透過您的圖書館登入
IP:3.236.139.73
  • 期刊

探討營養衛教對慢性腎臟病門診病人營養素攝取及生化指標之影響

The Effect of Nutritional Counseling on the Changes of Nutritional Intake and Biochemical Indicators in Outpatients With Chronic Kidney Disease

摘要


飲食控制蛋白質及攝取足夠熱量為慢性腎臟病營養介入重點。本回溯性研究,探討南部某醫學中心於2003年「慢性腎臟病保健推廣機構計畫」時期,營養諮詢對病人營養素攝取及生化指標改變之影響。此研究分析對象主要以2003~2007年間於本院腎臟內科門診就診,經醫師診斷為慢性腎臟病且為「慢性腎臟病保健推廣機構計畫」收案之病人。研究分析篩選慢性腎臟病3b~4期病人,且接受初複診兩次營養衛教,由當天醫院門診營養師執行衛教,具完整基本資料、體位、生化值及飲食紀錄共153人以配對t檢定分析病人熱量、三大營養素及生化值在初複診之差異性。結果顯示,個案接受營養衛教的平均間隔為兩年,經過營養師初、複診二次衛教後熱量攝取維持(初診:1652.3 ± 499.0 kcal/day,複診:1589.8 ± 416.9 kcal/day,p = 0.05),未達統計之差異;而蛋白質攝取由初診58.9 ± 23.8 g/day降至複診54.8 ± 21.5 g/day,攝取量顯著降低4.1 ±20.4 g/day(p < 0.05)。其他營養相關指標,總膽固醇(195.1 ± 41.9 vs. 192.1± 40.1 mg/dL)、血清白蛋白(4.0 ± 0.5 vs. 4.0 ± 0.3 mg/dL)及體重(64.2 ±12.6 vs. 64.1 ± 13.2 kg),初複診前後皆無顯著改變,顯示營養狀態仍維持不變。故本研究結果顯示,「慢性腎臟病保健推廣機構計畫」收案之慢性腎臟病晚期個案,且接受營養衛教的平均間隔為兩年,對維持其整體營養狀況有益,但定期且提高營養師諮詢頻率對飲食遵循度及營養狀態的影響須更進一步研究。

並列摘要


The goal of nutrition intervention when treating patients with chronic kidney disease (CKD) is to optimize energy/protein intake while maintaining a healthy nutrition status. This retrospective study investigated the relationship between nutritional counseling and changes of nutritional intake and status in CKD patients participating "Kidney Health Promotion Institution Setup & Guidance Project" in a medical center located in southern Taiwan in 2003. One hundred fifty-three outpatients with CKD stages 3b-4 visited the Department of Nephrology and Department of Nutrition and Dietetics during 2003-2007 study period. In the current study, the average time interval for CKD patients to receive counseling by dieticians was 2 years and all patients received nutrition counseling twice. We included patients with complete anthropometric, biochemical data and dietary records. We found no difference in caloric intake between the first and the second nutrition counseling session (1652.3 ± 499.0 vs. 1589.8 ± 416.9 kcal/day, p = 0.05), but protein intake decreased significantly (58.9 ± 23.8 to 54.8 ± 21.5 g/day, p < 0.05). No significant differences were found in nutrition indicators, total cholesterol (195.1 ± 41.9 vs. 192.1 ± 40.1 mg/dL), albumin (4.0 ± 0.5 vs. 4.0 ± 0.3 mg/dL) and body weight (64.2 ± 12.6 vs. 64.1 ± 13.2 kg), indicating the nutritional status was well maintained. These findings suggest later stage CKD patients participated "Kidney Health Promotion Institution Setup & Guidance Project" and received nutrition counseling by dieticians with average time interval of 2 years may help patients maintain optimal nutrition status. However, impact of provision increased frequency of nutrition consultation on dietary compliance and nutritional status needs further study.

延伸閱讀