| Summary: | 碩士 === 中山醫學大學 === 營養科學研究所 === 91 === Both inadequate alimentation and metabolic alterations contribute to the malnutrition, which is frequently encountered in maintenance hemodialysis (MHD) patients. PEM is a powerful predictor of subsequent high morbidity and mortality in dialysis patients. Our purpose of this study was designed an antegrade longitudinal study to evaluate whether oral high protein supplement could improve the nutritional satus of malnourished dialysis patients and impact of oral high protein supplement on dialysis therapy. Candidates with liver cirrhosis, infections, HbA1c＞8.0 or cachesia disease were excluded. The criteria for malnourished HD patients were based on a subjective global assessment（SGA）scores-overall SGA rating including B（mild to moderately malnourished）or C（severely malnourished）, biochemical indicators of malnutrition for the 3 months’ period before the oral high protein nutrition supplement interventions with serum albumin levels below 3.8 gm/dL and 1 months’ period before the oral high protein nutrition supplement interventions with serum prealbumin levels below 30gm/dL；presence of two out of three criteria were classified malnourished. The daily oral high protein supplements contained 281 kcal energy and 22 g protein（Whey-Aid 20 g and Nutri-Aid 46 g）. Month 0 was a baseline period for the usual diet；months 1,2 and 3 were nutritional intervention period. The nutritional status was monitored by dietary assessment, anthropometric parameters, blood biochemical assays, indicator of adequacy dialysis and subjective global assessment during the baseline period and the intervention period. Eighteen patients were finished and included in data analysis. The nutrition intervention stage, oral high protein nutrition supplement could provide 16%~17% in actual calorie intake and 28-30% of actual protein intake. Our results showed that the mean protein intake was 1.0 g/kg/day and mean calorie intake was 27 kcal/kg/day in the baseline. After oral high protein supplement provided as nutritional intervention for three consecutive months, the dietary assessment data showed that patients’ daily protein intake increased to 1.3~1.4 g/kg, calorie intake increase to 30~32 kcal/kg. During whole study period, fractional clearance of urea as a function of its distribution volume（Kt/V）and urea reduction ratio（URR）, they were all in the normal range, and there was no significant difference between the baseline period and the intervention period. The normalized protein catabolic rate（NPCR）was significantly increased after giving oral high protein supplement（p＜0.01）. The C-reactive protein（CRP） was no statistical difference between the baseline period and the intervention period. Albumin was significantly increased（p＜0.01），but prealbumin was no significant difference after giving oral high protein supplement. Additionally, after giving oral high protein supplement, serum pre-dialysis blood urea nitrogen was significantly increased（p＜0.05）, but did not influence level of phosphorus and potassium in malnourished dialysis patients. After giving oral high protein supplement, patients’ dry weight increased 1 kg, being significantly increased（p＜0.05）. Also the serial change of body mass index, being significantly increased in month 2 and month 3 (p＜0.05). During whole study period, triceps skin-fold thickness（TSF）, mid-arm circumference（MAC）and mid-arm muscle circumference（MAMC）were no significant difference. Oral high protein supplement did not influence on body fat and lean body mass. The result of SGA score showed that oral high protein supplement improves the nutritional status of MHD with malnutrition. In conclusion, oral high protein nutritional supplement provided as nutritional intervention has effectively increased nutrients intake, gaining body weight, improving nutritional indexes, and improve the nutritional status of MHD with malnutrition.
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