| 特集名 | 合併症を伴う透析患者の栄養指導 | |
|---|---|---|
| 題名 | 肥満と痩せ | |
| 発刊年月 | 1998年 12月 | |
| 著者 | 水入 苑生 | 東邦大学医学部附属大森病院腎臓科 |
| 著者 | 森本 修三 | 東邦大学医学部附属大森病院栄養部 |
| 【 要旨 】 | 透析患者は一般的に蛋白・エネルギー不足である．低栄養は患者の罹病率，死亡率を増す．透析患者の肥満はまれではあるが存在する．CAPDでは，腹膜からの糖吸収による体脂肪の増加による体重増加がある．慢性維持透析患者では高トリグリセリド血症とHDLコレステロールの低下がある．肥満は慢性腎不全自体以上に脂質代謝異常を悪化させる． HD患者，CAPD患者とも健常者に比し蛋白必要量は多いがエネルギー必要量は差異がない，透析患者のエネルギー必要量としては35kcal/kg/dayが勧められているが，BMI 15以下の痩せではそれ以上必要であり，BMI22以上の肥満者では制限を要する．また，身体活動量によっても必要エネルギー量を変えていく必要性がある． |
|
| Theme | Nutritional Guidance for Hemodialysis Patients with Complications | |
|---|---|---|
| Title | Obesity and leanness | |
| Author | Sonoo Mizuiri | Department of Nephrology, Ohmori Hospital, Toho University School of Medicine |
| Author | Shuzo Morimoto | Department of Nutrition, Ohmori Hospital, Toho University School of Medicine |
| [ Summary ] | Protein and energy malnutrition are common in dialysis patients. Signs of malnutrition are strongly associated with increased morbidity and mortality. Obesity is not a feature of dialysis patients but is observed. In CAPD, a significant increase in body weight, derived from peritoneal glucose absorption was observed, mainly due to a rise in fat mass. In subjects on chronic dialysis, the lipid profile is characterized by hypertriglyceridemia accompanied by reduced high-density lipoprotein (HDL) cholesterol. Obesity is a more potent factor than renal failure as a cause of deteriorating lipid profiles. The requirements for protein are increased in both HD and CAPD patients, whereas energy requirements are not different from those of healthy subjects. Recommended energy intake for dialysis patients is 35kcal/kg/day. However, energy requirements depend on the level of physical activity. Higher intake is necessary if the BMI is below 15. Obese patients whose BMI is above 22 should limit their energy intake. Energy requirements also depend on the level of physical activity. |
|