Effects of Diet Intervention on Body Composition in the Elderly with Chronic Kidney Disease

Abstract

Objective: It has been uncertain that low protein diet for patients with chronic kidney disease (CKD) may predispose to malnutrition. The study aimed to investigate the effects of low protein diet on body composition of CKD patients and analyze the influence of age.Methods: Patients with glomerular filtration rate less than 45 mL/min/1.73m2 including 103 elderly (70.7 ± 6.9 years old) and 56 non-elderly (49.8 ± 9.1 years old) CKD patients were enrolled. All patients were educated by dietitians to take low protein diet and were followed up regularly every three months. Their demographic data, underlying disease and body mass index (BMI) were reviewed and recorded. Results of body composition measurement and laboratory tests were collected every three months for one year.Results: At baseline, the distribution of body composition was similar in non-elderly patients between non-low and low protein groups. In the elderly, patients in low protein group had higher fat and lower muscle percentage. In one-year follow-up, non-elderly patients did not present significant changes in their BMI, serum albumin level and body compositions in both protein groups. Non-low protein group in elderly patients had significant decrease in BMI and estimated glomerular filtration rate (eGFR) after 12 months (both p< 0.05). Determination in body composition showed decrease in fat and increase in muscle component. In low protein group, their BMI was decreased and eGFR was not influenced. Fat component was decreased and muscle percentage was increased in one-year follow-up.Conclusions: In elderly CKD patients, low protein diet maintained good nutritional status and muscle mass was preserved.

Prevalence and Correlates of Sarcopenia among Elderly CKD Outpatients on Tertiary Care

“…In our study sarcopenia was found to be widespread in an elderly male CKD population, and it was related to age and physical inactivity and not to dietary habits or degree of renal-function impairment. Our findings are in keeping with those of Hung and his co-workers, who demonstrated that low-protein diet therapy did not affect nutritional status in CKD patients, and that a low-protein diet was even associated with increased serum albumin in CKD patients over 60 years of age, probably as an effect of careful nutritional counseling [40].…”

Medical Nutritional Therapy for Patients with Chronic Kidney Disease not on Dialysis: The Low Protein Diet as a Medication

“…While very old patients (usually defined as over 80 years of age) are seldom included in RCTs, good results, at least in terms of safety, are reported in observational cohort studies [ 76 ]. A careful evaluation of dietary habits, functional and cognitive status, and regular monitoring of the nutritional status may allow extending the indications to this wide subset of the CKD population, selecting patients who can benefit from LPDs and adapting dietary recommendations to their needs [ 76 , 77 ].…”

The effect of oral nutritional supplement on muscle fitness of patients undergoing dialysis: A systematic review and meta‐analysis

“…Subgroup analyses were conducted to explore the characteristics of intervention on muscle fitness by predetermined subgroups, including two primary subgroups‐types: type of ONS (a mixture of macronutrients, whey protein, essential amino‐acids, and other nutrients) and duration of intervention. The percentage of muscle mass was found lower in CKD patients with low protein intake than those with normal protein intake after 1‐year's follow‐up (Hung, Chiou, et al., 2017) and muscle loss with ageing could not be counteracted by nutritional intervention in a short time (Kim et al., 2016). Therefore, the duration of intervention was defined less than and over 48 weeks.…”

“…The percentage of muscle mass was found lower in CKD patients with low protein intake than those with normal protein intake after 1-year's follow-up (Hung, Chiou, et al, 2017) and muscle loss with ageing could not be counteracted by nutritional intervention in a short time (Kim et al, 2016). Therefore, the duration of intervention was defined less than and over 48 weeks.…”