Mg. Herselman et al., AMINO-ACID SUPPLEMENTATION AND THE NUTRITIONAL-STATUS OF THE PREDIALYSIS PATIENT, South African medical journal, 86(7), 1996, pp. 873-879
Objectives. This study investigated the effect of the conventional low
-protein diet compared with a very-low-protein diet supplemented with
essential amino acids with regard to the nutritional status of the pre
dialysis patient. Design. The study was designed as a randomised clini
cal trial for intervention, Setting. The trial was conducted at the ne
phrology outpatient clinics of Tygerberg Hospital, Patients. Twenty-tw
o predialysis patients with chronic renal failure were randomly assign
ed to a conventional low-protein diet containing 0.6 g protein/kg/d (N
= 11), or a very-low-protein diet containing 0.4 g protein/kg/d suppl
emented with essential amino acids (N = 11), Nutritional status was as
sessed by dietary, anthropometric and biochemical methods at baseline
and after 9 months of follow-up, Results. With the exception of energy
, there was a significant reduction in the intake of most nutrients on
both diets, Protein and phosphorus intake was, however, still above t
he recommendations, whereas energy intake generally failed to meet the
recommendations. No significant changes were found in the body mass i
ndex, arm muscle area, and percentage body fat in any of the groups, a
nd the majority of patients fell within normal limits, Very few signif
icant changes were observed in biochemical parameters of nutritional s
tatus, but plasma amino acid profiles were abnormal in all patients; c
holesterol levels were increased in about 50% of patients, the vitamin
E/total lipid ratio was increased in almost all patients; and there w
as an increase in the percentage of patients with iron deficiency, Fol
ate and vitamin B-6 marginal status was common at baseline, but signif
icant improvement was demonstrated with supplementation for plasma pyr
idoxal-5-P (low-protein diet) and red cell folate (low-protein and ver
y-low-protein diet). Conclusion. It is concluded that there was virtua
lly no difference between the effects of the low-protein and very-low-
protein diets, and that nutritional status was maintained on both diet
s during intervention.