Byrne Fiona, Gillman Barbara, Palmer Brendan, Kiely Mairead, Eustace Joseph, Kearney Patricia, Davidson Fred, Shiely Frances
Department of Nutrition & Dietetics, Cork, Cork University Hospital, Cork, T12 DC4A, Ireland.
Department of Renal Medicine, Cork University Hospital, Cork, T12 DC4A, Ireland.
HRB Open Res. 2021 Nov 10;4:119. doi: 10.12688/hrbopenres.13382.1. eCollection 2021.
Potential dietary strategies for controlling hyperphosphataemia include the use of protein sources with lower phosphorus bioavailability such as pulses and nuts, focus on phosphorus to protein ratios and the avoidance of all phosphate additives. We conducted a controlled crossover feeding study in 8 haemodialysis (HD) patients to investigate the acute postprandial effect of a modified versus standard low phosphorus diet for one day on serum phosphate, potassium and intact parathyroid levels in prevalent HD patients. Each participant consumed the modified diet on one day and the standard diet on a second day one week apart. The modified diet included beef and less dairy, with a lower phosphorus to protein ratio, as well as plant-based protein, whole grains, pulses and nuts containing phytates which reduces phosphorus bioavailability. Both diets were tailored for each participant to provide 1.1g protein/kg ideal body weight. Participants provided fasting bloods before breakfast, a pre-prandial sample before the lunch time main meal and samples at one-hour intervals for the four hours after the lunch time main meal, for analysis of phosphate, potassium and intact parathyroid hormone (iPTH). At four hours post the lunch time main meal on each study day, individuals on the modified diet had serum phosphate readings 0.30 mmol/l lower than when on the standard diet (p-value = 0.015, 95% confidence interval [CI] -0.57, -0.04). The corresponding change in serum potassium at four hours was a decrease of 0.675 mmol/l (p-value = 0.011, CI -1.25, -0.10). : Decreases in both serum phosphate and serum potassium readings on a modified low phosphorus diet encourage further larger studies to explore the possibility of greater food choice and healthier plant-based diets in HD patients. NCT04845724 (15/04/2021).
控制高磷血症的潜在饮食策略包括使用磷生物利用度较低的蛋白质来源，如豆类和坚果，关注磷与蛋白质的比例，并避免使用所有磷酸盐添加剂。我们对8名血液透析（HD）患者进行了一项对照交叉喂养研究，以调查改良低磷饮食与标准低磷饮食一天的急性餐后效应，对HD患者血清磷、钾和完整甲状旁腺水平的影响。每位参与者在一天食用改良饮食，在一周后的第二天食用标准饮食。改良饮食包括牛肉和较少的乳制品，磷与蛋白质的比例较低，以及含有植酸盐的植物性蛋白质、全谷物、豆类和坚果，这会降低磷的生物利用度。两种饮食都根据每位参与者的情况进行调整，以提供1.1g蛋白质/千克理想体重。参与者在早餐前提供空腹血液，在午餐主餐前提供餐前样本，并在午餐主餐后四小时内每隔一小时提供样本，用于分析磷、钾和完整甲状旁腺激素（iPTH）。在每个研究日午餐主餐后四小时，食用改良饮食的个体血清磷读数比食用标准饮食时低0.30 mmol/l（p值 = 0.015，95%置信区间[CI] -0.57，-0.04）。四小时时血清钾的相应变化是降低0.675 mmol/l（p值 = 0.011，CI -1.25，-0.10）。改良低磷饮食使血清磷和血清钾读数均降低，这鼓励开展进一步的大型研究，以探索HD患者有更多食物选择和更健康的植物性饮食的可能性。NCT04845724（2021年4月15日）
