Randomized Controlled Trial of Nutritional Counseling on Body Composition and Dietary Intake in Severe CKD

Campbell, Katrina L.; Ash, Susan; Davies, Peter S.W.; Bauer, Judith D.

doi:10.1053/j.ajkd.2007.12.015

« Previous Next »American Journal of Kidney Diseases
Volume 51, Issue 5 , Pages 748-758, May 2008

Randomized Controlled Trial of Nutritional Counseling on Body Composition and Dietary Intake in Severe CKD

Katrina L. Campbell, PhD
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
- Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Address correspondence to Katrina L. Campbell, PhD, Department of Nutrition and Dietetics, King's College London, 150 Stamford St, London, SE1 9NH, UK.
Susan Ash, PhD
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
- Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Brisbane, Australia
Peter S.W. Davies, PhD
- Children's Nutrition Research Centre, Royal Children's Hospital, University of Queensland, Brisbane, Australia
Judith D. Bauer, PhD
- Wesley Research Institute, The Wesley Hospital, Brisbane, Australia.

Received 19 June 2007; accepted 26 December 2007. published online 04 March 2008.

Background

Progressive loss of kidney function results in an increased risk of malnutrition. Despite this, there is little evidence informing the impact of nutrition intervention on predialysis patients with chronic kidney disease (CKD; stages 4 and 5).

Study Design

Randomized controlled trial.

Setting & Participants

56 outpatients (men, 62%; mean age, 70.7 ± 14.0 [SD] years) with CKD were randomly allocated to intervention (n = 29) or control (n = 27) by using a concealed computer-generated sequence.

Intervention

The intervention group, provided with individualized dietary counseling with regular follow-up aimed at achieving an intake of 0.8 to 1.0 g/kg of protein and greater than 125 kJ/kg of energy, or control, receiving written material only.

Outcomes & Measures

Change in body composition (body cell mass, measured by means of total-body potassium, in 40 of 56 participants), nutritional status (Subjective Global Assessment), and energy and protein intake (3-day food record).

Results

During the 12 weeks, the intervention group had 3.5% (95% confidence interval, −2.1 to 9.1) less decrease in body cell mass, 17.7-kJ/kg/d (95% confidence interval, 8.2 to 27.2) greater increase in energy intake, greater improvement in Subjective Global Assessment (P < 0.01), and no significant difference in protein intake compared with the control group (−0.04 g/kg/d; 95% confidence interval, −0.73 to 0.16). The intervention was associated with greater increases in energy and protein intake in women than men (interaction P < 0.001 for both).

Limitations

Power to detect change in body cell mass, potential bias in ascertainment of Subjective Global Assessment.

Conclusions

In predialysis patients with CKD, structured nutrition intervention had a greater effect on energy and protein intake in women than men. Additional investigations are warranted to determine the impact on body composition.

Index Words: Nutrition intervention, chronic kidney disease, predialysis, randomized controlled trial, body cell mass, dietary counseling