Aconselhamento em nutrição na doença inflamatória intestinal: de novos marcadores à assistência

Abstract

INTRODUCTION: Nutrition is an important component of the clinical care of people with Inflammatory Bowel Disease (IBD). Nutrition counseling (NC) provided by health professionals with expertise in nutrition can promote the best nutritional advances and prognoses. OBJECTIVE: To evaluate factors that may allow for more effective nutrition interventions to assist people with IBD. METHODS: This thesis consists of three methodological sections, culminating in 3 bibliographical products: 1. Systematic review of the potential of thiols as a biomarker of IBD activity, aiming to direct more assertive nutritional interventions; 2. Review of the evidence inherent to NC as a care strategy for IBD, seeking to characterize the importance and effectiveness of NC for better assistance in IBD; 3. Historical cohort study, involving adult and elderly individuals, who underwent clinical follow-up at a reference outpatient clinic for the treatment of IBD. The data contained in the participants' medical records were allocated into 2 evaluation groups, based on specialized assistance: I. group assisted by registered dietitian nutritionist (SN) and II. group not assisted by registered dietitian nutritionist (NN), and evaluated at the first and last consultations at the reference outpatient clinic for IBD care. The data were treated statistically to verify the association between clinical and nutritional variables and specialized assistance. RESULTS: The results of the investigations of this thesis are presented in the form of 3 manuscripts: 1. Thiols as a marker of inflammatory bowel disease activity: a systematic review: individual studies included in this review suggest an association between disease activity and systemic oxidation, measured by serum thiol levels; 2. Nutrition counseling in inflammatory bowel disease: a review based on WH questions: NC is an important strategy for the treatment of IBD, it must occur early and continuously. The registered dietitian nutritionist (RDN) is the professional who brings together specific skills and competencies for safe and effective NC; 3. Assistance from RDN favors better nutritional evolution of individuals with inflammatory bowel disease: Having been assisted by RDN increased the chance of using a dietary supplement (p=0.029). The SN had a lower erythrocyte sedimentation rate in the final evaluation, suggesting that it was less inflamed than the NN (P =0.042). The NN showed greater weight variation during the assessment interval. Adequate body mass index evolution was associated with RDN assistance (P=0.018). CONCLUSION: Thiols may be a good parameter for monitoring the clinical course of IBD. Specialized care from RDN may favor better clinical and nutritional evolution of people with Crohn's disease and ulcerative colitis, considering the role of RDN in effective NC, justifying the inclusion of RDN as mandatory members of multidisciplinary care teams in IBD. More robust studies may confirm these findings and direct more assertive nutritional interventions in IBD.