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Biruete A, Leal-Escobar G, Espinosa-Cuevas Á, Mojica L, Kistler BM. Dieta de la Milpa: A Culturally-Concordant Plant-Based Dietary Pattern for Hispanic/Latine People with Chronic Kidney Disease. Nutrients 2024; 16:574. [PMID: 38474703 DOI: 10.3390/nu16050574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/16/2024] [Accepted: 02/18/2024] [Indexed: 03/14/2024] Open
Abstract
Chronic kidney disease (CKD) disproportionately affects minorities in the United States, including the Hispanic/Latine population, and is a public health concern in Latin American countries. An emphasis on healthy dietary patterns, including the Mediterranean and the Dietary Approaches to Stop Hypertension (DASH) diets, has been suggested as they are associated with a lower incidence of CKD, slower CKD progression, and lower mortality in kidney failure. However, their applicability may be limited in people from Latin America. The Dieta de la Milpa (Diet of the Cornfield) was recently described as the dietary pattern of choice for people from Mesoamerica (Central Mexico and Central America). This dietary pattern highlights the intake of four plant-based staple foods from this geographical region, corn/maize, common beans, pumpkins/squashes, and chilies, complemented with seasonal and local intake of plant-based foods and a lower intake of animal-based foods, collectively classified into ten food groups. Limited preclinical and clinical studies suggest several health benefits, including cardiometabolic health, but there is currently no data concerning CKD. In this narrative review, we describe and highlight the potential benefits of the Dieta de la Milpa in CKD, including acid-base balance, protein source, potassium and phosphorus management, impact on the gut microbiota, inflammation, and cultural appropriateness. Despite these potential benefits, this dietary pattern has not been tested in people with CKD. Therefore, we suggest key research questions targeting measurement of adherence, feasibility, and effectiveness of the Dieta de la Milpa in people with CKD.
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Affiliation(s)
- Annabel Biruete
- Department of Nutrition Science, Purdue University, West Lafayette, IN 47907, USA
- Division of Nephrology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Gabriela Leal-Escobar
- Departamento de Nefrología, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico
| | - Ángeles Espinosa-Cuevas
- Departamento de Nefrología y Metabolismo Mineral, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
| | - Luis Mojica
- Tecnología Alimentaria, Centro de Investigación y Asistencia en Tecnología y Diseño del Estado de Jalisco (CIATEJ), Zapopan 45019, Mexico
| | - Brandon M Kistler
- Department of Nutrition Science, Purdue University, West Lafayette, IN 47907, USA
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López-Cisneros S, Ramos-Acevedo S, Reyes-Ramírez LM, Rodríguez-Gómez L, Serralde-Zúñiga AE, González-Ortiz A, Espinosa-Cuevas Á. Does intradialytic oral nutrition impact hemodialysis patients' quality of Life, appetite, and safety? A pilot study of a crossover clinical trial. NUTR HOSP 2024. [PMID: 38450518 DOI: 10.20960/nh.04703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024] Open
Abstract
INTRODUCTION due to the catabolic characteristics of hemodialysis (HD), patients should consume foods or supplements during this treatment to meet their energy requirements and maintain a neutral nitrogen balance; however, there are some outcomes in which the effect of intradialytic oral nutrition (ION) is scarcely known. OBJECTIVES this study aims to evaluate the effect of two types of ION (liquid and solid) on QoL, appetite, and safety in HD patients. METHODS a pilot randomized, crossover clinical trial was performed in 18 patients on chronic HD. One group received ION for 18 HD sessions, after the crossover continued for 18 more sessions in the control group, and vice versa. We recorded QoL, appetite, systolic blood pressure (SBP), and intradialytic hypotension (IH) events. RESULTS clinical improvement was observed for most QoL components. Regardless of the consistency of supplementation, SBP increased to 4.10 mmHg. Both study groups reported a "very good-to-good" appetite. CONCLUSION favorable clinical changes were observed in QoL scores during the study. Five of six IH events were reported for patients in the ION group, and SBP increased within the safe range (≤ 10 mmHg); appetite remained stable in both groups. Therefore, we concluded that this strategy, regardless of implementation consistency, is safe to be used in stable patients.
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Affiliation(s)
| | - Samuel Ramos-Acevedo
- Nephrology and Mineral Metabolism Department. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
| | | | - Luis Rodríguez-Gómez
- Nephrology and Mineral Metabolism Department. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
| | - Aurora E Serralde-Zúñiga
- Clinical Nephrology Department. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
| | | | - Ángeles Espinosa-Cuevas
- Nephrology and Mineral Metabolism Department. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
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López-Cisneros S, Ramos-Acevedo S, González-Ortiz A, González-Garay AG, Serralde-Zúñiga AE, Espinosa-Cuevas Á. Is intradialytic oral nutritional supplementation safe and effective on clinical outcomes? A systematic review with conventional meta-analysis and network meta-analysis. Clin Nutr ESPEN 2023; 58:301-310. [PMID: 38057020 DOI: 10.1016/j.clnesp.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 09/13/2023] [Accepted: 10/09/2023] [Indexed: 12/08/2023]
Abstract
AIM determine the effect of intradialytic oral nutrition (ION) on clinical and safety outcomes. DESIGN Systematic Review with conventional Meta-analysis, and a Network Meta-analysis (NMA) as sensitivity analysis. We searched on MEDLINE, LILACS, CENTRAL, and EMBASE in June 2020, and the last update was until August 2022. We selected observational and randomized controlled trials with ION for at least four weeks. Primary outcomes were all-cause mortality and quality of life (QoL); adverse events, physical performance, and appetite were secondary outcomes. RESULTS Seven clinical trials and three observational studies were selected. Even when we did not obtain significant differences in physical performance and gastrointestinal symptoms, we identified a clinical improvement in the QoL's physical role, bodily pain, and physical performance domains. After pooling the data on mortality, a protection rate trend was observed in the ION group without statistical significance. The home-prepared ION was the best nutritional supplementation when assessing the appetite outcome through NMA. CONCLUSIONS ION seems to have a protective trend in mortality risk; the current evidence is insufficient to establish a relationship with adverse events or other clinical outcomes. The lack of homogeneity in the trials makes it difficult to generalize these results. PROSPERO REGISTRATION CRD42020186311.
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Affiliation(s)
- Sonia López-Cisneros
- Multidisciplinary Unit Care for Older Person, Instituto Nacional de Geriatría. Av. Contreras 428 Col. San Jerónimo Lídice 10200, Mexico City, Mexico
| | - Samuel Ramos-Acevedo
- Nephrology and Mineral Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Sección XVI Tlalpan, CP 14000, Mexico City, Mexico
| | - Ailema González-Ortiz
- Translational Research Center, Instituto Nacional de Pediatría, Insurgentes Sur 3700C, Insurgentes Cuicuilco, Coyoacán, CP 04530 Mexico City, Mexico
| | - Alejandro G González-Garay
- Methodology Research Unit, Instituto Nacional de Pediatría, Insurgentes Sur 3700C, Insurgentes Cuicuilco, Coyoacán, CP 04530 Mexico City, Mexico
| | - Aurora E Serralde-Zúñiga
- Clinical Nutrition, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Sección XVI Tlalpan, CP 14000, Mexico City, Mexico
| | - Ángeles Espinosa-Cuevas
- Nephrology and Mineral Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Sección XVI Tlalpan, CP 14000, Mexico City, Mexico; Health Care Department. Universidad Autónoma Metropolitana. Calz. Del Hueso 1100, Coapa Villa Quietud, Alcaldía Coyoacán CP 04960, Mexico City, Mexico.
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González-Ortiz A, Ramos-Acevedo S, Santiago-Ayala V, Gaytan G, Valencia-Flores M, Correa-Rotter R, Carrero JJ, Xu H, Espinosa-Cuevas Á. Sleep Quality After Intradialytic Oral Nutrition: A New Benefit of This Anabolic Strategy? A Pilot Study. Front Nutr 2022; 9:882367. [PMID: 35938133 PMCID: PMC9355791 DOI: 10.3389/fnut.2022.882367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundSince disturbances of appetite and sleep are closely related and both affect metabolic disorders, it would be expected that a renal specific oral nutritional supplement (RS-ONS) that covers the energy the patient does not consume on the HD day, could contribute to improve the nutritional status and body composition, as well as sleep quality. There is still scarce information related to this topic.AimTo evaluate the effect of the use of intra-dialytic RS-ONS vs. RS-ONS at home on sleep quality, nutritional status, and body composition in patients on HD.MethodsAdult patients < 65 years, with ≥3 months on HD were invited to participate in an open randomized pilot study (ISRCTN 33897). Patients were randomized to a dialysis-specific high-protein supplement provided during the HD session (Intradialytic oral nutrition [ION]) or at home (control), during non-HD days (thrice weekly, for both) 12 weeks. The primary outcome was sleep quality defined by the Pittsburgh Sleep Quality Index (PSQI) score. Nutritional assessment included Malnutrition Inflammation Score (MIS), bioelectrical impedance analysis, anthropometry, 3-day food records, and routine blood chemistries.ResultsA total of 23 patients completed the study. Age was median 35 (range 24–48 years), 42% were women. At baseline, the PSQI score was median 4 (range 2–7), and MIS showed a median of 6 (range 5–8); there were no baseline differences between groups. After intervention, both groups improved their MIS scores and similarly when we analyzed the whole cohort (pre- vs. post-intervention P < 0.01). Patients in the ION group improved the overall PSQI score to median 3 (2–5), and assessment of sleep duration and sleep disturbances (pre- vs. post-intervention P < 0.05), with a trend toward an effect difference compared to patients consuming the supplement at home (P for treatment-effect across arms 0.07 for PSQI score and 0.05 for sleep latency).ConclusionOral supplementation improved nutritional status in the whole cohort, but only ION improved the PSQI score. More studies are needed to explore the nutritional strategies that influence the relationship between sleep and nutritional status in HD patients.
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Affiliation(s)
| | - Samuel Ramos-Acevedo
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Victoria Santiago-Ayala
- Neurology Department, Sleep Disorders Clinic, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- School of Psychology, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Gabriela Gaytan
- Neurology Department, Sleep Disorders Clinic, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Matilde Valencia-Flores
- Neurology Department, Sleep Disorders Clinic, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- School of Psychology, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Ricardo Correa-Rotter
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Juan Jesus Carrero
- Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Hong Xu
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Ángeles Espinosa-Cuevas
- Translational Research Center, Instituto Nacional de Pediatría, Mexico City, Mexico
- Health Care Department, Universidad Autónoma Metropolitana-Xochimilco, Mexico City, Mexico
- *Correspondence: Ángeles Espinosa-Cuevas
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Ramos-Acevedo S, Rodríguez-Gómez L, López-Cisneros S, González-Ortiz A, Espinosa-Cuevas Á. Nutritional Status and Other Clinical Variables Are Associated to the Resting Energy Expenditure in Patients With Chronic Kidney Disease: A Validity Study. Front Nutr 2022; 9:881719. [PMID: 35662942 PMCID: PMC9161672 DOI: 10.3389/fnut.2022.881719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/13/2022] [Indexed: 11/30/2022] Open
Abstract
Background Estimating energy requirements (ER) is crucial for nutritional attention to chronic kidney disease (CKD) patients. Current guidelines recommend measuring ER with indirect calorimetry (IC) when possible. Due to clinical settings, the use of simple formulas is preferred. Few studies have modeled equations for estimating ER for CKD. Nevertheless, variables of interest such as nutritional status and strength have not been explored in these models. This study aimed to develop and validate a model for estimating REE in patients with CKD stages 3–5, who were not receiving renal replacement therapy (RTT), using clinical variables and comparing it with indirect calorimetry as the gold standard. Methods In this study 80 patients with CKD participated. Indirect calorimetry (IC) was performed in all patients. The calorimeter analyzed metabolic measurements every minute for 15 min after autocalibration with barometric pressure, temperature, and humidity. Bioelectrical Impedance Analysis (BIA) was performed. Fat-free mass (FFM) was registered among other bioelectrical components. Handgrip strength (HGS) was evaluated and an average of 3 repetitions was recorded. Nutritional status was assessed with the subjective global assessment (SGA). Patients categorized as B or C were then considered as having malnutrition. Results We analyzed 71 patients and 3 models were generated. Model 1a included FFM; Model 2a included weight; Model 3c included handgrip strength (HGS). All other variables were stepwise, computer-selected with a p < 0.01 significance level; Malnutrition was consistently associated with ER among other clinical variables in all models (p < 0.05). The model that included BIA-FFM had R2adjusted = 0.46, while the model that included weight (Kg) had an adjusted R2adjusted = 0.44. The models had moderate concordance, LC = 0.60–0.65 with the gold standard, whereas other energy expenditure estimation equations had LC = 0.36 and 0.55 with indirect calorimetry. Using these previously validated equations as a reference, our models had concordance values ranging from 0.66 to 0.80 with them. Conclusion Models incorporating nutritional status and other clinical variables such as weight, FFM, comorbidities, gender, and age have a moderate agreement with REE. The agreement between our models and others previously validated for the CKD patient is good; however, the agreement between the latter and IC measurements is moderate. The KDOQI lowest recommendation (25 Kcals/kg body weight) considering the 22% difference with respect to the IC for total energy expenditure rather than for REE.
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Affiliation(s)
- Samuel Ramos-Acevedo
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Programa de Maestría y Doctorado en Ciencias Médicas y Odontológicas y de la Salud, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Luis Rodríguez-Gómez
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Sonia López-Cisneros
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Ángeles Espinosa-Cuevas
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Department of Health Care, Universidad Autónoma Metropolitana, Mexico City, Mexico
- *Correspondence: Ángeles Espinosa-Cuevas,
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González-Ortiz A, Xu H, Ramos-Acevedo S, Avesani CM, Lindholm B, Correa-Rotter R, Espinosa-Cuevas Á, Carrero JJ. Nutritional status, hyperkalaemia and attainment of energy/protein intake targets in haemodialysis patients following plant-based diets: a longitudinal cohort study. Nephrol Dial Transplant 2021; 36:681-688. [PMID: 33020805 PMCID: PMC8008364 DOI: 10.1093/ndt/gfaa194] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/24/2020] [Indexed: 02/06/2023] Open
Abstract
Background Patients undergoing haemodialysis (HD) are often discouraged from eating fruits and vegetables because of fears of hyperkalaemia and undernutrition, yet evidence to support these claims is scarce. We here explore the association between adherence to a healthy plant-based diet with serum potassium, surrogates of nutritional status and attainment of energy/protein intake targets in HD patients. Methods We performed an observational single-centre study of stable patients undergoing HD with repeated dietary assessment every 3 months. Patients were provided with personalized nutritional counselling according to current guidelines. The diet was evaluated by 3-day food records and characterized by a healthy plant-based diet score (HPDS), which scores positively the intake of plant foods and negatively animal foods and sugar. The malnutrition inflammation score (MIS) and serum potassium were also assessed at each visit. We used mixed-effects models to evaluate the association of the HPDS with markers of nutritional status, serum potassium levels and attainment of energy/protein intake targets. Results After applying inclusion and exclusion criteria, a total of 150 patients contributing to 470 trimestral observations were included. Their mean age was 42 years [standard deviation (SD) 18] and 59% were women. In multivariable models, a higher HPDS was not associated with serum potassium levels or odds of hyperkalaemia {potassium >5.5 mEq/L; odds ratio [OR] 1.00 [95% confidence interval (CI) 0.94–1.07] per HPDS unit higher}. Patients with a higher HPDS did not differ in terms of energy intake [OR for consuming <30 kcal/kg day 1.05 (95% CI 0.97–1.13)] but were at risk of low protein intake [OR for consuming <1.1 g of protein/kg/day 1.11 (95% CI 1.04–1.19)]. A higher HPDS was associated with a lower MIS, indicating better nutritional status. Conclusions In patients undergoing HD, adherence to a healthy plant-based diet was not associated with serum potassium, hyperkalaemia or differences in energy intake. Although these patients were less likely to reach daily protein intake targets, they appeared to associate with better nutritional status over time.
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Affiliation(s)
- Ailema González-Ortiz
- Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Hong Xu
- Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden
| | - Samuel Ramos-Acevedo
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Carla M Avesani
- Department of Clinical Science, Intervention and Technology, Division of Renal Medicine and Baxter Novum, Karolinska Institutet, Stockholm, Sweden
| | - Bengt Lindholm
- Department of Clinical Science, Intervention and Technology, Division of Renal Medicine and Baxter Novum, Karolinska Institutet, Stockholm, Sweden
| | - Ricardo Correa-Rotter
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Ángeles Espinosa-Cuevas
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Juan Jesús Carrero
- Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Ramos-Acevedo S, González-Ortiz A, Serralde-Zúñiga AE, Colín-Ramírez E, Miranda-Alatriste P, López-Cisneros S, Rodríguez-González N, Correa-Rotter R, Atilano-Carsi X, Espinosa-Cuevas Á. Frequency of Intradialytic Hypotension Events Do Not Increase with Oral Nutritional Supplementation during Hemodialysis Treatment: A Randomized Controlled Trial. J Ren Nutr 2021; 31:669-678. [PMID: 33648870 DOI: 10.1053/j.jrn.2020.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/22/2020] [Accepted: 10/21/2020] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE This study aimed to compare the effect of the use of a renal-specific oral nutritional supplement (RS-ONS) during hemodialysis sessions and the use of RS-ONS at home on the incidence of intradialytic hypotension. METHODS A single-center, 12-week, open-label, randomized controlled clinical trial was conducted. The intervention was a RN-ONS divided into two portions: 100 and 137 mL. The first portion was given after 1 hour of hemodialysis (HD) treatment, while the second portion was given 45 minutes before the end of HD. The research staff registered the baseline and final nutritional parameters and systolic arterial pressure (SAP) from the screen of the HD device during 36 HD sessions. Hypotension symptoms were also recorded every hour during each HD session. The nutritional and functional status was also assessed. RESULTS We registered a total of 16 hypotensive events during 1082 HD sessions: 9 were in patients supplemented at home (551 HD sessions) and 7 occurred in patients supplemented during HD P = .668. Incidence of intradialytic hypotension (IH) during 1082 HD sessions was 1.4%. The total malnutrition inflammation score (MIS) decreased in both groups (P < .01), and the percentage of cachexia improved in the supplemented-during-HD group (P < .05). CONCLUSIONS In this randomized controlled trial, intradialytic hypotension events did not increase with the RS-ONS during HD treatment. This strategy appears to be a safe anabolic nutritional strategy for the prevention of PEW, selecting stable patients and administering a fractioned volume of the supplement after the first hour of HD treatment. More studies with larger samples size are required to confirm these findings.
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Affiliation(s)
- Samuel Ramos-Acevedo
- Nephrology and Mineral Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City
| | - Ailema González-Ortiz
- Nephrology and Mineral Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City
| | - Aurora E Serralde-Zúñiga
- Clinical Nutrition Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City
| | - Eloisa Colín-Ramírez
- Research Associate, Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Paola Miranda-Alatriste
- Nephrology and Mineral Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City
| | - Sonia López-Cisneros
- Nephrology and Mineral Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City
| | - Norberto Rodríguez-González
- Nephrology and Mineral Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City
| | - Ricardo Correa-Rotter
- Nephrology and Mineral Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City
| | - Ximena Atilano-Carsi
- Nephrology and Mineral Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City
| | - Ángeles Espinosa-Cuevas
- Nephrology and Mineral Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City.
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Gómez-Sámano MÁ, Vargas-Abonce VP, Martínez-Sánchez FD, Palacios-Báez L, Vera-Zertuche JM, Navarro-Flores MF, Morales-García MG, Fonseca-Correa JI, Zuarth-Vázquez JM, Vega-Vega O, Correa-Rotter R, Rincón-Pedrero R, Morales-Buenrostro LE, Alberú-Gómez J, Ramírez-González JB, Pacheco-Domínguez RL, López-Cervantes M, Mendoza-de-la-Garza MDLÁ, Baeza-Arias YV, Espinosa-Cuevas Á, López-Carrasco G, López-Estrada A, Guillén-Pineda LE, Gómez-Pérez FJ, Cuevas-Ramos D. Fibroblast growth factor 21 is associated with increased serum total antioxidant capacity and oxidized lipoproteins in humans with different stages of chronic kidney disease. Ther Adv Endocrinol Metab 2021; 12:20420188211001160. [PMID: 33854753 PMCID: PMC8010821 DOI: 10.1177/20420188211001160] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 02/12/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND AIMS Oxidative stress (OS) induces the production of fibroblast growth factor 21 (FGF21). Previous data have revealed that FGF21 protects cells from OS injury and death, making it a potential therapeutic option for many diseases with increased OS. However, the association of this growth factor with OS markers in humans with chronic kidney disease (CKD) remains unknown. This study aims to evaluate the association of serum FGF21 with serum total antioxidant capacity (TAC) and oxidized low-density lipoproteins (OxLDL) in subjects in different stages of kidney disease. METHODS This is a cross-sectional study that included 382 subjects with different stages of CKD, irrespective of type 2 diabetes (T2D) diagnosis. Associations of serum FGF21 with OxLDL, TAC, sex, age, body mass index (BMI), fasting plasma glucose, estimated glomerular filtration rate (eGFR), T2D, and smoking, were evaluated through bivariate and partial correlation analyses. Independent associations of these variables with serum FGF21 were evaluated using multiple linear regression analysis. RESULTS Serum FGF21 was significantly and positively correlated with age (r = 0.236), TAC (lnTAC) (r = 0.217), and negatively correlated with eGFR (r = -0.429) and male sex (r = -0.102). After controlling by age, sex, BMI, T2D, smoking, and eGFR; both TAC and OxLDL were positively correlated with FGF21 (r = 0.117 and 0.158 respectively, p < 0.05). Using multiple linear regression analysis, eGFR, male sex, T2D, OxLDL, and TAC were independently associated with serum FGF21 (STDβ = -0.475, 0.162, -0.153, 0.142 and 0.136 respectively; p < 0.05 for all) adjusted for age, BMI, smoking, and fasting plasma glucose. CONCLUSION A positive association between serum FGF21 and OS has been found independently of renal function in humans. Results from the present study provide novel information for deeper understanding of the role of FGF21 in OS in humans with CKD and T2D; mechanistic studies to explain the association of serum FGF21 with oxidative stress in CKD are needed.
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Affiliation(s)
| | | | | | - Lucía Palacios-Báez
- Instituto Nacional de Ciencias Medicas y
Nutricion Salvador Zubiran, Mexico City, Mexico
| | | | | | | | | | | | - Olynka Vega-Vega
- Instituto Nacional de Ciencias Medicas y
Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Ricardo Correa-Rotter
- Instituto Nacional de Ciencias Medicas y
Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Rodolfo Rincón-Pedrero
- Instituto Nacional de Ciencias Medicas y
Nutricion Salvador Zubiran, Mexico City, Mexico
| | | | - Josefina Alberú-Gómez
- Instituto Nacional de Ciencias Medicas y
Nutricion Salvador Zubiran, Mexico City, Mexico
| | | | | | - Malaquías López-Cervantes
- Department of Preventive Medicine and Public
Health, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | | | | | | | | | - Angelina López-Estrada
- Instituto Nacional de Ciencias Medicas y
Nutricion Salvador Zubiran, Mexico City, Mexico
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9
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Ramirez-Sandoval JC, Atilano-Carsi X, Sánchez-Silva J, Arce-Santander C, Cruz C, Basulto-Sosa P, Tamez-Pedroza L, García de León M, Espinosa-Cuevas Á, Correa-Rotter R. P1396EFFECT OF MIXED VERSUS ANIMAL-BASED LOW PHOSPHORUS DIETS IN DIALYSIS PATIENTS ON INTACT FGF23 LEVELS: A RANDOMIZED CLINICAL TRIAL. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p1396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and Aims
The FGF23-lowering effect of different phosphate-sources (vegetable versus animal) in low-phosphorus diets are scarcely known. In this trial, we assess the effect on intact FGF23 (iFGF23) of two low-phosphorus diets, animal versus mixed (vegetable + animal), in dialysis patients.
Method
A randomized, two-center, open-label, clinical trial was performed. Subjects on stable dialysis for >6 months with P>4.5 mg/dL were randomized into a mixed-based (3 ounces equivalent of animal protein + 3 ounces equivalent of legumes) vs. animal-based (6 ounce equivalent of animal protein) low phosphorus diet with equivalent nutrients (phosphorus <1000 mg/day; protein=1.3 g/kg/day). The primary outcome was the difference in serum iFGF23 change (ELISA) after 12 wks. We excluded patients who modified their dialysis dose, phosphate binder, or vitamin D prescription during trial.
Results
556 subjects were screened, only 57 subjects (37 hemodialysis[HD] and 18 peritoneal dialysis[PD]) were randomized. Age, sex, phosphate-binders use, and other baseline characteristics were similar between groups. Baseline iFGF23 levels were 7394 (IQR 2379-16629) and 6859 (1543-17521) ng/mL in mixed-based and animal-based groups respectively (p=0.62). Both groups had a significant decrease in iFGF23 after 12 weeks of intervention (iFGF23 change: -285 [IQR -3002 to 227] ng/mL, p<0.001, and -182 [IQR -9323 to 228] ng/mL, p<0.001); there were not significant differences in iFGF23-decrease between both diets (Figure, p:0.78). Serum phosphorus in the mixed-based and the animal-based declined by -0.66 (95% confidence interval [95% IC], -1.39 to -0.04] mg/dL and -0.21 (95% IC -0.81 to 0.38) respectively (p=0.14). There was a trend between the decrease in observed phosphorus and iFGF23 (rho = 0.265, p=0.058). There were no differences between groups in the change of serum Ca, albumin, PTH, and other biochemical parameters.
Conclusion
Dietary phosphorus restriction for 12 weeks with animal-based or mixed-based phosphorus sources similarly decreases iFGF23 concentration in HD or PD patients.
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Affiliation(s)
- Juan C Ramirez-Sandoval
- Salvador Zubirán National Institute of Health Sciences and Nutrition, Nephrology and Mineral Metabolism, Ciudad de México, Mexico
| | - Ximena Atilano-Carsi
- Salvador Zubirán National Institute of Health Sciences and Nutrition, Nephrology and Mineral Metabolism, Ciudad de México, Mexico
| | - Jorge Sánchez-Silva
- Salvador Zubirán National Institute of Health Sciences and Nutrition, Nephrology and Mineral Metabolism, Ciudad de México, Mexico
| | - Celene Arce-Santander
- Salvador Zubirán National Institute of Health Sciences and Nutrition, Nephrology and Mineral Metabolism, Ciudad de México, Mexico
| | - Cristino Cruz
- Salvador Zubirán National Institute of Health Sciences and Nutrition, Nephrology and Mineral Metabolism, Ciudad de México, Mexico
| | - Pamela Basulto-Sosa
- Salvador Zubirán National Institute of Health Sciences and Nutrition, Nephrology and Mineral Metabolism, Ciudad de México, Mexico
| | - Luis Tamez-Pedroza
- Salvador Zubirán National Institute of Health Sciences and Nutrition, Nephrology and Mineral Metabolism, Ciudad de México, Mexico
| | - Miguel García de León
- Salvador Zubirán National Institute of Health Sciences and Nutrition, Nephrology and Mineral Metabolism, Ciudad de México, Mexico
| | - Ángeles Espinosa-Cuevas
- Salvador Zubirán National Institute of Health Sciences and Nutrition, Nephrology and Mineral Metabolism, Ciudad de México, Mexico
| | - Ricardo Correa-Rotter
- Salvador Zubirán National Institute of Health Sciences and Nutrition, Nephrology and Mineral Metabolism, Ciudad de México, Mexico
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10
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Ramos-Acevedo S, González-Ortiz AJ, Correa-Rotter R, Serralde-Zuñiga AE, Miranda-Alatriste P, Atilano-Carsi X, Dominguez-Zambrano E, Espinosa-Cuevas Á. SURVEY ON THE PERCEPTION OF HEALTH PROFESSIONALS ON THE USE OF INTRADIALYTIC ORAL NUTRITION IN PATIENTS UNDER HEMODIALYSIS. Rev Invest Clin 2019; 71:255-264. [PMID: 31448783 DOI: 10.24875/ric.19002947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Intradialytic oral nutrition (ION) has been shown to improve many clinical outcomes, including lowering mortality, in hemodialysis (HD) patients. Despite the benefits, ION is underused in many countries. Objective The objective of our study was to determine the perception of health-care professionals (HCP) in our environment of the use of ION in patients undergoing HD. Methods Survey applied to HCP in Mexico who worked or had worked in an HD unit in their locality. Results From 272 HCP who answered the survey, 74.3% believed that the use of ION has at least one beneficial effect; of these, the most frequently mentioned were an improvement in quality of life (QoL) (54.7%) followed by an improvement in serum albumin (37.9%) and muscle anabolism (31.6%). However, 49% consider that its use involves some risks. Of the respondents, 22% reported that their HD units allowed patients to consume food or supplements during HD sessions; the main reason given to forbid the introduction of food or supplements was the clinic's policy (41%). Conclusions The personnel surveyed heterogeneous opinions regarding ION, but most believe that it may improve the QoL or the nutritional status of the patients. Nevertheless, the use of ION is uncommon in our country as it is against the internal regulations of most HD units.
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Affiliation(s)
- Samuel Ramos-Acevedo
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Ailema J González-Ortiz
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Ricardo Correa-Rotter
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Aurora E Serralde-Zuñiga
- Clinical Nutrition Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Paola Miranda-Alatriste
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Ximena Atilano-Carsi
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Etna Dominguez-Zambrano
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Ángeles Espinosa-Cuevas
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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11
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González-Ortiz A, Correa-Rotter R, Vázquez-Rangel A, Vega-Vega O, Espinosa-Cuevas Á. Relationship between protein-energy wasting in adults with chronic hemodialysis and the response to treatment with erythropoietin. BMC Nephrol 2019; 20:316. [PMID: 31412807 PMCID: PMC6694582 DOI: 10.1186/s12882-019-1457-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 07/08/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND It is known that one of the leading causes of morbidity in chronic kidney disease (CKD) is the anemic syndrome. Although the pathogenic mechanisms of anemia are multiple, erythropoietin deficiency appears as the dominant factor. Patients in hemodialysis (HD) have a high prevalence of protein energy wasting (PEW) that may explains the poor response to Erythropoietin (EPO). METHODS Retrospective cohort study of patients on HD from January to December 2014. The participants were classified according to a diagnostic of PEW using the "Malnutrition Inflammation Score" (MIS) and bioimpedance analysis (BIA) measurement of body composition at the start of erythropoietin therapy and after 3 months of follow up. We performed descriptive statistics and analyzed the differences between groups with and without PEW considering their responsiveness. In addition, we calculated the relative risk of EPO resistance, considering p value < 0.05 as statistically significant. RESULTS Sixty-one patients ended the follow up. Both groups were similar in basal hemoglobin, hematocrit and other hematopoiesis markers (p = NS). Patients without PEW have a decrease risk for poor response to treatment with EPO (RR = 0.562 [95% CI, 0.329-0.961-]) than those with PEW. Finally, hemoglobin concentrations were evaluated at baseline and every four weeks until week 12, finding a statistically significant improvement only in patients without PEW according MIS (p < 0.05). CONCLUSIONS PEW is an incremental predictor of poor responsiveness to EPO in HD patients, thus, it is important to consider correcting malnutrition or wasting for a favorable response to treatment with EPO.
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Affiliation(s)
- Ailema González-Ortiz
- Nephrology and Mineral Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga No. 15, Col. Belisario Dominguez Sección XVI, Deleg. Tlalpan, 14080 Mexico City, CP Mexico
- School of Medicine, Universidad Nacional Autónoma de México, Ave. Universidad No. 3000, Col. Ciudad Universitaria, Deleg, Coyoacán, 04510 México City, CP Mexico
| | - Ricardo Correa-Rotter
- Nephrology and Mineral Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga No. 15, Col. Belisario Dominguez Sección XVI, Deleg. Tlalpan, 14080 Mexico City, CP Mexico
| | - Armando Vázquez-Rangel
- Nephrology Department, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano No. 1, Colonia Belisario Dominguez Sección XVI, Deleg. Tlalpan, 14080 Mexico City, CP Mexico
| | - Olynka Vega-Vega
- Nephrology and Mineral Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga No. 15, Col. Belisario Dominguez Sección XVI, Deleg. Tlalpan, 14080 Mexico City, CP Mexico
| | - Ángeles Espinosa-Cuevas
- Nephrology and Mineral Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga No. 15, Col. Belisario Dominguez Sección XVI, Deleg. Tlalpan, 14080 Mexico City, CP Mexico
- Health Care Department, Universidad Autónoma Metropolitana-Xochimilco, Calz. Del Hueso No. 1100, Col. Villa Quietud, Deleg. Coyoacán, 04960 Mexico City, CP Mexico
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12
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Carrera-Jiménez D, Miranda-Alatriste P, Atilano-Carsi X, Correa-Rotter R, Espinosa-Cuevas Á. Relationship between Nutritional Status and Gastrointestinal Symptoms in Geriatric Patients with End-Stage Renal Disease on Dialysis. Nutrients 2018; 10:E425. [PMID: 29596313 PMCID: PMC5946210 DOI: 10.3390/nu10040425] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 03/07/2018] [Accepted: 03/15/2018] [Indexed: 12/12/2022] Open
Abstract
Gastrointestinal symptoms (GIS) are common in patients with end-stage renal disease (ESRD) and are associated with nutritional risks resulting from low food intake. Little is known about the relationship between GIS and malnutrition in geriatric patients with ESRD. The main objective of this study was to determine the relationship between nutritional status and severity of GIS in geriatric patients on dialysis therapy. Clinically-stable geriatric patients (older than 60 years old) who were dialysis outpatients were included in this cross-sectional study. The severity of GIS was assessed using the Gastrointestinal Symptoms Questionnaire (GSQ, short version), with patients classified into three groups: mild, moderate, and severe. Nutritional status was evaluated with the Malnutrition Inflammation Score (MIS), anthropometric assessment, biochemical parameters, and bioelectrical impedance. Descriptive statistics were used and differences between groups were analyzed with ANOVA and Kruskal Wallis, with a p < 0.05 considered to indicate significance. Fifty patients completed the study; the median age was 67 years old. Twenty-three patients were on hemodialysis (HD) and 27 were on peritoneal dialysis (PD). No significant differences were found according to dialysis modality, presence of diabetes, or gender. Ninety percent of patients had at least one GIS. Poorer nutritional status (evaluated by MIS) was related to a higher severity of GIS. There were no significant differences with other nutritional parameters. Our study showed a high prevalence of GIS in geriatric patients. There were no differences in observed GIS values that were attributed to dialysis modality, gender, or presence of type 2 diabetes mellitus (DM2). Severe GIS values were associated with poorer nutritional status determined by MIS, however, there was no association with anthropometry, biochemical values, or bioimpedance vector analysis.
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Affiliation(s)
- Dinorah Carrera-Jiménez
- Nephrology and Mineral Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico.
| | - Paola Miranda-Alatriste
- Nephrology and Mineral Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico.
| | - Ximena Atilano-Carsi
- Nephrology and Mineral Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico.
| | - Ricardo Correa-Rotter
- Nephrology and Mineral Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico.
| | - Ángeles Espinosa-Cuevas
- Nephrology and Mineral Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico.
- Health Care Department, Autonomous Metropolitan University, Mexico City 04960, Mexico.
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13
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Colin-Ramirez E, Espinosa-Cuevas Á, Miranda-Alatriste PV, Tovar-Villegas VI, Arcand J, Correa-Rotter R. Food Sources of Sodium Intake in an Adult Mexican Population: A Sub-Analysis of the SALMEX Study. Nutrients 2017; 9:nu9080810. [PMID: 28749449 PMCID: PMC5579604 DOI: 10.3390/nu9080810] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 07/19/2017] [Accepted: 07/25/2017] [Indexed: 11/16/2022] Open
Abstract
Excessive dietary sodium intake increases blood pressure and cardiovascular risk. In Western diets, the majority of dietary sodium comes from packaged and prepared foods (≈75%); however, in Mexico there is no available data on the main food sources of dietary sodium. The main objective of this study was to identify and characterize the major food sources of dietary sodium in a sample of the Mexican Salt and Mexico (SALMEX) cohort. Adult male and female participants of the SALMEX study who provided a complete and valid three-day food record during the baseline visit were included. Overall, 950 participants (mean age 38.6 ± 10.7 years) were analyzed to determine the total sodium contributed by the main food sources of sodium identified. Mean daily sodium intake estimated by three-day food records and 24-h urinary sodium excretion was 2647.2 ± 976.9 mg/day and 3497.2 ± 1393.0, in the overall population, respectively. Processed meat was the main contributor to daily sodium intake, representing 8% of total sodium intake per capita as measured by three-day food records. When savory bread (8%) and sweet bakery goods (8%) were considered together as bread products, these were the major contributor to daily sodium intake, accounting for the 16% of total sodium intake, followed by processed meat (8%), natural cheeses (5%), and tacos (5%). These results highlight the need for public health policies focused on reducing the sodium content of processed food in Mexico.
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Affiliation(s)
- Eloisa Colin-Ramirez
- Sociomedical Research Department, Instituto Nacional de Cardiología 'Ignacio Chávez', Mexico City 14080, Mexico.
- Consejo Nacional de Ciencia y Tecnología (CONACYT), Mexico City 03940, Mexico.
| | - Ángeles Espinosa-Cuevas
- Nephrology and Mineral Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico.
| | - Paola Vanessa Miranda-Alatriste
- Nephrology and Mineral Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico.
| | | | - JoAnne Arcand
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, ON L1H 7K4, Canada.
| | - Ricardo Correa-Rotter
- Nephrology and Mineral Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico.
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14
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Ruiz-Margáin A, Macías-Rodríguez RU, Duarte-Rojo A, Ríos-Torres SL, Espinosa-Cuevas Á, Torre A. Malnutrition assessed through phase angle and its relation to prognosis in patients with compensated liver cirrhosis: a prospective cohort study. Dig Liver Dis 2015; 47:309-14. [PMID: 25618555 DOI: 10.1016/j.dld.2014.12.015] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 12/15/2014] [Accepted: 12/28/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND Malnutrition is a frequent complication of cirrhosis and it has been associated to more severe disease and development of complications. Phase angle is a bedside reliable tool for nutritional assessment based on conductivity properties of body tissues. AIM To evaluate the association between malnutrition assessed through phase angle and mortality in patients with liver cirrhosis. METHODS We performed a prospective cohort study in a tertiary care centre; 249 patients were enrolled with 48 months of follow-up. Clinical, nutritional (malnutrition = phase angle ≤ 4.9°) and biochemical evaluations were performed. Student's t-test and χ(2) method were used as appropriate. Kaplan-Meier curves and multivariate Cox regression were used to evaluate mortality. RESULTS Mean follow-up was 33.5 months. Survival analysis showed higher mortality in the malnourished group compared to the well-nourished group (p = 0.076), Kaplan-Meier curves were further stratified according to compensated and decompensated status showing higher mortality in compensated patients according to Child-Pugh (p = 0.002) and Model for End-Stage Liver Disease score (p = 0.008) when malnutrition was present. Multivariate analysis showed that malnutrition was independently associated with mortality (HR = 2.15, 1.18-3.92). CONCLUSIONS In our cohort, malnutrition was independently associated with mortality. This is the first study showing higher mortality in malnourished compensated cirrhotic patients.
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Affiliation(s)
- Astrid Ruiz-Margáin
- Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", México, D.F., Mexico
| | - Ricardo U Macías-Rodríguez
- Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", México, D.F., Mexico
| | - Andrés Duarte-Rojo
- Division of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Silvia L Ríos-Torres
- Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", México, D.F., Mexico
| | - Ángeles Espinosa-Cuevas
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", México, D.F., Mexico
| | - Aldo Torre
- Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", México, D.F., Mexico.
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