Comparison of nutritional and inflammatory markers in dialysis patients with reduced appetites

Comparison of nutritional and inflammatory markers in dialysis patients with reduced appetites

Author Carrero, Juan Jesus Google Scholar
Qureshi, Abdul Rashid Google Scholar
Axelsson, Jonas Google Scholar
Avesani, Carla Maria Autor UNIFESP Google Scholar
Suliman, Mohammed E. Google Scholar
Kato, Sawako Google Scholar
Barany, Peter Google Scholar
Snaedal-Jonsdottir, Sunna Google Scholar
Alvestrand, Anders Google Scholar
Heimburger, Olof Google Scholar
Lindholm, Bengt Google Scholar
Stenvinkel, Peter Google Scholar
Institution Karolinska Univ Hosp Huddinge
Universidade Federal de São Paulo (UNIFESP)
Hosp La Paz
Abstract Background: Anorexia is common in chronic kidney disease and worsens as the disease progresses. Sex hormones and inflammatory cytokines may be related to feeding behavior.Objective: We hypothesized that appetite would be related to inflammation and outcome in hemodialysis patients but that sex may account for differences in the symptoms associated with poor appetite.Design: A cross-sectional study was conducted in patients undergoing prevalent hemodialysis (n = 223; 127 M; (x) over bar +/- SD age: 66 +/- 14 y). Anthropometric markers of body composition, handgrip strength, and nutritional and inflammatory status were measured, and 3 groups according to their self-reported appetite were established. Overall mortality was assessed after 19 mo (range: 2-29 mo) of follow-up.Results: Poor appetite was associated with a longer vintage time, increased inflammation (higher serum concentrations of interleukin 6 and C-reactive protein), and a worse nutritional status (lower serum concentrations of insulin-like growth factor 1, albumin, urea, and creatinine). However, across worsening appetite scale, handgrip strength was incrementally lower in men but not in women (multivariate analysis of variance). In a multivariate logistic regression analysis (pseudo r(2) = 0.19), appetite loss was associated with sex [odds ratio (OR): 0.41; 95% CI: 0.24, 0.72], insulin-like growth factor I (3.58; 2.10, 6.32), and C-reactive protein > 10 mg/L (2.39; 1.34, 4.11). Finally, appetite loss was associated with worse clinical outcome even after adjustment for age, sex, inflammation, dialysis vintage, and comorbidity (likelihood ratio = 44.3; P < 0.0001).Conclusions: These results show a close association among appetite, malnutrition, inflammation, and outcome in patients undergoing prevalent hemodialysis. Moreover, our data suggest that uremic men may be more susceptible than are women to inflammation-induced anorexia.
Keywords hemodialysis
inflammation
malnutrition
appetite
anorexia
sex
outcome
Language English
Date 2007-03-01
Published in American Journal Of Clinical Nutrition. Bethesda: Amer Soc Clinical Nutrition, v. 85, n. 3, p. 695-701, 2007.
ISSN 0002-9165 (Sherpa/Romeo, impact factor)
Publisher Amer Soc Clinical Nutrition
Extent 695-701
Origin http://ajcn.nutrition.org/content/85/3/695.full
Access rights Open access Open Access
Type Article
Web of Science ID WOS:000244917900007
URI http://repositorio.unifesp.br/11600/42269

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