{"id":1812,"date":"2022-07-27T15:49:59","date_gmt":"2022-07-27T18:49:59","guid":{"rendered":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/?p=1812"},"modified":"2022-07-28T09:50:49","modified_gmt":"2022-07-28T12:50:49","slug":"cuidados-nutricionais-pacientes-com-covid-19-e-obesos","status":"publish","type":"post","link":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/cuidados-nutricionais-pacientes-com-covid-19-e-obesos\/","title":{"rendered":"Cuidados nutricionais em pacientes obesos com Covid-19"},"content":{"rendered":"<p>A <strong>obesidade \u00e9 reconhecidamente um fator de risco para as formas graves da Covid-19.<\/strong> <a class=\"bibliography-sup\" title=\"1. Barazzoni, R. et al. Nutritional management of individuals with obesity and COVID-19: ESPEN expert statements and practical guidance. Clinical Nutrition Dispon\u00edvel em: https:\/\/www.espen.org\/files\/education\/COVID_ObesityPaper2021.pdf\" href=\"#\" data-bibliography-link=\"\">1,<\/a> <a class=\"bibliography-sup\" title=\"2. [25] Foldi M, Farkas N, Kiss S, Dembrovszky F, Szakacs Z, Balasko M, et al. Visceral adiposity elevates the risk of critical condition in COVID-19: a systematic review and meta-analysis. Obesity 2021;29(3):521e8.\" href=\"#\" data-bibliography-link=\"\">2,<\/a>\u00a0<a class=\"bibliography-sup\" title=\"3. [30] Singh S, Bilal M, Pakhchanian H, Raiker R, Kochhar GS, Thompson CC. Impact of obesity on outcomes of patients with coronavirus disease 2019 in the United States: a multicenter electronic health records network study. Gastroenterology 2020;159(6):2221e5. e6.\" href=\"#\" data-bibliography-link=\"\">3,<\/a> <a class=\"bibliography-sup\" title=\"39. [26] Huang Y, Lu Y, Huang YM, Wang M, Ling W, Sui Y, et al. Obesity in patients with COVID-19: a systematic review and meta-analysis. Metab Clin Exp 2020;113:154378.\" href=\"#\" data-bibliography-link=\"\">39,<\/a> <a class=\"bibliography-sup\" title=\"40. [28] Sharma A, Garg A, Rout A, Lavie CJ. Association of obesity with more critical illness in COVID-19. Mayo Clin Proc 2020;95(9):2040e2.\" href=\"#\" data-bibliography-link=\"\">40,<\/a> <a class=\"bibliography-sup\" title=\"47. [27] Muscogiuri G, Pugliese G, Barrea L, Savastano S, Colao A. Commentary: Obesity: the \" href=\"#\" data-bibliography-link=\"\">47,<\/a> <a class=\"bibliography-sup\" title=\"48. [29] Simonnet A, Chetboun M, Poissy J, Raverdy V, Noulette J, Duhamel A, et al. High prevalence of obesity in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) requiring invasive mechanical ventilation. Obesity 2020;28(7):1195e9.\" href=\"#\" data-bibliography-link=\"\">48<\/a>\u00a0E um fator importante no cuidado com os pacientes obesos infectados pelo v\u00edrus SARS-CoV-2 \u00e9 a abordagem nutricional.<\/p>\n<p>Como se sabe, a <a href=\"https:\/\/unidospelanutricaoclinica.com.br\/o-impacto-economico-da-desnutricao-relacionada-a-doenca-na-america-latina\/\">desnutri\u00e7\u00e3o<\/a> aumenta a suscetibilidade a infec\u00e7\u00f5es, reduz a resposta imunol\u00f3gica e torna o paciente obeso mais propenso a desfechos negativos, especialmente no caso de doentes cr\u00edticos.<\/p>\n<p>Tendo esse contexto em vista, a Sociedade Europeia de Nutri\u00e7\u00e3o Enteral e Parenteral (Espen) publicou um <a href=\"https:\/\/www.espen.org\/files\/education\/COVID_ObesityPaper2021.pdf\">guia pr\u00e1tico<\/a> para o manejo nutricional de pacientes obesos com Covid-19.<a class=\"bibliography-sup\" title=\"1. Barazzoni, R. et al. Nutritional management of individuals with obesity and COVID-19: ESPEN expert statements and practical guidance. Clinical Nutrition Dispon\u00edvel em: https:\/\/www.espen.org\/files\/education\/COVID_ObesityPaper2021.pdf\" href=\"#\" data-bibliography-link=\"\">1<\/a><\/p>\n<p>Neste artigo, trazemos alguns dos principais pontos apresentados e discutidos na publica\u00e7\u00e3o.<\/p>\n<p>&nbsp;<\/p>\n<h2>Desnutri\u00e7\u00e3o e Covid-19<\/h2>\n<p>A desnutri\u00e7\u00e3o tem um <strong>impacto negativo sobre as fun\u00e7\u00f5es imunol\u00f3gica, muscular, respirat\u00f3ria e card\u00edaca,<\/strong><a class=\"bibliography-sup\" title=\"4. [10] Calder PC. Feeding the immune system. Proc Nutr Soc 2013;72(3):299e309.\" href=\"#\" data-bibliography-link=\"\">4,<\/a><a class=\"bibliography-sup\" title=\"5. [11] Arora NS, Rochester DF. Respiratory muscle strength and maximal voluntary ventilation in undernourished patients. Am Rev Respir Dis 1982;126(1):5e8.\" href=\"#\" data-bibliography-link=\"\">5,<\/a><a class=\"bibliography-sup\" title=\"6. [12] Heymsfield SB, Bethel RA, Ansley JD, Gibbs DM, Felner JM, Nutter DO. Cardiac abnormalities in cachectic patients before and during nutritional repletion. Am Heart J 1978;95(5):584e94.\" href=\"#\" data-bibliography-link=\"\">6<\/a>\u00a0favorecendo quadros de infec\u00e7\u00e3o e superinfec\u00e7\u00e3o<a class=\"bibliography-sup\" title=\"7. [9] Schneider SM, Veyres P, Pivot X, Soummer AM, Jambou P, Filippi J, et al. Malnutrition is an independent factor associated with nosocomial infections. Br J Nutr 2004;92(1):105e11.\" href=\"#\" data-bibliography-link=\"\">7<\/a>.<\/p>\n<p>A perda de massa muscular esquel\u00e9tica causada pela desnutri\u00e7\u00e3o pode levar \u00e0 m\u00e1 qualidade de vida e morbidade, mesmo muito tempo ap\u00f3s a alta hospitalar. <a class=\"bibliography-sup\" title=\"8. [6] Gomes F, Schuetz P, Bounoure L, Austin P, Ballesteros-Pomar M, Cederholm T, et al. ESPEN guidelines on nutritional support for polymorbid internal medicine patients. Clin Nutr 2018;37(1):336e53.\" href=\"#\" data-bibliography-link=\"\">8,<\/a> <a class=\"bibliography-sup\" title=\"9. [8] Cederholm T, Barazzoni R, Austin P, Ballmer P, Biolo G, Bischoff SC, et al. ESPEN guidelines on definitions and terminology of clinical nutrition. Clin Nutr 2017;36(1):49e64.\" href=\"#\" data-bibliography-link=\"\">9,<\/a>\u00a0<a class=\"bibliography-sup\" title=\"10. [13] Hiesmayr M, Frantal S, Schindler K, Themessl-Huber M, Mouhieddine M, Schuh C, et al. The patient- and nutrition-derived outcome risk assessment score (PANDORA): development of a simple predictive risk score for 30-day in-hospital mortality based on demographics, clinical observation, and nutrition. PloS One 2015;10(5):e0127316.\" href=\"#\" data-bibliography-link=\"\">10,<\/a> <a class=\"bibliography-sup\" title=\"11. [15] Souza TT, Sturion CJ, Faintuch J. Is the skeleton still in the hospital closet? A review of hospital malnutrition emphasizing health economic aspects. Clin Nutr 2015;34(6):1088e92.\" href=\"#\" data-bibliography-link=\"\">11,<\/a> <a class=\"bibliography-sup\" title=\"27. [14] Singer P, Blaser AR, Berger MM, Alhazzani W, Calder PC, Casaer MP, et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr 2019;38(1):48e79.\" href=\"#\" data-bibliography-link=\"\">27,<\/a> <a class=\"bibliography-sup\" title=\"33. [7] Volkert D, Beck AM, Cederholm T, Cruz-Jentoft A, Goisser S, Hooper L, et al. ESPEN guideline on clinical nutrition and hydration in geriatrics. Clin Nutr 2019;38(1):10e47.\" href=\"#\" data-bibliography-link=\"\">33<\/a><\/p>\n<p>As evid\u00eancias em pacientes acometidos pela Covid-19 t\u00eam demonstrado:<\/p>\n<ul>\n<li>alta preval\u00eancia de desnutri\u00e7\u00e3o na admiss\u00e3o hospitalar;<a class=\"bibliography-sup\" title=\"12. [16] Allard L, Ouedraogo E, Molleville J, Bihan H, Giroux-Leprieur B, Sutton A, et al. Malnutrition: percentage and association with prognosis in patients hospitalized for coronavirus disease 2019. Nutrients 2020;12(12):3679. \" href=\"#\" data-bibliography-link=\"\">12,<\/a> <a class=\"bibliography-sup\" title=\"13. [22] Zhang P, He Z, Yu G, Peng D, Feng Y, Ling J, et al. The modified NUTRIC score can be used for nutritional risk assessment as well as prognosis prediction in critically ill COVID-19 patients. Clin Nutr 2021;40(2):534e41.\" href=\"#\" data-bibliography-link=\"\">13,<\/a> <a class=\"bibliography-sup\" title=\"14. [19] Li T, Zhang Y, Gong C, Wang J, Liu B, Shi L, et al. Prevalence of malnutrition and analysis of related factors in elderly patients with COVID-19 in Wuhan, China. Eur J Clin Nutr 2020;74(6):871e5.\" href=\"#\" data-bibliography-link=\"\">14,<\/a> <a class=\"bibliography-sup\" title=\"15. [21] Yu Y, Ye J, Chen M, Jiang C, Lin W, Lu Y, et al. Malnutrition prolongs the hospitalization of patients with COVID-19 infection: a clinical epidemiological analysis. J Nutr Health Aging 2021;25(3):369e73. \" href=\"#\" data-bibliography-link=\"\">15,<\/a> <a class=\"bibliography-sup\" title=\"49. [17] Hu X, Deng H, Wang Y, Chen L, Gu X, Wang X. Predictive value of the prognostic nutritional index for the severity of coronavirus disease 2019. Nutrition 2020;84:111123.\" href=\"#\" data-bibliography-link=\"\">49,<\/a> <a class=\"bibliography-sup\" title=\"50. [18] Li G, Zhou CL, Ba YM, Wang YM, Song B, Cheng XB, et al. Nutritional risk and therapy for severe and critical COVID-19 patients: a multicenter retrospective observational study. Clin Nutr 2020;40(4):2154e61.\" href=\"#\" data-bibliography-link=\"\">50,<\/a> <a class=\"bibliography-sup\" title=\"51. [20] Pironi L, Sasdelli AS, Ravaioli F, Baracco B, Battaiola C, Bocedi G, et al. Malnutrition and nutritional therapy in patients with SARS-CoV-2 disease. Clin Nutr 2020;40(3):1330e7.\" href=\"#\" data-bibliography-link=\"\">51<\/a><\/li>\n<li>impacto negativo da desnutri\u00e7\u00e3o no progn\u00f3stico da Covid-19;<a class=\"bibliography-sup\" title=\"12. [16] Allard L, Ouedraogo E, Molleville J, Bihan H, Giroux-Leprieur B, Sutton A, et al. Malnutrition: percentage and association with prognosis in patients hospitalized for coronavirus disease 2019. Nutrients 2020;12(12):3679. \" href=\"#\" data-bibliography-link=\"\">12,<\/a> <a class=\"bibliography-sup\" title=\"13. [22] Zhang P, He Z, Yu G, Peng D, Feng Y, Ling J, et al. The modified NUTRIC score can be used for nutritional risk assessment as well as prognosis prediction in critically ill COVID-19 patients. Clin Nutr 2021;40(2):534e41.\" href=\"#\" data-bibliography-link=\"\">13,<\/a> <a class=\"bibliography-sup\" title=\"14. [19] Li T, Zhang Y, Gong C, Wang J, Liu B, Shi L, et al. Prevalence of malnutrition and analysis of related factors in elderly patients with COVID-19 in Wuhan, China. Eur J Clin Nutr 2020;74(6):871e5.\" href=\"#\" data-bibliography-link=\"\">14,<\/a> <a class=\"bibliography-sup\" title=\"15. [21] Yu Y, Ye J, Chen M, Jiang C, Lin W, Lu Y, et al. Malnutrition prolongs the hospitalization of patients with COVID-19 infection: a clinical epidemiological analysis. J Nutr Health Aging 2021;25(3):369e73. \" href=\"#\" data-bibliography-link=\"\">15,<\/a> <a class=\"bibliography-sup\" title=\"16. [23] Mendes A, Serratrice C, Herrmann FR, Gold G, Graf CE, Zekry D, et al. Nutritional risk at hospital admission is associated with prolonged length of hospital stay in old patients with COVID-19. Edinburgh, Scotland): Clinical Nutrition; 2021.\" href=\"#\" data-bibliography-link=\"\">16<\/a><\/li>\n<li>impacto negativo do Covid-19 no peso de pacientes hospitalizados e n\u00e3o hospitalizados.<a class=\"bibliography-sup\" title=\"17. [24] Di Filippo L, De Lorenzo R, D\u2019Amico M, Sofia V, Roveri L, Mele R, et al. COVID19 is associated with clinically significant weight loss and risk of malnutrition, independent of hospitalisation: a post-hoc analysis of a prospective cohort study. Clin Nutr 2020;40(4):2420e6. \" href=\"#\" data-bibliography-link=\"\">17<\/a><\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h2>Obesidade e Covid-19<\/h2>\n<p>Pacientes obesos frequentemente apresentam transtornos metab\u00f3licos como hipertens\u00e3o, resist\u00eancia \u00e0 insulina, hiperglicemia e diabetes tipo 2. Juntos, eles formam a s\u00edndrome metab\u00f3lica.<a class=\"bibliography-sup\" title=\"18. [31] Collard D, Nurmohamed NS, Kaiser Y, Reeskamp LF, Dormans T, Moeniralam H, et al. Cardiovascular risk factors and COVID-19 outcomes in hospitalised patients: a prospective cohort study. BMJ Open 2021;11(2): e045482.\" href=\"#\" data-bibliography-link=\"\">18,<\/a> <a class=\"bibliography-sup\" title=\"19. [33] Racine-Brzostek SE, Yang HS, Jack GA, Chen Z, Chadburn A, Ketas TJ, et al. Post convalescent SARS-CoV-2 IgG and neutralizing antibodies are elevated in individuals with poor metabolic health. J Clin Endocrinol Metab 2021;106(5):e2025e34. \" href=\"#\" data-bibliography-link=\"\">19,<\/a> <a class=\"bibliography-sup\" title=\"28. [32] Coppelli A, Giannarelli R, Aragona M, Penno G, Falcone M, Tiseo G, et al. Hyperglycemia at hospital admission is associated with severity of the prognosis in patients hospitalized for COVID-19: the pisa COVID-19 study. Diabetes Care 2020;43(10):2345e8.\" href=\"#\" data-bibliography-link=\"\">28<\/a><\/p>\n<p><strong>Pessoas obesas com complica\u00e7\u00f5es metab\u00f3licas podem desenvolver uma resist\u00eancia anab\u00f3lica muscular e um catabolismo exacerbado<\/strong>.<a class=\"bibliography-sup\" title=\"20. [37] Guillet C, Masgrau A, Walrand S, Boirie Y. Impaired protein metabolism: interlinks between obesity, insulin resistance and inflammation. Obes Rev : Off J Int Ass Study Obes 2012;13(Suppl 2):51e7.\" href=\"#\" data-bibliography-link=\"\">20<\/a> Assim, t\u00eam alto risco de perda de massa e fun\u00e7\u00e3o muscular esquel\u00e9tica, principalmente se forem idosos.<a class=\"bibliography-sup\" title=\"Ass Study Obes 2012;13(Suppl 2):51e7. 21. [36] Barazzoni R, Bischoff SC, Boirie Y, Busetto L, Cederholm T, Dicker D, et al. Sarcopenic obesity: time to meet the challenge. Clin Nutr 2018;37(6 Pt A): 1787e93. \" href=\"#\" data-bibliography-link=\"\">21<\/a><\/p>\n<p>A diminui\u00e7\u00e3o da s\u00edntese proteica muscular \u00e9 causada por baixa resposta a est\u00edmulos anab\u00f3licos, em conjunto com um baixo grau de inflama\u00e7\u00e3o (que compromete a fun\u00e7\u00e3o imunol\u00f3gica<a class=\"bibliography-sup\" title=\"22. [34] Huizinga GP, Singer BH, Singer K. The collision of meta-inflammation and SARS-CoV-2 pandemic infection. Endocrinol 2020;161(11):bqaa154.\" href=\"#\" data-bibliography-link=\"\">22<\/a>), desuso muscular<a class=\"bibliography-sup\" title=\"23. [39] Wall BT, Cruz AM, Otten B, Dunlop MV, Fulford J, Porter C, et al. The impact of disuse and high-fat overfeeding on forearm muscle amino acid metabolism in humans. J Clin Endocrinol Metab 2020;105(7).\" href=\"#\" data-bibliography-link=\"\">23<\/a> e aumento da gordura intramuscular.<a class=\"bibliography-sup\" title=\"24. [40] Tardif N, Salles J, Guillet C, Tordjman J, Reggio S, Landrier JF, et al. Muscle ectopic fat deposition contributes to anabolic resistance in obese sarcopenic old rats through eIF2alpha activation. Aging Cell 2014;13(6):1001e11.\" href=\"#\" data-bibliography-link=\"\">24<\/a><\/p>\n<p>\u00c9 importante lembrar ainda que a defici\u00eancia de micronutrientes \u00e9 comum em pessoas obesas, aumentando a chance de desnutri\u00e7\u00e3o e levando a maior risco de infec\u00e7\u00e3o e perda de massa muscular esquel\u00e9tica.<a class=\"bibliography-sup\" title=\"25. [47] Fedele D, De Francesco A, Riso S, Collo A. Obesity, malnutrition, and trace element deficiency in the coronavirus disease (COVID-19) pandemic: an overview. Nutrition 2021;81:111016.\" href=\"#\" data-bibliography-link=\"\">25,<\/a> <a class=\"bibliography-sup\" title=\"26. [48] Sahin E, Orhan C, Uckun FM, Sahin K. Clinical impact potential of supplemental nutrients as adjuncts of therapy in high-risk COVID-19 for obese patients. Front Nutr 2020;7:580504.\" href=\"#\" data-bibliography-link=\"\">26<\/a><\/p>\n<p>&nbsp;<\/p>\n<h2>Ingest\u00e3o cal\u00f3rica e proteica<\/h2>\n<p>O <strong>c\u00e1lculo da energia e da prote\u00edna necess\u00e1rias para pacientes obesos<\/strong> nem sempre \u00e9 simples. Uma possibilidade recomendada \u00e9 utilizar o peso corporal ajustado (ABW).<a class=\"bibliography-sup\" title=\"27. [14] Singer P, Blaser AR, Berger MM, Alhazzani W, Calder PC, Casaer MP, et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr 2019;38(1):48e79.\" href=\"#\" data-bibliography-link=\"\">27<\/a><\/p>\n<p>Essa medida permite um ajuste gradual de oferta energ\u00e9tica por faixas de \u00cdndice de Massa Corporal (IMC), al\u00e9m de fornecer doses de prote\u00ednas adequadas para estimular o anabolismo do m\u00fasculo esquel\u00e9tico.<a class=\"bibliography-sup\" title=\"1. Barazzoni, R. et al. Nutritional management of individuals with obesity and COVID-19: ESPEN expert statements and practical guidance. Clinical Nutrition Dispon\u00edvel em: https:\/\/www.espen.org\/files\/education\/COVID_ObesityPaper2021.pdf\" href=\"#\" data-bibliography-link=\"\">1<\/a><\/p>\n<p>A seguir temos as recomenda\u00e7\u00f5es para o paciente obeso com Covid-19 e desnutrido ou em risco de desnutri\u00e7\u00e3o:<\/p>\n<ul>\n<li>Requisitos de prote\u00edna: &gt; 1 g\/ kg ABW\/ dia<a class=\"bibliography-sup\" title=\"1. Barazzoni, R. et al. Nutritional management of individuals with obesity and COVID-19: ESPEN expert statements and practical guidance. Clinical Nutrition Dispon\u00edvel em: https:\/\/www.espen.org\/files\/education\/COVID_ObesityPaper2021.pdf\" href=\"#\" data-bibliography-link=\"\">1<\/a><\/li>\n<li>Necessidades cal\u00f3ricas: 25 kcal\/ kg ABW\/ dia<a class=\"bibliography-sup\" title=\"1. Barazzoni, R. et al. Nutritional management of individuals with obesity and COVID-19: ESPEN expert statements and practical guidance. Clinical Nutrition Dispon\u00edvel em: https:\/\/www.espen.org\/files\/education\/COVID_ObesityPaper2021.pdf\" href=\"#\" data-bibliography-link=\"\">1<\/a><\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p>Tamb\u00e9m \u00e9 importante evitar que o suporte nutricional cause ou piore a hiperglicemia, que est\u00e1 associada a desfechos negativos e mais graves em pacientes com Covid-19 n\u00e3o criticamente enfermos.<a class=\"bibliography-sup\" title=\"28. [32] Coppelli A, Giannarelli R, Aragona M, Penno G, Falcone M, Tiseo G, et al. Hyperglycemia at hospital admission is associated with severity of the prognosis in patients hospitalized for COVID-19: the pisa COVID-19 study. Diabetes Care 2020;43(10):2345e8.\" href=\"#\" data-bibliography-link=\"\">28,<\/a> <a class=\"bibliography-sup\" title=\"29. [129] Klonoff DC, Messler JC, Umpierrez GE, Peng L, Booth R, Crowe J, et al. Association between achieving inpatient glycemic control and clinical outcomes in hospitalized patients with COVID-19: a multicenter, retrospective hospital-based analysis. Diabetes Care 2021;44(2):578e85.\" href=\"#\" data-bibliography-link=\"\">29,<\/a> <a class=\"bibliography-sup\" title=\"30. [130] Pareek M, Singh A, Vadlamani L, Eder M, Pacor J, Park J, et al. Relation of cardiovascular risk factors to mortality and cardiovascular events in hospitalized patients with coronavirus disease 2019 (from the yale COVID-19 cardiovascular registry). Am J Cardiol 2021;146:99e106.\" href=\"#\" data-bibliography-link=\"\">30<\/a> Nesse sentido, uma possibilidade \u00e9 optar por f\u00f3rmulas enterais para pessoas com diabetes, que t\u00eam mostrado melhorar a hiperglicemia.<a class=\"bibliography-sup\" title=\"31. [164] Laesser CI, Cumming P, Reber E, Stanga Z, Muka T, Bally L. Management of glucose control in noncritically ill, hospitalized patients receiving parenteral and\/or enteral nutrition: a systematic review. J Clin Med 2019;8(7).\" href=\"#\" data-bibliography-link=\"\">31,<\/a> <a class=\"bibliography-sup\" title=\"32. [165] Ojo O, Weldon SM, Thompson T, Crockett R, Wang XH. The effect of diabetesspecific enteral nutrition formula on cardiometabolic parameters in patients with type 2 diabetes: a systematic review and meta-analysis of randomised controlled trials. Nutrients 2019;11(8).\" href=\"#\" data-bibliography-link=\"\">32<\/a><\/p>\n<p>Outro ponto de destaque \u00e9 a <strong>escolha dos lip\u00eddios<\/strong>. Os \u00e1cidos graxos PUFA t\u00eam a\u00e7\u00e3o reconhecida sobre a inflama\u00e7\u00e3o e coagula\u00e7\u00e3o. Por isso, pode ser interessante preferir dietas que priorizem alta ingest\u00e3o de \u00f4mega 3.<a class=\"bibliography-sup\" title=\"8. [6] Gomes F, Schuetz P, Bounoure L, Austin P, Ballesteros-Pomar M, Cederholm T, et al. ESPEN guidelines on nutritional support for polymorbid internal medicine patients. Clin Nutr 2018;37(1):336e53.\" href=\"#\" data-bibliography-link=\"\">8,<\/a> <a class=\"bibliography-sup\" title=\"27. [14] Singer P, Blaser AR, Berger MM, Alhazzani W, Calder PC, Casaer MP, et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr 2019;38(1):48e79.\" href=\"#\" data-bibliography-link=\"\">27,<\/a> <a class=\"bibliography-sup\" title=\"33. [7] Volkert D, Beck AM, Cederholm T, Cruz-Jentoft A, Goisser S, Hooper L, et al. ESPEN guideline on clinical nutrition and hydration in geriatrics. Clin Nutr 2019;38(1):10e47.\" href=\"#\" data-bibliography-link=\"\">33<\/a><\/p>\n<p>Leia tamb\u00e9m: <a href=\"https:\/\/unidospelanutricaoclinica.com.br\/lipidios-em-terapia-enteral\/\">Qual \u00e9 a recomenda\u00e7\u00e3o de lip\u00eddios para paciente em terapia nutricional enteral<\/a><\/p>\n<p>&nbsp;<\/p>\n<h3>Ingest\u00e3o cal\u00f3rica e proteica na UTI<\/h3>\n<p>A defini\u00e7\u00e3o ideal das necessidades de energia em UTI deve ser baseada na medi\u00e7\u00e3o direta por <strong>calorimetria indireta.<\/strong><a class=\"bibliography-sup\" title=\"34. [176] Singer P, Pichard C, De Waele E. Practical guidance for the use of indirect calorimetry during COVID 19 pandemic. Clin Nutr Exp 2020;33:18e23.\" href=\"#\" data-bibliography-link=\"\">34<\/a>\u00a0Na aus\u00eancia dessa possibilidade, deve-se seguir as Diretrizes para UTI Espen 2019, com alimenta\u00e7\u00e3o hipocal\u00f3rica (at\u00e9 70% de necessidades estimadas) nos primeiros 3 a 7 dias de UTI.27<\/p>\n<p>Os alvos proteicos ideais tamb\u00e9m podem ser guiados pelo balan\u00e7o de nitrog\u00eanio (que avalia perdas de prote\u00edna e, portanto, as necessidades).<a class=\"bibliography-sup\" title=\"27. [14] Singer P, Blaser AR, Berger MM, Alhazzani W, Calder PC, Casaer MP, et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr 2019;38(1):48e79.\" href=\"#\" data-bibliography-link=\"\">27<\/a> Quando isso n\u00e3o for poss\u00edvel, as recomenda\u00e7\u00f5es de prote\u00ednas fornecidas nas diretrizes da Espen UTI devem ser seguidas, fornecendo pelo menos 1,3 g\/ kg ABW\/ por dia.<a class=\"bibliography-sup\" title=\"27. [14] Singer P, Blaser AR, Berger MM, Alhazzani W, Calder PC, Casaer MP, et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr 2019;38(1):48e79.\" href=\"#\" data-bibliography-link=\"\">27,<\/a> <a class=\"bibliography-sup\" title=\"35. [179] Trethewey SP, Brown N, Gao F, Turner AM. Interventions for the management and prevention of sarcopenia in the critically ill: a systematic review. J Crit Care 2019;50:287e95.\" href=\"#\" data-bibliography-link=\"\">35<\/a><\/p>\n<p>A f\u00f3rmula nutricional para pacientes de UTI deve fornecer alta densidade cal\u00f3rica (1,5 kcal\/ mL) e alto teor de prote\u00edna27 e deve-se evitar a variabilidade da glicemia.<a class=\"bibliography-sup\" title=\"1. Barazzoni, R. et al. Nutritional management of individuals with obesity and COVID-19: ESPEN expert statements and practical guidance. Clinical Nutrition Dispon\u00edvel em: https:\/\/www.espen.org\/files\/education\/COVID_ObesityPaper2021.pdf\" href=\"#\" data-bibliography-link=\"\">1<\/a><\/p>\n<p>&nbsp;<\/p>\n<h2>Micronutrientes<\/h2>\n<p>Diversos estudos j\u00e1 demonstraram a rela\u00e7\u00e3o entre o <strong>equil\u00edbrio de micronutrientes e a imunidade<\/strong>. Baixa ingest\u00e3o ou baixo n\u00edvel circulante de determinadas vitaminas e minerais est\u00e3o associados a resultados cl\u00ednicos adversos durante infec\u00e7\u00f5es virais.<a class=\"bibliography-sup\" title=\"36. [111] Calder PC, Carr AC, Gombart AF, Eggersdorfer M. Optimal nutritional status for a well-functioning immune system is an important factor to protect against viral infections. Nutrients 2020;12(4).\" href=\"#\" data-bibliography-link=\"\">36<\/a> \u00c9 poss\u00edvel que essa rela\u00e7\u00e3o tamb\u00e9m se aplique \u00e0 Covid-19.<a class=\"bibliography-sup\" title=\"1. Barazzoni, R. et al. Nutritional management of individuals with obesity and COVID-19: ESPEN expert statements and practical guidance. Clinical Nutrition Dispon\u00edvel em: https:\/\/www.espen.org\/files\/education\/COVID_ObesityPaper2021.pdf\" href=\"#\" data-bibliography-link=\"\">1<\/a><\/p>\n<p>Assim, a Espen recomenda que as necessidades di\u00e1rias de ingest\u00e3o de micronutrientes sejam garantidas a todos os pacientes hospitalizados com Covid-19, particularmente a pessoas com obesidade.<a class=\"bibliography-sup\" title=\"1. Barazzoni, R. et al. Nutritional management of individuals with obesity and COVID-19: ESPEN expert statements and practical guidance. Clinical Nutrition Dispon\u00edvel em: https:\/\/www.espen.org\/files\/education\/COVID_ObesityPaper2021.pdf\" href=\"#\" data-bibliography-link=\"\">1<\/a><\/p>\n<p>&nbsp;<\/p>\n<h2>Cuidados na interna\u00e7\u00e3o<\/h2>\n<p>Diante desse cen\u00e1rio, <strong>pacientes obesos e desnutridos precisam de aten\u00e7\u00e3o nutricional,<\/strong> preferencialmente com in\u00edcio de terapia nutricional precoce dentro de 24-48 horas da admiss\u00e3o.<a class=\"bibliography-sup\" title=\"37. [140] Dennis MS, Lewis SC, Warlow C, Collaboration FT. Effect of timing and method of enteral tube feeding for dysphagic stroke patients (FOOD): a multicentre randomised controlled trial. Lancet 2005;365(9461):764e72.\" href=\"#\" data-bibliography-link=\"\">37,<\/a> <a class=\"bibliography-sup\" title=\"38. [141] Li JY, Yu T, Chen GC, Yuan YH, Zhong W, Zhao LN, et al. Enteral nutrition within 48 hours of admission improves clinical outcomes of acute pancreatitis by reducing complications: a meta-analysis. PloS One 2013;8(6): e64926.\" href=\"#\" data-bibliography-link=\"\">38<\/a><\/p>\n<p>O objetivo \u00e9 preservar a massa muscular,<a class=\"bibliography-sup\" title=\"8. [6] Gomes F, Schuetz P, Bounoure L, Austin P, Ballesteros-Pomar M, Cederholm T, et al. ESPEN guidelines on nutritional support for polymorbid internal medicine patients. Clin Nutr 2018;37(1):336e53.\" href=\"#\" data-bibliography-link=\"\">8<\/a> que \u00e9 o principal reservat\u00f3rio de prote\u00ednas do organismo, pois a maior gravidade da doen\u00e7a na interna\u00e7\u00e3o pode implicar em respostas inflamat\u00f3rias catab\u00f3licas mais intensas, menor ingest\u00e3o alimentar e mais chance de se manter acamado.<a class=\"bibliography-sup\" title=\"1. Barazzoni, R. et al. Nutritional management of individuals with obesity and COVID-19: ESPEN expert statements and practical guidance. Clinical Nutrition Dispon\u00edvel em: https:\/\/www.espen.org\/files\/education\/COVID_ObesityPaper2021.pdf\" href=\"#\" data-bibliography-link=\"\">1<\/a><\/p>\n<p>&nbsp;<\/p>\n<h2>Cuidados na UTI<\/h2>\n<p><strong>Pacientes com Covid com qualquer grau de obesidade t\u00eam um risco significativamente maior de admiss\u00e3o em UTI<\/strong>, ventila\u00e7\u00e3o mec\u00e2nica ou morte em compara\u00e7\u00e3o com pacientes n\u00e3o-obesos.<a class=\"bibliography-sup\" title=\"2. [25] Foldi M, Farkas N, Kiss S, Dembrovszky F, Szakacs Z, Balasko M, et al. Visceral adiposity elevates the risk of critical condition in COVID-19: a systematic review and meta-analysis. Obesity 2021;29(3):521e8.\" href=\"#\" data-bibliography-link=\"\">2,<\/a> <a class=\"bibliography-sup\" title=\"3. [30] Singh S, Bilal M, Pakhchanian H, Raiker R, Kochhar GS, Thompson CC. Impact of obesity on outcomes of patients with coronavirus disease 2019 in the United States: a multicenter electronic health records network study. Gastroenterology 2020;159(6):2221e5. e6.\" href=\"#\" data-bibliography-link=\"\">3,<\/a> <a class=\"bibliography-sup\" title=\"39. [26] Huang Y, Lu Y, Huang YM, Wang M, Ling W, Sui Y, et al. Obesity in patients with COVID-19: a systematic review and meta-analysis. Metab Clin Exp 2020;113:154378.\" href=\"#\" data-bibliography-link=\"\">39,<\/a> <a class=\"bibliography-sup\" title=\"40. [28] Sharma A, Garg A, Rout A, Lavie CJ. Association of obesity with more critical illness in COVID-19. Mayo Clin Proc 2020;95(9):2040e2.\" href=\"#\" data-bibliography-link=\"\">40, <\/a><a class=\"bibliography-sup\" title=\"41. [166] Aminian A, Fathalizadeh A, Tu C, Butsch WS, Pantalone KM, Griebeler ML, et al. Association of prior metabolic and bariatric surgery with severity of coronavirus disease 2019 (COVID-19) in patients with obesity. Sur Obes Rel Dis: Off J Am Soc Bariat Sur 2021;17(1):208e14.\" href=\"#\" data-bibliography-link=\"\">41<\/a><\/p>\n<p>H\u00e1 orienta\u00e7\u00f5es espec\u00edficas para pacientes que precisam de cuidados intensivos, dependendo de cada necessidade.<a class=\"bibliography-sup\" title=\"1. Barazzoni, R. et al. Nutritional management of individuals with obesity and COVID-19: ESPEN expert statements and practical guidance. Clinical Nutrition Dispon\u00edvel em: https:\/\/www.espen.org\/files\/education\/COVID_ObesityPaper2021.pdf\" href=\"#\" data-bibliography-link=\"\">1<\/a><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1813 aligncenter\" src=\"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/wp-content\/uploads\/sites\/3\/2022\/07\/obsidade-e-covid19.png\" alt=\"\" width=\"1379\" height=\"960\" srcset=\"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/wp-content\/uploads\/sites\/3\/2022\/07\/obsidade-e-covid19.png 1379w, https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/wp-content\/uploads\/sites\/3\/2022\/07\/obsidade-e-covid19-300x209.png 300w, https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/wp-content\/uploads\/sites\/3\/2022\/07\/obsidade-e-covid19-1024x713.png 1024w, https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/wp-content\/uploads\/sites\/3\/2022\/07\/obsidade-e-covid19-768x535.png 768w, https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/wp-content\/uploads\/sites\/3\/2022\/07\/obsidade-e-covid19-539x375.png 539w\" sizes=\"auto, (max-width: 1379px) 100vw, 1379px\" \/><\/p>\n<h3>Pr\u00e9-intuba\u00e7\u00e3o<\/h3>\n<ul>\n<li>A suplementa\u00e7\u00e3o oral ou nutri\u00e7\u00e3o enteral (NE) deve ser implementada para atingir as metas de prote\u00edna e energia; A nutri\u00e7\u00e3o parenteral (NP) deve ser considerada se as terapias nutricionais oral e enteral forem contraindicadas ou insuficientes ou se houver risco de aspira\u00e7\u00e3o.<a class=\"bibliography-sup\" title=\"1. Barazzoni, R. et al. Nutritional management of individuals with obesity and COVID-19: ESPEN expert statements and practical guidance. Clinical Nutrition Dispon\u00edvel em: https:\/\/www.espen.org\/files\/education\/COVID_ObesityPaper2021.pdf\" href=\"#\" data-bibliography-link=\"\">1<\/a><\/li>\n<li>A NE pode ser desafiadora durante o suporte respirat\u00f3rio n\u00e3o invasivo.<a class=\"bibliography-sup\" title=\"42. [53] Barazzoni R, Bischoff SC, Breda J, Wickramasinghe K, Krznaric Z, Nitzan D, et al. ESPEN expert statements and practical guidance for nutritional management of individuals with SARS-CoV-2 infection. Clin Nutr 2020;39(6): 1631e8.\" href=\"#\" data-bibliography-link=\"\">42<\/a> No entanto, um novo dispositivo de m\u00e1scara que permite a introdu\u00e7\u00e3o de uma sonda nasog\u00e1strica tem sido testado com sucesso e pode ser considerado.<a class=\"bibliography-sup\" title=\"43. [170] Lemyze M, Mascot M, Orfi A. Enteral feeding and non-invasive ventilation during the COVID-19 crisis: a new snorkeling mask specially-fit to provide both concomitantly. Clin Nutr 2020;39(12):3852e3.\" href=\"#\" data-bibliography-link=\"\">43<\/a><\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h3>Intuba\u00e7\u00e3o<\/h3>\n<ul>\n<li>A NE deve ser iniciada para atingir gradualmente as metas de energia ao mesmo tempo em que garante a administra\u00e7\u00e3o de f\u00f3rmula hiperproteica.<a class=\"bibliography-sup\" title=\"1. Barazzoni, R. et al. Nutritional management of individuals with obesity and COVID-19: ESPEN expert statements and practical guidance. Clinical Nutrition Dispon\u00edvel em: https:\/\/www.espen.org\/files\/education\/COVID_ObesityPaper2021.pdf\" href=\"#\" data-bibliography-link=\"\">1<\/a><\/li>\n<li>A posi\u00e7\u00e3o prona n\u00e3o representa uma limita\u00e7\u00e3o ou contraindica\u00e7\u00e3o para NE tamb\u00e9m nos obesos.<a class=\"bibliography-sup\" title=\"1. Barazzoni, R. et al. Nutritional management of individuals with obesity and COVID-19: ESPEN expert statements and practical guidance. Clinical Nutrition Dispon\u00edvel em: https:\/\/www.espen.org\/files\/education\/COVID_ObesityPaper2021.pdf\" href=\"#\" data-bibliography-link=\"\">1<\/a><\/li>\n<li>Devido ao alto risco de perda de massa muscular esquel\u00e9tica, as pessoas com obesidade devem ser mobilizadas e\/ou realizar atividade f\u00edsica controlada durante a perman\u00eancia na UTI.<a class=\"bibliography-sup\" title=\"1. Barazzoni, R. et al. Nutritional management of individuals with obesity and COVID-19: ESPEN expert statements and practical guidance. Clinical Nutrition Dispon\u00edvel em: https:\/\/www.espen.org\/files\/education\/COVID_ObesityPaper2021.pdf\" href=\"#\" data-bibliography-link=\"\">1<\/a><\/li>\n<li>Hipoxemia e hipercapnia graves s\u00e3o contraindica\u00e7\u00f5es ao suporte nutricional.<a class=\"bibliography-sup\" title=\"1. Barazzoni, R. et al. Nutritional management of individuals with obesity and COVID-19: ESPEN expert statements and practical guidance. Clinical Nutrition Dispon\u00edvel em: https:\/\/www.espen.org\/files\/education\/COVID_ObesityPaper2021.pdf\" href=\"#\" data-bibliography-link=\"\">1<\/a><\/li>\n<li>NP pode ser utilizada em pacientes que n\u00e3o conseguem usar a via enteral ou n\u00e3o atingem suas metas nutricionais ao final da primeira semana. Tamb\u00e9m \u00e9 usada em caso de diarreia grave.<a class=\"bibliography-sup\" title=\"1. Barazzoni, R. et al. Nutritional management of individuals with obesity and COVID-19: ESPEN expert statements and practical guidance. Clinical Nutrition Dispon\u00edvel em: https:\/\/www.espen.org\/files\/education\/COVID_ObesityPaper2021.pdf\" href=\"#\" data-bibliography-link=\"\">1<\/a><\/li>\n<li>O uso de oxigena\u00e7\u00e3o por membrana extra corp\u00f3rea (ECMO) n\u00e3o \u00e9 uma contraindica\u00e7\u00e3o \u00e0 NE, mas n\u00e3o deve ser administrada em pacientes em choque ou disfun\u00e7\u00e3o gastrointestinal grave.<a class=\"bibliography-sup\" title=\"44. [175] Al-Dorzi HM, Arabi YM. Enteral nutrition safety with advanced treatments: extracorporeal membrane oxygenation, prone positioning, and infusion of neuromuscular blockers. Nutr Clin Pract : Off Publ Am Soc Parent Ent Nutr 2021;36(1):88e97.\" href=\"#\" data-bibliography-link=\"\">44<\/a><\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h3>P\u00f3s-intuba\u00e7\u00e3o<\/h3>\n<ul>\n<li>A nutri\u00e7\u00e3o oral deve ser reintroduzida para atingir as metas nutricionais ap\u00f3s a extuba\u00e7\u00e3o.<a class=\"bibliography-sup\" title=\"1. Barazzoni, R. et al. Nutritional management of individuals with obesity and COVID-19: ESPEN expert statements and practical guidance. Clinical Nutrition Dispon\u00edvel em: https:\/\/www.espen.org\/files\/education\/COVID_ObesityPaper2021.pdf\" href=\"#\" data-bibliography-link=\"\">1<\/a><\/li>\n<li>A disfagia \u00e9 um risco, principalmente em adultos mais velhos e ap\u00f3s intuba\u00e7\u00e3o prolongada, comum em pacientes com Covid-19.<a class=\"bibliography-sup\" title=\"45. [53] Barazzoni R, Bischoff SC, Breda J, Wickramasinghe K, Krznaric Z, Nitzan D, et al. ESPEN expert statements and practical guidance for nutritional management of individuals with SARS-CoV-2 infection. Clin Nutr 2020;39(6): 1631e8. \" href=\"#\" data-bibliography-link=\"\">45<\/a><\/li>\n<li>Nesse caso, pode-se alterar a textura da dieta ou, quando houver risco de aspira\u00e7\u00e3o, iniciar NE.<a class=\"bibliography-sup\" title=\"46. [173] Thibault R, Seguin P, Tamion F, Pichard C, Singer P. Nutrition of the COVID-19 patient in the intensive care unit (ICU): a practical guidance. Crit Care 2020;24(1):447.\" href=\"#\" data-bibliography-link=\"\">46<\/a> Se NE n\u00e3o for poss\u00edvel (por exemplo, se a reabilita\u00e7\u00e3o para degluti\u00e7\u00e3o precisa que a sonda seja retirada), NP tempor\u00e1ria pode ser considerada.<a class=\"bibliography-sup\" title=\"46. [173] Thibault R, Seguin P, Tamion F, Pichard C, Singer P. Nutrition of the COVID-19 patient in the intensive care unit (ICU): a practical guidance. Crit Care 2020;24(1):447.\" href=\"#\" data-bibliography-link=\"\">46<\/a><\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>A obesidade \u00e9 reconhecidamente um fator de risco para as formas graves da Covid-19. 1, 2,\u00a03, 39, 40, 47, 48\u00a0E um fator importante no cuidado com os pacientes obesos infectados pelo v\u00edrus SARS-CoV-2 \u00e9 a abordagem nutricional. Como se sabe, a desnutri\u00e7\u00e3o aumenta a suscetibilidade a infec\u00e7\u00f5es, reduz a resposta imunol\u00f3gica e torna o paciente [&hellip;]<\/p>\n","protected":false},"author":67,"featured_media":1814,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[41,5],"tags":[65,70,66,169,170,69],"class_list":["post-1812","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-artigo","category-desnutricao-relacionada-a-doenca","tag-covid-19","tag-desnutricao","tag-nutricao","tag-obesidade","tag-sindrome-metabolica","tag-uti"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v24.5 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Cuidados nutricionais de pacientes obesos com Covid-19<\/title>\n<meta name=\"description\" content=\"Pessoas obesas correm risco de desnutri\u00e7\u00e3o e agravamento da Covid-19. 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