Shahdadian Farnaz, Javaheri Fatemeh Sadat Hashemi, Shams Fateme, Navab Fatemeh, Foshati Sahar, Bagherniya Mohammad, Moeinzadeh Firouzeh, Ziaei Rahele, Rouhani Mohammad Hossein
Nutrition and Food Security Research Center, Department of Clinical Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran.
Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Sci Rep. 2025 Jul 1;15(1):22010. doi: 10.1038/s41598-025-05637-2.
Hemodialysis patients often face significant challenges related to their quality of life, which can be influenced by various dietary factors. Among these, dietary minerals and the phosphorus to protein ratio may play important roles in maintaining overall quality of life and its subscales. Despite the critical nature of this topic, there remains a dearth of studies examining these associations. Therefore, we aimed to investigate the relationship between dietary intake of phosphorus, calcium, magnesium, and the phosphorus to protein ratio with quality of life and its subscales in hemodialysis patients. The present multi-center cross-sectional study was performed on 323 maintenance hemodialysis patients. Dietary intake was obtained through a validated 168-item semi-quantitative food frequency questionnaire. The Kidney Disease Quality of Life Short Form (KDQOL-SF) was used to assess quality of life and its subscales. Exclusion criteria were applied to individuals whose daily caloric intake exceeded 4200 kcal or fell below 800 kcal. Nutritionist IV software was used to calculate overall energy and nutrient intake and SPSS software version 20 was utilized for data analysis. The results showed that lower phosphorus intake increased the odds of symptoms (OR = 2.65, 95% CI: 1.07-6.59), sleep disturbances (OR = 2.82, 95% CI: 1.18-6.71), and low emotional well-being (OR = 2.63, 95% CI: 1.09-6.31) in fully adjusted model, adjusted for age, sex, BMI, energy intake, Kt-V, and URR. Low calcium intake was also associated with higher odds of low role-physical component (OR = 1.88, 95% CI: 1.13-3.15) in age and sex adjusted model. However, high dietary calcium decreased odds of low QoL in general health subscale in fully adjusted model (OR = 0.28, 95% CI: 0.09-0.88). Low magnesium intake increased odds of low QoL in work status subscale, and physical and mental composite in age and sex adjusted model, while improved symptom/problem subscale in fully adjusted model. High phosphorus to protein ratio associated with low patient satisfaction in fully adjusted model (p-value < 0.05). The study indicated a relationship between the intakes of certain minerals with low QoL in HD patients. Phosphorus, calcium, and magnesium intake were positively associated with increased overall QoL scores, while an increased phosphorus-to-protein ratio was associated with a decline in QoL. Larger sample sizes and the inclusion of healthy control groups should be pursued in future research on this topic.
血液透析患者常常面临与生活质量相关的重大挑战，而生活质量会受到多种饮食因素的影响。其中，膳食矿物质以及磷与蛋白质的比例可能对维持整体生活质量及其各个维度起着重要作用。尽管这个话题至关重要，但研究这些关联的研究仍然匮乏。因此，我们旨在调查血液透析患者膳食中磷、钙、镁的摄入量以及磷与蛋白质的比例与生活质量及其各个维度之间的关系。本多中心横断面研究对323例维持性血液透析患者进行。通过一份经验证的包含168个项目的半定量食物频率问卷获取膳食摄入量。使用肾脏病生活质量简表（KDQOL-SF）评估生活质量及其各个维度。排除标准适用于每日热量摄入超过4200千卡或低于800千卡的个体。使用Nutritionist IV软件计算总体能量和营养摄入量，并使用SPSS 20版软件进行数据分析。结果显示，在调整了年龄、性别、体重指数、能量摄入、Kt-V和尿素清除率的完全调整模型中，较低的磷摄入量增加了出现症状（OR = 2.65，95% CI：1.07 - 6.59）、睡眠障碍（OR = 2.82，95% CI：1.18 - 6.71）以及情绪低落（OR = 2.63，95% CI：1.09 - 6.31）的几率。在年龄和性别调整模型中，低钙摄入量也与身体功能角色维度得分低的几率较高相关（OR = 1.88，95% CI：1.13 - 3.15）。然而，在完全调整模型中，高膳食钙摄入量降低了总体健康维度生活质量低的几率（OR = 0.28，95% CI：0.09 - 0.88）。在年龄和性别调整模型中，低镁摄入量增加了工作状态维度生活质量低以及身心综合维度得分低的几率，而在完全调整模型中改善了症状/问题维度得分。在完全调整模型中，高磷与蛋白质比例与患者满意度低相关（p值 < 0.05）。该研究表明血液透析患者某些矿物质的摄入量与生活质量低之间存在关联。磷、钙和镁的摄入量与总体生活质量得分增加呈正相关，而磷与蛋白质比例增加与生活质量下降相关。未来关于这个话题的研究应采用更大的样本量并纳入健康对照组。
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