慢性肾脏病一体化管理门诊患者的营养状况与饮食调查  

A nutritional and dietary survey among CKD outpatients

作　　者：鲍云非[1] 王红[1] 周楚[1] 王晋伟[1] 张路霞[1] 

机构地区：[1]北京大学第一医院肾脏内科,北京100034

出　　处：《中国血液净化》2017年第3期154-157,共4页Chinese Journal of Blood Purification

基　　金：北京大学第一医院科研基金项目(2016HL33)资助

摘　　要：目的调查慢性肾脏病(chronic kidney disease,CKD)一体化管理门诊患者的饮食及营养状况,为更好的开展CKD营养管理工作提供依据。方法调查北京大学第一医院肾内科CKD一体化管理门诊患者,搜集患者一般资料。测量并计算体质量指数,并通过主观综合性营养评估问卷评定患者营养状况。饮食情况通过3天饮食日记的方法获得,计算患者每日热量和蛋白质,优质蛋白质摄取情况,同时营养师给予推荐摄入量。结果患者总数120人,年龄(60.491±14.167)岁,随访时间(3.403±2.707)年,以CKD3~4期患者为主。在营养指标中,体质量指数低于18.5kg/m2的有8人(6.667%);主观综合性营养评估评估达到B级轻-中度营养不良16人(13.333%)。患者实际每日每公斤体质量热量摄入量显著低于营养师推荐量[分别为26.798±6.236 kcal/(kg·d)与28.677±2.584kcal/(kg·d),t=-3.194,P=0.002]。患者实际每日每公斤体质量蛋白摄入量高于营养师推荐量[分别为(0.963±0.281)g/(kg·d)与(0.736±0.090)g/(kg·d),t=9.053,P<0.001],其中优质蛋白的摄入比例为(44.230±12.933)%,显著低于营养师推荐的(60.000±0.000)%(t=-13.355,P<0.001)。结论 CKD门诊随访患者营养不良的比例偏高、饮食情况与指南推荐有一定差距,需加强对CKD门诊随访患者的营养治疗的管理。Objective To perform a survey to evaluate diet and nutritional status among outpatients with CKD and to provide the bases for nutritional management in CKD patients. Methods The CKD outpatients followed in Peking University First Hospital were enrolled in this study. General characteristics including sex,age and follow-up period, estimated glomerular filtration rate（e GFR） and past dietary instruction were collected. Body mass index（BMI） was calculated, and subjective global assessment（SGA） was used to evaluate the nutrition status of the patients. Dietary information was collected using three-day food diary under the instruction of dietitians. Daily energy, protein, and high quality protein intake were calculated using corresponding software according to Chinese Food Ingredients（2002）. At the same time, recommended intake was given by dietitians. Results A total of 120 patients（average age 60.491 ± 14.167 years old） with CKD were enrolled.The average follow-up time was 3.403±2.707 years, and most of the patients were in CKD stage 3-4. Eight of the patients（6.667%） had BMI less than 18.5, and 16 patients（13.333%） were defined as mild to medium malnutrition（Stage B） by SGA evaluation. The actual daily energy intake was 26.798±6.236 kcal/kg· d, significantly lower than the recommended intake of 28.677±2.584 kcal/kg· d（t=-3.194, P=0.002） by dietitians. The actual daily protein intake was 0.963±0.281 g/kg· d, significantly higher than the recommend intake of 0.736±0.090 g/kg· d（t=9.053, P〈0.001）. However, the actual high quality protein intake ratio was 44.230±12.933%,significantly lower than the recommended ratio of 60.000±0.000%（t=-13.355, P〈0.001）. Conclusions Our study indicates that malnutrition is not rare among CKD outpatients and the actual dietary condition is not quite rational concerning the recommendations by the guideline. Therefore, the nutritional management of CKD outpatients needs to be reinforced.

关 键 词：慢性肾脏病 低蛋白饮食 营养管理 营养不良 

分 类 号：R692.5[医药卫生—泌尿科学]