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

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.

Processed and ultra-processed food consumption are related to metabolic markers in hemodialysis subjects / Consumo de alimentos processados e ultraprocessados está relacionado a marcadores metabólicos em indivíduos em hemodiálise

ABSTRACT Objective To investigate the consumption of processed and ultra-processed foods and evaluate its relationship with the nutritional and metabolic status of hemodialysis patients in a single center in Brazil. Methods This cross-sectional study enrolled 73 individuals in hemodialysis (50 men and 23 women, 21-87 years-old). Clinical and lifestyle variables were assessed by a semi-structured questionnaire and dietary data by food frequency questionnaire. Anthropometric and metabolic data are collected from medical records. Results Processed and ultra-processed foods represented 11.0% of daily caloric intake, 53.0% of trans fatty acid, and 12.5% of salt consumed in the study sample. Individuals who had high intake of this food group (≥128.4g/day, median intake) had higher serum phosphorus and pre-dialysis urea values (p=0.038; p=0.013, respectively). Also, individual with higher consumption of processed meat, sausages and ready prepared food had higher pre-dialysis serum urea (p=0.021), while serum potassium was higher among the subjects who consumed more sauces and salt-based seasonings (p=0.002). Conclusion Higher consumption of processed and ultra-processed foods was associated with important biomarkers of metabolic control for hemodialysis subjects, probably due to non-health dietary composition. Nutritional guidelines and intervention strategies must be promoted to reduce consumption of these food-group in thisspecific population.

RESUMO Objetivo Investigar o consumo de alimentos processados e ultraprocessados e avaliar sua relação com o estado nutricional e metabólico de pacientes em hemodiálise em um único centro brasileiro. Métodos Este é um estudo transversal com 73 indivíduos em hemodiálise (50 homens e 23 mulheres, 21-87 anos de idade). As variáveis clínicas e de estilo de vida foram avaliados por um questionário semi-estruturado, bem como dados dietéticos por questionário de frequência alimentar. Dados antropométricos e metabólicos foram coletados de registros médicos. Resultados Os alimentos processados e ultraprocessados representaram 11,0% das calorias diárias, 53,0% dos ácidos graxos trans e 12,5% de sódio consumido na amostra estudada. Os indivíduos que tiveram alta ingestão deste grupo alimentar (≥128,4 g/dia, ingestão mediana) apresentaram maiores valores de fósforo sérico e uréia pré-diálise (p=0,038; p=0,013, respectivamente). Também, indivíduos com maior consumo de carne processada, embutidos e refeições prontas apresentaram maior ureia sérica pré-diálise (p=0,021), enquanto o potássio sérico foi maior entre os indivíduos que consumiram mais molhos e temperos á base de sal (p=0,002). Conclusão O maior consumo de alimentos processados e ultraprocessados foi associado a importantes biomarcadores de controle metabólico para indivíduos em hemodiálise, provavelmente devido à composição dietética não saudável. Orientações nutricionais e estratégias de intervenção devem ser promovidas para reduzir o consumo desses alimentos nessa população específica.

Processed and ultra-processed food consumption are related to metabolic markers in hemodialysis subjects / Consumo de alimentos processados e ultraprocessados está relacionado a marcadores metabólicos em indivíduos em hemodiálise

ABSTRACT Objective To investigate the consumption of processed and ultra-processed foods and evaluate its relationship with the nutritional and metabolic status of hemodialysis patients in a single center in Brazil. Methods This cross-sectional study enrolled 73 individuals in hemodialysis (50 men and 23 women, 21-87 years-old). Clinical and lifestyle variables were assessed by a semi-structured questionnaire and dietary data by food frequency questionnaire. Anthropometric and metabolic data are collected from medical records. Results Processed and ultra-processed foods represented 11.0% of daily caloric intake, 53.0% of trans fatty acid, and 12.5% of salt consumed in the study sample. Individuals who had high intake of this food group (≥128.4g/day, median intake) had higher serum phosphorus and pre-dialysis urea values (p=0.038; p=0.013, respectively). Also, individual with higher consumption of processed meat, sausages and ready prepared food had higher pre-dialysis serum urea (p=0.021), while serum potassium was higher among the subjects who consumed more sauces and salt-based seasonings (p=0.002). Conclusion Higher consumption of processed and ultra-processed foods was associated with important biomarkers of metabolic control for hemodialysis subjects, probably due to non-health dietary composition. Nutritional guidelines and intervention strategies must be promoted to reduce consumption of these food-group in thisspecific population.

RESUMO Objetivo Investigar o consumo de alimentos processados e ultraprocessados e avaliar sua relação com o estado nutricional e metabólico de pacientes em hemodiálise em um único centro brasileiro. Métodos Este é um estudo transversal com 73 indivíduos em hemodiálise (50 homens e 23 mulheres, 21-87 anos de idade). As variáveis clínicas e de estilo de vida foram avaliados por um questionário semi-estruturado, bem como dados dietéticos por questionário de frequência alimentar. Dados antropométricos e metabólicos foram coletados de registros médicos. Resultados Os alimentos processados e ultraprocessados representaram 11,0% das calorias diárias, 53,0% dos ácidos graxos trans e 12,5% de sódio consumido na amostra estudada. Os indivíduos que tiveram alta ingestão deste grupo alimentar (≥128,4 g/dia, ingestão mediana) apresentaram maiores valores de fósforo sérico e uréia pré-diálise (p=0,038; p=0,013, respectivamente). Também, indivíduos com maior consumo de carne processada, embutidos e refeições prontas apresentaram maior ureia sérica pré-diálise (p=0,021), enquanto o potássio sérico foi maior entre os indivíduos que consumiram mais molhos e temperos á base de sal (p=0,002). Conclusão O maior consumo de alimentos processados e ultraprocessados foi associado a importantes biomarcadores de controle metabólico para indivíduos em hemodiálise, provavelmente devido à composição dietética não saudável. Orientações nutricionais e estratégias de intervenção devem ser promovidas para reduzir o consumo desses alimentos nessa população específica.

Dietary intake as a predictor for all-cause mortality in hemodialysis subjects (NUGE-HD study).

This study aimed to identify the factors capable of mortality prediction in patients on hemodialysis, using a prospective cohort with three years of follow-up. We hypothesized that lack of clinical-metabolic control, impairment of nutritional status, and inadequate food consumption are risk factors for mortality in this population. This is a longitudinal study on a non-probabilistic sample of 85 adults and elderly patients undergoing hemodialysis, aged ≥ 18 years (66.0% male, 61.6±13.7 years). Data on anthropometric, biomarkers, body composition and food intake were obtained. Predictors of mortality were evaluated using Cox regression analysis. During the three years follow-up, 16 patients (18.8%) died. We observed that age (HR = 1.319, CI 95% = 1.131-1.538), calcium-phosphorus product (HR = 1.114, CI 95% = 1.031-1.205), ferritin (HR = 1.001, CI 95% = 1.001-1.002), nitric oxide (HR = 1.082, CI 95% = 1.006-1.164), and vitamin C intake (HR = 1.005, CI 95% = 1.001-1.009) were positively associated with mortality. Serum iron (HR = 0.717, CI 95% = 0.567-0.907), triceps skinfold thickness (HR = 0.704, CI 95% = 0.519-0.954), lean mass (HR = 0.863, CI 95% = 0.787-0.945), and the ratio of dietary monounsaturated/polyunsaturated fat (HR = 0.022, CI 95% = 0.001-0.549) were independent negative predictors of mortality. Our results suggest that dietary intake is also a predictor of mortality in patients on hemodialysis, besides nutritional status, body composition, oxidative stress, inflammation, and bone metabolism, indicating the importance of evaluation of these factors altogether for better prognosis.