老年糖尿病肾病患者膳食结构的调查与分析

Investigation and analysis of the dietary structure of elderly diabetic nephropathy patients

目的调查老年糖尿病肾病（diabetic nephropathy，DN）患者的膳食结构，并分析其影响因素。方法采用描述性研究，应用24h膳食回顾法调查老年糖尿病肾病患者的膳食结构。收集性别、年龄、糖尿病病程、糖尿病‘肾病病程、糖尿病。肾病治疗方式等一般资料；糖化血红蛋白、糖化白蛋白、血肌酐、24h尿蛋白以及尿微量白蛋白等实验室检查指标，并分析其对膳食结构的影响。结果113例患者中，热量摄入3．92～23．57Kcal／Kg／d，平均（12．19±3．12）Kcal／Kg／d；3期DN患者蛋白质摄入量（0．16～1．39）g／Kg／d，平均（0．66±0．25）g／Kg／d，4期DN患者蛋白质摄入量（0．34～1．24）g／Kg／d，平均（0．76±0．22）g／Kg／d，5期DN患者（腹膜透析患者）蛋白质摄入量（0．18～0．89）g／Kg／d，平均（0．64±0．24）g／Kg／d。碳水化合物供能比为29．22％～76．29％，平均（52．59±7．86）％；脂肪供能比为8．19％～42．19％，平均（24．31土5．93）％；蛋白质供能比为9．92％～36．00％，平均（23．10±4．27）％；优质蛋白摄入量／蛋白质摄入总量为2．08％～96．7％，平均为（74．14±4．98）％。不同性别、。肾病分期、血糖浓度、是否透析患者的膳食结构，差异有统计学意义，回顾分析显示性别和糖尿病肾病分期是膳食结构的独立影响因素。结论老年DN患者的膳食结构不合理，总热量摄入不足，碳水化合物供能不足。膳食结构受性别、肾病分期、是否透析和是否独居影响，性别和肾病分期是膳食结构的独立影响因素。

Objective To investigate of the dietary structure of elderly patients with diabetic nephropathy and to analyze the influencing factors. Method A descriptive study was conducted, 24 hour dietary recall was used to assess the dietary structure. General information （gender, age, course of diabetes, course of diabetic nephropathy, dialysis or not, and so on） and laboratory parameters （glycated hemoglobin, glycated albumin, serum creatinine, 24h urine protein and urine albumin, and so on ） were collected, and their influence on dietary structure was analyzed. Result In 113 patients, the energy range was （3.92-23.57） Kcal/Kg/d, the average was （12.19±3.12） Kcal/Kg/d; the protein range was （0.16-1.39） g/Kg/d, （0.34-1.24） g/Kg/d, （0.18-0.89） g/Kg/d, the average was （0.66±0.25） g/Kg/d, （0.76±0.22） g/Kg/d and （0.64±0.24） g/Kg/d in 3, 4, 5 stage DN patients respectively; carbohydrates energy ratio was 29.22% -76.29%, the averagewas （52.59±7.86）%; fat energyratiowas8.19%-42.19%, the averagewas （24.31±5.93）%; protein energy ratio was 9.92 % - 36.00 %, the average （23.10±4.27） %; percentage of high biologic value protein intake amount/ total protein intake amount was 2.08%-96.7%, the average was （74.14±4.98） %. DN stage, dialysis or not, living alone or not were influence factors. Logistic regression revealed that diabetic renal disease stage and gender were independent influencing factors of dietary structure. Conclusion The dietary structure in elderly patients with diabetic nephropathy is not reasonable, total energy and carbohydrates were short. The gender, dialysis or not, living alone and different stages of diabetic nephropathy were influence factors for dietary structure, gender and diabetic nephropathy stage were independent factors of dietary structure.