Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, K56, Karolinska University Hospital Huddinge, S-141 86 Stockholm, Sweden.
Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden.
Br J Nutr. 2014 Jun 28;111(12):2184-9. doi: 10.1017/S0007114514000518. Epub 2014 Mar 17.
Energy intake and renal function decrease with age. In patients with chronic kidney disease (CKD), spontaneous food intake decreases in parallel with the loss of renal function. The objective of the present study was to evaluate a possible relationship between renal dysfunction and energy intake in elderly community-dwelling men. A cross-sectional study including 1087 men aged 70 years from the Uppsala Longitudinal Study of Adult Men (ULSAM) community-based cohort was carried out. Dietary intake was assessed using 7 d food records, and glomerular filtration rate was estimated from serum cystatin C concentrations. Energy intake was normalised by ideal body weight, and macronutrient intake was energy-adjusted. The median normalised daily energy intake was 105 (interquartile range 88-124) kJ, and directly correlated with estimated glomerular filtration rate (eGFR) as determined by univariate analysis. Across the decreasing quartiles of eGFR, a significant trend of decreasing normalised energy intake was observed (P = 0·01). A multivariable regression model including lifestyle factors and co-morbidities was used for predicting total energy intake. In this model, regular physical activity (standardised β = 0·160; P = 0·008), smoking (standardised β = -0·081; P = 0·008), hypertension (standardised β = -0·097; P = 0·002), hyperlipidaemia (standardised β = -0·064; P = 0·037) and eGFR (per sd increase, standardised β = 0·064; P = 0·04) were found to be independent predictors of energy intake. Individuals with manifest CKD (eGFR < 60 ml/min per 1·73 m²) were more likely to have lower energy intake than those without. In conclusion, there was a direct and independent correlation between renal function and energy intake in a population-based cohort of elderly men. We speculate on a possible link between renal dysfunction and malnutrition in the elderly.
能量摄入和肾功能随年龄增长而下降。在慢性肾脏病（CKD）患者中，随着肾功能的丧失，自发食物摄入量会平行下降。本研究的目的是评估肾功能障碍与老年社区居住男性能量摄入之间的可能关系。对来自乌普萨拉成人男性纵向研究（ULSAM）社区队列的 1087 名 70 岁男性进行了横断面研究。通过 7 天的食物记录评估饮食摄入，通过血清胱抑素 C 浓度估计肾小球滤过率。能量摄入通过理想体重标准化，宏量营养素摄入通过能量调整。中位数正常化每日能量摄入为 105（四分位距 88-124）kJ，与单变量分析确定的估计肾小球滤过率（eGFR）直接相关。在 eGFR 降低的四个四分位数中，观察到正常化能量摄入呈显著下降趋势（P=0.01）。使用包含生活方式因素和合并症的多变量回归模型来预测总能量摄入。在该模型中，有规律的体力活动（标准化β=0.160；P=0.008）、吸烟（标准化β=-0.081；P=0.008）、高血压（标准化β=-0.097；P=0.002）、高脂血症（标准化β=-0.064；P=0.037）和 eGFR（每标准差增加，标准化β=0.064；P=0.04）被认为是能量摄入的独立预测因子。有明显 CKD（eGFR <60 ml/min/1.73 m²）的个体比没有 CKD 的个体更有可能摄入较少的能量。总之，在一个基于人群的老年男性队列中，肾功能与能量摄入之间存在直接且独立的相关性。我们推测肾功能障碍与老年人营养不良之间可能存在联系。
