Povezava med kislinsko obremenitvijo telesa s hrano in telesno sestavo pri bolnikih z odpovedjo ledvic

Petrovič, Kristina (author), Knap, Bojan (mentor)

V sklopu magistrskega dela smo analizirali prehranski status bolnikov s kronično ledvično odpovedjo, ki prihajajo na hemodializno zdravljenje v Univerzitetni Klinični center v Ljubljani. S klinično študijo smo želeli ugotoviti, kako se bolniki prehranjujejo, kakšno kislinsko obremenitev telesa predstavlja njihova prehrana ter kakšna je povezava s telesno sestavo. Na 170 bolnikih smo izvedli bioimpedančne meritve telesne sestave ter ocenili njihov prehranski status s pomočjo vprašalnika MIS (ang. Malnutrition Inflammation Score). Z izbranimi 56 bolniki smo izvedli podroben prehranski intervju ter ocenili fizično pripravljenost s testom stiska pesti in testom vstani-sedi. Kislinsko obremenitev smo ocenili z izračunom PRAL (ang. Potential Renal Acid Load) in NEAP (ang. Estimated Net Endogenous Acid Production). Med 170 bolniki je bil povprečni indeks mišičnega tkiva pri ženskah 11,0 ± 2,3 kg/m2 in pri moških 13,9 ± 3,3 kg/m2. Povprečen delež maščobnega tkiva pri ženskah je bil 36 ± 10 % in pri moških 29 ± 11 %. Povprečen fazni kot pri ženskah je bil 3,7 ± 1,1º in pri moških 4,3 ± 1,2º. Pri izbrani skupini 56 bolnikov je povprečen dnevni energijski vnos znašal 22,6 ± 6,2 kcal/kg tm in povprečen dnevni vnos beljakovin 0,91 ± 0,28 g/kg tm. Povprečen dnevni vnos vlaknin je bil 15,2 ± 5,3 g. Povprečen PRAL je znašal 13,2 ± 9,2 mEq/dan in povprečen NEAP je znašal 68 ± 17 mEq/dan. Povprečen serumski albumin je bil 37,9 ± 5,1 g/L. Glede na rezultate meritev v našem vzorcu lahko zaključimo, da imajo dializni bolniki v povprečju slab prehranski status, kar je posledica pomanjkljivega prehranjevanja, saj bolniki ne zadostijo svojim potrebam po energiji in beljakovinah. Prisotnost energijsko-beljakovinske podhranjenosti dokazujejo tudi nizke vrednosti serumskega albumina ter povprečen indeks mišične mase pod priporočeno vrednostjo. Poleg tega delež maščobne mase nad priporočeno vrednostjo nakazuje na sarkopenično debelost. Glede na rezultate naše raziskave PRAL ni imel vpliva na telesno sestavo, saj na telesno sestavo v prvi vrsti vpliva zadosten vnos energije, beljakovin in vzdrževanje telesne aktivnosti.

• Language: Slovenian
• Keywords: prehrana, kronična ledvična bolezen, odpoved ledvic, hemodializni bolniki, prehranski status, kislinska obremenitev, metabolična acidoza, telesna sestava, bioimpedančne meritve, beljakovinska podhranjenost, metoda jedilnika prejšnjega dne
• Work type: Master's thesis/paper
• Typology: 2.09 - Master's Thesis
• Organization: BF - Biotechnical Faculty
• Place of publishing: Ljubljana
• Publisher: [K. Petrovič]
• Year: 2021
• PID: 20.500.12556/RUL-127007
• UDC: 613.24:616.61
• COBISS.SI-ID: 62995715
• Publication date in RUL: 13.05.2021

Secondary language

• Language: English
• Title: The relationship between dietary acid load and body composition in patients with renal failure

Abstract

The aim of the study was to analyse nutritional status of patients with end stage kidney disease who are receiving hemodialysis treatment at the University Clinical Center in Ljubljana. Our goal was to analyse nutritional intake of the patients, dietary acid load of their diet and the relationship with body composition. We performed bioimpedance measurements of body composition and we assessed nutritional status of 170 patients using the MIS (Malnutrition Inflammation Score) questionnaire. With selected group of 56 patients we conducted nutritional interview and assessed their physical fitness level with grip strength test and sit to stand test. Acid load was estimated by calculating PRAL (Potential Renal Acid Load) and NEAP (Estimated Net Endogenous Acid Production). The mean index of muscle tissue in women was 11.0 ± 2.3 kg/m2 and in men 13.9 ± 3.3 kg/m2. The average proportion of adipose tissue in women was 36 ± 10 % and in men 29 ± 11 %. The mean phase angle in women was 3.7 ± 1.1º and in men 4.3 ± 1.2º. The average daily energy intake was 22.6 ± 6.2 kcal/kg bw and the average daily protein intake 0.91 ± 0.28 g/kg bw, the mean daily fibre intake was 15.2 ± 5.3 g. The mean PRAL was 13.2 ± 9.2 mEq/day and the mean NEAP was 68 ± 17 mEq/day. The mean serum albumin was 37.9 ± 5.1 g/L. Based on the results obtained from this study, we can conclude that on average our dialysis patients have poor nutritional status, which is due to unmet needs for energy and protein. The presence of energy-protein malnutrition is also evidenced by low serum albumin values and an average muscle mass index below the recommended value. In addition, the proportion of fat mass above the recommended value indicates sarcopenic obesity. According to the results of our study, PRAL had no effect on body composition, presumably because the body composition is primarily affected by adequate energy intake, protein and maintenance of physical activity.

• Keywords: nutrition, chronic kidney disease, kidney failure, hemodialysis patients, nutritional status, dietary acid load, metabolic acidosis, body composition, bioimpedance, protein-energy wasting, 24 hour diet recall