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

Abstract

tilakavati Karupaiah 10* & patcH investigators * 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 (Hf dp), Sugar-sweetened beverages (SSB dp), and Eating out noodles (eo-n dp). The highest tertile of patients in HF (T3-HF dp) 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-SSB dp 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-N dp 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-SSB dp 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-SSB dp. The SSB dp was associated with greater consumption of inorganic phosphate and higher serum phosphorus levels.

A Mobile App for Triangulating Strategies in Phosphate Education Targeting Patients with Chronic Kidney Disease in Malaysia: Development, Validation, and Patient Acceptance

“…The PMA features enabled offline mode use, whereas data synchronization and educational videos required internet access. Initially, the food database was restricted to food patterns yielding 335 foods prevalent amongst the Klang Valley HD population [ 43 , 44 ]. However, the continuous virtual real-time updates of foods not in the database resulted in 471 new food items added through the users’ feedback.…”

“…The nutrient values used in this food database were derived from the Malaysian Food Composition 4 and Singapore Food Composition 5 databases. The PMA food choices reflected typical food intake patterns of Malay, Chinese, and Indian patients living in the Klang Valley [ 43 , 44 ].…”

Effectiveness of a Nutritional Mobile Application for Management of Hyperphosphatemia in Patients on Hemodialysis: A Multicenter Open-Label Randomized Clinical Trial

“…We observed significant reductions of more than ~20% in dietary phosphorus intakes for both groups. Despite protein food sources being the prime source of phosphorus, the post-3-months dietary protein intakes remained consistent with baseline values for both groups, suggesting that the dietary phosphorus reduction was likely due to the reduced consumption of non-protein sources of phosphorus, such as carbonated beverages and sugar-sweetened beverages, which are common in this patient population [ 31 ]. In tandem, the PPR was significantly reduced in both groups, with a large effect, and comparatively, a 1.7 times greater reduction was noted for UG patients, though not reaching statistical significance.…”

Phosphate intake and removal in predominantly vegetarian patients on twice-weekly hemodialysis

“…Home food–based diets, even when these diets had animal proteins, did not result in similar elevations in serum phosphorus levels. [ 13 ] These findings are pertinent, as predominantly plant-based sources contribute to both dietary protein and phosphorus content of a majority of dialysis patients in our region. [ 14 ] Only a few earlier studies have assessed dietary phosphorus intake in this region and none have assessed it in the dialysis population.…”