血液透析患者营养状况调查（SNIPS）：糖尿病状态与营养不良风险。

Status of Nutrition In Hemodialysis Patients Survey (SNIPS): Malnutrition risk by diabetes status.

机构信息

Department of Nutrition Sciences, School of Health Sciences, Ariel University, Ariel, Israel.

Department of Nephrology, Rabin Medical Center, Beilinson Campus, Petah Tikvah, Israel.

出版信息

Diabet Med. 2021 Jun;38(6):e14543. doi: 10.1111/dme.14543. Epub 2021 Feb 24.

DOI:10.1111/dme.14543

PMID:33583032

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8248169/

Abstract

BACKGROUND

Increased malnutrition risk has been observed in more than 40% people on haemodialysis in Israel. It is not clear that this risk is homogeneously distributed among people with versus without diabetes.

OBJECTIVES

To examine the influence of diabetes on malnutrition risk among people on haemodialysis.

METHODS

This cross-sectional study included a representative sample of 375 individuals on haemodialysis treated in hospital dialysis centres throughout Israel. Of these, 126 had diabetes. Dietary intake, biochemistry, anthropometric and hemodynamic measures were recorded. Malnutrition risk categories were defined: "minimal": body mass index (BMI) ≥23 kg/m2 and serum albumin ≥38 mmol/L; "mild": BMI <23 kg/m2 and albumin ≥38 mmol/L; "moderate": BMI ≥23 kg/m2 and albumin <38 mmol/L; "severe": BMI<23 k/m2 and serum albumin <38 mmol/L. These categories were dichotomized to "minimal" versus elevated malnutrition risk.

RESULTS

Despite greater BMI, elevated malnutrition risk was identified in 58.8% of individuals with versus 39.3% without diabetes. Adherence to International Society for Renal Nutrition and Metabolism nutrition guidelines was poor regardless of diabetes status. In multivariable logistic regression analysis, diabetes: OR 2.15; C-reactive protein (nmol/L): OR 1.02; delivered dialysis dose (Kt/V): OR 6.07; and haemoglobin (g/L): OR 0.79, predicted elevated malnutrition risk, even after controlling for age, sex and years on haemodialysis.

DISCUSSION

Individuals on haemodialysis who have diabetes have elevated malnutrition risk compared to those without diabetes despite greater BMI.

摘要

背景

在以色列，超过 40%的血液透析患者存在营养风险增加。目前尚不清楚这种风险是否在有糖尿病和无糖尿病的患者中均匀分布。

目的

研究糖尿病对血液透析患者营养风险的影响。

方法

本横断面研究纳入了以色列各地医院透析中心接受血液透析治疗的 375 名代表性患者，其中 126 名患者患有糖尿病。记录了饮食摄入、生化指标、人体测量和血液动力学指标。营养风险类别定义为：“轻度”：体重指数（BMI）≥23kg/m2 且血清白蛋白≥38mmol/L；“中度”：BMI≥23kg/m2 且白蛋白<38mmol/L；“重度”：BMI<23kg/m2 且血清白蛋白<38mmol/L。这些类别被分为“轻度”和“升高的营养风险”。

结果

尽管 BMI 较高，但患有糖尿病的患者中，营养风险升高的比例为 58.8%，而无糖尿病的患者中为 39.3%。无论是否患有糖尿病，患者对国际肾脏营养与代谢学会的营养指南的依从性都很差。在多变量逻辑回归分析中，糖尿病（OR=2.15）、C 反应蛋白（nmol/L）（OR=1.02）、透析剂量（Kt/V）（OR=6.07）和血红蛋白（g/L）（OR=0.79）均预测了营养风险升高，即使在控制了年龄、性别和血液透析年限后也是如此。