9 lutego 2022 roku udostępnione zostały zalecenia żywieniowe dla pacjentów z cukrzycą, opracowane przez ekspertów American Limb Preservation Society. W dokumencie podkreślono rolę żywienia w profilaktyce i leczeniu ran na podłożu cukrzycy.
Nowe wytyczne w zakresie leczenia żywieniowego dla pacjentów z zespołem stopy cukrzycowej zostały opracowane przez interdyscyplinarny zespół ekspertów, w skład którego weszli podiatrzy, dietetycy oraz chirurdzy różnych specjalności, w tym m.in. flebolog oraz chirurg plastyczny.
Jak podkreślają autorzy dokumentu, wdrożenie interwencji żywieniowej na odpowiednim etapie leczenia może znacząco poprawić rokowania i jakość życia pacjenta z cukrzycą, a także zapobiec groźnym powikłaniom, w tym również amputacji.
Niedożywienie przyczyną amputacji u pacjentów z cukrzycą
Według statystyk przytaczanych przez autorów projektu jeden na czterech dorosłych Amerykanów cierpi na cukrzycę. Spośród tej grupy nawet u 34% pacjentów dojdzie do rozwoju zespołu stopy cukrzycowej. W 15-25% przypadków następstwem ZSC może być amputacja kończyny dolnej.
Jednym z czynników zwiększających ryzyko amputacji jest niedożywienie, które może występować nawet u ponad połowy pacjentów z zespołem stopy cukrzycowej. U chorych z niedożywieniem lub niedoborem określonych składników i mikroelementów gojenie ran ulega opóźnieniu lub całkowitemu zahamowaniu.
Z tego względu leczenie żywieniowe to kluczowy element terapii trudno gojących się ran na podłożu cukrzycy. Celem leczenia żywieniowego, jak podkreślają autorzy dokumentu, powinno być utrzymanie prawidłowej podaży kalorii, białka i mikroelementów, a także optymalnego nawodnienia.
Regularna kontrola i indywidualny plan żywienia
Autorzy zaleceń postulują regularne badanie poziomu odżywienia pacjentów. W tym celu zalecają wprowadzenie standaryzowanych badań odżywienia w ramach opieki ambulatoryjnej. Pozwoliłoby to na odpowiednio wczesne rozpoznanie niedożywienia lub jego zwiększonego ryzyka.
Badania fizykalne wykonywane podczas każdej wizyty powinny uwzględniać ocenę zmian wagi oraz BMI pacjenta, stanu skóry (występowanie obrzęków, pęknięć i innych zmian skórnych) i włosów (zwiększone wypadanie), a także napięcia mięśniowego. Eksperci zalecają również, by monitorować dietę pacjenta oraz nawyki żywieniowe (np. skłonność do wysokokalorycznych przekąsek lub wysoko przetworzonego jedzenia).
W ocenie odżywienia należy także wziąć pod uwagę choroby i czynniki współistniejące (np. choroby jelit, które mogą wpływać na trawienie, nawracające infekcje, choroba nowotworowa, podeszły wiek, trudności w żuciu lub połykaniu) oraz wyniki badań laboratoryjnych.
Uwzględnienie wszystkich powyższych czynników pozwoli na stworzenie indywidualnego planu żywienia pacjenta.
Zapotrzebowanie żywieniowe pacjenta z cukrzycą
Indywidualny plan żywienia powinien według autorów dokumentu uwzględniać następujące czynniki:
- nawodnienie,
- podaż kalorii,
- podaż makroskładników (białka, tłuszcze, cukry),
- poziom glikemii,
- podaż aminokwasów (m.in. arginina, glutamina),
- podaż witamin i mikroelementów (witaminy A, C, D, E, B12, cynk).
W zaleceniach uwzględniono optymalne wartości dla każdego parametru. Przedstawiono również algorytmy oceny odżywienia oraz dalszego postępowania dla różnych grup pacjentów. Autorzy zaleceń podkreślają jednak, że dokument ten ma stanowić narzędzie edukacyjne i nie powinien być traktowany jako samodzielna instrukcja postępowania terapeutycznego.
Źródło: Nutrition Interventions in Adults with Diabetic Foot Ulcers – American Limb Preservation Society
Przeczytaj także: Żywienie pacjentów z ranami przewlekłymi
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