Chronic hemodialysis patients: A comparison of clinical, laboratory and nutritional parameters among elderly and non-elderly patients

ABSTRACT Aim: To compare nutritional, clinical and laboratory parameters data among elderly and non-elderly patients on hemodialysis. Methods: It is a cross-sectional study, with a sample of 34 patients (17 non-elderly participants between 18 to 59 years of age, and 17 elderly participants aged 60 years or older), from the Nephrology Unit, Hospital Santa Casa de Misericórdia, Pelotas/RS/BR. Demographic, socioeconomic, clinical, laboratory, anthropometric data and information on food consumption were collected. Results: Most elderly and non-elderly patients had low income and education. Among elderly participants, weight values, pre and post-dialysis, interdialytic weight gain, median diastolic blood pressure pre and post-dialysis and urea, were higher than among the non-elderly. About 65% of the non-elderly and 70.6% of the elderly subjects had inadequate caloric intake. The same occurred with protein intake, for which 58.8% of the non-elderly and 82.3% of the elderly patients presented inadequate protein intake. Conclusion: There was a tendency of weight gain in the elderly, which may increase the risks of treatment. Evidence indicates an association between the intake of energy and protein in the diet of patients on hemodialysis, requiring an adequate diet and dialysis, in order to avoid complications related to kidney disease.

RESUMEN Objetivos: Comparar parámetros nutricionales, clínicos y de laboratorio de pacientes ancianos y no ancianos sometidos a hemodiálisis. Métodos: Estudio transversal, realizado con una muestra de 34 pacientes, de los cuales 17 eran no ancianos de 18 años y más y menos de 60 años y 17 ancianos de 60 años y más, de la Unidad de Nefrología del Hospital Santa Casa. de Misericórdia de Pelotas / RS / BR. Se recopilaron datos demográficos, socioeconómicos, clínicos, de laboratorio, antropométricos y de consumo de alimentos. Resultados: La mayoría de los pacientes ancianos y no ancianos eran de bajos ingresos y educación. En los ancianos, se encontraron valores de peso, pre y posdiálisis, aumento de peso interdialítico, mediana de la presión arterial diastólica pre y posdiálisis y urea más alta en comparación con los no ancianos. Aproximadamente el 65% de las personas no ancianas y el 70,6% de las personas mayores presentaban una ingesta calórica inadecuada, lo mismo ocurrió con la ingesta proteica, donde el 58,8% de las personas no ancianas y el 82,3% de las personas mayores presentaban una ingesta proteica inadecuada. Conclusión: Hubo una tendencia al aumento de peso en los ancianos, lo que puede traer riesgos al tratamiento. La evidencia indica una asociación entre la ingesta energética y proteica en la dieta de pacientes en hemodiálisis, requiriendo adaptación de la dieta y diálisis para evitar complicaciones relacionadas con la enfermedad renal.

Influence of nutritional factors and the PON1 C(-107)T polymorphism on paraoxonase-1 activity in childhood / Influência de fatores nutricionais e do polimorfismo PON1 C(-107)T sobre a atividade da Paraoxonase 1 na infância

Abstract Objective: The cardioprotective enzyme paraoxonase-1 (PON1) suffers an important influence from genetic polymorphisms and nutritional factors. The aim of this study was to investigate the influence of diet, nutritional status, and the C(-107)T polymorphism on PON1 arylesterase activity in children. Methods: This was a cross-sectional study with 97 children, aged between 5 and 8 years, of both genders, from a pediatric outpatient clinic in southern Brazil. A sociodemographic, behavioral, and food consumption questionnaire was applied, and anthropometric measurements and laboratory blood samples were taken. PON1 arylesterase activity was measured by phenol extinction (U/mL), and DNA extraction and analysis of the PON1 C(-107)T polymorphism were performed. The Hardy-Weinberg equilibrium was tested with the chi-squared test and linear regression was used to estimate PON1 activity according to four adjustment models, with an acceptable error of 5%. Results: In the sample, the male gender accounted for 50.5%, 39.2% were 6 years of age, 54.5% had normal weight, and 51.5% had PON1 activity below the median (90.0, 15-30 U/mL). Genotype frequency was 54.6% (53/97), 31.0% (30/97), and 14.4% (14/97), respectively, for CT, CC, and TT, consistent with the Hardy-Weinberg equilibrium (p = 0.22). In the regression analysis, the model that included sociodemographic variables as well as frequency of consumption of fruits, vegetables, legumes, dairy products, and beans estimated a variability of 14.8% in PON1 activity combined with the PON1 C(-107)T polymorphism. Conclusions: During childhood, a good-quality diet with greater inclusion of healthy foods was important to predict the activity of the cardioprotective enzyme PON1 combined with the C(-107)T polymorphism of the PON1 gene.

Resumo Objetivo: A enzima cardioprotetora Paraoxonase 1 (PON1) sofre importante influência de polimorfismos genéticos e fatores nutricionais. O objetivo deste estudo foi investigar a influência da alimentação, do estado nutricional e do polimorfismo C(-107)T sobre a atividade arilesterase da PON1 em crianças. Métodos: Estudo transversal com 97 crianças entre 5 e 8 anos, de ambos os sexos, de um ambulatório de pediatria no sul do Brasil. Realizou-se questionário sociodemográfico, de comportamento e de consumo alimentar, medidas antropométricas e coleta de sangue em laboratório. A atividade arilesterase da PON1 foi mensurada pela extinção de fenol (U/mL), realizada extração do DNA e análise do polimorfismo PON1 C(-107)T. O equilíbrio de Hardy-Weinberg foi testado com qui-quadrado e usada regressão linear para estimar a atividade da PON1 segundo quatro modelos de ajuste, erro aceitável de 5%. Resultados: Na amostra o sexo masculino representou 50,5%, 39,2% tinham 6 anos, 54,5% eram eutróficos e 51,5% tinha atividade da PON1 inferior à mediana (90,0;15-30 U/ml). A frequência dos genótipos foi 54,6% (53/97), 31,0% (30/97) e 14,4% (14/97), respectivamente, para CT, CC e TT, estiveram em equilíbrio de Hardy-Weinberg (p = 0,22). Na análise de regressão o modelo que incluiu variáveis sociodemográficas, de frequência do consumo de frutas, verduras, legumes, laticínios e feijões estimou uma variabilidade de 14,8% na atividade da PON1 combinada ao polimorfismo PON1 C(-107)T. Conclusões: Na infância uma alimentação de boa qualidade, com maior participação de alimentos saudáveis foi importante para predizer a atividade da enzima cardioprotetora PON1 combinada ao polimorfismo C(-107)T do gene da PON1.

Association between paraoxonase 1 (PON1) enzyme activity, PON1 C(−107)T polymorphism, nutritional status, and lipid profile in children

BACKGROUND: Paraoxonase 1 (PON1) is an enzyme that possesses anti-atherogenic and anti-inflammatory properties with serum levels determined by genetic and exogenous factors. Lower serum PON1 arylesterase activity is associated to metabolic alterations related to childhood overweight and onset and/or development of diabetes and CVD later in life. However, data on the relationship between genetic PON1 polymorphisms and nutritional status as well as lipid profile in children are limited. To investigate the distribution of the C(−107)T PON1 gene polymorphism and its relation with serum PON1 enzyme activity, nutritional status and lipid profile in children. METHODS: A cross-sectional study was performed including 73 children aged 5 to 7 years who attended public pediatric clinics. PON1 C(−107)T, arylesterase activity, body mass index for the age, and serum lipid profile were evaluated. RESULTS: PON1 activity was higher in overweight children compared to the normal weight ones (p= 0.02). The genotypic frequency did not differ between the two groups (p> 0.05). Carriers of CC genotype had higher enzyme activity than T allele carriers, and this difference was greater among normal weight children. HDL levels were higher among normal weight children carrying CC genotype, compared to those carrying the T allele (p< 0.01).CONCLUSION: The PON1 C(−107)T polymorphism is associated with higher serum enzyme activity in children, as observed previously in adults. In addition, this polymorphism also shows association to higher high density lipoprotein (HDL) levels and serum PON1 arylesterase activity in the normal weight children studied.