IJCS | Volume 32, Nº2, May/June 2019

270 Costa et al. Effect of surgery on loss of muscle mass Int J Cardiovasc Sci. 2019;32(3)269-273 Original Article restriction in the preoperative period. Participants who showed NYHA class worsening, 2 or had hemodynamic decompensation, renal failure, sepsis or myocardial infarction were excluded. All participants started preoperative fasting 12 hours before the surgery. Oral feeding with a liquid diet in small amounts was offered 24 hours after the surgery and was maintained until 48 hours postoperatively. It consisted of meatless vegetable soup, fruit juice and teas. Participants were recruited using convenience sampling. The participants’ energy and protein reserves were evaluated by anthropometry performed by the same trained evaluator in the preoperative period and on the seventh postoperative day. Height (m) and weight (kg) were measured in a portable stadiometer and electronic balance, respectively with participants dressed in lightweight clothes. Body mass index (BMI) was calculated as the ratio between weight and squared height (kg / m²). Normal weight was considered when BMI was between 22 - 27 kg / m²) and overweight as BMI > 27- < 30 kg/m². Waist circumference (WC; cm) was measured with an inextensible metric tape, at midpoint between the lowest rib and the iliac crest after exhalation. The mean of the two measurements was considered in the analysis: high risk of metabolic complications was associatedwith obesity when WC > 102 cm. In order to evaluate armmuscle circumference (AMC; cm), the arm circumference (AC; cm) was measured at arm midpoint between the acromion and the olecranon with the arm flexed, using a tape measure. Then, the triceps skinfold thickness (TST; mm) was measured in the same place using an adipose compass (Cescorf, Brazil). AMC was calculated based on the AC and TST using the formula: AMC = AC - (3.14 × TST). The AMC reference range for age 70–79 years was P 50 = 27.2 cm. Adequacy percentage was calculated considering P 50 value: normal weight > 90%. The fat reserves were evaluated through TST and body fat percentage (BF%). TST reference range for age 70-79 years at P 50 = 12.4 mm. Adequacy percentage was calculated considering P 50 value: normal weight: 90 – 110%; obesity > 110%. BF%was calculated based on the sumof the four folds: TST, bicipital (mm), suprailiac (mm) and subscapular (mm) folds. The bicipital fold was measured towards the longitudinal axis of the arm, on its anterior face, at the point of greatest apparent circumference of the biceps. The suprailiac fold was obtained in the medial axillary line at midpoint between the iliac crest and the last costal arch. The subscapular fold was measured one centimeter below the inferior angle of the scapula. Adequacy percentage of normal range for men is 15-18%; risk of diseases associatedwith obesity: ≥ 25%). Themean of two measurements was considered in the analysis. Serum albumin (g/dL) was also evaluated: normal range > 3.5 g/dL; medium risk: 2.8 – 3.4 g/dL. Statistical analysis Data were analyzed using the software SPSS, version 10 (SPSS Inc.), PASW version 18 (IBM) and Microsoft Excel. Data normality was verified by the Shapiro–Wilks test. Paired t Test was used to compare the pre- and postoperative periods when the variables had normal distribution. When the normality criterion was not met, the Mann-Whitney test was used. A significance level was considered at p value < 0.05. Results From July 2016 to August 2017, thirty-seven patients (94.6% males) were recruited and followed. Nineteen (51%) patients were excluded: seven (18.9%) patients had NYHA class worsening, seven had hemodynamic decompensation, two (5.4%) had kidney disease, one (2.7%) had acute myocardial infarction, one (2.7%) had sepsis and one (2.7%) died. Eighteen patients completed the study. Table 1 3-5 summarizes clinical and demographic characteristics of the study population. The risk factors and comorbidities for ischemic heart disease were observed. The values found for body composition and plasma albumin in the preoperative period and on the 7 th postoperative day are shown in table 2. BMI, AMC and albumin had values reduced by 4.2%, 25% and 1.8%, respectively. Discussion Preoperative nutritional risk assessment is well established and aims to minimize postoperative morbidity andmortality, 6 as well as targeting caloric and nitrogen support for healing and preventing excessive loss of lean body mass. 7 Studies that evaluated the postoperative body composition of patients after major cardiac surgeries