腹膜透析患者饮食与肌少症的相关性研究及护理启示

doi:10.3761/j.issn.0254-1769.2026.05.002

摘要/Abstract

摘要：

目的探讨腹膜透析患者膳食摄入与肌少症风险的关系，并分析其剂量-反应关系，为医护人员开展饮食指导提供依据。方法采取1 ∶ 2配对病例对照设计，纳入2024年12月至2025年5月于南昌市某三级甲等医院规律随访的腹膜透析患者213例（肌少症组71例，非肌少症组142例）。通过3日24 h回顾法评估膳食，采用限制性立方样条分析剂量-反应关系。结果能量摄入量与肌少症风险呈非线性剂量-反应关系（P_非线性=0.029）。能量摄入低于1 880 kcal/d（1 kcal=4.184 kJ）时，肌少症风险随饮食摄入增加明显降低，高于此值时保护效应趋于稳定。多因素分析结果显示，蔬菜类（OR=1.034）和维生素C（OR=1.253）过量摄入增加肌少症风险，而薯类（OR=0.868）、水果（OR=0.965）、畜禽肉（OR=0.950）、总维生素A（OR=0.955）、维生素B₁（OR=0.991）、维生素D（OR=0.244）、钙（OR=0.998）足量摄入具有保护作用。结论腹膜透析患者能量摄入存在1 880 kcal/d的阈值效应，临床营养护理应确保能量摄入达标并优化膳食结构。建议优先增加薯类、水果、畜禽肉等食物摄入，控制蔬菜摄入在300 g/d以内，以避免其对关键营养素摄入的稀释作用。

关键词: 腹膜透析, 肌少症, 病例对照研究, 剂量-反应关系, 护理

Abstract:

Objective To explore the relationship between dietary intake and the risk of sarcopenia in patients undergoing peritoneal dialysis（PD），and to analyze the dose-response relationship between them，so as to provide accurate dietary guidance. Methods A 1 ∶ 2 matched case-control study was conducted. A total of 213 PD patients who received regular follow-up in a tertiary hospital in Nanchang from December 2024 to May 2025 were included，with 71 cases in the sarcopenia group and 142 cases in the non-sarcopenia group. Dietary intake was assessed using a 3-day 24-hour recall method，and restricted cubic splines（RCS） were applied to analyze the dose-response relationship. Results There was a non-linear dose-response relationship between energy intake and the risk of sarcopenia （non-linear P=0.029）. When energy intake was less than 1880 kcal/day，the risk of sarcopenia decreased significantly with the increase in dietary intake；when energy intake exceeded this value，the protective effect tended to stabilize. Multivariate analysis showed that high intake of vegetables（OR=1.034） and vitamin C（OR=1.253） increased the risk of sarcopenia，while high intake of tubers（OR=0.868），fruits（OR=0.965），livestock and poultry meat（OR=0.950），total vitamin A（OR=0.955），vitamin B₁（OR=0.991），vitamin D（OR=0.244），and calcium（OR=0.998） had protective effects against sarcopenia. Conclusion There is a threshold effect of energy intake（1 880 kcal/d） in PD patients. Clinical nursing should take ensuring adequate energy intake as the primary goal and optimize the dietary structure. It is recommended to prioritize increasing the intake of protective foods such as tubers，fruits，and livestock and poultry meat，while controlling vegetable intake within 300 g/d to avoid its diluting effect on the intake of key nutrients such as protein.

Key words: Peritoneal Dialysis, Sarcopenia, Case-Control Study, Dose-Response Relationship, Nursing Care

张笑天, 黄姣, 郑园华, 熊宇欣, 孙鑫, 李鸿艳. 腹膜透析患者饮食与肌少症的相关性研究及护理启示[J]. 中华护理杂志, 2026, 61(5): 590-597.

ZHANG Xiaotian, HUANG Jiao, ZHENG Yuanhua, XIONG Yuxin, SUN Xin, LI Hongyan. Study on the relationship between diet and sarcopenia in patients undergoing peritoneal dialysis and nursing implications[J]. Chinese Journal of Nursing, 2026, 61(5): 590-597.

图/表 7

表1 两组一般资料的比较

Table 1 Comparison of general data between the non-sarcopenia group and the sarcopenia group

表2 非肌少症组与肌少症组膳食摄入量的比较

Table 2 Comparison of dietary intake between the non-sarcopenia group and the sarcopenia group

表3 膳食摄入量指标对肌少症的影响（n=213）

Table 3 Effects of dietary intake on sarcopenia（n=213）

表4 能量及营养素指标对肌少症的影响（n=213）

Table 4 Effects of energy and nutrients on sarcopenia（n=213）

图1 能量摄入量与腹膜透析患者肌少症发生的剂量反应关系

Figure 1 Dose-response relationship between energy intake and the occurrence of sarcopenia in peritoneal dialysis patients

图2 食物类别摄入量与腹膜透析患者肌少症发生的剂量-反应关系注：a为薯类摄入量与腹膜透析患者肌少症发生的剂量反应关系。b为蔬菜类摄入量与腹膜透析患者肌少症发生的剂量反应关系。c为畜禽肉摄入量与腹膜透析患者肌少症发生的剂量反应关系。

Figure 2 Dose-response relationship between food category intake and the occurrence of sarcopenia in peritoneal dialysis patients

图3 营养素摄入量与腹膜透析患者肌少症发生的剂量-反应关系注：a为维生素C摄入量与腹膜透析患者肌少症发生的剂量反应关系。b为维生素D摄入量与腹膜透析患者肌少症发生的剂量反应关系。

Figure 3 Dose-response relationship between nutrient intake and the occurrence of sarcopenia in peritoneal dialysis patients

参考文献 27

[1]	Duarte MP, Almeida LS, Neri SGR, et al. Prevalence of sarcopenia in patients with chronic kidney disease:a global systematic review and meta-analysis[J]. J Cachexia Sarcopenia Muscle, 2024, 15(2):501-512. DOI URL
[2]	胡丹丹, 胡锦, 孙惠, 等. 社区老年肌少症患者自我管理干预方案的构建及应用研究[J]. 中华护理教育, 2025, 22(10):1250-1257.
	Hu DD, Hu J, Sun H, et al. Construction and application of a self-management intervention program for community-dwelling elderly patients with sarcopenia[J]. Chin J Nurs Educ, 2025, 22(10):1250-1257.
[3]	余姜璇, 单雪琪, 王俊杰, 等. 老年肌少症患者营养管理的最佳证据总结[J]. 中华护理杂志, 2022, 57(18):2261-2268.
	Yu JX, Shan XQ, Wang JJ, et al. Best evidence summary for nutrition management in elderly patients with sarcopenia[J]. Chin J Nurs, 2022, 57(18):2261-2268.
[4]	Ganapathy A, Nieves JW. Nutrition and sarcopenia:what do we know?[J]. Nutrients, 2020, 12(6):1755. DOI URL
[5]	Shaaker H, Davenport A. Assessment of nutritional intake in patients with kidney failure treated by haemodialysis on dialysis and non-dialysis days[J]. J Ren Nutr, 2025, 35(1):172-180.e1. DOI URL
[6]	王颖, 雷娟, 檀敏, 等. 30例维持性血液透析患者膳食调查[J]. 中国血液净化, 2014, 13(5):413-416.
	Wang Y, Lei J, Tan M, et al. The dietary investigation of 30 cases of maintenance hemodialysis patients[J]. Chin J Blood Purif, 2014, 13(5):413-416.
[7]	Morgan PT, Smeuninx B, Breen L. Exploring the impact of obesity on skeletal muscle function in older age[J]. Front Nutr, 2020, 7:569904. DOI URL
[8]	高雅靖, 单岩, 杜理平, 等. 终末期肾脏病患者肌少症的研究进展[J]. 中华护理杂志, 2019, 54(9):1423-1426. DOI
	Gao YJ, Shan Y, Du LP, et al. Advance in research on sarcopenia in patients with end-stage renal disease[J]. Chin J Nurs, 2019, 54(9):1423-1426.
[9]	徐文琪, 韩慧敏, 郭畔旭, 等. 腹膜透析患者容量管理的最佳证据总结[J]. 中华护理教育, 2025, 22(3):371-378.
	Xu WQ, Han HM, Guo PX, et al. Best evidence summary for volume management in peritoneal dialysis patients[J]. Chin J Nurs Educ, 2025, 22(3):371-378.
[10]	张静娟, 薛芃石, 赵白雪, 等. 饮食干预对腹膜透析患者营养状况的影响[J]. 中华护理杂志, 2015, 50(1):62-65.
	Zhang JJ, Xue PS, Zhao BX, et al. The effect of diet intervention on nutritional status in patients with peritoneal dialysis[J]. Chin J Nurs, 2015, 50(1):62-65.
[11]	关天俊, 许树根, 梁萌. CAPD患者入院时低钾血症的发生率及其临床意义[J]. 福建医药杂志, 2003, 25(4):11-13.
	Guan TJ, Xu SG, Liang M. The incidence of hypokalemia associated with CAPD patients on admission and its clinical significance[J]. Fujian Med J, 2003, 25(4):11-13.
[12]	Beaudart C, Locquet M, Touvier M, et al. Association between dietary nutrient intake and sarcopenia in the SarcoPhAge study[J]. Aging Clin Exp Res, 2019, 31(6):815-824. DOI PMID
[13]	杨月欣. 中国食物成分表标准版[M]. 6版. 北京: 北京大学医学出版社, 2018.
	Yang YX. China food composition table-standard edition[M]. 6th ed. Beijing: Peking University Medical Press, 2018.
[14]	Chen LK, Woo J, Assantachai P, et al. Asian Working Group for Sarcopenia:2019 consensus update on sarcopenia diagnosis and treatment[J]. J Am Med Dir Assoc, 2020, 21(3):300-307. DOI URL
[15]	Funk DP, Chambrier C, Slim K. Postoperative nutrition in the setting of enhanced recovery programmes[J]. Eur J Surg Oncol, 2024, 50(5):106866. DOI URL
[16]	Sabatino A, Regolisti G, Karupaiah T, et al. Protein-energy wasting and nutritional supplementation in patients with end-stage renal disease on hemodialysis[J]. Clin Nutr, 2017, 36(3):663-671. DOI PMID
[17]	Yang S, Dong ZY, Zhao JQ, et al. Association of vitamins B1 and B2 intake with early-onset sarcopenia in the general adult population of the US:a cross-sectional study of NHANES data from 2011 to 2018[J]. Front Nutr, 2024, 11:1369331. DOI URL
[18]	Wu HHL, McDonnell T, Chinnadurai R. Physiological associations between vitamin B deficiency and diabetic kidney disease[J]. Biomedicines, 2023, 11(4):1153. DOI URL
[19]	Behrouzi P, Grootswagers P, Keizer PLC, et al. Dietary intakes of vegetable protein,folate,and vitamins B-6 and B-12 are partially correlated with physical functioning of Dutch older adults using copula graphical models[J]. J Nutr, 2020, 150(3):634-643. DOI PMID
[20]	Bjørnsen T, Salvesen S, Berntsen S, et al. Vitamin C and E supplementation blunts increases in total lean body mass in elderly men after strength training[J]. Scand J Med Sci Sports, 2016, 26(7):755-763. DOI URL
[21]	Lewis LN, Hayhoe RPG, Mulligan AA, et al. Lower dietary and circulating vitamin C in middle-and older-aged men and women are associated with lower estimated skeletal muscle mass[J]. J Nutr, 2020, 150(10):2789-2798. DOI PMID
[22]	Park CY, Shin S. Low dietary vitamin C intake is associated with low muscle strength among elderly Korean women[J]. Nutr Res, 2024,127:75-83.
[23]	Ely IA, Phillips BE, Smith K, et al. A focus on leucine in the nutritional regulation of human skeletal muscle metabolism in ageing,exercise and unloading states[J]. Clin Nutr, 2023, 42(10):1849-1865. DOI URL
[24]	林海风, 庞亮亮. 纯乳清蛋白食品在运动员营养规划中的应用:以“第五届食品科学与人类健康国际研讨会”为例[J]. 核农学报, 2024, 38(12):2485-2486.
	Lin HF, Pang LL. Application of pure whey protein food in athletes’ nutrition planning:taking the fifth international symposium on food science and human health as an example[J]. J Nucl Agric Sci, 2024, 38(12):2485-2486.
[25]	Jiang JL, Chen G, Li YG, et al. Serum calcium levels and the risk of sarcopenia in young adults:insights from NHANES 2011-2018[J]. Front Nutr, 2025, 12:1526879. DOI URL
[26]	Yu SX, Ren BQ, Chen HY, et al. 1,25-Dihydroxyvitamin D deficiency induces sarcopenia by inducing skeletal muscle cell senescence[J]. Am J Transl Res, 2021, 13(11):12638-12649. PMID
[27]	Hwang B, Lim JY, Lee J, et al. Prevalence rate and associated factors of sarcopenic obesity in korean elderly population[J]. J Korean Med Sci, 2012, 27(7):748-755. DOI PMID