Selenate-supplemented nutritional formula increases plasma selenium in hemodialysis patients

OBJECTIVE

The purpose of this study was to determine the short-term effect of feeding selenium-supplemented formulas on the selenium status of end-stage renal disease patients on hemodialysis.

DESIGN AND SETTING

The prospective, randomized, single-blind study of parallel design was conducted at three hemodialysis clinics.

PATIENTS

A total of 79 hemodialysis patients were randomly assigned into one of three groups.

INTERVENTION

Liquid nutritional formula supplemented with either selenite (28 microg Se/8 oz, n = 26), selenate (28 microg Se/8 oz, n = 26), or nonfortified (7 microg Se/8 oz, n = 27) was fed to hemodialysis patients as their sole source of nutrition for 14 days.

MAIN OUTCOME MEASURE

Plasma and red blood cell (RBC) selenium and glutathione peroxidase (GPX) activities were measured in predialysis blood both before (day 1) and after (day 8) a 7-day baseline period, and after subjects received the formula as the sole source of nutrition (approximately 35 kcal/kg/d) for 14 days (day 22).

RESULTS

Selenium intake (Mean +/- SEM, microg/d) was 134 +/- 9, 140 +/- 9, and 35 +/- 2 for patients receiving selenite-, selenate-, or non-supplemented formula, respectively. On day 22, plasma selenium (micromol/L) was greater (P <.032) in the selenate-supplemented group (1.5 +/- 0.1) compared with the nonsupplemented group (1.2 +/- 0.1), but not compared with the selenite-supplemented group (1.4 +/- 0.1). Plasma GPX activity was 44% to 60% that of healthy controls and not different among groups. RBC selenium and GPX activities were within the normal range and were not different among groups.

CONCLUSION

The results of this study indicate that a liquid formula supplemented with selenium as selenate is successful at maintaining selenium concentrations within normal range, as well as significantly increasing plasma selenium levels compared with nonsupplementation.

Safety and tolerance of medical nutritional products as sole sources of nutrition in people on hemodialysis

OBJECTIVE

Establish and compare the safety and tolerance of three medical nutritional products when used as sole sources of nutrition in stable hemodialysis patients.

DESIGN

Prospectively randomized, controlled, single blind, parallel design.

SETTING

Three outpatient hemodialysis clinics.

PARTICIPANTS

Seventy-nine normally nourished, stable, anuric, adequately dialyzed, adult outpatients with end-stage renal disease (ESRD) and requiring thrice weekly hemodialysis.

INTERVENTION

A 3-week trial was conducted. During the first week, baseline medical history and physical examination, gastrointestinal symptom, urea kinetic, bowel habit, and biochemical data were collected while participants ingested their usual diet. During the last 2 weeks, the same data were collected while participants orally ingested 35 kcal/kg actual weight/d of one of three medical nutritional products as a sole source of nutrition. Products were a standard medical nutritional (EN-9527) and two renal nutritionals (EN-9528 and EN-9529). The latter product was a reformulation of EN-9528 and contained added beta-carotene and fructooligosaccharides.

MAIN OUTCOME MEASURES

Gastrointestinal symptoms, bowel habits (stool frequency and consistency), routine blood chemistries, urea kinetics, and normalized protein catabolic rate (nPCR) RESULTS: All three groups achieved a mean energy and protein intake of approximately 35 kcal/kg/d and 1.25 g protein/kg/d during the last 10 days of the sole source feeding period. Adherence with the formula ingestion targets was assessed using both a patient-completed product consumption log and nPCR. By intent to treat analysis, there were no changes in number or severity of gastrointestinal symptoms, stool frequency or stool consistency, or urea kinetics between the baseline week and during product consumption. In comparison to the standard formulation, the disease-specific formulations resulted in improved serum phosphorus and calcium-phosphorus product. Patients receiving the fructooligosaccharide-containing product (EN-9529), by Chi-squared analysis, had less constipation than for the comparable product without oligosaccharides (EN-9528) or the standard medical nutritional (EN-9527).

CONCLUSION

Use of enteral nutritionals as a sole source of nutrition is both possible and well tolerated in hemodialyzed patients. Selection of a disease-specific formulation offered advantages over a standard formulation in the management of biochemical complications of renal disease when the products were used as a sole source of nutrition.

The hemodialysis pilot study: nutrition program and participant characteristics at baseline. The HEMO Study Group

OBJECTIVE

Describe the nutrition program (assessments and interventions) and the participants' baseline nutritional characteristics in the Hemodialysis Pilot Study.

DESIGN

Cross sectional survey in which hemodialysis patients were examined during 10 weeks of baseline (BL), before randomization study interventions (dose and flux).

SETTING

Four hemodialysis centers (eight dialysis units in total).

PATIENTS

Twenty-nine male (mean age, 63 years; range, 34 to 75) and 20 female (mean age, 61 years; range, 29 to 73) hemodialysis patients.

INTERVENTIONS

None during BL.

MAIN OUTCOME MEASURES

Feasibility of implementing the proposed nutrition program before conducting the full-scale trial, and description of baseline characteristics related to nutrition.

RESULTS

A nutrition program was developed to assess nutritional status during BL and follow-up periods and to intervene in patients with weight loss or decreasing serum albumin. Methods for collecting biochemical, dietary and anthropometric data were implemented at four clinical centers. At baseline, mean protein intake estimated by single pool normalized protein catabolic rate was 0.95 +/- 0.21 gm/kg adjusted body weight (ABW) (n = 42) and by diet record assisted recalls (n = 47) 0.94 +/- 0.36 gm/kg ABW/d, respectively. Mean energy intake was 22.8 +/- 8 kcal/kg ABW/day (n = 39). Mean serum albumin concentration using the bromcresol green method was 3.8 +/- 0.4 gm/dL (n = 40). Mean body mass index was within the normal limits of 19-27 kg/m2. Mean skinfold thicknesses in females, but not males, were shifted toward the lower end of usual distributions for healthy individuals.

CONCLUSIONS

The goal of designing, developing, and implementing the diet and nutrition component, and related data collection for the HEMO pilot study was accomplished at four separate clinical centers. Baseline mean protein and energy intake were low, suggesting that continuing dietary surveillance is needed. The ongoing full-scale HEMO study will provide the first prospective analysis of dietary intake, nutritional status, and outcome in maintenance hemodialysis patients as a function of dialysis dose and membrane flux.

Mechanical and physiologic modifiers and bioelectrical impedance spectrum determinants of body composition

Fat-free mass and total and percentage body fat were determined by dual-energy X-ray absorptiometry (DXA) and total-body and segmental impedance measures were taken at 16 frequencies from 5 to 1300 kHz in a sample of white men and women aged 18-30 y. Plots of total-body and segmental impedance against frequency for each individual indicated that the general shape of these curves was described by the same mathematical function consisting of three components-ai, bi, and ci,-that contain information derived from the individual measurements of impedance summarized across the spectrum of current frequencies. Total-body and segmental multifrequency impedance were significantly correlated with hemoglobin, hematocrit, and serum sodium, potassium, creatinine, and osmolality. Regression models of body composition with total-body or segmental impedance measures at discrete frequencies or the impedance spectrum variables were similar to corresponding findings for impedance models at 50 kHz. The segmental impedance spectrum variables for total and percentage body fat and the ratios of low- to high-frequency impedance from the trunk were significantly associated with total body fatness as measured by DXA.

Use of statistical methods to estimate body composition

Epidemiologic investigations of chronic diseases in relation to body composition require large samples. This necessitates simple, reliable, and portable measures of body composition. Bioelectrical impedance analysis (BIA) variables and selected anthropometric characteristics are frequently used to predict body composition for groups or individuals when the application of sophisticated methods is not practical. We address statistical issues pertinent to the formulation of prediction equations for body composition from BIA measures and anthropometry, and factors associated with the accuracy and precision of the prediction equations.

Evaluation of accuracy and reliability of calipers for measuring recumbent knee height in elderly people

Height measurements in elderly individuals are frequently not feasible and stature must be estimated from knee height. This study compared the accuracy and reliability of a knee-height caliper developed by Ross Laboratories with Mediform and GPN models. Two observers measured 40 elderly ambulatory volunteers with each caliper. Knee height was measured on the left leg from the heel to a point 5 cm proximal to the patella. Intracaliper reliability was similar. Mean absolute differences between repeated measurements ranged from 0.17 to 0.25 cm, technical errors of the estimate ranged from 0.16 to 0.26 cm, and coefficients of reliability exceeded 0.99 for each model. Equations based on knee height predicted subjects' stature to +/- 2.3 cm, an amount unlikely to substantially impair height-based nutrition indices. This comparatively inexpensive caliper was as accurate and reliable as more expensive commercially available models and may be recommended as an alternative to the other calipers.