Department of Clinical and Experimental Medicine, University of Pisa, 56125 Pisa, Italy.
Postgraduate School of Nephrology, Vita Salute San Raffaele University, 20121 Milan, Italy.
Nutrients. 2021 Sep 27;13(10):3396. doi: 10.3390/nu13103396.
The correct management of energy intake is crucial in CKD (chronic kidney disease) patients to limit the risk of protein energy wasting especially during low-protein regimes, but also to prevent overweight/obesity. The aim of this study was to assess the energy requirement of older CKD patients using objective measurements. This cross-sectional study enrolled 67 patients (aged 60-86 years) with CKD stages 3-5 not on dialysis, all of whom were metabolically and nutritionally stable. All patients underwent indirect calorimetry and measurement of daily physical activity level expressed by the average daily Metabolic Equivalent Task, using an accelerometer, in order to measure total energy expenditure (mTEE). Estimated TEE (eTEE) was derived from predictive equations for resting energy expenditure and physical activity levels coefficients. The mTEE were lower than eTEE-based on Harris-Benedict or Schofield or Mifflin equations (1689 ± 523 vs. 2320 ± 434 or 2357 ± 410 or 2237 ± 375 Kcal, < 0.001, respectively). On average mTEE was 36.5% lower than eTEE. When eTEE was recalculated using ideal body weight the gap between mTEE and eTEE was reduced to 26.3%. A high prevalence of a sedentary lifestyle and reduced physical capabilities were also detected. In conclusion, our data support the energy intake of 25-35 Kcal/Kg/d recently proposed by the NKF-KDOQI (National Kidney Foundation-Kidney Disease Improving Quality Initiative) guidelines on nutritional treatment of CKD, which seem to be more adequate and applicable than that of previous guidelines (30-35 Kcal/Kg/d) in elderly stable CKD patients with a sedentary lifestyle. According to our findings we believe that an energy intake even lower than 25 Kcal/Kg/d may be adequate in metabolically stable, elderly CKD patients with a sedentary lifestyle.
能量摄入的正确管理对于慢性肾脏病（CKD）患者至关重要，以限制蛋白质能量消耗的风险，尤其是在低蛋白饮食期间，但也要预防超重/肥胖。本研究的目的是使用客观测量方法评估老年 CKD 患者的能量需求。这项横断面研究纳入了 67 名（年龄 60-86 岁）非透析的 CKD 3-5 期患者，所有患者代谢和营养状态均稳定。所有患者均接受间接热量测定和使用加速度计测量日常体力活动水平（以平均日常代谢当量任务表示），以测量总能量消耗（mTEE）。估计的总能量消耗（eTEE）是根据静息能量消耗和体力活动水平系数的预测方程推导出来的。mTEE 低于基于 Harris-Benedict、Schofield 或 Mifflin 方程的 eTEE（分别为 1689 ± 523 比 2320 ± 434 或 2357 ± 410 或 2237 ± 375 Kcal，均<0.001）。平均而言，mTEE 比 eTEE 低 36.5%。当使用理想体重重新计算 eTEE 时，mTEE 与 eTEE 之间的差距缩小到 26.3%。还检测到久坐的生活方式和体力活动能力下降的高患病率。总之，我们的数据支持最近由 NKF-KDOQI（美国国家肾脏基金会-肾脏疾病改善质量倡议）指南提出的 CKD 营养治疗中 25-35 Kcal/Kg/d 的能量摄入，这似乎比以前的指南（30-35 Kcal/Kg/d）更适合和适用于久坐的老年稳定 CKD 患者。根据我们的发现，我们认为对于代谢稳定、久坐的老年 CKD 患者，即使摄入低于 25 Kcal/Kg/d 的能量也可能足够。
