Valeria M Saglimbene1,2, Germaine Wong3,4,5, Marinella Ruospo2, Suetonia C Palmer6, Vanessa Garcia-Larsen7, Patrizia Natale2,8, Armando Teixeira-Pinto3,4, Katrina L Campbell9, Juan-Jesus Carrero10, Peter Stenvinkel11, Letizia Gargano2, Angelo M Murgo2, David W Johnson12,13, Marcello Tonelli14, Rubén Gelfman2, Eduardo Celia2, Tevfik Ecder2, Amparo G Bernat2, Domingo Del Castillo2, Delia Timofte2, Marietta Török2, Anna Bednarek-Skublewska2,15, Jan Duława2,16, Paul Stroumza2, Susanne Hoischen2, Martin Hansis2, Elisabeth Fabricius2, Paolo Felaco17, Charlotta Wollheim2, Jörgen Hegbrant2, Jonathan C Craig18, Giovanni F M Strippoli3,2,8,19. 1. Faculty of Medicine and Health, Sydney School of Public Health, University of Sydney, Sydney, Australia; vsag1982@gmail.com. 2. Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden. 3. Faculty of Medicine and Health, Sydney School of Public Health, University of Sydney, Sydney, Australia. 4. Centre for Kidney Research, Children's Hospital at Westmead, Westmead, Australia. 5. Department of Renal Medicine, Westmead Hospital, Westmead, Australia. 6. Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand. 7. Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. 8. Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy. 9. Department of Nutrition and Dietetics and. 10. Department of Medical Epidemiology and Biostatistics and. 11. Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden. 12. Division of Medicine, Department of Nephrology, University of Queensland at the Princess Alexandra Hospital, Woolloongabba, Australia. 13. Translational Research Institute, University of Queensland, Woolloongabba, Australia. 14. Health Sciences Centre, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. 15. Medical University of Lublin, Lublin, Poland. 16. Department of Internal Medicine and Metabolic Diseases, Medical University of Silesia, Katowice, Poland. 17. Nephrology and Dialysis Unit, Hospital of the Penne Presidium, Unita' Sanitaria Locale, Pescara, Italy. 18. College of Medicine and Public Health, Flinders University, Adelaide, Australia; and. 19. Diaverum Academy, Diaverum, Bari, Italy.
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.
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.
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