新北欧肾脏饮食对 3 期和 4 期慢性肾脏病患者的健康影响与习惯性饮食相比：一项随机试验。
Health effects of the New Nordic Renal Diet in patients with stage 3 and 4 chronic kidney disease, compared with habitual diet: a randomized trial.
机构信息
Department of Nephrology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
Department of Nephrology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
出版信息
Am J Clin Nutr. 2023 Nov;118(5):1042-1054. doi: 10.1016/j.ajcnut.2023.08.008. Epub 2023 Aug 19.
BACKGROUND
Chronic kidney disease (CKD) leads to an accumulation of waste products and causes adverse cardiometabolic effects.
OBJECTIVES
We investigated the health effects of the New Nordic Renal Diet (NNRD), a novel meal pattern reduced in phosphorus, protein, and sodium.
METHODS
A 26-wk randomized trial compared the NNRD with a habitual diet. The NNRD group received weekly home deliveries of food and recipes. Monthly study visits included fasting blood samples, 24-h urine samples, blood pressure, and anthropometric measurements. Intention-to-treat analysis used linear mixed-effects models.
RESULTS
Sixty patients, mean estimated glomerular filtration rate (eGFR) 34 mL/min/1.73 m and body mass index of 25-27 kg/m, were included and 58 completed. Metabolic syndrome was present in 53% (NNRD group) and 57% (control group). The NNRD group (n = 30) reduced their 24-h urine phosphorus excretion by 19% (-153 mg; 95% confidence interval [CI]: -210, -95), control group (n = 30) (no change), between-group difference -171 mg (95% CI: -233, -109; P < 0.001). Proteinuria was reduced by 39% in the NNRD group (-0.33 g/d; 95% CI: -0.47, -0.18), control group (no change), between-group difference -0.34 g/d (95% CI: -0.52, -0.17; P < 0.001). Plasma urea was reduced by -1.5 mmol/L in the NNRD group (95% CI: -2.1, -0.9), control group (no change), between-group difference -1.4 mmol/L (95% CI: -2.0, -0.7; P < 0.001). Systolic blood pressure fell by -5.2 mmHg in the NNRD group (95% CI: -8.4, -2.1), control group (no change), between-group difference -3.9 mmHg (95% CI; -7.6, -0.2; P = 0.04). The NNRD group lost -1.7 kg (95% CI: -2.6, -0.8), control group (no change), between-group difference -2.0 kg (95% CI: -3.0, -1.0; P < 0.001). There were no effects on eGFR during the 26-wk intervention.
CONCLUSION
NNRD in moderate CKD reduces phosphorus excretion, proteinuria, systolic blood pressure, and weight, mainly by reducing abdominal fat. This trial was registered at clinicaltrials.gov as NCT04579315.
背景
慢性肾脏病（CKD）导致废物堆积，并引起不良的心脏代谢影响。
目的
我们研究了新北欧肾脏饮食（NNRD）的健康效应，这是一种磷、蛋白质和钠含量降低的新型膳食模式。
方法
一项 26 周的随机试验比较了 NNRD 与习惯性饮食。NNRD 组每周接受家庭送餐和食谱。每月的研究访问包括空腹血样、24 小时尿液样本、血压和人体测量。意向治疗分析使用线性混合效应模型。
结果
共纳入 60 例估计肾小球滤过率（eGFR）为 34 mL/min/1.73 m 且体重指数为 25-27 kg/m 的患者，其中 58 例完成了研究。53%（NNRD 组）和 57%（对照组）的患者存在代谢综合征。与对照组相比，NNRD 组（n=30）的 24 小时尿磷排泄减少了 19%（-153 mg；95%置信区间 [CI]：-210，-95），对照组（n=30）无变化，组间差异为-171 mg（95% CI：-233，-109；P<0.001）。与对照组相比，NNRD 组的蛋白尿减少了 39%（-0.33 g/d；95% CI：-0.47，-0.18），对照组无变化，组间差异为-0.34 g/d（95% CI：-0.52，-0.17；P<0.001）。与对照组相比，NNRD 组的血浆尿素降低了 1.5 mmol/L（95% CI：-2.1，-0.9），对照组无变化，组间差异为-1.4 mmol/L（95% CI：-2.0，-0.7；P<0.001）。与对照组相比，NNRD 组的收缩压降低了 5.2 mmHg（95% CI：-8.4，-2.1），对照组无变化，组间差异为-3.9 mmHg（95% CI；-7.6，-0.2；P=0.04）。NNRD 组体重减轻了 1.7 公斤（95% CI：-2.6，-0.8），对照组无变化，组间差异为 2.0 公斤（95% CI：-3.0，-1.0；P<0.001）。在 26 周的干预期间，eGFR 没有变化。
结论
中重度 CKD 患者采用 NNRD 可减少磷排泄、蛋白尿、收缩压和体重，主要通过减少腹部脂肪。该试验在 clinicaltrials.gov 注册为 NCT04579315。
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