优化营养指导模式对改善中晚期慢性肾脏病患者营养状况的作用

摘要

目的：探讨以慢性肾脏病（CKD）一体化门诊为平台的优化营养指导模式对提高非透析患者低蛋白饮食依从性并改善其营养状况的作用。方法：将196例CKD 3B～4期非透析CKD患者随机分为优化模式组和传统模式组。两组均给予饮食蛋白质0．6 g／（kg · d）和30～35 kcal／（kg · d）的营养处方，接受两种不同模式的营养管理。随访12个月，每3个月通过MDRD公式估算肾小球滤过率（eGFR）；运用人体测量、生化营养指标和主观综合营养评估法（SGA）评估营养状况。结果：两组患者eGFR的变化差异无统计学意义。与传统模式组相比，优化模式组低蛋白饮食依从性更高，每日饮食蛋白质摄入量较低，饮食热量较高，血清白蛋白水平较高，体质量增加，血尿素氮和甲状旁腺激素下降，SGA评估的营养状况改善，差异均有统计学意义（P＜0．05）。结论：优化营养指导模式有助于提高中晚期非透析 CKD患者对低蛋白饮食的依从性，改善其营养状况，且安全性良好。%Objective:To explore the effects of optimal nutritional guidance based on chronic kidney disease (CKD) integrative outpatient service in improving adherence to low protein diet and the nutritional status of non‐dialysis CKD patients . Methods :The 196 stage 3B to 4 CKD patients were randomly assigned to the optimized‐nutrition group and the traditional group .All participants received dietary counseling aimed at achieving a daily protein intake of 0 .6 g/kg and a daily energy intake of 30‐35 kcal/kg by two different modes of nutrition management . By using MDRD to calculate the eGFR , the nutritional status including human body measurement ,biochemical indexes and subjective global nutritional assessment (SGA ) were assessed every three months in one‐year follow‐up .Results:There was no significant difference in change of the eGFR between the two groups .Compared with the traditional group ,the optimized‐nutrition group had better low protein diet adherence ,lower dietary protein intake ,higher dietary calorie ,higher serum albumin level and weight ,lower serum urea nitrogen and parathyroid hormone ,and the nutritional status assessed by SGA improved significantly (P<0 .05) .Conclusions :The optimal nutritional guidance is effective in increasing patient adherence ,improving the nutrition status and with good safety .