臨牀透析 Vol.34 No.11(2-6)


特集名 透析食の調理者と透析患者
題名 全国各地の透析患者の食事事情 (6) 腹膜透析をしながら通学中の小・中学生の患者(給食との関わり)
発刊年月 2018年 10月
著者 伊藤 圭子 県立広島病院栄養管理科
著者 大田 敏之 県立広島病院小児腎臓科
著者 眞次 康弘 県立広島病院栄養管理科/県立広島病院消化器・乳腺・移植外科
【 要旨 】 小児PD患者の栄養管理は,成長を考慮した適切なエネルギーや栄養素を摂取することが重要である.食事療法は長期間に及ぶため,成長に合わせた身体計測,検査所見や食事摂取状況などを利用して定期的に栄養評価を行う必要がある.基本は健常児と同じ食事摂取基準を遵守するが,リンや塩分の過剰摂取に注意を要する.学校給食は,多様な食品を適切に組み合わせた栄養バランスのとれた食事であるが,リン含有量が多い.本症例では給食制限や個別対応は行わず,給食の栄養量と栄養素データをもとに,家庭内の食事献立を調節した.リン制限が負担にならないよう精神的にサポートしながら自立支援を行ったことで腎移植につなぐことができた.
Theme Dialysis patients and people who are in charge of preparing food
Title Providing school lunches for children receiving peritoneal dialysis
Author Keiko Ito Department of Clinical Nutrition, Hiroshima Prefectural Hospital
Author Toshiyuki Ohta Department of Pediatric Nephrology, Hiroshima Prefectural Hospital
Author Yasuhiro Matsugu Department of Clinical Nutrition, Hiroshima Prefectural Hospital / Department of Gastroenterological, Breast and Transplant Surgery, Hiroshima Prefectural Hospital
[ Summary ] Elementary and junior high school outpatients receiving peritoneal dialysis must be cared for regarding lunch planning. The relationship between school lunches and homemade meals is important in that patients must consume appropriate amounts of energy and nutriention for nutritional management of pediatric peritoneal dialysis (PPD). Since dietary therapy is often provided for extended periods, it is necessary to perform periodic nutritional assessments according to patient growth stages. The recommended dietary allowance for PPD is nearly equivalent to that of healthy children based on the "Dietary Reference Intake for Japanese" guidelines. However, excessive phosphorus and salt intake should be monitored in PPD diets. Although school lunches are planned according to appropriately balanced dietary needs, the phosphorus content in those foods provided may be high. For this reason, the main focus of dietary therapy for PPD is management of phosphorus intake. In the presented case, the patient ate the same school lunches as his classmates and we modified the phosphorus amount in his meals at home. We provided dietary suggestions and an overall program regarding awareness of menu planning with the aim of restricting phosphorus intake. We also supported the mental state and nutritional self-reliance of the patient until renal transplantation could be provided.
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