Diet is a key component of care during chronic kidney disease (CKD). Nutritional interventions, and, specifically, a restricted protein diet has been under debate for decades. In order to reduce the risk of nutritional disorders in very-low protein diets (VLDP), supplementation by nitrogen-free ketoacid analogues (KAs) have been proposed. The aim of this review is to summarize the potential effects of this dietary therapy on renal function, uremic toxins levels, and nutritional and metabolic parameters and propose future directions. The purpose of this paper is also to select all experimental and randomized clinical studies (RCTs) that have compared VLDP + KA to normal diet or/and low protein diet (LPD). We reviewed the SCOPUS, WEB of SCIENCES, CENTRAL, and PUBMED databases from their inception to 1 January, 2019. Following duplicate removal and application of exclusion criteria, 23 RCTs and 12 experimental studies were included. LPD/VLPD + KAs appear nutritionally safe even if how muscle protein metabolism adapts to an LPD/VLPD + KAs is still largely unknown. VLPD + KAs seem to reduce uremic toxins production but the impact on intestinal microbiota remains unexplored. All studies observed a reduction of acidosis, phosphorus, and possibly sodium intake, while still providing adequate calcium intake. The impact of this diet on carbohydrate and bone parameters are only preliminary and need to be confirmed with RCTs. The Modification of Diet in Renal Disease study, the largest RCTs, failed to demonstrate a benefit in the primary outcome of the decline rate for the glomerular filtration rate. However, the design of this study was challenged and data were subsequently reanalyzed. However, when adherent patients were selected, with a rapid rate of progression and a long-term follow up, more recent meta-analysis and RCTs suggest that these diets can reduce the loss of the glomerular filtration rate in addition to the beneficial effects of renin-angiotensin-aldosterone system (RAAS) inhibitors. The current evidence suggests that KAs supplemented LPD diets should be included as part of the clinical recommendations for both the nutritional prevention and metabolic management of CKD. More research is needed to examine the effectiveness of KAs especially on uremic toxins. A reflection about the dose and composition of the KAs supplement, the cost-effective features, and their indication to reduce the frequency of dialysis needs to be completed.

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Purpose Sedentarism is a global epidemic that engages 60 to 70% of the global population. A progressive physical activities decline occurs from childhood to adolescence. This study aims to compare extracurricular physical activity among students with and without overweight and to relate it to the level of physical activity of their parents. Methods This cross-sectional study evaluated 375 children aged 6-11 years from two public schools that have extracurricular and optional activities. Data collected: weight and height for the calculation of body mass index and height/age z-scores; waist circumference to calculate waist to height ratio; extracurricular physical activity of children and parents/caregivers (short version of the IPAQ-International Physical Activity Questionnaire). Results Mean age was 8.7 ± 1.4 years in the studied population; overweight and obesity was observed in 98 (26.8%) and 79 (21.6%) children, respectively. Extracurricular physical activity was observed in 86 (22.9%) children. Physical activity of parents was not associated with children's practice or their nutritional status. No difference was found in relation to physical activity and nutritional status. However, boys were less engaged in physical activities compared with girls (32-37.2% vs 54-62.8%, p = 0.003). Conclusion Considering the importance of promoting children's physical activity and based on the results evidenced in this study highlighting the low demand for physical activity provided by schools, stimulating measures by educators and family members are clearly required.

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ObjetivoAvaliar o efeito da orientação nutricional individual nas mudanças das práticas alimentares e estilo de vida dos pacientes.MétodosForam aplicados recordatórios de 24 horas antes e depois da orientação nutricional, para posterior cálculo do Índice Qualidade da Dieta Revisado, referente a cada um dos recordatórios. Foram avaliados trinta pacientes encaminhados para orientação nutricional individual no Ambulatório de Nutrição do Adulto do Centro de Saúde Escola, unidade auxiliar da Faculdade de Medicina de Botucatu, da Universidade Estadual Paulista.ResultadosComo resultados da análise comparativa Índice Qualidade da Dieta Revisado, calculados, foi verificado o aumento do consumo de frutas, verduras, legumes e leguminosas, assim como a diminuição do consumo de carnes vermelhas, doces, bebidas açucaradas e laticínios integrais, depois das orientações nutricionais. Para as primeiras entrevistas, a pontuação média conquistada pelos pacientes foi de 61,45 e para a segunda entrevista foi visto que a pontuação aumentou para 70,20. A adesão ao programa nutricional proposto não foi muito satisfatória: 57% dos pacientes necessitaram ser reagendados duas ou mais vezes até comparecerem a consulta de retorno.ConclusãoHouve mudança positiva no padrão alimentar dos participantes após orientação nutricional. A adesão ao tratamento pode ser estimulada por meio da educação nutricional, fundamental para que mudanças alimentares e de estilo de vida sejam efetivamente realizadas.Palavras-chave: Doenças crônicas não-transmissíveis. Estilo de vida. Orientação nutricional. Qualidade da dieta.