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

Year 2019, Volume: 13 Issue: 3, 184 - 192, 24.05.2019

Nevra Koç

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

Abstract

 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. 

Keywords

Children, Chronic kidney disease, Dietary habits, Dietary management

Kronik Böbrek Hastalığı Olan Çocuklarda Beslenme Alışkanlıklarının ve Diyet Yönetiminin Değerlendirilmesi

Abstract

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. 

Keywords

Çocuklar, Kronik böbrek hastalığı, Beslenme alışkanlıkları, Diyet yönetimi

References

• 1. Kim H, Lim H, Choue R. Compromised diet is associated with decreased renal function in children with chronic kidney diesase. Clin Nutr Res 2014; 3: 142-9.
• 2. Betts PR, Magrath G. Growth pattern and dietary intake of children with chronic renal insufficiency. Br Med J 1974;2:189–93.
• 3. Norman LJ, Coleman JE, Macdonald IA, Tomsett AM, Watson AR. Nutrition and growth in relation to severity of renal disease in children. Pediatric nephrol 2000;15:259–65.
• 4. Rees L, Jones H. Nutritional management and growth in children with chronic kidney disease. Pediatric Nephrol 2013;28:527–36.
• 5. Armstrong JE, Laing DG, Wilkes FJ, Kainer G. Smell and taste function in children with chronic kidney disease. Pediatr Nephrol 2010; 25:1497–1504.
• 6. Rees L, Rigden SP, Ward GM. Chronic renal failure and growth. Arch Dis Child 1989;64:573–7.
• 7. Mahan JD, Warady BA; Consensus Committee. Assessment and treatmentof short stature in pediatric patients with chronic kidney disease: A consensus statement. Pediatr Nephrol 2006;21:917- 30.
• 8. Battelino N, Rus R, Novljan G. Nutritional requirements in children with chronic kidney disease. Clin Nutr ESPEN 2016;14:42-6.
• 9. Secker DJ, Jeejeebhoy KN. Subjective global nutrition assessment for children. Am J Clin Nutr 2007;85:1083-9.
• 10. NAP. National Academy Press. Nutrient Adeqency-Asessment Using Food Consumption Surveys. Washington D.C: 1986:14.
• 11. Graf L, Candelaria S, Doyle M, Kaskel F. Nutrition assessment and hormonal influences on body composition in children with chronic kidney disease. Adv Chronic Kidney Dis 2007;14:215-23.
• 12. Gupta A, Mantan M, Sethi M. Nutritional assessment in children with chronic kidney disease. Saudi J Kidney Dis Transpl 2016;27:733-9.
• 13. Rosenkranz J, Reichwald-Klugger E, Oh J, Turzer M, Mehls O, Schaefer F. Psychosocial rehabilitation and satisfaction with life in adults with childhood-onset of end-stage renal disease. Pediatr Nephrol 2005;20:1288-94.
• 14. Rodig NM, McDermott KC, Schneider MF, Hotchkiss HM, Yadin O, Seikaly MG, et al. Growth in children with chronic kidney disease: A report from the chronic kidney disease in children study. Pediatr Nephrol 2014;29:1987-95.
• 15. Stanczyk M, Miklaszewska M, Zachwieja K, Wiercin´ SR, Stankiewicz R, Firszt AA, et al. Growth and nutritional status in children with chronic kidney disease on maintenance dialysis in Poland. Adv Med Sci 2016;61:46–51.
• 16. Fischbach M, Fothergill H, Seuge L, Zaloszyc A. Dialysis strategies to ımprove growth in children with chronic kidney disease. J Ren Nutr 2011; 21:43–6.
• 17. Goldstein SL, Graham N, Burwinkle T, Warady B, Farrah R, Varni JW. Health-related quality of life in pediatric patients with ESRD. Pediatr Nephrol 2006;21:846-50.
• 18. Johnson RJ, Warady BA. Long-term neurocognitive outcomes of patients with end-stage renal disease during infancy. Pediatr Nephrol 2013;28:1283-91.
• 19. Seliger SL, Weiner DE. Cognitive impairment in dialysis patients: Focus on the blood vessels? Am J Kidney Dis 2013;61:187-90.
• 20. Neul SK, Minard CG, Currier H, Goldstein SL. Health related quality of life functioning over a 2-year period in children with end-stage renal disease. Pediatr Nephrol 2013;28:285-93.
• 21. Apostolou A, Printza N, Karagiozoglou-Lampoudi T, Dotis J, Papachristou F. Nutrition assessment of children with advanced stages of chronic kidney disease-A single center study. Hipokratia 2014;18:212-6.
• 22. KDOQI work group. KDOQI clinical practice guideline for nutrition in children with CKD: 2008 update. Executive summary. Am J Kidney Dis 2009;53:11-104.
• 23. Druml W, Cano N, Teplan V. Nutritional support in renal disease. In: Sobotka L, (ed). Basics in Clinical Nutrition. 4th ed. Prague: House Galen, 2011:473-85.
• 24. Warady BA, Neu AM, Schaefer F. Optimal care of the infant, child, and adolescent on dialysis: 2014 update. Am J Kidney Dis 2014;64:128-42.
• 25. Fernandes AS, Ramos CI, Nerbass FB, Cuppari L. Diet quality of chronic kidney disease patients and the impact of nutritional counseling. J Ren Nutr 2017;X:1-8.