Fruit and Vegetable Intake and Mortality in Adults undergoing Maintenance Hemodialysis.
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.
['Saglimbene|Valeria M|VM|', 'Wong|Germaine|G|', 'Ruospo|Marinella|M|', 'Palmer|Suetonia C|SC|', 'Garcia-Larsen|Vanessa|V|', 'Natale|Patrizia|P|', 'Teixeira-Pinto|Armando|A|', 'Campbell|Katrina L|KL|', 'Carrero|Juan-Jesus|JJ|', 'Stenvinkel|Peter|P|', 'Gargano|Letizia|L|', 'Murgo|Angelo M|AM|', 'Johnson|David W|DW|', 'Tonelli|Marcello|M|', 'Gelfman|Rubén|R|', 'Celia|Eduardo|E|', 'Ecder|Tevfik|T|', 'Bernat|Amparo G|AG|', 'Del Castillo|Domingo|D|', 'Timofte|Delia|D|', 'Török|Marietta|M|', 'Bednarek-Skublewska|Anna|A|', 'Duława|Jan|J|', 'Stroumza|Paul|P|', 'Hoischen|Susanne|S|', 'Hansis|Martin|M|', 'Fabricius|Elisabeth|E|', 'Felaco|Paolo|P|', 'Wollheim|Charlotta|C|', 'Hegbrant|Jörgen|J|', 'Craig|Jonathan C|JC|', 'Strippoli|Giovanni F M|GFM|']
D000368:Aged D002318:Cardiovascular Diseases D015331:Cohort Studies D004032:Diet D004034:Diet Surveys D005260:Female D005638:Fruit D006801:Humans D007676:Kidney Failure, Chronic D008297:Male D008875:Middle Aged D009026:Mortality D006435:Renal Dialysis D014675:Vegetables
Fruit Vegetables mortality hemodialysis Risk Hyperkalemia Asthma Cardiovascular Diseases Diet ESRD Epidemiology and outcomes Hypersensitivity Proportional Hazards Models Surveys and Questionnaires clinical epidemiology clinical nephrology mortality risk nutrition renal dialysis risk factors survival