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Abstract(s)
Este estudo teve por objetivo principal determinar a evolução do gasto energético em repouso (GER) e do quociente respiratório (QR) numa amostra de 15 recém-nascidos de termo e pré-termo submetidos a cirurgia corretiva de malformações congénitas do trato gastrointestinal. Teve como objetivo secundário determinar fatores associados à evolução do GER e QR, incluindo sexo, idade gestacional, peso ao nascer, adiposidade e suprimento nutricional (energia e macronutrientes). O GER e o QR foram medidos por calorimetria indireta (Deltatrac® II Metabolic Monitor, Datex-Ohmeda) e a composição corporal por pletismografia de deslocação de ar (Pea Pod®, Life Measurement, Inc.) e a adiposidade definida pela percentagem de massa gorda (%MG). O suprimento nutricional (energia e macronutrientes) foi registado diariamente. Durante o período de estudo, a evolução ponderal manteve-se positiva em todos os casos, mas os valores de adiposidade foram inferiores aos mínimos de referência em 87,5% dos casos. O aporte energético foi consideravelmente inferior e o suprimento proteico superior ao recomendado. Na maioria dos casos, os valores de GER foram superiores aos de referência, embora tivessem diminuído à medida que a idade avançou e se distanciou do período da cirurgia. O GER elevado poderá estar relacionado não só com a reparação tecidular pós-cirúrgica, mas também com a recuperação do crescimento e elevado metabolismo dos órgãos vitais. Os valores de QR situaram-se maioritariamente entre os 0,70 e 0,90, o que sugere a oxidação preferencial de lípidos e proteínas. O QR baixo, associado ao baixo aporte energético e elevado aporte proteico registados, sugerem a necessidade de se ter que aumentar o aporte energético não-proteico (glícidos e lípidos) para promover a oxidação preferencial de glícidos, propiciando assim a lipogénese com reposição da reserva adiposa e poupando proteína para deposição tecidular. Apenas em três casos foi possível a medição longitudinal da adiposidade e, nestes, não se encontrou uma associação significativa com o GER e o QR. No entanto, verificou-se um aumento gradual da adiposidade associado ao aumento do QR, que atingiu valores relativamente elevados (≥1), o que nesta circunstância pode justificar a recuperação da reserva gorda pela oxidação preferencial dos glícidos, poupando os lípidos para deposição no tecido adiposo.
ABSTRACT - This primary objective of this study was to determine the evolution of resting energy expenditure (REE) and respiratory quotient (RQ) in 15 term and preterm newborn infants undergoing corrective surgery of congenital malformations of the gastrointestinal tract. The secondary objective was to determine factors associated with the evolution of REE and RQ, including sex, gestational age, birth weight, adiposity, and nutritional supply (energy and macronutrients). The REE and RQ were measured using indirect calorimetry (Deltatrac® II Metabolic Monitor, Datex-Ohmeda). Body composition was measured using the air displacement plethysmography (Pea Pod®, Life Measurement, Inc.) method, and adiposity was defined by the percentage of fat mass. Daily nutritional intake was recorded. During the study period, a steady weight gain was observed in all cases, but the adiposity values were lower than the minimum reference in 87.5% of cases. Energy intake was considerably lower than recommended and protein intake was higher than recommended. In the majority of cases, REE values were higher than the reference, although the values tended to decrease as the age advanced and distanced from the early surgical period. The high REE values may have been related not only to post-surgical tissue repair but also to catch-up growth and high metabolism of vital organs. The RQ values were mostly between 0.70 and 0.90, suggesting preferential oxidation of fat and proteins. The low QR values associated with measured low energy intake and high protein intake suggest the need to increase non-protein (carbohydrates and fat) energy intake, to promote preferential oxidation of carbohydrates, saving both lipids for lipogenesis and replenishment of fat reserve and protein for tissue accretion. Longitudinal measurements of adiposity were possible only in three cases and, in these, a significant association with REE and RQ was not found. However, there was a gradual increase in adiposity associated with an increase of the RQ, reaching relatively high values (≥1) that may justify the catch-up of the fat reserve due to preferential oxidation of the carbohydrates, saving fat for adipose tissue accretion.
ABSTRACT - This primary objective of this study was to determine the evolution of resting energy expenditure (REE) and respiratory quotient (RQ) in 15 term and preterm newborn infants undergoing corrective surgery of congenital malformations of the gastrointestinal tract. The secondary objective was to determine factors associated with the evolution of REE and RQ, including sex, gestational age, birth weight, adiposity, and nutritional supply (energy and macronutrients). The REE and RQ were measured using indirect calorimetry (Deltatrac® II Metabolic Monitor, Datex-Ohmeda). Body composition was measured using the air displacement plethysmography (Pea Pod®, Life Measurement, Inc.) method, and adiposity was defined by the percentage of fat mass. Daily nutritional intake was recorded. During the study period, a steady weight gain was observed in all cases, but the adiposity values were lower than the minimum reference in 87.5% of cases. Energy intake was considerably lower than recommended and protein intake was higher than recommended. In the majority of cases, REE values were higher than the reference, although the values tended to decrease as the age advanced and distanced from the early surgical period. The high REE values may have been related not only to post-surgical tissue repair but also to catch-up growth and high metabolism of vital organs. The RQ values were mostly between 0.70 and 0.90, suggesting preferential oxidation of fat and proteins. The low QR values associated with measured low energy intake and high protein intake suggest the need to increase non-protein (carbohydrates and fat) energy intake, to promote preferential oxidation of carbohydrates, saving both lipids for lipogenesis and replenishment of fat reserve and protein for tissue accretion. Longitudinal measurements of adiposity were possible only in three cases and, in these, a significant association with REE and RQ was not found. However, there was a gradual increase in adiposity associated with an increase of the RQ, reaching relatively high values (≥1) that may justify the catch-up of the fat reserve due to preferential oxidation of the carbohydrates, saving fat for adipose tissue accretion.
Description
Mestrado em Nutrição Clínica
Keywords
Nutrição clínica Cirurgia neonatal Composição corporal Gasto energético em repouso Quociente respiratório Suporte nutricional Recém-nascido Clinical nutrition Neonatal surgery Body composition Resting energy expenditure Respiratory quotient Newborn
Citation
Barradas SI. Evolução do gasto energético em repouso e do quociente respiratório em recém-nascidos submetidos a cirurgia corretiva de malformações congénitas do trato gastrointestinal [dissertation]. Lisboa: Escola Superior de Tecnologia da Saúde de Lisboa/Faculdade de Medicina da Universidade de Lisboa; 2018.
Publisher
Instituto Politécnico de Lisboa, Escola Superior de Tecnologia da Saúde de Lisboa