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Marashi-Hosseini L, Jafarirad S, Hadianfard AM. A fuzzy based dietary clinical decision support system for patients with multiple chronic conditions (MCCs). Sci Rep 2023; 13:12166. [PMID: 37500949 PMCID: PMC10374573 DOI: 10.1038/s41598-023-39371-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 07/25/2023] [Indexed: 07/29/2023] Open
Abstract
Due to the multifaceted nature of Multiple Chronic Conditions (MCCs), setting a diet for these patients is complicated and time-consuming. In this study, a clinical decision support system based on fuzzy logic was modeled and evaluated to aid dietitians in adjusting the diet for patients with MCCs. Mamdani fuzzy logic with 1144 rules was applied to design the model for MCCs patients over 18 years who suffer from one or more chronic diseases, including obesity, diabetes, hypertension, hyperlipidemia, and kidney disease. One hundred nutrition records from three nutrition clinics were employed to measure the system's performance. The findings showed that the diet set by nutritionists had no statistically significant difference from the diet recommended by the fuzzy model (p > 0.05), and there was a strong correlation close to one between them. In addition, the results indicated a suitable model performance with an accuracy of about 97%. This system could adjust the diet with high accuracy as well as humans. In addition, it could increase dietitians' confidence, precision, and speed in setting the diet for MCCs patients.
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Affiliation(s)
- Leila Marashi-Hosseini
- Department of Health Information Technology, School of Allied Medical Science, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Sima Jafarirad
- Associate Professor of Nutrition and Metabolic Diseases Research Center, Clinical Sciences Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ali Mohammad Hadianfard
- Associate Professor (Medical Informatics), Nutrition, and Metabolic Diseases Research Center, Clinical Sciences Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
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Abstract
Individuals with chronic kidney disease (CKD), particularly those undergoing maintenance dialysis, are prone to protein-energy wasting (PEW), the latter of which can be ameliorated with different methods of nutrition support. Dietary counseling guided by dietitians is the key for preventing and managing PEW in CKD. If dietary counseling per se fails to meet the recommended energy and protein requirements, the addition of oral nutrition supplements (ONSs) would be necessary. When these initial measures cannot attain the recommended energy and protein requirements, nutrition support, including enteral tube feeding or parenteral nutrition (PN), should be considered as a viable option to improve nutrition status. Partial PN, comprising intraperitoneal PN (IPPN) and intradialytic PN (IDPN) therapies, may be attempted as supplemental nutrition support in patients with PEW requiring peritoneal dialysis and hemodialysis, respectively. Despite the debatable effectiveness of IPPN for patients undergoing peritoneal dialysis, it remains a feasible means in these patients. The indications for IPPN in patients undergoing peritoneal dialysis include inadequate dietary intake of energy and protein, and barriers of oral intake and other forms of enteral supplementation such as issues with suitability, tolerance, and compliance. Nonetheless, in the case of spontaneous dietary consumption of energy and protein meeting the difference between the IDPN provision and the nutrition targets, the use of IDPN is rational. In patients with PEW and malfunctioning gastrointestinal tract, as well as those whose enteral intake (with or without partial PN) is below the recommended nutrient requirements, total PN becomes a relevant nutrition intervention.
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Affiliation(s)
- Winnie Chan
- School of Sport, Exercise and Rehabilitation Sciences, The University of Birmingham, Edgbaston, Birmingham, United Kingdom.,Department of Nephrology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Edgbaston, Birmingham, United Kingdom
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Li HL, Li H, Cao YF, Qi Y, Wang WQ, Liu SQ, Yang CD, Yu XY, Xu T, Zhu Y, Chen W, Tao JL, Li XW. Effects of keto acid supplements on Chinese patients receiving maintenance hemodialysis: a prospective, randomized, controlled, single-center clinical study. Chin Med J (Engl) 2020; 133:9-16. [PMID: 31923099 PMCID: PMC7028198 DOI: 10.1097/cm9.0000000000000578] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The effects of keto acid (KA) supplements on Chinese patients receiving maintenance hemodialysis (MHD) are unclear. This study aimed to evaluate the effects of KA supplementation on nutritional status, inflammatory markers, and bioelectric impedance analysis (BIA) parameters in a cohort of Chinese patients with MHD without malnutrition. METHODS This was a prospective, randomized, controlled, single-center clinical study conducted in 2011 till 2014. Twenty-nine patients with MHD were randomly assigned to a control (n = 14) or a KA (n = 15) group. The control group maintained a dietary protein intake of 0.9 g/kg/day. The KA group received additional KA supplement (0.1 g/kg/day). BIA was used to determine the lean tissue mass, adipose tissue mass, and body cell mass. The patients' nutritional status, dialysis adequacy, and biochemical parameters were assessed at the ends of the third and sixth months with t test or Wilcoxon rank-sum test. RESULTS The daily total energy intake for both groups was about 28 kcal/kg/day. After 6 months, the Kt/V (where K is the dialyzer clearance of urea, t is the dialysis time, and V is the volume of the distribution of urea) was 1.33 ± 0.25 in KA group, and 1.34 ± 0.25 in the control group. The median triceps skin-fold thickness in KA group was 12.00 and 9.00 mm in the control group. In addition, the median hand-grip strength in KA group was 21.10 and 25.65 kg in the control group. There were no significant differences between the groups with respect to the anthropometry parameters, dialysis adequacy, serum calcium and phosphorus levels, inflammatory markers, and amino-acid profiles, or in relation to the parameters determined by BIA. Both groups achieved dialysis adequacy and maintained nutritional status during the study. CONCLUSIONS In this cohort of Chinese patients with MHD, the patients in the control group whose dietary protein intake was 0.9 g/kg/day and total energy intake was 28 kcal/kg/day, maintained well nutritional status during study period. The KA supplement (0.1 g/kg/day) did not improve the essential amino acid/non-essential amino acid ratio, nor did it change the patients' mineral metabolism, inflammatory parameters, or body compositions.
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Affiliation(s)
- Hai-Long Li
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Hui Li
- Department of Nephrology, Shanxi Medical College Affiliated First Hospital, Taiyuan, Shanxi 030001, China
| | - Yi-Fu Cao
- Department of Nephrology, Shijiazhuang Third Hospital, Shijiazhuang, Hebei 050011, China
| | - Yue Qi
- Department of Nephrology, Shanxi Medical College Affiliated Second Hospital, Taiyuan, Shanxi 030001, China
| | - Wei-Qi Wang
- School of Medicine, Stanford University, Stanford, CA 94305, USA
| | - Shi-Qin Liu
- Department of Nephrology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Chen-Die Yang
- Department of Cardiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Xiao-Yan Yu
- Department of Nephrology, Qiqihar Medical College Affiliated Third Hospital, Qiqihar, Heilongjiang 161000, China
| | - Tao Xu
- Department of Statistics, Institute of Basic Medical Sciences, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Yan Zhu
- Department of Nephrology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Wei Chen
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Jian-Ling Tao
- Department of Nephrology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Xue-Wang Li
- Department of Nephrology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100730, China
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Giaretta AG, Schulz M, Silveira TT, de Oliveira MV, Patrício MJ, Gonzaga LV, Fett R, da Silva EL, Wazlawik E. Apple intake improves antioxidant parameters in hemodialysis patients without affecting serum potassium levels. Nutr Res 2018; 64:56-63. [PMID: 30802723 DOI: 10.1016/j.nutres.2018.12.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 11/30/2018] [Accepted: 12/20/2018] [Indexed: 12/23/2022]
Abstract
Oxidative stress (OS) is associated with increased morbidity and mortality in hemodialysis (HD) patients, and the consumption of fruits seems to improve OS due to their antioxidant properties. Therefore, we hypothesized that Fuji apple intake improves OS markers in HD patients due to its polyphenolic compounds without increasing serum potassium levels. This trial was a 1-group, pre- and posttest comparison between 16 patients who had been on hemodialysis for at least 3 months without any acute illness or hyperkalemia. Each volunteer consumed 2 Fuji apples (~360 g) per day for 1 week. Blood samples were collected at the baseline period and after 8 days for the measurement of total antioxidant status, ascorbic acid, catalase, glutathione peroxidase, superoxide dismutase, reduced glutathione, total oxidant status, oxidative stress index, potassium, phosphorus, uric acid, glucose, and fructosamine. For tolerance evaluation, participants were asked about their bowel habits. Apple intake increased glutathione peroxidase (P = .006) and superoxide dismutase activities (P = .006) and ascorbic acid levels (P = .002). No significant changes were observed in uric acid, potassium, phosphorus, glucose, and fructosamine levels. Additionally, there was a decrease in the catalase activity (P = .021) and in the total antioxidant status values (P = .004). However, increased total oxidant status (P = .003) and oxidative stress index (P = .033) levels were observed after apple intake. In conclusion, the intake of 2 Fuji apples per day for 1 week was well tolerated and improved antioxidant parameters in HD patients without affecting serum potassium levels.
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Affiliation(s)
- Andréia G Giaretta
- Post-graduate Program in Nutrition, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil.
| | - Mayara Schulz
- Department of Food Science and Technology, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil.
| | - Taís T Silveira
- Post-graduate Program in Nutrition, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil.
| | - Marina V de Oliveira
- Department of Clinical Analyses, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil.
| | | | - Luciano V Gonzaga
- Department of Food Science and Technology, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil.
| | - Roseane Fett
- Department of Food Science and Technology, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil.
| | - Edson L da Silva
- Post-graduate Program in Nutrition, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil; Department of Clinical Analyses, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil.
| | - Elisabeth Wazlawik
- Post-graduate Program in Nutrition, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil.
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Fernandes AS, Ramos CI, Nerbass FB, Cuppari L. Diet Quality of Chronic Kidney Disease Patients and the Impact of Nutritional Counseling. J Ren Nutr 2018; 28:403-410. [DOI: 10.1053/j.jrn.2017.10.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 10/24/2017] [Accepted: 10/25/2017] [Indexed: 11/11/2022] Open
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Nerbass FB, Calice-Silva V, Pecoits-Filho R. Sodium Intake and Blood Pressure in Patients with Chronic Kidney Disease: A Salty Relationship. Blood Purif 2018; 45:166-172. [PMID: 29478050 DOI: 10.1159/000485154] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Hypertension affects almost all chronic kidney disease patients and is related to poor outcomes. Sodium intake is closely related to blood pressure (BP) levels in this population and decreasing its intake consistently improves the BP control particularly in short-term controlled trials. However, most patients struggle in following a controlled diet on sodium according to the guidelines recommendation due to several factors and barriers discussed in this article. SUMMARY This review article summarizes the current knowledge related to the associations between sodium consumption, BP, and the risk of cardiovascular disease and chronic kidney disease (CKD); it also provides recommendations of how to achieve sodium intake lowering. Key Messages: Evidences support the benefits in decreasing sodium intake on markers of cardiovascular and renal outcomes in CKD. Trials had shorter follow-up and to maintain long-term sodium intake control is a major challenge. Larger studies with longer follow-up looking at hard endpoints will be important to drive future recommendations.
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Affiliation(s)
- Fabiana B Nerbass
- Department of Internal Medicine, School of Medicine, Pontificia Universidade Católica do Paraná, Curitiba, Brazil.,Division of Nephrology, Pro-Rim Foundation, Joinville, Brazil
| | - Viviane Calice-Silva
- Department of Internal Medicine, School of Medicine, Pontificia Universidade Católica do Paraná, Curitiba, Brazil.,Division of Nephrology, Pro-Rim Foundation, Joinville, Brazil
| | - Roberto Pecoits-Filho
- Department of Internal Medicine, School of Medicine, Pontificia Universidade Católica do Paraná, Curitiba, Brazil
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Verseput C, Piccoli GB. Eating Like a Rainbow: The Development of a Visual Aid for Nutritional Treatment of CKD Patients. A South African Project. Nutrients 2017; 9:nu9050435. [PMID: 28452932 PMCID: PMC5452165 DOI: 10.3390/nu9050435] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 04/11/2017] [Accepted: 04/17/2017] [Indexed: 12/21/2022] Open
Abstract
Providing nutritional education for chronic kidney disease (CKD) patients in South Africa is complicated by several conditions: the population is composed of diverse ethnic groups, each with its own culture and food preferences; eleven languages are spoken and illiteracy is common in the lower socio-economic groups. Food preparation and storage are affected by the lack of electricity and refrigeration, and this contributes to a monotonous diet. In traditional African culture, two meals per day are often shared "from the pot", making portion control difficult. There is both under- and over-nutrition; late referral of CKD is common. Good quality protein intake is often insufficient and there are several misconceptions about protein sources. There is a low intake of vegetables and fruit, while daily sodium intake is high, averaging 10 g/day, mostly from discretionary sources. On this background, we would like to describe the development of a simplified, visual approach to the "renal diet", principally addressed to illiterate/non-English speaking CKD patients in Southern Africa, using illustrations to replace writing. This tool "Five steps to improve renal diet compliance", also called "Eating like a Rainbow", was developed to try to increase patients' understanding, and has so far only been informally validated by feedback from users. The interest of this study is based on underlining the feasibility of dietary education even in difficult populations, focusing attention on this fundamental issue of CKD care in particular in countries with limited access to chronic dialysis.
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Affiliation(s)
- Cecile Verseput
- RD Consultant Renal Dietitian, 6 Janet Street, Glenvista, Johannesburg 2091, South Africa.
| | - Giorgina Barbara Piccoli
- Department of Clinical and Biological Sciences, University of Torino, 10124 Torino, Italy.
- Nephrologie, Centre Hospitalier Le Mans, 72037 Le Mans, France.
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Piccoli GB, Cupisti A. 'Let food be thy medicine…': lessons from low-protein diets from around the world. BMC Nephrol 2017; 18:102. [PMID: 28347277 PMCID: PMC5368994 DOI: 10.1186/s12882-017-0515-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 03/15/2017] [Indexed: 12/25/2022] Open
Abstract
In this editorial we present the special issue dedicated to low-protein diets (LPDs) in chronic kidney disease, from a global perspective.The experiences gathered from several countries across all continents have created an issue which we hope you will find insightful, and lead to further discussion on this interesting topic.We discover that LPDs are feasible in both developed and low income countries, in patients where literacy is an issue, and are also safe, including during pregnancy and in old age.Patients prescribed a low protein diet are more inclined to follow and adhere to this change in lifestyle, provided the diet has been adapted to meet their own individual needs. With an increasing list of different menu options and better medical advice being offered we no longer need to identify low protein diets with a specific menu, ingredient or supplement, or with a specific level of protein restriction. Evidence shows how the best diet is often the one chosen by the patients, which doesn't drastically affect their day-to-day life, and delays the start of dialysis for as long as is safe under careful clinical control. The colourful menus gathered from all over the world remind us that a low protein diet does not necessarily mean that the pleasure of preparing a delicious meal is lost. The final comment is therefore dedicated to our patients: low protein diets can be beautiful.
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Affiliation(s)
- Giorgina B Piccoli
- Department of Clinical and Biological Sciences, University of Torino, Torino, Italy. .,Nephrologie, CH Le Mans, Le Mans, 72000, France.
| | - Adamasco Cupisti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Piccoli GB, Nazha M, Capizzi I, Vigotti FN, Mongilardi E, Bilocati M, Avagnina P, Versino E. Patient Survival and Costs on Moderately Restricted Low-Protein Diets in Advanced CKD: Equivalent Survival at Lower Costs? Nutrients 2016; 8:E758. [PMID: 27898000 PMCID: PMC5188413 DOI: 10.3390/nu8120758] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 10/23/2016] [Accepted: 11/16/2016] [Indexed: 12/20/2022] Open
Abstract
The indications for delaying the start of dialysis have revived interest in low-protein diets (LPDs). In this observational prospective study, we enrolled all patients with chronic kidney disease (CKD) who followed a moderately restricted LPD in 2007-2015 in a nephrology unit in Italy: 449 patients, 847 years of observation. At the start of the diet, the median glomerular filtration rate (GFR) was 20 mL/min, the median age was 70, the median Charlson Index was 7. Standardized mortality rates for the "on-diet" population were significantly lower than for patients on dialysis (United States Renal Data System (USRDS): 0.44 (0.36-0.54); Italian Dialysis Registry: 0.73 (0.59-0.88); French Dialysis Registry 0.70 (0.57-0.85)). Considering only the follow-up at low GFR (≤15 mL/min), survival remained significantly higher than in the USRDS, and was equivalent to the Italian and French registries, with an advantage in younger patients. Below the e-GFR of 15 mL/min, 50% of the patients reached a dialysis-free follow-up of ≥2 years; 25% have been dialysis-free for five years. Considering an average yearly cost of about 50,000 Euros for dialysis and 1200 Euros for the diet, and different hypotheses of "spared" dialysis years, treating 100 patients on a moderately restricted LPD would allow saving one to four million Euros. Therefore, our study suggests that in patients with advanced CKD, moderately restricted LPDs may allow prolonging dialysis-free follow-up with comparable survival to dialysis at a lower cost.
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Affiliation(s)
- Giorgina Barbara Piccoli
- Department of Clinical and Biological Sciences, University of Torino, Torino 10100, Italy.
- Nephrologie, Centre Hospitalier Le Mans, Le Mans 72000, France.
| | - Marta Nazha
- Department of Clinical and Biological Sciences, University of Torino, Torino 10100, Italy.
| | - Irene Capizzi
- Department of Clinical and Biological Sciences, University of Torino, Torino 10100, Italy.
| | - Federica Neve Vigotti
- Department of Clinical and Biological Sciences, University of Torino, Torino 10100, Italy.
| | - Elena Mongilardi
- Department of Clinical and Biological Sciences, University of Torino, Torino 10100, Italy.
| | - Marilisa Bilocati
- Obstetrics, Department of Surgery, Città Della Salute e Della Scienza, University of Torino, Torino 10100, Italy.
| | - Paolo Avagnina
- SSD Clinical Nutrition, Department of Clinical and Biological Sciences, ASOU san Luigi, University of Torino, Torino 10100, Italy.
| | - Elisabetta Versino
- SS Epidemiology, Department of Clinical and Biological Sciences, ASOU san Luigi, University of Torino, Torino 10100, Italy.
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