如何改善日本老年透析患者的食欲?

Yukie Kitajima
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摘要

有必要确保透析患者摄入充足的能量和蛋白质。然而,老年透析患者除了因衰老导致饮食摄入量下降外,厌食率在透析患者中也很高,这增加了蛋白质能量消耗(PEW)、肌肉疏松症和虚弱的风险。导致透析患者(包括老年透析患者)厌食的原因有很多,改善这类患者食欲的方法也有报道,但还没有一种成熟的方法能充分改善食欲。因此,一个关键的实际目标是及早发现厌食症,并在体重减轻之前及时采取干预措施。食欲评估工具和体重减轻评估有助于筛查和早期识别厌食症征兆。营养干预措施包括减少饮食限制、使用口服营养补充剂和透析内肠外营养,以及补充能量、蛋白质和锌,以防止老年透析患者出现营养失调。食欲评估、早期干预以及饮食和营养咨询是改善这些患者食欲的关键。日本透析患者的老龄化速度是全球前所未有的,我相信这种情况最终也会在其他国家出现。我将讨论导致厌食症(尤其是老年透析患者)的因素,以及日本为解决这一问题所做的努力,例如放宽饮食限制和使用口服营养补充剂。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
How Can We Improve the Appetite of Older Patients on Dialysis in Japan?
It is necessary to ensure adequate energy and protein intake in dialysis patients. However, in addition to the decline in dietary intake in older dialysis patients due to aging, the rate of anorexia is high in dialysis patients, which increases the risk of protein–energy wasting (PEW), sarcopenia, and frailty. There are many causes of anorexia in dialysis patients, including older dialysis patients, and approaches to improve the appetite of such patients have been reported; however, there has been no established approach to improve appetite adequately. Therefore, a key practical goal is to identify anorexia early and implement timely interventions before weight loss occurs. Appetite assessment tools and weight loss assessments are helpful for the screening and early identification of anorectic signs. Nutritional interventions include reducing dietary restrictions, using oral nutritional supplements, and intradialytic parenteral nutrition, as well as replenishing energy, protein, and zinc to prevent the development of nutritional disorders among older dialysis patients. Appetite assessments, early intervention, and dietary and nutritional counseling are key to improving appetite in these patients. The aging rate of dialysis patients in Japan is unprecedented globally, and I believe that this is a situation that will eventually occur in other countries as well. I discuss the factors that contribute to anorexia, especially in older dialysis patients, and Japan’s efforts to address this problem, such as the relaxation of dietary restrictions and the use of oral nutritional supplements.
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