THE RISKS AND BENEFITS OF A LOW PROTEIN ESSENTIAL AMINO-ACID KETO ACID DIET
THE RISKS AND BENEFITS OF A LOW PROTEIN ESSENTIAL AMINO-ACID KETO ACID DIET
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DOI：
10.1038/ki.1986.99
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发表时间：
1986-05-01
影响因子：
19.6
通讯作者：
COLES, GA
中科院分区：
文献类型：
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作者：
LUCAS, PA;MEADOWS, JH;COLES, GA
对12例进行性肾功能衰竭患者进行了为期6 ~ 12个月的极低蛋白饮食补充必需氨基酸-酮酸混合物治疗。每日总摄入量为0.04 g氮/kg和50 kcal/kg。8例受试者的血浆肌酐倒数斜率发生显著变化，变得不那么陡峭，2例为阳性。GFR没有改善，但在4例患者的下降超过12个月小于0.5毫升/分钟。有显着福尔斯下降，血和尿尿素，血清磷酸PTH和钙X磷酸盐产品。体重在前三个月下降。上臂肌围下降0.9cm（P < 0.005）。血清白蛋白和转铁蛋白水平没有显着变化。一些患者的肌肉质量和血浆肌酐同时下降。人体测量学评估的每公斤肌肉质量肌酐排泄量在前三个月下降了21%。这种饮食可以减缓一部分患者的肾功能下降。然而，肌肉质量可能会丢失。血清蛋白水平不能准确反映营养变化。血浆肌酐下降可能不是由于GFR改善，而是由于肌酐代谢改变。
Twelve patients with progressive renal failure were placed on a very low protein diet supplemented by an essentail amino acid-keto acid mixture for six to twelve months. Total daily intake was 0.04 g nitrogen/kg and 50 kcal/kg. Eight subjects had a significant change in the slope of reciprocal plasma creatinine, becoming less steep and in two cases positive. GFR did not improve, but in four patients the decline over twelve months was less than 0.5 mliter/min. There were significant falls in blood and urinary urea, serum phosphate PTH and calcium X phosphate product. Body wt decreased during the first three months. Arm muscle circumference fell of 0.9 cm (P < 0.005). Serum albumin and transferrin levels did not change significantly. Muscle mass and plasma creatinine fell simultaneously in several patients. Creatinine excretion per kg muscle mass, assessed anthropometrically, declined by 21% in the first three months. This diet may slow the decline in renal function in a proportion of patients. However, muscle mass can be lost. Serum protein levels do not accurately reflect nutritional changes. A fall in plasma creatinine may not be due to improved GFR but instead to altered creatinine metabolism.