Continuous ambulatory peritoneal dialysis patients are unable to increase dietary intake to recommended levels.
OBJECTIVE
This study's objective was to determine whether offering dietary advice was effective in supporting patients in adjusting energy intake.


METHODS
We performed a prospective, randomized, controlled trial of dietary intervention involving 59 patients on continuous ambulatory peritoneal dialysis over a 4-month follow-up period.


METHODS
The study involved outpatients on home-based renal replacement therapy.


METHODS
All participants were adult patients on continuous ambulatory peritoneal dialysis. All eligible patients were invited to take part. Subjects were randomized into two groups: control and intervention. Those with diabetes mellitus, malabsorption, malignancy, or eating disorders were excluded.


METHODS
Baseline measurements to assess current dietary intake and nutritional status were performed in all subjects. Measurements included a 5-day food diary, subjective global assessment (SGA), anthropometry, and serum biochemistry. After analysis of the food diaries, the participants in the control group were given follow-up dietary advice that would enable them to match intake with current dietary recommendations for this group of 1.2 g of protein per kilogram of ideal body weight, 25 cal/kg ideal body weight. Participants in the intervention group were given follow-up dietary advice that would encourage them to match energy intake with an estimate of total energy expenditure based on their calculated basal metabolic rate and physical activity level as designated using information from SGA, with a significantly lower protein intake of 0.8 to 1.0 g/kg ideal body weight and an emphasis on calories from carbohydrate and fat. Both groups completed further 5-day food diaries at 2 and 4 months to assess their ability to make the recommended changes. SGA, anthropometry, and biochemistry were all remeasured at the end of the study period.


METHODS
Differences in energy and protein intakes between and within the two groups from baseline to 4 months were assessed.


RESULTS
Protein and energy intakes did not change during 4 months in either group, and there was no significant difference in intake between the two groups. In the control group (n = 27), 18 subjects (69%) matched their reported dietary energy intake to the recommended intake. In the intervention group (n = 28), 17 subjects (63%) matched their reported dietary intake to their estimated total energy expenditure. In the control group (n = 27), 8 subjects (28%) achieved the protein intake recommended to them of 1.2 g/kg. In the intervention group (n = 28), 23 subjects (85%) achieved the protein intake recommended to them of greater than 0.8 g/kg.


CONCLUSIONS
Patients not meeting their dietary prescription did not adjust their intake to match the recommended advice they had been given from a dietitian. Food diary analysis showed that subjects ate less than the recommended intakes for energy and protein. This inability to change suggests that subjects may be eating to the limit of their appetite. SGA sections concerning appetite, body weight, body mass index, and estimates of energy expenditure support the view that energy intake matches requirements.
Sutton
Debbie
D
Wessex Renal and Transplant Unit, Queen Alexandra Hospital, Portsmouth, United Kingdom. Debbie.Sutton@porthosp.nhs.uk <Debbie.Sutton@porthosp.nhs.uk>
Higgins
Bernie
B
Stevens
Judith M
JM
D001066:Appetite / Q000502:physiology; D018753:Diet, Protein-Restricted; D004044:Dietary Proteins / Q000008:administration & dosage*; D004435:Eating / Q000502:physiology; D002149:Energy Intake / Q000502:physiology*; D004734:Energy Metabolism / Q000502:physiology; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007676:Kidney Failure, Chronic / Q000178:diet therapy / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015596:Nutrition Assessment; D018673:Nutrition Policy; D009751:Nutritional Requirements; D009752:Nutritional Status; D010353:Patient Education as Topic / Q000379:methods*; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000523:psychology; D011446:Prospective Studies
D004044:Dietary Proteins