A1bertazzi A, Cappelli P, Del Rosso G, Di Paolo B, Evangelista M, Palmieri PF (eds): Nutritional and Pharmacological Strategies in Chronic Renal Failure. Contrib Nephrol. Basel, Karger, 1990, vol 81, pp 208-213
Evaluation of Nutritional Status in the GDR Trial Karl Vetter·, Ingrid Kaschube·, C. Metzner·, Kristina Lindenau b, Peter T. Frdhling C
• Research Clinic of Nutrition, Potsdam-Rehbriicke; bDistrict Hospital, and cSt. losefs-Hospital, Potsdam, GDR
Latent malnutrition is a well-known risk factor in the dietary treatment of chronic renal failure. Insufficient energy intake, deficiency of essdntial amino acids and overprotracted protein restriction are the main causes of malnutrition. This paper aims at investigating the nutritional status of the patients involved in the prospective clinical trial comparing the long-term results of essential amino acid (EAA)- and keto acid (KA)-substituted low protein diets.
This investigation includes only patients who had at least two complete investigations of their nutritional status before and 12 months after the administration of the supplemented diet. Only 59 out of 112 patients fulfilled these criteria. Their characteristics are given in table I. The residual renal function was slightly higher in the EAA group. The methods applied to evaluate the nutritional status are shown in table 2. It can be seen that anthropometric, biochemical and immunological methods were included in this investigation. The protein intake was 0.4 glkg, the energy intake at least 35 kcal/kg. We preferred a mixed low protein diet aimed at meeting patients' dietary habits as much as possible. Amino acids were supplemented corresponding to I g of nitrogen (14 tablets ofEAS-Oral®; Fresenius, Bad Homburg, FRG), keto acids according to 0.5 g of nitrogen (15 tablets of Ketosteril®; Fresenius). Clinical check-ups were performed between 2 and 4 weeks under outpatient conditions. Every 3 months a special control was carried out for I week under clinical balance conditions and the complete nutritional status was evaluated every 12 months.
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Patients and Methods
Evaluation of Nutritional Status in the GDR Trial
209
Table 1. Characteristics of patient groups n
EAA KA
22 37
Estimations, n
40 75
Cl er mllmin
11.4 10.8
Age years
51.0 45.0
Sex
Diagnosis
m
f
GN
IN
PCD
10 16
12 21
4 13
12 18
6 6
Table 2. Evaluation of nutritional status Anthropometric data Body weight, % of normal Skinfold thickness, % of normal Upper arm muscle circumference, % of normal Biochemical data Albumin, gil Transferrin, gil Cholinesterase, I1molls·1 Immunological data Abs. lymphocytic count Cutan test (score) Immunoglobulins (IgG, IgA, IgM)
Figure 1 shows the anthropometric data before and 12 and 24 months after the supplemented diet. Body weight remained nearly constant in the EAA group and increased slightly in the KA group but the median values changed only within the normal range. Median values of skinfold thickness decreased in both groups but remained in the upper normal range under KA treatment. Upper arm muscle circumferences (UAMC) were slightly decreased in the KA group at the onset of supplemented diet but it was normalized within the first 12 months and continued to increase. Under EAA, these parameters remained in the lower normal range. The comparison of both diets reveals a tendency for a better anabolic effect of the KA-supplemented diet.
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Results and Discussion
Vetter/Kaschube/Metzner/Lindenau/Frbhling
210
Table 3. Biochemical data in patients under EAA/KA treatment over a 2-year period
EEA omonths 12 months 24 months
n
Creatinine /Lmolll
Albumin gil
Transferrin gil
Cholinesterase /Lmolls · 1
Hemoglobulin mmolll
22 22 11
562 636 780
40.2 40.3 45.3
2.10 2.20 2.10
74.0 73.0 66.0
7.2 6.4 6.4
37 37 22
661 811 885
44.2 43.2 43.5
2.10 2. 10 2.20
84.0 8\.0 84.0
6.9 6.6 6.0
](A
o months 12 months 24 months
EAA
KA
'\
o
\ \
\.
\. '\ r- .
.10%
\
'\.
\
IDEAL BODY WEIGHT
"'._ ..., SKINFOLD THICKNESS x-
\,
x UAMC
(Upper arm muscle circumference I
'.
100 % +-----'L-'I"---'---'----==-----'~__'__
"'\-"
.....- . " -x
-10%
a
'.
\
\--
\
12
• 24
12
24 MONTHS
Table 3 gives the biochemical data during the course of treatment. In spite of the progression of renal insufficiency in both groups, all estimated parameters remained in the normal range. Cholinesterase declined in the EAA group. All other parameters did not change significantly. The behavior of the immunoglobulins is demonstrated in table 4. A tendency of declining was registered for IgG in the EAA group and for IgM in the KA group, but the median values remained in the normal range. The course of the cellular immunological parameters is shown in figure 2.
Downloaded by: Université de Paris 193.51.85.197 - 1/26/2020 10:10:32 AM
Fig. 1. Anthropometric data in patients under different therapeutical strategies.
Evaluation of Nutritional Status in the GDR Trial
211
Table 4. Immunoglobulins in patients under EAA/KA treatment over a 2-year period Normal range of:
n
EAA o months 12 months 24 months
IgG, 9-15 gil
IgM, 0.5-3.0 gil
19A, 1.0-3.5 gil
22 22 11
14.1 11.3 13.6
1.6 1.5 1.5
2.4 2.0 2.3
37 37 22
13.2 13.0 12.9
1.6 1.1 1.3
J.7 2.2 1.6
KA
o months 12 months 24 months
KA
2000
-ABSOL. LYMPHOCYTIC COUNT
1750
CUTAN-TEST SCORE 1.5
1500
•
1250 1000
j
1.0
1.5
1.7
1.6
1.2
1.5
1.5
o
12 22
24 11
37
o
12 37
24 MONTHS 22
n=22
.p
Evaluation of Nutritional Status in the GDR Trial Karl Vetter·, Ingrid Kaschube·, C. Metzner·, Kristina Lindenau b, Peter T. Frdhling C
• Research Clinic of Nutrition, Potsdam-Rehbriicke; bDistrict Hospital, and cSt. losefs-Hospital, Potsdam, GDR
Latent malnutrition is a well-known risk factor in the dietary treatment of chronic renal failure. Insufficient energy intake, deficiency of essdntial amino acids and overprotracted protein restriction are the main causes of malnutrition. This paper aims at investigating the nutritional status of the patients involved in the prospective clinical trial comparing the long-term results of essential amino acid (EAA)- and keto acid (KA)-substituted low protein diets.
This investigation includes only patients who had at least two complete investigations of their nutritional status before and 12 months after the administration of the supplemented diet. Only 59 out of 112 patients fulfilled these criteria. Their characteristics are given in table I. The residual renal function was slightly higher in the EAA group. The methods applied to evaluate the nutritional status are shown in table 2. It can be seen that anthropometric, biochemical and immunological methods were included in this investigation. The protein intake was 0.4 glkg, the energy intake at least 35 kcal/kg. We preferred a mixed low protein diet aimed at meeting patients' dietary habits as much as possible. Amino acids were supplemented corresponding to I g of nitrogen (14 tablets ofEAS-Oral®; Fresenius, Bad Homburg, FRG), keto acids according to 0.5 g of nitrogen (15 tablets of Ketosteril®; Fresenius). Clinical check-ups were performed between 2 and 4 weeks under outpatient conditions. Every 3 months a special control was carried out for I week under clinical balance conditions and the complete nutritional status was evaluated every 12 months.
Downloaded by: Université de Paris 193.51.85.197 - 1/26/2020 10:10:32 AM
Patients and Methods
Evaluation of Nutritional Status in the GDR Trial
209
Table 1. Characteristics of patient groups n
EAA KA
22 37
Estimations, n
40 75
Cl er mllmin
11.4 10.8
Age years
51.0 45.0
Sex
Diagnosis
m
f
GN
IN
PCD
10 16
12 21
4 13
12 18
6 6
Table 2. Evaluation of nutritional status Anthropometric data Body weight, % of normal Skinfold thickness, % of normal Upper arm muscle circumference, % of normal Biochemical data Albumin, gil Transferrin, gil Cholinesterase, I1molls·1 Immunological data Abs. lymphocytic count Cutan test (score) Immunoglobulins (IgG, IgA, IgM)
Figure 1 shows the anthropometric data before and 12 and 24 months after the supplemented diet. Body weight remained nearly constant in the EAA group and increased slightly in the KA group but the median values changed only within the normal range. Median values of skinfold thickness decreased in both groups but remained in the upper normal range under KA treatment. Upper arm muscle circumferences (UAMC) were slightly decreased in the KA group at the onset of supplemented diet but it was normalized within the first 12 months and continued to increase. Under EAA, these parameters remained in the lower normal range. The comparison of both diets reveals a tendency for a better anabolic effect of the KA-supplemented diet.
Downloaded by: Université de Paris 193.51.85.197 - 1/26/2020 10:10:32 AM
Results and Discussion
Vetter/Kaschube/Metzner/Lindenau/Frbhling
210
Table 3. Biochemical data in patients under EAA/KA treatment over a 2-year period
EEA omonths 12 months 24 months
n
Creatinine /Lmolll
Albumin gil
Transferrin gil
Cholinesterase /Lmolls · 1
Hemoglobulin mmolll
22 22 11
562 636 780
40.2 40.3 45.3
2.10 2.20 2.10
74.0 73.0 66.0
7.2 6.4 6.4
37 37 22
661 811 885
44.2 43.2 43.5
2.10 2. 10 2.20
84.0 8\.0 84.0
6.9 6.6 6.0
](A
o months 12 months 24 months
EAA
KA
'\
o
\ \
\.
\. '\ r- .
.10%
\
'\.
\
IDEAL BODY WEIGHT
"'._ ..., SKINFOLD THICKNESS x-
\,
x UAMC
(Upper arm muscle circumference I
'.
100 % +-----'L-'I"---'---'----==-----'~__'__
"'\-"
.....- . " -x
-10%
a
'.
\
\--
\
12
• 24
12
24 MONTHS
Table 3 gives the biochemical data during the course of treatment. In spite of the progression of renal insufficiency in both groups, all estimated parameters remained in the normal range. Cholinesterase declined in the EAA group. All other parameters did not change significantly. The behavior of the immunoglobulins is demonstrated in table 4. A tendency of declining was registered for IgG in the EAA group and for IgM in the KA group, but the median values remained in the normal range. The course of the cellular immunological parameters is shown in figure 2.
Downloaded by: Université de Paris 193.51.85.197 - 1/26/2020 10:10:32 AM
Fig. 1. Anthropometric data in patients under different therapeutical strategies.
Evaluation of Nutritional Status in the GDR Trial
211
Table 4. Immunoglobulins in patients under EAA/KA treatment over a 2-year period Normal range of:
n
EAA o months 12 months 24 months
IgG, 9-15 gil
IgM, 0.5-3.0 gil
19A, 1.0-3.5 gil
22 22 11
14.1 11.3 13.6
1.6 1.5 1.5
2.4 2.0 2.3
37 37 22
13.2 13.0 12.9
1.6 1.1 1.3
J.7 2.2 1.6
KA
o months 12 months 24 months
KA
2000
-ABSOL. LYMPHOCYTIC COUNT
1750
CUTAN-TEST SCORE 1.5
1500
•
1250 1000
j
1.0
1.5
1.7
1.6
1.2
1.5
1.5
o
12 22
24 11
37
o
12 37
24 MONTHS 22
n=22
.p
