Randomized Controlled Trial of Nutritional Counseling on Body Composition and Dietary Intake in Severe CKD
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.
1Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
2Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Brisbane, Australia
3Children's Nutrition Research Centre, Royal Children's Hospital, University of Queensland, Brisbane, Australia
4Wesley Research Institute, The Wesley 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.
Trial registration: www.anzctr.org.au; study number: ACTRN012606000493549.
ABSTRACT