Since suffering from kidney disease, many kidney friends have experienced weight loss, albumin loss, and other conditions. They often hear doctors (nutritionists) saying, "You have malnutrition now" or "You should eat more and be careful of malnutrition.". What exactly does malnutrition in the mouth of a doctor (dietitian) mean? 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 ordinary people simply refers to nutritional deficiency diseases, such as vitamin A and D deficiency, which is a narrow sense of malnutrition; In a broad sense, malnutrition includes excess nutrition, such as overweight and obesity. Therefore, malnutrition is a general term for nutrient deficiency, excess, or imbalance.
For patients with kidney disease, clinically speaking, malnutrition referred to by doctors (nutritionists) 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 and 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.
1. Serum albumin and total protein decreased significantly during protein deficiency, and edema occurred 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, and so on.
A complete nutritional evaluation includes disease and dietary history, physical measurements, biochemical tests, and body composition. Physical examination and biochemical indicators are the most common methods for nutritional evaluation, which are simple, convenient, and repeatable.
How to adjust your diet
As everyone knows, malnutrition in kidney disease is often secondary, so it is important to actively investigate the cause, such as gastrointestinal symptoms and infections in kidney disease. In addition to symptomatic treatment, it is important to cooperate with dietary support.
Reasonable nutrition and increased energy
Low energy intake can lead to weight loss, rapid weight loss, low immunity, and slow wound healing. When patients with kidney disease 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 staple foods. Among natural foods, you can choose sweet potatoes, taros, potatoes, and other potato and taro staple foods. If conditions permit, you can also eat low-protein staple foods, such as low-protein rice, noodles, and so on;
2) Low blood sugar can also supplement honey, white granulated sugar, glucose, etc;
3) When blood lipids are not high, you can also add more cooking vegetable oil to increase energy intake.
Many kidney friends have severe malnutrition, poor appetite, and weak digestive function. When replenishing energy, it is necessary to step by step and not blindly increase their appetite.
Appropriate protein intake
For most patients with kidney disease, a low protein diet is required. Many patients with kidney disease with strong awareness convert a low protein diet to a vegetarian diet, resulting in a serious lack of protein intake, which is also a factor in PEM.
The calculation of protein for the whole day is based on the standard weight [standard weight=height (cm) - 105], calculated based on the standard weight of 60kg:
1) CKD1-2 phase: calculated at 0.8g/kg per day, the daily protein content is 48g.
2) After CKD3: 0.6g/kg per day, or even lower, with a daily protein concentration of no more than 36g.
3) Taking α- Ketonic acid preparations require a very low protein diet with a 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 foods such as fish, shrimp, lean meat, eggs, and milk can be preferred.
It is essential to ensure that appropriate protein is available daily, both to prevent malnutrition and to protect residual renal function.
Malnutrition is often accompanied by some complications, such as anemia, water electrolyte disorders, and so on. 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).