Cunningham Sue E D, Verkaik Darlene, Gross Georgiana, Khazim Khalid, Hirachan Padam, Agarwal Gurav, Lorenzo Carlos, Matteucci Elena, Bansal Shweta, Fanti Paolo
Divisions of Nephrology, University of Texas Health Science Center San Antonio, San Antonio, Texas School of Health Professions, University of Texas Health Science Center San Antonio, San Antonio, Texas.
Audie L. Murphy Veterans Memorial Hospital, STVHCS, San Antonio, Texas.
Nutr Clin Pract. 2015 Oct;30(5):698-708. doi: 10.1177/0884533615575046. Epub 2015 Apr 21.
U.S. military veterans have high rates of chronic disease and social disadvantage, which are risk factors for protein-energy wasting (PEW). It is not known whether this translates into high prevalence of PEW in veterans with end-stage renal disease.
We compared the clinical, socioeconomic, and nutrition status and the diet of 33 veteran and 38 nonveteran clinically stable patients receiving maintenance hemodialysis (MHD) in south-central Texas.
The whole cohort included 82% Mexican Americans (MAs), 72% type 2 diabetics, and 73% males. The body mass index was 28.9 ± 6.2, while energy intake was 21.5 ± 8.2 kcal/kg/d and protein intake was 1.0 ± 0.4 g/kg/d. Serum albumin (bromocresol purple) was 3.5 ± 0.4 g/dL, transferrin was 171.9 ± 27.8 mg/d, C-reactive protein was 2.9 (1.4-6.5) mg/L, interleukin-6 (IL-6) was 8.3 (4.2-17.9) pg/mL, neutrophil gelatinase-associated lipocalin was 729 (552-1256) ng/mL, and the malnutrition-inflammation score was 8.8 ± 3.0. In group comparison that adjusted for sex and ethnicity, the veterans had better household income, less MAs (60% vs 100%), more males (94% vs 55%), more use of a renin-angiotensin-aldosterone system blockade (66% vs 33%), and lower IL-6 levels (4.4 [3.1-5.8] vs 15.4 [8.3-20.5] pg/mL; P = .01) than nonveterans. In regression analysis, the lower serum IL-6 level in veterans was independently explained by dialysis clinic, sex, and, possibly, household income (intermediate significance).
In a relatively small cohort of clinically stable MHD patients, the veterans showed equivalent nutrition status and dietary intake and less inflammation than the nonveterans, thus not supporting the possibility that veteran MHD patients may have worse nutrition than the nonveteran counterpart.
美国退伍军人慢性病发病率高且处于社会劣势，这些都是蛋白质 - 能量消耗（PEW）的风险因素。目前尚不清楚这是否会导致终末期肾病退伍军人中PEW的高患病率。
我们比较了德克萨斯州中南部33名接受维持性血液透析（MHD）的退伍军人和38名非退伍军人临床稳定患者的临床、社会经济和营养状况以及饮食情况。
整个队列中82%为墨西哥裔美国人（MAs），72%为2型糖尿病患者，73%为男性。体重指数为28.9±6.2，能量摄入量为21.5±8.2千卡/千克/天，蛋白质摄入量为1.0±0.4克/千克/天。血清白蛋白（溴甲酚紫法）为3.5±0.4克/分升，转铁蛋白为171.9±27.8毫克/分升，C反应蛋白为2.9（1.4 - 6.5）毫克/升，白细胞介素 - 6（IL - 6）为8.3（4.2 - 17.9）皮克/毫升，中性粒细胞明胶酶相关脂质运载蛋白为729（552 - 1256）纳克/毫升，营养不良 - 炎症评分为8.8±3.0。在对性别和种族进行调整的组间比较中，退伍军人的家庭收入更高，MAs比例更低（60%对100%），男性比例更高（94%对55%），肾素 - 血管紧张素 - 醛固酮系统阻滞剂的使用更多（66%对33%），且IL - 6水平更低（4.4[3.1 - 5.8]对15.4[8.3 - 20.5]皮克/毫升；P = 0.01）。在回归分析中，退伍军人较低的血清IL - 6水平可由透析诊所、性别以及可能的家庭收入独立解释（具有中等显著性）。
在一个相对较小的临床稳定的MHD患者队列中，退伍军人的营养状况和饮食摄入量与非退伍军人相当，且炎症较轻，因此不支持退伍军人MHD患者营养状况可能比非退伍军人更差的可能性。
