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This study aimed to evaluate the impact of a nutritional behavioral intervention on intuitive eating (IE) scores of overweight non-dialysis-dependent (NDD) women with chronic kidney disease (CKD) and to investigate the relationship of IE scores with demographic, nutritional, and quality of life parameters in this group.This is a prospective non-controlled clinical trial of a behavioral multi-session group intervention for dietary management. Each group comprised five to eight participants in 14 weekly or biweekly sessions lasting about 90 minutes each. The IE principles were discussed during the meetings. The IE scale (IES-2), translated and adapted to the study population, with a four-factor model was applied to assess IE attitudes. The 36-Item Short-Form Health Survey (SF-36) questionnaire was applied to assess health-related quality of life.Of the 33 patients who began participation in the study, 23 patients [median (interquartile): age = 62.0 years (58.0-68.0); 52.2% with diabetes; BMI = 32.6 kg/mThe nutritional behavioral intervention embracing IE principles was effective to improve IE attitudes for this group of CKD patients. These results are promising and may contribute to a paradigm change in the strategies to enhance motivation and adherence to dietary recommendations in this population.

The aim of this study is to evaluate the association between bowel habits and microbial-derived uremic toxins p-cresyl sulfate (PCS) and indoxyl sulfate (IS) in patients with non-dialysis-dependent chronic kidney disease (NDD-CKD).This is a cross-sectional analysis including 43 nondiabetic NDD-CKD patients (58% men; 59.0 ± 13.5 years; estimated glomerular filtration rate, 21.3 ± 7.9 mL/min/1.73 mThe frequency of constipation assessed by BSS and Rome III criteria was 33% (n = 14/43) and 35% (n = 15/43), respectively. The BSS3 exhibited higher PCS, independent of renal function and dietary protein-fiber ratio (β [95% confidence interval {CI}]: serum, total PCS = 1.54 [1.06-2.23], P = .02; serum free PCS = 1.40 [1.00-1.97], P = .05; urinary PCS = 1.78 [1.10-2.90], P .02). According to the Rome III criteria, a tendency for a higher serum total PCS (β [95% CI]: 1.39 [0.95-2.03 μmol/L], P = .09) and a significantly higher urinary PCS (β [95% CI]: 1.80 [1.11-2.94 μmol/24 h], P = .02) was found in constipated participants. No effect of a compromised bowel habit (Rome III criteria or BSS) was found on IS.Constipation may lead to production of PCS in nondiabetic NDD-CKD patients.

Objective The role of vitamin D supplementation on vascular calcification (VC) in patients with chronic kidney disease (CKD) is controversial. The objective of this study was to evaluate the effects of long-term cholecalciferol supplementation on VC in nondialysis patients with CKD stages 3–4 with hypovitaminosis D. Design and Methods Eighty patients aged 18–85 years with creatinine clearance between 15 and 60 mL/min/1.73 m2 and serum 25(OH)D level Results During the study, VC did not change in the treated insufficient group (418 [81–611] to 364 [232–817] AU, P = 0.25) but increased in the placebo group (118 [37–421] to 199 [49–490] AU, P = 0.01). The calcium score change was inversely correlated with 25(OH)D change (r = −0.45; P = 0.037) in the treated insufficient group but not in the placebo group. Renal function did not change in the insufficient, treated, and placebo groups. In multivariate analysis, there was no difference in VC progression between the treated and placebo insufficient groups (interaction P = 0.92). In the deficient group, VC progressed (265 [84–733] to 333 [157–745] AU; P = 0.006) and renal function declined (33 [26–43] to 23 [17–49] mL/min/1.73 m2; P = 0.04). The calcium score change was inversely correlated with cholecalciferol cumulative doses (r = −0.41; P = 0.048) and kidney function change (r = −0.43; P = 0.033) but not with 25(OH)D change (r = −0.08; P = 0.69). Conclusion: Vitamin D supplementation did not attenuate VC progression in CKD patients with hypovitaminosis D. Conclusion Vitamin D supplementation did not attenuate VC progression in CKD patients with hypovitaminosis D.

Background End-stage renal disease results in B cell lymphopenia and low levels of vitamin D. Since the link between vitamin D deficiency and B lymphocytes dysfunction are not clear in patients with end-stage renal disease, we suggest that vitamin D adequacy and factors related to the homeostasis of these cells should be investigated. B lymphocytes homeostasis is a process mainly regulated signals of grown and death as interleukin (IL)-7, B cell-activating factor (BAFF)/BAFF-receptor and CD95 expression. Objective As vitamin D serum levels were reduced in patients with end stage renal disease and it is associated with human B homeostasis, we evaluated the effect of cholecalciferol supplementation on dialysis. Design Randomized, double blind clinical trial in dialysis patients with 25OH Vitamin D deficiency for a period of 12 weeks. Main Outcome Measure In a pilot study, we investigated the effect of cholecalciferol supplementation (100,000 UI once per week or placebo. In vitro, peripheral blood mononuclear cells isolated by Ficoll-Hypaque centrifugation from 12 healthy volunteers were incubated with healthy or uremic serum in the presence or absence of 25 (OH)DC with 5% CO. Results There was an increase in the serum 25(OH)D level in the cholecalciferol group. No differences were found in BAFF and IL7 levels and CD95 and BAFF-R expression in B lymphocytes from patients on dialysis after cholecalciferol supplementation. Uremic serum induced an increase in the IL-7, BAFF, BAFF-R and CD95 expression compared with the control. However, we observed no effect of incubation of 25(OH)D3 and 1,25(OH)2D3 on the expression of IL-7, BAFF, BAFF-R and CD95 when incubated in the presence of normal or uremic serum. Conclusion Our results suggest that vitamin D is not involved in mechanisms of regulation of differentiation and survival in B lymphocytes. In conclusion, further studies are needed to explore the effects of vitamin D on B lymphocytes to better evaluate the possible impact of vitamin D on humoral response in the CKD population.

Objectives The aims of the study were to evaluate the quality of the diet of nondialysis-dependent patients with chronic kidney disease and to investigate the impact of dietary counseling in the quality of the diet of these patients. Methods In the cross-sectional analysis, 3-day food records of 100 nondialysis-dependent patients with chronic kidney disease patients, in the first visit to the renal dietitians, were evaluated using the Diet Quality Index (DQI). Under-reporters were excluded. DQI is comprised by 10 components: 6 are food groups (fruits, vegetables, cereals, milk and dairy, meats and eggs, and legumes); 3 are nutrients (total fat, sodium, and cholesterol), and the last one is the diet variety. Each component is scored from 0 to 10, according to the adequacy of the Brazilian dietary guideline, and an overall score ranging from 0 (poor) to 100 (good) is obtained. In a subsample of 44 patients, a prospective analysis was performed to compare the DQI and its components before and after dietary counseling. Results The median DQI score was 68.6 (62.3-75.6; interquartile range), which means that most of the patients (92%) had a diet that "needs improvement" (DQI between 50 and 80 points). The DQI components with the lowest scores (lower adequacy) were sodium (0.0 [0.0-0.9]), dairy (3.9 [2.1-6.0]), and vegetables (6.0 [2.8-9.5]), whereas meat/egg, legumes, and cholesterol had the highest scores. Vegetables, legumes, and diet variety components were significantly lower in the lower tertiles of DQI. After a median follow-up of 25.0 (17.0-35.8) months comprising 6 (5-10) visits to the dietitian, energy, protein, and micronutrients intake were significantly reduced. The dietary counseling did not improve the overall DQI (after: 69.0 [69.0-74.8]; P = .95) and, a significant reduction in the score of legumes (from 10.0 [2.7-10.0] to 7.8 [4.7-10.0], P = .00) and diet variety (from 7.0 [5.3-10.0] to 6.0 [4.0-9.0], P = .02) components were observed. Conclusion The diet of this cohort of patients needs to be improved, particularly regarding vegetables, food variety, and sodium intake. Dietary counseling had no positive impact on the diet quality. This result highlights the importance of focusing the dietary counseling not simply on nutrient or food restriction but providing healthy food choices aiming to improve the overall diet quality of the patients.

Objectives Diagnosing obesity by body mass index (BMI) may not be reliable in elderly individuals due to the changes in body composition. We aimed to analyze the accuracy of BMI thresholds by World Health Organization (WHO) and Nutrition Screening Initiative (NSI) to diagnose obesity in elderly patients on hemodialysis (HD). Design Multicenter cross-sectional study. Setting Six dialysis facilities. Subjects 169 elderly on chronic HD (70.4 ± 7.1 years; 63.9% men). Main Outcome Variable Total body fat percentage (BF%) was assessed by the sum of skinfold thicknesses and abdominal fat by waist circumference (WC). Both were used as reference to test the specificity and sensitivity of BMI thresholds (WHO: ≥30 kg/m 2 ; NSI: >27 kg/m 2 ). Results The prevalence of obesity according to NSI-BMI, WHO-BMI, BF%, and WC thresholds were 31%, 13%, 27%, and 29.6% in men, respectively, and 36%, 15%, 13%, and 75% in women. Compared to BF%, the sensitivity of NSI-BMI was moderate (65.5%) for men and high (100%) for women, whereas that of WHO-BMI was low (31%) for men and high (87.5%) for women. Compared with WC, NSI-BMI had good (75%) sensitivity for men and moderate (47.8%) for women, whereas WHO-BMI had moderate (43.8%) sensitivity for men and low (19.6%) for women. The best agreement with BF% was observed for NSI-BMI in men (kappa = 0.46) and for WHO-BMI in women (kappa = 0.80). For WC, the best agreement was for WHO-BMI for men (kappa = 0.63) and NSI-BMI for women (kappa = 0.31). Conclusions BMI thresholds do not accurately diagnose adiposity in elderly on HD. Therefore, using BMI may lead to misclassifications in this segment population.

To evaluate the effects of olive oil and flaxseed oil compared with mineral oil for the treatment of constipation in patients undergoing hemodialysis.A 4-week, double-blind, randomized, and controlled trial was conducted. Fifty constipated patients (29% male, 51 ± 12 years) diagnosed by the Rome III criteria were randomly assigned to receive mineral oil (control group; n = 17), olive oil (n = 16), or flaxseed oil (n = 17). The initial oil dose was 4 mL/day, and adjustments during the follow-up could be made as needed. The impact of the intervention was assessed by the Rome III criteria scores.The most frequent symptoms of constipation evaluated by the Roma III criteria at baseline were comparable among the groups and included "incomplete evacuation" (92%), "lumpy or hard stools," (72%) and "anorectal obstruction" (70%). The Rome III score improved significantly in patients receiving mineral oil (10.5 ± 5.0 to 4.1 ± 4.0; P .01), olive oil (10.3 ± 4.2 to 3.2 ± 3.8; P = .01), and flaxseed oil (9.6 ± 4.2 to 6.0 ± 5.1; P .01), with no significant group-by-time interaction (P = .15). The scores of 5 from 6 constipation symptoms reduced similarly in the mineral oil and olive oil groups, whereas only the frequency of evacuation and the consistency of stools improved in the flaxseed oil group.We demonstrated that the daily use of olive oil or flaxseed oil was as effective as mineral oil in the treatment of constipation in patients undergoing hemodialysis.

Objective: The malnutrition-inflammation score (MIS) is a nutritional scoring system that has been associated with muscle strength among dialysis patients. We aimed to test whether MIS is able to predict muscle strength in nondialysis-dependent chronic kidney disease (NDD-CKD) individuals. Design andMethods:Thiswas across-sectional study conducted at theDante Pazzanese Instituteof Cardiology, Hypertension, and Nephrology Division outpatient clinic. We evaluated 190 patients with NDD-CKD stages 2-5 (median 59.5 [interquartile range 51.4-66.9] years; 64% men). MIS was calculated without computing dialysis vintage to the scoring. HGS was assessed in the dominant arm. Anthropometric, laboratory, and body composition parameters were recorded. Results: A strong negative correlation was found between HGS and MIS (r 52 0.42; P # .001) in univariate analysis. In multivariate regressions, adjustment for age, sex, diabetes, glomerular filtration rate, body cell mass, and C-reactive protein did not materially diminish these relationships. Conclusions: MIS shares strong links with objective measures of muscle strength in NDD-CKD patients.

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Oswaldo Ramos Foundation Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Background: Hypovitaminosis D is highly prevalent among patients with chronic kidney disease and has been associated with worse outcome even in the earlier stages of the disease.Objective: This study aimed to investigate the risk factors for hypovitaminosis D in nondialyzed patients with chronic kidney disease.Design: This cross-sectional study included 120 patients with chronic kidney disease at stages 2 to 5 (62% male, age: 55.4 +/- 11.3 year, estimated glomerular filtration rate: 35.1 +/- 15 mL/minute, body mass index [BMI]: 27.1 +/- 5.2 kg/m(2), 31% diabetics). Serum 25-hydroxivitamin D [25(OH) D] was measured by chemiluminescence. Subjective global assessment, total body fat (dual-energy X-ray absorptiometry), visceral and subcutaneous abdominal fat (computed tomography), and several laboratory parameters were assessed.Results: Insufficiency of 25(OH) D (15 to 30 ng/mL) was observed in 55% and deficiency (= 30 kg/m(2), and who had the blood collection during the winter or spring had lower levels of 25(OH) D. Serum 25(OH) D correlated inversely with parathyroid hormone, proteinuria, insulin resistance, leptin, and subcutaneous abdominal fat. the risk factors for hypovitaminosis D were diabetes (odds ratio: 3.8; 95% CI: 1.2 to 11.7; P = .022) and BMI >= 30 kg/m(2) (odds ratio: 4.3; 95% CI: 1.2 to 15.3; P = .018). in the logistic regression analysis adjusting for gender, skin color, and season of the year, diabetes and BMI >= 30 kg/m(2) were independently associated with hypovitaminosis D.Conclusions: Diabetes and obesity were the risk factors for hypovitaminosis D in nondialyzed patients with chronic kidney disease. Effective interventional protocols of vitamin D supplementation taking into account these risk factors are warranted for this population. (C) 2012 by the National Kidney Foundation, Inc. All rights reserved. Universidade Federal de São Paulo, Nutr Program, BR-04039000 São Paulo, Brazil Universidade Federal de São Paulo, Nutr Program, BR-04039000 São Paulo, Brazil FAPESP: 05/02442-4 CNPq: 136605/2008-7 Web of Science

The aim of this study was to evaluate the activity-related energy expenditure (AEE) of patients undergoing hemodialysis (HD) and to compare it with that of healthy controls.This was a cross-sectional study.This was an in-center study conducted at the Dialysis Unit, Nephrology Division, Federal University of São Paulo-Oswaldo Ramos Foundation, Brazil.AEE was evaluated in 32 patients undergoing HD (20 men, aged: 46.3 ± 12.2 years). A subgroup consisting of 22 patients was pair-matched by gender and age with 22 sedentary, healthy individuals. AEE was measured over a period of 5 days using a portable physical activity monitor. Body fat and lean body mass were assessed by dual energy X-ray absorptiometry and body cell mass by bioelectrical impedance analysis.AEE correlated positively with lean body mass and body cell mass, and negatively with age, body fat, and body mass index. From the multiple regression analysis, it was found that age and lean body mass (r(2) = 0.32) or body cell mass (r(2) = 0.30) were the best among the variables that explained variations in AEE. AEE of HD patients in comparison with healthy controls was found to be lower on dialysis days (234 [9.5 to 1,145] kcal/day vs. 565 [214 to 1,319] kcal/day, median [range]; P.01) as well as on nondialysis days (369 [89.5 to 1,242] kcal/day vs. 565 [214 to 1,319] kcal/day; P = .02). Total energy expenditure of the HD patients on dialysis days (2,051 ± 289 kcal/day) as well as nondialysis days (2,202 ± 283 kcal/day) was also found to be lower in comparison with controls (2,514 ± 307 kcal/day; P.01). The average contribution of the AEE toward total energy expenditure in HD patients was 15%, whereas in controls it was 24% (P = .03).As compared with sedentary, healthy individuals, AEE was reported to be considerably lower in HD patients.

Objective: The assessment of energy expenditure in patients with chronic kidney disease (CKD) is a subject that has started to be investigated in the past 3 decades. This review will focus on studies that have assessed the energy expenditure of CKD predialysis and dialysis patients. Till date, most studies on this subject have focused on the assessment ofresting energy expenditure (REE).In this regard,the currentpublished datahave demonstratedthat clinically stable nondialysed CKD patients have REE similar or slightly lower than that of age- and gender-matched healthy individuals. For dialyzed patients, in both hemodialysis and peritoneal dialysis, the results are indicative that the REE of these patients is similar to that of age- and gender-matched healthy controls. The investigation of REE in specific catabolic conditions, such as poorly controlled diabetes, hyperparathyroidism, and inflammation, has shown that the REE in these catabolic conditions is increased. Additionally, it has also been reported that the hemodialysis procedure per se is also capable of enhancing the energy expenditure. The energy expenditure for physical activity is also an important component of energy expenditure and has been scarcely investigated in patients with CKD. The few studies that have investigated energy expenditure for physical activity have shown values lower than that of healthy sedentary individuals. Conclusion: These results are highly suggestive that patients with CKD have a sedentary lifestyle. The effect of the present knowledge of energy expenditure on the energy requirements of the patients with CKD remains to be investigated in studies using gold standard methods for this purpose. 2011 by the National Kidney Foundation, Inc. All rights reserved.

Vitamin D was discovered and had its chemical structure described in the early years of the last century. Although classified as a nutrient because it was found in small quantities in butter, it soon became clear that exposure of skin to sunlight, supplies most of the vitamin D necessary for good health in human beings. Vitamin D (D3 or cholecalciferol) synthesis in the skin is extremely rapid and remarkably robust despite the complexity of the mechanisms involved. However, a number of factors related to latitude location, season, and skin characteristics can interfere with the photoproduction of vitamin D. The 2 forms of vitamin D (D3 or D2-ergocalciferol) are biologically inactive and require activation in the liver and kidney. The product of the first hydroxylation of vitamin D in the liver, 25-hydroxyvitamin D (25(OH)D), is the marker of vitamin D status. Hypovitaminosis D (serum 25(OH)D

In the past decade, there has been accumulating evidence indicating that vitamin D may provide great health benefits. Indeed, it has been shown that vitamin D deficiency not only causes bone and mineral disturbances but also may increase the risk of many common chronic diseases. Since very few foods contain vitamin D, humans depend on sun exposure to satisfy their requirements for vitamin D. However, factors related to the location, climate, aging, skin pigmentation, and use of barriers to protect from the sun light contribute to limit the synthesis of vitamin D in the skin. Vitamin D deficiency is highly prevalent in the general population and even more common in patients with chronic kidney disease (CKD). Certain conditions associated with CKD such as protein losses and the decreased food intake can predispose these patients to hypovitaminosis D. The interest in the nutritional status of vitamin D of CKD patients has been renewed after the recognition that low circulating levels of 25 hydroxyvitamin D, and not only of the vitamin D active form (1,25 dihydroxyvitamin D), can contribute to the development of secondary hyperparathyroidism. Therefore, vitamin D supplementation with either ergocalciferol or cholicalciferol has been recommended to restore and maintain adequate vitamin D status in CKD.

Objective The deletion/deletion (del/del) polymorphism of uncoupling protein 2 (UCP2) was associated with decreased energy expenditure in diabetic and obese patients. There is evidence of decreased resting energy expenditure (REE) in chronic kidney disease (CKD) patients not yet on dialysis. However, whether REE is associated with the UCP2 polymorphism was not previously investigated in this population. This study evaluated whether the del/del polymorphism of the UCP2 gene is associated with lower REE in nondialyzed CKD patients. Design This was a cross-sectional study. Patients and Methods Forty-four nondialyzed CKD patients (29 male; aged 52 ± 12 years; creatinine clearance, 37 ± 13 mL/min/1.73 m 2 [values are mean ± SD unless otherwise noted]) were included. Their REE was assessed by indirect calorimetry, and body composition by bioelectrical impedance. High-sensitivity C-reactive protein (hs-CRP) was also evaluated. The insertion/deletion (ins/del) polymorphism of the UCP2 gene was determined in all participants. To test whether the deletion/deletion (del/del) polymorphism of the UCP2 gene was associated with lower REE, the REE of carriers of the del/del genotype (n = 24; group Del) was compared with that of carriers of the insertion and ins/del genotype (n = 20; group Ins). Main Outcome Measure The main outcome measure was REE. Results The REE of group Del was similar to that of the group Ins (1379 ± 239 kcal/day vs. 1360 ± 289 kcal/day, respectively, P = NS). This result was maintained even after the REE was adjusted for lean body mass by analysis of covariance. In addition, in a multiple-regression analysis using REE as the dependent variable, only lean body mass and hs-CRP were significant predictors of REE. Conclusion The results suggest that the del/del polymorphism of the UCP2 gene is not associated with lower REE in nondialyzed CKD patients.

Vitamin D nutritional status has been poorly investigated in chronic kidney disease (CKD) patients, especially those inhabiting a subtropical area where the sunlight incidence is abundant all year.The purpose of this study was to evaluate the status of vitamin D and to analyze the relationship of circulating 25-hydroxyvitamin D [25(OH)D] with other serum parameters of mineral metabolism in patients with CKD not yet on dialysis.This cross-sectional study enrolled 144 nondiabetic CKD patients not yet receiving dialysis (stages 2 to 5 of CKD). Fasting blood samples were obtained for measurements of 25-hydroxyvitamin D [25(OH)D], 1,25-dihydroxyvitamin D [1,25(OH)(2)D], intact parathyroid hormone, phosphorus, and calcium.In the entire sample, the serum concentration of 25(OH) was 34.3 +/- 18.3 ng/mL (+/-SD unless otherwise noted). A deficiency of vitamin D, i.e., 25(OH)D15 ng/mL, was found in only one patient. Fifty-seven patients (39.6%) were considered vitamin D-insufficient (16 to 30 ng/mL). The vitamin D-insufficient group contained more females, a higher degree of proteinuria, and a lower serum concentration of 1,25(OH)(2)D. In multiple regression analysis, 25(OH)D was associated positively with 1,25(OH)(2)D, serum calcium, and proteinuria, whereas 1,25(OH)(2)D was associated only with 25(OH)D and phosphorus. The variables associated with intact parathormone were serum phosphorus and creatinine clearance, but not 1,25(OH)(2)D or 25(OH)D.Despite an elevated prevalence of vitamin D insufficiency, the serum concentration of 25(OH)D was, on average, higher than that found in patients inhabiting higher-latitude regions. This higher serum concentration may have contributed to the differences found in the relationship between vitamin D metabolites and other serum markers of mineral metabolism in our CKD patients.

Objective: The purpose of this study was to assess the zinc and iron status in patients with chronic renal failure (CRF) who were not receiving dialysis. Design: Cross-sectional study. Setting: Outclinic patients of the Nephrology Division at Federal University of Sao Paulo. Patients: This study was performed on 29 stable patients with CRF who were not receiving dialysis. Main outcome measure: The parameters for determining iron and zinc status were transferrin saturation, zinc protoporphyrin, serum ferritin, hematocrit, serum iron, total iron binding capacity, erythrocyte, and plasma zinc levels (measured by atomic absorption spectrophotometry). Results: The serum ferritin level was reduced to 85.5 ± 67.1 ng/mL and the zinc protoporphyrin level was high (68 ± 32.9 μmol/mol heme), serum transferrin saturation was 19.9% ± 7.85%, mean serum iron level was 66.6 ± 26.3 μg/dL, and mean total iron binding capacity was 336 ± 45.7 μg/dL. Absolute iron deficiency was found in 34.5% of the patients. Zinc level in erythrocytes was high (50.0 ± 7.2 μg/g hemoglobin), whereas plasma zinc was at a borderline level (74 ± 17.7 μg/dL) when compared with normal values. There were significant correlations among plasma zinc and serum iron and transferrin saturation, zinc erythrocyte, and parameters of iron. Conclusion: These results show that absolute iron deficiency can occur in patients who are not receiving dialysis and that there is an abnormal distribution of zinc levels in these patients. Moreover, a possible relationship between iron deficiency and zinc distribution was observed. © 2002 by the National Kidney Foundation, Inc.

■ Objective: To evaluate the effect of an oral energy-protein supplementation on the nutritional status of severely malnourished uremic hemodialysis patients. ■ Design: A cohort study of malnourished patients orally supplemented for 4 months. ■ Setting: A satellite hemodialysis unit at the Escola Paulista de Medicina, Sao Paulo, Brazil. ■ Patients: In a population-based sample, 14 of 123 chronic severe malnourished patients selected by clinical and anthropometric criteria initiated the study. Ten patients completed the trial. ■ Interventions: In addition to the instructed diet, each patient received a flavored oral powder supplement containing egg albumin, corn and coconut oils, hydrogenated fat, and malto-dextrin, providing 800 kcal and 19.6 g protein/d. ■ Main outcome measures: The following parameters were obtained: 3-day dietary diaries, protein catabolic rate (PCR), body weight (BW), triceps skinfold thickness (TSF), midarm circumference (MAC), body mass index, body fat (BF), percentage of body fat (PF), lean body mass (LBM), midarm muscle area (MAMA), and hematological and biochemical indices. ■ Results: At the end of the study, significant increases in total energy (27 ± 6 to 43 ± 6 kcal/kg/d) and protein consumption (1.07 ± 0.4 to 1.57 ± 0.4 g/kg/d) were observed. Significant increases were also observed in BW (48.9 ± 8.4 to 50.4 ± 8.9 kg), MAC (23 ± 2.6 to 23.8 ± 2.5 cm), TSF (6.5 ± 3.1 to 7.9 ± 3.6 mm), and BF (7.2 ± 2.8 to 8.6 ± 3.3 kg). There were no modifications in LBM and MAMA. Changes in BW correlated significantly with changes in PF ( r = 0.47; P r = 0.63; P ■ Conclusion: The oral supplement was well tolerated and was effective in improving the nutritional status of malnourished hemodialysis patients.