臨牀透析 Vol.26 No.13(2-7)


特集名 身体所見からのCKD患者の栄養評価の重要性
題名 [各論]身体計測による評価
発刊年月 2010年 12月
著者 熊谷 裕通 静岡県立大学食品栄養科学部臨床栄養学研究室
【 要旨 】 慢性腎臓病患者の栄養評価を適切に行うためには身体計測が必要である.身体計測法では,身長,体重,肥満度(BMI),上腕筋面積などを計測する.これらは簡単な器具があればいつでもどこでも測定できる.二重エネルギーX線吸収法(DEXA法)は,体幹と四肢の脂肪量,除脂肪量,骨塩量を正確に測定でき,ほかの方法の基準となる測定法である.生体電気インピーダンス(BIA)法も,体内総水分量,除脂肪量,体脂肪量を比較的正確に測定できるが,水分量が変動する慢性腎臓病患者では精度が劣る可能性がある.X線CT法は,内臓脂肪や皮下脂肪の測定に有用であるほか,筋肉量の測定にも用いられる.いずれの方法も,経時的な栄養評価には十分実用になる.
Theme Importance of Nutritional Assessment by Physical Examination in CKD
Title Anthropometric measurements and assessments of body composition
Author Hiromichi Kumagai Department of Clinical Nutrition, School of Food and Nutritional Sciences, University of Shizuoka
[ Summary ] Assessment of body composition is necessary for evaluating the nutritional status of patients with chronic kidney diseases (CKD). Anthropometric measurements such as height, body weight, body mass index and upper-arm muscle area are essential assessments of body composition. These measurements can be easily applied to patients anytime and anywhere by trained examiners. Dual energy X-ray absorptiometry produces accurate measurements of bone mass, and fat versus lean body mass. Thus, these values are recognized as the reference standard. However, the equipment needed to make these evaluations is very expensive. Bioelectrical impedance analysis can also measure total body-water ratios and fat mass versus lean body mass with relatively high precision. This method is now widely used in various clinical settings because of its easy application. X-ray computed tomography is useful for measuring visceral fat area, subcutaneous fat area and thigh muscle area. Repeated measurements using these methods are important for nutritional assessment of CKD patients.
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