{"id":35426,"date":"2012-05-21T03:00:00","date_gmt":"2012-05-21T06:00:00","guid":{"rendered":"https:\/\/nutritotal.com.br\/pro?p=10135"},"modified":"2023-05-31T14:13:21","modified_gmt":"2023-05-31T17:13:21","slug":"emulsao-lipidica-parenteral-tcm-tcl-ainda-oferece-vantagens-na-pratica-clinica","status":"publish","type":"post","link":"https:\/\/nutritotal.com.br\/pro\/emulsao-lipidica-parenteral-tcm-tcl-ainda-oferece-vantagens-na-pratica-clinica\/","title":{"rendered":"Emuls\u00e3o lip\u00eddica parenteral TCM\/TCL: ainda oferece vantagens na pr\u00e1tica cl\u00ednica?"},"content":{"rendered":"

Emuls\u00e3o lip\u00eddica parenteral TCM\/TCL (triglic\u00e9rides de cadeia m\u00e9dia\/ triglic\u00e9rides de cadeia longa) encontra-se dispon\u00edvel para uso cl\u00ednico no Brasil na forma de mistura f\u00edsica de triglic\u00e9rides de cadeia m\u00e9dia com \u00f3leo de soja, na propor\u00e7\u00e3o 1:1 (1). Durante algumas d\u00e9cadas, essa emuls\u00e3o representou a principal alternativa para infundir menores quantidades de \u00e1cidos graxos \u00f4mega-6 (potencialmente inflamat\u00f3rios e imunossupressores) do que aquelas disponibilizadas por emuls\u00f5es lip\u00eddicas padr\u00e3o, compostas exclusivamente por \u00f3leo de soja (1).<\/p>\n

Ao contr\u00e1rio dos \u00e1cidos graxos \u00f4mega-6, os TCM n\u00e3o s\u00e3o precursores de mediadores inflamat\u00f3rios, s\u00e3o pouco suscept\u00edveis \u00e0 peroxida\u00e7\u00e3o lip\u00eddica e facilmente degradados pela lipoprote\u00edna lipase para utiliza\u00e7\u00e3o celular (1). Gra\u00e7as a essas caracter\u00edsticas, a emuls\u00e3o lip\u00eddica TCM\/TCL tem menor impacto sobre a resposta imunol\u00f3gica e n\u00e3o sobrecarrega o sistema reticuloendotelial, comparada \u00e0 emuls\u00e3o de \u00f3leo de soja (1). Al\u00e9m disso, os TCM n\u00e3o necessitam da a\u00e7\u00e3o da carnitina para atravessarem a membrana mitocondrial e, portanto, constituem fonte mais r\u00e1pida de energia (1).<\/p>\n

Atualmente, outras emuls\u00f5es lip\u00eddicas parenterais com menores quantidades de \u00e1cidos graxos \u00f4mega-6 do que emuls\u00f5es de \u00f3leo de soja est\u00e3o dispon\u00edveis para a pr\u00e1tica cl\u00ednica e incluem emuls\u00e3o de \u00f3leo de oliva e emuls\u00f5es contendo \u00f3leo de peixe (1).<\/p>\n

Emuls\u00e3o de \u00f3leo de oliva \u00e9 rica em \u00e1cidos graxos monoinsaturados \u00f4mega-9 e cont\u00e9m apenas 20% de \u00f3leo de soja. Ela oferece o mesmo conceito de dilui\u00e7\u00e3o de \u00e1cidos graxos \u00f4mega-6 com \u00e1cidos graxos que clamam por ter efeito neutro sobre a resposta imunol\u00f3gica (1). No entanto, em culturas celulares e em volunt\u00e1rios saud\u00e1veis, essa emuls\u00e3o foi associada com preju\u00edzo de fun\u00e7\u00f5es linfocit\u00e1rias (2-4). Estudos cl\u00ednicos que compararam sua infus\u00e3o com a infus\u00e3o de emuls\u00e3o TCM\/TCL s\u00e3o de natureza metab\u00f3lica e demonstraram resultados similares entre elas em rela\u00e7\u00e3o a marcadores de fun\u00e7\u00e3o hep\u00e1tica, \u00e0 peroxida\u00e7\u00e3o e a n\u00edveis de lip\u00eddios plasm\u00e1ticos (5,6).<\/p>\n

Emuls\u00f5es lip\u00eddicas contendo \u00f3leo de peixe isolado ou misturado a diferentes \u00f3leos oferecem a vantagem adicional de serem fonte de \u00e1cidos graxos \u00f4mega-3 que, al\u00e9m de essenciais, apresentam propriedades anti-inflamat\u00f3rias (7). Na pr\u00e1tica cl\u00ednica, essas emuls\u00f5es est\u00e3o associadas com modula\u00e7\u00e3o favor\u00e1vel de mediadores inflamat\u00f3rios e marcadores de fun\u00e7\u00e3o imunol\u00f3gica, com redu\u00e7\u00e3o na incid\u00eancia de complica\u00e7\u00f5es infecciosas e n\u00e3o infecciosas e no tempo de interna\u00e7\u00e3o hospitalar e na unidade de terapia intensiva (UTI) de pacientes cir\u00fargicos e pacientes cr\u00edticos (7). A maioria desses benef\u00edcios foi identificada em compara\u00e7\u00e3o \u00e0 emuls\u00e3o de \u00f3leo de soja.<\/p>\n

Apenas dois estudos compararam emuls\u00e3o TCM\/TCL com emuls\u00e3o contendo \u00f3leo de peixe. Nesses estudos, emuls\u00e3o composta exclusivamente por \u00f3leo de peixe foi infundida em pacientes com sepse ou s\u00edndrome da resposta inflamat\u00f3ria sist\u00eamica (SIRS) na forma de suplemento, associada \u00e0 emuls\u00e3o TCM\/TCL na concentra\u00e7\u00e3o de 20% do total de gordura infundida. Somente um desses estudos encontrou melhora de marcadores de les\u00e3o pulmonar e diminui\u00e7\u00e3o do tempo de interna\u00e7\u00e3o hospitalar, em rela\u00e7\u00e3o \u00e0 emuls\u00e3o TCM\/TCL. No outro, n\u00e3o foram identificadas diferen\u00e7as nos n\u00edveis de interleucina-6 (IL-6), na express\u00e3o de mol\u00e9culas do complexo de histocompatibilidade classe II do tipo DR (HLA-DR), na incid\u00eancia de infec\u00e7\u00f5es, tempo de ventila\u00e7\u00e3o mec\u00e2nica, perman\u00eancia na UTI e nas taxas de mortalidade (8,9).<\/p>\n

Tomados em conjunto, os dados cl\u00ednicos dispon\u00edveis na literatura quanto \u00e0 vantagem de outras emuls\u00f5es lip\u00eddicas alternativas \u00e0 emuls\u00e3o de \u00f3leo de soja sobre emuls\u00e3o TCM\/TCL ainda s\u00e3o escassos. No entanto, n\u00e3o se podem ignorar os benef\u00edcios associados com a infus\u00e3o de emuls\u00f5es contendo \u00f3leo de peixe e h\u00e1 de se considerar o desenvolvimento de mais estudos que comparem seus efeitos com emuls\u00e3o TCM\/TCL, bem como seu custo-benef\u00edcio, j\u00e1 que emuls\u00f5es contendo \u00f3leo de peixe s\u00e3o mais onerosas. Em rela\u00e7\u00e3o \u00e0 emuls\u00e3o de \u00f3leo de oliva, estudos que comparem seus efeitos com TCM\/TCL sobre marcadores imunol\u00f3gicos e de evolu\u00e7\u00e3o cl\u00ednica tamb\u00e9m s\u00e3o necess\u00e1rios.<\/p>\n

Clinicamente, emuls\u00e3o TCM\/TCL \u00e9 segura, bem tolerada e fornece quantidade adequada de \u00e1cidos graxos essenciais. Em rela\u00e7\u00e3o \u00e0 emuls\u00e3o de \u00f3leo de soja, apresenta diversas vantagens que incluem menor impacto na resposta imunol\u00f3gica e melhor perfil metab\u00f3lico, com fornecimento mais r\u00e1pido de energia para todos os tecidos. Por outro lado, pode ser cetog\u00eanica se administrada sozinha, mas sua administra\u00e7\u00e3o concomitante com glicose evita a acelera\u00e7\u00e3o da cetog\u00eanese, sem influenciar sua taxa de depura\u00e7\u00e3o (1).<\/p>\n

O uso de emuls\u00e3o lip\u00eddica TCM\/TCL permanece, portanto, como uma op\u00e7\u00e3o segura e financeiramente mais acess\u00edvel para o tratamento de pacientes sob nutri\u00e7\u00e3o parenteral, especialmente aqueles com comprometimento da resposta imunol\u00f3gica.<\/p>\n

Raquel Susana M. de M. Torrinhas<\/b><\/span><\/p>\n


\nBi\u00f3loga e Doutoranda em Ci\u00eancias da Faculdade de Medicina da Universidade de S\u00e3o Paulo.<\/small><\/p>\n

<\/p>\n

Refer\u00eancias:<\/p>\n

1. Waitzberg DL, Torrinhas RS, Jacintho TM. New parenteral lipid emulsions for clinical use. JPEN J Parent Enteral Nutr. 2006; 30:351\u2013367.<\/p>\n

2. Granato D, Blum S, R\u00f6ssle C, Le Boucher J, Malno\u00eb A, Dutot G. Effects of parenteral lipid emulsions with different fatty acid composition on immune cell functions in vitro. JPEN J Parenter Enteral Nutr. 2000; 24:113-8.<\/p>\n

3. Reimund JM, Scheer O, Muller CD, Pinna G, Duclos B, Baumann R. In vitro modulation of inflammatory cytokine production by three lipid emulsions with different fatty acid compositions. Clin Nutr. 2004; 23:1324-32.<\/p>\n

4. Cury-Boaventura MF, Gorj\u00e3o R, de Lima TM, Fiamoncini J, Torres RP, Mancini-Filho J, Soriano FG, Curi R. Effect of olive oil-based emulsion on human lymphocyte and neutrophil death. JPEN J Parenter Enteral Nutr. 2008; 32:81-7.<\/p>\n

5. Hartman C, Ben-Artzi E, Berkowitz D, Elhasid R, Lajterer N, Postovski S, Hadad S, Shamir R. Olive oil-based intravenous lipid emulsion in pediatric patients undergoing bone marrow transplantation: a short-term prospective controlled trial. Clin Nutr. 2009 Dec;28(6):631-5.<\/p>\n

6. Puiggr\u00f2s C, S\u00e1nchez J, Chac\u00f3n P, Sab\u00edn P, Rosell\u00f3 J, Bou R, Planas M. Evolution of lipid profile, liver function, and pattern of plasma fatty acids according to the type of lipid emulsion administered in parenteral nutrition in the early postoperative period after digestive surgery. JPEN J<\/p>\n

7. Parenter Enteral Nutr. 2009 Sep-Oct;33(5):501-12.<\/p>\n

Waitzberg DL, Torrinhas RS. Fish oil lipid emulsions and immune response: what clinicians need to know. Nutr Clin Pract. 2009; 24:487-99.<\/p>\n

8. Barbosa VM, Miles EA, Calhau C, Lafuente E, Calder PC. Effects of a fish oil containing lipid emulsion on plasma phospholipid fatty acids, inflammatory markers, and clinical outcomes in septic patients: a randomized, controlled clinical trial. Crit Care. 2010; 14:R5.<\/p>\n

9. Friesecke S, Lotze C, K\u00f6hler J, Heinrich A, Felix SB, Abel P. Fish oil supplementation in the parenteral nutrition of critically ill medical patients: a randomised controlled trial. Intensive Care Med. 2008 Aug;34(8):1411-20.<\/p>\n","protected":false},"excerpt":{"rendered":"

Emuls\u00e3o lip\u00eddica parenteral TCM\/TCL (triglic\u00e9rides de cadeia m\u00e9dia\/ triglic\u00e9rides de cadeia longa) encontra-se dispon\u00edvel para uso cl\u00ednico no Brasil na forma de mistura f\u00edsica de triglic\u00e9rides de cadeia m\u00e9dia com \u00f3leo de soja, na propor\u00e7\u00e3o 1:1 (1). Durante algumas d\u00e9cadas, essa emuls\u00e3o representou a principal alternativa para infundir menores quantidades de \u00e1cidos graxos \u00f4mega-6 (potencialmente […]<\/p>\n","protected":false},"author":112416,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"divisao":[2185,2192,3327],"acf":[],"yoast_head":"\nEmuls\u00e3o lip\u00eddica parenteral TCM\/TCL: ainda oferece vantagens na pr\u00e1tica cl\u00ednica? - Nutritotal PRO<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/nutritotal.com.br\/pro\/emulsao-lipidica-parenteral-tcm-tcl-ainda-oferece-vantagens-na-pratica-clinica\/\" \/>\n<meta property=\"og:locale\" content=\"pt_BR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Emuls\u00e3o lip\u00eddica parenteral TCM\/TCL: ainda oferece vantagens na pr\u00e1tica cl\u00ednica? - Nutritotal PRO\" \/>\n<meta property=\"og:description\" content=\"Emuls\u00e3o lip\u00eddica parenteral TCM\/TCL (triglic\u00e9rides de cadeia m\u00e9dia\/ triglic\u00e9rides de cadeia longa) encontra-se dispon\u00edvel para uso cl\u00ednico no Brasil na forma de mistura f\u00edsica de triglic\u00e9rides de cadeia m\u00e9dia com \u00f3leo de soja, na propor\u00e7\u00e3o 1:1 (1). Durante algumas d\u00e9cadas, essa emuls\u00e3o representou a principal alternativa para infundir menores quantidades de \u00e1cidos graxos \u00f4mega-6 (potencialmente […]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/nutritotal.com.br\/pro\/emulsao-lipidica-parenteral-tcm-tcl-ainda-oferece-vantagens-na-pratica-clinica\/\" \/>\n<meta property=\"og:site_name\" content=\"Nutritotal PRO\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/nutritotalPRO\/\" \/>\n<meta property=\"article:published_time\" content=\"2012-05-21T06:00:00+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2023-05-31T17:13:21+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/nutritotal.com.br\/pro\/wp-content\/uploads\/2015\/11\/286-Logo-B.-BraunUltimo_1-03-12pq.jpg\" \/>\n<meta name=\"author\" content=\"nutriletterimportacao\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Escrito por\" \/>\n\t<meta name=\"twitter:data1\" content=\"nutriletterimportacao\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. tempo de leitura\" \/>\n\t<meta name=\"twitter:data2\" content=\"6 minutos\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\/\/nutritotal.com.br\/pro\/emulsao-lipidica-parenteral-tcm-tcl-ainda-oferece-vantagens-na-pratica-clinica\/#article\",\"isPartOf\":{\"@id\":\"https:\/\/nutritotal.com.br\/pro\/emulsao-lipidica-parenteral-tcm-tcl-ainda-oferece-vantagens-na-pratica-clinica\/\"},\"author\":{\"name\":\"nutriletterimportacao\",\"@id\":\"https:\/\/nutritotal.com.br\/pro\/#\/schema\/person\/2d4bd08bf67e2157e88c9e0de685c224\"},\"headline\":\"Emuls\u00e3o lip\u00eddica parenteral TCM\/TCL: ainda oferece vantagens na pr\u00e1tica cl\u00ednica?\",\"datePublished\":\"2012-05-21T06:00:00+00:00\",\"dateModified\":\"2023-05-31T17:13:21+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\/\/nutritotal.com.br\/pro\/emulsao-lipidica-parenteral-tcm-tcl-ainda-oferece-vantagens-na-pratica-clinica\/\"},\"wordCount\":1200,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\/\/nutritotal.com.br\/pro\/#organization\"},\"image\":{\"@id\":\"https:\/\/nutritotal.com.br\/pro\/emulsao-lipidica-parenteral-tcm-tcl-ainda-oferece-vantagens-na-pratica-clinica\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/nutritotal.com.br\/pro\/wp-content\/uploads\/2015\/11\/286-Logo-B.-BraunUltimo_1-03-12pq.jpg\",\"inLanguage\":\"pt-BR\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\/\/nutritotal.com.br\/pro\/emulsao-lipidica-parenteral-tcm-tcl-ainda-oferece-vantagens-na-pratica-clinica\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\/\/nutritotal.com.br\/pro\/emulsao-lipidica-parenteral-tcm-tcl-ainda-oferece-vantagens-na-pratica-clinica\/\",\"url\":\"https:\/\/nutritotal.com.br\/pro\/emulsao-lipidica-parenteral-tcm-tcl-ainda-oferece-vantagens-na-pratica-clinica\/\",\"name\":\"Emuls\u00e3o lip\u00eddica parenteral TCM\/TCL: ainda oferece vantagens na pr\u00e1tica cl\u00ednica? 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