Khoom noj khoom haus txaus ntawm Tsiaj-raws li thiab cog-raws li Asian noj zaub mov rau cov neeg mob raum mob ntev
Feb 21, 2022
Hu rau: emily.li@wecistanche.com
Ban-Hock Khob, et al
Abstract:
Kev noj zaub mov tsis muaj protein ntau (LPDs) tau txais txiaj ntsig los tswjmob ntevraumkab mob(CKD) cov neeg mob. Kev noj zaub mov txaus ntawm cov no thiab lwm cov LPDs tau sau tseg rau cov neeg mob CKD tsis tau raug tshuaj xyuas kom zoo. Txoj kev tshawb no tau soj ntsuam cov khoom noj muaj pes tsawg leeg ntawm cov LPDs thiab cov khoom noj muaj protein tsawg (MHPDs) uas yuav raug sau rau cov neeg mob hauv Asia Pacificregion nrogmob ntevmob raum uastsis tau dialyzed los yog tu ncua kev lim ntshav. Kev noj zaub mov uas muaj tsawg kawg yog 50 feem pua ntawm cov tsiaj cov protein thiab cov zaub mov raws li cov nroj tsuag kuj tau npaj nrog cov tshuaj protein ntau ntawm 0.5 txog 0.8 g/kg/hnub thiab MHPDs nrog cov tshuaj protein ntau ntawm 1.0 txog 1.2 g / kg / hnub. Plant-based, lacto-, ovo-, thiab lacto-ovo-vegetarian thiab vegan LPDs thiab MHPDs tau npaj los ntawm kev hloov qee lossis tag nrho cov tsiaj proteins los ntawm kev noj zaub mov zoo. Nrog 0.5 g protein/kg/hnub, tag nrho cov zaub mov tau qis dua qhov pom zoo Dietary Allowances (RDA) rau tsawg kawg yog ib qho tseem ceeb amino acid (EAA). Ntawm cov tshuaj noj protein ntawm 0.6 g/kg/hnub, tsuas yog cov pa LPD tau ntsib RDA rau tag nrhoEAAs. Qhov kev tsis txaus siab no nrog cov nroj tsuag-raws li LPDs txuas ntxiv txawm tias muaj ntau yam khoom noj hloov pauv. Nrog rau cov tshuaj muaj protein ntau dua lossis sib npaug li 0.7 g / kg / hnub, tag nrho cov nroj tsuag raws li cov neeg tsis noj nqaij thiab LPDs tau muab RDA rau tag nrho EAA. Cov zaub mov raws li cov nroj tsuag thiab cov neeg tsis noj nqaij kuj muaj cov poov tshuaj ntau dua, phosphorus, thiab calcium cov ntsiab lus tab sis qis dua cov saw ntev n-3 polyunsaturated fatty acids thiab vitamin B-12 ntau dua li cov zaub mov noj. Lwm qhov tseem ceeb micronutrients feem ntau qis dua RDAeven ntawm kev noj cov protein ntau dua. Cov ntsiab lus qis ntawm qee qhov tseem ceeb micronutrients tau pom nyob rau hauv ob qho tib si tsiaj raws li cov khoom noj thiab cov nroj tsuag. Kev tshuaj xyuas tag nrho LPDs raumob ntevraumkab mobCov neeg mob, tshwj xeeb tshaj yog cov nroj tsuag thiab cov neeg tsis noj nqaij LPDs, yuav tsum tau ua tib zoo npaj los xyuas kom meej cov as-ham txaus, tshwj xeeb yog cov amino acids tseem ceeb. Kev txiav txim siab yuav tsum tau muab ntxiv rau kev ntxiv tag nrho cov tsiaj txhu thiab cov nroj tsuag raws li LPDs thiab MHPDs nrog cov vitamins ntau thiab qee yam kab mob.
Ntsiab lus: mob ntevraumkab mob; kev noj zaub mov noj; noj neeg tsis noj nqaij; noj cov protein tsawg; amino acids; micronutrients; Neeg Esxias noj zaub mov
1. Taw qhia
Ntevraumkab mob(CKD) yog kev txhawj xeeb txog kev noj qab haus huv thoob ntiaj teb. Kev txheeb xyuas tsis ntev los no kwv yees tias 9.1 feem pua ntawm cov neeg laus thoob ntiaj teb raug cuam tshuam los ntawm CKD, thiab yuav luag ib feem peb ntawm cov neeg uas muaj CKD nyob hauv Suav teb thiab Is Nrias teb [1]. Kev noj zaub mov tsis muaj protein ntau (LPD) muab 0.6 mus rau 0.8 g protein ib kg lub cev qhov hnyav tau raug pom zoo rau cov neeg mob uas tsis yog mob ntshav qab zib.mob ntevraumkab mobtheem 3 mus rau 5 txij li kev txwv cov protein ua rau txo qis ntawm cov proteinuria thiab txo qis cov protein los ntawm co toxins, nrog rau cov kua qaub, lwm yam metabolites thiab phosphate [2,3]. Piv txwv li, cov protein ntau ntau (1.0–1.2 g / kg) raug pom zoo rau cov neeg mob CKD uas tab tom kho lub lim piam kom them nyiaj rau qhov nce hauv cov protein catabolism nrog rau cov protein, peptide, thiab amino acid poob hauv dialysate uas tshwm sim thaum lub sij hawm dialysis kho [3,4].
Tsis ntev los no, cov neeg tsis noj nqaij thiab cov zaub mov cog tau raug npaj ua ib feem ntawm kev noj qab haus huv thiab kev noj qab haus huv ntau dua. Txawm hais tias cov ntsiab lus "kev noj zaub mov tsis zoo" thiab "kev noj zaub mov zoo" feem ntau siv sib hloov, lawv sawv cev rau ob hom kev noj mov sib txawv. Cov neeg noj zaub mov tshem tawm cov khoom noj nqaij, suav nrog nqaij, nqaij qaib, qus qus, thiab nqaij nruab deg, thaum lawv cov khoom, xws li qe thiab mis nyuj, yuav raug cais tawm [5]. Tsis tas li ntawd, kev noj zaub mov ntawm cov nroj tsuag hais txog kev noj zaub mov feem ntau los ntawm cov nroj tsuag, xws li txiv hmab txiv ntoo, zaub, txiv ntoo, roj noj qab haus huv, tag nrho cov nplej, thiab legumes, nrog rau cov khoom noj me me ntawm tsiaj txhu, suav nrog mis nyuj, qe, nqaij, thiab ntses [6]. Lub cev loj hlob ntawm cov pov thawj kis tau txhawb nqa cov lus pom zoo ntawm cov nroj tsuag thiab cov neeg tsis noj nqaij noj los tiv thaiv thiab kho qee yam kev noj haus uas muaj feem xyuam nrog cov kab mob xws li kev rog, ntshav qab zib hom 2, kub siab, kab mob plawv, thiab qee cov qog nqaij hlav [5,7]. Ntau cov ntawv ceeb toom qhia tias cov khoom noj uas cog qoob loo tuaj yeem cuam tshuam nrog cov txiaj ntsig zoo raumob ntevraumkab mobCov neeg mob hais txog ntshav siab, phosphorus lub nra, acid load, uremic toxins, o, thiab oxidative stress [8-14]. Txawm li cas los xij, cov txiaj ntsig tau hais tseg no tseem tsis tau lees paub ntau hauv cov kev sim tshuaj ntsuam xyuas kev soj ntsuam nrog cov txiaj ntsig kho mob raws li cov txiaj ntsig tseem ceeb ntsuas.
Txij li thaum cog cov protein ntau yuav muaj qis dua ntawm qee yam tseem ceeb amino acids (EAAs), tshwj xeeb tshaj yog lysine thiab sulfur-muaj cov amino acids [15], nrog rau tsawg dua ntawm qee cov micronutrients [5], nws tau raug nug txog seb puas Cov LPDs cog qoob loo no tuaj yeem ua rau tsis muaj qee yam khoom noj tseem ceeb. Ob peb txoj kev tshawb fawb los ntawm Ltalis [16,17] thiab Ixayees [18] tsis tau piav qhia txog kev nce ntxiv ntawm cov protein-zog nkim lossis khoom noj tsis txaus hauv cov neeg mob uas tsis tau lim ntshav CKD tau sau cov neeg tsis noj nqaij LPDs txij li 0.7 mus rau {{ 11}}.75 g protein ib kg lub cev hnyav. Txawm li cas los xij, qhov kev ntsuam xyuas ntawm kev noj haus tau ua nyob rau hauv cov kev tshawb fawb no tsuas yog suav nrog lub cev hnyav thiab ntau cov piam thaj hauv cov ntshav, thaum cov neeg mob cov amino acid, vitamin, ntxhia, thiab kab kawm tsis raug soj ntsuam. Cov ntaub ntawv tom kawg no tseem tsis tau ua tib zoo taug qab qhov kev noj zaub mov tiag tiag ntawm cov neeg mob CKD uas tau kawm. Ntawm qhov tod tes, kev soj ntsuam kev tshawb fawb hauv Taiwan tau tshaj tawm tias Lacto-ovo cov neeg tsis noj nqaij nrog CKD muaj lub zog noj zaub mov qis thiab noj cov protein ntau thiab qis dua lub cev qhov hnyav dua li lawv cov omnivore counterparts [19]. Tus kheej qhia txog kev noj zaub mov muaj protein ntau ntawm cov neeg mob tom kawg no muaj txij li 0.79 txog 0.92 g ib kg lub cev hnyav. Yog li, txawm hais tias kev noj zaub mov kom tsawg li {{20}}.6 g protein / kg / hnub raug pom zoo, muaj cov ntaub ntawv me me txog qhov txaus ntawm cov as-ham tseem ceeb, suav nrog EAAs, ntawm cov neeg tsis noj nqaij lossis cov nroj tsuag- raws li LPDs muab 0.5 mus rau 0.6 g protein ib kg lub cev hnyav.
Vegetarianism muaj kev lig kev cai ntev nyob rau hauv Indian kab lis kev cai vim tsawg kawg yog ib feem ntawm kev cai dab qhuas interdictions tawm tsam noj creatures lub neej [20]. Tam sim no, kwv yees li 40 feem pua ntawm Is Nrias teb cov pej xeem ib txwm ua raws li cov neeg tsis noj nqaij noj, uas feem ntau suav nrog cov mis fermented (piv txwv li, curds), lentils, thiab cov noob sprouting tshiab xws li ntsuab gram / mung taum ua cov protein ntau [20]. Ib yam li ntawd, cov neeg tsis noj nqaij hauv Suav teb kuj tau txhawb nqa los ntawm kev coj ua ntawm Buddhism thiab Daoism, thiab cov neeg noj zaub mov Suav feem ntau suav nrog cov khoom lag luam taum, xws li taum curd (tofu) thiab textured zaub protein raws li cov protein [21]. Qhov xwm txheej thiab kev noj zaub mov txaus ntawm cov neeg tsis noj nqaij lossis cov zaub mov raws li cog tau muab rau cov neeg mob CKD los ntawm ob kab lis kev cai no tsis tau ua tib zoo tshuaj xyuas, txawm hais tias ob lub tebchaws no muaj, nyob deb, cov neeg coob tshaj plaws hauv ntiaj teb. Tsis tas li ntawd, cov ntaub ntawv hais txog cov neeg tsis noj nqaij thiab cov zaub mov cog qoob loo rau kev tswj hwm CKD feem ntau yog npaj rau cov neeg sab hnub poob, thiab me ntsis tau tshaj tawm txog nws qhov kev siv tau hauv cov kab lis kev cai Esxias. Yog li, txoj kev tshawb fawb tam sim no tau tshuaj xyuas cov khoom noj khoom haus txaus ntawm EAA thiab micronutrients ntawm cov nroj tsuag thiab cov neeg tsis noj nqaij noj rau cov neeg Esxias CKD, feem ntau ntawm Suav los yog Indian kab lis kev cai keeb kwm. Txij li thaum tseem muaj cov ntaub ntawv tshaj tawm me me hais txog cov ntsiab lus tseem ceeb ntawm cov tsiaj txhu LPDs uas tau sau tseg rau cov neeg mob CKD, peb tau txheeb xyuas cov khoom noj tseem ceeb hauv cov tsiaj txhu ntau dua li LPDs thiab cov khoom noj muaj protein ntau (MHPDs) uas tej zaum yuav raug sau rau Asian CKD. cov neeg mob.
2. Cov ntaub ntawv thiab cov txheej txheem
2.1. Kev npaj ntawm cov ntawv qhia zaub mov
Raws li kev sib piv siv cov khoom noj khoom haus, peb tau tsim ib qho piv txwv {{0}}hnub zaub mov noj tsiaj siv 70 kg raws li qhov hnyav hnyav rau tus neeg laus (Table 1). Cov LPDs muaj plaub yam tshuaj protein, muab 0.5, {{10}}.6, 0.7, thiab 0.8 g protein ib kg lub cev hnyav. Tsawg kawg yog 50 feem pua ntawm cov protein yog cov khoom noj muaj txiaj ntsig zoo uas tau los ntawm cov khoom noj tsiaj txhu [22]. MHPDs muab 1.0, 1.1, thiab 1.2 g protein ib kg lub cev qhov hnyav uas feem ntau tau sau tseg rau kev saib xyuas hemodialysis, thiab cov neeg mob peritoneal dialysis kuj tau txheeb xyuas [2,3]. Lub zog tshuaj tau teem rau ntawm 2100 kcal rau tag nrho cov khoom noj, raws li 30 kcal ib kg lub cev qhov hnyav. Tag nrho cov carbohydrates pab txhawb 54 mus rau 58 feem pua ntawm lub zog (284–305 g) thoob plaws txhua daim ntawv tshuaj protein, thaum qhov feem pua ntawm tag nrho cov rog hauv cov zaub mov muaj li ntawm 30 txog 35 feem pua ntawm lub zog (70–82 g).
Tom qab ntawd peb txiav txim siab qhov sib pauv lossis qhov loj me rau txhua pawg zaub mov raws li kev faib cov macronutrient thoob plaws cov tshuaj noj protein. Tag nrho cov phiaj xwm noj mov raug kho kom muab peb qhov kev sib pauv ntawm cov txiv hmab txiv ntoo thiab plaub qhov zaub tsis muaj hmoov txhuv nplej siab. Rau LPDs, muaj yim pauv ntawm cov khoom noj khoom haus lossis cov khoom noj khoom haus thiab 14 kev sib pauv roj. Kev hloov pauv rau tus lej ntawm cov khoom noj protein sib pauv tau los ntawm ob mus rau tsib qhov sib pauv nrog peb mus rau tsib qhov sib pauv suab thaj. Rau MHPDs, muaj 11 kev sib pauv khoom noj khoom haus lossis cov khoom noj khoom haus. Cov zaub mov muaj protein ntau sib txawv hauv kev muab rau rau yim kev sib pauv nrog 11 txog 13 pauv roj.
2.2. Cov ntawv qhia zaub mov
Txoj hauv kev rau kev tsim cov ntawv qhia zaub mov yog nyob ntawm cov qauv kev noj haus ntawm cov neeg Indian thiab yav qab teb Suav haiv neeg los ntawm kev siv rau cov neeg mob cov ntaub ntawv kawm thiab cov ntawv qhia zaub mov tsim rau cov neeg mob nrog CKD los ntawm North Indian (Indraprastha Apollo Tsev Kho Mob, New Delhi, India), South Indian ( Apollo Tsev Kho Mob Chennai, Tamil Nadu, Is Nrias teb), thiab yav qab teb Tuam Tshoj (Guangzhou Red Cross Tsev Kho Mob, Guangzhou, Tuam Tshoj) cov tsev kho mob Cov zaub mov no tau txais los ntawm kev sib txuas lus ntawm tus kheej nrog cov neeg noj zaub mov (Anita Jatana, Apollo Tsev Kho Mob, New Delhi, India, thiab Daphnee DK, Tsev Kho Mob Apollo, Chennai, TamilNadu, Is Nrias teb) thiab tus kws kho mob nephrologist (Prof. Dr. Tan Rong Shao, Guangzhou Red Cross Hospital, Guangzhou, Suav) nyob thiab ua haujlwm hauv cov cheeb tsam no.
Cov cereals thiab cov khoom lag luam cereal pawg muaj feem ntau ntawm cov nplej, uas yog cov zaub mov tseem ceeb rau cov neeg Esxias. Lwm yam khoom noj khoom haus ntawm cov zaub mov suav nrog dosa, biscuits, thiab noodles. Peb suav nrog cov txiv hmab txiv ntoo thiab zaub uas muaj nyob hauv thaj av Esxias, xws li papaya, txiv tsawb, txiv duaj, txiv apple, txiv nkhaus taw, txiv kab ntxwv, okra, dib, eggplant, zaub qhwv, thiab spinach. Rau LPDs, txoj kev npaj rau ntses thiab nqaij qaib tais yog qhov tob tob. Cov dej haus xws li tshuaj yej, feem ntau noj nrog qab zib hauv Is Nrias teb, txawm hais tias tsis yog Tuam Tshoj tau nthuav tawm hauv cov ntawv qhia zaub mov los txhawb kev tsim nyog ntawm lub zog tshuaj tsis pub dhau cov protein txwv.
2.3. Protein Food Changes in Plant-based and Vegetarian Diets
Peb npaj ib daim ntawv qhia zaub mov rau cov nroj tsuag thiab plaub tus neeg tsis noj nqaij noj los ntawm kev hloov cov tsiaj raws li cov protein nyob rau hauv cov zaub mov uas muaj cov protein ntau xws li cov kua txiv hmab txiv ntoo (piv txwv li, taum pauv thiab tempeh), lentils (dhal), los yog taum. Lwm pawg zaub mov ntawm cov nroj tsuag thiab cov zaub mov noj zaub mov tseem zoo ib yam li cov ntawv qhia zaub mov. Cov ntawv qhia ua tsev yog muab los ua cov khoom siv ntxiv (Table S1). Cov ntawv qhia zaub mov cov ntsiab lus rau txhua cov nroj tsuag thiab cov neeg tsis noj nqaij noj muaj raws li hauv qab no:
Qauv 1: Kev noj zaub mov cog qoob loo tau npaj raws li cov hauv paus ntsiab lus ntawm kev noj zaub mov zoo tshaj plaws (PLADO) npaj los ntawm Kalantar-Zadeh li al. [13]. Cov zaub mov no muaj li ntawm 70 feem pua ntawm cov nroj tsuag-raws li cov protein. Piv txwv li, ib daim ntawv qhia zaub mov nrog tag nrho cov ntsiab lus ntawm cov protein ntawm 49 g / hnub yuav suav nrog 35 g ntawm cov protein los ntawm cov zaub mov cog thiab 14 g ntawm cov protein los ntawm cov tsiaj txhu. Yog li ntawd, txhua yam khoom noj tsiaj xws li nqaij qaib, ntses, lossis nqaij npuas los ntawm cov ntawv qhia zaub mov tau hloov nrog cov khoom noj uas muaj cov nroj tsuag kom cov tsiaj raws li cov zaub mov tsuas yog 30 feem pua ntawm tag nrho cov protein.
Qauv 2: Cov khoom noj vegan uas tsis suav tag nrho cov khoom noj uas tau los ntawm cov tsiaj, nrog rau cov qe thiab cov khoom siv mis nyuj. Tag nrho cov tsiaj-raws li cov protein tau hloov nrog cov nroj tsuag-raws li cov proteins xws li taum paj, taum pauv mis, lentils, thiab chickpeas.
Qauv 3: Kev noj zaub mov ovo-vegetarian uas tsis suav tag nrho cov zaub mov tau los ntawm cov tsiaj tshwj tsis yog qe. Tag nrho cov tsiaj-raws li cov protein, tshwj tsis yog cov qe, tau hloov nrog cov protein-raws li cov nroj tsuag, thiab tsawg kawg yog ib qho kev sib pauv ntawm qe (piv txwv li, ib lub qe tag nrho los yog cov qe dawb los ntawm ob lub qe) tau suav nrog hauv cov khoom noj txhua hnub. Qhov siab tshaj plaws ntawm cov qe suav nrog hauv cov ntawv qhia zaub mov yog peb qhov sib pauv hauv ib hnub.
Qauv 4: Lacto-vegetarian noj zaub mov uas tsis suav tag nrho cov khoom noj uas tau los ntawm cov tsiaj tshwj tsis yog cov khoom siv mis nyuj (xws li mis nyuj, paneer, thiab curd). Tag nrho cov tsiaj raws li cov protein, tshwj tsis yog cov khoom siv mis nyuj, tau hloov nrog cov khoom noj uas muaj protein ntau, thiab tsawg kawg ib qho kev sib pauv ntawm cov khoom siv mis nyuj (piv txwv li, 8 ooj lossis 240 mL mis nyuj) tau suav nrog hauv cov khoom noj txhua hnub. Qhov siab tshaj plaws ntawm cov khoom siv mis nyuj muaj nyob rau hauv cov ntawv qhia zaub mov yog ob qhov kev sib pauv hauv ib hnub.
Qauv 5: Lacto-Ovo cov neeg tsis noj nqaij noj uas tsis suav tag nrho cov khoom noj uas tau los ntawm cov tsiaj tshwj tsis yog qe thiab cov khoom noj siv mis. Tag nrho cov tsiaj raws li cov protein tau hloov nrog cov zaub mov raws li cov nroj tsuag, thiab tsawg kawg yog ib qho kev sib pauv ntawm cov qe thiab cov khoom siv mis nyuj muaj nyob rau hauv cov khoom noj txhua hnub. Qhov siab tshaj plaws ntawm cov qe thiab cov khoom noj siv mis muaj nyob rau hauv cov ntawv qhia zaub mov yog peb thiab ob qhov kev sib pauv hauv ib hnub, raws li.
2.4. Nutrient Analyzes
Cov khoom noj khoom haus ntawm txhua cov ntawv qhia zaub mov tau txheeb xyuas siv Nutritionist Pro Software (Axxya Systems LLC, Redmond, WA, USA), uas yog hais txog Food Data Central Database ntawm United States Department of Agriculture [23]. Peb tshem tawm ntsev thiab seasonings nyob rau hauv cov ntawv qhia zaub mov kev tsim kho thiab kev soj ntsuam nutrient vim hais tias kev siv cov condiments txawv ntawm tus neeg nyiam thiab kev ua noj ua haus, uas tsis muaj kev cuam tshuam cov nutrient muaj pes tsawg leeg sib txawv los ntawm kev hloov cov tsiaj-raws li proteins nrog cov nroj tsuag-based protein. Yog li ntawd, cov ntsiab lus sodium ntawm tag nrho cov ntawv qhia zaub mov qhia txog sodium ib txwm muaj nyob hauv cov khoom noj. Ib yam li ntawd, cov ntsiab lus ntawm cov poov tshuaj tau cuam tshuam txog kev muaj cov poov tshuaj hauv cov khoom noj uas hloov ntsev xws li potassium chloride tsis suav nrog hauv cov ntawv qhia zaub mov thiab tshuaj xyuas cov khoom noj. Peb nthuav qhia tus nqi tseeb ntawm cov ntsiab lus phosphorus ntawm tag nrho cov khoom noj uas tau tshaj tawm hauv cov ntaub ntawv tsis muaj kev cuam tshuam hauv bioavailability ntawm phosphorus qhov chaw. Cov ntsiab lus phosphorus tej zaum yuav underestimated vim hais tias phosphorus-muaj cov khoom noj additives tsis suav rau hauv cov zaub mov muaj pes tsawg leeg database.
Peb kuj tau suav cov Potential Renal Acid Load (PRAL) raws li cov khoom noj muaj pes tsawg leeg ntawm txhua hom LPDs thiab MHPDs siv cov qauv raws li tau piav qhia los ntawm Remer li al. [24]:
PRAL (mEq/d) {{0}}.49 × protein (g/d) plus 0.037 × phosphorus (mg/d) − 0 .021 × poov tshuaj (mg / d) −0.026 × magnesium (mg / d) − 0.013 × calcium (mg / d)
Kev noj zaub mov nrog tus nqi PRAL zoo qhia tias cov kua qaub tsim tawm thaum noj zaub mov nrog tus nqi PRAL tsis zoo qhia tias yog tsim los.
2.5. Defining Nutritional Reference values
Peb tau txiav txim siab qhov txaus ntawm EAAs los ntawm kev xa mus rau Daim Ntawv Pom Zoo Noj Khoom Haus (RDA) rau cov neeg laus (19 xyoo thiab laus dua) [25]. Kev pom zoo rau eicosapentaenoic acid (EPA) ntxiv rau docosahexaenoic acid (DHA) tau teeb tsa ntawm 250 mg / hnub [26]. Qhov txaus ntawm cov khoom noj fiber ntau yog raws li Kev Noj Qab Haus Huv Txaus (AI) rau tag nrho cov khoom noj fiber ntau, uas yog 14 g / 1000 kcal [25]. Txij li thaum lub zog tshuaj yog 2100 kcal, AI ntawm fiber ntau tau teem rau ntawm 29 g / hnub. Peb tau txiav txim siab qhov txaus ntawm thiamine, riboflavin, niacin, folate, cobalamin, magnesium, tooj liab, hlau, thiab zinc raws li lawv cov RDAs, thaum AI rau manganese tau siv los ua tus nqi siv los txiav txim siab txaus [27–29]. CKD cov lus pom zoo tshwj xeeb tau siv los ua qhov tseem ceeb rau kev xaiv cov khoom noj xws li sodium, calcium, thiab pyridoxine [3,30]. Tsis muaj qhov tshwj xeeb siv tus nqi rau kev noj zaub mov phosphorus thiab potassium vim tias qhov kev pom zoo ntawm Kev Kho Mob Raum Kho Kom Zoo Tshaj Plaws Cov Txheej Txheem Kev Ua Haujlwm Zoo yog los kho kev noj zaub mov kom tsawg ntawm ob cov zaub mov no kom tswj cov ntshav phosphate thiab potassium nyob rau hauv ib txwm muaj [3].
3. Cov txiaj ntsig
Cov muaj pes tsawg leeg ntawm macronutrients nyob rau hauv LPDs ({0}}.5–0.8 g protein/kg/hnub) yog qhia nyob rau hauv Table 2. Lub zog ranged los ntawm 2016–2229 kcal los yog 29–32 kcal/kg raws li nyob rau hauv kev siv lub cev hnyav ntawm 70 kg. Cov vegan LPDs muaj cov carbohydrate thiab fiber ntau tshaj plaws, thaum Lacto-Ovo LPDs muaj cov roj ntau tshaj. Tsuas yog cov pa thiab PLADO LPDs tau ntsib WHO cov lus pom zoo rau EPA thiab DHA, thaum EPA thiab DHA cov ntsiab lus hauv vegan thiab lacto-vegetarian LPDs yuav luag tsis pom zoo.
Ntawm kev noj zaub mov muaj protein ntau ntawm 0.5 g / kg / hnub, tsis muaj kev noj haus tau ntsib RDA rau threonine, leucine, lysine, thiab histidine. Tsis tas li ntawd, PLADO, Lacto-vegetarian, Ovo-vegetarian, thiab vegan noj tsis tau raws li RDA rau methionine ntxiv rau cysteine. Qhov feem pua tau txaus rau cov EAAs raws li lawv cov RDA tau nthuav tawm hauv daim duab 1A.
Ntawm kev noj zaub mov muaj protein ntau ntawm {{{0}}}.6 g/kg/hnub, cov khoom noj khoom haus tau ntsib RDA rau tag nrho EAAs. PLADO, ovo-neeg tsis noj nqaij, lacto-vegetarian, thiab lacto-ovo-neeg tsis noj nqaij noj tau qis dua RDA nkaus xwb rau lysine, thaum noj zaub mov tsis tau raws li RDAs rau lysine thiab methionine ntxiv rau cysteine. Qhov feem pua ntawm qhov tsim nyog rau cov EAAs raws li RDAs tau nthuav tawm hauv daim duab 1B. Nrog kev noj zaub mov ntawm 0.7 g protein / kg / hnub thiab ntau dua, tag nrho cov nroj tsuag raws li kev noj haus thiab cov neeg tsis noj nqaij nrog rau cov khoom noj khoom haus tau ntsib RDA rau tag nrho EAAs.
Cov muaj pes tsawg leeg ntawm macronutrients nyob rau hauv lub MHPDs (1.0–1.2 g/kg/hnub) yog qhia nyob rau hauv Table 3. Lub zog ranged ntawm 2079–2410 kcal los yog 20–34 kcal/kg raws li lub cev hnyav ua 70kg. Cov vegan MHPDs muaj cov carbohydrates ntau tshaj plaws thiab cov khoom noj muaj fiber ntau, thaum Lacto-Ovo MHPDs muaj cov roj ntau tshaj. Tsuas yog cov lus pom zoo thiab PLADO MHPDs tau ntsib WHO cov lus pom zoo rau EPA thiab DHA, thaum EPA thiab DHA cov ntsiab lus hauv vegan thiab lacto-vegetarian LPDs yuav luag tsis pom zoo. Txhua MHPDs tau ntsib RDA rau txhua EAA.
Cov macromineral, kab kawm, thiab cov ntsiab lus vitamin ntawm LPDs thiab MHPDs tau nthuav tawm hauv Cov Lus 4 thiab 5, raws li. Cov zaub mov raws li cov nroj tsuag thiab cov neeg tsis noj nqaij muaj ntau ntawm cov poov tshuaj, phosphorus, thiab calcium ntau dua li cov zaub mov noj. Ntawm qhov tod tes, cov zaub mov zoo ib txwm muaj cov sodium ntau dua piv rau cov nroj tsuag thiab cov neeg tsis noj nqaij, txawm hais tias cov ntsiab lus sodium tseem qis dua qhov feem ntau pom zoo rau cov neeg mob CKD [3]. Cov nroj tsuag raws li cov neeg tsis noj nqaij thiab cov neeg tsis noj nqaij LPDs, tab sis tsis yog cov qauv LPD, tau ntsib RDA rau tooj liab, thaum txhua tus MHPDs tau ntsib RDA rau tooj liab. Txhua LPDs thiab MHPDs kuj tau ntsib AI rau manganese. Tsis muaj LPD ntsib RDA rau zinc, qhov tsuas yog vegan MHPDs (Ntau dua lossis sib npaug rau 1.0 g/kg/hnub), lacto-ovo-neeg tsis noj nqaij MHPDs (Ntau dua lossis sib npaug rau 1.1 g/kg/hnub ), Lacto-vegetarian MHPDs (Ntau dua lossis sib npaug li 1.1 g / kg / hnub), thiab ovo-vegetarian MHPDs (Ntau dua lossis sib npaug li 1.2 g / kg / hnub) tau txaus. Ib yam li ntawd, tsis muaj LPD tau ntsib RDA rau magnesium, tab sis vegan MHPDs (Ntau dua lossis sib npaug rau 1.0 g/kg/hnub), Lacto-vegetarian MHPDs (Ntau dua lossis sib npaug rau 1.1 g/kg / hnub) , thiab ovo-vegetarian MHPDs (Ntau dua lossis sib npaug ntawm 1.2 g / kg / hnub) tau ntsib RDA rau magnesium. Txhua tus LPDs thiab MHPDs tau ntsib RDA rau cov hlau rau cov txiv neej thiab cov poj niam hnub nyoog qis dua 50 xyoo (8 mg/hnub), hos cov zaub mov vegan (Ntau dua lossis sib npaug rau 0.6 g/kg/ hnub), ovo-neeg tsis noj nqaij noj (Ntau dua lossis sib npaug rau 0.7 g/kg/hnub), ovo-neeg tsis noj nqaij noj (Ntau dua lossis sib npaug rau 0.8 g/kg/hnub) , PLADO cov zaub mov (Ntau dua lossis sib npaug ntawm 0.8 g / kg / hnub) thiab cov zaub mov lacto-ovo-neeg tsis noj nqaij (Ntau dua lossis sib npaug li 1.0 g / kg / hnub), tab sis tsis yog cov zaub mov noj, tau ntsib hlau RDA rau cov poj niam 19-50 xyoo (18 mg / hnub) [29].
Rau cov vitamins B, tag nrho LPDs thiab MHPDs tau ntsib RDA rau thiamine thiab folate, thaum tsis muaj LPD lossis MHPD tau ntsib CKD-kev pom zoo rau pyridoxine. Tsis muaj LPD ntsib RDA rau riboflavin tshwj tsis yog Lacto-Ovo cov neeg tsis noj nqaij LPDs (Ntau dua lossis sib npaug rau 0.6 g / kg / hnub). Cov ovo neeg tsis noj nqaij thiab lacto-vegetarian noj cov zaub mov ntawm cov zaub mov muaj protein ntau dua lossis sib npaug li 1.1 g / kg / hnub tau ntsib RDA rau riboflavin. Tsis muaj leej twg ntawm ovo-vegetarian thiab lacto-ovo-vegetarian noj zaub mov tau ntsib RDA rau niacin, thaum cov pa LPDs (Ntau dua lossis sib npaug rau {{10}}}.6 g / kg / hnub), PLADO LPDs ( Ntau dua lossis sib npaug rau 0.7 g / kg / hnub), vegan MHPDs (Ntau dua lossis sib npaug rau 1.1 g / kg / hnub), thiab lacto-neeg tsis noj nqaij MHPDs (Ntau dua lossis sib npaug rau 1.2 g / kg / hnub) ntsib RDA rau niacin. Hais txog RDA rau cobalamin, tsis muaj leej twg ntawm ovo-neeg tsis noj nqaij, cov neeg tsis noj nqaij, thiab cov neeg tsis noj nqaij LPDs lossis MHPDs tau ntsib qhov RDA no, thaum cov zaub mov noj (Ntau dua lossis sib npaug rau 0.6 g / kg / hnub ), PLADO cov zaub mov (Ntau dua lossis sib npaug ntawm 0.6 g / kg / hnub), thiab lacto-ovo-neeg tsis noj nqaij noj (Ntau dua lossis sib npaug ntawm 0.7 g / kg / hnub) tau ntsib RDA rau cobalamin.
Daim duab 2 qhia txog PRAL ntawm txhua hom LPDs thiab MHPDs. Txhua PLADO, lactovegetarian, thiab vegan noj cov zaub mov tsis zoo PRAL, txawm hais tias ntawm qhov txo qis thaum cov tshuaj noj protein ntau ntxiv. Cov zaub mov ovo-neeg tsis noj nqaij muaj qhov tsis zoo PRAL qhov tseem ceeb ntawm cov tshuaj noj protein los ntawm 0.5 mus rau 1.1 g / kg lub cev hnyav / hnub, thiab PRAL tus nqi tau los ua qhov zoo ntawm cov tshuaj protein ntawm 1.2 g / kg lub cev hnyav / hnub. Cov pa thiab Lacto-ovo-neeg tsis noj nqaij noj muaj qhov tsis zoo PRAL qhov tseem ceeb ntawm cov tshuaj protein hauv qab no {{10}}.8 g / kg lub cev hnyav / hnub, thiab PRAL qhov tseem ceeb tau los ua qhov zoo ntawm 1.0 g protein / kg lub cev. hnyav / hnub thiab siab dua.
4. Kev sib tham
The World Health Organization recommends that the safe level of protein intake for healthy adults is 0.83 g/kg body weight per day, for proteins with protein digestibilitycorrected amino acid score value of 1.0 [31]. The LPDs (0.6–0.8 g/kg) prescribed to nondialysis dependent CKD patients have been recommended to include at least 50% high biological value protein to ensure the adequacy of dietary needs [22]. Our LPD food pattern modeling concurred with this recommendation since only the conventional LPD (0.6 g/kg/day) containing at least 50% of the animal-based protein met the RDA for all EAAs. However, the plant-based and vegetarian diets only met the RDA for all EAA with the protein prescription of >{{0}}.7 g / kg thiab siab dua, thiab cov EAAs no zoo li yuav tsis muaj peev xwm thaum cov protein tau txwv rau 0.6 g ib kg lub cev hnyav.
Cov proteins cog feem ntau muaj tsawg dua li cov tsiaj proteins hauv qee yam EAAs, tshwj xeeb tshaj yog methionine thiab lysine [15]. Ib txoj kev tshawb nrhiav ntu ntu sib piv cov kev noj zaub mov kom tsawg thiab ntshav ntshav siab ntawm cov amino acids ntawm cov txiv neej noj qab haus huv raws li lawv cov kev noj haus ib txwm muaj qhia tias cov vegans tau noj tsawg tshaj plaws thiab cov ntshav plasma ntau ntawm lysine thiab methionine piv rau cov neeg noj nqaij, noj ntses, thiab neeg tsis noj nqaij [32]. Table 6 qhia txog cov ntsiab lus ntawm EAA cov proteins los ntawm cov khoom noj sib txawv hauv ib qho kev sib pauv (7 g protein). Rau ib qho LPD muab 0.6 g protein / kg / hnub lossis 42 g / hnub (siv lub cev hnyav ntawm 7{18}} kg), peb pauv (21 g protein) ntawm tsiaj protein, xws li raws li ntses lossis nqaij qaib, muab li 55-75 feem pua ntawm RDA rau leucine, lysine, thiab methionine ntxiv rau cysteine. Txawm li cas los xij, thaum cov tsiaj proteins hloov nrog cov nroj tsuag protein xws li taum paj, lentils, los yog taum, cov ntsiab lus ntawm EAAs yuav tsum qis dua, txij li peb qhov kev sib pauv ntawm cov nroj tsuag cov protein no tsuas yog 50-55 feem pua ntawm RDA rau leucine thiab lysine. , thiab 30-40 feem pua ntawm RDA rau methionine ntxiv rau cysteine. Raws li cov tshuaj noj protein ntau dua (Ntau dua lossis sib npaug li 0.7 g / kg / hnub) thiab ntau cov nroj tsuag cov protein tuaj yeem suav nrog hauv cov zaub mov, nws yog qhov ua tau rau kev noj zaub mov kom tau raws li RDAs rau tag nrho EAAs.
Barsotti et al. [16] thiab Soraka et al. [18] pom tau tias tus neeg tsis noj nqaij LPD nrog cov tshuaj noj protein ntawm 0.70–0.75 g ib kg lub cev qhov hnyav tuaj yeem ua tau raws li lawv cov lus qhia rau txhua qhov EAAs. Cov kws sau ntawv tau sau tseg tias cov neeg mob tau sau cov zaub mov no tsis muaj kev puas tsuaj rau kev noj zaub mov tsis zoo, txawm tias tus neeg tsis noj nqaij LPD tau qis dua hauv lysine, leucine, thiab methionine hauv kev sib piv rau ob qho tib si tsiaj noj zaub mov ntawm cov protein tsawg thiab RDAs. Muaj ob peb txoj kev piav qhia rau cov kev soj ntsuam no. Ua ntej, RDA rau cov khoom noj yog txiav txim siab yog tias cov khoom noj khoom haus tau muab cov khoom noj muaj txiaj ntsig zoo ntawm cov khoom noj rau li ntawm 97 feem pua ntawm cov pej xeem ib txwm [25]. Los ntawm qhov kev ntsuas no, cov neeg feem coob tuaj yeem noj tsawg dua RDA ntawm cov khoom noj uas tau muab thiab tseem tau txais cov khoom noj txaus txaus kom muaj zaub mov txaus rau lawv. Qhov thib ob, cov neeg mob qhov kev noj zaub mov muaj protein ntau yuav ntau dua li qhov lawv tau sau tseg, tsawg kawg qee lub sijhawm [33]. Thib peb, qhov kev txwv yuav tshwm sim los ntawm lawv txoj kev ntsuas kev noj haus los txiav txim siab cov neeg mob cov protein-zog uas tsis txaus rhiab vim nws tsuas yog tso siab rau ntawm lub cev qhov hnyav thiab cov protein ntau, thaum tus neeg mob cov vitamin, ntxhia, thiab kab kawm tsis raug ntsuas los ntawm cov kev tshawb fawb no.
Rau qhov zoo tshaj plaws ntawm peb txoj kev paub, cov ntsiab lus protein tsawg tshaj plaws rau kev noj zaub mov tsis zoo rau cov neeg mob CKD uas tau kuaj yav dhau los yog {{0}}.7 g / kg lub cev hnyav / hnub, thiab cov txheej txheem rau kev ntsuas kev noj haus. nyob rau hauv cov neeg mob no heev tsis meej [16]. Raws li pom nyob rau hauv Table 6, cov nroj tsuag muaj protein ntau inherently tsawg nyob rau hauv lysine thiab methionine. Yog li, kev ua tiav RDA ntawm EAAs no tsis zoo li thaum noj zaub mov tsis muaj protein ntau (0.6 g / kg) thiab muaj cov proteins tshwj xeeb rau tib lub sijhawm. PLADO cov zaub mov tsis muaj protein ntau (0.6 g / kg) tsuas yog 30 feem pua ntawm cov tsiaj cov protein kuj tsis muaj lysine. Qhov tseeb, peb cov ntaub ntawv qhia tau hais tias cov khoom noj muaj protein tsawg (0.6 g / kg) nrog 50 feem pua ntawm cov tsiaj proteins kuj marginally tau ntsib RDA rau lysine (108 feem pua). Txawm li cas los xij, ntau qhov kev tshawb fawb txog nitrogen qhia tau hais tias 0.60 g protein / kg / hnub noj zaub mov muab txog 50 feem pua ntawm cov protein uas muaj txiaj ntsig zoo (xws li, tsiaj protein) yuav tswj hwm qhov nruab nrab lossis zoo nitrogen sib npaug hauv cov neeg mob CKD qib siab uas tsis tau txais kev kho mob ntshav qab zib. [22, 34].
Txawm hais tias cov ntaub ntawv los ntawm cov qauv qauv zaub mov no qhia tau hais tias kev npaj cog qoob loo zoo los yog neeg tsis noj nqaij LPD (Ntau dua lossis sib npaug rau 0.7 g / kg / hnub) tuaj yeem ua tau raws li RDA rau tag nrho EAAs, RDA yog tsis yog CKD tshwj xeeb. Nws yog qhov ua tau tias muaj kev hloov pauv hauv cov kev cai noj zaub mov rau qee qhov EAAs hauv cov neeg uas muaj CKD, tshwj xeeb tshaj yog tias cov tib neeg no muaj comorbid mob [35–38]. Cov neeg mob uas muaj CKD siab heev tau hloov cov ntshav plasma thiab cov nqaij mos amino acid profiles [39–41]. Muaj pov thawj rau intracellular taurine depletion nyob rau hauv uas tsis yog-dialyzed CKD thiab tu cov neeg mob hemodialysis [35,36,42], thiab cov nroj tsuag cov zaub mov yog tsis txaus nyob rau hauv taurine [43]. Yog li ntawd, cov nroj tsuag los yog cov zaub mov vegan yuav tsis muaj peev xwm muab tau cov taurine txaus los yog lwm cov amino acids uas muaj cov sulfur-muaj cov amino acids los tswj cov qib cellular taurine ib txwm [44], thiab CKD thiab cov neeg mob dialysis ntev noj cov zaub mov vegan tuaj yeem muaj kev pheej hmoo. rau taurine deficiency. Cov kev tshawb fawb yav tom ntej tau qhia kom paub meej tias cov nroj tsuag no thiab tshwj xeeb tshaj yog vegan LPDs yog cov khoom noj txaus rau cov neeg mob CKD. Cov kev txiav txim siab no tseem qhia tau tias CKD thiab cov neeg mob ntshav lim ntshav ntev ua raws li vegan LPD yuav tsum tau saib xyuas tshwj xeeb los ntsuas lawv cov zaub mov noj thiab tiv thaiv kom tsis txhob muaj protein ntau. Qhov teeb meem no tej zaum yuav nyuaj tshwj xeeb tshaj yog nyob rau hauv cov teb chaws Es Xias uas tau nyiaj tsawg thiab nruab nrab cov neeg tau txais kev noj haus tsawg [45] thiab qhov twg muaj kev pheej hmoo ntawm kev noj zaub mov tsis zoo yuav muaj kev pheej hmoo siab, muaj kab mob ntev xws li tuberculosis yog ib qho mob [46], thiab cov neeg muaj cov khoom noj tsis txaus [47] ].
Kev tshuaj xyuas tsis ntev los no ntawm kev soj ntsuam kev tshawb fawb los ntawm Picard thiab al. [48] tau tshaj tawm tias cov neeg mob CKD nyob dawb uas noj cov neeg tsis noj nqaij lossis cov zaub mov noj zaub mov muaj qhov txo qis ntawm tus kheej qhia txog kev noj zaub mov kom tsawg. Txawm li cas los xij, qhov cuam tshuam ntawm qhov txo qis ntawm cov protein kom tsawg ntawm cov neeg mob cov protein-zog tsis tau ua tib zoo soj ntsuam; tsuas yog cov qib ntshav albumin tau tshaj tawm, thiab cov ntshav albumin, uas tsis txawv nyob rau hauv cov neeg mob noj cov tsiaj raws li cov zaub mov raws li cov nroj tsuag, yog ib qho kev qhia rhiab heev ntawm kev mob ntau dua li kev noj haus [49]. Txawm li cas los xij, qhov kev tshuaj xyuas no txhawb nqa qhov kev sib cav uas cov neeg mob CKD tau sau LPDs, thiab tshwj xeeb tshaj yog cov nroj tsuag lossis cov neeg tsis noj nqaij LPDs, yuav tsum tau ntuas los ntawm cov kws paub txog kev noj haus, thiab lawv cov protein-zog cov xwm txheej yuav tsum tau saib xyuas ib ntus [48]. Kev tshawb fawb txog kev kis kab mob ntawm Suav cov neeg mob hemodialysis tau qhia tias qhov kev faib ua feem ntawm cov nroj tsuag-raws li cov proteins hauv lawv cov zaub mov tau cuam tshuam U-kov kev sib raug zoo nrog kev hloov pauv tag nrho-ua rau kev tuag thiab kev tuag ntawm cov hlab plawv [49]. Cov kev hloov kho qis tshaj plaws tau pom nyob rau hauv kev saib xyuas cov neeg mob lim ntshav uas noj cov zaub mov raws li cov nroj tsuag thiab tsiaj txhu hauv kwv yees li ntawm 0.45 piv. Yog li, 55 feem pua ntawm kev noj zaub mov yog tsiaj raws li cov ntaub ntawv no. Txoj kev tshawb no tau txwv los ntawm qhov tseeb tias qhov kev ntsuam xyuas ntawm kev noj zaub mov tau ua rau peb lub sijhawm sib cais 24 teev thaum pib ntawm lub sijhawm nruab nrab ntawm 28 lub hlis [50].
Cov kev sib tham yav dhau los qhia tau hais tias LPDs cog qoob loo tuaj yeem ua rau cov neeg mob CKD muaj kev pheej hmoo rau kev noj zaub mov tsis zoo, tshwj xeeb tshaj yog tias cov zaub mov no muaj tsawg dua 0.7 g protein / kg / hnub. Txawm li cas los xij, cov khoom noj uas muaj cov nroj tsuag tuaj yeem ua rau kom tau txais lwm cov as-ham mus rau qib tsis xav tau. Rau cov neeg mob CKD, qhov no yuav yog qhov tshwj xeeb tshaj yog rau cov poov tshuaj thiab phosphorus, uas tuaj yeem ua rau cov neeg mob CKD ntau dua. Tseeb tiag, cov neeg tsis noj nqaij LPDs thiab MHPDs muaj ntau cov poov tshuaj thiab phosphorus ntau dua li cov khoom noj khoom haus thiab cov nroj tsuag, raws li qhia hauv Cov Lus 4 thiab 5. Qhov no yog qhov tseeb tshwj xeeb tshaj yog rau cov zaub mov vegan. Cov ntsiab lus sodium ntawm cov khoom noj no tsuas yog pom cov sodium uas muaj nyob hauv cov khoom noj, thiab cov nyiaj tau qis dua li cov neeg ib txwm noj. Raws li condiments thiab seasonings tsis suav nrog hauv kev tshuaj xyuas cov khoom noj, cov ntsiab lus ntawm cov poov tshuaj thiab phosphorus tseem tsis tau kwv yees vim tias qee cov khoom noj uas nquag siv hauv Suav zaub mov xws li kua ntses, oyster sauce, thiab ntses ntses kuj muaj cov ntsiab lus ntawm cov poov tshuaj thiab phosphorus [51] .
Hauv txoj kev tshawb no, peb tsis suav nrog cov nqaij tsis noj nqaij hloov pauv uas yuav muaj ntau ntau ntawm sodium, potassium, thiab phosphorus [52]. Tsis tas li ntawd, cov nroj tsuag-raws li cov nqaij hloov pauv no muaj qee yam khoom noj xws li zinc, calcium, thiab vitamin B12 [53]. Yog li ntawd, natural los yog unprocessed cog-raws li proteins raug xaiv. Txawm hais tias cov phosphorus ntawm cov khoom noj uas cog qoob loo feem ntau ntseeg tau tias muaj cov khoom noj tsawg dua (10-30 feem pua) vim yog cov phytates hauv cov khoom noj no, kev tshuaj xyuas ntawm tib neeg kev cuam tshuam cov kev tshawb fawb qhia tias ntau npaum li cas ntawm phytate-phosphorus yog absorbed (tsawg kawg. 50 feem pua). Kev ua lag luam ua zaub mov tseem ua rau cov nyiaj bioavailable phosphorus. Yog li ntawd, phosphorus ntawm cov nroj tsuag cov protein, tshwj xeeb tshaj yog cov uas tau ua tiav heev, yuav tsum tsis txhob xav tias yuav tsis zoo absorbed [54]. Txawm li cas los xij, phosphorus bioavailability ntawm cov nroj tsuag cov zaub mov tseem qis dua cov khoom noj tsiaj. Ntawm qhov tod tes, cov khoom noj siv mis muaj nyob rau hauv lacto- thiab Lacto-ovo cov neeg tsis noj nqaij noj yog qhov tseem ceeb ntawm kev noj haus phosphorus thiab calcium. Kev noj zaub mov muaj calcium ntau tuaj yeem ua rau muaj kev pheej hmoo ntawm calcium deposition hauv cov ntaub so ntswg, uas tsis yog ib qho tshwm sim tsis tshua muaj tshwm sim ntawm cov neeg mob CKD siab heev [55].
Kev noj zaub mov ntawm cov nroj tsuag thiab cov neeg tsis noj nqaij kuj tseem yuav tsis muaj lwm yam khoom noj uas tseem ceeb uas muaj ntau dua hauv cov khoom noj ntawm cov tsiaj keeb kwm, xws li cov saw ntev n-3 PUFAs thiab vitamin B-12 lossis cobalamin [56]. Ib txoj kev tshawb fawb hla ntu tau qhia tias cov neeg noj ntses tau noj zaub mov ntau dua ntawm cov saw ntev n-3 PUFAs dua li cov neeg tsis noj nqaij lossis cov neeg tsis noj nqaij. Txawm li cas los xij, qhov sib txawv ntawm plasma long-chain n{10}} PUFAs xwm txheej ntawm cov ntses noj thiab cov neeg tsis noj nqaij los yog cov neeg tsis noj nqaij yog me dua li qhov xav tau, tej zaum yog vim qhov kwv yees ntau dua cov khoom lag luam ntawm kev noj haus -linolenic acid rau cov saw ntev n -3 PUFAs ntawm cov neeg tsis noj nqaij lossis vegans [57]. Yog li ntawd, cov neeg mob ua raws li cov nroj tsuag los yog cov neeg tsis noj nqaij noj yuav tsum tau txhawb kom noj cov zaub mov siab hauv -linolenic acid kom pom cov ntshav zoo n-3 PUFAs xwm txheej. Ntawm qhov tod tes, txij li cov vitamin B-12 tau txais tshwj xeeb los ntawm cov tsiaj txhu, CKD cov neeg mob ua raws li cov neeg tsis noj nqaij noj yuav tsum tau noj cov zaub mov muaj vitamin B -12 fortified zaub mov los yog kev noj zaub mov kom tsis txhob muaj qhov tsis zoo [5].
Ntawm qhov tod tes, nws yog qhov tsim nyog los qhia tias cov kev npaj cog qoob loo thiab cov neeg tsis noj nqaij noj muaj cov khoom noj muaj fiber ntau ntau dua li cov khoom noj uas yog cov tsiaj txhu. Meta-analyses ntawm kev soj ntsuam kev tshawb fawb tau pom cov txiaj ntsig ntawm kev noj zaub mov fiber ntau (ntau npaum li ntawm 7 txog 50 g / hnub) hauv kev txo cov ntshav urea, creatinine, thiab p-cresyl sulfate [58,59]. Hauv peb txoj kev tshawb fawb, cov ntsiab lus fiber ntau ntawm cov nroj tsuag los yog cov neeg tsis noj nqaij LPDs (0.5–{23}}.8 g/kg/hnub) yog ntau dua li cov LPDs li qub los ntawm 8–2{{25. }}g/hnub. Tsis tas li ntawd, cov nroj tsuag cov proteins xws li taum, legumes, thiab lentils muaj PRAL qis dua li cov tsiaj proteins xws li nqaij, cheese, thiab qe [60]. Ob qho kev tshawb fawb txog kab mob sib kis [61,62] thiab kev sim tshuaj ntsuam xyuas [63,64] tau qhia tias txawm tias mob acidosis me me tuaj yeem cuam tshuam nrog kev loj hlob sai ntawm CKD, thiab kev noj zaub mov tsis zoo hauv nws cov PRAL tuaj yeem ua rau qeeb li kev loj hlob [65,66] . Txawm li cas los xij, peb txoj kev tshawb fawb pom tau tias PRAL qhov tseem ceeb ntawm cov pa LPDs tsis tau siab dua li cov nroj tsuag los yog cov neeg tsis noj nqaij noj thaum cov ntsiab lus protein tsawg (0.5-0.6 g / kg lub cev hnyav / hnub).
Cov nroj tsuag cov protein kuj tsis muaj cov roj cholesterol thiab muaj cov roj saturated qis dua li cov tsiaj protein. Txawm li cas los xij, cov pov thawj tsis tau qhia tias cov neeg mob ntshav qab zib CKD lossis cov neeg mob ntshav qab zib ntev uas noj cov zaub mov qis qis lossis cov neeg noj statins muaj cov kab mob plawv tsawg lossis txo cov neeg tuag [67]. Kev noj cov zaub mov raws li cov nroj tsuag tau thov kom muab cov txiaj ntsig zoo raws li qhov cuam tshuam tsis zoo ntawm cov nqaij loj loj hauv ib puag ncig ntawm kev siv av, siv dej, thiab emissions ntawm tsev cog khoom gases tau qhia [68]. Nws yuav tsum raug xam tias yog rau ntau lub tebchaws Esxias, cov tsiaj protein feem ntau muab los ntawm cov nqaij nruab deg, nqaij qaib, lossis nqaij npuas, tsis yog los ntawm nyuj [69]. Nrog ceev faj, cov nroj tsuag cov proteins yuav raug txhawb rau cov tib neeg uas muaj CKD ntev npaum li kev noj zaub mov kom zoo los xyuas kom meej tias tag nrho cov khoom noj khoom haus txaus txaus. Raws li peb txoj kev tshawb fawb pom zoo, nrog rau 0.60 g protein / kg / hnub noj, tej zaum yuav nyuaj los xyuas kom meej cov nyiaj txaus ntawm tag nrho cov EAAs tsis suav nrog tsiaj protein.
Peb txoj kev tshawb fawb muaj qee qhov kev txwv. Ua ntej, LPD thiab MHPD qauv yog ua raws li kev npaj zaub mov zoo tshaj plaws uas yog kev xav hauv qhov xwm txheej thiab yog li tsis tas yuav cuam tshuam txog kev noj zaub mov zoo ntawm ib tus neeg mob CKD. Qhov thib ob, txoj kev kawm ua qauv yog ua raws li kev xaiv zaub mov uas feem ntau siv hauv Asian cuisine, feem ntau yog Suav thiab Khab. Yog li, cov kev tshawb nrhiav no yuav tsis raug nthuav dav rau lwm cov kab lis kev cai Asian zaub mov, tab sis kev soj ntsuam ntawm cov khoom noj hauv tsev kho mob Suav thiab Indian no tuaj yeem muab kev nkag siab zoo rau kev xaiv zaub mov thoob plaws Asian spectrum. Tsis tas li ntawd, peb txiav txim siab cov amino acid cov ntsiab lus siv cov khoom noj muaj pes tsawg leeg database (FoodData Central) es tsis yog los ntawm kev soj ntsuam ncaj qha cov txheej txheem. Tsis tas li ntawd, qhov sib txawv ntawm cov khoom noj muaj nyob hauv thaj chaw thiab ntawm lub tebchaws. Txawm li cas los xij, qhov kev txhawj xeeb no tseem ua rau muaj qhov ua tau tias qee cov khoom noj khoom haus yuav muaj tsawg dua cov as-ham tseem ceeb tshaj li tau tshaj tawm hauv cov ntaub ntawv no. Tsis tas li ntawd, peb tsis suav nrog cov khoom tsis muaj protein ntau (piv txwv li, pasta, qhob cij, thiab hmoov nplej) hauv kev npaj cov LPDs, uas, yog tias suav nrog, yuav txo qhov feem pua ntawm cov protein los ntawm cov nplej zom thiab tso cai rau cov khoom noj muaj protein ntau dua. rau LPDs. Txawm li cas los xij, cov khoom zoo li no tsis zoo rau cov neeg Esxias cov zej zog thiab yog li ntawd muaj kev txwv tsis pub muaj nyob hauv cov khw muag khoom noj, thaum mov yog cov khoom noj tseem ceeb ntawm kev xaiv hauv thaj av Esxias [70]. Thaum kawg, cov ntsiab lus phosphorus tiag tiag ntawm cov khoom noj yuav muaj ntau dua li tau hais hauv cov khoom noj muaj pes tsawg leeg vim tias kev siv cov phosphorus-based additives tsis tau muab coj los rau hauv tus account thiab muaj peev xwm muaj nyob rau hauv cov hmoov nplej npaj siv, flavorings, thiab cov khoom noj uas tau ua tiav muaj rau cov neeg Khab thiab Suav. Tsis tas li ntawd, qhov sib txawv ntawm bioavailability ntawm phosphorus nyob rau hauv cov khoom noj sib txawv tsis tau hais hauv peb cov kev suav.
5. Cov lus xaus
Peb cov qauv qauv zaub mov qhia tau hais tias cov neeg Esxias cov nroj tsuag thiab cov neeg tsis noj nqaij noj zaub mov muab 0.7 g protein / kg / hnub lossis ntau dua tuaj yeem ua tau raws li RDA rau tag nrho EAAs. Txawm li cas los xij, ntawm cov zaub mov muaj protein ntau ntawm 0.6 g / kg / hnub, tsuas yog cov khoom noj ib txwm muaj xws li 50 feem pua cov protein ntau ntawm cov khoom noj tsiaj muaj peev xwm ua tau raws li RDA ntawm tag nrho EAAs. , thaum cov neeg tsis noj nqaij lossis cov nroj tsuag raws li LPDs yuav muaj qhov tsis zoo hauv EAAs. Yog li ntawd, qib protein ntau dua (tsawg kawg 0.7 g protein / kg / hnub) yuav tsum raug txiav txim siab rau cov tib neeg uas xav ua raws li cov neeg tsis noj nqaij lossis cov zaub mov noj, thiab cov zaub mov no yuav tsum tau ua tib zoo npaj vim tias cov tshuaj noj protein tseem qis dua RDA. . Hais txog macrominerals, cov nroj tsuag raws li kev noj haus thiab cov neeg tsis noj nqaij noj muaj ntau npaum li cas ntawm cov poov tshuaj, phosphorus, thiab calcium raws li piv rau cov pa noj. Kev noj zaub mov tsis zoo xws li zinc, tooj liab, magnesium, riboflavin, thiab pyridoxine thaum cov zaub mov noj thiab cov neeg tsis noj nqaij tsis muaj n{13}} ntev-chain polyunsaturated fatty acids, magnesium, riboflavin, niacin, pyridoxine. , thiab cobalamin. Kev siv cov tshuaj multivitamin thiab kab mob ntxiv yuav tsum tau txiav txim siab nrog cov khoom noj no. Cov ntaub ntawv hais los saum toj no qhia tau hais tias kev tshuaj xyuas tag nrho LPDs rau cov neeg mob CKD yuav tsum tau ua tib zoo npaj thiab saib xyuas txuas ntxiv.
Tus sau kev koom tes:
Conceptualization, B.-HK, TK, PK, thiab JDK; methodology, B.-HK; kev soj ntsuam, B.-HK, thiab DAT; kev tshawb nrhiav, B.-HK, DAT, TK, thiab MC; kev sau ntawv—kev npaj ua ntej, B.-HK, TK thiab JDK sau—kev tshuaj xyuas thiab kho, DAT, PK, thiab MC; kev saib xyuas, JDK Txhua tus kws sau ntawv tau nyeem thiab pom zoo rau cov ntawv luam tawm ntawm cov ntawv sau.
Los ntawm: ' Khoom noj khoom haus kom txaus ntawm Tsiaj-raws li thiab cog-raws li Asian noj zaub mov rau cov neeg mob raum mob ntev' los ntawmBan-Hock Khob, et al
---Nutrients 2021, 13, 3341
