Dietary inflammatory index and parameters of diet quality in normal weight and obese patients undergoing hemodialysis

• Published in: Nutrition (Burbank, Los Angeles County, Calif.) Los Angeles County, Calif.), 2019-05, Vol.61, p.32-37
• Main Authors: Alipoor, Elham, Karimbeiki, Razieh, Shivappa, Nitin, Yaseri, Mehdi, Hebert, James R., Hosseinzadeh-Attar, Mohammad Javad
• Format: Article
• Language: English
• Subjects: Adequacy; Aged; Anthropometry; Body Mass Index; Body size; Cross-Sectional Studies; Dialysis; Diet; Diet quality; Diet Surveys; Diet, Healthy - statistics & numerical data; Dietary inflammatory index; Energy; Energy Intake; Fatty acids; Female; Flux density; Hemodialysis; Humans; Ideal Body Weight; Inflammation; Kidney Diseases - complications; Kidney Diseases - physiopathology; Kidney Diseases - therapy; Male; Malnutrition; Malnutrition inflammation score; Mathematical analysis; Metabolism; Middle Aged; Mortality; Nutrients; Nutrition research; Nutritional Status; Obesity; Obesity - complications; Obesity - physiopathology; Obesity - therapy; Parameters; Patients; Potassium; Prognosis; Proteins; Renal Dialysis - statistics & numerical data; Renal failure; Skinfold thickness; Vitamins; Wasting Syndrome - complications; Wasting Syndrome - physiopathology; Wasting Syndrome - therapy; Weight
• ISSN: 0899-9007; 1873-1244
• DOI: 10.1016/j.nut.2018.09.036

•Obese hemodialysis patients had significantly higher inflammatory potential of diet and higher dietary energy density.•Obese hemodialysis patients had better nutritional reserves based on malnutrition inflammation score.•No significant difference was observed in total adequacy of diet between groups; however, mean adequacy ratio was inversely correlated with malnutrition inflammation score.•The inflammatory potential of diet was directly associated with body mass index in hemodialysis patients. Better nutritional reserves are proposed as a mechanism for the protective role of obesity in hemodialysis. Little is known about the quality of diet as a major contributor to nutritional status, specifically body mass index and obesity. The aim of this study was to assess dietary inflammatory index (DII®) score and other parameters of diet in normal-weight and obese patients undergoing hemodialysis to understand whether there is a benefit for obese patients. This cross-sectional study included 85 hemodialysis patients (44 obese and 41 normal-weight). Four-day 24-h dietary recalls and anthropometric measurements were collected. DII, energy-adjusted DII (E-DII), dietary energy density (DED), mean adequacy ratio (MAR), and malnutrition inflammation score (MIS) were calculated. Median E-DII score (1 [0.29–1.47] versus 0.42 [0.12–1.27]; P = 0.047) was higher and DII score (1.18 [0.03–2.26] versus 1.79 [0.47–2.49]; P = 0.046) was lower in the obese group. Obese patients had higher DED (1.52 ± 0.23 versus 1.43 ± 0.28; P = 0.034) and lower MIS (6.3 ± 2.5 versus 10.5 ± 3.1; P < 0.001) compared with the normal weight group. There was no significant difference in MAR between groups (P = 0.358). E-DII had significant positive correlation with weight (r = 0.226; P = 0.037), triceps skinfold thickness (r = 0.239; P = 0.035), and DED (r = 0.227; P = 0.036). MAR had significant negative correlation with MIS (r = –0.287; P = 0.008). Observed higher diet inflammatory potential and energy density and lower wasting in the obese group, along with similar adequacy of nutrients intake between groups, indicates that lower wasting, but not other indicators of nutritional status, are involved in better prognosis of obese patients with hemodialysis. Further studies are required to assess the potential dietary factors involved in determining wasting in advanced kidney failure.