FANOR MANUAL DE AVALIAÇÃO NUTRICIONAL 2017

\ue003\ue003 \ue003 \ue003 \ue003 \ue003 \ue003 \ue003 \ue003 Organização: \ue003 Prof. \ue003 Me. \ue003 José \ue003 Francisco \ue003 Diogo \ue003 da \ue003 Silva \ue003 Junior \ue003 Prof. \ue003 Me. \ue003 Paulo \ue003 Carvalho \ue003 de \ue003 Paula \ue003 \ue003 \ue003 \ue003 \ue003 \ue003 \ue003 \ue003 \ue003 \ue003 \ue003 \ue003 \ue003 \ue003 \ue003 \ue003\ue003\ue003\ue003\ue003\ue003\ue003\ue003\ue003\ue003\ue003\ue003\ue003\ue003\ue003\ue003\ue003\ue003\ue003FORTALEZA\u2010CE/2017\ue003 \ue003 Manual \ue003 de A VALIAÇÃO \ue003 N UTRICIONAL \ue003 A VAN Ç ADA DeVry \ue003 | \ue003 FANOR \ue003 \u2013 \ue003 Campus \ue003 Dunas \ue003 Av.\ue003Santos\ue003Dumont,\ue0037800\ue003 60191\u2010156\ue003\u2013\ue003Dun as\ue003\u2013\ue003Fortaleza\ue003\u2013\ue003CE\ue003 http://www.devrybrasil.edu.br/fanor \ue003 \ue003 \ue003 Coordenador \ue003 de \ue003 Operações \ue003 Acadêmicas \ue003\ue003 Prof.\ue003Rosiane\ue003Freire\ue003Cavalcanti\ue003 \ue003 Coordenadora \ue003 Acadêmica \ue003 do \ue003 Curso \ue003 de \ue003 Nutrição \ue003 Prof.\ue003Me.\ue003Ana\ue003Paula\ue003Moreira\ue003Bezerra\ue003 \ue003 \ue003 Projeto \ue003 Gráfico \ue003 e \ue003 Imagens \ue003 Digitais \ue003 Patrick\ue003Barroso\ue003Camelo\ue003da\ue003Silva\ue003 \ue003 1ª\ue003Edição\ue003@\ue003Ja neiro\ue003de\ue0032017.\ue003 \ue003 José \ue003 Francisco \ue003 Diogo \ue003 da \ue003 Silva \ue003 Junior. \ue003 Nutricionista.\ue003 Especialista\ue003 em\ue003 Nutrição\ue003 Clínica\ue003 pela\ue003 Uni\u2010 v e r s i d a d e \ue003G a m a \ue003F i l h o \ue003( U G F ) . \ue003M e s t r e \ue003e m \ue003N u t r i ç ã o \ue003e \ue003S a ú d e \ue003p e l a \ue003U n i vers idade\ue003 Estadual\ue003 do\ue003 Ceará\ue003 (UECE).\ue003Professor\ue003do\ue003Curso\ue003de\ue003Ci ências\ue003da\ue003Nutrição\ue003da\ue003DeVry\ue003FAN OR.\ue003 \ue003 Paulo \ue003 Carvalho \ue003 de \ue003 Paula. \ue003 Nutricionista.\ue003Mestre\ue003em\ue003Bioquím ica\ue003pela\ue003Universidade\ue003Federal\ue003d o\ue003Ce\u2010 ará\ue003 (UFC).\ue003 Doutorando\ue003 do\ue003 p rograma\ue003 de\ue003 Pós\u2010Grad uação\ue003 em\ue003 Bioquímic a\ue003 e\ue003 B iologia\ue003 Molecular\ue003 da\ue003 Uni\u2010 versidade\ue003Federal\ue003do\ue003Ceará\ue003(UFC) .\ue003Professor\ue003do\ue003Curso\ue003de\ue003Ciência s\ue003da\ue003Nutrição\ue003da\ue003DeVry\ue003FANOR.\ue003 \ue003 \ue003 Os\ue003autores\ue003se\ue003empenharam\ue003par a\ue003citar\ue003adequad amente\ue003e\ue003dar\ue003o\ue003devid o\ue003crédit o\ue003a\ue003todos\ue003os\ue003detentore s\ue003de\ue003direitos\ue003 autorais\ue003 de\ue003 qualquer\ue003 material\ue003 utilizado\ue003 nest e\ue003 manual,\ue003 dispondo\u2010 s e \ue003a \ue003po s sí v e i s\ue003 a ce r to s \ue003p os t e r i or e s \ue003c as o , \ue003i na d \u2010 vertida\ue003e\ue003involuntariamente,\ue003a\ue003i dentificação\ue003de\ue003algum\ue003deles\ue003ten ha \ue003sido\ue003omitida.\ue003 \ue003 \ue003 \ue003 \ue003 Todo\ue003o\ue003 conteúdo\ue003 deste\ue003trabalho,\ue003 exceto\ue003 quando\ue003houver\ue003 ressalva,\ue003 é\ue003 publicado\ue003 sob\ue003 a\ue003 lice nça\ue003 Creative\ue003 Commons\ue003 Atribuição\ue003\u2013\ue003 Não\ue003Comercia l\ue003\u2013\ue003Com partilha\ue003Igual\ue0034.0\ue003Internaciona l\ue003(CC\ue003BY\u2010NC\u2010SA\ue0034.0).\ue003 All\ue003the\ue003 contents\ue003of\ue003 this\ue003w ork,\ue003e xcept\ue003 where\ue003otherwise\ue003noted,\ue003 is \ue003licensed \ue003unde r\ue003a\ue003 Creative\ue003Commons\ue003 Attribution\ue003 \u2013\ue003Non\ue003Commercial\ue003\u2013\ue003ShareAlike\ue0034. 0\ue003International\ue003(CC\ue003BY\u2010NC\u2010SA\ue0034. 0).\ue003 \ue003 \ue003 MANUAL\ue003DE\ue003AVALIAÇÃO\ue003NUTRICIONAL\ue003AVANÇADA \ue003 1 \ue003 \ue003 Sumário\ue003 1.\ue003 INTRODUÇÃO\ue003................................................. ............................................................... ........................\ue003 6\ue003 1.1.\ue003 PARÂMETROS\ue003PARA\ue003AVALI AÇÃO\ue003DO\ue003ESTADO\ue003NUTRICIONAL \ue003 .......... ................................................\ue003 6\ue003 \ue003 História\ue003nutricional\ue003(entrevista)\ue003 ............................ ............................................................... .....\ue003 6\ue003 \ue003 Exame\ue003físico\ue003 ................................................. ............................................................... ..............\ue003 7\ue003 \ue003 Antropometria\ue003 ................................................ ............................................................... ...........\ue003 7\ue003 \ue003 Inquéritos\ue003alimentares\ue003 ....................................... ............................................................... ........\ue003 9\ue003 1.2.\ue003 PRESCRIÇÃO\ue003DIETÉTICA\ue003 ..................................... ............................................................... ..............\ue003 10\ue003 2.\ue003 ANTROPOMETRIA\ue003 .............................................. ............................................................... ...................\ue003 11\ue003 2.1.\ue003 AVALIAÇÃO\ue003ANTROPOMÉTRICA\ue003EM\ue003ADULTOS\ue003E\ue003IDOSOS\ue003 ............. .................................................\ue003 11\ue003 \ue003 Peso\ue003 ......................................................... ............................................................... .................\ue003 11\ue003 \ue003 Estatura\ue003 ..................................................... ............................................................... ...............\ue003 15\ue003 2.2.\ue003 ÍNDICES\ue003CORPORAIS\ue003 ........................................ ............................................................... ................\ue003 16\ue003 \ue003 Índice\ue003de\ue003Massa\ue003C orporal\ue003(IMC)\ue003 ............................... ..............................................................\ue003 16\ue003 \ue003 Recíproco\ue003Índice\ue003Ponderal \ue003(RIP)\ue003 .............................. ............................................................... \ue003 18\ue003 \ue003 Índice\ue003de\ue003Adiposidad e\ue003Corporal\ue003(IAC)\ue003 ......................... ............................................................\ue003 18 \ue003 3.\ue003 COMPOSIÇÃO\ue003CORPORAL \ue003........................................ ............................................................... ............\ue003 19\ue003 3.1.\ue003 DOBRAS\ue003CUTÂNEAS \ue003 .......................................... ............................................................... ...............\ue003 19\ue003 \ue003 Dobra\ue003cutânea\ue003tricipital\ue003(D CT)\ue003 ............................... ............................................................... ..\ue003 19\ue003 \ue003 Dobra\ue003cutânea\ue003sube scapul ar\ue003(DCSE)\ue003 ............................ ...........................................................\ue003 19\ue003 \ue003 Somatório\ue003das\ue003dob ras\ue003DCT\ue003e \ue003DCSE\ue003 .............................. ...........................................................\ue003 19\ue003 \ue003 Somatório\ue003de\ue003dobras\ue003\u2013\ue003determinação\ue003do\ue003%\ue003de\ue003gordur a\ue003corporal\ue003 .. ........................................\ue003 20\ue003 \ue003 Percentual\ue003de\ue003gordura\ue003 ........................................ ............................................................... .....\ue003 22\ue003 3.2.\ue003 CIRCUNFERÊNCIAS\ue003 .......................................... ............................................................... .................\ue003 25\ue003 \ue003 Circunferência\ue003do\ue003braço\ue003(C B)\ue003 ................................. ............................................................... ..\ue003 25\ue003 \ue003 Circunferência\ue003muscular\ue003do\ue003braço\ue003(C MB)\ue003 ....................... ........................................................\ue003 25\ue003 \ue003 Área\ue003total\ue003do\ue003b raço\ue003(ATB)\ue003 .................................... ............................................................... ....\ue003 26\ue003 \ue003 Área\ue003muscular\ue003do\ue003braço\ue003(A MB)\ue003e\ue003Área\ue003muscular\ue003do \ue003braço\ue003corrigid a\ue003(AMBc)\ue003........................\ue003 26\ue003 \ue003 Área\ue003gordurosa\ue003do\ue003braço\ue003(AGB)\ue003e \ue003Índice\ue003de\ue003 gordura\ue003do\ue003braço\ue003(IG B) \ue003 .....................................\ue003 26\ue003 \ue003 Circunferência\ue003da\ue003cintura \ue003(CC)\ue003 ............................... ............................................................... ..\ue003 27\ue003 \ue003 Circunferência\ue003da\ue003coxa \ue003(CCx)\ue003................................. ............................................................... ..\ue003 27\ue003 \ue003 Circunferência\ue003muscul ar\ue003da\ue003coxa\ue003(CMCx )\ue003 ....................... ........................................................\ue003 27\ue003 \ue003 Área\ue003de\ue003seção\ue003transversa\ue003do \ue003músculo\ue003da\ue003coxa\ue003(ASTC x)\ue003 .......... ................................................\ue003 27\ue003 \ue003 Área\ue003muscular\ue003da\ue003coxa \ue003corrigida\ue003(AMCx)\ue003 ....................... .........................................................\ue003 28\ue003 \ue003 Área\ue003gordurosa\ue003da\ue003coxa\ue003(AGCx)\ue003e\ue003 índice\ue003de\ue003gordura \ue003da\ue003coxa\ue003(IGC x)\ue003 ......................................\ue003 28\ue003 \ue003 Circunferência\ue003do\ue003pesco ço\ue003 .................................... ............................................................... ...\ue003 28\ue003 \ue003 Relação\ue003Cintura/Coxa\ue003......................................... ............................................................... .....\ue003 29\ue003 \ue003 Circunferência\ue003da\ue003panturril ha\ue003(CP)\ue003........................... ..............................................................\ue003 29\ue003 \ue003 Circunferência\ue003muscular \ue003da\ue003panturril ha\ue003(CMP)\ue003 ................. .....................................................\ue003 29\ue003 \ue003 MANUAL\ue003DE\ue003AVALIAÇÃO\ue003NUTRICIONAL\ue003AVANÇADA \ue003 2 \ue003 \ue003 Área\ue003total\ue003da\ue003pan turrilha\ue003(ATP)\ue003 .............................. ............................................................... .\ue00329\ue003 \ue003 Área\ue003muscular\ue003da\ue003panturrilha\ue003(A MPant)\ue003 ........................ ........................................................\ue003 29\ue003 \ue003 Área\ue003gordurosa\ue003da\ue003panturrilha\ue003(A GP)\ue003e\ue003Índice\ue003de\ue003gordura\ue003da\ue003pa n turrilha\ue003(IGP)\ue003 ...................\ue00329\ue003 3.3.\ue003 AVALIAÇÃO\ue003DA\ue003ESTRUTURA\ue003CORPORA L\ue003 .......................... ..............................................................\ue003 29\ue003 \ue003 Relação\ue003cintura \u2010quadril\ue003(RCQ)................................. ............................................................... \ue003 29\ue003 \ue003 Índice\ue003de\ue003conicidade\ue003\u2013 \ue003Índice\ue003C\ue003 .............................. ............................................................... .\ue003 31\ue003 \ue003 Relação\ue003cintura\u2010e statura\ue003(R CEst)\ue003 ............................. ..............................................................\ue003 31\ue003 \ue003 Somatotipo.................................................... ............................................................... ..........\ue003 32\ue003 \ue003 Massa\ue003muscular\ue003total\ue003(MMT)\ue003e\ue003Ma ssa\ue003muscular\ue003apen dicular\ue003(MMA)\ue003 em\ue003i dosos\ue003 .................\ue003 35\ue003 3.4.\ue003 MEDIDAS\ue003LINEARES\ue003......................................... ............................................................... ...............\ue003 37\ue003 \ue003 Diâmetro\ue003abdomina l\u2010sagital\ue003 (DAS)\ue003 ............................. ...........................................................\ue00337\ue003 \ue003 Índice\ue003Sagital\ue003(IS)\ue003 .......................................... ............................................................... ...........\ue003 37\ue003 \ue003 Outras\ue003medidas\ue003lineares\ue003 ...................................... ............................................................... ...\ue003 37\ue003 3.5.\ue003 MEDIDAS\ue003DE\ue003ES PESSURA\ue003MUSCULAR ............................. ............................................................... \ue00338\ue003 \ue003 Espessura\ue003do\ue003músculo\ue003 adutor\ue003do\ue003polegar\ue003 ....................... .......................................................\ue003 38\ue003 3.6.\ue003 MEDIDAS\ue003DIN AMOMÉTRICAS\ue003 ................................... ............................................................... ......\ue003 38\ue003 \ue003 Força\ue003de\ue003preensão \ue003palmar\ue003(FPP)\ue003 ............................... .............................................................\ue003 3 8\ue003 4.\ue003 TÉCNICAS\ue003DE\ue003AFERIÇÃO\ue003DE\ue003MEDIDAS\ue003AN TROPOMÉTRICAS\ue003 ............ ..................................................\ue00340\ue003 4.1.\ue003 PESO\ue003 ..................................................... ............................................................... ...........................\ue003 40\ue003 4.2.\ue003 ESTATURA\ue003 ................................................. ............................................................... ......................\ue003 40\ue003 \ue003 Altura\ue003do\ue003joelho\ue003............................................. ............................................................... .........\ue003 40\ue003 \ue003 Envergadura \ue003do\ue003braço\ue003 ......................................... ............................................................... ....\ue003 41\ue003 \ue003 Comprimento\ue003do\ue003braço\ue003 ......................................... ............................................................... ..\ue00341\ue003 \ue003 Comprimento\ue003da\ue003ulna\ue003 .......................................... ............................................................... ...\ue003 41\ue003 \ue003 Estatura\ue003recumbente \ue003 .......................................... ............................................................... ....\ue003 41\ue003 4.3.\ue003 CIRCUNFERÊNCIAS\ue003 .......................................... ............................................................... ................\ue003 42\ue003 \ue003 Circunferência\ue003da\ue003ci ntura\ue003 .................................... ............................................................... ....\ue003 42\ue003 \ue003 Circunferência\ue003do\ue003quadril \ue003 .................................... ............................................................... ....\ue003 42\ue003 \ue003 Circunferência\ue003abdominal\ue003 ..................................... ............................................................... ..\ue003 42\ue003 \ue003 Circunferência\ue003do\ue003braço \ue003 ...................................... ............................................................... ....\ue003 43\ue003 \ue003 Circunferência\ue003da\ue003panturril ha\ue003 ................................ ............................................................... .\ue00343\ue003 \ue003 Circunferência\ue003da\ue003coxa \ue003 ....................................... ............................................................... .....\ue003 44\ue003 \ue003 Circunferência\ue003do\ue003punho \ue003 ...................................... ............................................................... ..\ue003 44\ue003 \ue003 Circunferência\ue003do\ue003tórax\ue003 ...................................... ............................................................... ....\ue003 45\ue003 \ue003 Circunferência\ue003do\ue003tornozelo \ue003.................................. ............................................................... .\ue003 45\ue003 \ue003 Circunferência\ue003do\ue003pesco ço\ue003 .................................... ............................................................... ..\ue003 45\ue003 4.4.\ue003 DOBRAS\ue003CUTÂNEAS \ue003 .......................................... ............................................................... ..............\ue003 45\ue003 \ue003 Dobra\ue003cutânea\ue003subescapul ar\ue003................................... ..............................................................\ue003 46\ue003 \ue003 Dobra\ue003cutânea\ue003supra\u2010ilíaca\ue003 ................................... ............................................................... ..\ue00346\ue003 \ue003 MANUAL\ue003DE\ue003AVALIAÇÃO\ue003NUTRICIONAL\ue003AVANÇADA \ue003 3 \ue003 \ue003 \ue003 Dobra\ue003cutânea\ue003tricipital \ue003 ..................................... ............................................................... ......\ue003 47\ue003 \ue003 Dobra\ue003cutânea\ue003bicipital \ue003 ...................................... ............................................................... ......\ue003 47\ue003 \ue003 Dobra\ue003cutânea\ue003abdominal\ue003...................................... ............................................................... .\ue003 47\ue003 \ue003 Dobra\ue003cutânea\ue003da\ue003coxa \ue003medial\ue003................................. ..............................................................\ue003 48\ue003 \ue003 Dobra\ue003cutânea\ue003peitoral\ue003 ....................................... ............................................................... .....\ue003 48\ue003 \ue003 Dobra\ue003cutânea\ue003da\ue003panturril ha\ue003medial \ue003 .......................... ...........................................................\ue003 48\ue003 4.5.\ue003 MEDIDAS\ue003LINEARES\ue003 ......................................... ............................................................... ................\ue003 49\ue003 \ue003 Medidas\ue003lineares\ue003longitudi nais\ue003 ............................... ............................................................... .\ue003 49\ue003 \ue003 Medidas\ue003lineares\ue003transversais\ue003................................ ............................................................... .\ue003 50\ue003 4.6.\ue003 ESPESSURA\ue003DO\ue003MÚSC ULO\ue003ADUTO R\ue003 .............................. ............................................................... ..\ue003 51\ue003 4.7.\ue003 FORÇA\ue003DE\ue003PREENSÃO\ue003PALMAR\ue003 ................................. ............................................................... ......\ue003 51\ue003 5.\ue003 ÍNDICES\ue003PROGNÓSTICOS \ue003 ....................................... ............................................................... ...............\ue003 52\ue003 5.1.\ue003 ÍNDICE\ue003PROGNÓSTIC O\ue003NUTRICIONAL\ue003(I PN)\ue003..................... ..............................................................\ue003 52\ue003 5.2.\ue003 ÍNDICE\ue003DE\ue003RISCO\ue003NUT RICIONAL\ue003(IRN )\ue003........................ ............................................................... .....\ue003 52\ue003 5.3.\ue003 ÍNDICE\ue003DE\ue003PROGNÓSTICO\ue003INFLAMATÓ RIO\ue003E\ue003NUTRICIONAL\ue003(IPIN)\ue003 .. ..............................................\ue003 52\ue003 6.\ue003 COMPETÊNCIA\ue003IMUNOLÓ GICA\ue003.................................... ............................................................... ........\ue003 53\ue003 6.1.\ue003 CONTAGEM\ue003TOTAL\ue003DE\ue003LIN FÓCITOS\ue003 ............................. ............................................................... ....\ue003 53\ue003 6.2.\ue003 PROVAS\ue003CUTÂNEAS \ue003 .......................................... ............................................................... ...............\ue003 53\ue003 7.\ue003 EXAMES\ue003BIOQUÍMICOS\ue003......................................... ............................................................... ...............\ue003 54\ue003 7.1.\ue003 PROTEÍNAS\ue003PLASMÁTICAS\ue003 .................................... ............................................................... ...........\ue003 54\ue003 \ue003 Albumina\ue003sérica\ue003.............................................. ............................................................... .........\ue003 54\ue003 \ue003 Transferrina\ue003................................................. ............................................................... ............\ue003 55\ue003 \ue003 Pré\u2010albumina.................................................. ............................................................... ..........\ue003 55\ue003 \ue003 Proteína\ue003carreado ra\ue003do\ue003retinol\ue003 ............................... ............................................................... .\ue003 56\ue003 7.2.\ue003 ÍNDICE\ue003CREATININA/ESTA TURA\ue003 ............................... ............................................................... .......\ue003 56\ue003 7.3.\ue003 BALANÇO\ue003NITROGEN ADO....................................... ............................................................... .........\ue003 57\ue003 7.4.\ue003 LIPIDOGRAMA\ue003.............................................. ............................................................... ...................\ue003 58\ue003 7.5.\ue003 HEMOGRAMA\ue003 ................................................ ............................................................... ..................\ue003 58\ue003 \ue003 Eritrograma\ue003\u2013\ue003S érie\ue003vermelha\ue003 ................................. ............................................................... .\ue003 58\ue003 \ue003 Leucograma\ue003\u2013\ue003Sé rie\ue003bran ca\ue003 .................................... ............................................................... ..\ue003 59\ue003 \ue003 Plaquetas\ue003.................................................... ............................................................... .............\ue003 60\ue003 7.6.\ue003 VALORES\ue003DE\ue003REFERÊNCIA\ue003P ARA\ue003EXAMES\ue003LABORATORIAIS\ue003 .......... ..................................................\ue003 60\ue003 8.\ue003 SEMIOLOGIA\ue003NUT RICIONAL\ue003..................................... ............................................................... ............\ue003 62\ue003 8.1.\ue003 PARÂMETROS\ue003NUT RICIONAIS\ue003DO \ue003EXAME\ue003FÍ SICO\ue003 .................. .........................................................\ue003 62\ue003 8.2.\ue003 PRINCIPAIS\ue003ALTERAÇÕES\ue003CLÍNICAS\ue003EM\ue003A LGUMAS\ue003DEFICIÊNCIAS\ue003NU T RICIONAIS\ue003 .........................\ue003 63\ue003 9.\ue003 AVALIAÇÃO\ue003DO\ue003ESTADO\ue003NUTRICIONA L\ue003............................ ............................................................... ...\ue003 64\ue003 9.1.\ue003 AVALIAÇÃO\ue003SUB JETIVA\ue003GLOBAL\ue003 ............................... ............................................................... .......\ue003 64\ue003 \ue003 Procedimento\ue003................................................. ............................................................... .........\ue003 64\ue003 \ue003 Como\ue003realizar\ue003a\ue003Avaliaçã o\ue003Sub jetiva \ue003Global\ue003 ................... .........................................................\ue003 64\ue003 \ue003 MANUAL\ue003DE\ue003AVALIAÇÃO\ue003NUTRICIONAL\ue003AVANÇADA \ue003 4 \ue003 \ue003 Exame\ue003físico\ue003do\ue003estado\ue003nutricion al\ue003da\ue003Avaliação\ue003Subjetiva\ue003Glob al\ue003 ........................................\ue00367\ue003 10.\ue003 MÉTODOS\ue003 DE\ue003 AVALIAÇÃO\ue003 DO\ue003CONSUMO\ue003 ALIMENTAR\ue003 ................. .....................................................\ue003 68\ue003 10.1.\ue003 RECORDATÓRIO\ue00324\ue003HORAS\ue003(R24H)\ue003 ............................ ............................................................... .....\ue003 69\ue003 10.2.\ue003 QUESTIONÁRIO\ue003DE \ue003FREQUÊNCIA\ue003D E\ue003CONSUMO\ue003ALIMENTA R\ue003\u2013\ue003QFCA\ue003 .. ........................................\ue003 70\ue003 11.\ue003 NECESSIDADES\ue003NUTRICIONAIS\ue003 E\ue003VALOR\ue003 ENERGÉTICO\ue003DOS \ue003NUTRIENTES \ue003.........................................\ue003 73\ue003 11.1.\ue003 INTRODUÇÃO\ue003 .............................................. ............................................................... ....................\ue003 73\ue003 11.2.\ue003 NECESSIDADE S\ue003CALÓRICAS\ue003 .................................. ............................................................... ...........\ue003 73\ue003 \ue003 Calorimetria\ue003indireta\ue003 ........................................ ............................................................... .......\ue003 73\ue003 11.3.\ue003 TAXA\ue003DE\ue003METAB OLISMO\ue003BASAL\ue003 ............................... ............................................................... ......\ue003 74\ue003 \ue003 Equação\ue003de\ue003Harri s\ue003Benedict\ue003 ................................... ............................................................... .\ue003 75\ue003 11.4.\ue003 EQUAÇÕES\ue003PARA\ue003ESTIMAR\ue003O\ue003G ASTO\ue003ENERGÉTICO\ue003TOTAL\ue003(GET)\ue003.... .............................................\ue003 75\ue003 \ue003 Equação\ue003de\ue003Long\ue003 .............................................. ............................................................... .......\ue00375\ue003 \ue003 Equação\ue003de\ue003Ireton\u2010Jones\ue003 ...................................... ............................................................... ...\ue00376\ue003 \ue003 Estimativa\ue003de\ue003Kcal\ue003por\ue003Kg\ue003de\ue003peso\ue003corporal\ue003 ................... ........................................................\ue003 76\ue003 \ue003 Necessidade\ue003energética\ue003segundo\ue003FAO\ue003(2004)\ue003.................... ...................................................\ue00377\ue003 11.5.\ue003 DISTRIBUIÇÃO\ue003DE\ue003MAC RONUTRIENTES\ue003NO\ue003GET \ue003 .................. .........................................................\ue00378\ue003 \ue003 Necessidades\ue003proteicas\ue003 ....................................... ............................................................... ....\ue003 78\ue003 \ue003 Necessidades\ue003de \ue003carboidratos\ue003 ................................. ..............................................................\ue003 80\ue003 \ue003 Necessidades\ue003de\ue003lipídios\ue003 ..................................... ............................................................... ....\ue00380\ue003 \ue003 Necessidades\ue003de\ue003vitaminas\ue003 .................................... ............................................................... .\ue003 80\ue003 \ue003 Necessidades\ue003de\ue003minerais\ue003 ..................................... ............................................................... ..\ue003 81\ue003 \ue003 Necessidades\ue003de\ue003líquidos\ue003 ..................................... ............................................................... ...\ue00382\ue003 \ue003 Controle\ue003da\ue003ingestão\ue003de\ue003Alimentos \ue003 ............................ ............................................................\ue003 83 \ue003 12.\ue003 REFERÊNCIAS\ue003 ............................................... ............................................................... ........................\ue003 84\ue003 13.\ue003 ANEXOS\ue003 .................................................... ............................................................... ............................\ue003 88\ue003 \ue003 \ue003\ue003 \ue003 MANUAL\ue003DE\ue003AVALIAÇÃO\ue003NUTRICIONAL\ue003AVANÇADA \ue003 5 \ue003 \ue003 \ue003 \ue003 \ue003 Caros\ue003estudantes,\ue003\ue003 \ue003\ue003 O\ue003presente\ue003 material\ue003foi\ue003elaborado\ue003 para\ue003auxiliá\u2010los\ue003 nas\ue003 diversas \ue003atividades\ue003 acadêmicas\ue003referentes\ue003ao\ue003 curso\ue003 de \ue003Nu t ri çã o\ue003d a\ue003De Vr y\ue003F an or, \ue003no\ue003q ue \ue003diz \ue003res pe ito \ue003à\ue003e xe cuç ão ,\ue003c ál culos\ue003e\ue003 análises\ue003 relacionadas\ue003 à\ue003 avaliação\ue003 nutricional\ue003antropométrica.\ue003\ue003\ue003 Nessa\ue003 obra,\ue003 estão\ue003 reunidas\ue003 inform ações\ue003 buscadas\ue003 em\ue003 artigos\ue003 cien tíficos,\ue003 livros,\ue003 documentos,\ue003 apostilas,\ue003 te xt os\ue003o n \u2010l in e\ue003e \ue003em\ue003o ut ra s\ue003fo nt es, \ue003na\ue003t ent at iva \ue003de\ue003s e \ue003el ab or ar \ue003 um\ue003 material\ue003 de\ue003 consulta\ue003 co mpleto\ue003 no\ue003 que \ue003 diz\ue003respeito\ue003à\ue003antropometr ia.\ue003\ue003 O\ue003objetivo\ue003 é\ue003 f acilitar\ue003 o\ue003 aprendizado\ue003 dessa\ue003 temáti ca\ue003e m\ue003 sala\ue003 de\ue003 aula ,\ue003t end o\ue003em \ue003mãos \ue003uma \ue003ót im a\ue003fon te\ue003de \ue003 consulta,\ue003 bem\ue003 como\ue003 fornecer\ue003 uma\ue003 ferramenta\ue003 útil\ue003 para\ue003 a\ue003 execução \ue003 das\ue003 atividades\ue003 prática s\ue003 de\ue003 avaliação\ue003 nutricional\ue003antropométrica\ue003nos\ue003ambie ntes\ue003de\ue003estágio\ue003extra\ue003e\ue003in t ra\ue003curricular.\ue003\ue003 \ue003 Com\ue003certeza\ue003 esse\ue003 material\ue003 também \ue003 será\ue003 de\ue003 grande\ue003 proveito\ue003 para\ue003 o s\ue003 outros\ue003 colegas\ue003professores\ue003 (e\ue003 Nutri\u2010 cionistas)\ue003da\ue003casa\ue003que,\ue003certamente,\ue003abo rdarão\ue003a\ue003temática\ue003da\ue003ant ropometria\ue003em\ue003suas\ue003disciplinas.\ue003\ue003 A p r ov e i t em \ue003es s e \ue003m at er ia l, \ue003t en do \ue003um a\ue003b oa \ue003r ot in a\ue003d e\ue003e st ud os .\ue003A \ue003me ta\ue003é,\ue003 sem\ue003 dúvida,\ue003 ajudá\u2010los\ue003 a \ue003 alcançar\ue003 o \ue003s u c e s s o \ue003p r o f i ss io na l . \ue003M e t a\ue003q u e \ue003nã o \ue003é \ue003s o m e n t e \ue003m i n h a , \ue003m a s \ue003de \ue003t o dos\ue003 os\ue003 colegas\ue003p rofessores\ue003 que\ue003t ambém\ue003 fazem\ue003parte\ue003da\ue003grade\ue003de\ue003pr ofissionais\ue003desse\ue003curso.\ue003\ue003 \ue003\ue003 Bons\ue003estudos,\ue003\ue003 \ue003\ue003 Paulo\ue003Carvalho\ue003de\ue003Paula \ue003 \ue003 \ue003 MANUAL\ue003DE\ue003AVALIAÇÃO\ue003NUTRICIONAL\ue003AVANÇADA \ue003 6 \ue003 1. INTRODUÇÃO \ue003 O\ue003 estado\ue003 nutricional\ue003 normal\ue003 reflete\ue003 o \ue003 equilíbrio\ue003 entre\ue003 a\ue003 ingest ão\ue003 balanceada\ue003 de\ue003 alimentos\ue003 e\ue003 o\ue003 consumo\ue003 de\ue003 energia \ue003 necessário\ue003para\ue003 manter\ue003 as\ue003funções\ue003 diárias\ue003 do\ue003organis mo . \ue003S e m p r e \ue003q u e \ue003a l g u m \ue003fa to r \ue003i n te rf e r e \ue003e m \ue003 qualquer\ue003etapa\ue003desse\ue003equilíbrio,\ue003os\ue003riscos\ue003de\ue003desnu trição\ue003torna m\u2010se\ue003imi nentes.\ue003Por\ue003isso,\ue003o\ue003estado\ue003nutrici\u2010 onal\ue003 é\ue003 um\ue003 dos\ue003 principais\ue003 fatores\ue003 a\ue003 cons iderar\ue003 nos\ue003 pacientes\ue003 hos pi talizados,\ue003 em\ue003 virtude\ue003 do\ue003 alto\ue003 risco\ue003 de\ue003 complicações\ue003 como:\ue003 infec ções,\ue003 fl ebite,\ue003 embolia\ue003 pulmonar,\ue003 insufi ciência\ue003 respiratória,\ue003 má\ue003 cicatrização \ue003 de\ue003 feridas\ue003 e\ue003 fístulas,\ue003 entre\ue003 outras,\ue003 que,\ue003 associadas\ue003 a\ue003 um\ue003 estado\ue003 n utricional\ue003 defici ente,\ue003 podem\ue003 aumentar\ue003 o\ue003 tempo\ue003de\ue003permanência\ue003no\ue003hospital \ue003e \ue003o\ue003risco\ue003de\ue003morte.\ue003A\ue003avaliaçã o\ue003nutricional\ue003é\ue003a\ue003interpre tação\ue003conjunta\ue003 de\ue003 todos\ue003 os\ue003 parâmetros,\ue003 permitindo\u2010nos\ue003 obter\ue003 um\ue003 diagnóstico\ue003 nut ricional\ue003 preciso.\ue003 (Mora\ue003 1997;\ue003 Valdes\ue003 1997).\ue003 \ue003 A\ue003 avaliação\ue003 nutricional\ue003 do\ue003 paciente\ue003 pediátrico\ue003 observa\ue003 e\ue003 detect a\ue003 as\ue003 necessidades\ue003 e\ue003 deficiências\ue003 nutricio\u2010 nais\ue003estabelecendo,\ue003planejando\ue003e\ue003 acompanhando\ue003a\ue003terapia\ue003nutrici onal\ue003com\ue003 eficácia\ue003e\ue003com\ue003um\ue003m ínimo\ue003de\ue003 complicações.\ue003 Consiste\ue003 na\ue003 combin ação \ue003do s\ue003dad os\ue003da \ue003his tó ria\ue003a lim entar\ue003da\ue003cria nça,\ue003 no\ue003 exame\ue003 físico\ue003 e\ue003 nas\ue003 medidas\ue003antropométricas.\ue003 \ue003 O\ue003 profissiona l\ue003 nutrici onista\ue003 é\ue003 o\ue003responsável\ue003pela\ue003 avaliação\ue003nut ricional,\ue003 ainda\ue003 que\ue003 toda\ue003 e quipe\ue003deva\ue003 conhe\u2010 cer\ue003detalhad amente\ue003 sua\ue003 metodol ogia.\ue003 Essa\ue003 avaliação\ue003 d eve\ue003 ser\ue003 r ealizada\ue003 prontamen te\ue003 quando\ue003 s olicitada,\ue003 e\ue003 repetir\u2010se\ue003 a\ue003 cada\ue003 10\ue003 dias\ue003 e\ue003 no\ue003 final\ue003 do\ue003 acompanhamento.\ue003 Os\ue003 da dos\ue003 devem\ue003 ser \ue003 registrados\ue003 em\ue003 formulários\ue003 previamente\ue003estabele cidos.\ue003(Mora\ue0031997)\ue003 A\ue003 avaliaç ão\ue003 n utricional\ue003 é\ue003 p arte\ue003 f undamental\ue003do\ue003 estudo\ue003integral\ue003 e\ue003da\ue003 atenção\ue003 de\ue003boa\ue003 qualidade\ue003dispensada\ue003 ao\ue003paci ente\ue003hos pitaliz ado.\ue003 Objetivos\ue003da\ue003Avaliação\ue003Nutricional \ue003 \uf0b7 Identificar\ue003os\ue003problemas\ue003existentes\ue003 \uf0b7 Estabelecer\ue003a\ue003magnitude\ue003d o\ue003problema\ue003encontrado\ue003 \uf0b7 Determinar\ue003a\ue003distribuição\ue003geográfica\ue003dos \ue003problemas\ue003nutricionais \ue003como\ue003problemas\ue003sanitários\ue003 \uf0b7 Descobrir\ue003e\ue003analisar\ue003os\ue003fatores\ue003 ambientais\ue003responsáveis\ue003direta\ue003ou\ue003indiretamente\ue003pelo\ue003proble ma\ue003 \uf0b7 Propor\ue003medidas\ue003adequadas\ue003que\ue003visem \ue003corrigir\ue003a\ue003situação\ue003encontra da\ue003 1.1. PARÂMET ROS\ue003PARA\ue003AVALI AÇÃO\ue003DO\ue003EST ADO\ue003NUTRICIONAL \ue003 a) História\ue003nutricional,\ue003socioeconômica,\ue003clínica,\ue003cirúrgic a,\ue003etc.\ue003 b) Exame\ue003físico\ue003nutricional\ue003 c) Antropometria\ue003 d) Verificação\ue003dos\ue003parâmetros\ue003bioquímicos\ue003 e) Inquéritos\ue003alimentares\ue003 História\ue003nutricional\ue003(entrevista)\ue003 Mudança\ue003de:\ue003apetite,\ue003ingestão\ue003e\ue003p eso\ue003\ue003 Tempo\ue003de\ue003alteração\ue003no\ue003peso\ue003 \ue003 MANUAL\ue003DE\ue003AVALIAÇÃO\ue003NUTRICIONAL\ue003AVANÇADA \ue003 7 \ue003 \ue003 Tipo\ue003de\ue003dieta\ue003 Sintomas\ue003gastrintestinais\ue003 Intolerância\ue003e/ou\ue003alergias.\ue003 Uso\ue003de\ue003suplementos\ue003 Relato\ue003da\ue003ingestão\ue003nas\ue003últimas\ue00324\ue003horas\ue003 Exame\ue003físico\ue003 O\ue003primeiro\ue003sinal\ue003físico\ue003a\ue003ser\ue003ve rificado\ue003é\ue003a\ue003perda\ue003de\ue003gordura\ue003s ubcutânea.\ue003 Deve\u2010se\ue003 observar\ue003 a\ue003área\ue003 em\ue003torno\ue003 dos\ue003olhos,\ue003 a\ue003fragilidade\ue003 do\ue003c a belo,\ue003 a\ue003presença\ue003 de \ue003 queilite\ue003angular.\ue003 Deve\u2010 se\ue003 examinar\ue003 as\ue003 áreas\ue003 de\ue003 reserva\ue003 adiposa\ue003 e\ue003 a\ue003 massa\ue003 muscular\ue003 do\ue003 b r a ç o , \ue003d a \ue003p a n t u r r i l h a , \ue003d a \ue003 e s c á p u l a , \ue003d a \ue003 clavícula,\ue003 dos\ue003 ombros\ue003 e\ue003 costelas,\ue003 classificando\ue003 subjetivamente\ue003 o\ue003 grau\ue003 de\ue003 perda.\ue003 A\ue003 perda\ue003 de\ue003 go rdura\ue003 sub\u2010 cutânea\ue003 pode\ue003 ser\ue003 avaliada\ue003 nas\ue003 se guintes\ue003 regiões:\ue003 tríceps,\ue003 linha \ue003 média\ue003 axilar\ue003 no\ue003 nível\ue003 da\ue003 última\ue003 costela,\ue003 áreas\ue003 interósseas\ue003 e\ue003 palmares\ue003 das\ue003 mãos\ue003 e\ue003 ombros.\ue003 Perda\ue003 de\ue003 massa\ue003 muscular\ue003 é\ue003 avaliada\ue003 através\ue003 da\ue003 palpaçã o\ue003 dos\ue003 deltóides\ue003 e\ue003 do\ue003 quadríceps,\ue003 observando\u2010se\ue003 tanto\ue003 o\ue003 volume\ue003 qua nto\ue003 o\ue003 tônus\ue003 muscular.\ue003 Levar\ue003 em\ue003 conta\ue003 a\ue003 presença\ue003 de\ue003 alterações\ue003 atróficas\ue003 de\ue003 origem\ue003 neurológica.\ue003 A\ue003 sen sação\ue003 de\ue003 "empastamento"\ue003 da\ue003 muscula tura\ue003 pode\ue003indicar\ue003a\ue003perda\ue003de\ue003tônus\ue003muscular.\ue003 Presença\ue003 de\ue003 líquido\ue003 extravascular:\ue003 observa\u2010se\ue003 edema\ue003 da\ue003 região\ue003 s a c r a \ue003e \ue003d o s \ue003t o r n o z e l o s , \ue003p r i n c i p a l m e n t e \ue003 nos\ue003pacientes\ue003que\ue003per manecem\ue003a\ue003 maior\ue003parte\ue003do\ue003t empo\ue003acamado. \ue003 Antropometria\ue003 É\ue003a\ue003 medida \ue003 do\ue003 tamanho\ue003 corporal\ue003 e\ue003 de\ue003 suas\ue003 proporções,\ue003 sendo\ue003 u m\ue003 d os\ue003 indicadores\ue003 diretos\ue003 do\ue003 estado\ue003 n u\u2010 tricional\ue003 do\ue003 indivíduo.\ue003 As \ue003 medid as\ue003 antropométricas\ue003 mais\ue003 utiliza das\ue003 na\ue003 avaliação\ue003 antropométrica\ue003 são:\ue003 peso, \ue003 estatura,\ue003dobras/pregas\ue003cutâneas\ue003e\ue003circunferências.\ue003 1.1.3.1. MEDIDAS,\ue003ÍNDICES\ue003E \ue003INDICADORES\ue003 \uf0b7 Medidas\ue003antropométricas: \ue003dimensões\ue003de\ue003peso,\ue003estatura\ue003e \ue003outras\ue003proporções\ue003corporais;\ue003 \uf0b7 Índices: \ue003é\ue003a\ue003 c o mb i na ç ã o \ue003e n tr e \ue003d u as \ue003o u \ue003 ma i s \ue003m ed i d a s \ue003a nt r o po m é tr ica s . \ue003G er al mente\ue003o\ue003índice\ue003incorpora\ue003 em\ue003 uma\ue003 única\ue003 medida,\ue003 diferentes\ue003 aspectos\ue003 o u\ue003 diferentes\ue003 indicad o res.\ue003 Em\ue003 avaliação\ue003 nutricional\ue003 os\ue003 mais\ue003 utilizados\ue003são\ue003P/I,\ue003P/A,\ue003A/I,\ue003IMC.\ue003 \uf0b7 Indicadores: \ue003 permitem\ue003 o\ue003 diagnóstico \ue003 nutricional.\ue003 É\ue003 utilizado\ue003 para\ue003 represent ar\ue003 ou\ue003 medir\ue003 aspectos\ue003 não\ue003 su j e i t o s \ue003à \ue003o b s e r v a ç ã o \ue003d i r e t a .\ue003O \ue003i n d i c a do r \ue003i n c l u i \ue003a p e n a s \ue003u m \ue003a s p e cto,\ue003por\ue003exemplo,\ue003a\ue003 desnutrição\ue003ou\ue003a\ue003obe\u2010 sidade.\ue003 Para\ue003tanto,\ue003 deve\u2010se\ue003comparar\ue003 a\ue003 população\ue003avaliada\ue003 com\ue003 u m a \ue003p o p u l a ç ã o \ue003d e \ue003r e f e r ê n c i a , \ue003o u \ue003n o r m a l , \ue003 po r\ue003m eio\ue003d os\ue003p on to s\ue003de \ue003cor te\ue003p ara\ue003o s\ue003índ ice s\ue003a nt ropo mét ric os, \ue003p ara\ue003possibilitar\ue003a\ue003 identifi cação\ue003 e\ue003 quanti\u2010 ficação\ue003da\ue003natureza\ue003e\ue003da\ue003gravidade\ue003das\ue003patologias\ue003nutricionais. \ue003 \uf0b7 Pontos\ue003de\ue003co rte: \ue003são\ue003os\ue003limites\ue003da \ue003normalidade\ue003de \ue003uma\ue003população\ue003de\ue003referência,\ue003 que\ue003podem\ue003ser\ue003infe\u2010 riores\ue003ou\ue003superiores\ue003à\ue003média.\ue003 1.1.3.2. MEDIDAS\ue003ANTROPOMÉTRICAS\ue003 a) Peso\ue003 O\ue003 p eso\ue003 é\ue003 a\ue003 soma\ue003 de\ue003 todos\ue003 os\ue003 componentes\ue003 corporais\ue003 (água,\ue003 gordur a , \ue003o s s o s , \ue003m ú s c u l o s ) \ue003e \ue003r e f l e t e \ue003o \ue003e q u i l í b r i o \ue003 proteico\u2010energético\ue003do\ue003indivíduo. \ue003 \uf0b7 Peso\ue003atual:\ue003 é\ue003o\ue003peso\ue003verific ado\ue003em\ue003uma\ue003balança\ue003calibrada,\ue003onde\ue003o\ue003indivíduo \ue003 é\ue003posicionado\ue003d e\ue003pé,\ue003des\u2010 calço,\ue003 no\ue003 centro\ue003 da\ue003 balança\ue003 e\ue003 com\ue003 roupas\ue003 leves.\ue003 O\ue003 valor\ue003 obtido\ue003 corresponde\ue003 ao\ue003 peso\ue003 atual\ue003 do\ue003 indivíduo \ue003 na\ue003referida\ue003data.\ue003 \uf0b7 Peso\ue003 usual:\ue003 utilizado \ue003 como\ue003 referência\ue003 na\ue003 avaliação\ue003 das\ue003 mudança s\ue003 recentes\ue003 de \ue003 peso\ue003 e\ue003 em\ue003 casos\ue003 de \ue003

FANOR MANUAL DE AVALIAÇÃO NUTRICIONAL 2017

Avaliação Nutricional I

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Avaliação Nutricional I

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