營養教育合併黃豆蛋白營養品補充改善腹膜透析個案營養狀態

蛋白質－熱量營養不良（Protein-energy malnutrition; PEM）頻繁發生於接受腹膜透析治療的病患。本報告個案為一位66歲女性接受腹膜透析已逾六年，長期營養狀況不佳且已使用胺基酸透析液（Nutrineal®）未有明顯改善，由腹膜透析品質改善計畫小組轉介給營養師，營養師評估後發現病患平日飲食熱量20 kcal/kg，蛋白質約0.6 g/kg，其長期營養不良狀態推測為飲食攝取量不足所導致，遂進行營養衛教以及讓病患補充黃豆蛋白營養品。介入初期，個案因飲用營養品而減少食用正餐頻率，導致整體攝食量以及血清白蛋白不升反降，營養師再重新調整衛教方式後，明確建議個案補充營養品時需與正餐相隔至少2小時，以免影響到食慾與正餐進食量，次月再度追蹤，個案整體進食量提升，第三個月飲食熱量攝取量提升至26 kcal/kg，蛋白質攝取量提升至1.07 g/ kg，血清白蛋白穩定上升，三個月後達到了目標值血清白蛋白≧3 mg/dL。

關鍵字

腹膜透析；黃豆蛋白；蛋白質－熱量營養不良

並列摘要

Protein-energy malnutrition is a prevalent problem in patients receiving peritoneal dialysis. We report a case of a 66-year-old woman who had received peritoneal dialysis for more than 6 years and had severe chronic malnutrition. Use of an amino acid-based peritoneal dialysis solution (Nutrineal) showed limited improvement of her nutritional status. To achieve satisfactory nutritional intake and a healthy nutritional status, she was referred to a dietitian by the ＂peritoneal dialysis care quality team＂. Dietitians assess insufficient caloric and protein intake of the daily diet (20 kcal/kg/body weight (BW) calories, 0.6 g/kg/BW protein). Nutrition education was carried out, and soy protein supplements were provided. In the beginning, she took soy protein supplements but had a reduced meal frequency, which resulted in a decrease in the total daily food intake and a depressed serum albumin level. We implemented nutrition re-education and recommended taking soy protein supplements 2 h after a meal, to avoid affecting her appetite and food intake. The next month, the total daily intake, including the number of calories and the amount of protein, had increased. After 3 months, calories had increased to 26 kcal/kg/BW, protein had increased to 1.06 g/kg/BW, and the serum albumin level had steadily risen to more than 3.0 mg/dl.

並列關鍵字

peritoneal dialysis ； soy protein ； protein-energy malnutrition

國際替代計量

營養教育合併黃豆蛋白營養品補充改善腹膜透析個案營養狀態

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