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Mirzababaei A, Abaj F, Roumi Z, Khosroshahi RA, Aali Y, Clark CCT, Radmehr M, Mirzaei K. Consumption of red, white, and processed meat and odds of developing kidney damage and diabetic nephropathy (DN) in women: a case control study. Sci Rep 2024; 14:10344. [PMID: 38710706 DOI: 10.1038/s41598-024-59097-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 04/08/2024] [Indexed: 05/08/2024] Open
Abstract
Diabetic nephropathy (DN) is one of the most prevalent and severe complications of diabetes mellitus (DM) and is associated with increased morbidity and mortality. We aimed to investigate the associations between red, processed, and white meat consumption and the odds of developing kidney damage and DN in women. We enrolled 105 eligible women with DN and 105 controls (30-65 years). A validated and reliable food frequency questionnaire (FFQ) was used to evaluate the consumption of red, processed, and white meat. Biochemical variables and anthropometric measurements were assessed for all patients using pre-defined protocols. Binary logistic regression was conducted to examine possible associations. The results of the present study showed that there was a direct significant association between high consumption of red meat and processed meats and odds of microalbuminuria (red meat 2.30, 95% CI 1.25, 4.22; P-value = 0.007, processed meat: OR 2.16, 95% CI 1.18, 3.95; P-value = 0.01), severe albuminuria (red meat OR 3.25, 95% CI 1.38, 7.46; P-value = 0.007, processed meat: OR 2.35, 95% CI 1.01, 5.49; P-value = 0.04), BUN levels (red meat: OR 2.56, 95% CI 1.10, 5.93; P-value = 0.02, processed meat: OR 2.42, 95% CI 1.04, 5.62; P-value = 0.03), and DN (red meat 2.53, 95% CI 1.45, 4.42; P-value = 0.001, processed meat: OR 2.21; 95% CI 1.27, 3.85; P-value = 0.005). In summary, our study suggests that higher consumption of red and processed meat sources may be associated with microalbuminuria, severe albuminuria, higher BUN level, and higher odds of DN.
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Affiliation(s)
- Atieh Mirzababaei
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Faezeh Abaj
- Department of nutrition, Dietetics and food, Monash University, Clayton, Australia
| | - Zahra Roumi
- Department of Nutrition, Electronic Health and Statistics Surveillance Research Center, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Reza Amiri Khosroshahi
- Department of Clinical Nutrition School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Yasaman Aali
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Cain C T Clark
- Centre for Intelligent Healthcare, Coventry University, Coventry, CV1 5FB, UK
| | - Mina Radmehr
- Department of Nutrition, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Khadijeh Mirzaei
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran.
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Machado AD, Marchioni DM, Lotufo PA, Benseñor IM, Titan SM. Dietary acid load and the risk of events of mortality and kidney replacement therapy in people with chronic kidney disease: the Progredir Cohort Study. Eur J Clin Nutr 2024; 78:128-134. [PMID: 37891227 DOI: 10.1038/s41430-023-01361-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND/OBJECTIVES The association between dietary acid load (DAL) and chronic kidney disease (CKD) progression remains controversial. Also, there is a gap in the literature on the association between DAL and mortality. In this study, we evaluated the association between NEAP (net endogenous acid production) and PRAL (potential renal acid load) and the risk of events of all-cause mortality and kidney replacement therapy (KRT) in people with CKD. SUBJECTS/METHODS We included 442 patients (250 diabetics) from the Progredir Cohort Study, based in São Paulo, Brazil. We estimated NEAP and PRAL from dietary intake. Events of death before KRT and KRT were ascertained after a median follow-up of 5.8 and 5.1 years, respectively. Cox proportional hazards regression, Weibull regression, and competing risk models were performed. RESULTS Median NEAP and PRAL were 49.5 and 4.8 mEq/d. There were 200 deaths and 75 KRT events. Neither NEAP nor PRAL were associated with mortality or KRT when all participants were analyzed. After stratification for diabetes, both estimates were positively related to the risk of KRT even after adjustment for age, sex, weight status, glomerular filtration rate, serum bicarbonate, and intakes of protein, phosphorus, and energy (HR 1.31; 95% CI 1.07, 1.60 for NEAP, and HR 1.27; 95% CI 1.04, 1.57 for every 10 mEq/d increments). Competing risk analyses confirmed these findings. CONCLUSIONS DAL estimates were associated with the risk of KRT in people with CKD and diabetes but not in non-diabetics. There was no association between all-cause mortality and DAL.
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Affiliation(s)
- Alisson Diego Machado
- Division of Nephrology, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil.
| | - Dirce Maria Marchioni
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, SP, Brazil
| | - Paulo Andrade Lotufo
- Epidemiological and Clinical Research Center, University Hospital of the University of São Paulo, São Paulo, SP, Brazil
| | - Isabela Martins Benseñor
- Epidemiological and Clinical Research Center, University Hospital of the University of São Paulo, São Paulo, SP, Brazil
| | - Silvia Maria Titan
- Division of Nephrology, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
- Division of Nephrology & Hypertension, Mayo Clinic, Rochester, MN, USA
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Oliveira MC, Viney A, Picard E, Barnel C, Fouque D, Koppe L. Dietary Intake and Nutritional Status in Diabetic and Nondiabetic Patients With Chronic Kidney Disease Stage 4-5 (NutriDiab Study). J Ren Nutr 2024; 34:19-25. [PMID: 37321431 DOI: 10.1053/j.jrn.2023.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/04/2023] [Accepted: 06/06/2023] [Indexed: 06/17/2023] Open
Abstract
OBJECTIVES The aim of the present study was to assess the dietary intake and nutritional status of patients with chronic kidney disease (CKD) stage 4-5 according to the presence of diabetes. METHODS This observational and cross-sectional study included adult patients with CKD stage 4-5 referred to a nephrology unit, between October 2018 and March 2019. Daily dietary intake was evaluated by 24-hour dietary inquiry and urine excretion. Nutritional status was assessed by measuring body composition using bioimpedance analysis and muscle function using handgrip strength. Undernutrition was considered using the protein energy wasting score. RESULTS A total of 75 CKD patients were included, 36 (48%) of whom had diabetes; median age (interquartile range) was 71 (60-80) years. The median weight-adjusted dietary energy intake (DEI) was 22.6 (19.1-28.2) kcal/kg/day and the mean weight-adjusted dietary protein intake (DPI) was 0.86 ± 0.19 g/kg/day. There was no significant difference in DEI and DPI between patients with diabetes and those without, except for weight-adjusted DPI which was significantly lower in diabetic patients (P = .022). In univariate analysis, diabetes was associated with weight-adjusted DPI (coefficient [95% confidence interval] -0.237 [-0.446; -0.004] kcal/kg/day; P = .040), but this association did not remain significant in multivariate analysis. Nutritional status did not differ significantly between diabetic and nondiabetic patients except for lean tissue mass, which was lower in diabetic patients (P = .046). The proportion of patients with protein energy wasting was not significantly different between diabetic and nondiabetic patients (13.9% vs. 10.2%, respectively). CONCLUSIONS In the present cohort, DPI and DEI were not significantly different between diabetic and nondiabetic CKD patients. Diabetes was not found to be associated with dietary intakes in CKD stage 4-5 patients.
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Affiliation(s)
- Mariana Cassani Oliveira
- Department of Medical Clinic, Botucatu Medical School, Universidade Estadual Paulista-UNESP, Botucatu, Brazil.
| | - Angelique Viney
- Department of Nephrology, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France
| | - Elodie Picard
- Department of Nephrology, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France
| | - Cécile Barnel
- Department of Nephrology, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France; University Lyon, CarMeN lab, INSA-Lyon, INSERM U1060, INRA, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Denis Fouque
- Department of Nephrology, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France; University Lyon, CarMeN lab, INSA-Lyon, INSERM U1060, INRA, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Laetitia Koppe
- Department of Nephrology, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France; University Lyon, CarMeN lab, INSA-Lyon, INSERM U1060, INRA, Université Claude Bernard Lyon 1, Villeurbanne, France
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Kochan Z, Szupryczynska N, Malgorzewicz S, Karbowska J. Dietary Lipids and Dyslipidemia in Chronic Kidney Disease. Nutrients 2021; 13:3138. [PMID: 34579015 PMCID: PMC8472557 DOI: 10.3390/nu13093138] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/01/2021] [Accepted: 09/07/2021] [Indexed: 12/18/2022] Open
Abstract
The progression of chronic kidney disease (CKD) leads to altered lipid metabolism. CKD patients exhibit high blood triglyceride (TG) levels, reduced concentrations and functionality of high-density lipoproteins (HDL), and elevated levels of atherogenic small, dense, low-density lipoproteins (sdLDL). Disorders of lipid metabolism and other metabolic disturbances place CKD patients at high risk for cardiovascular disease (CVD). Extensive evidence supports the cardioprotective effects of unsaturated fatty acids, including their beneficial effect on serum cholesterol and TG levels. Dietary lipids might therefore be especially important in the nutritional management of CKD. We review current dietary recommendations for fat intake by CKD patients and suggest potential nutritional interventions by emphasizing dietary lipids that might improve the blood lipid profile and reduce cardiovascular risk in CKD.
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Affiliation(s)
- Zdzislaw Kochan
- Laboratory of Nutritional Biochemistry, Department of Clinical Nutrition, Faculty of Health Sciences, Medical University of Gdansk, 80-210 Gdansk, Poland; (Z.K.); (N.S.)
| | - Natalia Szupryczynska
- Laboratory of Nutritional Biochemistry, Department of Clinical Nutrition, Faculty of Health Sciences, Medical University of Gdansk, 80-210 Gdansk, Poland; (Z.K.); (N.S.)
| | - Sylwia Malgorzewicz
- Department of Clinical Nutrition, Division of Clinical Nutrition and Dietetics, Faculty of Health Sciences, Medical University of Gdansk, 80-210 Gdansk, Poland;
- Department of Nephrology, Transplantology and Internal Medicine, Faculty of Medicine, Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Joanna Karbowska
- Department of Biochemistry, Faculty of Medicine, Medical University of Gdansk, 80-210 Gdansk, Poland
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Quintela BCSF, Carioca AAF, de Oliveira JGR, Fraser SDS, da Silva Junior GB. Dietary patterns and chronic kidney disease outcomes: A systematic review. Nephrology (Carlton) 2021; 26:603-612. [PMID: 33864650 DOI: 10.1111/nep.13883] [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: 10/22/2019] [Revised: 07/09/2020] [Accepted: 04/14/2021] [Indexed: 01/11/2023]
Abstract
Chronic kidney disease (CKD) is a serious public health problem and its prevalence is growing in many countries, often related to issues resulting from the lifestyle in growing economies and the population's life expectancy. Nutritional therapy is a beneficial but still neglected strategy for preventing CKD and delaying disease progression. The aim of this study was to assess the association of dietary patterns with CKD development and progression. Observational studies conducted in adult humans and the correlation between the adopted dietary pattern and prevalent and incident cases of CKD were assessed. A significant association was observed between unhealthy dietary patterns and an increased risk of developing or worsening CKD, as well as an adverse effect. Whereas healthy eating patterns characterized by the consumption of fruit, vegetables and dietary fibre showed nephroprotective outcomes.
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Affiliation(s)
| | | | | | - Simon D S Fraser
- Academic Unit of Primary Care and Population Science, Faculty of Medicine, University of Southampton, Southampton, Hampshire, United Kingdom
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Association of dietary patterns with serum phosphorus in maintenance haemodialysis patients: a cross-sectional study. Sci Rep 2020; 10:12278. [PMID: 32704087 PMCID: PMC7378243 DOI: 10.1038/s41598-020-68893-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 07/03/2020] [Indexed: 12/18/2022] Open
Abstract
Sources of dietary phosphate differentially contribute to hyperphosphatemia in maintenance haemodialysis (MHD) patients. This cross-sectional study in Malaysia investigated association between dietary patterns and serum phosphorus in MHD patients. Dietary patterns were derived by principal component analysis, based on 27 food groups shortlisted from 3-day dietary recalls of 435 MHD patients. Associations of serum phosphorus were examined with identified dietary patterns. Three dietary patterns emerged: Home foods (HFdp), Sugar-sweetened beverages (SSBdp), and Eating out noodles (EO-Ndp). The highest tertile of patients in HF (T3-HFdp) pattern significantly associated with higher intakes of total protein (p = 0.002), animal protein (p = 0.001), and animal-based organic phosphate (p < 0.001), whilst T3-SSBdp patients had significantly higher intakes of total energy (p < 0.001), inorganic phosphate (p < 0.001), and phosphate:protein ratio (p = 0.001). T3-EO-Ndp patients had significantly higher intakes of total energy (p = 0.033), total protein (p = 0.003), plant protein (p < 0.001), but lower phosphate:protein ratio (p = 0.009). T3-SSBdp patients had significantly higher serum phosphorus (p = 0.006). The odds ratio of serum phosphorous > 2.00 mmol/l was significantly 2.35 times higher (p = 0.005) with the T3-SSBdp. The SSBdp was associated with greater consumption of inorganic phosphate and higher serum phosphorus levels.
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Sualeheen A, Khor BH, Balasubramanian GV, Sahathevan S, Ali MSM, Narayanan SS, Chinna K, Daud ZAM, Khosla P, Gafor AHA, Karupaiah T, Cheak BB, Ahmad G, Goh BL, Lim SK, Visvanathan R, Yahya R, Bavanandan S, Morad Z. Habitual Dietary Patterns of Patients on Hemodialysis Indicate Nutritional Risk. J Ren Nutr 2020; 30:322-332. [DOI: 10.1053/j.jrn.2019.09.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 09/05/2019] [Accepted: 09/15/2019] [Indexed: 02/07/2023] Open
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Lee H, Kim H, Kim TY, Ryu H, Ju DL, Jang M, Oh KH, Ahn C, Han SN. Dietary Assessment of Korean Non-dialysis Chronic Kidney Disease Patients with or without Diabetes. J Korean Med Sci 2020; 35:e181. [PMID: 32537952 PMCID: PMC7295604 DOI: 10.3346/jkms.2020.35.e181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 04/14/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Dietary intervention at the early stage of chronic kidney disease (CKD) is important for preventing progression to the end-stage renal disease (ESRD). However, few studies have investigated dietary intake of CKD patients in non-dialysis stage. Therefore, we investigated the dietary intake of Korean non-dialysis CKD patients and aimed to establish baseline data for the development of dietary education and intervention strategies for CKD patients. METHODS Three hundred fifty CKD patients who visited Seoul National University Hospital outpatient clinic from February 2016 to January 2017 were recruited for this cross-sectional study. Subjects on dialysis and those who had undergone kidney transplantation were excluded. Dietary intake, demographic information, and biochemical characteristics of 256 subjects who completed three-day dietary records were analyzed. Subjects were divided into four groups based on diabetes mellitus (DM) (DM-CKD and Non-DM-CKD groups) and kidney function (Early-CKD and Late-CKD groups). RESULTS Total energy intake was lower in the Late-CKD group compared with the Early-CKD group. In men, carbohydrate intake was higher and protein and fat intakes tended to be lower in the Late-CKD group compared with the Early-CKD group. In women, carbohydrate intake tended to be lower in the DM-CKD group than the Non-DM-CKD group. Protein intake tended to be higher in the DM-CKD groups. Phosphorus and sodium intakes were higher in the DM-CKD groups compared with the Non-DM-CKD groups in women, and tended to be higher in the DM-CKD groups in men. CONCLUSION DM and kidney function affected energy and nutrient intakes. Subjects in the Late-CKD group consumed less energy than those in the Early-CKD group. Non-DM subjects seemed to restrict protein intake starting from the Early-CKD stage than subjects with DM. Subjects in this study had low energy and high sodium intakes compared with recommended levels. Protein intake was lower in advanced CKD patients, but their intake level was still higher than the recommendation. Dietary intervention strategies for non-dialysis CKD patients need to be customized depending on the presence of DM and kidney function.
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Affiliation(s)
- Hyesu Lee
- Department of Food and Nutrition, College of Human Ecology, Seoul National University, Seoul, Korea
| | - Hyunsuk Kim
- Department of Internal Medicine, Hallym University Medical Center, Chuncheon Sacred Heart Hospital, Chuncheon, Korea
| | - Tae Yeon Kim
- Department of Food and Nutrition, College of Human Ecology, Seoul National University, Seoul, Korea
| | - Hyunjin Ryu
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Dal Lae Ju
- Department of Nutrition, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Miyoung Jang
- Department of Food Service and Nutrition Care, Seoul National University Hospital, Seoul, Korea
| | - Kook Hwan Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Curie Ahn
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Nim Han
- Department of Food and Nutrition, College of Human Ecology, Seoul National University, Seoul, Korea
- Research Institute of Human Ecology, College of Human Ecology, Seoul National University, Seoul, Korea.
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10
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Conley M, Lioufas N, Toussaint ND, Elder GJ, Badve SV, Hawley CM, Pascoe EM, Pedagogos E, Valks A, Campbell KL. Dietary Phosphate Consumption in Australians With Stages 3b and 4 Chronic Kidney Disease. J Ren Nutr 2020; 31:155-163. [PMID: 32466982 DOI: 10.1053/j.jrn.2020.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 02/10/2020] [Accepted: 02/16/2020] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Dietary phosphate modification is a common therapy to treat hyperphosphatemia in individuals with chronic kidney disease (CKD). However, current dietary intake and common food sources of phosphate typically consumed by individuals with CKD are not well characterized. This study examined a cohort of CKD patients to determine total dietary intake and common food sources of phosphate, including phosphate additives. DESIGN AND METHODS Participants with CKD stages 3b and 4 recruited to a substudy of the "IMPROVE-CKD (IMpact of Phosphate Reduction On Vascular End-points in Chronic Kidney Disease) Study" completed a 7-day self-administered diet record at baseline. Diet histories were analyzed and daily phosphate intakes determined using FoodWorks V.9 (Xyris). The proportion of phosphate contributed by each food group was determined using the AUSNUT 2011-2013 Food Classification System. Ingredient lists of packaged food items consumed were reviewed to determine frequency of phosphate-based additives. RESULTS Ninety participants (mean eGFR 26.5 mL/min/1.73 m2) completed this substudy. Mean phosphate intake of participants was 1544 ± 347 mg/day, with 96% of individuals exceeding the recommended daily intake of phosphate (1000 mg/day). The highest sources of dietary phosphate were milk-based products (25%) and meat and poultry products/dishes (25%). Phosphate-based food additives were identified in 39% (n = 331/845) of packaged foods consumed by participants. CONCLUSION Dietary phosphate intakes of Australians with CKD are high and come from a variety of sources. Managing dietary phosphate intake requires a patient-centered, tailored approach with an emphasis on maintaining nutritional adequacy and awareness of phosphate additives.
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Affiliation(s)
- Marguerite Conley
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.
| | - Nicole Lioufas
- Department of Nephrology, The Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Medicine (RMH), The University of Melbourne, Parkville, Victoria, Australia; Department of Nephrology, Western Health, St Albans, Victoria, Australia
| | - Nigel D Toussaint
- Department of Nephrology, The Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Medicine (RMH), The University of Melbourne, Parkville, Victoria, Australia
| | - Grahame J Elder
- Department of Renal Medicine, Westmead Hospital, Westmead, New South Wales, Australia; Osteoporosis and Bone Biology Division, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
| | - Sunil V Badve
- Department of Renal Medicine, St George Hospital, Sydney, NSW, Australia; Renal and Metabolic Division, George Institute for Global Health, University of New South Wales Medicine, Sydney, NSW, Australia
| | - Carmel M Hawley
- Department of Nephrology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia; Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia
| | - Elaine M Pascoe
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia
| | - Eugenia Pedagogos
- Department of Nephrology, Western Health, St Albans, Victoria, Australia; Department of Nephrology, Alfred Health, Melbourne, Victoria, Australia
| | - Andrea Valks
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia
| | - Katrina L Campbell
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia; Department of Nutrition and Dietetics, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
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Santin F, Canella D, Borges C, Lindholm B, Avesani CM. Dietary Patterns of Patients with Chronic Kidney Disease: The Influence of Treatment Modality. Nutrients 2019; 11:E1920. [PMID: 31443269 PMCID: PMC6723967 DOI: 10.3390/nu11081920] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 07/12/2019] [Accepted: 07/15/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND We analyzed the dietary patterns of Brazilian individuals with a self-declared diagnosis of chronic kidney disease (CKD) and explored associations with treatment modality. METHODS Weekly consumption of 14 food intake markers was analyzed in 839 individuals from the 2013 Brazil National Health Survey with a self-declared diagnosis of CKD undergoing nondialysis (n = 480), dialysis (n = 48), or renal transplant (n = 17) treatment or no CKD treatment (n = 294). Dietary patterns were derived by exploratory factor analysis of food intake groups. Multiple linear regression models, adjusted by sociodemographic and geographical variables, were used to evaluate possible differences in dietary pattern scores between different CKD treatment groups. RESULTS Two food patterns were identified: an "Unhealthy" pattern (red meat, sweet sugar beverages, alcoholic beverages, and sweets and a negative loading of chicken, excessive salt, and fish) and a "Healthy" pattern (raw and cooked vegetables, fruits, fresh fruit juice, and milk). The Unhealthy pattern was inversely associated with nondialysis and dialysis treatment (β: -0.20 (95% CI: -0.33; -0.06) and β: -0.80 (-1.16; -0.45), respectively) and the Healthy pattern was positively associated with renal transplant treatment (β: 0.32 (0.03; 0.62)). CONCLUSIONS Two dietary patterns were identified in Brazilian CKD individuals and these patterns were linked to CKD treatment modality.
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Affiliation(s)
- Fernanda Santin
- Graduate Program in Food, Nutrition and Health, Nutrition Institute, Rio de Janeiro State University, Rio de Janeiro 20559-900, Brazil
| | - Daniela Canella
- Department of Applied Nutrition, Nutrition Institute, Rio de Janeiro State University, Rio de Janeiro 20559-900, Brazil
| | - Camila Borges
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo 01246-904, Brazil
| | - Bengt Lindholm
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institute, 14186 Stockholm, Sweden
| | - Carla Maria Avesani
- Department of Applied Nutrition, Nutrition Institute, Rio de Janeiro State University, Rio de Janeiro 20559-900, Brazil.
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Talavera JO, Roy-García I, Palacios-Cruz L, Rivas-Ruiz R, Hoyo I, Pérez-Rodríguez M. De vuelta a la clínica. Métodos I. Diseños de investigación. Mayor calidad de información, mayor certeza a la respuesta. GAC MED MEX 2019; 155:399-405. [PMID: 31486784 PMCID: PMC7446753 DOI: 10.24875/gmm.19005226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 05/17/2019] [Indexed: 11/17/2022] Open
Abstract
Research designs refer to the way information is obtained and are limited by ethical, economic and temporal viability. Research designs are standardized strategies to reduce biases, which in the architectural model of research are identified in the baseline state, the maneuver and the outcome; hence, there are no specific designs for each question. The design with the lowest probability of bias is the clinical trial, followed by cohort and case-control studies and, finally, by cross-sectional surveys. Among the main characteristics that give merit to research designs are the following: population inquiry, which refers to the situation of the population in relation to the clinical course/natural history of the disease; the maneuver, or action that is expected to modify the baseline state, which can be observational or experimental; follow-up, or documented monitoring that is given to each subject, which can be longitudinal or cross-sectional; and directionality, which can prolective or retrolective and refers to the timing of data collection for research purposes. It will always be better having a valuable question, even when answered with a design with higher risk of bias, than a question that is irrelevant or has no applicability.
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Affiliation(s)
| | - Ivonne Roy-García
- Instituto Mexicano del Seguro Social, Coordinación de Investigación en Salud, Centro Médico Nacional Siglo XXI, Centro de Adiestramiento en Investigación Clínica
| | - Lino Palacios-Cruz
- Instituto Nacional de Psiquiatría “Dr. Ramón de la Fuente”, Subdirección de Investigaciones Clínicas, Departamento Epidemiología Clínica
| | - Rodolfo Rivas-Ruiz
- Instituto Mexicano del Seguro Social, Coordinación de Investigación en Salud, Centro Médico Nacional Siglo XXI, Centro de Adiestramiento en Investigación Clínica
| | - Irma Hoyo
- Servicio de Medicina Interna, Centro Médico ABC. Ciudad de México
| | - Marcela Pérez-Rodríguez
- Instituto Mexicano del Seguro Social, Coordinación de Investigación en Salud, Centro Médico Nacional Siglo XXI, Centro de Adiestramiento en Investigación Clínica
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Association between Dietary Intake and Coronary Artery Calcification in Non-Dialysis Chronic Kidney Disease: The PROGREDIR Study. Nutrients 2018; 10:nu10030372. [PMID: 29562658 PMCID: PMC5872790 DOI: 10.3390/nu10030372] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 03/12/2018] [Accepted: 03/12/2018] [Indexed: 12/27/2022] Open
Abstract
Coronary artery calcification (CAC) is a widespread condition in chronic kidney disease (CKD). Diet may play an important role in CAC, but this role is not clear. This study evaluated the association between macro-and micronutrient intakes and CAC in non-dialysis CKD patients. We analyzed the baseline data from 454 participants of the PROGREDIR study. Dietary intake was evaluated by a food frequency questionnaire. CAC was measured by computed tomography. After exclusion of participants with a coronary stent, 373 people remained for the analyses. The highest tertile of CAC was directly associated with the intake of phosphorus, calcium and magnesium. There was a higher intake of pantothenic acid and potassium in the second tertile. After adjustments for confounding variables, the intake of pantothenic acid, phosphorus, calcium and potassium remained associated with CAC in the generalized linear mixed models. In order to handle the collinearity between these nutrients, we used the LASSO (least absolute shrinkage and selection operator) regression to evaluate the nutrients associated with CAC variability. In this approach, the nutrients that most explained the variance of CAC were phosphorus, calcium and potassium. Prospective studies are needed to confirm these findings and assess the role of interventions regarding these micronutrients on CAC prevention and progression.
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