The Effects of Oral Energy-Dense Supplements on Nutritional Status in Nondiabetic Maintenance Hemodialysis Patients

Abstract

Background and objectives: Fat-based energy-dense nutritional supplements may offer benefits over protein or carbohydrate dense supplements for patients receiving dialysis because of the adverse metabolic consequences of the latter. We conducted a randomized controlled trial to assess the effects of the short-term use of a fat-based nutritional supplement on various measures of nutritional status in patients receiving maintenance hemodialysis who have low dietary energy intake. Design, setting, participants, and measurements: We enrolled nondiabetic patients receiving hemodialysis for more than 3 months and had inadequate dietary energy intake (<30kcal/kg/d). The participants were randomly assigned in a 1:1 ratio to receive an oral fat-based energy-dense supplement (300kcal daily) or routine care for 12 weeks (n=120 per group). The primary outcome was the change in phase angle, measured by bioelectrical impedance analysis, a marker of cell integrity and body cell mass, from the baseline to week 12. The secondary outcomes were changes in quality of life. Other outcomes included laboratory nutritional indicators and physical examinations. Results: The average age of the total population was 47 (SD: 12) years and 55% were male. The median of dialysis vintage was 43.4 (22.5, 76.3) months. 240 participants were randomly assigned to the intervention (n=120) or control group (n=120). In total, 228 (95%) participants completed the trial. The change in phase angle did not differ significantly between the intervention and the control groups (estimate (95% confidence interval [CI]): 0.0 (-0.1, 0.1) vs. 0.0 (-0.1, 0.1); estimated difference, 0.0; 95% [CI], −0.2 to 0.2; P=0.99). None of the 19 domains of quality of life differed between the groups. Adverse events were reported in 23 (19%) participants in the control group and 40 (33%) participants in the intervention group. Conclusions: In nondiabetic maintenance hemodialysis patients, short-term administration of fat-based energy-dense nutritional supplement has no clinically significant effect on nutritional status as measured by phase angle.

Effects of oral non-protein calorie supplements on nutritional status among maintenance hemodialysis patients with protein-energy wasting: a multi-center randomized controlled trial

“…In accordance with the present results, Allman et al 12 concluded that the addition of glucose polymer to the diet could increase the weight of MHD patients with low BMI. Nonetheless, contrary to our expectation, Yang et al 17 evaluated the efficacy of three-month administration of an oral energy-dense protein-free nutritional supplement (300 kcal, fat-based) among 240 MHD patients with low energy intake, and no significant effect was recognized on the nutritional status, which is conflicting with the current study. This incon- Nutritional supplementation was considered to increase energy intake and improve the nutritional status of patients as inadequate energy intake was the main contributor to PEW in MHD patients.…”

“…Nonetheless, contrary to our expectation, Yang et al 17 Nutrition support was considered to increase energy intake and improve nutritional status of patients as inadequate energy intake was the main contributor to PEW in MHD patients 4,25 . Noteworthily, in this study, the SGA score of patients in intervention group was significantly higher compared with control at the end of the study, suggesting that the oral non-protein calorie supplements had a positive influence on the nutritional status of MHD patients.…”

“…12 However, evaluation of the overall nutritional status of patients was not included in the study. 12 In contrast, Yang et al 17 reported no clinically significant effect of fat-based energy-dense supplements on the nutritional status of MHD patients as measured by phase angle. Although different types of oral supplements were utilized to explore meliorating nutritional conditions in MHD patients, the efficacy of renal-specific non-protein calorie oral supplements on MHD patients with PEW has not been studied.…”

Oral energy supplementation improves nutritional status in hemodialysis patients with protein–energy wasting: A pilot study

“…However, many patients fail to comply with these recommendations due to dietary restrictions, anorexia, and socioeconomic limitations (Wu et al, 2013;Sabatino et al, 2018;Bolasco, 2020). Additional intervention is needed to aid patients in achieving therapeutic nutritional energy goals, in which oral energy supplements (OESs) may offer benefits over protein-or carbohydrate-dense supplements for patients undergoing dialysis because of the adverse metabolic consequences of the latter (Yang et al, 2021). However, previous studies had considered oral nutritional supplements, which contain proteins and electrolytes.…”

The Effects of Oral fat Based High-Energy Supplements on Nutritional and Inflammatory Status in Maintenance Hemodialysis Patients

“…The guidelines strong recommended nutritional interventions in MHD patients [10]. However, evidence regarding the effects of oral nutritional supplements (ONS) on the nutritional status of MHD patients is insu cient and inconsistent [11][12][13][14]. Most of the ONS used in previous studies were amino acid or protein-based supplements.…”