Inadequate dietary energy intake associates with higher prevalence of metabolic syndrome in different groups of hemodialysis patients: a clinical observational study in multiple dialysis centers

Abstract

BackgroundMetabolic syndrome (MetS) has been established as a risk for cardiovascular diseases and mortality in hemodialysis patients. Energy intake (EI) is an important nutritional therapy for preventing MetS. We examined the association of self-reported dietary EI with metabolic abnormalities and MetS among hemodialysis patients.MethodsA cross-sectional study design was carried out from September 2013 to April 2017 in seven hemodialysis centers. Data were collected from 228 hemodialysis patients with acceptable EI report, 20 years old and above, underwent three hemodialysis sessions a week for at least past 3 months. Dietary EI was evaluated by a three-day dietary record, and confirmed by 24-h dietary recall. Body compositions were measured by bioelectrical impedance analysis. Biochemical data were analyzed using standard laboratory tests. The cut-off values of daily EI were 30 kcal/kg, and 35 kcal/kg for age ≥ 60 years and < 60 years, respectively. MetS was defined by the American Association of Clinical Endocrinologists (AACE-MetS), and Harmonizing Metabolic Syndrome (HMetS). Logistic regression models were utilized for examining the association between EI and MetS. Age, gender, physical activity, hemodialysis vintage, Charlson comorbidity index, high sensitive C-reactive protein, and interdialytic weight gains were adjusted in the multivariate analysis.ResultsThe prevalence of inadequate EI, AACE-MetS, and HMetS were 60.5%, 63.2%, and 53.9%, respectively. Inadequate EI was related to higher proportion of metabolic abnormalities and MetS (p < 0.05). Results of the multivariate analysis shows that inadequate EI was significantly linked with higher prevalence of impaired fasting glucose (OR = 2.42, p < 0.01), overweight/obese (OR = 6.70, p < 0.001), elevated waist circumference (OR = 8.17, p < 0.001), AACE-MetS (OR = 2.26, p < 0.01), and HMetS (OR = 3.52, p < 0.01). In subgroup anslysis, inadequate EI strongly associated with AACE-MetS in groups of non-hypertension (OR = 4.09, p = 0.004), and non-cardiovascular diseases (OR = 2.59, p = 0.012), and with HMetS in all sub-groups of hypertension (OR = 2.59~ 5.33, p < 0.05), diabetic group (OR = 8.33, p = 0.003), and non-cardiovascular diseases (OR = 3.79, p < 0.001).ConclusionsInadequate EI and MetS prevalence was high. Energy intake strongly determined MetS in different groups of hemodialysis patients.

Daily dietary phosphorus intake variability and hemodialysis patient adherence to phosphate binder therapy

“…In comparison with previous studies, the percentages of patients consuming low dietary energy (69%) were close to that in a study in Taiwan (60%) using a 3-day dietary intake record, but lower than that being reported in Poland (80%) using a dietary questionnaire. 24,25 This study also showed that almost twothirds of patients consumed less protein than recommended, which is consistent with the results from the Poland study. 25 The relatively few patients who consumed enough protein could be explained by the restriction of dietary phosphorus intake.…”

“…The mean daily protein and energy intake of our patients did not achieve the target recommendations for clinically stable hemodialysis patients, especially on NDDs. In comparison with previous studies, the percentages of patients consuming low dietary energy (69%) were close to that in a study in Taiwan (60%) using a 3‐day dietary intake record, but lower than that being reported in Poland (80%) using a dietary questionnaire . This study also showed that almost two‐thirds of patients consumed less protein than recommended, which is consistent with the results from the Poland study .…”

Energy, protein, and potassium intake with nutritional status among chronic renal failure patients undergoing hemodialysis in hospital Dr. M.Yunus, Bengkulu, Indonesia

“…More than half of hemodialysis patients have problems following healthy dietary guidelines (related to energy and nutritional intake) related to behavior, technical difficulties, physical condition, time and food preparation. Inadequate food intake is also a result of significant lifestyle changes when receiving dialysis treatment (6) . Furthermore, this research was in line with Sharif's research (7) which states that there is no correlation between energy intake and nutritional status in patients with chronic renal failure with hemodialysis in Wahidin Sudirohusodo Hospital, Makassar, Indonesia.…”

Adaptation and Validation of Alternative Healthy Eating Index in Hemodialysis Patients (AHEI-HD) and Its Association with all-Cause Mortality: A Multi-Center Follow-Up Study

“…The dietary data were assessed using the 24-hour dietary recall form in paper format [22]. A qualified dietician instructed patients to complete the assessment forms on one dialysis day, one non-dialysis day, one non-dialysis day during the weekend, including meal time, meal location, food name, brand names, ingredients, portion or weight of food, and the cooking methods, oils used [20,23]. To confirm the data collected, dietitians used the 24-hour dietary recall form with common utensils to ask patients face-to-face or by phone call, as described previously [20,23,24,25].…”

“…Restrictive dietary approaches are one of the causes [40]. Therefore, adequate energy and protein intake are critically important in securing the nutritional status of hemodialysis patients [23,29]. The total grain consumption and total protein intake were suggested based on the level of energy requirements according to the Daily Food Guides [7].…”