Evaluation of Nutritional Habits and Dietary Management in Children with Chronic Kidney Disease

Yıl 2019, , 184 - 192, 24.05.2019

Nevra Koç

https://doi.org/10.12956/tjpd.2018.365

Öz

 Objective: This study was conducted to evaluate the dietary habits, nutritional status and dietary management practices of children with chronic kidney disease. 

Material and Methods: The study was conducted on 16 patients aged 2 to 18 years (9 boys, 7 girls) who were followed at our clinic with predialysis chronic kidney disease and with peritoneal dialysis. The nutritional status of the patients was determined by 24-hour dietary recall and subjective global nutritional assessment. In addition, anthropometric measurements and biochemical parameters were evaluated. 

Results: When the anthropometric measurements of the children were evaluated; 56.2% of them were found to be wasted and 62.5% were found to be stunted. According to subjective global nutritional assessment, 60% were found to be severely malnourished. Iron binding capacity, glomerular filtration rate and albumin levels were significantly higher in the predialysis group than in the peritoneal dialysis group (p<0.05). When uric acid, total protein, hemoglobin, hematocrit, ferritin, iron, sodium, potassium, and phosphorus levels were examined, no difference was found between the groups (p>0.05) The average daily energy intake of the children was 1564.3±982.4 kcal. Carbohydrates were found to be the source of 45.6±9.0% of the daily energy intake while 12.4±4.1% of the energy intake was from proteins and 41.9±7% from fats. We found that children with chronic kidney disease had consumed dietary fibers, calcium and magnesium inadequately while consuming salt more than their requirements. 

Conclusion: Children with chronic kidney disease had irregular eating habits and their dietary management was inadequate. Attitudes, behaviors and knowledge of these children and their families were inadequate regarding the patients’s dietary needs. For this reason, it is believed that a diet based on individual nutrition rather than a nutrient-based dietary approach consisting of a chain of restrictions is more suitable for children with chronic kidney disease. 

Anahtar Kelimeler

Children, Chronic kidney disease, Dietary habits, Dietary management

Kronik Böbrek Hastalığı Olan Çocuklarda Beslenme Alışkanlıklarının ve Diyet Yönetiminin Değerlendirilmesi

Öz

Amaç: Çalışma kronik böbrek hastalığı olan olan çocukların beslenme alışkanlıklarını, malnütrisyon durumlarını ve diyet yönetimlerindeki uygulamalarını değerlendirmek amacıyla yapılmıştır. 

Gereç ve Yöntemler: Kliniğimizde izlenen ayaktan ve yatarak tedavi gören prediyaliz ve periton diyalizi uygulanan kronik böbrek hastalığı olan 2-18 yaşları arasında 16 (9 erkek, 7 kız) gönüllü hasta çalışmaya dahil edilmiştir. Hastaların beslenme durumu, 24 saatlik geriye dönük besin tüketim kaydı ve subjektif global nutrisyonel değerlendirme yöntemi ile belirlenmiştir. Ayrıca antropometrik ölçümleri, biyokimyasal parametreleri değerlendirilmiştir. 

Bulgular: Hastalar antropometrik ölçümlerine göre değerlendirildiğinde; %56.2’sinin kavruk, %62.5’inin bodur olduğu bulunmuştur. Subjektif Global Nutrisyonel Değerlendirme yöntemine göre %60.0’ı ağır malnütrisyonludur. Prediyaliz grubunda periton diyalizi grubuna göre demir bağlama kapasitesi, glomerül filtrasyon hızı ve albümin seviyesi anlamlı olarak daha yüksek bulunmuştur (p<0.05). Ürik asit, total protein, hemoglobin, hematokrit, ferritin, demir, sodyum, potasyum, fosfor seviyeleri incelendiğinde, gruplar arasında fark bulunmamıştır (p>0.05). Çocukların günlük enerji alımı ortalama 1564.3±982.4 kcal’dir. Alınan enerjinin %45.6±9.0’u karbonhidrattan, %12.4±4.1’i proteinden, %41.9 ±7.0’si yağdan gelmektedir. Hastaların diyet posasını, kalsiyum ve magnezyumu yetersiz aldıkları, tuz tüketiminin ise gereksinimden fazla olduğu saptanmıştır.

Sonuç: Çalışmaya alınan kronik böbrek hastalığı olan çocukların düzensiz beslenme alışkanlıkları mevcut olup, diyet yönetimleri oldukça zayıftır. Ailelerinin ve kendilerinin beslenme konusundaki eğitimleri, tutum ve davranışları yetersizdir. Bu nedenle kronik böbrek hastalığı olan çocuk hastalarda yasaklar zincirinden oluşan besin ögesi odaklı bir diyet yaklaşımı yerine bireysel beslenme odaklı bir diyet yaklaşımının daha doğru olduğu düşünülmektedir. 

Anahtar Kelimeler

Çocuklar, Kronik böbrek hastalığı, Beslenme alışkanlıkları, Diyet yönetimi

Kaynakça

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