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El Pescado En La Dieta Del Paciente Renal: Relación Fósforo:Ácidos Grasos N-3

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El Pescado En La Dieta Del Paciente Renal: Relación Fósforo:Ácidos Grasos N-3 ARTÍCULO ORIGINAL El pescado en la dieta del paciente renal: relación fósforo:ácidos grasos n-3 María Isabel Castro-González,* Daniela Miranda-Becerra* * Departamento de Nutrición Animal. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Fish in renal patient’s diet: RESUMEN phosphorus: n-3 fatty acids ratio Objetivo. Identificar entre 24 especies de pescados marinos, ABSTRACT las benéficas para pacientes renales, evaluando la relación fós- foro (P): ácidos grasos n-3 (AG n-3). Material y métodos. Objective. To identify between 24 marine fish species the Se seleccionaron aleatoriamente 15 pescados por especie, se fi- most beneficial to renal patient evaluating its phosphorus:n- letearon y homogenizaron para tomar 100 g de muestra y lle- 3 fatty acids ratio. Material and methods. 15 fishes of each var a cabo los análisis químicos por triplicado (n = 3) según specie were randomly selected; they were filleted and homog- técnicas del AOAC. La proteína cruda (Pr) se analizó en enized to take 100g to carry out the chemical analysis by trip- un equipo automatizado Kjeltec. Potasio y calcio se analiza- licate. Crude protein (Pr) was analyzed in kjeltec equipment. ron por absorción atómica y el fósforo con espectrofotómetro Potassium and calcium was detected by atomic absorption UV/Visible. Resultados. Los valores de (Pr) variaron de and phosphorus (P) in an UV/Visible spectrophotometer. Re- 15 g/100 g (pámpano) a 28.21 g/100 g de filete (conejo). Los sults. Crude protein (g/100g) values varied from 15 (pompa- pescados con mayor contenido de (P)(mg/100 g) fueron: pám- no) up to 28.2 (big head tile-fish). The fishes with highest pano (287), sierra (274), peto (257), conejo (255) y picuda (P) (mg/100 g) content were pompano (287), Spanish macker- (252). La especie con menor relación P: AG n-3 fue cintilla el (274), king mackerel (257), big head tile-fish (255) and pa- (0.09, seguida por albacora (0.17), peto (0.40) y sierra (0.45); y cific barracuda (252). The specie with the lowest ratio (P):n-3 la especie con la relación más alta fue el bobo (45.20). Los pes- PUFA was slender frostfish (0.09), followed by albacore cados con mayor contenido de AG n-3/g de Pr fueron: albaco- (0.17), king mackerel (0.40) and Spanish mackerel; the highest ra (71.20), peto (35.96), sierra (32.50) y baqueta (21.76). Se was blue bobo (45.20). Fishes with a high n-3 PUFA/g Pr con- encontró diferencia significativa (p < 0.05) en el contenido de tent were albacore (71.20), king mackerel (35.96), Spanish (P) en los pescados clasificados por su contenido graso en mackerel (32.50) and rooster hind (2.76). Differences were sig- músculo (mg/100 g): pescados magros (193), semigrasos nificant (p < 0.05), in (P) content, in fishes classified by the (235), grasos (244). Conclusiones. Los pescados no reco- fat content in muscle (mg P/100 g): lean fishes (193), semi fat- mendados en la dieta de pacientes renales por su bajo aporte ty fishes (235) and fatty fishes (244). Conclusions. None of de AG n-3/ g de Pr son: el bobo, loro y extraviado. Por su bajo the following fishes are recommended in renal patient’s diet contenido de P/g de Pr se sugiere incluir: bagre, cabrilla, ru- by it lowest contribution of n-3PUFA/g of Pr: blue bobo, yel- bia, lenguado, loro y conejo. Por su contenido de proteína de lowedge grouper, parrot sandbass. It is suggested to include alto valor biológico, por la relación P: AG n-3 y por su bajo chilhuil sea catfish, broomtail grouper, yellow tail snapper, contenido de potasio y calcio se recomienda incluir: albacora, southern flounder, parrot sand bass and big head tilefish by peto, sierra y baqueta. their low content of P/g Pr. The following species included reg- ularly in the diet at least thrice a week could be considered beneficial to the general health status of patients. Key words. Phosphorus. Fatty acids n-3. Protein. Marine Palabras clave. Fósforo. Ácidos grasos n-3. Proteína. Pes- fishes. Renal patient. cados marinos. Pacientes renales. Revista de Investigación Clínica / Vol. 62, Núm. 1 / Enero-Febrero, 2010 / pp 44-53 INTRODUCCIÓN La terapéutica en las enfermedades renales cons- ta de tratamiento médico y manejo nutricional. Este En un organismo sano los riñones se encargan de último es de suma importancia y puede hacer la dife- eliminar los productos de desecho, de mantener el rencia en cuanto a la calidad y tiempo de vida del pa- balance hidroelectrolítico y el equilibrio ácido-base ciente. Debido a que las enfermedades renales son constante, eliminan el exceso de agua y secretan dis- diversas, el manejo nutricional tiene que ser dife- tintas hormonas. Si por alguna razón se produce rente, de acuerdo a las condiciones físicas y niveles una continua inhabilitación de las nefronas con la de los indicadores clínicos en cada paciente. Sin em- consecuente disminución del filtrado glomerular, se bargo, en algunas etapas de la enfermedad renal, los trata entonces de un estado patológico, el cual tratamientos nutricionales incluyen recomendacio- se puede clasificar en cinco categorías fisiológicas nes dietéticas con un consumo restringido de fósfo- diferentes: insuficiencia renal aguda (IRA); insufi- ro, potasio y proteína de alto valor biológico3-10 ciencia renal crónica (IRC), enfermedad renal hiper- (Cuadro 1). Este tipo de proteína se encuentra en los tensiva, síndrome nefrótico y anomalías tubulares.1 pescados; sin embargo, se sabe que la mayoría con- En las nefropatías se observa un deterioro de la tiene elevadas cantidades de fósforo, aún desconoci- función renal con acumulación de productos nitroge- da en muchas de las especies de consumo cotidiano nados como la urea y la creatinina y desequilibrio en México. Junto con la proteína de buena calidad del agua y de algunos electrolitos (P, Na, K, Ca). La biológica, el pescado aporta importantes cantidades falla renal origina un desequilibrio metabólico pro- de los ácidos grasos poliinsaturados n-3: ac. eico- porcional a la pérdida de la función renal; la dismi- sapentaenoico (C20:5n-3) conocido por sus siglas en nución o pérdida de los mecanismos reguladores del inglés como EPA y el ac. docosahexaenoico (C22:6 n- riñón pueden ser transitorias como en la insuficien- 3), conocido como DHA (Cuadro 2).11,12 Se ha de- cia renal aguda o permanentes como en el caso de la mostrado que en pacientes renales, la proteinuria se insuficiencia renal crónica.2 previene prolongándose la sobrevivencia en modelos Cuadro 1. Comparativo de las recomendaciones nutrimentales para pacientes renales. Proteína (E) (P) (K) (Ca) Ref. (g/kg/día) (kcal/kg/día) (mg/día) (mg/día) (mg/día) Síndrome nefrótico 0.8-1.0 30-35 * * * (6) IRA de corta duración Fase inicial: 0.3-0.6 Fase recuperación: 35 600-1200 2000-2500 1000-1500 (6,4) 0.8-1.0 IRC Leve 1.0-1.2 25-40 < 800-1200 1500-2000 1000-1200 (4,6,7,9) Moderada 0.6-1.0 Avanzada 0.6 Hemodiálisis 1-1.2 30-35 800-1000 2000-2500 < 1000 (4,6,7,9,10) Diálisis peritoneal 1.2-1.5 25-35 800-1400 2000-2500 < 1000 (4,6,7,8,9,10) continua ambulatoria Trasplante < 1er mes 1.3-1.5 30-35 * * (6) > 1er mes 1.0 * * < 1er mes 1.3-1.5 30-35 1200 2000-2700 1000-1500 (4) > 1er mes 1.0 * Individualizado. E: Energía. P: Fósforo. K: Potasio. Ca: Calcio. Ref.: Referencias. Castro-González MI, et al. El pescado en la dieta del paciente renal: relación fósforo:ácidos grasos n-3. Rev Invest Clin 2010; 62 (1): 44-53 45 autoinmunes de nefritis, después de una dieta suple- MATERIAL Y MÉTODOS mentada con aceite de pescado, además de que se han observado beneficios sobre el daño vascular, la Todas las especies estudiadas en el presente tra- agregación plaquetaria y los lípidos plasmáticos; en bajo son de consumo humano directo y se comercia- otros estudios se ha demostrado que los ácidos gra- lizan en diferentes estados de la República Mexicana. sos n-3 parecen disminuir la nefrotoxicidad inducida La selección de las especies se realizó con base en por ciclosporina, así como una disminución de las las publicaciones previas existentes sobre el conteni- complicaciones de la hipertensión al inhibir los me- do de ácidos grasos n-3 en especies marinas realiza- canismos inflamatorios y aterogénicos en casos de das por el mismo grupo de trabajo que escribe el nefritis lúpica, ayudando a conservar la función re- presente manuscrito,11,12 el cual forma parte de un nal y reduciendo la proteinuria en nefropatías por proyecto que contempla el estudio de cuarenta y cin- IgA.13-15 co especies pesqueras. Existen pocos datos sobre el contenido de P en las especies de pescados de nuestro país, y es casi Muestreo nula la información sobre la concentración de AG n-3 en la mayoría de los productos pesqueros, por Las muestras se obtuvieron de las diferentes bo- lo que el objetivo del presente trabajo fue evaluar, degas del centro de acopio más grande de Latino- como una opción alimenticia para pacientes rena- américa conocido como Mercado de Pescados y les, diferentes especies de pescados marinos de con- Mariscos “La Nueva Viga”, obteniendo de cada una sumo cotidiano, por su contenido de proteína y diversos ejemplares y teniendo como mínimo 15 pes- fósforo en relación a sus ácidos grasos poliinsatu- cados por especie, los cuales se filetearon y se toma- rados n-3 (EPA y DHA). ron 5 kg de muestra, la cual se sometió a un cuarteo Cuadro 2.
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