Metabolic disturbances are common in patients with chronic kidney disease (CKD). A longitudinal study is being conducted in Fortaleza, Brazil, to evaluate nutritional status and dietary habits among CKD patients in conservative treatment. The study began in May 2015 and, during the initial evaluation, a complete anthropometric assessment was completed and dietary habits were recorded through a 24-hour food recalling. Patients were re-evaluated every 3 months. A total of 93 patients were included, the majority of whom were female (54.8%), and their mean age was 67±14 years, which points to an ageing population with CKD. The majority of patients had Stage III CKD (51%). According to BMI, the majority of patients (53.8%) had excess weight and, according to waist circumference, 81.7% had high cardiometabolic risk. Most of the studied patients had low socio-economic status, which limits access to a proper diet and regular exercise. This resulted in the participants being overweight. A recent study with elderly women concluded that nearly 50% of the cohort were classified as overweight, and 36% were classified as obese. Increased central fat distribution was found in 91.7%. Participants with CKD were older and had higher prevalence of either diabetes or hypertension.1
Our study provided evidence that abdominal obesity is an important predictor of CKD, as suggested in previous studies.2 Associations between BMI and CKD were found in a study in the UK, which provided evidence that being overweight increases the risk of advanced CKD, that being obese further increases such risk, and that this remains true for those with and without diabetes, hypertension, or cardiovascular disease.3 In our study, mean daily energy intake was 1,312±504 kcal. Evaluation of macronutrient intake evidenced mean daily consumption of carbohydrate at 51±5.5%, lipid consumption at 28±14%, and protein intake at 43±14 g/day. Mean daily fibre intake was 13.2±8.5 g/day.
According to a study that analysed the macronutrients and energy prescribed to CKD patients on conservative treatment, the diets analysed had, on average, 1,393 kcal less than the value contained in the diet manual used by the hospital nutrition service.4 The diets studied were always inadequate, with respect to the nutrients evaluated, and carried an insufficient amount of energy. CKD patients in conservative treatment present nutritional risk, as they have excess weight, high cardiometabolic risk, and a diet with a high amount of carbohydrates and lipids and low amounts of fibre. Nutritional intervention is very important to this group of patients, and dietary modifications could have a positive impact on slowing CKD progression. Further results of this longitudinal study will be available soon and may highlight novel aspects of nutrition in CKD.