Supplemented low-protein diets : are they superior in chronic renal failure?

CITATION: Herselman, M. G. et al 1995. Supplemented low-protein diets : are they superior in chronic renal failure? South African Medical Journal, 85(5):361-365.The original publication is available at http://www.samj.org.zaTwenty-two patients with chronic renal failure were randomly assigned to a conventional low-protein diet containing 0,6g protein/kg/day or a very-low-protein diet containing 0,6g protein/kg/day supplemented with essential amino acids; they were followed up for 9 months. There were no significant changes in body mass index, arm muscle area, percentage body fat, serum albumin and transferrin levels in any of the groups; neither was there any difference between the groups in respect of these parameters. Renal function, as measured by the reciprocal of serum creatinine over time, stabilised in both groups during intervention, with no significant difference between the groups. There was however no correlation between changes in renal function and changes in blood pressure, or dietary intake of protein, phosphorus, cholesterol, polyunsaturated and saturated fatty acids. There were also no significant changes and no significant differences between the groups in serum levels of parathyroid hormone and alkaline phosphatase, urine cyclic adenosine monophosphate, tubular reabsorption of phosphate, and the theoretical renal threshold for phosphate. The results of this study suggest that the supplemented very-low-protein diet was not superior to the conventional low-protein diet in terms of its effect on protein-energy status, renal function and biochemical parameters of renal osteodystrophy.Publisher’s versio

Supplemented low-protein diets : are they superior in chronic renal failure?

CITATION: Herselman, M. G. et al 1995. Supplemented low-protein diets : are they superior in chronic renal failure? South African Medical Journal, 85(5):361-365.The original publication is available at http://www.samj.org.zaTwenty-two patients with chronic renal failure were randomly assigned to a conventional low-protein diet containing 0,6g protein/kg/day or a very-low-protein diet containing 0,6g protein/kg/day supplemented with essential amino acids; they were followed up for 9 months. There were no significant changes in body mass index, arm muscle area, percentage body fat, serum albumin and transferrin levels in any of the groups; neither was there any difference between the groups in respect of these parameters. Renal function, as measured by the reciprocal of serum creatinine over time, stabilised in both groups during intervention, with no significant difference between the groups. There was however no correlation between changes in renal function and changes in blood pressure, or dietary intake of protein, phosphorus, cholesterol, polyunsaturated and saturated fatty acids. There were also no significant changes and no significant differences between the groups in serum levels of parathyroid hormone and alkaline phosphatase, urine cyclic adenosine monophosphate, tubular reabsorption of phosphate, and the theoretical renal threshold for phosphate. The results of this study suggest that the supplemented very-low-protein diet was not superior to the conventional low-protein diet in terms of its effect on protein-energy status, renal function and biochemical parameters of renal osteodystrophy.Publisher’s versio

Risk factors for the development of osteoporosis in a South African population. A prospective study

CITATION: Blaauw, R. et al. 1994. Risk factors for the development of osteoporosis in a South African population. A prospective study. South African Medical Journal, 84:328-332.The original publication is available at http://www.samj.org.zaDespite the vast number of risk factors that apparently predispose to the development of osteoporosis (OP), they have not been accurately identified and given relative priority. In order to analyse possible risk factors prospectively in a local patient population with overt OP (histomorphometrically confirmed and characterised) and compare it with an appropriately matched non-OP control group (with normal bone mass on dual-energy X-ray absorptiometry), a detailed general history, risk factor analysis, dietary history and anthropometric data were obtained from 56 OP and 125 non-OP subjects. In females a positive family history of OP (P = 0,002), a fair complexion (P = 0,009), lower body mass (P = 0,02) and height (P = 0,03), no breast-feeding of babies (P = 0,006), a history of smoking (P = 0,001) and fat distribution around the waist (P = 0,009) were idenfified as risk factors. In males lack of exercise (P = 0,008), a history of smoking (P = 0,01), lower body mass (P = 0,04) and height (P = 0,04), a preference for salty food (P = 0,02) and fat distribution around the waist (P = 0,002) appeared to predispose. Dietary calcium, phosphorus, protein and caffeine intakes were similar in OP and control subjects, but alcohol consumption was clearly higher in both OP males (P = 0,001) and females (P = 0,01).Publisher’s versio

Body fat distribution as a risk factor for osteoporosis

CITATION: Blaauw, R. Albertse, E. C. & Hough, S. 1996. Body fat distribution as a risk factor for osteoporosis. South African Medical Journal, 86:1081-1084.The original publication is available at http://www.samj.org.zaObjective. The aim of this study was to compare the body fat distribution of patients with osteoporosis (OP) with that of an appropriately matched non-OP control group. Design. Case control study. Setting. Department of Endocrinology and Metabolism, Tygerberg Hospital. Participants. A total of 56 patients with histologically proven idiopathic OP, of whom 39 were women (mean age 61 ± 11 years) and 17 men (49 ± 15 years), were compared with 125 age- and sex-matched non-OP (confirmed by dual energy X-ray absorptiometry) subjects, 98 women (60 ± 11 years) and 27 men (51 ± 16 years). Outcome measures. Anthropometric data, including weight, height, skinfold measurements, mid-upper arm, waist and hip circumferences, as well as elbow breadth. Results. The men and women with OP were significantly shorter (P = 0.04 and P = 0.03 respectively) and of lower body mass (P = 0.04 and P = 0.02 respectively) than the control subjects, although their mean body mass indices were comparable. The OP population had significantly lower skinfold, elbow breadth and arm circumference values, although the majority of subjects in both groups fell within the 15 - 85th percentiles. Despite their lower body mass, both the OP women (P = 0.009) and men (P = 0.002) had significantly higher waist/hip ratios than corresponding controls. Conclusion. Whatever the underlying pathogenesis, this new finding suggests that, should these results be confirmed by larger studies, OP can be added to the list of diseases associated with a waist fat distribution.Publisher’s versio

Liraglutide and Renal Outcomes in Type 2 Diabetes.

BACKGROUND: In a randomized, controlled trial that compared liraglutide, a glucagon-like peptide 1 analogue, with placebo in patients with type 2 diabetes and high cardiovascular risk who were receiving usual care, we found that liraglutide resulted in lower risks of the primary end point (nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular causes) and death. However, the long-term effects of liraglutide on renal outcomes in patients with type 2 diabetes are unknown. METHODS: We report the prespecified secondary renal outcomes of that randomized, controlled trial in which patients were assigned to receive liraglutide or placebo. The secondary renal outcome was a composite of new-onset persistent macroalbuminuria, persistent doubling of the serum creatinine level, end-stage renal disease, or death due to renal disease. The risk of renal outcomes was determined with the use of time-to-event analyses with an intention-to-treat approach. Changes in the estimated glomerular filtration rate and albuminuria were also analyzed. RESULTS: A total of 9340 patients underwent randomization, and the median follow-up of the patients was 3.84 years. The renal outcome occurred in fewer participants in the liraglutide group than in the placebo group (268 of 4668 patients vs. 337 of 4672; hazard ratio, 0.78; 95% confidence interval [CI], 0.67 to 0.92; P=0.003). This result was driven primarily by the new onset of persistent macroalbuminuria, which occurred in fewer participants in the liraglutide group than in the placebo group (161 vs. 215 patients; hazard ratio, 0.74; 95% CI, 0.60 to 0.91; P=0.004). The rates of renal adverse events were similar in the liraglutide group and the placebo group (15.1 events and 16.5 events per 1000 patient-years), including the rate of acute kidney injury (7.1 and 6.2 events per 1000 patient-years, respectively). CONCLUSIONS: This prespecified secondary analysis shows that, when added to usual care, liraglutide resulted in lower rates of the development and progression of diabetic kidney disease than placebo. (Funded by Novo Nordisk and the National Institutes of Health; LEADER ClinicalTrials.gov number, NCT01179048 .)