Willingness to change diet and exercise behavior is associated with better lifestyle in dialysis patients close to a kidney transplant.

BACKGROUND & AIMS: Evidence suggests that multiple-behavior interventions (with a specialist) have a greater impact on public health than single-behavior interventions, particularly in a chronic patient. However, there is little understanding of some very basic principles concerning multiple health behavior change, especially in situations such as kidney transplantation, which requires a great willingness to change negative lifestyle behaviors to achieve intermediate and long-term success. We compared healthy lifestyles and nutritional status according to the willingness to change dietary and exercise behavior in dialysis patients from a living donor kidney transplant program. METHODS: 400 dialysis patients had a dietetic, anthropometric, protein-energy wasting [subjective global assessment (SGA)] and biochemical evaluation. Lifestyle was evaluated with an adapted instrument to measure lifestyle in chronic disease. Willingness to change behaviors was evaluated by the trans-theoretical model; 2 groups were formed: willingness to change dietary and exercise behaviors and unwillingness to change. RESULTS: Willingness to change dietary behavior was 50% and exercise 25%. Patients with willingness to change dietary and exercise behaviors had better healthy lifestyle scores, and higher frequency of healthy food consumption. Healthy lifestyle score (R2 = 0.37, p < 0.0001) was predicted by older age, higher educational degree, shorter time on dialysis, and the highest willingness to change dietary and exercise behaviors. CONCLUSIONS: Willingness to change dietary and exercise behaviors was associated with healthy lifestyle, as well as with higher frequency of healthy food consumption and with lower frequency of unhealthy food consumption.

Interleukine 6 and C-reactive protein predict growth impairment and acute malnutrition in children and adolescents with chronic kidney disease / La interleucina 6 y la proteína C-reactiva predicen el retraso del crecimiento y la desnutrición aguda en niños y adolescentes con enfermedad renal crónica

Objective: secondary malnutrition and systemic inflammation may impair growth and body composition in children and adolescents with chronic kidney disease (CKD). This association has been scantily studied, particularly in pre-dialytic stages. Our aim was to correlate growth and nutritional status indicators with the serum concentration of interleukine 6 (IL-6) and ultrasensitive C-reactive protein (CRP) in children with CKD. Methods: this was a prospective cross-sectional study in 29 children and adolescents aged 3-16 years with CKD, stages 3 or 4, in two third-level general hospitals. The outcome variables were height for age, body mass index, arm anthropometric indicators, plus lean mass/fat percentage by bioelectrical impedance. The independent variables were IL-6 and CRP. This study was reviewed and approved by the Health Research and Ethics Committees of both hospitals. Results: height for age, body mass index, subscapular skinfold, arm fat area, and lean mass had a significant negative correlation with IL-6. The height-for-age z-score had a negative correlation with CRP. IL-6 explained 15% to 35% of the variance in height for age and nutritional status indicators. CRP predicted 22% of height for age. One fifth of the patients had acute malnutrition, and one third were stunted. Muscle was the most affected compartment. Conclusion: IL-6 and CRP in children and adolescents with CKD in the pre-dialytic stage predicted one fifth and one third of the variance in acute and chronic malnutrition indicators. The frequency of acute malnutrition and impaired growth was considered clinically significant. Muscular mass deficit was a central component of malnutrition

Objetivo: correlacionar indicadores de crecimiento y del estado nutricional con la concentración sérica de interleucina 6 (IL-6) y proteína C-reactiva ultrasensible (PCR) en niños con enfermedad renal crónica (ERC). Métodos: estudio transversal analítico de 29 niños y adolescentes de 3 a 16 años de edad con ERC, estadios 3 o 4, en dos hospitales generales de tercer nivel. Las variables dependientes fueron indicadores antropométricos de crecimiento y del estado nutricional y la composición corporal por impedancia bioeléctrica. Las variables independientes fueron IL-6 y PCR. Este estudio fue revisado y aprobado por los Comités de Ética y de Investigación de ambos hospitales. Resultados: la talla para la edad (T/E), el índice de masa corporal, el pliegue cutáneo subescapular, el área de grasa del brazo y la masa magra obtuvieron una correlación negativa con la IL-6. La T/E obtuvo una correlación negativa con la PCR. La IL-6 explicó el 15% y 35% de la varianza de la T/E y de los indicadores del estado nutricional. La CRP predijo el 22% de la T/E. Una quinta parte de los pacientes tenía desnutrición aguda y una tercera parte desmedro. El compartimento corporal más afectado fue el muscular. Conclusión: la IL-6 y la PCR en niños y adolescentes con ERC en etapa predialítica explicaron una quinta y una tercera parte de la varianza de los indicadores de desnutrición aguda y crónica, respectivamente. La frecuencia de la desnutrición aguda y el desmedro fueron clínicamente significativos. El déficit de masa muscular fue un componente central de la desnutrición

Interleukine 6 and C-reactive protein predict growth impairment and acute malnutrition in children and adolescents with chronic kidney disease.

INTRODUCTION: Objective: secondary malnutrition and systemic inflammation may impair growth and body composition in children and adolescents with chronic kidney disease (CKD). This association has been scantily studied, particularly in pre-dialytic stages. Our aim was to correlate growth and nutritional status indicators with the serum concentration of interleukine 6 (IL-6) and ultrasensitive C-reactive protein (CRP) in children with CKD. Methods: this was a prospective cross-sectional study in 29 children and adolescents aged 3-16 years with CKD, stages 3 or 4, in two third-level general hospitals. The outcome variables were height for age, body mass index, arm anthropometric indicators, plus lean mass/fat percentage by bioelectrical impedance. The independent variables were IL-6 and CRP. This study was reviewed and approved by the Health Research and Ethics Committees of both hospitals. Results: height for age, body mass index, subscapular skinfold, arm fat area, and lean mass had a significant negative correlation with IL-6. The height-for-age z-score had a negative correlation with CRP. IL-6 explained 15% to 35% of the variance in height for age and nutritional status indicators. CRP predicted 22% of height for age. One fifth of the patients had acute malnutrition, and one third were stunted. Muscle was the most affected compartment. Conclusion: IL-6 and CRP in children and adolescents with CKD in the pre-dialytic stage predicted one fifth and one third of the variance in acute and chronic malnutrition indicators. The frequency of acute malnutrition and impaired growth was clinically significant. Muscular mass deficit was a central component of malnutrition.

INTRODUCCIÓN: Objetivo: correlacionar indicadores de crecimiento y del estado nutricional con la concentración sérica de interleucina 6 (IL-6) y proteína C-reactiva ultrasensible (PCR) en niños con ERC. Métodos: estudio transversal analítico de 29 niños y adolescentes de 3 a 16 años de edad con ERC, estadios 3 o 4, en dos hospitales generales de tercer nivel. Las variables dependientes fueron indicadores antropométricos de crecimiento y del estado nutricional y la composición corporal por impedancia bioeléctrica. Las variables independientes fueron IL-6 y PCR. Este estudio fue revisado y aprobado por los Comités de Ética y de Investigación de ambos hospitales. Resultados: la talla para la edad (T/E), el índice de masa corporal, el pliegue cutáneo subescapular, el área de grasa del brazo y la masa magra obtuvieron una correlación negativa con la IL-6. La T/E obtuvo una correlación negativa con la PCR. La IL-6 explicó el 15% y 35% de la varianza de la T/E y de los indicadores del estado nutricional. La CRP predijo el 22% de la T/E. Una quinta parte de los pacientes tenía desnutrición aguda y una tercera parte desmedro. El compartimento corporal más afectado fue el muscular. Conclusión: la IL-6 y la PCR en niños y adolescentes con ERC en etapa predialítica explicaron una quinta y una tercera parte de la varianza de los indicadores de desnutrición aguda y crónica, respectivamente. La frecuencia de la desnutrición aguda y el desmedro fueron clínicamente significativos. El déficit de masa muscular fue un componente central de la desnutrición.

Effects of a symbiotic on gut microbiota in Mexican patients with end-stage renal disease.

OBJECTIVES: Gut microbiota provides beneficial effects under physiological conditions, but is able to contribute to inflammatory diseases in susceptible individuals. Thus, we designed this study to test whether additional intake of symbiotic gel affects specific modifications of gut microbiota in patients with end-stage renal disease (ESRD). METHODS: Eighteen patients with ESRD diagnosis with renal replacement therapy (hemodialysis) were included in this study. They were randomly assigned to 2 treatment groups: (1) test group (nutritional counseling + symbiotic) and (2) control group (nutritional counseling + placebo). Clinical history and the evaluation of Gastrointestinal Symptom Rating Scale were performed. Gut microbiota composition was analyzed by real-time polymerase chain reaction from fecal samples. All subjects were followed for 2 months. RESULTS: Bifidobacterial counts were higher in the second samples (mean: 5.5 ± 1.72 log10 cells/g) than in first samples (4.2 ± 0.88 log 10 cells/g) in the patients of the test group (P = .0344). Also, lactobacilli counts had a little decrease in the test group (2.3 ± 0.75 to 2.0 ± 0.88 log 10 cells/g) and the control group (2.2 ± 0.90 to 1.8 ± 1.33 log 10 cells/g), between the first and the second samples. Gastrointestinal symptoms scores (scale 8-40) were reduced in the test group (start 12 [10-14] and end 9 [8-10]) compared with control group (start 11 [8-21] and end 11 [9-15]). CONCLUSIONS: Short-term symbiotic treatment in patients with ESRD can lead to the increase of Bifidobacterium counts, maintaining the intestinal microbial balance.