蛋白質攝取量建議及高蛋白飲食對腎臟的影響

Recommendation for Daily Protein Intake and The Impact of High-Protein Diet On Glomerular Filtration Rate

10.53106/168232812022123204001

黃敬軒(Jing-Xuan Huang)；王淳理(Chun-Li Wang)

高蛋白飲食 ； 慢性腎臟病 ； 蛋白質攝取 ； 超過濾 ； 腎損傷 ； chronic kidney disease ； high-protein diet ； hyperfiltration ； protein intake ； renal impairment

台灣家庭醫學雜誌

32卷4期（2022 / 12 / 01）

231 - 244

繁體中文;英文

現今蛋白質攝取量多採用世界衛生組織（World Health Organization, WHO）每日0.83 g/kg標準體重（ideal body weight, IBW）為標準。然而，此標準僅適用於活動量低的成人，針對不同族群需做個人化的調整。除了有慢性腎臟病（chronic kidney disease, CKD）的族群須減少攝取蛋白質，年長者、有運動習慣者、以及正在減重的族群則是需要提高攝取量。高蛋白飲食產生了更多含氮廢物，在生理上可能會以增加腎絲球過濾率（estimated glomerular filtration rate, eGFR）來幫助代謝，然而此反應僅在部分研究中出現。而長期eGFR的增加是否會導致慢性腎臟病的產生，現有文獻仍不足以做出結論。然而每日攝取量若大於2 g/kg標準體重，或是大於1.7 g/kg實際體重（actual body weight），目前結果顯示有較高風險會影響腎功能。建議要施行高蛋白飲食的人，需先確認腎功能正常再實行計劃，避免過高的攝取量，並定期抽血追蹤腎功能變化。蛋白質來源的選擇應多方攝取，且多攝取植物性蛋白尤佳。動物性蛋白應盡量避免紅肉及加工肉品，以免造成腎臟的負擔。

The most common suggestion for daily protein intake, which is 0.83 g/kg, is based on the WHO nutrition guideline. However, this suggestion is mainly for adults who are sedentary or lightly active. Optimal amount of protein is in need of proper adjustment to fit individual needs. For instance, patients with chronic kidney disease (CKD) need to restrict protein intake, while the elderly, exercisers, and people on a weight loss program need to increase their daily protein intake. High-protein intake produces more nitrogenous waste, which may result in increasing eGFR. This response is called hyperfiltration, and extant research remains inconclusive about whether long-term hyperfiltration increases the risk of developing de novo CKD. However, long-term daily protein intake exceeding 2 g/kg ideal body weight or 1.7 g/kg actual body weight has been observed to heighten the risk of renal impairment. People with underlying CKD should steer clear of high-protein diet, and for kidney health, plant-based protein and healthy animal protein should be preferred over red meat and processed meat.

1. Addis T: Glomerular nephritis: diagnosis and treatment. JAMA 1948; 138: 327.
2. Agostini, F,Bernetti, A,Di Giacomo, G(2021).Rehabilitative good practices in the treatment of sarcopenia: a narrative review.Am J Phys Med Rehabil,100,280-287.
3. American Diabetes Association(2019).5. Lifestyle management: Standards of Medical Care in Diabetes-2019.Diabetes Care,42(Suppl 1),S46-S60.
4. Bauer, J,Biolo, G,Cederholm, T(2013).Evidence-based recommendations for optimal dietary protein intake in older people: a position paper from the PROT-AGE Study Group.J Am Med Dir Assoc,14,542-559.
5. Beasley, JM,Katz, R,Shlipak, M,Rifkin, DE,Siscovick, D,Kaplan, R(2014).Dietary protein intake and change in estimated GFR in the cardiovascular health study.Nutrition,30,794-799.
6. Brenner, BM,Meyer, TW,Hostetter, TH(1982).Dietary protein intake and the progressive nature of kidney disease: the role of hemodynamically mediated glomerular injury in the pathogenesis of progressive glomerular sclerosis in aging, renal ablation, and intrinsic renal disease.N Engl J Med,307,652-659.
7. Campbell, WW,Trappe, TA,Jozsi, AC,Kruskall, LJ,Wolfe, RR,Evans, WJ(2002).Dietary protein adequacy and lower body versus whole body resistive training in older humans.J Physiol,542(Pt2),631-642.
8. Campbell, WW,Trappe, TA,Wolfe, RR,Evans, WJ(2001).The recommended dietary allowance for protein may not be adequate for older people to maintain skeletal muscle.J Gerontol A Biol Sci Med Sci,56(6),M373-M380.
9. Cirillo, M,Lombardi, C,Chiricone, D,De Santo, NG,Zanchetti, A,Bilancio, G(2014).Protein intake and kidney function in the middle-age population: contrast between cross-sectional and longitudinal data.Nephrol Dial Transplant,29,1733-1740.
10. Dent, E,Morley, JE,Cruz-Jentoft, AJ(2018).International clinical practice guidelines for sarcopenia (ICFSR): screening, diagnosis and management.J Nutr Health Aging,22,1148-1161.
11. Devries, MC,Sithamparapillai, A,Brimble, KS,Banfield, L,Morton, RW,Phillips, SM(2018).Changes in kidney function do not differ between healthy adults consuming highercompared with lower- or normal-protein diets: a systematic review and meta-analysis.J Nutr,148,1760-1775.
12. Esmeijer, K,Geleijnse, JM,de Fijter, JW,Kromhout, D,Hoogeveen, EK(2020).Dietary protein intake and kidney function decline aftermyocardial infarction: the alpha omega cohort.Nephrol Dial Transplant,35,106-115.
13. Farhadnejad, H,Asghari, G,Emamat, H,Mirmiran, P,Azizi, F(2019).Low-carbohydrate highprotein diet is associated with increased risk of incident chronic kidney diseases among Tehranian adults.J Ren Nutr,29,343-349.
14. Halbesma, N,Bakker, SJ,Jansen, DF(2009).PREVEND Study Group: High protein intake associates with cardiovascular events but not with loss of renal function.J Am Soc Nephrol,20,1797-1804.
15. Haring, B,Selvin, E,Liang, M(2017).Dietary protein sources and risk for incident chronic kidney disease: Results from the atherosclerosis risk in communities (ARIC) study.J Ren Nutr,27,233-242.
16. Houston, DK,Nicklas, BJ,Jingzhong, D(2008).Dietary protein intake is associated with lean mass change in older, community-dwelling adults: the Health, Aging, and Body Composition (Health ABC) Study.Am J Clin Nutr,87,150-155.
17. Ikizler, TA,Burrowes, JD,Byham-Gray, LD(2020).KDOQI clinical practice guideline for nutrition in CKD: 2020 update.Am J Kidney Dis,76(Suppl 1),S1-S107.
18. Jäger, R,Kerksick, CM,Campbell, BI(2017).International Society of Sports Nutrition Position Stand: protein and exercise.J Int Soc Sports Nutr,14,20.
19. Jhee, JH,Kee, YK,Park, S(2020).High-protein diet with renal hyperfiltration is associated with rapid decline rate of renal function: a community-based prospective cohort study.Nephrol Dial Transplant,35,98-106.
20. Kalantar-Zadeh, K,Fouque, D(2017).Nutritional management of chronic kidney disease.N Engl J Med,377,1765-1776.
21. Kamper, AL,Strandgaard, S(2017).Long-term effects of high-protein diets on renal function.Annu Rev Nutr,37,347-369.
22. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group(2013).KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease.Kidney Int Suppl,3,73-90.
23. Knight, EL,Stampfer, MJ,Hankinson, SE,Spiegelman, D,Curhan, GC(2003).The impact of protein intake on renal function decline in women with normal renal function or mild renal insufficiency.Ann Intern Med,138,460-467.
24. Ko, GJ,Rhee, CM,Kalantar-Zadeh, K,Joshi, S(2020).The effects of high-protein diets on kidney health and longevity.J Am Soc Nephrol,31,1667-1679.
25. Lew, QJ,Jafar, TH,Koh, HW(2017).Red meat intake and risk of ESRD.J Am Soc Nephrol,28,304-312.
26. Ley, SH,Hamdy, O,Mohan, V,Hu, FB(2014).Prevention and management of type 2 diabetes: dietary components and nutritional strategies.Lancet,383,1999-2007.
27. Lin, J,Fung, TT,Hu, FB,Curhan, GC(2011).Association of dietary patterns with albuminuria and kidney function decline in older white women: A subgroup analysis from the Nurses’ health study.Am J Kidney Dis,57,245-254.
28. Malhotra, R,Lipworth, L,Cavanaugh, KL(2018).Protein intake and long-term change in glomerular filtration rate in the Jackson heart study.J Ren Nutr,28,245-250.
29. Rand, WM,Pellett, PL,Young, VR(2003).Metaanalysis of nitrogen balance studies for estimating protein requirements in healthy adults.Am J Clin Nutr,77,109-127.
30. Sabatino, A,Stenvinkel, P,Lindholm, B,Avesani, CM(2021).Sarcopenia in chronic kidney disease: what have we learned so far?.J Nephrol,34,1347-1372.
31. Schwingshackl, L,Hoffmann, G(2014).Comparison of high vs. normal/low protein diets on renal function in subjects without chronic kidney disease: a systematic review and metaanalysis.PLoS One,9,e97656.
32. Thomas, DT,Erdman, KA,Burke, LM(2016).Position of the Academy of Nutrition and Dietetics, Dietitians of Canada, and the American College of Sports Medicine: Nutrition and Athletic Performance.J Acad Nutr Diet,116,501-528.
33. WHO=World Health Organization(2007).Protein and Amino Acids Requirements in Human Nutrition: Report of a joint of WHO/FAO/UNU Expert Consultation.Geneva:WHO press.
34. Wu, G(2016).Dietary protein intake and human health.Food Funct,7,1251-1265.
35. Yu, Z,Nan, F,Wang, LY,Jiang, H,Chen, W,Jiang, Y(2020).Effects of high-protein diet on glycemic control, insulin resistance and blood pressure in type 2 diabetes: A systematic review and meta-analysis of randomized controlled trials.Clin Nutr,39,1724-1734.
36. 財團法人國家衛生研究院(2015).2015台灣慢性腎臟病臨床診療指引.苗栗:國家衛生研究院.