Impacto da flexibilização de jejum na quantificação do perfil lipídico
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Tipo
TCC
Data de publicação
2018-12
Periódico
Citações (Scopus)
Autores
Braga, Thiago Albini
Orientador
Barrinha, Fernanda Fernandes
Título da Revista
ISSN da Revista
Título de Volume
Membros da banca
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Resumo
Nos últimos anos notou-se a necessidade de reavaliar a importância de jejum de 8-12 horas para exame de perfil lipídico. O presente trabalho realizou uma revisão da literatura para verificar a necessidade de jejum para análise do perfil lipídico, bem como, o impacto desta flexibilização aos indivíduos. Verificou-se que a não realização do jejum já vem sendo praticada em diversos países incluindo o Brasil. Porém, para que essa alteração seja realizada foram necessárias modificações nos métodos de quantificação do LDL, sendo necessária a utilização da fórmula de Martin, ao invés da equação de Friedewald usada apenas quando se realiza o jejum. Vale ressaltar que, quando os níveis de triglicérides forem superiores a 440 mg/dL e em casos específicos pré-determinados pelo médico, pode ser solicitada uma nova coleta ou a realização do exame em jejum. Em relação aos laudos houve simplificação dos intervalos de referência para colesterol total, HDL-C e TG, já que agora apresentam apenas a faixa “desejável”. Uma substancial mudança encontra-se nos intervalos de referência para as frações LDL-C e colesterol não-HDL, uma vez que, essas frações não vão mais exibir valores de referência para a população saudável. Seus valores representam alvo terapêutico a ser atingido com o tratamento hipolipemiante, levando em consideração a estimativa do risco cardiovascular calculado para cada paciente. Além dessas mudanças pode-se considerar que o estado pós-prandial indica de forma mais precisa as condições fisiológicas pelas quais o indivíduo está exposto no dia a dia ao contrário do jejum. Além disso, há comodidade em realizar o exame após uma consulta médica além de diminuir a chance de ocorrer hipoglicemia em pacientes diabéticos. Os estudos envolvendo testes clínicos demonstraram que o perfil lipídico em pacientes no estado pós-prandial mostrou valores mais precisos para a predição de riscos cardíacos. Desta forma deve ser realizada uma avaliação individual pelo médico e só assim em casos específicos realizar o exame com jejum.
In recent years, it has been noted the necessity to reevaluate the importance of fasting for 8-12 hours to undergo the examination of lipidic profile. The present paper carried out a review of the literature to verify the need for fasting in order to analyze the lipid profile, as well as the impact of this flexibilization on the individuals. It was verified that non-fasting is been practiced in several countries, including Brazil. However, in order to make this alteration, modifications were necessary in the methods of quantification of LDL, requiring the use of the Martin formula, instead of the Friedewald equation, used only when fasting. A point worth mentioning is that when triglyceride levels are higher than 440 mg / dL and in specific pre-determined cases by the physician, a new sample of blood or fasting test may be required. Regarding the medical reports, there was a simplification of the reference intervals for total cholesterol, HDL-C and TG, since they now only display the "desirable" range. A substantial change is found in the reference ranges for the LDL-C and non-HDL cholesterol fractions, since these fractions will no longer display reference values for the healthy population. Its values represent a therapeutic target to be reached with lipid-lowering treatment, taking into account the estimated cardiovascular risk calculated for each patient. In addition to these changes, it can be considered that the postprandial state indicates more precisely the physiological conditions through which the individual is exposed in a daily basis as opposed to the fast. Also, there is convenience in conducting the examination after a medical consultation, further decreasing the chance of hypoglycemia occurring in diabetic patients. Studies involving clinical trials have demonstrated that the lipidic profile in patients in the postprandial state have resulted in more accurate values for the prediction of cardiac risks. In this way, an individual evaluation by the doctor must be carried out and only in specific cases should the examination with fasting be performed.
In recent years, it has been noted the necessity to reevaluate the importance of fasting for 8-12 hours to undergo the examination of lipidic profile. The present paper carried out a review of the literature to verify the need for fasting in order to analyze the lipid profile, as well as the impact of this flexibilization on the individuals. It was verified that non-fasting is been practiced in several countries, including Brazil. However, in order to make this alteration, modifications were necessary in the methods of quantification of LDL, requiring the use of the Martin formula, instead of the Friedewald equation, used only when fasting. A point worth mentioning is that when triglyceride levels are higher than 440 mg / dL and in specific pre-determined cases by the physician, a new sample of blood or fasting test may be required. Regarding the medical reports, there was a simplification of the reference intervals for total cholesterol, HDL-C and TG, since they now only display the "desirable" range. A substantial change is found in the reference ranges for the LDL-C and non-HDL cholesterol fractions, since these fractions will no longer display reference values for the healthy population. Its values represent a therapeutic target to be reached with lipid-lowering treatment, taking into account the estimated cardiovascular risk calculated for each patient. In addition to these changes, it can be considered that the postprandial state indicates more precisely the physiological conditions through which the individual is exposed in a daily basis as opposed to the fast. Also, there is convenience in conducting the examination after a medical consultation, further decreasing the chance of hypoglycemia occurring in diabetic patients. Studies involving clinical trials have demonstrated that the lipidic profile in patients in the postprandial state have resulted in more accurate values for the prediction of cardiac risks. In this way, an individual evaluation by the doctor must be carried out and only in specific cases should the examination with fasting be performed.
Descrição
Palavras-chave
jejum , perfil lipídico , dislipidemia , escore de risco , flexibilização , fasting , lipid profile , dyslipidemia , risk score , flexibilization