Division of Nephrology, Dialysis and Transplantation, Department of Internal Medicine and IRCCS Ospedale Policlinico San Martino, University of Genova, Genova, Italy.
Nephrol Dial Transplant. 2020 May 1;35(5):741-751. doi: 10.1093/ndt/gfaa072.
Adaptation to a low-protein diet (LPD) involves a reduction in the rate of amino acid (AA) flux and oxidation, leading to more efficient use of dietary AA and reduced ureagenesis. Of note, the concept of 'adaptation' to low-protein intakes has been separated from the concept of 'accommodation', the latter term implying a decrease in protein synthesis, with development of wasting, when dietary protein intake becomes inadequate, i.e. beyond the limits of the adaptive mechanisms. Acidosis, insulin resistance and inflammation are recognized mechanisms that can increase protein degradation and can impair the ability to activate an adaptive response when an LPD is prescribed in a chronic kidney disease (CKD) patient. Current evidence shows that, in the short term, clinically stable patients with CKD Stages 3-5 can efficiently adapt their muscle protein turnover to an LPD containing 0.55-0.6 g protein/kg or a supplemented very-low-protein diet (VLPD) by decreasing muscle protein degradation and increasing the efficiency of muscle protein turnover. Recent long-term randomized clinical trials on supplemented VLPDs in patients with CKD have shown a very good safety profile, suggesting that observations shown by short-term studies on muscle protein turnover can be extrapolated to the long-term period.
适应低蛋白饮食（LPD）涉及氨基酸（AA）流量和氧化率的降低，从而更有效地利用膳食 AA 和减少尿素生成。值得注意的是，“适应”低蛋白摄入的概念已经与“适应”的概念分开，后者意味着当饮食中的蛋白质摄入不足时，即超出适应机制的限制时，蛋白质合成减少，会导致消耗。酸中毒、胰岛素抵抗和炎症是公认的机制，这些机制可以增加蛋白质降解，并在慢性肾脏病（CKD）患者中规定低蛋白饮食时损害激活适应性反应的能力。目前的证据表明，在短期内，临床稳定的 CKD 3-5 期患者可以通过降低肌肉蛋白质降解和增加肌肉蛋白质周转率的效率，有效地将其肌肉蛋白质周转率适应含有 0.55-0.6 g/kg 蛋白质的 LPD 或补充极低蛋白饮食（VLPD）。最近在 CKD 患者中进行的补充 VLPD 的长期随机临床试验显示出很好的安全性，这表明短期研究中关于肌肉蛋白质周转率的观察结果可以推断到长期。
