Plant-based Versus Tsiaj-raws li cov khoom noj muaj protein tsawg hauv Kev Tswj Xyuas Kab Mob raum

Hu rau: jerry.he@wecistanche.com

Carmen-Antonia Mocanu12,*, Tudor Petrisor Simionescu 2, Andreea Elena Mocanu2 thiab Liliana Garneata 1,2

1 Department of Internal Medicine thiab Nephrology,"Carol Davila"University of Medicine thiab Pharmacy,

050474 Bucharest, Romania; lilianagarna@yahoo.com

2 Department of Nephrology,"Dr. Carol Davila"Teaching Hospital of Nephrology,4 Calea Grivitei, Sector 1,

010731 Bucharest, Romania; tudorsimi@yahoo.com (TPS); andreeamocanu91@gmail.com (AEM)*Cov ntaub ntawv: antonia.mocanu@drd.umfcd.ro

Abstract: Cov ntaub ntawv tsis ntev los no rov hais dua qis-protein ntaunoj zaub mov (LPDs) ua lub hauv paus hauv kev tswj hwm kev tswj hwm ntawmmob raum mob(CKD). Kev txo qis hauv cov proteinuria, kev tswj ntshav siab zoo dua thiab txo qis ntawm tus nqi qis hauvraumKev ua haujlwm nrog LPDs tau tshaj tawm, ob qho tib si hauv cov neeg tsis muaj ntshav qab zib thiab cov neeg mob ntshav qab zib. Supplemented, neeg tsis noj nqaij, heev-qis-protein ntaukev noj haus (sVLPD, 0.3 g/kg-hnub) tuaj yeem ncuaraumKev hloov kho (KR) pib, feem ntau los ntawm kev tswj kom zoo dua ntawm cov kab mob metabolic ntawm qib siab CKD hauv cov neeg mob uas tsis yog ntshav qab zib. Kev noj zaub mov ntawm cov nroj tsuag tuaj yeem ua kom lub plab microbiota thiab zoo li zoo tshaj rau kev noj zaub mov hypoproteic hauv kev kho mob siab heev CKD: kev tswj cov nitrogen zoo dua, cov kua qaub-puag metabolism thiab cov pob txha ntxhia. Cov neeg tsis noj nqaij noj ua kom tsawg dua cov co toxins thiab txo cov ntsev kom tsawg thiab cov kua qaub ntau dhau. Nyob rau tib lub sijhawm, lawv tuaj yeem txhim kho lipid metabolism, muab qhov sib piv siab ntawm unsaturated rau saturated fatty acids, nrog rau insulin tsis kam.

Ntsiab lus: mob raum mob; noj cov protein tsawg; noj zaub mov noj; cov zaub mov uas muaj cog; kev tswj hwm ntawm CKD; kev noj zaub mov hauv CKD

Cistanche tuaj yeem txhim kho lub raum ua haujlwm

1. Taw qhia

NtevraumKab mob (CKD) yog ib qho teeb meem kev noj qab haus huv thoob ntiaj teb, ob qho tib si nyob rau hauv cov theem predia-ysis thiab thaum lub raum hloov kho (KRT).Nrog rau qhov ntau ntawm 10 feem pua ​​​​ntawm cov pej xeem [1], nws cuam tshuam rau cov neeg mob 'morbidity, tuag thiab zoo. ntawm lub neej, nrog rau cov nqi kho mob.

Yog li ntawd, nws yog ib qho tseem ceeb uas yuav tsum tau tsom mus rau qhov muaj peev xwm ntawm kev txo qis ntawm CKD thiab ncua RRT los ntawm ntau txoj hauv kev, suav nrog kev noj haus.protein ntautxwv.

Qhov kev sim loj tshaj plaws uas tau tshuaj xyuas qhov ua tau zoo ntawm kev cuam tshuam kev noj haus hauv CKD, Kev Hloov Kho Kev Noj Qab Haus Huv hauvLub raumPawg kawm kab mob (kev tshawb fawb MDRD), tau txais txiaj ntsig tsis sib haum xeeb [2]. Raws li kev soj ntsuam thib ob, kev txhim kho me me ntawm tus nqi poob qis hauvraumKev ua haujlwm tau pom nrog LPDs piv rau cov khoom noj muaj protein ntau. Concomitantly, kev txhawj xeeb txog kev noj zaub mov tsis txaus tau raug tsa [3]. Kev soj ntsuam mus sij hawm ntev ntawm cov txiaj ntsig no tsis pom qhov txawv ntawmraumkev ciaj sia, tshwj tsis yog hauv cov neeg mob txom nyem txoj kev ciaj sia nyob rau hauv supplemented heev-tsawg-protein ntaudiet (sVLPD) pawg [4]. Txawm li cas los xij, ob peb lub ntsiab lus los ntawm MDRD txoj kev tshawb fawb tau sib cav: kev siv qhov ua tiav tiv thaiv tau sau tsegprotein ntaukev nkag mus rau hauv kev tshuaj ntsuam, nrog rau qhov sib txawv ntawm cov txheej txheem xaiv thiab hauv lub sijhawm saib xyuas [4].

Nyob rau hauv xyoo tas los no, muaj ntau cov pov thawj tias cov khoom noj muaj protein tsawg (LPDs) tuaj yeem cuam tshuam rau kev poob qis.raumfunction [5-7].

2. Cov Khoom Noj Tsawg-Protein hauv CKD

Qhov pom zooprotein ntaunoj. KDOQI Clinical Practice Guidelines for Nu-trition in CKD pom zoo rau cov neeg mob uas muaj metabolically ruaj khov CKD theem 3 ntxiv, nyob rau hauv kev saib xyuas, txwv tsis pub muaj protein ntau thiab qee qhov xwm txheej ntxiv nrog ketoanalogues ntawm cov amino acids tseem ceeb. Cov txiaj ntsig ntawm hom kev noj zaub mov no zoo li txo qhov kev pheej hmoo ntawm kev tuag thiab kev loj hlob mus rau theem kawg ntawm CKD, nrog rau kev txhim kho cov neeg mob lub neej zoo [8]. Hauv qhov no, rau cov neeg mob uas tsis muaj ntshav qab zib tau pom zoo kom noj cov protein ntau ntawm 0.55–{7}}.6 g / kg-hnub (xws li LPD) lossis noj cov protein ntau ntawm {{1{{ 12}}}}.28 rau 0.43 g/kg-hnub ntxiv nrog ketoanalogues ( sawv cev rau sVLPD) [8]. Cov neeg mob ntshav qab zib muaj kev pom zoo kom tswj hwm cov protein kom tsawg ntawm 0.6–0.8 g / kg-hnub nrog kev ua kom zoo ntxiv ntawm kev tswj ntshav qabzib [8].

Txoprotein ntauKev noj haus tuaj yeem cuam tshuam rau kev noj zaub mov zoo ntawm cov neeg mob uas muaj kev pheej hmoo ntawm cov protein-zog pov tseg. Txawm li cas los xij, cov neeg mob sab hnub poob uas noj cov nqaij liab ua tiav muaj cov protein ntau tshaj qhov pom tau tias tsim nyog kom ua tiav cov khoom noj muaj txiaj ntsig (1.35 g.protein ntau/kg-hnub piv rau 0.8 g/kg-hnub). Tsis tas li ntawd, kev txo qis ntxiv ntawm cov protein kom tsawg (0.3–{6}}.4 g / kg-hnub) ntxiv nrog ketoanalogues nws kuj tuaj yeem muab cov koob tshuaj txhua hnub ntawm cov amino acids tseem ceeb [8]. Ketoanalogues yog cov organic tebchaw uas muaj pawg carboxylic acid thiab pawg ketone uas, los ntawm kev hloov pauv, tsim cov amino acids. Yog li ntawd, ketoanalogues tuaj yeem siv tau tshwj xeeb rau cov amino acids ntxiv rau kev noj haus hauv cov neeg mob CKD. Feem ntau cov ketoanalogues muaj plaub ketoacids ntawm qhov tseem ceeb amino acids (isoleucine, leucine, phenylalanine thiab valine), hydroxy-acid ntawm methionine, thiab plaub qhov tseem ceeb amino acids rau cov neeg mob CKD (tryptophan, threonine, histidine thiab tyrosine) [9].

Qhov kev txhawj xeeb loj thaum nws los txog rau LPDs, tshwj xeeb tshaj yog nyob rau hauv cov neeg tsis noj nqaij, yog qhov kev pheej hmoo ntawm kev noj zaub mov tsis txaus, vim tias kev noj zaub mov nruj heev nrog cov khoom noj tsawg tuaj yeem tawm tsam kom ncav cuag qhov pom zoo niaj hnub noj ntawm qee cov amino acids, vitamins lossis txawm tias lub zog noj.

Tseem muaj cov teebmeem ntawmraummuaj nuj nqi. Kev noj hausprotein ntauKev noj haus hauv CKD tau raug tshawb xyuas hauv ntau qhov kev tshawb fawb tsis ntev los no, qhia tias Western noj zaub mov, nrog rau cov ntsiab lus ntawm cov nqaij liab ua tiav, tau cuam tshuam nrog kev nce qib ntawm CKD, peb zaug siab dua li qhov xav tau (-3 mL / min / 1.73 m2) thiab nce proteinuria [10,11].

Hauv txoj kev tshawb fawb Atherosclerosis Risk hauv Zej Zog (ARIC), hauv 14,882 cov neeg mob nrog qhov nruab nrab kwv yees glomerular filtration rate (eGFR) siab dua 60 mL / min / 1.73 m2 ntawm lub hauv paus, kev noj cov nqaij liab feem ntau cuam tshuam txog li 25 feem pua ​​​​txo hauv lub cev ua haujlwm [12] Nyob rau hauv sib piv, cov neeg mob nyob rau hauv txoj kev Dietary Approaches rau Stop Hypertension (DASH) noj cov zaub mov, nrog ib tug tsawg nqaij noj thiab nce zaub, txiv hmab txiv ntoo thiab tsawg-rog noj muaj ib tug 14 feem pua ​​​​txo txoj kev pheej hmoo ntawm tsim CKD [13].

Ib high-protein ntauKev noj haus ua rau vasodilation ntawm afferent arteriola, ua rau lub siab intraglomerular, thiab yog li kev loj hlob ntawm glomerulosclerosis [11]; thaum qis-protein ntauKev noj zaub mov ua rau vasoconstriction ntawm afferent arteriola, txo qis intra-glomerular siab thiab tus nqi ntawm CKD kev loj hlob [14].

Cov kev tshawb fawb soj ntsuam tau pom tias muaj txiaj ntsig ntxiv ntawm LPDs hauv CKD: amelioration ntawm nitrogen tshuav, metabolic acidosis, calcium-phosphorus metabolism, insulin tsis kam thiab tswj ntshav siab [15-17].

Lub raumthiab tus neeg mob ciaj sia. Ntau qhov kev tshawb fawb pom tias LPDs tau txais txiaj ntsig zoo rau cov neeg mob thiabraumciaj sia nyob rau hauv cov neeg mob adherent. Xyoo 1985, Rosman et al. pom tau hais tias cov neeg mob uas tau ua raws li LPD muaj qhov muaj sia nyob zoo dua piv rau cov neeg mob uas tsis ua raws li kev noj zaub mov noj (55 piv rau 40 feem pua) [18]. Hauv qhov no, lwm cov kev tshawb fawb kuj tau pom muaj txiaj ntsig zoo rau lub raum ciaj sia nyob rau hauv cov neeg mob ua raws li LPDs (90 piv rau 73 feem pua) [19]. Lwm qhov kev sim tshuaj ntsuam xyuas randomized txhawm rau ntsuas tus neeg mob thiab lub raum ciaj sia nyob rau hauv cov neeg mob uas tsis muaj ntshav qab zib nrog qhov ruaj khov CKD theem 4 ntxiv, uas cov neeg mob tau randomized rau LPD (0.6 g / kg-hnub) thiab sVLPD (0.3 g / kg. -hnub ntxiv 1 tb / 5 kg-hnub ntawm ketoanalogues) [20]. Kev noj cov protein ua tiav tau raug soj ntsuam siv cov khoom noj mis nyuj thiab cov zis urea hauv 24 teev tso zis [21]. Cov neeg mob txuas ntxiv ua raws li kev cuam tshuam thawj zaug rau kev soj ntsuam nruab nrab ntawm 10 xyoo. Muaj qhov sib txawv tseem ceeb ntawm cov pab pawg ob qho tib si hauv cov neeg mob ciaj sia (89 feem pua ​​​​hauv sVLPD piv rau 60 feem pua ​​​​hauv LPD) thiab hauv lub raum ciaj sia (51 feem pua ​​​​cov neeg mob los ntawm sVLPD pab pawg tsis xav tau KRT piv rau 93 feem pua ​​​​hauv LPD pawg) [20]. Txawm li cas los xij, txij li hauv qhov kev tshawb fawb no muaj ob qhov sib txawv tseem ceeb ntawm cov pab pawg, piv txwv li, qib ua tiavprotein ntaukev noj haus, nrog rau cov ntsiab lus ntawm cov neeg tsis noj nqaij noj, lub luag haujlwm ntawm cov neeg tsis noj nqaij noj ib leeg yog qhov nyuaj rau kev soj ntsuam.

LPDs nyob rau hauv Diabetic raum Kab Mob. Mob raum mob ntshav qab zib yog ib qho ntawm feem ntau etiologies ntawm CKD, tus cwj pwm los ntawm cov proteinuria ntau dua, thiab yog li kev poob qis hauv lub raum sai dua thaum piv rau lwm cov kab mob raum [22]. Tsis tu ncua hyperglycemia, insulin tsis kam lossis insulin tsis txaus ua rau muaj kev cuam tshuam ntawm metabolic, txhawb oxidative kev nyuaj siab thiab qib siab glycosylation compounds. Qhov no ua rau endothelial dysfunction, podocyte dysfunction, nrog rau mesangial thiab tubular abnormalities [23]. Ib qho tseem ceeb hauv kev tsim cov ntshav qab zib nephropathy uas tsim nyog tau txais kev saib xyuas ntxiv yog kev txhawb nqa ntawm renin-angiotensin-aldosterone system [24]. LPDs zoo li cuam tshuam nrog cov kab mob angiotensin-aldosterone, thiab yog li txo qis intraglomerular siab. Cov txiaj ntsig zoo tseem ceeb tau pom hauv kev txo cov proteinuria [3,25,26], tab sis kuj tseem nyob rau ncua sijhawm KRT [27].

Tam sim no txoj kev multifactorial tau pom zoo rau cov neeg mob ntshav qab zib; yog li ntawd, muaj tsawg cov ntaub ntawv hais txog cov teebmeem ntawm ib tug tsawg-protein ntaukev noj zaub mov hauv ib tus neeg mob ntshav qab zib mellitus, tab sis ob peb txoj kev tshawb fawb uas hais txog lub luag haujlwm ntawm kev noj zaub mov zoo yog qhov pom zoo rau qis-protein ntaunoj zaub mov, feem ntau yog neeg tsis noj nqaij, feem ntau vim yog cov nyhuv hemodynamic ntawm xws li kev noj haus [17,26]. Ntau tshaj li ntawd, cov neeg mob ntshav qab zib uas tau ua raws li cov neeg tsis noj nqaij LPD tau tswj hwm cov piam thaj metabolism zoo dua vim tias qhov txo qis ntawm insulin tsis kam [28].

Cistanche tuaj yeem txhim kho lub raum ua haujlwm

3. Plant-Based Diets hauv CKD

Kev noj zaub mov Mediterranean, nplua nuj nyob hauv zaub, txiv hmab txiv ntoo thiab cereals tau cuam tshuam nrog kev muaj sia nyob zoo dua hauv cov neeg mob CKD piv rau Western cov zaub mov [29]. Cov neeg mob uas haus cov khoom noj uas tau ua tiav zoo li muaj cov hlab plawv thiab tag nrho cov neeg tuag thiab muaj ntau dua ntawm cov kab mob neoplastic piv nrog cov neeg mob uas tsis haus cov khoom noj uas tau ua tiav [30,31].

Cov neeg tsis noj nqaij thiab vegan noj zaub mov tau nce ntxiv rau cov neeg mob uas muaj kab mob ntev, suav nrog CKD, tshwj xeeb tshaj yog los pab txhawb kev sib koom ua ke ntawm LPDs [32,33]. Cov zaub mov vegan thiab neeg tsis noj nqaij feem ntau muaj 0.6–{4}}.8 g / kg-hnub ntawm cov proteins thiab zoo li txo qis hyperfiltration, los ntawm kev txo qis bioavailability ntawm cov nroj tsuag.cov proteinspiv nrog cov tsiaj txhu [34–36].

Tsis tas li ntawd, cov neeg tsis noj nqaij thiab vegan noj zaub mov muaj ntau cov vitamins.

Kev noj zaub mov raws li cog cov proteins nkaus xwb tau txiav txim siab rau lub sijhawm ntev noj zaub mov tsis txaus, feem ntau yog vim muaj peev xwm tsis txaus ntawm cov amino acids tseem ceeb hauv cov tsiaj.cov proteins. Qhov tseeb, txhua yam khoom noj muaj cov amino acids thiab cov vitamins nyob rau hauv sib txawv proportions; Kev noj zaub mov kom tsim nyog tau txais cov amino acid tib yam thiab cov vitamins raws li tsiaj cov proteins [37-39].

Rau kev ntsuam xyuas cov khoom noj muaj txiaj ntsig ntawm cov zaub mov Protein Digestibility Corrected Amino Acid Score (PDCAAS) tuaj yeem siv [40]. Cov qhab nia no tau raug siv los ntsuas qhov zoo ntawm cov proteins los ntawm aliments los yog pab pawg ntawm aliments nrog cov qauv amino acid profilles. Cov qhab nia sib piv cov nqi ntawm cov amino acids tseem ceeb los ntawm ib qho kev noj zaub mov rau ib qho kev sib tw raws li qhov yuav tsum tau muaj ntawm 2- rau 5- cov menyuam yaus hnub nyoog, uas muaj cov qauv, cov khoom noj khoom haus siab tshaj plaws [41 ]. Qhov kev txwv tseem ceeb ntawm qhov qhab nia no yog tias nws tsis suav nrog cov qib ntawm qee cov tshuaj tiv thaiv, xws li phytic acid lossis trypsin. Txij li xyoo 2013, Lub Koom Haum Saib Xyuas Khoom Noj thiab Kev Ua Liaj Ua Teb ntawm United Nations tau tshaj tawm lwm txoj hauv kev rau kev ntsuas cov protein zoo, Digestible Indispensable Amino Acid Score (DIAAS), uas muab cov ntaub ntawv ntxiv txogprotein ntauzoo [42]. Tsiaj cov proteins muaj cov qhab nia PDCAAS ntau dua li cov zaub protein, tsis muaj qhov sib txawv ntawm cov khoom noj muaj txiaj ntsig thaum tus neeg mob ua raws li kev noj zaub mov muaj ntau haiv neeg [43].

Txoj kev tshawb fawb loj tshaj plaws tau ua los ntsuam xyuas qhov cuam tshuam ntawm cov khoom noj uas cog qoob loo, Adventist Health Study 2, tau tso npe rau 96,335 tus neeg koom ua ke ua tsib txoj kev noj zaub mov txawv: tsis yog neeg tsis noj nqaij (siv nqaij tsis yog ntses ntau dua ib hlis ib hlis lossis ib qho nqaij ntau dua ib zaug ib zaug. lub lim tiam), ib nrab neeg tsis noj nqaij (siv cov nqaij uas tsis yog ntses lossis ib qho nqaij ntau tshaj ib hlis ib hlis, tab sis tsis pub ntau tshaj ib zaug hauv ib lub lis piam), pesco-neeg tsis noj nqaij (siv nqaij ntses ntau tshaj ib zaug hauv ib lub hlis tab sis tag nrho lwm cov nqaij tsawg dua ib zaug ib zaug). lub hli), lacto-ovo-neeg tsis noj nqaij (siv qe lossis mis nyuj ntau dua ib hlis ib zaug, tab sis ntses lossis tag nrho lwm cov nqaij tsawg dua ib zaug hauv ib lub hlis), thiab vegan (siv qe lossis mis nyuj, ntses thiab tag nrho lwm cov nqaij tsawg dua ib zaug ib zaug). hli) [44]. Cov qauv kev noj zaub mov tsis zoo tau cuam tshuam nrog kev tuag tsawg dua piv nrog cov tsis yog neeg tsis noj nqaij noj [44]. Hais txog qhov muaj feem cuam tshuam ntawm kev noj zaub mov tsis zoo, txoj kev tshawb fawb tau qhia tias cov neeg mob uas noj cov qauv sib txawv ntawm cov neeg tsis noj nqaij noj tau mus txog lossis tseem tshaj qhov tsawg kawg nkaus ntawm kev noj cov protein [18,44,45].

Nitrogen tshuav nyiaj li cas. Cov zaub mov vegan thiab cov neeg tsis noj nqaij zoo li tsim kom muaj me me ntawm cov co toxins los ntawm kev hloov cov kab mob hauv plab hnyuv proteolytic rau hauv Saccharolytic profile nrog kev txhawb nqa ntawm cov saw hlau luv fatty acids los tsim cov kab mob hauv plab hnyuv thiab txo cov kab mob translocation thiab inflammation [45,46. ].

Acid-base thiab electrolytic abnormalities. Nqaij noj feem ntau yog txuam nrog nceprotein ntaunoj; cov nqaij nws tus kheej, feem ntau nyob rau hauv ib tug heev ua daim ntawv, accentuates metabolic acidosis nyob rau hauv cov neeg mob nrog CKD. Acidemia induces protein-zog malnutrition los ntawm kev txhawb nqa glucocorticoid secretion thiab insulin tsis kam, yog li cuam tshuam nrog albumin synthesis [47]. Zaubcov proteinsfeem ntau yog pH nruab nrab. Kev noj zaub ntau ntxiv pab kom ua tiav kev tswj hwm ntawm acid-base tshuav [47]. Tsis tas li ntawd, txawm hais tias vegan thiab neeg tsis noj nqaij noj zaub mov muaj cov ntsiab lus ntawm cov poov tshuaj ntau ntxiv, hyperkalemia kuj tsis tshua muaj, vim muaj cov ntsiab lus fiber ntau uas tso cai rau me me ntawm cov poov tshuaj kom rov ua dua [48,49]. Kho cov kab mob metabolic acidosis txhim kho cov neeg mob ciaj sia thiab txo qhov kev loj hlob ntawm CKD [50].

Cov pob txha ntxhia pob txha. Mineral thiab pob txha mob hauv CKD yog txuam nrog kev mob plawv thiab kev tuag tag nrho thiab kev poob sai dua hauvraumua haujlwm [51–53]. Cov nroj tsuag muaj cov phosphorus ntau dua piv rau cov tsiaj proteins. Txawm li cas los xij, phosphates yog khaws cia rau hauv daim ntawv uas tsis yog-absorbable phytate. Yog li ntawd, tsuas yog ib feem peb ntawm phosphate los ntawm cov zaub mov cog yog bioavailable vim tsis muaj peev xwm ntawm tib neeg lub cev los metabolize phytate. LPDs muaj kev cuam tshuam ntxiv hauv calcium thiab phosphate homeostasis los ntawm kev txo cov ntshav hauv cov ntshav ntawm cov fibroblast kev loj hlob 23 (FGF 23) txog li 33.5 feem pua ​​[54]. Kwv yees li ob feem peb ntawm tag nrho cov phosphates los ntawm cov khoom noj tsiaj txhu yog bioavailable; Yog li ntawd, qhov txawv txav ntawm calcium-phosphorus metabolism yog ntau dua nyob rau hauv cov neeg mob uas noj cov tsiaj feem ntau.cov proteins, nce theem nrab hyper- parathyroidism [6,51,55].

Arterial hypertension. Qee qhov txiaj ntsig zoo ntawm kev tswj ntshav siab, tshwj xeeb tshaj yog ntawm cov ntshav siab diastolic, kuj tau pom [53,56]. Ntxiv mus, qhov txiaj ntsig zoo li tseem ceeb dua rau cov neeg mob uas tau ua raws li kev noj zaub mov vegan. Los ntawm kev sib piv, cov neeg mob no tau tswj hwm lawv cov ntshav siab [57–62].

Qhov zoo ntawm cov amino acids zoo li cuam tshuam rau kev tswj ntshav siab. Kev nce qib ntawm methionine thiab alanine, pom nyob rau hauv cov neeg mob uas nyiam noj tsiajcov proteins, tau txuam nrog cov ntshav siab. Kev nce qib ntawm threonine thiab histidine, nquag ntawm cov neeg mob vegan thiab cov neeg tsis noj nqaij, tau cuam tshuam nrog kev tswj ntshav siab [62].

Cov txiaj ntsig ntawm cov neeg tsis noj nqaij LPDs kuj tau pom hauv cov neeg mob ntshav qab zib. Hauv qhov no, nws zoo nkaus li tias qhov nruab nrab ntawm cov ntshav siab tuaj yeem txo qis los ntawm 13 mmHg nrog kev pom zoo rau ntau txoj hauv kev, suav nrog kev noj zaub mov ntawm feem ntau cov neeg tsis noj nqaij LPD [17].

Lipid metabolism. Cov neeg mob nrog CKD feem ntau cuam tshuam nrog kev txawv txav hauv lipid metabolism, yog li txhawb atherosclerosis. Yog li, kev tswj cov lipid metabolism sawv cev rau lub hom phiaj tseem ceeb. Kev noj cov kua txiv hmab txiv ntoo txo ​​qis cov roj cholesterol LDL thiab cov nplej gluten txo qis LDL-cholesterol, triglycerides thiab uric acid [63-65]. Cov neeg tsis noj nqaij noj muaj txiaj ntsig zoo hauv kev tswj cov lipid metabolism, vim tias qhov txo qis hauv cov roj saturated fatty acids, uas tau hloov nrog cov roj monosaturated los ntawm cov tshuaj ntsuab lossis cov roj ntses [64-66].

Lub luag haujlwm ntawm plab microbiota. Hauv cov neeg mob CKD, muaj cov kab mob dysbiotic plab microbiota, ua rau muaj kev cuam tshuam los ntawm kev txo qis hauv cov kab mob commensal thiab nce cov kab mob uremic toxin-ua cov kab mob. Nws zoo nkaus li tias plab-derived uremic toxins, xws li p-cresol thiab indoxyl sulfate txhawb kev nrawm ntawm cov kab mob plawv [67,68]. Lwm yam uremic toxins, xws li trimethylamine N-oxide (TMAO) txhawb atherosclerosis thiab tuaj yeem ua rau muaj kev pheej hmoo ntawm kev tuag hauv CKD [69]. Qhov kev tsis txaus ntseeg no zoo li tau hloov kho los ntawm kev cuam tshuam kev noj haus. Hauv qhov no, cov ntsiab lus fiber ntau ntawm LPDs, tshwj xeeb tshaj yog nyob rau hauv vegan thiab neeg tsis noj nqaij noj zoo li txo qis.protein ntaufermentation thiab nce carbohydrate fermentation [70,71]. Piv nrog rau omnivores, vegan thiab neeg tsis noj nqaij noj cov zaub mov muaj cov ntsiab lus qis ntawm L-carnitine, uas yuav txo tau cov khoom ntawm TMAO, thiab yog li txo cov neeg tuag los ntawm cov kab mob plawv [72].

Cistanche tuaj yeem txhim khoraummuaj nuj nqi

4. Neeg tsis noj nqaij LPDs nyob rau hauv cov xwm txheej tshwj xeeb

Txawm hais tias LPDs muaj cov txiaj ntsig zoo ntawm kev ncua sijhawm KRT thiab tau txais kev tswj hwm ntawm cov metabolism sib txawv, nws yuav tsum tau xav txog tias muaj cov neeg mob tshwj xeeb uas LPD zoo li yuav tsum tau contraindicated [46]. Hauv qhov kev hwm no, peb xa mus rau qhov muaj cov mob hypercatabolic,protein ntau-energy nkim, noj tsis zoo lossis txawm tias lub neej luv luv ntawm cov neeg mob [46].

Socio-economic thiab kab lis kev cai teeb meem yuav ua rau muaj kev cuam tshuam rau kev ua raws li LPDs tab sis tuaj yeem kov yeej los ntawm kev ua tus kheej ntawm kev puas siab puas ntsws, ntxiv rau kev cuam tshuam kev noj haus.

Cov neeg mob uas muaj kev puas siab puas ntsws sawv cev rau lwm qhov kev sib tw hauv kev ua raws li kev noj zaub mov zoo, tab sis nrog kev cuam tshuam txog kev puas siab puas ntsws thiab kev soj ntsuam zoo dua, kev ua raws li LPD tuaj yeem ua tiav vim kev sib txuas lus sib tham.

Lub hnub nyoog laus tsis yog ib qho kev txwv tsis pub siv LPD, tab sis kev saib xyuas ze ntawm cov neeg laus (xws li hnub nyoog tshaj 80 xyoo) yuav tsum raug coj mus rau hauv tus account vim muaj qhov ua tsis tau zoo, nrog rau lawv cov kev sib raug zoo nrog kev paub tsis meej. Muaj ob peb txoj kev tshawb fawb uas txheeb xyuas cov txiaj ntsig thiab kev pheej hmoo ntawm LPDs hauv cov neeg mob laus, tab sis qhov xaus yuav yog tias kev tshuaj xyuas LPD rau cov neeg laus kuj zoo li ncua KRT yam tsis muaj qhov tshwm sim rau cov neeg mob ciaj sia [73].

5. Cov lus xaus

Tsawg-protein ntaukev noj zaub mov ua tau thiab muaj txiaj ntsig zoo rau cov neeg mob uas mob ntevraumkab mob, nrog thiab tsis muaj ntshav qab zib, ob qho tib si hauv kev ncua sijhawmraumKev hloov kho, tab sis kuj ua rau cov neeg mob muaj sia nyob zoo dua rau lub sijhawm ntev, vim tias cov khoom noj no muaj kev nyab xeeb. Cov neeg tsis noj nqaij ntxiv, tsawg heev-protein ntaukev noj zaub mov zoo li muaj txiaj ntsig zoo ntxiv rau tus neeg mob thiab lub raum ciaj sia.

Cov neeg tsis noj nqaij thiab vegan noj zaub mov zoo li zoo tshaj rau cov khoom noj sib xyaw thiab tuaj yeem txhim kho qee qhov kev cuam tshuam metabolic cuam tshuam txog kev mob ntev.raumkab mob thiab optimize ntshav siab tswj.

Proteintxwv, nrog rau cov nroj tsuag-raws li, qis-protein ntaucov zaub mov (cov neeg tsis noj nqaij lossis vegan noj zaub mov), muaj kev noj qab haus huv zoo nyob rau hauv cov mob ntevraumcov neeg mob, nrog lossis tsis muaj ntshav qab zib mellitus, hauv cov neeg mob uas ua tiav qhov kev xav tau ntawm lub zog.

Sau Kev Pabcuam: Txhua tus kws sau ntawv tau pab txhawb rau kev xav, kev sau ntawv, kev npaj ua ntej, tshuaj xyuas thiab kho. Txhua tus kws sau ntawv nyeem thiab pom zoo rau cov ntawv luam tawm ntawm cov ntawv sau.

Kev Kawm Txuj Ci: Qhov kev tshawb fawb no tsis tau txais nyiaj txiag sab nraud.

Cov paj laum tsis sib haum xeeb: Tsis muaj qhov cuam tshuam ntawm kev txaus siab tsis sib haum xeeb tau tshaj tawm los ntawm cov kws sau ntawv.