{"id":1837,"date":"2022-10-06T09:48:49","date_gmt":"2022-10-06T12:48:49","guid":{"rendered":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/?p=1837"},"modified":"2022-10-06T09:48:49","modified_gmt":"2022-10-06T12:48:49","slug":"lipidios-nutricao-prematuro","status":"publish","type":"post","link":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/lipidios-nutricao-prematuro\/","title":{"rendered":"Qual a import\u00e2ncia dos lip\u00eddios na nutri\u00e7\u00e3o do prematuro?"},"content":{"rendered":"

A nutri\u00e7\u00e3o parenteral (NP) de pr\u00e9-termos representa um grande desafio cl\u00ednico, embora seja fundamental para garantia da sa\u00fade, inclusive em longo prazo. Nesse contexto, entre outros micros e macronutrientes, a presen\u00e7a dos lip\u00eddios na nutri\u00e7\u00e3o do prematuro \u00e9 essencial para desenvolvimento e a preven\u00e7\u00e3o de uma s\u00e9rie de intercorr\u00eancias.<\/strong><\/p>\n

Ainda assim, os par\u00e2metros de recomenda\u00e7\u00e3o para a introdu\u00e7\u00e3o dos lip\u00eddios variam de acordo com uma s\u00e9rie de fatores<\/strong>, como mostram v\u00e1rios estudos. Al\u00e9m disso, h\u00e1 sempre a preocupa\u00e7\u00e3o com a oxida\u00e7\u00e3o, que pode ser agravada na presen\u00e7a desse nutriente.<\/p>\n

Diante disso, esses ser\u00e3o os t\u00f3picos abordados ao longo deste artigo. Prossiga com a leitura!<\/p>\n

 <\/p>\n

A import\u00e2ncia dos lip\u00eddios na nutri\u00e7\u00e3o parenteral para prematuros<\/h2>\n

Os lip\u00eddios s\u00e3o uma fonte-chave para o suprimento de energia para o crescimento do pr\u00e9-termo.<\/strong> Os \u00e1cidos graxos essenciais tamb\u00e9m s\u00e3o indispens\u00e1veis para o desenvolvimento cerebral1<\/a>. Ademais, esse nutriente atua como um importante componente de todos os fosfolip\u00eddios das membranas celulares e \u00e9 um ve\u00edculo para as vitaminas lipossol\u00faveis.<\/p>\n

Com isso, emuls\u00f5es de lip\u00eddios est\u00e3o relacionadas a desfechos positivos em aspectos do neurodesenvolvimento, bem como de medidas antropom\u00e9tricas como o crescimento linear, ganho de peso e circunfer\u00eancia da cabe\u00e7a1<\/a>.<\/p>\n

A recomenda\u00e7\u00e3o nutricional de lip\u00eddios na NP de pr\u00e9-termos<\/h2>\n

Em geral, a recomenda\u00e7\u00e3o \u00e9 introduzir os lip\u00eddios na nutri\u00e7\u00e3o parenteral do prematuro logo ap\u00f3s o nascimento<\/strong>, como demonstram Rizzo et al.<\/a> em revis\u00e3o bibliogr\u00e1fica publicada em 2022.1<\/a><\/p>\n

Embora alguns autores n\u00e3o tenham demonstrado grandes diferen\u00e7as nos principais desfechos com rela\u00e7\u00e3o ao tempo de in\u00edcio para oferta de lip\u00eddios2<\/a>, atrasar seu fornecimento via nutri\u00e7\u00e3o parenteral de pr\u00e9-termos pode causar defici\u00eancia de \u00e1cidos graxos1<\/a>.<\/p>\n

H\u00e1 evid\u00eancias que a introdu\u00e7\u00e3o precoce contribui em uma menor incid\u00eancia de retinopatias2<\/a> e melhora no desenvolvimento neurol\u00f3gico3<\/a>. Por outro lado, outros autores indicam eventual v\u00ednculo entre o fornecimento de lip\u00eddios logo ap\u00f3s o nascimento com um risco maior do desenvolvimento de colestase4<\/a><\/strong>.<\/p>\n

A recomenda\u00e7\u00e3o do Guideline de Nutri\u00e7\u00e3o Parenteral em Pediatria da ESPEN\/ESPGHAN\/ESPR\/CSPEN6<\/a> \u00e9 que, como primeira escolha, sejam utilizadas emuls\u00f5es lip\u00eddicas a 20% infundidas protegidas da luz. As emuls\u00f5es lip\u00eddicas compostas, com ou sem o \u00f3leo de peixe, s\u00e3o preferidas em rela\u00e7\u00e3o \u00e0 emuls\u00e3o com \u00f3leo de soja, que apresenta elevada concentra\u00e7\u00e3o de \u00e1cido linoleico (50%).<\/p>\n

 <\/p>\n

Leia mais: Entenda a <\/strong>import\u00e2ncia das doses adequadas na nutri\u00e7\u00e3o parenteral.<\/strong><\/a><\/p>\n

 <\/p>\n

\u00c9 indicado sempre come\u00e7ar de um patamar mais<\/strong> baixo (0,5 g\/kg\/dia, por exemplo). A partir disso, a progress\u00e3o pode ser feita lentamente, de acordo com a toler\u00e2ncia do rec\u00e9m-nascido at\u00e9 a dose alvo (3,0 g\/kg\/dia). A recomenda\u00e7\u00e3o \u00e9 fazer essa evolu\u00e7\u00e3o progredindo 0,5g\/kg\/dia. Doses m\u00e1ximas entre 3g e 4g\/kg\/dia foram consideradas seguras e efetivas.1<\/a>,5<\/a>,6<\/a><\/span><\/strong><\/p>\n

Essa conduta est\u00e1 relacionada a uma menor incid\u00eancia de retinopatia e hipertrigliceridemia se comparados ao suprimento inicial com doses maiores de 2,0g\/kg\/dia e que alcan\u00e7am o alvo em um per\u00edodo menor1<\/a>.<\/p>\n

Por fim, o uso da emuls\u00f5es lip\u00eddicas compostas com \u00f3leo de peixe<\/a>, oliva, soja e triglicer\u00eddeos de cadeia m\u00e9dia (TCM) possibilita a melhora da raz\u00e3o de \u00f4mega 3\/\u00f4mega 6, e relaciona-se com um menor risco de colestase e maior resist\u00eancia \u00e0 oxida\u00e7\u00e3o8<\/a>.<\/p>\n

No sentido oposto, emuls\u00f5es lip\u00eddicas contendo uma alta propor\u00e7\u00e3o de \u00e1cidos graxos poli-insaturados est\u00e3o mais suscet\u00edveis a oxida\u00e7\u00e3o1<\/a>. Tal condi\u00e7\u00e3o pode provocar danos aos tecidos causados por radicais livres9<\/a>,10<\/a>,11<\/a><\/p>\n

 <\/p>\n

\"\"<\/p>\n

Os lip\u00eddios e o risco de oxida\u00e7\u00e3o<\/h2>\n

Vale refor\u00e7ar que emuls\u00f5es lip\u00eddicas s\u00e3o mais propensas ao estresse oxidativo causado pelos radicais livres.<\/strong> Esse aspecto precisa ser considerado de forma cuidadosa.<\/p>\n

Devido a imaturidade do organismo do rec\u00e9m-nascido, a exposi\u00e7\u00e3o de oxidantes via nutri\u00e7\u00e3o parenteral pode comprometer a sa\u00fade do pr\u00e9-termo. O excesso de diferentes fontes oxidantes pode levar a doen\u00e7as no f\u00edgado, displasia broncopulmonar, atrofia intestinal, enterocolite necrosante e retinopatia.12<\/a>,13<\/a><\/p>\n

Como j\u00e1 destacado, a composi\u00e7\u00e3o da emuls\u00e3o lip\u00eddica afeta o seu perfil de oxida\u00e7\u00e3o, ainda que poucos estudos confirmem isso, de acordo com Karthigesu e colaboradores (2021)<\/a>.7<\/a> Por isso, os mesmos autores apontam que a suplementa\u00e7\u00e3o de antioxidantes e a manipula\u00e7\u00e3o das f\u00f3rmulas de NP em ambiente adequado podem reduzir esse risco.<\/strong><\/p>\n

Assim, todos os benef\u00edcios dos lip\u00eddios na nutri\u00e7\u00e3o do prematuro ser\u00e3o assegurados, minimizando os riscos. Isso permite que a NP cumpra seu objetivo de assegurar o suprimento de todos os nutrientes necess\u00e1rios para o desenvolvimento do rec\u00e9m-nascido.<\/p>\n

O Unidos pela Nutri\u00e7\u00e3o Cl\u00ednica traz tudo o que voc\u00ea precisa saber sobre nutri\u00e7\u00e3o parenteral. <\/a>Ent\u00e3o aproveite que essa leitura terminou e continue navegando.<\/p>\n","protected":false},"excerpt":{"rendered":"

A nutri\u00e7\u00e3o parenteral (NP) de pr\u00e9-termos representa um grande desafio cl\u00ednico, embora seja fundamental para garantia da sa\u00fade, inclusive em longo prazo. Nesse contexto, entre outros micros e macronutrientes, a presen\u00e7a dos lip\u00eddios na nutri\u00e7\u00e3o do prematuro \u00e9 essencial para desenvolvimento e a preven\u00e7\u00e3o de uma s\u00e9rie de intercorr\u00eancias. Ainda assim, os par\u00e2metros de recomenda\u00e7\u00e3o […]<\/p>\n","protected":false},"author":67,"featured_media":1839,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[49,9],"tags":[98,97,67,191,190],"class_list":["post-1837","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-artigo-5","category-nutricao-parenteral","tag-acidos-graxos","tag-lipidios","tag-nutricao-parenteral","tag-oxidantes","tag-prematuros"],"acf":[],"yoast_head":"\nA import\u00e2ncia dos lip\u00eddios na nutri\u00e7\u00e3o do prematuro<\/title>\n<meta name=\"description\" content=\"Lip\u00eddios exercem papel fundamental na nutri\u00e7\u00e3o parenteral de prematuros. Contudo, eles precisam ser ofertados de maneira precisa. 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