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Mansouri F, Shateri Z, Jahromi SE, Mahmudi-Zadeh M, Nouri M, Babajafari S. Association between pro-vegetarian dietary pattern and the risk of protein-energy wasting and sarcopenia in patients with chronic kidney disease. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2024; 43:110. [PMID: 39085942 DOI: 10.1186/s41043-024-00606-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Accepted: 07/26/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Chronic kidney disease (CKD) is characterized by structural abnormalities in nephrons, loss of functional nephrons, and impaired renal excretory function. A pro-vegetarian dietary pattern (PDP) is a gradual and progressive approach to vegetarianism. The current study aimed to assess the association between PDP and the odds of protein-energy wasting (PEW) and sarcopenia in patients with CKD. METHODS The present cross-sectional study was conducted on kidney disease patients (n = 109) referred to two clinics in Shiraz, Iran. The diagnosis of sarcopenia and PEW was made according to the guidelines of the Asian Working Group for Sarcopenia (AWGS) and the International Society of Renal Nutrition and Metabolism (ISRNM) criteria, respectively. The participants' dietary intake was evaluated using a 168-item semi-quantitative food frequency questionnaire (FFQ). For PDP index calculation, plant and animal food sources were categorized into 12 subgroups. The association between sarcopenia and PEW with PDP was evaluated using logistic regression. RESULTS The PDP was significantly associated with a lower risk of PEW in the second tertile compared to the first in the crude model (odds ratio (OR) = 0.225; confidence interval (CI): 0.055-0.915; p-value = 0.037). After adjusting for potential confounders, lower significant odds of PEW were observed in the second and last tertiles of PDP compared to the first (T2: OR = 0.194; CI: 0.039-0.962; p-value = 0.045, and T3: OR = 0.168; CI: 0.030-0.950; p-value = 0.044). In contrast, no significant relationship was observed between PDP and the odds of sarcopenia (p-value ˃ 0.05). CONCLUSIONS Overall, the findings indicated that greater adherence to PDP was negatively associated with the odds of PEW. Additionally, the results showed no association between PDP and the odds of sarcopenia. Further studies are needed to support these findings.
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Affiliation(s)
- Fatemeh Mansouri
- Department of Clinical Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zainab Shateri
- Department of Nutrition and Biochemistry, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Shahrokh Ezzatzadegan Jahromi
- Department of Medicine, School of Medicine, Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Melika Mahmudi-Zadeh
- Department of Community Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehran Nouri
- Mobility Impairment Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.
| | - Siavash Babajafari
- Department of Clinical Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
- Nutrition research center, Department of Clinical Nutrition, School of Nutrition and Food Science, Shiraz University of Medical Sciences, Shiraz, Iran.
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Marrone G, Murri A, Urciuoli S, Di Lauro M, Grazioli E, Vignolini P, Cornali K, Tranchita E, Masci C, Cerulli C, Di Marco L, Mitterhofer AP, Parisi A, Noce A. Functional Foods and Adapted Physical Activity as New Adjuvant Therapy for Chronic Kidney Disease Patients. Nutrients 2024; 16:2325. [PMID: 39064768 PMCID: PMC11279472 DOI: 10.3390/nu16142325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 07/10/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) will become the fifth leading cause of death in the world by 2040. It is fundamental to prevent and treat this pathology to reduce its impact on national health costs. This trial's aim is to evaluate the effects induced by a combination of consumed functional foods (FFs) with adapted physical activity (APA) on the progression of CKD-related comorbidities. METHODS The study lasted 12 weeks. We divided 40 CKD patients into four groups: mixed (FF + APA), APA, FF and control group (usual care). The FFs were characterized by their total antioxidant capacity and antiradical activity. The APA was performed though an online training protocol, three times per week, 1 h each session. RESULTS At the end of the study, we observed, in the mixed group, a decrease in azotemia (p = 0.0272), diastolic blood pressure (p = 0.0169), and C-reactive protein (p = 0.0313), with increases in the FORD test (p = 0.0203) and fat free mass (p = 0.0258). The APA group showed a reduction in total cholesterol (p = 0.0039). CONCLUSIONS The combination of FFs and APA can help counteract several CKD-related comorbidities, such as arterial hypertension, dyslipidemia and uremic sarcopenia, and improve the CKD patients' quality of life.
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Affiliation(s)
- Giulia Marrone
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (K.C.); (C.M.); (L.D.M.); (A.P.M.); (A.N.)
| | - Arianna Murri
- Department of Exercise, Human and Health Sciences, Foro Italico University of Rome, 00135 Rome, Italy
| | - Silvia Urciuoli
- Department of Statistics, Computer Science and Application—PHYTOLAB (Pharmaceutical, Cosmetic, Food Supplement, Technology and Analysis), University of Florence, Sesto Fiorentino, 50019 Florence, Italy; (S.U.); (P.V.)
| | - Manuela Di Lauro
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (K.C.); (C.M.); (L.D.M.); (A.P.M.); (A.N.)
| | - Elisa Grazioli
- Department of Exercise, Human and Health Sciences, Foro Italico University of Rome, 00135 Rome, Italy
| | - Pamela Vignolini
- Department of Statistics, Computer Science and Application—PHYTOLAB (Pharmaceutical, Cosmetic, Food Supplement, Technology and Analysis), University of Florence, Sesto Fiorentino, 50019 Florence, Italy; (S.U.); (P.V.)
| | - Kevin Cornali
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (K.C.); (C.M.); (L.D.M.); (A.P.M.); (A.N.)
| | - Eliana Tranchita
- Department of Exercise, Human and Health Sciences, Foro Italico University of Rome, 00135 Rome, Italy
| | - Claudia Masci
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (K.C.); (C.M.); (L.D.M.); (A.P.M.); (A.N.)
| | - Claudia Cerulli
- Department of Exercise, Human and Health Sciences, Foro Italico University of Rome, 00135 Rome, Italy
| | - Luca Di Marco
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (K.C.); (C.M.); (L.D.M.); (A.P.M.); (A.N.)
| | - Anna Paola Mitterhofer
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (K.C.); (C.M.); (L.D.M.); (A.P.M.); (A.N.)
- UOSD Nephrology and Dialysis, Policlinico Tor Vergata, 00133, Rome, Italy
| | - Attilio Parisi
- Department of Exercise, Human and Health Sciences, Foro Italico University of Rome, 00135 Rome, Italy
| | - Annalisa Noce
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (K.C.); (C.M.); (L.D.M.); (A.P.M.); (A.N.)
- UOSD Nephrology and Dialysis, Policlinico Tor Vergata, 00133, Rome, Italy
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3
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Shaaker H, Davenport A. Does Dietary Intake Differ in Kidney Failure Patients With Sarcopenia and Frailty Treated by Hemodialysis. Gerontol Geriatr Med 2024; 10:23337214241253433. [PMID: 38765918 PMCID: PMC11100388 DOI: 10.1177/23337214241253433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/16/2023] [Accepted: 04/22/2024] [Indexed: 05/22/2024] Open
Abstract
Background: Inadequate nutrition is common for both sarcopenia and frailty. We investigated whether hemodialysis patients with sarcopenia and frailty have reduced dietary intakes. Methods: Dietary intake, and physical activity were analyzed, along with body composition and relevant clinical data. Results: We studied 51 hemodialysis patients; 52.9% male, age 60 ± 15 years; 33.3% sarcopenic, and 72.5% frail. Dietary protein and calories were similar for sarcopenic and non-sarcopenic patients 0.68 (0.38-3.5) vs. 0.68 (0.18-2.9) g protein/kg/day and 19.2 (8.2-77.5) vs. 15.2 (6.2-38.5) kcal/kg/day. More sarcopenic patients had low physical activity (88.2% vs. 58.8%, X2 4.6, p = .03). Frail and non-frail patients had similar intakes 0.67 (0.28-3.5) versus 0.83 (0.18-1.6) g protein/kg/day and 15.5 (8.1-77.5) vs. 18.8 (6.2-45.4) kcal/kg/day. Sarcopenia was associated with age [Odds ratio (OR) 1.09, 95% confidence interval (CI) [1.02, 1.18], p = .017], body mass index [OR 0.84, 95% CI [0.71, 0.99], p = .042] and lack of exercise [OR 7.62, 95% CI [1.16, 50.29], p = .035]. Frailty was associated with female gender [OR 17.79, 95% CI [2.09, 151.59], p = .008], age [OR 1.13, 95% CI [1.04, 1.22], p = .006], and dialysis vintage [OR 1.55, 95% CI [1.06, 2.26], p = .024]. Conclusion: Hemodialysis patients with sarcopenia and frailty did not have lower dietary protein and calorie intake. Frailty was associated with age and sarcopenia with a sedentary lifestyle.
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Affiliation(s)
- Haalah Shaaker
- University College London, UK
- King Abdulaziz University, Jeddah, Saudi Arabia
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Inoshita H, Asaoka D, Matsuno K, Yanagisawa N, Suzuki Y, Miyauchi K. Cross-Sectional Study on the Association between Dietary Patterns and Sarcopenia in Elderly Patients with Chronic Kidney Disease Receiving Conservative Treatment. Nutrients 2023; 15:4994. [PMID: 38068851 PMCID: PMC10708199 DOI: 10.3390/nu15234994] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 11/21/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023] Open
Abstract
Sarcopenia is a poor prognostic factor in patients with chronic kidney disease (CKD). Adequate dietary patterns are important for preventing sarcopenia; however, evidence regarding the underlying association between sarcopenia and diet is insufficient. Therefore, in this study, we aimed to investigate the association between sarcopenia and dietary patterns in CKD patients receiving conservative treatment. In this cross-sectional study, 441 patients with conservative CKD were examined using the Asian Working Group for Sarcopenia diagnostic criteria. CKD was defined as an eGFR of <60 mL/min/1.73 m2 present for >3 months. The participants were divided into sarcopenia and non-sarcopenia groups, and dietary patterns were compared between the two groups using the dietary variety score, a simple dietary survey method that investigates the weekly frequency of consumption of 10 food groups. Logistic regression analysis for CKD G3 showed that female sex (odds ratio (OR): 0.166, 95% confidence interval (CI): 0.086-0.320), increased body mass index (OR: 0.663, 95% CI: 0.590-0.745), and almost daily consumption of green/yellow vegetables (OR: 0.350, 95% CI: 0.176-0.695) were positively associated with non-sarcopenia. Although further prospective studies are required, the results suggest that low frequent consumption of vegetables is associated with sarcopenia in patients with CKD.
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Affiliation(s)
- Hiroyuki Inoshita
- Department of Nephrology, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo 136-0075, Japan
| | - Daisuke Asaoka
- Department of Gastroenterology, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo 136-0075, Japan
| | - Kei Matsuno
- Department of Respiratory Medicine, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo 136-0075, Japan
| | - Naotake Yanagisawa
- Medical Technology Innovation Center, Juntendo University, Tokyo 113-8421, Japan
| | - Yusuke Suzuki
- Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan;
| | - Katsumi Miyauchi
- Department of Cardiology, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo 136-0075, Japan
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Marashi-Hosseini L, Jafarirad S, Hadianfard AM. A fuzzy based dietary clinical decision support system for patients with multiple chronic conditions (MCCs). Sci Rep 2023; 13:12166. [PMID: 37500949 PMCID: PMC10374573 DOI: 10.1038/s41598-023-39371-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 07/25/2023] [Indexed: 07/29/2023] Open
Abstract
Due to the multifaceted nature of Multiple Chronic Conditions (MCCs), setting a diet for these patients is complicated and time-consuming. In this study, a clinical decision support system based on fuzzy logic was modeled and evaluated to aid dietitians in adjusting the diet for patients with MCCs. Mamdani fuzzy logic with 1144 rules was applied to design the model for MCCs patients over 18 years who suffer from one or more chronic diseases, including obesity, diabetes, hypertension, hyperlipidemia, and kidney disease. One hundred nutrition records from three nutrition clinics were employed to measure the system's performance. The findings showed that the diet set by nutritionists had no statistically significant difference from the diet recommended by the fuzzy model (p > 0.05), and there was a strong correlation close to one between them. In addition, the results indicated a suitable model performance with an accuracy of about 97%. This system could adjust the diet with high accuracy as well as humans. In addition, it could increase dietitians' confidence, precision, and speed in setting the diet for MCCs patients.
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Affiliation(s)
- Leila Marashi-Hosseini
- Department of Health Information Technology, School of Allied Medical Science, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Sima Jafarirad
- Associate Professor of Nutrition and Metabolic Diseases Research Center, Clinical Sciences Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ali Mohammad Hadianfard
- Associate Professor (Medical Informatics), Nutrition, and Metabolic Diseases Research Center, Clinical Sciences Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
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Massini G, Caldiroli L, Molinari P, Carminati FMI, Castellano G, Vettoretti S. Nutritional Strategies to Prevent Muscle Loss and Sarcopenia in Chronic Kidney Disease: What Do We Currently Know? Nutrients 2023; 15:3107. [PMID: 37513525 PMCID: PMC10384728 DOI: 10.3390/nu15143107] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/07/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
Loss of muscle mass is an extremely frequent complication in patients with chronic kidney disease (CKD). The etiology of muscle loss in CKD is multifactorial and may depend on kidney disease itself, dialysis, the typical chronic low-grade inflammation present in patients with chronic kidney disease, but also metabolic acidosis, insulin resistance, vitamin D deficiency, hormonal imbalances, amino acid loss during dialysis, and reduced dietary intake. All these conditions together increase protein degradation, decrease protein synthesis, and lead to negative protein balance. Aging further exacerbates sarcopenia in CKD patients. Nutritional therapy, such as protein restriction, aims to manage uremic toxins and slow down the progression of CKD. Low-protein diets (LPDs) and very low-protein diets (VLPDs) supplemented with amino acids or ketoacids are commonly prescribed. Energy intake is crucial, with a higher intake associated with maintaining a neutral or positive nitrogen balance. Adequate nutritional and dietary support are fundamental in preventing nutritional inadequacies and, consequently, muscle wasting, which can occur in CKD patients. This review explores the causes of muscle loss in CKD and how it can be influenced by nutritional strategies aimed at improving muscle mass and muscle strength.
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Affiliation(s)
- Giulia Massini
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Lara Caldiroli
- Unit of Nephrology, Dialysis and Kidney Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, 20122 Milan, Italy
| | - Paolo Molinari
- Unit of Nephrology, Dialysis and Kidney Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, 20122 Milan, Italy
| | - Francesca Maria Ida Carminati
- Unit of Nephrology, Dialysis and Kidney Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, 20122 Milan, Italy
| | - Giuseppe Castellano
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
- Unit of Nephrology, Dialysis and Kidney Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, 20122 Milan, Italy
| | - Simone Vettoretti
- Unit of Nephrology, Dialysis and Kidney Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, 20122 Milan, Italy
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Tobe A, Sawano M, Kohsaka S, Ishii H, Tanaka A, Numasawa Y, Amano T, Nakamura M, Ikari Y, Murohara T. Ischemic and Bleeding Outcomes in Patients Who Underwent Percutaneous Coronary Intervention With Chronic Kidney Disease or Dialysis (from a Japanese Nationwide Registry). Am J Cardiol 2023; 195:37-44. [PMID: 37004333 DOI: 10.1016/j.amjcard.2023.02.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 02/09/2023] [Accepted: 02/28/2023] [Indexed: 04/04/2023]
Abstract
The relation between chronic kidney disease (CKD) and outcomes in patients receiving percutaneous coronary intervention (PCI) is thought to be bidirectional; these patients are at a higher risk of ischemic and bleeding events. From a Japanese nationwide PCI registry, ischemic (cardiovascular death, nonfatal myocardial infarction, or nonfatal ischemic stroke) and bleeding events (fatal or nonfatal major bleeding) 1 year after discharge among patients who had second- or newer-generation drug-eluting stent implantation were analyzed. Patients on oral anticoagulants were excluded. Patients were stratified according to their preprocedural renal function: CKD stages 1 to 2 (estimated glomerular filtration rate [eGFR] ≥60 ml/min/1.73 m2), 3 (eGFR 30 to 59), or 4 to 5 (eGFR <30), or those receiving dialysis. Overall, 23,349 patients, including 2,798 patients with CKD 3 to 5 (12.0%) and 1,464 patients on dialysis (6.3%), were investigated. One-year ischemic events were observed in 1.5%, 5.2%, 9.7%, and 5.3% in the CKD stages 1-to-2, 3, 4-to-5, and dialysis groups, respectively; patients with CKD stages 3 or 4 to 5 and those receiving dialysis were associated with higher risks of ischemic events after adjustment of covariates than were patients without CKD. Compared with ischemic events, 1-year bleeding events were low, with incidence rates of 1.5%, 2.0%, 3.4%, and 2.3%, respectively. Furthermore, the presence of CKD or dialysis was not associated with a higher risk of bleeding events after adjustment of covariates. In conclusion, in the contemporary nationwide PCI registry, the presence of CKD and dialysis was independently associated with a higher risk of ischemic events but not with bleeding events, and this suggests a need to alter the models of care delivery in these patients.
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Affiliation(s)
- Akihiro Tobe
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Mitsuaki Sawano
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Hideki Ishii
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Akihito Tanaka
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yohei Numasawa
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan
| | - Tetsuya Amano
- Department of Cardiology, Aichi-Medical University, Nagakute, Japan
| | - Masato Nakamura
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Yuji Ikari
- Department of Cardiovascular Medicine, Tokai University, Isehara, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Barreto Silva MI, Picard K, Klein MRST. Sarcopenia and sarcopenic obesity in chronic kidney disease: update on prevalence, outcomes, risk factors and nutrition treatment. Curr Opin Clin Nutr Metab Care 2022; 25:371-377. [PMID: 36039925 DOI: 10.1097/mco.0000000000000871] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This review summarizes literature from the last 18 months reporting on sarcopenia (or its components) in chronic kidney disease (CKD). RECENT FINDINGS The prevalence of sarcopenia in CKD is reported to be 5-62.5%, with higher rates observed later in the disease. Sarcopenic obesity rates are reported to be 2-23%. Sarcopenia in CKD is associated with increased risk of mortality, cardiovascular disease and vascular calcification. Risk factors include kidney disease itself and the impacts of CKD on lifestyle (reduced physical activity, diet changes). In earlier stages of CKD, if the risks from sarcopenia outweigh the risk of reaching end-stage renal disease, ensuring adequate energy intake combined with modest protein liberalization and physical activity may be indicated. Protein intakes above 1.3 g/kg of body weight per day should be avoided. For dialysis patients, interventions that provide a combination of carbohydrate, protein and fat appear more effective than those that provide protein alone, though it may take as long as 48 weeks for detectable changes in muscle mass. SUMMARY Sarcopenia is prevalent in CKD as kidney disease significantly impacts muscle mass and function. Nutrition interventions can improve components of sarcopenia, with an emphasis on adequate energy and protein.
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Affiliation(s)
- Maria Inês Barreto Silva
- Human Nutrition Research Unit, Division of Human Nutrition, Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
- Department of Applied Nutrition, Nutrition Institute, Rio de Janeiro State University
- Department of Applied Nutrition, Nutrition School, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Kelly Picard
- Human Nutrition Research Unit, Division of Human Nutrition, Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
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An JN, Kim JK, Lee HS, Kim SG, Kim HJ, Song YR. Serum cystatin C to creatinine ratio is associated with sarcopenia in non-dialysis-dependent chronic kidney disease. Kidney Res Clin Pract 2022; 41:580-590. [PMID: 35791742 PMCID: PMC9576455 DOI: 10.23876/j.krcp.21.214] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 04/06/2022] [Indexed: 11/04/2022] Open
Abstract
Background Methods Results Conclusion
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Affiliation(s)
- Jung Nam An
- Division of Nephrology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Jwa-Kyung Kim
- Division of Nephrology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
- Hallym University Kidney Research Institute, Anyang, Republic of Korea
| | - Hyung-Seok Lee
- Division of Nephrology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
- Hallym University Kidney Research Institute, Anyang, Republic of Korea
| | - Sung Gyun Kim
- Division of Nephrology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
- Hallym University Kidney Research Institute, Anyang, Republic of Korea
| | - Hyung Jik Kim
- Division of Nephrology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
- Hallym University Kidney Research Institute, Anyang, Republic of Korea
| | - Young Rim Song
- Division of Nephrology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
- Hallym University Kidney Research Institute, Anyang, Republic of Korea
- Department of Biomedical Gerontology, Graduate School of Hallym University, Chuncheon, Republic of Korea
- Correspondence: Young Rim Song Division of Nephrology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, 22 Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang 14068, Republic of Korea. E-mail:
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Kwon YJ, Lee HS, Park GE, Kim HM, Lee JJ, Kim WJ, Lee JW. The Association Between Total Protein Intake and All-Cause Mortality in Middle Aged and Older Korean Adults With Chronic Kidney Disease. Front Nutr 2022; 9:850109. [PMID: 35445069 PMCID: PMC9014017 DOI: 10.3389/fnut.2022.850109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 02/25/2022] [Indexed: 11/15/2022] Open
Abstract
Background and Aims Over the past decades, the optimum protein intake for patients with chronic kidney disease (CKD) has been an important, controversial issue. Dietary protein restriction has been commonly recommended for patients with CKD for preserving kidney function. However, evidence of the associations between long-term protein intake and mortality is not consistent in patients with CKD. Therefore, we aimed to examine the associations between total protein intake and all-cause mortality in Korean adults with CKD. Methods From three sub-cohorts of the Korean Genome and Epidemiology Study (KoGES) starting from 2001, total 3,892 participants with eGFR < 60 mL/min/1.73 m2 (CKD stage 3–5) were included in this study. Dietary data were collected using food-frequency questionnaires at baseline. Deaths were followed from 2001 to 2019. Cox proportional hazards regression model was used to evaluate the association between protein intake and all-cause mortality. Results During a median follow-up (min-max) of 11.1 years (0.3–15.1), 602 deaths due to all causes of mortality were documented. After adjustment for covariates, higher total protein intake was not associated with all-cause mortality [highest vs. lowest quintile of total protein intake (g/kg/day) and proportion (%) (Q5 vs. Q1), HR = 1.14 (0.75–1.72), and HR = 0.87 (0.67–1.13)] in CKD stage 3–5 patients. Conclusion Dietary protein intake was not associated with mortality from all causes in patients with CKD. Further research is needed to establish optimal protein intake levels and examine the impact of the dietary source of protein on various health outcomes and mortality in CKD.
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Affiliation(s)
- Yu-Jin Kwon
- Department of Family Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Department of Research Affairs, Yonsei University College of Medicine, Seoul, South Korea
| | - Go Eun Park
- Biostatistics Collaboration Unit, Department of Research Affairs, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyung-Mi Kim
- Department of Food and Nutrition, Dongduck Women's University, Seoul, South Korea
| | - Jung Joo Lee
- Nutrition Team, Yongin Severance Hospital, Yongin, South Korea
| | - Woo Jeong Kim
- Department of Nutrition Service, Gangnam Severance Hospital, Seoul, South Korea
| | - Ji-Won Lee
- Department of Family Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
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Gonzalez P, Lozano P, Solano F. Unraveling the Metabolic Hallmarks for the Optimization of Protein Intake in Pre-Dialysis Chronic Kidney Disease Patients. Nutrients 2022; 14:nu14061182. [PMID: 35334840 PMCID: PMC8954715 DOI: 10.3390/nu14061182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/28/2022] [Accepted: 03/10/2022] [Indexed: 02/04/2023] Open
Abstract
The daily amount and quality of protein that should be administered by enteral nutrition in pre-dialysis chronic kidney disease (CKD) patients is a widely studied but still controversial issue. This is due to a compromise between the protein necessary to maintain muscular proteostasis avoiding sarcopenia, and the minimal amount required to prevent uremia and the accumulation of nitrogenous toxic substances in blood because of the renal function limitations. This review underlines some intracellular and extracellular features that should be considered to reconcile those two opposite factors. On one hand, the physiological conditions and usual side effects associated with CKD, mTOR and other proteins and nutrients involved in the regulation of protein synthesis in the muscular tissue are discussed. On the other hand, the main digestive features of the most common proteins used for enteral nutrition formulation (i.e., whey, casein and soy protein) are highlighted, due to the importance of supplying key amino acids to serum and tissues to maintain their concentration above the anabolic threshold needed for active protein synthesis, thereby minimizing the catabolic pathways leading to urea formation.
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Affiliation(s)
- Patricia Gonzalez
- Project Manager, Fresenius Kabi España, Sociedad Anonima Unipersonal, Marina 16-18, 08005 Barcelona, Spain
- Correspondence: (P.G.); (F.S.)
| | - Pedro Lozano
- Department of Biochemistry and Molecular Biology “B” and Immunology, Faculty of Chemistry, Campus de Espinardo, University of Murcia, 30100 Murcia, Spain;
| | - Francisco Solano
- Department of Biochemistry and Molecular Biology “B” and Immunology, IMIB (Murcian Institute of Health Research), Faculty of Medicine, Campus de Espinardo, University of Murcia, 30100 Murcia, Spain
- Correspondence: (P.G.); (F.S.)
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Pujia A, Montalcini T, Donini LM, Frittitta L, Galvano F, Natali A, Pironi L, Porrini M, Riso P, Rivellese AA, Russo D, Scapagnini G, Serafini M, Tagliabue A, De Lorenzo A. Roles and competencies in the nutritional domain for the management of the metabolic diseases and in the hospital setting: A position paper of the Italian College of Academic Nutritionists, MED-49 (ICAN-49). Nutr Metab Cardiovasc Dis 2021; 31:2993-3003. [PMID: 34518088 DOI: 10.1016/j.numecd.2021.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 05/19/2021] [Accepted: 07/02/2021] [Indexed: 11/26/2022]
Abstract
Epidemiological evidence has confirmed the potential causal relationship between specific dietary factors and non-communicable diseases. However, currently nutrition was shown to be insufficiently integrated into medical education, regardless of the country. Without an adequate nutrition education, it is reasonable to assume that future physicians, as well as other health care professionals, will be not able to provide the highest quality care to patients in preventing and treating non-communicable diseases. Furthermore, the insufficient availability of physicians with specializations in nutrition has posed the basis for the development of non-medical careers in the field of nutrition. The present document was drafting by the Italian College of Academic Nutritionists, MED-49 (ICAN-49), with the aim to provide an overview on the nutritional competency standards covered by several health care professionals (Physicians Clinical Nutrition Specialists, Clinical Dietitians, Professional Clinical Nutrition Specialists, etc) for the prevention of diseases and/or support of pharmacological therapies. The aim of the ICAN 49 is to suggest a major shift in practice opportunities and roles for many nutritionists, especially for the management of the metabolic diseases, and promote a paradigm change: a clinical and educational leadership role for Physician Clinical Nutrition Specialists in the hospital setting.
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Affiliation(s)
- Arturo Pujia
- Department of Medical and Surgical Science, University of Catanzaro Magna Grecia, Viale Europa, Catanzaro, 88100, Italy.
| | - Tiziana Montalcini
- Department of Clinical and Experiment Medicine, University of Catanzaro Magna Grecia, Viale Europa, Catanzaro, 88100, Italy.
| | - Lorenzo M Donini
- Department of Experimental Medicine, University of La Sapienza, Piazzale Aldo Moro 5, 00185, Rome, Italy.
| | - Lucia Frittitta
- Department of Clinical and Experiment Medicine, University of Catania, Via Santa Sofia, 86-95123, Catania, Italy.
| | - Fabio Galvano
- Department of Biomedical and Biotechnology Science, University of Catania, Via Santa Sofia, 86-95123, Catania, Italy.
| | - Andrea Natali
- Department of Clinical and Experiment Medicine, University of Pisa, Lungarno Antonio Pacinotti, 43, 56126, Pisa, Italy.
| | - Loris Pironi
- Department of Medical and Surgical Sciences, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy.
| | - Marisa Porrini
- Department of Food, Environmental and Nutritional Sciences, University of Milan, Via Celoria, 2, 20133, Milano, Italy.
| | - Patrizia Riso
- Department of Food, Environmental and Nutritional Sciences, University of Milan, Via Celoria, 2, 20133, Milano, Italy.
| | - Angela Albarosa Rivellese
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Corso Umberto I, 40, 80138, Napoli, Italy.
| | - Diego Russo
- Department of Health Science, University of Catanzaro Magna Grecia, Viale Europa, 88100, Catanzaro, Italy.
| | - Giovanni Scapagnini
- Department of Medicine and Health Science, University of Molise, Via F. De Sanctis, 86100, Campobasso, Italy.
| | - Mauro Serafini
- Faculty of Biosciences and Technologies for Agriculture, Food and Environment, University of Teramo, Via Renato Balzarini, 1, 64100, Teramo, Italy.
| | - Anna Tagliabue
- Department of Public Health, University of Pavia, Via Agostino Bassi, 21, 27100, Pavia, Italy.
| | - Antonino De Lorenzo
- Biomedicine and Prevention, University of Tor Vergata, Via Montpellier, 1, 00133, Roma, Italy.
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13
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Petroni ML, Brodosi L, Marchignoli F, Sasdelli AS, Caraceni P, Marchesini G, Ravaioli F. Nutrition in Patients with Type 2 Diabetes: Present Knowledge and Remaining Challenges. Nutrients 2021; 13:nu13082748. [PMID: 34444908 PMCID: PMC8401663 DOI: 10.3390/nu13082748] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/03/2021] [Accepted: 08/06/2021] [Indexed: 02/07/2023] Open
Abstract
Unhealthy behaviours, including diet and physical activity, coupled with genetic predisposition, drive type 2 diabetes (T2D) occurrence and severity; the present review aims to summarise the most recent nutritional approaches in T2D, outlining unmet needs. Guidelines consistently suggest reducing energy intake to counteract the obesity epidemic, frequently resulting in sarcopenic obesity, a condition associated with poorer metabolic control and cardiovascular disease. Various dietary approaches have been proposed with largely similar results, with a preference for the Mediterranean diet and the best practice being the diet that patients feel confident of maintaining in the long term based on individual preferences. Patient adherence is indeed the pivotal factor for weight loss and long-term maintenance, requiring intensive lifestyle intervention. The consumption of nutritional supplements continues to increase even if international societies do not support their systematic use. Inositols and vitamin D supplementation, as well as micronutrients (zinc, chromium, magnesium) and pre/probiotics, result in modest improvement in insulin sensitivity, but their use is not systematically suggested. To reach the desired goals, patients should be actively involved in the collaborative development of a personalised meal plan associated with habitual physical activity, aiming at normal body weight and metabolic control.
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Affiliation(s)
- Maria Letizia Petroni
- IRCCS-Azienda Ospedaliera di Bologna Sant’Orsola-Malpighi, I-40138 Bologna, Italy; (M.L.P.); (L.B.); (F.M.); (A.S.S.); (P.C.); (F.R.)
- Department of Medical and Surgical Sciences, Alma Mater University of Bologna, I-40138 Bologna, Italy
| | - Lucia Brodosi
- IRCCS-Azienda Ospedaliera di Bologna Sant’Orsola-Malpighi, I-40138 Bologna, Italy; (M.L.P.); (L.B.); (F.M.); (A.S.S.); (P.C.); (F.R.)
- Department of Medical and Surgical Sciences, Alma Mater University of Bologna, I-40138 Bologna, Italy
| | - Francesca Marchignoli
- IRCCS-Azienda Ospedaliera di Bologna Sant’Orsola-Malpighi, I-40138 Bologna, Italy; (M.L.P.); (L.B.); (F.M.); (A.S.S.); (P.C.); (F.R.)
| | - Anna Simona Sasdelli
- IRCCS-Azienda Ospedaliera di Bologna Sant’Orsola-Malpighi, I-40138 Bologna, Italy; (M.L.P.); (L.B.); (F.M.); (A.S.S.); (P.C.); (F.R.)
| | - Paolo Caraceni
- IRCCS-Azienda Ospedaliera di Bologna Sant’Orsola-Malpighi, I-40138 Bologna, Italy; (M.L.P.); (L.B.); (F.M.); (A.S.S.); (P.C.); (F.R.)
- Department of Medical and Surgical Sciences, Alma Mater University of Bologna, I-40138 Bologna, Italy
| | - Giulio Marchesini
- Department of Medical and Surgical Sciences, Alma Mater University of Bologna, I-40138 Bologna, Italy
- Correspondence: ; Tel.: +39-051-2144889
| | - Federico Ravaioli
- IRCCS-Azienda Ospedaliera di Bologna Sant’Orsola-Malpighi, I-40138 Bologna, Italy; (M.L.P.); (L.B.); (F.M.); (A.S.S.); (P.C.); (F.R.)
- Department of Medical and Surgical Sciences, Alma Mater University of Bologna, I-40138 Bologna, Italy
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14
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Extension of Healthy Life Span of Dialysis Patients in the Era of a 100-Year Life. Nutrients 2021; 13:nu13082693. [PMID: 34444853 PMCID: PMC8400994 DOI: 10.3390/nu13082693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 07/30/2021] [Indexed: 12/11/2022] Open
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