探討台灣地區血液透析患者熱量需要量

評估熱量需要量為醫學營養治療中制定熱量建議量的起始步驟。依美國腎臟學會（National Kidney Foundation, NKF）慢性腎臟疾病臨床指導原則（Kidney Disease Outcomes Quality Initiative, K/DOQI），血液透析（hemodialysis, HD）患者熱量建議量為 ˂ 60歲：35 kcal/kg/day、≥ 60歲：30 ~ 35 kcal/kg/day。因為台灣與歐美國家人種、飲食習慣及活動量情形不同，或許將適用於西方國家人種的K/DOQI指引應用於台灣地區HD患者身上有其不適切性。且先前文獻顯示台灣地區HD患者平均飲食熱量攝取量（dietary energy intake, DEI）普遍未達K/DOQI指引建議量，但仍無營養不良的情況。故本次研究目的為調查北部某醫學大學附屬的兩所醫院HD患者營養狀況、DEI及其影響因子，進而得出適用於台灣地區HD患者基本熱量需求量。本研究以橫斷型研究（Cross-sectional study）進行調查。研究通過台北醫學大學聯合人體試驗委員會申請審查。2010年8月到2011年3月進行收集。受試者召募於台北醫學大學附設醫院及台北市立萬芳醫院HD中心，收案期間（包含追蹤期2個月）由病歷回顧方式收集受試者基本資料、體位、血液生化數值、透析品質等測量值及3日飲食紀錄。本次共有108位受試者完成此研究，平均DEI為22.9 ± 8.0 kcal/kg/day。利用多重線性迴歸分析得年紀、性別、體重及飲食蛋白質攝取量為DEI顯著影響因子。研究結果得欲維持理想體重及良好營養狀況下，男性受試者平均基本熱量需要量為24.6 kcal/kg/day，女性受試者為21.0 kcal/kg/day。再以DEI達基本熱量需求量前提下，比較追蹤期與起始期營養相關指標，藉以推估此基本熱量需要量是否足以維持營養狀況，研究結果得追蹤期營養狀況指標無顯著低於起始期。其中年齡 ≥ 60歲的男性受試者在DEI達基本熱量需求量前提下，追蹤期的血清白蛋白値及老人營養風險指數（geriatric nutritional risk index, GNRI）皆高於起始期，具有增加趨勢（p = 0.083、p = 0.066）。結論：建議台灣地區HD患者基本熱量需要量為男性為24.6 kcal/kg/day、女性為21.0 kcal/kg/day。亦即HD患者在21~25kcal/kg/day時，可以維持理想體重及營養狀況。關鍵字：血液透析、熱量需要量、熱量需要量預測公式、營養狀況

關鍵字

血液透析；熱量需要量；熱量需要量預測公式；營養狀況

並列摘要

Assessment of energy requirements (ER) is a critical first step of nutrition therapy. American National Kidney Foundation (NKF) Kidney Disease Outcomes Quality Initiative (K/DOQI) guideline proposes that energy recommendation in hemodialysis (HD) patients: ˂ 60 years old 35 kcal/kg/day; ≥ 60 years old 30-35 kcal/kg/day. Most of Taiwan’s studies showed that averaged dietary energy intake (DEI) of HD patients were lower than K/DOQI guideline, but they were not in poor nutritional status. We hypothesis that K/DOQI guideline’s energy recommendation is not appropriate for Taiwan HD patients because of different ethnic, dietary habit and physical activity between Taiwanese and Americans. The aim of study is to estimate energy requirement of Taiwan HD patients. This is a cross-sectional study. Subjects recruited in 2010. Subjects’ demographic, anthropometric, and laboratory measurements data were obtained from chart review and dietary data were obtained from 3-days dietary records at baseline and follow-up of this study. A total number of 108 subjects have finished in this study. Averaged DEI is 22.9 ± 8.0 kcal/kg/day. By using DEI as dependent variable, and sex, age, weight (kg) and dietary protein intake (DPI) (kcal/kg/day) as independent variables of DEI in HD patients in the multiple linear regression analysis (R2 = 0.6598). Appropriate ER: (1) male 24.6 (kcal/kg/day) (2) female 21.0 (kcal/kg/day). Based on DEI reached appropriate ER, a comparison of nutritional parameters in baseline and follow-up were not significant differences. In ≥ 60 years old male, their Albumin values and geriatric nutritional risk index (GNRI) scores in follow-up were higher than in baseline, although it was not significant differences. Conclusion: We recommend energy requirement about 21-25 (kcal/kg/day) to maintain ideal body weight and well nutritional status in Taiwan HD patients. Key words: hemodialysis, energy requirement, equation of energy requirement, nutritional status