Duong Tuyen Van, Wong Te-Chih, Su Chien-Tien, Chen Hsi-Hsien, Chen Tzen-Wen, Chen Tso-Hsiao, Hsu Yung-Ho, Peng Sheng-Jeng, Kuo Ko-Lin, Liu Hsiang-Chung, Lin En-Tsu, Yang Shwu-Huey
School of Nutrition and Health Sciences, Taipei Medical University Department of Nutrition and Health Sciences, Chinese Culture University School of Public Health, Taipei Medical University Department of Family Medicine Department of Nephrology, Taipei Medical University Hospital School of Medicine, Taipei Medical University Department of Nephrology, Taipei Medical University-Wan Fang Hospital Division of Nephrology, Department of Internal Medicine, Taipei Medical University Shuang Ho Hospital, Taipei Medical University Division of Nephrology, Cathay General Hospital Division of Nephrology, Taipei Tzu-Chi Hospital, Taipei Department of Nephrology, Wei Gong Memorial Hospital, Miaoli Department of Nephrology, Lotung Poh-Ai Hospital, Yilan Nutrition Research Center, Taipei Medical University Hospital Research Center of Geriatric Nutrition, Taipei Medical University, Taipei, Taiwan.
Medicine (Baltimore). 2018 Jun;97(26):e11306. doi: 10.1097/MD.0000000000011306.
The current study was to examine the association of adequate intake of macronutrients and micronutrients with traditional and nontraditional cardiovascular risk factors in hemodialysis patients.A clinical cross-sectional study was conducted between September 2013 and April 2017 on 492 hemodialysis patients aged 20 years and above, received thrice-weekly hemodialysis treatment for at least 3 months, adequate dialysis quality (equilibrated Kt/V ≥ 1.2 g/kg/d) from 7 hospital-based hemodialysis centers in Taiwan. The dietary intake was evaluated by the 3-day dietary record, and a 24-hour dietary recall. Biochemical parameters were archived from laboratory tests. The cardiovascular disease (CVD) risk factors were defined by the Kidney Disease Outcomes Quality Initiative (K/DOQI) Clinical Practice Guidelines. The adequate dietary intake of macronutrients and micronutrients was recommended by the European Best Practice Guidelines, K/DOQI, and Institute of Medicine guidelines. Logistic regression analysis was used.All hemodialysis patients had CVD risks, the lowest proportion of patients with adequate intake of macronutrients and micronutrients were 8.7% and 1.8%, respectively. The adequate dietary intake associated with lower likelihood of having CVD risks in hemodialysis patient by 47% to 84%, including 39% to 58% lower hypertension, 37% to 50% lower dyslipidemia, 42% to 63% diabetes mellitus, 44% to 84% lower obesity, 58% lower low calcium, 38% lower hyperparathyroidism, 47% to 64% lower hyperhomocysteinemia, and 41% to 67% lower inflammation, 63% to 74% lower hypoalbumin, 73% lower inadequate normalized protein nitrogen appearance.Adequate dietary nutrients intake may reduce the cardiovascular risks factors, in turn, to prevent the cardiovascular morbidity and mortality.
本研究旨在探讨宏量营养素和微量营养素的充足摄入与血液透析患者传统及非传统心血管危险因素之间的关联。2013年9月至2017年4月，对492例年龄在20岁及以上、每周接受三次血液透析治疗至少3个月、透析质量良好（平衡Kt/V≥1.2g/kg/d）的台湾7家医院血液透析中心的患者进行了一项临床横断面研究。通过3天饮食记录和24小时饮食回顾来评估饮食摄入量。生化参数来自实验室检测存档。心血管疾病（CVD）危险因素根据肾脏病预后质量倡议（K/DOQI）临床实践指南定义。宏量营养素和微量营养素的充足饮食摄入量依据欧洲最佳实践指南、K/DOQI和医学研究所指南推荐。采用逻辑回归分析。所有血液透析患者均有CVD风险，宏量营养素和微量营养素摄入充足的患者比例分别低至8.7%和1.8%。充足的饮食摄入使血液透析患者发生CVD风险的可能性降低47%至84%，包括高血压降低39%至58%、血脂异常降低37%至50%、糖尿病降低42%至63%、肥胖降低44%至84%、低钙血症降低58%、甲状旁腺功能亢进降低38%、高同型半胱氨酸血症降低47%至64%、炎症降低41%至67%、低白蛋白血症降低63%至74%、蛋白氮表现未达标降低73%。充足的饮食营养素摄入可能降低心血管危险因素，进而预防心血管疾病的发病率和死亡率。
