[국내논문]Dietary inflammatory index is associated with serum C-reactive protein and protein energy wasting in hemodialysis patients: A cross-sectional study원문보기
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)
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 die...
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.
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.
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문제 정의
In conclusion, DII is a new index associated with inflammatory cytokines including CRP and IL-6 [11,34], increased odds of asthma [35], colorectal cancer risk [36,37], prostate cancer among Italian men [38], risk of pancreatic cancer [39], and length of hospitalization among surgical patients treated for colorectal cancer [40]. The findings of this study demonstrate the evidence of a new tool for assessing the overall inflammatory potential of diet in HD patients. This study also suggests the application of DII for assessment of nutritional and inflammatory status as a target for reducing morbidity and mortality.
The findings of this study demonstrate the evidence of a new tool for assessing the overall inflammatory potential of diet in HD patients. This study also suggests the application of DII for assessment of nutritional and inflammatory status as a target for reducing morbidity and mortality.
제안 방법
To better our knowledge, the efficiency of the new dietary assessment in evaluation of pro-inflammatory and anti-inflammatory nutrients should be investigated for different chronic diseases. The aim of this cross sectional study was to evaluate the application of DII on dietary intake of HD patients and examine the associations between DII and malnutrition-inflammation markers.
Study participants were interviewed after their HD session about socio-demographic characteristics (age, gender, marital status, education level, etc.), medical diagnosis or being treated for chronic conditions, and other potential covariates. Dietary assessment was performed using three days dietary recalls with two non-dialysis days and one dialysis day.
In this study, 25 food parameters were available from dietary intake data, including mean daily intakes of energy, protein, carbohydrate, fat, saturated fat, polyunsaturated fatty acids (PUFA), monounsaturated fatty acids (MUFA), omega-3 fatty acids, omega-6 fatty acids, cholesterol, vitamin A, carotene, vitamin E, vitamin B1, vitamin B2, niacin, vitamin B6, vitamin B12, folic acid, vitamin C, magnesium, iron, zinc, fiber, and caffeine were used for the calculation of DII. Table 1 shows the inflammatory effect scores for dietary components used for calculation of DII in this study population.
The study population was divided into three subgroups according to their DII score and analysis of covariance (ANCOVA) was used for testing the differences across DII tertiles, with gender, education level, and marital status as covariates.
To the best of our knowledge, this is the first study to apply the DII to the diets of maintenance HD patients and examine the association between DII and malnutrition-inflammation markers. The result of this cross-sectional study shows that DII is significantly associated with reliable malnutrition and inflammation indicators including SGA (r = 0.
대상 데이터
This cross sectional study was conducted on 105 HD patients recruited from the RFM hemodialysis unit, Ankara, Turkey between April and October 2014. Inclusion criteria were age over 20 years, maintained HD therapy at least 3 months.
The authors gratefully acknowledge the final year students at the Department of Nutrition and Dietetic in Hacettepe University; Burcu Demirtaş, Cansu Bekar, Elif Çelik, Gizem Aytekin, Hediye Arıöz, Mehmet Miktat Doğar, Merve Dağdemir, Yasemin Doğrul who provided support for data collection.
데이터처리
The study population was divided into three subgroups according to their DII score and analysis of covariance (ANCOVA) was used for testing the differences across DII tertiles, with gender, education level, and marital status as covariates. Partial correlation coefficient was used to assess the relationship between DII and some nutritional assessment parameters controlling for gender, education level, and marital status. Statistical significance was accepted as P < 0.
* One-Way ANOVA test was used.
이론/모형
‡ Kruskall-Wallis test was used.
† Chi-squared test was used.
성능/효과
Briefly, DII is a scoring algorithm based on a 1943 literature review published from 1950 to 2010 evaluating the effect of diet on six inflammatory biomarkers; IL-1β, IL-4, IL-6, IL-10, TNF-α, and CRP. Forty-five food parameters including various macronutrients, micronutrients, flavonoids, and individual food items associated with these inflammatory biomarkers were scored according to whether they increased (+1), decreased (-1) or had no effect (0) on inflammation. An overall food parameter specific inflammatory effect score was calculated for each food item.
In addition, strong positive correlation was observed between DII and SGA score (r = 0.28, P < 0.01) and MIS (r = 0.28, P < 0.01), and SGA score showed positive correlation with CRP (r = 0.24, P < 0.05), negative correlation with BMI (r = -0.27, P < 0.01) and TSF (r = -0.18, P < 0.05).
The result of this cross-sectional study shows that DII is significantly associated with reliable malnutrition and inflammation indicators including SGA (r = 0.28, P < 0.01), MIS (r = 0.28, P < 0.01), and CRP (r = 0.35, P < 0.001) in HD patients.
In conclusion, DII is a new index associated with inflammatory cytokines including CRP and IL-6 [11,34], increased odds of asthma [35], colorectal cancer risk [36,37], prostate cancer among Italian men [38], risk of pancreatic cancer [39], and length of hospitalization among surgical patients treated for colorectal cancer [40]. The findings of this study demonstrate the evidence of a new tool for assessing the overall inflammatory potential of diet in HD patients.
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