BACKGROUND: Chronic renal failure (CRF) provokes derangement in various hormonal regulations of food intake and energy expenditure. In the present study, we have examined the effect of a low protein, low phosphorus diet on circulating levels of leptin, tumour necrosis factor (TNF)-alpha, and insulin in patients with CRF. METHODS: Seventeen male, non-diabetic subjects with conservatively treated CRF (estimated creatinine clearance 39.5 +/- 11.1 mL/min), and proteinuria below 2 g/day were prospectively studied. Measurements of hormonal, metabolic and anthropometric parameters were performed before and after 16 weeks of dietary treatment (protein 0.6 g/kg of ideal body mass, 30% of calories derived from fat, 62% of calories derived from carbohydrates and 10 mg/kg of phosphorus). Actual dietary intake in patients was measured by using 3-day food records and was supervised by the dietician. RESULTS: Body mass index and body fat mass remained unchanged during the 4 months of dietary treatment. Urea, leptin, and TNF-alpha serum concentrations decreased significantly. CONCLUSIONS: A low protein, low phosphorus diet reduces TNF-alpha and leptin levels in plasma. The effect on leptin appears not to be mediated by an insulin-dependent mechanism.
BACKGROUND:Chronic renal failure (CRF) provokes derangement in various hormonal regulations of food intake and energy expenditure. In the present study, we have examined the effect of a low protein, low phosphorus diet on circulating levels of leptin, tumour necrosis factor (TNF)-alpha, and insulin in patients with CRF. METHODS: Seventeen male, non-diabetic subjects with conservatively treated CRF (estimated creatinine clearance 39.5 +/- 11.1 mL/min), and proteinuria below 2 g/day were prospectively studied. Measurements of hormonal, metabolic and anthropometric parameters were performed before and after 16 weeks of dietary treatment (protein 0.6 g/kg of ideal body mass, 30% of calories derived from fat, 62% of calories derived from carbohydrates and 10 mg/kg of phosphorus). Actual dietary intake in patients was measured by using 3-day food records and was supervised by the dietician. RESULTS: Body mass index and body fat mass remained unchanged during the 4 months of dietary treatment. Urea, leptin, and TNF-alpha serum concentrations decreased significantly. CONCLUSIONS: A low protein, low phosphorus diet reduces TNF-alpha and leptin levels in plasma. The effect on leptin appears not to be mediated by an insulin-dependent mechanism.