Nutr Res Pract.  2016 Aug;10(4):404-410. 10.4162/nrp.2016.10.4.404.

Dietary inflammatory index is associated with serum C-reactive protein and protein energy wasting in hemodialysis patients: A cross-sectional study

• Kizil M
• Tengilimoglu-Metin MM
• Gumus D
• Sevim S
• Turkoglu I
• Mandiroglu F

• KMID: 2390143
• DOI: http://doi.org/10.4162/nrp.2016.10.4.404

Abstract

BACKGROUND
/OBJECTIVE: Malnutrition and inflammation are reported as the most powerful predictors of mortality and morbidity in hemodialysis (HD) patients. Diet has a key role in modulating inflammation and dietary inflammatory index (DII) is a new tool for assessment of inflammatory potential of diet. The aim of this study was to evaluate the application of DII on dietary intake of HD patients and examine the associations between DII and malnutrition-inflammation markers.
SUBJECTS/METHODS
A total of 105 subjects were recruited for this cross-sectional study. Anthropometric measurements, 3-day dietary recall, and pre-dialysis biochemical parameters were recorded for each subject. Subjective global assessment (SGA), which was previously validated for HD patients, and malnutrition inflammation score (MIS) were used for the diagnosis of protein energy wasting. DII was calculated according to average of 3-day dietary recall data.
RESULTS
DII showed significant correlation with reliable malnutrition and inflammation indicators including SGA (r = 0.28, P < 0.01), MIS (r = 0.28, P < 0.01), and serum C-reactive protein (CRP) (r = 0.35, P < 0.001) in HD patients. When the study population was divided into three subgroups according to their DII score, significant increasing trends across the tertiles of DII were observed for SGA score (P = 0.035), serum CRP (P = 0.001), dietary energy (P < 0.001), total fat (P < 0.001), saturated fatty acids (P < 0.001), polyunsaturated fatty acids (P = 0.006), and omega-6 fatty acids (P = 0.01) intakes.
CONCLUSION
This study shows that DII is a good tool for assessing the overall inflammatory potential of diet in HD patients.

Keyword

Kidney failure; inflammation; malnutrition; dietary fat; dietary management

MeSH Terms

C-Reactive Protein*
Cross-Sectional Studies*
Diagnosis
Diet
Dietary Fats
Fatty Acids
Fatty Acids, Omega-6
Fatty Acids, Unsaturated
Humans
Inflammation
Malnutrition
Mortality
Renal Dialysis*
Renal Insufficiency
C-Reactive Protein
Dietary Fats
Fatty Acids
Fatty Acids, Omega-6
Fatty Acids, Unsaturated

Reference

1. Kalantar-Zadeh K, Block G, McAllister CJ, Humphreys MH, Kopple JD. Appetite and inflammation, nutrition, anemia, and clinical outcome in hemodialysis patients. Am J Clin Nutr. 2004; 80:299–307.

2. Kalantar-Zadeh K. Recent advances in understanding the malnutrition-inflammation-cachexia syndrome in chronic kidney disease patients: What is next? Semin Dial. 2005; 18:365–369.

3. Kalantar-Zadeh K, Abbott KC, Salahudeen AK, Kilpatrick RD, Horwich TB. Survival advantages of obesity in dialysis patients. Am J Clin Nutr. 2005; 81:543–554.

4. Stack AG, Bloembergen WE. Prevalence and clinical correlates of coronary artery disease among new dialysis patients in the United States: a cross-sectional study. J Am Soc Nephrol. 2001; 12:1516–1523.

5. Hung SC, Kuo KL, Peng CH, Wu CH, Lien YC, Wang YC, Tarng DC. Volume overload correlates with cardiovascular risk factors in patients with chronic kidney disease. Kidney Int. 2014; 85:703–709.

6. Menon V, Wang X, Greene T, Beck GJ, Kusek JW, Marcovina SM, Levey AS, Sarnak MJ. Relationship between C-reactive protein, albumin, and cardiovascular disease in patients with chronic kidney disease. Am J Kidney Dis. 2003; 42:44–52.

7. Ortega O, Rodriguez I, Gallar P, Carreño A, Ortiz M, Espejo B, Jimenez J, Gutierrez M, Oliet A, Vigil A. Significance of high C-reactive protein levels in pre-dialysis patients. Nephrol Dial Transplant. 2002; 17:1105–1109.

8. Tonelli M, Sacks F, Pfeffer M, Jhangri GS, Curhan G. Cholesterol and Recurrent Events (CARE) Trial Investigators. Biomarkers of inflammation and progression of chronic kidney disease. Kidney Int. 2005; 68:237–245.

9. Heyland DK, Novak F, Drover JW, Jain M, Su X, Suchner U. Should immunonutrition become routine in critically ill patients? A systematic review of the evidence. JAMA. 2001; 286:944–953.

10. Cavicchia PP, Steck SE, Hurley TG, Hussey JR, Ma Y, Ockene IS, Hébert JR. A new dietary inflammatory index predicts interval changes in serum high-sensitivity C-reactive protein. J Nutr. 2009; 139:2365–2372.

11. Shivappa N, Steck SE, Hurley TG, Hussey JR, Hébert JR. Designing and developing a literature-derived, population-based dietary inflammatory index. Public Health Nutr. 2014; 17:1689–1696.

12. Shivappa N, Steck SE, Hurley TG, Hussey JR, Ma Y, Ockene IS, Tabung F, Hébert JR. A population-based dietary inflammatory index predicts levels of C-reactive protein in the Seasonal Variation of Blood Cholesterol Study (SEASONS). Public Health Nutr. 2014; 17:1825–1833.

13. Tabung FK, Steck SE, Zhang J, Ma Y, Liese AD, Agalliu I, Hingle M, Hou L, Hurley TG, Jiao L, Martin LW, Millen AE, Park HL, Rosal MC, Shikany JM, Shivappa N, Ockene JK, Hebert JR. Construct validation of the dietary inflammatory index among postmenopausal women. Ann Epidemiol. 2015; 25:398–405.

14. Kalantar-Zadeh K, Kleiner M, Dunne E, Lee GH, Luft FC. A modified quantitative subjective global assessment of nutrition for dialysis patients. Nephrol Dial Transplant. 1999; 14:1732–1738.

15. Kalantar-Zadeh K, Kopple JD, Humphreys MH, Block G. Comparing outcome predictability of markers of malnutrition-inflammation complex syndrome in haemodialysis patients. Nephrol Dial Transplant. 2004; 19:1507–1519.

16. As'habi A, Tabibi H, Nozary-Heshmati B, Mahdavi-Mazdeh M, Hedayati M. Comparison of various scoring methods for the diagnosis of protein-energy wasting in hemodialysis patients. Int Urol Nephrol. 2014; 46:999–1004.

17. Clinical practice guidelines for nutrition in chronic renal failure. K/DOQI, National Kidney Foundation. Am J Kidney Dis. 2000; 35:S1–S140.

18. Mehrotra R, Kopple JD. Nutritional management of maintenance dialysis patients: why arent we doing better? Annu Rev Nutr. 2001; 21:343–379.

19. Kalantar-Zadeh K, Ikizler TA, Block G, Avram MM, Kopple JD. Malnutrition-inflammation complex syndrome in dialysis patients: causes and consequences. Am J Kidney Dis. 2003; 42:864–881.

20. Rambod M, Bross R, Zitterkoph J, Benner D, Pithia J, Colman S, Kovesdy CP, Kopple JD, Kalantar-Zadeh K. Association of malnutrition-inflammation score with quality of life and mortality in hemodialysis patients: a 5-year prospective cohort study. Am J Kidney Dis. 2009; 53:298–309.

21. Galland L. Diet and inflammation. Nutr Clin Pract. 2010; 25:634–640.

22. Cardozo LF, Pedruzzi LM, Stenvinkel P, Stockler-Pinto MB, Daleprane JB, Leite M Jr, Mafra D. Nutritional strategies to modulate inflammation and oxidative stress pathways via activation of the master antioxidant switch Nrf2. Biochimie. 2013; 95:1525–1533.

23. Kalantar-Zadeh K, Stenvinkel P, Bross R, Khawar OS, Rammohan M, Colman S, Benner D. Kidney insufficiency and nutrient-based modulation of inflammation. Curr Opin Clin Nutr Metab Care. 2005; 8:388–396.

24. Lemos JR, Alencastro MG, Konrath AV, Cargnin M, Manfro RC. Flaxseed oil supplementation decreases C-reactive protein levels in chronic hemodialysis patients. Nutr Res. 2012; 32:921–927.

25. Shema-Didi L, Sela S, Ore L, Shapiro G, Geron R, Moshe G, Kristal B. One year of pomegranate juice intake decreases oxidative stress, inflammation, and incidence of infections in hemodialysis patients: a randomized placebo-controlled trial. Free Radic Biol Med. 2012; 53:297–304.

26. Raphael W, Sordillo LM. Dietary polyunsaturated fatty acids and inflammation: the role of phospholipid biosynthesis. Int J Mol Sci. 2013; 14:21167–21188.

27. Santos S, Oliveira A, Casal S, Lopes C. Saturated fatty acids intake in relation to C-reactive protein, adiponectin, and leptin: a population-based study. Nutrition. 2013; 29:892–897.

28. King DE, Egan BM, Geesey ME. Relation of dietary fat and fiber to elevation of C-reactive protein. Am J Cardiol. 2003; 92:1335–1339.

29. Ruperto M, Sánchez-Muniz FJ, Barril G. Predictors of protein-energy wasting in haemodialysis patients: a cross-sectional study. J Hum Nutr Diet. 2016; 29:38–47.

30. Udeanu M, Guizzardi G, Di Pasquale G, Marchetti A, Romani F, Dalmastri V, Capelli I, Stalteri L, Cianciolo G, Rucci P, La Manna G. Relationship between coronary artery disease and C-reactive protein levels in NSTEMI patients with renal dysfunction: a retrospective study. BMC Nephrol. 2014; 15:152–159.

31. DeAngelis RA, Reis ES, Ricklin D, Lambris JD. Targeted complement inhibition as a promising strategy for preventing inflammatory complications in hemodialysis. Immunobiology. 2012; 217:1097–1105.

32. Salahudeen AK. Obesity and survival on dialysis. Am J Kidney Dis. 2003; 41:925–932.

33. Beberashvili I, Sinuani I, Azar A, Yasur H, Feldman L, Efrati S, Averbukh Z, Weissgarten J. Nutritional and inflammatory status of hemodialysis patients in relation to their body mass index. J Ren Nutr. 2009; 19:238–247.

34. Wirth MD, Burch J, Shivappa N, Violanti JM, Burchfiel CM, Fekedulegn D, Andrew ME, Hartley TA, Miller DB, Mnatsakanova A, Charles LE, Steck SE, Hurley TG, Vena JE, Hébert JR. Association of a dietary inflammatory index with inflammatory indices and metabolic syndrome among police officers. J Occup Environ Med. 2014; 56:986–989.

35. Wood LG, Shivappa N, Berthon BS, Gibson PG, Hbert JR. Dietary inflammatory index is related to asthma risk, lung function and systemic inflammation in asthma. Clin Exp Allergy. 2015; 45:177–183.

36. Shivappa N, Prizment AE, Blair CK, Jacobs DR Jr, Steck SE, Hébert JR. Dietary inflammatory index and risk of colorectal cancer in the Iowa Women's Health Study. Cancer Epidemiol Biomarkers Prev. 2014; 23:2383–2392.

37. Tabung FK, Steck SE, Ma Y, Liese AD, Zhang J, Caan B, Hou L, Johnson KC, Mossavar-Rahmani Y, Shivappa N, Wactawski-Wende J, Ockene JK, Hebert JR. The association between dietary inflammatory index and risk of colorectal cancer among postmenopausal women: results from the Women's Health Initiative. Cancer Causes Control. 2015; 26:399–408.

38. Shivappa N, Bosetti C, Zucchetto A, Montella M, Serraino D, La Vecchia C, Hébert JR. Association between dietary inflammatory index and prostate cancer among Italian men. Br J Nutr. 2015; 113:278–283.

39. Shivappa N, Bosetti C, Zucchetto A, Serraino D, La Vecchia C, Hébert JR. Dietary inflammatory index and risk of pancreatic cancer in an Italian case-control study. Br J Nutr. 2015; 113:292–298.

40. Galas A, Kulig P, Kulig J. Dietary inflammatory index as a potential determinant of a length of hospitalization among surgical patients treated for colorectal cancer. Eur J Clin Nutr. 2014; 68:1168–1174.