Dietary acid load and markers of malnutrition, inflammation, and oxidative stress in hemodialysis patients.

Aims: The present study was conducted to examine the association between dietary acid load (DAL) and markers of inflammation, oxidative stress, and malnutrition in a group of Iranian hemodialysis (HD) patients. Methods: This cross-sectional study was performed on individuals aged ≥18 years who were on HD at least 6 months before their enrollment in the study. A 4-day dietary recall was used for the evaluation of dietary intake. DAL was calculated using two methods including potential renal acid load (PRAL) and net endogenous acid production (NEAP). For assessing the malnutrition status, we used the subjective global assessment (SGA), dialysis malnutrition score (DMS), and malnutrition inflammation score (MIS). Fasting blood samples were collected from each participant to assess serum levels of high-sensitivity C-reactive protein (hs-CRP), soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular adhesion molecule-1 (sVCAM-1), sE-selectin, malondialdehyde (MDA), nitric oxide (NO), and endothelin-1. Results: In total, 291 patients with a mean age of 57.73 ± 0.88 years and HD vintage of 4.27 ± 0.25 months were enrolled in the current study. Significant positive associations were observed between PRAL and hs-CRP (ß = 1.77, 95% CI: 0.88, 2.65), sICAM-1 (ß = 83.21, 95% CI: 10.39, 156.04), sVCAM-1 (ß = 194.63, 95% CI: 74.68, 314.58), and sE-selectin (ß = 6.66, 95% CI: 1.81, 11.50) among participants with the highest PRAL scores, compared to those with the lowest PRAL scores. NEAP was positively correlated with hs-CRP (ß = 1.34, 95% CI: 0.46, 2.22), sICAM-1 (ß = 88.83, 95% CI: 16.99, 160.67), and MDA (ß = 0.35, 95% CI: 0.005, 0.71). Additionally, marginally significant higher odds of SGA (OR = 1.98, 95% CI: 0.95, 4.11) and DMS (OR = 1.94, 95% CI: 0.92, 4.05) were observed in individuals in the third tertile of PRAL vs. the first tertile of PRAL. NEAP had also a marginally significant positive correlation with DMS (OR = 2.01, 95% CI: 0.93, 4.31). Conclusion: This study illustrates that higher consumption of acidic foods is correlated with markers of inflammation, oxidative stress, and malnutrition in HD patients.

Association between the dietary inflammatory index and markers of endothelial and systemic inflammation in hemodialysis patients.

Objectives: The current survey aimed to investigate the link between energy-adjusted dietary inflammatory index (E-DII) and risk factors for CVD including markers of endothelial and systemic inflammation in Iranian hemodialysis patients. Methods: Patients on hemodialysis for at least 6 months prior to enrollment were considered eligible in this cross-sectional study. The usual dietary intakes of the hemodialysis individuals were examined through 4 non-consecutive days including 2 dialysis days and 2 non-dialysis days using a 24-h recall approach to calculate E-DII. Multiple linear regression analysis was utilized to investigate the link between E-DII and selected biomarkers of inflammation and oxidative stress including high-sensitive C reactive protein (hs-CRP), serum intercellular adhesion molecule (sICAM), serum vascular cell adhesion molecule (sVCAM), malondialdehyde, and nitric oxide (NO), sE-selectin, and endothelin-1, and beta (ß) and 95% confidence interval (CI) was reported. Value of p < 0.05 was considered statistically significant. Results: Overall, 291 hemodialysis patients make up our study population. In the crude model, the E-DII score was positively associated with a higher sVCAM-1 (ß = 177.39; 95% CI: 60.51, 294.26; ptrend = 0.003). Further adjustment for potential confounders attenuated the findings in a way that an increase of 128.72 in the sVCAM-1 was observed when the E-DII score increased from -2.68 to -1.14 (95% CI: 13.50, 243.94). After controlling for potential confounders, E-DII was associated with sE-selectin in hemodialysis patients in the highest category of E-DII as compared to the lowest category (ß = 4.11; 95% CI: 0.22, 8.00; ptrend = 0.039). Conclusion: The present findings suggest that adherence to a pro-inflammatory diet among hemodialysis patients is associated with a higher inflammatory status as evidenced by sVCAM-1 and sE-selectin; however, bidirectionality may exist and the role of residual confounders should be taken into account. Therefore, more longitudinal investigations are needed to elucidate the role of diet on the inflammatory status of hemodialysis patients.

Hyperlipoproteinemia (a) and Phytoestrogen Therapy in Dialysis Patients: A Review.

PURPOSE: Hyperlipoproteinemia (a) is a prevalent complication in dialysis patients, with no valid treatment strategy. The aim of this narrative review was to investigate the clinical significance of hyperlipoproteinemia (a) and phytoestrogen therapy in dialysis patients. METHODS: A comprehensive literature search of the published data was performed regarding the effects of phytoestrogen therapy on hyperlipoproteinemia (a) in dialysis patients. FINDINGS: Hyperlipoproteinemia (a) occurs in dialysis patients due to decreased catabolism and increased synthesis of lipoprotein (a) [Lp(a)]. A few clinical trials have studied the effects of phytoestrogens on serum Lp(a). All studies of dialysis patients or nonuremic individuals with hyperlipoproteinemia (a), except one, showed that phytoestrogens could significantly reduce serum Lp(a) levels. However, all investigations of phytoestrogen therapy in individuals with normal serum Lp(a) levels showed that it had no effect on serum Lp(a). Phytoestrogens seem to have effects similar to those of estrogen in lowering Lp(a) concentrations. IMPLICATIONS: Considering the high prevalence of hyperlipoproteinemia (a) in dialysis patients, phytoestrogen therapy is a reasonable approach for reducing serum Lp(a) levels and its complications in these patients.

Association between inflammatory potential of diet and markers of malnutrition in haemodialysis patients.

In this study, we aimed to examine the relationship between energy-adjusted dietary inflammatory index (E-DII) and a comprehensive profile of malnutrition in Iranian haemodialysis (HD) patients. In this cross-sectional study, 291 participants on HD for at least 6 months before enrollment were included. The current dietary intakes of participants were assessed using a 4-d diet diary-assisted recall, including 2 non-dialysis days and 2 dialysis days to calculate E-DII. To determine the malnutrition status of HD patients, BMI, subjective global assessment (SGA), dialysis malnutrition score (DMS) and malnutrition inflammation score (MIS) were used. Overall, 291 HD patients comprised our study population. After controlling for potential confounders, E-DII was associated with a higher risk of malnutrition, as evidenced by SGA (OR = 2·23; 95 % CI: 1·11, 4·49), DMS (OR = 2·31; 95 % CI: 1·16, 4·60) and MIS (OR = 2·50; 95 % CI: 1·28, 4·88). No significant association was detected between E-DII and BMI either before (OR = 1·78; 95 % CI: 0·83, 3·81) or after adjustment for possible confounders (OR = 1·43; 95 % CI: 0·58, 3·54). This study showed that E-DII was significantly associated with reliable malnutrition markers including SGA, DMS and MIS in HD patients. However, further longitudinal studies are warranted to infer a cause-and-effect relationship between DII and malnutrition.

A Case-Control Study on Dietary Acid Load in Relation to Glioma.

Limited data are available linking dietary factors to glioma. The current study was conducted to investigate the association between Dietary Acid Load (DAL) and odds of glioma in Iranian adults. This case-control study was done on 128 newly diagnosed patients with glioma and 256 healthy controls in Tehran, Iran. A validated detailed food frequency questionnaire (FFQ) was used to assess dietary intakes of participants. DAL was estimated using the protein to potassium ratio (Pro: K). Glioma was diagnosed based on pathological tests. A detailed questionnaire including several non-dietary confounders was also completed. Participants in the highest tertile of DAL score had a non-significant higher odds of glioma as compared to those in the lowest tertile (OR: 1.50; 95% CI: 0.88-2.57), which remained after controlling for some potential confounders (OR: 1.66; 0.70-3.91). After further adjustment for dietary intakes of meats and processed meats, legumes and nuts, fruits, salt tea, and coffee, those in the top tertile of DAL score were significantly more likely to have glioma than those in the bottom tertile (OR: 3.09; 95% CI: 1.06, 8.99; P = 0.03). This association was also reached following further adjustment for BMI (OR: 3.05; 95% CI: 1.04, 8.91; P = 0.03). We found a significant positive association between dietary acid load, as estimated by Prot:K ratio, and odds of glioma among adults. Further studies, in particular prospective cohorts with long-term follow up, are required to confirm these findings.

Effects of Soy Isoflavones on Glycemic Parameters and Blood Pressure in Peritoneal Dialysis Patients: A Randomized, Double Blind, Placebo-Controlled Trial.

INTRODUCTION: High serum concentrations of glucose, advanced glycation end products (AGEs), and hypertension are some of the major risk factors for cardiovascular disease and peritoneal membrane fibrosis in peritoneal dialysis (PD) patients. Some investigations in nonuremic individuals have indicated that isoflavones can reduce serum glucose, blood pressure, and increase insulin sensitivity. However, such study in this field in PD patients is still lacking. Therefore, we aimed to determine the effects of isoflavones on serum glucose, fructosamine, AGEs, and blood pressure in PD patients. METHODS: This study was a randomized, double blind, placebocontrolled trial. Thirty-eight PD patients were randomly assigned to either the isoflavone group or the placebo. The patients in the isoflavone group received 100 mg/d soy isoflavone for 8 weeks, while the control group received corresponding placebo. At baseline and the end of the 8th week, 7 mL of blood was collected from each patient and serum glucose, fructosamine, carboxymethyl lysine, pentosidine, accompanied by systolic and diastolic blood pressures were measured. RESULTS: Serum glucose and pentosidine reduced significantly in the isoflavone group at the end of 8th week compared with baseline (P < .05), whereas no statistically significant changes were observed in the placebo group. Serum carboxymethyl lysine, fructosamine, and systolic and diastolic blood pressures did not significantly change within each group during the study. CONCLUSION: This study indicates that soy isoflavones could decrease serum glucose and pentosidine in PD patients.

Effects of isoflavones on bone turnover markers in peritoneal dialysis patients: a randomized controlled trial.

PURPOSE: The aim of this study was to investigate the effects of soy isoflavones on serum markers of bone formation and resorption in peritoneal dialysis (PD) patients. METHODS: In this randomized, double-blind, placebo-controlled trial, 40 PD patients were randomly assigned to either the soy isoflavone or the placebo group. The patients in the soy isoflavone group received 100 mg soy isoflavones daily for 8 weeks, whereas the placebo group received corresponding placebos. At baseline and the end of the 8th week, 7 ml of blood was obtained from each patient after a 12- to 14-h fast and serum concentrations of bone formation markers (osteocalcin and bone alkaline phosphatase), bone resorption markers [N-telopeptide and receptor activator of nuclear factor kappa B ligand (RANKL)], and osteoprotegerin as an inhibitor of bone resorption were measured. RESULTS: Serum N-telopeptide concentration decreased significantly up to 27% in the soy isoflavone group at the end of week 8 compared to baseline (P = 0.003). Also, serum RANKL concentration reduced significantly up to 17% in the soy isoflavone group at the end of week 8 compared to baseline (P = 0.03). These bone resorption markers did not significantly change in the placebo group during the study. There were no significant differences between the two groups in mean changes of serum osteocalcin, bone alkaline phosphatase, and osteoprotegerin. CONCLUSION: This study indicates that daily administration of 100 mg soy isoflavone supplement to PD patients reduces serum N-telopeptide and RANKL which are two bone resorption markers. CLINICALTRIALS.GOV: NCT03773029, 2018.

Effects of soy isoflavones on serum lipids and lipoprotein (a) in peritoneal dialysis patients.

BACKGROUND AND AIM: Lipid abnormalities are common in peritoneal dialysis (PD) patients and no effective treatment to decrease serum lipoprotein (a) [Lp(a)] in dialysis patients is known so far. Therefore, this research was designed to investigate the effects of soy isoflavone supplement on serum lipids and Lp(a) in PD patients. METHODS & RESULTS: In this randomized, double-blind, placebo-controlled trial, 40 PD patients were randomly assigned to either the isoflavone or the placebo group. The patients in the isoflavone group received 100 mg soy isoflavone daily for 8 weeks, whereas the placebo group received corresponding placebos. At baseline and the end of the 8th week, 7 mL of blood was obtained from each patient and serum triglycerides, total cholesterol, low density lipoprotein-cholesterol (LDL-C), high density lipoprotein-cholesterol (HDL-C), and Lp(a) were measured. Serum Lp(a) reduced significantly up to 10% in the isoflavone group at the end of week 8 compared to baseline (P < 0.05), and the reduction was significant in comparison with the placebo group (P < 0.05). Serum HDL-C increased significantly up to 11.5% in the isoflavone group at the end of week 8 compared to baseline (P = 0.05), and the increment was significant in comparison with the placebo group (P < 0.05). There were no significant differences between the two groups in mean changes of serum triglycerides, total cholesterol, and LDL-C. CONCLUSIONS: This study indicates that daily administration of 100 mg soy isoflavones reduces serum Lp(a) and increases HDL-C concentration which are two determinants of cardiovascular disease in PD patients. CLINICALTRIALS.GOV: NCT03773029. REGISTRATION NUMBER AND DATE: NCT03773029 - 2018.

Effects of soy isoflavones on serum systemic and vascular inflammation markers and oxidative stress in peritoneal dialysis patients: A randomized controlled trial.

Cardiovascular disease (CVD) is common in peritoneal dialysis (PD) patients. This study was designed to investigate the effects of isoflavones on systemic and vascular inflammation markers and oxidative stress in PD patients. In this randomized clinical trial, 40 PD patients were randomly assigned to either the isoflavone or the placebo group. The isoflavone group received 100 mg soy isoflavones daily for 8 weeks, whereas the placebo group received corresponding placebos. At baseline and the end of eighth week, serum high sensitive C-reactive protein (hs-CRP), intercellular adhesion molecule type 1 (ICAM-1), vascular cell adhesion molecule type 1 (VCAM-1), E-selectin, and malondialdehyde were measured. Serum VCAM-1 decreased significantly in the isoflavone group at the end of Week 8 compared to baseline (p = .01), whereas no significant change was observed in the placebo group. Serum ICAM-1 decreased significantly in the isoflavone (p = .01) and placebo (p = .01) group compared to baseline. However, the reduction of ICAM-1 was significantly higher in the isoflavone group than in the placebo group (p = .02). There were no significant differences between the two groups in mean changes of serum E-selectin, malondialdehyde, and hs-CRP. This study indicates that isoflavones reduce serum VCAM-1 and ICAM-1, which are two CVD risk factors, in PD patients.

Associations of Body Composition, Muscle Function, and Physical Activity with Mortality in Peritoneal Dialysis Patients.

INTRODUCTION: Loss of skeletal muscle mass and muscle strength is common in dialysis patients. Therefore, this investigation was designed to determine the association between body composition, muscle function, and physical activity with mortality in peritoneal dialysis (PD) patients. METHODS: This was a multicenter cohort study on all eligible PD patients (n = 79) in Tehran PD centers. At baseline, skeletal muscle mass and muscle strength were determined using bioelectrical impedance analysis and handgrip strength, respectively. Physical performance was assessed by a 4-meter walk gait speed test. Physical activity level was estimated by using the long-form International Physical Activity Questionnaire at baseline. The mortality of PD patients was evaluated two years after the start of this study. RESULTS: The total dialysis adequacy was significantly lower in dead patients in comparison with live patients (P < .05). In contrast, serum hs-CRP (P < .05), and the total amount of glucose absorbed daily from PD solutions (P < .05) were significantly higher in dead patients in comparison with live patients. There were no significant associations between body fat mass, skeletal muscle mass, skeletal muscle mass index, muscle strength and physical performance with mortality in PD patients. However, in PD patients with physical activity ≤ median, odds of mortality was 7.4 times higher than those with physical activity > median (OR = 7.4, 95% CI: 1.3 to 43.3; P < .05). CONCLUSION: This study indicates that low physical activity; low dialysis adequacy, high serum hs-CRP, and high amount of glucose absorbed from PD solutions are related with high mortality in PD patients.

Dietary Intake and Its Related Factors in Peritoneal Dialysis Patients in Tehran, Iran.

INTRODUCTION: Poor nutritional status is prevalent in peritonealdialysis (PD) patients and is related to morbidity and mortality.Therefore, the aim of the present study was to assess the dietaryintake and its related factors in PD patients in Tehran, Iran. METHODS: All eligible PD patients in Tehran peritoneal dialysiscenters were included in this cross-sectional study. Dietary intakeof PD patients was determined using a 3-day dietary recall. Also,a 4 mL blood sample was obtained from each patient to measureserum biochemical parameters. RESULTS: Intake of energy, protein, and fiber were lower thanrecommended values in 81%, 92%, and 100% of PD patients;respectively. The prevalence of inadequate energy intake in PDpatients with dialysis vintage ≤ 5 years was significantly higheras compared to those with dialysis vintage > 5 years (P < .05). Asignificant association was observed between inadequate energyintake and inadequate vitamin B3 intake (P < .05). There was amarginally (not) significant association between inadequate energyintake and inadequate vitamin B1 intake (P = 0.06). Intake of thevitamins B1, B2, B3, B6, folic acid, B12, E, C, and of the minerals,calcium, and zinc from both the diet and supplements were lowerthan recommended values in 15%, 38%, 23%, 39%, 52%, 32%, 47%,29%, 54%, and 50.5% of PD patients, respectively. CONCLUSION: Insufficient intake of energy and various nutrients arecommon in PD patients in Tehran, Iran; which may contribute tomorbidity and mortality in these patients.

Prevalence of Protein-Energy Wasting and Its Association With Cardiovascular Disease Risk Factors in Iranian Peritoneal Dialysis Patients.

INTRODUCTION: Protein-energy wasting (PEW) is prevalent in dialysis patients, and cardiovascular disease (CVD) is the leading cause of mortality in these patients. This study aimed to determine the prevalence of PEW and its relationship with CVD risk factors in peritoneal dialysis (PD) patients in Tehran, Iran. MATERIALS AND METHODS: All eligible PD patients in Tehran peritoneal dialysis centers were included in this cross-sectional study. The diagnosis of PEW was done based on the criteria of the International Society of Renal Nutrition and Metabolism. Serum high-sensitivity C-reactive protein, soluble intercellular adhesion molecule type 1, malondialdehyde, and lipid profile were measured. RESULTS: The prevalence of PEW was 29% in the PD patients. Significant associations were found between the prevalence of PEW in PD patients and sex (P = .01), age (P = .03), type of PD dialysis solution (P = .04), and microinflammation (P = .03). Serum C-reactive protein (P = .02), soluble intercellular adhesion molecule type 1 (P = .001), and triglyceride (P = .03) were significantly higher in the PD patients without PEW as compared to those with PEW, whereas high-density lipoprotein cholesterol level was significantly lower in the PD patients without PEW as compared to those with PEW (P = .003). CONCLUSIONS: Our study shows that PEW is prevalent in Iranian PD patients. In addition, serum concentrations of CVD risk factors are dependent on the amount of glucose absorbed from PD solutions and are more impaired in PD patients without PEW as compared to those with PEW.

Patterns of nutrients intakes in relation to glioma: A case-control study.

BACKGROUND & AIMS: Nutrient pattern analysis is an easy way to compare nutrient intakes across different nations due to the universality of nutrients nature. The current study aimed to investigate the relation between patterns of nutrients intake and glioma in a case-control study in Iranian adults. METHODS: In this hospital-based case-control study, we enrolled 128 pathologically confirmed new cases of glioma and 256 age and sex-matched controls. Dietary intakes of study participants were assessed using the validated Block-format 123-item semi-quantitative FFQ. Data on potential confounders were also collected through the use of pre-tested questionnaire. RESULTS: Four nutrient patterns were identified through the use of factor analysis. Participants were categorized based on tertiles of nutrient patterns' scores. Adherence to the first nutrient pattern was not significantly associated with the odds of glioma (0.93; 0.40-2.15). Participants with greater adherence to the second nutrient pattern were less likely to have glioma in crude model (0.48; 0.28-0.83). The inverse association remained significant after controlling for age, sex and energy intake (0.42; 0.24-0.78). Further controlling for other potential confounders, including BMI, resulted in the disappearance of the association (0.52; 0.25-1.10). Greater adherence to the third nutrient pattern was directly associated with the odds of glioma (1.92; 1.10-3.35). Even after controlling for sex, age and energy intake, the association was statistically significant (2.83; 1.28-4.21). However, when other confounders were taken into account, the association became non-significant (2.28; 0.89-5.82). The fourth nutrient pattern was not associated with the odds of glioma (0.71; 0.35-1.42). CONCLUSION: We failed to find any significant independent association between nutrient patterns and odds of glioma. Further studies needed to confirm these findings.

Tea and coffee consumption in relation to glioma: a case-control study.

PURPOSE: Data on the link between tea and coffee consumption and risk of glioma are controversial. We aimed to examine the association between tea and coffee consumption and glioma in Iranian adults. METHODS: In this hospital-based case-control study, we enrolled 128 pathologically confirmed new cases of glioma and 256 age- and sex-matched controls. Dietary intakes of study participants including tea and coffee consumption was assessed using the validated Block-format 123-item semi-quantitative FFQ. Participants were categorized based on tertiles of tea and coffee consumption. Data on potential confounders were also collected through the use of pre-tested questionnaire. RESULTS: Individuals with the greatest tea consumption were less likely to have glioma compared with those with the lowest consumption (0.36; 0.20-0.68). This inverse association was not changed after controlling for energy intake. The association remained statistically significant even after taking other potential confounders, including dietary intakes of red and processed meats, legumes and nuts, fruits, salt and mutual effects of tea and coffee consumption, into account (0.33; 0.13-0.86). Additional adjustments for BMI did not alter the association. After controlling for potential confounders, including dietary intakes and BMI, coffee consumption was inversely associated with odds of glioma; such that individuals in the top category of coffee consumption were 91% less likely to have glioma compared with those in the bottom category (0.09; 0.03-0.24). Considering coffee and tea intake combined, those in the highest tertile were 65% less likely to have glioma compared with those in the lowest tertile (0.35; 0.15-0.83). CONCLUSION: We found an inverse association between tea and coffee consumption and odds of glioma, even after controlling for a wide range of confounders.

Effects of Flaxseed Oil on Serum Bone Turnover Markers in Hemodialysis Patients: a Randomized Controlled Trial.

INTRODUCTION: Chronic kidney disease-mineral and bone disorder is a common complication in hemodialysis patients. The present study was designed to investigate the effects of flaxseed oil, a rich source of plant omega-3 fatty acid alpha-linolenic acid, on serum markers of bone formation and resorption in hemodialysis patients. MATERIALS AND METHODS: In this randomized controlled trial, 34 hemodialysis patients were randomly assigned to either the flaxseed oil or the control group. The patients in the flaxseed oil group received 6 g/d of flaxseed oil for 8 weeks, whereas the control group received 6 g/d of medium chain triglycerides oil. At baseline and the end of the 8th week, 7 mL of blood was obtained from each patient after a 12- to 14-hour fast and serum concentrations of osteocalcin, osteoprotegerin, N-telopeptide, and receptor activator of nuclear factor kappa B ligand were measured. RESULTS: Serum N-telopeptide concentration decreased significantly up to 17% in the flaxseed oil group at the end of week 8, as compared to baseline (P < .01), and the reduction was significant in comparison with the control group. There were no significant differences between the two groups in the mean changes of serum osteocalcin, osteoprotegerin, or receptor activator of nuclear factor kappa B ligand. CONCLUSIONS: This study indicates that daily consumption of 6 g/d of flaxseed oil may reduce bone resorption in hemodialysis patients.

Prevalence of Sarcopenia and Dynapenia and Their Determinants in Iranian Peritoneal Dialysis Patients.

INTRODUCTION: Uremic sarcopenia and dynapenia are prevalent in chronic kidney disease patients, including dialysis patients. The present study was designed to determine the prevalence of sarcopenia and dynapenia and their determinants in peritoneal dialysis (PD) patients in Tehran, Iran. MATERIALS AND METHODS: All eligible PD patients at the peritoneal dialysis centers of Tehran were included in this cross-sectional study. Skeletal muscle mass and muscle strength were assessed using bioelectrical impedance analysis and hand grip strength, respectively. Physical performance was determined by a 4-m walk gait speed test. RESULTS: The prevalence rates of dynapenia and sarcopenia were 43.0% and 11.5% in the PD patients, respectively. There were significant associations between the prevalence of dynapenia and the age of patients (P = .03), physical activity level (P = .04), and the presence of diabetes mellitus (P = .005). In addition, a significant association was found between the prevalence of sarcopenia and sex (P = .009). CONCLUSIONS: This study indicates that uremic sarcopenia and dynapenia are prevalent in PD patients in Tehran, Iran. These conditions may contribute to physical disability, decreased the quality of life, increased morbidity, and a high mortality rate. Therefore, prevention and treatment of uremic sarcopenia and dynapenia are necessary for Iranian PD patients.

Prevalence of dynapenic obesity and sarcopenic obesity and their associations with cardiovascular disease risk factors in peritoneal dialysis patients.

BACKGROUND: Dynapenic obesity and sarcopenic obesity increase cardiovascular disease (CVD) and mortality in nonuremic patients. The present study was designed to determine the prevalence of dynapenic obesity and sarcopenic obesity and their associations with CVD risk factors in peritoneal dialysis (PD) patients. METHODS: All eligible PD patients in Tehran peritoneal dialysis centers were included in this cross-sectional study. Skeletal muscle mass and fat mass were assessed using bioelectrical impedance analysis. Muscle strength and physical performance were determined using hand grip strength and a 4-meter walk gait speed test, respectively. In addition, a 5-mL blood sample was obtained from each patient. RESULTS: The prevalence of dynapenic obesity and sarcopenic obesity were 11.4% and 3.8% in PD patients, respectively. Serum high-sensitive C-reactive protein (hs-CRP), soluble intercellular adhesion molecule type 1, triglyceride, total cholesterol, and low-density lipoprotein cholesterol were significantly higher in PD patients with dynapenic obesity than in dynapenic nonobese and nondynapenic nonobese patients. Similarly, serum concentrations of CVD risk factors in PD patients with sarcopenic obesity were higher than in nonsarcopenic nonobese patients, but these differences were statistically significant only for serum hs-CRP and triglyceride. In addition, muscle strength and skeletal muscle mass percentage were negatively associated with markers of inflammation and dyslipidemia, whereas body fat percentage was positively associated with these CVD risk factors. CONCLUSION: This study indicates that although the prevalence of dynapenic obesity and sarcopenic obesity are relatively low in PD patients, these disorders may be associated with CVD risk factors.

Nephrotoxic Effect of Aspartame as an Artificial Sweetener: a Brief Review.

Aspartame is one of the most popular artificial sweeteners over the world. Although its consumption is considered to be safe in acceptable daily intake ranges which were set by the United States Food and Drugs Administration and other regulatory agencies, there are lots of controversies regarding its safety nowadays. Some of the recent experimental and epidemiological studies showed that consumption of aspartame may causes some adverse health effects including obesity, metabolic syndrome, and alteration in gut microbiota. Moreover, studies on the nephrotoxic effect of aspartame have increased. A search of several literature databases for publications on adverse effects of aspartame on the kidney function from 1980 to 2016 showed that long-term consumption of aspartame led to a dose-dependent increased production of free radicals in renal tissues as well as kidney injury, based on several studies on animals However, given the lack of clinical data in this area, it is difficult to make a definitive conclusion regarding nephrotoxic effect of aspartame. Overall, consumers should be aware of the potential side effects of aspartame and other artificial sweeteners. At present it may be recommended that only a minimal amount of them would be consumed.

Effects of flaxseed oil on blood hepcidin and hematologic factors in hemodialysis patients.

INTRODUCTION: In hemodialysis (HD) patients, one of the common complications is renal anemia. Therefore, the present study was designed to investigate the effects of flaxseed oil consumption on blood hepcidin and hematologic factors in HD patients. METHODS: In this randomized, double-blind, clinical trial, 38 HD patients were randomly assigned to either the flaxseed oil or the control group. The patients in the flaxseed oil group received 6 g/d flaxseed oil for 8 wk, whereas the control group received 6 g/d medium chain triglycerides (MCT) oil. At baseline and the end of week 8, serum hepcidin, and blood hemoglobin, hematocrit, red blood cells (RBCs), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC) were measured after a 12- to 14-h fast. FINDINGS: Flaxseed oil consumption significantly reduced serum hepcidin concentration up to 25% during 8 weeks, and the reduction was significant in comparison with the MCT oil group. In addition, the number of RBCs, blood hemoglobin, hematocrit, MCH and MCHC increased significantly in the flaxseed oil group up to 6%, 10%, 6%, 5%, and 2%, respectively, and these elevations were significant in comparison with the MCT oil group. There was no significant difference between the two groups in mean changes of MCV. DISCUSSION: This study indicates that daily consumption of 6 g flaxseed oil reduces serum hepcidin and improves hematologic factors in HD patients.

Effects of Flaxseed Oil on Serum Lipids and Lipoproteins in Hemodialysis Patients: a Randomized Controlled Trial.

INTRODUCTION: One of the major risk factors for cardiovascular disease is lipid abnormalities among hemodialysis patients. The present study was designed to investigate the effects of flaxseed oil consumption on serum lipids and lipoproteins in hemodialysis patients. MATERIALS AND METHODS: In a randomized double-blinded controlled trial, 34 hemodialysis patients were assigned to either the flaxseed oil or the control group. The patients in the flaxseed oil group received 6 g/d of flaxseed oil for 8 weeks, whereas the control group received 6 g/d of medium chain triglycerides oil. At baseline and the end of week 8, blood samples were obtained after a 12- to 14-hour fast and serum concentrations of triglyceride, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and lipoprotein(a) were measured. RESULTS: Serum triglyceride concentration decreased significantly up to 23% in the flaxseed oil group at the end of week 8 compared to baseline, and the reduction was significant in comparison with the medium chain triglycerides oil group (P < .01). There were no significant differences between the two groups in the mean changes of serum total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and lipoprotein(a). CONCLUSIONS: This study indicates that daily consumption of 6 g of flaxseed oil reduces serum triglyceride concentration, which is a risk factor for cardiovascular disease in hemodialysis patients, whereas it has no effects on other lipid parameters, especially lipoprotein(a).