Effectiveness of Oral Energy-Protein Supplementation in Severely Malnourished Hemodialvsis Patients
■ Objective: To evaluate the effect of an oral energy-protein supplementation on the nutritional status of severely malnourished uremic hemodialysis patients. ■ Design: A cohort study of malnourished patients orally supplemented for 4 months. ■ Setting: A satellite hemodialysis unit at the Escola Paulista de Medicina, Sao Paulo, Brazil. ■ Patients: In a population-based sample, 14 of 123 chronic severe malnourished patients selected by clinical and anthropometric criteria initiated the study. Ten patients completed the trial. ■ Interventions: In addition to the instructed diet, each patient received a flavored oral powder supplement containing egg albumin, corn and coconut oils, hydrogenated fat, and malto-dextrin, providing 800 kcal and 19.6 g protein/d. ■ Main outcome measures: The following parameters were obtained: 3-day dietary diaries, protein catabolic rate (PCR), body weight (BW), triceps skinfold thickness (TSF), midarm circumference (MAC), body mass index, body fat (BF), percentage of body fat (PF), lean body mass (LBM), midarm muscle area (MAMA), and hematological and biochemical indices. ■ Results: At the end of the study, significant increases in total energy (27 ± 6 to 43 ± 6 kcal/kg/d) and protein consumption (1.07 ± 0.4 to 1.57 ± 0.4 g/kg/d) were observed. Significant increases were also observed in BW (48.9 ± 8.4 to 50.4 ± 8.9 kg), MAC (23 ± 2.6 to 23.8 ± 2.5 cm), TSF (6.5 ± 3.1 to 7.9 ± 3.6 mm), and BF (7.2 ± 2.8 to 8.6 ± 3.3 kg). There were no modifications in LBM and MAMA. Changes in BW correlated significantly with changes in PF ( r = 0.47; P r = 0.63; P ■ Conclusion: The oral supplement was well tolerated and was effective in improving the nutritional status of malnourished hemodialysis patients.