Taipei Medical University
T
he
e
ffect
o
f
D
ietary
P
rotein
a
nd
P
hosphorus
(
DPP
) e
ducation
p
rogram
t
o
i
mprove
p
rotein-nutritional
s
tatus
a
nd
s
erum
p
hosphate
l
evel
o
n
c
hronic
h
emodialysis
p
atients
I
ntroduction
O
bjective
Serum phosphate is hard to eliminate during hemodialysis process. Chronic hemodialysis (CHD) patients should comply low phosphorus diet and
medications to control serum phosphate level. If patients whoever did not have sufficient knowledge of nutrients, phosphorus restriction may lead to reduce dietary protein intake, then lead to protein-energy wasting.
S
ubjects and Methods
R
esults and Discussion
C
onclusion
Lin WC
1, Jin MY
2, Chen TH
3, Yang SH
1,41School of Nutrition and Health Sciences, Taipei Medical University 2Department of Nutrition, Wanfang Hospital 3Department of Internal Medicine, Wanfang Hospital4Nutrition research center, Taipei Medical University Hospital
This Dietary Protein and Phosphorus (DPP) education program had integrated health education theoretical framework that expected to improve adequate dietary intake, optimal nutritional status and serum phosphate level on CHD patients.
CHD subjects were recruited from Wanfang Hospital from Sep. to Dec. 2010. Subjects with either serum phosphate level above 5.0 mg/dL or serum albumin level less than 4.0 g/dL during last 3 months were invited into study. There were 123 CHD patients who were assigned to intervention or control group according to their
intention. Intervention subjects received DPP education program, providing 6 education sessions in 3 months. Control subjects continued to receive standard care. We collected demographic data, anthropometric and
laboratory measurements, knowledge, attitude and practice (KAP) questionnaires and 3-day diet records to evaluate subjects’ behavior skill and compliance.
significantly, maintained phosphorus-to-protein ratio (table1) and approximately 70% patients comply
medications properly and regularly. Intervention subjects had better phosphorus restriction compliance, improved nutritional status and reduced serum phosphate level (table2). Control subjects increased dietary protein intake, maintained nutritional status while elevated serum
phosphate level.
This DPP education program had integrated education theoretical framework, including behavior modification and health belief model. Information is simple, limited in number, targeted, reinforced and intensive education sessions to success in achieving phosphorus restriction, with adequate dietary protein intake and medications compliance on CHD patients. Teaching materials including DPP booklet, diet diary, pill box and pill cutter also helped to motivate, reminder and drive self-control to reinforce their compliance.
This DPP education program successes in motivating behavior change, improving adequate dietary intake skill, keeping optimal nutritional status and lowering serum phosphate level on CHD patients.
Table2.Comparison of laboratory and indicator of nutritional status between 6 months in intervention and control group.
Intervention group (n = 36) Control group (n = 83)
Baseline Month2 Month3 Month5 Month6 Baseline Month2 Month3 Month5 Month6 p
1 p2 Albumin, g/dL 3.7 ±0.1 3.8 ±0.0 3.8 ±0.1 3.8 ±0.1 3.8 ±0.1 3.8 ±0b 3.8 ±0.0ab 3.8 ±0.0ab 3.9 ± 0a 3.8 ± 0.0ab 0.78 0.10 GNRI 95.3 ±1.0 96.3 ±0.8 96.1 ±0.8 96.8 ±1.0 96.6 ±1.1 95.6 ±0.8b 95.9 ±0.9ab 96.2 ±0.9a 96.9 ± 0.8a 96.3 ± 0.8ab 0.78 0.08 nPCR, g/kg 1.09 ±0.04b - 1.12 ±0.04a - 1.18 ±0.09a 1.06 ±0.03b - 1.14 - 0.03a - 1.12 ± 0.04a 0.97 0.05 Ca, mg/dL 9.2 ±0.1a 9.2 ±0.1ab 9.2 ±0.1a 9.0 ±0.1b 9.0 ±0.1ab 9.0 ±0.1b 9.1 ±0.1a 9.1 ±0.1b 8.8 ± 0.1c 8.9 ± 0.1bc 0.07 0.00 P, mg/dL 5.4 ±0.2a 4.7 ±0.2b 5.2 ±0.2a 5.6 ±0.3a 5.0 ±0.3ab 5.2 ±0.1b 5.3 ±0.2ab 5.7 ±0.2ab 5.7 ± 0.2a 5.6 ± 0.2ab 0.22 0.02 Ca×P, mg2/dL2 49.4 ±2.2 a 43.5 ±2.6b 47.7 ±2.2a 50.1 ±2.9ab 44.9 ±2.7ab 47.1 ±1.4 48.8 ±1.6 51.6 ±1.9 51.0 ± 1.7 50.3 ± 1.8 0.47 0.16 K, mEq/L 4.7 ±0.1 4.6 ±0.1 4.7 ±0.2 4.6 ±0.1 4.8 ±0.1 4.7 ±0.1b 4.7 ±0.1b 5.0 ±0.1a 4.9 ± 0.1a 4.8 ± 0.1b 0.36 0.01
Values are expressed as mean ± SE. 1p for group, 2p for time. GNRI, geriatric nutritional risk index; nPCR; normalized protein catabolic ratio; Ca, calcium; P,
phosphate; K, potassium. Values with different superscripts are significantly different at p < 0.05 by one-way and two-way repeated measures ANOVA and post hoc test with Friedman's test and Scheffe's test.
Table1.Comparison of daily nutrients intake between 6 months in intervention group.
Intervention group (n = 36)
Baseline Month1 Month3 Month6 p
Calorie, kcal/kg 23.8 ± 1.4 24.6 ±1.2 25.5 ± 1.3 24.7 ±1.3 0.54 Protein, g/kg 0.92 ± 0.06ab 0.95 ±0.05b 1.06 ± 0.06a 0.97 ±0.06ab 0.14 P, mg 577 ± 40b 625 ±31b 715 ± 40a 612 ±47b 0.03 P, mg/g protein 11.4 ± 0.4 11.7 ±0.3 12.1 ± 0.3 11.1 ±0.5 0.20 Values are expressed as mean ± SE. P, phosphorus. Values with different superscripts are significantly different at p < 0.05 by one-way repeated measures ANOVA.
After 3 months intervention, subjects increased their KAP scores of all components and dietary protein intake
