Abstract
BackgroundMetabolic syndrome (MetS) has been established as a risk for cardiovascular diseases and mortality in hemodialysis patients. Energy intake (EI) is an important nutritional therapy for preventing MetS. We examined the association of self-reported dietary EI with metabolic abnormalities and MetS among hemodialysis patients.MethodsA cross-sectional study design was carried out from September 2013 to April 2017 in seven hemodialysis centers. Data were collected from 228 hemodialysis patients with acceptable EI report, 20 years old and above, underwent three hemodialysis sessions a week for at least past 3 months. Dietary EI was evaluated by a three-day dietary record, and confirmed by 24-h dietary recall. Body compositions were measured by bioelectrical impedance analysis. Biochemical data were analyzed using standard laboratory tests. The cut-off values of daily EI were 30 kcal/kg, and 35 kcal/kg for age ≥ 60 years and < 60 years, respectively. MetS was defined by the American Association of Clinical Endocrinologists (AACE-MetS), and Harmonizing Metabolic Syndrome (HMetS). Logistic regression models were utilized for examining the association between EI and MetS. Age, gender, physical activity, hemodialysis vintage, Charlson comorbidity index, high sensitive C-reactive protein, and interdialytic weight gains were adjusted in the multivariate analysis.ResultsThe prevalence of inadequate EI, AACE-MetS, and HMetS were 60.5%, 63.2%, and 53.9%, respectively. Inadequate EI was related to higher proportion of metabolic abnormalities and MetS (p < 0.05). Results of the multivariate analysis shows that inadequate EI was significantly linked with higher prevalence of impaired fasting glucose (OR = 2.42, p < 0.01), overweight/obese (OR = 6.70, p < 0.001), elevated waist circumference (OR = 8.17, p < 0.001), AACE-MetS (OR = 2.26, p < 0.01), and HMetS (OR = 3.52, p < 0.01). In subgroup anslysis, inadequate EI strongly associated with AACE-MetS in groups of non-hypertension (OR = 4.09, p = 0.004), and non-cardiovascular diseases (OR = 2.59, p = 0.012), and with HMetS in all sub-groups of hypertension (OR = 2.59~ 5.33, p < 0.05), diabetic group (OR = 8.33, p = 0.003), and non-cardiovascular diseases (OR = 3.79, p < 0.001).ConclusionsInadequate EI and MetS prevalence was high. Energy intake strongly determined MetS in different groups of hemodialysis patients.
Highlights
The prevalence of treated end-stage renal disease (ESRD) has steadily increased from 2001 to 2014 in all countries, and become a burden to every nation and healthcare system [1]
Continuous data is presented as mean ± standard deviation (SD), or median bInadequate energy intake was classified as Energy intake (EI) < 30 kcal/kg/day for age 60 and above; < 35 for age less than 60 cIndependent-samples T-test, Mann-Whitney U test, or Chi-square tests are performed dMetabolic syndrome diagnosed by American Association of Clinical Endocrinologists (IFG plus any other abnormality: overweight/obese, high TG, low Highdensity lipoprotein (HDL), high blood pressure) eMetabolic syndrome diagnosed by Harmonizing Metabolic Syndrome which cause the MetS and exacerbate the dialysis outcomes [64]
CRP: high sensitive C-reactive protein, IDWG, interdialytic weight gains; BF: body fat; EI: energy intake, Ideal body weight (IBW): ideal body weight, Saturated fatty acid (SFA): saturated fatty acid, Mono-unsaturated fatty acid (MUFA): mono-unsaturated fatty acid, Poly-unsaturated fatty acid (PUFA): polyunsaturated fatty acid, Unsaturated fatty acid (UFA): unsaturated fatty acid aMetabolic syndrome diagnosed by American Association of Clinical Endocrinologists (IFG plus any other abnormality: overweight/obese, high TG, low high-density lipoprotein cholesterol (HDL-C), high Blood pressure (BP)) bMetabolic syndrome diagnosed by Harmonizing Metabolic Syndrome Significant level at * p < 0.05, ** p < 0.01, *** p < 0.001
Summary
The prevalence of treated end-stage renal disease (ESRD) has steadily increased from 2001 to 2014 in all countries, and become a burden to every nation and healthcare system [1]. It was summarized that nutritional factor was implicated as a risk factor for the development of metabolic in chronic kidney disease, especially in ESRD patients [2]. Nutritional therapy is recognized as an effective approach to prevent metabolic abnormalities and unfavorable outcomes in people with chronic conditions [3,4,5,6,7,8]. Increased dietary energy intake is mentioned in the National Kidney Foundation-Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines [9]. It is recommended that consuming enough energy daily guarantees the nitrogen balance and prevents protein catabolism and tissue destruction, which could optimize the nutritional status and hemodialysis outcomes [9]. Energy intake (EI) is an important nutritional therapy for preventing MetS. We examined the association of self-reported dietary EI with metabolic abnormalities and MetS among hemodialysis patients
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