斷食療法和體重、168、NEJM、JAMA

Effects of Intermittent Fasting on Health, Aging, and Disease

N Engl J Med 2019; 381:2541-2551 DOI: 10.1056/NEJMra1905136

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September 28, 2020

Effects of Time-Restricted Eating on Weight Loss and Other Metabolic Parameters in Women and Men With Overweight and Obesity

The TREAT Randomized Clinical Trial

JAMA Intern Med. 2020;180(11):1491-1499. doi:10.1001/jamainternmed.2020.4153

Finally, the DXA analysis of lean mass did not factor in muscle hydration, so it is possible that changes
in hydration could confound the lean mass calculations. To help control for this, participants fasted for more than 12 hours and voided their bladder prior to DXA scans. The change in lean mass in the TRE group was much greater than the loss of body water, so it is unlikely that differences in muscle hydration would account for all of the lean mass loss.

PS1: 非脂肪組織：瘦體組織（Lean Body Mass，LBM）

PS2: 四肢骨骼肌肉質量(appendicular skeletal muscle mass,ASM)

差點被中藥包紮壓壞的洗腎瘻管

一位幾週前跌倒洗腎患者，原本左手包上困定架，不需要開刀。2天前骨科回診說定型了、不用包了（應該就是好了），但是患者覺得骨科沒有開刀、沒有開藥吃，他覺得還會痛或是腫？說要再去找中醫看。

結果今天來時，洗腎瘻管幾乎沒有聲音，護理師將中醫纏的繃帶鬆開，請患者手動一動，才稍微恢復了瘻管的流量，打上針，幸好還可以洗，真是萬幸！

這位中醫不知道洗腎瘻管不能壓迫或是纏繞嗎？

善良的病人說：沒關係，若是瘻管塞住或是壞掉，再去通或是開刀就好了...

洗腎 通血管 二難的開刀選擇

 一位年輕、剛開始洗腎患者，少年時有腦傷留下右手無力後遺症，慣用手是左手，因此自體瘻管就開在右手了。這真的是兩難，右手是無法配合握力來訓練瘻管的狀況，但是左手是他的慣用手也不是開瘻管的首選啊！（倫pt瑋）

結論：還是開在右手，瘻管血流不夠時怎麼辦？只好通血管了

穀類食物和心血管疾病死亡率關係

Associations of cereal grains intake with cardiovascular disease and mortality across 21 countries in Prospective Urban and Rural Epidemiology study: prospective cohort study

BMJ 2021; 372 doi: https://doi.org/10.1136/bmj.m4948 (Published 03 February 2021)

結論：
High intake of refined grains was associated with higher risk of mortality and major cardiovascular
disease events. Globally, lower consumption of refined grains should be considered.

No significant associations were found between intakes of whole grains or white rice and health outcomes.

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看起來要少食低纖類穀物才能減少心血管疾病，但是白米和全穀類相比則無差異。

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We defined refined grains as wheat grain products or flours that have been modified to remove the bran (麥麩) (the aleurone layer) and germ and therefore have a low fibre content. Products in this category are made with refined (white) flour, including white bread, pasta/noodles, breakfast cereals, crackers, and bakery products/desserts containing refined grains. For bakery products and desserts, we counted only the proportion of refined grains. Ready to eat breakfast made from corn was also included in this group.

The whole grains group contained two types of grains. The first was whole grain flours such as those
made from wheat, rye, triticale, oats, barley, maize, finger and pearl millet, sorghum, or buckwheat.

前析、後析、血液透析過濾 HDF

看起來後析的中大分子清除率也不輸前析，所以繼續用高容量的後析HDF沒錯！

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Acta Nephrologica 34(2): 69-79, 2020

DOI:10.6221/AN.202006_34(2).0003

Comparative Study of the Efficacy of High Volume Predilution Online Hemodiafiltration and High Volume Postdilution Online Hemodiafiltration

Hung-Ping Chen, Chang-Hsu Chen, Paik-Seong Lim

Division of Renal Medicine, Tungs’ Taichung Metroharbor Hospital, Taichung, Taiwan

洗腎、C型肝炎

目前依Anti-HCV Ab做初步的檢查，若陽性再加做HCV RNA，是可行的辦法。

註：這2012年，可能是北榮台東分院疑似C肝爆發所做的分析，非常像現在新冠病毒在做疫調，一步一步拆炸彈！

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Acta Nephrologica 34(3): 136-141, 2020

DOI:10.6221/AN.202009_34(3).0005

Combined Application of the Hepatitis C Virus Serologic Testing and the Nucleic Acid Amplification Testing Simultaneously for HCV Infection Isolation Strategy in Hemodialysis Units 

 Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

高蛋白飲食會傷害腎臟

#lpd

高蛋白飲食不利於腎臟健康: 釋放禁忌2020

https://academic.oup.com/ndt/article/35/1/1/5614387

1. 有這麼嚴重嗎？吃三明治只吃中間的肉，不敢吃外面的麵包？哈
「We feel compelled to eat only the meat patty of the sandwich and leave behind the bun when eating in front of others, otherwise we may lose credibility among friends and peers. If somebody dares to recommend a ‘low-protein diet’ (LPD) or, even worse, to imply that ‘HPD may cause harm’, then it would be considered a serious aberration to health and a taboo.」

2. 生酮飲食 ?? 為了腎臟好，還是不要試比較好
To save ourselves from an obese and diabetic destiny, we accepted the emerging data suggesting that we can lose weight by eating more protein. Subsequently, high-protein regimens such as the Atkins, Zone, South Beach and Ketogenic diets emerged in which daily protein intake increased to 20–25% or more of the total daily energy intake

3. 高蛋白飲食短期提高了eGFR，但是長期卻加速了腎功能的喪失。

「It is important to note that persons with higher versus lower DPI >1.2 versus <0.8 g/kg/day had a
higher versus lower eGFR of 82 +/- 18 versus 75 +/- 19 mL/min/1.73 m2, respectively. This makes sense, given that higher protein intake increases GFR in the short term, whereas it accelerates kidney function loss in the long term」