Objective: To develop high protein low phosphorus snacks (HPLPS) and to investigate the effect of HPLPS on nutritional
status among Thai children and adolescents with continuous ambulatory peritoneal dialysis (CAPD).
Material and Method: The present study was divided into two phases. The first phase, HPLPS were developed by adding
high protein and low phosphorus ingredients into favorite snacks. Sensory evaluation and nutritional values of each snack
were determined. For the second phase, a randomized, crossover study was conducted. Fourteen children with CAPD, aged 3 to 19 years were randomly assigned into group A (n = 7), received HPLPS for 12 weeks, washout for four weeks and
received regular snacks (RS) for 12 weeks and group B (n = 7), received RS for 12 weeks, washout for four weeks and received HPLPS for 12 weeks. Each snack was provided to participants (two servings/day) as a dietary supplement. The data of nutritional assessments were collected at baseline (week 0) and at the end of supplementation period (week 12).
Results: Five food items of HPLPS were developed including potato chips, crispy prawns, butter cookies, tuiles cookies, and
cupcakes. The overall acceptability score for the developed snacks range from good to super good with the mean score of
4.16+0.55 to 4.39+0.49. The protein content of HPLPS were 7.04 to 7.81 g and phosphorus content were 12.39 to 37.51 mg
per serving. At baseline, all nutritional parameters were not significantly different between groups. At the end of the study, the tricep skinfold (TSF), mid upper arm circumference (MUAC), and mid arm muscle circumference (MAMC) in HPLPS group
were significantly higher than RS group. For HPLPS group, the energy and protein intake were significantly increased from
25.12 kcal/kg/day at baseline to 30.19 kcal/kg/day at the end of the study and from 0.69 g/kg/day to 1.09 g/kg/day, respectively. In addition, the present study found that the protein intake of participants was significantly increased in HPLPS group, however, their level of serum phosphorus was not increased.
Conclusion: Use of HPLPS as a dietary supplement is an alternative choice for improving nutritional status among children with CAPD.

Keywords: High protein low phosphorus snacks, Nutritional status, Children, Continuous ambulatory peritoneal dialysis