Dietary intake, clinical-nutritional status, and homocysteine in hemodialysis subjects: the mediating role of inflammation (NUGE-HD study)

Abstract

The aim of the present study was to test the hypothesis that inflammation mediates the associations among food intake, clinical-nutritional status, and plasma homocysteine (Hcys) in hemodialysis (HD) subjects. This was a cross-sectional analysis of data on 129 subjects undergoing HD (58.9% male, 61.8 ± 15.5 years of age) from the cohort Nutrition and Genetics on HD outcomes (NUGE-HD study). Sociodemographic, anthropometric, and metabolic data were collected, and food intake was assessed using a quantitative food frequency questionnaire. Plasma C-reactive protein (CRP) was used as an inflammatory marker. Data were analyzed by structural equation modeling. Regarding the direct effects, complex B vitamin intake was negatively associated with body mass index, and diabetes mellitus was positively associated with CRP. Plasma CRP also showed a negative association with Hcys, and the ratio of saturated and polyunsaturated fatty acids intake showed a positive association with Hcys. Regarding indirect effects, the results showed that the relationship between the presence of diabetes mellitus and Hcys is mediated by plasma CRP. In conclusion, the ratio of saturated and polyunsaturated fatty acids had a direct effect on plasma Hcys, whereas inflammation had a direct and mediating effect on the relationship between Hcys and diabetes mellitus in HD subjects. Novelty In end-stage renal disease, CRP influences plasma Hcys directly and also indirectly through its mediating effect. The quantity and quality of dietary fatty acids influence plasma Hcys concentrations in HD subjects.

Relative validity and reproducibility of food frequency questionnaire for individuals on hemodialysis (NUGE‐HD study)

“…Studies show that proper homeostasis of these minerals reduces CKD complications such as bone mineral disease and cardiovascular changes. 38,39 Thus, knowing the consumption of these minerals would decreased related metabolic complications as well as public health costs and mortality rates. 3,40 A differential of our FFQ-HD is the categorization of fruits and vegetables, according to potassium content (low, medium, and high) and in strategic location (second and third groups of the instrument), corroborating for greater information accuracy.…”

“…In this sense, the phosphorus, potassium, and sodium micronutrients stood out in this analysis. Studies show that proper homeostasis of these minerals reduces CKD complications such as bone mineral disease and cardiovascular changes 38,39 . Thus, knowing the consumption of these minerals would decreased related metabolic complications as well as public health costs and mortality rates 3,40 .…”