Arab Arman, Karimi Elham, Nazari Maryam, Tabibi Hadi, As'habi Atefeh
Department of Community Nutrition, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran.
Department of Clinical Nutrition, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran.
Front Nutr. 2023 Sep 14;10:1230747. doi: 10.3389/fnut.2023.1230747. eCollection 2023.
The current survey aimed to investigate the link between energy-adjusted dietary inflammatory index (E-DII) and risk factors for CVD including markers of endothelial and systemic inflammation in Iranian hemodialysis patients.
Patients on hemodialysis for at least 6 months prior to enrollment were considered eligible in this cross-sectional study. The usual dietary intakes of the hemodialysis individuals were examined through 4 non-consecutive days including 2 dialysis days and 2 non-dialysis days using a 24-h recall approach to calculate E-DII. Multiple linear regression analysis was utilized to investigate the link between E-DII and selected biomarkers of inflammation and oxidative stress including high-sensitive C reactive protein (hs-CRP), serum intercellular adhesion molecule (sICAM), serum vascular cell adhesion molecule (sVCAM), malondialdehyde, and nitric oxide (NO), sE-selectin, and endothelin-1, and beta (β) and 95% confidence interval (CI) was reported. Value of < 0.05 was considered statistically significant.
Overall, 291 hemodialysis patients make up our study population. In the crude model, the E-DII score was positively associated with a higher sVCAM-1 (β = 177.39; 95% CI: 60.51, 294.26; = 0.003). Further adjustment for potential confounders attenuated the findings in a way that an increase of 128.72 in the sVCAM-1 was observed when the E-DII score increased from -2.68 to -1.14 (95% CI: 13.50, 243.94). After controlling for potential confounders, E-DII was associated with sE-selectin in hemodialysis patients in the highest category of E-DII as compared to the lowest category (β = 4.11; 95% CI: 0.22, 8.00; = 0.039).
The present findings suggest that adherence to a pro-inflammatory diet among hemodialysis patients is associated with a higher inflammatory status as evidenced by sVCAM-1 and sE-selectin; however, bidirectionality may exist and the role of residual confounders should be taken into account. Therefore, more longitudinal investigations are needed to elucidate the role of diet on the inflammatory status of hemodialysis patients.
本次调查旨在研究能量调整饮食炎症指数（E-DII）与伊朗血液透析患者心血管疾病（CVD）危险因素之间的联系，这些危险因素包括内皮和全身炎症标志物。
在这项横断面研究中，纳入登记前至少已进行6个月血液透析的患者。采用24小时回顾法，通过4个非连续日（包括2个透析日和2个非透析日）检查血液透析患者的日常饮食摄入量，以计算E-DII。利用多元线性回归分析研究E-DII与选定的炎症和氧化应激生物标志物之间的联系，这些生物标志物包括高敏C反应蛋白（hs-CRP）、血清细胞间黏附分子（sICAM）、血清血管细胞黏附分子（sVCAM）、丙二醛和一氧化氮（NO）、sE-选择素和内皮素-1，并报告β系数和95%置信区间（CI）。P<0.05的值被认为具有统计学意义。
总体而言，291名血液透析患者构成了我们的研究群体。在粗模型中，E-DII评分与较高的sVCAM-1呈正相关（β = 177.39；95% CI：60.51，294.26；P = 0.003）。对潜在混杂因素进行进一步调整后，研究结果有所减弱，当E-DII评分从-2.68增加到-1.14时，观察到sVCAM-1增加了128.72（95% CI：13.50，243.94）。在控制潜在混杂因素后，与最低类别相比，处于最高E-DII类别的血液透析患者中，E-DII与sE-选择素相关（β = 4.11；95% CI：0.22，8.00；P = 0.039）。
目前的研究结果表明，血液透析患者坚持促炎饮食与较高的炎症状态相关，sVCAM-1和sE-选择素可证明这一点；然而，可能存在双向性，应考虑残留混杂因素的作用。因此，需要更多的纵向研究来阐明饮食对血液透析患者炎症状态的作用。
