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非透析慢性肾脏病患者肥胖的营养评估和医学膳食治疗:内分泌学家、营养师和肾脏病学家实用指南。意大利内分泌学会(SIE)、俱乐部营养-激素和代谢工作组;意大利营养保健品学会(SINut)、酮饮食和营养保健品“KetoNut-SINut”俱乐部;以及意大利肾脏病学会(SIN)的共识声明。

Nutritional assessment and medical dietary therapy for management of obesity in patients with non-dialysis chronic kidney disease: a practical guide for endocrinologist, nutritionists and nephrologists. A consensus statement from the Italian society of endocrinology (SIE), working group of the club nutrition-hormones and metabolism; the Italian society of nutraceuticals (SINut), club ketodiets and nutraceuticals "KetoNut-SINut"; and the Italian society of nephrology (SIN).

机构信息

Facoltà di Scienze Umane, della Formazione e dello Sport, Università Telematica Pegaso, Via Porzio, Centro Direzionale, Isola F2, 80143, Naples, Italy.

Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy.

出版信息

J Endocrinol Invest. 2024 Dec;47(12):2889-2913. doi: 10.1007/s40618-024-02446-8. Epub 2024 Sep 18.

Abstract

PURPOSE

Chronic kidney disease (CKD) is a serious health concern with an estimated prevalence of about 13.4% worldwide. It is cause and consequence of various comorbidities, including cardiovascular diseases. In parallel, common pathological conditions closely related to ageing and unhealthy dietary habits increase the risk of CKD development and progression, including type 2 diabetes and obesity. Among these, obesity is either independent risk factor for new onset kidney disease or accelerates the rate of decline of kidney function by multiple mechanisms. Therefore, the role of diets aimed at attaining weight loss in patients with obesity is clearly essential to prevent CKD as to slow disease progression. Various dietary approaches have been licensed for the medical dietary therapy in CKD, including low-protein diet and Mediterranean diet. Interestingly, emerging evidence also support the use of low-carbohydrate/ketogenic diet (LCD/KD) in these patients. More specifically, LCD/KDs may efficiently promote weight loss, improve metabolic parameters, and reduce inflammation and oxidative stress, resulting in a dietary strategy that act globally in managing collateral conditions that are directly and indirectly related to the kidney function.

CONCLUSION

This consensus statement from the Italian Society of Endocrinology (SIE), working group of the Club Nutrition - Hormones and Metabolism; the Italian Society of Nutraceuticals (SINut), Club Ketodiets and Nutraceuticals "KetoNut-SINut"; and the Italian Society of Nephrology (SIN) is intended to be a guide for Endocrinologist, Nutritionists and Nephrologist who deal with the management of patients with obesity with non-dialysis CKD providing a practical guidance on assessing nutritional status and prescribing the optimal diet in order to best manage obesity to prevent CKD and its progression to dialysis.

摘要

目的

慢性肾脏病(CKD)是一个严重的健康问题,全球估计患病率约为 13.4%。它是各种合并症的原因和后果,包括心血管疾病。与此同时,与衰老和不健康饮食习惯密切相关的常见病理状况增加了 CKD 发展和进展的风险,包括 2 型糖尿病和肥胖症。在这些疾病中,肥胖症是新发肾脏疾病的独立危险因素,或者通过多种机制加速肾功能下降的速度。因此,对于肥胖症患者,旨在实现体重减轻的饮食作用显然对于预防 CKD 和减缓疾病进展至关重要。已经有多种饮食方法被许可用于 CKD 的医学饮食治疗,包括低蛋白饮食和地中海饮食。有趣的是,新出现的证据也支持在这些患者中使用低碳水化合物/生酮饮食(LCD/KD)。更具体地说,LCD/KD 可以有效地促进体重减轻、改善代谢参数、减轻炎症和氧化应激,从而形成一种饮食策略,在管理与肾功能直接和间接相关的并发疾病方面具有全局作用。

结论

本共识声明由意大利内分泌学会(SIE)、营养-激素和代谢俱乐部的工作组;意大利营养学会(SINut)、生酮饮食和营养学会“KetoNut-SINut”;以及意大利肾脏病学会(SIN)共同制定,旨在为处理非透析 CKD 肥胖患者的内分泌科医生、营养师和肾病学家提供指导,就评估营养状况和开出处方的最佳饮食方法提供实用指导,以最佳管理肥胖症,预防 CKD 及其进展至透析。

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