The different LPDs offered in the different centres and employed in this study
| Type of diet . | Protein intake (g/kg/day) . | Main features . | Notes . | TO . | PI . | CA . | SO . |
|---|---|---|---|---|---|---|---|
| LPD with protein-free food | 0.6 g/kg/day; mixed proteins | Protein-free pasta, bread and other carbohydrates replace standard bread, pasta and rice | Carbohydrates are the basis of Mediterranean cuisine and replacing them makes it possible to restrict protein intake to 0.6 g/kg/BW | + | + | + | + |
| Vegan supplemented (moderate restriction) | 0.6 g/kg/day; vegetable proteins, supplemented with amino- and keto-acids (Alfa-kappa or ketosteril) | Based on forbidden (animal origin) and allowed (plant-based) food. Supplementation with Alfa-kappa or ketosteril is tailored to nutritional status and clinical situation (1:8–1: 10 kg BW) | Amino- and keto-acid supplements ensure adequate intake of proteins without the need to rely on plant-derived food;1–3 unrestricted meals per week in TO | + | − | − | + |
| Very low-protein supplemented vegan diet | 0.3 g/kg/day; vegetable proteins only with protein-free food, supplemented with Alfa-kappa or ketosteril | This diet is vegan and supplementation with Alfa-kappa or ketosteril pills is higher (1:5 kg BW). Carbohydrates are mainly or exclusively protein-free | This diet merges vegan supplemented and protein-free food. It is demanding and requires taking a large number of pills. It is not prescribed as a ‘first-line’ diet | + | + | − | + |
| Tailored solutions | Usually 0.6 g/kg/day; vegetable or mixed | These solutions employ different combinations of protein-free and vegan foods plus supplements | The main reason for prescribing these diets is to take the patient’s needs into account: example vegan and protein-free food at different meals | + | + | + | − |
| ‘Traditional’ | 0.6–0.8 g/kg/day; mixed proteins (animal and plant derived) | Modulated on quantity of usual food; mainly based on traditional Italian regional dishes | Often corresponds to what elderly patients already eat, in particular if they cook their own food | + | + | + | − |
| Vegan non-supplemented | 0.6–0.8 g/kg/day; vegetable proteins | Average protein intake in unrestricted vegan diets is 0.7–0.9 g/kg/day; due to the different bioavailability, a 0.7 diet roughly corresponds to a 0.6 mixed protein diet | This diet is based on the integration of cereals and legumes at each meal, thus ensuring complementarity in amino acids | + | + | − | − |
| Type of diet . | Protein intake (g/kg/day) . | Main features . | Notes . | TO . | PI . | CA . | SO . |
|---|---|---|---|---|---|---|---|
| LPD with protein-free food | 0.6 g/kg/day; mixed proteins | Protein-free pasta, bread and other carbohydrates replace standard bread, pasta and rice | Carbohydrates are the basis of Mediterranean cuisine and replacing them makes it possible to restrict protein intake to 0.6 g/kg/BW | + | + | + | + |
| Vegan supplemented (moderate restriction) | 0.6 g/kg/day; vegetable proteins, supplemented with amino- and keto-acids (Alfa-kappa or ketosteril) | Based on forbidden (animal origin) and allowed (plant-based) food. Supplementation with Alfa-kappa or ketosteril is tailored to nutritional status and clinical situation (1:8–1: 10 kg BW) | Amino- and keto-acid supplements ensure adequate intake of proteins without the need to rely on plant-derived food;1–3 unrestricted meals per week in TO | + | − | − | + |
| Very low-protein supplemented vegan diet | 0.3 g/kg/day; vegetable proteins only with protein-free food, supplemented with Alfa-kappa or ketosteril | This diet is vegan and supplementation with Alfa-kappa or ketosteril pills is higher (1:5 kg BW). Carbohydrates are mainly or exclusively protein-free | This diet merges vegan supplemented and protein-free food. It is demanding and requires taking a large number of pills. It is not prescribed as a ‘first-line’ diet | + | + | − | + |
| Tailored solutions | Usually 0.6 g/kg/day; vegetable or mixed | These solutions employ different combinations of protein-free and vegan foods plus supplements | The main reason for prescribing these diets is to take the patient’s needs into account: example vegan and protein-free food at different meals | + | + | + | − |
| ‘Traditional’ | 0.6–0.8 g/kg/day; mixed proteins (animal and plant derived) | Modulated on quantity of usual food; mainly based on traditional Italian regional dishes | Often corresponds to what elderly patients already eat, in particular if they cook their own food | + | + | + | − |
| Vegan non-supplemented | 0.6–0.8 g/kg/day; vegetable proteins | Average protein intake in unrestricted vegan diets is 0.7–0.9 g/kg/day; due to the different bioavailability, a 0.7 diet roughly corresponds to a 0.6 mixed protein diet | This diet is based on the integration of cereals and legumes at each meal, thus ensuring complementarity in amino acids | + | + | − | − |
BW: body weight; TO: Torino; PI: Pisa; CA: Cagliari; SO: Solofra. The last three diets were included under the heading ‘other diets’. Vegan diets: diets without any animal-derived food (except in the unrestricted meals).
The different LPDs offered in the different centres and employed in this study
| Type of diet . | Protein intake (g/kg/day) . | Main features . | Notes . | TO . | PI . | CA . | SO . |
|---|---|---|---|---|---|---|---|
| LPD with protein-free food | 0.6 g/kg/day; mixed proteins | Protein-free pasta, bread and other carbohydrates replace standard bread, pasta and rice | Carbohydrates are the basis of Mediterranean cuisine and replacing them makes it possible to restrict protein intake to 0.6 g/kg/BW | + | + | + | + |
| Vegan supplemented (moderate restriction) | 0.6 g/kg/day; vegetable proteins, supplemented with amino- and keto-acids (Alfa-kappa or ketosteril) | Based on forbidden (animal origin) and allowed (plant-based) food. Supplementation with Alfa-kappa or ketosteril is tailored to nutritional status and clinical situation (1:8–1: 10 kg BW) | Amino- and keto-acid supplements ensure adequate intake of proteins without the need to rely on plant-derived food;1–3 unrestricted meals per week in TO | + | − | − | + |
| Very low-protein supplemented vegan diet | 0.3 g/kg/day; vegetable proteins only with protein-free food, supplemented with Alfa-kappa or ketosteril | This diet is vegan and supplementation with Alfa-kappa or ketosteril pills is higher (1:5 kg BW). Carbohydrates are mainly or exclusively protein-free | This diet merges vegan supplemented and protein-free food. It is demanding and requires taking a large number of pills. It is not prescribed as a ‘first-line’ diet | + | + | − | + |
| Tailored solutions | Usually 0.6 g/kg/day; vegetable or mixed | These solutions employ different combinations of protein-free and vegan foods plus supplements | The main reason for prescribing these diets is to take the patient’s needs into account: example vegan and protein-free food at different meals | + | + | + | − |
| ‘Traditional’ | 0.6–0.8 g/kg/day; mixed proteins (animal and plant derived) | Modulated on quantity of usual food; mainly based on traditional Italian regional dishes | Often corresponds to what elderly patients already eat, in particular if they cook their own food | + | + | + | − |
| Vegan non-supplemented | 0.6–0.8 g/kg/day; vegetable proteins | Average protein intake in unrestricted vegan diets is 0.7–0.9 g/kg/day; due to the different bioavailability, a 0.7 diet roughly corresponds to a 0.6 mixed protein diet | This diet is based on the integration of cereals and legumes at each meal, thus ensuring complementarity in amino acids | + | + | − | − |
| Type of diet . | Protein intake (g/kg/day) . | Main features . | Notes . | TO . | PI . | CA . | SO . |
|---|---|---|---|---|---|---|---|
| LPD with protein-free food | 0.6 g/kg/day; mixed proteins | Protein-free pasta, bread and other carbohydrates replace standard bread, pasta and rice | Carbohydrates are the basis of Mediterranean cuisine and replacing them makes it possible to restrict protein intake to 0.6 g/kg/BW | + | + | + | + |
| Vegan supplemented (moderate restriction) | 0.6 g/kg/day; vegetable proteins, supplemented with amino- and keto-acids (Alfa-kappa or ketosteril) | Based on forbidden (animal origin) and allowed (plant-based) food. Supplementation with Alfa-kappa or ketosteril is tailored to nutritional status and clinical situation (1:8–1: 10 kg BW) | Amino- and keto-acid supplements ensure adequate intake of proteins without the need to rely on plant-derived food;1–3 unrestricted meals per week in TO | + | − | − | + |
| Very low-protein supplemented vegan diet | 0.3 g/kg/day; vegetable proteins only with protein-free food, supplemented with Alfa-kappa or ketosteril | This diet is vegan and supplementation with Alfa-kappa or ketosteril pills is higher (1:5 kg BW). Carbohydrates are mainly or exclusively protein-free | This diet merges vegan supplemented and protein-free food. It is demanding and requires taking a large number of pills. It is not prescribed as a ‘first-line’ diet | + | + | − | + |
| Tailored solutions | Usually 0.6 g/kg/day; vegetable or mixed | These solutions employ different combinations of protein-free and vegan foods plus supplements | The main reason for prescribing these diets is to take the patient’s needs into account: example vegan and protein-free food at different meals | + | + | + | − |
| ‘Traditional’ | 0.6–0.8 g/kg/day; mixed proteins (animal and plant derived) | Modulated on quantity of usual food; mainly based on traditional Italian regional dishes | Often corresponds to what elderly patients already eat, in particular if they cook their own food | + | + | + | − |
| Vegan non-supplemented | 0.6–0.8 g/kg/day; vegetable proteins | Average protein intake in unrestricted vegan diets is 0.7–0.9 g/kg/day; due to the different bioavailability, a 0.7 diet roughly corresponds to a 0.6 mixed protein diet | This diet is based on the integration of cereals and legumes at each meal, thus ensuring complementarity in amino acids | + | + | − | − |
BW: body weight; TO: Torino; PI: Pisa; CA: Cagliari; SO: Solofra. The last three diets were included under the heading ‘other diets’. Vegan diets: diets without any animal-derived food (except in the unrestricted meals).
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