducted. The CC was adjusted for BMI by reducing 3, 7, or 12 cm for BMI (in kg/m2) of 25–29.9, 30–39.9, and ≥40, respectively. Low CC was defined as ≤34 cm for males and ≤33 cm for females. Primary outcomes included length of hospital stay (LOS) and in-hospital death, and secondary outcomes were hospital readmissions and mortality within 6 mo after discharge. Results: We included 554 patients (55.2 ± 14.9 y, 52.9% men). Among them, 25.3% presented with low CC, whereas 60.6% had BMI-adjusted low CC. In-hospital death occurred in 13 patients (2.3%), and median LOS was 10.0 (5.0–18.0) d. Within 6 mo from discharge, 43 patients (8.2%) died, and 178 (34.0%) were readmitted to the hospital. BMI-adjusted low CC was an independent predictor of LOS ≥ 10 d (odds ratio = 1.70; 95% confidence interval: 1.18, 2.43], but it was not associated with the other outcomes. Conclusions: BMI-adjusted low CC was identified in more than 60% of hospitalized patients and was an independent predictor of longer LOS
Low calf circumference is an independent predictor of mortality in cancer patients: a prospective cohort study
(Nutrition, 2020-11) Fayh, Ana Paula Trussardi; Sousa, Iasmin Matias; Bielemann, Renata Moraes; Gonzalez, Maria Cristina; Rocha, Ilanna Marques Gomes da; Barbalho, Erica Roberta; Carvalho, Ana Lúcia Miranda de; Dantas, Maria Amélia Marques; Medeiros, Galtieri Otávio Cunha de; Silva, Flavia Moraes
Objective: Loss of muscle mass is associated with worse outcomes in patients with cancer. The objective of this study was to evaluate the prognostic value of calf circumference (CC) and skeletal muscle index from computed tomography (CT) to predict mortality in patients with cancer. Methods: A single-center prospective study was conducted with patients aged 20 y attending a reference center of oncology and who had recent abdominal CT images. Data were collected through a semistructured form and patients’ records and included sociodemographic data (sex, age and ethnicity), clinical data (primary site and staging of tumor and treatments performed), anthropometric variables (body mass index and CC), and outcome (death). Low CC for men was considered to be 34 cm and for women 33 cm. Muscle mass was assessed by CT images at the level of L3. The Cox proportional hazard model adjusted for age, sex, and staging of disease was used. Results: A total of 250 patients were evaluated, 52.8% female, with a median age of 63 y (interquartile ratio: 5573). Normal body mass index was identified in 44.4%; 29.2% had low skeletal muscle index, and 46.4% had low CC. Death by any cause occurred in 16%, and only low CC was a significant predictor of mortality (hazard ratio = 3.01; confidence interval 1.525.98; P = 0.002). Conclusions: Low CC can predict risk of mortality in this cohort of patients. The findings suggest the use of CC as a simple, easy, cost-effective anthropometric measurement to quickly screen patients at risk of death who could benefit from targeted care to improve their prognosis
Low skeletal muscle radiodensity is the best predictor for short-term major surgical complications in gastrointestinal surgical cancer: a cohort study
(Plos One, 2021-02) Fayh, Ana Paula Trussardi; Carvalho, Ana Lúcia Miranda de; Gonzalez, Maria Cristina; Sousa, Iasmin Matias de; Virgens, Isabel Pinto Amorim das; Medeiros, Galtieri Otavio Cunha de; Oliveira, Marília Nelo; Dantas, Jeane Cristina Alves de Souza
The aim of this study was to evaluate whether body composition, muscle function, and their association are predictive factors for short-term postoperative complications in patients with gastric and colorectal cancer. A prospective cohort study was conducted with patients undergoing resection of gastric and colorectal tumors. Nutritional status was assessed using Patient-Generated Subjective Global Assessment (PG-SGA) and anthropometric techniques. Low handgrip strength (HGS) was observed when <16kg for women, and <27kg for men. Computed tomography images were used to measure visceral adipose tissue, skeletal muscle index (SMI), and skeletal muscle radiodensity (SMD). Complications of grade II or above (according to Clavien-Dindo’s classification) were considered in a follow-up period of up to 30 days after surgery. Major complications were defined when they reached grade III or above. A total of 84 patients were analyzed (57.1% female, 59.7 ± 12.6 years) and 19% were diagnosed with low HGS + low SMI or SMD. Postoperative complications occurred in 51.2%, and these patients presented significantly longer duration of surgery and hospital stay. Major complications were observed in 16.7% of the total number of patients. Binary logistic regression adjusted by age, sex, and tumor staging showed that low SMD, low HGS + low SMI or SMD, and obesity were independent risk factors for postoperative complications, but only low SMD was an independent risk factor for major postoperative complications. Low SMD is an independent risk factor for short-term major complications following surgery in patients with gastric and colorectal cancer.
New insights on how and where to measure muscle mass
(Current Opinion In Supportive & Palliative Care, 2020-12) Fayh, Ana Paula Trussardi; Sousa, Iasmin Matias de; Gonzalez, Maria Cristina
Purpose of review: This article will discuss different muscle mass assessment methods and emphasize their highlights. Recent findings: Several measurement techniques can be used to evaluate muscle mass, recognized as important prognostic markers for adverse functional and clinical outcomes. Choosing the best method depends on the knowledge regarding their theoretical and practical limitations and the purpose of the assessment. Image techniques are considered the gold standards, with good accuracy and precision, but not always available in clinical settings. A new biological technique, the D3-creatinine dilution, can provide not only direct information about muscle mass but also shows a strong association with physical function. With the advancement of the use of the computed tomography (CT) images to assess skeletal muscle mass, mainly in patients with cancer, the assessment of skeletal muscle radiodensity (SMD), as a marker of muscle quality, may provide additional information regarding the association between muscle composition, muscle function and prognosis. Additional muscle function assessment can improve the risk prediction in several clinical situations. Summary: The use of the best tool for the muscle mass assessment should be performed carefully among the various methodologies, according to their characteristics and clinical situation

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Navegando por Autor "Gonzalez, Maria Cristina"