Dietary intake of non-dialysis chronic kidney disease patients
the PROGREDIR study. A cross-sectional study
Keywords:
Renal insufficiency, chronic, Diet, Health surveysAbstract
BACKGROUND: Despite evidence that diet is very important in relation to chronic kidney disease (CKD) progression, studies in this field are scarce and have focused only on some specific nutrients. We evaluated the energy, macronutrient and micronutrient intakes and dietary patterns of non-dialysis CKD participants in the PROGREDIR study. DESIGN AND SETTING: Cross-sectional study; CKD cohort, São Paulo, Brazil. METHODS: Baseline data on 454 participants in the PROGREDIR study were analyzed. Dietary intake was evaluated through a food frequency questionnaire. Dietary patterns were derived through principal component analysis. Energy and protein intakes were compared with National Kidney foundation recommendations. Linear regression analysis was performed between energy and nutrient intakes and estimated glomerular filtration rate (eGFR), and between sociodemographic and clinical variables and dietary patterns. RESULTS: Median energy and protein intakes were 25.0 kcal/kg and 1.1 g/kg, respectively. In linear regression, protein intake (β = -3.67; P = 0.07) was related to eGFR. Three dietary patterns (snack, mixed and traditional) were retained. The snack pattern was directly associated with male gender (β = 0.27; P = 0.006) and inversely with diabetes (β = -0.23; P = 0.02). The traditional pattern was directly associated with male gender (β = 0.27; P = 0.007) and schooling (β = 0.40; P < 0.001) and inversely with age (β = -0.01; P = 0.001) and hypertension (β = -0.34; P = 0.05). CONCLUSIONS: We identified low energy and high protein intake in this population. Protein intake was inversely related to eGFR. Dietary patterns were associated with age, gender, schooling level, hypertension and diabetes.
Downloads
References
Levey AS, Schoolwerth AC, Burrows NR, et al. Comprehensive public health strategies for preventing the development, progression, and complications of CKD: report of an expert panel convened by Centers for Disease Control and Prevention. Am J Kidney Dis. 2009;53(3):522-35. doi: 10.1053/j.ajkd.2008.11.019.
James MT, Hemmelgarn BR, Tonelli M. Early recognition and prevention of chronic kidney disease. Lancet. 2010;375(9722):1296-309. doi: 10.1016/S0140-6736(09)62004-3.
Jha V, Garcia-Garcia G, Iseki K, et al. Chronic kidney disease: global dimension and perspectives. Lancet. 2013;382(9888):260-72. doi: 10.1016/S0140-6736(13)60687-X.
Snelson M, Clarke RE, Coughlan MT. Stirring the pot: can dietary modification alleviate the burden of CKD? Nutrients. 2017;9(3).pii:E265. doi: 10.3390/nu9030265.
Beto JA, Ramirez WE, Bansal VK. Medical nutrition therapy in adults with chronic kidney disease: integrating evidence and consensus into practice for the generalist registered dietitian nutritionist. J Acad Nutr Diet. 2014;114(7):1077-87. doi: 10.1016/j.jand.2013.12.009.
Mitch WE, Remuzzi G. Diets for patients with chronic kidney disease, should we reconsider? BMC Nephrol. 2016;17(1):80. doi: 10.1186/s12882-016-0283-x.
Chan M, Kelly J, Tapsell L. Dietary Modeling of Foods for Advanced CKD Based on General Healthy Eating Guidelines: What Should Be on the Plate? Am J Kidney Dis. 2017;69(3):436-50. doi: 10.1053/j.ajkd.2016.09.025.
Goraya N, Wesson DE. Dietary interventions to improve outcomes in chronic kidney disease. Curr Opin Nephrol Hypertens. 2015;24(6):505-10. doi: 10.1097/MNH.0000000000000160.
Domingos MAM, Goulart AC, Lotufo PA, Benseñor IJM, Titan SMO. Chronic kidney disease - determinants of progression and cardiovascular risk. PROGREDIR cohort study: design and methods. São Paulo Med J. 2017;135(2):133-9. doi: 10.1590/1516-3180.2016.0272261116.
Levey AS, Stevens LA, Schmid CH, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150(9):604-12. PMID: 19414839.
Molina M del C, Benseñor IM, Cardoso L de O, et al. Reprodutibilidade e validade relativa do Questionário de Frequência Alimentar do ELSA-Brasil [Reproducibility and relative validity of the Food Frequency Questionnaire used in the ELSA-Brasil]. Cad Saúde Pública. 2013;29(2):379-89. PMID: 23459823.
United States Department of Agriculture [Internet]. Agricultural Research Service. USDA Food Composition Databases [cited 2016 May 17]. Available from: https://ndb.nal.usda.gov/ndb/ Accessed in 2017 (Dec 15).
Núcleo de Estudos e Pesquisas em Alimentação, Universidade Estadual de Campinas. Tabela Brasileira de Composição de Alimentos. 4a ed. Campinas: NEPA-UNICAMP; 2011. Available from: http://www.cfn.org.br/wp-content/uploads/2017/03/taco_4_edicao_ampliada_e_revisada.pdf Accessed in 2017 (Dec 15).
Willett WC. Nutritional epidemiology. New York: Oxford University Press; 1998. ISBN-13: 978-0195045017/ISBN-10: 0195045017.
Willett W, Stampfer MJ. Total energy intake: implications for epidemiologic analyses. Am J Epidemiol. 1986;124(1):17-27. PMID: 3521261.
Clinical practice guidelines for nutrition in chronic renal failure. K/DOQI, National Kidney Foundation. Am J Kidney Dis. 2000;35(6 Suppl 2):S1-140. PMID: 10895784.
Hu FB. Dietary pattern analysis: a new direction in nutritional epidemiology. Curr Opin Lipidol. 2002;13(1):3-9. PMID: 11790957.
Avesani CM, Kamimura MA, Draibe AS, Cuppari L. Is energy intake underestimated in nondialyzed chronic kidney disease patients? J Ren Nutr. 2005;15(1):159-65. PMID: 15648027.
Ellam T, Fotheringham J, Kawar B. Differential scaling of glomerular filtration rate and ingested metabolic burden: implications for gender differences in chronic kidney disease outcomes. Nephrol Dial Transplant. 2014;29(6):1186-94. doi: 10.1093/ndt/gft466.
Kalantar-Zadeh K, Moore LW, Tortorici AR, et al. North American experience with low protein diet for non-dialysis-dependent chronic kidney disease. BMC Nephrol. 2016;17(1):90. doi: 10.1186/s12882-016-0304-9.
Mafra D, Leal VO. A practical approach to a low protein diet in Brazil. BMC Nephrol. 2016;17(1):105. doi: 10.1186/s12882-016-0305-8.
Bellizzi V, Cupisti A, Locatelli F, et al. Low-protein diets for chronic kidney disease patients: the Italian experience. BMC Nephrol. 2016;17(1):77. doi: 10.1186/s12882-016-0280-0.
Carrero JJ, Stenvinkel P, Cuppari L, et al. Etiology of the protein-energy wasting syndrome in chronic kidney disease: a consensus statement from the International Society of Renal Nutrition and Metabolism (ISRNM). J Ren Nutr. 2013;23(2):77-90. doi: 10.1053/j.jrn.2013.01.001.
Huang MC, Chen ME, Hung HC, et al. Inadequate energy and excess protein intakes may be associated with worsening renal function in chronic kidney disease. J Ren Nutr. 2008;18(2):187-94. doi: 10.1053/j.jrn.2007.08.003.
Fávaro DIT, Mafra D, Maihara VA, et al. Evaluation of Zn and Fe in diets of patients with chronic renal failure. J Radioanal Nucl Chem. 2004;259(3):533-6. doi:10.1023/B:JRNC.0000020932.60770.f8.
Wlodarek D, Glabska D, Rojek-Trebicka J. Assessment of diet in chronic kidney disease female predialysis patients. Ann Agric Environ Med. 2014;21(4):829-34. doi: 10.5604/12321966.1129942.
Kopple JD. Nutritional management of nondialyzed patients with chronic renal failure. In: Kopple JD, Massry SG, editors. Nutritional management of renal disease. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 2004. p. 379-414. ISBN-13: 978-0781735940/ISBN-10: 0781735947.
Toledo AL, Koifman RJ, Koifman S, Marchioni DM. Dietary patterns and risk of oral and pharyngeal cancer: a case-control study in Rio de Janeiro, Brazil. Cad Saúde Pública. 2010;26(1):135-42. PMID: 20209217.
Moreira PL, Corrente JE, Villas Boas PJF, Ferreira ALA. Padrões alimentares associados com obesidade geral e central em idosos residentes em uma cidade brasileira [Dietary patterns are associated with general and central obesity in elderly living in a Brazilian city]. Rev Assoc Med Bras. 2014;60(5):457-64. doi:10.1590/1806-9282.60.05.014.
Vilela AA, Sichieri R, Pereira RA, et al. Dietary patterns associated with anthropometric indicators of abdominal fat in adults. Cad Saúde Pública. 2014;30(3):502-10. PMID: 24714940.
Olinto MTA. Padrões alimentares: análise de componentes principais. In: Kac G, Sichieri R, Gigante DP, organizers. Epidemiologia nutricional. Rio de Janeiro: FIOCRUZ/Atheneu; 2007. p. 213-25. ISBN 978-85-7541-320-3.
Ferreira PM, Papini SJ, Corrente JE. Diversity of eating patterns in older adults: A new scenario? Rev Nutr. 2014;27(1):67-79. doi:10.1590/1415-52732014000100007.
Marchioni DM, Latorre M do R, Eluf-Neto J, Wünsch-Filho V, Fisberg RM. Identification of dietary patterns using factor analysis in an epidemiological study in São Paulo. São Paulo Med J. 2005;123(3):124-7. doi: /S1516-31802005000300007.
Cardoso L de O, Carvalho MS, Cruz OG, et al. Eating patterns in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil): an exploratory analysis. Cad Saúde Pública. 2016;32(5):e00066215. doi: 10.1590/0102-311X00066215.
Gutiérrez OM, Muntner P, Rizk DV, et al. Dietary patterns and risk of death and progression to ESRD in individuals with CKD: a cohort study. Am J Kidney Dis. 2014;64(2):204-13. doi: 10.1053/j.ajkd.2014.02.013.
Kelly JT, Palmer SC, Wai SN, et al. Healthy Dietary Patterns and Risk of Mortality and ESRD in CKD: A Meta-Analysis of Cohort Studies. Clin J Am Soc Nephrol. 2017;12(2):272-9. doi: 10.2215/CJN.06190616.
Lin J, Fung TT, Hu FB, Curhan GC. Association of dietary patterns with albuminuria and kidney function decline in older white women: a subgroup analysis from the Nurses' Health Study. Am J Kidney Dis. 2011;57(2):245-54. doi: 10.1053/j.ajkd.2010.09.027.
Huang X, Jiménez-Moleón JJ, Lindholm B, et al. Mediterranean diet, kidney function, and mortality in men with CKD. Clin J Am Soc Nephrol. 2013;8(9):1548-55. doi: 10.2215/CJN.01780213.