营养和运动干预对血液透析患者肌肉状态的影响：系统综述和网络荟萃分析

IF 7.4 2区医学 Q1 NUTRITION & DIETETICS

Clinical nutrition Pub Date : 2025-08-08 DOI:10.1016/j.clnu.2025.08.005

Liang Zhang , Fang Wang , Syoichi Tashiro , Peng Ju Liu

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引用次数: 0

摘要

背景：血液透析（HD）患者的肌肉质量消耗和功能下降与死亡风险增加相关。本研究系统地评估了营养和运动干预对HD患者肌肉状态的有效性。方法：我们对来自4个数据库的89项随机对照试验进行了网络荟萃分析，包括26个干预组的6128名HD患者。有关肌肉质量、力量、功能和生活质量的数据是从初步研究中提取的。结果以95%可信区间（CrI）的平均差（MD）表示。结果有氧运动(AE) +阻力运动（RE）可显著改善6 min步行测试（6MWT）（MD = 52.2 m; 95% CrI, 31.7 ~ 73.0）。多模态训练（MME）在增强握力方面表现最好（MD = 9.1 kg; 95%CrI, 1.8-16.4），在提高6MWT和30STS性能方面也比AE + RE有潜在优势。蛋白质口服营养补充剂对瘦体重有积极影响（MD = 0.3 kg; 95%CrI, 0.1-0.45）。结论我们的研究验证了AE + RE在改善肌肉功能方面的作用，揭示了MME在增强肌肉力量和功能方面超越AE + RE的潜力。补充蛋白质可以改善肌肉质量。这些发现支持了对HD患者进行有效运动和营养干预的临床决策，并为探索最佳组合策略提供了基础。未来需要更大规模、高质量的研究来扩展和加强我们的结论。

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Nutritional and exercise interventions for muscle status in hemodialysis patients: A systematic review and network meta-analysis

Background

Muscle mass depletion and functional decline in hemodialysis (HD) patients are associated with an increased risk of mortality. This study systematically assessed the effectiveness of nutritional and exercise interventions on muscle status in HD patients.

Methods

We conducted a network meta-analysis of 89 randomized controlled trials retrieved from four databases, including 6,128 HD patients across 26 intervention arms. Data on muscle mass, strength, function, and quality of life were extracted from primary studies. Results were presented as mean difference (MD) with 95 % credible interval (CrI).

Results

Combined aerobic exercise (AE) and resistance exercise (RE) significantly improved 6-min walk test (6MWT) (MD = 52.2 m; 95 % CrI, 31.7–73.0). Multi-modality exercise (MME) performed best in enhancing the handgrip strength (MD = 9.1 kg; 95%CrI, 1.8–16.4), also showed potential superiority over AE + RE in improving 6MWT and 30STS performance. Protein oral nutritional supplements positively affected lean body mass (MD = 0.3 kg; 95%CrI, 0.1–0.45).

Conclusion

Our research validates the role of AE + RE in improving muscle function and reveals the potential of MME to surpass AE + RE in enhancing muscle strength and function. Protein supplementation may improve muscle mass. These findings support clinical decisions regarding effective exercise and nutritional interventions for HD patients and provide a foundation for exploring optimal combination strategies. Larger-scale, high-quality studies are needed in the future to expand and strengthen our conclusions.

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来源期刊

Clinical nutrition 医学-营养学

CiteScore

14.10

自引率

6.30%

发文量

356

审稿时长

28 days

期刊介绍： Clinical Nutrition, the official journal of ESPEN, The European Society for Clinical Nutrition and Metabolism, is an international journal providing essential scientific information on nutritional and metabolic care and the relationship between nutrition and disease both in the setting of basic science and clinical practice. Published bi-monthly, each issue combines original articles and reviews providing an invaluable reference for any specialist concerned with these fields.