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Nutr Clin Med Mar Juan Díaz, Ainhoa Serrano Lázaro y Alfonso Mesejo Arizmendi > 92 < >>C onCepto , metabolismo y Calidad pRoteiCa Definición de proteína Las proteínas son macromoléculas complejas, componente principal, funcional y estructural de las células. Cumplen numerosas funciones en el organismo, siendo las más importantes el aporte de nitrógeno (N 2 ) y aminoácidos (AA). Los aminoácidos son ácidos orgánicos que constituyen la base para la síntesis de proteí- nas y, a su vez, son el punto final en su degra- dación metabólica para poder ser absorbidas. El 17% de la masa corporal son proteínas y, dentro de la misma, el 25% es proteína estruc- tural (colágeno, actina, miosina) y hemoglobi- na 1 . El contenido medio de N 2 de las proteínas es de un 16%, siendo el elemento que se utiliza para medir los cambios en la proteína corpo- ral total. En función de la ingesta y la excre- ción, existe un balance nitrogenado positivo (anabolismo proteico) o negativo (catabolismo proteico). Key words proteins, protein quality, nutritional support, enteral nutrition, parenteral nutrition >>a bstRaCt Proteins are a key, functional and structural element of the cells. Nitrogen (N 2 ) and aminoacids (AA) supply is one of their most relevant functions. Synthesis, protein degradation, and oxidation of AA are regulated to preserve lean body mass through out protein replacement. 40% of body proteins are found in the muscle tissue. Daily protein synthesis in adults is 3-4 times higher than intake, which means a recycling process from the free AA reserve. Protein quality depends on the kind of AA they are composed of, given that protein synthesis requires the availability of every AA integrating it. A high quality protein will have all the AA in the right pro- portions. A protein’s nutritional efficiency can be established by the quantity of protein nitrogen absorbed and retained by the body, when it is able to positively balance its daily losses. Usual recommendations about protein intake in healthy adults are 0.8-1.1 g/kg/d, and 1.2-1.5 g/kg/d in catabolic patients without kidney or liver failure. The administration of an adequate quantity of non-protein calories is essential to allow the aminoacids intake to be used in the protein synthesis, thus minimizing their oxidation as a source of energy. In certain conditions such as stress hypercatabolism, kidney failure, inflammatory bowel disease, chro- nic obstructive pulmonary disease or neoplasia, it is the degree of protein malnutrition which sets up the clinical development in the short to medium term, and can therefore be considered a prognostic factor. Body protein loss is associated with many pathological disturbances and with an increase in the mor- bi-mortality. It is important to understand the metabolism of proteins and their quality, as well as the consequences derived from the nutritional support. Those patients who may be at risk of malnutrition because of their main disease should be carefully as- sessed so that nutritional support programs can be established, selecting the right administration route and the best kind of nutrients. A specific nutrition with AA and nitrogen compounds my be recommen- ded, thus changing the simple concept of nutritional support by that of nutro-metabolic support, with special attention to the quantity and quality of protein intake. Nutr Clin Med 2014; VIII (3): 91-108 DOI: 10.7400/NCM.2014.08.3.5021 nutricion clinica_003-2014.indb 92 11/09/14 20:14
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