Department of Nutrition and Health, Universidade Federal de Viçosa, Viçosa, MG 36570-900, Brazil.
Division of Nephrology, São João Batista Hospital, Viçosa, MG 36570-005, Brazil.
Appl Physiol Nutr Metab. 2020 Aug;45(8):845-850. doi: 10.1139/apnm-2019-0800. Epub 2020 Jul 17.
The aim of the present study was to test the hypothesis that inflammation mediates the associations among food intake, clinical-nutritional status, and plasma homocysteine (Hcys) in hemodialysis (HD) subjects. This was a cross-sectional analysis of data on 129 subjects undergoing HD (58.9% male, 61.8 ± 15.5 years of age) from the cohort Nutrition and Genetics on HD outcomes (NUGE-HD study). Sociodemographic, anthropometric, and metabolic data were collected, and food intake was assessed using a quantitative food frequency questionnaire. Plasma C-reactive protein (CRP) was used as an inflammatory marker. Data were analyzed by structural equation modeling. Regarding the direct effects, complex B vitamin intake was negatively associated with body mass index, and diabetes mellitus was positively associated with CRP. Plasma CRP also showed a negative association with Hcys, and the ratio of saturated and polyunsaturated fatty acids intake showed a positive association with Hcys. Regarding indirect effects, the results showed that the relationship between the presence of diabetes mellitus and Hcys is mediated by plasma CRP. In conclusion, the ratio of saturated and polyunsaturated fatty acids had a direct effect on plasma Hcys, whereas inflammation had a direct and mediating effect on the relationship between Hcys and diabetes mellitus in HD subjects. In end-stage renal disease, CRP influences plasma Hcys directly and also indirectly through its mediating effect. The quantity and quality of dietary fatty acids influence plasma Hcys concentrations in HD subjects.
本研究旨在检验炎症是否介导了饮食摄入、临床营养状况和血液透析（HD）患者血浆同型半胱氨酸（Hcys）之间关联的假说。这是对来自 HD 营养和遗传学结局队列（NUGE-HD 研究）的 129 名接受 HD 治疗的患者（58.9%为男性，61.8±15.5 岁）的数据进行的横断面分析。收集了社会人口统计学、人体测量学和代谢数据，并使用定量食物频率问卷评估了饮食摄入情况。使用 C 反应蛋白（CRP）作为炎症标志物。采用结构方程模型进行数据分析。直接效应方面，复合维生素 B 摄入与体重指数呈负相关，糖尿病与 CRP 呈正相关。血浆 CRP 与 Hcys 呈负相关，饱和和多不饱和脂肪酸摄入比值与 Hcys 呈正相关。间接效应方面，结果表明，糖尿病与 Hcys 之间的关系受血浆 CRP 介导。总之，饱和与多不饱和脂肪酸比值对 HD 患者的血浆 Hcys 有直接影响，而炎症对 Hcys 与糖尿病之间的关系有直接和介导作用。在终末期肾病中，CRP 直接影响血浆 Hcys，也通过其介导作用间接影响。膳食脂肪酸的数量和质量影响 HD 患者的血浆 Hcys 浓度。
