Avaliação da adequação de micronutrientes em pacientes em nutrição enteral exclusiva na UTI
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Apr 29, 2025
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Resumo
Objetivo: Avaliar a adequação de micronutrientes dos pacientes admitidos em Unidade de Terapia Intensiva (UTI) recebendo nutrição enteral exclusiva. Métodos: Foram coletados dados em prontuário eletrônico e banco de dados computadorizado. A adequação da ingestão de micronutrientes foi avaliada através das Dietary Reference Intakes (DRIs). Resultados: Foram incluídos no estudo 179 pacientes internados em UTI recebendo nutrição enteral exclusiva, com mediana de idade de 67 anos (IIQ = 58,00 – 76,00), e 57% do sexo masculino. O motivo de internação mais prevalente foi por doenças do aparelho respiratório (56,4%). Nove micronutrientes apresentavam maior prevalência de valores abaixo da recomendação, como o sódio, cálcio, potássio, cloro, magnésio, ácido fólico, cobre, vitamina A e vitamina D, com 81,6%, 67,6%, 100%, 100%, 85,5%, 97,8%, 50,3%, 44,7%, 54,7%, respectivamente. Conclusão: A administração de nutrição enteral não atendeu às ingestões dietéticas recomendadas para nove micronutrientes e satisfatoriamente não excedeu o limite superior tolerável de ingestão.
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Como Citar
VianaE. C. R. de M., SilvaJ. L., FredericoR. F., Sant’AnaR. G., LoyolaY. C. de S., AngeliD. S., NadaiM. Z. de, GamaL. C., PignatonL. M. P., & Bellettini-SantosT. (2025). Avaliação da adequação de micronutrientes em pacientes em nutrição enteral exclusiva na UTI. Revista Eletrônica Acervo Saúde, 25, e19382. https://doi.org/10.25248/reas.e19382.2025
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Referências
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15. INSTITUTE OF MEDICINE (US) STANDING COMMITTEE ON THE SCIENTIFIC EVALUATION OF DIETARY REFERENCE INTAKES. Dietary reference intakes for calcium, phosphorus, magnesium, vitamin D, and fluoride. Washington (DC): National Academies Press (US), 1997.
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18. KIM H, et al. Why patients in critical care do not receive adequate enteral nutrition?. A review of the literature. J Crit Care, 2012; 27(6): 702-713.
19. KLEIN CJ, et al. Overfeeding macronutrients to critically ill adults: metabolic complications. J Am Diet Assoc, 1998; 98(7): 795-806.
20. KOEKKOEK WAC, et al. Micronutrient deficiencies in critical illness. Clin Nutr, 2021; 40(6): 3780-3786.
21. KRAUSE MV, et al. Alimentos, nutrição e dietoterapia. Rio de Janeiro: Elsevier, 2022; 1164 p.
22. LEE JW. Fluid and electrolyte disturbances in critically ill patients. Electrolyte Blood Press, 2010; 8(2): 72-81.
23. LEW CCH, et al. Association Between Malnutrition and Clinical Outcomes in the Intensive Care Unit: A Systematic Review. JPEN J Parenter Enteral Nutr, 2017; 41(5): 744-758.
24. LIPSKI PS, et al. A study of nutritional deficits of long-stay geriatric patients. Age Ageing, 1993; 22(4): 244-255.
25. MCGOWAN JE, et al. An exploratory study of sodium, potassium, and fluid nutrition status of tube-fed nonambulatory children with severe cerebral palsy. Appl Physiol Nutr Metab, 2012; 37(4): 715-723.
26. MCLEAN RM, WANG NX. Potassium. Adv Food Nutr Res, 2021; 96: 89-121.
27. OSLAND EJ, et al. Micronutrient deficiency risk in long-term enterally fed patients: A systematic review. Clin Nutr ESPEN, 2022; 52: 395-420.
28. PADOVANI RM, et al. Dietary reference intakes: aplicabilidade das tabelas em estudos nutricionais. Rev Nutr, 2006; 19(6): 741-760.
29. REID C. Frequency of under- and overfeeding in mechanically ventilated ICU patients: causes and possible consequences. J Hum Nutr Diet, 2006; 19(1): 13-22.
30. RIBEIRO LM, et al. Adequacy of energy and protein balance of enteral nutrition in intensive care: what are the limiting factors?. Rev Bras Ter Intensiva, 2014; 26(2): 155-162.
31. RITTER CG, et al. Fatores de risco para a inadequação proteico-calórica em pacientes de unidade de terapia intensiva. Rev bras ter intensiva, 2019; 31(4): 504-510.
32. RUBINSON L, et al. Low caloric intake is associated with nosocomial bloodstream infections in patients in the medical intensive care unit. Crit Care Med, 2004; 32(2): 350-357.
33. SHKEMBI B, HUPPERTZ T. Calcium Absorption from Food Products: Food Matrix Effects. Nutrients, 2021; 14(1): 180.
34. TAKO E. Dietary Trace Minerals. Nutrients, 2019; 11(11): 2823.
35. TRUMBO P, et al. Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein and amino acids. J Am Diet Assoc, 2002; 102(11): 1621-1630.
36. VERONESE N, et al. Enteral tube feeding and mortality in hospitalized older patients: A multicenter longitudinal study. Clin Nutr, 2020; 39(5): 1608-1612.
37. VIANA LA, et al. Refeeding syndrome: clinical and nutritional relevance. Arq Bras Cir Dig, 2012; 25(1): 56-59.
38. WAITZBERG DL. Nutrição Oral, Enteral e Parenteral na pratica clínica. v.2. 5ª ed. São Paulo: Atheneu, 2017; 3296 p.
39. WEIJS PJ, et al. Early high protein intake is associated with low mortality and energy overfeeding with high mortality in non-septic mechanically ventilated critically ill patients. Crit Care, 2014; 18(6): 701.
40. WISCHMEYER PE. Overcoming challenges to enteral nutrition delivery in critical care. Curr Opin Crit Care, 2021; 27(2): 169-176.
2. AMAYA-FARFAN J, et al. DRI: síntese comentada das novas propostas sobre recomendações nutricionais para antioxidantes. Revista De Nutrição, 2001; 14(1), 71-78.
3. AMREIN K, et al. Vitamin D and critical illness: what endocrinology can learn from intensive care and vice versa. Endocr Connect, 2018; 7(12): R304-R315.
4. AN Y, et al. The Role of Copper Homeostasis in Brain Disease. Int J Mol Sci, 2022; 23(22): 13850.
5. BEREND K, et al. Chloride: the queen of electrolytes?. Eur J Intern Med, 2012; 23(3): 203-211.
6. BERGER MM, et al. ESPEN micronutrient guideline. Clin Nutr, 2022; 41(6): 1357-1424.
7. BREIK L, et al. Micronutrient intake from enteral nutrition in critically ill adult patients: A retrospective observational study. Nutrition, 2022; 95: 111543.
8. CASTRO MG, et al. Diretriz BRASPEN de Terapia Nutricional no Paciente Grave. BRASPEN Journal, 2023; 38(2, Supl 2): 0-0.
9. CHA JK, et al. Effect of Early Nutritional Support on Clinical Outcomes of Critically Ill Patients with Sepsis and Septic Shock: A Single-Center Retrospective Study. Nutrients, 2022; 14(11): 2318.
10. COZZOLINO SM. Biodisponibilidade de nutrientes. Barueri: Manole, 2020; 910 p.
11. DA SILVA JSV, et al. ASPEN Consensus Recommendations for Refeeding Syndrome. Nutr Clin Pract, 2020; 35(2): 178-195.
12. FAISY C, et al. Impact of energy deficit calculated by a predictive method on outcome in medical patients requiring prolonged acute mechanical ventilation. British Journal of Nutrition, 2008; 101(7): 1079-1087.
13. GREEN CL, LAMMING DW. Regulation of metabolic health by essential dietary amino acids. Mech Ageing Dev, 2019; 177: 186-200.
14. IACONE R, et al. Micronutrient content in enteral nutrition formulas: comparison with the dietary reference values for healthy populations. Nutr J, 2016; 15: 30.
15. INSTITUTE OF MEDICINE (US) STANDING COMMITTEE ON THE SCIENTIFIC EVALUATION OF DIETARY REFERENCE INTAKES. Dietary reference intakes for calcium, phosphorus, magnesium, vitamin D, and fluoride. Washington (DC): National Academies Press (US), 1997.
16. KASTI AN, et al. Factors Associated with Interruptions of Enteral Nutrition and the Impact on Macro- and Micronutrient Deficits in ICU Patients. Nutrients, 2023; 15(4): 917.
17. KIM H, et al. Enteral nutritional intake in adult korean intensive care patients. Am J Crit Care, 2013; 22(2): 126-135.
18. KIM H, et al. Why patients in critical care do not receive adequate enteral nutrition?. A review of the literature. J Crit Care, 2012; 27(6): 702-713.
19. KLEIN CJ, et al. Overfeeding macronutrients to critically ill adults: metabolic complications. J Am Diet Assoc, 1998; 98(7): 795-806.
20. KOEKKOEK WAC, et al. Micronutrient deficiencies in critical illness. Clin Nutr, 2021; 40(6): 3780-3786.
21. KRAUSE MV, et al. Alimentos, nutrição e dietoterapia. Rio de Janeiro: Elsevier, 2022; 1164 p.
22. LEE JW. Fluid and electrolyte disturbances in critically ill patients. Electrolyte Blood Press, 2010; 8(2): 72-81.
23. LEW CCH, et al. Association Between Malnutrition and Clinical Outcomes in the Intensive Care Unit: A Systematic Review. JPEN J Parenter Enteral Nutr, 2017; 41(5): 744-758.
24. LIPSKI PS, et al. A study of nutritional deficits of long-stay geriatric patients. Age Ageing, 1993; 22(4): 244-255.
25. MCGOWAN JE, et al. An exploratory study of sodium, potassium, and fluid nutrition status of tube-fed nonambulatory children with severe cerebral palsy. Appl Physiol Nutr Metab, 2012; 37(4): 715-723.
26. MCLEAN RM, WANG NX. Potassium. Adv Food Nutr Res, 2021; 96: 89-121.
27. OSLAND EJ, et al. Micronutrient deficiency risk in long-term enterally fed patients: A systematic review. Clin Nutr ESPEN, 2022; 52: 395-420.
28. PADOVANI RM, et al. Dietary reference intakes: aplicabilidade das tabelas em estudos nutricionais. Rev Nutr, 2006; 19(6): 741-760.
29. REID C. Frequency of under- and overfeeding in mechanically ventilated ICU patients: causes and possible consequences. J Hum Nutr Diet, 2006; 19(1): 13-22.
30. RIBEIRO LM, et al. Adequacy of energy and protein balance of enteral nutrition in intensive care: what are the limiting factors?. Rev Bras Ter Intensiva, 2014; 26(2): 155-162.
31. RITTER CG, et al. Fatores de risco para a inadequação proteico-calórica em pacientes de unidade de terapia intensiva. Rev bras ter intensiva, 2019; 31(4): 504-510.
32. RUBINSON L, et al. Low caloric intake is associated with nosocomial bloodstream infections in patients in the medical intensive care unit. Crit Care Med, 2004; 32(2): 350-357.
33. SHKEMBI B, HUPPERTZ T. Calcium Absorption from Food Products: Food Matrix Effects. Nutrients, 2021; 14(1): 180.
34. TAKO E. Dietary Trace Minerals. Nutrients, 2019; 11(11): 2823.
35. TRUMBO P, et al. Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein and amino acids. J Am Diet Assoc, 2002; 102(11): 1621-1630.
36. VERONESE N, et al. Enteral tube feeding and mortality in hospitalized older patients: A multicenter longitudinal study. Clin Nutr, 2020; 39(5): 1608-1612.
37. VIANA LA, et al. Refeeding syndrome: clinical and nutritional relevance. Arq Bras Cir Dig, 2012; 25(1): 56-59.
38. WAITZBERG DL. Nutrição Oral, Enteral e Parenteral na pratica clínica. v.2. 5ª ed. São Paulo: Atheneu, 2017; 3296 p.
39. WEIJS PJ, et al. Early high protein intake is associated with low mortality and energy overfeeding with high mortality in non-septic mechanically ventilated critically ill patients. Crit Care, 2014; 18(6): 701.
40. WISCHMEYER PE. Overcoming challenges to enteral nutrition delivery in critical care. Curr Opin Crit Care, 2021; 27(2): 169-176.