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The risks and benefits of a low protein–essential amino acid–keto acid diet

1986; Elsevier BV; Volume: 29; Issue: 5 Linguagem: Inglês

10.1038/ki.1986.99

1523-1755

Philip Lucas, J. H. Meadows, David E. Roberts, Gerald A. Coles,

Nutrition and Health in Aging

The risks and benefits of a low protein-essential amino acid-keto acid diet.Twelve patients with progressive renal failure were placed on a very low protein diet supplemented by an essential 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 muter/mm.There were significant falls in blood and urinary urea, serum phosphate P'FH and calcium X phosphate product.Body wt decreased during the first three months.Arm muscle circumference fell by 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.Low protein diets have been used for many years for symptomatic relief of uremic symptoms.In an attempt to improve the uremic state various combinations of essential amino acids and their keto acid analogues (EAA/KAA) have been given as supplements to diets low in nitrogen [1][2][3][4][5].Recently it has been claimed that low protein diets may slow the progression of renal failure [6,7].The evidence for a protective effect of a low protein intake is striking in experimental renal failure produced in rats by subtotal nephrectomy [8] or glomerulonephritis [9].A number of reports have appeared which suggest there may be a similar effect in man [10][11][12][13][14] but to date there has been only one attempt at a prospective randomly allocated trial in human renal disease [15].Barsotti et al [16] reported that a very low protein diet supplemented by an essential amino acid/keto acid mixture appeared to slow or in some cases completely halt the progression of advanced renal failure.If decline in renal function can indeed be arrested by such regimes, they would prove to be of enormous importance in both human and economic terms.The results of Barsotti et al were sufficiently striking to demand