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The early life programming of adult hypertension by glucocorticoidsGardner, David Stuart January 1998 (has links)
No description available.
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Quantitative estimation of dietary energy deficiency and effects of Its supplementation on protein nutritional status of nondiabetic uremic patients undergoing protein restricted dietary regimensIwayama, Norihisa, Shinzato, Toru, Nakai, Shigeru, Ando, Shizue, Nagake, Yoshio, Makino, Hirofumi, Maeda, Kenji 05 1900 (has links)
No description available.
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Methods for detecting abnormal adaptation to protein restriction in humans with special reference to insulin-dependent diabetes mellitusHamadeh, Mazen Jamal. January 2001 (has links)
Postprandial urea production in subjects with insulin dependent diabetes mellitus (IDDM) on conventional insulin therapy is normal when the previous diet is high in protein, but there is an incomplete adaptive reduction in urea production following protein restriction. To evaluate the nutritional implications of restricted protein intake in human diabetes mellitus, it is first necessary to establish a reliable method to measure changes in urea production and amino acid catabolism in response to changes in dietary protein intake. We therefore tested (1) the accuracy of the urea production rate (Ra) to depict changes in urea production, (2) whether sulfate production can be accurately depicted using tracer or nontracer approaches, after establishing the use of electrospray tandem mass spectrometry to measure sulfate concentrations and 34SO4 enrichments following administration of the stable isotope tracer sodium [34S]sulfate, (3) the reproducibility of urea and sulfate measurements following a test meal low in protein (0.25 g/kg) in subjects previously adapted to high (1.5 g/kg.d) and low (0.3 g/kg.d) protein intakes, and compared the metabolic fate of [ 15N]alanine added to the test meal with that of [15N] Spirulina platensis, a 15N-labeled intact protein, and (4) whether we could identify the differences in postprandial urea and sulfate productions between normal subjects and persons with IDDM receiving conventional insulin therapy previously adapted to high protein intake, when the test meal was limiting in protein. Under basal conditions, steady state urea Ra is an accurate measure of urea production. Following changes in urea production, both the tracer and nontracer methods seriously underestimated total urea Ra. The tracer method overestimated sulfate production by 20%, but the nontracer method provided an accurate measure of sulfate production and, hence, sulfur amino acid catabolism. Postprandial changes in urea and sulfate productions following normal ada
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Methods for detecting abnormal adaptation to protein restriction in humans with special reference to insulin-dependent diabetes mellitusHamadeh, Mazen Jamal. January 2001 (has links)
No description available.
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The effect of varying levels of dietary protein on carcass composition of eleven- and eighteen-month-old male ratsLinley, Lisa K. January 1988 (has links)
Carcass composition of male Sprague-Dawley rats, aged 11 and 18 months, in response to varying levels of dietary protein was determined. Groups varying of ten rats of each age were fed diets containing from 1.53 to 8.05 percent protein as casein supplemented with d-1-methionine for five weeks. The 8.05% protein groups were used as controls. Carcasses were analyzed for total nitrogen and percent protein, fat, and water. Liver composition and total serum protein values were also determined. Two-way analysis of variance and Student's t-tests were used to determine significant age and diet effects. Differences in the response of the two age groups of rats were evident. Eighteen-month-old rats required more protein than the younger animals for the maintenance of body weight. When compared to control values, older rats also needed a higher level of dietary protein to maintain normal total carcass nitrogen. Fatty livers in older rats persisted at higher dietary protein levels than fatty livers in 11-month-old rats, indicating that 18-month-old rats required more protein to support adequate liver lipoprotein synthesis. These findings suggest that 18-month-old rats have a higher dietary protein requirement than 11-month-old rats. High serum protein values for older rats at lower protein levels, however, do not support this conclusion. The increased body weight and proportionally greater fat mass of older animals was a complicating factor in this study. Further research is needed to more clearly define changes in protein requirements during aging. For future studies, using rats of a more advanced age and three, rather than two, different age groups is recommended. / Master of Science
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Avaliação do impacto de um programa de educação nutricional sobre a adesão à dieta hipoproteica em pacientes com doença renal crônica em tratamento conservador / Impact of a nutrition education program on the adherence to the low protein diet in patients with chronic kidney disease under conservative treatmentJuliana Giglio Paes Barreto 04 July 2011 (has links)
Pacientes com doença renal crônica (DRC) na fase não dialítica são normalmente orientados a seguir uma dieta hipoproteica e hipossódica. Estudos nacionais e internacionais mostram que a adesão a essa dieta tem sido baixa e difícil de ser mantida, pois requer mudanças importantes no hábito alimentar. O objetivo do presente estudo foi avaliar o impacto de um programa de educação nutricional sobre a adesão à dieta hipoproteica em pacientes com DRC em tratamento conservador. Trata-se de um ensaio clínico randomizado, prospectivo com duração de 5 1,5 meses. Foram acompanhados 85 pacientes com DRC na fase não dialítica, atendidos em dois Ambulatórios de Nutrição e Doenças Renais do Hospital Universitário Pedro Ernesto. Os pacientes foram divididos de forma aleatória em 2 grupos: Intervenção (n=39) e Controle (n=46). Os pacientes do Grupo Intervenção foram submetidos a um programa de educação nutricional, além da orientação de dieta hipoproteica (0,6 a 0,75 g/kg/dia). Os pacientes do Grupo Controle foram submetidos apenas à orientação de dieta hipoproteica (0,6 a 0,75 g/kg/dia). A avaliação da adesão foi feita a partir da estimativa do consumo de proteína por recordatório alimentar de 24 horas. Adotou-se como critério de adesão apresentar ao final do estudo redução de ao menos 20% da ingestão proteica inicial. A avaliação nutricional e laboratorial foi realizada no início e no término do estudo. Os parâmetros antropométricos avaliados foram peso, estatura, dobras cutâneas do tríceps, bíceps, subescapular e supra-ilíaca e perímetro da cintura e do braço. As laboratoriais foram creatinina, uréia, potássio, fósforo, glicose e albumina no plasma e sódio e uréia na urina de 24 horas. Ao avaliar o amostra total, 51,8% dos pacientes eram do sexo masculino, com média de idade de 63,4 11,0 anos, IMC indicativo de sobrepeso (28,8 5,4 kg/m2) e filtração glomerular estimada (FGe) de 32,6 12,2 mL/mim/1,73m2. As características iniciais não diferiram entre os Grupos Intervenção e Controle. Ambos os grupos apresentaram melhora dos parâmetros laboratoriais e antropometricos, com redução significante da uréia plasmática e da glicemia no Grupo Controle (P < 0,05 vs início do estudo) e do IMC em ambos os grupos (P < 0,05 vs início do estudo). Após o período de acompanhamento, o Grupo Intervenção e o Grupo Controle apresentaram ingestão proteica significantemente diferente (0,62 0,2 vs 0,77 0,26 g/kg/dia, respectivamente). A ingestão de sódio não mudou de forma significante em ambos os grupos no inicio e término do acompanhamento. A Adesão à ingestão proteica foi observada em 74,4% do Grupo Intervenção e em 47,8% do Grupo Controle (P < 0,05). A análise de regressão logística multivariada revelou que pertencer ao Grupo Intervenção e sexo masculino se associaram com a Adesão (P <0,05), mesmo após corrigir para outras variáveis testadas. Com base nos achados desse estudo, pode-se concluir que o programa de educação nutricional foi uma ferramenta eficaz no tratamento dietoterápico do paciente com DRC na pré-diálise, pois promoveu melhora na adesão à dieta hipoproteica, além de ter promovido melhora dos parâmetros antropométricos e laboratoriais. / Nondialyzed chronic kidney disease (CKD) patients are normally counseled to follow a low protein and sodium diet. Nationals and internationals surveys have shown a low adherence to such diet. In addition, it has been also demonstrated that maintaining a low protein and sodium intake is difficult, because it requires important changes in eating habits. The objective of the present study was to evaluate the impact of a nutritional education program on the adherence to the low protein diet in CKD patients being followed in a conservative outpatient clinic. Study design: clinical, randomized, controlled and prospective essay (follow-up of 5 1.5 months (mean SD)). Eighty five nondialyzed CKD patients, under treatment in two CKD outpatient clinics from Pedro Ernesto University Hospital, were included in this study. These patients were randomized in two groups: Intervention (n=39) and Control (n=46). The patients of the Intervention Group were submitted to a nutritional education program, besides the low protein diet prescription (0.6 to 0.75 g/kg/day). The patients from the Control Group were submitted only to the low protein diet prescription (0.6 to 0.75 g/kg/day). The evaluation of the adherence was done by estimating the protein intake from the 24 hour food recall. The adherence criterion adopted was to present, at the end of the study, a reduction of at least 20% of the initial protein intake. The nutritional and laboratorial assessments were made at the beginning and at the end of the follow-up period. The anthropometric parameters assessed were body weight, height, triceps, biceps, subscapulars and suprailiacs skinfolds thicknesses and waists and arms circumferences. The laboratorial parameters included plasma creatinine, urea, potassium, phosphate, glucose and albumin and 24 hour urines sodium and urea. In the total studied sample, 51.8% of the patients were male, with an mean age of 63.4 11.0 years, mean BMI indicating overweight (28.8 5.4 kg/m) and a mean glomerular filtration rate (GFR) of 32.6 12.2 mL/mim/1,73m. The main characteristics at the beginning of the follow-up were not different between Intervention and Control Groups. Both groups presented an improvement on the laboratorial and anthropometrical parameters, with significant reduction of plasma urea and glucose in the Control Group (P < 0.05 vs baseline) and BMI in both groups (P < 0.05 vs baseline). After the follow-up period, the Intervention and Control Groups showed a significant decrease in the protein intake (0.62 0.2 vs 0.77 0.26 g/kg/day, respectively). The sodium intake did not significantly change in both groups at the beginning and end of the study. A higher degree of adherence to the low protein diet was observed in Intervention Group (74.4%) than in Control Group (47.8%) (P < 0.05). The multivariate logistic regression analysis revealed that belonging to the Intervention Group and male gender were significantly associated with Adherence (P < 0.05), even after controlling to others tested variables. Based on these findings, it can be concluded that the nutritional education program was an effective tool to reduce the protein intake of nondialyzed CKD patients, as it has leaded to an improvement in the adherence to the low protein diet, and promoted an amelioration of anthropometric and laboratorial parameters.
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Avaliação do impacto de um programa de educação nutricional sobre a adesão à dieta hipoproteica em pacientes com doença renal crônica em tratamento conservador / Impact of a nutrition education program on the adherence to the low protein diet in patients with chronic kidney disease under conservative treatmentJuliana Giglio Paes Barreto 04 July 2011 (has links)
Pacientes com doença renal crônica (DRC) na fase não dialítica são normalmente orientados a seguir uma dieta hipoproteica e hipossódica. Estudos nacionais e internacionais mostram que a adesão a essa dieta tem sido baixa e difícil de ser mantida, pois requer mudanças importantes no hábito alimentar. O objetivo do presente estudo foi avaliar o impacto de um programa de educação nutricional sobre a adesão à dieta hipoproteica em pacientes com DRC em tratamento conservador. Trata-se de um ensaio clínico randomizado, prospectivo com duração de 5 1,5 meses. Foram acompanhados 85 pacientes com DRC na fase não dialítica, atendidos em dois Ambulatórios de Nutrição e Doenças Renais do Hospital Universitário Pedro Ernesto. Os pacientes foram divididos de forma aleatória em 2 grupos: Intervenção (n=39) e Controle (n=46). Os pacientes do Grupo Intervenção foram submetidos a um programa de educação nutricional, além da orientação de dieta hipoproteica (0,6 a 0,75 g/kg/dia). Os pacientes do Grupo Controle foram submetidos apenas à orientação de dieta hipoproteica (0,6 a 0,75 g/kg/dia). A avaliação da adesão foi feita a partir da estimativa do consumo de proteína por recordatório alimentar de 24 horas. Adotou-se como critério de adesão apresentar ao final do estudo redução de ao menos 20% da ingestão proteica inicial. A avaliação nutricional e laboratorial foi realizada no início e no término do estudo. Os parâmetros antropométricos avaliados foram peso, estatura, dobras cutâneas do tríceps, bíceps, subescapular e supra-ilíaca e perímetro da cintura e do braço. As laboratoriais foram creatinina, uréia, potássio, fósforo, glicose e albumina no plasma e sódio e uréia na urina de 24 horas. Ao avaliar o amostra total, 51,8% dos pacientes eram do sexo masculino, com média de idade de 63,4 11,0 anos, IMC indicativo de sobrepeso (28,8 5,4 kg/m2) e filtração glomerular estimada (FGe) de 32,6 12,2 mL/mim/1,73m2. As características iniciais não diferiram entre os Grupos Intervenção e Controle. Ambos os grupos apresentaram melhora dos parâmetros laboratoriais e antropometricos, com redução significante da uréia plasmática e da glicemia no Grupo Controle (P < 0,05 vs início do estudo) e do IMC em ambos os grupos (P < 0,05 vs início do estudo). Após o período de acompanhamento, o Grupo Intervenção e o Grupo Controle apresentaram ingestão proteica significantemente diferente (0,62 0,2 vs 0,77 0,26 g/kg/dia, respectivamente). A ingestão de sódio não mudou de forma significante em ambos os grupos no inicio e término do acompanhamento. A Adesão à ingestão proteica foi observada em 74,4% do Grupo Intervenção e em 47,8% do Grupo Controle (P < 0,05). A análise de regressão logística multivariada revelou que pertencer ao Grupo Intervenção e sexo masculino se associaram com a Adesão (P <0,05), mesmo após corrigir para outras variáveis testadas. Com base nos achados desse estudo, pode-se concluir que o programa de educação nutricional foi uma ferramenta eficaz no tratamento dietoterápico do paciente com DRC na pré-diálise, pois promoveu melhora na adesão à dieta hipoproteica, além de ter promovido melhora dos parâmetros antropométricos e laboratoriais. / Nondialyzed chronic kidney disease (CKD) patients are normally counseled to follow a low protein and sodium diet. Nationals and internationals surveys have shown a low adherence to such diet. In addition, it has been also demonstrated that maintaining a low protein and sodium intake is difficult, because it requires important changes in eating habits. The objective of the present study was to evaluate the impact of a nutritional education program on the adherence to the low protein diet in CKD patients being followed in a conservative outpatient clinic. Study design: clinical, randomized, controlled and prospective essay (follow-up of 5 1.5 months (mean SD)). Eighty five nondialyzed CKD patients, under treatment in two CKD outpatient clinics from Pedro Ernesto University Hospital, were included in this study. These patients were randomized in two groups: Intervention (n=39) and Control (n=46). The patients of the Intervention Group were submitted to a nutritional education program, besides the low protein diet prescription (0.6 to 0.75 g/kg/day). The patients from the Control Group were submitted only to the low protein diet prescription (0.6 to 0.75 g/kg/day). The evaluation of the adherence was done by estimating the protein intake from the 24 hour food recall. The adherence criterion adopted was to present, at the end of the study, a reduction of at least 20% of the initial protein intake. The nutritional and laboratorial assessments were made at the beginning and at the end of the follow-up period. The anthropometric parameters assessed were body weight, height, triceps, biceps, subscapulars and suprailiacs skinfolds thicknesses and waists and arms circumferences. The laboratorial parameters included plasma creatinine, urea, potassium, phosphate, glucose and albumin and 24 hour urines sodium and urea. In the total studied sample, 51.8% of the patients were male, with an mean age of 63.4 11.0 years, mean BMI indicating overweight (28.8 5.4 kg/m) and a mean glomerular filtration rate (GFR) of 32.6 12.2 mL/mim/1,73m. The main characteristics at the beginning of the follow-up were not different between Intervention and Control Groups. Both groups presented an improvement on the laboratorial and anthropometrical parameters, with significant reduction of plasma urea and glucose in the Control Group (P < 0.05 vs baseline) and BMI in both groups (P < 0.05 vs baseline). After the follow-up period, the Intervention and Control Groups showed a significant decrease in the protein intake (0.62 0.2 vs 0.77 0.26 g/kg/day, respectively). The sodium intake did not significantly change in both groups at the beginning and end of the study. A higher degree of adherence to the low protein diet was observed in Intervention Group (74.4%) than in Control Group (47.8%) (P < 0.05). The multivariate logistic regression analysis revealed that belonging to the Intervention Group and male gender were significantly associated with Adherence (P < 0.05), even after controlling to others tested variables. Based on these findings, it can be concluded that the nutritional education program was an effective tool to reduce the protein intake of nondialyzed CKD patients, as it has leaded to an improvement in the adherence to the low protein diet, and promoted an amelioration of anthropometric and laboratorial parameters.
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Vliv nízkobílkovinné diety na progresi chronického onemocnění ledvin / The effect of low-protein diet on progression of chronic kidney diseaseČmerdová, Kristýna January 2019 (has links)
Background: Low protein diet is one of the treatments for patients with chronic kidney disease during the pre-dialysis period. Studies about this subject have been published for more than 20 years, but the conclusions about its effect and the most appropriate composition are not clear. A low-protein diet is recommended for some patients at the Nephrology Clinic of General University Hospital. These patients are educated and re- educated by a nutrition therapist who also controls their food intake through a food diary. Objectives: To evaluate the effect of low-protein diet on the progression of chronic kidney disease in our conditions and to compare the results with the control group. Furthermore, to evaluate the nutritional status of these patients and the influence of the diet on it. Last but not least, describe a set of patients coming to education about low-protein diet. Methods: The input data was retrospectively retrieved from the medical records of patients who attended medical checks at the Nephrology Clinic of General University Hospital between 10/2016 and 3/2018. A group of 15 patients with a low-protein diet was compared with a control group of 15 patients who did not receive low-protein diet education. The main data collected was year of birth, estimated GFR, urea, creatinine, albumin,...
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The role of the mTOR pathway and amino acid availability for pre- and postnatal cardiac development, growth and functionHennig, Maria 11 August 2015 (has links)
Die Entwicklung eines Embryos und Fetus beeinflusst die Anfälligkeit für kardiovaskuläre Erkrankungen im weiteren Verlauf des Lebens entscheidend. Zugrundeliegende Mechanismen sind jedoch weitestgehend unbekannt. Unter Zuhilfenahme eines neuen Mausmodells für intrauterine kardiale Wachstumsretardierung zielt die vorliegende Dissertation auf die Identifikation adaptiver Wachstumsmechanismen ab, welche die Anpassung der Organgröße und die Aufrechterhaltung einer normalen Herzfunktion ermöglichen. Vielzählige Gene des Aminosäure (AS)-Metabolismus und der Proteinhomeostase zeigten eine vermehrte Expression in neugeborenen Mausherzen nach gestörter Embryonalentwicklung. Es wurde angenommen, dass sowohl die AS-Verfügbarkeit als auch die Aktivität der mechanistic target of rapamycin (mTOR) Signalkaskade entscheidend für eine normale Herzentwicklung und postnatales kompensatorisches Wachstum sind. Der mTOR Komplex 1 (mTORC1) wurde in prä- und perinatalen Mäusen mittels Rapamycin-Behandlung trächtiger Weibchen inhibiert. Die Auswirkungen einer prä- und postnatalen AS-Restriktion wurden anhand einer Niedrigproteindiät untersucht. Rapamycin-behandelte Neugeborene zeichneten sich durch vermindertes Gesamtwachstum sowie Entwicklungsverzögerung aus. Dabei war die kardiale Entwicklung besonders betroffen. Kardiale Proliferationsraten waren nicht verändert, die verminderte Herzgröße wurde jedoch auf eine verringerte Kardiomyozytengröße sowie eine erhöhte Apoptoserate zurückgeführt. Die intrauterine AS-Restriktion wurde überraschend gut von den Mausherzen toleriert. Zusammenfassend konnte gezeigt werden, dass die mTOR Signalkaskade essentiell für eine normale Herzentwicklung sowie kompensatorisches kardiales Wachstum ist. Darüber hinaus stellt die pränatale Rapamycin-Behandlung möglicherweise ein neues Modell der intrauterinen Wachstumsretardierung dar, welches Untersuchungen von Programmierungs-Mechanismen vor allem während der fötalen und perinatalen Herzentwicklung ermöglicht. / Intrauterine development influences the susceptibility to cardiovascular disease in adulthood, although the underlying molecular mechanisms are vastly unknown. Utilizing a new mouse model of impaired heart development, this thesis aims at identifying pre- and postnatal adaptive growth mechanisms to restore organ size and allow normal cardiac function. Unbiased functional annotation of genes differentially expressed in neonatal hearts after impaired intrauterine development revealed numerous gene clusters involved in amino acid (AA) metabolism and protein homeostasis. It was hypothesized that both AA availability and mechanistic target of rapamycin (mTOR) pathway activation are crucial for normal heart development and compensatory cardiac growth. mTOR complex 1 (mTORC1) was inhibited in fetal and neonatal mice by rapamycin treatment of pregnant dams. The effects of pre- and postnatal AA restriction were studied by feeding dams a low protein diet (LPD) throughout pregnancy and keeping the offspring on LPD postnatally. Rapamycin treated neonates were characterized by overall growth restriction and developmental delay, where cardiac development was especially affected (reduction of heart size, weight and heart weight to body weight ratio, severe thinning and noncompaction of the ventricular myocardium as well as immature myocardial morphology). While proliferation rates were unaffected, the reduced neonatal heart size was attributed to decreased cardiomyocyte size and increased apoptosis. Strikingly, the murine heart appeared to be surprisingly resistant to intrauterine AA restriction. In conclusion, the data revealed mTOR being essential for normal as well as compensatory cardiac development and growth. Moreover, prenatal rapamycin treatment might represent a new model of intrauterine growth restriction, which potentially allows the investigation of developmental programming mechanisms within the heart particularly in the fetal and neonatal phase of development.
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Efeitos da ingestão protéica na progressão da doença renal e nos parâmetros inflamatório e oxidativo de pacientes com insuficiência renal em fase pré-diálisePizzato, Alessandra Campani January 2006 (has links)
Introdução: A maioria dos distúrbios metabólicos presentes na doença renal crônica (DRC) resulta, principalmente, do acúmulo de produtos do metabolismo do nitrogênio presentes nos alimentos ricos em proteínas. Dietas hiperprotéicas estão associadas à hiperperfusão, hipertensão e hiperfiltração glomerular e, conseqüentemente, à progressão da DRC. A dietoterapia tem um papel importante no tratamento da DRC, consistindo, principalmente, na redução da oferta diária de proteínas. Objetivo: Verificar o efeito da intervenção dietoterápica no estado nutricional, na progressão da doença renal e nos parâmetros inflamatórios, lipídicos, estado oxidativo e níveis séricos de potássio, de pacientes com insuficiência renal crônica em fase pré-dialítica. Pacientes e Métodos: Foi realizado um estudo prospectivo randomizado controlado cruzado em pacientes com DRC Estágio IV, em atendimento ambulatorial. O estudo constou de dois grupos de pacientes com DRC em fase pré-dialítica, que seguiram dois esquemas dietoterápicos diferentes, durante seis semanas: 21 pacientes iniciaram com prescrição de dieta normoprotéica (1 g/kg/dia) e 20 com prescrição de dieta hipoprotéica (0,6 g/kg/dia). Após esse período, os grupos inverteram as dietas. Foram avaliados parâmetros dietéticos, bioquímicos e antropométricos no momento basal e após seis e doze semanas. Os dados foram analisados segundo a intenção de tratamento na análise de crossover e por adesão à dieta hipoprotéica. Utilizaramse testes ANOVA para medidas repetidas e correlação de Spearman. O nível de significância adotado foi o de P < 0,05. Resultados: Foram avaliados 41 pacientes. Apenas um paciente (2,4%) foi considerado desnutrido e 28 (68%) apresentaram sobrepeso ou obesidade. Dezessete pacientes (41,5%) foram considerados inflamados, de acordo com o nível de PCR. Houve baixa adesão à dieta hipoprotéica.Não se observou prejuízo no estado nutricional dos pacientes durante o seguimento de prescrição de dieta hipoprotéica. Nos pacientes não inflamados observou-se melhora nos parâmetros de função renal, ao passo que, nos inflamados, estes parâmetros apresentaram deterioração. Observaram-se correlações negativas significativas entre os níveis séricos de HDL-colesterol e creatinina; HDL-colesterol e IMC; e correlações positivas significativas entre colesterol-total e uréia; LDL-colesterol e uréia; PNA/kg e HDL, triglicerídios e tirosina; triglicerídios e fibrinogênio; triglicerídios e creatinina; uréia e albumina. Conclusões: A adesão à dieta hipoprotéica foi muito pequena. A dieta hipoprotéica não interferiu no estado nutricional. A presença de inflamação influenciou, negativamente, a evolução da função renal. O perfil lipídico esteve relacionado ao estado nutricional, aos fatores de progressão da DRC e à inflamação; a lipoperoxidação esteve associada aos níveis séricos de albumina. / Background: Most metabolic disorders presented by patients with chronic renal disease (CRD) are mainly a result of accumulation of products of nitrogen metabolism, present in protein rich foods. High protein diets are associated with hyperperfusion, hypertension and hyperfiltration of the glomeruli and, as a consequence, may accelerate the progression of CRF. Nutritional therapy plays an important role in CRF treatment, consisting mainly in reduction of daily protein intake. Objective: To verify the effect of nutrition therapy intervention on nutritional status, on renal disease progression and on inflammatory and lipid parameters, oxidative status and potassium serum levels in patients with chronic renal insufficiency in the pre dialysis period. Patients and Methods: A crossover controlled prospective, randomized study in outpatients with stage IV CRD was carried out. The study consisted in the follow up of two groups of patients with CRD in the pre dialysis period. By randomization 21 patients were started on a 1g protein/kg/day diet prescription and 20 patients on low protein diet (0.6g/kg/day). After six weeks diets were reversed between the two groups and followed for another six week period. Dietetic, biochemical and anthropometric parameters were assessed at baseline and after 6 and 12 weeks. Data were analyzed according to the intention to treat approach in the crossover analysis and by adherence to the low protein diet. ANOVA for repeated measures and Spearman´s correlation tests were used for statistical analysis. The significance level adopted was P < 0.05. Results: 41 patients were evaluated. Only one patient (2.4%) was considered undernourished and 28 patients (68%) presented either over weighted or obese. Seventeen patients (41.5%) were considered inflamed according to the level of C reactive protein (CRP). Low adherence to the low protein diet was observed. Damage on nutritional status was not observed on low protein diet. In non-inflamed patients an improvement on renal function parameters was observed, whereas in the inflamed ones these parameters presented deterioration. Significant negative correlations between HDL-cholesterol serum levels and creatinine, HDL-cholesterol and body mass index (BMI) were observed. Significant positive correlations were observed between total cholesterol and urea, LDL-cholesterol and urea, PNA/kg and HDL, triglycerides and tyrosine, triglycerides and fibrinogen, triglycerides and creatinine, urea and albumin. Conclusions: Patients adhered poorly to low protein diets. Low protein diet did not influence the nutritional status. Presence of inflammation influenced negatively the evolution of renal function. The lipid profile was related to the nutritional status, to the progression factors of CRF and to inflammation. Lipoperoxidation was associated to serum levels of albumin.
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