Examining natural and added phosphorus intake in dialysis patients

检查透析患者的天然磷和添加磷摄入量

• 批准号: 9332637
• 负责人: Amanda Regina Tortorici
• 金额: $ 3.86万
• 依托单位: UNIVERSITY OF CALIFORNIA-IRVINE
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-04-03 至 2020-04-02
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9332637
• 关键词: Address; Adherence; Adult; African American; Animals; Assessment tool; Bread; Cereals; Cheese; Counseling; Data; Dialysis patients; Diet; Diet Records; Dietary Assessment; Dietary Phosphorus; Dietary intake; Dietitian; Disease; Doctor of Philosophy; Domestic Fowls; Eating; End stage renal failure; Ethnic Origin; Ethnic group; Fabaceae; Fishes; Food; Food Analysis; Food Preferences; Frequencies; Gastrointestinal tract structure; General Population; Genus Cola; Health; Health Personnel; Health Professional; Hemodialysis; Hispanics; Human; Intake; Interview; Kidney; Kidney Diseases; Light; Maintenance; Measures; Meat; Mediating; Methods; Mexican Americans; Not Hispanic or Latino; Nutrition Therapy; Outcome; Patient Self-Report; Patients; Phosphorus; Plants; Play; Process; Prospective cohort; Proteins; Public Health; Quality of life; Questionnaires; Race; Recommendation; Recommended Daily Allowances; Research Personnel; Risk; Role; Seafood; Serum; Serum Phosphorus Level; Source; Students; Subgroup; base; beef; dietary restriction; gastrointestinal system; improved; instrument; mortality; nutrition; nutrition education; patient oriented; phytate; prevent; racial and ethnic; tool

PROJECT SUMMARY End-stage renal disease (ESRD) patients treated with maintenance hemodialysis (HD) are encouraged to follow several dietary recommendations related to dietary phosphorus (P) intake in light of the evidence that hyperphosphatemia is associated with increased mortality in these patients. ESRD patients are advised to have a maximum of 800 to 1000 mg of dietary P per day, but these recommendations do not distinguish between different types of dietary P. There are two types of P in food: (1) natural or organic P that is bound to proteins and found in foods that are high in protein, and (2) added or inorganic P that does not naturally occur but is added as a preservative in processed foods such as colas, deli meats, cereals, and processed cheeses. The added inorganic P is more readily absorbed through the digestive system and may have a greater influence on hyperphosphatemia in ESRD patients than an equal amount of organic P. Ethnic and cultural influences often mediate dietary food choices. Compared to Whites, African Americans may have greater intake of high protein foods and may be more likely to eat processed food with added inorganic P. The differences in dietary P intake across racial/ethnic groups of HD patients are not well studied. Renal dietitians play an integral role in the management of dietary P intake in HD patients. We dietitians are responsible for communicating nutrition therapy recommendations while also being sensitive to patients' personal and cultural food preferences and explore the underlying factors related to adherence to a low-P-diet. Different assessment tools may result in major differences in estimating P and its subtypes, and race may have a role in these differences and their impact on occurrence of hyperphosphatemia. The paucity of reliable patient-centered assessment of dietary intake of P through identification of key foods and analysis of actual food intake among different racial/ethnic groups in HD patients is a major gap in our understanding. As a Black renal dietitian and PhD student, I am committed to studying these important questions. I plan to examine the hypothesis that different dietary P assessment methods yield different estimates and that dietary P intake of HD patients is different across race/ethnicity. To do so, I will assess dietary P intake and sources of dietary P by a food frequency questionnaire in 450 HD patients and through a 3-day diet record with interview in a randomly selected subgroup of 120 patients. I will also examine the hypothesis that estimated P intake by diet record is more strongly associated with hyperphosphatemia than estimates from FFQ, and that African American HD patients by virtue of eating more processed food with higher added inorganic P have higher likelihood of hyperphosphatemia. My proposed 3-year study will enable me to address an important gap, and my project also has the potential to inform kidney disease nutrition education materials, which would allow us to provide more efficient and culturally sensitive nutrition counseling to kidney disease patients in order to improve their adherence to P intake recommendations. I plan to use this valuable data for my doctoral dissertation.

项目摘要 鼓励接受维持性血液透析（HD）治疗的终末期肾病（ESRD）患者 根据以下证据，遵循与膳食磷（P）摄入量相关的几项膳食建议： 高磷酸盐血症与这些患者的死亡率增加有关。建议ESRD患者 每天最多摄入800至1000毫克的膳食磷，但这些建议并不区分 食物中有两种类型的磷：（1）天然或有机磷，它与食物中的磷结合， 蛋白质和在高蛋白质食物中发现的蛋白质，以及（2）添加的或无机的磷，而不是天然存在的 但在加工食品如可乐、熟食、谷类和加工奶酪中作为防腐剂添加。 添加的无机磷更容易通过消化系统吸收， 对ESRD患者高磷血症的影响大于等量的有机磷。 影响往往介导饮食食物的选择。与白人相比，非洲裔美国人可能有更大的 摄入高蛋白食物，可能更有可能吃添加无机磷的加工食品。 在HD患者的种族/民族群体中，膳食磷摄入量的差异还没有得到很好的研究。肾脏营养师 在HD患者的膳食磷摄入管理中发挥不可或缺的作用。我们营养师负责 沟通营养治疗建议，同时对患者的个人和文化敏感 食物偏好，并探索与坚持低磷饮食相关的潜在因素。不同的评估 工具可能导致P及其亚型的估计存在重大差异，种族可能在其中发挥作用。 差异及其对高磷血症发生的影响。缺乏可靠的以病人为中心的 通过确定关键食物和分析实际食物摄入量， 不同种族/民族的HD患者是我们理解的一个主要差距。作为一名黑人肾脏营养师， 博士生，我致力于研究这些重要的问题。我打算验证一个假设 不同的膳食磷评估方法产生不同的估计，HD患者的膳食磷摄入量是 不同种族/民族之间的差异。为此，我将评估膳食磷摄入量和膳食磷的来源， 对450例HD患者进行频率问卷调查，并通过3天饮食记录和随机访谈， 选择120例患者的亚组。我还将检验通过饮食记录估计磷摄入量的假设， 与FFQ的估计相比，与高磷酸盐血症的相关性更强， 患者由于多吃无机磷添加量较高的加工食品， 高磷血症我提出的3年学习将使我能够解决一个重要的差距，我的项目 也有可能为肾病营养教育材料提供信息，这将使我们能够提供 为肾病患者提供更有效和文化敏感的营养咨询，以改善他们的健康状况。 遵循P摄入建议。我计划在我的博士论文中使用这些有价值的数据。