Dietary n-3 polyunsaturated fatty acid intake and all-cause and cardiovascular mortality in adults on hemodialysis: The DIET-HD multinational cohort study

Valeria M Saglimbene; Germaine Wong; Marinella Ruospo; Suetonia C Palmer; Katrina Campbell; Vanessa Garcia Larsen; Patrizia Natale; Armando Teixeira-Pinto; Juan-Jesus Carrero; Peter Stenvinkel; Letizia Gargano; Angelo M Murgo; David W Johnson; Marcello Tonelli; Rubén Gelfman; Eduardo Celia; Tevfik Ecder; Amparo G Bernat; Domingo Del Castillo; Delia Timofte; Marietta Török; Anna Bednarek-Skublewska; Jan Duława; Paul Stroumza; Susanne Hoischen; Martin Hansis; Elisabeth Fabricius; Charlotta Wollheim; Jörgen Hegbrant; Jonathan C Craig; Giovanni F M Strippoli

doi:10.1016/j.clnu.2017.11.020

Dietary n-3 polyunsaturated fatty acid intake and all-cause and cardiovascular mortality in adults on hemodialysis: The DIET-HD multinational cohort study

Clin Nutr. 2019 Feb;38(1):429-437. doi: 10.1016/j.clnu.2017.11.020. Epub 2017 Dec 6.

Authors

Valeria M Saglimbene¹, Germaine Wong², Marinella Ruospo³, Suetonia C Palmer⁴, Katrina Campbell⁵, Vanessa Garcia Larsen⁶, Patrizia Natale⁷, Armando Teixeira-Pinto⁸, Juan-Jesus Carrero⁹, Peter Stenvinkel¹⁰, Letizia Gargano¹¹, Angelo M Murgo¹², David W Johnson¹³, Marcello Tonelli¹⁴, Rubén Gelfman¹⁵, Eduardo Celia¹⁶, Tevfik Ecder¹⁷, Amparo G Bernat¹⁸, Domingo Del Castillo¹⁹, Delia Timofte²⁰, Marietta Török²¹, Anna Bednarek-Skublewska²², Jan Duława²³, Paul Stroumza²⁴, Susanne Hoischen²⁵, Martin Hansis²⁶, Elisabeth Fabricius²⁷, Charlotta Wollheim²⁸, Jörgen Hegbrant²⁹, Jonathan C Craig³⁰, Giovanni F M Strippoli³¹

Affiliations

¹ Sydney School of Public Health, The University of Sydney, Edward Ford Building A27, NSW 2006, Australia; Diaverum Medical-Scientific Office, Trollebergsvagen 2-4, 222 29 Lund, Sweden. Electronic address: [email protected].
² Sydney School of Public Health, The University of Sydney, Edward Ford Building A27, NSW 2006, Australia; Centre for Kidney Research, Children's Hospital at Westmead, 170 Hawkesbury Road, Westmead, NSW 2145, Australia; Department of Renal Medicine, Westmead Hospital, Hawkesbury Rd & Darcy Road, Westmead, NSW 2145, Australia. Electronic address: [email protected].
³ Diaverum Medical-Scientific Office, Trollebergsvagen 2-4, 222 29 Lund, Sweden; Division of Nephrology and Transplantation, Amedeo Avogadro University of Eastern Piedmont, Via Solaroli 17, 28100 Novara, Italy. Electronic address: [email protected].
⁴ Department of Medicine, University of Otago Christchurch, PO Box 4345, 8140, New Zealand. Electronic address: [email protected].
⁵ Department of Nutrition and Dietetics, University of Queensland at Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Brisbane, QLD 4102, Australia. Electronic address: [email protected].
⁶ Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA. Electronic address: [email protected].
⁷ Diaverum Medical-Scientific Office, Trollebergsvagen 2-4, 222 29 Lund, Sweden; Department of Emergency and Organ Transplantation, University of Bari, Piazza Giulio Cesare, 70124 Bari, Italy. Electronic address: [email protected].
⁸ Sydney School of Public Health, The University of Sydney, Edward Ford Building A27, NSW 2006, Australia. Electronic address: [email protected].
⁹ Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, SE-171 77 Stockholm, Sweden. Electronic address: [email protected].
¹⁰ Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, SE-171 77 Stockholm, Sweden. Electronic address: [email protected].
¹¹ Diaverum Medical-Scientific Office, Trollebergsvagen 2-4, 222 29 Lund, Sweden. Electronic address: [email protected].
¹² Diaverum Medical-Scientific Office, Trollebergsvagen 2-4, 222 29 Lund, Sweden. Electronic address: [email protected].
¹³ Department of Nephrology, Division of Medicine, University of Queensland at the Princess Alexandra Hospital, ARTS Building, Ipswich Road, Woolloongabba, Brisbane, QLD 4102, Australia; Translational Research Institute, University of Queensland, 37 Kent Street, Woolloongabba, QLD 4102, Australia. Electronic address: [email protected].
¹⁴ Cumming School of Medicine, Health Sciences Centre, University of Calgary, 2500 University Dr NW, Calgary AB T2N 1N4, Canada. Electronic address: [email protected].
¹⁵ Diaverum Medical-Scientific Office, Trollebergsvagen 2-4, 222 29 Lund, Sweden. Electronic address: [email protected].
¹⁶ Diaverum Medical-Scientific Office, Trollebergsvagen 2-4, 222 29 Lund, Sweden. Electronic address: [email protected].
¹⁷ Diaverum Medical-Scientific Office, Trollebergsvagen 2-4, 222 29 Lund, Sweden. Electronic address: [email protected].
¹⁸ Diaverum Medical-Scientific Office, Trollebergsvagen 2-4, 222 29 Lund, Sweden. Electronic address: [email protected].
¹⁹ Diaverum Medical-Scientific Office, Trollebergsvagen 2-4, 222 29 Lund, Sweden. Electronic address: [email protected].
²⁰ Diaverum Medical-Scientific Office, Trollebergsvagen 2-4, 222 29 Lund, Sweden. Electronic address: [email protected].
²¹ Diaverum Medical-Scientific Office, Trollebergsvagen 2-4, 222 29 Lund, Sweden. Electronic address: [email protected].
²² Diaverum Medical-Scientific Office, Trollebergsvagen 2-4, 222 29 Lund, Sweden; Medical University of Lublin, Aleje Racławickie 1, Lublin, Poland. Electronic address: [email protected].
²³ Diaverum Medical-Scientific Office, Trollebergsvagen 2-4, 222 29 Lund, Sweden; Medical University of Silesia, Medyków 18, Katowice, Poland. Electronic address: [email protected].
²⁴ Diaverum Medical-Scientific Office, Trollebergsvagen 2-4, 222 29 Lund, Sweden. Electronic address: [email protected].
²⁵ Diaverum Medical-Scientific Office, Trollebergsvagen 2-4, 222 29 Lund, Sweden. Electronic address: [email protected].
²⁶ Diaverum Medical-Scientific Office, Trollebergsvagen 2-4, 222 29 Lund, Sweden. Electronic address: [email protected].
²⁷ Diaverum Medical-Scientific Office, Trollebergsvagen 2-4, 222 29 Lund, Sweden. Electronic address: [email protected].
²⁸ Diaverum Medical-Scientific Office, Trollebergsvagen 2-4, 222 29 Lund, Sweden. Electronic address: [email protected].
²⁹ Diaverum Medical-Scientific Office, Trollebergsvagen 2-4, 222 29 Lund, Sweden. Electronic address: [email protected].
³⁰ Sydney School of Public Health, The University of Sydney, Edward Ford Building A27, NSW 2006, Australia; Centre for Kidney Research, Children's Hospital at Westmead, 170 Hawkesbury Road, Westmead, NSW 2145, Australia. Electronic address: [email protected].
³¹ Sydney School of Public Health, The University of Sydney, Edward Ford Building A27, NSW 2006, Australia; Diaverum Medical-Scientific Office, Trollebergsvagen 2-4, 222 29 Lund, Sweden; Department of Emergency and Organ Transplantation, University of Bari, Piazza Giulio Cesare, 70124 Bari, Italy; Diaverum Academy, Via Solarino 1, Bari 70124, Italy. Electronic address: [email protected].

PMID: 29248251
DOI: 10.1016/j.clnu.2017.11.020

Abstract

Background & aims: Patients on hemodialysis suffer from high risk of premature death, which is largely attributed to cardiovascular disease, but interventions targeting traditional cardiovascular risk factors have made little or no difference. Long chain n-3 polyunsaturated fatty acids (n-3 PUFA) are putative candidates to reduce cardiovascular disease. Diets rich in n-3 PUFA are recommended in the general population, although their role in the hemodialysis setting is uncertain. We evaluated the association between the dietary intake of n-3 PUFA and mortality for hemodialysis patients.

Methods: The DIET-HD study is a prospective cohort study (January 2014-June 2017) in 9757 adults treated with hemodialysis in Europe and South America. Dietary n-3 PUFA intake was measured at baseline using the GA²LEN Food Frequency Questionnaire. Adjusted Cox regression analyses clustered by country were conducted to evaluate the association of dietary n-3 PUFA intake with cardiovascular and all-cause mortality.

Results: During a median follow up of 2.7 years (18,666 person-years), 2087 deaths were recorded, including 829 attributable to cardiovascular causes. One third of the study participants consumed sufficient (at least 1.75 g/week) n-3 PUFA recommended for primary cardiovascular prevention, and less than 10% recommended for secondary prevention (7-14 g/week). Compared to patients with the lowest tertile of dietary n-3 PUFA intake (<0.37 g/week), the adjusted hazard ratios (95% confidence interval) for cardiovascular mortality for patients in the middle (0.37 to <1.8 g/week) and highest (≥1.8 g/week) tertiles of n-3 PUFA were 0.82 (0.69-0.98) and 1.03 (0.84-1.26), respectively. Corresponding adjusted hazard ratios for all-cause mortality were 0.96 (0.86-1.08) and 1.00 (0.88-1.13), respectively.

Conclusions: Dietary n-3 PUFA intake was not associated with cardiovascular or all-cause mortality in patients on hemodialysis. As dietary n-3 PUFA intake was low, the possibility that n-3 PUFA supplementation might mitigate cardiovascular risk has not been excluded.

Keywords: End stage renal disease; Fish oil; Hemodialysis; Mortality; Omega 3; n-3 PUFA.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cardiovascular Diseases / epidemiology*
Cohort Studies
Diet / methods*
Europe / epidemiology
Fatty Acids, Omega-3 / administration & dosage*
Female
Humans
Male
Middle Aged
Prospective Studies
Renal Dialysis / mortality*
South America / epidemiology

Substances

Fatty Acids, Omega-3