a importância do ácido fólico na redução dos defei
Transcrição
a importância do ácido fólico na redução dos defei
A IMPORTÂNCIA DO ÁCIDO FÓLICO NA REDUÇÃO DOS DEFEITOS DO TUBO NEURAL DURANTE A GESTAÇÃO 2/,9(,5$Adriana Cristina1 )DFXOGDGH0XQLFLSDO³3URI)UDQFR0RQWRUR´)03)0 GULFFE#KRWPDLOFRP 5(**,2//,Márcia Regina )DFXOGDGH0XQLFLSDO³3URI)UDQFR0RQWRUR´)03)0 PUUHJJLROOL#WHUUDFRPEU 5,%(,52, Karina Rosa )DFXOGDGH0XQLFLSDO³3URI)UDQFR0RQWRUR´)03)0 .DULQDURVD#JPDLOFRP RESUMO: Introdução:$GH¿FLrQFLDGHiFLGRIyOLFRpRSULQFLSDOIDWRUGHULVFRUHODFLRQDGRDRVGHIHLWRV GRWXERQHXUDO$IRUWL¿FDomRGHDOLPHQWRVFRPiFLGRIyOLFRpXPDLQWHUYHQomRLQGLVSHQViYHOQDSUH YHQomRGHVWDDOWHUDomRQRIHWRObjetivo:5HDOL]DUXPDUHYLVmRELEOLRJUi¿FDGHVWDFDQGRRHIHLWRGHDOL PHQWRVIRUWL¿FDGRVFRPiFLGRIyOLFRHGDVXSOHPHQWDomRGHIRODWRQDSUHYDOrQFLDGRVGHIHLWRVGRWXER neural. Metodologia:/HYDQWDPHQWRELEOLRJUi¿FRGHDUWLJRVUHODFLRQDGRVjVQHFHVVLGDGHVHVSHFt¿FDV de nutrientes durante a gestação. 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ABSTRACT: Introduction:7KHGH¿FLHQF\RIIROLFDFLGLVWKHPDLQIDFWRURIULVNUHODWHGWRWKHGHIHFWVLQ WKHQHXUDOWXEH7KHHQULFKPHQWRIIRRGZLWKIROLFDFLGLVDQLQGLVSHQVDEOHLQWHUIHUHQFHIRUWKHSUHYHQWLRQ RIWKLVIHWDODOWHUDWLRQObjective:0DNHDELEOLRJUDSKLFDOUHYLVLRQKLJKOLJKWLQJWKHHIIHFWRIHQULFKHGIRRG ZLWKIROLFDFLGDQGWKHVXSSOHPHQWRIIRODWHLQWKHSUHGRPLQDQFHRIGHIHFWVRIFORVXUHLQWKHQHXUDOWXEH Methodology:%LEOLRJUDSKLFDOVXUYH\RIDUWLFOHVUHODWHGWRWKHVSHFL¿FQHHGVRIQRXULVKLQJGXULQJWKH SUHJQDQF\ Considerations: 7KH XVH RI RUDO VXSSOHPHQWDWLRQV RI IRODWH SHULFRQFHSWLRQDO DQG GXULQJ WKH¿UVWWKUHHPRQWKVRISUHJQDQF\GLPLQLVKHVWKHULVNRIRFFXUUHQFHRIWKHGHIHFWVLQWKHQHXUDOWXEHLQ DERXWWRZKLOHWKHHQULFKHGIRRGVKRZVDYDULDEOHSURWHFWRUHIIHFWRIVLJQL¿FDQFHLQWKHSUHYDOHQFHRIGHIHFWVLQWKHQHXUDOWXEHYDU\LQJIURPWR KEYWORDS:(QULFKHGIRRG6XSSOHPHQWDWLRQRI)RODWHLQWKH*HVWDWLRQ'HIHFWVLQWKH1HXUDO7XEH. 1. INTRODUÇÃO $ JUDYLGH] SURYRFD PXGDQoDV ¿ VLROyJLFDV QR RUJDQLVPR TXH FDXVDP D necessidade aumentada de nutrientes es VHQFLDLV 2 DSRUWH HQHUJpWLFR LQDGHTXDGR GD JHVWDQWH VHMD HP WHUPRV GH PDFUR RX PLFURQXWULHQWHVSRGHLQGX]LUDXPDFRQFRU rência nutricional entre a mãe e o feto, limi WDQGRDGLVSRQLELOLGDGHHQHUJpWLFDQHFHVVi ULDDRDGHTXDGRFUHVFLPHQWRIHWDO0(//2 HWDO 2HVWDGRQXWULFLRQDOPDWHUQRpLQ 9 GLFDGRUGHVD~GHHTXDOLGDGHGHYLGDWDQWR SDUDDPXOKHUTXDQWRSDUDRFUHVFLPHQWRGR VHX ¿OKR 2 SHVR GR EHEr DR QDVFLPHQWR pXPLPSRUWDQWHLQGLFDGRUGRHVWDGRQXWUL FLRQDOGDPmHGXUDQWHDJHVWDomRXPDYH] TXHD~QLFDIRQWHGHQXWULHQWHVGRFRQFHS WRpFRPSRVWDSHODVUHVHUYDVQXWULFLRQDLVH LQJHVWmR DOLPHQWDU PDWHUQD 0(/2 HW DO $ GLHWD QR SULPHLUR WULPHVWUH GD JHVWDomR p PXLWR LPSRUWDQWH SDUD R GH VHQYROYLPHQWRHGLIHUHQFLDomRGRVGLYHUVRV yUJmRVIHWDLV-iQRVWULPHVWUHVVXEVHTXHQ Interciência & Sociedade ,QWHUFLrQFLD6RFLHGDGH,6619RO1 WHVDGLHWDHVWiPDLVHQYROYLGDFRPDRWLPL ]DomRGRFUHVFLPHQWRHGRGHVHQYROYLPHQ WRFHUHEUDOGRIHWR5,)$66&+,0$1HWDO O sucesso de uma gestação sem FRPSOLFDo}HVHVWiUHODFLRQDGRDXPDGLHWD balanceada e equilibrada, contendo todos RV QXWULHQWHV QHFHVViULRV HQHUJLD SURWHt QDVFDUERLGUDWRVOLStGHRVYLWDPLQDV$' ( & SLULGR[LQD FREDODPLQD WLDPLQD ULER ÀDYLQDQLDFLQDFiOFLRIyVIRUR]LQFRIHUUR iFLGRIyOLFRSDUDDVD~GHGDPXOKHUGXUDQ WHDJUDYLGH]DVD~GHGRFRQFHSWRREHP HVWDUPDWHUQRSRVVLELOLWDQGRDQXWULomRGR UHFpPQDVFLGRHSURWHomRFRQWUDRGHVHQ YROYLPHQWR GH PiV IRUPDo}HV FRQJrQLWDV H GRHQoDV FU{QLFDV GXUDQWH D YLGD DGXOWD /8&<.H)8580272 $V JHVWDQWHV HVWmR SUHGLVSRVWDV HVSHFLDOPHQWHDGHVHQYROYHUGH¿FLrQFLDGH iFLGRIyOLFRGHYLGRDRDXPHQWRGDQHFHV VLGDGHGHVVHQXWULHQWHSDUDRFUHVFLPHQWR IHWDOHWHFLGRVPDWHUQRVRTXHSRGHGHVHQ FDGHDU PRGL¿FDo}HV QD VtQWHVH GH '1$ H DOWHUDo}HV FURPRVV{PLFDV 0(==202 HW DO 8PD GLHWD QRUPDO QmR p FDSD] GHVXSULUDVQHFHVVLGDGHVGHiFLGRIyOLFRGD JHVWDQWH H GR IHWR GXUDQWH R SHUtRGR JHV WDFLRQDO GHYLGR DR DXPHQWR GD GHPDQGD GHVVDYLWDPLQDVHQGRQHFHVViULRRXVRGH VXSOHPHQWDomR GH IRODWR 6$1726 H 3( 5(,5$ 2REMHWLYRGHVWHHVWXGRIRLUHDOL]DU XPDUHYLVmRELEOLRJUi¿FDGHVWDFDQGRRHIHL WRGHDOLPHQWRVIRUWL¿FDGRVFRPiFLGRIyOLFR H VXSOHPHQWDomR GH IRODWR QD SUHYDOrQFLD de defeitos de fechamento do tubo neural. 2. METODOLOGIA 8PD H[WHQVD UHYLVmR GH OLWHUDWXUD SHUPLWLX DQDOLVDU RV HVWXGRV FLHQWt¿FRV UH ODFLRQDGRVDRVREMHWLYRVGHVWHWUDEDOKRGH PDQHLUDVLVWHPiWLFDHDPSOD 2 OHYDQWDPHQWR GD SHVTXLVD IRL UHDOL]DGR DWUDYpV GD ELEOLRWHFD YLUWXDO HP VD~GHDWUDYpVGRVEDQFRVGHGDGRVFRPR 6FLHOR6FLHQWL¿F(OHFWURQLF/LEUDU\2QOLQH %'(1)%DVHGH'DGRV%LEOLRJUi¿FRV(VSHFLDOL]DGRV QD ÈUHD GH (QIHUPDJHP QR %UDVLO%9606%LEOLRWHFD9LUWXDOHP6D~GH0LQLVWpULRGD6D~GHDPERVGDiUHDGD VD~GHUHODFLRQDGRVjVQHFHVVLGDGHVHVSH 10 Ft¿FDV GH QXWULHQWHV GXUDQWH D JHVWDomR Essas bases de dados foram selecionadas GHYLGR jV PHVPDV SRVVXtUHP SXEOLFDo}HV de ordem nacional e internacional. A escolha dos artigos foi obtida DWUDYpV GH SDODYUDV FKDYHV FRPR ³6XSOH mentação de Folato na gestação, Alimentos IRUWL¿FDGRVH'HIHLWRGR7XER1HXUDO´ )RUDPDQDOLVDGDVSDUDDSHVTXLVD ELEOLRJUi¿FDYLQWHHXPDSXEOLFDo}HVFLHQ Wt¿FDV VHQGR GH]HVVHLV QDFLRQDLV H FLQFR internacionais. 3. DEFEITOS DO FECHAMENTO DO TUBO NEURAL (DFTN) 2WXERQHXUDOpXPDHVWUXWXUDSUH FXUVRUDGRFpUHEURHGDPHGXODHVSLQKDOGR IHWR2IHFKDPHQWRGRWXERQHXUDOSULPyU GLR GR VLVWHPD QHUYRVR FHQWUDO RFRUUH HP TXDWURRXFLQFRORFDLVHPP~OWLSORVSRQWRV VLPXOWkQHRVHGHIRUPDELGLUHFLRQDOQDVSUL PHLUDVTXDWURVHPDQDVDSyVDFRQFHSomR 4XDQGRHVVHWXERQmRFRQVHJXHFRPSOHWDU DQHXUXODomRRXHQYROWyULRVRFRUUHRGHIHL to de fechamento, sendo uma malformação RFRUULGDQDIDVHLQLFLDOGRGHVHQYROYLPHQWR IHWDOTXHWHPDVXDPRUIRORJLDGHSHQGHQWH GRWLSRGHIDOKDHGRORFDODIHWDGRRULJLQDQ do doenças que causam morte ou seqüelas JUDYHVQRVUHFpPQDVFLGRV$*8,$5HWDO $ LQFLGrQFLD GRV ')71 p HP Pp GLDGHQDVFLGRVYLYRV'HVWDFDQGR DLQGD TXH GDV PXOKHUHV FRP ¿OKRV DIHWDGRV SRU ')71 QmR DSUHVHQWDP DQWH FHGHQWHVSHVVRDLVRXIDPLOLDUHV&21&(, d2 $V JHVWDo}HV FRP FRPSOLFDo}HV como defeito de fechamento de tubo neural, UHVXOWDPHPDERUWRVHTXDQGRQDVFLGRVYL YRVPRUUHPSRXFDVKRUDVRXSRXFRVGLDV DSyV R SDUWR RX DLQGD UHVXOWDP HP OHVmR QHUYRVD SHUPDQHQWH FDXVDQGR SDUDOLVLDV HPQtYHLVGLYHUVRVGRVPHPEURVLQIHULRUHV EH[LJDLQWHVWLQRFRPSURPHWLPHQWRItVLFRH GL¿FXOGDGH GH DSUHQGL]DJHP 0(==202 HWDO 'HDFRUGRFRP0HORH5LR PXOKHUHV FXMRV IHWRV RX UHFpPQDVFLGRV DSUHVHQWDP GHIHLWRV GR WXER QHXUDO SUHFL VDP VHU QRUWHDGDV TXDQWR j SRVVLELOLGDGH GR ULVFR GH UHFRUUrQFLD QDV SUy[LPDV JHV Interciência & Sociedade ,QWHUFLrQFLD6RFLHGDGH,6619RO1 WDo}HV VHQGR QHFHVViULR PDQWHU D VXSOH PHQWDomR FRQWtQXD GH IRODWR GLDULDPHQWH QRSHUtRGRSHULFRQFHSFLRQDODWpDVH mana da gestação. As causas dos defeitos do tubo QHXUDOQmRVmRFRPSOHWDPHQWHFRQKHFLGDV PDVDVHYLGrQFLDVLQGLFDPTXHSHORPHQRV HPSDUWHVHGHYHPDREHVLGDGHPDWHUQDD SUREOHPDV QXWULFLRQDLV D DJHQWHV DPELHQ WDLVDFDXVDVJHQpWLFDVDRXVRGHGURJDV e ao uso de certos medicamentos, como os DQWLFRQYXOVLYDQWHV H j QXWULomR GH¿FLHQWH HVSHFLDOPHQWHHPiFLGRIyOLFRVHQGRFRQVL GHUDGRRSULQFLSDOIDWRUGHULVFRUHODFLRQDGR DRVGHIHLWRVGRWXERQHXUDO6$1726H3( 5(,5$ 0H]]RPR HW DO UHODWDUDP HP XP HVWXGR GH FDVRFRQWUROH GH EDVH SRSXODFLRQDO HP 3HORWDV 5LR *UDQGH GR 6XOQR%UDVLODRFRUUrQFLDGHQDV FLPHQWRVGXUDQWHRSHUtRGRGHGHMDQHLUR GHjGHGH]HPEURGHVHQGR TXH GHVWH WRWDO UHFpPQDVFLGRV DSUH VHQWDUDPVHPDOIRUPDGRV'HVWHV WLYHUDP GLDJQyVWLFR GH DQHQFHID OLD'RVUHFpPQDVFLGRVPDOIRUPDGRV DSUHVHQWDYDPGHIHLWRVGRWXERQHXUDO (VWHVGDGRVGHPRQVWUDPXPDSUHYDOrQFLD LPSRUWDQWH HVWLPDGD HP PLO VHQGR QH FHVViULD PDLRU DWHQomR DRV FXLGDGRV SUH YHQWLYRVGHVVDVPDOIRUPDo}HV 3HUDOWD GHVFUHYH TXH RV (VWDGRV8QLGRVSRVVXLXPJDVWRDQXDOHP WRUQRGHPLOK}HVGHGyODUHVFRPRVSD FLHQWHVFRP')71 &RQVHTXrQFLDV GRV HIHLWRV GH IHFKD mento do tubo neural (VWXGRVWrPLQGLFDGRTXHDGH¿FL rQFLDGHiFLGRIyOLFRSRGHGHVHQFDGHDUGH IHLWRVQRWXERQHXUDOHYiULDVFRPSOLFDo}HV QDJHVWDomR7$085$ As consequências mais frequen WHV FDXVDGDV SHOR IHFKDPHQWR LQFRPSOHWR GRWXERQHXUDOVmRDDQHQFHIDOLD)LJXUD RFDVLRQDGDTXDQGRDH[WUHPLGDGHVXSHULRU do tubo neural não se fecha, resultando na DXVrQFLDGRFpUHEURHDHVSLQKDEt¿GD)L JXUDRFRUULGDTXDQGRDH[WUHPLGDGHLQ ferior do tubo neural não se fecha, causan GRGDQRVPHGXODUHVVLJQL¿FDWLYRV Figura 1 : $QHQFHIDOLD$GDSWDGRGHKWWSZZZEUDVLOLDFDWROLFDFRP$FHVVRHPRXW Figura 2:(VSLQKD%t¿GD)RQWHKWWSZZZHVSLQKDEL¿GDFRP!$FHVVRHPRXW 11 Interciência & Sociedade ,QWHUFLrQFLD6RFLHGDGH,6619RO1 *UXSRGHULVFRSDUDRGHIHLWRGRIHFKD mento do tubo neural (PXPHVWXGRUHFHQWHIRLLGHQWL¿ FDGRTXHXPDHPFDGDVHWHSHVVRDVSRGH SRUWDUXPDPXWDomRJHQpWLFDTXHIDYRUHFH XPDGH¿FLrQFLDGHiFLGRIyOLFRPHVPRTXH a alimentação contenha a quantidade reco PHQGDGDGHiFLGRIyOLFRQDWXUDO(VWDVSHV VRDVWrPSUREOHPDVSDUDSURFHVVDUDIRUPD GD YLWDPLQD TXH VH HQFRQWUD QDWXUDOPHQWH QRVDOLPHQWRVFRPSURPHWHQGRDVVLPDDE VRUomRGLPLQXLQGRRVQtYHLVGHiFLGRIyOLFR no sangue. Desta forma as mulheres que SRVVXHPHVWDPXWDomRJHQpWLFDFRQWrPXP risco maior de gerar um feto com defeito de WXERQHXUDO6$1726H3(5(,5$ De acordo com Souza e Machado p FRQVLGHUDGR JUXSR GH ULVFR WRGD PXOKHUJUiYLGDHHPLGDGHUHSURGXWLYDTXH QmRID]HPRXVRGDVXSOHPHQWDomRGHIR lato corretamente durante a gestação, ou DLQGDWRGDVDTXHODVTXHSRVVXHPDOLPHQ WDomRGH¿FLHQWHHPiFLGRIyOLFR ÈFLGRIyOLFR 'H DFRUGR FRP 1DVVHU R iFLGRIyOLFRpDIRUPDVLQWpWLFDGRIRODWROR FDOL]DGRHPVXSOHPHQWRVYLWDPtQLFRVHDOL PHQWRV IRUWL¿FDGRV H WHP PDLRU ELRGLVSR QLELOLGDGH QD IRUPD VLQWpWLFD TXH QD IRUPD QDWXUDO e WDPEpP FRQVLGHUDGR XP WHUPR JHQpULFR SDUD RV FRPSRVWRV TXH WrP DWL YLGDGHYLWDPtQLFDSDUHFLGDDGRiFLGRSWH URLOJOXWkPLFRVHQGRDIRUPDGHYLWDPLQDQD turalmente encontrada nos alimentos. Sua LPSRUWkQFLD IRL GHVFREHUWD Ki FHUFD GH anos, quando foi testado que a anemia ges WDFLRQDO SRGLD VHU WUDWDGD FRP H[WUDWR GH OHYHGXUD LGHQWL¿FDQGR H H[WUDLQGR R IRODWR GDVIROKDVGHHVSLQDIUH&RPS}HXPJUDQ GHDOLDGRGDJHVWDQWHQRSHUtRGRGHJUDYL GH]RQGHRRUJDQLVPRPDWHUQRSUHFLVDGH XPD PDLRU TXDQWLD GHVVD YLWDPLQD SDUD D FRQVWLWXLomR GH FRPSRQHQWHV PDWHUQRV H WDPEpPGHVHQYROYLPHQWRGRIHWR 2 iFLGR IyOLFR p D YLWDPLQD % GR FRPSOH[R % DEXQGDQWH QDV IROKDV YHUGHV GDtRQRPHIyOLFRHOHPHQWRGHJUDQGHLP SRUWkQFLDTXHGHYHVHUDGPLQLVWUDGRGXUDQ WHDJUDYLGH]GHYLGRDVXDDomRQRSHUtRGR GDIRUPDomRGREHErSRUDJLUHPFRQMXQWR 12 FRPDYLWDPLQD%QDWUDQVIRUPDomRVtQ WHVH GH SURWHtQDV IRUPDomR GRV JOyEXORV YHUPHOKRV FUHVFLPHQWR GRV WHFLGRV H QD IRUPDomRGRiFLGRGHVR[LUULERQXFOpLFRTXH LQWHUYpPQDKHUHGLWDULHGDGH628=$H0$ &+$'2 )UHLWDV HW DO UHODWDP TXH RiFLGRIyOLFRWHPGHVHPSHQKRIXQGDPHQ WDO QR SURFHVVR GH UHSURGXomR FHOXODU QR DXPHQWR GRV HULWUyFLWRV QR DODUJDPHQWR GR~WHURQRFUHVFLPHQWRGDSODFHQWDHGR IHWRQRFUHVFLPHQWRQRUPDOQDIDVHUHSUR GXWLYD 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