Calegari Adaiane, Barros Elvino Guardão, Veronese Francisco Veríssimo, Thomé Fernando Saldanha
Instituto de Doenças Renais, Brazil.
J Bras Nefrol. 2011 Dec;33(4):394-401.
Malnutrition is multifactorial and may be modified by nutritional intervention. We aimed to assess the impact of an intervention on the nutritional status of malnourished hemodialysis patients and their acceptance of a non-industrialized nutritional supplement.
18 patients were studied, they were selected from a previous nutritional assessment where nutritional risk was defined as: subjective global assessment > 15 plus one criterion for malnutrition. The following variables were assessed: anthropometric parameters, subjective global assessment, dietary intake, six-minute walking test, quality of life (SF-36), and biochemical tests. Patients were randomized to either Control or Intervention Groups. The Intervention Group received a dietetic supplement during dialysis containing 355 kcal, prepared from simple ingredients. After three months, subjects from the Control Group and other patients also considered at nutritional risk underwent the same intervention. The study groups were compared after three months, and all patients were analyzed before and after the intervention.
Fifteen men and three women, aged 56.4 ± 15.6 years-old, nine in each group, were studied. The Intervention Group showed an improvement in the subjective global assessment (p = 0.04). There were differences in role physical and bodily pain domains of SF-36, with improvement in the Intervention Group and worsening in the Control Group (p = 0.034 and p = 0.021). Comparisons before and after intervention for all patients showed improvement in the subjective global assessment (16.18 ± 4.27 versus 14.37 ± 4.20, p = 0.04), and in the six-minute walking test (496.60 ± 132.59 versus 547.80 ± 132.48 m; p = 0.036). The nutritional supplement was well tolerated by all patients, and it did not cause side effects.
The nutritional intervention improved the subjective global assessment and quality of life of hemodialysis patients at short-term. A global intervention by a dietitian produced specific and nonspecific positive effects in the whole group. Nutritional supplementation was feasible, palatable, and had low cost. Its clinical impact and effectiveness need to be further assessed in a larger group of patients at long-term.
营养不良是多因素导致的，可能会通过营养干预得到改善。我们旨在评估一种干预措施对营养不良的血液透析患者营养状况的影响以及他们对一种非工业化营养补充剂的接受程度。
对18名患者进行了研究，他们是从之前的营养评估中选取的，其中营养风险被定义为：主观全面评定>15分加上一项营养不良标准。评估了以下变量：人体测量参数、主观全面评定、饮食摄入量、六分钟步行试验、生活质量（SF-36）和生化检查。患者被随机分为对照组或干预组。干预组在透析期间接受一种由简单成分制成的含有355千卡热量的饮食补充剂。三个月后，对照组的受试者以及其他也被认为有营养风险的患者接受了相同的干预。三个月后对研究组进行比较，并对所有患者在干预前后进行分析。
研究对象为15名男性和3名女性，年龄56.4±15.6岁，每组9人。干预组的主观全面评定有所改善（p=0.04）。SF-36的角色身体和身体疼痛领域存在差异，干预组有所改善而对照组恶化（p=0.034和p=0.021）。所有患者干预前后的比较显示主观全面评定有所改善（16.18±4.27对14.37±4.20，p=0.04），六分钟步行试验也有所改善（496.60±132.59对547.80±132.48米；p=0.036）。所有患者对营养补充剂耐受性良好，且未引起副作用。
营养干预在短期内改善了血液透析患者的主观全面评定和生活质量。营养师进行的全面干预在整个组中产生了特定和非特定的积极效果。营养补充是可行的、可口的且成本低。其临床影响和有效性需要在更大规模的患者群体中进行长期进一步评估。
