Is energy intake underestimated in nondialyzed chronic kidney disease patients?

Abstract

To evaluate whether energy intake of nondialyzed chronic kidney disease (CKD) patients is underestimated. Cross-sectional study. Outpatient clinic of the Federal University of Sao Paulo, Oswaldo Ramos Foundation. One hundred and thirty-one nondialyzed CKD patients (86 male, 66%; body mass index [BMI] 26 +/- 4.21, mean +/- standard deviation) were included. Body weight change was evaluated after 6 to 12 months in 59 patients of the entire group. Energy intake was evaluated using 4-day food diaries (3 weekdays and 1 weekend day), and resting energy expenditure (REE) was measured by indirect calorimetry. The ratio of energy intake to REE (EI/REE) was used to evaluate the accuracy of the recorded energy intake. An EI/REE ratio below 1.27 was used to identify patients who were underreporting their current energy intake. The majority of the patients reported an energy intake substantially below the recommendation (22.4 +/- 7.15 kcal/kg/d) and had an EI/REE ratio lower than 1.27. In patients with a BMI >or= 25, the mean EI/REE ratio was significantly lower than that of patients with a BMI < 25 (1.01 +/- 0.28 versus 1.27 +/- 0.42, P < .01, respectively). In addition, only in the group with higher BMI was the mean ratio indicative of underreporting. When the body weight of a subgroup of patients (n = 59) was evaluated after 7.9 +/- 2.4 months, it was observed that the subgroup of patients who maintained or gained body weight had a mean EI/REE not compatible with this condition (1.13 +/- 0.38). The low ratio, despite increasing or maintaining body weight, is highly suggestive of underreported energy intake. Energy intake of nondialyzed CKD patients seemed to be underestimated and was more pronounced in overweight and obese patients.