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Parra Guasca M, Manafi M, Parnham A, Angus R. Use of a Very Low Calorie Diet for Weight Loss in a Patient with Acute Kidney Injury and Class III Obesity: A Case Study. J Ren Nutr 2023; 33:698-702. [PMID: 37302718 DOI: 10.1053/j.jrn.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 04/04/2023] [Accepted: 05/15/2023] [Indexed: 06/13/2023] Open
Abstract
Very low calorie diets (VLCDs) induce rapid weight loss through severe energy restriction resulting in ketosis. VLCD manufacturer guidelines list acute kidney injury (AKI) as a contraindication for use with concerns around further damage to kidney function through increased protein catabolic load, diuresis, and risk of electrolyte derangements. We report on the successful concurrent management of AKI alongside provision of a VLCD for weight loss in the acute setting in a patient with class III obesity and comorbid complications during a prolonged hospital stay. AKI resolved at week 5 of a 15-week VLCD program, with no adverse side effects noted on electrolytes, fluid, or kidney function. A weight loss of 76 kg was attained. VLCD appears safe for use in patients with AKI during hospitalization under close medical supervision. Both health system sustainability and patients may benefit from seizing the opportunity to address obesity during protracted hospital admission.
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Affiliation(s)
- Martha Parra Guasca
- Clinical Dietitian, Nutrition and Food Services, Gold Coast Hospital and Health Service, Southport, Queensland, Australia.
| | - Meri Manafi
- Senior Renal Dietitian, Assistant Director, Nutrition and Food Services, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Alan Parnham
- Nephrologist, Renal Medicine, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Rebecca Angus
- Research Dietitian, Nutrition and Food Services, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
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Abstract
Type-2 diabetes (T2D) is a chronic condition, generally regarded as an irreversible, that is among the top 10 causes of death globally. The hallmark of T2D is hyperglycemia, which results from disturbances in insulin sensitivity, insulin secretion, β-cell dysfunction and insulin resistance. Several clinical and lifestyle factors are involved in the progression of T2D, such as obesity and physical inactivity. A high-calorie diet is the main contributor to the development of obesity, which results in T2D, as obesity or increased intra-abdominal adipose tissue is related to insulin resistance. Technological advances have contributed to individuals having a more sedentary lifestyle, leading to obesity and T2D. T2D can be treated with lifestyle interventions, such as diet and exercise. Herein, we highlight the positive impact of a very low-calorie diet (VLCD) and lifestyle modalities in the treatment and prevention of T2D. An inclusion of VLCD 400-800 kcal/day for 8 weeks and ≥ 150 minutes exercise 5 times a week as lifestyle interventions can decrease glucose levels to normal, reduce HbA1c and improve insulin resistance and sensitivity. Therefore, a potential mechanism in maintaining glucose homeostasis and remission of T2D by VLCD and exercise reduces body weight.
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Lambert K, Bahceci S, Lucan B, Ryan M. A practical guide for the use of very low calorie diets in adults with chronic kidney disease. Nephrology (Carlton) 2019; 25:281-289. [PMID: 31715058 DOI: 10.1111/nep.13680] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 10/24/2019] [Accepted: 10/27/2019] [Indexed: 12/11/2022]
Abstract
Obesity is increasingly common in individuals with chronic kidney disease (CKD). Being overweight or obese is associated with both the development and progression of kidney disease. Lifestyle interventions such as the use of very low-calorie diets (VLCD) are being used increasingly for patients with CKD despite warnings from manufacturers that they should be avoided or used with caution. Whilst these diets are effective and can induce rapid weight loss and suppress appetite, their use in patients with chronic and end stage kidney disease is more complex than in the general population. VLCD use in adults with kidney disease requires a more nuanced approach to prescription and closer monitoring for unintended side effects. This review describes the indications and clinical management of patients with CKD undertaking a very low-calorie diet and provides practical guidance regarding how to manage a VLCD, particularly for the latter stages of CKD.
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Affiliation(s)
- Kelly Lambert
- School of Medicine, Faculty of Science, Medicine and Health, and Illawarra Health and Medical Research Institute, University of Wollongong, New South Wales, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, New South Wales, Australia
| | - Su Bahceci
- Nutrition and Dietetics Department, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Beth Lucan
- Nutrition Services, St Vincent's Hospital, Darlinghurst, New South Wales, Australia
| | - Murielle Ryan
- Department of Nutrition, Royal North Shore Hospital, St Leonards, New South Wales, Australia
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Taheri S, Chagoury O, Zaghloul H, Elhadad S, Ahmed SH, Omar O, Payra S, Ahmed S, El Khatib N, Amona RA, El Nahas K, Bolton M, Chaar H, Suleiman N, Jayyousi A, Zirie M, Janahi I, Elhag W, Alnaama A, Zainel A, Hassan D, Cable T, Charlson M, Wells M, Al-Hamaq A, Al-Abdulla S, Abou-Samra AB. Diabetes Intervention Accentuating Diet and Enhancing Metabolism (DIADEM-I): a randomised controlled trial to examine the impact of an intensive lifestyle intervention consisting of a low-energy diet and physical activity on body weight and metabolism in early type 2 diabetes mellitus: study protocol for a randomized controlled trial. Trials 2018; 19:284. [PMID: 29784059 PMCID: PMC5963071 DOI: 10.1186/s13063-018-2660-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 05/02/2018] [Indexed: 01/06/2023] Open
Abstract
Background Type 2 diabetes mellitus (T2DM) and obesity are syndemic and will have a significant impact on affected individuals and healthcare services worldwide. Evidence shows that T2DM remission can be achieved with significant weight loss in those who are younger with early diabetes and requiring fewer medications for glycaemic control. DIADEM-I aims to examine the impact of an intensive lifestyle intervention (ILI) using a low-energy diet (LED) meal replacement approach combined with physical activity in younger individuals with early T2DM. Methods The planned study is an ongoing, non-blinded, pragmatic, randomised controlled, parallel-group trial examining the impact of an LED-based ILI on body weight and diabetes remission in younger (18–50 years) T2DM individuals with early diabetes (≤ 3-year duration). The ILI will be compared to usual medical care (UMC). The primary outcome will be weight loss at 12 months. Other key outcomes of interest include diabetes remission, glycaemic control, diabetes complications, cardiovascular health, physical activity, mental health, and quality of life. It is planned for the study to include 138 subjects for assessment of the primary outcome. Safety will be assessed throughout. Discussion If DIADEM-I demonstrates a clinically significant effect for younger individuals with early T2DM, it will inform clinical guidelines and services of the future for management of T2DM. Trial registration ISRCTN: ISRCTN20754766 (date assigned: 7 June 2017); ClinicalTrials.gov, ID: NCT03225339 Registered on 26 June 2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-2660-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shahrad Taheri
- Department of Medicine, Weill Cornell Medicine - Qatar, Doha, Qatar. .,Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine - New York, New York, NY, USA. .,Clinical Research Core, Weill Cornell Medicine - Qatar, Doha, Qatar. .,Qatar Metabolic Institute (QMI), Department of Medicine, Hamad Medical Corporation, Doha, Qatar. .,Weill Cornell Medicine - Qatar, Qatar Foundation - Education City, PO 24144, Doha, Qatar.
| | - Odette Chagoury
- Department of Medicine, Weill Cornell Medicine - Qatar, Doha, Qatar.,Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine - New York, New York, NY, USA.,Clinical Research Core, Weill Cornell Medicine - Qatar, Doha, Qatar
| | - Hadeel Zaghloul
- Department of Medicine, Weill Cornell Medicine - Qatar, Doha, Qatar.,Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine - New York, New York, NY, USA.,Clinical Research Core, Weill Cornell Medicine - Qatar, Doha, Qatar
| | - Sara Elhadad
- Clinical Research Core, Weill Cornell Medicine - Qatar, Doha, Qatar
| | | | - Omar Omar
- Clinical Research Core, Weill Cornell Medicine - Qatar, Doha, Qatar
| | - Sherryl Payra
- Clinical Research Core, Weill Cornell Medicine - Qatar, Doha, Qatar
| | - Salma Ahmed
- Clinical Research Core, Weill Cornell Medicine - Qatar, Doha, Qatar
| | - Neda El Khatib
- Qatar Diabetes Association, Qatar Foundation, Doha, Qatar
| | | | - Katie El Nahas
- Qatar Diabetes Association, Qatar Foundation, Doha, Qatar
| | - Matthew Bolton
- Clinical Research Core, Weill Cornell Medicine - Qatar, Doha, Qatar
| | - Henem Chaar
- Clinical Research Core, Weill Cornell Medicine - Qatar, Doha, Qatar
| | - Noor Suleiman
- Department of Diabetes and Endocrinology, Hamad Medical Corporation, Doha, Qatar
| | - Amin Jayyousi
- Department of Diabetes and Endocrinology, Hamad Medical Corporation, Doha, Qatar
| | - Mahmoud Zirie
- Department of Diabetes and Endocrinology, Hamad Medical Corporation, Doha, Qatar
| | - Ibrahim Janahi
- Department of Diabetes and Endocrinology, Hamad Medical Corporation, Doha, Qatar
| | - Wahiba Elhag
- Qatar Metabolic Institute (QMI), Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | | | | | | | | | - Mary Charlson
- Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine - New York, New York, NY, USA
| | - Martin Wells
- Department of Statistical Science, Cornell University, Ithaca, NY, USA
| | | | | | - Abdul Badi Abou-Samra
- Department of Medicine, Weill Cornell Medicine - Qatar, Doha, Qatar.,Qatar Metabolic Institute (QMI), Department of Medicine, Hamad Medical Corporation, Doha, Qatar.,Department of Diabetes and Endocrinology, Hamad Medical Corporation, Doha, Qatar
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