1
|
Martino FK, Zattarin A, Cinquini C, Toniazzo S, Francini Pesenti F, Stefanelli LF, Cacciapuoti M, Bettin E, Calò LA, Spinella P. Low-Protein Diet in Elderly Patients with Chronic Kidney Disease Stage 4 and 5 in Conservative Management: Focus on Sarcopenia Development. Nutrients 2024; 16:1498. [PMID: 38794736 PMCID: PMC11123811 DOI: 10.3390/nu16101498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 05/05/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024] Open
Abstract
INTRODUCTION Chronic kidney disease is a degenerative and increasingly prevalent condition that includes metabolic abnormalities and is associated with a higher risk of sarcopenia. The conservative approach points primarily to controlling metabolic issues and reducing the risk of malnutrition and sarcopenia, slowing the progression of kidney disease. The present study aims to evaluate the effect of a low-protein diet on malnutrition and sarcopenia. METHODS A total of 45 patients (33 male and 12 female) aged over 70 with chronic kidney disease stage 4-5 in conservative management were considered. All patients had a dietary assessment and prescription of personalized low-protein dietary plans (≤0.6 g protein/kg) and a follow-up control between 4 and 6 months. In preliminary and follow-up evaluations, anthropometric data, blood examinations, body composition results, muscle strength, physical performance, and a 3-day food diary were collected. RESULTS In the follow-up period, a significant weight loss (p = 0.001) and a decrease in body mass index (p = 0.002) were recorded. Food diaries revealed a significant reduction in protein, sodium, potassium, and phosphorus intake (p < 0.001), with a significant reduction in urea (p < 0.001) and proteinuria (p = 0.01) without any impact on lean mass (p = 0.66). Considerable variations in adherence between food diaries and the prescribed diet were also noted. CONCLUSIONS Providing a personalized low-protein diet led to significant benefits in a short period without worsening the patient's nutritional status.
Collapse
Affiliation(s)
- Francesca K. Martino
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine (DIMED), University of Padova, 35128 Padua, Italy; (L.F.S.); (M.C.); (E.B.)
| | - Alessandra Zattarin
- Department of Medicine (DIMED), Clinical Nutrition, University of Padua, 35128 Padua, Italy; (A.Z.); (C.C.); (S.T.); (F.F.P.); (P.S.)
| | - Chiara Cinquini
- Department of Medicine (DIMED), Clinical Nutrition, University of Padua, 35128 Padua, Italy; (A.Z.); (C.C.); (S.T.); (F.F.P.); (P.S.)
| | - Silvia Toniazzo
- Department of Medicine (DIMED), Clinical Nutrition, University of Padua, 35128 Padua, Italy; (A.Z.); (C.C.); (S.T.); (F.F.P.); (P.S.)
| | - Francesco Francini Pesenti
- Department of Medicine (DIMED), Clinical Nutrition, University of Padua, 35128 Padua, Italy; (A.Z.); (C.C.); (S.T.); (F.F.P.); (P.S.)
| | - Lucia Federica Stefanelli
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine (DIMED), University of Padova, 35128 Padua, Italy; (L.F.S.); (M.C.); (E.B.)
| | - Martina Cacciapuoti
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine (DIMED), University of Padova, 35128 Padua, Italy; (L.F.S.); (M.C.); (E.B.)
| | - Elisabetta Bettin
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine (DIMED), University of Padova, 35128 Padua, Italy; (L.F.S.); (M.C.); (E.B.)
| | - Lorenzo A. Calò
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine (DIMED), University of Padova, 35128 Padua, Italy; (L.F.S.); (M.C.); (E.B.)
| | - Paolo Spinella
- Department of Medicine (DIMED), Clinical Nutrition, University of Padua, 35128 Padua, Italy; (A.Z.); (C.C.); (S.T.); (F.F.P.); (P.S.)
| |
Collapse
|
2
|
Cacciapuoti N, Lonardo MS, Di Lauro M, Di Lorenzo M, Aurino L, Pacella D, Guida B. Effects of Dietary Intervention on Nutritional Status in Elderly Individuals with Chronic Kidney Disease. Nutrients 2024; 16:632. [PMID: 38474760 DOI: 10.3390/nu16050632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/15/2024] [Accepted: 02/21/2024] [Indexed: 03/14/2024] Open
Abstract
The prevalence of chronic kidney disease (CKD) is rising, especially in elderly individuals. The overlap between CKD and aging is associated with body composition modification, metabolic abnormalities, and malnutrition. Renal care guidelines suggest treating CKD patient with a low-protein diet according to the renal disease stage. On the other hand, geriatric care guidelines underline the need for a higher protein intake to prevent malnutrition. The challenge remains of how to reconcile a low dietary protein intake with insuring a favorable nutritional status in geriatric CKD populations. Therefore, this study aims to evaluate the effect of a low-protein adequate energy intake (LPAE) diet on nutritional risk and nutritional status among elderly CKD (stage 3-5) patients and then to assess its impact on CKD metabolic abnormalities. To this purpose, 42 subjects [age ≥ 65, CKD stage 3-5 in conservative therapy, and Geriatric Nutritional Risk Index (GNRI) ≥ 98] were recruited and the LPAE diet was prescribed. At baseline and after 6 months of the LPAE diet, the following data were collected: age, sex, biochemical parameters, anthropometric measurements, body composition, and the GNRI. According to their dietary compliance, the subjects were divided into groups: compliant and non-compliant. For the compliant group, the results obtained show no increased malnutrition risk incidence but, rather, an improvement in body composition and metabolic parameters, suggesting that the LPAE diet can provide a safe tool in geriatric CKD patients.
Collapse
Affiliation(s)
- Nunzia Cacciapuoti
- Physiology Nutrition Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Sergio Pansini 5, 80131 Napoli, Italy
| | - Maria Serena Lonardo
- Physiology Nutrition Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Sergio Pansini 5, 80131 Napoli, Italy
| | - Mariastella Di Lauro
- Physiology Nutrition Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Sergio Pansini 5, 80131 Napoli, Italy
| | - Mariana Di Lorenzo
- Physiology Nutrition Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Sergio Pansini 5, 80131 Napoli, Italy
| | - Laura Aurino
- Physiology Nutrition Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Sergio Pansini 5, 80131 Napoli, Italy
| | - Daniela Pacella
- Department of Public Health, University of Naples Federico II, Via Sergio Pansini 5, 80131 Napoli, Italy
| | - Bruna Guida
- Physiology Nutrition Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Sergio Pansini 5, 80131 Napoli, Italy
| |
Collapse
|
3
|
Guo Y, Zhang M, Ye T, Wang Z, Yao Y. Application of Bioelectrical Impedance Analysis in Nutritional Management of Patients with Chronic Kidney Disease. Nutrients 2023; 15:3941. [PMID: 37764725 PMCID: PMC10537787 DOI: 10.3390/nu15183941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/09/2023] [Accepted: 09/09/2023] [Indexed: 09/29/2023] Open
Abstract
Body composition measurement plays an important role in the nutritional diagnosis and treatment of diseases. In the past 30 years, the detection of body composition based on bioelectrical impedance analysis (BIA) has been widely used and explored in a variety of diseases. With the development of technology, bioelectrical impedance analysis has gradually developed from single-frequency BIA (SF-BIA) to multi-frequency BIA (multi-frequency BIA, MF-BIA) and over a range of frequencies (bioimpedance spectroscopy, BIS). As the clinical significance of nutrition management in chronic kidney disease has gradually become prominent, body composition measurement by BIA has been favored by nephrologists and nutritionists. In the past 20 years, there have been many studies on the application of BIA in patients with CKD. This review describes and summarizes the latest research results of BIA in nutritional management of patients with CKD including pre-dialysis, hemodialysis, peritoneal dialysis and kidney transplantation, in order to provide reference for the application and research of BIA in nutritional management of chronic kidney disease in the future.
Collapse
Affiliation(s)
- Yanchao Guo
- Department of Nutrition, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (Y.G.); (T.Y.)
| | - Meng Zhang
- Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (M.Z.); (Z.W.)
| | - Ting Ye
- Department of Nutrition, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (Y.G.); (T.Y.)
| | - Zhixiang Wang
- Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (M.Z.); (Z.W.)
| | - Ying Yao
- Department of Nutrition, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (Y.G.); (T.Y.)
- Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (M.Z.); (Z.W.)
| |
Collapse
|
4
|
Gungor O, Kara AV, Hasbal NB, Zadeh KK. Dietary protein and muscle wasting in chronic kidney disease: new insights. Curr Opin Clin Nutr Metab Care 2023; 26:226-234. [PMID: 36942878 DOI: 10.1097/mco.0000000000000903] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
PURPOSE OF REVIEW Muscle wasting is an important health problem in chronic kidney disease (CKD) patients. Protein restriction in the diet can be one of the main causes of muscle wasting in this population. In this review, we aimed to investigate the relationship between dietary protein intake and muscle wasting in CKD patients according to recent literature. RECENT FINDINGS The one of the main mechanisms responsible for the muscle wasting is the disturbances in skeletal muscle protein turnover. Muscle wasting primarily occurs when the rates of muscle protein breakdown exceed the muscle protein synthesis. Dietary protein intake represents an important role by causing a potent anabolic stimulus resulting a positive muscle protein balance. Compared to studies made in healthy populations, there are very limited studies in the literature about the relationship between dietary protein intake and muscle wasting in the CKD population. Majority of the studies showed that a more liberal protein intake is beneficial for muscle wasting in especially advanced CKD and hemodialysis population. SUMMARY Although evaluating muscle wasting in CKD patients, the amount of protein in the diet of patients should also be reviewed. Although excessive protein intake has some negative consequences on this patient group, a more liberated dietary protein intake should be taken into account in this patient group with muscle wasting and especially in dialysis patients.
Collapse
Affiliation(s)
- Ozkan Gungor
- Department of Nephrology, Medical Faculty, Kahramanmaras Sutcu Imam University, Kahramanmaras
| | - Ali Veysel Kara
- Department of Nephrology, Binali Yildirim University Mengücek Gazi Training and Research Hospital, Erzincan
| | | | - Kamyar Kalantar Zadeh
- Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine School of Medicine, Orange, California, USA
| |
Collapse
|
5
|
Tang M, Ge Y, Zhang Q, Zhang X, Xiao C, Li Q, Zhang X, Zhang K, Song M, Wang X, Yang M, Ruan G, Mu Y, Huang H, Cong M, Zhou F, Shi H. Near-term prognostic impact of integrated muscle mass and function in upper gastrointestinal cancer. Clin Nutr 2021; 40:5169-5179. [PMID: 34461591 DOI: 10.1016/j.clnu.2021.07.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 07/13/2021] [Accepted: 07/26/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Despite the known association between muscle mass/function and malnutrition-related mortality in upper gastrointestinal (UGI) cancer, no comprehensive study to determine the impact of muscle mass-dominant nutritional status on cancer prognosis has been conducted. The present study aimed to investigate the prognostic significance of integrated muscle mass and function in UGI cancer. METHODS Between July 2013 and March 2018, we enrolled 2546 cancer patients with risks of malnutrition (Nutrition Risk Screening 2002, ≥3 points) from a multicenter cohort study and split 527 patients with primary UGI cancer into an internal validation group. We prospectively performed instant nutritional assessment and recorded all general clinical characteristics of the participants, such as weight loss, body mass index, anthropometric measurements of muscle mass and function, dietary intake conditions, and disease burden and/or inflammation status based on the validated tools. Prognostic analyses were performed with post-assessment overall survival (OS). RESULTS According to the entire set, UGI cancer was identified as the dominant risk factor for disease burden and inflammation criteria (hazard ratio (HR), 2.08, 95% confidence interval (Cl), 1.81-2.39, P < 0.001). Integrated muscle mass/function analysis with validated cutoff values showed that hand grip strength/weight followed by triceps skinfold thickness and maximum calf circumference are the most potent predictors. Univariate and multivariate analyses revealed that reduced muscle mass/function (74.8%) and dietary intake (66.2%) independently affect OS of patients with UGI cancer. Significant associations were found between the reduced muscle mass/reduced dietary intake and the shortest OS (HR, 4.48; 95% Cl, 3.07-6.53; P < 0.001). Appending subgroups of muscle mass/function and dietary intake to the pre-existing risk model increased the efficiency of the time-dependent receiver operating characteristic curve analysis for OS in UGI cancer, particularly within 2 years of instant nutritional assessment. CONCLUSION Impaired muscle mass/function adversely affects the near-term prognosis in patients with UGI cancer. Along with a comprehensive evaluation of dietary intake conditions, the timely nutritional assessment might be useful for risk stratification of UGI cancers with potential for enteral and parenteral nutrition interventions. REGISTRATION NUMBER ChiCTR1800020329.
Collapse
Affiliation(s)
- Meng Tang
- Department of GI Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
| | - Yizhong Ge
- Department of GI Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
| | - Qi Zhang
- Department of GI Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
| | - Xi Zhang
- Department of GI Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
| | - Chunyun Xiao
- Department of Clinical Nutrition Baylor Scott & White Institute for Rehabilitation, Dallas, TX, 75204, USA
| | - Qinqin Li
- Department of GI Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
| | - Xiaowei Zhang
- Department of GI Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
| | - Kangping Zhang
- Department of GI Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
| | - Mengmeng Song
- Department of GI Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
| | - Xin Wang
- Department of GI Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
| | - Ming Yang
- Department of GI Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
| | - Guotian Ruan
- Department of GI Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
| | - Ying Mu
- Department of Oncology, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
| | - Hongyan Huang
- Department of Oncology, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
| | - Minghua Cong
- Comprehensive Oncology Department, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Fuxiang Zhou
- Department of Radiation and Medical Oncology, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Clinical Cancer Study Center, Zhongnan Hospital, Wuhan University, Wuhan, 430071, China.
| | - Hanping Shi
- Department of GI Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China.
| |
Collapse
|