Division of Internal Medicine, Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,
Department of Nephrology, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang, China.
Am J Nephrol. 2021;52(12):909-918. doi: 10.1159/000520027. Epub 2021 Nov 26.
High risk of early death, especially contributed to cardiovascular disease, exists in patients who have chronic kidney disease (CKD). And the burden of cardiovascular disease is able to be lightened by an increase in omega-3 polyunsaturated fatty acid (omega-3 PUFA). A diet high in omega-3 PUFA in the general population is protective, although it is inconclusive about its beneficial role in the CKD population.
From the 1999 to 2014 National Health and Nutrition Examination Surveys (NHANES), we can collect 2,990 participants who suffered from CKD, who were classified into 4 groups: <0.86, 0.87-1.30, 1.31-1.92, and 1.93-9.65 g/day based on NHANES 24-h dietary recall questionnaire dietary omega-3 PUFA. Moreover, their mortality details were available to be obtained by linking NHANES to the National Death Index. The associations between dietary omega-3 PUFA and mortality were evaluated by constructing multivariable Cox proportional hazards models.
Over 8 years of a median follow-up, 864 deaths were recorded. The adjusted hazard ratios (95% confidence interval) for all-cause mortality of the diseased people with CKD in the 2nd (0.87-1.30 g/day), 3rd (0.87-1.30 g/day), and 4th (1.93-9.65 g/day) quartiles of dietary omega-3 PUFA were 0.94 (0.72, 1.23), 0.74 (0.54, 1.02), and 0.67 (0.48, 0.93), respectively, versus those with the lowest quartile of dietary omega-3 PUFA intake (<0.86 g/day) (p for trend = 0.011).
There may be a inverse relation of dietary omega-3 PUFA intake and all-cause mortality in patients with CKD. Therefore, an increase of dietary omega-3 PUFA may be encouraged to be used clinically in patients with CKD.
患有慢性肾病(CKD)的患者早期死亡风险较高,尤其是心血管疾病的风险较高。而增加ω-3 多不饱和脂肪酸(ω-3 PUFA)可以减轻心血管疾病的负担。一般人群中ω-3 PUFA 含量高具有保护作用,但对于 CKD 人群,其有益作用尚不确定。
我们可以从 1999 年至 2014 年的全国健康和营养调查(NHANES)中收集 2990 名患有 CKD 的参与者,他们根据 NHANES 24 小时膳食回顾问卷中的膳食 ω-3 PUFA 分为 4 组:<0.86、0.87-1.30、1.31-1.92 和 1.93-9.65 g/天。此外,通过将 NHANES 与国家死亡指数链接,可以获得他们的死亡详细信息。通过构建多变量 Cox 比例风险模型来评估膳食 ω-3 PUFA 与死亡率之间的关系。
在中位数为 8 年的随访期间,记录了 864 例死亡。患有 CKD 的患者的全因死亡率的调整后危险比(95%置信区间)分别为第 2(0.87-1.30 g/天)、第 3(0.87-1.30 g/天)和第 4(1.93-9.65 g/天)四分位数的膳食 ω-3 PUFA 为 0.94(0.72,1.23)、0.74(0.54,1.02)和 0.67(0.48,0.93),与膳食 ω-3 PUFA 摄入量最低四分位数的患者相比(<0.86 g/天)(p 趋势=0.011)。
在患有 CKD 的患者中,膳食 ω-3 PUFA 的摄入量与全因死亡率之间可能存在反比关系。因此,临床上可以鼓励增加膳食 ω-3 PUFA 的摄入量。