Revista de trastornos nutricionales y terapia

Abstracto

Nutrición clínica 2020: Efecto del asesoramiento nutricional en forma de plan de alimentación individualizado sobre el nivel de albúmina sérica entre pacientes de hemodiálisis - Suhair Abdalla Khalil Abdallah - Universidad de Mujeres Ahfad

Suhair AbdallaKhalil Abdallah

Introducción: El estado nutricional óptimo es un tema importante en el manejo a largo plazo de los pacientes con enfermedad renal crónica y es un prerrequisito para un mejor pronóstico de los pacientes con enfermedad renal crónica. La Iniciativa de Calidad de los Resultados de la Enfermedad Renal (KDOQI) recomienda el uso de prácticas estandarizadas en nutrición renal como parte central e integral del manejo dietético de los pacientes con enfermedad renal terminal (ESRD) en HD. Un dietista con experiencia renal debe ser responsable de la evaluación continua del estado nutricional del paciente y del desarrollo de planes para el cuidado dietético. Esto garantiza una evaluación apropiada del estado nutricional y la identificación oportuna de los pacientes en riesgo. Por lo tanto, la evaluación del estado nutricional es una parte integral del manejo nutricional. Se deben evaluar varios parámetros juntos, incluidos los antecedentes de pérdida de peso, la ingesta de proteínas y energía en la dieta, la masa grasa subcutánea y la masa muscular y el índice de masa corporal (IMC), la evaluación global subjetiva (SGA) utilizada por los funcionarios de salud para puntuar el estado nutricional proteico-energético y se han utilizado varios marcadores bioquímicos (albúmina sérica, prealbúmina y transferrina) para evaluar las reservas de proteínas viscerales. De estos, la albúmina sérica ha sido hasta ahora la más utilizada. Es la única medida de proteína corporal total, tanto muscular como visceral, que es el marcador más frecuentemente utilizado del estado proteico y es el estándar recomendado por KDOQI. Para ser utilizado en la evaluación del estado nutricional entre los pacientes con ERC. Es un fuerte marcador para la evaluación de la desnutrición entre los pacientes de HD. Es poco probable que una disminución de la albúmina resulte en un aumento de la morbilidad y la mortalidad. Lo que se ha demostrado para los pacientes con ESRD cuya albúmina está por debajo de 40 g / d, y resulta en un exceso de riesgo de muerte. El bajo nivel de albúmina es un sólido analista de humanidad y enfermedad entre los pacientes de hemodiálisis. Es un marcador sustituto de PEM que es común entre los pacientes con ESRD en HD con una prevalencia estimada del 10 al 70% y sin duda contribuye a un mayor riesgo de morbilidad y mortalidad. Esto se agrava por el hecho de que estos pacientes pierden grandes cantidades de proteínas en el líquido de dializado (lo que conduce a hipoalbuminemia entre este grupo) (la mayoría de los estudios previos mostraron que la cantidad de aminoácidos perdidos en el dializado durante una sesión de diálisis puede variar de 4 a 13 g. y no toman constantemente las cantidades recomendadas de energía y proteína para pacientes con ESRD en HD. Necesitan planes de alimentación individualizados, pero rara vez consultan a un dietista. En otras palabras, se necesita una dieta especial para pacientes con ESRD en HD. La ingesta diaria recomendada de nutrientes para un adulto en HD son: proteína 1,2 g/kg de peso corporal (50% de alto valor biológico); energía para un adulto < 60 años 35 kcal/kg y para un adulto > 60 años u obeso 30 kcal/kg; los minerales (mg/kg/día) - sodio 2 - 4, potasio 40 y fósforo 17; los líquidos dependen de la producción de líquidos + 500 ml.

Serum albumin is the most commonly used malnutrition marker in clinical practice as hypo albuminemia is considered to be a malnutrition risk among the patients on hemodialysis and a strong predictor of death. Low serum albumin levels are due to low intakes of energy and protein or insufficient energy intake resulting in poor protein utilization.

Purpose: This was a prospective, clinical trial hospital based (intervention) study to evaluate the effect of nutritional counseling in the form of individualized meal plan on serum albumin level among hemodialysis patients.

Methods: The study was conducted on maintenance hemodialysis patients attending Dr Salma Hemodialysis & Transplant Center outpatient clinic, Khartoum. 134 adult patients (males & females) were divided into a test group (n=77) and a control group (n=57). The test group after nutritional counseling consumed individualized diets for a period of 6 months that provided adequate amounts of energy and protein according to the recommendations of the National Kidney Foundation whereas the control group sustained overwhelming their usual diets. Serum albumin was determined at baseline and every 2 months. Data were analyzed using SPSS.

Nutritional status assessment:

Intervention Eighty-three HD patients who were included in the study as test group received conventional nutritional counseling and individual meal plan to achieve adequate protein and calories intake. Monitoring was done during 6 months of follow up. The individual meal plan was designed and explained to patient and their families by the following ways:

Educational lecture: Educational lecture was given exclusively to the test group. It was presented by the researcher to the patients and their families during their dialysis session by using a data-show to educate the patients and their families on the nutritional needs to provide appropriate food with adequate calories and protein to the patients.

Presentation included all the important information needed to be known by ESRD patient on HD. It was concentrated on calorie and protein needed, fluids limitation, intake of sodium, potassium and phosphorus in foods. Information was provided in a simple way and was explained by pictures for more understanding.

Pamphlets: were prepared and distributed to all intervention group participants after the lecture and all the summary information that was presented was found in the sheet which the researcher called it as the over-all training sheet for renal patients on HD.

Individualized meal plans: Individual meal plan was designed individually to all intervention group participants after analysis of the full information that helped the researcher to conduct the meal plan. The meal plan was based on: patient’s economic status, medical history, diet history, like and dislike, chewing and swallowing status, food allergies, blood investigation result, age, weight, height and sex. (Food exchange list was used to help patients for food substitutes if participant unable to follow the meal prescribed according to like and dislike or socio economic reasons). After calculation of all nutrients needed by each participant, individual meal plan for the whole week was designed by researcher, typed, organized, color printed and given to participant with full explanation of uses. The meals planned were designed only for intervention patients, whereas control patients continued to receive their usual care.

Results: Demographic characteristic of the study sample: For the demographic characteristic of the study participants, test and control, Males represented a higher percentage than the females. The age group distribution of subject shows that most of the patients (46.3%) were in the active age group of 30 - 45 yrs. (49.4% test and 42.1% control). The majority (31.3%) had higher secondary school education (29.9% test and 33.3 % control), followed by 17.9% university graduates (23.4% test and 10.5% control), the rest were illiterate or with low educational level. Medical profile of the participants

The medical characteristics of the study: Participants are shown that 53.7% of the participant had hypertension (61.0% test and 43.9% control), while only 3.0% had diabetes mellitus and hypertension (1.3% test and 5.3% control) and the rest 43.3% did not have any comorbid disease (37.7% test and 50.9% control). The mean extents of dialysis eras were 57.08 ± 36.16 months for the together groups (61.77 ± 38.84 test and (50.75 ± 31.42 control group).

Serum albumin augmented progressively from 3.14 g/dl at zero to 4.32 g/dl at 6 months with test group. The study displays big alterations in accumulation of serum albumin level during the study with intervention group compared with control. The mean test group was (3.1, 3.3, 3.9 and 4.3) and the mean of control group was (3.2, 3.16, 3.19 and 3.84) in baseline, 2-4-6 months respectively.

Conclusion: The study demonstrated that effective nutritional counseling rendered to maintenance hemodialysis patients in the form of individualized meal plans that provided adequate energy and protein was active in the switch and enhancement of serum albumin equal among these patients. Therefore, nutritious counseling by skilled dietitians is mandatory in renal units as part of the medical therapy management to reduce the incidence of hypoalbminemia among hemodialysis patients.

Biography:

Suhair Abdalla Khalil Abdallah completó su doctorado en Nutrición Clínica en la Universidad Ahfad para Mujeres, Sudán. Es dietista clínica en el King Faisal Specialist Hospital & Research Center, Reino de Arabia Saudita. Tiene una larga experiencia de 18 años en el campo de la nutrición clínica.

NOTA: Este trabajo se presentó parcialmente en la 5ª Conferencia Europea de Nutrición y Dietética, celebrada del 16 al 18 de junio de 2016 en Roma, Italia.