Franny Jongbloed

179 7 FEASIBILITY AND SAFETY OF A PREOPERATIVE DIET Before After Before After Before After 0 100 200 300 * Restricted DER-diet Control Prealbumin (mg/L) Before After Before After Before After 0 20 40 60 Restricted DER-diet Control * Retinol binding protein (mgl/L) A B Before After 100 150 200 250 300 Uncompleted restricted diet Prealbumin (mg/L) Before After 0 20 40 60 Uncompleted restricted diet Retinol binding protein (mgl/L) C D Figure 5. Plasma levels of prealbumin (PAB) and retinol binding protein (RBP) after the three dietary interventions. (A) Prealbumin (PAB) and (B) retinol binding protein (RBP) both decreased significantly after the restricted diet, with no changes seen in the DER-diet group or in the control group. (C) PAB and (D) RBP did not change in patients who did not complete the restricted diet. The two corresponding values for the individual patients are connected with a line. * P≤ 0.002. Red symbols = kidney donors in the restricted diet group. DER = daily energy requirements. DISCUSSION In this study, we showed that both kidney donors and morbidly obese patients are able to adhere to a synthetic calorie- and protein-restricted diet for five consecutive days with only minor discomfort. The metabolic markers PAB and RBP showed the strongest correlation with adherence to the diet, and together with serum urea could form a potential objective marker set to validate compliance to a diet comprising 30% DR and 80% PR. The rationale for combining DR and PR in this clinical diet was based on the known beneficial effects of short-termDR and short-termPR 17-18 . We showed previously that several DR regimens protect against renal IRI in mice and result in upregulation of anti-oxidants,