探討門診鼻咽癌患者接受營養介入後蛋白質及非蛋白質熱量的攝取變化與體重變化之間的關係

The Relationship Between Protein and Non-Protein Calories Intake and Body Weight Changes in Outpatients With Nasopharyngeal Carcinoma After Receiving Counseling

張佑寧(Yu-Ning Chang)

《臺灣膳食營養學雜誌》 12卷1期 (2020/06) Pp. 13-23

https://doi.org/10.6709/TJD.202006_12(1).0002

摘要

在接受放射治療的鼻咽癌病人中，經常遭遇許多的治療副作用，並導致進食量下降。同時若觀察到因營養攝取不足導致的體重流失，通常可能表示病況較嚴重。然而有許多病人在癌症確診後，會特別針對肉類等高蛋白質食物有禁忌的情況。本研究以病歷回溯方式，收集2012年1月1日～2017年12月31日間曾於「癌症病人營養門診」接受營養諮詢的鼻咽癌病人資料，探討營養師營養介入前後，蛋白質、非蛋白質熱量的攝取量及體重彼此間之相關性。結果有169人納入分析，結果顯示複診平均非蛋白質熱量攝取量與每日蛋白質攝取量呈現正相關趨勢，但未達到統計上顯著差異（β=0.217,p=0.005）。複診平均每日蛋白質攝取量與最終次門診及初診之體重變化百分比呈現正相關（β=0.168,p=0.029）；複診平均每日非蛋白質熱量攝取量與最終次門診及初診間之體重變化百分比呈現正相關（β=0.370,p＜0.001）。綜合分析結果顯示，複診平均每日蛋白質攝取量在非蛋白質熱量攝取量與最終次門診及初診間體重變化百分比中具有中介效果。因此初診加強衛教高蛋白飲食原則，可讓病人在治療期間仍可以維持蛋白質的攝取，也可以間接提升非蛋白質熱量的攝取量及降低總熱量攝取的減少幅度。且接受放射治療的病人在治療過程中，會有非蛋白質熱量攝取量下降的狀況，若病人前來複診，且出現進食量下降、體重下降等狀況時，可再依病人情況加強高熱量的飲食指導。

關鍵字

鼻咽癌 ； 營養門診 ； 蛋白質攝取量 ； 非蛋白質熱量 ； 體重變化

並列摘要

Patients with nasopharyngeal cancer who undergo radiotherapy often experience many side effects from treatment and decreased eating. If weight loss due to inadequate nutrient intake is observed, it may indicate a more serious condition. However, there are many patients who, after cancer diagnosis, are restricted from high-protein foods, such as meat. In this study, we collected retrospective medical records of nasopharyngeal cancer patients who had received nutrition consultation at the ＂Nutrition Clinic for Cancer Patients＂ during 2012/1/1 and 2017/12/31 to investigate correlations between protein and non-protein caloric intake, and body weight before and after nutritional intervention by dietitians. The analysis included 169 patients. There was a positive correlation between the average non-protein caloric intake and daily protein intake during follow-up visits, which did not reach statistical significance (β = 0.217, p = 0.005). The percent change in weight between the initial visit and the last visit was positively correlated with both the mean daily protein intake (β = 0.168, p = 0.029) and the mean daily non-protein caloric intake (β = 0.370, p ＜ 0.001) recorded at the last follow-up visit. While we observed a decrease in non-protein caloric intake in patients who had undergone radiotherapy, the analysis showed that the average daily protein intake recorded at follow-up visits had a mediating effect on non-protein caloric intake and percent change in weight between the last visit and the initial visit. Therefore, reinforcing the principles of a high-protein diet at the initial visit will encourage patients to maintain protein intake during treatment, and will indirectly increase non-protein caloric intake and reduce the percent decrease in total caloric intake. When a patient comes in for a follow-up visit and has experienced a decrease in eating and weight loss, the patient can be advised to follow a higher calorie diet.

並列關鍵字

nasopharyngeal carcinoma ； nutrition consultation ； protein intake ； non-protein calories intake ； body weight changes