{"id":1949,"date":"2024-02-21T11:00:48","date_gmt":"2024-02-21T14:00:48","guid":{"rendered":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/?p=1949"},"modified":"2024-02-21T11:00:48","modified_gmt":"2024-02-21T14:00:48","slug":"antioxidantes-nutricao-parenteral","status":"publish","type":"post","link":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/antioxidantes-nutricao-parenteral\/","title":{"rendered":"A import\u00e2ncia dos minerais antioxidantes na nutri\u00e7\u00e3o parenteral"},"content":{"rendered":"

Al\u00e9m da energia e de outros nutrientes fundamentais para o funcionamento do organismo, \u00e9 preciso sempre levar em conta o papel dos antioxidantes no paciente cr\u00edtico que precisa de uma nutri\u00e7\u00e3o parenteral.<\/strong><\/p>\n

A nutri\u00e7\u00e3o parenteral e a suplementa\u00e7\u00e3o de micronutrientes (sobretudo de minerais), se devidamente prescritos, contribuem para manuten\u00e7\u00e3o do estado nutricional, com o desempenho adequado de diversas fun\u00e7\u00f5es do metabolismo e uma chance maior de desfechos positivos em diferentes quadros.<\/p>\n

 <\/p>\n

O papel dos antioxidantes no organismo<\/h2>\n

\u00c9 fundamental compreender as fun\u00e7\u00f5es dos antioxidantes no organismo para refor\u00e7ar sua import\u00e2ncia na nutri\u00e7\u00e3o parenteral. Isso passa primeiro por entender a a\u00e7\u00e3o dos chamados radicais livres. Em resumo, eles s\u00e3o qualquer tipo de componente com um ou mais el\u00e9trons desemparelhados1<\/sup>.<\/p>\n

Eles reagem na presen\u00e7a de oxig\u00eanio e podem ter origem tanto de fontes externas quanto resultado de processos metab\u00f3licos comuns1<\/sup>. A rea\u00e7\u00e3o dos radicais livres, quando n\u00e3o inativados, pode danificar diferentes mol\u00e9culas no organismo, incluindo prote\u00ednas, carboidratos, lip\u00eddios e \u00e1cidos nucleicos, prejudicando as c\u00e9lulas e o organismo como um todo1<\/sup>.<\/strong><\/p>\n

No sentido oposto, os antioxidantes s\u00e3o qualquer componente capaz de conter a a\u00e7\u00e3o dos radicais livres e promover o balan\u00e7o oxidativo1<\/sup>. Assim, sempre que h\u00e1 desequil\u00edbrio entre a presen\u00e7a de radicais livres (pr\u00f3-oxidantes) e antioxidantes, ocorre o chamado estresse oxidativo1<\/sup><\/strong>. Em geral, essa condi\u00e7\u00e3o \u00e9 secund\u00e1ria em rela\u00e7\u00e3o a uma doen\u00e7a principal.<\/p>\n

No entanto, o estresse oxidativo pode provocar ainda mais dano celular do que a doen\u00e7a prim\u00e1ria, ainda mais quando se leva em conta que a capacidade antioxidante do organismo pode ser ainda pior em per\u00edodos de estresse catab\u00f3lico1<\/sup>. Ou seja, quadros de enfermidade, sobretudo graves, devem ser considerados como situa\u00e7\u00f5es de alto estresse oxiditativo2<\/sup>.<\/p>\n

 <\/p>\n

Os benef\u00edcios dos minerais antioxidantes na nutri\u00e7\u00e3o parenteral<\/h2>\n

\u00c9 nesse contexto que os antioxidantes na nutri\u00e7\u00e3o parenteral desempenham uma fun\u00e7\u00e3o relevante no manejo do estado cl\u00ednico. Isso \u00e9 alcan\u00e7ado pela correta administra\u00e7\u00e3o de determinados micronutrientes (em especial por meio da suplementa\u00e7\u00e3o de minerais), seguindo orienta\u00e7\u00e3o das necessidades di\u00e1rias contidas em diversas diretrizes para p\u00fablicos espec\u00edficos de pacientes.<\/p>\n

V\u00e1rias evid\u00eancias apontam para os resultados negativos devido \u00e0 defici\u00eancia de diversos oligoelementos (e, por consequ\u00eancia, da eleva\u00e7\u00e3o do estresse oxidativo) em conjunto com complexas intera\u00e7\u00f5es que envolvem ativa\u00e7\u00e3o endotelial, coagulopatia, dist\u00farbios na microcircula\u00e7\u00e3o, fun\u00e7\u00e3o mitocondrial prejudicada, apoptose aumentada, permeabilidade intestinal aumentada e metabolismo alterado de glicose e prote\u00ednas2<\/sup>.<\/p>\n

Entre alguns dos problemas mais observados nesse quadro, que \u00e9 comum p\u00f3s-sepse e como consequ\u00eancia de perman\u00eancia em UTI, est\u00e3o a dificuldade de <\/strong>cicatriza\u00e7\u00e3o<\/strong><\/a>, pior resposta imune, fraqueza muscular e outras disfun\u00e7\u00f5es org\u00e2nicas2<\/sup>.<\/strong><\/p>\n

\u00a0<\/em><\/p>\n

Saiba mais:<\/em> Veja qual a import\u00e2ncia dos micronutrientes na nutri\u00e7\u00e3o parenteral<\/em><\/a><\/p>\n

 <\/p>\n

Algumas das indica\u00e7\u00f5es gerais para a suplementa\u00e7\u00e3o de minerais antioxidantes<\/h2>\n

Diversos minerais t\u00eam papel importante e, claro, recomenda\u00e7\u00f5es espec\u00edficas para a administra\u00e7\u00e3o junto \u00e0 f\u00f3rmula de nutri\u00e7\u00e3o parenteral<\/a>, conforme indicam as diretrizes da ESPEN3<\/sup>.<\/p>\n

\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
Recomenda\u00e7\u00f5es di\u00e1rias de minerais com a\u00e7\u00e3o antioxidante na NP<\/p>\n

conforme diretrizes da ESPEN4<\/sup><\/td>\n<\/tr>\n

 <\/td>\nNutri\u00e7\u00e3o parenteral domiciliar\/longo prazo<\/strong><\/td>\nNutri\u00e7\u00e3o Parenteral em situa\u00e7\u00f5es de necessidades aumentadas<\/strong><\/td>\n<\/tr>\n
Cromo<\/td>\n10 \u2013 15 \u00b5g<\/td>\n15 \u00b5g<\/td>\n<\/tr>\n
Ferro<\/td>\n1 mg<\/td>\n1 mg<\/p>\n

 <\/td>\n<\/tr>\n

Mangan\u00eas<\/td>\n55 \u00b5g<\/td>\n55 \u00b5g<\/td>\n<\/tr>\n
Iodo<\/td>\n130 \u00b5g<\/td>\n130 \u00b5g<\/td>\n<\/tr>\n
Molibd\u00eanio<\/td>\n19 \u2013 25 mg<\/td>\n19 – 25 mg<\/td>\n<\/tr>\n
Fl\u00faor<\/td>\n0 \u2013 1 mg<\/td>\n0 \u2013 1 mg<\/td>\n<\/tr>\n
Sel\u00eanio<\/td>\n60 \u00b5g \u2013100 \u00b5g<\/td>\n150 \u00b5g \u2013200 \u00b5g<\/td>\n<\/tr>\n
Zinco<\/td>\n3 mg \u20135 mg<\/td>\n6 mg \u201312 mg<\/td>\n<\/tr>\n
Cobre<\/td>\n0,3 mg \u2013 0,5 mg<\/td>\n\u00a00,5\u2013 1,0 mg<\/td>\n<\/tr>\n
Adaptado de: Berger MM, Shenkin A, Schweinlin A, Amrein K, Augsburger M, Biesalski HK, … & Cuerda C. (2022). ESPEN micronutrient guideline. Clinical Nutrition<\/em>, 41<\/em>(6), 1357-1424.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n

Em todo caso, \u00e9 preciso levar em conta que a influ\u00eancia dos antioxidantes na nutri\u00e7\u00e3o parenteral, inclusive quando se considera a suplementa\u00e7\u00e3o mineral, pode ser diferente dependendo do estado dos pacientes.<\/p>\n

Doentes graves (que podem ter aumento cont\u00ednuo de perdas gastrointestinais), em terapia de substitui\u00e7\u00e3o renal cont\u00ednua, em estado hipermetab\u00f3lico ou que chegam para o tratamento em condi\u00e7\u00e3o de deple\u00e7\u00e3o, por exemplo, podem precisar de doses mais altas de micronutrientes3<\/sup>.<\/p>\n

Assim sendo, algumas condi\u00e7\u00f5es refor\u00e7am a necessidade de conferir o n\u00edvel s\u00e9rico de determinados micronutrientes antioxidantes.<\/strong> Exemplos disso s\u00e3o os pacientes j\u00e1 desnutridos, com quadro de alcoolismo cr\u00f4nico, com doen\u00e7a cr\u00edtica que eleve a demanda por esses componentes ou devido a quadros que favore\u00e7am a reten\u00e7\u00e3o de tais oligoelementos4<\/sup>. Por outro lado, identificar poss\u00edveis defici\u00eancias ainda \u00e9 um desafio, j\u00e1 que muitos dos m\u00e9todos s\u00e3o inacess\u00edveis na pr\u00e1tica cl\u00ednica di\u00e1ria4<\/sup>.<\/strong><\/p>\n

Por fim, pode ser necess\u00e1rio tamb\u00e9m acompanhar a administra\u00e7\u00e3o desses elementos antioxidantes na nutri\u00e7\u00e3o parenteral de longo prazo.<\/strong> Minerais como ferro, mangan\u00eas e cobre s\u00e3o essenciais ao organismo, mas podem causar quadros de intoxica\u00e7\u00e3o se em n\u00edveis elevados por muito tempo4<\/sup>. Em outras palavras, a nutri\u00e7\u00e3o e reposi\u00e7\u00e3o com tais elementos \u00e9 t\u00e3o fundamental quanto o acompanhamento pr\u00f3ximo e cont\u00ednuo desse paciente, assim como a qualidade dos poliminerais<\/a> administrados.<\/p>\n

 <\/p>\n

Aproveite e veja mais sobre a import\u00e2ncia do sel\u00eanio, um mineral essencial na composi\u00e7\u00e3o da nutri\u00e7\u00e3o parenteral<\/a>.<\/u><\/p>\n

 <\/p>\n

 <\/p>\n

Refer\u00eancias<\/p>\n

    \n
  1. Furst P. Basics in clinical nutrition: Role of antioxidants in nutritional support. ESPEN. 2009;4(3):e105-e107. Dispon\u00edvel em: https:\/\/clinicalnutritionespen.com\/article\/S1751-4991(08)00082-6\/fulltext<\/a>. Acesso em 30 de novembro de 2023.<\/li>\n
  2. De Waele E, Malbrain MLNG, Spapen H. Nutrition in sepsis: a bench-to-bedside review. Nutrients. 2020;12(2):395. Dispon\u00edvel em: https:\/\/www.mdpi.com\/2072-6643\/12\/2\/395<\/a>. Acesso em 30 de novembro de 2023.<\/li>\n
  3. Berger MM, Shenkin A, Schweinlin A, Amrein K, Augsburger M, Biesalski HK, et al. ESPEN micronutrient guideline. Clinical Nutrition. 2022;41(6):1357-1424. Dispon\u00edvel em: https:\/\/www.clinicalnutritionjournal.com\/article\/S0261-5614(22)00066-8\/fulltext<\/a>. Acesso em 30 de novembro de 2023.<\/li>\n
  4. BRASPEN. Posicionamento BRASPEN sobre o uso de micronutrientes via parenteral em adultos. Revista Brasileira de Nutri\u00e7\u00e3o Cl\u00ednica. 2021;36(Suppl 1):3-19. Dispon\u00edvel em: https:\/\/wdcom.s3.sa-east-1.amazonaws.com\/hosting\/braspen\/journal\/2021\/journal\/jan-mar-2021\/artigos\/01-Posicionamento-BRASPEN.pdf<\/a>. Acesso em 11 de maio de 2023 e 30 de novembro de 2023.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

    Al\u00e9m da energia e de outros nutrientes fundamentais para o funcionamento do organismo, \u00e9 preciso sempre levar em conta o papel dos antioxidantes no paciente cr\u00edtico que precisa de uma nutri\u00e7\u00e3o parenteral. A nutri\u00e7\u00e3o parenteral e a suplementa\u00e7\u00e3o de micronutrientes (sobretudo de minerais), se devidamente prescritos, contribuem para manuten\u00e7\u00e3o do estado nutricional, com o desempenho […]<\/p>\n","protected":false},"author":5902,"featured_media":1950,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[49],"tags":[244,133,82,123,67],"class_list":["post-1949","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-artigo-5","tag-antioxidantes","tag-estresse-oxidativo","tag-micronutrientes","tag-minerais","tag-nutricao-parenteral"],"acf":[],"yoast_head":"\nQual a fun\u00e7\u00e3o dos antioxidantes na nutri\u00e7\u00e3o parenteral?<\/title>\n<meta name=\"description\" content=\"Os antioxidantes na nutri\u00e7\u00e3o parenteral (sobretudo aqueles de origem mineral) ajudam na conten\u00e7\u00e3o do estresse oxidativo, 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