Oral supplements

August 11, 2021

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In hemodialysis patients, daily intake of an oral fat-based high-energy dietary supplement had no clinically significant effect on nutritional status, as the results of a randomized controlled study showed.

“Adequate dietary energy intake is necessary to maintain nitrogen balance and body composition in maintenance hemodialysis patients. Low energy intake from food

Oral food supplements

The content of the infographic was adapted from Yang Y, et al. Clin J Am Soc Nephrol. 2021; doi: 10.2215 / CJN.16821020.

(<30kcal / kg / d) is associated with a higher mortality risk. " Yaya Yang, MS, from the National Clinical Research Center of Kidney Diseases in Guangzhou, China and colleagues wrote. “However, anorexia, comorbidities and prescribed dietary restrictions make it difficult for hemodialysis patients to achieve adequate energy intake, which contributes to poor nutritional status. The guidelines recommended nutritional interventions in maintenance hemodialysis patients. However, the evidence regarding the effects of oral supplements on the nutritional status of such patients is limited and contradicting. ”

To investigate whether supplementation would benefit this patient population, the researchers randomized 240 patients to either 300 kcal daily of an oral fat-based energy-dense supplement or routine treatment for 12 weeks. Both groups received nutritional advice, but the control group received no nutritional supplements. Patients with diabetes were excluded because the supplement manufacturer’s product manual (Fresubin) warned against excessive fat intake due to its effects on insulin sensitivity, according to the researchers.

Change of phase angle

“Although there are a number of indicators of nutritional status, including serum albumin, [BMI]and grip strength, no single parameter can show the general nutritional status of hemodialysis patients as a whole, ”write Yang and colleagues. “Recently, bioelectrical impedance analysis (BIA) has become a widely used tool to estimate body composition and monitor nutritional status. Resistance (R) and reactance (Xc) obtained from BIA were used to calculate the phase angle by the following equation: phase angle (°) = arctangent (Xc / R) × (180 /). Although the biological meaning of the phase angle is not clearly understood, it is viewed as a measure of cell integrity and body cell mass and can reflect the nutritional status. ”

In addition to considering changes in phase angle between groups, the researchers also assessed changes in quality of life in 19 areas and the occurrence of adverse events.

After 12 weeks, Yang and colleagues found that the average energy intake from food in the control and intervention groups was 23 kcal per kg per day and 23.2 kcal per kg per day, respectively, with the oral supplement providing an additional energy intake of 4 .9 kcal supplied per kg per day.

Effects of Supplements

The results showed no significant differences in the change in phase angle between the intervention and control groups and no differences in quality of life between the groups.

Side effects were reported in 19% of patients in the control group and in 33% of patients in the intervention group and were most commonly gastrointestinal problems. The average therapy adherence in the intervention group was 88%, with patients citing side effects and an aversion to the taste of the supplement as the main reasons for non-adherence.

“In this randomized controlled trial, taking an oral, fat-based, high-energy dietary supplement for 12 weeks in non-diabetic maintenance hemodialysis patients did not significantly improve the phase angle,” concluded Yang and colleagues from the results. “Compared to the control group, this nutritional intervention can improve BMI, serum albumin and adipose tissue indices. However, the extent of these changes was small and therefore may not be clinically significant. In addition, the results must be interpreted with caution because of the likelihood of statistical type errors from multiple comparisons. Therefore, the results of the present study are to be regarded as generating hypotheses. ”

The researchers recommend conducting longer-term, larger-sample clinical trials to further evaluate the effects of supplementation on patients on maintenance hemodialysis.

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Rx Nutrition Resource Center

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