Nakagawa Naoki, Koyama Satoshi, Maruyama Keisuke, Maruyama Jun-Ichi, Hasebe Naoyuki
Division of Cardiology and Nephrology, Department of Internal Medicine, Asahikawa Medical University, 2-1-1-1 Midorigaoka-Higashi, Asahikawa 078-8510, Hokkaido, Japan.
Department of Internal Medicine, Asahikawa Rehabilitation Hospital, Asahikawa 078-8510, Hokkaido, Japan.
Nutrients. 2024 Dec 11;16(24):4264. doi: 10.3390/nu16244264.
BACKGROUND/OBJECTIVES: Dietary protein intake can potentially influence renal function. This study aimed to elucidate the association between dietary protein supplementation and a decrease in the estimated glomerular filtration rate (eGFR) in Japanese stroke patients undergoing rehabilitation.
From July 2017 to June 2021, 60 patients undergoing post-stroke rehabilitation were randomly assigned to a rehabilitation alone or rehabilitation nutrition group, which received 120 g Reha-Time Jelly after each session. Both groups were followed up for 3 months. Serum nutritional markers (prealbumin and retinol-binding protein), muscle strength, body composition, renal function markers (eGFR based on creatinine [eGFR-Cr] and cystatin C [eGFR-Cys]), urinary protein-to-creatinine ratio (UPCR), and motor function (walking speed, 2-min walk distance, and chair stand test) were assessed at baseline and post-intervention.
Of the 60 participants (mean age: 70.2 ± 10.0 years), 39 were men (65.0%) and 19 (31.7%) had chronic kidney disease. Initial eGFR-Cr and eGFR-Cys values were 70.5 ± 17.2 and 66.6 ± 14.8 mL/min/1.73 m, respectively. After the intervention, the rehabilitation nutrition group demonstrated a significantly greater increase in body mass index (BMI) and a smaller decrease in bone mineral content than the rehabilitation alone group. However, no significant between-group differences were noted in serum marker levels or motor function, including grip strength and knee extensor strength, on the paralyzed and non-paralyzed sides. The change in chair stand test performance indicated a trend toward improvement in the rehabilitation nutrition group. No significant differences were observed in the changes in renal function.
A 3-month nutritional supplementation intervention may help increase BMI, preserve bone mineral content, and support physical activity levels in patients undergoing post-stroke rehabilitation without negatively affecting renal function.
背景/目的：膳食蛋白质摄入量可能会影响肾功能。本研究旨在阐明在接受康复治疗的日本中风患者中，补充膳食蛋白质与估计肾小球滤过率（eGFR）降低之间的关联。
2017年7月至2021年6月，60名中风后接受康复治疗的患者被随机分为单纯康复组或康复营养组，康复营养组每次康复治疗后服用120克康复时光果冻。两组均随访3个月。在基线和干预后评估血清营养标志物（前白蛋白和视黄醇结合蛋白）、肌肉力量、身体成分、肾功能标志物（基于肌酐的eGFR [eGFR-Cr]和胱抑素C [eGFR-Cys]）、尿蛋白与肌酐比值（UPCR）以及运动功能（步行速度、2分钟步行距离和起立试验）。
60名参与者（平均年龄：70.2±10.0岁）中，39名男性（65.0%），19名（31.7%）患有慢性肾脏病。初始eGFR-Cr和eGFR-Cys值分别为70.5±17.2和66.6±14.8 mL/min/1.73 m²。干预后，康复营养组的体重指数（BMI）显著增加，骨矿物质含量下降幅度小于单纯康复组。然而，两组在血清标志物水平或运动功能方面，包括瘫痪侧和非瘫痪侧的握力和膝伸肌力量，均未观察到显著差异。起立试验表现的变化表明康复营养组有改善趋势。肾功能变化方面未观察到显著差异。
为期3个月的营养补充干预可能有助于增加中风后康复患者的BMI、保留骨矿物质含量并支持身体活动水平，且不会对肾功能产生负面影响。
