应用调整的膳食平衡指数-16评价血液透析患者的膳食质量

目的 应用中国平衡膳食指数-16（Diet Balance Index-16，DBI-16）评价维持性血液透析患者的膳食质量和膳食结构，从而为该疾病患者针对性饮食干预方法的建立和膳食营养教育的开展提供科学依据。方法对4家三甲医院进行维持性血液透析治疗的403例患者使用3 d 24 h膳食回顾法进行膳食调查，采用DBI-16综合评价其膳食质量水平。结果血液透析患者的整体膳食质量不平衡，处于中度失衡状态（膳食质量距=37.6），其中54.1%的受试者处于低度失衡状态，33.5%处于中度失衡状态，摄入量不足的问题较为突出（负端分=35.7），中度和高度摄入不足的比例分别为53.1%和36.2%。与中国居民平衡膳食宝塔（2016）相比，被调查者水果、奶类、鱼虾类摄入明显不足（P<0.001），而盐摄入过量（P<0.001），患者主要膳食模式为模式B，存在一定程度的摄入不足。结论被调查的血液透析患者整体膳食结构不合理，建议适当增加水果、奶类、鱼虾类的摄入，减少盐的用量，需要通过营养宣教来提高血液透析患者平衡膳食的理念。

Evaluation of dietary quality by Diet Balance Index-16 inmaintenance dialysis patients

Objective To evaluate the diet quality and diet structure of patients with maintenance hemodialysis by Chinese Diet Balance Index-16(DBI-16),thus to providing scientific basis for dietary guidance and nutrition intervention. Methods A total of 403 patients who received hemodialysis in four hospitals were included for dietary intake investigation and basic situation survey. Dietary data of the 24 h recall method for 3 consecutive days were evaluated using DBI-16. Results The overall dietary quality of maintenance hemodialysis patients was somewhat imbalance (DQD=37.6) with 54.1% of participants in the low level of dietary quality and 33.5% in the moderate level. The problem of insufficient intake (LBS=35.7) was obvious with the portion of moderate and high level inadequate intakeswere 53.1% and 36.2%, respectively. The intakes of fruit,milk and aquatic products were significantly insufficient (P<0.001), while the salt intake was significantly excessive (P<0.001). Model B was the main dietary pattern. Conclusion The overall dietary pattern of maintenance hemodialysis patients who were surveyed is irrational. It should be emphasized that adequate intakes of fruit, milk, aquatic products and limit intake of salt. It is necessary to improve the patients′ concept of balanced diet through nutrition education．