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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Background</span><p id="par0005" class="elsevierStylePara elsevierViewall">Dietary protein intake is a pivotal issue in the progression and treatment of the chronic kidney disease &#40;CKD&#41; patients&#46; The early primary care on moderate-to-advanced CKD stages of well-known causative factors such as reduction of accumulation of nitrogenous wastes&#44; metabolic derangements and protein-energy wasting &#40;PEW&#41;&#44; have showed a central role to slow onset of dialysis<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">1&#44;2</span></a> and mortality rates<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">3</span></a> in CKD population&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Guidelines on CKD<a class="elsevierStyleCrossRefs" href="#bib0375"><span class="elsevierStyleSup">4&#44;5</span></a> and Nutrition&#44;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">6&#44;7</span></a> recommend two tentative nutritional approaches for managing dietary protein intake in CKD stages 4&#44;5&#46; A low-protein diet &#40;LPD&#41;&#44; consists of 0&#46;6&#8211;0&#46;8<span class="elsevierStyleHsp" style=""></span>g&#47;kg BW&#47;day or a very low-protein diet &#40;VLPD&#41;&#44; providing a protein intake between 0&#46;3 and 0&#46;4<span class="elsevierStyleHsp" style=""></span>g&#47;kg BW&#47;day supplemented with essential aminoacids &#40;EAA&#41; and ketoanalogues &#40;KA&#41;&#46; Both therapeutic strategies preserve renal function in well-nourished patients<a class="elsevierStyleCrossRefs" href="#bib0385"><span class="elsevierStyleSup">8&#8211;10</span></a> whereas&#44; the ideal recommendation of dietary protein restriction on the progression of CKD&#44; and its potential consequences on nutritional status and body composition still unclear&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">PEW is frequently associated with higher risk of morbidity and mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">3</span></a> Lack of appetite and uremic anorexia interferes on nutritional status and body composition measures in CKD patients&#46; Bioelectrical impedance &#40;BIA&#41;&#44; is a non-invasive method for the assessment of body composition and conditions associated with expanded extracellular water &#40;ECW&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">11</span></a> Previous studies<a class="elsevierStyleCrossRefs" href="#bib0400"><span class="elsevierStyleSup">12&#44;13</span></a> reported that BIA-derived measures may be important in glomerular filtration rate &#40;GFR&#41; prediction and several studies<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">14&#44;15</span></a> demonstrated that the inclusion of muscle mass improved GFR estimations&#46; Dumler et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">16</span></a> showed that CKD patients with stable renal function following a daily dietary protein intake &#40;0&#46;6&#8211;0&#46;8<span class="elsevierStyleHsp" style=""></span>g&#47;kg normalized body weight&#47;day&#41;&#44; had no loss of body cell mass &#40;BCM&#41; or fat-free mass &#40;FFM&#41; over a 9-month period measured by BIA&#46; Thus&#44; assessment and follow-up by nutritional indicators and body composition measures could be useful to early diagnosis of being wasted&#46; These results push up to study whether the body composition in CKD patients stages 3&#8211;5 according to their daily dietary protein intake might predispose to muscle wasting because of dietary restrictions and the catabolic effects of uremia&#46; There is little evidence with regard to the dietary protein intake restriction on body composition in moderate-advanced CKD&#46; This study aimed to analyze usual dietary protein intake and its potential contribution on body composition in CKD patients on stages 3&#8211;5&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Patients and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Study design</span><p id="par0020" class="elsevierStylePara elsevierViewall">This cross-sectional study was carried out at Hospital Universitario de La Princesa&#44; Madrid &#40;Spain&#41; in 134 CKD patients on stages 3&#8211;5&#46; Eligible participants were CKD adults &#40;&#8805;18 years&#41; stabilized for at least &#40;minimum&#41; of 3 months before enrolment&#46; Patients with amputated limbs&#44; clinically evident active infection&#44; liver disease&#44; autoimmune diseases&#44; or malignancies were excluded to avoid the possible effects of these comorbid conditions on inflammatory markers and on body composition status&#46; Informed consent was obtained from every participant&#46; The study was conducted in accordance with the Declaration of Helsinki and was approved by the Medical Ethic Committee of Hospital de la Princesa &#40;code number&#58; 2849&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Clinical assessment</span><p id="par0025" class="elsevierStylePara elsevierViewall">Demographic&#44; clinical and nutritional data were obtained from the medical history of each patient&#46; The monographic nutrition CKD consultation at advanced-CKD unit&#44; was usually recommended 0&#46;8<span class="elsevierStyleHsp" style=""></span>g&#47;kg BW&#47;day of protein intake and dietary salt-restriction according to the guidelines for CKD patients&#46;<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">4</span></a> Nutritional counseling and follow-up is carried out every three months for ensuring adherence to nutritional recommendations&#46; Serial nPna measures and body composition analysis at each three-month visit&#44; are routinely performed in order to check compliance with protein prescription&#46; LPD supplemented with KA&#44; were not currently used for managing CKD at the advanced CKD-unit&#46; Glomerular filtration rate was estimated by the Chronic Kidney Disease Epidemiology Collaboration &#40;CKD-EPI&#41; equation for the estimated glomerular filtration rate &#40;e-GFR&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">17</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Normalized protein nitrogen appearance &#40;nPna&#41; as a surrogate indicator of dietary protein intake according to the equation proposed by the Kidney Disease Outcomes Quality Initiative clinical practice guidelines<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">18</span></a> was calculated as follows&#58;<elsevierMultimedia ident="eq0005"></elsevierMultimedia></p><p id="par0035" class="elsevierStylePara elsevierViewall">The sample was classified into three nPna groups &#40;G<span class="elsevierStyleInf"><span class="elsevierStyleItalic">n</span></span>&#41; according the daily mean of the protein intake &#40;to mean of daily protein intake&#41;&#58; &#40;G<span class="elsevierStyleInf">1</span>&#41;&#58; nPna<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;8<span class="elsevierStyleHsp" style=""></span>g&#47;kg&#47;day&#59; &#40;G<span class="elsevierStyleInf">2</span>&#41;&#58; nPna 0&#46;8&#8211;1<span class="elsevierStyleHsp" style=""></span>g&#47;kg&#47;day and&#44; &#40;G<span class="elsevierStyleInf">3</span>&#41;&#58; nPna<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>g&#47;kg&#47;day&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Nutritional assessment</span><p id="par0040" class="elsevierStylePara elsevierViewall">Nutritional status was assessed by the malnutrition-inflammation score &#40;MIS&#41; questionnaire&#44;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">19</span></a> including six different components&#58; five subjective assessments &#40;concerning the patient&#39;s medical history and physical examination&#41;&#44; and three objective assessments &#91;s-albumin&#44; total binding iron capacity and body mass index &#40;BMI&#41;&#93;&#46; In agreement with other studies&#44;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">20</span></a> PEW was defined as a MIS score &#8805;5&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Anthropometric measurements</span><p id="par0045" class="elsevierStylePara elsevierViewall">Body weight &#40;BW&#41;&#44; BMI&#44; standard body weight &#40;SBW&#41;&#44; triceps skinfold thickness &#40;TSF&#41;&#44; and mid-arm muscle circumference &#40;MAMC&#41; were recorded as anthropometric measures&#46; The BMI as dry weight in kilograms divided by the square of height in meters was calculated&#46; TSF was measured with a Lange Skin Calipers &#40;Holtain Caliper&#44; Crymch&#44; Dyfed&#44; UK&#41;&#44; using standard techniques&#46; MAMC was estimated as follows&#58; MAMC &#40;cm&#41;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>mid-arm circumference &#40;cm&#41;<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>0&#46;314<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>TSF &#40;mm&#41;&#46; All anthropometric measurements were done in duplicate by the same investigator&#44; and the mean values were taken for the analysis&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Handgrip strength was performed on the dominant arm or non-fistula side&#44; using a manual dynamometer &#40;Baseline<span class="elsevierStyleSup">&#174;</span> Hydraulic Hand Dynamometer &#8211; 12-0240&#59; Irvington&#44; NY&#44; USA&#41; device&#46; All anthropometric measures were repeated three times and the mean value was taken for the analysis&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Body composition analysis</span><p id="par0055" class="elsevierStylePara elsevierViewall">Monofrequency BIA was determined on the non-dominant side of the body&#44; in the post-absorptive state&#44; injecting 800<span class="elsevierStyleHsp" style=""></span>&#956;A alternating sinusoidal current with a standard tetrapolar technique &#40;BIA 101 Impedance Analyzer&#59; Akern&#44; Firenze&#44; Italy&#41;&#46; BIA was performed at fasting state in the supine position<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">21&#44;22</span></a> with disposable electrodes &#40;BiatrodesTM 100&#39;S&#59; Akern&#41;&#46; Body composition analysis by gender&#44; age&#44; BW and height was individually measured at 50<span class="elsevierStyleHsp" style=""></span>kHz&#44; which resistance and reactance were obtained&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The BIA-derived variables &#91;&#40;exchange Na&#47;K&#44; percentage of total body water &#40;TBW&#37;&#41;&#44; extracellular body water &#40;ECW&#37;&#41;&#44; intracellular body water &#40;ICW&#37;&#41;&#44; body cell mass &#40;BCM&#37;&#41;&#44; fat mass &#40;FM&#37;&#41;&#44; muscle mass &#40;MM&#37;&#41;&#44; fat-free mass &#40;FFM&#37;&#41; and values of phase angle &#40;PA&#41;&#93;&#44; were estimated by BIA<span class="elsevierStyleSup">&#174;</span> software&#46; This method was previously validated in CKD<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">11</span></a> and dialysis patients&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">23</span></a></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Laboratory parameters</span><p id="par0065" class="elsevierStylePara elsevierViewall">Early morning blood samples were drawn from every patient in a 12-h overnight fasting conditions&#46; Serum albumin &#40;s-albumin&#41; using bromocresol green method was measured using an automated analyzer &#40;Abbot&#44; Aeroset<span class="elsevierStyleSup">&#174;</span>&#44; Diamond Diagnosis&#44; Holliston&#44; MA&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">24</span></a> Variation coefficients were lower than 2&#37;&#46; CRP &#40;<span class="elsevierStyleItalic">no-high sesnsitivity</span>&#41;&#44; was measured by immunoturbidimetry &#40;Roche&#47;Hitachi 904<span class="elsevierStyleSup">&#174;</span>&#47;Model P&#58; ACN 218&#44; Roche Diagnostics&#44; Basel&#44; Switzerland&#41;&#46; S-CRP was logarithmically transformed to normality using the natural log &#40;Ln s-CRP&#41;&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Statistical analysis</span><p id="par0070" class="elsevierStylePara elsevierViewall">The statistical analyses were carried out using the SPSS v&#46;20 software and the results expressed as the arithmetic mean and standard deviation&#46; Correlation between continuous variables by Pearson test was calculated&#46; The normality and homoscedasticity of the data were verified by the Kolmogorov&#8211;Smirnov and Shapiro&#8211;Wilk test&#44; respectively&#46; The analysis of variance &#40;ANOVA&#41; followed by the Bonferroni and Tukey <span class="elsevierStyleItalic">post-hoc</span> test was used when the variables showed a normal distribution and Welch and Brown&#8211;Forsythe when the variables were non-parametric&#46; Analysis of covariance &#40;ANCOVA&#41; was used to test extent variations of gender as a covariate&#46; Linear regression analysis was used to test the effect of nPna on other variables&#46; The level of significance was set at <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Results</span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Demographic characteristics</span><p id="par0075" class="elsevierStylePara elsevierViewall">A total of 134 CKD patients participated in the study&#46; The aged population was 70&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46;11 years&#44; 68&#46;7&#37; were men and the primary etiology of CKD was diabetes mellitus &#40;35&#46;8&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; Most of the patients were in CKD stage 3 &#40;34&#46;5&#37;&#41; and stage 4 &#40;56&#46;5&#37;&#41;&#44; with mean nPna values of 0&#46;84<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;21 and 0&#46;93<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;21<span class="elsevierStyleHsp" style=""></span>g&#47;kg&#47;day&#44; respectively &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;033&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Correlations</span><p id="par0080" class="elsevierStylePara elsevierViewall">nPna was positively and significantly associated with e-GFR &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;19&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#44; BCM&#37; &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;32&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; MM&#37; &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;42&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; and s-albumin &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;26&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#44; whilst inverse correlation was observed between nPna and exchange Na&#47;K &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;18&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; Not significant correlation between nPna and Ln s-CRP was found&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Patient characteristics according to dietary protein intake</span><p id="par0085" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows laboratory data according to nPna groups of daily protein intake&#46; Of the 134 CKD patients&#44; 43 patients &#40;32&#46;1&#37;&#41; had nPna<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;8<span class="elsevierStyleHsp" style=""></span>g&#47;kg BW&#47;day &#40;G<span class="elsevierStyleInf">1</span>&#41;&#44; 53 patients &#40;39&#46;2&#37;&#41; with nPna of 0&#46;8&#8211;1<span class="elsevierStyleHsp" style=""></span>g&#47;kg BW&#47;day &#40;G<span class="elsevierStyleInf">2</span>&#41; and 38 patients &#40;28&#46;3&#37;&#41; had a nPna<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>g&#47;kg BW&#47;day &#40;G<span class="elsevierStyleInf">3</span>&#41;&#46; Patients with lower nPna &#40;G<span class="elsevierStyleInf">1</span>&#41;&#44; were older and showed also significantly higher proteinuria in comparison with mean values of nPna<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;8<span class="elsevierStyleHsp" style=""></span>g&#47;kg BW&#47;day&#46; Mean values of s-albumin showed significantly differences between nPna groups &#40;G<span class="elsevierStyleInf">1</span>&#44; G<span class="elsevierStyleInf">2</span>&#44; G<span class="elsevierStyleInf">3</span>&#41;&#44; being highlighted mean values of albumin level &#62;4<span class="elsevierStyleHsp" style=""></span>g&#47;dL in the three groups &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;015&#41;&#46; Ln s-CRP tended in a non-significant manner to be higher levels with nPna<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>g&#47;kg BW&#47;day&#46; The prevalence of PEW was 15&#37; in this study&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows anthropometric&#44; nutritional and body composition data according to nPna groups of daily protein intake&#46; Anthropometric measures as BW&#44; BMI and TSF were significantly higher within nPna<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>g&#47;kg&#47;day group&#46; MAMC&#37;&#44; tended significantly to be decreased across nPna groups but&#44; being within normal range&#46; As regards the BIA-derived hydration parameters&#44; patients with low protein intake had higher values of exchange Na&#47;K &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#44; and ECW&#37; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#44; whereas TBW&#37; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#44; ICW&#37; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41; and s-albumin &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;015&#41; were also significantly lower with nPna<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;8<span class="elsevierStyleHsp" style=""></span>g&#47;kg BW&#47;day &#40;G<span class="elsevierStyleInf">1</span>&#41;&#46; Low protein intake &#40;G<span class="elsevierStyleInf">1</span>&#41; showed significantly lower FFM&#37;&#44; MM&#37; and PA values&#44; but not significant differences with handgrip strength &#40;kg&#41; were found&#46; Interestingly&#44; MM&#37; was higher with nPna values &#8805;0&#46;8<span class="elsevierStyleHsp" style=""></span>g&#47;kg BW&#47;day&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">In a sub-analysis data&#44; robust test of equal means showed significant differences with BCM&#37;&#44; ECW&#37;&#44; FFM&#37;&#44; MM&#37; and s-albumin in the sample &#40;at least&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#46; Gender inter-subjects&#8217; analysis showed significant differences with BW&#44; FFM&#37;&#44; TSF and MAMC&#37;&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Protein intake as a predictor of nutritional and body composition status in chronic kidney disease patients</span><p id="par0100" class="elsevierStylePara elsevierViewall">In the linear regression analysis adjusted by gender&#44; age and BW &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#44; parameters as resistance&#44; BCM&#37;&#44; MM&#37;&#44; and s-albumin were significantly predictors of nPna as a surrogate marker of daily protein intake &#40;<span class="elsevierStyleItalic">R</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;51&#59; <span class="elsevierStyleItalic">R</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;29&#59; <span class="elsevierStyleItalic">R</span><span class="elsevierStyleSup">2</span> adjusted&#58; 0&#46;23&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Discussion</span><p id="par0105" class="elsevierStylePara elsevierViewall">The results of this study revealed that low dietary protein intake in CKD patients on stages 3&#44; 4&#8211;5&#44; was associated with loss of muscle mass even in patients receiving dietary counseling and nutritional follow-up at the advanced-CKD unit&#46; In this study&#44; older ages and lower e-GFR in CKD patients showed lower protein intake and loss of muscle mass&#44; especially in women&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">nPna an indirect measure of protein intake was showed as a strong and independent predictor of morbidity and mortality in CKD patients<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">25</span></a> and dialysis patients&#46;<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">26</span></a> Clinical practice guideline for CKD patients&#44;<a class="elsevierStyleCrossRefs" href="#bib0375"><span class="elsevierStyleSup">4&#8211;7</span></a> defined as those with e-GFR<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#44; have recommended reducing dietary protein intake to 0&#46;8<span class="elsevierStyleHsp" style=""></span>g&#47;kg&#47;day in adults both with and without diabetes to slow disease progression&#44; and achieve&#47;maintain adequate s-albumin concentration and nutritional status&#46; In the current study&#44; overall nPna values were slightly increased&#44; but only 57&#37; of the eligible CKD patients correctly achieved the low protein intake reduction&#46; Patients with CKD on stage 3&#44; had mean nPna values closed to current protein intake recommendation&#44; whilst advanced CKD on stages 4&#8211;5&#44; showed higher daily protein intake&#46; In this study&#44; diet adherence of usual nutritional recommendation was low&#44; being observed a 67&#46;9&#37; of CKD patients with nPna<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>0&#46;8<span class="elsevierStyleHsp" style=""></span>g&#47;kg BW&#47;day&#46; However&#44; a dietary protein intake &#60;0&#46;8<span class="elsevierStyleHsp" style=""></span>g&#47;kg BW&#47;day &#40;G<span class="elsevierStyleInf">1</span>&#41;&#44; showed significantly depletion of MAMC&#44; BCM&#37;&#44; FFM&#37; and PA in a similar way compared with one another nPna categories&#46; These findings are of importance because the loss of muscle mass and wasting has been demonstrated to be associated with poor outcomes in CKD patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0420"><span class="elsevierStyleSup">27&#44;28</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">PEW is common in CKD patients and is associated with a subsequent increased risk of mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">3</span></a> Dietary protein and energy intake may be masked in patients with advanced CKD due to uremic anorexia&#44; inter-current illness&#44; systemic inflammation&#44; fluid overload and&#47;or excessive dietary protein restriction&#46; S-albumin concentration and BMI are the most often used indicators of nutritional assessment in daily clinical practice<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">29&#44;30</span></a> However&#44; both are influenced by several non-nutritional factors&#44; including proteinuria&#44; fluid overload and inflammation statuses&#46;<a class="elsevierStyleCrossRefs" href="#bib0335"><span class="elsevierStyleSup">31&#44;32</span></a> In the current study&#44; PEW was assessed by MIS&#44; as a nutritional screening tool previously validated in CKD and dialysis patients together with commonly used nutritional-inflammatory markers&#46; Overall&#44; only 15&#37; of CKD patients were wasted&#46; In accordance with previous studies&#44;<a class="elsevierStyleCrossRefs" href="#bib0430"><span class="elsevierStyleSup">33&#44;34</span></a> the prevalence of PEW in the study was low compared with others&#46;<a class="elsevierStyleCrossRefs" href="#bib0435"><span class="elsevierStyleSup">35&#44;36</span></a> Furthermore&#44; despite of low e-GFR &#40;mean 19&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;7<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#41;&#44; a common used marker of protein turnover such as s-albumin was &#8805;4<span class="elsevierStyleHsp" style=""></span>g&#47;dL in all nPna groups&#46; Therefore&#44; a routine nutritional screening &#40;i&#46;e&#46; MIS&#41; could decreased the contribution of each indicator by combining s-albumin and BMI&#46; In fact&#44; this study found significantly positive correlation between nPna with e-GFR&#44; BCM&#37;&#44; MM&#37; and s-albumin&#44; but not Ln s-CRP and BMI&#46; These findings suggest that a multifactorial approach in CKD patients is mandatory&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Additional methods such as BIA and anthropometric measures may be also clinically useful to assess nutritional status&#46; Body composition analysis in patients with CKD are characterized by high content of ECW associated with sodium retention and a decreased of BCM&#44; both related with well-known causes as inflammation&#44; fluid overload and wasting&#46;<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">22&#44;31&#44;32</span></a> In this study&#44; exchange Na&#47;K and ECW&#37; were significantly higher as protein intake was &#60;0&#46;8<span class="elsevierStyleHsp" style=""></span>g of protein&#47;kg BW&#47;day&#46; Additionally&#44; BIA-derived parameters such as FFM&#37; and MM&#37; were also diminished&#46; Linear regression analysis showed that BIA-measures as resistance&#44; MM&#37; and s-albumin were independent predictors of nPna in the study population&#44; but an inverse relation was found with BCM&#37;&#46; These findings suggest that a high protein intake could worsen renal function and&#44; consequently the homeostasis of internal environment&#46; Nevertheless&#44; parameters such as exchange Na&#47;K&#44; FFM&#37; and FM&#37; were not found significant predictors of nPna in the linear regression analysis&#46; Thus&#44; in addition to common used nutritional markers&#44; data suggest that body composition parameters should be taken into account in the nutritional monitoring&#44; in patients with CKD&#46; In this clinical setting&#44; a &#8220;tailored diet prescription&#8221; considering gender-aged and body composition differences is required&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Prescription of a KA&#47;EAA supplemented VLPD may be considered in well-nourished not-inflamed CKD patients aimed to preserve the renal function and metabolic disturbances related to uremic milieu&#46; However&#44; in wasted patients with alterations of fluid status and body composition parameters may be further considered dietary protein intake definition&#46; There are potential limitations to be taking into account in this study&#46; The sample size of this study due to its nature as a single-center cross-sectional study may reduce the generalizability of the findings&#46; First&#44; there are fluctuations in nPna from day to day caused by changes in daily protein intake or endogenous protein catabolism related with e-GFR value in CKD patients&#46; Monitoring sequentially the body composition measures &#40;i&#46;e&#46; muscle mass&#41;&#44; could provide early nutritional interventions&#46; Second&#44; for nPna to accurately estimate protein intake&#44; the patient&#39;s protein metabolism should be at equilibrium or nearly so at the time of measurement&#46; This condition is not always met&#44; particularly in CKD patients with many comorbidities&#44; inflammation or acute disease states&#46; In this study&#44; eligible CKD patients were stabilized for at least 3 months before enrolment&#46; Third&#44; nPna could be masked usual dietary protein intake in wasted-inflamed patients&#46; Assessment of nutritional-inflammatory status by validated nutritional tools&#44; could early diagnose inadequate food intake and nutritional related-problems &#40;i&#46;e&#46; PEW&#41; in CKD patients&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">In conclusion&#44; controlled protein intake is one of the mainstays of CKD patients&#46; A low protein intake in patients with CKD stages 3&#44; 4&#8211;5&#44; was associated with muscle wasting&#44; even in patients receiving dietary advice and nutritional follow-up in the advanced-CKD unit&#46; The loss of muscle mass appears as an early indicator of being wasting&#46; Factors such as advanced age and loss of eGFR&#44; showed lower protein intake and were associated with muscle loss&#44; especially in women&#46; In addition&#44; of standard medical care&#44; assessment of nutritional status and body composition should be included to prevent&#44; diagnose and&#47;or treat PEW&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Further longitudinal studies are required for evaluating the contribution of different protein intake in uremic symptoms&#44; nutritional status&#44; body composition and CKD progression&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Authors&#8217; contributions</span><p id="par0140" class="elsevierStylePara elsevierViewall">GB designed the study&#44; collected the data&#44; analyzed and interpreted the results&#44; and drafted the manuscript&#46; AN collected the data and drafted the manuscript&#46; MR&#44; analyzed&#44; interpreted the results&#44; and drafted the manuscript&#46; YC analyzed and interpreted the statistical results&#46; JST analyzed&#44; interpreted the results&#44; and drafted the manuscript&#46; All of the authors read and approved the final version of manuscript&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Declarations</span><p id="par0145" class="elsevierStylePara elsevierViewall">None&#46;</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Conflict of interests</span><p id="par0150" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interests&#46;</p></span></span>"
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              "titulo" => "Anthropometric measurements"
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              "titulo" => "Body composition analysis"
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              "titulo" => "Correlations"
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              "identificador" => "sec0065"
              "titulo" => "Patient characteristics according to dietary protein intake"
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              "identificador" => "sec0070"
              "titulo" => "Protein intake as a predictor of nutritional and body composition status in chronic kidney disease patients"
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          "titulo" => "Discussion"
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    "fechaRecibido" => "2017-12-23"
    "fechaAceptado" => "2018-06-07"
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            0 => "Protein intake"
            1 => "Normalized protein nitrogen appearance"
            2 => "Muscle mass"
            3 => "Protein-energy wasting"
            4 => "Body composition"
            5 => "Bioelectrical impedance"
            6 => "Chronic kidney disease"
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          "clase" => "abr"
          "titulo" => "Abbreviations"
          "identificador" => "xpalclavsec1060978"
          "palabras" => array:28 [
            0 => "BCM&#37;"
            1 => "BIA"
            2 => "BIVA"
            3 => "BMI"
            4 => "BW"
            5 => "CKD"
            6 => "CRP"
            7 => "ECW"
            8 => "FFM&#37;"
            9 => "FM"
            10 => "e-GFR"
            11 => "ICW&#37;"
            12 => "KA"
            13 => "Ln s-CRP"
            14 => "LPD"
            15 => "MAMC&#37;"
            16 => "MIS"
            17 => "MM&#37;"
            18 => "nPna"
            19 => "PA"
            20 => "PEW"
            21 => "RRT"
            22 => "SBW&#37;"
            23 => "s-albumin"
            24 => "s-CRP"
            25 => "TBW&#37;"
            26 => "TSF"
            27 => "VLPD"
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          "palabras" => array:7 [
            0 => "Ingesta de prote&#237;nas"
            1 => "Aparici&#243;n de nitr&#243;geno proteico normalizado"
            2 => "Masa muscular"
            3 => "P&#233;rdida de energ&#237;a proteica"
            4 => "Composici&#243;n corporal"
            5 => "Impedancia bioel&#233;ctrica"
            6 => "Enfermedad renal cr&#243;nica"
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      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A controlled protein intake has shown beneficial effects to preserve renal function and nutritional status in chronic kidney disease &#40;CKD&#41; patients&#46; This study aimed to analyze usual dietary protein intake and its potential contribution to body composition in CKD patients in stages 3&#8211;5&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Cross-sectional study in 134 CKD patients in stages 3&#8211;5 &#40;mean e-GFR&#58; 19&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;7<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#59; males 68&#46;7&#37; and primary CKD etiology was diabetes mellitus&#44; 35&#46;8&#37;&#41;&#46; Demographic&#44; clinical and nutritional parameters were evaluated&#46; Normalized protein nitrogen appearance &#40;nPNA&#41;&#44; was used as a surrogate marker of dietary protein intake&#46; The sample was classified into three nPNA groups &#40;G<span class="elsevierStyleInf"><span class="elsevierStyleItalic">n</span></span>&#41;&#58; G<span class="elsevierStyleInf">1</span>&#58; &#60;0&#46;8<span class="elsevierStyleHsp" style=""></span>g&#47;kg&#47;day&#59; G<span class="elsevierStyleInf">2</span>&#58; 0&#46;8&#8211;1<span class="elsevierStyleHsp" style=""></span>g&#47;kg&#47;day and&#44; G<span class="elsevierStyleInf">3</span>&#58; &#8805;1<span class="elsevierStyleHsp" style=""></span>g&#47;kg&#47;day&#46; Assessment of nutritional status using the malnutrition-inflammation score &#40;MIS&#41;&#44; anthropometric measures and laboratory parameters&#46; Analysis of body composition and hydration status by bioelectrical impedance analysis &#40;BIVA-101-RJL system&#41;&#46; Statistical analysis by SPSS v&#46;20&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Overall mean nPNA values were 0&#46;91<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;23<span class="elsevierStyleHsp" style=""></span>g of protein&#47;kg BW&#47;day and only 32&#46;1&#37; had a dietary protein intake &#60;0&#46;8<span class="elsevierStyleHsp" style=""></span>g of protein&#47;kg BW&#47;day&#46; Most of the CKD patients &#40;65&#46;5&#37;&#41; were in stages 4 or 5&#46; Prevalence of protein&#8211;energy&#8211;wasting &#40;PEW&#41; syndrome measured by MIS was 15&#37;&#46; By analyzing differences between nPNA groups&#44; body weight &#40;BW&#41;&#44; BMI and triceps-skinfold &#40;TSF&#41; thickness were significantly higher in the group with nPNA &#8805;1<span class="elsevierStyleHsp" style=""></span>g&#47;kg BW&#47;day &#40;G<span class="elsevierStyleInf">3</span>&#41;&#44; whereas a significant inverse relationship was found with the percentages of body cell mass &#40;BCM&#37;&#41;&#44; fat-free mass &#40;FFM&#37;&#41;&#44; muscle mass &#40;MM&#37;&#41; and phase angle &#40;PA&#41; in the group with the lowest nPNA &#40;G<span class="elsevierStyleInf">1</span>&#41;&#46; Analysis of gender among subjects showed significant differences with BW&#44; FFM&#37;&#44; TSF and mid-arm muscle circumference &#40;MAMC&#37;&#41;&#46; Linear regression analysis showed that resistance&#44; BCM&#37;&#44; MM&#37;&#44; and serum albumin were significant predictors of nPNA as a surrogate marker of daily protein intake &#40;<span class="elsevierStyleItalic">R</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;51&#59; <span class="elsevierStyleItalic">R</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;29&#59; <span class="elsevierStyleItalic">R</span><span class="elsevierStyleSup">2</span> adjusted<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;23&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Controlled protein intake is one of the cornerstones of treatment in CKD patients&#46; A low protein intake in patients with CKD stages 3 and 4&#8211;5 was associated with loss of muscle mass in the advanced-CKD unit&#46; The loss of muscle mass appears as an early indicator of nutritional comprised&#46; Factors such&#44; elderly age and loss of eGFR&#44; showed lower protein intake and were associated with muscle loss&#44; especially in women&#46; Further longitudinal studies are required to evaluate the contribution of different protein intakes to uremic symptoms&#44; nutritional status&#44; body composition and CKD progression&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Method"
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          2 => array:2 [
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El control de la ingesta proteica ha mostrado efectos beneficiosos preservando la funci&#243;n renal y el estado nutricional en pacientes con enfermedad renal cr&#243;nica &#40;ERC&#41;&#46; El objetivo del estudio fue analizar la ingesta habitual de prote&#237;na&#44; y su potencial contribuci&#243;n en la composici&#243;n corporal en los pacientes con ERC estadios 3-5&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional transversal en 134 pacientes con ERC estadios 3-5 &#40;media e-TFG&#58; 19&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#44;7<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#44;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#59; varones&#58; 68&#44;7&#37; y etiolog&#237;a primaria de la ERC&#44; diabetes mellitus&#58; 35&#44;8&#37;&#41;&#46; Se evaluaron par&#225;metros demogr&#225;ficos&#44; cl&#237;nicos y nutricionales&#46; La aparici&#243;n de nitr&#243;geno proteico normalizado &#40;nPNA&#41; se utiliz&#243; como marcador sustituto de la ingesta proteica&#46; La muestra fue clasificada seg&#250;n el nPNA en 3 grupos &#40;G<span class="elsevierStyleInf">n</span>&#41;&#58; G<span class="elsevierStyleInf">1</span>&#58; &#60; 0&#44;8<span class="elsevierStyleHsp" style=""></span>g&#47;kg&#47;d&#237;a&#59; G<span class="elsevierStyleInf">2</span>&#58; 0&#44;8-1<span class="elsevierStyleHsp" style=""></span>g&#47;kg&#47;d&#237;a y G<span class="elsevierStyleInf">3</span>&#58;<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>g&#47;kg&#47;d&#237;a&#46; Valoraci&#243;n nutricional por la escala de malnutrici&#243;n-inflamaci&#243;n &#40;MIS&#41;&#44; medidas antropom&#233;tricas y par&#225;metros de laboratorio&#46; An&#225;lisis de composici&#243;n corporal y del patr&#243;n de hidrataci&#243;n mediante bioimpedancia el&#233;ctrica &#40;BIVA-101<span class="elsevierStyleSup">&#174;</span>&#44; RJL System&#41;&#46; An&#225;lisis estad&#237;stico por SPSS<span class="elsevierStyleSup">&#174;</span> v&#46;20&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Globalmente los valores medios de nPNA fueron 0&#44;91<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;23<span class="elsevierStyleHsp" style=""></span>g prote&#237;na&#47;kg peso corporal&#47;d&#237;a&#44; y tan solo el 32&#44;1&#37; ten&#237;an una ingesta proteica &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;8<span class="elsevierStyleHsp" style=""></span>g de prote&#237;na&#47;kg peso corporal&#47;d&#237;a&#46; El 65&#44;5&#37; de los pacientes con ERC estaban en estadios 4 y 5&#46; La prevalencia de s&#237;ndrome de desgaste proteico-energ&#233;tico &#40;SDP&#41; medido por MIS era del 15&#37;&#46; Analizando las diferencias con el nPNA entre los grupos&#44; el peso corporal&#44; el &#237;ndice de masa corporal y el pliegue tricipital &#40;PCT&#41;&#44; eran significativamente mayores en el grupo con nPNA<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>g&#47;kg peso corporal&#47;d&#237;a &#40;G<span class="elsevierStyleInf">3</span>&#41;&#44; mientras que se encontr&#243; relaci&#243;n inversa significativa con los porcentajes de la masa celular &#40;MC&#37;&#41;&#44; de la masa magra &#40;MMagra&#37;&#41;&#44; de la masa muscular &#40;MM&#37;&#41; y del &#225;ngulo de fase &#40;AF&#41; en el grupo con menor nPNA &#40;G<span class="elsevierStyleInf">1</span>&#41;&#46; El an&#225;lisis del g&#233;nero entre los sujetos mostr&#243; diferencias significativas con el peso corporal&#44; MMagra&#37;&#44; PCT y la circunferencia muscular del brazo &#40;CMB&#37;&#41;&#46; El an&#225;lisis de regresi&#243;n lineal demostr&#243; que la resistencia MC&#37;&#44; MM&#37; y la alb&#250;mina s&#233;rica eran predictores significativos del nPNA como marcador de la ingesta proteica habitual &#40;R<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;51&#59; R<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;29&#59; R<span class="elsevierStyleSup">2</span> ajustado<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;23&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El control de la ingesta proteica es uno de los pilares del tratamiento en los pacientes con ERC&#46; La dieta hipoproteica en pacientes con ERC estadios 3-5 se asoci&#243; con una p&#233;rdida de la masa muscular en la unidad de ERC avanzada&#46; La p&#233;rdida de masa muscular aparece como un indicador temprano de compromiso nutricional&#46; La edad avanzada y la p&#233;rdida de TFG-e se asociaron con menor ingesta proteica y p&#233;rdida de masa muscular asociada&#44; especialmente en mujeres&#46; Nuevos estudios longitudinales&#44; son necesarios para evaluar la contribuci&#243;n de la ingesta de prote&#237;nas en los s&#237;ntomas ur&#233;micos&#44; el estado nutricional&#44; la composici&#243;n corporal y la progresi&#243;n de la ERC&#46;</p></span>"
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          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">e-GFR&#44; estimated glomerular filtration rate measured by CKD-EPI equation&#59; Ln s-CRP&#44; natural logarithmic of C-reactive protein&#59; nPna&#44; normalized protein nitrogen appearance&#46; PEW&#44; protein-energy wasting&#46;</p><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">&#42;</span><span class="elsevierStyleItalic">p</span>-values are based on Chi-square tests or ANOVA-tests according to cut-off points of normalized protein nitrogen appearance &#40;nPna&#41;&#46;</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">&#35;</span>Daily protein intake measured by nPna were defined in different groups as follows&#58; G1&#58; nPna<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;8<span class="elsevierStyleHsp" style=""></span>g&#47;kg BW&#47;day&#59; G2&#58; nPna 0&#46;8&#8211;1<span class="elsevierStyleHsp" style=""></span>g&#47;kg<span class="elsevierStyleHsp" style=""></span>BW&#47;day and&#59; G3&#58; nPna<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>g&#47;kg BW&#47;day&#46; <span class="elsevierStyleSup">a&#44;b&#44;c</span><span class="elsevierStyleItalic">p</span>-values within the means of nPna bearing different letters were significantly different&#59; <span class="elsevierStyleSup">a</span><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#44; <span class="elsevierStyleSup">b</span><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#44; <span class="elsevierStyleSup">c</span><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001 &#40;Brown&#8211;Forsythe test for equal means&#41;&#46;</p><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">&#8224;</span>PEW was defined by MIS score &#8805;5 points&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variables&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Global&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">G<span class="elsevierStyleInf">1</span>&#58; nPna<br>&#60;0&#46;8<span class="elsevierStyleHsp" style=""></span>g&#47;kg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">G<span class="elsevierStyleInf">2</span>&#58; nPna 0&#46;8&#8211;1<span class="elsevierStyleHsp" style=""></span>g&#47;kg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">G<span class="elsevierStyleInf">3</span>&#58; nPna<br>&#8805;1<span class="elsevierStyleHsp" style=""></span>g&#47;kg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>-value<span class="elsevierStyleSup">&#42;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">n</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">134&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">nPna &#40;g&#47;kg BW&#47;day&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;91<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;65<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;08&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;89<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;16<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">71<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">73&#46;58<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#46;58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">70&#46;22<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#46;27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">69&#46;21<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#46;79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Men&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">92 &#40;68&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25 &#40;17&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">40 &#40;29&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27 &#40;20&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diabetes&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">48 &#40;36&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24 &#40;17&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28 &#40;20&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;12&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">e-GFR &#40;mL&#47;min&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16&#46;34<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17&#46;43<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17&#46;73<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hemoglobin &#40;g&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#46;25<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#46;86<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#46;19<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#46;50<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;076&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">s-Albumin &#40;g&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;18<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;04<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;20<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;11<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;015<span class="elsevierStyleSup">b</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total Lymphocytes count &#40;&#215;10<span class="elsevierStyleSup">3</span>&#47;mm<span class="elsevierStyleSup">3</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2026&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1133&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1897&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>881&#46;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2142<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1529&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2016&#46;87<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>744&#46;23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">s-Creatinine &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;27<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;39<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;08&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;54<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;42<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;94&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ln s-CRP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8722;0&#46;84<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8722;0&#46;75<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8722;0&#46;87<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8722;1&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Proteinuria &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">58&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>69&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">82&#46;34<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>72&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">49&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>63&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">44&#46;70<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>70&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;032&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PEW&#44;<span class="elsevierStyleSup">&#8224;</span><span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20 &#40;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;5&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 &#40;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#40;3&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Demographic and laboratory data in 134 CKD patients stages&#44; 3&#8211;5 according to daily dietary protein intake&#46;&#35;&#46;</p>"
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        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
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          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">BMI&#44; body mass index&#59; ECW&#44; extracellular water&#59; FM&#44; fat mass&#59; FFM&#44; fat free mass&#59; ICW&#44; intracellular water&#59; MAMC&#44; middle-arm muscle circumference&#59; MIS&#44; Malnutrition-Inflammation Score&#59; TBW&#44; total body water&#59; TSF&#44; triceps skinfold thickness&#46;</p><p id="spar0105" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">&#42;</span>p-values are based on Chi-square tests or ANOVA-tests according to cut-off points of normalized protein nitrogen appearance &#40;nPna&#41;&#46;</p><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">&#35;</span>Daily protein intake measured by nPna were defined in different groups as follows&#58; G<span class="elsevierStyleInf">1</span>&#58; nPna &#60; 0&#46; 8<span class="elsevierStyleHsp" style=""></span>g&#47;kg BW&#47;day&#59; G<span class="elsevierStyleInf">2</span>&#58; nPna 0&#46;8&#8211;1<span class="elsevierStyleHsp" style=""></span>g&#47;kg BW&#47;day and&#59; G<span class="elsevierStyleInf">3</span>&#58; nPna &#8805; 1<span class="elsevierStyleHsp" style=""></span>g&#47;kg BW&#47;day&#46; <span class="elsevierStyleSup">a&#44;b&#44;c</span><span class="elsevierStyleItalic">p</span>-values within the means of nPna bearing different letters were significantly different&#59; <span class="elsevierStyleSup">a</span><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#44; <span class="elsevierStyleSup">b</span><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#44; <span class="elsevierStyleSup">c</span><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001 &#40;Brown&#8211;Forsythe test for equal means&#41;&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variables&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Global&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">G<span class="elsevierStyleInf">1</span>&#58; nPna<br>&#60;0&#46;8<span class="elsevierStyleHsp" style=""></span>g&#47;kg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">G<span class="elsevierStyleInf">2</span>&#58; nPna<br>0&#46;8&#8211;1<span class="elsevierStyleHsp" style=""></span>g&#47;kg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">G<span class="elsevierStyleInf">3</span>&#58; nPna<br>&#8805;1<span class="elsevierStyleHsp" style=""></span>g&#47;kg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>-value<span class="elsevierStyleSup">&#42;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Body weight &#40;kg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">74&#46;41<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#46;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">77&#46;78<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#46;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">76&#46;32<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46;99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">69&#46;32<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#46;96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;037<span class="elsevierStyleSup">a</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Standard Body Weight &#40;kg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">68&#46;08<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">67&#46;77<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70&#46;01<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">68&#46;62<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;301&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BMI &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;19<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&#46;42<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;40<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&#46;56<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;012<span class="elsevierStyleSup">b</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">TSF &#40;mm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#46;84<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&#46;02<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;79<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#46;75<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;016<span class="elsevierStyleSup">b</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">MAMC &#40;cm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&#46;96<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&#46;14<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&#46;58<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;041<span class="elsevierStyleSup">a</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">MAMC &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">130&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>22&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">136&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>27&#46;44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">130&#46;97<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18&#46;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">122&#46;59<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;024<span class="elsevierStyleSup">a</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Handgrip strength right &#40;kg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Handgrip strength left &#40;kg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Exchange Na&#47;K&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;46<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;58<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;47<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;45<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;463&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Body cell mas &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;008<span class="elsevierStyleSup">b</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total body water &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">54&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">52&#46;90<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55&#46;77<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55&#46;63<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;91&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;037&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ECW &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56&#46;45<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">59&#46;86<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55&#46;99<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55&#46;10<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;007<span class="elsevierStyleSup">b</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ICW &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">43&#46;51<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40&#46;13<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">44<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">44&#46;79<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;008<span class="elsevierStyleSup">b</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fat mass &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&#46;46<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;91&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&#46;50<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&#46;80<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fat-free mass &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">68&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">66&#46;31<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70&#46;49<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">71&#46;19<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;009<span class="elsevierStyleSup">b</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Muscle mass &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&#46;78<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&#46;68<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34&#46;82<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55&#46;77<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001<span class="elsevierStyleSup">c</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Phase angle &#40;&#176;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;17<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;77<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;26<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;27<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;033&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                0 => "xTab1921407.png"
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          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Anthropometric&#44; nutritional and body composition data in 134 CKD patients stages&#44; 3&#8211;5 according to daily dietary protein intake&#46;<span class="elsevierStyleSup">&#35;</span>&#46;</p>"
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          "leyenda" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">&#35;</span>Normalized nitrogen protein appearance as a dependent variable in a linear regression model adjusted by gender&#44; age and body weight&#46; 95&#37;CI&#44; confidence interval&#46; <span class="elsevierStyleItalic">R</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;53&#59; <span class="elsevierStyleItalic">R</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;29&#59; <span class="elsevierStyleItalic">R</span><span class="elsevierStyleSup">2</span> adjusted<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;23&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">95&#37;CI&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;276&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;00 to 0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Exchange Na&#47;K&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;445&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8722;0&#46;136 to 0&#46;522&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;24&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;1&#46;996&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8722;0&#46;008 to &#8722;0&#46;092&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;019&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fat-free mass &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;574&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8722;0&#46;026 to 0&#46;054&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;485&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Muscle mass &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;724&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;028 to 0&#46;139&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fat mass &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;161&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;000 to 0&#46;107&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;050&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">s-Albumin &#40;g&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;203&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;012 to 0&#46;209&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;028&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Constant&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8722;8&#46;63 to 0&#46;97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;117&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Normalized nitrogen protein appearance in a linear regression analysis as likely predictor in CKD stages 3&#8211;5 patients&#46;<span class="elsevierStyleSup">&#35;</span>&#46;</p>"
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    "bibliografia" => array:2 [
      "titulo" => "References"
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        0 => array:2 [
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            0 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "1"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The effect of dietary protein restriction on the progression of diabetic and nondiabetic renal diseases&#58; a meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46;T&#46; Pedrini"
                            1 => "A&#46;S&#46; Levey"
                            2 => "J&#46; Lau"
                            3 => "T&#46;C&#46; Chalmers"
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Original article
Influence of dietary protein intake on body composition in chronic kidney disease patients in stages 3–5: A cross-sectional study
Influencia del consumo de proteínas en la composición corporal de pacientes con enfermedad renal crónica en estadios 3-5: estudio transversal
Guillermina Barrila,
Corresponding author
gbarril43@gmail.com

Corresponding author.
, Angel Nogueirab, Mar Ruperto Lópezc, Yone Castrod, José Antonio Sánchez-Tomeroe
a Department of Nephrology, Advanced-chronic Kidney Disease Unit, Hospital Universitario de la Princesa, C/ Diego de León n° 62, 28006 Madrid, Spain
b Advanced-chronic Kidney Disease Unit, Hospital Universitario de la Princesa, C/ Diego de León n° 62, 28006 Madrid, Spain
c Human Nutrition and Dietetics Department, Faculty of Health Sciences, Universidad Alfonso X el Sabio, Avda. Universidad s/n, 28691 Villanueva de la Cañada, Madrid, Spain
d Orientation Department, Area of Investigation, Prodis Foundation, C/ Bulevar Indalecio Prieto 2, 28032 Madrid, Spain
e Department of Nephrology, Advanced-chronic Kidney Disease Unit, Hospital Universitario de la Princesa, 28006 Madrid, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Background</span><p id="par0005" class="elsevierStylePara elsevierViewall">Dietary protein intake is a pivotal issue in the progression and treatment of the chronic kidney disease &#40;CKD&#41; patients&#46; The early primary care on moderate-to-advanced CKD stages of well-known causative factors such as reduction of accumulation of nitrogenous wastes&#44; metabolic derangements and protein-energy wasting &#40;PEW&#41;&#44; have showed a central role to slow onset of dialysis<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">1&#44;2</span></a> and mortality rates<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">3</span></a> in CKD population&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Guidelines on CKD<a class="elsevierStyleCrossRefs" href="#bib0375"><span class="elsevierStyleSup">4&#44;5</span></a> and Nutrition&#44;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">6&#44;7</span></a> recommend two tentative nutritional approaches for managing dietary protein intake in CKD stages 4&#44;5&#46; A low-protein diet &#40;LPD&#41;&#44; consists of 0&#46;6&#8211;0&#46;8<span class="elsevierStyleHsp" style=""></span>g&#47;kg BW&#47;day or a very low-protein diet &#40;VLPD&#41;&#44; providing a protein intake between 0&#46;3 and 0&#46;4<span class="elsevierStyleHsp" style=""></span>g&#47;kg BW&#47;day supplemented with essential aminoacids &#40;EAA&#41; and ketoanalogues &#40;KA&#41;&#46; Both therapeutic strategies preserve renal function in well-nourished patients<a class="elsevierStyleCrossRefs" href="#bib0385"><span class="elsevierStyleSup">8&#8211;10</span></a> whereas&#44; the ideal recommendation of dietary protein restriction on the progression of CKD&#44; and its potential consequences on nutritional status and body composition still unclear&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">PEW is frequently associated with higher risk of morbidity and mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">3</span></a> Lack of appetite and uremic anorexia interferes on nutritional status and body composition measures in CKD patients&#46; Bioelectrical impedance &#40;BIA&#41;&#44; is a non-invasive method for the assessment of body composition and conditions associated with expanded extracellular water &#40;ECW&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">11</span></a> Previous studies<a class="elsevierStyleCrossRefs" href="#bib0400"><span class="elsevierStyleSup">12&#44;13</span></a> reported that BIA-derived measures may be important in glomerular filtration rate &#40;GFR&#41; prediction and several studies<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">14&#44;15</span></a> demonstrated that the inclusion of muscle mass improved GFR estimations&#46; Dumler et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">16</span></a> showed that CKD patients with stable renal function following a daily dietary protein intake &#40;0&#46;6&#8211;0&#46;8<span class="elsevierStyleHsp" style=""></span>g&#47;kg normalized body weight&#47;day&#41;&#44; had no loss of body cell mass &#40;BCM&#41; or fat-free mass &#40;FFM&#41; over a 9-month period measured by BIA&#46; Thus&#44; assessment and follow-up by nutritional indicators and body composition measures could be useful to early diagnosis of being wasted&#46; These results push up to study whether the body composition in CKD patients stages 3&#8211;5 according to their daily dietary protein intake might predispose to muscle wasting because of dietary restrictions and the catabolic effects of uremia&#46; There is little evidence with regard to the dietary protein intake restriction on body composition in moderate-advanced CKD&#46; This study aimed to analyze usual dietary protein intake and its potential contribution on body composition in CKD patients on stages 3&#8211;5&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Patients and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Study design</span><p id="par0020" class="elsevierStylePara elsevierViewall">This cross-sectional study was carried out at Hospital Universitario de La Princesa&#44; Madrid &#40;Spain&#41; in 134 CKD patients on stages 3&#8211;5&#46; Eligible participants were CKD adults &#40;&#8805;18 years&#41; stabilized for at least &#40;minimum&#41; of 3 months before enrolment&#46; Patients with amputated limbs&#44; clinically evident active infection&#44; liver disease&#44; autoimmune diseases&#44; or malignancies were excluded to avoid the possible effects of these comorbid conditions on inflammatory markers and on body composition status&#46; Informed consent was obtained from every participant&#46; The study was conducted in accordance with the Declaration of Helsinki and was approved by the Medical Ethic Committee of Hospital de la Princesa &#40;code number&#58; 2849&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Clinical assessment</span><p id="par0025" class="elsevierStylePara elsevierViewall">Demographic&#44; clinical and nutritional data were obtained from the medical history of each patient&#46; The monographic nutrition CKD consultation at advanced-CKD unit&#44; was usually recommended 0&#46;8<span class="elsevierStyleHsp" style=""></span>g&#47;kg BW&#47;day of protein intake and dietary salt-restriction according to the guidelines for CKD patients&#46;<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">4</span></a> Nutritional counseling and follow-up is carried out every three months for ensuring adherence to nutritional recommendations&#46; Serial nPna measures and body composition analysis at each three-month visit&#44; are routinely performed in order to check compliance with protein prescription&#46; LPD supplemented with KA&#44; were not currently used for managing CKD at the advanced CKD-unit&#46; Glomerular filtration rate was estimated by the Chronic Kidney Disease Epidemiology Collaboration &#40;CKD-EPI&#41; equation for the estimated glomerular filtration rate &#40;e-GFR&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">17</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Normalized protein nitrogen appearance &#40;nPna&#41; as a surrogate indicator of dietary protein intake according to the equation proposed by the Kidney Disease Outcomes Quality Initiative clinical practice guidelines<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">18</span></a> was calculated as follows&#58;<elsevierMultimedia ident="eq0005"></elsevierMultimedia></p><p id="par0035" class="elsevierStylePara elsevierViewall">The sample was classified into three nPna groups &#40;G<span class="elsevierStyleInf"><span class="elsevierStyleItalic">n</span></span>&#41; according the daily mean of the protein intake &#40;to mean of daily protein intake&#41;&#58; &#40;G<span class="elsevierStyleInf">1</span>&#41;&#58; nPna<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;8<span class="elsevierStyleHsp" style=""></span>g&#47;kg&#47;day&#59; &#40;G<span class="elsevierStyleInf">2</span>&#41;&#58; nPna 0&#46;8&#8211;1<span class="elsevierStyleHsp" style=""></span>g&#47;kg&#47;day and&#44; &#40;G<span class="elsevierStyleInf">3</span>&#41;&#58; nPna<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>g&#47;kg&#47;day&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Nutritional assessment</span><p id="par0040" class="elsevierStylePara elsevierViewall">Nutritional status was assessed by the malnutrition-inflammation score &#40;MIS&#41; questionnaire&#44;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">19</span></a> including six different components&#58; five subjective assessments &#40;concerning the patient&#39;s medical history and physical examination&#41;&#44; and three objective assessments &#91;s-albumin&#44; total binding iron capacity and body mass index &#40;BMI&#41;&#93;&#46; In agreement with other studies&#44;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">20</span></a> PEW was defined as a MIS score &#8805;5&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Anthropometric measurements</span><p id="par0045" class="elsevierStylePara elsevierViewall">Body weight &#40;BW&#41;&#44; BMI&#44; standard body weight &#40;SBW&#41;&#44; triceps skinfold thickness &#40;TSF&#41;&#44; and mid-arm muscle circumference &#40;MAMC&#41; were recorded as anthropometric measures&#46; The BMI as dry weight in kilograms divided by the square of height in meters was calculated&#46; TSF was measured with a Lange Skin Calipers &#40;Holtain Caliper&#44; Crymch&#44; Dyfed&#44; UK&#41;&#44; using standard techniques&#46; MAMC was estimated as follows&#58; MAMC &#40;cm&#41;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>mid-arm circumference &#40;cm&#41;<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>0&#46;314<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>TSF &#40;mm&#41;&#46; All anthropometric measurements were done in duplicate by the same investigator&#44; and the mean values were taken for the analysis&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Handgrip strength was performed on the dominant arm or non-fistula side&#44; using a manual dynamometer &#40;Baseline<span class="elsevierStyleSup">&#174;</span> Hydraulic Hand Dynamometer &#8211; 12-0240&#59; Irvington&#44; NY&#44; USA&#41; device&#46; All anthropometric measures were repeated three times and the mean value was taken for the analysis&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Body composition analysis</span><p id="par0055" class="elsevierStylePara elsevierViewall">Monofrequency BIA was determined on the non-dominant side of the body&#44; in the post-absorptive state&#44; injecting 800<span class="elsevierStyleHsp" style=""></span>&#956;A alternating sinusoidal current with a standard tetrapolar technique &#40;BIA 101 Impedance Analyzer&#59; Akern&#44; Firenze&#44; Italy&#41;&#46; BIA was performed at fasting state in the supine position<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">21&#44;22</span></a> with disposable electrodes &#40;BiatrodesTM 100&#39;S&#59; Akern&#41;&#46; Body composition analysis by gender&#44; age&#44; BW and height was individually measured at 50<span class="elsevierStyleHsp" style=""></span>kHz&#44; which resistance and reactance were obtained&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The BIA-derived variables &#91;&#40;exchange Na&#47;K&#44; percentage of total body water &#40;TBW&#37;&#41;&#44; extracellular body water &#40;ECW&#37;&#41;&#44; intracellular body water &#40;ICW&#37;&#41;&#44; body cell mass &#40;BCM&#37;&#41;&#44; fat mass &#40;FM&#37;&#41;&#44; muscle mass &#40;MM&#37;&#41;&#44; fat-free mass &#40;FFM&#37;&#41; and values of phase angle &#40;PA&#41;&#93;&#44; were estimated by BIA<span class="elsevierStyleSup">&#174;</span> software&#46; This method was previously validated in CKD<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">11</span></a> and dialysis patients&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">23</span></a></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Laboratory parameters</span><p id="par0065" class="elsevierStylePara elsevierViewall">Early morning blood samples were drawn from every patient in a 12-h overnight fasting conditions&#46; Serum albumin &#40;s-albumin&#41; using bromocresol green method was measured using an automated analyzer &#40;Abbot&#44; Aeroset<span class="elsevierStyleSup">&#174;</span>&#44; Diamond Diagnosis&#44; Holliston&#44; MA&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">24</span></a> Variation coefficients were lower than 2&#37;&#46; CRP &#40;<span class="elsevierStyleItalic">no-high sesnsitivity</span>&#41;&#44; was measured by immunoturbidimetry &#40;Roche&#47;Hitachi 904<span class="elsevierStyleSup">&#174;</span>&#47;Model P&#58; ACN 218&#44; Roche Diagnostics&#44; Basel&#44; Switzerland&#41;&#46; S-CRP was logarithmically transformed to normality using the natural log &#40;Ln s-CRP&#41;&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Statistical analysis</span><p id="par0070" class="elsevierStylePara elsevierViewall">The statistical analyses were carried out using the SPSS v&#46;20 software and the results expressed as the arithmetic mean and standard deviation&#46; Correlation between continuous variables by Pearson test was calculated&#46; The normality and homoscedasticity of the data were verified by the Kolmogorov&#8211;Smirnov and Shapiro&#8211;Wilk test&#44; respectively&#46; The analysis of variance &#40;ANOVA&#41; followed by the Bonferroni and Tukey <span class="elsevierStyleItalic">post-hoc</span> test was used when the variables showed a normal distribution and Welch and Brown&#8211;Forsythe when the variables were non-parametric&#46; Analysis of covariance &#40;ANCOVA&#41; was used to test extent variations of gender as a covariate&#46; Linear regression analysis was used to test the effect of nPna on other variables&#46; The level of significance was set at <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Results</span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Demographic characteristics</span><p id="par0075" class="elsevierStylePara elsevierViewall">A total of 134 CKD patients participated in the study&#46; The aged population was 70&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46;11 years&#44; 68&#46;7&#37; were men and the primary etiology of CKD was diabetes mellitus &#40;35&#46;8&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; Most of the patients were in CKD stage 3 &#40;34&#46;5&#37;&#41; and stage 4 &#40;56&#46;5&#37;&#41;&#44; with mean nPna values of 0&#46;84<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;21 and 0&#46;93<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;21<span class="elsevierStyleHsp" style=""></span>g&#47;kg&#47;day&#44; respectively &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;033&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Correlations</span><p id="par0080" class="elsevierStylePara elsevierViewall">nPna was positively and significantly associated with e-GFR &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;19&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#44; BCM&#37; &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;32&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; MM&#37; &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;42&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; and s-albumin &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;26&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#44; whilst inverse correlation was observed between nPna and exchange Na&#47;K &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;18&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; Not significant correlation between nPna and Ln s-CRP was found&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Patient characteristics according to dietary protein intake</span><p id="par0085" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows laboratory data according to nPna groups of daily protein intake&#46; Of the 134 CKD patients&#44; 43 patients &#40;32&#46;1&#37;&#41; had nPna<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;8<span class="elsevierStyleHsp" style=""></span>g&#47;kg BW&#47;day &#40;G<span class="elsevierStyleInf">1</span>&#41;&#44; 53 patients &#40;39&#46;2&#37;&#41; with nPna of 0&#46;8&#8211;1<span class="elsevierStyleHsp" style=""></span>g&#47;kg BW&#47;day &#40;G<span class="elsevierStyleInf">2</span>&#41; and 38 patients &#40;28&#46;3&#37;&#41; had a nPna<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>g&#47;kg BW&#47;day &#40;G<span class="elsevierStyleInf">3</span>&#41;&#46; Patients with lower nPna &#40;G<span class="elsevierStyleInf">1</span>&#41;&#44; were older and showed also significantly higher proteinuria in comparison with mean values of nPna<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;8<span class="elsevierStyleHsp" style=""></span>g&#47;kg BW&#47;day&#46; Mean values of s-albumin showed significantly differences between nPna groups &#40;G<span class="elsevierStyleInf">1</span>&#44; G<span class="elsevierStyleInf">2</span>&#44; G<span class="elsevierStyleInf">3</span>&#41;&#44; being highlighted mean values of albumin level &#62;4<span class="elsevierStyleHsp" style=""></span>g&#47;dL in the three groups &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;015&#41;&#46; Ln s-CRP tended in a non-significant manner to be higher levels with nPna<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>g&#47;kg BW&#47;day&#46; The prevalence of PEW was 15&#37; in this study&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows anthropometric&#44; nutritional and body composition data according to nPna groups of daily protein intake&#46; Anthropometric measures as BW&#44; BMI and TSF were significantly higher within nPna<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>g&#47;kg&#47;day group&#46; MAMC&#37;&#44; tended significantly to be decreased across nPna groups but&#44; being within normal range&#46; As regards the BIA-derived hydration parameters&#44; patients with low protein intake had higher values of exchange Na&#47;K &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#44; and ECW&#37; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#44; whereas TBW&#37; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#44; ICW&#37; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41; and s-albumin &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;015&#41; were also significantly lower with nPna<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;8<span class="elsevierStyleHsp" style=""></span>g&#47;kg BW&#47;day &#40;G<span class="elsevierStyleInf">1</span>&#41;&#46; Low protein intake &#40;G<span class="elsevierStyleInf">1</span>&#41; showed significantly lower FFM&#37;&#44; MM&#37; and PA values&#44; but not significant differences with handgrip strength &#40;kg&#41; were found&#46; Interestingly&#44; MM&#37; was higher with nPna values &#8805;0&#46;8<span class="elsevierStyleHsp" style=""></span>g&#47;kg BW&#47;day&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">In a sub-analysis data&#44; robust test of equal means showed significant differences with BCM&#37;&#44; ECW&#37;&#44; FFM&#37;&#44; MM&#37; and s-albumin in the sample &#40;at least&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#46; Gender inter-subjects&#8217; analysis showed significant differences with BW&#44; FFM&#37;&#44; TSF and MAMC&#37;&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Protein intake as a predictor of nutritional and body composition status in chronic kidney disease patients</span><p id="par0100" class="elsevierStylePara elsevierViewall">In the linear regression analysis adjusted by gender&#44; age and BW &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#44; parameters as resistance&#44; BCM&#37;&#44; MM&#37;&#44; and s-albumin were significantly predictors of nPna as a surrogate marker of daily protein intake &#40;<span class="elsevierStyleItalic">R</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;51&#59; <span class="elsevierStyleItalic">R</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;29&#59; <span class="elsevierStyleItalic">R</span><span class="elsevierStyleSup">2</span> adjusted&#58; 0&#46;23&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Discussion</span><p id="par0105" class="elsevierStylePara elsevierViewall">The results of this study revealed that low dietary protein intake in CKD patients on stages 3&#44; 4&#8211;5&#44; was associated with loss of muscle mass even in patients receiving dietary counseling and nutritional follow-up at the advanced-CKD unit&#46; In this study&#44; older ages and lower e-GFR in CKD patients showed lower protein intake and loss of muscle mass&#44; especially in women&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">nPna an indirect measure of protein intake was showed as a strong and independent predictor of morbidity and mortality in CKD patients<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">25</span></a> and dialysis patients&#46;<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">26</span></a> Clinical practice guideline for CKD patients&#44;<a class="elsevierStyleCrossRefs" href="#bib0375"><span class="elsevierStyleSup">4&#8211;7</span></a> defined as those with e-GFR<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#44; have recommended reducing dietary protein intake to 0&#46;8<span class="elsevierStyleHsp" style=""></span>g&#47;kg&#47;day in adults both with and without diabetes to slow disease progression&#44; and achieve&#47;maintain adequate s-albumin concentration and nutritional status&#46; In the current study&#44; overall nPna values were slightly increased&#44; but only 57&#37; of the eligible CKD patients correctly achieved the low protein intake reduction&#46; Patients with CKD on stage 3&#44; had mean nPna values closed to current protein intake recommendation&#44; whilst advanced CKD on stages 4&#8211;5&#44; showed higher daily protein intake&#46; In this study&#44; diet adherence of usual nutritional recommendation was low&#44; being observed a 67&#46;9&#37; of CKD patients with nPna<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>0&#46;8<span class="elsevierStyleHsp" style=""></span>g&#47;kg BW&#47;day&#46; However&#44; a dietary protein intake &#60;0&#46;8<span class="elsevierStyleHsp" style=""></span>g&#47;kg BW&#47;day &#40;G<span class="elsevierStyleInf">1</span>&#41;&#44; showed significantly depletion of MAMC&#44; BCM&#37;&#44; FFM&#37; and PA in a similar way compared with one another nPna categories&#46; These findings are of importance because the loss of muscle mass and wasting has been demonstrated to be associated with poor outcomes in CKD patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0420"><span class="elsevierStyleSup">27&#44;28</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">PEW is common in CKD patients and is associated with a subsequent increased risk of mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">3</span></a> Dietary protein and energy intake may be masked in patients with advanced CKD due to uremic anorexia&#44; inter-current illness&#44; systemic inflammation&#44; fluid overload and&#47;or excessive dietary protein restriction&#46; S-albumin concentration and BMI are the most often used indicators of nutritional assessment in daily clinical practice<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">29&#44;30</span></a> However&#44; both are influenced by several non-nutritional factors&#44; including proteinuria&#44; fluid overload and inflammation statuses&#46;<a class="elsevierStyleCrossRefs" href="#bib0335"><span class="elsevierStyleSup">31&#44;32</span></a> In the current study&#44; PEW was assessed by MIS&#44; as a nutritional screening tool previously validated in CKD and dialysis patients together with commonly used nutritional-inflammatory markers&#46; Overall&#44; only 15&#37; of CKD patients were wasted&#46; In accordance with previous studies&#44;<a class="elsevierStyleCrossRefs" href="#bib0430"><span class="elsevierStyleSup">33&#44;34</span></a> the prevalence of PEW in the study was low compared with others&#46;<a class="elsevierStyleCrossRefs" href="#bib0435"><span class="elsevierStyleSup">35&#44;36</span></a> Furthermore&#44; despite of low e-GFR &#40;mean 19&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;7<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#41;&#44; a common used marker of protein turnover such as s-albumin was &#8805;4<span class="elsevierStyleHsp" style=""></span>g&#47;dL in all nPna groups&#46; Therefore&#44; a routine nutritional screening &#40;i&#46;e&#46; MIS&#41; could decreased the contribution of each indicator by combining s-albumin and BMI&#46; In fact&#44; this study found significantly positive correlation between nPna with e-GFR&#44; BCM&#37;&#44; MM&#37; and s-albumin&#44; but not Ln s-CRP and BMI&#46; These findings suggest that a multifactorial approach in CKD patients is mandatory&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Additional methods such as BIA and anthropometric measures may be also clinically useful to assess nutritional status&#46; Body composition analysis in patients with CKD are characterized by high content of ECW associated with sodium retention and a decreased of BCM&#44; both related with well-known causes as inflammation&#44; fluid overload and wasting&#46;<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">22&#44;31&#44;32</span></a> In this study&#44; exchange Na&#47;K and ECW&#37; were significantly higher as protein intake was &#60;0&#46;8<span class="elsevierStyleHsp" style=""></span>g of protein&#47;kg BW&#47;day&#46; Additionally&#44; BIA-derived parameters such as FFM&#37; and MM&#37; were also diminished&#46; Linear regression analysis showed that BIA-measures as resistance&#44; MM&#37; and s-albumin were independent predictors of nPna in the study population&#44; but an inverse relation was found with BCM&#37;&#46; These findings suggest that a high protein intake could worsen renal function and&#44; consequently the homeostasis of internal environment&#46; Nevertheless&#44; parameters such as exchange Na&#47;K&#44; FFM&#37; and FM&#37; were not found significant predictors of nPna in the linear regression analysis&#46; Thus&#44; in addition to common used nutritional markers&#44; data suggest that body composition parameters should be taken into account in the nutritional monitoring&#44; in patients with CKD&#46; In this clinical setting&#44; a &#8220;tailored diet prescription&#8221; considering gender-aged and body composition differences is required&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Prescription of a KA&#47;EAA supplemented VLPD may be considered in well-nourished not-inflamed CKD patients aimed to preserve the renal function and metabolic disturbances related to uremic milieu&#46; However&#44; in wasted patients with alterations of fluid status and body composition parameters may be further considered dietary protein intake definition&#46; There are potential limitations to be taking into account in this study&#46; The sample size of this study due to its nature as a single-center cross-sectional study may reduce the generalizability of the findings&#46; First&#44; there are fluctuations in nPna from day to day caused by changes in daily protein intake or endogenous protein catabolism related with e-GFR value in CKD patients&#46; Monitoring sequentially the body composition measures &#40;i&#46;e&#46; muscle mass&#41;&#44; could provide early nutritional interventions&#46; Second&#44; for nPna to accurately estimate protein intake&#44; the patient&#39;s protein metabolism should be at equilibrium or nearly so at the time of measurement&#46; This condition is not always met&#44; particularly in CKD patients with many comorbidities&#44; inflammation or acute disease states&#46; In this study&#44; eligible CKD patients were stabilized for at least 3 months before enrolment&#46; Third&#44; nPna could be masked usual dietary protein intake in wasted-inflamed patients&#46; Assessment of nutritional-inflammatory status by validated nutritional tools&#44; could early diagnose inadequate food intake and nutritional related-problems &#40;i&#46;e&#46; PEW&#41; in CKD patients&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">In conclusion&#44; controlled protein intake is one of the mainstays of CKD patients&#46; A low protein intake in patients with CKD stages 3&#44; 4&#8211;5&#44; was associated with muscle wasting&#44; even in patients receiving dietary advice and nutritional follow-up in the advanced-CKD unit&#46; The loss of muscle mass appears as an early indicator of being wasting&#46; Factors such as advanced age and loss of eGFR&#44; showed lower protein intake and were associated with muscle loss&#44; especially in women&#46; In addition&#44; of standard medical care&#44; assessment of nutritional status and body composition should be included to prevent&#44; diagnose and&#47;or treat PEW&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Further longitudinal studies are required for evaluating the contribution of different protein intake in uremic symptoms&#44; nutritional status&#44; body composition and CKD progression&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Authors&#8217; contributions</span><p id="par0140" class="elsevierStylePara elsevierViewall">GB designed the study&#44; collected the data&#44; analyzed and interpreted the results&#44; and drafted the manuscript&#46; AN collected the data and drafted the manuscript&#46; MR&#44; analyzed&#44; interpreted the results&#44; and drafted the manuscript&#46; YC analyzed and interpreted the statistical results&#46; JST analyzed&#44; interpreted the results&#44; and drafted the manuscript&#46; All of the authors read and approved the final version of manuscript&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Declarations</span><p id="par0145" class="elsevierStylePara elsevierViewall">None&#46;</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Conflict of interests</span><p id="par0150" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interests&#46;</p></span></span>"
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              "titulo" => "Anthropometric measurements"
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              "titulo" => "Body composition analysis"
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              "titulo" => "Correlations"
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              "identificador" => "sec0065"
              "titulo" => "Patient characteristics according to dietary protein intake"
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              "identificador" => "sec0070"
              "titulo" => "Protein intake as a predictor of nutritional and body composition status in chronic kidney disease patients"
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          "titulo" => "Discussion"
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    "fechaRecibido" => "2017-12-23"
    "fechaAceptado" => "2018-06-07"
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            0 => "Protein intake"
            1 => "Normalized protein nitrogen appearance"
            2 => "Muscle mass"
            3 => "Protein-energy wasting"
            4 => "Body composition"
            5 => "Bioelectrical impedance"
            6 => "Chronic kidney disease"
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          "clase" => "abr"
          "titulo" => "Abbreviations"
          "identificador" => "xpalclavsec1060978"
          "palabras" => array:28 [
            0 => "BCM&#37;"
            1 => "BIA"
            2 => "BIVA"
            3 => "BMI"
            4 => "BW"
            5 => "CKD"
            6 => "CRP"
            7 => "ECW"
            8 => "FFM&#37;"
            9 => "FM"
            10 => "e-GFR"
            11 => "ICW&#37;"
            12 => "KA"
            13 => "Ln s-CRP"
            14 => "LPD"
            15 => "MAMC&#37;"
            16 => "MIS"
            17 => "MM&#37;"
            18 => "nPna"
            19 => "PA"
            20 => "PEW"
            21 => "RRT"
            22 => "SBW&#37;"
            23 => "s-albumin"
            24 => "s-CRP"
            25 => "TBW&#37;"
            26 => "TSF"
            27 => "VLPD"
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          "palabras" => array:7 [
            0 => "Ingesta de prote&#237;nas"
            1 => "Aparici&#243;n de nitr&#243;geno proteico normalizado"
            2 => "Masa muscular"
            3 => "P&#233;rdida de energ&#237;a proteica"
            4 => "Composici&#243;n corporal"
            5 => "Impedancia bioel&#233;ctrica"
            6 => "Enfermedad renal cr&#243;nica"
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      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A controlled protein intake has shown beneficial effects to preserve renal function and nutritional status in chronic kidney disease &#40;CKD&#41; patients&#46; This study aimed to analyze usual dietary protein intake and its potential contribution to body composition in CKD patients in stages 3&#8211;5&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Cross-sectional study in 134 CKD patients in stages 3&#8211;5 &#40;mean e-GFR&#58; 19&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;7<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#59; males 68&#46;7&#37; and primary CKD etiology was diabetes mellitus&#44; 35&#46;8&#37;&#41;&#46; Demographic&#44; clinical and nutritional parameters were evaluated&#46; Normalized protein nitrogen appearance &#40;nPNA&#41;&#44; was used as a surrogate marker of dietary protein intake&#46; The sample was classified into three nPNA groups &#40;G<span class="elsevierStyleInf"><span class="elsevierStyleItalic">n</span></span>&#41;&#58; G<span class="elsevierStyleInf">1</span>&#58; &#60;0&#46;8<span class="elsevierStyleHsp" style=""></span>g&#47;kg&#47;day&#59; G<span class="elsevierStyleInf">2</span>&#58; 0&#46;8&#8211;1<span class="elsevierStyleHsp" style=""></span>g&#47;kg&#47;day and&#44; G<span class="elsevierStyleInf">3</span>&#58; &#8805;1<span class="elsevierStyleHsp" style=""></span>g&#47;kg&#47;day&#46; Assessment of nutritional status using the malnutrition-inflammation score &#40;MIS&#41;&#44; anthropometric measures and laboratory parameters&#46; Analysis of body composition and hydration status by bioelectrical impedance analysis &#40;BIVA-101-RJL system&#41;&#46; Statistical analysis by SPSS v&#46;20&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Overall mean nPNA values were 0&#46;91<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;23<span class="elsevierStyleHsp" style=""></span>g of protein&#47;kg BW&#47;day and only 32&#46;1&#37; had a dietary protein intake &#60;0&#46;8<span class="elsevierStyleHsp" style=""></span>g of protein&#47;kg BW&#47;day&#46; Most of the CKD patients &#40;65&#46;5&#37;&#41; were in stages 4 or 5&#46; Prevalence of protein&#8211;energy&#8211;wasting &#40;PEW&#41; syndrome measured by MIS was 15&#37;&#46; By analyzing differences between nPNA groups&#44; body weight &#40;BW&#41;&#44; BMI and triceps-skinfold &#40;TSF&#41; thickness were significantly higher in the group with nPNA &#8805;1<span class="elsevierStyleHsp" style=""></span>g&#47;kg BW&#47;day &#40;G<span class="elsevierStyleInf">3</span>&#41;&#44; whereas a significant inverse relationship was found with the percentages of body cell mass &#40;BCM&#37;&#41;&#44; fat-free mass &#40;FFM&#37;&#41;&#44; muscle mass &#40;MM&#37;&#41; and phase angle &#40;PA&#41; in the group with the lowest nPNA &#40;G<span class="elsevierStyleInf">1</span>&#41;&#46; Analysis of gender among subjects showed significant differences with BW&#44; FFM&#37;&#44; TSF and mid-arm muscle circumference &#40;MAMC&#37;&#41;&#46; Linear regression analysis showed that resistance&#44; BCM&#37;&#44; MM&#37;&#44; and serum albumin were significant predictors of nPNA as a surrogate marker of daily protein intake &#40;<span class="elsevierStyleItalic">R</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;51&#59; <span class="elsevierStyleItalic">R</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;29&#59; <span class="elsevierStyleItalic">R</span><span class="elsevierStyleSup">2</span> adjusted<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;23&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Controlled protein intake is one of the cornerstones of treatment in CKD patients&#46; A low protein intake in patients with CKD stages 3 and 4&#8211;5 was associated with loss of muscle mass in the advanced-CKD unit&#46; The loss of muscle mass appears as an early indicator of nutritional comprised&#46; Factors such&#44; elderly age and loss of eGFR&#44; showed lower protein intake and were associated with muscle loss&#44; especially in women&#46; Further longitudinal studies are required to evaluate the contribution of different protein intakes to uremic symptoms&#44; nutritional status&#44; body composition and CKD progression&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Method"
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          2 => array:2 [
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El control de la ingesta proteica ha mostrado efectos beneficiosos preservando la funci&#243;n renal y el estado nutricional en pacientes con enfermedad renal cr&#243;nica &#40;ERC&#41;&#46; El objetivo del estudio fue analizar la ingesta habitual de prote&#237;na&#44; y su potencial contribuci&#243;n en la composici&#243;n corporal en los pacientes con ERC estadios 3-5&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional transversal en 134 pacientes con ERC estadios 3-5 &#40;media e-TFG&#58; 19&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#44;7<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#44;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#59; varones&#58; 68&#44;7&#37; y etiolog&#237;a primaria de la ERC&#44; diabetes mellitus&#58; 35&#44;8&#37;&#41;&#46; Se evaluaron par&#225;metros demogr&#225;ficos&#44; cl&#237;nicos y nutricionales&#46; La aparici&#243;n de nitr&#243;geno proteico normalizado &#40;nPNA&#41; se utiliz&#243; como marcador sustituto de la ingesta proteica&#46; La muestra fue clasificada seg&#250;n el nPNA en 3 grupos &#40;G<span class="elsevierStyleInf">n</span>&#41;&#58; G<span class="elsevierStyleInf">1</span>&#58; &#60; 0&#44;8<span class="elsevierStyleHsp" style=""></span>g&#47;kg&#47;d&#237;a&#59; G<span class="elsevierStyleInf">2</span>&#58; 0&#44;8-1<span class="elsevierStyleHsp" style=""></span>g&#47;kg&#47;d&#237;a y G<span class="elsevierStyleInf">3</span>&#58;<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>g&#47;kg&#47;d&#237;a&#46; Valoraci&#243;n nutricional por la escala de malnutrici&#243;n-inflamaci&#243;n &#40;MIS&#41;&#44; medidas antropom&#233;tricas y par&#225;metros de laboratorio&#46; An&#225;lisis de composici&#243;n corporal y del patr&#243;n de hidrataci&#243;n mediante bioimpedancia el&#233;ctrica &#40;BIVA-101<span class="elsevierStyleSup">&#174;</span>&#44; RJL System&#41;&#46; An&#225;lisis estad&#237;stico por SPSS<span class="elsevierStyleSup">&#174;</span> v&#46;20&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Globalmente los valores medios de nPNA fueron 0&#44;91<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;23<span class="elsevierStyleHsp" style=""></span>g prote&#237;na&#47;kg peso corporal&#47;d&#237;a&#44; y tan solo el 32&#44;1&#37; ten&#237;an una ingesta proteica &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;8<span class="elsevierStyleHsp" style=""></span>g de prote&#237;na&#47;kg peso corporal&#47;d&#237;a&#46; El 65&#44;5&#37; de los pacientes con ERC estaban en estadios 4 y 5&#46; La prevalencia de s&#237;ndrome de desgaste proteico-energ&#233;tico &#40;SDP&#41; medido por MIS era del 15&#37;&#46; Analizando las diferencias con el nPNA entre los grupos&#44; el peso corporal&#44; el &#237;ndice de masa corporal y el pliegue tricipital &#40;PCT&#41;&#44; eran significativamente mayores en el grupo con nPNA<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>g&#47;kg peso corporal&#47;d&#237;a &#40;G<span class="elsevierStyleInf">3</span>&#41;&#44; mientras que se encontr&#243; relaci&#243;n inversa significativa con los porcentajes de la masa celular &#40;MC&#37;&#41;&#44; de la masa magra &#40;MMagra&#37;&#41;&#44; de la masa muscular &#40;MM&#37;&#41; y del &#225;ngulo de fase &#40;AF&#41; en el grupo con menor nPNA &#40;G<span class="elsevierStyleInf">1</span>&#41;&#46; El an&#225;lisis del g&#233;nero entre los sujetos mostr&#243; diferencias significativas con el peso corporal&#44; MMagra&#37;&#44; PCT y la circunferencia muscular del brazo &#40;CMB&#37;&#41;&#46; El an&#225;lisis de regresi&#243;n lineal demostr&#243; que la resistencia MC&#37;&#44; MM&#37; y la alb&#250;mina s&#233;rica eran predictores significativos del nPNA como marcador de la ingesta proteica habitual &#40;R<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;51&#59; R<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;29&#59; R<span class="elsevierStyleSup">2</span> ajustado<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;23&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El control de la ingesta proteica es uno de los pilares del tratamiento en los pacientes con ERC&#46; La dieta hipoproteica en pacientes con ERC estadios 3-5 se asoci&#243; con una p&#233;rdida de la masa muscular en la unidad de ERC avanzada&#46; La p&#233;rdida de masa muscular aparece como un indicador temprano de compromiso nutricional&#46; La edad avanzada y la p&#233;rdida de TFG-e se asociaron con menor ingesta proteica y p&#233;rdida de masa muscular asociada&#44; especialmente en mujeres&#46; Nuevos estudios longitudinales&#44; son necesarios para evaluar la contribuci&#243;n de la ingesta de prote&#237;nas en los s&#237;ntomas ur&#233;micos&#44; el estado nutricional&#44; la composici&#243;n corporal y la progresi&#243;n de la ERC&#46;</p></span>"
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          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">e-GFR&#44; estimated glomerular filtration rate measured by CKD-EPI equation&#59; Ln s-CRP&#44; natural logarithmic of C-reactive protein&#59; nPna&#44; normalized protein nitrogen appearance&#46; PEW&#44; protein-energy wasting&#46;</p><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">&#42;</span><span class="elsevierStyleItalic">p</span>-values are based on Chi-square tests or ANOVA-tests according to cut-off points of normalized protein nitrogen appearance &#40;nPna&#41;&#46;</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">&#35;</span>Daily protein intake measured by nPna were defined in different groups as follows&#58; G1&#58; nPna<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;8<span class="elsevierStyleHsp" style=""></span>g&#47;kg BW&#47;day&#59; G2&#58; nPna 0&#46;8&#8211;1<span class="elsevierStyleHsp" style=""></span>g&#47;kg<span class="elsevierStyleHsp" style=""></span>BW&#47;day and&#59; G3&#58; nPna<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>g&#47;kg BW&#47;day&#46; <span class="elsevierStyleSup">a&#44;b&#44;c</span><span class="elsevierStyleItalic">p</span>-values within the means of nPna bearing different letters were significantly different&#59; <span class="elsevierStyleSup">a</span><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#44; <span class="elsevierStyleSup">b</span><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#44; <span class="elsevierStyleSup">c</span><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001 &#40;Brown&#8211;Forsythe test for equal means&#41;&#46;</p><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">&#8224;</span>PEW was defined by MIS score &#8805;5 points&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variables&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Global&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">G<span class="elsevierStyleInf">1</span>&#58; nPna<br>&#60;0&#46;8<span class="elsevierStyleHsp" style=""></span>g&#47;kg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">G<span class="elsevierStyleInf">2</span>&#58; nPna 0&#46;8&#8211;1<span class="elsevierStyleHsp" style=""></span>g&#47;kg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">G<span class="elsevierStyleInf">3</span>&#58; nPna<br>&#8805;1<span class="elsevierStyleHsp" style=""></span>g&#47;kg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>-value<span class="elsevierStyleSup">&#42;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">n</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">134&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">nPna &#40;g&#47;kg BW&#47;day&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;91<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;65<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;08&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;89<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;16<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">71<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">73&#46;58<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#46;58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">70&#46;22<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#46;27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">69&#46;21<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#46;79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Men&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">92 &#40;68&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25 &#40;17&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">40 &#40;29&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27 &#40;20&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diabetes&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">48 &#40;36&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24 &#40;17&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28 &#40;20&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;12&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">e-GFR &#40;mL&#47;min&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16&#46;34<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17&#46;43<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17&#46;73<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hemoglobin &#40;g&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#46;25<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#46;86<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#46;19<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#46;50<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;076&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">s-Albumin &#40;g&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;18<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;04<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;20<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;11<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;015<span class="elsevierStyleSup">b</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total Lymphocytes count &#40;&#215;10<span class="elsevierStyleSup">3</span>&#47;mm<span class="elsevierStyleSup">3</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2026&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1133&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1897&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>881&#46;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2142<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1529&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2016&#46;87<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>744&#46;23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">s-Creatinine &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;27<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;39<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;08&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;54<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;42<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;94&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ln s-CRP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8722;0&#46;84<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8722;0&#46;75<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8722;0&#46;87<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8722;1&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Proteinuria &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">58&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>69&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">82&#46;34<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>72&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">49&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>63&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">44&#46;70<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>70&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;032&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PEW&#44;<span class="elsevierStyleSup">&#8224;</span><span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20 &#40;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;5&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 &#40;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#40;3&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Demographic and laboratory data in 134 CKD patients stages&#44; 3&#8211;5 according to daily dietary protein intake&#46;&#35;&#46;</p>"
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        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
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          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">BMI&#44; body mass index&#59; ECW&#44; extracellular water&#59; FM&#44; fat mass&#59; FFM&#44; fat free mass&#59; ICW&#44; intracellular water&#59; MAMC&#44; middle-arm muscle circumference&#59; MIS&#44; Malnutrition-Inflammation Score&#59; TBW&#44; total body water&#59; TSF&#44; triceps skinfold thickness&#46;</p><p id="spar0105" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">&#42;</span>p-values are based on Chi-square tests or ANOVA-tests according to cut-off points of normalized protein nitrogen appearance &#40;nPna&#41;&#46;</p><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">&#35;</span>Daily protein intake measured by nPna were defined in different groups as follows&#58; G<span class="elsevierStyleInf">1</span>&#58; nPna &#60; 0&#46; 8<span class="elsevierStyleHsp" style=""></span>g&#47;kg BW&#47;day&#59; G<span class="elsevierStyleInf">2</span>&#58; nPna 0&#46;8&#8211;1<span class="elsevierStyleHsp" style=""></span>g&#47;kg BW&#47;day and&#59; G<span class="elsevierStyleInf">3</span>&#58; nPna &#8805; 1<span class="elsevierStyleHsp" style=""></span>g&#47;kg BW&#47;day&#46; <span class="elsevierStyleSup">a&#44;b&#44;c</span><span class="elsevierStyleItalic">p</span>-values within the means of nPna bearing different letters were significantly different&#59; <span class="elsevierStyleSup">a</span><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#44; <span class="elsevierStyleSup">b</span><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#44; <span class="elsevierStyleSup">c</span><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001 &#40;Brown&#8211;Forsythe test for equal means&#41;&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variables&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Global&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">G<span class="elsevierStyleInf">1</span>&#58; nPna<br>&#60;0&#46;8<span class="elsevierStyleHsp" style=""></span>g&#47;kg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">G<span class="elsevierStyleInf">2</span>&#58; nPna<br>0&#46;8&#8211;1<span class="elsevierStyleHsp" style=""></span>g&#47;kg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">G<span class="elsevierStyleInf">3</span>&#58; nPna<br>&#8805;1<span class="elsevierStyleHsp" style=""></span>g&#47;kg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>-value<span class="elsevierStyleSup">&#42;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Body weight &#40;kg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">74&#46;41<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#46;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">77&#46;78<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#46;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">76&#46;32<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46;99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">69&#46;32<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#46;96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;037<span class="elsevierStyleSup">a</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Standard Body Weight &#40;kg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">68&#46;08<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">67&#46;77<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70&#46;01<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">68&#46;62<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;301&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BMI &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;19<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&#46;42<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;40<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&#46;56<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;012<span class="elsevierStyleSup">b</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">TSF &#40;mm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#46;84<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&#46;02<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;79<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#46;75<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;016<span class="elsevierStyleSup">b</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">MAMC &#40;cm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&#46;96<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&#46;14<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&#46;58<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;041<span class="elsevierStyleSup">a</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">MAMC &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">130&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>22&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">136&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>27&#46;44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">130&#46;97<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18&#46;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">122&#46;59<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;024<span class="elsevierStyleSup">a</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Handgrip strength right &#40;kg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Handgrip strength left &#40;kg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Exchange Na&#47;K&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;46<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;58<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;47<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;45<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;463&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Body cell mas &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;008<span class="elsevierStyleSup">b</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total body water &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">54&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">52&#46;90<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55&#46;77<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55&#46;63<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;91&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;037&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ECW &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56&#46;45<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">59&#46;86<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55&#46;99<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55&#46;10<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;007<span class="elsevierStyleSup">b</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ICW &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">43&#46;51<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40&#46;13<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">44<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">44&#46;79<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;008<span class="elsevierStyleSup">b</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fat mass &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&#46;46<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;91&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&#46;50<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&#46;80<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fat-free mass &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">68&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">66&#46;31<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70&#46;49<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">71&#46;19<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;009<span class="elsevierStyleSup">b</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Muscle mass &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&#46;78<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&#46;68<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34&#46;82<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55&#46;77<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001<span class="elsevierStyleSup">c</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Phase angle &#40;&#176;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;17<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;77<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;26<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;27<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;033&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                0 => "xTab1921407.png"
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          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Anthropometric&#44; nutritional and body composition data in 134 CKD patients stages&#44; 3&#8211;5 according to daily dietary protein intake&#46;<span class="elsevierStyleSup">&#35;</span>&#46;</p>"
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          "leyenda" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">&#35;</span>Normalized nitrogen protein appearance as a dependent variable in a linear regression model adjusted by gender&#44; age and body weight&#46; 95&#37;CI&#44; confidence interval&#46; <span class="elsevierStyleItalic">R</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;53&#59; <span class="elsevierStyleItalic">R</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;29&#59; <span class="elsevierStyleItalic">R</span><span class="elsevierStyleSup">2</span> adjusted<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;23&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">95&#37;CI&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;276&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;00 to 0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Exchange Na&#47;K&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;445&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8722;0&#46;136 to 0&#46;522&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;24&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;1&#46;996&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8722;0&#46;008 to &#8722;0&#46;092&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;019&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fat-free mass &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;574&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8722;0&#46;026 to 0&#46;054&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;485&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Muscle mass &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;724&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;028 to 0&#46;139&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fat mass &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;161&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;000 to 0&#46;107&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;050&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">s-Albumin &#40;g&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;203&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;012 to 0&#46;209&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;028&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Constant&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8722;8&#46;63 to 0&#46;97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;117&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Normalized nitrogen protein appearance in a linear regression analysis as likely predictor in CKD stages 3&#8211;5 patients&#46;<span class="elsevierStyleSup">&#35;</span>&#46;</p>"
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    "bibliografia" => array:2 [
      "titulo" => "References"
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        0 => array:2 [
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            0 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "1"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The effect of dietary protein restriction on the progression of diabetic and nondiabetic renal diseases&#58; a meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46;T&#46; Pedrini"
                            1 => "A&#46;S&#46; Levey"
                            2 => "J&#46; Lau"
                            3 => "T&#46;C&#46; Chalmers"
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Article information
ISSN: 20132514
Original language: English
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