Assessment of Protein and Energy Nutritional Status
| Autor: | Lara B. Pupim, Cathi J. Martin, T. Alp Ikizler |
|---|---|
| Rok vydání: | 2013 |
| Předmět: |
medicine.medical_specialty
Nitrogen balance biology business.industry medicine.medical_treatment Physiology Nutritional status Dialysis patients medicine.disease Muscle mass Transthyretin Endocrinology Internal medicine medicine biology.protein medicine.symptom business Wasting Dialysis Kidney disease |
| DOI: | 10.1016/b978-0-12-391934-2.00010-2 |
| Popis: | Screening and assessment of nutritional status is of paramount importance for the management of patients with chronic kidney disease (CKD), especially individuals undergoing maintenance dialysis. The complex nature of CKD and its associated adverse consequences lead to a unique constellation of nutritional and metabolic abnormalities that adversely affect the body’s protein and energy status. These abnormalities can be defined as protein-energy wasting (PEW), i.e. a state of decreased body stores of protein and energy fuels. There are several clinical, nutritional, and biochemical parameters that are associated with and frequently indicative of PEW in individuals with CKD. Among the biochemical indices, serum albumin or serum transthyretin (prealbumin) provide the best diagnostic and prognostic information. However, both are influenced by multiple conditions inherent to kidney disease. When combined with low visceral protein concentrations, low relative body weight, reduced total body fat or muscle mass or progressive weight loss are diagnostic of PEW. Several composite indices such as subjective global assessment can also be incorporated in screening for or diagnosing PEW. Protein intake can be estimated from the urea nitrogen appearance or, for dialysis patients, the protein equivalent of total nitrogen appearance (PNA or PCR). Measurement of dietary energy intake along with estimates of daily energy expenditure should also be incorporated in the assessment of nutritional status in kidney disease patients. For research purposes, nitrogen balance studies or metabolic assessment by stable isotopes can provide invaluable physiological information complementing routine nutritional assessment tools. Similarly, a number of more sophisticated tools such as dual energy X-ray absorptiometry or magnetic resonance imaging can provide more precise information on body composition and are primarily used for research purposes. Incorporation of clinical information with practical methods of nutritional assessment is the core of appropriate screening for and assessment of PEW in the clinical setting. More sophisticated methods should be added to these only for research purposes. |
| Databáze: | OpenAIRE |
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