An adequate protein intake prevents the loss of fat-free mass during weight loss. Laparoscopic sleeve gastrectomy (SG) jeopardizes protein intake due to post-operative dietary restriction and intolerance to protein-rich foods. The purpose of this study is to evaluate protein intake in the first three months after SG. We evaluated, 1 month and 3 months after surgery, 47 consecutive patients treated with SG. Protein intake, both from foods and from protein supplementation, was assessed through a weekly dietary record. Patients consumed 30.0 ± 10.2 g of protein/day on average from foods in the first month, with a significant increase to 34.9 ± 4.8 g of protein/day in the third month (p = 0.003). The use of protein supplementation significantly increased total protein intake to 42.3 ± 15.9 g protein/day (p < 0.001) in the first month and to 39.6 ± 14.2 g of protein/day (p = 0.002) in the third one. Compliance with supplement consumption was 63.8% in the first month and only 21.3% in the third month. In conclusion, both one and three months after SG, protein intake from foods was not sufficient. The use of modular supplements seems to have a significant impact on protein intake, but nevertheless it remains lower than recommended.

Introduction: Chronic kidney disease is a degenerative and increasingly prevalent condition that includes metabolic abnormalities and is associated with a higher risk of sarcopenia. The conservative approach points primarily to controlling metabolic issues and reducing the risk of malnutrition and sarcopenia, slowing the progression of kidney disease. The present study aims to evaluate the effect of a low-protein diet on malnutrition and sarcopenia. Methods: A total of 45 patients (33 male and 12 female) aged over 70 with chronic kidney disease stage 4–5 in conservative management were considered. All patients had a dietary assessment and prescription of personalized low-protein dietary plans (≤0.6 g protein/kg) and a follow-up control between 4 and 6 months. In preliminary and follow-up evaluations, anthropometric data, blood examinations, body composition results, muscle strength, physical performance, and a 3-day food diary were collected. Results: In the follow-up period, a significant weight loss (p = 0.001) and a decrease in body mass index (p = 0.002) were recorded. Food diaries revealed a significant reduction in protein, sodium, potassium, and phosphorus intake (p < 0.001), with a significant reduction in urea (p < 0.001) and proteinuria (p = 0.01) without any impact on lean mass (p = 0.66). Considerable variations in adherence between food diaries and the prescribed diet were also noted. Conclusions: Providing a personalized low-protein diet led to significant benefits in a short period without worsening the patient’s nutritional status.

Background/Objectives: Comprehensive conservative management (CCM) is a viable treatment option for elderly patients with end-stage kidney disease (ESKD). However, it involves a significant change in dietary habits, such as adopting a low-protein diet. Therefore, it is crucial to understand its impact on the patient’s quality of life (QoL), particularly when compared to hemodialysis (HD). The study aims to evaluate the differences in the QoL between patients undergoing CCM and HD. Methods: The study included 50 patients over 75 with ESKD, with 25 patients in the CCM group and 25 in the HD group. The CCM group followed a personalized low-protein diet, while the HD group did not have protein restrictions. Various parameters were assessed, including demographic data, urine output, blood tests, comorbidity index, Visual Analog Scale (VAS), and hospitalization. The SF-12 questionnaire assessed the QoL, and the Physical Composite Score (PCS) and Mental Composite Score (MCS) were calculated. Results: The study revealed no age and comorbidity index differences between CCM and HD patients. In contrast, CCM patients reported significantly better physical and mental well-being than HD patients. In univariate analysis, CCM (B 0.24, p = 0.001), protein intake (B −0.004, p = 0.008), hospitalization (B −0.18, p = 0.024), urine output (B 0.25, p = 0.001), and VAS (B −0.26, p < 0.001) influenced the PCS. At the same time, only the type of treatment (B = 0.15, p = 0.048), urine output (B 0.18, p = 0.02), and VAS (B −0.14, p = 0.048) influence the MCS. In contrast, in multivariate analysis, only CCM contributed to an improved PCS (B 0.19, p = 0.003) and MCS (B 0.16, p = 0.03), while a higher VAS worsened the PCS (B −0.24, p < 0.001) and MCS (B −0.157, p = 0.0024). Conclusions: In elderly patients with similar basal conditions, health-related QoL perception is better in CCM than in HD patients.

Background/Objectives: Educational support is a well-established strategy in diet management for chronic diseases. No study has reported the impact of protein counting in a low-protein diet for chronic kidney disease (CKD). We aimed to assess how a protein-counting educational program could enhance adherence and satisfaction in managing a low-protein diet in CKD patients with an eGFR below 20 mL/min/1.73 m2. Methods: We conducted a prospective pilot study comparing adherence and satisfaction before and after an educational program, which included four group meetings and two individual meetings over six months. Diet adherence was assessed by estimating protein intake using 24 h urine urea excretion, while diet satisfaction was evaluated with the MDRD questionnaire. Results: Twenty-four patients with a mean age of 63.9 years experienced improved diet adherence, with a significant reduction in protein intake (from 59.82 ± 15.57 g/day to 47.18 ± 13.7 g/day, p < 0.001) and a significant increase in overall diet satisfaction (from a median of 3.57 (3.1–4) to 4 (3.6–4.1), p = 0.001). Conclusions: An educational program that includes protein counting assists CKD stage 4–5 patients in improving their diet adherence and increasing overall dietary satisfaction.

Chrono-nutrition studies dietary habits and their role in the onset of metabolic diseases. The aim of this study is to describe chrono-nutritional patterns based on the analysis of the eating habits of patients with severe obesity during the 24-h cycle and investigate a possible relationship between these profiles, the comorbidities, and the psychological status. From the overall evaluation of the chrono-nutritional profiles of 173 patients with severe obesity, four predominant eating patterns were obtained with a refined statistical model. A regression analysis was performed to determine the relationship between chrono-nutritional patterns, medical comorbidities, and psychological status. Profile 1 was the most frequent (46.2%) and characterised by the regular presence of the three main meals. The distribution of the chrono-nutritional profiles did not vary with BMI. Chrono-nutritional profiles affected predominantly psychological variables, with lower performances among chrono-nutritional profiles 3 (to eat during all the 24-h, with nibbling and snacking also during the night) and 4 (like the fourth but without night-eating). This finding could be useful in the assessment and treatment of patients with obesity, allowing the identification of patients with a higher probability of suffering from a psychopathological condition simply by knowing the patients’ dietary profiles.

Background: Hyperuricemia is a well-known problem in end-stage kidney disease. Currently, the end-stage kidney disease patients may be treated with comprehensive conservative management, hemodialysis, or peritoneal dialysis, which impact uric acid levels distinctly. We assessed the impact of these strategies on uric acid control and identified the factors that influence it. Methods: We conducted a preliminary case–control study comparing patients in comprehensive conservative management, hemodialysis and peritoneal dialysis. For each patient, we evaluated demographic characteristics, comorbidities, body mass index, protein intake, urine output and blood test results. Results: In the entire population, uric acid levels were slightly higher in the comprehensive conservative management group. Furthermore, uric acid control was influenced primarily by body mass index (β = −0.005, p = 0.03) and treatment modality (β = −0.0026, p = 0.05). In comprehensive conservative management, body mass index (β = −0.007, p = 0.02) and urine urea excretion (β = 0.014, p = 0.04) were independent predictors of uric acid level. Conversely, only the suggested protein intake (β = 0.16, p = 0.05), potassium levels (β = −0.046, p = 0.04) and allopurinol therapy (β = −0.073, p = 0.03) were independent predictors of uric acid in hemodialysis patients. Finally, only the recommended protein intake (B = −0.005, p = 0.03) was associated with uric acid levels in patients undergoing peritoneal dialysis. Conclusions: In our series, uric acid control correlates with the treatment modality used for end-stage kidney disease and dietary protein intake.