Lack of Awareness of Dietary Sources of Phosphorus Is a Clinical Concern

Knowledge, attitudes, and practices of Lebanese licensed dietitians regarding hyperphosphatemia management in patients undergoing hemodialysis in a Lebanese Governorate

BACKGROUND

Hyperphosphatemia is deemed to be an asymptomatic silent killer, its high prevalence in patients undergoing hemodialysis (HD) is correlated mainly with malnutrition and mortality. Dietitian's renal nutrition education has a major impact on chronic kidney disease patients' knowledge, and attitude towards nutrition guidelines. However, a large number of factors are acting as barriers to the appropriate practices of Lebanese dietitians in renal therapy. This study evaluated the knowledge, attitudes, and practices (KAP) of licensed dietitians (LDs) regarding hyperphosphatemia management in patients undergoing HD.

METHODS

A total of 408 LDs from Mount-Lebanon Governorate in Lebanon participated in this study. A 52-item online questionnaire was used to assess nutritional phosphorus' KAP of all LDs, in compliance with dietetic practices with KDOQI guidelines updated version 2020 and identified the factors preventing dietitians from dealing with renal patients undergoing HD, e.g., nutrition care. The data was analyzed using SPSS version 25.

RESULTS

There was a significant association between KAP levels, and almost all sociodemographic characteristics evaluated. Only 2% of dietitians applied all KDOQI guidelines, 64% attained poor and moderate knowledge, and 60% had a positive attitude towards renal care. Working in a clinical field was a common predictor of positive knowledge (adjusted OR = 2.453, 95% CI 1.244-4.836), positive attitude (adjusted OR = 1.900, 95% CI 1.300-2.541) and positive practice (adjusted OR = 0.192, 95% CI 0.184-0.491) while HD/hospital-based field increased the odds for positive knowledge (adjusted OR = 4.520, 95% CI 1.189-17.182). LDs, compared to registered dietitians, had lower odds of positive knowledge (adjusted OR = 0.390, 95% CI 0.231-0.658) and positive attitude (adjusted OR = 0.270, 95% CI 0.154-0.471). Lack of training was the main reason preventing the appropriate dietetic practices regarding hyperphosphatemia management in patients undergoing HD.

CONCLUSION

The Ministry of Public Health (MOPH) should be asked to endorse the integration of renal nutrition programs in the Lebanese curriculum, to aid in the empowerment of dietitians from different backgrounds towards renal therapy, in order to enhance the knowledge and attitude regarding nutritional guidelines of poorly supported Lebanese patients undergoing HDhemodialysis. Other stakeholders may include the Syndicate of Dietitians in Lebanon.

Micronutrients Importance in Cancer Prevention-Minerals

Cancer, a non-communicable disease with diverse kinds is one of the major global problems with high incidence and no proven method to prevent or treat. Minerals including trace elements are significant micronutrients for preserving the body's typical physiological function. In contrast to extremely processed industrial food, they are rich in natural sources of food and frequently included in nutritional supplements. The daily intake, storage capacities, and homeostasis of micronutrients depend on specific dietary practices in contemporary civilization and can be disturbed by various malignancies. Varied minerals have different effects on the status of cancer depending on how they affect these pathways. The outcomes could differ depending on the mineral such as calcium's supply and the cancer's location. A mineral called zinc helps the immune system function better and aids in wound healing. On the other hand, selenium exhibits anti-oxidant functions and has a dose-response relationship with many cancer types. However, this component can make the patient's condition worse. Although the body produces free radicals when iron is deficient, anaemia affects a patient's quality of life and ability to receive therapy. This chapter compiles the knowledge of minerals connected to unusual accumulation or depletion states in various malignancies.

Family-centered empowerment approach to optimize phosphate management among hemodialysis patients: an experimental study

BACKGROUND

This study aimed to investigate the effect of a family-centered empowerment program on hyperphosphatemia management.

METHOD

This experimental study was performed on 80 randomly selected eligible patients with hyperphosphatemia undergoing hemodialysis. Patients were assigned randomly to two groups of family-centered empowerment program (FCEPG) and control group (CG) by coin toss (40 people per group). Data collection tools were the researcher-made Phosphate Control Knowledge Scale, the researcher-made Adherence to Dietary Restriction of Phosphorus Intake Scale, the eight-item Morisky Medication Adherence Scale, and serum phosphorus measurements. Data were collected before the intervention, one month, and three months after the intervention. Patients in FCEPG participated in a family-centered empowerment program. The statistical significance level was considered to be 0.05.

RESULTS

Inter-group comparisons showed no significant difference between FCEPG and CG in terms of the mean score of knowledge of phosphate control, adherence to dietary restriction of phosphorus intake, adherence to medication, and the mean serum phosphorus level before the empowerment program, but showed significant differences between them in these respects at one month after the program and three months after the program (p < 0.05). Intra-group comparisons showed a significant difference in FCEPG between the mean and standard deviation of all four variables before the empowerment program and the corresponding values one month and three months after the program (P < 0.05).

CONCLUSION

The findings of this study can be used in various fields of healthcare in the hospital and community.

Obesity, Diabetes Mellitus, and Vascular Impediment as Consequences of Excess Processed Food Consumption

Regular intake of ready-to-eat meals is related to obesity and several noninfectious illnesses, such as cardiovascular diseases, hypertension, diabetes mellitus (DM), and tumors. Processed foods contain high calories and are often enhanced with excess refined sugar, saturated and trans fat, Na⁺ andphosphate-containing taste enhancers, and preservatives. Studies showed that monosodium glutamate (MSG) induces raised echelons of oxidative stress, and excessive hepatic lipogenesis is concomitant to obesity and type 2 diabetes mellitus (T2DM). Likewise, more than standard salt intake adversely affects the cardiovascular system, renal system, and central nervous system (CNS), especially the brain. Globally, excessive utilization of phosphate-containing preservatives and additives contributes unswervingly to excessive phosphate intake through food. In addition, communities and even health experts, including medical doctors, are not well-informed about the adverse effects of phosphate preservatives on human health. Dietary phosphate excess often leads to phosphate toxicity, ultimately potentiating kidney disease development. The mechanisms involved in phosphate-related adverse effects are not explainable. Study reports suggested that high blood level of phosphate causes vascular ossification through the deposition of Ca²⁺ and substantially alters fibroblast growth factor-23 (FGF23) and calcitriol.

The effect of egg white diet on phosphorus control in dialysis patients

INTRODUCTION

Nutritional interventions have been envisaged to improve hyperphosphatemia and malnutrition, two important risk factors associated with mortality in dialysis patients. We evaluated the effects of egg white consumption on serum phosphate and malnutrition in dialysis patients.

METHODS

In an open-label, per protocol clinical trial, conducted in Kerman dialysis centers, 150 hemodialysis patients aged ≥18 years with serum phosphorus ≥5.5 mg/dl were included in the study. All participants limited their intake of foods containing phosphorus for 4 weeks, and then they were divided into a control and an intervention group. The control group continued their ordinary diet and the participants in the intervention group consumed a Telavang egg white pack (containing six egg whites, 96 calories, 24 g protein) as a substitute for meat products 3 days a week for 8 weeks. Finally, changes in serum albumin, phosphorus, calcium, PTH, and cholesterol were measured.

FINDINGS

At the baseline, there were no significant differences in the laboratory variables between the two groups. After 8 weeks, serum cholesterol (124.3 ± 38.1, vs. 135.8 ± 28.8, p = 0.003) and phosphorus levels (4.5 ± 1.03, vs. 6.7 ± 1.5, p = 0.001) were significantly lower in the intervention group compared with the control group. Also, serum albumin (4.5 ± 0.07 vs. 3.7 ± 0.4, p = 0.001) was significantly higher in the intervention group. Moreover, phosphorus, PTH, and cholesterol levels in the intervention group were significantly lower than their baseline values (p = 0.001).

CONCLUSION

The results showed that the egg white could be a useful source of protein for dialysis patients, as it simultaneously reduces serum phosphorus and cholesterol, and increases serum albumin.

Minerals and Cancer: Overview of the Possible Diagnostic Value

Cancer is the second leading cause of death worldwide and is expected to increase by one-third over the next two decades, in parallel with the growing proportion of the elderly population. Treatment and control of cancer incidence is a global issue. Since there is no clear way to prevent or cure this deadly malignancy, diagnostic, predictive, and prognostic markers for oncological diseases are of great therapeutic value. Minerals and trace elements are important micronutrients for normal physiological function of the body. They are abundant in natural food sources and are regularly included in dietary supplements whereas highly processed industrial food often contains reduced or altered amounts of them. In modern society, the daily intake, storage pools, and homeostasis of these micronutrients are dependent on certain dietary habits and can be thrown out of balance by malignancies. The current work summarizes the data on minerals and trace elements associated with abnormal accumulation or depletion states in tumor patients and discusses their value as potential tumor-associated biomarkers that could be introduced into cancer therapy.

A High Phosphorus Diet Impairs Testicular Function and Spermatogenesis in Male Mice with Chronic Kidney Disease

Hyperphosphatemia is a serious complication in chronic kidney disease (CKD) that occurs due to insufficient excretion of phosphorus during failure of renal function. Both CKD and an excessive phosphorus intake have been reported to increase oxidative stress and result in poor male fertility, but little is known about the reproductive function of the CKD under a poorly controlled phosphate intake. Eight-week-old C57BL/6 mice (n = 66) were randomly divided into four groups: a sham operation group received a chow diet as control (SC group, n = 14), CKD-induced mice received a chow diet (CKDC group, n = 16), control mice received a high phosphorus (HP) diet (SP group, n = 16), and CKD-induced mice received a HP diet (CKDP group, n = 20). CKD was induced by performing a 5/6 nephrectomy. The chow diet contained 0.6% phosphorus, while the HP diet contained 2% phosphorus. Impaired testicular function and semen quality found in the CKD model may result from increased oxidative stress, causing apoptosis and inflammation. The HP diet aggravated the negative effects of testicular damage in the CKD-induced mice.