Dietary Patterns and Mortality in a Multinational Cohort of Adults Receiving Hemodialysis

DIET-HD Investigators and Dieticians

Research output: Contribution to journalArticle

Abstract

Rationale & Objective: Clinical practice guidelines for dietary intake in hemodialysis focus on individual nutrients. Little is known about associations of dietary patterns with survival. We evaluated the associations of dietary patterns with cardiovascular and all-cause mortality among adults treated by hemodialysis. Study Design: Prospective cohort study. Setting & Participants: 8,110 of 9,757 consecutive adults on hemodialysis (January 2014 to June 2017) treated in a multinational private dialysis network and with analyzable dietary data. Exposures: Data-driven dietary patterns based on the GA2LEN food frequency questionnaire. Participants received a score for each identified pattern, with higher scores indicating closer resemblance of their diet to the identified pattern. Quartiles of standardized pattern scores were used as primary exposures. Outcomes: Cardiovascular and all-cause mortality. Analytical Approach: Principal components analysis with varimax rotation to identify common dietary patterns. Adjusted proportional hazards regression analyses with country as a random effect to estimate the associations between dietary pattern scores and mortality. Associations were expressed as adjusted HRs with 95% CIs, using the lowest quartile score as reference. Results: During a median follow-up of 2.7 years (18,666 person-years), there were 2,087 deaths (958 cardiovascular). 2 dietary patterns, “fruit and vegetable” and “Western,” were identified. For the fruit and vegetable dietary pattern score, adjusted HRs, in ascending quartiles, were 0.94 (95% CI, 0.76-1.15), 0.83 (95% CI, 0.66-1.06), and 0.91 (95% CI, 0.69-1.21) for cardiovascular mortality and 0.95 (95% CI, 0.83-1.09), 0.84 (95% CI, 0.71-0.99), and 0.87 (95% CI, 0.72-1.05) for all-cause mortality. For the Western dietary pattern score, the corresponding estimates were 1.10 (95% CI, 0.90-1.35), 1.11 (95% CI, 0.87-1.41), and 1.09 (95% CI, 0.80-1.49) for cardiovascular mortality and 1.01 (95% CI, 0.88-1.16), 1.00 (95% CI, 0.85-1.18), and 1.14 (95% CI, 0.93-1.41) for all-cause mortality. Limitations: Self-reported food frequency questionnaire, data-driven approach. Conclusions: These findings did not confirm an association between mortality among patients receiving long-term hemodialysis and the extent to which dietary patterns were either high in fruit and vegetables or consistent with a Western diet.

Original languageEnglish (US)
JournalAmerican Journal of Kidney Diseases
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Renal Dialysis
Mortality
Vegetables
Fruit
Food
Principal Component Analysis
Practice Guidelines
Dialysis
Cohort Studies
Regression Analysis
Prospective Studies
Diet
Survival

Keywords

  • cardiovascular disease (CVD)
  • Diet
  • dietary patterns
  • end-stage kidney disease (ESKD)
  • Food Frequency Questionnaire (FFQ)
  • food intake
  • fruit
  • hemodialysis
  • modifiable risk factor
  • mortality
  • mortality
  • principal component analysis
  • vegetables
  • Western diet

ASJC Scopus subject areas

  • Nephrology

Cite this

Dietary Patterns and Mortality in a Multinational Cohort of Adults Receiving Hemodialysis. / DIET-HD Investigators and Dieticians.

In: American Journal of Kidney Diseases, 01.01.2019.

Research output: Contribution to journalArticle

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title = "Dietary Patterns and Mortality in a Multinational Cohort of Adults Receiving Hemodialysis",
abstract = "Rationale & Objective: Clinical practice guidelines for dietary intake in hemodialysis focus on individual nutrients. Little is known about associations of dietary patterns with survival. We evaluated the associations of dietary patterns with cardiovascular and all-cause mortality among adults treated by hemodialysis. Study Design: Prospective cohort study. Setting & Participants: 8,110 of 9,757 consecutive adults on hemodialysis (January 2014 to June 2017) treated in a multinational private dialysis network and with analyzable dietary data. Exposures: Data-driven dietary patterns based on the GA2LEN food frequency questionnaire. Participants received a score for each identified pattern, with higher scores indicating closer resemblance of their diet to the identified pattern. Quartiles of standardized pattern scores were used as primary exposures. Outcomes: Cardiovascular and all-cause mortality. Analytical Approach: Principal components analysis with varimax rotation to identify common dietary patterns. Adjusted proportional hazards regression analyses with country as a random effect to estimate the associations between dietary pattern scores and mortality. Associations were expressed as adjusted HRs with 95{\%} CIs, using the lowest quartile score as reference. Results: During a median follow-up of 2.7 years (18,666 person-years), there were 2,087 deaths (958 cardiovascular). 2 dietary patterns, “fruit and vegetable” and “Western,” were identified. For the fruit and vegetable dietary pattern score, adjusted HRs, in ascending quartiles, were 0.94 (95{\%} CI, 0.76-1.15), 0.83 (95{\%} CI, 0.66-1.06), and 0.91 (95{\%} CI, 0.69-1.21) for cardiovascular mortality and 0.95 (95{\%} CI, 0.83-1.09), 0.84 (95{\%} CI, 0.71-0.99), and 0.87 (95{\%} CI, 0.72-1.05) for all-cause mortality. For the Western dietary pattern score, the corresponding estimates were 1.10 (95{\%} CI, 0.90-1.35), 1.11 (95{\%} CI, 0.87-1.41), and 1.09 (95{\%} CI, 0.80-1.49) for cardiovascular mortality and 1.01 (95{\%} CI, 0.88-1.16), 1.00 (95{\%} CI, 0.85-1.18), and 1.14 (95{\%} CI, 0.93-1.41) for all-cause mortality. Limitations: Self-reported food frequency questionnaire, data-driven approach. Conclusions: These findings did not confirm an association between mortality among patients receiving long-term hemodialysis and the extent to which dietary patterns were either high in fruit and vegetables or consistent with a Western diet.",
keywords = "cardiovascular disease (CVD), Diet, dietary patterns, end-stage kidney disease (ESKD), Food Frequency Questionnaire (FFQ), food intake, fruit, hemodialysis, modifiable risk factor, mortality, mortality, principal component analysis, vegetables, Western diet",
author = "{DIET-HD Investigators and Dieticians} and Saglimbene, {Valeria M.} and Germaine Wong and Armando Teixeira-Pinto and Marinella Ruospo and Vanessa Garcia-Larsen and Palmer, {Suetonia C.} and Patrizia Natale and Katrina Campbell 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 Martin Hansis and Elisabeth Fabricius and Paolo Felaco and Charlotta Wollheim and J{\"o}rgen Hegbrant and Craig, {Jonathan C.} and Strippoli, {Giovanni F.M.} and A. Badino and L. Petracci and C. Villareal and M. Soto and M. Arias and F. Vera and V. Quispe and S. Morales and D. Bueno and R. Bargna and G. Pe{\~n}aloza and L. Alcalde and J. Dayer and A. Mil{\'a}n and N. Centuri{\'o}n and A. Ramos and {De Orta}, E. and S. Menardi and {Austa Bel}, N.",
year = "2019",
month = "1",
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language = "English (US)",
journal = "American Journal of Kidney Diseases",
issn = "0272-6386",
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TY - JOUR

T1 - Dietary Patterns and Mortality in a Multinational Cohort of Adults Receiving Hemodialysis

AU - DIET-HD Investigators and Dieticians

AU - Saglimbene, Valeria M.

AU - Wong, Germaine

AU - Teixeira-Pinto, Armando

AU - Ruospo, Marinella

AU - Garcia-Larsen, Vanessa

AU - Palmer, Suetonia C.

AU - Natale, Patrizia

AU - Campbell, Katrina

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 - Hansis, Martin

AU - Fabricius, Elisabeth

AU - Felaco, Paolo

AU - Wollheim, Charlotta

AU - Hegbrant, Jörgen

AU - Craig, Jonathan C.

AU - Strippoli, Giovanni F.M.

AU - Badino, A.

AU - Petracci, L.

AU - Villareal, C.

AU - Soto, M.

AU - Arias, M.

AU - Vera, F.

AU - Quispe, V.

AU - Morales, S.

AU - Bueno, D.

AU - Bargna, R.

AU - Peñaloza, G.

AU - Alcalde, L.

AU - Dayer, J.

AU - Milán, A.

AU - Centurión, N.

AU - Ramos, A.

AU - De Orta, E.

AU - Menardi, S.

AU - Austa Bel, N.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Rationale & Objective: Clinical practice guidelines for dietary intake in hemodialysis focus on individual nutrients. Little is known about associations of dietary patterns with survival. We evaluated the associations of dietary patterns with cardiovascular and all-cause mortality among adults treated by hemodialysis. Study Design: Prospective cohort study. Setting & Participants: 8,110 of 9,757 consecutive adults on hemodialysis (January 2014 to June 2017) treated in a multinational private dialysis network and with analyzable dietary data. Exposures: Data-driven dietary patterns based on the GA2LEN food frequency questionnaire. Participants received a score for each identified pattern, with higher scores indicating closer resemblance of their diet to the identified pattern. Quartiles of standardized pattern scores were used as primary exposures. Outcomes: Cardiovascular and all-cause mortality. Analytical Approach: Principal components analysis with varimax rotation to identify common dietary patterns. Adjusted proportional hazards regression analyses with country as a random effect to estimate the associations between dietary pattern scores and mortality. Associations were expressed as adjusted HRs with 95% CIs, using the lowest quartile score as reference. Results: During a median follow-up of 2.7 years (18,666 person-years), there were 2,087 deaths (958 cardiovascular). 2 dietary patterns, “fruit and vegetable” and “Western,” were identified. For the fruit and vegetable dietary pattern score, adjusted HRs, in ascending quartiles, were 0.94 (95% CI, 0.76-1.15), 0.83 (95% CI, 0.66-1.06), and 0.91 (95% CI, 0.69-1.21) for cardiovascular mortality and 0.95 (95% CI, 0.83-1.09), 0.84 (95% CI, 0.71-0.99), and 0.87 (95% CI, 0.72-1.05) for all-cause mortality. For the Western dietary pattern score, the corresponding estimates were 1.10 (95% CI, 0.90-1.35), 1.11 (95% CI, 0.87-1.41), and 1.09 (95% CI, 0.80-1.49) for cardiovascular mortality and 1.01 (95% CI, 0.88-1.16), 1.00 (95% CI, 0.85-1.18), and 1.14 (95% CI, 0.93-1.41) for all-cause mortality. Limitations: Self-reported food frequency questionnaire, data-driven approach. Conclusions: These findings did not confirm an association between mortality among patients receiving long-term hemodialysis and the extent to which dietary patterns were either high in fruit and vegetables or consistent with a Western diet.

AB - Rationale & Objective: Clinical practice guidelines for dietary intake in hemodialysis focus on individual nutrients. Little is known about associations of dietary patterns with survival. We evaluated the associations of dietary patterns with cardiovascular and all-cause mortality among adults treated by hemodialysis. Study Design: Prospective cohort study. Setting & Participants: 8,110 of 9,757 consecutive adults on hemodialysis (January 2014 to June 2017) treated in a multinational private dialysis network and with analyzable dietary data. Exposures: Data-driven dietary patterns based on the GA2LEN food frequency questionnaire. Participants received a score for each identified pattern, with higher scores indicating closer resemblance of their diet to the identified pattern. Quartiles of standardized pattern scores were used as primary exposures. Outcomes: Cardiovascular and all-cause mortality. Analytical Approach: Principal components analysis with varimax rotation to identify common dietary patterns. Adjusted proportional hazards regression analyses with country as a random effect to estimate the associations between dietary pattern scores and mortality. Associations were expressed as adjusted HRs with 95% CIs, using the lowest quartile score as reference. Results: During a median follow-up of 2.7 years (18,666 person-years), there were 2,087 deaths (958 cardiovascular). 2 dietary patterns, “fruit and vegetable” and “Western,” were identified. For the fruit and vegetable dietary pattern score, adjusted HRs, in ascending quartiles, were 0.94 (95% CI, 0.76-1.15), 0.83 (95% CI, 0.66-1.06), and 0.91 (95% CI, 0.69-1.21) for cardiovascular mortality and 0.95 (95% CI, 0.83-1.09), 0.84 (95% CI, 0.71-0.99), and 0.87 (95% CI, 0.72-1.05) for all-cause mortality. For the Western dietary pattern score, the corresponding estimates were 1.10 (95% CI, 0.90-1.35), 1.11 (95% CI, 0.87-1.41), and 1.09 (95% CI, 0.80-1.49) for cardiovascular mortality and 1.01 (95% CI, 0.88-1.16), 1.00 (95% CI, 0.85-1.18), and 1.14 (95% CI, 0.93-1.41) for all-cause mortality. Limitations: Self-reported food frequency questionnaire, data-driven approach. Conclusions: These findings did not confirm an association between mortality among patients receiving long-term hemodialysis and the extent to which dietary patterns were either high in fruit and vegetables or consistent with a Western diet.

KW - cardiovascular disease (CVD)

KW - Diet

KW - dietary patterns

KW - end-stage kidney disease (ESKD)

KW - Food Frequency Questionnaire (FFQ)

KW - food intake

KW - fruit

KW - hemodialysis

KW - modifiable risk factor

KW - mortality

KW - mortality

KW - principal component analysis

KW - vegetables

KW - Western diet

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U2 - 10.1053/j.ajkd.2019.05.028

DO - 10.1053/j.ajkd.2019.05.028

M3 - Article

C2 - 31515137

AN - SCOPUS:85071901375

JO - American Journal of Kidney Diseases

JF - American Journal of Kidney Diseases

SN - 0272-6386

ER -