No abstract

No abstract

No abstract

No abstract

Summary 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. Key Words maintenance hemodialysis patients, protein requirement, protein and energy intakes, bioelectrical impedance analysis, body composition Nutritional status is an important factor for prognosis of dialysis patients. There are various factors inducing malnutrition in dialysis patients, such as inflammation, various stimuli from dialysis, loss of protein and amino acids and complications of acute or chronic illnesses. Decreased protein or energy intakes are a primary issue for protein energy malnutrition (PEM) ( 1-4 ).Nutritional guidelines of the National Kidney Foundation Dialysis Outcomes Quality Initiative (NKF-DOQI) recommend a dietary energy intake (DEI) of 30-35 kcal/kg/d and a dietary protein intake (DPI) of at least 1.2 g/kg/d for maintenance HD (MHD) patients ( 5 ). The Japanese Society of Nephrology also recommends a DEI and DPI of 30-35 kcal/kg/d and 1.0-1.2 g/kg/d ( 6 ), respectively. These values of DPI for MHD patients are considerably higher compared to those for general healthy populations, 0.8 g/kg/d in the United States ( 7 ) and 0.9 g/kg/d in Japan ( 8 ). These recommendations are based on the evidence from N balance studies ( 9-13 ) and the relationships between DPI and morbidity or mortality ( 14 ).Most of the N balance studies were done with a relativel...