Chauveau P, Barthe N, Rigalleau V, Ozenne S, Castaing F, Delclaux C, de Précigout V, Combe C, Aparicio M
Service de Biophysique, Hôpital Pellegrin-Tripode, Bordeaux Cedex, France.
Am J Kidney Dis. 1999 Sep;34(3):500-7. doi: 10.1016/s0272-6386(99)70078-8.
Concern has been raised about the nutritional adequacy of a very low protein diet (VLPD). Monthly clinical evaluation by a physician and dietitian and quarterly dietary records, anthropometric measurements, blood testing, and dual energy X-ray absorptiometry (DEXA) were used to assess the course of nutritional status for 1 year in 10 clinically stable patients (six men, four women; age, 57.1 +/- 9.3 years) with advanced chronic renal failure (mean glomerular filtration rate, 13.2 +/- 4.8 mL/min/1.73 m(2)). These patients received a VLPD providing 0.3 g/kg/d of protein and were supplemented with amino acids and ketoanalogues. Conventional nutritional markers remained unchanged after 1 year of the VLPD. However, during the same period, whole-body DEXA showed a significant decrease in lean tissue from 46.2 +/- 10.2 to 45.0 +/- 9. 8 kg (P < 0.02); limb-trunk lean tissue ratio was reduced from 0.86 +/- 0.12 to 0.82 +/- 0.12 (P < 0.02), total-body fat increased from 20.0 +/- 6.9 to 21.4 +/- 7.0 kg (P < 0.05), and the percentage of total-body fat increased from 29.2% +/- 8.7% to 31.7% +/- 8.8% (P < 0.03). These different modifications occurred abruptly during the first 3 months, then stabilized or slightly improved thereafter. These mild changes do not appear to be deleterious given the favorable long-term outcome of these patients, even after they began treatment by dialysis or after renal transplantation.
极低蛋白饮食（VLPD）的营养充足性已引起关注。10例临床稳定的晚期慢性肾衰竭患者（6名男性，4名女性；年龄57.1±9.3岁，平均肾小球滤过率13.2±4.8 mL/min/1.73 m²）接受了为期1年的每月一次由医生和营养师进行的临床评估以及每季度的饮食记录、人体测量、血液检测和双能X线吸收法（DEXA），以评估营养状况的变化过程。这些患者接受了提供0.3 g/kg/d蛋白质的VLPD，并补充了氨基酸和酮类似物。VLPD治疗1年后，传统营养指标保持不变。然而，在同一时期，全身DEXA显示瘦组织显著减少，从46.2±10.2 kg降至45.0±9.8 kg（P<0.02）；肢体-躯干瘦组织比率从0.86±0.12降至0.82±0.12（P<0.02），全身脂肪从20.0±6.9 kg增加至21.4±7.0 kg（P<0.05），全身脂肪百分比从29.2%±8.7%增加至31.7%±8.8%（P<0.03）。这些不同的变化在最初3个月内突然发生，此后趋于稳定或略有改善。鉴于这些患者即使在开始透析治疗或肾移植后仍有良好的长期预后，这些轻微变化似乎并无危害。
