V SAGLIMBENE1,2, G WONG1, M RUOSPO2, S PALMER3, P NATALE2,6, V GARCIA-LARSEN4, K CAMPBELL5, A TEIXEIRA-PINTO1, J-J CARRERO7, P STENVINKEL7, L GARGANO2, A MURGO2, D JOHNSON8, M TONELLI9, R GELFMAN2, E CELIA2, T ECDER2, A BERNAT2, D CASTILLO2, D TIMOFTE2, M TÖRÖK2, A BEDNAREK-SKUBLEWSKA2, J DUŁAWA2, P STROUMZA2, S HOISCHEN2, M HANSIS2, E FABRICIUS2, P FELACO10, C WOLLHEIM2, J HEGBRANT2, J CRAIG1,11, G STRIPPOLI1,2,6
1University Of Sydney, Sydney, Australia, 2Diaverum Medical-Scientific Office, Lund, Sweden, 3University of Otago Christchurch, Christchurch, New Zealand, 4Johns Hopkins Bloomberg School of Public Health, Baltimore, US, 5Princess Alexandra Hospital, Woolloongabba, Australia, 6University of Bari, Bari, Italy, 7Karolinska Institutet, Stockholm, Sweden, 8University of Queensland at the Princess Alexandra Hospital, Woolloongabba, Australia, 9University of Calgary, Calgary, Canada, 10Presidio Ospedalierio Penne, Pescara, Italty, 11Flinders University, Adelaide, Australia
Aim: To evaluate the association of fruits and vegetables intake with mortality in adults on haemodialysis.
Background: Higher fruits and vegetables intake is associated with lower cardiovascular and all-cause mortality in the general population. It is unclear whether this association occurs in haemodialysis patients, in whom high fruits and vegetables intake is generally discouraged due to a potential risk of hyperkalaemia.
Methods: Fruits and vegetables intake was ascertained by the GA2LEN food frequency questionnaire within the DIET-HD study, a multinational cohort study of 9757 adults on haemodialysis. Adjusted Cox regression analyses clustered by country were conducted to evaluate the association between tertiles of fruits and vegetables intake with all-cause, cardiovascular, and non-cardiovascular mortality. Estimates were calculated as hazard ratio (HR) with 95% confidence interval (CI).
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 fruits and vegetables was 8 (4-14) per week; only 4% of the study population consumed at least 4 servings/ day as recommended in the general population. Compared with the lowest tertile of servings/ week (0 to 5.5, median 2), the adjusted HR (95% CI) for the middle (5.6 to 10, median 8) and highest (>10, median 17) tertiles were 0.90 (0.81-1.00) and 0.80 (0.71-0.91) for all-cause mortality; 0.88 (0.76-1.02) and 0.77 (0.66-0.91) for non-cardiovascular mortality; and 0.95 (0.81-1.11) and 0.84 (0.70-1.00) for cardiovascular mortality.
Conclusions: Fruits and vegetables intake in the haemodialysis population is substantially lower than recommended in the general population; an higher consumption (approximately 17 servings per week, 2 to 3 per day) is associated with lower risk of all-cause and non-cardiovascular mortality.
Valeria Saglimbene has a Bachelor of Pharmaceutical Chemistry (Honours) from the University of Palermo (Italy) and a Master of Clinical Epidemiology at the University of Sydney. In 2008 she joined the Mario Negri Sud Consorzium (Italy) as Research Assistant at the Department of Pharmacology and Epidemiology, working on RCTs, cohort studies and systematic reviews in CKD. In 2016 she started a PhD at the University of Sydney focused on understanding novel determinants of health outcomes in CKD. As part of her PhD, she conducted a cohort study of 10,000 haemodialysis patients to investigate the association between nutrition and mortality