血液透析患者的膳食酸负荷与营养不良、炎症及氧化应激标志物

Dietary acid load and markers of malnutrition, inflammation, and oxidative stress in hemodialysis patients.

作者信息

Balali Arghavan, Nehls Marilyn S, Tabibi Hadi, As'habi Atefeh, Arab Arman

机构信息

Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran.

Department of Community Nutrition, School of Nutrition and Food Science, Nutrition and Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

出版信息

Front Nutr. 2024 Mar 22;11:1369206. doi: 10.3389/fnut.2024.1369206. eCollection 2024.

DOI:10.3389/fnut.2024.1369206

PMID:38585612

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10998450/

Abstract

AIMS

The present study was conducted to examine the association between dietary acid load (DAL) and markers of inflammation, oxidative stress, and malnutrition in a group of Iranian hemodialysis (HD) patients.

METHODS

This cross-sectional study was performed on individuals aged ≥18 years who were on HD at least 6 months before their enrollment in the study. A 4-day dietary recall was used for the evaluation of dietary intake. DAL was calculated using two methods including potential renal acid load (PRAL) and net endogenous acid production (NEAP). For assessing the malnutrition status, we used the subjective global assessment (SGA), dialysis malnutrition score (DMS), and malnutrition inflammation score (MIS). Fasting blood samples were collected from each participant to assess serum levels of high-sensitivity C-reactive protein (hs-CRP), soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular adhesion molecule-1 (sVCAM-1), sE-selectin, malondialdehyde (MDA), nitric oxide (NO), and endothelin-1.

RESULTS

In total, 291 patients with a mean age of 57.73 ± 0.88 years and HD vintage of 4.27 ± 0.25 months were enrolled in the current study. Significant positive associations were observed between PRAL and hs-CRP ( = 1.77, 95% CI: 0.88, 2.65), sICAM-1 ( = 83.21, 95% CI: 10.39, 156.04), sVCAM-1 ( = 194.63, 95% CI: 74.68, 314.58), and sE-selectin ( = 6.66, 95% CI: 1.81, 11.50) among participants with the highest PRAL scores, compared to those with the lowest PRAL scores. NEAP was positively correlated with hs-CRP ( = 1.34, 95% CI: 0.46, 2.22), sICAM-1 ( = 88.83, 95% CI: 16.99, 160.67), and MDA ( = 0.35, 95% CI: 0.005, 0.71). Additionally, marginally significant higher odds of SGA (OR = 1.98, 95% CI: 0.95, 4.11) and DMS (OR = 1.94, 95% CI: 0.92, 4.05) were observed in individuals in the third tertile of PRAL vs. the first tertile of PRAL. NEAP had also a marginally significant positive correlation with DMS (OR = 2.01, 95% CI: 0.93, 4.31).

CONCLUSION

This study illustrates that higher consumption of acidic foods is correlated with markers of inflammation, oxidative stress, and malnutrition in HD patients.

摘要

目的

本研究旨在探讨伊朗一组血液透析（HD）患者的膳食酸负荷（DAL）与炎症、氧化应激及营养不良标志物之间的关联。

方法

本横断面研究针对年龄≥18岁且在入组研究前至少已接受6个月血液透析的个体进行。采用4天膳食回顾法评估膳食摄入量。使用潜在肾酸负荷（PRAL）和净内源性酸产生（NEAP）两种方法计算DAL。为评估营养不良状况，我们采用了主观全面评定法（SGA）、透析营养不良评分（DMS）和营养不良炎症评分（MIS）。采集每位参与者的空腹血样，以评估血清中高敏C反应蛋白（hs-CRP）、可溶性细胞间黏附分子-1（sICAM-1）、可溶性血管黏附分子-1（sVCAM-1）、sE-选择素、丙二醛（MDA）、一氧化氮（NO）和内皮素-1的水平。

结果

本研究共纳入291例患者，平均年龄为57.73±0.88岁，血液透析时间为4.27±0.25个月。与PRAL得分最低的参与者相比，PRAL得分最高的参与者中，PRAL与hs-CRP（β = 1.77，95%CI：0.88，2.65）、sICAM-1（β = 83.21，95%CI：10.39，156.04）、sVCAM-1（β = 194.63，95%CI：74.68，314.58）和sE-选择素（β = 6.66，95%CI：1.81，11.50）之间存在显著正相关。NEAP与hs-CRP（β = 1.34，95%CI：0.46，2.22）、sICAM-1（β = 88.83，95%CI：16.99，160.67）和MDA（β = 0.35，95%CI：0.005，0.71）呈正相关。此外，与PRAL第一三分位数的个体相比，PRAL第三三分位数的个体中，SGA（OR = 1.98，95%CI：0.95，4.11）和DMS（OR = 1.94，95%CI：0.92，4.05）的比值略高且具有统计学意义。NEAP与DMS也呈边缘显著正相关（OR = 2.01，95%CI：0.93，4.31）。