糖尿病肾病及慢性肾病合并糖尿病病人的膳食调查分析

目的调查糖尿病肾病（diabetic kidney disease，DKD）及慢性肾脏病（chronic kidney disease，CKD）合并糖尿病病人膳食摄入情况，为进一步营养治疗提供方向。方法采用3 d 24 h膳食回顾法，纳入DKD及CKD合并糖尿病病人93例，通过食物成分表计算病人营养素摄入量，与我国卫生行业标准（WS/T 557-2017）CKD病人膳食指导所推荐的需要量比较。结果纳入人群的蛋白质摄入明显低于推荐量（P < 0.01），优质蛋白质摄入比例明显高于推荐值（P < 0.01），能量摄入与推荐量差异无统计学意义（P>0.05）。不同性别病人的营养摄入情况差异均无统计学意义（P>0.05），不同CKD分期病人的优质蛋白质摄入比例间差异有统计学意义（P < 0.05），透析与非透析病人的蛋白质摄入差异有统计学意义（P < 0.05）。不同性别、CKD分期和是否透析病人的蛋白质摄入均明显低于推荐量（P < 0.01）；不同性别、是否透析和CKD 4、5期病人的优质蛋白摄入比例均明显高于推荐值（P < 0.01），CKD 3期病人的优质蛋白摄入比例与推荐值差异无统计学意义（P>0.05）。结论DKD及CKD合并糖尿病病人蛋白质摄入量低于指南推荐量，不同CKD分期和是否透析病人的蛋白质摄入情况存在差异，应加强病人营养教育，结合疾病阶段及治疗状态给予个体化膳食指导。

Dietary investigation and analysis of the diabetic kidney disease and chronic kidney disease patients complicated with diabetes mellitus

ObjectiveTo investigate the dietary intake in patients with diabetic kidney disease(DKD)and patients with chronic kidney disease(CKD)complicated with diabetes, and provide the direction for further nutritional therapy.MethodsThe dietary survey was implemented using 3-day 24 h dietary review method.The nutrient intake in 93 patients with DKD and CKD complicated with diabetes were calculated using food composition table, and which was compared with China health industry standard(WS/T 557-2017) recommended dietary requirements for CKD patients.ResultsThe actual protein intake in the population was lower than that of recommended amount(P < 0.01).The proportion of high-quality protein intake was significantly higher than that of the recommended value(P < 0.01), and the difference between energy intake and recommended amount was not statistically significant(P>0.05).There was no statistical significance in the nutritional intake of patients with different genders(P>0.05), the difference of the proportion of high-quality protein intake among patients with different CKD stages were statistically significant(P < 0.05), and the difference of protein intake between dialysis and non-dialysis patients was statistically significant(P < 0.05).The protein intake in patients with different genders, CKD stages and dialysis status were significantly lower than those of recommended value(P < 0.01).The proportion of high-quality protein intake in patients with different genders, dialysis status and CKD stage 4 and 5 were significantly higher than that of recommended value(P < 0.01), and the difference between the proportion of high-quality protein intake and recommended value in patients with CKD stage 3 was not statistically significant(P>0.05).ConclusionsThe protein intake of(DKD patients and CKD patients complicated with diabetes are lower than that of recommended amount of the guideline.There are differences in protein intake among patients with different CKD stages and with or without dialysis.The nutrition education should be strengthened and individualized dietary guidance in combination with disease stage and treatment status.