Body composition of patients on a very low-protein diet: a two-year survey with DEXA.
BACKGROUND
It has been reported that patients on a very-low-protein diet (VLPD) maintain a satisfactory nutritional status because of a conserved adaptive metabolic response. However, only few studies have examined the course of nutritional status and body composition in the long term (2 years).


METHODS
Thirteen stable patients (8 men; age, 55 +/- 12 years; glomerular filtration rate (GFR), 15 +/- 5 mL/min) receiving a VLPD (0.3 g/kg/day protein) supplemented with amino acids and ketoanalogues (SVLPD) were studied for 2 years. A joint visit with a physician and a dietitian and routine blood and urine analyses were performed every month. Dual-energy x-ray absorptiometry (DEXA), which was used to assess modification of body composition, and GFR (urinary 51Cr-EDTA) and urinary urea and creatinine excretion, which were used to assess nutritional status and compliance to the diet, were assessed every 3 months.


RESULTS
GFR, albumin, and prealbumin levels remained stable. Urea urinary excretion decreased at 3 months and then slightly increased at 2 years, but the calculated protein intake remained low at 0.38 +/- 0.1 g/kg/day. Energy intake remained close to 30 kcal/kg/day. No significant change was observed for total fat mass or percent fat mass. After an initial decrease, lean body mass stabilized at 6 months and then increased significantly from 6 to 24 months (P =.02, paired t-test); the mean increase during this period was of 2 kg, that is, 4.6%. Urinary creatinine excretion showed the same profile. Total bone mass, lumbar or hip site bone mass, and Z-score significantly decreased from T0 to 1 and 2 years (P <.05).


CONCLUSIONS
This study confirms that a supplemented VLPD is nutritionally safe for a long period, but attention must be paid to bone mass.
Chauveau
Philippe
P
Service de Néphrologie, Hôpital Pellegrin, Bordeaux, France.ph.chauveau@wanadoo.fr
Vendrely
Benot
B
El Haggan
Wael
W
Barthe
Nicole
N
Rigalleau
Vincent
V
Combe
Christian
C
Aparicio
Michel
M
D015502:Absorptiometry, Photon; D000328:Adult; D000368:Aged; D000596:Amino Acids / Q000008:administration & dosage*; D000601:Amino Acids, Essential / Q000008:administration & dosage; D001823:Body Composition; D015519:Bone Density; D003404:Creatinine / Q000652:urine; D015930:Diet Records; D018753:Diet, Protein-Restricted / Q000009:adverse effects / Q000592:standards; D019587:Dietary Supplements; D002149:Energy Intake; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000178:diet therapy*; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D010349:Patient Compliance; D011502:Protein-Energy Malnutrition / Q000209:etiology* / Q000517:prevention & control; D014508:Urea / Q000652:urine
D000596:Amino Acids; D000601:Amino Acids, Essential; C048995:ketosteril; D014508:Urea; D003404:Creatinine