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Begum MM, Biruete A, Kistler B, Meade A, Westhoff J, St-Jules DE. A Systematic Review of Online Resources for the Dietary Management of Hyperphosphatemia in People With Chronic Kidney Disease. J Ren Nutr 2024:S1051-2276(24)00033-5. [PMID: 38485068 DOI: 10.1053/j.jrn.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 01/22/2024] [Accepted: 01/28/2024] [Indexed: 04/14/2024] Open
Abstract
OBJECTIVE Internet search engines and social media websites are prominent and growing sources of dietary information for people with chronic kidney disease (CKD) and their healthcare providers. However, nutrition therapy for CKD is undergoing a paradigm shift, which may lead to inconsistent advice for managing hyperphosphatemia. The aim of this study was to summarize and evaluate online resources for phosphorus-specific nutrition therapy. DESIGN AND METHODS Patient-facing resources were collected from Google, Yahoo, and Facebook in June-July 2021. Using nine independent search terms, the first 100 hits were reviewed. Dietary advice for food types, food groups, food subgroups, and individual food items was categorized as "restricted," "recommended," "mixed," and "not mentioned." Information on publication date, source, and author(s), phosphorus bioavailability, and demineralization were also collected. RESULTS After removing duplicates, 199 resources from Google and Yahoo and 33 from Facebook were reviewed. Resources ranged from 2005 to 2021 and were primarily authored by registered dietitians and medical doctors (65% and 31%, respectively). Dietary advice mostly focuses on restricting high-phosphorus foods and phosphorus additive-based processed foods. Dietary restrictions were generally consistent with the traditional low-phosphorus diet, which targets whole grains, dairy, and plant-based protein foods, although major inconsistencies were noted. Phosphorus bioavailability and demineralization were rarely mentioned (16% and 8%, respectively). Similar findings were found on Facebook, but the limited number of resources limited meaningful comparisons. CONCLUSION Results showed that online resources for phosphorus-specific nutrition therapy are highly restrictive of heart-healthy food items and contain significant inconsistencies. Given the widespread and increasing use of online resources by people with CKD and health care professionals to inform dietary choices, efforts are urgently needed to establish consensus for phosphorus-specific nutrition therapy. Until then, the findings of this study provide a basis for increasing awareness of the potential for confusion arising from online resources.
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Affiliation(s)
| | - Annabel Biruete
- Department of Nutrition Science, Purdue University, West Lafayette, Indiana
| | - Brandon Kistler
- Department of Nutrition Science, Purdue University, West Lafayette, Indiana
| | - Anthony Meade
- Central Northern Adelaide Renal and Transplantation Service Department, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - John Westhoff
- Department of Internal Medicine, School of Medicine, University of Nevada, Reno, Nevada
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2
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St-Jules DE, Fouque D. Response to "Plant-based diets and postprandial hyperkalemia". Nutr Rev 2024; 82:572-577. [PMID: 37354557 DOI: 10.1093/nutrit/nuad068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2023] Open
Abstract
Diet therapy for hyperkalemia in people with chronic kidney disease (CKD) has shifted considerably in recent years with the observations that reported potassium intake is weakly, or not at all, associated with plasma potassium levels in this population. One of the lingering debates is whether dietary potassium presents a risk of hyperkalemia in the postprandial state. Although there is general agreement about the need for additional research, the commentary by Varshney et al contends that the available research sufficiently demonstrates that high-potassium plant foods do not pose a risk of postprandial hyperkalemia. Others argue that this remains unsettled science. Although the traditional approach of providing people with CKD lists of high-potassium foods to limit or avoid may be unnecessary, those at high risk of hyperkalemia should be encouraged to consume balanced meals and control portions, at least until some of the key research gaps in this area are resolved. This editorial critiques the analyses offered by Varshney et al and explains the rationale for a more cautious approach to care.
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Affiliation(s)
- David E St-Jules
- Department of Nutrition, University of Nevada, Reno, Nevada, USA
| | - Denis Fouque
- Department of Nephrology, Nutrition and Dialysis, University Claude Bernard Lyon, Hôpital Lyon Sud, Pierre-Benite, France
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3
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St-Jules DE. Current Controversies in Kidney Nutrition. Semin Dial 2024. [PMID: 38439672 DOI: 10.1111/sdi.13204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 02/04/2024] [Indexed: 03/06/2024]
Abstract
Dietetic practice aims to help people modify their diet to slow disease progression and manage disease-related complications while also meeting their nutritional and personal dietary needs. This can be challenging in people with kidney failure undergoing dialysis, particularly in our current food environment and culture. Fortunately, advancements in nutritional-behavioral science and technology are providing new avenues and resources to help meet the challenge. However, progress is slow, and much of dietetic practice in the dialysis population still relies on the interpretation, translation, and application of low-quality, indirect evidence. This Special Issue of Seminars in Dialysis provides readers with an update on and critical insights into some of the major issues and controversies impacting the field of kidney nutrition today.
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Affiliation(s)
- David E St-Jules
- Department of Nutrition, University of Nevada, Reno, Reno, Nevada, USA
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4
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Popp CJ, Wang C, Hoover A, Gomez LA, Curran M, St-Jules DE, Barua S, Sevick MA, Kleinberg S. Objective Determination of Eating Occasion Timing: Combining Self-Report, Wrist Motion, and Continuous Glucose Monitoring to Detect Eating Occasions in Adults With Prediabetes and Obesity. J Diabetes Sci Technol 2024; 18:266-272. [PMID: 37747075 PMCID: PMC10973869 DOI: 10.1177/19322968231197205] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
BACKGROUND Accurately identifying eating patterns, specifically the timing, frequency, and distribution of eating occasions (EOs), is important for assessing eating behaviors, especially for preventing and managing obesity and type 2 diabetes (T2D). However, existing methods to study EOs rely on self-report, which may be prone to misreporting and bias and has a high user burden. Therefore, objective methods are needed. METHODS We aim to compare EO timing using objective and subjective methods. Participants self-reported EO with a smartphone app (self-report [SR]), wore the ActiGraph GT9X on their dominant wrist, and wore a continuous glucose monitor (CGM, Abbott Libre Pro) for 10 days. EOs were detected from wrist motion (WM) using a motion-based classifier and from CGM using a simulation-based system. We described EO timing and explored how timing identified with WM and CGM compares with SR. RESULTS Participants (n = 39) were 59 ± 11 years old, mostly female (62%) and White (51%) with a body mass index (BMI) of 34.2 ± 4.7 kg/m2. All had prediabetes or moderately controlled T2D. The median time-of-day first EO (and interquartile range) for SR, WM, and CGM were 08:24 (07:00-09:59), 9:42 (07:46-12:26), and 06:55 (04:23-10:03), respectively. The median last EO for SR, WM, and CGM were 20:20 (16:50-21:42), 20:12 (18:30-21:41), and 21:43 (20:35-22:16), respectively. The overlap between SR and CGM was 55% to 80% of EO detected with tolerance periods of ±30, 60, and 120 minutes. The overlap between SR and WM was 52% to 65% EO detected with tolerance periods of ±30, 60, and 120 minutes. CONCLUSION The continuous glucose monitor and WM detected overlapping but not identical meals and may provide complementary information to self-reported EO.
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Affiliation(s)
- Collin J. Popp
- Department of Population Health,
Institute for Excellence in Health Equity, NYU Langone Health, New York, NY,
USA
| | - Chan Wang
- Division of Biostatistics, Department
of Population Health, NYU Langone Health, New York, NY, USA
| | - Adam Hoover
- Holcombe Department of Electrical and
Computer Engineering, Clemson University, Clemson, SC, USA
| | - Louis A. Gomez
- Department of Computer Science, Stevens
Institute of Technology, Hoboken, NJ, USA
| | - Margaret Curran
- Department of Population Health,
Institute for Excellence in Health Equity, NYU Langone Health, New York, NY,
USA
| | | | - Souptik Barua
- Department of Medicine, NYU Langone
Health, New York, NY, USA
| | - Mary Ann Sevick
- Division of Precision Medicine,
Department of Medicine, NYU Langone Health, New York, NY, USA
- Department of Medicine, NYU Langone
Health, New York, NY, USA
| | - Samantha Kleinberg
- Department of Computer Science, Stevens
Institute of Technology, Hoboken, NJ, USA
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5
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Winkelman D, Gallant KH, Moe S, St-Jules DE. Seeing the Whole Picture: Evaluating the Contribution of Whole Grains to Phosphorus Exposure in People With Kidney Failure Undergoing Dialysis Treatment. Semin Dial 2024. [PMID: 38418258 DOI: 10.1111/sdi.13195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 01/29/2024] [Indexed: 03/01/2024]
Abstract
Excessive dietary phosphorus is a concern among patients with kidney failure undergoing dialysis treatment because it may contribute to hyperparathyroidism and hyperphosphatemia. A long-standing but untested component of the low-phosphorus diet is the promotion of refined grains over whole grains. This paper reviews the scientific premise for restricting whole grains in the dialysis population and estimates phosphorus exposure from grain products based on three grain intake patterns modeled from reported intakes in the general US population, adjusting for the presence of phosphorus additives and phosphorus bioavailability: (1) standard grain intake, (2) 100% refined grain intake, and (3) mixed (50/50 whole and refined grain) intake. Although estimated phosphorus exposure from grains was higher with the mixed grain pattern (231 mg/day) compared to the 100% refined grain pattern (127 mg/day), the amount of additional phosphorus from grains was relatively low. Given the lack of strong evidence for restricting whole grains in people with CKD, as well as the potential health benefits of whole grains, clinical trials are warranted to address the efficacy and health impact of this practice.
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Affiliation(s)
- Dillon Winkelman
- Department of Environmental Science and Health, University of Nevada, Reno, Nevada, USA
| | - Kathleen Hill Gallant
- Department of Food Science and Nutrition, University of Minnesota, Saint Paul, Minnesota, USA
| | - Sharon Moe
- Department of Medicine, Division of Nephrology and Hypertension, Indiana University, Indianapolis, Indiana, USA
| | - David E St-Jules
- Department of Nutrition, University of Nevada, Reno, Nevada, USA
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6
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St-Jules DE, Lloyd L, Meade A, Biruete A, Kistler B, Carrero JJ. Deconstructing Disease-Related Malnutrition: A New Assessment Framework for Clinical Practice. J Ren Nutr 2023; 33:707-716. [PMID: 37116625 PMCID: PMC10603213 DOI: 10.1053/j.jrn.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/06/2023] [Accepted: 04/16/2023] [Indexed: 04/30/2023] Open
Abstract
Protein-energy wasting (PEW) is a key cause of functional impairment and poor health outcomes in people with chronic kidney disease. While PEW can be mitigated with nutrition therapy, it is a complex myriad of disorders with numerous interacting etiologies and corresponding presentations, which make it difficult to diagnose and manage in practice. A variety of scoring rubrics have been developed to facilitate malnutrition assessment. Although these tools have greatly benefited the recognition and treatment of PEW, the typical format of grading specified PEW indicators has the potential to overlook or overstate highly relevant individual-specific factors. This review presents a simple framework for malnutrition assessment that can be used to complement and evaluate conventional assessment tools. Unlike standard tools, which are designed to identify and rate malnutrition risk and severity, the malnutrition framework is conceptual model that organizes PEW assessment into three distinct, but interacting facets of PEW risk: nutrient balance, nutrition status, and malnutrition risk. The new framework encourages critical thinking about PEW risk that may help clinicians plan and interpret assessments to efficiently and effectively manage this condition.
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Affiliation(s)
- David E St-Jules
- Assistant Professor, Department of Nutrition, University of Nevada, Reno, Nevada.
| | - Lyn Lloyd
- Senior Renal Dietitian, Nutrition and Dietetics, Te Toka Tumai Auckland Hospital, Te Whatu Ora Health New Zealand
| | - Anthony Meade
- Advanced Renal Dietitian, Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Annabel Biruete
- Assistant Professor, Department of Nutrition Science, Purdue University, West Lafayette, and Division of Nephrology, Indiana University School of Medicine, Indianapolis
| | - Brandon Kistler
- Assistant Professor, Department of Nutrition Science, Purdue University, West Lafayette
| | - Juan-Jesus Carrero
- Professor, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden, and Division of Nephrology, Department of Clinical Sciences at Danderyd Hospital, Stockholm, Sweden
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7
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Kelly JT, Gonzalez-Ortiz A, St-Jules DE, Carrero JJ. Animal Protein Intake and Possible Cardiovascular Risk in People With Chronic Kidney Disease: Mechanisms and Evidence. Adv Kidney Dis Health 2023; 30:480-486. [PMID: 38453263 DOI: 10.1053/j.akdh.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
Individuals with chronic kidney disease (CKD) have an increased risk of cardiovascular disease (CVD), and the kidney function is a critical determinant of this risk. CKD is also a major cause of complications and disease progression in patients with CVD. Practice guidelines suggest that CVD risk in CKD patients can be managed through healthy lifestyle and dietary behaviors. Assessing the impact of diet on heart and kidney health is complex because numerous bioactive compounds from diet may contribute to or prevent CVD or CKD via a myriad of pathways and mechanisms. The objective of this review was to provide a discussion of the mechanisms and evidence linking protein-rich foods and CVD risk in people with CKD. This review highlights the current evidence-based strategies for primary CKD prevention that incorporate a healthy dietary pattern, while tertiary prevention strategies focus on avoiding excess protein and reducing dietary acid load. The effect of protein restriction for improving CVD and CKD outcomes is conflicting; however, these approaches show no negative effects on kidney health. Low-protein and very low-protein diets are promising interventions for reducing the progression of CKD and CVD. Animal-sourced protein may be more detrimental to kidney health than plant-sourced protein due to specific acid load, amino acid composition, generation of uremic toxins, accompanying saturated fat content, low fiber composition, and higher generation of advanced glycation end-products. There are no one-size fits all nutrition prescriptions. Personalized nutrition interventions that target the unique risk factors for CVD associated with reduced kidney function are required to improve the health of people living with CKD.
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Affiliation(s)
- Jaimon T Kelly
- Centre for Online Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia; Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.
| | - Ailema Gonzalez-Ortiz
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Translational Research Center, Instituto Nacional de Pediatría, Mexico
| | | | - Juan Jesus Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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8
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Biruete A, Hill Gallant KM, Lloyd L, Meade A, Moe SM, St-Jules DE, Kistler BM. 'Phos'tering a Clear Message: The Evolution of Dietary Phosphorus Management in Chronic Kidney Disease. J Ren Nutr 2023; 33:S13-S20. [PMID: 37343779 PMCID: PMC10728341 DOI: 10.1053/j.jrn.2023.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 04/21/2023] [Accepted: 05/04/2023] [Indexed: 06/23/2023] Open
Abstract
Phosphorus is a vital nutrient, but disturbances in phosphorus homeostasis are central to chronic kidney disease-mineral and bone disorder. To minimize disturbances, traditional dietary guidance focused on a numerical phosphorus target leading to the exclusion of many healthy foods and implementation challenges. Contemporary phosphorus guidance focuses on dietary source, avoiding additives, and emphasizing low-phosphorus bioaccessibility foods, leading to a more liberal approach. Additional work is needed to demonstrate the efficacy of these contemporary approaches and understand the influence of specific foods, processing, and cooking methods. Unfortunately, patient education using traditional and contemporary strategies may give mixed messages, particularly related to plant-based foods. Thus, greater clarity on the effects of specific foods and dietary patterns may improve phosphorus education. This review aims to discuss the evolution of dietary phosphorus management while highlighting areas for future research that can help move the field toward stronger evidence-based guidance to prevent and treat hyperphosphatemia.
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Affiliation(s)
- Annabel Biruete
- Department of Nutrition and Dietetics, Indiana University-Purdue University Indianapolis, Indianapolis; Department of Medicine, Division of Nephrology, Indiana University School of Medicine, Indianapolis; Department of Nutrition Science, Purdue University, West Lafayette, Indiana
| | - Kathleen M Hill Gallant
- Department of Medicine, Division of Nephrology, Indiana University School of Medicine, Indianapolis; Department of Food Science and Nutrition, University of Minnesota, St. Paul
| | - Lyn Lloyd
- Nutrition and Dietetics, Auckland City Hospital, Auckland, New Zealand
| | - Anthony Meade
- Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, Australia
| | - Sharon M Moe
- Department of Medicine, Division of Nephrology, Indiana University School of Medicine, Indianapolis
| | | | - Brandon M Kistler
- Department of Nutrition Science, Purdue University, West Lafayette, Indiana; Department of Nutrition and Health Science, Ball State University, Muncie.
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Kharmats AY, Popp C, Hu L, Berube L, Curran M, Wang C, Pompeii ML, Li H, Bergman M, St-Jules DE, Segal E, Schoenthaler A, Williams N, Schmidt AM, Barua S, Sevick MA. A randomized clinical trial comparing low-fat with precision nutrition-based diets for weight loss: impact on glycemic variability and HbA1c. Am J Clin Nutr 2023; 118:443-451. [PMID: 37236549 PMCID: PMC10447469 DOI: 10.1016/j.ajcnut.2023.05.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 05/16/2023] [Accepted: 05/23/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Recent studies have demonstrated considerable interindividual variability in postprandial glucose response (PPGR) to the same foods, suggesting the need for more precise methods for predicting and controlling PPGR. In the Personal Nutrition Project, the investigators tested a precision nutrition algorithm for predicting an individual's PPGR. OBJECTIVE This study aimed to compare changes in glycemic variability (GV) and HbA1c in 2 calorie-restricted weight loss diets in adults with prediabetes or moderately controlled type 2 diabetes (T2D), which were tertiary outcomes of the Personal Diet Study. METHODS The Personal Diet Study was a randomized clinical trial to compare a 1-size-fits-all low-fat diet (hereafter, standardized) with a personalized diet (hereafter, personalized). Both groups received behavioral weight loss counseling and were instructed to self-monitor diets using a smartphone application. The personalized arm received personalized feedback through the application to reduce their PPGR. Continuous glucose monitoring (CGM) data were collected at baseline, 3 mo and 6 mo. Changes in mean amplitude of glycemic excursions (MAGEs) and HbA1c at 6 mo were assessed. We performed an intention-to-treat analysis using linear mixed regressions. RESULTS We included 156 participants [66.5% women, 55.7% White, 24.1% Black, mean age 59.1 y (standard deviation (SD) = 10.7 y)] in these analyses (standardized = 75, personalized = 81). MAGE decreased by 0.83 mg/dL per month for standardized (95% CI: 0.21, 1.46 mg/dL; P = 0.009) and 0.79 mg/dL per month for personalized (95% CI: 0.19, 1.39 mg/dL; P = 0.010) diet, with no between-group differences (P = 0.92). Trends were similar for HbA1c values. CONCLUSIONS Personalized diet did not result in an increased reduction in GV or HbA1c in patients with prediabetes and moderately controlled T2D, compared with a standardized diet. Additional subgroup analyses may help to identify patients who are more likely to benefit from this personalized intervention. This trial was registered at clinicaltrials.gov as NCT03336411.
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Affiliation(s)
- Anna Y Kharmats
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, New York University Langone Health, New York, NY, United States; Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Collin Popp
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, New York University Langone Health, New York, NY, United States; Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Lu Hu
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, New York University Langone Health, New York, NY, United States; Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Lauren Berube
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, New York University Langone Health, New York, NY, United States; Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States.
| | - Margaret Curran
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, New York University Langone Health, New York, NY, United States; Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Chan Wang
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Mary Lou Pompeii
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, New York University Langone Health, New York, NY, United States; Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Huilin Li
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Michael Bergman
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States; Division of Endocrinology, Diabetes and Metabolism, New York University Grossman School of Medicine, New York, NY, United States
| | - David E St-Jules
- Department of Nutrition, University of Nevada, Reno, Reno, NV, United States
| | - Eran Segal
- Department of Computer Science and Applied Math, Weizmann Institute of Science, Rehovot, Israel
| | - Antoinette Schoenthaler
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, New York University Langone Health, New York, NY, United States; Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Natasha Williams
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, New York University Langone Health, New York, NY, United States; Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Ann Marie Schmidt
- Diabetes Research Program, Department of Medicine, New York University Langone Health, New York, NY, United States
| | - Souptik Barua
- Division of Precision Medicine, Department of Medicine, New York University Langone Health, New York, NY, United States
| | - Mary Ann Sevick
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, New York University Langone Health, New York, NY, United States; Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States; Division of Endocrinology, Diabetes and Metabolism, New York University Grossman School of Medicine, New York, NY, United States
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10
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St-Jules DE, Hu L, Woolf K, Wang C, Goldfarb DS, Katz SD, Popp C, Williams SK, Li H, Jagannathan R, Ogedegbe O, Kharmats AY, Sevick MA. An Evaluation of Alternative Technology-Supported Counseling Approaches to Promote Multiple Lifestyle Behavior Changes in Patients With Type 2 Diabetes and Chronic Kidney Disease. J Ren Nutr 2023; 33:35-44. [PMID: 35752400 PMCID: PMC9772360 DOI: 10.1053/j.jrn.2022.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 05/10/2022] [Accepted: 05/27/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES Although technology-supported interventions are effective for reducing chronic disease risk, little is known about the relative and combined efficacy of mobile health strategies aimed at multiple lifestyle factors. The purpose of this clinical trial is to evaluate the efficacy of technology-supported behavioral intervention strategies for managing multiple lifestyle-related health outcomes in overweight adults with type 2 diabetes (T2D) and chronic kidney disease (CKD). DESIGN AND METHODS Using a 2 × 2 factorial design, adults with excess body weight (body mass index ≥27 kg/m2, age ≥40 years), T2D, and CKD stages 2-4 were randomized to an advice control group, or remotely delivered programs consisting of synchronous group-based education (all groups), plus (1) Social Cognitive Theory-based behavioral counseling and/or (2) mobile self-monitoring of diet and physical activity. All programs targeted weight loss, greater physical activity, and lower intakes of sodium and phosphorus-containing food additives. RESULTS Of 256 randomized participants, 186 (73%) completed 6-month assessments. Compared to the ADVICE group, mHealth interventions did not result in significant changes in weight loss, or urinary sodium and phosphorus excretion. In aggregate analyses, groups receiving mobile self-monitoring had greater weight loss at 3 months (P = .02), but between 3 and 6 months, weight losses plateaued, and by 6 months, the differences were no longer statistically significant. CONCLUSIONS When engaging patients with T2D and CKD in multiple behavior changes, self-monitoring diet and physical activity demonstrated significantly larger short-term weight losses. Theory-based behavioral counseling alone was no better than baseline advice and demonstrated no interaction effect with self-monitoring.
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Affiliation(s)
- David E St-Jules
- Department of Nutrition, University of Nevada, Reno, Reno, Nevada
| | - Lu Hu
- Department of Population Health, Grossman School of Medicine, New York University, New York, New York
| | - Kathleen Woolf
- Department of Nutrition and Food Studies, New York University Steinhardt, New York, New York
| | - Chan Wang
- Department of Population Health, Grossman School of Medicine, New York University, New York, New York
| | - David S Goldfarb
- Department of Medicine, Grossman School of Medicine, New York University, New York, New York
| | - Stuart D Katz
- Department of Medicine, Grossman School of Medicine, New York University, New York, New York
| | - Collin Popp
- Department of Population Health, Grossman School of Medicine, New York University, New York, New York
| | - Stephen K Williams
- Department of Population Health, Grossman School of Medicine, New York University, New York, New York; Department of Medicine, Grossman School of Medicine, New York University, New York, New York
| | - Huilin Li
- Department of Population Health, Grossman School of Medicine, New York University, New York, New York
| | - Ram Jagannathan
- Division of Hospital Medicine, Emory University, Atlanta, Georgia
| | - Olugbenga Ogedegbe
- Department of Population Health, Grossman School of Medicine, New York University, New York, New York; Institute for Excellence in Health Equity, Grossman School of Medicine, New York University, New York, New York
| | - Anna Y Kharmats
- Department of Population Health, Grossman School of Medicine, New York University, New York, New York
| | - Mary Ann Sevick
- Department of Population Health, Grossman School of Medicine, New York University, New York, New York; Department of Medicine, Grossman School of Medicine, New York University, New York, New York.
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11
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Popp CJ, Hu L, Kharmats AY, Curran M, Berube L, Wang C, Pompeii ML, Illiano P, St-Jules DE, Mottern M, Li H, Williams N, Schoenthaler A, Segal E, Godneva A, Thomas D, Bergman M, Schmidt AM, Sevick MA. Effect of a Personalized Diet to Reduce Postprandial Glycemic Response vs a Low-fat Diet on Weight Loss in Adults With Abnormal Glucose Metabolism and Obesity: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2233760. [PMID: 36169954 PMCID: PMC9520362 DOI: 10.1001/jamanetworkopen.2022.33760] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Interindividual variability in postprandial glycemic response (PPGR) to the same foods may explain why low glycemic index or load and low-carbohydrate diet interventions have mixed weight loss outcomes. A precision nutrition approach that estimates personalized PPGR to specific foods may be more efficacious for weight loss. OBJECTIVE To compare a standardized low-fat vs a personalized diet regarding percentage of weight loss in adults with abnormal glucose metabolism and obesity. DESIGN, SETTING, AND PARTICIPANTS The Personal Diet Study was a single-center, population-based, 6-month randomized clinical trial with measurements at baseline (0 months) and 3 and 6 months conducted from February 12, 2018, to October 28, 2021. A total of 269 adults aged 18 to 80 years with a body mass index (calculated as weight in kilograms divided by height in meters squared) ranging from 27 to 50 and a hemoglobin A1c level ranging from 5.7% to 8.0% were recruited. Individuals were excluded if receiving medications other than metformin or with evidence of kidney disease, assessed as an estimated glomerular filtration rate of less than 60 mL/min/1.73 m2 using the Chronic Kidney Disease Epidemiology Collaboration equation, to avoid recruiting patients with advanced type 2 diabetes. INTERVENTIONS Participants were randomized to either a low-fat diet (<25% of energy intake; standardized group) or a personalized diet that estimates PPGR to foods using a machine learning algorithm (personalized group). Participants in both groups received a total of 14 behavioral counseling sessions and self-monitored dietary intake. In addition, the participants in the personalized group received color-coded meal scores on estimated PPGR delivered via a mobile app. MAIN OUTCOMES AND MEASURES The primary outcome was the percentage of weight loss from baseline to 6 months. Secondary outcomes included changes in body composition (fat mass, fat-free mass, and percentage of body weight), resting energy expenditure, and adaptive thermogenesis. Data were collected at baseline and 3 and 6 months. Analysis was based on intention to treat using linear mixed modeling. RESULTS Of a total of 204 adults randomized, 199 (102 in the personalized group vs 97 in the standardized group) contributed data (mean [SD] age, 58 [11] years; 133 women [66.8%]; mean [SD] body mass index, 33.9 [4.8]). Weight change at 6 months was -4.31% (95% CI, -5.37% to -3.24%) for the standardized group and -3.26% (95% CI, -4.25% to -2.26%) for the personalized group, which was not significantly different (difference between groups, 1.05% [95% CI, -0.40% to 2.50%]; P = .16). There were no between-group differences in body composition and adaptive thermogenesis; however, the change in resting energy expenditure was significantly greater in the standardized group from 0 to 6 months (difference between groups, 92.3 [95% CI, 0.9-183.8] kcal/d; P = .05). CONCLUSIONS AND RELEVANCE A personalized diet targeting a reduction in PPGR did not result in greater weight loss compared with a low-fat diet at 6 months. Future studies should assess methods of increasing dietary self-monitoring adherence and intervention exposure. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03336411.
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Affiliation(s)
- Collin J. Popp
- Institute for Excellence in Health Equity, Center for Healthful Behavior Change, Department of Population Health, NYU Langone Health, New York, New York
| | - Lu Hu
- Institute for Excellence in Health Equity, Center for Healthful Behavior Change, Department of Population Health, NYU Langone Health, New York, New York
| | - Anna Y. Kharmats
- Institute for Excellence in Health Equity, Center for Healthful Behavior Change, Department of Population Health, NYU Langone Health, New York, New York
| | - Margaret Curran
- Institute for Excellence in Health Equity, Center for Healthful Behavior Change, Department of Population Health, NYU Langone Health, New York, New York
| | - Lauren Berube
- Institute for Excellence in Health Equity, Center for Healthful Behavior Change, Department of Population Health, NYU Langone Health, New York, New York
| | - Chan Wang
- Division of Biostatistics, Department of Population Health, NYU Langone Health, New York, New York
| | - Mary Lou Pompeii
- Institute for Excellence in Health Equity, Center for Healthful Behavior Change, Department of Population Health, NYU Langone Health, New York, New York
| | - Paige Illiano
- Institute for Excellence in Health Equity, Center for Healthful Behavior Change, Department of Population Health, NYU Langone Health, New York, New York
| | | | - Meredith Mottern
- Institute for Excellence in Health Equity, Center for Healthful Behavior Change, Department of Population Health, NYU Langone Health, New York, New York
| | - Huilin Li
- Division of Biostatistics, Department of Population Health, NYU Langone Health, New York, New York
| | - Natasha Williams
- Institute for Excellence in Health Equity, Center for Healthful Behavior Change, Department of Population Health, NYU Langone Health, New York, New York
| | - Antoinette Schoenthaler
- Institute for Excellence in Health Equity, Center for Healthful Behavior Change, Department of Population Health, NYU Langone Health, New York, New York
| | - Eran Segal
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Rehovot, Israel
| | - Anastasia Godneva
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Rehovot, Israel
| | - Diana Thomas
- Department of Mathematical Sciences, United States Military Academy, West Point, New York
| | - Michael Bergman
- Institute for Excellence in Health Equity, Center for Healthful Behavior Change, Department of Population Health, NYU Langone Health, New York, New York
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, NYU Langone Health, New York, New York
| | - Ann Marie Schmidt
- Diabetes Research Program, Department of Medicine, NYU Langone Health, New York, New York
| | - Mary Ann Sevick
- Institute for Excellence in Health Equity, Center for Healthful Behavior Change, Department of Population Health, NYU Langone Health, New York, New York
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, NYU Langone Health, New York, New York
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12
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St-Jules DE, Fouque D. A Novel Approach for Managing Protein-Energy Wasting in People With Kidney Failure Undergoing Maintenance Hemodialysis: Rationale and Call for Trials. Am J Kidney Dis 2022; 80:277-284. [PMID: 34974032 DOI: 10.1053/j.ajkd.2021.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 10/28/2021] [Indexed: 01/27/2023]
Abstract
Protein-energy wasting (PEW) is a unique presentation of protein-energy malnutrition in people with kidney disease that is characterized by body protein catabolism exceeding anabolism. PEW is especially common in patients undergoing maintenance hemodialysis (HD) treatment. Dietary guidelines for managing PEW in HD patients primarily focus on protein adequacy and typically promote the intake of animal-based protein foods. Although intake of protein and essential amino acids is important for protein synthesis, the emphasis on protein adequacy largely fails to address-and may actually exacerbate-many of the root causes of PEW. This perspective examines the dietary determinants of PEW in people undergoing HD treatment, with an emphasis on upstream disease-related factors that reduce dietary protein utilization and impair dietary intakes. From this, we present a theoretical diet model for managing PEW that includes etiology-based dietary strategies to address barriers to intake and treat disease-related factors, as well as supportive dietary strategies to promote adequate energy and protein intakes. Given the complexity of diet-disease interactions in the pathogenesis of PEW, and its ongoing burden in HD patients, interventional trials are urgently needed to evaluate alternative diet therapy approaches for PEW in this population.
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Affiliation(s)
| | - Denis Fouque
- CarMeN Laboratory, INSERM U1060, Université Claude Bernard Lyon 1, Villeurbanne, and Department of Nephrology, Nutrition, and Dialysis, Centre Hopitalier Lyon Sud, Pierre-Benite, France.
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13
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Popp CJ, Zhou B, Manigrasso MB, Li H, Curran M, Hu L, St-Jules DE, Alemán JO, Vanegas SM, Jay M, Bergman M, Segal E, Sevick MA, Schmidt AM. Soluble Receptor for Advanced Glycation End Products (sRAGE) Isoforms Predict Changes in Resting Energy Expenditure in Adults with Obesity during Weight Loss. Curr Dev Nutr 2022; 6:nzac046. [PMID: 35542387 PMCID: PMC9071542 DOI: 10.1093/cdn/nzac046] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/17/2022] [Accepted: 03/24/2022] [Indexed: 01/05/2023] Open
Abstract
Background Accruing evidence indicates that accumulation of advanced glycation end products (AGEs) and activation of the receptor for AGEs (RAGE) play a significant role in obesity and type 2 diabetes. The concentrations of circulating RAGE isoforms, such as soluble RAGE (sRAGE), cleaved RAGE (cRAGE), and endogenous secretory RAGE (esRAGE), collectively sRAGE isoforms, may be implicit in weight loss and energy compensation resulting from caloric restriction. Objectives We aimed to evaluate whether baseline concentrations of sRAGE isoforms predicted changes (∆) in body composition [fat mass (FM), fat-free mass (FFM)], resting energy expenditure (REE), and adaptive thermogenesis (AT) during weight loss. Methods Data were collected during a behavioral weight loss intervention in adults with obesity. At baseline and 3 mo, participants were assessed for body composition (bioelectrical impedance analysis) and REE (indirect calorimetry), and plasma was assayed for concentrations of sRAGE isoforms (sRAGE, esRAGE, cRAGE). AT was calculated using various mathematical models that included measured and predicted REE. A linear regression model that adjusted for age, sex, glycated hemoglobin (HbA1c), and randomization arm was used to test the associations between sRAGE isoforms and metabolic outcomes. Results Participants (n = 41; 70% female; mean ± SD age: 57 ± 11 y; BMI: 38.7 ± 3.4 kg/m2) experienced modest and variable weight loss over 3 mo. Although baseline sRAGE isoforms did not predict changes in ∆FM or ∆FFM, all baseline sRAGE isoforms were positively associated with ∆REE at 3 mo. Baseline esRAGE was positively associated with AT in some, but not all, AT models. The association between sRAGE isoforms and energy expenditure was independent of HbA1c, suggesting that the relation was unrelated to glycemia. Conclusions This study demonstrates a novel link between RAGE and energy expenditure in human participants undergoing weight loss.This trial was registered at clinicaltrials.gov as NCT03336411.
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Affiliation(s)
- Collin J Popp
- Center for Healthful Behavior Change, Department of Population Health, New York University Langone Health, New York, NY, USA
| | - Boyan Zhou
- Division of Biostatistics, Department of Population Health, New York University Langone Health, New York, NY, USA
| | - Michaele B Manigrasso
- Diabetes Research Program, Department of Medicine, New York University Langone Health, New York, NY, USA
| | - Huilin Li
- Division of Biostatistics, Department of Population Health, New York University Langone Health, New York, NY, USA
| | - Margaret Curran
- Center for Healthful Behavior Change, Department of Population Health, New York University Langone Health, New York, NY, USA
| | - Lu Hu
- Center for Healthful Behavior Change, Department of Population Health, New York University Langone Health, New York, NY, USA
| | - David E St-Jules
- Department of Nutrition, University of Nevada, Reno, Reno, NV, USA
| | - José O Alemán
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, New York University Langone Health, New York, NY, USA
| | - Sally M Vanegas
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, New York University Langone Health, New York, NY, USA
| | - Melanie Jay
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, New York University Langone Health, New York, NY, USA
| | - Michael Bergman
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, New York University Langone Health, New York, NY, USA
| | - Eran Segal
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Rehovot, Israel
| | - Mary A Sevick
- Center for Healthful Behavior Change, Department of Population Health, New York University Langone Health, New York, NY, USA
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, New York University Langone Health, New York, NY, USA
| | - Ann M Schmidt
- Diabetes Research Program, Department of Medicine, New York University Langone Health, New York, NY, USA
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14
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St-Jules DE, Clegg DJ, Palmer BF, Carrero JJ. Can Novel Potassium Binders Liberate People with Chronic Kidney Disease from the Low-Potassium Diet? A Cautionary Tale. Clin J Am Soc Nephrol 2022; 17:467-472. [PMID: 34670798 PMCID: PMC8975039 DOI: 10.2215/cjn.09660721] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The advent of new potassium binders provides an important breakthrough in the chronic management of hyperkalemia for people with CKD. In addition to the direct benefits of managing hyperkalemia, many researchers and clinicians view these new medications as a possible means to safely transition patients away from the low-potassium diet to a more healthful eating pattern. In this review, we examine the mechanisms of potassium binders in the context of hyperkalemia risk related to dietary potassium intake in people with CKD. We note that whereas these medications target hyperkalemia caused by potassium bioaccumulation, the primary evidence for restricting dietary potassium is risk of postprandial hyperkalemia. The majority of ingested potassium is absorbed alongside endogenously secreted potassium in the small intestines, but the action of these novel medications is predominantly constrained to the large intestine. As a result and despite their effectiveness in lowering basal potassium levels, it remains unclear whether potassium binders would provide protection against hyperkalemia caused by excessive dietary potassium intake in people with CKD. Until this knowledge gap is bridged, clinicians should consider postprandial hyperkalemia risk when removing restrictions on dietary potassium intake in people with CKD on potassium binders.
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Affiliation(s)
| | - Deborah J. Clegg
- Department of Internal Medicine, Paul Foster School of Medicine, Texas Tech Medical Center, El Paso, Texas
| | - Biff F. Palmer
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Juan-Jesus Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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15
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Popp CJ, Curran M, Wang C, Prasad M, Fine K, Gee A, Nair N, Perdomo K, Chen S, Hu L, St-Jules DE, Manoogian ENC, Panda S, Sevick MA, Laferrère B. Temporal Eating Patterns and Eating Windows among Adults with Overweight or Obesity. Nutrients 2021; 13:nu13124485. [PMID: 34960035 PMCID: PMC8705992 DOI: 10.3390/nu13124485] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/09/2021] [Accepted: 12/11/2021] [Indexed: 11/16/2022] Open
Abstract
We aim to describe temporal eating patterns in a population of adults with overweight or obesity. In this cross-sectional analysis, data were combined from two separate pilot studies during which participants entered the timing of all eating occasions (>0 kcals) for 10-14 days. Data were aggregated to determine total eating occasions, local time of the first and last eating occasions, eating window, eating midpoint, and within-person variability of eating patterns. Eating patterns were compared between sexes, as well as between weekday and weekends. Participants (n = 85) had a median age of 56 ± 19 years, were mostly female (>70%), white (56.5%), and had a BMI of 31.8 ± 8.0 kg/m2. The median eating window was 14 h 04 min [12 h 57 min-15 h 21 min], which was significantly shorter on the weekend compared to weekdays (p < 0.0001). Only 13.1% of participants had an eating window <12 h/d. Additionally, there was greater irregularity with the first eating occasion during the week when compared to the weekend (p = 0.0002). In conclusion, adults with overweight or obesity have prolonged eating windows (>14 h/d). Future trials should examine the contribution of a prolonged eating window on adiposity independent of energy intake.
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Affiliation(s)
- Collin J. Popp
- Department of Population Health, Center for Healthful Behavior Change, New York University Langone Health, 180 Madison Ave, New York, NY 10016, USA; (M.C.); (K.P.); (S.C.); (L.H.); (M.A.S.)
- Correspondence: ; Tel.: +1-(646)-501-3446
| | - Margaret Curran
- Department of Population Health, Center for Healthful Behavior Change, New York University Langone Health, 180 Madison Ave, New York, NY 10016, USA; (M.C.); (K.P.); (S.C.); (L.H.); (M.A.S.)
| | - Chan Wang
- Department of Population Health, Division of Biostatistics, New York University Langone Health, 180 Madison Ave, New York, NY 10016, USA;
| | - Malini Prasad
- Department of Medicine, Division of Endocrinology, New York Obesity Research Center, Columbia University Irving Medical Center, 1150 Saint Nicholas Avenue, R-121-G, New York, NY 10032, USA; (M.P.); (K.F.); (A.G.); (N.N.); (B.L.)
| | - Keenan Fine
- Department of Medicine, Division of Endocrinology, New York Obesity Research Center, Columbia University Irving Medical Center, 1150 Saint Nicholas Avenue, R-121-G, New York, NY 10032, USA; (M.P.); (K.F.); (A.G.); (N.N.); (B.L.)
| | - Allen Gee
- Department of Medicine, Division of Endocrinology, New York Obesity Research Center, Columbia University Irving Medical Center, 1150 Saint Nicholas Avenue, R-121-G, New York, NY 10032, USA; (M.P.); (K.F.); (A.G.); (N.N.); (B.L.)
| | - Nandini Nair
- Department of Medicine, Division of Endocrinology, New York Obesity Research Center, Columbia University Irving Medical Center, 1150 Saint Nicholas Avenue, R-121-G, New York, NY 10032, USA; (M.P.); (K.F.); (A.G.); (N.N.); (B.L.)
| | - Katherine Perdomo
- Department of Population Health, Center for Healthful Behavior Change, New York University Langone Health, 180 Madison Ave, New York, NY 10016, USA; (M.C.); (K.P.); (S.C.); (L.H.); (M.A.S.)
| | - Shirley Chen
- Department of Population Health, Center for Healthful Behavior Change, New York University Langone Health, 180 Madison Ave, New York, NY 10016, USA; (M.C.); (K.P.); (S.C.); (L.H.); (M.A.S.)
| | - Lu Hu
- Department of Population Health, Center for Healthful Behavior Change, New York University Langone Health, 180 Madison Ave, New York, NY 10016, USA; (M.C.); (K.P.); (S.C.); (L.H.); (M.A.S.)
| | - David E. St-Jules
- Department of Nutrition, University of Nevada, Reno, 1664 N. Virginia Street, Reno, NV 89557, USA;
| | - Emily N. C. Manoogian
- Regulatory Biology Department, Salk Institute for Biological Studies, 10010 N Torrey Pines Rd., La Jolla, CA 92037, USA; (E.N.C.M.); (S.P.)
| | - Satchidananda Panda
- Regulatory Biology Department, Salk Institute for Biological Studies, 10010 N Torrey Pines Rd., La Jolla, CA 92037, USA; (E.N.C.M.); (S.P.)
| | - Mary Ann Sevick
- Department of Population Health, Center for Healthful Behavior Change, New York University Langone Health, 180 Madison Ave, New York, NY 10016, USA; (M.C.); (K.P.); (S.C.); (L.H.); (M.A.S.)
- Department of Medicine, New York University Langone Health, 550 First Avenue, New York, NY 10016, USA
| | - Blandine Laferrère
- Department of Medicine, Division of Endocrinology, New York Obesity Research Center, Columbia University Irving Medical Center, 1150 Saint Nicholas Avenue, R-121-G, New York, NY 10032, USA; (M.P.); (K.F.); (A.G.); (N.N.); (B.L.)
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16
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St-Jules DE, Woolf K, Goldfarb DS, Pompeii ML, Li H, Wang C, Mattoo A, Marcum ZA, Sevick MA. Feasibility and Acceptability of mHealth Interventions for Managing Hyperphosphatemia in Patients Undergoing Hemodialysis. J Ren Nutr 2021; 31:403-410. [DOI: 10.1053/j.jrn.2020.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 06/25/2020] [Accepted: 07/26/2020] [Indexed: 11/11/2022] Open
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St-Jules DE, Fouque D. Is it time to abandon the nutrient-based renal diet model? Nephrol Dial Transplant 2021; 36:574-577. [PMID: 33263766 DOI: 10.1093/ndt/gfaa257] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 09/21/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- David E St-Jules
- University of Nevada, Reno, Department of Nutrition, Reno, NV, USA and
| | - Denis Fouque
- Department Nephrology, Nutrition and Dialysis, Hôpital Lyon Sud, University of Lyon, Carmen, Pierre-Benite, France
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18
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St-Jules DE, Rozga MR, Handu D, Carrero JJ. Effect of Phosphate-Specific Diet Therapy on Phosphate Levels in Adults Undergoing Maintenance Hemodialysis: A Systematic Review and Meta-Analysis. Clin J Am Soc Nephrol 2020; 16:107-120. [PMID: 33380474 PMCID: PMC7792658 DOI: 10.2215/cjn.09360620] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 10/07/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Hyperphosphatemia is a persistent problem in individuals undergoing maintenance hemodialysis, which may contribute to vascular and bone complications. In some dialysis centers, dietitians work with patients to help them manage serum phosphate. Given the regularity of hyperphosphatemia in this population and constraints on kidney dietitian time, the authors aimed to evaluate the evidence for this practice. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS There was a systematic review and meta-analysis of clinical trials. MEDLINE, Embase, CINAHL, Web of Science, Cochrane Central Register of Controlled Trials, and other databases were searched for controlled trials published from January 2000 until November 2019 in the English language. Included studies were required to examine the effect of phosphate-specific diet therapy provided by a dietitian on serum phosphate in individuals on hemodialysis. Risk of bias and certainty of evidence were assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) method. RESULTS Of the 8054 titles/abstracts identified, 168 articles were reviewed, and 12 clinical trials (11 randomized, one nonrandomized) were included. Diet therapy reduced serum phosphate compared with controls in all studies, reaching statistical significance in eight studies, although overall certainty of evidence was low, primarily due to randomization issues and deviations from protocol. Monthly diet therapy (20-30 minutes) significantly lowered serum phosphate in patients with persistent hyperphosphatemia for 4-6 months, without compromising nutrition status (mean difference, -0.87 mg/dl; 95% confidence interval, -1.40 to -0.33 mg/dl), but appeared unlikely to maintain these effects if discontinued. Unfortunately, trials were too varied in design, setting, and approach to appropriately pool in meta-analysis, and were too limited in number to evaluate the timing, dose, and strategy of phosphate-specific diet therapy. CONCLUSIONS There is low-quality evidence that monthly diet therapy by a dietitian appears to be a safe and efficacious treatment for persistent hyperphosphatemia in patients on HD.
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Affiliation(s)
| | - Mary R. Rozga
- Evidence Analysis Center, Academy of Nutrition and Dietetics, Chicago, Illinois
| | - Deepa Handu
- Evidence Analysis Center, Academy of Nutrition and Dietetics, Chicago, Illinois
| | - Juan Jesus Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Hu L, Wang C, Li H, Curran M, Popp CJ, St-Jules DE, Schoenthaler A, Williams N, Sevick MA. Does Personalized Nutrition Increase Weight Loss Self-Efficacy? Curr Dev Nutr 2020. [DOI: 10.1093/cdn/nzaa059_027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objectives
We examined whether a diet personalized to reduce postprandial glycemic response (PPGR) to foods increases weight loss self-efficacy.
Methods
The Personal Diet Study is an ongoing clinical trial that aims to compare two weight loss diets: a one-size-fits-all, calorie-restricted, low-fat diet (Standardized) versus a diet having the same calorie restriction but utilizing a machine learning algorithm to predict and reduce PPGR (Personalized). Both groups receive the same behavioral counseling to enhance weight loss self-efficacy. Both groups self-monitor dietary intake using a mobile app, with Standardized receiving real-time feedback on calories and macronutrient distribution, and Personalized receiving real time feedback on calories, macronutrient distribution, and predicted PPGR. We examined changes in self-efficacy between baseline and 3 mos, using the 20-item Weight Efficacy Lifestyle questionnaire (WEL). Linear mixed models were used to analyze differences, adjusting for age, gender, and race.
Results
The analyses included the first 75 participants to complete 3-mos assessments (41 Personalized and 34 Standardized). The majority of the participants were white (69.3%), female (61.3%), with a mean age of 61.7 years (SD = 9.9) and BMI of 33.4 kg/m2 (SD = 4.8). At baseline, WEL scores were similar between the 2 groups [Standardized WEL: 118.8 (SD = 27.6); Personalized WEL: 124.9 (SD = 29.5), P = 0.47]. At 3 mos, the WEL score was significantly improved in both groups [16.0 (SD = 4.1) in the Standardized group (P < 0.001) and 7.4 (SD = 3.7) in the Personalized group (P = 0.048)], but the between group difference was not significant (P = 0.12).
Conclusions
Personalized feedback on predicted PPGRs does not appear to enhance weight loss self-efficacy at 3 mos. The lack of significance may be related to the short follow-up period in these preliminary analyses, the small sample accrued to date, or the fact that WEL is designed to assess confidence in various situations (e.g., depressed, anxious) that may not be impacted by personalization. These analyses will be replicated with a larger sample using data obtained through the 6-mos follow-up. New self-efficacy measures may be required to assess the impact of personalized dietary counseling.
Funding Sources
This research was supported by the American Heart Association.
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Curran M, Popp CJ, St-Jules DE, Sevick MA. Self-Reported Weight Cycling Is Associated with Adaptive Thermogenesis in Individuals with Overweight and Obesity. Curr Dev Nutr 2020. [DOI: 10.1093/cdn/nzaa063_022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
We aimed to examine the association between self-reported weight cycling (WC) history and the presence of adaptive thermogenesis (AT) in overweight and obese individuals.
Methods
Data for this analysis were collected during baseline visits of participants enrolled in an ongoing weight loss study, the Personal Diet study. The sample was limited to participants who had reported attempting weight loss prior to enrollment. Body composition (fat mass (FM), fat-free mass (FFM)) and resting energy expenditure (REE) were measured via bioelectrical impedance analysis and indirect calorimetry, respectively. Weight and dieting history was obtained via investigator-generated questionnaire, and WC was defined as the reported number of successful weight loss attempts of ≥5 lbs since age 18. Predicted REE (REEp) was determined using a multiple regression model including FM (kg), FFM (kg), and age. AT (kcal/day) was defined as the difference between predicted and measured REE (REEm-REEp). Pearson's correlations and multivariable models were run using SAS 9.4.
Results
Complete datasets for both WC and REE were collected from 121 participants. Participants (n = 5) with AT ± 2 SD were considered outliers and excluded from this analysis. The sample was mostly female (70%), with a mean age of 59 ± 12 years and a BMI of 34.1 ± 4.8 kg/m2. AT ≥100 kcal/day was found in 41 participants (35%). Mean number of weight cycles was 8.6 ± 5.7, with 49 participants (42.2%) reporting ≥10 cycles. WC was positively associated with AT after adjusting for sex (P = 0.018).
Conclusions
As predicted, WC is common in individuals with overweight and obesity and was significantly associated with AT. However, the clinical relevance of AT is unknown. Therefore, future directions should include an assessment of the effect of WC and AT on weight loss success.
Funding Sources
The Personal Diet study is supported by the American Heart Association.
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St-Jules DE, Marinaro M, Goldfarb DS, Byham-Gray LD, Wilund KR. Managing Hyperkalemia: Another Benefit of Exercise in People With Chronic Kidney Disease? J Ren Nutr 2019; 30:380-383. [PMID: 31767517 DOI: 10.1053/j.jrn.2019.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 09/20/2019] [Accepted: 10/05/2019] [Indexed: 01/16/2023] Open
Abstract
People with chronic kidney disease (CKD) are at increased risk of hyperkalemia, an electrolyte abnormality that can cause serious, sometimes fatal, cardiac arrhythmias. Muscle contraction causes potassium to be released from cells, increasing serum potassium concentrations. However, these effects are transient, and the long-term impact of exercise training on hyperkalemia risk in CKD patients is largely unknown. In this review, we examine the effects of exercise on factors affecting potassium balance in people with CKD, highlighting the potential benefits of regular exercise on hyperkalemia risk in this population. Although regular exercise is already recommended for people with CKD, research examining this hypothesis may lead to novel therapeutic treatments for this life-threatening condition.
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Affiliation(s)
- David E St-Jules
- Department of Population Health, New York University School of Medicine, New York, New York.
| | - Meredith Marinaro
- Natural Sciences Department, Concordia University Chicago, River Forest, Illinois
| | - David S Goldfarb
- Division of Nephrology, New York University School of Medicine, New York, New York
| | - Laura D Byham-Gray
- Department of Clinical and Preventive Nutrition Sciences, Rutgers University, New Brunswick, New Jersey
| | - Kenneth R Wilund
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, Illinois
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22
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Popp CJ, Butler M, Curran M, Illiano P, Sevick MA, St-Jules DE. Evaluating steady-state resting energy expenditure using indirect calorimetry in adults with overweight and obesity. Clin Nutr 2019; 39:2220-2226. [PMID: 31669004 DOI: 10.1016/j.clnu.2019.10.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 09/08/2019] [Accepted: 10/02/2019] [Indexed: 01/23/2023]
Abstract
BACKGROUND Determining a period of steady state (SS) is recommended when estimating resting energy expenditure (REE) using a metabolic cart. However, this practice may be unnecessarily burdensome and time-consuming in the research setting. AIM The aim of the study was to evaluate the use of SS criteria, and compare it to alternative approaches in adults with overweight and obesity. METHODS In this cross-sectional, ancillary analysis, participants enrolled in a bariatric (study 1; n = 13) and lifestyle (study 2; n = 51) weight loss intervention were included. Indirect calorimetry was performed during baseline measurements using a metabolic cart for 25 min, including a 5-min stabilization period at the start. SS was defined as the first 5-min period with a coefficient of variation (CV) ≤10% for both VO2 and VCO2 (hereafter REE5-SS). Body composition was measured using bioelectrical impedance analysis in study 2 participants only. REE5-SS was compared against the lowest CV (REECV-lowest), 5-min time intervals (REE6-10, REE11-15, REE16-20, REE21-25), 4-min and 3-min SS intervals (REE4-SS and REE3-SS), and time intervals of 6-15, 6-20 and 6-25 min (REE6-15, REE6-20, and REE6-25) using repeated measures ANOVA and Bland-Altman analysis to test for bias, limits of agreement and accuracy (±6% measured REE). RESULTS Participants were 54 ± 13 years old, mostly women (75%) and had a BMI of 35 ± 5 kg/m2. Overall, 54/63 (84%) of participants reached REE5-SS, often (47/54, 87%) within the first 10-min (6-15 min). Alternative approaches to estimating REE had a relatively low bias (-16 to 13 kcals), narrow limits of agreement and high accuracy (83-98%) when compared to REE5-SS, in particular, outperforming standard prediction equations (e.g., Mifflin St. Joer). CONCLUSION Indirect calorimetry measurements that utilize the 5-min SS approach to estimate REE are considered the gold-standard. Under circumstances of non-SS, it appears 4-min and 3-min SS periods, or fixed time intervals of atleast 5 min are accurate and practical alternatives for estimating REE in adults with overweight and obesity. However, future trials should validate alternative methods in similar populations to confirm these findings.
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Affiliation(s)
- C J Popp
- Department of Population Health, New York University, USA.
| | - M Butler
- Department of Population Health, New York University, USA
| | - M Curran
- Department of Population Health, New York University, USA
| | - P Illiano
- Department of Population Health, New York University, USA
| | - M A Sevick
- Department of Population Health, New York University, USA; Department of Medicine, New York University, USA
| | - D E St-Jules
- Department of Population Health, New York University, USA
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Popp CJ, St-Jules DE, Hu L, Ganguzza L, Illiano P, Curran M, Li H, Schoenthaler A, Bergman M, Schmidt AM, Segal E, Godneva A, Sevick MA. The rationale and design of the personal diet study, a randomized clinical trial evaluating a personalized approach to weight loss in individuals with pre-diabetes and early-stage type 2 diabetes. Contemp Clin Trials 2019; 79:80-88. [PMID: 30844471 DOI: 10.1016/j.cct.2019.03.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 02/20/2019] [Accepted: 03/01/2019] [Indexed: 12/31/2022]
Abstract
Weight loss reduces the risk of type 2 diabetes mellitus (T2D) in overweight and obese individuals. Although the physiological response to food varies among individuals, standard dietary interventions use a "one-size-fits-all" approach. The Personal Diet Study aims to evaluate two dietary interventions targeting weight loss in people with prediabetes and T2D: (1) a low-fat diet, and (2) a personalized diet using a machine-learning algorithm that predicts glycemic response to meals. Changes in body weight, body composition, and resting energy expenditure will be compared over a 6-month intervention period and a subsequent 6-month observation period intended to assess maintenance effects. The behavioral intervention is delivered via mobile health technology using the Social Cognitive Theory. Here, we describe the design, interventions, and methods used.
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Affiliation(s)
- Collin J Popp
- Department of Population Health, Center for Healthful Behavior Change, New York University School of Medicine, New York, NY, USA
| | - David E St-Jules
- Department of Population Health, Center for Healthful Behavior Change, New York University School of Medicine, New York, NY, USA
| | - Lu Hu
- Department of Population Health, Center for Healthful Behavior Change, New York University School of Medicine, New York, NY, USA
| | - Lisa Ganguzza
- Department of Population Health, Center for Healthful Behavior Change, New York University School of Medicine, New York, NY, USA
| | - Paige Illiano
- Department of Population Health, Center for Healthful Behavior Change, New York University School of Medicine, New York, NY, USA
| | - Margaret Curran
- Department of Population Health, Center for Healthful Behavior Change, New York University School of Medicine, New York, NY, USA
| | - Huilin Li
- Department of Population Health, Division of Biostatistics, New York University School of Medicine, New York, NY, USA
| | - Antoinette Schoenthaler
- Department of Population Health, Center for Healthful Behavior Change, New York University School of Medicine, New York, NY, USA
| | - Michael Bergman
- Department of Population Health, Center for Healthful Behavior Change, New York University School of Medicine, New York, NY, USA; Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, New York University School of Medicine, New York, NY, USA
| | - Ann Marie Schmidt
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, New York University School of Medicine, New York, NY, USA
| | - Eran Segal
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Rehovot, Israel
| | - Anastasia Godneva
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Rehovot, Israel
| | - Mary Ann Sevick
- Department of Population Health, Center for Healthful Behavior Change, New York University School of Medicine, New York, NY, USA; Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, New York University School of Medicine, New York, NY, USA.
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24
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Hu L, St-Jules DE, Popp CJ, Sevick MA. Determinants and the Role of Self-Efficacy in a Sodium-Reduction Trial in Hemodialysis Patients. J Ren Nutr 2018; 29:328-332. [PMID: 30579673 DOI: 10.1053/j.jrn.2018.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 08/21/2018] [Accepted: 10/12/2018] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE This study was to assess the impact of baseline dietary self-efficacy on the effect of a dietary intervention to reduce sodium intake in patients undergoing hemodialysis (HD) and to identify determinants of low dietary self-efficacy. METHODS This is a post hoc analysis of the BalanceWise study, a randomized controlled trial that aimed to reduce dietary sodium intake in HD patients recruited from 17 dialysis centers in Pennsylvania. The main outcome measures include dietary self-efficacy and reported dietary sodium density. Analysis of variance with post hoc group-wise comparison was used to examine the effect of baseline dietary self-efficacy on changes in reported sodium density in the intervention and control groups at 8 and 16 weeks. Chi-square test, independent t tests, or Wilcoxon rank-sum tests were used to identify determinants of low dietary self-efficacy. RESULTS The interaction between dietary self-efficacy and the impact of the intervention on changes in reported dietary sodium density approached significance at 8 and 16 weeks (P interaction = 0.051 and 0.06, respectively). Younger age and perceived income inadequacy were significantly associated with low self-efficacy in patients undergoing HD. CONCLUSION The benefits of dietary interventions designed to improve self-efficacy may differ by the baseline self-efficacy status. This may be particularly important for HD patients who are younger and report inadequate income as they had lower dietary self-efficacy.
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Affiliation(s)
- Lu Hu
- New York University School of Medicine, Center for Healthful Behavior Change, New York, New York.
| | - David E St-Jules
- New York University School of Medicine, Center for Healthful Behavior Change, New York, New York
| | - Collin J Popp
- New York University School of Medicine, Center for Healthful Behavior Change, New York, New York
| | - Mary Ann Sevick
- New York University School of Medicine, Center for Healthful Behavior Change, New York, New York
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25
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Crowley G, Kwon S, Haider SH, Caraher EJ, Lam R, St-Jules DE, Liu M, Prezant DJ, Nolan A. Metabolomics of World Trade Center-Lung Injury: a machine learning approach. BMJ Open Respir Res 2018; 5:e000274. [PMID: 30233801 PMCID: PMC6135464 DOI: 10.1136/bmjresp-2017-000274] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 03/19/2018] [Indexed: 12/15/2022] Open
Abstract
Introduction Biomarkers of metabolic syndrome expressed soon after World Trade Center (WTC) exposure predict development of WTC Lung Injury (WTC-LI). The metabolome remains an untapped resource with potential to comprehensively characterise many aspects of WTC-LI. This case–control study identified a clinically relevant, robust subset of metabolic contributors of WTC-LI through comprehensive high-dimensional metabolic profiling and integration of machine learning techniques. Methods Never-smoking, male, WTC-exposed firefighters with normal pre-9/11 lung function were segregated by post-9/11 lung function. Cases of WTC-LI (forced expiratory volume in 1s <lower limit of normal, n=15) and controls (n=15) were identified from previous cohorts. The metabolome of serum drawn within 6 months of 9/11 was quantified. Machine learning was used for dimension reduction to identify metabolites associated with WTC-LI. Results 580 metabolites qualified for random forests (RF) analysis to identify a refined metabolite profile that yielded maximal class separation. RF of the refined profile correctly classified subjects with a 93.3% estimated success rate. 5 clusters of metabolites emerged within the refined profile. Prominent subpathways include known mediators of lung disease such as sphingolipids (elevated in cases of WTC-LI), and branched-chain amino acids (reduced in cases of WTC-LI). Principal component analysis of the refined profile explained 68.3% of variance in five components, demonstrating class separation. Conclusion Analysis of the metabolome of WTC-exposed 9/11 rescue workers has identified biologically plausible pathways associated with loss of lung function. Since metabolites are proximal markers of disease processes, metabolites could capture the complexity of past exposures and better inform treatment. These pathways warrant further mechanistic research.
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Affiliation(s)
- George Crowley
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, New York University School of Medicine, New York, USA
| | - Sophia Kwon
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, New York University School of Medicine, New York, USA
| | - Syed Hissam Haider
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, New York University School of Medicine, New York, USA
| | - Erin J Caraher
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, New York University School of Medicine, New York, USA
| | - Rachel Lam
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, New York University School of Medicine, New York, USA
| | - David E St-Jules
- Departmentof Population Health, Division of Health and Behavior, New York University School of Medicine, New York, USA
| | - Mengling Liu
- Department of Environmental Medicine, New York University School of Medicine, New York, USA.,Bureau of Health Services and Office of Medical Affairs, Fire Department of New York, Brooklyn, New York, USA
| | - David J Prezant
- Department of Population Health, Divison of Biostatistics, New York University School of Medicine, New York, USA.,Department of Medicine, Pulmonary Medicine Divison, Montefiore Medical Center and Albert Einstein College of Medicine, Brooklyn, New York, USA
| | - Anna Nolan
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, New York University School of Medicine, New York, USA.,Bureau of Health Services and Office of Medical Affairs, Fire Department of New York, Brooklyn, New York, USA.,Department of Population Health, Divison of Biostatistics, New York University School of Medicine, New York, USA
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St-Jules DE, Goldfarb DS, Popp CJ, Pompeii ML, Liebman SE. Managing protein-energy wasting in hemodialysis patients: A comparison of animal- and plant-based protein foods. Semin Dial 2018; 32:41-46. [DOI: 10.1111/sdi.12737] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- David E. St-Jules
- Division of Health and Behavior, Department of Population Health; New York University School of Medicine; New York NY USA
| | - David S. Goldfarb
- Division of Nephrology, Department of Medicine; New York University School of Medicine; New York NY USA
| | - Collin J. Popp
- Division of Health and Behavior, Department of Population Health; New York University School of Medicine; New York NY USA
| | - Mary Lou Pompeii
- Division of Health and Behavior, Department of Population Health; New York University School of Medicine; New York NY USA
| | - Scott E. Liebman
- Division of Nephrology, Department of Medicine; University of Rochester School of Medicine; Rochester NY USA
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27
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St-Jules DE, Goldfarb DS, Pompeii ML, Liebman SE, Sherman RA. Assessment and misassessment of potassium, phosphorus, and protein in the hemodialysis diet. Semin Dial 2018; 31:479-486. [DOI: 10.1111/sdi.12713] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- David E. St-Jules
- Division of Health and Behavior; Department of Population Health; New York University School of Medicine; New York NY USA
| | - David S. Goldfarb
- Division of Nephrology; Department of Medicine; New York University School of Medicine; New York NY USA
| | - Mary Lou Pompeii
- Division of Health and Behavior; Department of Population Health; New York University School of Medicine; New York NY USA
| | - Scott E. Liebman
- Division of Nephrology; Department of Medicine; University of Rochester School of Medicine; Rochester NY USA
| | - Richard A. Sherman
- Division of Nephrology; Department of Medicine; Rutgers-Robert Wood Johnson Medical School; New Brunswick NJ USA
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28
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Rhee CM, You AS, Koontz Parsons T, Tortorici AR, Bross R, St-Jules DE, Jing J, Lee ML, Benner D, Kovesdy CP, Mehrotra R, Kopple JD, Kalantar-Zadeh K. Effect of high-protein meals during hemodialysis combined with lanthanum carbonate in hypoalbuminemic dialysis patients: findings from the FrEDI randomized controlled trial. Nephrol Dial Transplant 2018; 32:1233-1243. [PMID: 27659126 DOI: 10.1093/ndt/gfw323] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 08/01/2016] [Indexed: 12/18/2022] Open
Abstract
Background Inadequate protein intake and hypoalbuminemia, indicators of protein-energy wasting, are among the strongest mortality predictors in hemodialysis patients. Hemodialysis patients are frequently counseled on dietary phosphorus restriction, which may inadvertently lead to decreased protein intake. We hypothesized that, in hypoalbuminemic hemodialysis patients, provision of high-protein meals during hemodialysis combined with a potent phosphorus binder increases serum albumin without raising phosphorus levels. Methods We conducted a randomized controlled trial in 110 adults undergoing thrice-weekly hemodialysis with serum albumin <4.0 g/dL recruited between July 2010 and October 2011 from eight Southern California dialysis units. Patients were randomly assigned to receive high-protein (50-55 g) meals during dialysis, providing 400-500 mg phosphorus, combined with lanthanum carbonate versus low-protein (<1 g) meals during dialysis, providing <20 mg phosphorus. Prescribed nonlanthanum phosphorus binders were continued over an 8-week period. The primary composite outcome was a rise in serum albumin of ≥0.2 g/dL while maintaining phosphorus between 3.5-<5.5 mg/dL. Secondary outcomes included achievement of the primary outcome's individual endpoints and changes in mineral and bone disease and inflammatory markers. Results Among 106 participants who satisfied the trial entrance criteria, 27% ( n = 15) and 12% ( n = 6) of patients in the high-protein versus low-protein hemodialysis meal groups, respectively, achieved the primary outcome (intention-to-treat P-value = 0.045). A lower proportion of patients in the high-protein versus low-protein intake groups experienced a meaningful rise in interleukin-6 levels: 9% versus 31%, respectively (P = 0.009). No serious adverse events were observed. Conclusion In hypoalbuminemic hemodialysis patients, high-protein meals during dialysis combined with lanthanum carbonate are safe and increase serum albumin while controlling phosphorus.
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Affiliation(s)
- Connie M Rhee
- Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, CA, USA
| | - Amy S You
- Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, CA, USA
| | - Tara Koontz Parsons
- Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Amanda R Tortorici
- Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, CA, USA
| | - Rachelle Bross
- Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - David E St-Jules
- Center for Healthful Behavior Change, New York University School of Medicine, New York, NY, USA
| | - Jennie Jing
- Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, CA, USA
| | - Martin L Lee
- UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | | | - Csaba P Kovesdy
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN, USA.,Nephrology Section, Memphis Veterans Affairs Medical Center, Memphis, TN, USA
| | - Rajnish Mehrotra
- Kidney Research Institute and Harborview Medical Center, Division of Nephrology, University of Washington, Seattle, WA, USA
| | - Joel D Kopple
- UCLA Fielding School of Public Health, Los Angeles, CA, USA.,Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, CA, USA.,David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, CA, USA.,Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, CA, USA.,UCLA Fielding School of Public Health, Los Angeles, CA, USA
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Abstract
IN BRIEF Dietary guidelines for patients with diabetes extend beyond glycemic management to include recommendations for mitigating chronic disease risk. This review summarizes the literature suggesting that excess dietary phosphorus intake may increase the risk of skeletal and cardiovascular disease in patients who are in the early stages of chronic kidney disease (CKD) despite having normal serum phosphorus concentrations. It explores strategies for limiting dietary phosphorus, emphasizing that food additives, as a major source of highly bioavailable dietary phosphorus, may be a suitable target. Although the evidence for restricting phosphorus-based food additives in early CKD is limited, diabetes clinicians should monitor ongoing research aimed at assessing its efficacy.
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Affiliation(s)
- David E. St-Jules
- New York University School of Medicine, Center for Healthful Behavior Change, New York, NY
| | - David S. Goldfarb
- New York University Medical Center, Division of Nephrology, New York, NY
| | - Mary Lou Pompeii
- New York University School of Medicine, Center for Healthful Behavior Change, New York, NY
| | - Mary Ann Sevick
- New York University School of Medicine, Center for Healthful Behavior Change, New York, NY
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30
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Aroner SA, Mukamal KJ, St-Jules DE, Budoff MJ, Katz R, Criqui MH, Allison MA, de Boer IH, Siscovick DS, Ix JH, Jensen MK. Fetuin-A and Risk of Diabetes Independent of Liver Fat Content: The Multi-Ethnic Study of Atherosclerosis. Am J Epidemiol 2017; 185:54-64. [PMID: 27856445 PMCID: PMC5209585 DOI: 10.1093/aje/kww095] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 08/23/2016] [Indexed: 12/28/2022] Open
Abstract
Fetuin-A is a hepatic secretory protein and a novel risk factor for diabetes. However, it remains unclear whether the association between high levels of fetuin-A and diabetes can be attributed to nonalcoholic fatty liver disease. We conducted a case-cohort study among 1,957 subcohort members and 455 incident diabetes cases in the Multi-Ethnic Study of Atherosclerosis, a multicenter US study of Caucasian, African-American, Hispanic, and Chinese-American adults aged 45-84 years. Serum fetuin-A and computed tomography-determined liver fat content were measured from samples collected at baseline (2000-2002). In multivariable Cox proportional hazards models with follow-up through 2012, a higher fetuin-A level was associated with a higher risk of diabetes, with a stronger association among women (for top quartile vs. bottom, hazard ratio (HR) = 3.36, 95% confidence interval (CI): 2.08, 5.44) than among men (HR = 1.47, 95% CI: 0.93, 2.35) (P-heterogeneity = 0.001). Adjustment for liver fat content attenuated these associations slightly (women: HR = 2.61, 95% CI: 1.59, 4.26; men: HR = 1.32, 95% CI: 0.84, 2.08). In this study, we observed a particularly strong association of fetuin-A with diabetes risk in women that could not be explained by liver fat.
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Affiliation(s)
- Sarah A. Aroner
- Correspondence to Dr. Sarah A. Aroner, Department of Nutrition, Harvard T.H. Chan School of Public Health, 655 Huntington Avenue, Building 2, Room 302, Boston, MA 02115 (e-mail: )
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31
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St-Jules DE, Jagannathan R, Gutekunst L, Kalantar-Zadeh K, Sevick MA. Examining the Proportion of Dietary Phosphorus From Plants, Animals, and Food Additives Excreted in Urine. J Ren Nutr 2016; 27:78-83. [PMID: 27810171 DOI: 10.1053/j.jrn.2016.09.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 08/26/2016] [Accepted: 09/01/2016] [Indexed: 01/16/2023] Open
Abstract
Phosphorus bioavailability is an emerging topic of interest in the field of renal nutrition that has important research and clinical implications. Estimates of phosphorus bioavailability, based on digestibility, indicate that bioavailability of phosphorus increases from plants to animals to food additives. In this commentary, we examined the proportion of dietary phosphorus from plants, animals, and food additives excreted in urine from four controlled-feeding studies conducted in healthy adults and patients with chronic kidney disease. As expected, a smaller proportion of phosphorus from plant foods was excreted in urine compared to animal foods. However, contrary to expectations, phosphorus from food additives appeared to be incompletely absorbed. The apparent discrepancy between digestibility of phosphorus additives and the proportion excreted in urine suggests a need for human balance studies to determine the bioavailability of different sources of phosphorus.
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Affiliation(s)
- David E St-Jules
- Center for Healthful Behavior Change, Department of Population Health, New York University School of Medicine, New York, New York.
| | - Ram Jagannathan
- Center for Healthful Behavior Change, Department of Population Health, New York University School of Medicine, New York, New York
| | - Lisa Gutekunst
- Department of Suburban Dialysis, Davita, Inc., Denver, Colorado
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology & Hypertension, University of California Irvine Medical Center, Orange, California
| | - Mary Ann Sevick
- Center for Healthful Behavior Change, Department of Population Health, New York University School of Medicine, New York, New York
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32
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St-Jules DE, Goldfarb DS, Sevick MA. Nutrient Non-equivalence: Does Restricting High-Potassium Plant Foods Help to Prevent Hyperkalemia in Hemodialysis Patients? J Ren Nutr 2016; 26:282-7. [PMID: 26975777 PMCID: PMC5986180 DOI: 10.1053/j.jrn.2016.02.005] [Citation(s) in RCA: 112] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 01/15/2016] [Accepted: 02/08/2016] [Indexed: 12/21/2022] Open
Abstract
Hemodialysis patients are often advised to limit their intake of high-potassium foods to help manage hyperkalemia. However, the benefits of this practice are entirely theoretical and not supported by rigorous randomized controlled trials. The hypothesis that potassium restriction is useful is based on the assumption that different sources of dietary potassium are therapeutically equivalent. In fact, animal and plant sources of potassium may differ in their potential to contribute to hyperkalemia. In this commentary, we summarize the historical research basis for limiting high-potassium foods. Ultimately, we conclude that this approach is not evidence-based and may actually present harm to patients. However, given the uncertainty arising from the paucity of conclusive data, we agree that until the appropriate intervention studies are conducted, practitioners should continue to advise restriction of high-potassium foods.
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Affiliation(s)
- David E St-Jules
- Center for Healthful Behavior Change, Department of Population Health, New York University School of Medicine, New York, New York.
| | - David S Goldfarb
- Division of Nephrology, Department of Medicine, New York University School of Medicine, New York, New York
| | - Mary Ann Sevick
- Center for Healthful Behavior Change, Department of Population Health, New York University School of Medicine, New York, New York
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Kalantar-Zadeh K, Moore LW, Tortorici AR, Chou JA, St-Jules DE, Aoun A, Rojas-Bautista V, Tschida AK, Rhee CM, Shah AA, Crowley S, Vassalotti JA, Kovesdy CP. North American experience with Low protein diet for Non-dialysis-dependent chronic kidney disease. BMC Nephrol 2016; 17:90. [PMID: 27435088 PMCID: PMC4952055 DOI: 10.1186/s12882-016-0304-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 06/14/2016] [Indexed: 12/20/2022] Open
Abstract
Whereas in many parts of the world a low protein diet (LPD, 0.6-0.8 g/kg/day) is routinely prescribed for the management of patients with non-dialysis-dependent chronic kidney disease (CKD), this practice is infrequent in North America. The historical underpinnings related to LPD in the USA including the non-conclusive results of the Modification of Diet in Renal Disease Study may have played a role. Overall trends to initiate dialysis earlier in the course of CKD in the US allowed less time for LPD prescription. The usual dietary intake in the US includes high dietary protein content, which is in sharp contradistinction to that of a LPD. The fear of engendering or worsening protein-energy wasting may be an important handicap as suggested by a pilot survey of US nephrologists; nevertheless, there is also potential interest and enthusiasm in gaining further insight regarding LPD’s utility in both research and in practice. Racial/ethnic disparities in the US and patients’ adherence are additional challenges. Adherence should be monitored by well-trained dietitians by means of both dietary assessment techniques and 24-h urine collections to estimate dietary protein intake using urinary urea nitrogen (UUN). While keto-analogues are not currently available in the USA, there are other oral nutritional supplements for the provision of high-biologic-value proteins along with dietary energy intake of 30–35 Cal/kg/day available. Different treatment strategies related to dietary intake may help circumvent the protein- energy wasting apprehension and offer novel conservative approaches for CKD management in North America.
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Affiliation(s)
- Kamyar Kalantar-Zadeh
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology & Hypertension, University of California Irvine Medical Center, 101 The City Drive South, Orange, CA, 92868-3217, USA. .,Long Beach Veterans Affairs Healthcare System, Long Beach, CA, USA. .,Department Epidemiology, UCLA Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA. .,Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA.
| | | | - Amanda R Tortorici
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology & Hypertension, University of California Irvine Medical Center, 101 The City Drive South, Orange, CA, 92868-3217, USA
| | - Jason A Chou
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology & Hypertension, University of California Irvine Medical Center, 101 The City Drive South, Orange, CA, 92868-3217, USA.,Long Beach Veterans Affairs Healthcare System, Long Beach, CA, USA
| | - David E St-Jules
- Center for Healthful Behavior Change, Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Arianna Aoun
- Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
| | - Vanessa Rojas-Bautista
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology & Hypertension, University of California Irvine Medical Center, 101 The City Drive South, Orange, CA, 92868-3217, USA
| | | | - Connie M Rhee
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology & Hypertension, University of California Irvine Medical Center, 101 The City Drive South, Orange, CA, 92868-3217, USA.,Long Beach Veterans Affairs Healthcare System, Long Beach, CA, USA
| | - Anuja A Shah
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Susan Crowley
- VA Connecticut Healthcare System, West Haven, CT, USA
| | - Joseph A Vassalotti
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.,National Kidney Foundation, Inc., New York, NY, USA
| | - Csaba P Kovesdy
- University of Tennessee Health Science Center, Memphis, TN, USA
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St-Jules DE, Woolf K, Pompeii ML, Kalantar-Zadeh K, Sevick MA. Reexamining the Phosphorus-Protein Dilemma: Does Phosphorus Restriction Compromise Protein Status? J Ren Nutr 2016; 26:136-40. [PMID: 26873260 PMCID: PMC5986175 DOI: 10.1053/j.jrn.2015.12.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 11/23/2015] [Accepted: 12/16/2015] [Indexed: 12/19/2022] Open
Abstract
Dietary phosphorus restriction is recommended to help control hyperphosphatemia in hemodialysis patients, but many high-phosphorus foods are important sources of protein. In this review, we examine whether restricting dietary phosphorus compromises protein status in hemodialysis patients. Although dietary phosphorus and protein are highly correlated, phosphorus intakes can range up to 600 mg/day for a given energy and protein intake level. Furthermore, the collinearity of phosphorus and protein may be biased because the phosphorus burden of food depends on: (1) the presence of phosphate additives, (2) food preparation method, and (3) bioavailability of phosphorus, which are often unaccounted for in nutrition assessments. Ultimately, we argue that clinically relevant reductions in phosphorus intake can be made without limiting protein intake by avoiding phosphate additives in processed foods, using wet cooking methods such as boiling, and if needed, substituting high-phosphorus foods for nutritionally equivalent foods that are lower in bioavailable phosphorus.
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Affiliation(s)
- David E St-Jules
- Center for Healthful Behavior Change, Department of Population Health, New York University School of Medicine, New York, NY.
| | - Kathleen Woolf
- Department of Nutrition, Food Studies, and Public Health, New York University Steinhardt, New York, NY
| | - Mary Lou Pompeii
- Center for Healthful Behavior Change, Department of Population Health, New York University School of Medicine, New York, NY
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology and Hypertension, Department of Medicine, University of California, Irvine, Irvine, CA
| | - Mary Ann Sevick
- Center for Healthful Behavior Change, Department of Population Health, New York University School of Medicine, New York, NY
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St-Jules DE, Woolf K, Pompeii ML, Sevick MA. Exploring Problems in Following the Hemodialysis Diet and Their Relation to Energy and Nutrient Intakes: The BalanceWise Study. J Ren Nutr 2016; 26:118-24. [PMID: 26586249 PMCID: PMC4762735 DOI: 10.1053/j.jrn.2015.10.002] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 09/08/2015] [Accepted: 10/06/2015] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE To identify the problems experienced by hemodialysis (HD) patients in attempting to follow the HD diet and their relation to energy and nutrient intakes. DESIGN Cross-sectional analysis of baseline data from the BalanceWise Study. SUBJECTS Participants included community-dwelling adults recruited from outpatient HD centers. After excluding participants with incomplete dietary analyses (n = 50), 140 African American and white (40/60%) men and women (52/48%) on chronic intermittent HD for at least 3 months (median 3 years) were included. INTERVENTION Participant responses, on a 5-point Likert scale ranging from "not at all a problem" to "a very important problem for me," to 34 questions pertaining to potential barriers to following the HD diet in the previous 2 months were classified as either a problem (1) or not a problem (2-5). MAIN OUTCOME MEASURE Energy and nutrient intakes determined using the Nutrition Data System for Research® based on 3, non-consecutive, unscheduled, 2-pass 24-hour dietary recalls collected on 1 dialysis and 1 non-dialysis weekday, and 1 non-dialysis weekend day. RESULTS More than half of participants reported having problems related to specific behavioral factors (e.g., feeling deprived), technical difficulties (e.g., tracking nutrients), and physical condition (e.g., appetite), but issues of time and food preparation and behavioral factors tended to be most deterministic of reported dietary intakes. Longer duration of HD was associated with lower intakes of protein, potassium, and phosphorus (P < .05). CONCLUSION Registered dietitian nutritionists should consider issues of time and food preparation, and behavioral factors in their nutrition assessment of HD patients and should continually monitor HD patients for changes in protein intake that may occur over time.
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Affiliation(s)
- David E St-Jules
- Department of Population Health, Center for Healthful Behavior Change, New York University School of Medicine, New York, New York.
| | - Kathleen Woolf
- Department of Nutrition, Food Studies, and Public Health, New York University Steinhardt, New York, New York
| | - Mary Lou Pompeii
- Department of Population Health, Center for Healthful Behavior Change, New York University School of Medicine, New York, New York
| | - Mary Ann Sevick
- Department of Population Health, Center for Healthful Behavior Change, New York University School of Medicine, New York, New York
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Sevick MA, Piraino BM, St-Jules DE, Hough LJ, Hanlon JT, Marcum ZA, Zickmund SL, Snetselaar LG, Steenkiste AR, Stone RA. No Difference in Average Interdialytic Weight Gain Observed in a Randomized Trial With a Technology-Supported Behavioral Intervention to Reduce Dietary Sodium Intake in Adults Undergoing Maintenance Hemodialysis in the United States: Primary Outcomes of the BalanceWise Study. J Ren Nutr 2016; 26:149-58. [PMID: 26868602 DOI: 10.1053/j.jrn.2015.11.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 10/23/2015] [Accepted: 11/18/2015] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy of behavioral counseling combined with technology-based self-monitoring for sodium restriction in hemodialysis (HD) patients. DESIGN Randomized clinical trial. SUBJECTS English literate adults undergoing outpatient, in-center intermittent HD for at least 3 months. INTERVENTIONS Over a 16-week period, both the intervention and the attention control groups were shown 6 educational modules on the HD diet. The intervention group also received social cognitive theory-based behavioral counseling and monitored their diets daily using handheld computers. MAIN OUTCOME MEASURES Average daily interdialytic weight gain (IDWGA) was calculated for every week of HD treatment over the observation period by subtracting the post-dialysis weight at the previous treatment time (t-1) from the pre-dialysis weight at the current treatment time (t), dividing by the number of days between treatments. Three 24-hour dietary recalls were obtained at baseline, 8 weeks, and 16 weeks and evaluated using the Nutrient Data System for Research. RESULTS A total of 179 participants were randomized, and 160 (89.4%) completed final measurements. IDWGA did not differ significantly by treatment group at any time point considered (P > .79 for each). A significant differential change in dietary sodium intake observed at 8 weeks (-372 mg/day; P = .05) was not sustained at 16 weeks (-191 mg/day; P = .32). CONCLUSION The BalanceWise Study intervention appeared to be feasible and acceptable to HD patients although IDWGA was unchanged and the desired behavioral changes observed at 8 weeks were not sustained. Unmeasured factors may have contributed to the mixed findings, and further research is needed to identify the appropriate patients for such interventions.
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Affiliation(s)
- Mary Ann Sevick
- Center for Healthful Behavior Change, Department of Population Health, New York University School of Medicine, New York, New York.
| | - Beth M Piraino
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - David E St-Jules
- Center for Healthful Behavior Change, Department of Population Health, New York University School of Medicine, New York, New York
| | - Linda J Hough
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Joseph T Hanlon
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Zachary A Marcum
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Susan L Zickmund
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | | | - Ann R Steenkiste
- Veterans Research Foundation of Pittsburgh, Pittsburgh, Pennsylvania
| | - Roslyn A Stone
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
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St-Jules DE, Watters CA. Alterations in Hepatic Lipid Metabolism, and their Relation to Dietary Macronutrients in Pediatric Nonalcoholic Fatty Liver Disease. Drug Metab Lett 2015; 9:72-9. [PMID: 26343136 DOI: 10.2174/1872312809666150907115208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 03/07/2014] [Accepted: 04/03/2015] [Indexed: 11/22/2022]
Abstract
Nonacoholic fatty liver disease (NAFLD) is a common complication of pediatric obesity in which diet is a major factor in causation and the cornerstone of treatment. In this review, the alterations in hepatic lipid metabolism that contribute to pediatric NAFLD, and impact of dietary proteins, carbohydrates, and fats on hepatic fat metabolism and NAFLD are described. Lastly, dietary recommendations for achieving changes in macronutrient intakes that can be beneficial in the treatment of NAFLD are provided.
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Affiliation(s)
- David E St-Jules
- Harvard School of Public Health, Department of Nutrition, 665 Huntington Avenue, Boston MA, USA, 02119.
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38
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Zamora-Ros R, Sacerdote C, Ricceri F, Weiderpass E, Roswall N, Buckland G, St-Jules DE, Overvad K, Kyrø C, Fagherazzi G, Kvaskoff M, Severi G, Chang-Claude J, Kaaks R, Nöthlings U, Trichopoulou A, Naska A, Trichopoulos D, Palli D, Grioni S, Mattiello A, Tumino R, Gram IT, Engeset D, Huerta JM, Molina-Montes E, Argüelles M, Amiano P, Ardanaz E, Ericson U, Lindkvist B, Nilsson LM, Kiemeney LA, Ros M, Bueno-de-Mesquita HB, Peeters PHM, Khaw KT, Wareham NJ, Knaze V, Romieu I, Scalbert A, Brennan P, Wark P, Vineis P, Riboli E, González CA. Flavonoid and lignan intake in relation to bladder cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Br J Cancer 2014; 111:1870-80. [PMID: 25121955 PMCID: PMC4453722 DOI: 10.1038/bjc.2014.459] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 07/16/2014] [Accepted: 07/20/2014] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND There is growing evidence of the protective role of dietary intake of flavonoids and lignans on cancer, but the association with bladder cancer has not been thoroughly investigated in epidemiological studies. We evaluated the association between dietary intakes of total and subclasses of flavonoids and lignans and risk of bladder cancer and its main morphological type, urothelial cell carcinoma (UCC), within the European Prospective Investigation into Cancer and Nutrition (EPIC) study. METHODS A cohort of 477 312 men and women mostly aged 35-70 years, were recruited in 10 European countries. At baseline, dietary flavonoid and lignan intakes were estimated using centre-specific validated questionnaires and a food composition database based on the Phenol-Explorer, the UK Food Standards Agency and the US Department of Agriculture databases. RESULTS During an average of 11 years of follow-up, 1575 new cases of primary bladder cancer were identified, of which 1425 were UCC (classified into aggressive (n=430) and non-aggressive (n=413) UCC). No association was found between total flavonoid intake and bladder cancer risk. Among flavonoid subclasses, significant inverse associations with bladder cancer risk were found for intakes of flavonol (hazard ratio comparing fifth with first quintile (HRQ5-Q1) 0.74, 95% confidence interval (CI): 0.61-0.91; P-trend=0.009) and lignans (HRQ5-Q1 0.78, 95% CI: 0.62-0.96; P-trend=0.046). Similar results were observed for overall UCC and aggressive UCC, but not for non-aggressive UCC. CONCLUSIONS Our study suggests an inverse association between the dietary intakes of flavonols and lignans and risk of bladder cancer, particularly aggressive UCC.
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Affiliation(s)
- R Zamora-Ros
- Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO), Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
- Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC), Lyon, France
| | - C Sacerdote
- Center for Cancer Prevention (CPO-Piemonte), and Human Genetic Foundation (HuGeF), Torino, Italy
| | - F Ricceri
- Center for Cancer Prevention (CPO-Piemonte), and Human Genetic Foundation (HuGeF), Torino, Italy
| | - E Weiderpass
- Department of Community Medicine, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
- Cancer Registry of Norway, Oslo, Norway
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Samfundet Folkhälsan, Helsinki, Finland
| | - N Roswall
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - G Buckland
- Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO), Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - D E St-Jules
- Department of Nutrition, Harvard School of Public Health, Boston, MA, USA
| | - K Overvad
- Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark
| | - C Kyrø
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - G Fagherazzi
- Inserm, Centre for research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health team, Villejuif, France
- Paris South University, UMRS 1018, Villejuif, France
- IGR, F-94805, Villejuif, France
| | - M Kvaskoff
- Inserm, Centre for research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health team, Villejuif, France
- Paris South University, UMRS 1018, Villejuif, France
- IGR, F-94805, Villejuif, France
| | - G Severi
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Molecular, Environmental, Genetic, and Analytic Epidemiology, The University of Melbourne, Melbourne, Victoria, Australia
| | - J Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - R Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - U Nöthlings
- Department of Nutrition and Food Sciences, Nutritional Epidemiology, University of Bonn, Bonn, Germany
| | - A Trichopoulou
- Hellenic Health Foundation, Athens, Greece
- Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece
| | - A Naska
- Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
| | - D Trichopoulos
- Hellenic Health Foundation, Athens, Greece
- Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
| | - D Palli
- Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute-ISPO, Florence, Italy
| | - S Grioni
- Nutritional Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - A Mattiello
- Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Naples, Italy
| | - R Tumino
- Cancer Registry and Histopathology Unit, ‘Civic MP Arezzo' Hospital, ASP Ragusa, Italy
| | - I T Gram
- Department of Community Medicine, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - D Engeset
- Department of Community Medicine, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - J M Huerta
- Department of Epidemiology, Murcia Regional Health Council, Murcia, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - E Molina-Montes
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Andalusian School of Public Health, Granada, Spain
| | | | - P Amiano
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Public Health Department of Gipuzkoa, BioDonostia Research Institute, Health Department of Basque Region, San Sebastián, Spain
| | - E Ardanaz
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Public Health Institute of Navarra, Pamplona, Spain
| | - U Ericson
- Diabetes and Cardiovascular disease, Genetic Epidemiology, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - B Lindkvist
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - L M Nilsson
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- Arcum, Arctic Research Centre at Umeå University, Umeå, Sweden
| | - L A Kiemeney
- Department for Health Evidence and Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M Ros
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- Department of Epidemiology, Biostatistics and HTA, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - H B Bueno-de-Mesquita
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, The Netherlands
- School of Public Health, Imperial College, London, UK
| | - P H M Peeters
- School of Public Health, Imperial College, London, UK
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - K-T Khaw
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - N J Wareham
- MRC Epidemiology Unit, Cambridge University, Institute of Metabolic Science, Cambridge, UK
| | - V Knaze
- Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC), Lyon, France
| | - I Romieu
- Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC), Lyon, France
| | - A Scalbert
- Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC), Lyon, France
| | - P Brennan
- Genetic Epidemiology Group, Section of Genetics, International Agency for Research on Cancer (IARC), Lyon, France
| | - P Wark
- School of Public Health, Imperial College, London, UK
| | - P Vineis
- School of Public Health, Imperial College, London, UK
| | - E Riboli
- School of Public Health, Imperial College, London, UK
| | - C A González
- Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO), Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
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Abstract
The use of fish oil-based lipid emulsions (FOLE) in the treatment of intestinal failure-associated liver disease (IFALD) remains investigational. Additional evidence for safety and efficacy, particularly in the neonatal and pediatric populations, is needed. Retrospective chart review was conducted on 10 infants with short bowel syndrome who received FOLE for IFALD. Direct bilirubin concentrations normalized in surviving subjects within 4.1 to 22.7 weeks of starting treatment. Although earlier initiation of FOLE was not associated with more rapid normalization of direct bilirubin concentrations, it trended toward a significant correlation with reduced length of hospital stay (P = .058). The reduction in direct bilirubin levels and transition from parenteral to enteral feeding were statistically significant within 6 weeks of initiating the FOLE. Subjects did not have impaired growth and did not develop an essential fatty acid deficiency. These infants were discharged from the hospital 7.9 to 42.3 weeks after starting FOLE treatment, and 2 infants had transitioned completely off parenteral nutrition at discharge. In this study, FOLE appeared to be a safe and effective treatment for IFALD in infants with short bowel syndrome. Future studies are necessary to determine whether FOLE can help to prevent or shorten the duration of cholestasis.
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Affiliation(s)
- David E St-Jules
- Department of Human Nutrition, Food and Animal Science, University of Hawai'i at Manoa, Honolulu, Hawai'i (DES, CAW)
| | - Corilee A Watters
- Department of Human Nutrition, Food and Animal Science, University of Hawai'i at Manoa, Honolulu, Hawai'i (DES, CAW)
| | - Lynn M Iwamoto
- Department of Human Nutrition, Food and Animal Science, University of Hawai'i at Manoa, Honolulu, Hawai'i (DES, CAW)
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St-Jules DE, Watters CA, Davis J, Waxman SH. Liver disease among children in Hawai'i diagnosed with metabolic syndrome. Hawaii J Med Public Health 2013; 72:167-171. [PMID: 23795321 PMCID: PMC3689517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The purpose of this study was to evaluate the prevalence of and factors related to liver disease among children in Hawai'i with metabolic syndrome. The medical charts of children diagnosed with metabolic syndrome by an outpatient endocrinologist between January 2000 and December 2010 were reviewed. Liver disease prevalence was estimated based on serum alanine aminotransferase (ALT) levels, which were then assessed for associations with demographic (age, gender, ethnicity), anthropometric (body mass index), biochemical (fasting blood glucose, hemoglobin A1c, triglycerides, and total, LDL- and HDL-cholesterol), and clinical (blood pressure) characteristics of subjects. Serum ALT was available for 167 of the 195 subjects. The proportion of subjects with liver disease (105/167 [63%]) was greater than many traditional features of metabolic syndrome including hypertriglyceridemia (73/177 [41%]), hypertension (37/194 [19%]) and hyperglycemia (37/170 [22%]). Serum ALT values were positively associated with age (P=.030), and liver disease was more common among boys than girls (62/91 [68%] vs 43/76 [57%]), although this difference was not statistically significant (P=.123). There was a significant difference in liver disease across ethnicities (P=.029), and appeared to be more common in children with Pacific Islander surnames (14/16 [88%]), and less common in children with Hispanic surnames (7/20 [35%]). Diastolic blood pressure was the only obesity-related disease parameter associated with serum ALT after adjusting for age and gender (P=.018). In conclusion, liver disease was common among children diagnosed with metabolic syndrome in Hawai'i. Age, gender, and ethnicity may be important determinants of liver disease risk, and should be investigated further.
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