Post Date December, 02 2023
Since the onset of kidney disease, many kidney friends have experienced weight loss, albumin loss, etc. They often hear from doctors (dietitian) that "you are malnourished now" or "you should eat more, be careful of malnutrition". What does the doctor (dietitian) mean by malnutrition? What should we pay attention to? How should we pay attention to the occurrence of malnutrition in our diet?
What is malnutrition
In daily life, malnutrition in the eyes of the common people only refers to nutritional deficiencies, such as vitamin A and D deficiency, which is a narrow definition of malnutrition; In a broad sense, malnutrition includes overnutrition, such as overweight and obesity. Therefore, malnutrition is a general term for nutrient deficiency, excess, or imbalance.
For patients with kidney disease, malnutrition in the mouth of clinical doctors (dietitian) mainly refers to protein energy deficiency (i.e. protein energy malnutrition, PEM). Most of them are secondary, and vitamin and mineral deficiencies can coexist, but are often masked by a lack of protein energy.
How to judge malnutrition
In clinical practice, the diagnosis of malnutrition should be determined by comprehensive analysis of the results of anthropometric and laboratory testing indicators obtained.
Remarks:
1. When protein deficiency occurs, serum albumin and total protein decrease significantly, and edema occurs when total plasma protein<45g/L and albumin<28g/L;
2. When anemia occurs, hemoglobin and red blood cell counts also decrease, which is one of the indicators of malnutrition;
3. The main immune indicators include lymphocyte count, delayed skin hypersensitivity, etc.
A complete nutritional evaluation includes: disease and dietary history, physical measurements, biochemical tests, body composition, etc. Among them, physical examination and biochemical indicators are the most common methods for nutrition evaluation, which are simple, convenient and reproducible.
How to adjust your diet
Everyone also knows that malnutrition in kidney disease is often secondary, so it is important to actively investigate the cause, such as gastrointestinal symptoms, infections, etc. In addition to targeted treatment, dietary support is very important.
Reasonable nutrition and increased energy
Low energy intake can lead to weight loss, rapid weight loss, weakened immunity, and slow wound healing. When kidney disease patients experience malnutrition, the first and most important thing is to increase energy intake. Choose more pure energy and low protein foods in your daily diet to increase energy.
1) The main way to increase energy is to supplement it in staple foods. In natural foods, sweet potatoes, taro, potatoes and other potato like staple foods can be chosen. If conditions permit, low-protein staple foods such as low-protein rice and noodles can also be consumed;
2) Low blood sugar can also supplement honey, white granulated sugar, glucose, etc;
3) When blood lipids are not high, cooking vegetable oil can also be added to increase energy intake.
Many kidney friends have severe malnutrition, poor appetite, and weak digestive function. When replenishing energy, it is necessary to gradually increase their appetite and not blindly increase it.
Appropriate protein intake
For most kidney disease patients, a low protein diet is required. Many highly conscious kidney disease patients equate a low protein diet with a vegetarian diet, which leads to severe insufficient protein intake and is also one of the factors causing PEM.
The calculation of protein for the whole day is based on the standard weight [standard weight=height (cm) -105], calculated at a standard weight of 60kg:
1) CKD1-2 phase: calculated at 0.8g/kg per day, the daily protein content is 48g.
2) After CKD3 phase: 0.6g/kg per day or even lower, with protein levels not exceeding 36g throughout the day.
3) Taking α- Ketonic acid preparations should adopt an extremely low protein diet with lower protein intake.
4) Hemodialysis, abdominal dialysis, and kidney transplantation: Protein restrictions are not too strict, and even a high protein diet is required. When malnutrition occurs, protein intake can be appropriately increased, and animal based foods such as fish, shrimp, lean meat, eggs, milk, etc. can be preferred.
It is necessary to ensure appropriate protein levels every day, which can prevent malnutrition and protect residual kidney function.
other
Malnutrition is often accompanied by complications such as anemia, water electrolyte disorders, etc. When anemia occurs, in addition to active clinical treatment, foods rich in iron can be added to the diet, such as animal blood and red meat (kidney disease patients often experience a series of complications, and animal liver is not recommended).
