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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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Yee-Moon Wang A, Kistler BM, Lambert K, Sumida K, Moore LW, Kalantar-Zadeh K. Nutrition and Metabolism for Kidney Health and Disease Management: 45 years of Development and Future Directions Under the International Society of Renal Nutrition and Metabolism. J Ren Nutr 2023; 33:S1-S5. [PMID: 37683983 DOI: 10.1053/j.jrn.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 08/28/2023] [Indexed: 09/10/2023] Open
Affiliation(s)
- Angela Yee-Moon Wang
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China.
| | - Brandon M Kistler
- Department of Nutrition Science, Purdue University, West Lafayette, Indiana
| | - Kelly Lambert
- Faculty of Science, Medicine and Health, School of Medicine, Indigenous and Health Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Keiichi Sumida
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Linda W Moore
- Department of Surgery, Houston Methodist Hospital, Houston, Texas
| | - Kamyar Kalantar-Zadeh
- The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California; Nephrology Section, Tibor Rubin Veterans Affairs Medical Center, Long Beach, California
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Sumida K, Biruete A, Kistler BM, Khor BH, Ebrahim Z, Giannini R, Sussman-Dabach EJ, Avesani CM, Chan M, Lambert K, Yee-Moon Wang A, Clegg DJ, Burrowes JD, Palmer BF, Carrero JJ, Kovesdy CP. New Insights Into Dietary Approaches to Potassium Management in Chronic Kidney Disease. J Ren Nutr 2023; 33:S6-S12. [PMID: 37610407 PMCID: PMC10872890 DOI: 10.1053/j.jrn.2022.12.003] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 10/07/2022] [Accepted: 12/13/2022] [Indexed: 08/24/2023] Open
Abstract
Potassium disorders are one of the most common electrolyte abnormalities in patients with chronic kidney disease (CKD), contributing to poor clinical outcomes. Maintaining serum potassium levels within the physiologically normal range is critically important in these patients. Dietary potassium restriction has long been considered a core strategy for the management of chronic hyperkalemia in patients with CKD. However, this has been challenged by recent evidence suggesting a paradigm shift toward fostering more liberalized, plant-based dietary patterns. The advent of novel potassium binders and an improved understanding of gastrointestinal processes involved in potassium homeostasis (e.g., gastrointestinal potassium wasting) may facilitate a paradigm shift and incorporation of heart-healthy potassium-enriched food sources. Nevertheless, uncertainty regarding the risk-benefit of plant-based diets in the context of potassium management in CKD remains, requiring well-designed clinical trials to determine the efficacy of dietary potassium manipulation toward improvement of clinical outcomes in patients with CKD.
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Affiliation(s)
- Keiichi Sumida
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee.
| | - Annabel Biruete
- Department of Nutrition and Dietetics, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana; Division of Nephrology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana; Department of Nutrition Science, Purdue University, West Lafayette, Indiana
| | - Brandon M Kistler
- Department of Nutrition Science, Purdue University, West Lafayette, Indiana; Department of Nutrition and Health Science, Ball State University, Muncie, Indiana
| | - Ban-Hock Khor
- Faculty of Food Science and Nutrition, University Malaysia Sabah, Kota Kinabalu, Malaysia
| | - Zarina Ebrahim
- Division of Human Nutrition, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - Rossella Giannini
- Division of Metabolic Diseases and Clinical Nutrition, University Hospital of Modena, Modena, Italy
| | - Elizabeth J Sussman-Dabach
- Department of Family and Consumer Sciences, California State University, Northridge, Northridge, California
| | - Carla Maria Avesani
- Division of Renal Medicine, Baxter Novum. Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Maria Chan
- Departments of Nutrition and Dietetics and Renal Medicine, The St. George Hospital, Kogarah, New South Wales, Australia
| | - Kelly Lambert
- Faculty of Science, Medicine and Health, School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Angela Yee-Moon Wang
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Deborah J Clegg
- Department of Internal Medicine, Paul Foster School of Medicine, Texas Tech Medical Center, El Paso, Texas
| | - Jerrilynn D Burrowes
- Department of Health Sciences and Administration, Program in Nutrition and Dietetics, Long Island University-Post, Greenvale, New York
| | - Biff F Palmer
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Juan-Jesus Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Csaba P Kovesdy
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
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Biruete A, Hill Gallant KM, Lloyd L, Meade A, Moe SM, St-Jules DE, Kistler BM. 'Phos'tering a Clear Message: The Evolution of Dietary Phosphorus Management in Chronic Kidney Disease. J Ren Nutr 2023; 33:S13-S20. [PMID: 37343779 PMCID: PMC10728341 DOI: 10.1053/j.jrn.2023.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 04/21/2023] [Accepted: 05/04/2023] [Indexed: 06/23/2023] Open
Abstract
Phosphorus is a vital nutrient, but disturbances in phosphorus homeostasis are central to chronic kidney disease-mineral and bone disorder. To minimize disturbances, traditional dietary guidance focused on a numerical phosphorus target leading to the exclusion of many healthy foods and implementation challenges. Contemporary phosphorus guidance focuses on dietary source, avoiding additives, and emphasizing low-phosphorus bioaccessibility foods, leading to a more liberal approach. Additional work is needed to demonstrate the efficacy of these contemporary approaches and understand the influence of specific foods, processing, and cooking methods. Unfortunately, patient education using traditional and contemporary strategies may give mixed messages, particularly related to plant-based foods. Thus, greater clarity on the effects of specific foods and dietary patterns may improve phosphorus education. This review aims to discuss the evolution of dietary phosphorus management while highlighting areas for future research that can help move the field toward stronger evidence-based guidance to prevent and treat hyperphosphatemia.
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Affiliation(s)
- Annabel Biruete
- Department of Nutrition and Dietetics, Indiana University-Purdue University Indianapolis, Indianapolis; Department of Medicine, Division of Nephrology, Indiana University School of Medicine, Indianapolis; Department of Nutrition Science, Purdue University, West Lafayette, Indiana
| | - Kathleen M Hill Gallant
- Department of Medicine, Division of Nephrology, Indiana University School of Medicine, Indianapolis; Department of Food Science and Nutrition, University of Minnesota, St. Paul
| | - Lyn Lloyd
- Nutrition and Dietetics, Auckland City Hospital, Auckland, New Zealand
| | - Anthony Meade
- Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, Australia
| | - Sharon M Moe
- Department of Medicine, Division of Nephrology, Indiana University School of Medicine, Indianapolis
| | | | - Brandon M Kistler
- Department of Nutrition Science, Purdue University, West Lafayette, Indiana; Department of Nutrition and Health Science, Ball State University, Muncie.
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Carlini NA, Romanowski S, Rabalais EN, Kistler BM, Campbell MS, Krishnakumar IM, Harber MP, Fleenor BS. Coconut sugar derived from coconut inflorescence sap lowers systolic blood pressure and arterial stiffness in middle-aged and older adults: a pilot study. J Appl Physiol (1985) 2023; 134:508-514. [PMID: 36656985 DOI: 10.1152/japplphysiol.00394.2022] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Nutraceutical-based interventions hold promise to reduce blood pressure (BP) and arterial stiffness, which are two cardiovascular disease (CVD) risk factors. However, the effects of coconut sap powder (CSP), an Asian sweetener and novel nutraceutical, on BP and arterial stiffness in middle-aged and older adults (MA/O, ≥45 yr) has yet to be established. We hypothesized CSP will decrease BP and arterial stiffness in MA/O adults. In a double-blind, randomized, placebo-controlled study design, 19 (age 55.3 ± 2.1 yr) MA/O adults completed measures of brachial and carotid BP, and arterial stiffness [carotid-femoral pulse wave velocity (cfPWV), common carotid artery (CCA) β-stiffness, compliance, distensibility, and Young's and Peterson's Elastic moduli] before and after 8 wk of CSP (1.5 g/day) or placebo (1.5 g/day). A two-way repeated-measures analysis of variance was used to compare group mean differences. Compared with placebo, CSP lowered brachial systolic BP (SBP) (CSP pre: 117.4 ± 2.9 vs. post: 109.0 ± 2.4 mmHg, P < 0.05), but not carotid SBP (P = 0.12). CSP also lowered Young's (CSP pre: 5,514.4 ± 1,115.4 vs. post: 3,690.6 ± 430.9 kPa) and Peterson's elastic moduli (CSP pre: 22.2 ± 4.4 vs. post: 19.2 ± 4.5 kPa) (P < 0.05, both). A trend for CSP to lower CCA β-stiffness (P = 0.06) and increase CCA compliance (P = 0.07) was also observed. Arterial stiffness assessed by cfPWV did not change (P > 0.05). No inflammatory or antioxidant biomarkers were affected by CSP. In summary, 8 wk of CSP lowers brachial SBP and CCA mechanical stiffness indicating a potential cardioprotective effect in MA/O adults.NEW & NOTEWORTHY Blood pressure (BP) and arterial stiffness are important predictors of cardiovascular health with aging. Nutraceuticals are an easy-to-implement lifestyle strategy demonstrating promise to effectively lower BP and arterial stiffness with aging and ultimately cardiovascular disease risk. We demonstrate that coconut sap powder (CSP), a traditional Asian sweetener, lowers brachial systolic BP and carotid artery mechanical stiffness in middle-aged and older (MA/O) adults. These findings provide initial evidence for the CSP-related cardioprotective effects in MA/O adults.
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Affiliation(s)
- Nicholas A Carlini
- Clinical Exercise Physiology, Human Performance Laboratory, Ball State University, Muncie, Indiana, United States
| | - Spencer Romanowski
- Clinical Exercise Physiology, Human Performance Laboratory, Ball State University, Muncie, Indiana, United States
| | - Emily N Rabalais
- Clinical Exercise Physiology, Human Performance Laboratory, Ball State University, Muncie, Indiana, United States
| | - Brandon M Kistler
- Department of Nutrition and Health Science, Ball State University, Muncie, Indiana, United States
| | - Marilyn S Campbell
- Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, Kentucky, United States
| | | | - Matthew P Harber
- Clinical Exercise Physiology, Human Performance Laboratory, Ball State University, Muncie, Indiana, United States
| | - Bradley S Fleenor
- Clinical Exercise Physiology, Human Performance Laboratory, Ball State University, Muncie, Indiana, United States
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Biruete A, Kistler BM, Kalantar-Zadeh K, Moore LW. Kidney Nutrition in the Era of Social Media: Bridging the Gap of Nutrition Education and Kidney Health Literacy by Leveraging Resources of Social Networking. J Ren Nutr 2022; 32:629-632. [PMID: 36113811 PMCID: PMC10411502 DOI: 10.1053/j.jrn.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 09/09/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Annabel Biruete
- Department of Nutrition Science, Purdue University, West Lafayette, IN; Division of Nephrology, Indiana University School of Medicine, Indianapolis, IN.
| | - Brandon M Kistler
- Department of Nutrition Science, Purdue University, West Lafayette, IN
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, CA
| | - Linda W Moore
- Department of Surgery, Houston Methodist Hospital, Houston, TX
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Kistler BM, Khubchandani J, Bennett P, Wilund KR, Sosnoff J. Depressive Disorders Are Associated With Risk of Falls in People With Chronic Kidney Disease. J Am Psychiatr Nurses Assoc 2022; 28:235-240. [PMID: 33150807 DOI: 10.1177/1078390320970648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES People with chronic kidney disease (CKD) are at increased risk for falls and fall-related injuries. Depressive disorders (DEP) are common in individuals with CKD and may increase the risk of falls and fall-related injuries. However, not much is known about the relationship between DEP and falls in people with CKD. The purpose of this study was to determine the influence of DEP on the relationship between CKD, falls, and fall-related injuries. METHOD Using the Behavioral Risk Factor Surveillance System, we identified 16,574 adults with CKD. Patients with CKD were stratified by history of self-reported DEP (SRDEP), and multivariate logistic regression was conducted to determine the odds for falls and fall-related injuries among those with and without SRDEP. RESULTS In unadjusted regression analysis, falls (OR = 2.40, 95% CI = 2.08-2.76) and fall-related injuries (OR = 2.12, 95% CI = 1.72-2.59) were higher in individuals with CKD and history of SRDEP compared to those with CKD and no history of SRDEP. Adjustment for confounders had little effect on the relationship between a history of SRDEP and either falls (AOR = 1.87, 95% CI = 1.60-2.19) or fall-related injuries (AOR = 1.58, 95% CI = 1.26-1.97). CONCLUSIONS People with CKD and DEP are at increased odds for falls and fall-related injuries even after adjustment for sociodemographic, lifestyle factors, and comorbidities. Prospective studies are warranted to further understand this relationship, but it may be prudent for clinicians, in particular nurses, to consider fall risk when treating DEP in patients with CKD.
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Affiliation(s)
- Brandon M Kistler
- Brandon M. Kistler, PhD, RD, Department of Nutrition and Health Science, Ball State University, Muncie, IN, USA
| | - Jagdish Khubchandani
- Jagdish Khubchandani, MBBS, PhD, Department of Public Health Sciences, New Mexico State University, Las Cruces, NM, USA
| | - Paul Bennett
- Paul Bennett, PhD, BN, Director, Research, Satellite Healthcare, San Jose, California, USA; Honorary Professor of Nursing, Deakin University, Melbourne, Victoria, Australia
| | - Kenneth R Wilund
- Kenneth R. Wilund, PhD, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Jacob Sosnoff
- Jacob Sosnoff, PhD, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA
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Song Y, March DS, Biruete A, Kistler BM, Nixon DDG, Highton PJ, Vogt BP, Ruddock N, Wilund KR, Smith AC, Burton JO. A Comparison of Dietary Intake Between Individuals Undergoing Maintenance Hemodialysis in the United Kingdom and China. J Ren Nutr 2022; 32:224-233. [PMID: 33888409 PMCID: PMC10053062 DOI: 10.1053/j.jrn.2021.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 01/03/2021] [Accepted: 03/07/2021] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Protein-energy wasting is highly prevalent in people with end-stage kidney disease receiving regular hemodialysis. Currently, it is unclear what the optimal nutritional recommendations are, which is further complicated by differences in dietary patterns between countries. The aim of the study was to understand and compare dietary intake between individuals receiving hemodialysis in Leicester, UK and Nantong, China. METHODS The study assessed 40 UK and 44 Chinese participants' dietary intake over a period of 14 days using 24-hour diet recall interviews. Nutritional blood parameters were obtained from medical records. Food consumed by participants in the UK and China was analyzed using the Nutritics and Nutrition calculator to quantify nutritional intake. RESULTS Energy and protein intake were comparable between UK and Chinese participants, but with both below the recommended daily intake. Potassium intake was higher in UK participants compared to Chinese participants (2,115 [888] versus 1,159 [861] mg/d; P < .001), as was calcium (618 [257] versus 360 [312] mg/d; P < .001) and phosphate intake (927 [485] versus 697 [434] mg/d; P = .007). Vitamin C intake was lower in UK participants compared to their Chinese counterparts (39 [51] versus 64 [42] mg/d; P = .024). Data are reported here as median (interquartile range). CONCLUSION Both UK and Chinese hemodialysis participants have insufficient protein and energy in their diet. New strategies are required to increase protein and energy intakes. All participants had inadequate daily intake of vitamins C and D; there may well be a role in the oral supplementation of these vitamins, and further studies are urgently needed.
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Affiliation(s)
- Yan Song
- Medical School, Nantong University, Nantong, Nantong, China
| | - Daniel S March
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom; NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust, Leicester, UK.
| | - Annabel Biruete
- Division of Nephrology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Brandon M Kistler
- Department of Nutrition and Health Science, Ball State University, Muncie
| | - Daniel D G Nixon
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Patrick J Highton
- Diabetes Research Centre, University of Leicester, Leicester, United Kingdom; NIHR Applied Research Collaboration (ARC), East Midlands, United Kingdom
| | - Barbara P Vogt
- School of Medicine, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - Nicola Ruddock
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Kenneth R Wilund
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Alice C Smith
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - James O Burton
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom; NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust, Leicester, UK; School of Sport, Exercise & Health Sciences, Loughborough University, United Kingdom
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Biruete A, Shin A, Kistler BM, Moe SM. Feeling gutted in chronic kidney disease (CKD): Gastrointestinal disorders and therapies to improve gastrointestinal health in individuals CKD, including those undergoing dialysis. Semin Dial 2021:10.1111/sdi.13030. [PMID: 34708456 PMCID: PMC9043041 DOI: 10.1111/sdi.13030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 09/21/2021] [Indexed: 12/15/2022]
Abstract
Chronic kidney disease (CKD) affects 9.1% of the population worldwide. CKD may lead to structural and functional gastrointestinal alterations, including impairment in the intestinal barrier, digestion and absorption of nutrients, motility, and changes to the gut microbiome. These changes can lead to increased gastrointestinal symptoms in people with CKD, even in early grades of kidney dysfunction. Gastrointestinal symptoms have been associated with lower quality of life and reduced nutritional status. Therefore, there has been considerable interest in improving gastrointestinal health in this clinical population. Gastrointestinal health can be influenced by lifestyle and medications, particularly in advanced grades of kidney dysfunction. Therapies focused on gastrointestinal health have been studied, including the use of probiotics, prebiotics, and synbiotics, yielding limited and conflicting results. This review summarizes the alterations in the gastrointestinal tract structure and function and provides an overview of potential nutritional interventions that kidney disease professionals can provide to improve gastrointestinal health in individuals with CKD.
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Affiliation(s)
- Annabel Biruete
- Department of Nutrition and Dietetics, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA
- Division of Nephrology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Andrea Shin
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Brandon M. Kistler
- Department of Nutrition and Health Science, Ball State University, Muncie, Indiana, USA
| | - Sharon M. Moe
- Division of Nephrology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Anatomy, Cell Biology, and Anatomy, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Biruete A, Cross TWL, Allen JM, Kistler BM, de Loor H, Evenepoel P, Fahey GC, Bauer L, Swanson KS, Wilund KR. Effect of Dietary Inulin Supplementation on the Gut Microbiota Composition and Derived Metabolites of Individuals Undergoing Hemodialysis: A Pilot Study. J Ren Nutr 2021; 31:512-522. [PMID: 34120835 PMCID: PMC8403151 DOI: 10.1053/j.jrn.2020.10.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 10/08/2020] [Accepted: 10/20/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE The prebiotic fiber inulin has been studied in individuals undergoing hemodialysis (HD) due to its ability to reduce gut microbiota-derived uremic toxins. However, studies examining the effects of inulin on the gut microbiota and derived metabolites are limited in these patients. We aimed to assess the impact of a 4-week supplementation of inulin on the gut microbiota composition and microbial metabolites of patients on HD. DESIGN AND METHODS In a randomized, double-blind, placebo-controlled, crossover study, twelve HD patients (55 ± 10 y, 50% male, 58% Black American, BMI 31.6 ± 8.9 kg/m2, 33% diabetes mellitus) were randomized to consume inulin [10 g/d for females; 15 g/d for males] or maltodextrin [6 g/d for females; 9 g/d for males] for 4 weeks, with a 4-week washout period. We assessed the fecal microbiota composition, fecal metabolites (short-chain fatty acids (SCFA), phenols, and indoles), and plasma indoxyl sulfate and p-cresyl sulfate. RESULTS At baseline, factors that explained the gut microbiota variability included BMI category and type of phosphate binder prescribed. Inulin increased the relative abundance of the phylum Verrucomicrobia and its genus Akkermansia (P interaction = 0.045). Inulin and maltodextrin resulted in an increased relative abundance of the phylum Bacteroidetes and its genus Bacteroides (P time = 0.04 and 0.03, respectively). Both treatments increased the fecal acetate and propionate (P time = 0.032 and 0.027, respectively), and there was a trend toward increased fecal butyrate (P time = 0.06). Inulin did not reduce fecal p-cresol or indoles, or plasma concentrations of p-cresyl sulfate or indoxyl sulfate. CONCLUSIONS A 4-week supplementation of inulin did not lead to major shifts in the fecal microbiota and gut microbiota-derived metabolites. This may be due to high variability among participants and an unexpected increase in fecal excretion of SCFA with maltodextrin. Larger studies are needed to determine the effects of prebiotic fibers on the gut microbiota and clinical outcomes to justify their use in patients on HD.
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Affiliation(s)
- Annabel Biruete
- Division of Nutritional Sciences, University of Illinois, Urbana, Illinois; Division of Nephrology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Tzu-Wen L Cross
- Division of Nutritional Sciences, University of Illinois, Urbana, Illinois; Department of Nutrition Science, Purdue University, West Lafayette, Indiana
| | - Jacob M Allen
- Department of Kinesiology and Community Health, University of Illinois, Urbana, Illinois
| | - Brandon M Kistler
- Department of Nutrition and Health Science, Ball State University, Muncie, Indiana
| | - Henriette de Loor
- KU Leuven Department of Microbiology and Immunology, Laboratory of Nephrology, Leuven, Belgium
| | - Pieter Evenepoel
- KU Leuven Department of Microbiology and Immunology, Laboratory of Nephrology, Leuven, Belgium; Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium
| | - George C Fahey
- Department of Animal Sciences, University of Illinois, Urbana, Illinois
| | - Laura Bauer
- Department of Animal Sciences, University of Illinois, Urbana, Illinois
| | - Kelly S Swanson
- Division of Nutritional Sciences, University of Illinois, Urbana, Illinois; Department of Animal Sciences, University of Illinois, Urbana, Illinois
| | - Kenneth R Wilund
- Division of Nutritional Sciences, University of Illinois, Urbana, Illinois; Department of Kinesiology and Community Health, University of Illinois, Urbana, Illinois.
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Kistler BM, Moore LW, Benner D, Biruete A, Boaz M, Brunori G, Chen J, Drechsler C, Guebre-Egziabher F, Hensley MK, Iseki K, Kovesdy CP, Kuhlmann MK, Saxena A, Wee PT, Brown-Tortorici A, Garibotto G, Price SR, Yee-Moon Wang A, Kalantar-Zadeh K. The International Society of Renal Nutrition and Metabolism Commentary on the National Kidney Foundation and Academy of Nutrition and Dietetics KDOQI Clinical Practice Guideline for Nutrition in Chronic Kidney Disease. J Ren Nutr 2021; 31:116-120.e1. [PMID: 32737016 PMCID: PMC8045140 DOI: 10.1053/j.jrn.2020.05.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/10/2020] [Indexed: 12/28/2022] Open
Abstract
The Academy of Nutrition and Dietetics and the National Kidney Foundation collaborated to provide an update to the Clinical Practice Guidelines (CPG) for nutrition in chronic kidney disease (CKD). These guidelines provide a valuable update to many aspects of the nutrition care process. They include changes in the recommendations for nutrition screening and assessment, macronutrients, and targets for electrolytes and minerals. The International Society of Renal Nutrition and Metabolism assembled a special review panel of experts and evaluated these recommendations prior to public review. As one of the highlights of the CPG, the recommended dietary protein intake range for patients with diabetic kidney disease is 0.6-0.8 g/kg/day, whereas for CKD patients without diabetes it is 0.55-0.6 g/kg/day. The International Society of Renal Nutrition and Metabolism endorses the CPG with the suggestion that clinicians may consider a more streamlined target of 0.6-0.8 g/kg/day, regardless of CKD etiology, while striving to achieve intakes closer to 0.6 g/kg/day. For implementation of these guidelines, it will be important that all stakeholders work to detect kidney disease early to ensure effective primary and secondary prevention. Once identified, patients should be referred to registered dietitians or the region-specific equivalent, for individualized medical nutrition therapy to slow the progression of CKD. As we turn our attention to the new CPG, we as the renal nutrition community should come together to strengthen the evidence base by standardizing outcomes, increasing collaboration, and funding well-designed observational studies and randomized controlled trials with nutritional and dietary interventions in patients with CKD.
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Affiliation(s)
- Brandon M Kistler
- Department of Nutrition and Health Science, Ball State University, Muncie, Indiana
| | - Linda W Moore
- Department of Surgery, Houston Methodist Hospital, Houston, Texas
| | | | - Annabel Biruete
- Division of Nephrology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Mona Boaz
- Department of Nutritional Sciences, Ariel University, Ariel, Israel
| | - Giuliano Brunori
- Nephrology and Dialysis Unite, Hospital of Trento, Trento, Italy
| | - Jing Chen
- Division of Nephrology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, P.R. China
| | | | | | | | | | - Csaba P Kovesdy
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Martin K Kuhlmann
- Department of Nephrology, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Anita Saxena
- Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Pieter Ter Wee
- Department of Nephrology, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Amanda Brown-Tortorici
- Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, Orange, California
| | - Giacomo Garibotto
- Division of Nephrology, Dialysis, and Transplantation, Department of Internal Medicine, University of Genoa and IRCCS AOU San Marino-IST, Genoa, Italy
| | - S Russ Price
- Departments of Internal Medicine and Biochemistry & Molecular Biology, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - Angela Yee-Moon Wang
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, Orange, California.
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Martin ZT, Shannon CA, Kistler BM, Nagelkirk PR, Del Pozzi AT. Effect of Sex and Menstrual Cycle on Skin Sensory Nerve Contribution to Local Heating. Int J Exerc Sci 2019; 12:1265-1279. [PMID: 31839845 PMCID: PMC6886618] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The purpose of this study was to determine sex differences in the contribution of sensory nerves to rapid cutaneous thermal hyperemia. Healthy young females (n = 15, tested during both the early follicular (EF) and the mid-luteal (ML) phase of the menstrual cycle) and males (n = 15) had a 4 cm2 area of skin on one forearm and one leg treated with a eutectic mixture of local anesthetic (EMLA). EMLA sites, along with corresponding control sites, were instrumented with laser Doppler flowmetry probes and local skin heaters. Baseline (33 °C), rapid and sustained vasodilation (42 °C), and maximal vasodilation (44 °C) skin blood flow data were obtained and expressed as a percentage of maximal cutaneous vascular conductance (%CVCmax). Contribution of sensory nerve involvement was determined by comparing the EMLA site to its matched control site utilizing the formula [(% CVCmax control - % CVCmax treatment) / % CVCmax control] × 100. The contribution of sensory nerves to rapid cutaneous thermal hyperemia in the forearm was 24 ± 18 %CVCmax in males, 41 ± 17 %CVCmax in ML females (p = 0.02 vs. males), and 35 ± 17 %CVCmax in EF females (p > 0.05 vs. males). In the leg, the contribution of sensory nerves was 16 ± 15 %CVCmax in males, 34 ± 17 %CVCmax for ML females (p = 0.02 vs. males), and 28 ± 21 %CVCmax in EF females (p > 0.05 vs. males). ML females exhibited a greater contribution of sensory nerves to rapid cutaneous thermal hyperemia in the forearm and leg, possibly attributed to elevated reproductive hormones during the ML phase.
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Affiliation(s)
- Zachary T Martin
- Integrative Exercise Physiology Laboratory, Ball State University, Muncie, IN, USA
| | - Carley A Shannon
- Integrative Exercise Physiology Laboratory, Ball State University, Muncie, IN, USA
| | - Brandon M Kistler
- Department of Nutrition and Health Sciences, Ball State University, Muncie, IN, USA
| | - Paul R Nagelkirk
- Integrative Exercise Physiology Laboratory, Ball State University, Muncie, IN, USA
| | - Andrew T Del Pozzi
- Integrative Exercise Physiology Laboratory, Ball State University, Muncie, IN, USA
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Kistler BM, Khubchandani J, Wiblishauser M, Wilund KR, Sosnoff JJ. Epidemiology of falls and fall-related injuries among middle-aged adults with kidney disease. Int Urol Nephrol 2019; 51:1613-1621. [PMID: 31165398 DOI: 10.1007/s11255-019-02148-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 04/10/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Comorbidities, such as kidney disease (CKD), increase the likelihood of falls and fall-related injuries. Despite the focus of most research in this population on older adults, falls are a significant cause of injury throughout adulthood. Therefore, we aimed to describe the epidemiology of falls in middle-aged adults with kidney diseases. METHODS We analyzed falls and fall-related injuries among middle-aged adults (45-65 years old) with and without CKD included in the 2014 Behavioral Risk Factor Surveillance System (BRFSS) utilizing multivariate logistic regression and complex sample survey data analysis procedures. RESULTS Middle-aged adults with CKD were more likely to suffer a fall (2.30, 95% CI 2.07-2.55) and a fall-related injury (1.54, 95% CI 1.32-1.80) compared to those without CKD. However, only the increased likelihood for falls remained significant after correction for multiple demographic, health, lifestyle, and comorbid conditions (AOR 1.22, 95% CI 1.08-1.39). Among adults with CKD, general health status, smoking, and total comorbidity scores were significant predictors of falls and fall-related injuries (p < 0.05 for all). Furthermore, individual comorbidities such as COPD, asthma, depressive disorders, stroke, and arthritis also predicted falls and fall-related injuries (p < 0.05 for all). CONCLUSION Middle-aged adults with CKD were more likely than those without CKD to fall and suffer a fall-related injury. However, injury risk did not remain elevated after accounting for differences between groups. The presence of comorbidities, especially depressive disorders, was associated with increased odds for falls and fall-related injuries. Given the high prevalence of depression among adults with CKD, the relationship between depression and falls warrants further examination.
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Affiliation(s)
- Brandon M Kistler
- Department of Nutrition and Health Science, Ball State University, 2000 W University Avenue, Muncie, Indiana, USA.
| | - Jagdish Khubchandani
- Department of Nutrition and Health Science, Ball State University, 2000 W University Avenue, Muncie, Indiana, USA
| | - Michael Wiblishauser
- School of Education, Health Professions and Human Development, University of Houston-Victoria, Victoria, Texas, USA
| | - Kenneth R Wilund
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, Illinois, USA
| | - Jacob J Sosnoff
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, Illinois, USA
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Kistler BM, Khubchandani J, Jakubowicz G, Wilund K, Sosnoff J. Falls and Fall-Related Injuries Among US Adults Aged 65 or Older With Chronic Kidney Disease. Prev Chronic Dis 2018; 15:E82. [PMID: 29935079 PMCID: PMC6016407 DOI: 10.5888/pcd15.170518] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Introduction Falls are among the leading causes of injury and death among adults aged 65 or older. People with chronic kidney disease (CKD) are at increased risk of falling and of having a serious injury from falls. However, information is limited about risk factors for falls and fall-related injuries among people with CKD. Methods We performed a secondary analysis of 157,753 adults (6.1% with CKD) aged 65 or older surveyed in the 2014 Behavioral Risk Factor Surveillance System. Results People with CKD were at increased risk of falls (odds ratio [OR] = 1.81; 95% confidence interval [CI], 1.63–2.01) and fall-related injuries (OR = 1.50; 95% CI, 1.27–1.78) even after adjusting for differences in demographic characteristics, health conditions, and lifestyle factors (P < .05 for all). Among people with CKD, women, people diagnosed with diabetes, diabetes duration, and arthritis were all significant predictors of falls and fall-related injuries (P < .05 for all). Lifestyle factors, such as engaging in recent exercise (adjusted odds ratio [AOR] = 0.68; 95% CI, 0.56–0.81) and limited physical function (assessed as difficulty in climbing stairs) (AOR = 2.84; 95% CI, 2.30–3.44), were most closely associated with falls and fall-related injuries. Conclusion Adults aged 65 or older with CKD were at increased risk of falling and of suffering an injury as a result of a fall compared with adults in the same age range without CKD. Potentially modifiable factors such as physical function and recent exercise were most closely related to reduced risk for falls and fall-related injuries and may be an appropriate target for fall prevention and rehabilitation programs in people with CKD.
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Affiliation(s)
- Brandon M Kistler
- Department of Nutrition and Health Science, 2000 W University Ave, Ball State University, Muncie, IN 47304.
| | - Jagdish Khubchandani
- Department of Nutrition and Health Science, Ball State University, Muncie, Indiana
| | - Gina Jakubowicz
- Department of Nutrition and Health Science, Ball State University, Muncie, Indiana
| | - Kenneth Wilund
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Jacob Sosnoff
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois
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Kistler BM, Biruete A, Chapman-Novakofski K, Wilund KR. The Relationship Between Intradialytic Nutrition and Gastrointestinal Symptoms Using a Modified Version of the Gastrointestinal Symptom Rating Scale. J Ren Nutr 2018; 28:129-134. [PMID: 29471989 PMCID: PMC10436647 DOI: 10.1053/j.jrn.2017.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 07/03/2017] [Accepted: 08/17/2017] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE Intradialytic nutrition has been shown to improve nutritional status in maintenance hemodialysis (HD) patients but remains controversial due in part to concerns over hemodynamic stability and gastrointestinal (GI) distress. There are limited data on the relationship between intradialytic nutrition and GI symptoms, possibly due to the lack of a validated tool. Therefore, we intended to validate a questionnaire to measure GI symptoms associated with a single HD treatment and determine the relationship between intradialytic nutrition and GI symptoms. DESIGN Cross-sectional study. Forty-eight maintenance HD patients. MAIN OUTCOME MEASURE GI symptoms and dietary intake during HD treatment. RESULTS In general, we found acceptable internal consistency (Cronbach's alpha >0.5, exception reflux domain) and repeatability in all 5 domains of a modified version of the Gastrointestinal Symptom Rating Scale. The prevalence of GI symptoms associated with a single HD treatment (generalized score greater than 1) was 54.2, 43.7, 6.2, 41.7, and 45.8% for the abdominal pain, indigestion, reflux, diarrhea, and constipation domains, respectively. More than two-thirds of patients chose to eat during treatment (168.6 ± 165.6 kcal) with the most commonly consumed items being candy, oral supplements, and cookies. There was no difference in GI symptoms among patients who did or did not eat (P > .05). However, the amount of total dietary fat and fiber consumed during treatment was associated with greater indigestion (P < .05) prior to accounting for outliers or multiple comparisons. CONCLUSION In this sample, the modified version of the Gastrointestinal Symptom Rating Scale was a generally valid tool for measuring GI symptoms associated with a single HD treatment. Patients who ate during treatment did not experience greater GI symptoms than those who did not; however, high amounts of fat and fiber may be associated with greater GI symptoms. Prospective trials should examine the relationship between GI symptoms and dietary intake during treatment in HD patients.
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Affiliation(s)
- Brandon M Kistler
- Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois; Department of Nutrition and Health Science, Ball State University, Muncie, Indiana.
| | - Annabel Biruete
- Division of Nutritional Science, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | | | - Kenneth R Wilund
- Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois; Division of Nutritional Science, University of Illinois at Urbana-Champaign, Urbana, Illinois
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Kistler BM, Benner D, Burrowes JD, Campbell KL, Fouque D, Garibotto G, Kopple JD, Kovesdy CP, Rhee CM, Steiber A, Stenvinkel P, ter Wee P, Teta D, Wang AY, Kalantar-Zadeh K. Eating During Hemodialysis Treatment: A Consensus Statement From the International Society of Renal Nutrition and Metabolism. J Ren Nutr 2018; 28:4-12. [DOI: 10.1053/j.jrn.2017.10.003] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 10/22/2017] [Indexed: 12/19/2022] Open
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Kistler BM, Wilund KR. Eating during treatment can be a cost-effective way to improve outcomes: a letter to the editor. Contemp Nurse 2016; 51:301-3. [PMID: 26983020 DOI: 10.1080/10376178.2016.1150191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Brandon M Kistler
- a Department of Kinesiology and Community Health , University of Illinois at Urbana-Champaign , 906 South Goodwin Avenue, Urbana , IL 61801 , USA
| | - Kenneth R Wilund
- a Department of Kinesiology and Community Health , University of Illinois at Urbana-Champaign , 906 South Goodwin Avenue, Urbana , IL 61801 , USA
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Kistler BM, Jeong JH, Wu PT, Fitschen PJ, Biruete A, Fernhall B, Wilund KR. Sex Differences in the Relationship Between Arterial Stiffness and Physical Fitness in Maintenance Hemodialysis Patients. Med Sci Sports Exerc 2015. [DOI: 10.1249/01.mss.0000477544.34638.ea] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Chung HR, Wu PT, Fitschen PJ, Kistler BM, Park HW, Jeong JH, Wilund KR, Woods J, Boppart M. The Impact of Physical Activity on Statin-Associated Skeletal Muscle Myopathy. Med Sci Sports Exerc 2015. [DOI: 10.1249/01.mss.0000477291.98365.c0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Fitschen PJ, Kistler BM, Jeong JH, Biruete A, Fernhall B, Wilund KR. Association Between Physical Activity Levels And Co-morbid Conditions In Hemodialysis Patients. Med Sci Sports Exerc 2015. [DOI: 10.1249/01.mss.0000477538.04143.1f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Wu PT, Fitschen PJ, Kistler BM, Jeong JH, Chung HR, Aviram M, Phillips SA, Fernhall B, Wilund KR. Effects of Pomegranate Extract Supplementation on Cardiovascular Risk Factors and Physical Function in Hemodialysis Patients. J Med Food 2015; 18:941-9. [PMID: 25826143 DOI: 10.1089/jmf.2014.0103] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
The purpose of this study was to evaluate the effects of oral supplementation with pomegranate extract on cardiovascular risk, physical function, oxidative stress, and inflammation in hemodialysis (HD) patients. Thirty-three HD subjects were randomized to the pomegranate (POM) or placebo (CON) group. Patients in POM ingested a 1000 mg capsule of a purified pomegranate polyphenol extract 7 days/week for 6 months. Individuals in CON ingested a noncaloric placebo capsule using the same protocol. Measurements were conducted at baseline and repeated 6 months following the start of the intervention. Brachial blood pressure (BP) was obtained using an automatic digital BP monitor. Cardiovascular risk was assessed using ultrasound and arterial tonometry. Blood samples were collected for the measurements of circulating markers of inflammation, oxidative stress, and antioxidant capacity. Muscle strength and physical function were assessed by isokinetic dynamometry, a validated shuttle walk test, and a battery of tests to assess functional fitness. Systolic blood pressure and diastolic blood pressure were reduced by 24 ± 13.7 and 10 ± 5.3 mmHg, respectively, in POM (P < .05). However, the BP differences in POM were no longer significant after controlling for baseline BP. The paraoxonase-1 activity increased by 26.6% (P < .05) in POM, compared to no significant change in CON. However, pomegranate supplementation had no effect on other markers of cardiovascular disease risk, inflammation and oxidative stress, or measures of physical function and muscle strength. While pomegranate extract supplementation may reduce BP and increase the antioxidant activity in HD patients, it does not improve other markers of cardiovascular risk, physical function, or muscle strength.
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Affiliation(s)
- Pei-Tzu Wu
- 1 School of Nursing, University of California-Los Angeles , Los Angeles, California, USA .,3 Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign , Urbana, Illinois, USA
| | - Peter J Fitschen
- 2 Division of Nutritional Sciences, University of Illinois at Urbana-Champaign , Urbana, Illinois, USA
| | - Brandon M Kistler
- 3 Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign , Urbana, Illinois, USA
| | - Jin Hee Jeong
- 3 Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign , Urbana, Illinois, USA
| | - Hae Ryong Chung
- 3 Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign , Urbana, Illinois, USA
| | - Michael Aviram
- 4 Technion Rappaport Faculty of Medicine, Rambam Medical Center , Haifa, Israel
| | - Shane A Phillips
- 5 Department of Physical Therapy, University of Illinois at Chicago , Chicago, Illinois, USA
| | - Bo Fernhall
- 6 Department of Kinesiology and Nutrition, University of Illinois at Chicago , Chicago, Illinois, USA
| | - Kenneth R Wilund
- 2 Division of Nutritional Sciences, University of Illinois at Urbana-Champaign , Urbana, Illinois, USA .,3 Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign , Urbana, Illinois, USA
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Kistler BM, Fitschen PJ, Ikizler TA, Wilund KR. Rethinking the Restriction on Nutrition During Hemodialysis Treatment. J Ren Nutr 2015; 25:81-7. [DOI: 10.1053/j.jrn.2014.08.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 08/02/2014] [Accepted: 08/25/2014] [Indexed: 12/30/2022] Open
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Tomayko EJ, Kistler BM, Fitschen PJ, Wilund KR. Intradialytic protein supplementation reduces inflammation and improves physical function in maintenance hemodialysis patients. J Ren Nutr 2014; 25:276-83. [PMID: 25455421 DOI: 10.1053/j.jrn.2014.10.005] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 10/05/2014] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE Protein malnutrition is both a cause and consequence of inflammation and related comorbidities for maintenance hemodialysis (MHD) patients. This study sought to determine if oral supplementation with soy or whey protein during dialysis treatment reduces inflammation and improves physical function and body composition in MHD patients. DESIGN The design used in the study was randomized controlled trial, and the setting used was hemodialysis clinics in Champaign and Chicago, Illinois. SUBJECTS Patients who received treatment ≥3 days/week, were ages ≥30 years did not have congestive heart failure or chronic obstructive pulmonary disease, and were receiving dialysis treatment for ≥3 months were eligible for inclusion. INTERVENTION Patients were randomized to oral supplementation with a whey protein, soy protein, or placebo beverage. Patients (WHEY, n = 11; SOY, n = 12; CON, n = 15) consumed their assigned beverage before every dialysis session for 6 months. MAIN OUTCOME MEASURES Body composition was measured by dual-energy x-ray absorptiometry, physical function by gait speed and shuttle walk test, and markers of inflammation (C-reactive protein and interleukin 6) using commercially available enzyme-linked immunosorbent assay kits before and after the 6-month intervention. Dietary intake was assessed by 24-hour dietary recalls. RESULTS Six months of whey or soy supplementation significantly reduced predialysis interleukin 6 levels (P < .05 for both), whereas there was a trend for a reduction in C-reactive protein when both protein groups were combined (P = .062). Gait speed and shuttle walk test performance also significantly improved in the protein groups (P < .05 for both). No changes in body composition were observed. However, alkaline phosphatase, a marker of bone turnover, was significantly reduced in the protein groups. CONCLUSIONS Intradialytic protein supplementation during a 6-month intervention reduced inflammation and improved physical function and represents an affordable intervention to improve the health of MHD patients.
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Affiliation(s)
- Emily J Tomayko
- Division of Nutritional Sciences, University of Illinois, Urbana, Illinois
| | - Brandon M Kistler
- Department of Kinesiology and Community Health, University of Illinois, Urbana, Illinois
| | - Peter J Fitschen
- Department of Kinesiology and Community Health, University of Illinois, Urbana, Illinois
| | - Kenneth R Wilund
- Division of Nutritional Sciences, University of Illinois, Urbana, Illinois; Department of Kinesiology and Community Health, University of Illinois, Urbana, Illinois.
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Kistler BM, Learmonth Y, Fitschen PJ, Ensari I, Biruete A, Sandroff BM, Jeong JH, Motl RW, Wilund KR. Blood-flow Restriction Training Does Not Increase Muscular Gains in Persons with Multiple Sclerosis. Med Sci Sports Exerc 2014. [DOI: 10.1249/01.mss.0000495118.74755.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Shin S, Chung HR, Kistler BM, Fitschen PJ, Wilund KR, Sosnoff JJ. Effect of muscle strength on gait in hemodialysis patients with and without diabetes. Int J Rehabil Res 2014; 37:29-33. [PMID: 23873223 DOI: 10.1097/mrr.0b013e3283643d76] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
There is minimal data on the gait of hemodialysis (HD) patients with and without diabetes. This investigation examined spatiotemporal parameters of gait in HD patients with and without diabetes compared with age-matched, sex-matched, and BMI-matched controls. The effect of muscle weakness on gait in HD patients was also examined. Eighteen HD patients and 18 age-matched, sex-matched, and BMI-matched controls completed two walking trials along a 7.9 m long pressure sensitive pathway. The HD participants were divided into groups based on their diabetic status (eight patients without diabetes and 10 with diabetes). Spatiotemporal markers of gait, including variability metrics, were determined. Knee strength was quantified only in the HD groups. Overall HD patients had a worse gait compared with controls (P<0.01). Furthermore, HD patients with diabetes had an elevated gait variability compared with those without diabetes, even after controlling for muscle strength (P<0.05). Further research is warranted to explore whether increases in lower extremity strength lead to improvements in gait in this population.
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Affiliation(s)
- Sunghoon Shin
- aDepartment of Biomedical Engineering, Kyung Hee University, Yongin, Korea bDepartment of Kinesiology and Community Health cDivision of Nutritional Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
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Shin S, Chung HR, Fitschen PJ, Kistler BM, Woo Park H, Wilund KR, Sosonff JJ. Postural control in hemodialysis patients. Gait Posture 2014; 39:723-7. [PMID: 24189110 PMCID: PMC3946821 DOI: 10.1016/j.gaitpost.2013.10.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 09/12/2013] [Accepted: 10/08/2013] [Indexed: 02/02/2023]
Abstract
The current investigation examined whether patients undergoing hemodialysis (HD) have reduced standing postural control performance during simultaneous cognitive task performance (i.e. dual task cost (DTC)) compared to age-gender matched controls. 19 persons undergoing HD and 19 age, gender, and body mass index (BMI) matched controls participated in the investigation. All participants performed 2 trials of quiet standing balance and 2 postural trials in which they performed a cognitive task. Postural control was indexed with various measures of the center of pressure (COP) trajectory. The change in postural control with a cognitive task (e.g. dual task cost DTC) was quantified as a change in the center of COP parameters of postural control from quiet standing to the cognitive condition. The primary observations were that (1) HD patients had significantly greater postural sway than age, gender, BMI matched controls (p's < 0.05); (2) HD patients had a greater DTC than the controls during quiet standing (p's < 0.05). The observations highlight that HD participants have poor postural control that is further exacerbated by a simultaneous performance of a cognitive task. It is possible that this impaired postural control places HD participants at elevated fall risk. Further study is necessary to determine contributing factors to an increased DTC in this population and whether targeted interventions such as exercise can reduce DTC.
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Affiliation(s)
- Sunghoon Shin
- Department of Biomedical Engineering, Kyung Hee Univeristy, Yongin, Korea
| | - Hae Ryong Chung
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, US
| | - Peter J. Fitschen
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, US
| | - Brandon M. Kistler
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, US
| | - Hyun Woo Park
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, US
| | - Kenneth R. Wilund
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, US
| | - Jacob J Sosonff
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, US
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Woods JA, Wilund KR, Martin SA, Kistler BM. Exercise, inflammation and aging. Aging Dis 2012; 3:130-140. [PMID: 22500274 PMCID: PMC3320801] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Revised: 10/10/2011] [Accepted: 10/18/2011] [Indexed: 05/31/2023] Open
Abstract
Aging results in chronic low grade inflammation that is associated with increased risk for disease, poor physical functioning and mortality. Strategies that reduce age-related inflammation may improve the quality of life in older adults. Regular exercise is recommended for older people for a variety of reasons including increasing muscle mass and reducing risk for chronic diseases of the heart and metabolic systems. Only recently has exercise been examined in the context of inflammation. This review will highlight key randomized clinical trial evidence regarding the influence of exercise training on inflammatory biomarkers in the elderly. Potential mechanisms will be presented that might explain why exercise may exert an anti-inflammatory effect.
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Affiliation(s)
- Jeffrey A. Woods
- Correspondence should be addressed to: Jeffrey A. Woods, Ph.D., Department of Kinesiology and Community Health, University of Illinois @Urbana-Champaign, Urbana IL, USA.
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Kistler BM, Walsh MS, Horn TS, Cox RH. The Acute Effects of Static Stretching on the Sprint Performance of Collegiate Men in the 60- and 100-m Dash After a Dynamic Warm-Up. J Strength Cond Res 2010; 24:2280-4. [DOI: 10.1519/jsc.0b013e3181e58dd7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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