JP2000264844A - Nutritive composition for kidney disease patient - Google Patents

Abstract

PROBLEM TO BE SOLVED: To obtain the subject composition which improves the nutritive states of kidney disease patients and is useful for preventing arteriosclerosis and cardiovascular diseases caused by the arteriosclerosis by specifying the compounding ratio of three large nutriments (lipid, protein, carbohydrate). SOLUTION: This composition contains (A) lipids (for example, rice bran oil, fish oil), (B) proteins (for example, casein calcium, gelatin) and/or their hydrolyzates, and (C) carbohydrates (for example, dextrin) in amounts of 35-70%, 8-15% and <=57%, respectively, based on the total calorie of the composition. If necessary, the composition may furthermore be mixed with edible fibers (for example, cellulose), vitamins (for example, vitamin B6), minerals (for example, calcium), and an emulsifier (for example, xanthan gum). When all of the meal of a kidney disease patent is replaced by the above composition, the composition is usually preferably taken by the patient in an amount of about 25-40 kcal/day/kg of the body weight.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

The present invention relates to a nutritional composition for a renal disease patient, in which the ratio of the three major nutrients in a nutritional composition for a renal disease patient such as acute or chronic renal insufficiency or nephritis is defined, in particular, The present invention relates to a nutritional composition for renal failure patients.

[0002]

2. Description of the Related Art Conventionally, dietary therapy for patients with renal disease includes:
A low protein diet is effective for reducing the burden on the kidney, and the ratio of protein to total energy is 5 to 8%.
Most of them are suppressed to about%. As a result of such protein restriction, renal disease patients are likely to suffer from malnutrition, and it has been difficult to maintain a low protein diet for a long period of time in terms of compliance with taste of meal and the like.

[0003] In a normal renal failure diet, the energy for protein reduction is supplemented by carbohydrate, so that 65-70% of energy supplementation is required.
Depends on carbohydrates. Therefore, in a normal renal failure diet, the proportion of carbohydrate and lipid in the total energy was 65 to 70% of carbohydrate and 25 to 30% of lipid. However, there is a concern that a conventional renal failure diet that relies on carbohydrates for energy supplement may further increase hypertriglyceridemia. That is, in patients with renal insufficiency, abnormalities in lipid metabolism such as hypertriglyceridemia were observed, and there was a high risk that arteriosclerosis or a cardiovascular disease resulting therefrom would be complicated.

[0004] On the other hand, it has been reported that ingestion of a low-carbohydrate, high-fat diet in renal failure patients improved blood lipids such as a decrease in blood triglycerides (Yoneda et al., Nutrition Journal) , Vol.43, No.1, 27-33, 1985). However, this report does not examine the conventional low protein therapy itself, and thus does not solve the above-mentioned problems caused by the low protein diet.

[0005]

DISCLOSURE OF THE INVENTION The present invention relates to a method for improving the nutritional status of patients with renal diseases such as renal failure and for preventing atherosclerosis and cardiovascular diseases resulting therefrom, which are optimal for patients with renal diseases. It is intended to provide a nutritional composition.

[0006]

Means for Solving the Problems The present inventors have conducted intensive studies on the optimal mixing ratios of the three major nutrients (proteins, carbohydrates and lipids) for the purpose of improving nutritional status and renal function in patients with renal disease. As a result, even if the protein mass is increased, the proportion of lipids in the total caloric value is increased, and the proportion of carbohydrates is reduced, without increasing hypertriglyceridemia,
Therefore, the present inventors have found a new finding that it is possible to administer a protein equivalent to a healthy person, which has been considered impossible as a therapeutic diet for conventional renal disease patients, and have completed the present invention.

That is, the nutritional composition for a patient with renal disease of the present invention, wherein the ratio of lipid to total calorie is 35 to 70%, the ratio of protein and / or its degradation product is 8 to 15%, and The ratio is not more than 57%. This nutritional composition for patients with renal disease is particularly suitable as a nutritional composition for patients with renal failure.

[0008]

BEST MODE FOR CARRYING OUT THE INVENTION As described above, the nutritional composition of the present invention has a fat content of 35 to 70%, a carbohydrate content of 57% or less, and a protein content of 8 to 15% of the total calorific value. %
It is assumed that. The ratio of the above-mentioned saccharides to the total calorific value is preferably as small as possible, but it is usually sufficient if the ratio is at least about 10%.

[0009] When the proportion of lipids in the total calories is below the above range, the proportion of carbohydrates is increased accordingly, so that the amount of lipids in the blood is increased and abnormalities in lipid metabolism such as hypertriglyceridemia are increased. There is a risk. On the other hand, when the proportion of lipids in the total calories exceeds the above range, no increase in blood triglyceride is observed, but cholesterol increases to cause hypercholesterolemia, which may lead to deterioration of renal disorder. In addition, when the proportion of the carbohydrate in the total calorie exceeds the above range, abnormalities in lipid metabolism such as hypertriglyceridemia may be increased.

[0010] Further, when the ratio of the protein to the total caloric value is lower than the above range, the nutritional status of the patient cannot be improved. On the other hand, if the proportion of the protein in the total calorific value exceeds the above range, the burden on the kidney is increased, which may cause deterioration of the renal disorder, which is not preferable.
Specifically, carbohydrate 30 to 35 to 80 parts by weight of protein
The content is preferably 0 parts by weight or less, and 65 to 165 parts by weight of lipid.

Examples of the above proteins include casein salts such as calcium caseinate, animal proteins such as chicken egg protein, milk protein and meat protein; vegetable proteins such as soybean protein; and gelatin. In addition, protein degradation products (such as soybean peptides) and amino acids may be used together with or in place of the above-mentioned proteins. One type of protein or its degradation product may be used alone, or two or more types may be used in combination.

Examples of lipids include vegetable oils such as rice bran oil, soybean oil, cottonseed oil, safflower oil, corn oil, rapeseed oil, palm oil, perilla oil, perilla oil, coconut oil and the like; animal oils such as cow oil;
Fish oil; synthetic triglyceride, etc., and these may be used alone or in combination of two or more. Preferably, a lipid having a high polyunsaturated fatty acid content in the lipid is used.

Examples of the saccharide include maltodextrin, dextrin, candy starch, monosaccharides such as glucose and fructose, disaccharides such as maltose and lactose, and granulated sugar. One type of saccharide may be used alone, or two or more types may be used in combination. Preferably, polysaccharides such as maltodextrin and dextrin are used. In the present invention, dietary fiber, vitamins, minerals that have been conventionally added to various nutritional compositions other than the above components,
An emulsifier and the like can be added as needed. It is preferable that the dietary fiber, vitamins and minerals have a composition taking into account the pathology of renal diseases such as renal failure.

Examples of the dietary fiber include cellulose, lignin, resistant starch, polydextrose,
Examples include indigestible polysaccharides such as oligosaccharides.

As vitamins, for example, vitamin A,
Fat-soluble or water-soluble vitamins such as vitamin B ₁ , vitamin B ₆ , vitamin B ₁₂ , vitamin C, vitamin D, vitamin E, niacin, folic acid, pantothenic acid, and the like. Also, two or more kinds may be used in combination. However, since it is intended for patients with renal disease, it is preferable that vitamin B ₆ and folic acid be mixed in more than the required amount for healthy individuals, and that vitamin A and vitamin D be less than the required amounts for healthy individuals.

As minerals, for example, calcium,
Examples thereof include iron, sodium, potassium, phosphorus, and magnesium, and these may be used alone or in combination of two or more. However, since the target is a patient with renal disease, the amount of sodium, potassium, phosphorus and the like is preferably not more than that required for a healthy person.

Examples of the emulsifier include glycerin fatty acid ester, sucrose fatty acid ester, sorbitan fatty acid ester, propylene glycol fatty acid ester, phospholipid, gum arabic, tragacanth gum, xanthan gum,
Guar gum, locust bean gum and the like.

In addition to the above components, flavor components such as citric acid and fruit juice, and flavors such as coffee flavor, matcha flavor and milk flavor can be appropriately blended.

The nutritional composition of the present invention can be used in the form of various pharmaceuticals and foods, such as powders, solids, pastes, liquid foods, etc., which are obtained by mixing and drying the above-mentioned components. They may be taken or dissolved or dispersed in water or hot water when taken. In addition, the nutritional composition of the present invention can be taken in place of all or part of a daily meal of a patient with renal disease.

In the case of a liquid food, its preparation can be carried out according to a conventional method. That is, a liquid food can be produced by weighing each component, putting it in water, mixing well, emulsifying, filling and sealing in a retort pouch, and performing a sterilization treatment. However, since it is intended for patients with renal disease, it is better to keep the water content low, and the calorie is 10
100-300 kcal per 0 ml, preferably 20
The respective amounts are adjusted so as to be 0 kcal or more.

When the whole diet is replaced with the nutritional composition of the present invention, the intake of the nutritional composition of the present invention is usually about 25 to 40 kca / kg body weight for patients with renal disease.
1 / day is appropriate. The nutritional composition of the present invention obtained in this way is different from conventional nutritional supplementation for patients with renal disease, in addition to being able to improve the nutritional state without deteriorating renal function, as well as blood triglyceride. Improvement of lipid metabolism such as reduction can prevent the development of renal disease and prevent arteriosclerosis and cardiovascular disease caused by it.

Hereinafter, the nutritional composition of the present invention will be described with reference to examples, but the present invention is not limited to only the following examples.

EXAMPLES Nutrient compositions shown in Tables 1 to 3 were prepared.

[0023]

[Table 1]

[0024]

[Table 2]

[0025]

[Table 3]

The nutritional compositions (test meals) shown in Tables 1 and 2 are ordinary protein food groups prepared by mixing the respective components in the amounts shown in the same table, and Pro12 has a protein calorie ratio. 12%, Pro9 has a protein calorie ratio of 9
%. Then, the lipid calorie ratio increases in the order of L, M, and H assigned to each sample number, and the saccharide calorie ratio decreases. Here, Pro12 / M, Pro1
Since 2 / H, Pro9 / M and Pro9 / H have the composition according to the present invention, Production Examples 1 to 9, respectively.
And 4.

On the other hand, the nutritional composition (test food) shown in Table 3
Is a low protein diet group (protein calorie ratio: 6%) prepared by mixing each component in the amount shown in the same table,
Sample numbers Pro6 / L, Pro6 / M and Pro6 /
In the order of H, the lipid calorie ratio increases and the saccharide calorie ratio decreases. Here, Pro6 / L has the same caloric ratio of proteins, carbohydrates and lipids as a normal renal failure diet.

In Tables 1 to 3, minerals and vitamins refer to mixtures having an AIN-76 formulation.

Next, a test example using a renal failure model animal will be described. Test Example 1 Using a 4-week-old male Wistar rat, 75% of the left kidney was excised under Nembutal anesthesia, and two weeks later,
The right kidney was completely removed and 60 rats with renal failure were produced. Two weeks after the total nephrectomy of the right kidney, 48 rats having a plasma creatinine concentration in the range of 0.9 to 1.7 mg / dl were selected from rats with renal insufficiency, and commercially available solid feed (CRF)
1; Oriental Yeast Co., Ltd.) for one week, and then divided into 6 groups of 8 animals each.
Was freely taken for 15 weeks. Also,
An untreated group was provided in which normal rats were fed a commercial chow.

Before ingestion of test food (0), 3, 6, 9, 1
At weeks 2 and 15, animals were placed in individual metabolic cages and allowed free access for 2 days. After an additional 12 hours of fasting, fundus blood sampling and body weight measurement were performed under ether anesthesia. The obtained blood sample was centrifuged (3000 rpm, 10 minutes, 4 minutes).
C), and plasma was used to measure triglyceride (TG) and creatinine (Cre). The measurement was performed using a blood biochemical analyzer (Fuji Dry Chem 5 manufactured by Fuji Medical Co., Ltd.).
500 ").

The measurement results are shown as an average value ± standard deviation, and statistical processing was performed between each test meal group using the Tukey method. The statistical results show a significant difference (p <) between the Pro6 / L group or Pro12 / L group, which is a conventional renal failure diet, and each test diet group.
0.05). Table 4 shows the measurement results of the amount of plasma creatinine, which is an indicator of kidney disease.

[0032]

[Table 4]

As is clear from Table 4, in the Pro12 / L group in which the protein caloric ratio was increased at the same lipid caloric ratio as that of the conventional renal failure diet group (Pro6 / L), the Pro6 / L group started from week 9 onward. And a significant difference was observed between them, indicating a tendency for renal function to deteriorate. In contrast, in Production Example 1 Group (Pro12 / M) and Production Example 2 Group (Pro12 / H) according to the present invention, the conventional renal failure diet group (P12 / M)
ro6 / L), there was no significant difference, and despite the increased protein calorie ratio, no tendency for deterioration of renal function was observed. Next, Table 5 shows the measurement results of the plasma triglyceride level, which indicates the blood lipid level.

[0034]

[Table 5]

As is clear from Table 5, the low protein diet group (P
Both the ro6 group and the normal protein diet group (Pro12 group) tended to decrease the blood triglyceride level by increasing the lipid calorie ratio. From the above,
In the Pro12 group in which the protein calorie ratio was increased to the same level as a normal diet, it can be seen that increasing the lipid calorie ratio does not increase the amount of triglyceride in blood and can also suppress the deterioration of renal impairment.

FIG. 1 shows the rate of increase in body weight (average value). As is evident from FIG. 1, in the Pro6 group having a low protein calorie ratio, suppression of weight gain was observed in all cases,
Body weight increased steadily in the Pro12 group with a high protein calorie ratio. This indicates that the nutritional status is improved in the Pro12 group.

Test Example 2 Using 4-week-old male Wistar rats, 75% of the left kidney was excised under Nembutal anesthesia, and two weeks later,
The right kidney was completely removed and 60 rats with renal failure were produced. Two weeks after the total nephrectomy of the right kidney, 40 rats whose plasma creatinine concentration was in the range of 1.1 to 1.9 mg / dl were selected from rats with renal insufficiency, and commercially available solid feed (CRF)
1; Oriental Yeast Co., Ltd.) for 1 week, and the animals were divided into 4 groups of 10 animals, and each group was allowed to freely ingest a test meal having the composition shown in Tables 2 and 3 for 6 weeks. Also,
An untreated group was provided in which normal rats were fed a commercial chow.

Before the start of the test food intake (0), 3 and 6 weeks,
Each animal was placed in a separate metabolic cage and allowed free access for 2 days. After an additional 12 hours of fasting, blood was collected from the fundus under ether anesthesia. The obtained blood sample was centrifuged (3
000 rpm, 10 minutes, 4 ° C.), and urea nitrogen (UN) was measured using plasma. The measurement was performed using a blood biochemical analyzer (“Fuji Dry Chem 5500” manufactured by Fuji Medical Co., Ltd.).
This was performed using

The measurement results are shown as an average value ± standard deviation, and statistical processing was performed between each test meal group using the Tukey method. Statistical results indicate a significant difference (p <0.p.) Between the conventional diet group of renal failure Pro6 / L group or Pro9 / L group and each test diet group.
05). Table 6 shows the fluctuation rate of the plasma urea nitrogen level, which is an index of renal disease.

[0040]

[Table 6]

As is clear from Table 6, in the Pro9 / L group in which the protein calorie ratio was increased at the same lipid calorie ratio as the conventional renal failure diet group (Pro6 / L group), Pro6 / L
The increase rate of urea nitrogen tended to be higher than that of the group. On the other hand, Pro9 / M according to the present invention (Production Example 3)
In the group and Pro9 / H (Preparation Example 4) group, Pro9 / H
The increase rate of urea nitrogen was clearly suppressed as compared with the L group, and the increase rate of urea nitrogen was suppressed as compared with the conventional renal failure diet group (Pro6 / L group). From the above, it was found that in the Pro9 group in which the protein calorie ratio was higher than that in the normal renal failure diet, increasing the lipid calorie ratio suppressed the increase in the amount of plasma urea nitrogen and had an effect of reducing the burden on the kidney. Was.

Example 1 Each component was weighed according to the following recipe. (Ingredients) (Raw materials) (Blending amount) (Heat amount) Protein Casein Ca 50.0 g 200 kcal Lipid Soybean oil 105.0 g 945 kcal Carbohydrate dextrin 195.0 g 780 kcal Vitamins Vitamin A 1111 IU Vitamin B ₁ 778 μg Vitamin B ₂ 1000 μg Vitamin B ₆ 5.0mg vitamin B ₁₂ 4.4 [mu] g vitamin C 111 mg vitamin D 100 IU vitamin E 17.8 mg niacin 13.3mg folic 400μg pantothenate 7.8mg minerals sodium 150mg calcium 667mg potassium 300mg phosphate 200mg magnesium 100mg iron 11.1mg zinc 16.7mg Emulsifier Glycerin fatty acid ester 2g Dietary fiber Oligosaccharide 0.44g Flavor Milk flavor 0.90mL

The protein, lipid, saccharide and emulsifier are formulated as described above.
And mixed with water at 100 parts by weight of the total amount.
150 parts by weight were added, and the temperature was raised to 70 ° C. At that time,
Serine fatty acid ester was previously dissolved in soybean oil
The mixture was pre-emulsified at 75 ° C. for 15 minutes.
After the first stage 150kg / cm^Two50 kg / cm for the second stage
^TwoTo obtain an emulsion by homogenizing treatment with the two-stage homogenization method
This emulsion was dried with a spray drier to obtain a powdered fat. Next
With vitamins, minerals, fiber and flavors
A powder composition mixed with a xer and having the above proportions
Was prepared.

Example 2 The amounts of calcium caseinate, dextrin, mineral dispersion, lecithin, oligosaccharides and soybean oil shown in the formulation of Example 1 were charged into pure water at about 65 ° C. and mixed. After mixing each component,
The mixed solution is charged into a homomixer, and is mixed at about 8000 rpm.
Coarse emulsification was performed for 0 minutes. Then, the mixture was heated to 60 ° C. and allowed to stand for 10 minutes, and then finely emulsified (500 kgf /
cm ² , 2 passes). About 20 ° C
After adding vitamins and fragrance, the volume was increased to 1 L. Cool the filling tank to about 7 ° C,
The resulting emulsion was charged while stirring at rpm. Then, after filling 225 g of the present solution into the pouch from the filling tank, the pouch was sealed while purging with nitrogen, and sterilized at 121 ° C. for 14 minutes. 500mL liquid food for sterilized pouches
Is filled with 200 kca per 100 mL
1 energy.

[0045]

As described above, the nutritional composition of the present invention comprises:
By increasing the proportion of lipids in the total calories compared to conventional nutritional compositions for patients with renal disease, it is possible to obtain protein equivalent to that of healthy individuals without increasing the burden on the kidneys and improve nutritional status At the same time, there is an effect that arteriosclerosis and cardiovascular diseases resulting therefrom can be prevented by improving lipid metabolism.

[Brief description of the drawings]

FIG. 1 is a graph showing the rate of weight gain of a renal failure model animal.

──────────────────────────────────────────────────続 き Continued on the front page (51) Int.Cl. ⁷ Identification symbol FI theme coat ゛ (Reference) A61P 13/12 A61P 13/12 A61K 37/18

Claims (2)

[Claims] (1) The proportion of lipids in the total heat is 35 to 70.
%, A ratio of a protein and / or a degradation product thereof is 8 to 15%, and a ratio of a carbohydrate is 57% or less. 2. The ratio of lipid to total calorie is 35 to 70.
%, A ratio of a protein and / or a degradation product thereof is 8 to 15%, and a ratio of a carbohydrate is 57% or less.