1993 Owen WF Jr New England Journal of Medicine (albumin) [1] 40 70% [2-4] (1) (2) (3) [5] ( 1 ) (2) (3) (4) 1931 Lyon et al [6] [7-10] (1) (2) (3) (4) (5) leptin -1 (insulin-like growth factor-1) [6] (pro-inflammatory cytokines) (acute phase reactants) 96 19 2 71
-1 [6] (malnutrition) (inflammation) 10~20 [11] (atherosclerosis) Malnutrition-Inflammation- Atherosclerosis syndrome (MIA syndrome) MIA (endothelium) [12] X-ray [14] (Subjective Global Nutritional Assessment, SGA) ( ) ( 1) (Anthropometry) (Anthropometry) ( 1) National Health and Nutrition Examination Surveys (NHANES II) 1976 1980 [13] (Dual Energy X-ray Absorptiometry, DEXA) X-ray 1. 1. SGA (A B C ) 1. 2. 3. 4. 5. 1. 2. 3. 4. 5. 72 96 19 2
死亡勝算 [15] [16] protein equivalent of nitrogen appearance (npna) (95%) [17] (Daily protein intake) (1) (albumin) (21 ) ( ) 3 g/dl ( 2) [1] (2) (pre-albumin) (2 ) (3) (transferrin) [18] (4) (cholesterol) 200 mg/dl [19] 15 12 9 比6 3 0 <2.5 2.5-2.9 3.0-3.4 3.5-3.9 4.0-4.4 4.5 g/dl 2. ( 1) 96 19 2 73
[20-24] (Low Protein Diet, LPD)0.6 (0.6 g/kg/day) Walser Trevino-Becerra (0.3 g/kg/day) (ketoacids) (ketosteril) [25-26] (National Kidney Foundation, NKF) Kidney/Disease Outcomes Quality Initiative (K/DOQI) GFR 20 ml/min (1) (2) (edema-free weight) (NHANES II) (SGA) (3) (PNA) (1) (2) (3) (GFR 15 ml/min) GFR 25 ml/min 0.6 g/kg/day 0.75 g/kg/day GFR 25 ml/min 6035 kcal/kg/ day 6030 35 kcal/kg/ day GFR 15 20 ml/min 74 96 19 2
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