{"id":1754,"date":"2025-09-24T10:00:03","date_gmt":"2025-09-24T13:00:03","guid":{"rendered":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/?p=1754"},"modified":"2025-09-24T10:02:28","modified_gmt":"2025-09-24T13:02:28","slug":"glutamina-nutricao-parenteral-beneficios-clinicos","status":"publish","type":"post","link":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/glutamina-nutricao-parenteral-beneficios-clinicos\/","title":{"rendered":"Benef\u00edcios do Uso da Glutamina em Nutri\u00e7\u00e3o Parenteral"},"content":{"rendered":"

A glutamina (GLN) \u00e9 o amino\u00e1cido n\u00e3o essencial de maior abund\u00e2ncia no plasma (1) e \u00e9 tamb\u00e9m o substrato de prefer\u00eancia das c\u00e9lulas de divis\u00e3o r\u00e1pida como enter\u00f3citos e linf\u00f3citos (2). Sendo assim, possui papel fundamental na indu\u00e7\u00e3o de vias de prote\u00e7\u00e3o celular e atua na modula\u00e7\u00e3o de resposta inflamat\u00f3ria (3).<\/p>\n

O uso de glutamina em nutri\u00e7\u00e3o parenteral vem sendo objeto de estudo na literatura cient\u00edfica, com intuito de avaliar os benef\u00edcios que a suplementa\u00e7\u00e3o poderia gerar. A seguir, confira o panorama atual das evid\u00eancias dispon\u00edveis.<\/p>\n

Glutamina em nutri\u00e7\u00e3o parenteral: para quais condi\u00e7\u00f5es cl\u00ednicas pode trazer benef\u00edcios?<\/h2>\n

Pacientes cir\u00fargicos<\/strong><\/h5>\n

Em pacientes cir\u00fargicos cr\u00edticos, a suplementa\u00e7\u00e3o parenteral de glutamina tem sido avaliada como estrat\u00e9gia de terapia nutricional.<\/p>\n

Uma revis\u00e3o sistem\u00e1tica e meta-an\u00e1lise de sete ensaios cl\u00ednicos randomizados demonstrou redu\u00e7\u00e3o significativa de complica\u00e7\u00f5es infecciosas e diminui\u00e7\u00e3o de 4,09 dias na dura\u00e7\u00e3o da interna\u00e7\u00e3o hospitalar<\/strong>, al\u00e9m de uma <\/span>redu\u00e7\u00e3o n\u00e3o significativa de 24% na mortalidade (4).<\/p>\n

A diretriz pr\u00e1tica da ESPEN de nutri\u00e7\u00e3o cl\u00ednica em cirurgia recomenda a adi\u00e7\u00e3o de glutamina (0,35\u20130,40 g\/kg\/dia)<\/strong> \u00e0 nutri\u00e7\u00e3o parenteral exclusiva em pacientes cir\u00fargicos cr\u00edticos quando a via enteral for invi\u00e1vel (5).<\/p>\n

Queimaduras<\/strong><\/h5>\n

A glutamina em nutri\u00e7\u00e3o parenteral tem sido avaliada em pacientes com queimaduras graves para melhorar os desfechos cl\u00ednicos.<\/p>\n

Uma meta-an\u00e1lise recente (6) incluiu 22 ECRs com 2.170 pacientes queimados e mostrou que a glutamina:<\/p>\n

    \n
  • Reduziu a dura\u00e7\u00e3o da interna\u00e7\u00e3o hospitalar <\/strong>(em m\u00e9dia 7,95 dias);<\/li>\n
  • Melhorou as taxas de cicatriza\u00e7\u00e3o de feridas e os tempos de cicatriza\u00e7\u00e3o de feridas<\/strong> (9,15%);<\/li>\n
  • Diminuiu as infec\u00e7\u00f5es de ferida<\/strong>.<\/li>\n<\/ul>\n

    Entretanto, os autores destacam a necessidade de mais ensaios multic\u00eantricos de grande porte para que a suplementa\u00e7\u00e3o rotineira de glutamina em nutri\u00e7\u00e3o parenteral seja indicada neste p\u00fablico.<\/p>\n

    Pancreatite<\/strong><\/h5>\n

    A suplementa\u00e7\u00e3o de glutamina parenteral tem sido investigada em pacientes com pancreatite aguda grave sem possibilidade de nutri\u00e7\u00e3o enteral adequada.<\/p>\n

    Uma rede de meta-an\u00e1lise recente (7), com 19 ECRs e 1.035 pacientes, comparou diferentes imunonutrientes \u2014 como glutamina, \u00f4mega-3, arginina e nucleot\u00eddeos \u2014 e demonstrou que a glutamina parenteral se destacou.<\/p>\n

    Em compara\u00e7\u00e3o ao controle, a glutamina reduziu significativamente a mortalidade, as complica\u00e7\u00f5es infecciosas, a dura\u00e7\u00e3o da interna\u00e7\u00e3o hospitalar<\/strong> (\u20133,32 dias), o tempo de perman\u00eancia na UTI <\/strong>(\u20132,53 dias) e os n\u00edveis de PCR<\/strong> (\u201317,78 mg\/L).<\/p>\n

    A diretriz pr\u00e1tica da ESPEN de nutri\u00e7\u00e3o cl\u00ednica para pacientes hospitalizados com pancreatite aguda ou cr\u00f4nica recomenda suplementar L-glutamina parenteral a 0,20 g\/kg\/dia<\/strong> quando a via enteral n\u00e3o for vi\u00e1vel (8).<\/p>\n

    Al\u00e9m disso, a diretriz BRASPEN tamb\u00e9m considera que o uso de glutamina, via enteral e\/ou parenteral, na dose de 0,3\u20130,5 g\/kg\/dia<\/strong>, para pancreatite aguda grave (9).<\/p>\n

    C\u00e2ncer<\/strong><\/h5>\n

    A glutamina em nutri\u00e7\u00e3o parenteral tem sido estudada como estrat\u00e9gia de imunonutri\u00e7\u00e3o para melhorar a fun\u00e7\u00e3o imune e reduzir complica\u00e7\u00f5es em pacientes submetidos \u00e0 ressec\u00e7\u00e3o radical de c\u00e2ncer colorretal.<\/p>\n

    Uma meta\u2010an\u00e1lise de 31 ECRs com 2.201 pacientes (10) demonstrou que, em compara\u00e7\u00e3o ao suporte nutricional convencional, a glutamina parenteral:<\/p>\n

      \n
    • Melhorou indicadores de fun\u00e7\u00e3o imunol\u00f3gica<\/strong>: IgA, IgM, IgG, CD4+ e raz\u00e3o CD4+\/CD8+;<\/li>\n
    • Reduziu complica\u00e7\u00f5es<\/strong>: infec\u00e7\u00e3o do s\u00edtio cir\u00fargico e vazamento anastom\u00f3tico;<\/li>\n
    • Diminuiu o tempo de interna\u00e7\u00e3o<\/strong> (m\u00e9dia \u20131,13).<\/li>\n<\/ul>\n

      Os autores ressaltam a necessidade de ensaios multic\u00eantricos de grande porte antes de recomendar a suplementa\u00e7\u00e3o rotineira desse nutriente. Contudo, os achados sugerem que a glutamina deve ser aplicada como uma terapia de imunonutri\u00e7\u00e3o eficaz no tratamento de pacientes com CCR ap\u00f3s cirurgia radical (10).<\/p>\n

      Conclus\u00e3o<\/h2>\n

      Em s\u00edntese, a glutamina em nutri\u00e7\u00e3o parenteral tem se mostrado uma aliada promissora em contextos espec\u00edficos, com benef\u00edcios como a redu\u00e7\u00e3o de complica\u00e7\u00f5es infecciosas, melhora da cicatriza\u00e7\u00e3o, menor tempo de interna\u00e7\u00e3o e suporte \u00e0 resposta imune.<\/p>\n

      Com o avan\u00e7o de novos estudos, seu papel tende a se consolidar ainda mais na pr\u00e1tica cl\u00ednica.<\/p>\n

       <\/p>\n

       <\/p>\n

       <\/p>\n

      Refer\u00eancias<\/strong><\/p>\n

      1 – Pimentel RFW, Fernandes SL. Effects of parenteral glutamine in critically ill surgical patients: a systematic review and meta-analysis. Nutr Hosp 2020;37(3):616-621.<\/p>\n

      2 – Co\u00ebffier M, D\u00e9chelotte P. The Role of Glutamine in Intensive Care Unit Patients:\u00a0 Mechanisms of Action and Clinical Outcome. Nutr Rev 2005;63(2):65-9.<\/p>\n

      3 – Wischmeyer PE. Glutamine: role in critical illness and ongoing clinical trials.\u00a0 Curr Opin Gastroenterol 2008;24(2):190-7.<\/p>\n

      4 – Pimentel RFW, Fernandes SL. Effects of parenteral glutamine in critically ill surgical patients: a systematic review and meta-analysis. Nutr Hosp. 2020 Jul 13;34(3):616-621.<\/p>\n

      5 – Weimann A, Braga M, Carli F, Higashiguchi T, H\u00fcbner M, Klek S, Laviano A, Ljungqvist O, Lobo DN, Martindale RG, Waitzberg D, Bischoff SC, Singer P. ESPEN practical guideline: Clinical nutrition in surgery. Clin Nutr. 2021 Jul;40(7):4745-4761.<\/p>\n

      6 – Tao W, Xu G, Zhou J, Luo Y, Li PS. Glutamine Supplementation on Burn Patients: A Systematic Review and Meta-analysis. J Burn Care Res. 2024 May 6;45(3):675-684.<\/p>\n

      7 – Tao X, Yang Y, Xu S, Xiong Q. Efficacy of immune nutrients in severe acute pancreatitis: A network meta-analysis. Medicine (Baltimore). 2023 Oct 27;102(43):e35615.<\/p>\n

      8 – Arvanitakis, M., Ockenga, J., Bezmarevic, M., Gianotti, L., Krznari\u0107, \u017d., Lobo, D. N., \u2026 & Bischoff, S. C. (2024). ESPEN practical guideline on clinical nutrition in acute and chronic pancreatitis. Clinical Nutrition, 43(2), 395-412.<\/p>\n

      9 – Castro MG et al. Diretriz BRASPEN de Terapia Nutricional no Paciente Grave. Sociedade Brasileira de Nutri\u00e7\u00e3o Parenteral e Enteral. BRASPEN Journal, 2023.<\/p>\n

      10 – Yang T, Yan X, Cao Y, Bao T, Li G, Gu S, Xiong K, Xiao T. Meta-analysis of Glutamine on Immune Function and Post-Operative Complications of Patients With Colorectal Cancer. Front Nutr. 2021 Dec 6;8:765809.<\/p>\n","protected":false},"excerpt":{"rendered":"

      A glutamina (GLN) \u00e9 o amino\u00e1cido n\u00e3o essencial de maior abund\u00e2ncia no plasma (1) e \u00e9 tamb\u00e9m o substrato de prefer\u00eancia das c\u00e9lulas de divis\u00e3o r\u00e1pida como enter\u00f3citos e linf\u00f3citos (2). Sendo assim, possui papel fundamental na indu\u00e7\u00e3o de vias de prote\u00e7\u00e3o celular e atua na modula\u00e7\u00e3o de resposta inflamat\u00f3ria (3). O uso de glutamina […]<\/p>\n","protected":false},"author":67,"featured_media":2110,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[47,4],"tags":[94,119,324,148,141,325,67,322,111,323,143,69],"class_list":["post-1754","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-artigo-4","category-nutricao-clinica","tag-aminoacidos","tag-braspen","tag-cancer-colorretal","tag-espen","tag-glutamina","tag-imunonutricao","tag-nutricao-parenteral","tag-pacientes-cirurgicos","tag-pancreatite","tag-queimaduras","tag-terapia-nutricional","tag-uti"],"acf":[],"yoast_head":"\nGlutamina em Nutri\u00e7\u00e3o Parenteral: Evid\u00eancias e Aplica\u00e7\u00f5es<\/title>\n<meta name=\"description\" content=\"Explore os benef\u00edcios da glutamina em nutri\u00e7\u00e3o parenteral para pacientes cir\u00fargicos, queimados, com pancreatite ou c\u00e2ncer, segundo 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