Health literacy (HL) encompasses an individual's ability to access, understand, and integrate health-related information. Routine use of functional, critical, and communicative HL screening questionnaires shows promise in identifying those at risk for poor clinical outcomes. Although it is evident that low levels of HL are associated with poor clinical outcomes in end-stage renal disease, it is unclear how varying HL levels are associated with nutrition-specific adherence. Here, we present a summary of literature published between 2018 and 2023 examining relationships between HL and nutrition-related adherence among individuals on hemodialysis. A positive association between higher HL scores and adherence to nutrition-related recommendations was found in this population. Based on these findings, screening for low levels of HL using validated tools should be integrated into standard practice for nutrition assessment. Future studies are warranted to explore the dietitian's role in improving HL and to develop a standardized measure for nutrition-related adherence.
{"title":"A Narrative Review of the Association Between Varying Levels of Health Literacy and Nutrition-Related Adherence in Adults on Hemodialysis","authors":"Malki Waldman MS, RD , Diane Rigassio Radler PhD, RD , Rena Zelig DCN, RDN, CDCES, CSG","doi":"10.1053/j.jrn.2024.06.008","DOIUrl":"10.1053/j.jrn.2024.06.008","url":null,"abstract":"<div><div>Health literacy (HL) encompasses an individual's ability to access, understand, and integrate health-related information. Routine use of functional, critical, and communicative HL screening questionnaires shows promise in identifying those at risk for poor clinical outcomes. Although it is evident that low levels of HL are associated with poor clinical outcomes in end-stage renal disease, it is unclear how varying HL levels are associated with nutrition-specific adherence. Here, we present a summary of literature published between 2018 and 2023 examining relationships between HL and nutrition-related adherence among individuals on hemodialysis. A positive association between higher HL scores and adherence to nutrition-related recommendations was found in this population. Based on these findings, screening for low levels of HL using validated tools should be integrated into standard practice for nutrition assessment. Future studies are warranted to explore the dietitian's role in improving HL and to develop a standardized measure for nutrition-related adherence.</div></div>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"35 1","pages":"Pages 15-24"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141472063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1053/j.jrn.2024.07.010
Thomas J. Wilkinson PhD , Courtney J. Lightfoot PhD , Alice C. Smith PhD
Objective
Dietary patterns are rapidly becoming a major focus of medical nutrition therapy in chronic kidney disease (CKD) and the analysis of dietary patterns has emerged as a practical approach to evaluate qualitative as well as quantitative aspects of overall diet. In an a-posteriori data-driven approach, dietary patterns are based on the actual food intake of the population evaluated. Investigation of dietary patterns in CKD is not well-described, and to our knowledge, has not been conducted in a UK-based cohort.
Methods
Adult participants with a diagnosed kidney condition (CKD 1-5 not requiring dialysis) were recruited into a multicenter observational cross-sectional study. Dietary intake was assessed using the European Prospective Investigation of Cancer in Norfolk Food Frequency Questionnaire. Logistic Principal Component Analysis was used to identify food group clusters. Differences between groups were assessed using univariate general linear modeling.
Results
In total, 696 patients were included. The mean age was 64.7 (±14.0) years, 61% of the cohort were male. Most participants were White British (89%). The mean estimated glomerular filtration rate was 36.6 (±20.9) mL/minute/1.732. We found differences in food group intake across stages (e.g., greater intake of nuts and seeds intake in CKD 1-2 versus CKD 4) and across sex (e.g., females had a higher intake of fruit and vegetables versus males). Comparison with the reference cohort revealed that, overall, the CKD cohort had reduced intakes of food stuffs such as cereals and cereal products, but higher intakes of groups such as meat and meat products. There were limited differences in micronutrients, although vitamin B2 and calcium were higher in earlier stages.
Conclusion
Overall, the findings from a novel a-posteriori approach underline the complex diversity of food patterns in CKD. The findings from our study may inform dieticians and other health-care providers about the need to consider treatment modalities and stages when giving dietary recommendations.
{"title":"Comparison of Dietary Patterns and Daily Food Intake Across Kidney Disease Stages in England: An A-Posteriori Cluster Analysis","authors":"Thomas J. Wilkinson PhD , Courtney J. Lightfoot PhD , Alice C. Smith PhD","doi":"10.1053/j.jrn.2024.07.010","DOIUrl":"10.1053/j.jrn.2024.07.010","url":null,"abstract":"<div><h3>Objective</h3><div>Dietary patterns are rapidly becoming a major focus of medical nutrition therapy in chronic kidney disease (CKD) and the analysis of dietary patterns has emerged as a practical approach to evaluate qualitative as well as quantitative aspects of overall diet. In an a-posteriori data-driven approach, dietary patterns are based on the actual food intake of the population evaluated. Investigation of dietary patterns in CKD is not well-described, and to our knowledge, has not been conducted in a UK-based cohort.</div></div><div><h3>Methods</h3><div>Adult participants with a diagnosed kidney condition (CKD 1-5 not requiring dialysis) were recruited into a multicenter observational cross-sectional study. Dietary intake was assessed using the European Prospective Investigation of Cancer in Norfolk Food Frequency Questionnaire. Logistic Principal Component Analysis was used to identify food group clusters. Differences between groups were assessed using univariate general linear modeling.</div></div><div><h3>Results</h3><div>In total, 696 patients were included. The mean age was 64.7 (±14.0) years, 61% of the cohort were male. Most participants were White British (89%). The mean estimated glomerular filtration rate was 36.6 (±20.9) mL/minute/1.73<sup>2</sup>. We found differences in food group intake across stages (e.g., greater intake of nuts and seeds intake in CKD 1-2 versus CKD 4) and across sex (e.g., females had a higher intake of fruit and vegetables versus males). Comparison with the reference cohort revealed that, overall, the CKD cohort had reduced intakes of food stuffs such as cereals and cereal products, but higher intakes of groups such as meat and meat products. There were limited differences in micronutrients, although vitamin B2 and calcium were higher in earlier stages.</div></div><div><h3>Conclusion</h3><div>Overall, the findings from a novel a-posteriori approach underline the complex diversity of food patterns in CKD. The findings from our study may inform dieticians and other health-care providers about the need to consider treatment modalities and stages when giving dietary recommendations.</div></div>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"35 1","pages":"Pages 90-102"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141604439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Recent research has suggested that adherence to plant-based dietary index (PDI) may reduce the risk of type 2 diabetes and related complications like diabetic nephropathy (DN). Therefore, the aim of this study was to investigate the possible association of PDI with the odds of DN.
Methods
We enrolled 105 eligible women with DN and 105 controls without DN (30–65 years). A 147-item food frequency questionnaire was used to evaluate an overall PDI, healthy plant-based dietary index (hPDI), and unhealthful PDI. Biochemical variables and anthropometric measurements were assessed for all patients using predefined protocols.
Results
According to our final analyses, after controlling for potential confounders, participants with greater adherence to overall PDI (OR: 0.29; 95% CI: 0.15–0.56; P < .001) and hPDI (OR: 0.30; 95% CI: 0.15–0.56; P < .001) had 71% and 70% lower odds of DN compared to those with a low adherence, respectively. Conversely, subjects with a higher adherence to the unhealthful PDI had a positive association with increased odds of DN in the crude (OR = 5.00; 95% CI = 2.78–8.98; P < .001) and adjusted models (OR = 4.27; 95% CI = 2.24–8.14; P < .001), respectively.
Conclusion
The results of this study showed that greater adherence to overall PDI and hPDI was inversely associated with the odds of DN. However, further prospective studies are warranted to confirm these results.
{"title":"Adherence of Plant-Based Dietary Index in Odds of Diabetic Nephropathy in Women: A Case-Control Study","authors":"Atieh Mirzababaei PhD , Faezeh Abaj MSc , Zahra Roumi MSc , Cain C.T. Clark PhD , Khadijeh Mirzaei PhD","doi":"10.1053/j.jrn.2024.07.015","DOIUrl":"10.1053/j.jrn.2024.07.015","url":null,"abstract":"<div><h3>Background & Aims</h3><div>Recent research has suggested that adherence to plant-based dietary index (PDI) may reduce the risk of type 2 diabetes and related complications like diabetic nephropathy (DN). Therefore, the aim of this study was to investigate the possible association of PDI with the odds of DN.</div></div><div><h3>Methods</h3><div>We enrolled 105 eligible women with DN and 105 controls without DN (30–65 years). A 147-item food frequency questionnaire was used to evaluate an overall PDI, healthy plant-based dietary index (hPDI), and unhealthful PDI. Biochemical variables and anthropometric measurements were assessed for all patients using predefined protocols.</div></div><div><h3>Results</h3><div>According to our final analyses, after controlling for potential confounders, participants with greater adherence to overall PDI (OR: 0.29; 95% CI: 0.15–0.56; <em>P</em> < .001) and hPDI (OR: 0.30; 95% CI: 0.15–0.56; <em>P</em> < .001) had 71% and 70% lower odds of DN compared to those with a low adherence, respectively. Conversely, subjects with a higher adherence to the unhealthful PDI had a positive association with increased odds of DN in the crude (OR = 5.00; 95% CI = 2.78–8.98; <em>P</em> < .001) and adjusted models (OR = 4.27; 95% CI = 2.24–8.14; <em>P</em> < .001), respectively.</div></div><div><h3>Conclusion</h3><div>The results of this study showed that greater adherence to overall PDI and hPDI was inversely associated with the odds of DN. However, further prospective studies are warranted to confirm these results.</div></div>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"35 1","pages":"Pages 118-127"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141793947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1053/j.jrn.2024.07.014
Nishigandha Pradhan MD , Sarah Delozier PhD , Sumeet Brar MD , Jaime Abraham Perez PhD , Mahboob Rahman MD , Mirela Dobre MD, MPH
Objective
Dietary interventions are the mainstay of chronic diseases prevention in general population, but the evidence to support such therapeutic approaches in patients with chronic kidney disease (CKD) is less robust. The objective of this study is to examine the association between dietary fiber intake and adverse cardiovascular and kidney outcomes and all-cause mortality in participants with CKD enrolled in the Chronic Renal Insufficiency Cohort study.
Design and Methods
A total of 3791 Chronic Renal Insufficiency Cohort participants with self-reported dietary fiber intake were included in the analyses stratified by tertiles of dietary fiber at study baseline. Hazard ratios for occurrence of all-cause mortality, composite cardiovascular events and composite kidney events were calculated using Cox Proportional Hazards models adjusted for demographic, clinical, and laboratory characteristics, including levels of inflammatory markers, C-reactive protein and interleukin-6.
Results
Mean daily dietary fiber intake was 15.2 g/day. During a median (standard deviation) follow up of 14.6 (4.4) years, 1074 deaths from any cause occurred. In multivariable adjusted models, participants in the middle and low dietary fiber tertiles had a 19% (hazard ratio [95% CI]), 1.19 [1.02, 1.39]) and 11% (1.11 [0.95, 1.31]) greater risk of death respectively, compared to those in the highest fiber intake tertile. No statistically significant associations were observed between dietary fiber intake and adverse cardiovascular and kidney outcomes. Higher dietary fiber intake was not significantly associated with lower levels of C-reactive protein and interleukin-6.
Conclusion
A lower intake of dietary fiber was not associated with all-cause mortality in participants with CKD after adjustments for kidney function and inflammatory biomarkers. There was no significant association between dietary fiber intake and adverse kidney and cardiovascular outcomes. Future randomized intervention trials are needed to identify whether a high dietary fiber intake translates into improved clinical outcomes in CKD.
{"title":"Dietary Fiber Intake and Clinical Outcomes in Chronic Kidney Disease: A Report From the Chronic Renal Insufficiency Cohort Study","authors":"Nishigandha Pradhan MD , Sarah Delozier PhD , Sumeet Brar MD , Jaime Abraham Perez PhD , Mahboob Rahman MD , Mirela Dobre MD, MPH","doi":"10.1053/j.jrn.2024.07.014","DOIUrl":"10.1053/j.jrn.2024.07.014","url":null,"abstract":"<div><h3>Objective</h3><div>Dietary interventions are the mainstay of chronic diseases prevention in general population, but the evidence to support such therapeutic approaches in patients with chronic kidney disease (CKD) is less robust. The objective of this study is to examine the association between dietary fiber intake and adverse cardiovascular and kidney outcomes and all-cause mortality in participants with CKD enrolled in the Chronic Renal Insufficiency Cohort study.</div></div><div><h3>Design and Methods</h3><div>A total of 3791 Chronic Renal Insufficiency Cohort participants with self-reported dietary fiber intake were included in the analyses stratified by tertiles of dietary fiber at study baseline. Hazard ratios for occurrence of all-cause mortality, composite cardiovascular events and composite kidney events were calculated using Cox Proportional Hazards models adjusted for demographic, clinical, and laboratory characteristics, including levels of inflammatory markers, C-reactive protein and interleukin-6.</div></div><div><h3>Results</h3><div>Mean daily dietary fiber intake was 15.2 g/day. During a median (standard deviation) follow up of 14.6 (4.4) years, 1074 deaths from any cause occurred. In multivariable adjusted models, participants in the middle and low dietary fiber tertiles had a 19% (hazard ratio [95% CI]), 1.19 [1.02, 1.39]) and 11% (1.11 [0.95, 1.31]) greater risk of death respectively, compared to those in the highest fiber intake tertile. No statistically significant associations were observed between dietary fiber intake and adverse cardiovascular and kidney outcomes. Higher dietary fiber intake was not significantly associated with lower levels of C-reactive protein and interleukin-6.</div></div><div><h3>Conclusion</h3><div>A lower intake of dietary fiber was not associated with all-cause mortality in participants with CKD after adjustments for kidney function and inflammatory biomarkers. There was no significant association between dietary fiber intake and adverse kidney and cardiovascular outcomes. Future randomized intervention trials are needed to identify whether a high dietary fiber intake translates into improved clinical outcomes in CKD.</div></div>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"35 1","pages":"Pages 110-117"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141793948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chronic kidney disease (CKD) represents a significant global public health challenge. Among the various clinical complications associated with CKD, olfactory dysfunction has been identified as a factor that substantially affects the quality of life of patients. This study aims to systematically explore the prevalence, implications, and therapeutic avenues of anosmia in CKD patients. This scoping review utilized the Arksey and O'Malley framework, incorporating the Joanna Briggs Institute methodology, and followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. The research question, formulated using the PIO framework, guided a thorough search of databases PubMed/Medline, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Cochrane Library and gray literature sources. Eligibility criteria focused on studies involving CKD patients with olfactory dysfunctions. From an initial pool of 832 articles, 17 studies met the criteria, providing insights into olfactory alterations in 4,025 CKD patients. The data that have been reported, define that 55,34% of the sample experienced olfactory changes and the 8.5% experienced anosmia. This review revealed a complex interplay of factors contributing to olfactory alterations, including uremic toxins, dialysis procedures, electrolyte imbalances, and malnutrition. Findings suggested the potential recovery of olfactory function following kidney transplantation. Various assessment tools were utilized, with the University of Pennsylvania Smell Identification Test and Sniffin’ Sticks emerging as the primary instruments. The observed variability in findings highlights the need for continued research to understand the mechanisms, enhance therapies, and improve quality of life for CKD patients with olfactory dysfunctions. Future studies should employ standardized methods, explore new assessment tools, and prioritize longitudinal assessments to advance our understanding and management of olfactory dysfunctions in this population.
{"title":"Olfactory Dysfunctions and Chronic Kidney Disease: A Scoping Review","authors":"Sara Morales Palomares RN, PhD , Mauro Parozzi RN, MSc, PhD(s) , Gaetano Ferrara RN , Desirèe Andreoli RN, MSc , Lea Godino RN, MSc, PhD(s) , Domenica Gazineo RN, MSc , Giuliano Anastasi RN, MSc, PhD(s) , Marco Sguanci RN, MSc, PhD , Stefano Mancin RN, MSc, PhD(s)","doi":"10.1053/j.jrn.2024.06.007","DOIUrl":"10.1053/j.jrn.2024.06.007","url":null,"abstract":"<div><div>Chronic kidney disease (CKD) represents a significant global public health challenge. Among the various clinical complications associated with CKD, olfactory dysfunction has been identified as a factor that substantially affects the quality of life of patients. This study aims to systematically explore the prevalence, implications, and therapeutic avenues of anosmia in CKD patients. This scoping review utilized the Arksey and O'Malley framework, incorporating the Joanna Briggs Institute methodology, and followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. The research question, formulated using the PIO framework, guided a thorough search of databases PubMed/Medline, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Cochrane Library and gray literature sources. Eligibility criteria focused on studies involving CKD patients with olfactory dysfunctions. From an initial pool of 832 articles, 17 studies met the criteria, providing insights into olfactory alterations in 4,025 CKD patients. The data that have been reported, define that 55,34% of the sample experienced olfactory changes and the 8.5% experienced anosmia. This review revealed a complex interplay of factors contributing to olfactory alterations, including uremic toxins, dialysis procedures, electrolyte imbalances, and malnutrition. Findings suggested the potential recovery of olfactory function following kidney transplantation. Various assessment tools were utilized, with the University of Pennsylvania Smell Identification Test and Sniffin’ Sticks emerging as the primary instruments. The observed variability in findings highlights the need for continued research to understand the mechanisms, enhance therapies, and improve quality of life for CKD patients with olfactory dysfunctions. Future studies should employ standardized methods, explore new assessment tools, and prioritize longitudinal assessments to advance our understanding and management of olfactory dysfunctions in this population.</div></div>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"35 1","pages":"Pages 4-14"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141460401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1053/j.jrn.2024.07.016
Hui Li MD , Xin Gu MM , Likui Qiu MM , Xianghua Wang MM , Yang Li MD
Objective
To explore the relationship between dietary fiber (DF) intake and hyperkalemia in maintenance hemodialysis (MHD) patients.
Methods
A total of 110 MHD patients were included, including 67 males and 43 females. Patients were divided into normal serum potassium group (N) and a hyperkalemia group (H) according to the serum potassium level before dialysis. The daily diet was recorded by the 3-day dietary recording method. The daily dietary nutrient intake of patients was analyzed. Logistic regression was used to analyze the relationship between hyperkalemia and DF intake. A receiver operating characteristic curve was used to analyze the cutoff value of DF intake to prevent hyperkalemia.
Results
Of the 110 patients, 38 had hyperkalemia (serum potassium >5.5 mmol/L) before dialysis. There was no difference in sex, residual kidney function, body mass index, energy intake, fat intake, protein intake, calcium intake, sodium intake, phosphorus intake or the administration history of potassium-lowering drugs between the 2 groups (P > .05). Compared with the H group, patients in the N group had higher carbohydrate intake (315 ± 76 g/d vs. 279 ± 66 g/d, P = .016), dietary fiber intake (19 ± 5 g/d vs. 12 ± 8 g/d, P < .0001), and potassium intake (1,698 ± 392 mg/d vs. 1,533 ± 413 mg/d, P = .041), and more patients in group N used renin-angiotensin-aldosterone system inhibitors (52.78% vs. 23.68%, P = .003). However, the number of patients with constipation in group N was less than that in group H (20.83% vs. 42.11%, P = .018). Logistic regression analysis showed that DF intake was an independent protective factor for hyperkalemia [P < .0001, odds ratio = 0.766 (95% confidence intervals: 0.675-0.870)]. Receiver operating characteristic analysis showed that daily intake of DF greater than 15.33 g may be helpful to prevent hyperkalemia.
Conclusion
Insufficient dietary nutrient intake is prevalent in MHD patients, especially DF intake, which may be associated with hyperkalemia. Clinically, attention should be given to the dietary balance of MHD patients, especially DF intake.
{"title":"The Effect of Dietary Fiber on Hyperkalemia in Maintenance Hemodialysis Patients: A Cross-Sectional Study","authors":"Hui Li MD , Xin Gu MM , Likui Qiu MM , Xianghua Wang MM , Yang Li MD","doi":"10.1053/j.jrn.2024.07.016","DOIUrl":"10.1053/j.jrn.2024.07.016","url":null,"abstract":"<div><h3>Objective</h3><div>To explore the relationship between dietary fiber (DF) intake and hyperkalemia in maintenance hemodialysis (MHD) patients.</div></div><div><h3>Methods</h3><div>A total of 110 MHD patients were included, including 67 males and 43 females. Patients were divided into normal serum potassium group (N) and a hyperkalemia group (H) according to the serum potassium level before dialysis. The daily diet was recorded by the 3-day dietary recording method. The daily dietary nutrient intake of patients was analyzed. Logistic regression was used to analyze the relationship between hyperkalemia and DF intake. A receiver operating characteristic curve was used to analyze the cutoff value of DF intake to prevent hyperkalemia.</div></div><div><h3>Results</h3><div>Of the 110 patients, 38 had hyperkalemia (serum potassium >5.5 mmol/L) before dialysis. There was no difference in sex, residual kidney function, body mass index, energy intake, fat intake, protein intake, calcium intake, sodium intake, phosphorus intake or the administration history of potassium-lowering drugs between the 2 groups (<em>P</em> > .05). Compared with the H group, patients in the N group had higher carbohydrate intake (315 ± 76 g/d vs. 279 ± 66 g/d, <em>P</em> = .016), dietary fiber intake (19 ± 5 g/d vs. 12 ± 8 g/d, <em>P</em> < .0001), and potassium intake (1,698 ± 392 mg/d vs. 1,533 ± 413 mg/d, <em>P</em> = .041), and more patients in group N used renin-angiotensin-aldosterone system inhibitors (52.78% vs. 23.68%, <em>P</em> = .003). However, the number of patients with constipation in group N was less than that in group H (20.83% vs. 42.11%, <em>P</em> = .018). Logistic regression analysis showed that DF intake was an independent protective factor for hyperkalemia [<em>P</em> < .0001, odds ratio = 0.766 (95% confidence intervals: 0.675-0.870)]. Receiver operating characteristic analysis showed that daily intake of DF greater than 15.33 g may be helpful to prevent hyperkalemia.</div></div><div><h3>Conclusion</h3><div>Insufficient dietary nutrient intake is prevalent in MHD patients, especially DF intake, which may be associated with hyperkalemia. Clinically, attention should be given to the dietary balance of MHD patients, especially DF intake.</div></div>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"35 1","pages":"Pages 181-186"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141793950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1053/j.jrn.2024.05.006
Nuratiqah Batrisyia Asan BSc , Dessy Wedannie Wei Kun BSc , Yasmin Beng Houi Ooi PhD , Ban-Hock Khor PhD
Objectives
Nutrition labeling is important to guide patients with chronic kidney disease to make informed choices. This study aimed to evaluate the extent and accessibility of nutrition labeling for sodium, potassium, and phosphorus on food and beverage products in a supermarket.
Methods
A cross-sectional survey was conducted in a Malaysian supermarket. Information on sodium, potassium, and phosphorus contents was collected from the nutrition fact panel, while information on food additives containing sodium, potassium, and phosphorus was collected from the ingredient list.
Results
The survey included 2,577 foods and beverages, and 79.4% of the products included sodium information in nutrition fact panels, but only 11.7% and 2.0% disclosed potassium and phosphorus content, respectively. Sodium-containing additives were found in 78.6% of products; potassium- and phosphorus-containing additives were reported in 28.5% and 46.9% of products, respectively. Sodium-containing additives were typically listed as “salt,” potassium-containing additives as “alternative names,” and phosphorus-containing additives as “starch” and “E numbers.” Imported products were more likely to include sodium (P < .001) and phosphorus (p = .036) contents, while more locally manufactured products reported sodium- (p = .003) and phosphorus- (P = .004) containing additives.
Conclusion
There is limited availability of potassium and phosphorus information on nutrition labels in Malaysia food and beverage products, which presents significant challenges for individuals with chronic kidney disease in choosing appropriate products for their dietary needs.
{"title":"A Survey on Nutrition Labeling for Sodium, Potassium, and Phosphorus of Packaged Food and Beverages","authors":"Nuratiqah Batrisyia Asan BSc , Dessy Wedannie Wei Kun BSc , Yasmin Beng Houi Ooi PhD , Ban-Hock Khor PhD","doi":"10.1053/j.jrn.2024.05.006","DOIUrl":"10.1053/j.jrn.2024.05.006","url":null,"abstract":"<div><h3>Objectives</h3><div>Nutrition labeling is important to guide patients with chronic kidney disease to make informed choices. This study aimed to evaluate the extent and accessibility of nutrition labeling for sodium, potassium, and phosphorus on food and beverage products in a supermarket.</div></div><div><h3>Methods</h3><div>A cross-sectional survey was conducted in a Malaysian supermarket. Information on sodium, potassium, and phosphorus contents was collected from the nutrition fact panel, while information on food additives containing sodium, potassium, and phosphorus was collected from the ingredient list.</div></div><div><h3>Results</h3><div>The survey included 2,577 foods and beverages, and 79.4% of the products included sodium information in nutrition fact panels, but only 11.7% and 2.0% disclosed potassium and phosphorus content, respectively. Sodium-containing additives were found in 78.6% of products; potassium- and phosphorus-containing additives were reported in 28.5% and 46.9% of products, respectively. Sodium-containing additives were typically listed as “salt,” potassium-containing additives as “alternative names,” and phosphorus-containing additives as “starch” and “E numbers.” Imported products were more likely to include sodium (<em>P</em> < .001) and phosphorus (<em>p</em> = .036) contents, while more locally manufactured products reported sodium- (<em>p</em> = .003) and phosphorus- (<em>P</em> = .004) containing additives.</div></div><div><h3>Conclusion</h3><div>There is limited availability of potassium and phosphorus information on nutrition labels in Malaysia food and beverage products, which presents significant challenges for individuals with chronic kidney disease in choosing appropriate products for their dietary needs.</div></div>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"35 1","pages":"Pages 229-233"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141288847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1053/j.jrn.2024.05.005
Jinxue Wang , Jing Zhao , Li Li , Xuechun Lin , Xiaolei Guo , Fan Peng , Xuezhi Zuo , Xiaoqin Liu MD , Chenjiang Ying PhD
Background
Excessive sugar intake increases the energy metabolic burden and the risk of cardiovascular disease (CVD). Patients on peritoneal dialysis absorb much more glucose than the World Health Organization recommends, but the link to CVD is unclear.
Objective
To identify the association between peritoneal glucose absorption, lipid metabolism, and CVD.
Methods
We applied generalized additive mixed effects and mixed effects Cox proportional hazard models to evaluate the impact of peritoneal glucose absorption on lipid profiles and CVD risk. We performed subgroup analyses by using protein intake (normalized protein nitrogen appearance [nPNA] and normalized protein catabolic rate [nPCR] were used to assess protein intake) and high-sensitivity C-reactive protein (hs-CRP).
Results
After multivariable adjustment, peritoneal glucose absorption per 10 g/d increase was associated with an increase in cholesterol of 0.145 (95% confidence interval [CI]: 0.086–0.204) mmol/L. No link with the total risk of CVD was observed; however, protein intake and hs-CRP levels affected the relationship between glucose absorption and CVD risk. Patients with values for nPNA and nPCR <1.0 g/(kg·d) were associated with a lower risk of CVD (hazard ratio [HR] 95% CI: 0.68 (0.46–0.98)) with glucose absorption per 10 g/d increase. While patients with hs-CRP levels ≥3 mg/d or values for nPNA or nPCR ≥1.0 g/(kg·d) were associated with a higher risk of CVD (HR 95% CI: 1.32 (1.07–1.63); 1.31 (1.02–1.68)) for glucose absorption per 10 g/d increase.
Conclusions
Our study found a positive correlation between peritoneal glucose absorption and lipid profiles. Increased glucose absorption was associated with a lower risk of CVD in lower protein intake patients and a higher risk of CVD in higher hs-CRP or protein intake levels in patients on peritoneal dialysis.
{"title":"Association Between Peritoneal Glucose Absorption, Lipid Metabolism, and Cardiovascular Disease Risk in Nondiabetic Patients on Peritoneal Dialysis","authors":"Jinxue Wang , Jing Zhao , Li Li , Xuechun Lin , Xiaolei Guo , Fan Peng , Xuezhi Zuo , Xiaoqin Liu MD , Chenjiang Ying PhD","doi":"10.1053/j.jrn.2024.05.005","DOIUrl":"10.1053/j.jrn.2024.05.005","url":null,"abstract":"<div><h3>Background</h3><div>Excessive sugar intake increases the energy metabolic burden and the risk of cardiovascular disease (CVD). Patients on peritoneal dialysis absorb much more glucose than the World Health Organization recommends, but the link to CVD is unclear.</div></div><div><h3>Objective</h3><div>To identify the association between peritoneal glucose absorption, lipid metabolism, and CVD.</div></div><div><h3>Methods</h3><div>We applied generalized additive mixed effects and mixed effects Cox proportional hazard models to evaluate the impact of peritoneal glucose absorption on lipid profiles and CVD risk. We performed subgroup analyses by using protein intake (normalized protein nitrogen appearance [nPNA] and normalized protein catabolic rate [nPCR] were used to assess protein intake) and high-sensitivity C-reactive protein (hs-CRP).</div></div><div><h3>Results</h3><div>After multivariable adjustment, peritoneal glucose absorption per 10 g/d increase was associated with an increase in cholesterol of 0.145 (95% confidence interval [CI]: 0.086–0.204) mmol/L. No link with the total risk of CVD was observed; however, protein intake and hs-CRP levels affected the relationship between glucose absorption and CVD risk. Patients with values for nPNA and nPCR <1.0 g/(kg·d) were associated with a lower risk of CVD (hazard ratio [HR] 95% CI: 0.68 (0.46–0.98)) with glucose absorption per 10 g/d increase. While patients with hs-CRP levels ≥3 mg/d or values for nPNA or nPCR ≥1.0 g/(kg·d) were associated with a higher risk of CVD (HR 95% CI: 1.32 (1.07–1.63); 1.31 (1.02–1.68)) for glucose absorption per 10 g/d increase.</div></div><div><h3>Conclusions</h3><div>Our study found a positive correlation between peritoneal glucose absorption and lipid profiles. Increased glucose absorption was associated with a lower risk of CVD in lower protein intake patients and a higher risk of CVD in higher hs-CRP or protein intake levels in patients on peritoneal dialysis.</div></div>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"35 1","pages":"Pages 196-206"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141293825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1053/j.jrn.2024.07.004
John S. Babich , Jason Patel , Léonie Dupuis , David S. Goldfarb , Stacy Loeb , James Borin , Shivam Joshi
Objective
In people with chronic kidney disease (CKD), hyperphosphatemia is a risk factor for mortality. Though unproven, dietary phosphorus control is considered essential in CKD. Although dietary and serum phosphorus are correlated, phosphorus from plant foods rich in phytate is less bioavailable than from animal and processed foods. Yogurt, valued for its low phosphorus and high protein, may be detrimental in CKD due to animal protein content. Plant-based yogurts (PBYs) might offer similar benefits without the downsides of animal protein, but little is known about their phosphorus content.
Design and Methods
Protein contents and phosphorus additives were gathered from nutrition labels of several PBYs, including almond, cashew, oat, coconut, and soy substrates. Phosphorus content was measured via emission spectrometry by Eurofins (Madison, WI), and the phosphorus-to-protein ratio (PPR) was calculated for each PBY.
Results
Phosphorus content was highest in Silk Soy Strawberry, Silk Almond Strawberry, and Siggi's Coconut Mixed Berries, while it was lowest in So Delicious Coconut Strawberry, Oatly Oat Strawberry, Forager Cashew Strawberry, and Kite Hill Almond Strawberry. Ingredient labels revealed that Silk Soy Strawberry, Silk Almond Strawberry, and Oatly Oat Strawberry contained phosphorus additives, and Siggi's Coconut Mixed Berries contained pea protein additives. Though from the same substrate class, So Delicious Coconut Strawberry and Siggi's Coconut Mixed Berries showed significant differences in phosphorus and protein contents. All seven PBYs had higher PPR ratios than dairy yogurts like Stonyfield Organic Oikos Strawberry, Chobani Nonfat Strawberry, and Yoplait Greek Strawberry.
Conclusion
Low-PPR foods are important for CKD patients. Siggi's Coconut Mixed Berries had the lowest PPR, making it potentially the most desirable for CKD patients. However, there is high variability in PPR among PBYs with the same substrate; therefore, Delicious Coconut Strawberry had the highest PPR, highlighting the importance of product selection for patients with CKD.
{"title":"Phosphorus Content of Several Plant-Based Yogurts","authors":"John S. Babich , Jason Patel , Léonie Dupuis , David S. Goldfarb , Stacy Loeb , James Borin , Shivam Joshi","doi":"10.1053/j.jrn.2024.07.004","DOIUrl":"10.1053/j.jrn.2024.07.004","url":null,"abstract":"<div><h3>Objective</h3><div>In people with chronic kidney disease (CKD), hyperphosphatemia is a risk factor for mortality. Though unproven, dietary phosphorus control is considered essential in CKD. Although dietary and serum phosphorus are correlated, phosphorus from plant foods rich in phytate is less bioavailable than from animal and processed foods. Yogurt, valued for its low phosphorus and high protein, may be detrimental in CKD due to animal protein content. Plant-based yogurts (PBYs) might offer similar benefits without the downsides of animal protein, but little is known about their phosphorus content.</div></div><div><h3>Design and Methods</h3><div>Protein contents and phosphorus additives were gathered from nutrition labels of several PBYs, including almond, cashew, oat, coconut, and soy substrates. Phosphorus content was measured via emission spectrometry by Eurofins (Madison, WI), and the phosphorus-to-protein ratio (PPR) was calculated for each PBY.</div></div><div><h3>Results</h3><div>Phosphorus content was highest in Silk Soy Strawberry, Silk Almond Strawberry, and Siggi's Coconut Mixed Berries, while it was lowest in So Delicious Coconut Strawberry, Oatly Oat Strawberry, Forager Cashew Strawberry, and Kite Hill Almond Strawberry. Ingredient labels revealed that Silk Soy Strawberry, Silk Almond Strawberry, and Oatly Oat Strawberry contained phosphorus additives, and Siggi's Coconut Mixed Berries contained pea protein additives. Though from the same substrate class, So Delicious Coconut Strawberry and Siggi's Coconut Mixed Berries showed significant differences in phosphorus and protein contents. All seven PBYs had higher PPR ratios than dairy yogurts like Stonyfield Organic Oikos Strawberry, Chobani Nonfat Strawberry, and Yoplait Greek Strawberry.</div></div><div><h3>Conclusion</h3><div>Low-PPR foods are important for CKD patients. Siggi's Coconut Mixed Berries had the lowest PPR, making it potentially the most desirable for CKD patients. However, there is high variability in PPR among PBYs with the same substrate; therefore, Delicious Coconut Strawberry had the highest PPR, highlighting the importance of product selection for patients with CKD.</div></div>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"35 1","pages":"Pages 234-238"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141591892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nutrition, lifestyle factors, and awareness of chronic kidney disease (CKD) risk are vital tools for preventing or delaying its development and progression in Black American (BA) males. Few published studies assess awareness of CKD risk in BA male college students despite being at high risk. This study aimed to 1) assess the awareness of CKD risk among BA male college students and 2) identify dietary and lifestyle habits related to CKD risk.
Methods
This was a cross-sectional online survey utilizing a network sampling technique. Inclusion criteria were self-identification as a BA male and current enrollment in a university. Participants were recruited through publicly available social media sites and emails. The online questionnaire contained demographic, health status, and food security items. Pearson's correlations explored associations between continuous variables; independent samples t-tests compared mean scores of responses between perceived risk of disease groups.
Results
Sixty-seven participants completed the survey. Only 22.4% perceived they were at increased risk for kidney disease, while 49.3% felt at increased risk for developing hypertension (HTN). More respondents (32.8%) also felt at increased risk for developing diabetes than kidney disease. Dietary sodium restriction was reported by 34.3%, while only 14.9% had been advised to do so by a health-care provider. Half of the respondents were deemed food insecure, and 17.86% were categorized as experiencing very low food security.
Conclusion
Awareness of CKD risk is low for BA male college students and lags behind awareness of HTN and diabetes risk. There may be a lack of knowledge regarding CKD as a long-term complication of HTN and diabetes. Dietary sodium restriction is marginal, and food security is a significant challenge in this high-risk group. Educational initiatives are needed to increase awareness of CKD risk among BA male college students.
目标：营养、生活方式因素和对慢性肾脏病（CKD）风险的认识是预防或延缓美国黑人（BA）男性慢性肾脏病发展和恶化的重要工具。尽管美国黑人男性大学生是慢性肾脏病的高危人群，但很少有已发表的研究对他们的慢性肾脏病风险意识进行评估。本研究旨在：1）评估美国黑人男性大学生对 CKD 风险的认识；2）确定与 CKD 风险相关的饮食和生活习惯：这是一项采用网络抽样技术进行的横断面在线调查。纳入标准是自我认同为美国黑人男性且目前就读于一所大学。参与者是通过公开的社交媒体网站和电子邮件招募的。在线问卷包含人口统计学、健康状况和食品安全项目。皮尔逊相关性检验探讨了连续变量之间的联系；独立样本 t 检验比较了感知疾病风险组之间的平均答卷得分：67 名参与者完成了调查。只有 22.4% 的人认为自己患肾病的风险增加，而 49.3% 的人认为自己患高血压（HTN）的风险增加。认为罹患糖尿病风险增加的受访者（32.8%）多于认为罹患肾病风险增加的受访者。有 34.3% 的受访者表示饮食中限制钠摄入量，而只有 14.9% 的受访者曾得到医疗保健提供者的建议。半数受访者被认为粮食不安全，17.86%的受访者被归类为粮食非常不安全：文理学院男大学生对慢性肾脏病风险的认识较低，落后于对高血压和糖尿病风险的认识。他们可能对慢性肾脏病是高血压和糖尿病的长期并发症缺乏了解。膳食中限制钠的摄入量微乎其微，食品安全是这一高风险群体面临的重大挑战。需要采取教育措施，提高 BA 男大学生对 CKD 风险的认识。
{"title":"Chronic Kidney Disease Risk Awareness, Dietary Intake, and Food Security Among Black Male College Students","authors":"Ellis A. Morrow DCN, MS, RDN, LD, FAND, FNKF , Keilon Robinson PharmD , Willie Capers PharmD , Simone P. Camel PhD, RDN, LD","doi":"10.1053/j.jrn.2024.04.006","DOIUrl":"10.1053/j.jrn.2024.04.006","url":null,"abstract":"<div><h3>Objectives</h3><div>Nutrition, lifestyle factors, and awareness of chronic kidney disease (CKD) risk are vital tools for preventing or delaying its development and progression in Black American (BA) males. Few published studies assess awareness of CKD risk in BA male college students despite being at high risk. This study aimed to 1) assess the awareness of CKD risk among BA male college students and 2) identify dietary and lifestyle habits related to CKD risk.</div></div><div><h3>Methods</h3><div>This was a cross-sectional online survey utilizing a network sampling technique. Inclusion criteria were self-identification as a BA male and current enrollment in a university. Participants were recruited through publicly available social media sites and emails. The online questionnaire contained demographic, health status, and food security items. Pearson's correlations explored associations between continuous variables; independent samples t-tests compared mean scores of responses between perceived risk of disease groups.</div></div><div><h3>Results</h3><div>Sixty-seven participants completed the survey. Only 22.4% perceived they were at increased risk for kidney disease, while 49.3% felt at increased risk for developing hypertension (HTN). More respondents (32.8%) also felt at increased risk for developing diabetes than kidney disease. Dietary sodium restriction was reported by 34.3%, while only 14.9% had been advised to do so by a health-care provider. Half of the respondents were deemed food insecure, and 17.86% were categorized as experiencing very low food security.</div></div><div><h3>Conclusion</h3><div>Awareness of CKD risk is low for BA male college students and lags behind awareness of HTN and diabetes risk. There may be a lack of knowledge regarding CKD as a long-term complication of HTN and diabetes. Dietary sodium restriction is marginal, and food security is a significant challenge in this high-risk group. Educational initiatives are needed to increase awareness of CKD risk among BA male college students.</div></div>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"35 1","pages":"Pages 56-63"},"PeriodicalIF":3.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141082225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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