Dietary Patterns and Mortality in a Multinational Cohort of Adults Receiving Hemodialysis
- PMID: 31515137
- DOI: 10.1053/j.ajkd.2019.05.028
Dietary Patterns and Mortality in a Multinational Cohort of Adults Receiving Hemodialysis
Abstract
Rationale & objective: Clinical practice guidelines for dietary intake in hemodialysis focus on individual nutrients. Little is known about associations of dietary patterns with survival. We evaluated the associations of dietary patterns with cardiovascular and all-cause mortality among adults treated by hemodialysis.
Study design: Prospective cohort study.
Setting & participants: 8,110 of 9,757 consecutive adults on hemodialysis (January 2014 to June 2017) treated in a multinational private dialysis network and with analyzable dietary data.
Exposures: Data-driven dietary patterns based on the GA2LEN food frequency questionnaire. Participants received a score for each identified pattern, with higher scores indicating closer resemblance of their diet to the identified pattern. Quartiles of standardized pattern scores were used as primary exposures.
Outcomes: Cardiovascular and all-cause mortality.
Analytical approach: Principal components analysis with varimax rotation to identify common dietary patterns. Adjusted proportional hazards regression analyses with country as a random effect to estimate the associations between dietary pattern scores and mortality. Associations were expressed as adjusted HRs with 95% CIs, using the lowest quartile score as reference.
Results: During a median follow-up of 2.7 years (18,666 person-years), there were 2,087 deaths (958 cardiovascular). 2 dietary patterns, "fruit and vegetable" and "Western," were identified. For the fruit and vegetable dietary pattern score, adjusted HRs, in ascending quartiles, were 0.94 (95% CI, 0.76-1.15), 0.83 (95% CI, 0.66-1.06), and 0.91 (95% CI, 0.69-1.21) for cardiovascular mortality and 0.95 (95% CI, 0.83-1.09), 0.84 (95% CI, 0.71-0.99), and 0.87 (95% CI, 0.72-1.05) for all-cause mortality. For the Western dietary pattern score, the corresponding estimates were 1.10 (95% CI, 0.90-1.35), 1.11 (95% CI, 0.87-1.41), and 1.09 (95% CI, 0.80-1.49) for cardiovascular mortality and 1.01 (95% CI, 0.88-1.16), 1.00 (95% CI, 0.85-1.18), and 1.14 (95% CI, 0.93-1.41) for all-cause mortality.
Limitations: Self-reported food frequency questionnaire, data-driven approach.
Conclusions: These findings did not confirm an association between mortality among patients receiving long-term hemodialysis and the extent to which dietary patterns were either high in fruit and vegetables or consistent with a Western diet.
Keywords: Diet; Food Frequency Questionnaire (FFQ); Western diet; cardiovascular disease (CVD); dietary patterns; end-stage kidney disease (ESKD); food intake; fruit; hemodialysis; modifiable risk factor; mortality; principal component analysis; vegetables.
Copyright © 2019 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.
Similar articles
-
Healthy Lifestyle and Mortality Among Adults Receiving Hemodialysis: The DIET-HD Study.Am J Kidney Dis. 2022 May;79(5):688-698.e1. doi: 10.1053/j.ajkd.2021.07.022. Epub 2021 Sep 20. Am J Kidney Dis. 2022. PMID: 34547395
-
Fruit and Vegetable Intake and Mortality in Adults undergoing Maintenance Hemodialysis.Clin J Am Soc Nephrol. 2019 Feb 7;14(2):250-260. doi: 10.2215/CJN.08580718. Epub 2019 Jan 31. Clin J Am Soc Nephrol. 2019. PMID: 31738182 Free PMC article.
-
Behavioral Counseling to Promote a Healthful Diet and Physical Activity for Cardiovascular Disease Prevention in Adults Without Known Cardiovascular Disease Risk Factors: Updated Systematic Review for the U.S. Preventive Services Task Force [Internet].Rockville (MD): Agency for Healthcare Research and Quality (US); 2017 Jul. Report No.: 15-05222-EF-1. Rockville (MD): Agency for Healthcare Research and Quality (US); 2017 Jul. Report No.: 15-05222-EF-1. PMID: 29364620 Free Books & Documents. Review.
-
Dietary n-3 polyunsaturated fatty acid intake and all-cause and cardiovascular mortality in adults on hemodialysis: The DIET-HD multinational cohort study.Clin Nutr. 2019 Feb;38(1):429-437. doi: 10.1016/j.clnu.2017.11.020. Epub 2017 Dec 6. Clin Nutr. 2019. PMID: 29248251
-
Associations of dietary patterns with the risk of all-cause, CVD and stroke mortality: a meta-analysis of prospective cohort studies.Br J Nutr. 2015 Jan 14;113(1):16-24. doi: 10.1017/S000711451400289X. Epub 2014 Nov 28. Br J Nutr. 2015. PMID: 25430485 Review.
Cited by
-
High facility-level serum potassium variability associated with mortality in hemodialysis patients: results from Chinese Dialysis Outcomes and Practice Patterns Study (DOPPS).Ren Fail. 2023 Dec;45(1):2211157. doi: 10.1080/0886022X.2023.2211157. Ren Fail. 2023. PMID: 37293774 Free PMC article.
-
Effects of Mediterranean Diet, DASH Diet, and Plant-Based Diet on Outcomes among End Stage Kidney Disease Patients: A Systematic Review and Meta-Analysis.Clin Pract. 2022 Dec 28;13(1):41-51. doi: 10.3390/clinpract13010004. Clin Pract. 2022. PMID: 36648844 Free PMC article.
-
Potassium Homeostasis, Chronic Kidney Disease, and the Plant-Enriched Diets.Kidney360. 2020 Jan 8;1(1):65-71. doi: 10.34067/KID.0000222019. eCollection 2020 Jan 30. Kidney360. 2020. PMID: 35372861 Free PMC article. Review.
-
Dietary Potassium Intake and Mortality in a Prospective Hemodialysis Cohort.J Ren Nutr. 2021 Jul;31(4):411-420. doi: 10.1053/j.jrn.2020.05.008. Epub 2020 Oct 27. J Ren Nutr. 2021. PMID: 33121888 Free PMC article.
-
Nutritional status, hyperkalaemia and attainment of energy/protein intake targets in haemodialysis patients following plant-based diets: a longitudinal cohort study.Nephrol Dial Transplant. 2021 Mar 29;36(4):681-688. doi: 10.1093/ndt/gfaa194. Nephrol Dial Transplant. 2021. PMID: 33020805 Free PMC article. Clinical Trial.
Publication types
MeSH terms
LinkOut - more resources
Full Text Sources
Medical