Assessment of habitual physical activity and energy expenditure in dialysis patients and relationships to nutritional parameters
Assessment of habitual physical activity and energy expenditure in dialysis patients and relationships to nutritional parameters
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DOI：
10.5414/cnp75218
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发表时间：
2011-03-01
影响因子：
1.1
通讯作者：
Barsotti, G.
中科院分区：
文献类型：
--
作者：
Cupisti, A.;Capitanini, A.;Barsotti, G.
背景和目标：体力活动水平和能量消耗的评估在透析患者的临床和营养护理中是重要的，但它并不容易实现。SenseWear（TM）臂带（SWA）是一种新型的多传感器设备，戴在上臂上，收集与身体活动有关的各种生理数据。因此，体力活动的持续时间和强度被记录并表示为MET（代谢当量任务），并估计能量消耗。本研究的目的是评估稳定的慢性血液透析（HD）患者的透析间期自发体力活动及其与营养状况和膳食营养素摄入的关系。患者和方法：在50名稳定的维持性血液透析治疗患者和33名正常受试者（对照组）中，通过SWA评估自发体力活动水平和估计每日能量消耗，并与生化和人体测量数据、生物电阻抗矢量分析以及来自3天食物回忆的能量和营养摄入信息相关。结果如下：与对照组相比，HD患者的平均每日MET值较低（1.3 +/- 0.3 vs. 1.5 +/- 0.2，p < 0.01），用于> 3 MET的活动的时间较短（89 +/- 85 vs. 143 +/- 104分钟/天，p < 0.05），每天步数较少（5，584 ± 3，734 vs. 11，735 ± 5，130，p < 0.001），导致较低的估计能量消耗（2，190 +/- 629 vs. 2，462 +/- 443千卡/天，p < 0.05）。50名HD患者中有31名（62%）的平均每日值< 1.4 MET，因此被定义为久坐。他们与活跃患者的不同之处在于年龄较高（63 +/- 12岁与54 +/- 12岁，p < 0.01）、能量摄入较低（26.1 +/- 6.4与32.4 +/- 11.3 Kcal/天，p < 0.05）和相位角较低（5.5 +/- 1.0与6.3 +/- 0.9，p < 0.05）。基于SWA的每日能量消耗估计与年龄呈负相关（r =-0.31，p < 0.05），而与HMI呈正相关（r = 0.51，p < 0.001）、相位角（r = 0.40，p < 0.01）、血磷（r = 0.49，p < 0.001）和白蛋白（r = 0.41，p < 0.01）。平均每日MET值与标准化能量摄入（r = 0.47，p < 0.001）、蛋白质摄入（r = 0.33，p < 0.05）和相位角（r = 0.38，p < 0.01）密切相关。多元回归分析表明，能量摄入和膳食蛋白质摄入与体力活动强度独立相关。结论：我们的研究结果表明，即使没有身体或神经功能障碍或严重的共病情况，稳定的透析患者也普遍存在体力活动不足。体力活动的水平和强度与身体成分和饮食营养摄入量呈正相关。这证实了运动和营养之间的强烈相互关系，这反过来又与透析患者的生存，康复和生活质量有关。
Background and aim: Assessment of physical activity level and of energy expenditure is important in the clinical and nutritional care of dialysis patients, but it is not so easy to accomplish. The SenseWear (TM) Armband (SWA) is a novel multisensory device that is worn on the upper arm and collects a variety of physiologic data related to physical activity. Thus, duration and intensity of physical activity is recorded and expressed as METs (Metabolic Equivalent Task), and energy expenditure is estimated. The aim of our study was to assess interdialytic spontaneous physical activity in stable chronic hemodialysis (HD) patients and the relation to nutritional status and dietary nutrient intake. Patients and methods: In 50 stable patients on maintenance hemodialysis treatment and 33 normal subjects (control group), level of spontaneous physical activity and estimated daily energy expenditure was assessed by SWA and related to biochemistry and anthropometry data, bioelectric impedance vector analysis, and energy and nutrient intake information coming from a 3-day food recall. Results: In respect to controls, HD patients showed lower mean daily METs value (1.3 +/- 0.3 vs. 1.5 +/- 0.2, p < 0.01), a lower time spent on activities > 3 METs (89 +/- 85 vs. 143 +/- 104 min/day, p < 0.05), lower number of steps per day (5,584 3,734 vs. 11,735 5,130, p < 0.001), resulting in a lower estimated energy expenditure (2,190 +/- 629 vs. 2,462 +/- 443 Kcal/day, p < 0.05). 31 out of the 50 HD patients (62%) had a mean daily value < 1.4 METs and hence were defined as sedentary. They differed from the active patients for higher age (63 +/- 12 vs. 54 +/- 12 y, p < 0.01), lower energy intake (26.1 +/- 6.4 vs. 32.4 +/- 11.3 Kcal/day, p < 0.05) and lower phase angle (5.5 +/- 1.0 vs. 6.3 +/- 0.9, p < 0.05). SWA-based estimation of daily energy expenditure was negatively related to age (r = -0.31, p < 0.05), whereas positive relations were observed with HMI (r = 0.51, p < 0.001), phase angle (r = 0.40, p < 0.01), serum phosphate (r = 0.49, p < 0.001) and albumin (r = 0.41, p < 0.01). The mean daily METs values were strongly related to normalized energy intake (r = 0.47, p < 0.001) and also to protein intake (r = 0.33, p < 0.05) and to phase angle (r = 0.38, p < 0.01). Multiple regression analysis showed that energy intake and dietary protein intake were independently related to the intensity of physical activity. Conclusion: Our findings indicate that poor physical activity is highly prevalent in stable dialysis patients even when free from physical or neurological disabilities or severe comorbid conditions. The level and intensity of physical activity is positively related to body composition and to dietary nutrient intake. This confirms the strong interrelationship between exercise and nutrition, which in turn are associated with survival, rehabilitation and quality of life in dialysis patients.