Analysis Of Nutritional Management Compliance In Chronic Kidney Disease And Establishment And Application Of Interactive Intelligent Auxiliary Program Of Traditional Chinese And Western Medicine

ObjectiveChronic kidney disease(CKD)is an important public health problem in the world,and it has affected the health of hundreds of millions of people.In recent years,exploring the role of "nutrition management" in improving CKD and its accompanying symptoms has become a hot spot in the industry.However,nutritional management is an intervention method that needs to change the eating habits of patients.A major problem currently facing is the inability to effectively supervise patients' dietary compliance and management qualification rate.Therefore,in order to understand the qualified rate of nutrient intake of CKD patients,optimize the CKD nutrition treatment plan,and improve the integrated,personalized and intelligent nutrition management of Chinese and Western medicine,we conducted a series of studies in the following four parts.The first part of this series of studies investigated the qualified rate of nutrient intake of CKD patients who participated in chronic disease management for the first time,and analyzed the influencing factors of protein and caloric intake of CKD patients.Based on the background that the qualification rate needs to be improved,for lean nutrition management,the second part of the series of studies investigated the needs of patients and constructed an"interactive Chinese and Western nutrition management auxiliary program." The third part evaluates the above procedures in controlled trials,and provides clinical evidence for the effectiveness and safety of intervention in CKD nutrition management.The fourth part of the series of studies puts forward the direction of program optimization and upgrading.The use of artificial intelligence technology provides a reference exploration model for the optimization and upgrade of the "interactive Chinese and Western nutrition management auxiliary program",and provides a reference for the precise and advanced cutting off the process of malnutrition events.Through the above-mentioned qualification rate survey,auxiliary program construction,auxiliary program evaluation,artificial intelligence model exploration and optimization,etc.,it is planned to explore new methods and strategies for the nutritional management of CKD patients,so as to solve clinical difficult problems.MethodsThe first part is a cross-sectional design.The 203 CKD patients who entered the management cohort for the first time in the Chronic Disease Management Clinic of Guangdong Provincial Hospital of Traditional Chinese Medicine from January 1,2018 to December 31,2018 were selected as the research objects.First,the participants calculated their nutrient intake through the "Three-Day Diet Recording Method";then,refer to the"People's Republic of China Health Industry Standard-Dietary Guidelines for Patients with Chronic Kidney Disease WS/557-2017" and K/DOQI Nutrition for Chronic Kidney Disease Manage the recommendations in the clinical practice guidelines,evaluate the qualified rate of nutrient intake;finally,by drawing the receiver operating curve(ROC),the continuous variables are converted into categorical variables,and the multivariate binary logistic regression model is used Explore the risk factors that affect the eligibility of LPD treatment.Among them,the nutrients evaluated for the qualified rate include:dietary protein intake(DPI),dietary energy intake(DEI),proportion of high-quality protein,proportion of fat supply,proportion of carbohydrate supply,sodium,phosphorus,calcium The intake of the elements;the screening factors include:(1)Demographic data:gender,age,marital status,work status,home address,education level,Charles comorbidity score,CKD staging;(2)Anthropometric data:height,Body weight,standard body weight,systolic blood pressure,diastolic blood pressure;(3)Laboratory tests:estimated glomerular filtration rate(eGFR),serum triglycerides(TG),serum total cholesterol(TC),hemoglobin(Hb),Blood albumin(ALB);(4)Body composition:total body water(TBW),intracellular water(ICW),extracellular water(ECW),lean body mass(FFM),body fat mass(BFM),protein quality(Protein),skeletal muscle mass(SMM),body fat percentage(PBF),upper arm circumference(AC),upper arm muscle circumference(AMC),body mass index(BMI),waist-to-hip ratio(WHR),whole body phase angle(WBPA).The second part covers the two-step research content.The first step is to use self-developed questionnaires to conduct a demand survey of nutritional management aids for patients in the Chronic Disease Management Center of the Department of Nephrology,Guangdong Provincial Hospital of Traditional Chinese Medicine,and analyze the influencing factors;the second step is based on the survey results and combined with the industry Standards,guidelines and professional books have been designed to be accepted by patients as "Interactive Chinese and Western Medicine Nutrition Management Auxiliary Program".The third part is a prospective,non-randomized,controlled study.A total of 100 CKD patients who had regular follow-up visits in the Chronic Disease Management Clinic of Guangdong Provincial Hospital of Traditional Chinese Medicine from June 2020 to August 2020 were included.They were divided into two groups according to the order of visits and nutritional management wishes of the patients.Finally,94 patients were included in the statistics,of which 45 were in the experimental group and 49 were in the control group.Under the premise of ensuring the basic treatment of CKD,this study provided two groups of patients with LPD treatment and other nutrition management health knowledge education,and during regular follow-up,the subjects' implementation of nutrition prescriptions was further corrected.On the basis of the above-mentioned treatment,patients in the experimental group were provided with an "interactive Chinese and Western medicine nutrition management auxiliary program",which relies on the WeChat applet platform and has a wealth of Chinese and Western medicine nutrition management auxiliary functions.The total observation time is 24 weeks.After the experiment,the main observation indexes and secondary observation indexes of the two groups of patients are compared.Among them,the main observation indicators are protein intake,calorie intake,DPI,DEI,DPI pass rate and DEI pass rate;the secondary observation indicators are chronic kidney disease TCM symptom score and quality of life score(quality of life score is through the concise life Mass scale SF-12 calculation).The fourth part is the exploratory research on the clinical application of artificial intelligence model.Using the data from the body composition analyzer of the Chronic Disease Management Center of Guangdong Provincial Hospital of Traditional Chinese Medicine,the data is divided into chronic kidney disease set and control data set according to the diagnostic criteria of CKD.The relevant factors recommended for malnutrition assessment in the K/DOQI chronic kidney disease nutrition management clinical practice guidelines(2020 update)are incorporated into the "subtype and stage derivation model"-the SuStaIn model using artificial intelligence algorithms.The relevant factors recommended in the guideline for assessing malnutrition are:?Comprehensive nutrition evaluation index:body weight,body mass index(BMI);?Fat loss index:body fat mass(BFM);?Muscle consumption index:fat-free mass(FFM);?Comprehensive evaluation index for fat and muscle loss:upper arm circumference(AC).After preprocessing the data,use the Z-value mixed linear model required in SuStaIn to standardize the data,and finally the standardized data will be converted into Z-stage values,dividing the above 5 variables into 33 unordered initialization sequences(S),Input it into the model calculation software Matlab 2020b,according to clinical practice and computer performance,set the model parameters(optimization number N=25,maximum sequence Cmax=5),then derive the maximum likelihood sequence of malnutrition events and output.ResultsIn the first part,in the cross-sectional study of nutrient intake qualification rate and risk factor analysis,the total population was 203 cases.The qualified number of nutrient intakes(qualified rate)were:DPI 37(18.23%)and DEI 70.(34.48%),high-quality protein accounted for 28 people(13.79%),fat energy accounted for 73 people(35.96%),carbohydrate energy accounted for 74 people(36.45%),sodium 162 people(79.80%),phosphorus 52 people(25.62%),203 people(100%)according to the intake of calcium<2000mg/d,and 9 people(4.43%)according to the intake of 800-1 000mg/d.Multivariate analysis showed that height(>161.25cm)is a protective factor that affects DPI qualification(P<0.05);while eGFR(>21.285ml·min·1.73m2),BFM(>15.25kg),TC(>5.20mmol)/L),and BMI(18.5-27.9kg/m2)are risk factors that affect DPI qualification(P<0.05).standard body weight(>49.15kg),eGFR(>30.20ml·min·1.73m2)and Hb(>135g/L)are protective factors that affect DEI qualification(P<0.05);while higher BMI(24.0-27.9)kg/m2)is a risk factor affecting DEI qualification(P<0.05).In the second part,in view of the low qualified rate of nutrient intake and poor compliance of CKD patients,this study plans to use mobile medical tools to improve patient compliance after preliminary investigations.The results of the questionnaire survey showed that 89.2%of patients had a positive attitude towards mobile medical tools(very strong,willing:52.9%;very willing:36.3%).58.8%of patients thought it would be more convenient to use the WeChat applet to manage their diet.The results of single factor analysis showed that "education level" was related to whether they had experience in remote disease management;"age" and "working status" were related to the choice of remote management methods,and the difference was statistically significant(P<0.05).Based on the above results,according to the opinions of the patients,this study carried out the construction of the "Interactive Chinese and Western Medicine Nutrition Management Auxiliary Program" through the WeChat applet platform.After the program was put into use,the nutrition management was more convenient,and the work efficiency of medical care was effectively improved.The actual needs of the patient.The third part is a prospective non-randomized controlled trial evaluating the above procedures.A total of 94 participants completed the study(45 in the experimental group and 49 in the control group).After the intervention,the difference in DPI between the two groups was statistically significant.The test group is lower than the control group[0.99(0.87,1.21)VS.1.22(0.92,1.62),P=0.022];the total score of TCM syndrome scores in the test group is lower than the control group[5(4,7)VS.10(7),14),P<0.001];the TCM symptoms with statistical difference between the two groups are:fatigue,chills,cold limbs,dry mouth,thirst and less drinking,full stomach and abdomen,appetite,weak waist and knees,limbs Heavy sleepiness,dry stools,loose stools,excessive nocturia(all P<0.05);the physiological health score of the test group was higher than that of the control group[51.67(45.58,54.02)VS.44.98(37.59,51.45),P=0.001];Mental health scores were also higher than those of the control group[55.76(52.92,58.83 VS.50.45(43.78,56.79),P=0.003].Compared with the control group,the DPI and DEI pass rate of the test group increased higher than before the intervention(DPI:17.78%VS.10.20%;DEI:2.20%VS.-4.10%),but the difference was not statistically significant(P>0.05).At the same time,the results of laboratory examinations related to the evaluation of adverse nutrition events before and after the intervention of the two groups of patients,The results of body composition analysis showed no statistically significant difference(P>0.05).In the fourth part,the SuStaIn model,a "subtype and stage derivation model" of artificial intelligence algorithms,is used to derive the occurrence and development of CKD patients' malnutrition events,and 5 sequences are output.Each sequence contains 33 occurrences of events.Among them,events 1 to 5 and events 6 to 7 are the common occurrence rules of all sequences.Events 8 to 10 form three different subtypes,and events 11 to 33 are divided into 5 different sequences.Therefore,according to the above rules,combined with clinical practice,the output results can be summarized as "4 stages,3 subtypes and 5 sequences".The 4 stages are the 4 changing stages of malnutrition assessment indicators,namely the "presymptomatic stage","mild stage","moderate stage",and "severe stage" changes.The sequence results suggest that in the "presymptomatic stage",the order of adverse nutrition events may be:weight loss-body fat mass(BFM)reduction-body mass index(BMI)reduction-upper arm circumference(AC)reduction--Lean body mass(FFM)decreased.The sequence of changes in the "mild stage" indicators may then be:a slight decrease in weight-a slight decrease in BFM.There are three subtypes of changes in the"medium stage" indicators,and there are 5 sequences under the "severe stage".Specifically,subtype I:moderate decrease in upper arm circumference-moderate decrease in BMI-moderate decrease in FFM,and then divided into three sequences.Sequence(1):Severe weight drop-AC Severe fall-BMI Severe fall-BFM Severe fall-FFM Severe fall;Sequence(2):Severe weight fall-Severe BFM fall-Severe FFM fall-BMI Severe decline-AC severely decline;sequence(3):severe weight decline-BMI severe decline-FFM severe decline-AC severe decline-BFM severe decline.The sequence of events in patients with subtype ? is:AC moderately decreased-BMI moderately decreased-weight decreased,followed by sequence(4):FFM severely decreased-BFM severely decreased-BMI severely decreased-Severe weight loss-AC is severely reduced.The sequence of event progression in patients with subtype ? is:moderate decrease in BMI—moderate decrease in AC—moderate decrease in FFM,followed by sequence(5):severe decrease in weight—severe decrease in AC—severe decrease in FFM—BFM is severely decreased-BMI is severely decreased.Conclusion1.In the initial stage of participating in nutrition management for patients with chronic kidney disease,except for sodium,the intake of other nutrients such as protein,energy,fat,carbohydrates,calcium and phosphorus are all low.2.In LPD treatment,the pass rates of DPI and DEI were 18.23%and 34.48%,respectively.The analysis of DPI influencing factors shows that higher levels of eGFR,TC,BFM,and BMI are risk factors that affect DPI qualification,and higher levels of height are protective factors;the analysis of DEI influencing factors shows that higher levels of BMI are influential DEI qualified risk factors,a higher degree of standard body weight,eGFR,Hb are protective factors.The above results indicate that CKD patients with larger height or standard body weight are more likely to qualify due to a larger intake;while patients with better renal function and lipid accumulation may have a larger intake,which will affect Compliance with nutrition management.3.The results of the controlled trial show that the combined use of the "Interactive Chinese and Western Medicine Nutrition Management Auxiliary Program" for nutritional management and LPD treatment can reduce the patient's total protein intake,reduce DPI and TCM syndrome scores,increase the pass rate of LPD,and improve The quality of life of CKD patients.4.In the data-driven SuStanIn artificial intelligence model,the 4 stages,3 subtypes and 5 sequences of the occurrence and development of malnutrition events are deduced.If this function is optimized into the program,it will be able to assist medical staff according to malnutrition.According to the law of the occurrence and development of events,the nutritional status of patients is predicted in advance,so as to prevent nutritional consumption,block the transition of the disease from pre-symptomatic,to mild,moderate,and severe,and implement precise interventions.5.This study shows that in the implementation of CKD nutrition management,patient compliance needs to be improved,and the mobile terminal program is a convenient and efficient disease management auxiliary tool.The construction of such tools is compatible with artificial intelligence.Combined,it will bring benefits to CKD patients.