Objective: To evaluate the effects on the nutritional and metabolic parameters of a very-low-protein diet supplemented with ketoacids (VLPD þ KA) in comparison with a conventional low-protein diet (LPD) in chronic kidney disease (CKD) patients. Design: Prospective, randomized, controlled clinical study. Setting: Outpatient Clinic of the Nephrology Division of Federal University of São Paulo, Brazil. Subjects: The study involved 24 patients with advanced CKD (creatinine clearance o25 ml/min) that were randomly assigned to either a VLPD þ KA (VLPD þ KA group, 12 patients) or to a conventional LPD with 0.6 g/kg/day (LPD group, 12 patients). The patients were followed for 4 months. Results: Nutritional status was adequately maintained with both diets for the studied period. Protein intake and serum urea nitrogen decreased significantly only in the VLPD þ KA group (from 0.6870.17 to 0.4370.12 g/kg/day, Po0.05; from 61.4712.8 to 43.6714.9 mg/dl, Po0.001; respectively). Ionized calcium did not change in the VLPD þ KA group but tended to decrease in the LPD group. Serum phosphorus tended to decrease in the VLPD þ KA group probably as a result of a significant reduction in dietary phosphorus (5297109 to 3737125 mg/day, Po0.05) associated to the phosphorus-binding effect of the ketoacids. No change in these parameters was found in the LPD group. Serum parathormone increased significantly only in the LPD group (from 2417138 to 4947390 pg/ml, Po0.01). The change in PTH concentration was negatively correlated with changes in ionized calcium concentration (r ¼ À0.75, P ¼ 0.02) and positively correlated with changes in serum phosphorus (r ¼ 0.71, P ¼ 0.03) only in the LPD group. Conclusion: This study indicates that a VLPD þ KA can maintain the nutritional status of the patients similarly to a conventional LPD. Besides, an improvement in calcium and phosphorus metabolism and a reduction in serum urea nitrogen were attained only with the VLPD þ KA. Thus, VLPD þ KA can constitute another efficient therapeutic alternative in the treatment of CKD patients. Sponsorship: This study was supported by CAPES, Oswaldo Ramos Foundation and Fresenius Kabi, Ltda.

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de consumo alimentar. Quanto ao estado nutricional, 42,9% dos menores de 2 anos e 28,6% dos maiores de 10 anos estavam desnutridos; na faixa etária de 2 a 10 anos não houve nenhuma criança desnutrida. Quanto ao consumo alimentar, 33,3% atingiram a recomendação de energia e 95,2% atingiram a recomendação de proteína. Podemos concluir que a mucoviscidose afeta o estado nutricional das crianças em períodos críticos de crescimento e desenvolvimento, e que a qualidade da dieta destes pacientes pode ser melhorada através de um cuidado nutricional adequado.Termos de indexação: nutrição, fibrose cística, avaliação nutricional, ingestão de alimentos, criança. ABSTRACT ABSTRACT ABSTRACT ABSTRACT ABSTRACTCystic fibrosis affects nutritional status because it interferes with adequate ingestion and absorption of nutrients. The present study evaluated 22 fibrocystic patients, who attended ambulatory visits at Hospital Infantil Joana de Gusmão, in the city of Florianópolis, Santa Catarina, Brazil, from August 1998 to January 1999. Nutritional status was determined by anthropometric measurements and food intake data. As to the nutritional status, 42.9% of the children under 2 years old and 28.6% over 10 years old were malnourished. Children between 2-10 years old did not present malnutrition. Evaluation of nutritional intake showed that 33.3% were eating adequate amounts of energy, and 95.2% of protein.It can be concluded that cystic fibrosis affects nutritional status of children in critical periods of growth and development, and that the quality of their diets can benefit from adequate nutritional care

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