156例维持性血液透析患者营养及膳食纤维摄入情况多中心调查研究

    A multicenter study on nutrition and dietary fiber intake in 156 maintenance hemodialysis patients

    • 摘要:
      目的  了解维持性血液透析(maintenance hemodialysis, MHD)患者的营养状况、膳食纤维和部分微量营养素摄入情况,为指导患者合理膳食及制定营养干预措施提供依据。
      方法  调查山东省千佛山医院、济南黄河肾病医院、郓城诚信医院和德州市第三人民医院4家透析中心的156例MHD患者,其中男100例,女56例,患者年龄为(53.26 ± 13.25)岁,年龄范围为26~84岁。采用主观全面评价法评估患者的营养状况,并应用3 d膳食记录法记录日常饮食,运用营养计算器软件计算患者日常平均膳食、营养及膳食纤维摄入情况,并进行膳食分析。
      结果  156例MHD患者中,98例(62.8%)营养良好,50例(32.1%)发生中度营养不良,8例(5.1%)发生重度营养不良。本研究中,MHD患者每日每人能量摄入量为(6612.77 ± 2255.21)kJ,达标率为41.0%;碳水化合物、脂肪、蛋白质每日每人摄入量分别为(279.78 ± 90.24)g、(28.74 ± 11.77)g、(48.31 ± 10.93)g,达标率分别为50.6%、89.1%、64.7%;膳食纤维每日每人摄入量为(10.07 ± 5.61)g,达标率为1.9%。每日每人摄入维生素A、维生素B1、维生素C、维生素D、维生素E、镁、锌、硒和钙的摄入量低于推荐摄入量,磷、铁和铜摄入量高于推荐摄入量。
      结论  MHD患者的营养不良发生率较高,膳食结构欠合理,膳食纤维摄入量明显不足,微量营养素摄入不均衡。医护人员应将营养风险筛查纳入血液透析患者的疾病管理中,加强对患者的膳食宣教,使其认识到膳食在疾病治疗中的重要性,及早制定精准化、个体化的营养干预策略,以平衡患者的营养需求。

       

      Abstract:
      Objective To understand the nutritional status, dietary fiber and ingesting some micronutrients of maintenance hemodialysis(MHD) patients to provide rationales for guiding a rational diet and formulating nutritional intervention measures.
      Methods  A survey was conducted for 156 MHD patients from four dialysis centers, namely Shandong Provincial Qianfoshan Hospital, Jinan Yellow River Nephropathy Hospital, Yuncheng Chengxin Hospital and Dezhou Third People's Hospital. There were 100 males and 56 females with age of (53.26 ± 13.25)(26-84) year. Nutritional status was evaluated by subjective global assessment of nutrition and daily diet recorded by 3-day dietary recording method. Daily average intakes of dietary nutrition and fiber were calculated by nutrition calculator software.
      Results  Among them, 98(62.8%) were well-nourished, 50(32.1%) moderately malnourished and 8(5.1%) severely malnourished. In this study, daily per capita energy intake was (6612.77 ± 2255.21) kJ, accounting for 41.0%; The daily per capita intake of carbohydrate, fat and protein were (279.78 ± 90.24)g, (28.74 ± 11.77)g and (48.31 ± 10.93) g with compliance rates accounting for 50.6%, 89.1% and 64.7% respectively; The daily per capita intake of dietary fiber was (10.07 ± 5.61) g, accounting for 1.9%. The daily intake of vitamin A/B/C/D/E, magnesium, zinc, selenium and calcium per capita was lower than recommended intake while phosphorus, iron and copper was higher than recommended intake.
      Conclusion The incidence of malnutrition in MHD patients is high with an irrational dietary structure. Intake of dietary fiber is obviously insufficient and intake of micronutrients remains uneven. Clinicians should include nutritional risk screening in disease management of hemodialysis patients, strengthen dietary education, reiterate the importance of diet in disease treatment, offer nutritional interventions as soon as possible and formulate accurate and individualized nutritional strategies for balancing nutritional needs.

       

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