indicatii de regim alimentar in bolile pancreatice - gastrotm.ro

INDICATII DE REGIM ALIMENTAR IN BOLILE<br />

PANCREATICE<br />

Consi<st<strong>ro</strong>ng>de</st<strong>ro</strong>ng>ratii generale<br />

—Pancreasul este o glanda anexa a tubului digestiv cu <strong>ro</strong>l atat <st<strong>ro</strong>ng>in</st<strong>ro</strong>ng> secretia endocr<st<strong>ro</strong>ng>in</st<strong>ro</strong>ng>a<br />

(p<strong>ro</strong>ducerea unor hormoni d<st<strong>ro</strong>ng>in</st<strong>ro</strong>ng> care cel mai important este <st<strong>ro</strong>ng>in</st<strong>ro</strong>ng>sul<st<strong>ro</strong>ng>in</st<strong>ro</strong>ng>a) cat si <st<strong>ro</strong>ng>in</st<strong>ro</strong>ng> cea exocr<st<strong>ro</strong>ng>in</st<strong>ro</strong>ng>a<br />

pr<st<strong>ro</strong>ng>in</st<strong>ro</strong>ng> secretia enzimelor implicate <st<strong>ro</strong>ng>in</st<strong>ro</strong>ng> digestia pr<st<strong>ro</strong>ng>in</st<strong>ro</strong>ng>cipiilor <st<strong>ro</strong>ng>alimentar</st<strong>ro</strong>ng>e:<br />

o amilaza —necesara metabolizarii gluci<st<strong>ro</strong>ng>de</st<strong>ro</strong>ng>lor;<br />

o lipaza —<st<strong>ro</strong>ng>in</st<strong>ro</strong>ng>terv<st<strong>ro</strong>ng>in</st<strong>ro</strong>ng>e <st<strong>ro</strong>ng>in</st<strong>ro</strong>ng> digestia grasimilor;<br />

o trips<st<strong>ro</strong>ng>in</st<strong>ro</strong>ng>a si chimotrips<st<strong>ro</strong>ng>in</st<strong>ro</strong>ng>a metabolizeaza p<strong>ro</strong>te<st<strong>ro</strong>ng>in</st<strong>ro</strong>ng>ele.<br />

—Sufer<st<strong>ro</strong>ng>in</st<strong>ro</strong>ng>tele <st<strong>ro</strong>ng>pancreatice</st<strong>ro</strong>ng> vor avea drept consec<st<strong>ro</strong>ng>in</st<strong>ro</strong>ng>ta maldigestia si malabsorbtia tutu<strong>ro</strong>r<br />

pr<st<strong>ro</strong>ng>in</st<strong>ro</strong>ng>cipiilor nutritive, dar <st<strong>ro</strong>ng>in</st<strong>ro</strong>ng> special a lipi<st<strong>ro</strong>ng>de</st<strong>ro</strong>ng>lor si p<strong>ro</strong>te<st<strong>ro</strong>ng>in</st<strong>ro</strong>ng>elor <st<strong>ro</strong>ng>de</st<strong>ro</strong>ng>oarece amilaza, enzima<br />

implicata <st<strong>ro</strong>ng>in</st<strong>ro</strong>ng> digestia gluci<st<strong>ro</strong>ng>de</st<strong>ro</strong>ng>lor, se secreta si <st<strong>ro</strong>ng>in</st<strong>ro</strong>ng> duo<st<strong>ro</strong>ng>de</st<strong>ro</strong>ng>n si <st<strong>ro</strong>ng>in</st<strong>ro</strong>ng> glan<st<strong>ro</strong>ng>de</st<strong>ro</strong>ng>le salivare.<br />

—D<st<strong>ro</strong>ng>in</st<strong>ro</strong>ng> punct <st<strong>ro</strong>ng>de</st<strong>ro</strong>ng> ve<st<strong>ro</strong>ng>de</st<strong>ro</strong>ng>re cl<st<strong>ro</strong>ng>in</st<strong>ro</strong>ng>icoevolutiv sufer<st<strong>ro</strong>ng>in</st<strong>ro</strong>ng>tele <st<strong>ro</strong>ng>pancreatice</st<strong>ro</strong>ng> pot fi acute sau c<strong>ro</strong>nice. In<br />

pancreatita acuta etiologia este dom<st<strong>ro</strong>ng>in</st<strong>ro</strong>ng>ata <st<strong>ro</strong>ng>in</st<strong>ro</strong>ng> 80% d<st<strong>ro</strong>ng>in</st<strong>ro</strong>ng> cazuri <st<strong>ro</strong>ng>de</st<strong>ro</strong>ng> consumul <st<strong>ro</strong>ng>de</st<strong>ro</strong>ng> alcool si<br />

litiaza biliara, <st<strong>ro</strong>ng>in</st<strong>ro</strong>ng> timp ce <st<strong>ro</strong>ng>in</st<strong>ro</strong>ng> pancreatita c<strong>ro</strong>nica <st<strong>ro</strong>ng>in</st<strong>ro</strong>ng>terv<st<strong>ro</strong>ng>in</st<strong>ro</strong>ng>, pe langa consumul <st<strong>ro</strong>ng>de</st<strong>ro</strong>ng> alcool, factori<br />

metabolici (hipercalcemie, hiperuricemie), ereditari, nutritionali, obstructivi.<br />

—Pancreatita acuta este o urgenta medicochirurgicala si necesita <st<strong>ro</strong>ng>in</st<strong>ro</strong>ng> toate cazurile<br />

<st<strong>ro</strong>ng>in</st<strong>ro</strong>ng>ternarea <st<strong>ro</strong>ng>in</st<strong>ro</strong>ng> spital. In pancreatita c<strong>ro</strong>nica semnele cl<st<strong>ro</strong>ng>in</st<strong>ro</strong>ng>ice card<st<strong>ro</strong>ng>in</st<strong>ro</strong>ng>ale sunt reprezentate <st<strong>ro</strong>ng>de</st<strong>ro</strong>ng><br />

durere, diaree cu steatoree (adica prezenta grasimilor nedigerate <st<strong>ro</strong>ng>in</st<strong>ro</strong>ng> scaun), sca<st<strong>ro</strong>ng>de</st<strong>ro</strong>ng>re <st<strong>ro</strong>ng>in</st<strong>ro</strong>ng><br />

greutate, semne ale diabetului zaharat. Carentele vitam<st<strong>ro</strong>ng>in</st<strong>ro</strong>ng>elor liposolubile (A, D, E, K) si a<br />

vitam<st<strong>ro</strong>ng>in</st<strong>ro</strong>ng>ei B12 sunt rar manifeste cl<st<strong>ro</strong>ng>in</st<strong>ro</strong>ng>ic. Mentionam ca <st<strong>ro</strong>ng>in</st<strong>ro</strong>ng>suficienta pancreatica exocr<st<strong>ro</strong>ng>in</st<strong>ro</strong>ng>a<br />

apare tardiv, dupa 10—20 <st<strong>ro</strong>ng>de</st<strong>ro</strong>ng> ani <st<strong>ro</strong>ng>de</st<strong>ro</strong>ng> evolutie a bolii, cand peste 90% d<st<strong>ro</strong>ng>in</st<strong>ro</strong>ng> masa pancretica<br />

a fost distrusa.<br />

Reguli generale priv<st<strong>ro</strong>ng>in</st<strong>ro</strong>ng>d dieta<br />

—<st<strong>ro</strong>ng>in</st<strong>ro</strong>ng> pancreatita acuta <st<strong>ro</strong>ng>de</st<strong>ro</strong>ng> cele mai multe ori este necesara suprimarea alimentatiei orale;<br />

reluarea acesteia se face dupa 3—4 zile si numai sub supraveghere medicala; <st<strong>ro</strong>ng>de</st<strong>ro</strong>ng> aceea<br />

recomandarile dietetice se vor referi <st<strong>ro</strong>ng>in</st<strong>ro</strong>ng> special la pancreatita c<strong>ro</strong>nica.<br />

—este cu <st<strong>ro</strong>ng>de</st<strong>ro</strong>ng>savarsire <st<strong>ro</strong>ng>in</st<strong>ro</strong>ng>terzis consumul <st<strong>ro</strong>ng>de</st<strong>ro</strong>ng> alcool sub orice forma ar fi acesta; trebuie sa<br />

stiti ca atat consumul <st<strong>ro</strong>ng>de</st<strong>ro</strong>ng> cafea cat si fumatul accentueaza durerea.<br />

—mancati <st<strong>ro</strong>ng>de</st<strong>ro</strong>ng> 4—5 ori pe zi, mese ap<strong>ro</strong>ximativ egale ca volum.<br />

—nu consumati prea multe alimente celulozice (cruditati), avand <st<strong>ro</strong>ng>in</st<strong>ro</strong>ng> ve<st<strong>ro</strong>ng>de</st<strong>ro</strong>ng>re efectul fibrelor<br />

<st<strong>ro</strong>ng>alimentar</st<strong>ro</strong>ng>e asupra enzimelor <st<strong>ro</strong>ng>pancreatice</st<strong>ro</strong>ng> (adsorbtie, sechestrare).<br />

—evitati consumul <st<strong>ro</strong>ng>de</st<strong>ro</strong>ng> lichi<st<strong>ro</strong>ng>de</st<strong>ro</strong>ng> <st<strong>ro</strong>ng>in</st<strong>ro</strong>ng> timpul mesei pentru a nu dilua enzimele digestive.<br />

—<st<strong>ro</strong>ng>in</st<strong>ro</strong>ng> lipsa altor afectiuni asociate consumul <st<strong>ro</strong>ng>de</st<strong>ro</strong>ng> sare va fi normal.<br />

—<st<strong>ro</strong>ng>regim</st<strong>ro</strong>ng>ul <st<strong>ro</strong>ng>alimentar</st<strong>ro</strong>ng> trebuie adaptat fiecarui caz <st<strong>ro</strong>ng>in</st<strong>ro</strong>ng> parte, dar <st<strong>ro</strong>ng>in</st<strong>ro</strong>ng> l<st<strong>ro</strong>ng>in</st<strong>ro</strong>ng>ii mari va fi hipercaloric<br />

(2500—3000 <st<strong>ro</strong>ng>de</st<strong>ro</strong>ng> calorii) si va cont<st<strong>ro</strong>ng>in</st<strong>ro</strong>ng>e 30% p<strong>ro</strong>te<st<strong>ro</strong>ng>in</st<strong>ro</strong>ng>e, 30% lipi<st<strong>ro</strong>ng>de</st<strong>ro</strong>ng> si 40% gluci<st<strong>ro</strong>ng>de</st<strong>ro</strong>ng>.<br />

P<strong>ro</strong>te<st<strong>ro</strong>ng>in</st<strong>ro</strong>ng>ele<br />

—cantitatea <st<strong>ro</strong>ng>de</st<strong>ro</strong>ng> p<strong>ro</strong>te<st<strong>ro</strong>ng>in</st<strong>ro</strong>ng>e variaza <st<strong>ro</strong>ng>in</st<strong>ro</strong>ng>tre 100—150 grame/zi, d<st<strong>ro</strong>ng>in</st<strong>ro</strong>ng> care 65—75% vor fi p<strong>ro</strong>te<st<strong>ro</strong>ng>in</st<strong>ro</strong>ng>e<br />

<st<strong>ro</strong>ng>de</st<strong>ro</strong>ng> orig<st<strong>ro</strong>ng>in</st<strong>ro</strong>ng>e animala.<br />

—se prefera carne slaba, usor digerabila (peste,vaca, vitel, pui, ficat) fiarta sau gratar<br />

(carnea fripta are avantajul ca la un volum mic aduce un aport p<strong>ro</strong>teic substantial), la care<br />

se adauga branza <st<strong>ro</strong>ng>de</st<strong>ro</strong>ng> vaca, oua fierte moi.<br />

Lipi<st<strong>ro</strong>ng>de</st<strong>ro</strong>ng>le<br />

—clasic se recomanda un <st<strong>ro</strong>ng>regim</st<strong>ro</strong>ng> sarac <st<strong>ro</strong>ng>in</st<strong>ro</strong>ng> grasimi (hipolipidic); se admite <st<strong>ro</strong>ng>in</st<strong>ro</strong>ng>sa ca 40% d<st<strong>ro</strong>ng>in</st<strong>ro</strong>ng><br />

grasimi se absorb totusi chiar <st<strong>ro</strong>ng>in</st<strong>ro</strong>ng> conditiile existentei <st<strong>ro</strong>ng>de</st<strong>ro</strong>ng>ficitului enzimatic.<br />

—fara a exagera, se accepta ca adm<st<strong>ro</strong>ng>in</st<strong>ro</strong>ng>istrarea unor cantitati ceva mai mari <st<strong>ro</strong>ng>de</st<strong>ro</strong>ng> lipi<st<strong>ro</strong>ng>de</st<strong>ro</strong>ng>, <st<strong>ro</strong>ng>in</st<strong>ro</strong>ng><br />

special <st<strong>ro</strong>ng>in</st<strong>ro</strong>ng> asociere cu preparate enzimatice (Nutrizim, Triferment, Festal, Kreon, etc.) va

---

evita sca<st<strong>ro</strong>ng>de</st<strong>ro</strong>ng>rea <st<strong>ro</strong>ng>in</st<strong>ro</strong>ng> greutate si va oferi o sansa suplimentara organismului <st<strong>ro</strong>ng>de</st<strong>ro</strong>ng> a—si valorifica<br />

la maxim posibilitatile enzimatice.<br />

—b<st<strong>ro</strong>ng>in</st<strong>ro</strong>ng>e tolerate sunt untul p<strong>ro</strong>aspat <st<strong>ro</strong>ng>de</st<strong>ro</strong>ng> vaca , branzeturile cu mai put<st<strong>ro</strong>ng>in</st<strong>ro</strong>ng> <st<strong>ro</strong>ng>de</st<strong>ro</strong>ng> 50% grasimi,<br />

laptele ecremat, uleiul <st<strong>ro</strong>ng>de</st<strong>ro</strong>ng> floarea soarelui, porumb sau soia.<br />

—<st<strong>ro</strong>ng>de</st<strong>ro</strong>ng> o mare importanta sunt trigliceri<st<strong>ro</strong>ng>de</st<strong>ro</strong>ng>le cu lant mediu; acestea sunt niste grasimi care<br />

se gasesc <st<strong>ro</strong>ng>in</st<strong>ro</strong>ng> special <st<strong>ro</strong>ng>in</st<strong>ro</strong>ng> uleiul <st<strong>ro</strong>ng>de</st<strong>ro</strong>ng> cocos, care cont<st<strong>ro</strong>ng>in</st<strong>ro</strong>ng> acizi grasi cu 8 sau 10 atomi <st<strong>ro</strong>ng>de</st<strong>ro</strong>ng> carbon<br />

si care se pot absorbi <st<strong>ro</strong>ng>in</st<strong>ro</strong>ng><st<strong>ro</strong>ng>de</st<strong>ro</strong>ng>pen<st<strong>ro</strong>ng>de</st<strong>ro</strong>ng>nt <st<strong>ro</strong>ng>de</st<strong>ro</strong>ng> prezenta lipazei.<br />

Gluci<st<strong>ro</strong>ng>de</st<strong>ro</strong>ng>le<br />

—se recomanda un <st<strong>ro</strong>ng>regim</st<strong>ro</strong>ng> hiperglucidic (<st<strong>ro</strong>ng>in</st<strong>ro</strong>ng> medie 400 g gluci<st<strong>ro</strong>ng>de</st<strong>ro</strong>ng>/zi), ceea ce asigura un<br />

aport caloric crescut.<br />

—se va adm<st<strong>ro</strong>ng>in</st<strong>ro</strong>ng>istra pa<st<strong>ro</strong>ng>in</st<strong>ro</strong>ng>e alba veche sau prajita, fierturi <st<strong>ro</strong>ng>de</st<strong>ro</strong>ng> cereale (mai put<st<strong>ro</strong>ng>in</st<strong>ro</strong>ng> cartofi),<br />

legume fierte <st<strong>ro</strong>ng>in</st<strong>ro</strong>ng> abur, fructe p<strong>ro</strong>aspete b<st<strong>ro</strong>ng>in</st<strong>ro</strong>ng>e coapte sau <st<strong>ro</strong>ng>in</st<strong>ro</strong>ng> compot, suc sau gelat<st<strong>ro</strong>ng>in</st<strong>ro</strong>ng>a <st<strong>ro</strong>ng>de</st<strong>ro</strong>ng><br />

fructe, miere.<br />

Atentie! In caz <st<strong>ro</strong>ng>de</st<strong>ro</strong>ng> aparitie a diabetului zaharat <st<strong>ro</strong>ng>regim</st<strong>ro</strong>ng>ul va avea caracteristicile <st<strong>ro</strong>ng>regim</st<strong>ro</strong>ng>ului<br />

diabetic , cu mentiunea ca gluci<st<strong>ro</strong>ng>de</st<strong>ro</strong>ng>le nu vor sca<st<strong>ro</strong>ng>de</st<strong>ro</strong>ng> niciodata sub 250 grame/zi, iar lipi<st<strong>ro</strong>ng>de</st<strong>ro</strong>ng>le<br />

se vor creste cu pru<st<strong>ro</strong>ng>de</st<strong>ro</strong>ng>nta astfel <st<strong>ro</strong>ng>in</st<strong>ro</strong>ng>cat starea <st<strong>ro</strong>ng>de</st<strong>ro</strong>ng> nutritie sa nu fie afectata.<br />

In loc <st<strong>ro</strong>ng>de</st<strong>ro</strong>ng> concluzie<br />

"Pa<st<strong>ro</strong>ng>in</st<strong>ro</strong>ng>ea <st<strong>ro</strong>ng>in</st<strong>ro</strong>ng>seamna mai mult <st<strong>ro</strong>ng>de</st<strong>ro</strong>ng>cat gustul pa<st<strong>ro</strong>ng>in</st<strong>ro</strong>ng>ii"—Trémolieres<br />

Exemplu <st<strong>ro</strong>ng>de</st<strong>ro</strong>ng> <st<strong>ro</strong>ng>regim</st<strong>ro</strong>ng> <st<strong>ro</strong>ng>alimentar</st<strong>ro</strong>ng> <st<strong>ro</strong>ng>in</st<strong>ro</strong>ng> pancreatita c<strong>ro</strong>nica (2227 calorii, 115 g p<strong>ro</strong>te<st<strong>ro</strong>ng>in</st<strong>ro</strong>ng>e, 318 g<br />

gluci<st<strong>ro</strong>ng>de</st<strong>ro</strong>ng>, 55 g lipi<st<strong>ro</strong>ng>de</st<strong>ro</strong>ng>)<br />

Ora 7 —ceai + pa<st<strong>ro</strong>ng>in</st<strong>ro</strong>ng>e prajita cu unt si peltea <st<strong>ro</strong>ng>de</st<strong>ro</strong>ng> gutui<br />

Ora 10 —pa<st<strong>ro</strong>ng>in</st<strong>ro</strong>ng>e cu sunca slaba<br />

Ora 13 —supa <st<strong>ro</strong>ng>de</st<strong>ro</strong>ng> legume cu fi<st<strong>ro</strong>ng>de</st<strong>ro</strong>ng>a; rasol <st<strong>ro</strong>ng>de</st<strong>ro</strong>ng> pui + piure <st<strong>ro</strong>ng>de</st<strong>ro</strong>ng> cartofi + salata <st<strong>ro</strong>ng>de</st<strong>ro</strong>ng> sfecla +<br />

pa<st<strong>ro</strong>ng>in</st<strong>ro</strong>ng>e; mere coapte cu gem<br />

Ora 16 —gelat<st<strong>ro</strong>ng>in</st<strong>ro</strong>ng>a <st<strong>ro</strong>ng>de</st<strong>ro</strong>ng> iaurt<br />

Ora 19 —chiftelute la gratar + salata <st<strong>ro</strong>ng>de</st<strong>ro</strong>ng> ar<st<strong>ro</strong>ng>de</st<strong>ro</strong>ng>i copti + pa<st<strong>ro</strong>ng>in</st<strong>ro</strong>ng>e; crema <st<strong>ro</strong>ng>de</st<strong>ro</strong>ng> branza <st<strong>ro</strong>ng>de</st<strong>ro</strong>ng> vaci

---

Dr Shikki