Uso Potencial de AGCC

La mayoría de las fórmulas entera les poseen polisacáridos digeribles pero escasa o ninguna cantidad de fibra. Se ha demostrado que las dietas enterales libres de fibra inducen a la atrofia del colon y del intestino delgado distal (79, 83) Y la nutrición parenteral total (NPT) induce a la atrofia en todo el tracto intestinal.

En pacientes con tracto gastrointestinal funcionante y quienes reciben una fórmula definida como dieta, la adición de fibra altamente fermentable, como por ejemplo pectina, previene la atrofia del colon y del intestino delgado distal o hace reversible la atrofia asociada a la dieta sin fibra (68, 80, 82). La diarrea ocurre en un 60% de los pacientes que reciben régimen enteral con fibra (88, 89). Se ha demostrado que al agregar pectina a los regímenes enterales libres de ella se previenen las deposiciones líquidas resultantes de la exclusiva ingestión de fibra por sujetos normales; mejora la función colónica medida por pH y electrolitos (Na y K) (90).

El proceso de fermentación de la fibra en el colon y la liberación de AGCC y su absorción, representan un potencial significativo de una fuente calórica alternativa que puede representar un 30% omás del aporte calórico (32, 91). En pacientes con intestino disminuido en su capacidad de absorción pero con un colon normal, sometidos a dietas enterales, el seguimiento calórico puede lograrse administrando fibra.

Enfermedad Intestinal

El reposo intestinal absoluto o relativo como modalidad terapéutica, indicado en pacientes con enfermedad Intestinal o en posoperatorio o en casos de resecciones intestinales, priva a la mucosa intestinal de sus sustratos preferidos y condiciona la atrofia intestinal. En varios modelos animales la adición de pectina a dietas entera les libres de fibra, ha facilitado la cicatrización y la resistencia a la tensión de anastomosis colónica (92), efectos favorables en colitis inducidas químicamente (93) y en readaptación intestinal luego de resecciones masivas (94) y síndromes de intestino corto (95).

Otra ventaja adicional es el mantenimiento de la microflora normal (96) la cual protege de colonización por bacterias patógenas (97) y la tras locación bacteriana desde el tracto gastrointestinal (98)

La provisión de nutrientes enterales no siempre es posible, aunque los nutrientes intraluminales sean más tróficos para la mucosa intestinal (84, 89, 101). El suministro de lossustratos oxidativos preferidos por la mucosa intestinal (AGCC, cuerpos cetónicos o glutamina) en soluciones deNPT, ha demostrado que puede inhibir la atrofia de la mucosa intestinal asociada a la administración de la NPT en animales.

En perspectiva, los AGCC, y sus precursores (fibra fermentable o almidones resistentes) y sus metabolitos (cuerposcetónicos), pueden ser utilizados en casi todas las situaciones en las cuales han sido propuestos los ácidos grasos de cadena media (104). Una ventaja potencial de usar AGCC y cuerpos cetónicos, es que éstos son solubles en agua y pueden administrarse como ácidos libres o como sales en los límites fisiológicos de carga de ácidos y sales.

Cuerpos Cetónicos

Igual que los AGCM, los AGCC y los cuerpos cetónicos pueden suministrarse a animales como monoglicéridos solubles en agua (105); administrados en esta forma, no han ocasionado efectos adversos (monoacetato y monobutirin), aportando hasta el 70% de las calorías no proteicas (78, 106, 108); también pueden darse como triglicéridos. Unicamente el triacetín (glicerol triacetato) es un triglicérido soluble en agua (109); su infusión intravenosa no ha tenido efectos adversos aparentes sobre el metabolismo del Ca o del fosfato ni toxicidad demostrable (110, 111).

En síntesis, la extensa revisión bibliográfica del tema, en la cual debemos destacar las publicaciones de Rombeau (112), Settle (113) y Campos (114), nos abre un nuevo panorama en las posibles indicaciones de los AGCC en situaciones clínicas, como complemento o alternartiva de apoyo nutricional.

Posteriores estudios clínicos evaluarán el tiempo recomendado de administración, su uso en NPT y en circunstancias clínicas complejas tales como insuficiencia hepática, renal, cardíaca, respiratoria, diabetes y sepsis.

Lea También: Ácidos Grasos Omega-6 pueden ser Buenos

Abstract – Uso Potencial de AGCC 

Long chain fatty acids are isotonic, providing high calorie content (9 kcal/gram). They prevent essential fatty acid deficiency and may be administered peripheraliy together with aminoacids and glucose. Among their unfavorable metabolic effects it should be pointed out that they needcarnitine for their oxidation and that they metabolize slowly in stress situationso AIso, blockade of the reticuloendothelial system has been reported in in vitro models and doses in excess of 3 g have been associated with liver steatosis and reduced capacity of lung diffusion in healthy men. 

Medium chain fatty acids do not require carnitine for their oxidation and they penetra te promptly in the mitochondria, but they do not prevent essential fatty acid deficiency. 

Short chain fatty acids are metabolized in the cecum with production of acetic acid, propionic acid and butyric acido The latter is the main substrate of the colonocyte. In addition, short chain fatty acids stimulate sodium and water absorption by the colon, exert a trophic action in the bowel and promote healing. They are water-soluble and they may be administered as free acids or as salts. Additionally, they could be given as complementary calorie input. Further studies are needed to demonstrate their potential clinical uses.

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