Dietary Patterns and Health Outcomes among African American Maintenance Hemodialysis Patients

Abstract

The association between dietary patterns and health outcomes, such as quality of life (QOL), in maintenance hemodialysis (MHD) patients with certain racial backgrounds has not been studied in detail. QOL is a powerful outcome measure in which dietary patterns could be a modifying factor. This study is a secondary analysis examining the association between dietary patterns and health outcomes in 101 African American (AA) maintenance hemodialysis (MHD) patients participating in the Palm Tocotrienols in Chronic Hemodialysis (PATCH) study. Quality of life (QOL) was assessed using the Kidney Disease Quality of Life 36-item survey (KDQOL-36™). Blood samples were analyzed for lipids, lipoprotein subfractions, and inflammatory markers. Food intake was measured using six non-consecutive 24-h dietary recalls over 15 months. Implausible energy intake reports were screened out by comparing reported energy intake (rEI) with predicted total energy expenditure (pTEE). Cluster analysis, using the k-means algorithm, identified two distinct dietary patterns in the study population: a high "sugar sweetened beverage" pattern (hiSSB) and a low "sugar sweetened beverage pattern" (loSSB). In the hiSSB group, consumption of SSB accounted for~28% of energy intake, while SSB represented only 9% of energy intake in the loSSB group. The hiSSB group was characterized by a higher intake of total calories, sugar and percentage of kilocalories from carbohydrates, whereas the percentage of kilocalories from protein and fat was lower. While additional micronutrient intakes differed between groups (vitamin C, zinc, chromium), these were significantly lower than recommended values in the entire cohort. Patients in the hiSSB group presented with lower high-density lipoprotein cholesterol (HDL-C), lower large HDL particles and smaller low density lipoprotein (LDL) particle diameters. Antidepressant usage was significantly higher in the hiSSB group. Patients in the hiSSB group scored lower across all five KDQOL domains and scored significantly lower in the mental composite domain. MHD patients following a hiSSB dietary pattern had smaller dense LDL particles, lower HDL-C, and a lower QOL. Suboptimal intakes of fruits, vegetables, and grains as well as key micronutrients were evident in both patterns.

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

“…In the United States, a cross-sectional analysis from the National Health and Nutrition Examination Survey revealed that consumption of dairy products and cereals or grains with inorganic phosphate additives were also associated with greater serum phosphorus in the general population 26 . Contrarily, a recent dietary pattern study on African American patients on MHD did not observe significant difference in serum phosphorus level between high SSB DP and low SBB DP , likely due to a smaller sample size, a homogenous population and different food selection 45 .…”

Frequency of intake of dietary fiber food groups, its determinants, and the relationship with hyperkalemia in hemodialysis patients in a multicenter study

“…Figure 1 shows the frequency of intake of ber source groups. The median score of fruits (6 [2][3][4][5][6][7][8][9][10][11][12][13][14]) and vegetables (6 [3][4][5][6][7][8][9][10]) indicates that these food groups were consumed around six times a week. A lower weekly frequency was observed for legumes (3 [1-6]), while whole grains (0 [0-1]) and seeds (0 [0-0]) were not consumed by most of the participants.…”

“…In a multinational HD cohort study, the usual intake in servings per week of fruits was (5.5 [1.0-7.0]), vegetables (3.0 [1.0-5.5]), and legumes and nuts (1.0 [0.5-3.0]) [3]. In a study conducted in the United States, only 3% of the study population consumed at least four servings of fruits and vegetables per day [4].…”

“…Patients undergoing HD have very low dietary ber intake compared to the daily recommendations for adults (25 g/day for women and 38 g/day for men [19]). In some American cohorts, the daily ber intake ranged from 10 to 12 g/day, or around 50% lower than in a large American cohort [4,20]. In Turkey, ber intake of 12.6 ± 4.7 g/day was reported by 128 participants [10], while in Brazil, it varied from 9 to 19 g/day [12,21,22].…”

“…In general, different HD populations have been found to have a consistently low intake of food groups considered healthy because of their natural content of dietary ber, vitamins, minerals, and phytochemicals [3][4][5]. In addition to the in uence of social, cultural, and other personal factors on dietary behavior [6], patients undergoing dialysis are frequently instructed to follow a lowpotassium diet to avoid the risk of hyperkalemia.…”