Journal of the Korean Dietetic Association (대한영양사협회학술지)

The Korean Dietetic Association (대한영양사협회)
권호 표지
DOI QR코드

DOI QR Code

A Prospective Study on Nutritional Status and Nutrient Intake of Hemodialysis Patients Based on Coexistence of Diabetes

혈액투석 환자에서 당뇨병 유무에 따른 영양상태와 영양섭취량 비교

  • Oh, Ye-Sung (Dept. of Food Service and Clinical Nutrition, Ajou University Hospital) ;
  • Ann, Jae-Young (Dept. of Food Service and Clinical Nutrition, Ajou University Hospital) ;
  • Kim, Mi-Hyang (Dept. of Food Service and Clinical Nutrition, Ajou University Hospital) ;
  • Choe, Sun-Jung (Dept. of Food Service and Clinical Nutrition, Ajou University Hospital) ;
  • Jeong, Jong Cheol (Dept. of Nephrology, Ajou University School of Medicine)
  • 오예성 (아주대학교병원 영양팀) ;
  • 안재영 (아주대학교병원 영양팀) ;
  • 김미향 (아주대학교병원 영양팀) ;
  • 최선정 (아주대학교병원 영양팀) ;
  • 정종철 (아주대학교 의과대학 신장내과학교실)
  • Received : 2016.07.21
  • Accepted : 2016.12.26
  • Published : 2017.02.02
Download PDF
⟨ Previous Next ⟩

Abstract

It is well known that malnutrition is a predictor of mortality in hemodialysis patients. The number of diabetic nephropathy patients is increasing rapidly. This study aimed to investigate nutritional status and nutrient intake according to the presence of diabetes among hemodialysis patients. The nutritional intake and general characteristics of outpatients at Ajou University Hospital (24 with diabetes and 30 without diabetes) were investigated between July and September 2015. Patients' general data were collected, and nutritional status by Patient-Generated Subjective Global Assessment (PG-SGA) was evaluated. Nutrient intakes were assessed according to 3-day food records. There was no significant difference regarding body weight between the two groups. However, the non-diabetic group showed a better nutritional status by Patient-Generated Subjective Global Assessment (PG-SGA) ($5.2{\pm}4.4$ vs. $8.0{\pm}4.3$ score, non-diabetics vs. diabetics, P<0.05). There was no difference in daily calorie intake ($1,473.9{\pm}370.5$ vs. $1,503.8{\pm}397.5kcal$) and protein intake ($60.3{\pm}19.7$ vs. $65.6{\pm}20.5g$) in those with diabetes. Intakes of vegetables protein, sodium, potassium, vitamin C, folic acid and fiber were significantly higher in the diabetic group compared to those of the non-diabetic group. There was no difference in daily nutrient intake between the hemodialysis weekday and weekend groups. The non-diabetic group had higher calorie and sodium intakes per meal in the hemodialysis weekday group, but the difference was not significant. Based on these results, intervention should be performed to improve nutritional status in consideration of diabetes and dietary patterns.

Keywords

References

  1. Bauer J, Capra S, Ferguson M (2002): Use of the scored patient-generated subjective global assessment (PG-SGA) as a nutrition assessment tool in patients with cancer. Eur J Clin Nutr 56(8):779-785 https://doi.org/10.1038/sj.ejcn.1601412
  2. Burrowes JD, Cockram DB, Dwyer JT, Larive B, Paranandi L, Bergen C, Poole D (2002): Cross-sectional relationship between dietary protein and energy intake, nutritional status, functional status, and comorbidity in older versus younger hemodialysis patients. J Ren Nutr 12(2):87-95 https://doi.org/10.1053/jren.2002.32209
  3. Cano A E, N eil AK, K ang JY, Barnab as A , Eastwood JB, Nelson SR, Hartley I, Maxwell D (2007): Gastrointestinal symptoms in patients with end-stage renal disease undergoing treatment by hemodialysis or peritoneal dialysis. Am J Gastroenterol 102(9):1990-1997 https://doi.org/10.1111/j.1572-0241.2007.01321.x
  4. Cano NJ, Roth H, Aparicio M, Azar R, Canaud B, Chauveau P, Combe C, Fouque D, Laville M, Leverve XM; French Study Group for Nutrition in Dialysis (FSG-ND) (2002): Malnutrition in hemodialysis diabetic patients: evaluation and prognostic influence. Kidney Int 62(2):593-601 https://doi.org/10.1046/j.1523-1755.2002.00457.x
  5. Cho JH, Hwang JY, Lee SE, Jang SP, Kim WY (2008): Nutritional status and the role of diabetes mellitus in hemodialysis patients. Nutr Res Pract 2(4):301-307 https://doi.org/10.4162/nrp.2008.2.4.301
  6. Choi KB, Lee YS (2003): Clinical significance of albumin slope in the hemodialysis patients. Korean J Nephrol 22(6):713-721
  7. Chung YJ, Park YS, Kim HS, Chang YK, Kim C (2002): Evaluation of nutrient intakes in the hemodialysis patients according to the socioeconomic status -In Daejeon and Chungnam areas-. Korean J Nutr 35(5):544-557
  8. Covinsky KE, Covinsky MH, Palmer RM, Sehgal AR (2002): Serum albumin concentration and clinical assessments of nutritional status in hospitalized older people: different sides of different coins? J Am Geriatr Soc 50(4):631-637 https://doi.org/10.1046/j.1532-5415.2002.50156.x
  9. Desbrow B, Bauer J, Blum C, Kandasamy A, McDonald A, Montgomery K (2005): Assessment of nutritional status in hemodialysis patients using patient-generated subjective global assessment. J Ren Nutr 15(2):211-216 https://doi.org/10.1053/j.jrn.2004.10.005
  10. ESRD Registry Committee, Korean Society of Nephrology (2015): Current renal replacement therapy in Korea - Insan memorial dialysis registry 2014. Korean Society of Nephrology. Seoul. pp.117-136
  11. Heimburger O, Bergstrom J, Lindholm B (1994): Is serum albumin an index of nutritional status in continuous ambulatory peritoneal dialysis patients? Perit Dial Int 14(2):108-114
  12. Hynote ED, McCamish MA, Depner TA, Davis PA (1995): Amino acid losses during hemodialysis: effects of high-solute flux and parenteral nutrition in acute renal failure. JPEN J Parenter Enteral Nutr 19(1):15-21 https://doi.org/10.1177/014860719501900115
  13. Johansen KL, Painter PL, Sakkas GK, Gordon P, Doyle J, Shubert T (2006): Effects of resistance exercise training and nandrolone decanoate on body composition and muscle function among patients who receive hemodialysis: a randomized, controlled trial. J Am Soc Nephrol 17(8):2307-2314 https://doi.org/10.1681/ASN.2006010034
  14. Kim DS (2010): A comparative study of dialysis adequacy with dietary intake and nutritional status in diabetic and non-diabetic hemodialysis patients. Masters degree thesis. Soonchunhyang University. pp.27-32
  15. Kim H, Lim H, Choue R (2015): A better diet quality is attributable to adequate energy intake in hemodialysis patients. Clin Nutr Res 4(1):46-55 https://doi.org/10.7762/cnr.2015.4.1.46
  16. Kim JH, Kim SR (2001): Subjective global assessment of nutrition in maintenance hemodialysis patients. Korean J Nephrol 20(2):270-276
  17. Kim SM, Lee YS, Cho DK (2000): Nutritional assessment of the hemodialysis patients. Korean J Nutr 33(2):179-185
  18. Kim YK, Choi KH, Kang SW, Lee HW, Lee SW, Lee HY, Han DS (1990): Nutritional assessment of chronic dialysis patients. Korean J Nephrol 9(1):58-66
  19. Korea Centers for Disease Control and Prevention (2012): Food photos for quantity estimation: Korean genome and epidemiology study. Korea Centers for Disease Control and Prevention. Cheongju. pp.18-68
  20. Korea Centers for Disease Control and Prevention (2014): Prevalence of chronic kidney disease in Korea. Korea Centers for Disease Control and Prevention. Cheongju. p.55
  21. Kuhlmann MK, Levin NW (2008): How common is malnutrition in ESRD? New approaches to diagnosis of malnutrition. Blood Purif 26(1):49-53 https://doi.org/10.1159/000110564
  22. Lee HS, Shin KH, Rha SY, Chung MJ, Song SY, Song SE, Ham HJ, Kim HM (2014): Changes in nutrient intake in patients at nutritional risk. J Korean Diet Assoc 20(4):285-295 https://doi.org/10.14373/JKDA.2014.20.4.285
  23. Lee JJ, Kim JM, Kim YR (2013a): Association of diet-related quality of life with dietary regimen practice, health-related quality of life, and gastrointestinal symptoms in end-stage renal disease patients with hemodialysis. Korean J Nutr 46(2):137-146 https://doi.org/10.4163/kjn.2013.46.2.137
  24. Lee YJ, Lee YJ, Oh IH, Lee CH, Lee SS (2013b): Comparative study of serum levels of albumin and hs-CRP in hemodialysis patients according to protein intake levels. J Nutr Health 46(6):521-530 https://doi.org/10.4163/jnh.2013.46.6.521
  25. Lowrie EG, Lew NL (1990): Death risk in hemodialysis patients: the predictive value of commonly measured variables and an evaluation of death rate differences between facilities. Am J Kidney Dis 15:458-482 https://doi.org/10.1016/S0272-6386(12)70364-5
  26. Luis D, Zlatkis K, Comenge B, Garcia Z, Navarro JF, Lorenzo V, Carrero JJ (2016): Dietary quality and adherence to dietary recommendations in patients undergoing hemodialysis. J Ren Nutr 26(3):190-195 https://doi.org/10.1053/j.jrn.2015.11.004
  27. National Kidney Foundation (2000): K/DOQI clinical practice guidelines for nutritional in chronic renal failure. Am J Kidney Dis 35:S40-S45 https://doi.org/10.1016/S0272-6386(00)70299-X
  28. Ottery FD (1996): Definition of standardized nutritional assessment and interventional pathways in oncology. Nutrition 12(1 Suppl):S15-S19 https://doi.org/10.1016/0899-9007(96)90011-8
  29. Stenvinkel P, Heimburger O, Lindholm B, Kaysen GA, Bergstrom J (2000): Are there two types of malnutrition in chronic renal failure? Evidence for relationships between malnutrition, inflammation and atherosclerosis (MIA syndrome). Nephrol Dial Transplant 15(7):953-960 https://doi.org/10.1093/ndt/15.7.953
  30. The Korean Nutrition Society (2011): CAN-Pro 4.0 software. The Korean Nutrition Society. Seoul
  31. The Korean Nutrition Society (2015): 2015 dietary reference intakes for Koreans. The Korean Nutrition Society. Seoul. p.96
  32. Theofilou P (2012): Quality of life and mental health in hemodialysis and peritoneal dialysis patients: the role of health beliefs. Int Urol Nephrol 44(1):245-253 https://doi.org/10.1007/s11255-011-9975-0
  33. Vaz IM, Freitas AT, Peixoto Mdo R, Ferraz SF, Campos MI (2015): Is energy intake underreported in hemodialysis patients? J Bras Nefrol 37(3):359-366 https://doi.org/10.5935/0101-2800.20150056
  34. Woo HJ, Lee YJ, Oh IH, Lee CH, Lee SS (2014): Association of food intake with serum levels of phosphorus and potassium in hemodialysis patients. J Nutr Health 47(1):33-44 https://doi.org/10.4163/jnh.2014.47.1.33
  35. World Medical Association (2013): World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA 310(20):2191-2194 https://doi.org/10.1001/jama.2013.281053
  36. Yoo HS, Woo HJ, Kang ET, Choue RW (2000): Evaluation of nutritional status and changes of biochemical parameters according to protein intake levels in hemodialysis patients. Korean J Nephrol 19(5):769-777
  37. Yoo SH, Oh EG, Youn MJ (2009): The reliab ility a nd v alidity of patient-generated subjective global assessment (PG-SGA) in stroke patients. J Korean Acad Adult Nurs 21(6):559-569
  38. Zabel R, Ash S, King N, Bauer J (2009): The relationship between subjective appetite sensations, markers of inflammation and appetite in dialysis patients. J Hum Nutr Diet 22(4):343-350 https://doi.org/10.1111/j.1365-277X.2009.00968.x