Fp780food Preferences Modified by the Hemodialysis Session: Should We Adapt Dietetic Advices?

Abstract

Introduction and Aims: The increase in morbidity and mortality associated with malnutrition in hemodialysis patients (HD) suggests an optimization of the food intakes. Food preferences are compared in control subjects and in HD patients, a correlation between leptin and ghrelin values is sought. Methods: This prospective study involves non-diabetic, non-smoker HD patients (P) without comorbidity (G1) and a group of healthy volunteers (G2). The study of food preferences, a day of dialysis (morning session), and a day without dialysis session, calls upon the presentation of 18 food samples and/or pictures (at 7am and 11am), with measures from 1 to 10 of the liking ("I like this aliment"), the wanting ("I want to eat"), and the feeling of hunger. Measurements of ghrelin (GHL), leptin and insulin are effected at 7am and 11am. The statistics tests used are the followings: Student test, Mann and Withney test, ANOVA test. Results: G1 includes 25 HD patients (mean age=61years) and 25 controls P (G2) are paired according to age, genre and BMI. Mean equilibrated KT/V is 1.4±0.2, mean nPCR is 1.04±0.2, mean albumin level is 36±7 g/l, mean prealbumin level is 0.33g/l in G1. Hunger sensation and carbohydrate liking are similar between G1 and G2, whereas lipid and protein liking increase at 11am versus 7am for the two groups ( p<0.05). Carbohydrate and lipid wanting increase at 11am compared to 7am ( p<0.05) for G1 and G2. The protein wanting at 7am is similar for G1 and G2 ( p>0.05), but it increases at 11am the day of HD session versus the day without dialysis ( p<0.01). Mean GHL level is at 1648 µg/ml for G1 at 7am versus 588µg/ml for G2 ( p<0.01) and it decreases after dialysis (988µg/ml, p<0.01). The leptin value is higher for G1 at 7am than for G2 ( p=0.01). Conclusions: The significant increase of the protein wanting after dialysis, corroborated by the food intakes, suggests to adapt dietetic advice: the increase in protein intake after the dialysis session could limit malnutrition. Ghrelin and leptin concentrations don't explain this modification in the food preferences, but amino-acid decrease after dialysis might be involved .