- 期刊
- OpenAccess
慢性腎臟病患者脂肪建議攝取量之實證營養依據
Lipid Recommendation Intake for Patients with Chronic Kidney Disease: An Evidence-Based Review
摘要
慢性腎臟病(CKD)患者限制蛋白質攝取時，應增加脂肪攝取以補充熱量，進而避免蛋白質-能量消耗症(PEW)的發生。然而，長期攝取過量或不當組成脂肪的患者易導致第二型糖尿病、肥胖及心血管疾病(CVD)的風險增加。根據美國心臟協會2013 AHA/ACC「降低心血管風臉生活方式管理指南」的建議，成年人預防CVD發生的飲食應為，每日脂肪攝取量應不超過總熱量的30%，其中5%至6%的熱量來自飽和脂肪(SFAs)，約10%熱量來自多元不飽和脂肪酸(PUFAs)，並降低反式脂肪的攝取。美國國家腎臟基金會建議CKD患者有蛋白質熱量耗損的現象並以脂肪補充熱量時，脂肪建議攝取量為總熱量的25%至35%。其中SFAs應低於總熱量的7%，其中PUFAs不超過10%，單元不飽和脂肪酸(MUFAs)不超過20%，且每日膽固醇攝取量低於200毫克，並避免反式脂肪的攝取。此外，臨床研究支持，CKD患者可補充ω-3 PUFAs以降低CVD的風險。本篇綜論以實證觀點為基礎，介紹國際建議中對CKD患者的脂肪攝取建議量，並整合最近的臨床及流行病學研究結果，以提供CKD患者營養照護中有關脂肪攝取量的資訊，期能減緩CKD患者腎臟功能惡化及降恆PEW與併發症的發生。
並列摘要
When protein intake was restricted, patients with chronic kidney disease (CKD) should increase fat intake to provide energy and to prevent the occurrence of protein-energy waste (PEW). However, CKD patients habitually consumed excess and inadequate fat tended to increase risks of type 2 diabetes and cardiovascular diseases. According to the 2013 AHNACC Guideline on Lifestyle Management to Reduce Cardiovascular Bisk, adults should consume a diet that achieves less than 30% of calories from fat, including 5% to 6% of calories from saturated fatty acids (SFAs), 10% of calories from polyunsaturated fatty acids (PUFAs). and reduced trans-fatty acid consumption. The American Kidney Foundation suggests that CKD patients with PEW should consume a diet with 25% to 35% of calories from fat, including less than 7% of calories from SFAs. no more than 10% of calories from PUFAs, no more than 20% of calories from monounsaturated fatty acids (MUFAs), less than 200 mg of cholesterol, and avoiding the consumption of trans-fatty acids. In addition, the results of clinical studies support that CKD patients may consume e-a PUFAs to reduce the risk of cardiovascular disease. In this evidence-based review article, we introduced the suggestions of fat intake for CKD patients in different international guidelines and the results of recent clinical and epidemiological studies. We aimed to provide state-of-art information on fat consumption recommendation for CKD patients.