title: Is energy intake underestimated in nondialyzed chronic kidney disease patients?
abstract: OBJECTIVE
  To evaluate whether energy intake of nondialyzed chronic kidney disease (CKD) patients is underestimated.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Outpatient clinic of the Federal University of Sao Paulo, Oswaldo Ramos Foundation.
  
  
  METHODS
  One hundred and thirty-one nondialyzed CKD patients (86 male, 66%; body mass index [BMI] 26 +/- 4.21, mean +/- standard deviation) were included. Body weight change was evaluated after 6 to 12 months in 59 patients of the entire group.
  
  
  METHODS
  Energy intake was evaluated using 4-day food diaries (3 weekdays and 1 weekend day), and resting energy expenditure (REE) was measured by indirect calorimetry. The ratio of energy intake to REE (EI/REE) was used to evaluate the accuracy of the recorded energy intake. An EI/REE ratio below 1.27 was used to identify patients who were underreporting their current energy intake.
  
  
  RESULTS
  The majority of the patients reported an energy intake substantially below the recommendation (22.4 +/- 7.15 kcal/kg/d) and had an EI/REE ratio lower than 1.27. In patients with a BMI >or= 25, the mean EI/REE ratio was significantly lower than that of patients with a BMI < 25 (1.01 +/- 0.28 versus 1.27 +/- 0.42, P < .01, respectively). In addition, only in the group with higher BMI was the mean ratio indicative of underreporting. When the body weight of a subgroup of patients (n = 59) was evaluated after 7.9 +/- 2.4 months, it was observed that the subgroup of patients who maintained or gained body weight had a mean EI/REE not compatible with this condition (1.13 +/- 0.38). The low ratio, despite increasing or maintaining body weight, is highly suggestive of underreported energy intake.
  
  
  CONCLUSIONS
  Energy intake of nondialyzed CKD patients seemed to be underestimated and was more pronounced in overweight and obese patients.
authors.affiliation: Renal Research Dietitian, Division of Nephrology, Dialysis Unit, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Carla Maria
authors.initials: CM
authors.lastname: Avesani
authors.forename: Maria Ayako
authors.initials: MA
authors.lastname: Kamimura
authors.forename: Sergio Antonio
authors.initials: SA
authors.lastname: Draibe
authors.forename: Lilian
authors.initials: L
authors.lastname: Cuppari
mesh_terms: D015992:Body Mass Index; D001835:Body Weight; D002153:Calorimetry, Indirect; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D015930:Diet Records; D002149:Energy Intake; D004734:Energy Metabolism; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000209:etiology / Q000503:physiopathology*; D008297:Male; D015596:Nutrition Assessment; D009752:Nutritional Status; D012146:Rest