Division of Nephrology, Department of Medicine, Federal University of São Paulo and Oswaldo Ramos Foundation-Hrim, São Paulo, Brazil.
Nutrition Graduation Program, Federal University of São Paulo, São Paulo, Brazil.
J Ren Nutr. 2018 Nov;28(6):403-410. doi: 10.1053/j.jrn.2017.10.005. Epub 2017 Dec 6.
The aims of the study were to evaluate the quality of the diet of nondialysis-dependent patients with chronic kidney disease and to investigate the impact of dietary counseling in the quality of the diet of these patients.
In the cross-sectional analysis, 3-day food records of 100 nondialysis-dependent patients with chronic kidney disease patients, in the first visit to the renal dietitians, were evaluated using the Diet Quality Index (DQI). Under-reporters were excluded. DQI is comprised by 10 components: 6 are food groups (fruits, vegetables, cereals, milk and dairy, meats and eggs, and legumes); 3 are nutrients (total fat, sodium, and cholesterol), and the last one is the diet variety. Each component is scored from 0 to 10, according to the adequacy of the Brazilian dietary guideline, and an overall score ranging from 0 (poor) to 100 (good) is obtained. In a subsample of 44 patients, a prospective analysis was performed to compare the DQI and its components before and after dietary counseling.
The median DQI score was 68.6 (62.3-75.6; interquartile range), which means that most of the patients (92%) had a diet that "needs improvement" (DQI between 50 and 80 points). The DQI components with the lowest scores (lower adequacy) were sodium (0.0 [0.0-0.9]), dairy (3.9 [2.1-6.0]), and vegetables (6.0 [2.8-9.5]), whereas meat/egg, legumes, and cholesterol had the highest scores. Vegetables, legumes, and diet variety components were significantly lower in the lower tertiles of DQI. After a median follow-up of 25.0 (17.0-35.8) months comprising 6 (5-10) visits to the dietitian, energy, protein, and micronutrients intake were significantly reduced. The dietary counseling did not improve the overall DQI (after: 69.0 [69.0-74.8]; P = .95) and, a significant reduction in the score of legumes (from 10.0 [2.7-10.0] to 7.8 [4.7-10.0], P = .00) and diet variety (from 7.0 [5.3-10.0] to 6.0 [4.0-9.0], P = .02) components were observed.
The diet of this cohort of patients needs to be improved, particularly regarding vegetables, food variety, and sodium intake. Dietary counseling had no positive impact on the diet quality. This result highlights the importance of focusing the dietary counseling not simply on nutrient or food restriction but providing healthy food choices aiming to improve the overall diet quality of the patients.
本研究旨在评估非透析依赖的慢性肾脏病患者的饮食质量，并探讨饮食咨询对这些患者饮食质量的影响。
在这项横断面分析中，对首次就诊于肾脏营养师的 100 名非透析依赖的慢性肾脏病患者的 3 天食物记录进行了评估，使用饮食质量指数（DQI）进行评估。排除低报告者。DQI 由 10 个部分组成：6 个是食物组（水果、蔬菜、谷物、牛奶和乳制品、肉类和蛋类、豆类）；3 个是营养素（总脂肪、钠和胆固醇），最后一个是饮食多样性。根据巴西饮食指南的充分性，每个成分的得分为 0 到 10 分，总分为 0（差）到 100（好）。在 44 名患者的亚样本中，进行了前瞻性分析，以比较饮食咨询前后的 DQI 和其成分。
中位 DQI 评分为 68.6（62.3-75.6；四分位间距），这意味着大多数患者（92%）的饮食“需要改进”（DQI 在 50 到 80 分之间）。得分最低（充分性较低）的 DQI 成分是钠（0.0 [0.0-0.9]）、乳制品（3.9 [2.1-6.0]）和蔬菜（6.0 [2.8-9.5]），而肉类/蛋类、豆类和胆固醇的得分最高。蔬菜、豆类和饮食多样性成分在 DQI 较低三分位的得分显著较低。中位随访 25.0（17.0-35.8）个月，包括 6（5-10）次就诊营养师，能量、蛋白质和微量营养素的摄入量显著减少。饮食咨询并没有改善整体 DQI（后：69.0 [69.0-74.8]；P =.95），豆类（从 10.0 [2.7-10.0]到 7.8 [4.7-10.0]，P =.00）和饮食多样性（从 7.0 [5.3-10.0]到 6.0 [4.0-9.0]，P =.02）的得分显著降低。
该队列患者的饮食需要改善，特别是蔬菜、食物多样性和钠的摄入量。饮食咨询对饮食质量没有积极影响。这一结果强调了关注饮食咨询不仅仅是营养或食物限制，而是提供健康的食物选择，以改善患者整体饮食质量的重要性。
