Effect of protein and energy intakes on body composition in non-diabetic maintenance-hemodialysis patients

• Published in: Journal of Nutritional Science and Vitaminology Vol. 53; no. 5; pp. 410 - 418
• Main Authors: Ichikawa, Y.(Shizuoka Univ. (Japan)), Hiramatsu, F, Hamada, H, Sakai, A, Hara, K, Kogirima, M, Kawahara, K, Minakuchi, J, Kawashima, S, Yamamoto, S
• Format: Journal Article
• Language: English
• Published: Tokyo Center for Academic Publications Japan 01-10-2007
• Subjects: Adipose Tissue - drug effects; ADMINISTRACION; ADMINISTRATION; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; bioelectrical impedance analysis; Biological and medical sciences; BLOOD; body composition; Body Composition - drug effects; Body Mass Index; Body Water - drug effects; Cross-Sectional Studies; DIALISIS; DIALYSE; DIALYSIS; DIET; Diet Records; DIETA; Dietary Proteins - administration & dosage; Dietary Proteins - pharmacology; Electric Impedance; Emergency and intensive care: renal failure. Dialysis management; ENERGIA; ENERGIE; ENERGY; Energy Intake; ESTADO NUTRICIONAL; ETAT NUTRITIONNEL; Female; GENERO HUMANO; GENRE HUMAIN; HISTOIRE; HISTORIA; HISTORY; Humans; Intensive care medicine; maintenance hemodialysis patients; Male; MANKIND; Medical sciences; Middle Aged; NUTRITIONAL STATUS; Nutritional Status - drug effects; protein and energy intakes; protein requirement; PROTEINAS; PROTEINE; PROTEINS; REGIME ALIMENTAIRE; Renal Dialysis; SANG; SANGRE; Serum Albumin - drug effects; Sex Factors; VITAMINAS; VITAMINE; VITAMINS; Endocrinopathy; Human; Maintenance hemodialysis; Diabetes mellitus; protein and energy intakes; Body composition; Protein; Feeding; protein requirement; Energy; Food intake; maintenance hemodialysis patients; bioelectrical impedance analysis; Nutritional status; Electrical impedance
• ISSN: 0301-4800; 1881-7742
• DOI: 10.3177/jnsv.53.410

This cross sectional study was performed to find the adequate amount and combination of dietary protein and energy for maintaining better nutritional status for stable non-diabetic maintenance hemodialysis (MHD) patients. The body composition including body fat, total body water, body cell mass and body protein were measured by multifrequency bioelectrical impedance analysis in 200 stable MHD patients without diabetes (124 men, 76 women). Dietary energy intake (DEI) and dietary protein intake (DPI) were assessed by a brief self-administered diet history questionnaire (BDHQ), the DPI value being confirmed by calculating the normalized protein equivalent of total nitrogen appearance (nPNA). The nutritional status and the body composition were compared among 4 groups of patients in each gender that were divided by the combination of DEI and DPI, high energy (HE)/high protein (HP), HE/low protein (LP), low energy (LE)/HP and LE/LP groups. The mean DPI ranged between 1.17-1.23 and 0.89-0.95 g/kg IBW/d in the HP and LP groups, respectively for both genders, and the mean DEI was 35-37 and 24-25 kcal/kg IBW/d in HE and LE groups, respectively. BMI and serum albumin concentration were not different among the 4 groups. Body cell mass index (BCMI) was maintained in the HE groups regardless of DPI, and it was significantly higher in the HE/HP group than in the LE/LP group. Multiple regression analysis also showed that the BCMI was more greatly affected by DEI than DPI. These results indicated that a DPI of 0.89-0.95 g/kg IBW/d could be sufficient for maintaining BCMI, if DEI is kept over 35 kcal/kg IBW/d in stable non-diabetic MHD patients. This DPI level is lower than the recommended DPI proposed by dietary guidelines in the US and Japan.