{"id":1801,"date":"2025-06-25T11:05:46","date_gmt":"2025-06-25T14:05:46","guid":{"rendered":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/?p=1801"},"modified":"2025-06-25T11:10:50","modified_gmt":"2025-06-25T14:10:50","slug":"emulsoes-lipidicas-parenterais","status":"publish","type":"post","link":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/emulsoes-lipidicas-parenterais\/","title":{"rendered":"Emuls\u00f5es Lip\u00eddicas Parenterais: Tudo que Voc\u00ea Precisa Saber\u00a0"},"content":{"rendered":"

Os lip\u00eddios foram uma adi\u00e7\u00e3o tardia de macronutrientes \u00e0 formula\u00e7\u00e3o de nutri\u00e7\u00e3o parenteral (NP) na d\u00e9cada de 1960. A experimenta\u00e7\u00e3o ao longo dos anos levou a uma ampla gama de emuls\u00f5es lip\u00eddicas parenterais, com vari\u00e1veis fontes de gordura e efeitos para o paciente nos dias atuais (1).<\/span>\u00a0<\/span><\/p>\n

Hoje, voc\u00ea ir\u00e1 descobrir o que s\u00e3o as emuls\u00f5es lip\u00eddicas parenterais, suas gera\u00e7\u00f5es, recomenda\u00e7\u00f5es pr\u00e1ticas para o seu uso, e muito mais. Confira a seguir!<\/span>\u00a0<\/span><\/p>\n

 <\/p>\n

O que s\u00e3o as emuls\u00f5es lip\u00eddicas?<\/span><\/span>\u00a0<\/span><\/h2>\n

Emuls\u00f5es \u200b\u200blip\u00eddicas (EL) s\u00e3o formula\u00e7\u00f5es complexas, que fornecem cerca de 25 a 40% de energia n\u00e3o proteica para a nutri\u00e7\u00e3o parenteral; previnem a defici\u00eancia de \u00e1cidos graxos essenciais; e podem ter propriedades anti-inflamat\u00f3rias ou imunomoduladoras (2, 3).<\/span>\u00a0<\/span><\/p>\n

As ELs s\u00e3o misturas de \u00f3leo em \u00e1gua, uma combina\u00e7\u00e3o aceit\u00e1vel gra\u00e7as ao uso de um agente emulsificante apropriado (3, 4).<\/span>\u00a0<\/span><\/p>\n

Suas fontes de gordura variam entre as formula\u00e7\u00f5es, incluindo <\/span>\u00f3leo de soja, \u00f3leo de oliva, \u00f3leo de peixe e \u00f3leo de coco<\/span><\/b>. Essas diferen\u00e7as resultam em propor\u00e7\u00f5es variadas de \u00f4megas 3, 6 e 9, fosfolip\u00eddios e triglic\u00e9rides de cadeia m\u00e9dia (TCM) que ter\u00e3o diferentes comportamentos em fun\u00e7\u00e3o de potencial oxidativo, inflamat\u00f3rio e imunossupressivo (5).<\/span>\u00a0<\/span><\/p>\n

Por conterem uma alta densidade energ\u00e9tica, as emuls\u00f5es lip\u00eddicas possibilitam reduzir o fornecimento de glicose na NP, evitando os riscos de hiperglicemia e insufici\u00eancia hep\u00e1tica (5, 6).<\/span>\u00a0<\/span><\/p>\n

 <\/p>\n

Emuls\u00f5es lip\u00eddicas: componentes oleicos e \u00e1cidos graxos<\/span><\/span>\u00a0<\/span><\/h2>\n

As diferentes fontes de gordura presente nas emuls\u00f5es lip\u00eddicas determinam seu teor de \u00e1cidos graxos. Como sabemos, de acordo com o comprimento da cadeia de carbonos, os \u00e1cidos graxos podem ser (1):<\/span>\u00a0<\/span><\/p>\n

    \n
  • AGs de cadeia curta<\/span><\/b>: 4 \u00e1tomos de carbono ou menos<\/span>\u00a0<\/span><\/li>\n<\/ul>\n
      \n
    • AGs de cadeia m\u00e9dia<\/span><\/b>: 6 a 14 \u00e1tomos de carbono<\/span>\u00a0<\/span><\/li>\n<\/ul>\n
        \n
      • AGs de cadeia longa<\/span><\/b>: acima de 14 \u00e1tomos de carbono<\/span>\u00a0<\/span><\/li>\n<\/ul>\n

        Al\u00e9m disso, os \u00e1cidos graxos tamb\u00e9m podem ser classificados pela presen\u00e7a ou aus\u00eancia de satura\u00e7\u00e3o entre as liga\u00e7\u00f5es de carbono (1).<\/span>\u00a0<\/span><\/p>\n

        Desse modo, os triglicer\u00eddeos presentes nas ELs podem ser constitu\u00eddos de <\/span>AGs poli-insaturados de cadeia longa<\/span><\/b> (\u00e1cido linol\u00eanico e \u00e1cido linoleico); de <\/span>AGs monoinsaturados de cadeia longa <\/span><\/b>(\u00e1cido oleico); e de <\/span>AGs saturados de cadeia m\u00e9dia <\/span><\/b>(7).\u00a0<\/span>\u00a0<\/span><\/p>\n

        As concentra\u00e7\u00f5es desses \u00e1cidos nas ELs qualificam-se de acordo com os anos de lan\u00e7amento no mercado (1, 3, 7):\u00a0<\/span>\u00a0<\/span><\/p>\n

        \u00a0<\/span><\/p>\n\n\n\n\n\n\n\n
        Gera\u00e7\u00e3o<\/span><\/b>\u00a0<\/span><\/td>\nComposi\u00e7\u00e3o<\/span><\/b>\u00a0<\/span><\/td>\nConsidera\u00e7\u00f5es<\/span><\/b>\u00a0<\/span><\/td>\n<\/tr>\n
        Primeira Gera\u00e7\u00e3o (1960)<\/span>\u00a0<\/span><\/td>\n100% \u00f3leo de soja<\/span>\u00a0<\/span><\/td>\n– Fonte de AGs essenciais e energia<\/span>\u00a0<\/span><\/p>\n

        – Rico em \u03c9-6<\/span>\u00a0<\/span><\/td>\n<\/tr>\n

        Segunda Gera\u00e7\u00e3o (1980)<\/span>\u00a0<\/span><\/td>\nInclus\u00e3o de TCM:<\/span>\u00a0<\/span><\/p>\n

        50% \u00f3leo de soja + 50% \u00f3leo de coco<\/span>\u00a0<\/span><\/p>\n

        \u00a0<\/span><\/p>\n

        \u00a0<\/span><\/td>\n

        		– Fonte de AGs essenciais e energia<\/span>\u00a0<\/span><\/p>\n

        – Teor de \u03c9-6 reduzido, diminuindo impacto inflamat\u00f3rio<\/span>\u00a0<\/span><\/p>\n

        — Produto mais est\u00e1vel<\/span>\u00a0<\/span><\/td>\n<\/tr>\n

        Terceira Gera\u00e7\u00e3o (1990)<\/span>\u00a0<\/span><\/td>\n75 a 80% de azeite de oliva + 20 a 25% de \u00f3leo de soja<\/span>\u00a0<\/span><\/td>\n– Fonte de AGs essenciais e energia<\/span>\u00a0<\/span><\/p>\n

        – Redu\u00e7\u00e3o ainda maior de \u03c9-6<\/span>\u00a0<\/span><\/p>\n

        – Redu\u00e7\u00e3o parcial do impacto inflamat\u00f3rio, imunol\u00f3gico e da coagula\u00e7\u00e3o devido inclus\u00e3o de \u03c9-9<\/span>\u00a0<\/span><\/td>\n<\/tr>\n

        Quarta Gera\u00e7\u00e3o (2000)<\/span>\u00a0<\/span><\/td>\nMistura de \u00f3leo de soja, \u00f3leo de oliva, \u00f3leo de coco e \u00f3leo de peixe em diferentes propor\u00e7\u00f5es;<\/span>\u00a0<\/span><\/p>\n

        \u00a0<\/span><\/p>\n

        OU apenas \u00f3leo de peixe<\/span>\u00a0<\/span><\/td>\n

        		– Fonte de AGs essenciais e energia<\/span>\u00a0<\/span><\/p>\n

        – Fonte de \u03c9-3 (EPA e DHA)<\/span>\u00a0<\/span><\/p>\n

        – Equil\u00edbrio entre \u03c9-3 e \u03c9-6<\/span>\u00a0<\/span><\/p>\n

        – A\u00e7\u00e3o imunomoduladora, essenciais para pacientes cr\u00edticos<\/span>\u00a0<\/span><\/p>\n

        – Potencial de reverter a doen\u00e7a hep\u00e1tica associada \u00e0 insufici\u00eancia intestinal (IFALD)<\/span>\u00a0<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

         <\/p>\n

        Outros componentes das emuls\u00f5es lip\u00eddicas\u00a0<\/span><\/span>\u00a0<\/span><\/h2>\n

        Embora os principais componentes das emuls\u00f5es lip\u00eddicas sejam os \u00e1cidos graxos, outros componentes tamb\u00e9m est\u00e3o presentes, com caracter\u00edsticas funcionais que precisam ser consideradas de acordo com o perfil e estado de cada paciente (1).<\/span><\/span>\u00a0<\/span><\/p>\n

        Fitoester\u00f3is<\/span><\/span>\u00a0<\/span><\/strong><\/h5>\n

        Os fitoester\u00f3is s\u00e3o compostos vegetais estruturalmente semelhantes ao colesterol. Normalmente, menos de 5% dos fitoester\u00f3is s\u00e3o absorvidos, mas em crian\u00e7as recebendo NP, ocorre uma absor\u00e7\u00e3o de 100%, podendo levar ao ac\u00famulo de sais biliares no f\u00edgado, um marcador de colestase hep\u00e1tica (1).\u00a0<\/span>\u00a0<\/span><\/p>\n

        A colestase surgiu como um problema com o uso a longo prazo de emuls\u00f5es lip\u00eddicas com \u00f3leo de oliva em beb\u00eas (8) ou \u00f3leo de soja em crian\u00e7as (9).<\/span>\u00a0<\/span><\/p>\n

        Alfa-tocopherol<\/span><\/b>\u00a0<\/span><\/h5>\n

        A principal forma de vitamina E em ELs \u00e9 o \u03b1-tocoferol, adicionado para prevenir a peroxida\u00e7\u00e3o lip\u00eddica em lip\u00eddios ricos em \u00e1cidos graxos poli-insaturados (1).\u00a0<\/span>\u00a0<\/span><\/p>\n

        Estudos sugerem que aumentar a concentra\u00e7\u00e3o de \u03b1-tocoferol pode melhorar a estabilidade das ELs e reduzir marcadores de les\u00e3o hep\u00e1tica. Emuls\u00f5es \u00e0 base de \u00f3leo de peixe s\u00e3o naturalmente ricas nesse nutriente, enquanto \u00f3leos de soja e c\u00e1rtamo s\u00e3o mais ricos em outra forma de tocoferol, menos protetora (1).<\/span>\u00a0<\/span><\/p>\n

        Emulsificantes<\/span><\/b>\u00a0<\/span><\/h5>\n

        As ELs s\u00e3o emuls\u00f5es de \u00f3leo em \u00e1gua estabilizadas por fosfolip\u00eddios, principalmente derivados de \u00f3leo de soja e gema de ovo (1).\u00a0<\/span>\u00a0<\/span><\/p>\n

        Entretanto, um excesso de emulsificante pode levar \u00e0 forma\u00e7\u00e3o de lipossomas, que podem interferir no metabolismo lip\u00eddico e contribuir para a hiperlipidemia e ac\u00famulo de colesterol. O impacto dos lipossomas na circula\u00e7\u00e3o depende da concentra\u00e7\u00e3o de \u00f3leo na emuls\u00e3o, taxa e dura\u00e7\u00e3o da infus\u00e3o (1).<\/span>\u00a0<\/span><\/p>\n

        Vitamina K<\/span><\/b>\u00a0<\/span><\/h5>\n

        A filoquinona (vitamina K1) \u00e9 essencial para a coagula\u00e7\u00e3o sangu\u00ednea, e sua defici\u00eancia prolonga o tempo de coagula\u00e7\u00e3o. As recomenda\u00e7\u00f5es diet\u00e9ticas variam, sendo de 1 \u03bcg\/kg para adultos (1).\u00a0<\/span>\u00a0<\/span><\/p>\n

        Em pacientes em terapia anticoagulante, o teor de vitamina K nas ELs deve ser considerado, pois \u00f3leos usados na formula\u00e7\u00e3o cont\u00eam diferentes quantidades: \u00f3leo de soja (150\u2013300 \u03bcg\/100 g), \u00f3leo de oliva (1.1\u20135.5 \u03bcg\/100 g) e \u00f3leo de c\u00e1rtamo (6\u201312 \u03bcg\/100 g) (1).<\/span>\u00a0<\/span><\/p>\n

         <\/p>\n

        Como escolher a emuls\u00e3o lip\u00eddica?<\/span><\/span>\u00a0<\/span><\/h2>\n
        Pacientes est\u00e1veis<\/span><\/b>\u00a0<\/span><\/h5>\n

        O <\/span>\u00f3leo de soja<\/span><\/b> \u00e9 a op\u00e7\u00e3o mais barata entre as fontes de lip\u00eddeos e funciona bem para pacientes est\u00e1veis, pois \u00e9 uma excelente fonte de calorias n\u00e3o proteicas e oferece potencialmente bom conte\u00fado de \u00e1cidos graxos essenciais (5).\u00a0<\/span>\u00a0<\/span><\/p>\n

        No entanto, \u00e9 importante considerar alguns fatores. Ele possui uma alta concentra\u00e7\u00e3o de \u00e1cidos graxos de cadeia longa, como o \u00e1cido linoleico, associado a <\/span>efeitos pr\u00f3-inflamat\u00f3rios e imunossupressores<\/span><\/b> (3, 10, 11).<\/span>\u00a0<\/span><\/p>\n

        Essa caracter\u00edstica, juntamente ao seu alto teor de fitoesterois, pode contribuir para uma s\u00e9rie de complica\u00e7\u00f5es, como doen\u00e7a hep\u00e1tica associada \u00e0 fal\u00eancia intestinal e hipertrigliceridemia, al\u00e9m de impactar o sistema imunol\u00f3gico (11, 12, 13, 14).<\/span>\u00a0<\/span><\/p>\n

        Pacientes hipermetab\u00f3licos e cr\u00edticos<\/span><\/b>\u00a0<\/span><\/h5>\n

        O estresse metab\u00f3lico \u00e9 um desafio frequente na pr\u00e1tica cl\u00ednica. A substitui\u00e7\u00e3o de um ter\u00e7o das calorias de formula\u00e7\u00f5es de nutri\u00e7\u00e3o parenteral baseadas em glicose e amino\u00e1cido por uma emuls\u00e3o lip\u00eddica j\u00e1 \u00e9 uma medida importante para atingir um estado anab\u00f3lico e foi associada com redu\u00e7\u00e3o das complica\u00e7\u00f5es metab\u00f3licas hep\u00e1tica e relacionadas \u00e0 glicose (15, 16, 17).<\/span>\u00a0<\/span><\/p>\n

        No entanto, estudos mais recentes v\u00eam demonstrando tamb\u00e9m que as formula\u00e7\u00f5es baseadas exclusivamente em \u00f3leo de soja devem ser evitadas em pacientes hipermetab\u00f3licos (5, 18).\u00a0<\/span>\u00a0<\/span><\/p>\n

        Deve-se dar prefer\u00eancia a <\/span>emuls\u00f5es lip\u00eddicas que contenham triglicer\u00eddeos de cadeia m\u00e9dia, \u00f3leo de oliva e \u00f3leo de peixe<\/span><\/b>. Fazendo essa troca, busca-se diminuir o fornecimento de \u00e1cidos graxos \u00f4mega 6, mais potencialmente oxidativos, inflamat\u00f3rios, imunossupressores e pr\u00f3-tromb\u00f3ticos (5, 18).<\/span>\u00a0<\/span><\/p>\n

        No caso de pacientes criticamente enfermos, a Sociedade Brasileira de Nutri\u00e7\u00e3o Parenteral e Enteral (BRASPEN) tamb\u00e9m n\u00e3o recomenda a utiliza\u00e7\u00e3o de emuls\u00f5es lip\u00eddicas baseadas exclusivamente em \u00f3leo de soja (19).<\/span>\u00a0<\/span><\/p>\n

        Indica-se dar prefer\u00eancia \u00e0s <\/span>emuls\u00f5es lip\u00eddicas que contenham \u00f3leo de peixe<\/span><\/b>, boas fontes de \u00e1cidos eicosapentaen\u00f3ico e docosahexaen\u00f3ico, que modulam a resposta imunol\u00f3gica e, provavelmente, reduzem a perman\u00eancia na unidade de terapia intensiva (5).<\/span>\u00a0<\/span><\/p>\n

         <\/p>\n

        Emuls\u00f5es lip\u00eddicas: recomenda\u00e7\u00f5es pr\u00e1ticas<\/h2>\n
        Quando iniciar a infus\u00e3o de emuls\u00e3o lip\u00eddica?<\/span><\/b>\u00a0<\/span><\/h5>\n

        Quando a nutri\u00e7\u00e3o parenteral \u00e9 indicada, a emuls\u00e3o lip\u00eddica deve ser infundida como parte da NP (5).<\/span>\u00a0<\/span><\/p>\n

        Infus\u00e3o de emuls\u00f5es lip\u00eddicas<\/span><\/b>\u00a0<\/span><\/h5>\n

        Na administra\u00e7\u00e3o de ELs, o tempo m\u00e1ximo de infus\u00e3o deve ser de at\u00e9 24 horas (3, 4, 7).<\/span>\u00a0<\/span><\/p>\n

        Entretanto, ao utilizar ELs reembalados, por exemplo, transferidos para seringas ou outras bolsas, a dura\u00e7\u00e3o da infus\u00e3o n\u00e3o deve exceder 12 horas para minimizar o risco de contamina\u00e7\u00e3o (3, 4).<\/span>\u00a0<\/span><\/p>\n

        Qual \u00e9 a dose recomendada?<\/span><\/b>\u00a0<\/span><\/h5>\n

        As doses di\u00e1rias de emuls\u00e3o lip\u00eddica para adultos, sugeridas pela Sociedade Americana de Nutri\u00e7\u00e3o Parenteral e Enteral (ASPEN), s\u00e3o fornecidas na tabela abaixo (3).<\/span>\u00a0<\/span><\/p>\n\n\n\n\n
        Emuls\u00e3o lip\u00eddica \u00e0 base de \u00f3leo de soja<\/span><\/b>\u00a0<\/span><\/td>\nEmuls\u00e3o lip\u00eddica com \u00f3leo de soja, TCM, azeite de oliva e \u00f3leo de peixe<\/span><\/b>\u00a0<\/span><\/td>\nEmuls\u00e3o lip\u00eddica \u00e0 base de azeite de oliva e \u00f3leo de soja\u00a0<\/span><\/b>\u00a0<\/span><\/td>\n<\/tr>\n
        Paciente criticamente doente: <1 g\/kg\/d<\/span>\u00a0<\/span><\/p>\n

        \u00a0<\/span><\/p>\n

        Paciente est\u00e1vel: 1 g\/kg\/d<\/span>\u00a0<\/span><\/p>\n

        \u00a0<\/span><\/p>\n

        N\u00e3o exceder 1,5 g\/kg\/d\u00a0<\/span>\u00a0<\/span><\/td>\n

        		1 a 1,5 g\/kg\/d<\/span>\u00a0<\/span><\/p>\n

        \u00a0<\/span><\/p>\n

        N\u00e3o exceder 1,5 g\/kg\/d<\/span>\u00a0<\/span><\/p>\n

        \u00a0<\/span><\/td>\n

        		1\u20131,5 g\/kg\/d<\/span>\u00a0<\/span><\/p>\n

        \u00a0<\/span><\/p>\n

        N\u00e3o exceder 1,5 g\/kg\/d<\/span>\u00a0<\/span><\/p>\n

        \u00a0<\/span><\/p>\n

        \u00a0<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

        Monitoramento<\/span><\/b>\u00a0<\/span><\/h2>\n

        Como em qualquer interven\u00e7\u00e3o terap\u00eautica, as emuls\u00f5es lip\u00eddicas t\u00eam o potencial de causar efeitos adversos, alguns dos quais s\u00e3o relacionados \u00e0 dose ou \u00e0 taxa de infus\u00e3o e podem ser evitados (3).<\/span>\u00a0<\/span><\/p>\n

        Os efeitos adversos incluem s\u00edndrome de sobrecarga de gordura, hipercoagula\u00e7\u00e3o, interfer\u00eancia na fun\u00e7\u00e3o imunol\u00f3gica, efeitos hep\u00e1ticos negativos, comprometimento pulmonar, risco de infec\u00e7\u00e3o, hipertrigliceridemia e pancreatite (3).<\/span>\u00a0<\/span><\/p>\n

        Desse modo, o monitoramento de pacientes inclui \u2013 mas n\u00e3o est\u00e1 limitado a \u2013 checar concentra\u00e7\u00f5es s\u00e9ricas de triglicer\u00eddeos basais e semanais e testes de fun\u00e7\u00e3o hep\u00e1tica durante a hospitaliza\u00e7\u00e3o. Os n\u00edveis de TG tamb\u00e9m devem ser verificados quando a dose de ELs muda (3).\u00a0<\/span>\u00a0<\/span><\/p>\n

        Para pacientes adultos que necessitam de terapia NP de longo prazo (> 1 m\u00eas), os n\u00edveis de TG devem ser obtidos pelo menos uma vez por m\u00eas. A frequ\u00eancia de monitoramento pode ser ajustada com base no estado cl\u00ednico de cada paciente (3).<\/span>\u00a0<\/span><\/p>\n

         <\/p>\n

        Conclus\u00e3o<\/h2>\n

        Em resumo, as emuls\u00f5es lip\u00eddicas s\u00e3o componentes essenciais da nutri\u00e7\u00e3o parenteral, fornecendo energia e \u00e1cidos graxos essenciais. A escolha da formula\u00e7\u00e3o e o monitoramento adequado s\u00e3o fundamentais para garantir a seguran\u00e7a e a efic\u00e1cia do tratamento.\u00a0<\/span>\u00a0<\/span><\/p>\n

        Afinal, na terapia nutricional, cada detalhe conta para a recupera\u00e7\u00e3o e qualidade de vida do paciente.<\/span>\u00a0<\/span><\/p>\n

         <\/p>\n

         <\/p>\n

         <\/p>\n

        Refer\u00eancias:\u00a0<\/strong><\/p>\n

          \n
        1. Sadu Singh BK, Narayanan SS, Khor BH, Sahathevan S, Abdul Gafor AH, Fiaccadori E, Sundram K, Karupaiah T. Composition and Functionality of Lipid Emulsions in Parenteral Nutrition: Examining Evidence in Clinical Applications. Front Pharmacol. 2020 Apr 29;11:506. Erratum in: Front Pharmacol. 2021 Apr 16;12:663960. <\/span>\u00a0<\/span><\/li>\n
        2. Kisioglu B, Tamer F. Impact of lipid emulsions in parenteral nutrition on platelets: a literature review. Journal of Nutritional Science. 2024;13:e18. \u00a0<\/span><\/li>\n
        3. Mirtallo JM, Ayers P, Boullata J, Gura KM, Plogsted S, Anderson CR, Worthington P, Seres DS, Nicolai E, Alsharhan M, Gutsul L, Mason AE. ASPEN Lipid Injectable Emulsion Safety Recommendations, Part 1: Background and Adult Considerations. Nutr Clin Pract. 2020 Oct;35(5):769-782. Epub 2020 May 27. Erratum in: Nutr Clin Pract. 2022 Apr;37(2):482. \u00a0<\/span><\/li>\n
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        5. Calder PC, Waitzberg DL, Koletzko B (eds): Intravenous Lipid Emulsions. The Complexity of Prescribing Intravenous Lipid Emulsions. World Rev Nutr Diet. Basel, Karger, 2015, vol 112, pp 150\u2013162.<\/li>\n
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        7. Castro MG, Torrinhas R, Waitzberg DL, da Silva MDLT, de Aguilar Nascimento JE, Alves JTM, Antunes MS, Costa GC, Feferbaum R, Machado JZ, Matos LBN de, Miola TM, Pinto LM, Portari Filho PE, Correia MITD. Posicionamento BRASPEN sobre o uso cl\u00ednico de \u00f4mega 3 via parenteral. Braspen J. 2023;37(2):199-138.<\/li>\n
        8. Savini S, D\u2019Ascenzo R, Biagetti C, Serpentini G, Pompilio A, Bartoli A, Cogo PE, Carnielli VP. The effect of 5 intravenous lipid emulsions on plasma phytosterols in preterm infants receiving parenteral nutrition: a randomized clinical trial. Am J Clin Nutr. 2013 Aug;98(2):312-8.\u00a0<\/span><\/li>\n
        9. Clayton PT, Bowron A, Mills KA, Massoud A, Casteels M, Milla PJ. Phytosterolemia in children with parenteral nutrition-associated cholestatic liver disease. 1993 Dec;105(6):1806-13.<\/li>\n
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        11. Mundi MS, Martindale R, Hurt RT. Emergence of Mixed-Oil Fat Emulsions for Use in Parenteral Nutrition. JPEN J Parenter Enteral Nutr. 2017;41(1_suppl):3S-13S<\/li>\n
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        14. Cavicchi M, Beau P, Crenn P, Degott C, Messing B. Prevalence of liver disease and contributing factors in patients receiving home parenteral nutrition for permanent intestinal failure. Ann Intern Med. 2000;132(7):525-532.<\/li>\n
        15. Meguid MM, Schimmel E, Johnson WC, et al: Reduced metabolic complications in total parenteral nutrition: pilot study using fat to replace one-third of glucose calories. JPEN J Parenter Enteral Nutr 1982; 6:304\u2013307.<\/li>\n
        16. Meguid MM, Akahoshi MP, Jeffers S, et al: Amelioration of metabolic complications of conventional total parenteral nutrition. A prospective randomized study. Arch Surg 1984;119:1294\u20131298<\/li>\n
        17. Paluzzi M, Meguid MM. A prospective randomized study of the optimal source of nonprotein calories in total parenteral nutrition. Surgery 1987;102:711\u2013 717.<\/li>\n
        18. Waitzberg DL, Torrinhas RS, Jacintho TM: New parenteral lipid emulsions for clinical use. JPEN J Parenter Enteral Nutr 2006;30:351\u2013367.<\/span><\/li>\n
        19. Castro MG, Torrinhas R, Waitzberg DL, da Silva MDLT, de Aguilar Nascimento JE, Alves JTM, et al. Posicionamento BRASPEN sobre o uso cl\u00ednico de \u00f4mega 3 via parenteral. Braspen J. 2023;37(2):199-138.\u00a0<\/span><\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

          Os lip\u00eddios foram uma adi\u00e7\u00e3o tardia de macronutrientes \u00e0 formula\u00e7\u00e3o de nutri\u00e7\u00e3o parenteral (NP) na d\u00e9cada de 1960. A experimenta\u00e7\u00e3o ao longo dos anos levou a uma ampla gama de emuls\u00f5es lip\u00eddicas parenterais, com vari\u00e1veis fontes de gordura e efeitos para o paciente nos dias atuais (1).\u00a0 Hoje, voc\u00ea ir\u00e1 descobrir o que s\u00e3o as […]<\/p>\n","protected":false},"author":67,"featured_media":2061,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[49],"tags":[98,294,158,295,67,135,292,143,291,293],"class_list":["post-1801","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-artigo-5","tag-acidos-graxos","tag-alfa-tocoferol","tag-emulsoes-lipidicas","tag-monitoramento-hepatico","tag-nutricao-parenteral","tag-oleo-de-peixe","tag-tcm","tag-terapia-nutricional","tag-triglicerideos","tag-vitamina-k"],"acf":[],"yoast_head":"\nEmuls\u00f5es Lip\u00eddicas Parenterais: Guia Essencial<\/title>\n<meta name=\"description\" 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