{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:55:09Z","timestamp":1787028909762,"version":"build-2736575974"},"reference-count":36,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2019,8,1]],"date-time":"2019-08-01T00:00:00Z","timestamp":1564617600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and objectives: Diabetes is largely prevalent in the chronic kidney disease (CKD) population. Both conditions have metabolic and nutritional abnormalities that affect body composition and the presence of diabetes makes the dietary management of CKD patients more difficult. The aim of this study was to assess peculiar nutritional and functional aspects of diabetic patients in an adult\/elderly CKD population, and their predictive significance. Materials and methods: This prospective cohort study included 144 out-patients aged &gt;55 years, affected by stage 3b-4 CKD, on tertiary care clinic; 48 (40 males) were type 2 diabetics and 96 (80 males) were nondiabetics. The two groups have similar age, gender, and residual renal function (30 \u00b1 9 vs. 31 \u00b1 11 mL\/min\u00d71.73). All patients underwent a comprehensive nutritional and functional assessment and were followed for 31 \u00b1 14 months. Results: Diabetic CKD patients showed higher waist circumference and fat body mass, lower muscle mass, and lower number of steps per day and average daily METs. Meanwhile, resting energy expenditure (REE), as assessed by indirect calorimetry, and dietary energy intake were similar as well as hand-grip and 6 min walking test. Diabetic patients did not show a greater risk for all-cause mortality and renal death with respect to nondiabetics. Middle arm muscle circumference, phase angle, serum cholesterol, and serum albumin were negatively related to the risk of mortality and renal death after adjustment for eGFR. Conclusions: CKD diabetic patients differed from nondiabetics for a greater fat mass, lower muscle mass, and lower physical activity levels. This occurred at the same REE and dietary energy intake. The outcome of diabetic or nondiabetic CKD patients on tertiary care management was similar in terms of risk for mortality or renal death. Given the same residual renal function, low levels of muscle mass, phase angle, serum albumin, and cholesterol were predictive of poor outcome. Overall, a malnutrition phenotype represents a major predictor of poor outcome in diabetic and nondiabetic CKD patients.<\/jats:p>","DOI":"10.3390\/medicina55080427","type":"journal-article","created":{"date-parts":[[2019,8,1]],"date-time":"2019-08-01T11:39:37Z","timestamp":1564659577000},"page":"427","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Nutritional Aspects in Diabetic CKD Patients on Tertiary Care"],"prefix":"10.3390","volume":"55","author":[{"given":"Claudia","family":"D\u2019Alessandro","sequence":"first","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimiliano","family":"Barsotti","sequence":"additional","affiliation":[{"name":"Nephrology, Transplant and Dialysis Unit, University Hospital of Pisa, 56126 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caterina","family":"Cianchi","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5614-8034","authenticated-orcid":false,"given":"Claudia","family":"Mannucci","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7783-0262","authenticated-orcid":false,"given":"Riccardo","family":"Morganti","sequence":"additional","affiliation":[{"name":"Section of Statistics, University Hospital of Pisa, 56126 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serena","family":"Tassi","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8995-936X","authenticated-orcid":false,"given":"Adamasco","family":"Cupisti","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2019,8,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1016\/j.exger.2016.02.003","article-title":"Kidney disease and aging: A reciprocal relation","volume":"87","author":"Kooman","year":"2017","journal-title":"Exp. Gerontol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1186\/s12955-015-0270-0","article-title":"Influence of frailty on health-related quality of life in pre-dialysis patients with chronic kidney disease in Korea: A cross-sectional study","volume":"29","author":"Lee","year":"2015","journal-title":"Health Qual. Life Outcomes"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1016\/j.maturitas.2013.07.013","article-title":"Malnutrition in the elderly: A narrative review","volume":"76","author":"Agarwal","year":"2013","journal-title":"Maturitas"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1053\/j.jrn.2017.12.003","article-title":"Association of Sarcopenia with Nutritional Parameters, Quality of Life, Hospitalization, and Mortality Rates of Elderly Patients on Hemodialysis","volume":"28","author":"Giglio","year":"2018","journal-title":"J. Ren. Nutr."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1265","DOI":"10.1093\/ndt\/gfm790","article-title":"Predictors of new-onset decline in kidney function in a general middle-European population","volume":"23","author":"Obermayr","year":"2008","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.1681\/ASN.2005111241","article-title":"Increasing body mass index and obesity in the incident ESRD population","volume":"17","author":"Kramer","year":"2006","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"822","DOI":"10.1681\/ASN.2012070702","article-title":"Association between physical performance and all-cause mortality in CKD","volume":"24","author":"Roshanravan","year":"2013","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Bellizzi, V., Cupisti, A., Locatelli, F., Bolasco, P., Brunori, G., Cancarini, G., Caria, S., De Nicola, L., Di Iorio, B.R., and Di Micco, L. (2016). \u201cConservative Treatment of CKD\u201d study group of the Italian Society of Nephrology. Low-protein diets for chronic kidney disease patients: The Italian experience. BMC Nephrol., 17.","DOI":"10.1186\/s12882-016-0280-0"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1053\/j.ajkd.2014.08.001","article-title":"Diabetic kidney disease: A report from an ada consensus conference","volume":"64","author":"Tuttle","year":"2014","journal-title":"Am. J. Kidney Dis."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1218","DOI":"10.1001\/jama.286.10.1218","article-title":"Effects of exercise on glycemic control and body mass in type 2 diabetes mellitus: A meta-analysis of controlled clinical trials","volume":"286","author":"Boule","year":"2001","journal-title":"JAMA"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"243","DOI":"10.4239\/wjd.v7.i12.243","article-title":"Daily physical activity and type 2 diabetes: A review","volume":"7","author":"Hamasaki","year":"2016","journal-title":"World J. Diabetes"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1111\/j.1532-5415.2007.01140.x","article-title":"Health, Aging and Body Composition Study. Alternative definitions of sarcopenia, lower extremity performance, and functional impairment with aging in older men and women","volume":"55","author":"Delmonico","year":"2007","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1016\/j.ijcard.2018.03.064","article-title":"Non-invasive testing for sarcopenia predicts future cardiovascular events in patients with chronic kidney disease","volume":"268","author":"Hanatani","year":"2018","journal-title":"Int. J. Cardiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"c7","DOI":"10.1159\/000286344","article-title":"Physical exercise in patients with severe kidney disease","volume":"115","author":"Kosmadakis","year":"2010","journal-title":"Nephron Clin. Pract."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1097\/MNH.0000000000000318","article-title":"Clinical relevance of sarcopenia in chronic kidney disease","volume":"26","author":"Moorthi","year":"2017","journal-title":"Curr. Opin. Nephrol. Hypertens."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1507","DOI":"10.2337\/dc06-2537","article-title":"Health, Aging, and Body Composition Study. Accelerated loss of skeletal muscle strength in older adults with type 2 diabetes: The health, aging, and body composition study","volume":"30","author":"Park","year":"2007","journal-title":"Diabetes Care"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"D\u2019Alessandro, C., Piccoli, G.B., Calella, P., Brunori, G., Pasticci, F., Egidi, M.F., Capizzi, I., Bellizzi, V., and Cupisti, A. (2016). \u201cDietaly\u201d: Practical issues for the nutritional management of CKD patients in Italy. BMC Nephrol., 17.","DOI":"10.1186\/s12882-016-0296-5"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Cupisti, A., D\u2019Alessandro, C., Di Iorio, B., Bottai, A., Zullo, C., Giannese, D., Barsotti, M., and Egidi, M.F. (2016). Nutritional support in the tertiary care of patients affected by chronic renal insufficiency: Report of a step-wise, personalized, pragmatic approach. BMC Nephrol., 17.","DOI":"10.1186\/s12882-016-0342-3"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1038\/ki.1985.10","article-title":"A method for estimating nitrogen intake in patients with chronic renal failure","volume":"27","author":"Maroni","year":"1985","journal-title":"Kidney Int."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"604","DOI":"10.7326\/0003-4819-150-9-200905050-00006","article-title":"CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration). A New Equation to Estimate Glomerular Filtration Rate","volume":"150","author":"Levey","year":"2009","journal-title":"Ann. Intern. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1016\/j.exger.2013.11.016","article-title":"Specific bioelectrical impedance vector reference values for assessing body composition in the Italian elderly","volume":"50","author":"Saragat","year":"2014","journal-title":"Exp. Gerontol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1080\/15438620600651512","article-title":"Validation of Cosmed\u2019s FitMate in measuring oxygen consumption and estimating resting metabolic rate. Appalachian State University, Boone, North Carolina, USA","volume":"14","author":"Nieman","year":"2006","journal-title":"Res. Sports Med."},{"key":"ref_23","first-page":"213","article-title":"New methods for calculating metabolic rate with special reference to protein metabolism","volume":"6","author":"Weir","year":"1949","journal-title":"Nutrition"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1080\/02701367.1999.10608028","article-title":"A 30-s chair-stand test as a measure of lower body strength in community-residing older adults","volume":"70","author":"Jones","year":"1999","journal-title":"Res. Q. Exerc. Sport"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories (2002). ATS Statement: Guidelines for the Six-Minute Walk Test. Am. J. Respir Crit. Care Med. Vol., 166, 111\u2013117.","DOI":"10.1164\/ajrccm.166.1.at1102"},{"key":"ref_26","first-page":"24","article-title":"Measuring functional fitness of older adults","volume":"1","author":"Jones","year":"2002","journal-title":"J. Act. Aging"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1016\/j.clnu.2008.04.004","article-title":"Reference values of handgrip dynamometry of healthy adults: A population-based study","volume":"27","author":"Schlussel","year":"2008","journal-title":"Clin. Nutr."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"879","DOI":"10.1007\/s00592-016-0880-y","article-title":"Muscle dysfunction in type 2 diabetes: A major threat to patient\u2019s mobility and independence","volume":"53","author":"Bianchi","year":"2016","journal-title":"Acta Diabetol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"68","DOI":"10.3164\/jcbn.11-012FR","article-title":"Oxidative stress in cardiac and skeletal muscle dysfunction associated with diabetes mellitus","volume":"48","author":"Tsutsui","year":"2011","journal-title":"J. Clin. Biochem. Nutr."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1053\/j.arrt.2003.10.007","article-title":"Is obesity a major cause of chronic kidney disease?","volume":"11","author":"Hall","year":"2004","journal-title":"Adv. Ren. Replace. Ther."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1053\/j.jrn.2010.10.009","article-title":"The effect of obesity on chronic kidney disease","volume":"21","author":"Kopple","year":"2011","journal-title":"J. Ren. Nutr."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Piccoli, G.B., Ventrella, F., Capizzi, I., Vigotti, F.N., Mongilardi, E., Grassi, G., Loi, V., Cabiddu, G., Avagnina, P., and Versino, E. (2016). Low-protein Diets in Diabetic Chronic Kidney Disease (CKD) Patients: Are They Feasible and Worth the Effort?. Nutrients, 8.","DOI":"10.3390\/nu8100649"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1016\/S2213-8587(15)00094-7","article-title":"ERA-EDTA diabesity working group. Non-proteinuric pathways in loss of renal function in patients with type 2 diabetes","volume":"3","author":"Porrini","year":"2015","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Metti, A.L., Best, J.R., Shaaban, C.E., Ganguli, M., and Rosano, C. (2018). Longitudinal changes in physical functionand physical activity in older adults. Age Ageing, 13.","DOI":"10.1093\/ageing\/afy025"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"3061","DOI":"10.12659\/MSM.913512","article-title":"Long-Term Intensive Lifestyle Intervention Promotes Improvement of Stage III Diabetic Nephropathy","volume":"25","author":"Dong","year":"2019","journal-title":"Med. Sci. Monit."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1038\/kisup.2013.97","article-title":"Fibroblast growth factor 23 and 25-hydroxyvitamin D levels are associated with estimated glomerular filtration rate decline","volume":"3","author":"Hamano","year":"2013","journal-title":"Kidney Int. Suppl."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/55\/8\/427\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T13:12:20Z","timestamp":1760188340000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/55\/8\/427"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,8,1]]},"references-count":36,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2019,8]]}},"alternative-id":["medicina55080427"],"URL":"https:\/\/doi.org\/10.3390\/medicina55080427","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,8,1]]}}}