1. Fruit and Vegetable Intake and Mortality in Adults undergoing Maintenance Hemodialysis
- Author
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Letizia Gargano, Delia Timofte, Angelo M. Murgo, Jörgen Hegbrant, Susanne Hoischen, Jan Duława, Elisabeth Fabricius, Domingo Del Castillo, Armando Teixeira-Pinto, Amparo G. Bernat, Anna Bednarek-Skublewska, David W. Johnson, Marinella Ruospo, Eduardo Celia, Vanessa Garcia-Larsen, Katrina L. Campbell, Charlotta Wollheim, Jonathan C. Craig, Marietta Török, Ruben Gelfman, Patrizia Natale, Tevfik Ecder, Marcello Tonelli, Juan Jesus Carrero, Valeria Saglimbene, Martin Hansis, Giovanni F.M. Strippoli, Paolo Felaco, Paul Stroumza, Suetonia C. Palmer, Peter Stenvinkel, and Germaine Wong
- Subjects
Male ,medicine.medical_specialty ,Epidemiology ,medicine.medical_treatment ,Population ,Critical Care and Intensive Care Medicine ,Diet Surveys ,Cohort Studies ,Renal Dialysis ,Median follow-up ,Interquartile range ,Internal medicine ,Vegetables ,Humans ,Medicine ,Mortality ,education ,Aged ,Transplantation ,education.field_of_study ,business.industry ,Proportional hazards model ,Hazard ratio ,Middle Aged ,Diet ,Cardiovascular Diseases ,Nephrology ,Fruit ,Kidney Failure, Chronic ,Population study ,Female ,Hemodialysis ,business ,Cohort study - Abstract
Background and objectives Higher fruit and vegetable intake is associated with lower cardiovascular and all-cause mortality in the general population. It is unclear whether this association occurs in patients on hemodialysis, in whom high fruit and vegetable intake is generally discouraged because of a potential risk of hyperkalemia. We aimed to evaluate the association between fruit and vegetable intake and mortality in hemodialysis. Design, setting, participants, & measurements Fruit and vegetable intake was ascertained by the Global Allergy and Asthma European Network food frequency questionnaire within the Dietary Intake, Death and Hospitalization in Adults with ESKD Treated with Hemodialysis study, a multinational cohort study of 9757 adults on hemodialysis, of whom 8078 (83%) had analyzable dietary data. Adjusted Cox regression analyses clustered by country were conducted to evaluate the association between tertiles of fruit and vegetable intake with all-cause, cardiovascular, and noncardiovascular mortality. Estimates were calculated as hazard ratios with 95% confidence intervals (95% CIs). Results During a median follow up of 2.7 years (18,586 person-years), there were 2082 deaths (954 cardiovascular). The median (interquartile range) number of servings of fruit and vegetables was 8 (4–14) per week; only 4% of the study population consumed at least four servings per day as recommended in the general population. Compared with the lowest tertile of servings per week (0–5.5, median 2), the adjusted hazard ratios for the middle (5.6–10, median 8) and highest (>10, median 17) tertiles were 0.90 (95% CI, 0.81 to 1.00) and 0.80 (95% CI, 0.71 to 0.91) for all-cause mortality, 0.88 (95% CI, 0.76 to 1.02) and 0.77 (95% CI, 0.66 to 0.91) for noncardiovascular mortality and 0.95 (95% CI, 0.81 to 1.11) and 0.84 (95% CI, 0.70 to 1.00) for cardiovascular mortality, respectively. Conclusions Fruit and vegetable intake in the hemodialysis population is low and a higher consumption is associated with lower all-cause and noncardiovascular death.
- Published
- 2019
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