{"id":1852,"date":"2025-08-06T11:00:54","date_gmt":"2025-08-06T14:00:54","guid":{"rendered":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/?p=1852"},"modified":"2025-08-06T14:25:50","modified_gmt":"2025-08-06T17:25:50","slug":"calorias-e-proteinas","status":"publish","type":"post","link":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/calorias-e-proteinas\/","title":{"rendered":"Como funciona a rela\u00e7\u00e3o entre calorias e prote\u00ednas na nutri\u00e7\u00e3o parenteral?"},"content":{"rendered":"

A nutri\u00e7\u00e3o parenteral (NP) garante ao paciente a energia e os nutrientes necess\u00e1rios para manuten\u00e7\u00e3o dos sinais vitais e para repara\u00e7\u00e3o e crescimento celular e tecidual.\u00a0 Ainda que essas necessidades variem de caso a caso, \u00e9 sempre importante ficar atento \u00e0 rela\u00e7\u00e3o entre calorias e prote\u00ednas.<\/p>\n

Fatores que devem ser levados em conta nesse c\u00e1lculo incluem a condi\u00e7\u00e3o do paciente, seu estado nutricional, as doen\u00e7as de base, seu estado metab\u00f3lico, entre outros. Mesmo assim, h\u00e1 v\u00e1rias dificuldades nessas estimativas, que precisam ser observadas com cuidado, sob o risco de gerar complica\u00e7\u00f5es.<\/p>\n

Nos t\u00f3picos abaixo, mostramos algumas diretrizes b\u00e1sicas a serem consideradas para esses macronutrientes na Nutri\u00e7\u00e3o Parenteral.<\/p>\n

Qual a ingest\u00e3o adequada de calorias na nutri\u00e7\u00e3o parenteral?<\/h2>\n

Os principais guias recomendam que o c\u00e1lculo das necessidades nutricionais deve se dar atrav\u00e9s da calorimetria indireta como um padr\u00e3o-ouro (1). Avan\u00e7os nessas t\u00e9cnicas e o desenvolvimento de novos dispositivos podem aumentar a sensibilidade e a precis\u00e3o dessa estimativa.<\/p>\n

Duas metan\u00e1lises mostraram que a utiliza\u00e7\u00e3o da calorimetria indireta para determina\u00e7\u00e3o das necessidades nutricionais do paciente est\u00e1 associada a menores taxas de mortalidade no curto prazo (2, 3). Portanto, isso deve estimular seu uso.<\/p>\n

Entretanto, essa op\u00e7\u00e3o nem sempre est\u00e1 dispon\u00edvel na pr\u00e1tica cl\u00ednica. Como alternativa, utiliza-se f\u00f3rmulas de bolso para estimar o gasto energ\u00e9tico (4).<\/p>\n

A recomenda\u00e7\u00e3o da maioria das diretrizes estima necessidades cal\u00f3ricas que variam entre 24 e 30 kcal\/kg\/dia (5, 6, 7), podendo variar de acordo com as condi\u00e7\u00f5es cl\u00ednicas, fase da doen\u00e7a cr\u00edtica, entre outros.<\/p>\n

Na tabela abaixo, confira exemplos de recomenda\u00e7\u00f5es para aporte cal\u00f3rico de alguns\u00a0 guidelines (8, 9, 10, 11).<\/p>\n\n\n\n\n\n\n\n
Diretriz<\/strong><\/td>\nRecomenda\u00e7\u00e3o energ\u00e9tica<\/strong><\/td>\n<\/tr>\n
Pacientes cr\u00edticos – ASPEN (2021)<\/td>\n12 a 25 kcal\/kg nos primeiros 7 a 10 dias de interna\u00e7\u00e3o na UTI<\/td>\n<\/tr>\n
Pacientes com c\u00e2ncer – ESPEN (2021)<\/td>\n25 a 30 kcal\/kg\/dia<\/td>\n<\/tr>\n
Pacientes graves – BRASPEN (2023)<\/td>\nOferta energ\u00e9tica inicial de 15 a 20 kcal\/kg, que deve progredir para 25 a 30 kcal\/kg entre o 4\u00ba e o 7\u00ba dia (fase p\u00f3s aguda\/recupera\u00e7\u00e3o)<\/td>\n<\/tr>\n
Doen\u00e7a inflamat\u00f3ria intestinal – ESPEN (2023)<\/td>\n30 a 35 kcal\/kg\/dia<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n

Qual a ingest\u00e3o adequada de prote\u00ednas na nutri\u00e7\u00e3o parenteral?<\/h2>\n

Em um adulto com metabolismo normal, a necessidade proteica esperada \u00e9 de 0,8 g\/kg\/dia para manter as fun\u00e7\u00f5es corporais saud\u00e1veis.<\/p>\n

Em situa\u00e7\u00f5es de estresse catab\u00f3lico, essa necessidade pode aumentar, variando em m\u00e9dia de 1,2 a 1,5 g\/kg\/dia, podendo chegar a 2,0 a 2,5 g\/kg\/dia em casos excepcionais (como obesos e pacientes com queimaduras graves) (4).<\/p>\n

A maior parte das diretrizes tem recomenda\u00e7\u00f5es que variam entre 1 a 2 g\/kg\/dia (5, 6, 7). Confira exemplos na tabela abaixo\u00a0 (8, 9, 10, 11, 12, 13, 14).<\/p>\n\n\n\n\n\n\n\n\n\n\n
Diretriz<\/strong><\/td>\nRecomenda\u00e7\u00e3o proteica<\/strong><\/td>\n<\/tr>\n
Pacientes cr\u00edticos – ASPEN (2021)<\/td>\n1,2 a 2 g\/kg\/d<\/td>\n<\/tr>\n
Pacientes com c\u00e2ncer – ESPEN (2021)<\/td>\n\u00a0Ingest\u00e3o superior a 1 g\/kg\/d e, se poss\u00edvel, at\u00e9 1,5 g\/kg\/d<\/td>\n<\/tr>\n
Pacientes de UTI – ESPEN (2023)<\/td>\n1,3 g\/kg\/d<\/td>\n<\/tr>\n
Pacientes cr\u00edticos – ACNC e AMCI (2023)<\/td>\n\u00a01.3 a 1.5 g\/kg\/d<\/p>\n

Na fase cr\u00f4nica ou p\u00f3s-cr\u00edtica, esses aportes podem ser mais altos (> 1,5 g\/kg\/d)<\/td>\n<\/tr>\n

Paciente grave – BRASPEN (2023)<\/td>\n1.2 g\/kg\/dia na fase inicial da doen\u00e7a. Ap\u00f3s o 4\u00ba dia na UTI, recomenda-se um aporte entre 1.3 a 2 g\/kg\/dia<\/td>\n<\/tr>\n
Pacientes com multimorbidades – ESPEN (2023)<\/td>\n1,2 a 1,5 g\/kg\/d<\/p>\n

Em pacientes com fun\u00e7\u00e3o renal prejudicada que n\u00e3o est\u00e3o em terapia de substitui\u00e7\u00e3o renal, a meta cai para 0,8 g\/kg\/d<\/td>\n<\/tr>\n

Doen\u00e7a inflamat\u00f3ria intestinal – ESPEN (2023)<\/td>\n1,2 a 1,5 g\/kg\/d na DII ativa, e 1 g\/kg\/d na DII em remiss\u00e3o<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n

A influ\u00eancia da quantidade de prote\u00edna no desfecho de pacientes cr\u00edticos tamb\u00e9m tem sido discutida de forma controversa nos desfechos de estudos cl\u00ednicos (15, 16).<\/p>\n

Uma an\u00e1lise secund\u00e1ria explorat\u00f3ria do ensaio EFFORT Protein, publicada em 2024, comparou a influ\u00eancia de doses proteicas mais baixas (\u2264 1,2 g\/kg\/dia) ou mais altas (\u2265 2,2 g\/kg\/dia) na mortalidade em 30 dias. Como resultado, altas doses foram associadas \u00e0 maior mortalidade (17).<\/p>\n

Os pesquisadores apoiaram a ado\u00e7\u00e3o de doses proteicas mais baixas no cuidado dos pacientes cr\u00edticos, n\u00e3o excedendo 1,2 g\/kg\/dia em qualquer est\u00e1gio da doen\u00e7a, principalmente em caso de aumento de ureia ou ureia crescente (17).<\/p>\n

Qual o c\u00e1lculo da rela\u00e7\u00e3o calorias x prote\u00ednas?<\/h2>\n

O c\u00e1lculo de consumo cal\u00f3rico e fornecimento adequado de prote\u00ednas na nutri\u00e7\u00e3o parenteral n\u00e3o se encerra nesse ponto. \u00c9 necess\u00e1rio garantir tamb\u00e9m o fornecimento de outros nutrientes, como carboidratos e lip\u00eddios, na propor\u00e7\u00e3o correta dentro da demanda energ\u00e9tica.<\/p>\n

A orienta\u00e7\u00e3o \u00e9, ap\u00f3s determinar a ingest\u00e3o de calorias necess\u00e1rias, definir a quantidade de prote\u00ednas, dentro das diretrizes mencionadas anteriormente.<\/p>\n

Em seguida, a f\u00f3rmula deve ser complementada com os carboidratos e os lip\u00eddios necess\u00e1rios at\u00e9 garantir o suprimento total de calorias.<\/p>\n

Vale ressaltar que cada grama de amino\u00e1cido infundido fornece 4 kcal de energia ap\u00f3s sua oxida\u00e7\u00e3o. Para pacientes com baixo estresse metab\u00f3lico (hospitalizados em enfermarias), a rela\u00e7\u00e3o entre gramas de nitrog\u00eanio e quilocalorias n\u00e3o proteicas (gN\/kcal n\u00e3o-AA)<\/strong> deve ser mantida entre 1\/110 – 1\/180<\/strong> (4).<\/p>\n

Para pacientes estressados (internados em unidades de terapia intensiva – UTI), essa rela\u00e7\u00e3o deve ser mais estreita, entre 1\/70 – 1\/100<\/strong> (4).<\/p>\n

Para calcular a quantidade de nitrog\u00eanio (em gramas) oferecida ao paciente, basta dividir a quantidade de amino\u00e1cidos infundidos na PN (em gramas) por 6,25 (ou seja, considerando que 16% do peso dos AA correspondem ao nitrog\u00eanio) (4).<\/p>\n

Exemplo pr\u00e1tico<\/strong>: Em um paciente que recebe 100 g de amino\u00e1cidos por dia, a quantidade de nitrog\u00eanio fornecida ser\u00e1: 100 g \u00f7 6,25 = 16 g de nitrog\u00eanio.<\/p>\n

    \n
  • Para um paciente com baixo estresse metab\u00f3lico: A quantidade de quilocalorias n\u00e3o proteicas necess\u00e1ria deve estar entre:<\/li>\n<\/ul>\n

    16 g \u00d7 110 = 1760 kcal<\/p>\n

    16 g \u00d7 180 = 2880 kcal<\/p>\n

      \n
    • Para um paciente estressado (UTI): A recomenda\u00e7\u00e3o \u00e9 de uma rela\u00e7\u00e3o mais pr\u00f3xima, entre:<\/li>\n<\/ul>\n

      16 g \u00d7 70 = 1120 kcal<\/p>\n

      16 g \u00d7 100 = 1600 kcal<\/p>\n

      Al\u00e9m disso, em todos os casos, \u00e9 preciso considerar tamb\u00e9m as chamadas calorias n\u00e3o-nutricionais.<\/p>\n

      Por fim, al\u00e9m da avalia\u00e7\u00e3o cuidadosa na rela\u00e7\u00e3o entre calorias e prote\u00ednas junto aos demais macro e micronutrientes, o monitoramento e reavalia\u00e7\u00f5es constantes na evolu\u00e7\u00e3o de cada quadro s\u00e3o fundamentais para a implementa\u00e7\u00e3o de ajustes que podem evitar defici\u00eancias nutricionais ou outras complica\u00e7\u00f5es.<\/p>\n

       <\/p>\n

       <\/p>\n

       <\/p>\n

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

      1 – Hill A, Elke G, Weimann A. Nutrition in the Intensive Care Unit – A Narrative Review. Nutrients. 2021;13:2851.<\/p>\n

      2 – Duan JY, Zheng WH, Zhou H, Xu Y, Huang HB. Energy delivery guided by indirect calorimetry in critically ill patients: A systematic review and meta-analysis. Crit Care. 2021;25:1-10.<\/p>\n

      3 – Pertzov B, Bar-Yoseph H, Mendel Y, Bendavid I, Kagan I, Glass YD, Singer P. The effect of indirect calorimetry guided isocaloric nutrition on mortality in critically ill patients-a systematic review and meta-analysis. Eur J Clin Nutr. 2021;1-11.<\/p>\n

      4 – Boemer HT. Parenteral nutrition: how to prescribe your inputs. Int J Nutrology. 2022;15(2).<\/p>\n

      5 – Elke G, Hartl WH, Kreymann KG, Adolph M, Felbinger TW, Graf T, de Heer G, Heller AR, Kampa U, Mayer K, et al. Clinical Nutrition in Critical Care Medicine\u2014Guideline of the German Society for Nutritional Medicine (DGEM). Clin Nutr ESPEN. 2019;33:220-275.<\/p>\n

      6 – Singer P, Blaser AR, Berger MM, Alhazzani W, Calder PC, Casaer M, Hiesmayr M, Mayer K, Montejo JC, Pichard C, et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr. 2018;38:48-79.<\/p>\n

      7 -McClave SA, Taylor BE, Martindale RG, Warren MM, Johnson DR, Braunschweig C, McCarthy MS, Davanos E, Rice TW, Cresci GA, et al. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). J Parenter Enteral Nutr. 2016;40:159-211.<\/p>\n

      8 – Compher C, Bingham AL, McCall M, Patel J, Rice TW, Braunschweig C, McKeever L. Guidelines for the provision of nutrition support therapy in the adult critically ill patient: The American Society for Parenteral and Enteral Nutrition. J Parenter Enteral Nutr. 2022;46(1):12-41.<\/p>\n

      9 – Muscaritoli M, et al. ESPEN practical guideline: Clinical Nutrition in cancer. Clin Nutr. 2021;40(5):2898-2913.<\/p>\n

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

      11 – Bischoff AS, Bager BP, Escher CJ, et al. ESPEN guideline on Clinical Nutrition in inflammatory bowel disease. Clin Nutr. 2023;42.<\/p>\n

      12 – Singer P, Blaser AR, Berger MM, Calder PC, Casaer M, Hiesmayr M, Mayer K, Montejo-Gonzalez JC, Pichard C, Preiser JC, Szczeklik W, van Zanten ARH, Bischoff SC. ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit. Clin Nutr. 2023;42(9):1671-1689. doi: 10.1016\/j.clnu.2023.07.011.<\/p>\n

      13 – Trejos-Gallego D, Pereira PF, P\u00e9rez CA, Barbosa BJ, Ochoa Gautier JB, Waitzberg D, Gil VB, Aguirre ME, Castillo BMA, Pizarro GCE, et al. Consenso sobre el uso de prote\u00edna en el paciente cr\u00edtico \u2013 ACNC. Rev Nutr Clin Metab. 2023;6(2).<\/p>\n

      14 – Wunderle C, Gomes F, Schuetz P, Stumpf F, Austin P, Ballesteros-Pomar MD, Cederholm T, Fletcher J, Laviano A, Norman K, et al. ESPEN guideline on nutritional support for polymorbid medical inpatients. Clin Nutr. 2023;42(9):1545-1568. doi: 10.1016\/j.clnu.2023.06.023.<\/p>\n

      15 – Patel DK, Bear D, Sacks G, Nixdorf H, Dolan J, Aloupis M, Licastro K, Jovanovic V, Rice TW, et al. The Effect of Higher Protein Dosing in Critically Ill Patients: A Multicenter Registry-Based Randomized Trial: The EFFORT Trial. J Parenter Enteral Nutr. 2018;43:326-334.<\/p>\n

      16 – Heyland DK, Stapleton R, Compher C. Should We Prescribe More Protein to Critically Ill Patients? Nutrients. 2018;10:462.<\/p>\n

      17 – Haines RW, Prowle JR, Day A, et al. Association between urea trajectory and protein dose in critically ill adults: a secondary exploratory analysis of the effort protein trial (RE-EFFORT). Crit Care. 2024;28:24. doi: 10.1186\/s13054-024-04799-1.<\/p>\n

       <\/p>\n","protected":false},"excerpt":{"rendered":"

      A nutri\u00e7\u00e3o parenteral (NP) garante ao paciente a energia e os nutrientes necess\u00e1rios para manuten\u00e7\u00e3o dos sinais vitais e para repara\u00e7\u00e3o e crescimento celular e tecidual.\u00a0 Ainda que essas necessidades variem de caso a caso, \u00e9 sempre importante ficar atento \u00e0 rela\u00e7\u00e3o entre calorias e prote\u00ednas. Fatores que devem ser levados em conta nesse c\u00e1lculo […]<\/p>\n","protected":false},"author":67,"featured_media":2089,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[49],"tags":[202,89,82,67,203],"class_list":["post-1852","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-artigo-5","tag-calorias","tag-macronutrientes","tag-micronutrientes","tag-nutricao-parenteral","tag-proteinas"],"acf":[],"yoast_head":"\nVeja como calcular de calorias e prote\u00ednas na nutri\u00e7\u00e3o parenteral<\/title>\n<meta name=\"description\" content=\"Calorias e prote\u00ednas s\u00e3o partes importantes das f\u00f3rmulas de nutri\u00e7\u00e3o parenteral. 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