血液透析患者之血液透析飲食評量指標與心血管疾病危險因子相關性

美國腎臟病資料登錄系統（United States Renal Data System, USRDS）2012年報告中顯示，2010年台灣末期腎臟病的發生率位居世界第二，盛行率則為第一。32–42%血液透析患者死亡原因為心血管疾病。不正確的飲食攝取為導致心血管疾病的主要原因之一。飲食評量指標可以用來評估整體飲食，結合營養素和食物的概念，將飲食品質量化及分數化的工具，目前的飲食評量指標皆適用於一般健康成人，而血液透析患者對飲食品質要求不同於一般民眾。目的：研究以台灣百年版每日飲食指南及美國腎臟基金會對於血液透析（hemodialysis, HD）患者的飲食建議，制定出適合血液透析患者的血液透析飲食評量指標（HemoDialysis Eating Index, HDEI），並探討HDEI與血液透析患者心血管疾病（cardiovascular disease, CVD）危險因子相關性。材料與方法：本次研究為橫斷性研究，在台北醫學大學附設醫院及台北市立萬芳醫院血液透析中心進行招募，共招募108名受試者，男女分別各54名，收集受試者CVD危險因子及3天飲食資料，並計算HDEI分數。HDEI分數共計採納12項：蔬菜類、水果類、全榖根莖類、全穀、豆魚肉蛋類、高生理價蛋白質百分比、紅肉/白肉比、魚類、油脂類、富含飽和或反式脂肪酸食物、堅果類及綜合維生素使用，其中全榖根莖類、全穀、油脂類、富含飽和或反式脂肪酸食物滿分為五分，其餘為10分，總分範圍在5-100分，分數較高分即有較高的飲食品質。以SAS 9.3進行統計分析，當p < 0.05具有統計意義。結果：HDEI和血清白蛋白呈顯著正相關，與多數CVD危險因子無顯著相關性，但其各項目分數分別和CVD危險因子有相關性存在，蔬菜分數和心臟胸廓比呈顯著負相關，水果、油脂及綜合維生素使用分數和血清白蛋白呈顯著正相關，水果、全榖根莖類及富含飽和或反式脂肪酸食物分數和血清磷呈顯著負相關，富含飽和或反式脂肪酸食物和血清總膽固醇呈顯著負相關，追蹤兩個月後，HDEI高分組會降低總膽固醇濃度及增加血紅素濃度，並且有較低的低白蛋白血症風險。結論：HDEI總分及各項目可以反應台灣血液透析患者飲食的質與量，故建議HDEI可作為台灣HD患者預防CVD發生之飲食評量指標。

關鍵字

血液透析、心血管疾病、血液透析飲食評量指標

並列摘要

The United States Renal Data Systems (USRDS) 2012 reported that incidence of end stage renal disease in Taiwan is the second of the world and prevalence of end dtage renal disease in Taiwan is the highest of the world. Taiwan Society of Nephrology proposed that cardiovascular disease (CVD) is the first cause of death of hemodialysis (HD) patients in Taiwan, about 32-42%. Incorrected dietary intake is one of the reasons that lead to cardiovascular disease. The dietary index can be used to assess the overall diet, its combination of nutrients and food, and to quantify the quality of diet. The higher dietary index indicates the better quality diet and lower disease risk. However, hemodialysis patients’s diet quality recommendation is different from the general public. Most of dietary index assess the diet quality and quantity of general healthy population, not for HD patients. Purpose: In accordance with Taiwan Daily Food Guide (DOH, 2011) and HD dietary recommendation (NKF), we developed the HemoDialysis Eating Index (HDEI) to assess the diet quality and quantity of the HD patients. To study out the correlation between HemoDialysis Eating Index (HDEI) score and cardiovascular disease risk in hemodialysis patients. Subject and method: This is a cross-sectional study. One hundred and eight subjects (including 54 females and 54 males) were recruited in 2010 from Taipei Medical University Hospital and Wan Fang Hospital Hemodialysis Center, and collected subjects’ cardiovascular disease risk factor including blood pressure, fasting blood lipid profiles (total cholesterol, triglyceride), blood glucose, white blood cell count, nutritional status markers (albumin, creatinine, hemoglobin), calcium, phosphate, potassium and cardiothoracic ratio. To calculate HDEI scores according to subjects’ dietary data (1 dialysis day, 1 non-dialysis day and 1 weekend). HDEI scores is composed by 12 food components including vegetable, fruit, total grains, whole grain, high protein food, the percentage of high biological value protein food, red/white meat, fish, oil, wihout saturated fatty acid or trans fatty acid food, nuts, duration of multivitamin use. The score range is from 5 to 100, and the higher score, the better dietary quality. SAS 9.3 for windows was used for statistical analysis. p < 0.05 was considered significant. Result: The average HDEI score is 72.5. HDEI score significantly positive correlated with serum albumin level (p < 0.05). HDEI components in accordance with Taiwan Daily Food Guide (2011) and HD dietary recommendation (NKF), and each component of HDEI can response CVD risk factor. Those score of fruits, oil and duration of multivitamin use were significantly positive correlated with serum albumin level (p < 0.05). Score of fruits, total grains and saturated fatty acid or trans-fatty acid food were significantly negative correlated with serum phosphate level (p < 0.05). Score of saturated fatty acid or trans-fatty acid food were significantly negative correlated with serum total cholesterol level (p < 0.05). After 2 months, the higher score of HDEI decrease total cholesterol level, increase hemoglobin level and decrease hypoalbuminemia risk. Conclusion: HDEI response the quality and quantity of the diet in hemodialysis patients, and predict CVD risk factors.