Dietary n-3 polyunsaturated fatty acid intake and all-cause and cardiovascular mortality in adults on hemodialysis: The DIET-HD multinational cohort study

Valeria M. Saglimbene, Germaine Wong, Marinella Ruospo, Suetonia C. Palmer, Katrina Campbell, Vanessa Garcia-Larsen    , Patrizia Natale, Armando Teixeira-Pinto, Juan Jesus Carrero, Peter Stenvinkel, Letizia Gargano, Angelo M. Murgo, David W. Johnson, Marcello Tonelli, Rubén Gelfman, Eduardo Celia, Tevfik Ecder, Amparo G. Bernat, Domingo Del Castillo, Delia TimofteMarietta Török, Anna Bednarek-Skublewska, Jan Duława, Paul Stroumza, Susanne Hoischen, Martin Hansis, Elisabeth Fabricius, Charlotta Wollheim, Jörgen Hegbrant, Jonathan C. Craig, Giovanni F.M. Strippoli

Research output: Contribution to journalArticle

Abstract

Background & aims: Patients on hemodialysis suffer from high risk of premature death, which is largely attributed to cardiovascular disease, but interventions targeting traditional cardiovascular risk factors have made little or no difference. Long chain n-3 polyunsaturated fatty acids (n-3 PUFA) are putative candidates to reduce cardiovascular disease. Diets rich in n-3 PUFA are recommended in the general population, although their role in the hemodialysis setting is uncertain. We evaluated the association between the dietary intake of n-3 PUFA and mortality for hemodialysis patients. Methods: The DIET-HD study is a prospective cohort study (January 2014-June 2017) in 9757 adults treated with hemodialysis in Europe and South America. Dietary n-3 PUFA intake was measured at baseline using the GA2LEN Food Frequency Questionnaire. Adjusted Cox regression analyses clustered by country were conducted to evaluate the association of dietary n-3 PUFA intake with cardiovascular and all-cause mortality. Results: During a median follow up of 2.7 years (18,666 person-years), 2087 deaths were recorded, including 829 attributable to cardiovascular causes. One third of the study participants consumed sufficient (at least 1.75 g/week) n-3 PUFA recommended for primary cardiovascular prevention, and less than 10% recommended for secondary prevention (7-14 g/week). Compared to patients with the lowest tertile of dietary n-3 PUFA intake (<0.37 g/week), the adjusted hazard ratios (95% confidence interval) for cardiovascular mortality for patients in the middle (0.37 to <1.8 g/week) and highest (≥1.8 g/week) tertiles of n-3 PUFA were 0.82 (0.69-0.98) and 1.03 (0.84-1.26), respectively. Corresponding adjusted hazard ratios for all-cause mortality were 0.96 (0.86-1.08) and 1.00 (0.88-1.13), respectively. Conclusions: Dietary n-3 PUFA intake was not associated with cardiovascular or all-cause mortality in patients on hemodialysis. As dietary n-3 PUFA intake was low, the possibility that n-3 PUFA supplementation might mitigate cardiovascular risk has not been excluded.

Original languageEnglish (US)
JournalClinical Nutrition
DOIs
StateAccepted/In press - Jan 1 2017

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Omega-3 Fatty Acids
Renal Dialysis
Cohort Studies
Mortality
Cardiovascular Diseases
Premature Mortality
South America
Primary Prevention
Secondary Prevention
Regression Analysis
Prospective Studies
Confidence Intervals
Diet
Food

Keywords

  • End stage renal disease
  • Fish oil
  • Hemodialysis
  • Mortality
  • N-3 PUFA
  • Omega 3

ASJC Scopus subject areas

  • Nutrition and Dietetics
  • Critical Care and Intensive Care Medicine

Cite this

Dietary n-3 polyunsaturated fatty acid intake and all-cause and cardiovascular mortality in adults on hemodialysis : The DIET-HD multinational cohort study. / Saglimbene, Valeria M.; Wong, Germaine; Ruospo, Marinella; Palmer, Suetonia C.; Campbell, Katrina; Garcia-Larsen    , Vanessa; Natale, Patrizia; Teixeira-Pinto, Armando; Carrero, Juan Jesus; Stenvinkel, Peter; Gargano, Letizia; Murgo, Angelo M.; Johnson, David W.; Tonelli, Marcello; Gelfman, Rubén; Celia, Eduardo; Ecder, Tevfik; Bernat, Amparo G.; Del Castillo, Domingo; Timofte, Delia; Török, Marietta; Bednarek-Skublewska, Anna; Duława, Jan; Stroumza, Paul; Hoischen, Susanne; Hansis, Martin; Fabricius, Elisabeth; Wollheim, Charlotta; Hegbrant, Jörgen; Craig, Jonathan C.; Strippoli, Giovanni F.M.

In: Clinical Nutrition, 01.01.2017.

Research output: Contribution to journalArticle

Saglimbene, VM, Wong, G, Ruospo, M, Palmer, SC, Campbell, K, Garcia-Larsen    , V, Natale, P, Teixeira-Pinto, A, Carrero, JJ, Stenvinkel, P, Gargano, L, Murgo, AM, Johnson, DW, Tonelli, M, Gelfman, R, Celia, E, Ecder, T, Bernat, AG, Del Castillo, D, Timofte, D, Török, M, Bednarek-Skublewska, A, Duława, J, Stroumza, P, Hoischen, S, Hansis, M, Fabricius, E, Wollheim, C, Hegbrant, J, Craig, JC & Strippoli, GFM 2017, 'Dietary n-3 polyunsaturated fatty acid intake and all-cause and cardiovascular mortality in adults on hemodialysis: The DIET-HD multinational cohort study', Clinical Nutrition. https://doi.org/10.1016/j.clnu.2017.11.020
Saglimbene, Valeria M. ; Wong, Germaine ; Ruospo, Marinella ; Palmer, Suetonia C. ; Campbell, Katrina ; Garcia-Larsen    , Vanessa ; Natale, Patrizia ; Teixeira-Pinto, Armando ; Carrero, Juan Jesus ; Stenvinkel, Peter ; Gargano, Letizia ; Murgo, Angelo M. ; Johnson, David W. ; Tonelli, Marcello ; Gelfman, Rubén ; Celia, Eduardo ; Ecder, Tevfik ; Bernat, Amparo G. ; Del Castillo, Domingo ; Timofte, Delia ; Török, Marietta ; Bednarek-Skublewska, Anna ; Duława, Jan ; Stroumza, Paul ; Hoischen, Susanne ; Hansis, Martin ; Fabricius, Elisabeth ; Wollheim, Charlotta ; Hegbrant, Jörgen ; Craig, Jonathan C. ; Strippoli, Giovanni F.M. / Dietary n-3 polyunsaturated fatty acid intake and all-cause and cardiovascular mortality in adults on hemodialysis : The DIET-HD multinational cohort study. In: Clinical Nutrition. 2017.
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abstract = "Background & aims: Patients on hemodialysis suffer from high risk of premature death, which is largely attributed to cardiovascular disease, but interventions targeting traditional cardiovascular risk factors have made little or no difference. Long chain n-3 polyunsaturated fatty acids (n-3 PUFA) are putative candidates to reduce cardiovascular disease. Diets rich in n-3 PUFA are recommended in the general population, although their role in the hemodialysis setting is uncertain. We evaluated the association between the dietary intake of n-3 PUFA and mortality for hemodialysis patients. Methods: The DIET-HD study is a prospective cohort study (January 2014-June 2017) in 9757 adults treated with hemodialysis in Europe and South America. Dietary n-3 PUFA intake was measured at baseline using the GA2LEN Food Frequency Questionnaire. Adjusted Cox regression analyses clustered by country were conducted to evaluate the association of dietary n-3 PUFA intake with cardiovascular and all-cause mortality. Results: During a median follow up of 2.7 years (18,666 person-years), 2087 deaths were recorded, including 829 attributable to cardiovascular causes. One third of the study participants consumed sufficient (at least 1.75 g/week) n-3 PUFA recommended for primary cardiovascular prevention, and less than 10{\%} recommended for secondary prevention (7-14 g/week). Compared to patients with the lowest tertile of dietary n-3 PUFA intake (<0.37 g/week), the adjusted hazard ratios (95{\%} confidence interval) for cardiovascular mortality for patients in the middle (0.37 to <1.8 g/week) and highest (≥1.8 g/week) tertiles of n-3 PUFA were 0.82 (0.69-0.98) and 1.03 (0.84-1.26), respectively. Corresponding adjusted hazard ratios for all-cause mortality were 0.96 (0.86-1.08) and 1.00 (0.88-1.13), respectively. Conclusions: Dietary n-3 PUFA intake was not associated with cardiovascular or all-cause mortality in patients on hemodialysis. As dietary n-3 PUFA intake was low, the possibility that n-3 PUFA supplementation might mitigate cardiovascular risk has not been excluded.",
keywords = "End stage renal disease, Fish oil, Hemodialysis, Mortality, N-3 PUFA, Omega 3",
author = "Saglimbene, {Valeria M.} and Germaine Wong and Marinella Ruospo and Palmer, {Suetonia C.} and Katrina Campbell and {Garcia-Larsen    }, Vanessa and Patrizia Natale and Armando Teixeira-Pinto and Carrero, {Juan Jesus} and Peter Stenvinkel and Letizia Gargano and Murgo, {Angelo M.} and Johnson, {David W.} and Marcello Tonelli and Rub{\'e}n Gelfman and Eduardo Celia and Tevfik Ecder and Bernat, {Amparo G.} and {Del Castillo}, Domingo and Delia Timofte and Marietta T{\"o}r{\"o}k and Anna Bednarek-Skublewska and Jan Duława and Paul Stroumza and Susanne Hoischen and Martin Hansis and Elisabeth Fabricius and Charlotta Wollheim and J{\"o}rgen Hegbrant and Craig, {Jonathan C.} and Strippoli, {Giovanni F.M.}",
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language = "English (US)",
journal = "Clinical Nutrition",
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TY - JOUR

T1 - Dietary n-3 polyunsaturated fatty acid intake and all-cause and cardiovascular mortality in adults on hemodialysis

T2 - The DIET-HD multinational cohort study

AU - Saglimbene, Valeria M.

AU - Wong, Germaine

AU - Ruospo, Marinella

AU - Palmer, Suetonia C.

AU - Campbell, Katrina

AU - Garcia-Larsen    , Vanessa

AU - Natale, Patrizia

AU - Teixeira-Pinto, Armando

AU - Carrero, Juan Jesus

AU - Stenvinkel, Peter

AU - Gargano, Letizia

AU - Murgo, Angelo M.

AU - Johnson, David W.

AU - Tonelli, Marcello

AU - Gelfman, Rubén

AU - Celia, Eduardo

AU - Ecder, Tevfik

AU - Bernat, Amparo G.

AU - Del Castillo, Domingo

AU - Timofte, Delia

AU - Török, Marietta

AU - Bednarek-Skublewska, Anna

AU - Duława, Jan

AU - Stroumza, Paul

AU - Hoischen, Susanne

AU - Hansis, Martin

AU - Fabricius, Elisabeth

AU - Wollheim, Charlotta

AU - Hegbrant, Jörgen

AU - Craig, Jonathan C.

AU - Strippoli, Giovanni F.M.

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Background & aims: Patients on hemodialysis suffer from high risk of premature death, which is largely attributed to cardiovascular disease, but interventions targeting traditional cardiovascular risk factors have made little or no difference. Long chain n-3 polyunsaturated fatty acids (n-3 PUFA) are putative candidates to reduce cardiovascular disease. Diets rich in n-3 PUFA are recommended in the general population, although their role in the hemodialysis setting is uncertain. We evaluated the association between the dietary intake of n-3 PUFA and mortality for hemodialysis patients. Methods: The DIET-HD study is a prospective cohort study (January 2014-June 2017) in 9757 adults treated with hemodialysis in Europe and South America. Dietary n-3 PUFA intake was measured at baseline using the GA2LEN Food Frequency Questionnaire. Adjusted Cox regression analyses clustered by country were conducted to evaluate the association of dietary n-3 PUFA intake with cardiovascular and all-cause mortality. Results: During a median follow up of 2.7 years (18,666 person-years), 2087 deaths were recorded, including 829 attributable to cardiovascular causes. One third of the study participants consumed sufficient (at least 1.75 g/week) n-3 PUFA recommended for primary cardiovascular prevention, and less than 10% recommended for secondary prevention (7-14 g/week). Compared to patients with the lowest tertile of dietary n-3 PUFA intake (<0.37 g/week), the adjusted hazard ratios (95% confidence interval) for cardiovascular mortality for patients in the middle (0.37 to <1.8 g/week) and highest (≥1.8 g/week) tertiles of n-3 PUFA were 0.82 (0.69-0.98) and 1.03 (0.84-1.26), respectively. Corresponding adjusted hazard ratios for all-cause mortality were 0.96 (0.86-1.08) and 1.00 (0.88-1.13), respectively. Conclusions: Dietary n-3 PUFA intake was not associated with cardiovascular or all-cause mortality in patients on hemodialysis. As dietary n-3 PUFA intake was low, the possibility that n-3 PUFA supplementation might mitigate cardiovascular risk has not been excluded.

AB - Background & aims: Patients on hemodialysis suffer from high risk of premature death, which is largely attributed to cardiovascular disease, but interventions targeting traditional cardiovascular risk factors have made little or no difference. Long chain n-3 polyunsaturated fatty acids (n-3 PUFA) are putative candidates to reduce cardiovascular disease. Diets rich in n-3 PUFA are recommended in the general population, although their role in the hemodialysis setting is uncertain. We evaluated the association between the dietary intake of n-3 PUFA and mortality for hemodialysis patients. Methods: The DIET-HD study is a prospective cohort study (January 2014-June 2017) in 9757 adults treated with hemodialysis in Europe and South America. Dietary n-3 PUFA intake was measured at baseline using the GA2LEN Food Frequency Questionnaire. Adjusted Cox regression analyses clustered by country were conducted to evaluate the association of dietary n-3 PUFA intake with cardiovascular and all-cause mortality. Results: During a median follow up of 2.7 years (18,666 person-years), 2087 deaths were recorded, including 829 attributable to cardiovascular causes. One third of the study participants consumed sufficient (at least 1.75 g/week) n-3 PUFA recommended for primary cardiovascular prevention, and less than 10% recommended for secondary prevention (7-14 g/week). Compared to patients with the lowest tertile of dietary n-3 PUFA intake (<0.37 g/week), the adjusted hazard ratios (95% confidence interval) for cardiovascular mortality for patients in the middle (0.37 to <1.8 g/week) and highest (≥1.8 g/week) tertiles of n-3 PUFA were 0.82 (0.69-0.98) and 1.03 (0.84-1.26), respectively. Corresponding adjusted hazard ratios for all-cause mortality were 0.96 (0.86-1.08) and 1.00 (0.88-1.13), respectively. Conclusions: Dietary n-3 PUFA intake was not associated with cardiovascular or all-cause mortality in patients on hemodialysis. As dietary n-3 PUFA intake was low, the possibility that n-3 PUFA supplementation might mitigate cardiovascular risk has not been excluded.

KW - End stage renal disease

KW - Fish oil

KW - Hemodialysis

KW - Mortality

KW - N-3 PUFA

KW - Omega 3

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