Association of dietary patterns with serum phosphorus in maintenance haemodialysis patients: a cross-sectional study

Ban-Hock Khor,Tilakavati Karupaiah,Ravindran Visvanathan,Soo Kun Lim,Sunita Bavanandan,Pramod Khosla,Bak-Leong Goh,Angela Yee-Moon Wang,Angela Yee-Moon Wang,Mohammad Zaimi Abdul Wahab,Boon Cheak Bee,Zaki Morad,Ayesha Sualeheen,Sharmela Sahathevan,Abdul Halim Abdul Gafor,Karuthan Chinna,Rosnawati Yahya,Ghazali Ahmad,Zulfitri Azuan Mat Daud

doi:10.1038/s41598-020-68893-4

Abstract

Sources of dietary phosphate differentially contribute to hyperphosphatemia in maintenance haemodialysis (MHD) patients. This cross-sectional study in Malaysia investigated association between dietary patterns and serum phosphorus in MHD patients. Dietary patterns were derived by principal component analysis, based on 27 food groups shortlisted from 3-day dietary recalls of 435 MHD patients. Associations of serum phosphorus were examined with identified dietary patterns. Three dietary patterns emerged: Home foods (HFdp), Sugar-sweetened beverages (SSBdp), and Eating out noodles (EO-Ndp). The highest tertile of patients in HF (T3-HFdp) pattern significantly associated with higher intakes of total protein (p = 0.002), animal protein (p = 0.001), and animal-based organic phosphate (p < 0.001), whilst T3-SSBdp patients had significantly higher intakes of total energy (p < 0.001), inorganic phosphate (p < 0.001), and phosphate:protein ratio (p = 0.001). T3-EO-Ndp patients had significantly higher intakes of total energy (p = 0.033), total protein (p = 0.003), plant protein (p < 0.001), but lower phosphate:protein ratio (p = 0.009). T3-SSBdp patients had significantly higher serum phosphorus (p = 0.006). The odds ratio of serum phosphorous > 2.00 mmol/l was significantly 2.35 times higher (p = 0.005) with the T3-SSBdp. The SSBdp was associated with greater consumption of inorganic phosphate and higher serum phosphorus levels.

Highlights

Sources of dietary phosphate differentially contribute to hyperphosphatemia in maintenance haemodialysis (MHD) patients
Sugar sweetened beverages 0.135 0.160 0.025. In this cross-sectional study of 435 MHD patients, three dietary patterns emerged through the à posteriori approach, namely Home FoodDP, SSBDP, and Eating-out N oodleDP
For the present study, which led to retention of only three dietary patterns, with the SSBDP accounting for the highest variance (45.3%)

Summary

Introduction

Sources of dietary phosphate differentially contribute to hyperphosphatemia in maintenance haemodialysis (MHD) patients This cross-sectional study in Malaysia investigated association between dietary patterns and serum phosphorus in MHD patients. The highest tertile of patients in HF (T3-HFdp) pattern significantly associated with higher intakes of total protein (p = 0.002), animal protein (p = 0.001), and animal-based organic phosphate (p < 0.001), whilst T3-SSBdp patients had significantly higher intakes of total energy (p < 0.001), inorganic phosphate (p < 0.001), and phosphate:protein ratio (p = 0.001). Inorganic phosphates are salts that readily disassociate in the stomach, and as a result > 90% are absorbed[7] Based on this understanding, the current approach in patient education should focus on choosing fresh food that contains phosphate with lower bioavailability, whereas avoiding food products with phosphate-containing a dditives[4,8]. In contrast to a singular nutrient/food-based approach, the dietary pattern-based approach takes into account that human food consumption falls into patterns reflecting a complex combination of dietary components and nutrients that are likely to have synergistic and competitive interactions[11]

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