Acceptability, adherence, safety and experiences of low energy diets in people with obesity and chronic kidney disease: a mixed methods study

OBJECTIVES: Obesity is a modifiable risk factor for chronic kidney disease (CKD) progression. Low energy diets (LEDs) have not been adequately studied in people with CKD. This study aimed to explore acceptability, adherence, safety, and experiences of two LED prescriptions in adults living with obesity and CKD.

DESIGN AND METHODS: In a mixed-methods study, obese adults with CKD were prescribed two LEDs (∼800 to 1000 kcal/day each), in a randomised order for two weeks each. One diet consisted of four meal replacement products daily (Optifast®, Nestlé Health Science) and the other two pre-prepared frozen meals (Lite n' Easy®, Mitchell's Quality Foods). Participants received weekly dietitian support, completed daily adherence checklists (converted to % of provided meals/replacements consumed) and participated in post-intervention semi-structured interviews to capture their experience.

RESULTS: Nine participants were included (mean age 46.5±14.3 years, estimated glomerular filtration rate 64±26 mL/min/1.73m 2, 4/9 male). Mean self-reported adherence was 88±11% and mean four-week weight change was -7.3±5.6kg. Two participants withdrew at week two. Most frequently reported side effects were hunger and headaches. Adverse events of interest included one episode each of hyperkalaemia and hypoglycaemia. No serious adverse events occurred. Four overarching themes of patient experiences were identified: strategies used to adapt, disruption to the norm, individual preferences, and influences on acceptability.

CONCLUSIONS: LEDs were found to be acceptable and safe with high self-reported adherence rates. Future LED trials should include specialist diabetes management, close monitoring for hyperkalaemia and adequate support to assist with managing side effects and dietary and social adjustments.