{"id":1879,"date":"2023-02-15T13:50:42","date_gmt":"2023-02-15T16:50:42","guid":{"rendered":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/?p=1879"},"modified":"2023-02-15T14:29:31","modified_gmt":"2023-02-15T17:29:31","slug":"omega3-braspen","status":"publish","type":"post","link":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/omega3-braspen\/","title":{"rendered":"O que a BRASPEN diz sobre o uso cl\u00ednico de \u00f4mega 3 via parenteral?"},"content":{"rendered":"

Com o tempo, o uso de emuls\u00f5es lip\u00eddicas nas f\u00f3rmulas para nutri\u00e7\u00e3o parenteral avan\u00e7ou consideravelmente. Desse modo, \u00e9 natural que as recomenda\u00e7\u00f5es tenham que ser atualizadas, com o que mais de recente a literatura aponta para que as diretrizes adequadas sejam seguidas, ampliando a efici\u00eancia e a seguran\u00e7a desse tipo de interven\u00e7\u00e3o. <\/strong><\/p>\n

\u00c9 por isso que a Sociedade Brasileira de Nutri\u00e7\u00e3o Parenteral e Enteral (BRASPEN) publicou em 2022<\/a>1<\/a>\u00a0um novo posicionamento a respeito do uso cl\u00ednico de \u00f4mega-3 via parenteral,<\/strong> com base nas diretrizes internacionais mais recentes sobre o tema.<\/p>\n

 <\/p>\n

Uso de emuls\u00f5es lip\u00eddicas na nutri\u00e7\u00e3o parenteral<\/h2>\n

Em pacientes recebendo nutri\u00e7\u00e3o via parenteral, as emuls\u00f5es lip\u00eddicas (EL) representam uma importante fonte de energia n\u00e3o proveniente da glicose e cont\u00eam uma s\u00e9rie de \u00e1cidos graxos essenciais<\/strong>2<\/a>, <\/strong>minimizando o risco de epis\u00f3dios de hiperglicemia e insufici\u00eancia hep\u00e1tica. Em geral, as ELs devem ser administradas em conjunto com a nutri\u00e7\u00e3o parenteral ou em complemento a nutri\u00e7\u00e3o via enteral ou oral, sempre que for identificado o risco de desnutri\u00e7\u00e3o<\/a>1<\/a>.<\/p>\n

Atualmente, existem no mercado ELs com diferentes fontes de \u00e1cidos graxos, indo al\u00e9m do \u00f3leo de soja, conhecido como um lip\u00eddio de primeira gera\u00e7\u00e3o. Ap\u00f3s a segunda gera\u00e7\u00e3o de lip\u00eddios (com o \u00f3leo de coco recebendo mais destaque), tornaram-se mais amplamente dispon\u00edveis os lip\u00eddios de terceira gera\u00e7\u00e3o. Entre eles est\u00e3o o \u00f3leo de oliva e, em especial, o \u00f3leo de peixe<\/a>, reconhecido\u00a0 pelo seu alto teor de \u00f4mega-3.1<\/a><\/p>\n

Se por um lado, ELs ricas em \u00f4mega-6 tem potencial pr\u00f3-inflamat\u00f3rio e imunossupressor e pr\u00f3-tromb\u00f3tico, aquelas com composi\u00e7\u00e3o rica em \u00e1cidos graxos da fam\u00edlia do \u00f4mega-3 atuam com propriedades anti-inflamat\u00f3rias e anti-tromb\u00f3ticas.3<\/a><\/p>\n

 <\/p>\n

Leia tamb\u00e9m: <\/em><\/strong>veja tudo o que voc\u00ea precisa saber sobre emuls\u00f5es lip\u00eddicas parenterais.<\/em><\/strong><\/a><\/p>\n

 <\/p>\n

Recomenda\u00e7\u00f5es de uso cl\u00ednico de \u00f4mega-3 via parenteral<\/h2>\n

O perfil metab\u00f3lico do paciente deve sempre ser levado em conta na escolha da EL introduzida na nutri\u00e7\u00e3o parenteral: aqueles enfermos hipermetab\u00f3licos devem receber, de prefer\u00eancia, emuls\u00f5es com lip\u00eddios mais modernos, com uma maior concentra\u00e7\u00e3o de \u00f4mega-3.<\/strong>1<\/a><\/p>\n

Diante disso, a BRASPEN indica que pacientes com perfil hipermetab\u00f3licos se beneficiam da adi\u00e7\u00e3o de \u00f4mega-3 em suas emuls\u00f5es lip\u00eddicas por meio do acr\u00e9scimo do \u00f3leo de peixe.1<\/a> Na maior parte dos casos, a EL pode ser acrescida \u00e0s solu\u00e7\u00f5es de glicose e amino\u00e1cido na forma de nutri\u00e7\u00e3o parenteral manipulada, embora o quadro cl\u00ednico possa indicar uma administra\u00e7\u00e3o \u00e0 parte.4,<\/a>5,<\/a>6<\/a><\/p>\n

A dose m\u00e1xima a ser ofertada sem risco \u00e0 seguran\u00e7a do paciente \u00e9 de at\u00e9 1,5 g\/ kg em 24 horas. Todavia, a dose usual \u00e9 de 1g\/kg\/ dia.4,<\/a>5,<\/a>7<\/a> <\/strong>Em rela\u00e7\u00e3o ao \u00f3leo de peixe, a maior parte dos estudos cl\u00ednicos analisados pela diretriz da BRASPEN indica a recomenda\u00e7\u00e3o entre 0,1 e 0,2 g\/kg\/dia para pacientes adultos clinicamente est\u00e1veis.1<\/a> Desde que sejam respeitados tais par\u00e2metros, n\u00e3o h\u00e1 evid\u00eancias de que a introdu\u00e7\u00e3o de ELs com \u00f3leo de peixe na composi\u00e7\u00e3o aumente o risco do desencadeamento de quadros de coagulopatia ou sangramentos.4,<\/a>8<\/a><\/p>\n

De todo modo, quadros espec\u00edficos como os que envolvam perioperat\u00f3rio, c\u00e2ncer, diferentes est\u00e1gios de enfermidades graves, pacientes pedi\u00e1tricos ou presen\u00e7a de disfun\u00e7\u00e3o hep\u00e1tica re\u00fanem evid\u00eancias significativas dos benef\u00edcios da introdu\u00e7\u00e3o de ELs ricas em \u00f4mega-31<\/a>, sempre levando em conta as especificidades de cada contexto.<\/p>\n

 <\/p>\n

Poss\u00edveis contraindica\u00e7\u00f5es<\/h2>\n

Como j\u00e1 destacado, se respeitadas as doses m\u00e1ximas recomendadas, a introdu\u00e7\u00e3o de ELs ricas em \u00f4mega-3 n\u00e3o parece representar riscos adicionais ao paciente.<\/strong> Isso, claro, n\u00e3o significa que o uso desse recurso na nutri\u00e7\u00e3o parenteral n\u00e3o tenha limita\u00e7\u00f5es para indica\u00e7\u00e3o e potencial mudan\u00e7a de desfechos. A pr\u00f3pria BRASPEN refor\u00e7a que n\u00e3o h\u00e1 evid\u00eancias s\u00f3lidas para o emprego de ELs ricas em \u00f4mega-3 para recupera\u00e7\u00e3o muscular na sarcopenia prim\u00e1ria ou secund\u00e1ria \u00e0 desnutri\u00e7\u00e3o.<\/strong>1<\/a><\/p>\n

Pacientes com hipertrigliceridemia grave ou com problemas no metabolismo lip\u00eddico devem ser observados com cuidado e geralmente se incluem no grupo para contraindica\u00e7\u00e3o.<\/strong> Al\u00e9m disso, o n\u00edvel s\u00e9rico de triglic\u00e9rides deve ser acompanhado desde o in\u00edcio e nunca deve ultrapassar 400 mg\/d durante o per\u00edodo de infus\u00e3o.4<\/a><\/p>\n

Entretanto, a principal contraindica\u00e7\u00e3o para esse tipo de EL s\u00e3o as rea\u00e7\u00f5es al\u00e9rgicas. Logo, \u00e9 fundamental observar as orienta\u00e7\u00f5es do fabricante da f\u00f3rmula, que indicam o risco de hipersensibilidade para o \u00f3leo de soja, de oliva, de amendoim e de peixe.9<\/a><\/strong><\/p>\n

Por fim, a utiliza\u00e7\u00e3o de ELs com tais perfis exigem aten\u00e7\u00e3o adicional contra riscos de contamina\u00e7\u00e3o, principalmente durante a manipula\u00e7\u00e3o. Al\u00e9m disso, \u00e9 preciso levar em conta o risco acentuado de peroxida\u00e7\u00e3o lip\u00eddica, que pode causar danos celulares e les\u00f5es hep\u00e1ticas. Acrescentar \u00e1cido asc\u00f3rbico e evitar a exposi\u00e7\u00e3o da emuls\u00e3o \u00e0 luz, em geral, reduz esse risco.10<\/a><\/p>\n

Com tudo isso, o uso cl\u00ednico do \u00f4mega-3 via parenteral, de acordo com o r posicionamento da BRASPEN, est\u00e3o claramente associados a melhores desfechos cl\u00ednicos em v\u00e1rios quadros<\/strong>1<\/a>, com pacientes de diferentes perfis e evid\u00eancias robustas confirmando as diretrizes existentes.<\/strong> Mas ainda h\u00e1 muito a ser explorado, principalmente para entender melhor as poss\u00edveis limita\u00e7\u00f5es dessa alternativa.<\/p>\n

 <\/p>\n

Para continuar entendendo a import\u00e2ncia do \u00f4mega-3 na nutri\u00e7\u00e3o parenteral, veja como ele pode ajudar na redu\u00e7\u00e3o de complica\u00e7\u00f5es p\u00f3s-operat\u00f3rias de c\u00e2ncer g\u00e1strico.<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

Com o tempo, o uso de emuls\u00f5es lip\u00eddicas nas f\u00f3rmulas para nutri\u00e7\u00e3o parenteral avan\u00e7ou consideravelmente. Desse modo, \u00e9 natural que as recomenda\u00e7\u00f5es tenham que ser atualizadas, com o que mais de recente a literatura aponta para que as diretrizes adequadas sejam seguidas, ampliando a efici\u00eancia e a seguran\u00e7a desse tipo de interven\u00e7\u00e3o. \u00c9 por isso […]<\/p>\n","protected":false},"author":5902,"featured_media":1880,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[49],"tags":[98,119,67,135,99],"class_list":["post-1879","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-artigo-5","tag-acidos-graxos","tag-braspen","tag-nutricao-parenteral","tag-oleo-de-peixe","tag-omega-3"],"acf":[],"yoast_head":"\nO que h\u00e1 de mais recente sobre o uso cl\u00ednico de \u00f4mega-3 via parenteral?<\/title>\n<meta name=\"description\" content=\"Entenda como o uso cl\u00ednico de \u00f4mega-3 via parenteral pode beneficiar 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