Examining natural and added phosphorus intake in dialysis patients

项目总结 鼓励接受维持性血液透析(HD)治疗的终末期肾病患者 根据以下证据，遵循与膳食磷(P)摄入量有关的几项饮食建议 在这些患者中，高磷血症与死亡率增加有关。建议终末期肾病患者 每天最多摄入800至1000毫克的膳食磷，但这些建议没有区分 在不同类型的饮食磷之间，食物中有两种类型的磷：(1)天然或有机磷 蛋白质和高蛋白食物中发现的磷，以及(2)添加的或非自然存在的无机磷 但作为防腐剂添加到加工食品中，如可乐、熟食肉、谷类食品和加工奶酪。 添加的无机磷更容易通过消化系统吸收，并可能具有更大的 等量有机磷、民族和文化对终末期肾病患者高磷血症的影响 影响往往会影响饮食食物的选择。与白人相比，非裔美国人可能拥有更多 摄入高蛋白食物，可能更倾向于食用添加了无机磷的加工食品。 不同种族/民族的HD患者饮食磷摄入量的差异没有得到很好的研究。肾脏营养师 在HD患者膳食磷摄入量的管理中发挥不可或缺的作用。我们营养师要对 传达营养治疗建议，同时对患者的个人和文化敏感 并探索与坚持低磷饮食有关的潜在因素。不同的评估 工具可能导致在估计磷及其亚型方面的重大差异，种族可能在其中起到作用 差异及其对高磷血症发生的影响。缺乏以患者为中心的可靠服务 通过确定关键食物和分析人群的实际食物摄入量来评估P的膳食摄入量 不同种族/民族的HD患者是我们认识上的一大差距。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。我计划检验这一假设 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/民族的不同。为此，我将评估饮食中磷的摄入量和食物中磷的来源 450例维持性血液透析患者频度问卷调查及通过3天饮食记录随机访谈 入选亚组120例。我还将检验这样一个假设，即根据饮食记录估计的磷摄入量是 与高磷血症的相关性比FFQ估计的更高，非裔美国人HD 患者因食用更多添加了更多无机磷的加工食品而患上糖尿病的可能性更高 高磷血症。我提议的为期3年的学习将使我能够解决一个重要的差距，我的项目 也有可能为肾脏疾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更具文化敏感性的营养咨询，以改善他们的 坚持磷的摄入量建议。我计划在我的博士论文中使用这些有价值的数据。

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.