蛋白質攝取量建議及高蛋白飲食對腎臟的影響
 
黃敬軒¹王淳理²

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。
(台灣家醫誌2022; 32: 231-244) DOI: 10.53106/168232812022123204001
 
關鍵詞：高蛋白飲食、慢性腎臟病、蛋白質攝取、超過濾、腎損傷
 

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¹臺中榮民總醫院教學部、²臺中榮民總醫院家庭醫學部
受理日期：110年10月18日 修改日期：111年8月11日 同意接受：111年9月20日
通訊作者：黃敬軒 通訊地址：台中市北屯區旅順路一段56號3樓E-mail: amy260803@gmail.com

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Recommendation for Daily Protein Intake and
The Impact of High-Protein Diet On Glomerular
Filtration Rate
 
Jing-Xuan Huang¹ and Chun-Li Wang²

 
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 longterm 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.
(Taiwan J Fam Med 2022; 32: 231-244) DOI: 10.53106/168232812022123204001
 
Key words: chronic kidney disease, high-protein diet, hyperfiltration, protein intake,
renal impairment
 

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¹Department of Medical Education, Taichung Veterans General Hospital, Taichung, Taiwan.
²Department of Family Medicine, Taichung Veterans General Hospital, Taichung Taiwan.
Received: October 18, 2021; Revised: August 11, 2022; Accepted: September 20, 2022.