[Status of macro and micronutrient intake as compared to DRI in hemodialysis patients]

Anorexia, limitation in the intake of some nutrients, loss of nutrients during dialysis, and extensive inflammation are important causes of malnutrition in hemodialysis patients. For this reason, this study reviews the status of macro- and micronutrient intake in these patients as compared to Dietary Reference Intake [DRI] values. This cross-sectional study was performed on 75 hemodialysis patients referred to the dialysis department of Vasei Hospital, Sabzevar, Iran. After measuring height and body weight, nutrient intake of each patient was determined using 24-hour food recall method for two consecutive days [one day on and one day off dialysis] and the frequency of meals was recorded. Nutrient intake of each individual was determined using Nutritionist IV software. Data were analyzed by descriptive statistics and one-sample t-test at the significance level p < 0.05. The mean BMI of patients in this study was 20.04 +/- 3.38 kg/m2. The mean energy intake was 1767.98 +/- 373.85 and 1816.76 +/- 433.16 kcal in women and men, respectively, and the mean protein intake was 67.92 +/- 21.11 and 69.30 +/- 21.38 g per day in men and women, respectively. Also, in this study, the intake of all nutrients, except vitamins B1, B3, B12, and iron, was less than the recommended standard in hemodialysis patients [p < 0.05]. Based on the findings of this study, the intake of most water- and fat-soluble vitamins and minerals was less than the recommended standard in hemodialysis patients

[Comparison of various methods for determination of protein-energy malnutrition with subjective global assessment in hemodialysis patients]

Protein-energy malnutrition [PEM] is prevalent among hemodialysis patients. So far, no study has compared various methods for determination of PEM, including subjective global assessment [SGA], dialysis malnutrition score [DMS], malnutrition inflammation score [MIS], and body mass index [BMI], in hemodialysis patients. The present study was designed to determine sensitivity, specificity, accuracy, positive and negative predictive values, as well as positive and negative likelihood ratios of DMS, MIS and BMI in comparison with SGA as the most common method for determination of PEM in hemodialysis patients. A total of 291 hemodialysis patients were randomly selected by systematic sampling from among 2302 eligible adult hemodialysis patients in Tehran hospitals. The nutritional status of the patients was assessed by completing SGA, DMS and MIS forms and determining BMI. In addition, after a 12- to 14-hour fast, 4-mL blood samples were obtained from each patient before dialysis for measurement of serum urea, creatinine, albumin and total iron binding capacity. Based on SGA, DMS, MIS, and BMI, the prevalence of mild-to-moderate PEM in Tehrani hemodialysis patients was, respectively, 60.5%, 61.5%, 54%, and 16.5%, and that of severe PEM 1%, 1.5%, 1%, and 1%. In comparison with SGA, the sensitivity, specificity, accuracy, area under the receiver operating characteristic [ROC] curve, positive and negative predictive values, and positive and negative likelihood ratios were, respectively, 94%, 88%, 92%, 97%, 93%, 92%, 7.8, and 0.07 for DMS; 87%, 96%, 91%, 97%, 97%, 83%, 22.0, and 0.13 for MIS; and 23%, 91%, 50%, 64%, 80%, 43%, 2.5, and 0.85 for BMI. The results of the present study indicate that the DMS and MIS are almost similar to SGA, in identifying malnutrition in hemodialysis patients, while BMI is not an appropriate index in this regard. In addition, it appears that the DMS is a more appropriate alternative method for SGA in routine hospital assessments

[Association of energy-protein malnutrition with risk factors of cardiovascular diseases in hemodialysis patients]

The risk of cardiovascular diseases among hemodialysis patients with energy-protein malnutrition [PEM] is higher compared to well-nourished hemodialysis patients. Traditional risk factors for cardiovascular diseases such as a high body mass index and serum total cholesterol cannot explain the high prevalence of cardiovascular diseases in hemodialysis patients with PEM. Therefore, the present study was designed to study the association of PEM with nontraditional risk factors of cardiovascular diseases in hemodialysis patients. A total of 291 hemodialysis patients were selected with systematic randoml sampling from among 2302 eligible adult hemodialysis patients in Tehran hospitals. The nutritional status of the patients was determined by subjective global assessment [SGA]. In addition, dialysis malnutrition score [DMS] and malnutrition inflammation score [MIS] of the patients were determined and their dietary intakes assessed using a 4-day dietary recall including 2 dialysis days and 2 non-dialysis days. Also, after a 12- to 14-hour fast, an 8 mL- sample of blood was taken from each patient before dialysis and serum urea, creatinine, albumin, CRP, sICAM-1, sVCAM-1, sE-selectin, MDA, NO, endothelin-1, and Lp[a] were measured. The serum concentrations of CRP and sICAM-1 were significantly higher in hemodialysis patients with PEM as compared to those without PEM [p<0.01], whereas there were no significant differences in serum concentrations of sVCAM-1, sE-selectin, MDA, NO, endothelin-1 or Lp[a] between the two groups. In addition, compared to hemodialysis patients with PEM types IIa or IIb, those with PEM type I had significantly lower serum CRP and sICAM-1 levels [p <0.01]. There were significant direct correlations between DMS and MIS, as two PEM indicators, with serum CRP and sICAM-1 [P <0.01]. The results of the present study indicate that nontraditional risk factors of cardiovascular diseases do not increase in hemodialysis patients with PEM type I, whereas serum CRP and sICAM-1, two risk factors of cardiovascular diseases, increase in PEM type II, which is accompanied with inflammation

[Effect of ground black seed [nigella sativa l.] on serum lipid profile, body weight and food intake in hyperlipidemic rabbits]

Black seed [Nigella sativa L.] is one of the most revered medicinal plants which has been used to treat many diseases including hypercholesterolemia in some folk medicines. The aim of this study was to examine the effect of dietary supplementation with crushed black seed on serum lipid profile, body weight and food intake in hyperlipidemic rabbits. Twenty-four New Zealand male rabbits after 2 weeks of adaptation received a hypercholesterolemic diet with 0.5% cholesterol for 1 month. Then the rabbits were randomly assigned into two groups, the control group was continued on the 0.5% cholesterol diet and the black seed group received 7.5 g/kg bw/day crushed black seed along with the 0.5% cholesterol diet, for 2 months. The diets were isocaloric and isonitrogenous. Fasting blood sampling and measurement of body weight was carried out at baseline, after hyperlipidemia, 1 month and 2 months of treatment and the levels of serum lipid profile were determined. Daily food intake also was measured by subtracting the given food from its residues. The concentrations of serum TC, TG, LDL-C, TC/HDL-C and LDL.C/ HDL-C were significantly lower in black seed group as compared to the control group during the 2 months of treatment, but there was no significant difference in body weight and food intake between the two groups. According to these findings, dietary black seed favorably decreased serum lipid profile in hyperlipidemic rabbits; therefore, black seed may be used as a useful therapy for hyperlipidemia

Effects of combined administration of lipoic acid and pyridoxine on albuminuria, oxidative stress, blood pressure, serum advanced glycated end products, nitric oxide and endothelin-1 in patients with diabetic nephropathy

Diabetic nephropathy is the most common cause of kidney failure. High serum concentrations of advanced glycated end products, oxidative stress, and hypertension are three important risk factors for diabetic nephropathy. As individual administration of lipoic acid or pyridoxine is not effective in improving diabetic nephropathy, the present study was designed to investigate the effects of combined administration of lipoic acid and pyridoxine on albuminuria, oxidative stress, blood pressure, serum advanced glycated end products, nitric oxide and endothelin-1 in patients with diabetic nephropathy. The study was a double-blind randomized clinical trial, in which 38 patients with diabetic nephropathy [23 females and 15 males] were randomly assigned to either a supplement-taking group or a placebo group. The patients in the supplement group received 800 mg lipoic acid and 80 mg pyridoxine daily for 12 weeks, while the placebo group received placebos. At baseline and at the end of week 12, a urine sample and 8 ml blood were collected from each patient after a 12- to 14-hour fast and serum pentosidine, carboxymethyl lysine, malondialdehyde, endothelin-1, nitric oxide, glucose, urinary albumin, systolic and diastolic blood pressures were measured. The serum concentrations of pentosidine and carboxymethyl lysine decreased significantly in the supplement-taking group at the end of week 12 as compared to the baseline values [P<0.05] The combined supplement also brought about significant reductions in the serum malondialdehyde [25%], systolic blood pressure [2 mmHg] and urinary albumin concentration [74 mg/g creatinine]; the reductions were significantly different from the placebo group values [P<0.05]. On the other hand, the serum nitric oxide concentration increased significantly in the supplement-taking group as compared to the placebo group [P<0.05]. No significant differences were observed between the two groups in the mean changes of serum endothelin-1, glucose or diastolic blood pressure. The results indicate that combined administration of lipoic acid and pyridoxine reduces significantly serum pentosidine, carboxymethyl lysine, malondialdehyde, systolic blood pressure and urinary albumin concentration, and increases serum nitric oxide. This treatment may, thus, have an effective role in retarding the progression of diabetic nephropathy

[Effects of combined administration of lipoic acid and pyridoxine on serum systemic and vascular inflammatory factors in patients with diabetic nephropathy]

Systemic and vascular inflammation are two risk factors for the development of diabetic nephropathy. In diabetic patients, serum systemic and vascular inflammatory factors have positive correlations with albuminuria. The present study was designed to investigate the effects of combined administration of lipoic acid and pyridoxine on the serum concentrations of these factors in patients with diabetic nephropathy. The study was a double-blind randomized clinical trial in which 38 patients with diabetic nephropathy [23 females and 15 males] were randomly assigned to either the supplement-taking or the placebo group. The patients in the supplement group received 800 mg lipoic acid and 80 mg pyridoxine daily for 12 weeks, while the placebo group received corresponding placebos. At baseline and the end of week 12, a urine sample and 10 ml blood was collected from each patient after a 12 to 14-hour fast and serum high sensitive C-reactive protein [hs-CRP], soluble intercellular adhesion molecule type 1 [sICAM-1], soluble vascular cell adhesion molecule type 1 [sVCAM-1], sE-selectin, Interleukine-6 [IL-6], glucose, percent of blood hemoglobin A1c and urinary albumin were measured. In the present study, no significant differences were observed between the two groups in mean changes of hs-CRP, IL-6, sICAM-1, sVCAM-1, sE-selectin, glucose, percent of blood hemoglobin A1c. Mean urinary albumin concentration decreased significantly in the supplement-taking group at the end of week 12, compared to the baseline [P<0.05] and the reduction was significant in comparison with the placebo group [P<0.05]. The results of the present study indicate that combined administration of lipoic acid and pyridoxine has no effect on serum systemic and vascular inflammatory factors, but it reduces urinary albumin concentration significantly. Therefore, combined administration of lipoic acid and pyridoxine may have an effective role in retarding the progression of diabetic nephropathy with a mechanism different from the effects of these supplements on inflammation

Effects of delta3-fatty acid supplement on serum lipids and lipoproteins in hemodialysis patients

Background and Purpose: Research on non-hemodialysis patients has shown that ?3-fatty acid supplement can reduce the concentration of serum Lp[a]. Therefore, the present study was designed to investigate the effects of?3-fatty acid supplement on serum lipids and lipoproteins in hemodialysis patients

Methods and Materials: This double-blind randomized clinical trial was conducted on 40 hemodialysis patients in 2008 in Vase'i Hospital in Sabzevar, Iran; they were randomly assigned to either ?3-fatty acid supplement or placebo group. Patients in the ?3-fatty acid supplement group received 2080 mg ?3-fatty acid daily as 4 capsules, while the placebo group received 4 corresponding placebo capsules containing MCT oil. At baseline and the end of week 10 of the study, 5 ml blood samples were collected from each patient after a 12 to 14-hour fasting before dialysis; their serum triglyceride, total cholesterol, LDL-C, HDL-C and Lp[a] were measured. The obtained data were analyzed in SPSS using Chi-square, t-test, 32?paired t-test and ANOVA

Results: Serum triglyceride concentration were 113 19 in the supplement and placebo groups respectively in the beginning and 109 17 at the end of week 10. The reduction?25 and 115?the amounts decreased to 101 was significant in the supplement group [p<0.01] and the difference between the supplement and placebo group was significant [P<0.0.006]. However, no significant differences were observed between the two groups as for the changes of serum total cholesterol, LDL-C, HDL-C and Lp[a] concentrations [P>0.05]

Conclusion: Results of the present study indicate that ?3-fatty acid supplement can reduce serum triglyceride concentration in hemodialysis patients but it does not affect other serum lipids and lipoproteins in hemodialysis patients

[Effects of dietary omega 3-fatty acid supplementation on the serum systemic and vascular inflammation markers in hemodialysis patients]

High serum concentrations of systemic and vascular inflammation markers are two major risk factors for cardiovascular diseases in hemodialysis patients. The present study was designed to investigate the effects of dietary omega 3-fatty acid supplementation on the serum systemic and vascular inflammation markers in these patients. The study was a double-blind randomized clinical trial. Forty hemodialysis patients were randomly assigned to either an omega 3-fatty acid supplement or a placebo group. The patients in the omega 3-fatty acid supplement group received 2080 mg omega 3-fatty acids as 4 capsules, each containing 310 mg eicosapentaenoic acid and 210 mg docosahexaenoic acid, daily for 10 weeks, while the placebo group received 4 corresponding placebo capsules containing MCT oil. At baseline and the end of week 10 of the study, 7 ml blood was collected from each patient after a 12- to 14-hour fast before dialysis and serum sICAM-1, sVCAM-1, sE-selectin, sP-selectin, CRP, IL-6, TNF-alpha, malondealdehyde [MDA] and total antioxidant capacity [TAC] were measured. Serum sICAM-1 concentration decreased significantly in the omega 3-fatty acid supplement group at the end of week 10, compared to the baseline value [P<0.05]; the reduction was also significant in comparison with the decrease in placebo group [P<0.05]. No significant differences were observed between the two groups with regard to the mean changes in the serum sVCAM-1, sE-selectin, sP-selectin, CRP, IL-6, TNF-alpha, MDA, and TAC concentrations. The results of the present study indicate that dietary omega 3-fatty acid supplements can reduce serum sICAM-1 concentration in hemodialysis patients, but it has no effect on serum systemic inflammation markers and oxidative stress

Effects of L-carnitine supplementation on serum lipids and apoproteins in hemodialysis patients with LP[a] hyperlipoproteinemia

Lipid abnormalities, especially high serum Lp[a] concentrations, are one of the major causes of cardiovascular diseases in hemodialysis patients. The present study was designed to investigate the effects of L-carnitine supplementation on serum lipids and apoproteins in hemodialysis patients with Lp[a] hyperlipoproteinemia. The study was a randomized clinical trial in which 36 hyper Lp[a] hemodialysis patients [23 males and 13 females] with serum Lp[a] more than 30 mg/dl were randomly assigned to receive either a daily oral carnitine supplement of 1000mg [carnitine group] or no supplement [control group] for 12 weeks. At the baseline and the end of the period 5ml blood were collected after a 12 to 14-hour fast from each patient before dialysis and serum free carnitine, triglyceride, total cholesterol, HDL-C, LDL-C, apoAI, apoB100, Lp[a], IL-6 and albumin were measured. As compared to the initial values, the mean serum free carnitine concentration increased significantly in the carnitine group at the end of the period [P<0.001], while serum triglyceride [P<0.05], total cholesterol [P<0.001] and IL-6 [P<0.001] decreased significantly. No significant changes were observed in the serum concentrations of free carnitine, triglyceride, total cholesterol and IL-6 in the control group. In addition, there were no significant differences between the 2groups as regards mean changes of the serum HDL-C, LDL-C, apoAI, apoB100, Lp[a], and albumin levels. The results of the present study indicate that an L-carnitine supplement has no effect on serum Lp[a] concentration in hemodialysis patients with Lp[a] hyperlipoproteinemia, but it may be effective in preventing cardiovascular diseases by reducing serum triglyceride and total cholesterol concentrations in these patients

[Effects of L-carnitine supplements on inflammatory cytokines, CRP and oxidative stress in hemodialysis patients]

Inflammation and oxidative stress are common in patients with chronic renal disease, including hemodialysis patients. The present study was designed to investigate the effects of L-carnitine supplements on inflammatory cytokines, CRP and oxidative stress in hemodialysis patients. The study was a randomized clinical trial. Thirty-six hemodialysis patients, [23 males and 13 females], were randomly assigned to either carnitine group or the control group. The patients in the carnitine group received 1000 mg/d oral L-carnitine for 12 weeks while the control group did not receive any L-carnitine supplement during the study. At the baseline and the end of 12th week of the study, 5 ml. blood was collected after a 12 to 14-hour fast from each patient before dialysis and then serum free carnitine, CRP, IL-1beta, IL-6, TNF-alpha and ox-LDL were measured. Mean serum free carnitine concentration increased significantly, by 86%, in the carnitine group at the end of 12th week as compared to the baseline [P<0.001], while serum CRP and IL-6 decreased significantly, by 29% [P<0.05] and 61% [P<0.001], respectively. No significant changes were observed in the serum concentrations of free carnitine, CRP and IL-6 in the control group during the study. There were no significant differences between mean changes of serum IL-1beta, TNF-alpha and ox-LDL concentrations in the two groups. This study indicated that L-carnitine supplement could improve carnitine deficiency and decrease inflammatory markers of CRP and IL-6 in hemodialysis patients

[Effects of combination of vitamin E and nicotinic acid on serum lipids and apoproteins of hypertriglyceridemic hemodialyzed patients]

Oxidative stress and lipid abnormalities are two major risk factors for development of atherosclerosis among hemodialyzed patients. Administrating of Lipidnormalising agents, solely or in combination together, can not correct all lipid abnormalities in hemodialyzed patients. The present study, therefore, was desinged to evaluate the effects of combination therapy of vitamin E and tolerable doses of nicotinic acid on serum lipids and apoproteins in hypertriglyceridemic hemodialyzed patients. The study was a double-blind randomized clinical trial. Thirty-nine hemodialyzed patients with fasting triglyceride range between 230 and 500 mg/dl were randomly assigned into three groups, receiving combination of vitamin E [600mg/d] and nicotinic acid [500mg/d], nicotinic acid alone [500mg/d], and placebo, respectively. All patients received their supplements for 13 weeks. The blood samples were collected after a 12 to 14-hour duration of fasting at the beginning of the study, followed by other samplings performed at the end of sixth and thirteenth weeks, respectively, and serum lipids and apoproteins were measured. accordingly. During the study, the mean serum triglyceride level was significantly reduced in the group receiving combination therapy of vitamin E and nicotinic acid, compared to the placebo group. Compared to that of placebo group, mean serum HDL-C levels were significantly increased two groups of combination therapy, and nicotinic acid alone, although LDL-C/HDL-C ratios were significantly decreased. There was no significant difference in the means of total cholesterol of serum, LDL-C, apoAI, apoB100 and Lp[a] between three groups. It is concluded that combination therapy of vitamin E and nicotinic acid in hypertriglyceridemic hemodialyzed patients can result in improvement in almost every lipid abnormalities, but except high levels of Lp[a]

[Comparison of the effects of rice bran and wheat bran on serum lipid profiles in hypercholesterolernic women]

Cardiovascular diseases are the most important causes of mortality in Iran. Hypercholesterolemia is one of the major risk factors for cardiovascular diseases. Dietary modification such as cereal bran consumption is an approach to reduce this risk factor. The purpose of this present study was to compare the effects of rice bran and wheat bran on serum lipids in hypercholesterolemic women. This study was a randomized clinical trial in which 19 women aged 35-65 years with fasting serum total cholesterol 240-300 mg/dl randomly allocated in two groups of wheat bran and rice bran. All subjects recieved 40 g/day bran in addition to their usual diet for 4 weeks. Anthropometric measurements, dietary assessments by using a 24-hr dietary recall questionnaire and determination of serum lipids were done at the beginning and the end of the study. Data were statistically analyzed by t-test and paired t-test. There were no significant differences between groups for mean body weight, BMI and dietary confounding factors. During 4 weeks, wheat bran significantly reduced serum total cholesterol and LDL-C by 11% and 21% respectively [P<0.01] but rice bran had no effects on these parameters. No significant changes were found in mean serum triglyceride, HDL-C levels, LDL-C/ HDL-C and total cholesterol/ HDL-C ratios in both groups. It is concluded that wheat bran have benefical effects on serum total cholesterol and LDL-C levels in hypercholesterolemic women in comparision with rice bran