河北医科大学学报

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对慢性肾脏病患者个体化目标营养管理的调查分析

  

  1. 兰州大学第二医院肾内科,甘肃 兰州 730000
  • 出版日期:2017-05-25 发布日期:2017-05-23
  • 作者简介:杨艳(1991-),女,甘肃兰州人,兰州大学第二医院医学硕士研究生,从事肾脏病营养学研究。

Investigation on the nutritional management of patients with chronic kidney disease

  1. Department of Nephrology,  Lanzhou University Second Hospital, Gansu Province, Lanzhou 730000, China
  • Online:2017-05-25 Published:2017-05-23

摘要: [摘要]〓
〖HTH〗目的〖HTSS〗〖KG*2〗调查慢性肾脏疾病(chronic kidney disease,CKD)患者膳食摄入中宏量营养素的达标率及蛋白质-能量消耗(proteinenergy wasting,PEW)的发生率,分析膳食摄入情况。
〖HTH〗方法〖HTSS〗〖KG*2〗选取兰州大学第二医院住院的CKD患者354例,采用食物称重法和3 d 24 h膳食记录法收集食物消费数据,应用《中国食物成分表》计算营养素的摄入量,统计CKD1~5期患者能量、蛋白、脂类、碳水化合物、白蛋白(albumin,Alb)、血红蛋白(hemoglobin,Hb)、体质量指数(body mass index,BMI)的达标率和PEW发生率,CKD1~5期患者豆类、白肉类、红肉类、蛋类、奶制品、主食类、油脂类、水果类、蔬菜类的9大类食品的摄入量。
〖HTH〗结果〖HTSS〗〖KG*2〗354例CKD1~5期患者能量达标总人数为88例(24.8%),蛋白质总达标32 例(9.0%),脂质总达标51例(14.4%),碳水化合物达标88例(24.8%),Alb达标173例(48.9%),Hb达标117例(33.0%),BMI达标165例(46.6%)。随着CKD进展,CKD各期的上述指标达标率基本是降低的,而PEW发生率是逐渐增加的。CKD1~5期患者豆类、白肉类、红肉类、蛋类、奶制品、主食类、油脂类、水果类、蔬菜类的9大类食品摄入量随着CKD病情的加重也不同程度降低。
〖HTH〗结论〖HTSS〗〖KG*2〗CKD患者膳食摄入的宏量营养素(蛋白质、脂类、碳水化合物)达标率低下而PEW发生率高;膳食以主食类为主,主要缺乏优质蛋白、蔬菜及水果。因此,所有CKD患者需要进行目标营养管理,实行个体化膳食指导甚至营养治疗。

关键词: 肾功能衰竭, 慢性, 营养疗法, 蛋白质能量消耗

Abstract: 〗[Abstract] Objective〖HTSS〗〓To investigate the compliance rate of macronutrients of dietary intake, the incidence of protein energy wasting(PEW) and food consumption data in patients with chronic kidney disease(CKD).
〖HTH〗〖WTHZ〗Methods〖HTSS〗〓A total of 354 CKD patients hospitalized in Lanzhou University Second Hospital were enrolled in this study. The food consumption data were collected by weighing method combined with 3 consecutive 24hour recalls, and the nutrients intake was calculated by China Food Composition Table. Nutritionrelated indexes were analyzed, which included energy, protein, lipid, carbohydrate, albumin,hemoglobin, body mass index(BMI), incidence of PEW, and consumption data of nine categories food, such as beans, white meat, red meat, eggs, dairy products, staple foods, oils, fruits and vegetables.
〖HTH〗〖WTHZ〗Results〖HTSS〗〓In 354 patients with the stages CKD1-5, the number of patients reached the energy recommendation was 88 and compliance rate was 24.8%. The number of patients reached the protein recommendation was 32 and compliance rate was 9.0%. The number of patients reached the lipid recommendation was 51 and compliance rate was 14.4%. The number of patients reached the carbohydrate recommendation was 88 and compliance rate was 24.8%. The number of patients reached the albumin recommendation was 173 and compliance rate was 48.9%. The number of patients reached the albumin recommendation was 117 and compliance rate was 33.0%. The number of patients reached the BMI recommendation was 165 and compliance rate was 46.6%. In total, these indexes mentioned above were gradually decreased but the incidence of PEW was increased with the progress of CKD. The intake of nine categories food, like beans, white meat, red meat, eggs, dairy products, staple foods, oils, fruits and vegetables was inclined with the progression of the disease. 〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓The compliance rate of dietary intake of three macronutrients, such as protein, lipid, carbohydrate, is low and the incidence of PEW is high in patients with CKD. The diets among CKD patients are mainly staple foods and are lack of biological protein, vegetables and fruits in these patients. Consequently,all patients with CKD need to implement target nutrition management by practicing individual dietary guidance and goal nutrition therapy.

Key words: kidney failure, chronic; nutrition therapy, proteinenergy wasting