1
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Chan RJ, Parikh N, Ahmed S, Ruzicka M, Hiremath S. Blood Pressure Control Should Focus on More Potassium: Controversies in Hypertension. Hypertension 2024; 81:501-509. [PMID: 37641923 DOI: 10.1161/hypertensionaha.123.20545] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Affiliation(s)
- Ryan J Chan
- Division of Nephrology, Department of Medicine, Ottawa Hospital, University of Ottawa, Ontario, Canada (R.J.C., N.P., S.A., M.R., S.H.)
| | - Namrata Parikh
- Division of Nephrology, Department of Medicine, Ottawa Hospital, University of Ottawa, Ontario, Canada (R.J.C., N.P., S.A., M.R., S.H.)
| | - Sumaiya Ahmed
- Division of Nephrology, Department of Medicine, Ottawa Hospital, University of Ottawa, Ontario, Canada (R.J.C., N.P., S.A., M.R., S.H.)
| | - Marcel Ruzicka
- Division of Nephrology, Department of Medicine, Ottawa Hospital, University of Ottawa, Ontario, Canada (R.J.C., N.P., S.A., M.R., S.H.)
| | - Swapnil Hiremath
- Division of Nephrology, Department of Medicine, Ottawa Hospital, University of Ottawa, Ontario, Canada (R.J.C., N.P., S.A., M.R., S.H.)
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ontario, Canada (S.H.)
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2
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AlSahow A. Moderate stepwise restriction of potassium intake to reduce risk of hyperkalemia in chronic kidney disease: A literature review. World J Nephrol 2023; 12:73-81. [PMID: 37766841 PMCID: PMC10520754 DOI: 10.5527/wjn.v12.i4.73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/13/2023] [Accepted: 06/26/2023] [Indexed: 09/20/2023] Open
Abstract
A potassium-rich diet has several cardiovascular and renal health benefits; however, it is not recommended for patients with advanced chronic kidney disease or end-stage kidney disease because of the risk of life-threatening hyperkalemia. To assess the strength of evidence supporting potassium intake restriction in chronic kidney disease, the medical literature was searched looking for the current recommended approach and for evidence in support for such an approach. There is a lack of strong evidence supporting intense restriction of dietary potassium intake. There are several ways to reduce potassium intake without depriving the patient from fruits and vegetables, such as identifying hidden sources of potassium (processed food and preservatives) and soaking or boiling food to remove potassium. An individualized and gradual reduction of dietary potassium intake in people at risk of hyperkalemia is recommended. The current potassium dietary advice in chronic kidney disease needs to be reevaluated, individualized, and gradually introduced.
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Affiliation(s)
- Ali AlSahow
- Department of Nephrology, Jahra Hospital, Jahra 00004, Kuwait
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3
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Shaw V, Anderson C, Desloovere A, Greenbaum LA, Haffner D, Nelms CL, Paglialonga F, Polderman N, Qizalbash L, Renken-Terhaerdt J, Stabouli S, Tuokkola J, Vande Walle J, Warady BA, Shroff R. Nutritional management of the infant with chronic kidney disease stages 2-5 and on dialysis. Pediatr Nephrol 2023; 38:87-103. [PMID: 35378603 PMCID: PMC9747855 DOI: 10.1007/s00467-022-05529-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/05/2022] [Accepted: 03/07/2022] [Indexed: 01/10/2023]
Abstract
The nutritional management of children with chronic kidney disease (CKD) is of prime importance in meeting the challenge of maintaining normal growth and development in this population. The objective of this review is to integrate the Pediatric Renal Nutrition Taskforce clinical practice recommendations for children with CKD stages 2-5 and on dialysis, as they relate to the infant from full term birth up to 1 year of age, for healthcare professionals, including dietitians, physicians, and nurses. It addresses nutritional assessment, energy and protein requirements, delivery of the nutritional prescription, and necessary dietary modifications in the case of abnormal serum levels of calcium, phosphate, and potassium. We focus on the particular nutritional needs of infants with CKD for whom dietary recommendations for energy and protein, based on body weight, are higher compared with children over 1 year of age in order to support both linear and brain growth, which are normally maximal in the first 6 months of life. Attention to nutrition during infancy is important given that growth is predominantly nutrition dependent in the infantile phase and the growth of infants is acutely impaired by disruption to their nutritional intake, particularly during the first 6 months. Inadequate nutritional intake can result in the failure to achieve full adult height potential and an increased risk for abnormal neurodevelopment. We strongly suggest that physicians work closely with pediatric renal dietitians to ensure that the infant with CKD receives the best possible nutritional management to optimize their growth and development.
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Affiliation(s)
- Vanessa Shaw
- University College London Great Ormond Street Hospital Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.
| | - Caroline Anderson
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | | | - Dieter Haffner
- Children's Hospital, Hannover Medical School, Hannover, Germany
| | | | - Fabio Paglialonga
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | | | - José Renken-Terhaerdt
- Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Stella Stabouli
- 1st Department of Pediatrics, Aristotle University Thessaloniki, Thessaloniki, Greece
| | - Jetta Tuokkola
- Children's Hospital and Clinical Nutrition Unit, Internal Medicine and Rehabilitation, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | | | - Rukshana Shroff
- University College London Great Ormond Street Hospital Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
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4
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Cecchini AL, Biscetti F, Rando MM, Nardella E, Pecorini G, Eraso LH, Dimuzio PJ, Gasbarrini A, Massetti M, Flex A. Dietary Risk Factors and Eating Behaviors in Peripheral Arterial Disease (PAD). Int J Mol Sci 2022; 23:10814. [PMID: 36142725 PMCID: PMC9504787 DOI: 10.3390/ijms231810814] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/10/2022] [Accepted: 09/13/2022] [Indexed: 11/17/2022] Open
Abstract
Dietary risk factors play a fundamental role in the prevention and progression of atherosclerosis and PAD (Peripheral Arterial Disease). The impact of nutrition, however, defined as the process of taking in food and using it for growth, metabolism and repair, remains undefined with regard to PAD. This article describes the interplay between nutrition and the development/progression of PAD. We reviewed 688 articles, including key articles, narrative and systematic reviews, meta-analyses and clinical studies. We analyzed the interaction between nutrition and PAD predictors, and subsequently created four descriptive tables to summarize the relationship between PAD, dietary risk factors and outcomes. We comprehensively reviewed the role of well-studied diets (Mediterranean, vegetarian/vegan, low-carbohydrate ketogenic and intermittent fasting diet) and prevalent eating behaviors (emotional and binge eating, night eating and sleeping disorders, anorexia, bulimia, skipping meals, home cooking and fast/ultra-processed food consumption) on the traditional risk factors of PAD. Moreover, we analyzed the interplay between PAD and nutritional status, nutrients, dietary patterns and eating habits. Dietary patterns and eating disorders affect the development and progression of PAD, as well as its disabling complications including major adverse cardiovascular events (MACE) and major adverse limb events (MALE). Nutrition and dietary risk factor modification are important targets to reduce the risk of PAD as well as the subsequent development of MACE and MALE.
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Affiliation(s)
- Andrea Leonardo Cecchini
- Internal Medicine, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Federico Biscetti
- Cardiovascular Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Maria Margherita Rando
- Cardiovascular Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Elisabetta Nardella
- Cardiovascular Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Giovanni Pecorini
- Internal Medicine, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Luis H. Eraso
- Division of Vascular and Endovascular Surgery, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Paul J. Dimuzio
- Division of Vascular and Endovascular Surgery, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Antonio Gasbarrini
- Internal Medicine, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
- Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Massimo Massetti
- Internal Medicine, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Andrea Flex
- Internal Medicine, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
- Cardiovascular Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
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5
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Martínez-Villaescusa M, Aguado-García Á, López-Montes A, Martínez-Díaz M, Gonzalvo-Díaz C, Pérez-Rodriguez A, Pedrón-Megías A, García-Arce L, Sánchez-Sáez P, García-Martínez C, Azaña-Rodríguez A, García-Martínez AB, Andrés-Pretel F, Botella-Romero F, Vega-Martínez A, Giménez Bachs JM, León-Sanz M. New approaches in the nutritional treatment of advanced chronic kidney disease. Nefrologia 2022; 42:448-459. [PMID: 36402686 DOI: 10.1016/j.nefroe.2022.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 04/04/2021] [Indexed: 06/16/2023] Open
Abstract
INTRODUCTION Patients with advanced chronic kidney disease (ACKD) have a high prevalence of malnutrition. The dietary restrictions that we usually apply in terms of macro and micronutrients force our patients to follow dietary guidelines that deviate from healthy patterns. OBJETIVES To determine if a personalized nutritional intervention program, minimizing the usual restrictions would be justified in case it improved the evolution of kidney disease compared to standard treatment. SECUNDARY OBJETIVES To determine changes in nutrient intakes and in anthropometric and biochemical parameters, as well as quantify episodes of hyperkalemia. MATERIAL AND METHODS A single-center, randomized and controlled educational intervention clinical trial was conduct in patients from the ERCA outpatients clinic at the Complejo Hospitalario Universitario de Albacete. 75 patients were included, assigning 35 to a Control group and 40 to the Intervention group with 1-year follow-up. The nutritional status was determined using anthropometric data, body composition by Bioimpedance, blood and urine biochemical parameters and a 24-h recall questionnaire. The nutritional intervention was carried out in three different ways: individual, collective and telephone recall. RESULTS At the beginning of the study, the BMI showed a situation of weight excess with a mean of 28.83 kg/m2 (5.4) in men and 26.96 kg/m2 (4.09) in women. 70% of our patients had overweight. The abdominal circumference was 105.3 cm (10.2) and 92.3 cm (13.7) for men and women respectively without significant changes throughout the study. The percentage of fat mass (FM) was high in both groups for men and women throughout the study. We did not find biochemical parameters of malnutrition and only significant differences were observed in glomerular filtration rate (GFR), which increased in the intervention group. No patient presented any episodes of hyperkalemia during the study. The energy intake in both groups showed an inadequate distribution of macronutrients with a poor intake of carbohydrates (CH) that was supplemented with an excess of fat. In the case of micronutrients, we did observe an increase in potassium and fiber intakes with a decrease in sodium and phosphorus in the intervention group. CONCLUSIONS Malnutrition is not exclusively an intake defficit and encompasses both the problems derived from a deficit and an excess of nutrients intake. Un to 70% of our patients showed weight excess and a fat mass higher than desirable. The implementation of an individualized nutritional education program, including a vegetables and fiber rich diet, less atherogenic, not only did not cause electrolyte alterations but also slowed the progression of kidney disease.
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Affiliation(s)
- María Martínez-Villaescusa
- Servicio de Nefrología, Complejo Hospitalario Universitario de Albacete y Instituto Médico Ricart, Alicante, Spain.
| | | | - Aurora López-Montes
- Servicio de Nefrología, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Mercedes Martínez-Díaz
- Servicio de Nefrología, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - César Gonzalvo-Díaz
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Ana Pérez-Rodriguez
- Servicio de Nefrología, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Asunción Pedrón-Megías
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Llanos García-Arce
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Paloma Sánchez-Sáez
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | | | | | | | - Fernando Andrés-Pretel
- Unidad de apoyo a la investigación clínica, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Francisco Botella-Romero
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | | | | | - Miguel León-Sanz
- Servicio de Endocrinología y Nutrición, Hospital Universitario 12 de Octubre, Madrid, Spain
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6
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Martínez-Villaescusa M, Aguado-García Á, López-Montes A, Martínez-Díaz M, Gonzalvo-Díaz C, Pérez-Rodriguez A, Pedrón-Megías A, García-Arce L, Sánchez-Sáez P, García-Martínez C, Azaña-Rodríguez A, García-Martínez AB, Andrés-Pretel F, Botella-Romero F, Vega-Martínez A, Giménez Bachs JM, León-Sanz M. New approaches in the nutritional treatment of advanced chronic kidney disease. Nefrologia 2021; 42:S0211-6995(21)00152-1. [PMID: 34393001 DOI: 10.1016/j.nefro.2021.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 03/19/2021] [Accepted: 04/04/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Patients with advanced chronic kidney disease (ACKD) have a high prevalence of malnutrition. The dietary restrictions that we usually apply in terms of macro and micronutrients force our patients to follow dietary guidelines that deviate from healthy patterns. OBJECTIVES To determine if a personalized nutritional intervention program, minimizing the usual restrictions would be justified in case it improved the evolution of kidney disease compared to standard treatment. SECONDARY OBJECTIVES To determine changes in nutrient intakes and in anthropometric and biochemical parameters, as well as quantify episodes of hyperkalemia. MATERIAL AND METHODS A single-center, randomized and controlled educational intervention clinical trial was conduct in patients from the ERCA outpatients clinic at the Complejo Hospitalario Universitario de Albacete. 75 patients were included, assigning 35 to a Control group and 40 to the Intervention group with 1-year follow-up. The nutritional status was determined using anthropometric data, body composition by Bioimpedance, blood and urine biochemical parameters and a 24-h recall questionnaire. The nutritional intervention was carried out in three different ways: individual, collective and telephone recall. RESULTS At the beginning of the study, the BMI showed a situation of weight excess with a mean of 28.83 kg/m2 (5.4) in men and 26.96 kg/m2 (4.09) in women. 70% of our patients had overweight. The abdominal circumference was 105.3 cm (10.2) and 92.3 cm (13.7) for men and women respectively without significant changes throughout the study. The percentage of fat mass (FM) was high in both groups for men and women throughout the study. We did not find biochemical parameters of malnutrition and only significant differences were observed in glomerular filtration rate (GFR), which increased in the intervention group. No patient presented any episodes of hyperkalemia during the study. The energy intake in both groups showed an inadequate distribution of macronutrients with a poor intake of carbohydrates (CH) that was supplemented with an excess of fat. In the case of micronutrients, we did observe an increase in potassium and fiber intakes with a decrease in sodium and phosphorus in the intervention group. CONCLUSIONS Malnutrition is not exclusively an intake deficit and encompasses both the problems derived from a deficit and an excess of nutrients intake. Un to 70% of our patients showed weight excess and a fat mass higher than desirable. The implementation of an individualized nutritional education program, including a vegetables and fiber rich diet, less atherogenic, not only did not cause electrolyte alterations but also slowed the progression of kidney disease.
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Affiliation(s)
- María Martínez-Villaescusa
- Servicio de Nefrología, Complejo Hospitalario Universitario de Albacete y Instituto Médico Ricart, Alicante, España.
| | | | - Aurora López-Montes
- Servicio de Nefrología, Complejo Hospitalario Universitario de Albacete, Albacete, España
| | - Mercedes Martínez-Díaz
- Servicio de Nefrología, Complejo Hospitalario Universitario de Albacete, Albacete, España
| | - César Gonzalvo-Díaz
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario Universitario de Albacete, Albacete, España
| | - Ana Pérez-Rodriguez
- Servicio de Nefrología, Complejo Hospitalario Universitario de Albacete, Albacete, España
| | - Asunción Pedrón-Megías
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario Universitario de Albacete, Albacete, España
| | - Llanos García-Arce
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario Universitario de Albacete, Albacete, España
| | - Paloma Sánchez-Sáez
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario Universitario de Albacete, Albacete, España
| | | | | | | | - Fernando Andrés-Pretel
- Unidad de apoyo a la investigación clínica, Complejo Hospitalario Universitario de Albacete, Albacete, España
| | - Francisco Botella-Romero
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario Universitario de Albacete, Albacete, España
| | | | | | - Miguel León-Sanz
- Servicio de Endocrinología y Nutrición, Hospital Universitario 12 de Octubre, Madrid, España
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7
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Desloovere A, Renken-Terhaerdt J, Tuokkola J, Shaw V, Greenbaum LA, Haffner D, Anderson C, Nelms CL, Oosterveld MJS, Paglialonga F, Polderman N, Qizalbash L, Warady BA, Shroff R, Vande Walle J. The dietary management of potassium in children with CKD stages 2-5 and on dialysis-clinical practice recommendations from the Pediatric Renal Nutrition Taskforce. Pediatr Nephrol 2021; 36:1331-1346. [PMID: 33730284 PMCID: PMC8084813 DOI: 10.1007/s00467-021-04923-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/18/2020] [Accepted: 01/05/2021] [Indexed: 02/07/2023]
Abstract
Dyskalemias are often seen in children with chronic kidney disease (CKD). While hyperkalemia is common, with an increasing prevalence as glomerular filtration rate declines, hypokalemia may also occur, particularly in children with renal tubular disorders and those on intensive dialysis regimens. Dietary assessment and adjustment of potassium intake is critically important in children with CKD as hyperkalemia can be life-threatening. Manipulation of dietary potassium can be challenging as it may affect the intake of other nutrients and reduce palatability. The Pediatric Renal Nutrition Taskforce (PRNT), an international team of pediatric renal dietitians and pediatric nephrologists, has developed clinical practice recommendations (CPRs) for the dietary management of potassium in children with CKD stages 2-5 and on dialysis (CKD2-5D). We describe the assessment of dietary potassium intake, requirements for potassium in healthy children, and the dietary management of hypo- and hyperkalemia in children with CKD2-5D. Common potassium containing foods are described and approaches to adjusting potassium intake that can be incorporated into everyday practice discussed. Given the poor quality of evidence available, a Delphi survey was conducted to seek consensus from international experts. Statements with a low grade or those that are opinion-based must be carefully considered and adapted to individual patient needs, based on the clinical judgment of the treating physician and dietitian. These CPRs will be regularly audited and updated by the PRNT.
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Affiliation(s)
| | - José Renken-Terhaerdt
- Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jetta Tuokkola
- Children's Hospital and Clinical Nutrition Unit, Internal Medicine and Rehabilitation, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Vanessa Shaw
- UCL Great Ormond Street Institute of Child Health, London, UK.
- University of Plymouth, Plymouth, UK.
| | - Larry A Greenbaum
- Emory University, Atlanta, GA, USA
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Dieter Haffner
- Children's Hospital, Hannover Medical School, Hannover, Germany
| | - Caroline Anderson
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Michiel J S Oosterveld
- Emma Children's Hospital, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Fabio Paglialonga
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | | | | | - Rukshana Shroff
- UCL Great Ormond Street Institute of Child Health, London, UK
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8
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Batista RAB, Japur CC, Prestes IV, Fortunato Silva J, Cavanha M, das Graças Pena G. Potassium reduction in food by preparation technique for the dietetic management of patients with chronic kidney disease: a review. J Hum Nutr Diet 2021; 34:736-746. [PMID: 33497513 DOI: 10.1111/jhn.12846] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 10/28/2020] [Accepted: 11/05/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Chronic kidney disease patients often use food preparation techniques to reduce potassium intake. However, the most effective techniques have not yet been determined for all food groups. The present study aimed to analyse all of the available information on potassium reduction in the food and identify the best preparation techniques by comparing the trend of change in potassium level. METHODS Nine databases were searched from 1976 to May 2020, according to the PRISMA Statement. We included all articles reporting the amount of potassium before and after the application of food preparation techniques. Data were analysed using the Wilcoxon test and statistical simulation. RESULTS A wide variety of food and culinary processes was observed in the 65 included articles. Cooking in water, pressure cooking and cooking in a microwave oven reduced potassium levels in all food groups, particularly in cereals and derivatives, fruits and derivatives, meats and derivatives, legumes, and leafy and cruciferous vegetables. Soaking food significantly reduced the potassium content in tubers and roots and leafy and cruciferous vegetables. Steam cooking and dry heating cooking also reduced potassium, although at a level lower than the other techniques. CONCLUSIONS The present review shows that, in general, all food preparation techniques can reduce the potassium content, although cooking in water and soaking promotes a greater reduction; however, more studies with standardised techniques and complete data are necessary.
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Affiliation(s)
- R Aparecida Borges Batista
- Graduate Program in Health Sciences, Medical School, Federal University of Uberlândia, Uberlândia, Brazil
| | - C Cremonezi Japur
- Division of Nutrition and Metabolism, Department of Health Sciences, University of São Paulo, Ribeirão Preto, Brazil
| | | | - J Fortunato Silva
- Nutrition Course, Medical School, Federal University of Uberlândia, Uberlândia, Brazil
| | - M Cavanha
- Nutrition Course, Medical School, Federal University of Uberlândia, Uberlândia, Brazil
| | - G das Graças Pena
- Graduate Program in Health Sciences, Medical School, Federal University of Uberlândia, Uberlândia, Brazil
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9
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Hanif AAM, Shamim AA, Hossain MM, Hasan M, Khan MSA, Hossaine M, Ullah MA, Sarker SK, Rahman SMM, Mitra DK, Mridha MK. Gender-specific prevalence and associated factors of hypertension among elderly Bangladeshi people: findings from a nationally representative cross-sectional survey. BMJ Open 2021; 11:e038326. [PMID: 33478960 PMCID: PMC7825269 DOI: 10.1136/bmjopen-2020-038326] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 12/09/2020] [Accepted: 01/04/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE We aimed to estimate the gender-specific prevalence and associated factors of hypertension among elderly people in Bangladesh. DESIGN AND METHOD We analysed data from the food security and nutrition surveillance round 2018-2019. The multistage cluster sampling method was used to select the study population. Hypertension was defined as systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg and/or having a history of hypertension. We carried out the descriptive analysis, bivariate and multivariable logistic regression to report the weighted prevalence of hypertension as well as crude and adjusted ORs with 95% CI. A p value<0.05 was considered statistically significant. SETTING The study was conducted in 82 clusters (57 rural, 15 non-slum urban and 10 slums) in all eight administrative divisions of Bangladesh. PARTICIPANTS A total of 2482 males and 2335 females aged ≥60 years were included in this analysis. RESULTS The weighted prevalence of hypertension was 42% and 56% among males and females, respectively. The prevalence was higher among females across all sociodemographic, behavioural and clinical strata. Factors associated with higher odds of hypertension (adjusted OR (AOR) (95% CI) for males and females, respectively) were age ≥70 years (1.32 (1.09, 1.60) and 1.40 (1.15, 1.71)); insufficient physical activity (1.50 (1.25, 1.81) and 1.38 (1.15, 1.67)); higher waist circumference (2.76 (2.22, 3.43) and 2.20 (1.82, 2.67)); and self-reported diabetes (1.36 (1.02, 1.82) and 1.82 (1.35, 2.45)). Additionally, living in slums decreased (0.71 (0.52, 0.96)) and education >10 years increased odds of hypertension (1.83 (1.38, 2.44)) among males. CONCLUSION In Bangladesh, half of the elderly persons were hypertensive, with a higher prevalence in females. In both sexes, odds of hypertension was higher among persons with older age (≥70 years), insufficient physical activity, higher waist circumference and self-reported diabetes. The Ministry of Health of Bangladesh should consider these findings while designing and implementing health programmes for elderly population.
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Affiliation(s)
- Abu Abdullah Mohammad Hanif
- Centre for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Abu Ahmed Shamim
- Centre for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Md Mokbul Hossain
- Centre for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Mehedi Hasan
- Centre for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Md Showkat Ali Khan
- Centre for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Moyazzam Hossaine
- Centre for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Mohammad Aman Ullah
- National Nutrition Services (NNS), Directorate General of Health Services, Government of Bangladesh, Dhaka, Bangladesh
| | - Samir Kanti Sarker
- National Nutrition Services (NNS), Directorate General of Health Services, Government of Bangladesh, Dhaka, Bangladesh
| | - S M Mustafizur Rahman
- National Nutrition Services (NNS), Directorate General of Health Services, Government of Bangladesh, Dhaka, Bangladesh
| | - Dipak K Mitra
- Public Health, North South University, Dhaka, Bangladesh
| | - Malay Kanti Mridha
- Centre for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
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Clegg DJ, Headley SA, Germain MJ. Impact of Dietary Potassium Restrictions in CKD on Clinical Outcomes: Benefits of a Plant-Based Diet. Kidney Med 2020; 2:476-487. [PMID: 32775988 PMCID: PMC7406842 DOI: 10.1016/j.xkme.2020.04.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
In patients with advanced-stage chronic kidney disease (CKD), progressive kidney function decline leads to increased risk for hyperkalemia (serum potassium > 5.0 or >5.5 mEq/L). Medications such as renin-angiotensin-aldosterone system inhibitors pose an additional hyperkalemia risk, especially in patients with CKD. When hyperkalemia develops, clinicians often recommend a diet that is lower in potassium content. This review discusses the barriers to adherence to a low-potassium diet and the impact of dietary restrictions on adverse clinical outcomes. Accumulating evidence indicates that a diet that incorporates potassium-rich foods has multiple health benefits, which may also be attributable to the other vitamin, mineral, and fiber content of potassium-rich foods. These benefits include blood pressure reductions and reduced risks for cardiovascular disease and stroke. High-potassium foods may also prevent CKD progression and reduce mortality risk in patients with CKD. Adjunctive treatment with the newer potassium-binding agents, patiromer and sodium zirconium cyclosilicate, may allow for optimal renin-angiotensin-aldosterone system inhibitor therapy in patients with CKD and hyperkalemia, potentially making it possible for patients with CKD and hyperkalemia to liberalize their diet. This may allow them the health benefits of a high-potassium diet without the increased risk for hyperkalemia, although further studies are needed.
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Affiliation(s)
- Deborah J. Clegg
- Drexel College of Nursing and Health Professions, Philadelphia, PA
| | - Samuel A. Headley
- Department of Exercise Science and Athletic Training, Springfield College, Springfield, MA
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Khanam R, Ahmed S, Rahman S, Kibria GMA, Syed JRR, Khan AM, Moin SMI, Ram M, Gibson DG, Pariyo G, Baqui AH. Prevalence and factors associated with hypertension among adults in rural Sylhet district of Bangladesh: a cross-sectional study. BMJ Open 2019; 9:e026722. [PMID: 31662350 PMCID: PMC6830635 DOI: 10.1136/bmjopen-2018-026722] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES Low-income and middle-income countries are undergoing epidemiological transition, however, progression is varied. Bangladesh is simultaneously experiencing continuing burden of communicable diseases and emerging burden of non-communicable diseases (NCDs). For effective use of limited resources, an increased understanding of the shifting burden and better characterisation of risk factors of NCDs, including hypertension is needed. This study provides data on prevalence and factors associated with hypertension among males and females 35 years and older in rural Bangladesh. METHODS This is a population-based cross-sectional study conducted in Zakiganj and Kanaighat subdistricts of Sylhet district of Bangladesh. Blood pressure was measured and data on risk factors were collected using STEPS instrument from 864 males and 946 females aged 35 years and older between August 2017 and January 2018. Individuals with systolic blood pressure of ≥140 mm Hg or diastolic blood pressure of ≥90 mm Hg or taking antihypertensive drugs were considered hypertensive. Bivariate and multivariate analyses were performed to identify factors associated with hypertension. RESULTS The prevalence of hypertension was 18.8% (95% CI 16.3 to 21.5) and 18.7% (95% CI 16.3 to 21.3) in adult males and females, respectively. Among those who were hypertensive, the prevalence of controlled, uncontrolled and unaware/newly identified hypertension was 23.5%, 25.9% and 50.6%, respectively among males and 38.4%, 22.6% and 39.0%, respectively among females. Another 22.7% males and 17.8% females had prehypertension. Increasing age and higher waist circumference (≥90 cm for males and ≥80 cm for females) were positively associated with hypertension both in males (OR 4.0, 95% CI 2.5 to 6.4) and females (OR 2.8, 95% CI 2.0 to 4.1). CONCLUSIONS In view of the high burden of hypertension and prehypertension, a context-specific scalable public health programme including behaviour change communications, particularly to increase physical activity and consumption of healthy diet, as well as identification and management of hypertension needs to be developed and implemented.
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Affiliation(s)
- Rasheda Khanam
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | | | | | - Gulam Muhammed Al Kibria
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | | | | | - Malathi Ram
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Dustin G Gibson
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - George Pariyo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Abdullah H Baqui
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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12
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[So doctor, what could I eat then?]. NUTR HOSP 2019; 36:898-904. [PMID: 31291738 DOI: 10.20960/nh.02576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Introduction Introduction: the strict dietary recommendations we impose on patients with advanced chronic kidney disease (ACKD) have negative impact on quality of life. Objective: determine whether such restrictions are justified and if an educational program can improve health-related quality of life (HRQL) parameters. Methods: we carried out an educational intervention, single center, randomized, controlled clinical trial on ACKD outpatients in Albacete. Seventy-five patients were included, 35 in the control group and 40 in the intervention group. Nutritional assessment was based on the Subjetive Global Assessment (SGA) and body mass index (BMI). We used the SF-36 health questionnaire to measure HRQL. In the intervention group we carried out individual, collective and telephone nutritional interventions, adapting diet advice and restrictions in a personalized way. Results: malnutrition measured by Subjective Global Assessment (SGA) in the control group was 20%; meanwhile, in the intervention group it was 29.3% and it improved at the end of the study, but not significantly. BMI showed overweight with a mean of 28.83 kg/m² (DE: 5.4) and 26.96 kg/m² (DE: 4.09), respectively, and did not change throughout the study. The nutritional intervention improved the score in all the subscales except for body pain score. Besides, mental and physical components also improved their scores in the intervention group and worsened them in the control group (p < 0.001). Conclusions: quality of life can be improved in ACKD patients applying an educational nutrition program.
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