( ) Christian Sandor
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- みいか おとじま
- 5 years ago
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1 NAIST-IS-MT
2 ( ) Christian Sandor
3 QOL, NAIST-IS-MT , i
4 ,,,, ii
5 Analysis of Nutritional Information and Proposal of Active Planning Support Method for Medical Diet Seiya Kojima Abstract In this work, we investigate the actual nutritional values in medical diet for Chronic Kidney Disease (CKD) patients and develop a dynamical method to support their medical diet preparation which aims to increase patients quality of life (QOL). In people s lives, daily diet has an important role not only from nutritional, but also from social and cultural point of view. However, current approach to medical diets for diabetes or CKD patients place different restrictions on their daily life activities. Furthermore, sometimes it is difficult for CKD patients to follow the prescribed diet for long periods of time. In this thesis, we focus two major problems of current medical diets. One of the problems is that the current medical diet method for CKD patients has a possibility that the required nutritional intake amounts could not be satisfied. We conducted a user study to obtain and analyze nutritional information about medical diet for CKD patients. The results revealed that the required intake amounts for some micronutrients which are not included in dietary recommendations for CKD were not being satisfied. We found that this situation was specific to the diets prepared for CKD patients. Second problem is the current medical diet puts significant amount of mental stress on patients due to strict restrictions and complicated constraints. Master s Thesis, Graduate School of Information Science, Nara Institute of Science and Technology, NAIST-IS-MT , March 14, iii
6 One of the causes which decreases the QOL of patients is the restrictions placed upon the patients when it comes to eating out, such as social gatherings. We aim to improve their quality of life by defining a dynamic method to support their menu planning activities and established a method to support menu planning for CKD patients. We did another user study with heathy people and evaluated the satisfaction of our test subjects after changing into our method. The results of the user study which we conducted showed that our method has a potential to increase the satisfaction after using it for longer periods of time. Based on these results, we confirmed that our method has a possibility to enhance the QOL of patients through an intelligently designed dynamic medical diet. Keywords: medical diet, chronic kidney disease, nutritional analysis, micronutrient, menu planning iv
7 v
8 vi
9 1 [6] CKD [40] [23] Rise[15] FoodLog[1] [8] KNApSAcK Family [36] : : : : 1 ( ) (1) (2) (3) (4) CKD % 20 [38] vii
10 2 CKD [39] (1) (2) p (1) (2) viii
11 [26] [35] 1895 X 1970 QOL, Quality of Life [42] CT MRI 1
12 1 [6] [6]( 1 ) 1.2 CKD, Chronic Kidney Disease 1, [38] 2
![1 CKD % 20 [38] 5 1 5 1 1 3a](/docs-images/88/114615121/images/13-0.jpg "1,600 [37] 2014 32 [41]( 1 )")
13 1 CKD % 20 [38] a 1,600 [37] [41]( 1 ) 3
![2 CKD [39]](/docs-images/88/114615121/images/14-0.jpg "[39] 2 2 4")
14 2 CKD [39] [39] 2 2 4
15 0.6 g/kg / 35 kcal/kg / g/kg / 35 kcal/kg / kcal/kg / [12] kcal/kg / g/kg / [3, 9] [17] 6 g/ [39] 5
16 3 g/ [13] 2015 [25] 2,500 mg/ 2,000 mg/ G1 G2 G3 [39] 1.3 [30] [27] 6
17 [29] B12 D [22] [33] [11] [43] [33] [19] 4 K % ( 2 ) 7
18 2 [48] [32] 85% 68.8% 39.6% 14.7% [50] 8
19 QOL [20] QOL 9
20 [39] 2014 CKD [40]( 3 ) 10
![3 CKD [40] [30,](/docs-images/88/114615121/images/21-0.jpg "21] [30] 3g 1")
21 3 CKD [40] [30, 21] [30] 3g 1 11
![4 [23] [34] 1 6 Adair [23] 4](/docs-images/88/114615121/images/22-0.jpg "National Kidney Foundation")
22 4 [23] [34] 1 6 Adair [23] 4 National Kidney Foundation 12
![図 5 食事のパーソナルコーチングサービス Rise[15] 提供している My Food Coach[14] も 腎臓病患者向けのレシピ検索機能を有して おり 世界中の患者の栄養管理を助けるアプリケーションである こうしたアプ リケーションは 献立の検索や食事の記録を基本機能としたものが多く 基本的 な栄養管理のための計算は食事療法基準に則っていると考えられる このような](/docs-images/88/114615121/images/23-0.jpg "アプリケーションは 献立の種類の多さや 計算をコンピュータが自動で行って くれる手軽さが書籍に比べて優位な点であると言える また Rise[15] をはじめ として 食事推薦サービスも数多く存在している これらのサービスは 管理栄 養士が常に食事内容をチェックし手動で食事推薦を行っているか 上記のアプリ ケーションと同様に栄養の摂取基準に則って食事推薦をしているものである場合")
23 図 5 食事のパーソナルコーチングサービス Rise[15] 提供している My Food Coach[14] も 腎臓病患者向けのレシピ検索機能を有して おり 世界中の患者の栄養管理を助けるアプリケーションである こうしたアプ リケーションは 献立の検索や食事の記録を基本機能としたものが多く 基本的 な栄養管理のための計算は食事療法基準に則っていると考えられる このような アプリケーションは 献立の種類の多さや 計算をコンピュータが自動で行って くれる手軽さが書籍に比べて優位な点であると言える また Rise[15] をはじめ として 食事推薦サービスも数多く存在している これらのサービスは 管理栄 養士が常に食事内容をチェックし手動で食事推薦を行っているか 上記のアプリ ケーションと同様に栄養の摂取基準に則って食事推薦をしているものである場合 が多い 13
24 [45] KNApSAcK Family DB[36] KNApSAcK Family DB [24] CKD 16.2% 14
25 . [44] 3 A, B1, B2, B6 20% 50% [28] Aizawa [1] FoodLog 6 FoodLog 15
![図 6 スマートフォンアプリケーション FoodLog[1] じる 慢性腎臓病をはじめとする疾患を有する患者の食事療法には的確な栄養摂 取量の管理が求められるため これらの誤差が存在する手法の利用には注意が必 要である 加えて 記録は事後に行うものであり 事前に献立を考える際におい ては 別の手法が必要となる 2.](/docs-images/88/114615121/images/26-0.jpg "2.3 食事検索を用いた食行動支援手法 献立計画を支援する手法として 食事検索機能を用いたものがある 特に在宅 での食事療法の実践の際には よほど栄養に関する知識がない限りは 食事の情 報を検索できることは非常に有効な機能であると考える Karikome ら [8] は 複 数のレシピを組み合わせて検索することが可能な献立検索システムを提案してい る (図 7 参照) Karikome")
26 図 6 スマートフォンアプリケーション FoodLog[1] じる 慢性腎臓病をはじめとする疾患を有する患者の食事療法には的確な栄養摂 取量の管理が求められるため これらの誤差が存在する手法の利用には注意が必 要である 加えて 記録は事後に行うものであり 事前に献立を考える際におい ては 別の手法が必要となる 食事検索を用いた食行動支援手法 献立計画を支援する手法として 食事検索機能を用いたものがある 特に在宅 での食事療法の実践の際には よほど栄養に関する知識がない限りは 食事の情 報を検索できることは非常に有効な機能であると考える Karikome ら [8] は 複 数のレシピを組み合わせて検索することが可能な献立検索システムを提案してい る (図 7 参照) Karikome らのシステムでは 調理時間や季節などの情報も使用 した食事検索ができるほか 食品群ごとの摂取状況を管理することが可能として いる また 以前の食事のデータに基づき 食事のバランスが良くなるような候 補に順位付けを実施している Karikome らの研究では 食事のバランスの計算 として食品群を用いているが これでは微量栄養素を含む多くの栄養素量に関し 16
![7 [8] [49]](/docs-images/88/114615121/images/27-0.jpg "Linked Open")
27 7 [8] [49] Linked Open Data 17
28 2.2.4 Hsiao [7] SmartDiet Kim [10] Marling [4] CAMPER Marling CAMP PRISM CAMPER [5, 16] Barbara [16] 30 1,
29 2.3 QOL 19
30 [30] 8 1 3g 51 ( 8 ) kcal 1 2g 20
31 図 8 実験に用いた献立本の内容と食事選択手順 21
32 mg 2800mg 400mg 1000mg 2 3b 2000mg mg 60kg 3b mg mg
33 3 mg mg
34 [30] kg 1 50 ( ) 46 ( ) (6 ) cm 60kg
35 3 20, 16, 12 2, 3a, 3b (I) (II) 25
36 (III) (IV) (IV-i). (IV-ii). (IV-iii). (V) (VI) KNApSAcK Family DB[36] 9 KNApSAcK Family 9 YAKUZEN 2010 EAR 50% 26
![9 KNApSAcK Family [36] RDA 97.](/docs-images/88/114615121/images/37-0.jpg "5% AI.")
37 9 KNApSAcK Family [36] RDA 97.5% AI. EAR RDA DG RDA RDA EAR AI DG 27
38 % E, K, B12 100% 5 100% % % 100% 50% 10 90% 50% D B ,16,
39 4 (1)!"#$ %&'!()" *+, #$%$ -./01!&'()" *+,-$. / 01$2 *2--$- 1*--$ !3" 4.$* / 4$* 44$- 01$- *1()! *,()! 1-()!!"@ABC DEFG!"@ABC DHFG 789:!53" *6-4$2 / *.0$ $- 8;!53" 26.$. / 2+$, 7 +--$-!<=>?!3" 0$2 / -$6 4$-,$- -./01!&'()" *+2+$. / 0.$1 *2--$- 1*--$ !3" 2-$, / 1$4 02$- 2*$- 789:!53" *.+*$+ / *64$ $- 8;!53" 6-0$0 /,4$* 7 *---$-!<=>?!3" 0$+ / -$2 4$-,$- -./01!&'()" *+20$, / 2-$6 *2--$- 1*--$ !3",4$1 / 1$, 26$-,4$- 789:!53" 1*-*$1 / *,6$ $- 8;!53".0-$+ /.-$+ 7 *---$-!<=>?!3" 2$2 / -$2 4$-,$- 29
40 5 (2) (/kl* (*kl* /0kl* *+,-./ %01&$'( '( ) '( ) $$%&!"#" '( ) $%&!"#"!"# $%&!"#" 23 %)& *+"*, (-". /0. +/"1, (("- /(1 **"2, (0"3 /00..". %#4& 4567 %)& /1/"1,.."3 (2* /*1"-, /-"1 (-- /*3"*, /0"1 (-. (3+"2 %#4& 89:;< %5)& (3(."., /30"2.0/ (1-0"/, (33"(./. /(+/"+, (1/"1.*/ *00 %678& =>?;< %5)& /*+"*, 2."1.3 /1-"., *2"( -/.-0"., 1(" %5)& (-1"/, /3"3 -. (+/"/, (3"+ -1 (13"0, (+" %8#7& C %5)& 2"(, ("1 *3 2"+, /"( +* *"1, ("* 1. +"2 %8#7& DE %5)& 2"., /". 2. *"2, ("- *2 +"3, ("- +3 (0 %8#7& F %5)& 0"3, 0"- 33 ("0, 0"2 ((/ ("., 0"1 (-3 0"1 %5)& /"0, 0"2 20 /"2, 0"2 */ /"*, 0"2 *2 - %79& I;# %:)& -/"*, -+"-.. -*"., 2/"0.*.0"0, /+"* /. (.0 %8#7& JKG %:)&.."2, (2"2 ((/ -/"0, (3"0 (-0 23"3, /("/ (1*.0 %8#7& LM< %:)& -"1, ("* -1 -"-, ("* -- -"3, ("* -3 (0 %79& N:OPG %:)& 3+"+, -("2.2( (/1"1, -/"3 2/0 (.."1,.-"1 2.2 /2 %8#7& QRSGT %:)876& -*("3, (30"( 2-2.-"0, //("- *. +/."2, /3-"* %8#7& QRSGU %:)& -"2, 2"3 3. -"2, 2"/ 3/ +"-, *". (.- 2"2 %79& QRSGV %5)& 3"2, ("3 (.( 1"., /"0 (-. 1"1, ("+ (2. *"2 %79& QRSGW %:)& (30"., +-"+ (/0 //*"1, 12"/ (2( /2."2, (00". (*1 (20 %79& QRSGXY %5)& 0"2, 0"/ -( 0"+, 0"/ 2( 0"3, 0"/ *0 (". %8#7& QRSGXZ %5)& 0"*, 0"/.3 0"+, 0". -1 0"1, 0"2 *0 ("2 %8#7& 8[\?G %5);6& 3"1, /". *. (("/, /"2 30 (-"2,.". (0. (- %8#7& QRSGX] %5)& 0"3, 0"/ 21 ("0, 0"/ +( ("(, 0"/ 3( ("- %8#7& QRSGXYZ %:)& +"*, (2"0.(* -"*, +"- (1- +"/, 1"0 /11 /"- %8#7& ^_ %:)& /(+"2, 1/"0 1( /*0"+, ((/"- (01../"., (13"( (.3 /-0 %8#7& `G9aG_ %5)&."2, 0"3 +( -"2, 0"3 10 2"/, ("( (0-2 %79& QbcG %:)& (1"(, (0"0.3 /("2, 1"* -. /2"2, (-"0 2( 20 %79& QRSGd %5)& 1-"2,.("0 1- (02"*,.("2 (0* (0*"+,./"( (0+ (00 %8#7& *7efgh %)& (("1, /"( 21 (/"1, ("3 *- (-"., ("1 +( /0 %#4& 30 '($$678$<$mn$%oph $$$$$$8#7$<$mqh $$$$$$79$<$ijh $$$$$$#4$<$i1h
41 10 100% 6 R ver Spearman r s 0.7 r s
42 6 p!"# $%&'!"# $(!%& )*+,- '()(*+ ()+&*./ ()&*, % ()-./ %%% 54 '()(0/ ()*/& 6.78 '()0+& %%% 9:;<= ()*+/ %%% >;<= ().1, %%% >+?<= ()01, ()./& %%% ;B ()1++ %%% C ()0// %%% DE ()+-- %%% F ()00( ()+0, %%% H<# '()&&1 ()(/* IJB ()+-( %%% KL= '()(+* ()+-/ M;NOB ()+,& %%% PQRB2 ()+&/ %%% PQRB3 ()&-* %%% PQRB4 ()0(( %%% PQRB5 ()0&* %%% PQRB6& ()++. %%% PQRB6, ()0+1 %%% 9ST?B ().+( %%% PQRB6. ()*/+ %%% PQRB6&, '()(&+ ()1,1 UV ()0&* %%% WB:XBV ()*-* %%% PYZB (),,0 %%% PQRB7 ()&*. % [8\]^_ ()+** %%% [`$a_ ()**1 %%% 32 %&!!!%!!!!8!$9!)(*bb!!!!!!!%%!!8!$9!)(&bb!!!!!!!%%%8!$9!)((*!b!
43 Iodine [μg] Vitamin B-12 [μg] Manganese [mg] Exchanges Exchanges Exchanges (a) (b) B12 11 (c) K H VA VB1 VB2 VC 3/
44 23 8/3 KNApSAcK Family DB[36] R ver t Wilcoxon % % 90% 4 100% B % 9 34
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
46 8 (2) (/jk* /0jk* l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`G9aG_ %5)&."1, 0"2 +( 1"/, ("( (0-2"., ("* (*+ 1 %79& QbcG %:)& (4"(, (0"0.2 /1"1, (-"0 1( -."/, (1"4 2* 10 %79& QRSGd %5)& 4-"1,.("0 4- (0*"+,./"( (0+ (+/"+, 1("1 (+. (00 %8#7& *7efgh %)& (("4, /"( 14 (-"., ("4 +( /-"0, 1"1 (/0 /0 %#3& 36 '($$678$<$mn$%oph $$$$$$8#7$<$mqh $$$$$$79$<$irh $$$$$$#3$<$i1h
47 Calcium (mg) exchanges 16 exchanges 20 exchanges regular RDA alpha-tocopherol (mg) exchanges 16 exchanges 20 exchanges regular AI Vitamin B-12 (μg) exchanges 16 exchanges 20 exchanges regular RDA Protein (g) Protein (g) Protein (g) (a) (b) E (c) B12 12 p<0.005 E B12 E B E B
48 9 _&`abcdefgh234i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
49 100% 50% 100% 50% D 12 38% 12 70% 80% 100% 39
50 B12 [31] 40
51 QOL [2]. [46] QOL
52 ,
53 (I) (II) [27, 29, 22, 33] 3 43
54 !"# $%# &"' (') &*" +,-!./!"#$%&'$ ()%*+,*-(+ $./!(/012 3$(#)% )&-2 3$(#)% ')1,'*
55 n 1 UL n LL n 1 Intake n (d) D d 1 D 1 LL n D Intake n (d x) UL n D (1) x=0 D 1 n (UL n ) (LL n ) LL n D (UL n ) D 1 Intake n (d) UL nd (LL n ) D 1 (2) QOL 45
56 [19]
57 14 10 kcal g mg mg ,14,14 3a
58 : 1 2 : 3 3 : 3 48
59 16 49
60 1 3 [47] (I) (II) (III) (IV) 1 (V) 3 (IV-i). 1 (IV-ii). (ii) 1 (VI) 50
61 15 5 (I) H 0 : 1 = 2, 1 = 3, 2 = 3 H 1 : 1 < 2, 1 < 3, 2 3 (II) H 0 : 1 = 2, 1 = 3, 2 = 3 H 1 : 1 < 2, 1 < 3, 2 < 3 (III) 1 H 0 : 1 = 2, 1 = 3, 2 = 3 H 1 : 1 < 2, 1 > 3, 2 > R ver Bartlett ANOVA 3 [18] t Bonferroni Friedman Scheffe
62 *$+$#"! %"#$ ("%$ ("#$ '"%$ 234 '"#$ &"%$ &"#$!"%$!"#$!"!$) #$%&!"&$) '(%&) *+,-./!"'$) '(%&) *+, : Bartlett p p t Bonferroni 1 2 p % , [a] 52
63 %"#$ ("%$ ("#$ 234 '"%$ '"#$ &"%$ &"#$!"%$!"#$!"!$) #$%&!"&$) '(%&) *+,-./!"'$) '(%&) *+,-01 [a] 3 n=9 %"#$ ("%$ ("#$ *$+$#"#% *$+$#"#% 234 '"%$ '"#$ &"%$ &"#$!"%$!"#$!"!$) #$%&!"&$) '(%&) *+,-./!"'$) '(%&) *+,-01 [b] 3 n=6 18 2: 53
64 3 18[b] 3 3 Bartlett p p t Bonferroni 1 3 p % p % Bartlett p p % 3 t Bonferroni 1 2 p % 2 1 p %
65 %"#$ *+#"#% *+#"#! ("%$ ("#$ '"%$ 234 '"#$ &"%$ &"#$!"%$!"#$!"!$) #$%&!"&$) '(%&) *+,-./!"'$) '(%&) *+, : ,500kcal 6,300kcal 2,100kcal 2,100kcal 1,900kcal 2,500kcal 2,500kcal 1,900kcal 2,500kcal 2,500kcal 55
66 ABC %"#$ ("%$ ("#$ '"%$ '"#$ &"%$ &"#$!"%$!"#$!"!$) #$%&!"'$) '(%&)*+,-./ 0* : 1 ( ) 1,300kcal 2,500kcal 1,900kcal 1,900kcal
67 18[a] 18[b]
68 58
69 5. QOL 50% 59
70 QOL QOL 60
71 Christian Sandor CKD 61
72 University of Oulu, Petri Pulli 62
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80 Energy (kcal) exchanges 16 exchanges 20 exchanges regular Lipid (g) exchanges 16 exchanges 20 exchanges regular Triacyl-glycerol equivalents (g) exchanges 16 exchanges 20 exchanges regular Protein (g) Protein (g) Protein (g) (a) (b) (c) Carbohydrate (g) exchanges 16 exchanges 20 exchanges regular Sodium (mg) exchanges 16 exchanges 20 exchanges regular Potassium (mg) exchanges 16 exchanges 20 exchanges regular Protein (g) Protein (g) Protein (g) (d) (e) (f) 12 exchanges 16 exchanges 20 exchanges regular RDA 12 exchanges 16 exchanges 20 exchanges regular RDA 12 exchanges 16 exchanges 20 exchanges regular Calcium (mg) Magnesium (mg) Phosphorus (mg) Protein (g) Protein (g) Protein (g) (g) (h) (i) 21 (1) 70
81 12 exchanges 16 exchanges 20 exchanges regular RDA 12 exchanges 16 exchanges 20 exchanges regular RDA 12 exchanges 16 exchanges 20 exchanges regular RDA Iron (mg) Zinc (mg) Copper (mg) Protein (g) Protein (g) Protein (g) (j) (k) (l) Manganese (mg) exchanges 16 exchanges 20 exchanges regular AI Iodine (μg) exchanges 16 exchanges 20 exchanges regular RDA Selenium (μg) exchanges 16 exchanges 20 exchanges regular RDA Protein (g) Protein (g) Protein (g) (m) (n) (o) Chromium (μg) exchanges 16 exchanges 20 exchanges regular AI Molybdenum (μg) exchanges 16 exchanges 20 exchanges regular RDA Retinol activity equivalents (μg) exchanges 16 exchanges 20 exchanges regular RDA Protein (g) Protein (g) Protein (g) (p) (q) (r) A 22 (2) 71
82 Vitamin D (μg) exchanges 16 exchanges 20 exchanges regular AI alpha-tocopherol (mg) exchanges 16 exchanges 20 exchanges regular AI Vitamin K (μg) exchanges 16 exchanges 20 exchanges regular AI Protein (g) Protein (g) Protein (g) (s) D (t) E (u) K Thiamin (mg) exchanges 16 exchanges 20 exchanges regular RDA Riboflavin (mg) exchanges 16 exchanges 20 exchanges regular RDA Niacin (mg) exchanges 16 exchanges 20 exchanges regular RDA Protein (g) Protein (g) Protein (g) (v) B1 (w) B2 (x) Vitamin B-6 (mg) exchanges 16 exchanges 20 exchanges regular RDA Vitamin B-12 (μg) exchanges 16 exchanges 20 exchanges regular RDA Folate (μg) exchanges 16 exchanges 20 exchanges regular RDA Protein (g) Protein (g) Protein (g) (y) B6 (z) B12 (aa) 23 (3) 72
83 12 exchanges 16 exchanges 20 exchanges regular AI 12 exchanges 16 exchanges 20 exchanges regular AI 12 exchanges 16 exchanges 20 exchanges regular RDA Pantothenic acid (mg) Biotin (μg) Ascorbic acid (mg) Protein (g) Protein (g) Protein (g) (ab) 12 exchanges 16 exchanges 20 exchanges regular DG (ac) 12 exchanges 16 exchanges 20 exchanges regular DG (ad) C Dietary fiber, total (g) Sodium chloride equivalents (g) Protein (g) Protein (g) (ae) (af) 24 (4) 73
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