DOI QR코드

DOI QR Code

Dietary inflammatory index is associated with serum C-reactive protein and protein energy wasting in hemodialysis patients: A cross-sectional study

  • Kizil, Mevlude (Department of Nutrition and Dietetics, Faculty of Health Sciences, Hacettepe University) ;
  • Tengilimoglu-Metin, M. Merve (Department of Nutrition and Dietetics, Faculty of Health Sciences, Hacettepe University) ;
  • Gumus, Damla (Department of Nutrition and Dietetics, Faculty of Health Sciences, Hacettepe University) ;
  • Sevim, Sumeyra (Department of Nutrition and Dietetics, Faculty of Health Sciences, Hacettepe University) ;
  • Turkoglu, Inci (Department of Nutrition and Dietetics, Faculty of Health Sciences, Hacettepe University) ;
  • Mandiroglu, Fahri (RFM Hemodialysis Units)
  • Received : 2015.11.19
  • Accepted : 2016.02.14
  • Published : 2016.08.01

Abstract

BACKGROUND/OBJECTIVE: Malnutrition and inflammation are reported as the most powerful predictors of mortality and morbidity in hemodialysis (HD) patients. Diet has a key role in modulating inflammation and dietary inflammatory index (DII) is a new tool for assessment of inflammatory potential of diet. The aim of this study was to evaluate the application of DII on dietary intake of HD patients and examine the associations between DII and malnutrition-inflammation markers. SUBJECTS/METHODS: A total of 105 subjects were recruited for this cross-sectional study. Anthropometric measurements, 3-day dietary recall, and pre-dialysis biochemical parameters were recorded for each subject. Subjective global assessment (SGA), which was previously validated for HD patients, and malnutrition inflammation score (MIS) were used for the diagnosis of protein energy wasting. DII was calculated according to average of 3-day dietary recall data. RESULTS: DII showed significant correlation with reliable malnutrition and inflammation indicators including SGA (r = 0.28, P < 0.01), MIS (r = 0.28, P < 0.01), and serum C-reactive protein (CRP) (r = 0.35, P < 0.001) in HD patients. When the study population was divided into three subgroups according to their DII score, significant increasing trends across the tertiles of DII were observed for SGA score (P = 0.035), serum CRP (P = 0.001), dietary energy (P < 0.001), total fat (P < 0.001), saturated fatty acids (P < 0.001), polyunsaturated fatty acids (P = 0.006), and omega-6 fatty acids (P = 0.01) intakes. CONCLUSION: This study shows that DII is a good tool for assessing the overall inflammatory potential of diet in HD patients.

References

  1. Kalantar-Zadeh K, Block G, McAllister CJ, Humphreys MH, Kopple JD. Appetite and inflammation, nutrition, anemia, and clinical outcome in hemodialysis patients. Am J Clin Nutr 2004;80:299-307. https://doi.org/10.1093/ajcn/80.2.299
  2. Kalantar-Zadeh K. Recent advances in understanding the malnutrition-inflammation-cachexia syndrome in chronic kidney disease patients: What is next? Semin Dial 2005;18:365-9. https://doi.org/10.1111/j.1525-139X.2005.00074.x
  3. Kalantar-Zadeh K, Abbott KC, Salahudeen AK, Kilpatrick RD, Horwich TB. Survival advantages of obesity in dialysis patients. Am J Clin Nutr 2005;81:543-54. https://doi.org/10.1093/ajcn/81.3.543
  4. Stack AG, Bloembergen WE. Prevalence and clinical correlates of coronary artery disease among new dialysis patients in the United States: a cross-sectional study. J Am Soc Nephrol 2001;12:1516-23.
  5. Hung SC, Kuo KL, Peng CH, Wu CH, Lien YC, Wang YC, Tarng DC. Volume overload correlates with cardiovascular risk factors in patients with chronic kidney disease. Kidney Int 2014;85:703-9. https://doi.org/10.1038/ki.2013.336
  6. Menon V, Wang X, Greene T, Beck GJ, Kusek JW, Marcovina SM, Levey AS, Sarnak MJ. Relationship between C-reactive protein, albumin, and cardiovascular disease in patients with chronic kidney disease. Am J Kidney Dis 2003;42:44-52. https://doi.org/10.1016/S0272-6386(03)00407-4
  7. Ortega O, Rodriguez I, Gallar P, Carreno A, Ortiz M, Espejo B, Jimenez J, Gutierrez M, Oliet A, Vigil A. Significance of high C-reactive protein levels in pre-dialysis patients. Nephrol Dial Transplant 2002;17:1105-9. https://doi.org/10.1093/ndt/17.6.1105
  8. Tonelli M, Sacks F, Pfeffer M, Jhangri GS, Curhan G; Cholesterol and Recurrent Events (CARE) Trial Investigators. Biomarkers of inflammation and progression of chronic kidney disease. Kidney Int 2005;68:237-45. https://doi.org/10.1111/j.1523-1755.2005.00398.x
  9. Heyland DK, Novak F, Drover JW, Jain M, Su X, Suchner U. Should immunonutrition become routine in critically ill patients? A systematic review of the evidence. JAMA 2001;286:944-53. https://doi.org/10.1001/jama.286.8.944
  10. Cavicchia PP, Steck SE, Hurley TG, Hussey JR, Ma Y, Ockene IS, Hebert JR. A new dietary inflammatory index predicts interval changes in serum high-sensitivity C-reactive protein. J Nutr 2009;139:2365-72. https://doi.org/10.3945/jn.109.114025
  11. Shivappa N, Steck SE, Hurley TG, Hussey JR, Hebert JR. Designing and developing a literature-derived, population-based dietary inflammatory index. Public Health Nutr 2014;17:1689-96. https://doi.org/10.1017/S1368980013002115
  12. Shivappa N, Steck SE, Hurley TG, Hussey JR, Ma Y, Ockene IS, Tabung F, Hebert JR. A population-based dietary inflammatory index predicts levels of C-reactive protein in the Seasonal Variation of Blood Cholesterol Study (SEASONS). Public Health Nutr 2014;17:1825-33. https://doi.org/10.1017/S1368980013002565
  13. Tabung FK, Steck SE, Zhang J, Ma Y, Liese AD, Agalliu I, Hingle M, Hou L, Hurley TG, Jiao L, Martin LW, Millen AE, Park HL, Rosal MC, Shikany JM, Shivappa N, Ockene JK, Hebert JR. Construct validation of the dietary inflammatory index among postmenopausal women. Ann Epidemiol 2015;25:398-405. https://doi.org/10.1016/j.annepidem.2015.03.009
  14. Kalantar-Zadeh K, Kleiner M, Dunne E, Lee GH, Luft FC. A modified quantitative subjective global assessment of nutrition for dialysis patients. Nephrol Dial Transplant 1999;14:1732-8. https://doi.org/10.1093/ndt/14.7.1732
  15. Kalantar-Zadeh K, Kopple JD, Humphreys MH, Block G. Comparing outcome predictability of markers of malnutrition-inflammation complex syndrome in haemodialysis patients. Nephrol Dial Transplant 2004;19:1507-19. https://doi.org/10.1093/ndt/gfh143
  16. As'habi A, Tabibi H, Nozary-Heshmati B, Mahdavi-Mazdeh M, Hedayati M. Comparison of various scoring methods for the diagnosis of protein-energy wasting in hemodialysis patients. Int Urol Nephrol 2014;46:999-1004. https://doi.org/10.1007/s11255-013-0638-1
  17. Clinical practice guidelines for nutrition in chronic renal failure. K/DOQI, National Kidney Foundation. Am J Kidney Dis 2000;35:S1-140.
  18. Mehrotra R, Kopple JD. Nutritional management of maintenance dialysis patients: why aren't we doing better? Annu Rev Nutr 2001;21:343-79. https://doi.org/10.1146/annurev.nutr.21.1.343
  19. Kalantar-Zadeh K, Ikizler TA, Block G, Avram MM, Kopple JD. Malnutrition-inflammation complex syndrome in dialysis patients:causes and consequences. Am J Kidney Dis 2003;42:864-81. https://doi.org/10.1016/j.ajkd.2003.07.016
  20. Rambod M, Bross R, Zitterkoph J, Benner D, Pithia J, Colman S, Kovesdy CP, Kopple JD, Kalantar-Zadeh K. Association of malnutrition-inflammation score with quality of life and mortality in hemodialysis patients: a 5-year prospective cohort study. Am J Kidney Dis 2009;53:298-309. https://doi.org/10.1053/j.ajkd.2008.09.018
  21. Galland L. Diet and inflammation. Nutr Clin Pract 2010;25:634-40. https://doi.org/10.1177/0884533610385703
  22. Cardozo LF, Pedruzzi LM, Stenvinkel P, Stockler-Pinto MB, Daleprane JB, Leite M Jr, Mafra D. Nutritional strategies to modulate inflammation and oxidative stress pathways via activation of the master antioxidant switch Nrf2. Biochimie 2013;95:1525-33. https://doi.org/10.1016/j.biochi.2013.04.012
  23. Kalantar-Zadeh K, Stenvinkel P, Bross R, Khawar OS, Rammohan M, Colman S, Benner D. Kidney insufficiency and nutrient-based modulation of inflammation. Curr Opin Clin Nutr Metab Care 2005;8:388-96. https://doi.org/10.1097/01.mco.0000172578.56396.9e
  24. Lemos JR, Alencastro MG, Konrath AV, Cargnin M, Manfro RC. Flaxseed oil supplementation decreases C-reactive protein levels in chronic hemodialysis patients. Nutr Res 2012;32:921-7. https://doi.org/10.1016/j.nutres.2012.08.007
  25. Shema-Didi L, Sela S, Ore L, Shapiro G, Geron R, Moshe G, Kristal B. One year of pomegranate juice intake decreases oxidative stress, inflammation, and incidence of infections in hemodialysis patients: a randomized placebo-controlled trial. Free Radic Biol Med 2012;53:297-304. https://doi.org/10.1016/j.freeradbiomed.2012.05.013
  26. Raphael W, Sordillo LM. Dietary polyunsaturated fatty acids and inflammation: the role of phospholipid biosynthesis. Int J Mol Sci 2013;14:21167-88. https://doi.org/10.3390/ijms141021167
  27. Santos S, Oliveira A, Casal S, Lopes C. Saturated fatty acids intake in relation to C-reactive protein, adiponectin, and leptin: a population-based study. Nutrition 2013;29:892-7. https://doi.org/10.1016/j.nut.2013.01.009
  28. King DE, Egan BM, Geesey ME. Relation of dietary fat and fiber to elevation of C-reactive protein. Am J Cardiol 2003;92:1335-9. https://doi.org/10.1016/j.amjcard.2003.08.020
  29. Ruperto M, Sanchez-Muniz FJ, Barril G. Predictors of protein-energy wasting in haemodialysis patients: a cross-sectional study. J Hum Nutr Diet 2016;29:38-47. https://doi.org/10.1111/jhn.12276
  30. Udeanu M, Guizzardi G, Di Pasquale G, Marchetti A, Romani F, Dalmastri V, Capelli I, Stalteri L, Cianciolo G, Rucci P, La Manna G. Relationship between coronary artery disease and C-reactive protein levels in NSTEMI patients with renal dysfunction: a retrospective study. BMC Nephrol 2014;15:152-9. https://doi.org/10.1186/1471-2369-15-152
  31. DeAngelis RA, Reis ES, Ricklin D, Lambris JD. Targeted complement inhibition as a promising strategy for preventing inflammatory complications in hemodialysis. Immunobiology 2012;217:1097-105. https://doi.org/10.1016/j.imbio.2012.07.012
  32. Salahudeen AK. Obesity and survival on dialysis. Am J Kidney Dis 2003;41:925-32. https://doi.org/10.1016/S0272-6386(03)00189-6
  33. Beberashvili I, Sinuani I, Azar A, Yasur H, Feldman L, Efrati S, Averbukh Z, Weissgarten J. Nutritional and inflammatory status of hemodialysis patients in relation to their body mass index. J Ren Nutr 2009;19:238-47. https://doi.org/10.1053/j.jrn.2008.11.007
  34. Wirth MD, Burch J, Shivappa N, Violanti JM, Burchfiel CM, Fekedulegn D, Andrew ME, Hartley TA, Miller DB, Mnatsakanova A, Charles LE, Steck SE, Hurley TG, Vena JE, Hebert JR. Association of a dietary inflammatory index with inflammatory indices and metabolic syndrome among police officers. J Occup Environ Med 2014;56:986-9. https://doi.org/10.1097/JOM.0000000000000213
  35. Wood LG, Shivappa N, Berthon BS, Gibson PG, Hebert JR. Dietary inflammatory index is related to asthma risk, lung function and systemic inflammation in asthma. Clin Exp Allergy 2015;45:177-83. https://doi.org/10.1111/cea.12323
  36. Shivappa N, Prizment AE, Blair CK, Jacobs DR Jr, Steck SE, Hebert JR. Dietary inflammatory index and risk of colorectal cancer in the Iowa Women's Health Study. Cancer Epidemiol Biomarkers Prev 2014;23:2383-92. https://doi.org/10.1158/1055-9965.EPI-14-0537
  37. Tabung FK, Steck SE, Ma Y, Liese AD, Zhang J, Caan B, Hou L, Johnson KC, Mossavar-Rahmani Y, Shivappa N, Wactawski-Wende J, Ockene JK, Hebert JR. The association between dietary inflammatory index and risk of colorectal cancer among postmenopausal women: results from the Women's Health Initiative. Cancer Causes Control 2015;26:399-408. https://doi.org/10.1007/s10552-014-0515-y
  38. Shivappa N, Bosetti C, Zucchetto A, Montella M, Serraino D, La Vecchia C, Hebert JR. Association between dietary inflammatory index and prostate cancer among Italian men. Br J Nutr 2015;113:278-83. https://doi.org/10.1017/S0007114514003572
  39. Shivappa N, Bosetti C, Zucchetto A, Serraino D, La Vecchia C, Hebert JR. Dietary inflammatory index and risk of pancreatic cancer in an Italian case-control study. Br J Nutr 2015;113:292-8. https://doi.org/10.1017/S0007114514003626
  40. Galas A, Kulig P, Kulig J. Dietary inflammatory index as a potential determinant of a length of hospitalization among surgical patients treated for colorectal cancer. Eur J Clin Nutr 2014;68:1168-74. https://doi.org/10.1038/ejcn.2014.120

Cited by

  1. Lower Dietary Inflammatory Index Scores Are Associated with Lower Glycemic Index Scores among College Students vol.10, pp.2, 2018, https://doi.org/10.3390/nu10020182
  2. Dietary inflammatory index: a potent association with cardiovascular risk factors among patients candidate for coronary artery bypass grafting (CABG) surgery vol.17, pp.1, 2018, https://doi.org/10.1186/s12937-018-0325-2
  3. Subjective Global Assessment–Dialysis Malnutrition Score and arteriovenous fistula outcome: A comparison with Charlson Comorbidity Index pp.1724-6032, 2018, https://doi.org/10.1177/1129729818779550
  4. Survival in patients on hemodialysis: Effect of gender according to body mass index and creatinine vol.13, pp.5, 2018, https://doi.org/10.1371/journal.pone.0196550
  5. Dietary inflammatory index positively associated with high-sensitivity C-reactive protein level in Japanese from NIPPON DATA2010 pp.1349-9092, 2019, https://doi.org/10.2188/jea.JE20180156