Malnutrition is more common in diabetic kidney disease (DKD), and can significantly increase the risk of all-cause death in patients with diabetes . Medical nutritional therapy (MNT) can delay the progression of DKD, reduce the proportion of end-stage renal disease (ESRD), and can also prevent and treat malnutrition caused by DKD or protein energy consumption. "Chinese Expert Consensus on Medical Nutrition Therapy for Adult Diabetes and Kidney Diseases" provides clinical workers with evidence-based MNT guidance for individualized DKD patients.
1. Energy
➤DKD The unified recommended standard for patients' total energy intake is 30~35 kcal·kg-1·d-1, which is adjusted according to the specific activity intensity and time (1|●●●●○).
➤ Overweight or obese DKD-CKD G1-2 patients, it is recommended to reduce total daily energy intake by 500~750 kcal (2|●●○○).
2. carbohydrates
➤It is recommended that daily carbohydrates provide energy for 45%~60% of the total energy (2|●●○○).
➤It is recommended to choose carbohydrates with lower glycemic index (glycemic index, GI) (2|●●○○).
3. Protein
➤DKD-CKD Recommended DKD-CKD Patients in G1-2 stage DKD-CKD The protein intake of patients with stage G1-2 is 0.8 g·kg-1·d-1 (1|●●●●○).
➤DKD-CKD Phase G3-5 nondialysis patients recommended for nondialysis patients with DKD-CKD Phase G3-5 nondialysis patients with protein intake is 0.6~0.8 g·kg-1·d-1, and supplemented with compound α-ketoacid preparations of 0.12 g·kg-1·d-1 (1|●●●●○).
➤DKD-CKD patients with stage G5 dialysis are recommended to have protein intake of 1.0~1.2 g·kg-1·d-1 (2|●●○○).
4. Fat
➤ It is recommended to adjust the composition ratio of fat intake in DKD patients, reduce the intake of saturated fatty acids and trans fatty acids , and appropriately increase the intake of polyunsaturated fatty acids (1|●●●●○).
➤It is recommended that the proportion of saturated fatty acids and trans fatty acid intake in DKD patients should not exceed 10% of the total daily energy (2|●●●●○).
➤It is recommended that the proportion of MUFA intake in DKD patients in total fat intake should be 10%~20% (2|●●○○).
5. Inorganic salt
1. Sodium
➤It is recommended that patients with DKD-CKD in each period have sodium intake of 1.2~2.0 g/d (3.0~5.0 g/d in salt) (2|●●●●○).
➤For patients with DKD who have hypertension and , dietary sodium intake should be individually managed (2|●●○○).
2.Potassium
➤It is recommended that patients with DKD-CKD in each period adjust their dietary potassium intake in combination with renal function to ensure that the blood potassium is within the normal range (2 | ●●○○).
3.Calcium
➤It is recommended that patients with DKD-CKD in each period adjust their calcium intake according to their blood calcium levels (2|●●○○).
4.Phospital
➤It is recommended that patients with DKD-CKD stage G3-5 reduce blood phosphorus to near normal range as much as possible (2|●●○○).
6. Vitamin and trace elements
1. vitamin D
➤ It is recommended that patients with DKD-CKD combined with vitamin D deficiency or deficiency should appropriately supplement vitamin D3 or D2 (2|●○○○).
2. Vitamin A, B, C, E
➤ It is recommended that adult patients with DKD-CKD stage G1-5 should give appropriate supplements if they are confirmed to have B or C deficiency (2|●●○○).
➤ Regular supplementation of vitamin A or E (2|●○○) is not recommended.
3. Trace Elements
It is recommended to supplement trace elements only for DKD-CKD stage G3-5 patients with trace element deficiency and causing related symptoms or abnormal biochemical indicators (2|●○○○).
7. Dietary fiber
➤It is recommended that patients with DKD increase their dietary fiber intake appropriately (2 | ●●○○).
8, alcohol
➤Drinking alcohol for patients with DKD-CKD in each period is not recommended (2 | ●○○○).
➤Patients who have previously consumed alcohol should strictly control the amount of alcohol consumption, and do not exceed 1 alcohol unit per day [1 alcohol unit is approximately 14 g pure alcohol, which is equivalent to 12% red wine 145 mL, ABV 3.5% beer 497 mL or ABV 40% white wine 43 mL], and is limited to 5% of the total intake energy (2●|○○○).
➤ For patients with DKD who use insulin and (or) insulin secretion, appropriately increase carbohydrates when drinking to avoid hypoglycemia (2●|○○○).
The above content is excerpted from: Endocrinology Branch of the Chinese Medical Association. Chinese Expert Consensus on Medical Nutrition Therapy for Adult Diabetes and Kidney Diseases [J]. Chinese Journal of Endocrinology and Metabolism , 2022, 38(11): 927-936.
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