title: Outcome of nutritional status and body composition of uremic patients on a very low protein diet.
abstract: Concern has been raised about the nutritional adequacy of a very low protein diet (VLPD). Monthly clinical evaluation by a physician and dietitian and quarterly dietary records, anthropometric measurements, blood testing, and dual energy X-ray absorptiometry (DEXA) were used to assess the course of nutritional status for 1 year in 10 clinically stable patients (six men, four women; age, 57.1 +/- 9.3 years) with advanced chronic renal failure (mean glomerular filtration rate, 13.2 +/- 4.8 mL/min/1.73 m(2)). These patients received a VLPD providing 0.3 g/kg/d of protein and were supplemented with amino acids and ketoanalogues. Conventional nutritional markers remained unchanged after 1 year of the VLPD. However, during the same period, whole-body DEXA showed a significant decrease in lean tissue from 46.2 +/- 10.2 to 45.0 +/- 9. 8 kg (P < 0.02); limb-trunk lean tissue ratio was reduced from 0.86 +/- 0.12 to 0.82 +/- 0.12 (P < 0.02), total-body fat increased from 20.0 +/- 6.9 to 21.4 +/- 7.0 kg (P < 0.05), and the percentage of total-body fat increased from 29.2% +/- 8.7% to 31.7% +/- 8.8% (P < 0.03). These different modifications occurred abruptly during the first 3 months, then stabilized or slightly improved thereafter. These mild changes do not appear to be deleterious given the favorable long-term outcome of these patients, even after they began treatment by dialysis or after renal transplantation.
authors.affiliation: Service de Biophysique, Hôpital Pellegrin-Tripode, Bordeaux Cedex, France.
authors.forename: P
authors.initials: P
authors.lastname: Chauveau
authors.forename: N
authors.initials: N
authors.lastname: Barthe
authors.forename: V
authors.initials: V
authors.lastname: Rigalleau
authors.forename: S
authors.initials: S
authors.lastname: Ozenne
authors.forename: F
authors.initials: F
authors.lastname: Castaing
authors.forename: C
authors.initials: C
authors.lastname: Delclaux
authors.forename: V
authors.initials: V
authors.lastname: de Précigout
authors.forename: C
authors.initials: C
authors.lastname: Combe
authors.forename: M
authors.initials: M
authors.lastname: Aparicio
mesh_terms: D015502:Absorptiometry, Photon; D000328:Adult; D000368:Aged; D000886:Anthropometry; D001823:Body Composition / Q000502:physiology*; D015992:Body Mass Index; D004044:Dietary Proteins / Q000008:administration & dosage* / Q000378:metabolism; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D006435:Renal Dialysis; D016896:Treatment Outcome; D014511:Uremia / Q000097:blood / Q000178:diet therapy*
chemical_list: D004044:Dietary Proteins