| 特集名 | 透析患者のるいそう | |
|---|---|---|
| 題名 | 保存期の低蛋白食は栄養状態を悪化させるか | |
| 発刊年月 | 2000年 04月 | |
| 著者 | 水入 苑生 | 東邦大学医学部腎臓学教室 |
| 著者 | 酒井 謙 | 東邦大学医学部腎臓学教室 |
| 【 要旨 】 | 保存期低蛋白食は低栄養を生じるか? という疑問は，低アルブミン血症は血液透析患者の死病率を高めることから起こっている．しかし，われわれの検討では保存期低蛋白食は透析導入1年目までの観察で蛋白摂取量，栄養指標(アルブミン，TG,BMI，体脂肪率)に悪影響を与えなかった．さらに，Walserらによると生存率は透析導入2年目までの観察で低蛋白食は栄養状態に悪影響せず，実質的には通常より良好であった．低蛋白食，超低蛋白食ともNバランスは0に保つことができる．大規模なMDRD Study(n=840)は低蛋白食の妥当性を示した．MDRD Studyでは超低蛋白食群を含め全体的に3年間の観察期間中，生化学的・身体的栄養指標は良好であった．慢性腎不全患者での保存期低蛋白食を成功させるには，ほかの栄養素(エネルギー，アミノ酸)が十分含まれていることと，摂食量，栄養指標の定期的なモニタリングが重要である． | |
| Theme | Emaciation in Chronic Dialysis Patients | |
|---|---|---|
| Title | Do low protein diets cause malnutrition? | |
| Author | Sonoo Mizuiri | Department of Nephrology, Toho University School of Medicine |
| Author | Ken Sakai | Department of Nephrology, Toho University School of Medicine |
| [ Summary ] | Do low protein diets cause malnutrition? This question arises from the observation that hypoaluguminemia is associated with an increased mortality risk in hemodialysis patients. However, our observations showed that a pre-dialysis low protein diet did not affect dietary protein intake and nutritional parameters (alubumin, TG, BMI, Fat) during the first year of dialysis. Furthermore, reports by Walser et al. showed that survival rates during the first two years of dialysis were not adversely affected by a low protein diet and they were substatially better than survival rates reported nationwide. It is reported that either an usually low protein diet (0.6g/kg/day) or a very low protein diet (0.3g/kg/day) with essential amino acids or keto acids in patients with chronic renal failure showed neutral nitrogen balances. The largest study on dietary protein restriction (n=840) : "Modification of Diet in Renal Disease (MDRD)" study have confirmed the adequacy of protein restricted diets. Biochemical and anthropometric indices of nutritional status during follow ups (for three years) were generally well within normal limits in all MDRD study groups including patients on very low protein diets. The successful use of a low protein diet by patients with chronic renal failure (CRF) depends on ensuring that the requirements for other nutrients (energy and essential amino acids) are included and there is regular monitoring of dietary intake and nutritional status. |
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