Elsevier

Nutrition Research

Volume 93, September 2021, Pages 99-110
Nutrition Research

Greater adherence to the dietary approaches to stop hypertension dietary pattern is associated with preserved muscle strength in patients with autosomal dominant polycystic kidney disease: a single-center cross-sectional study

https://doi.org/10.1016/j.nutres.2021.07.006Get rights and content

Abstract

The present study aimed to determine whether certain diets lower the risk of low muscle strength in patients with autosomal dominant polycystic kidney disease (ADPKD). In this cross-sectional study, outpatient ADPKD patients were enrolled from a tertiary care hospital. Muscle strength was assessed on the basis of handgrip strength (HGS), and dietary pattern indices were calculated using dietary intake data. Among the 68 participants included in this study, 19 (27.9%) had low HGS. Cystatin C concentrations were significantly higher in all participants, and in women in the low compared to the normal HGS group in the unadjusted analyses (P = 0.004). Among analyzed dietary pattern indices, the Dietary Approaches to Stop Hypertension (DASH) score was lower, for all participants and men, in the low compared to the normal HGS group (P < 0.05). Especially, the component score for whole grains of the DASH score was significantly lower in men in the low compared to the normal HGS group in unadjusted analyses. The DASH score was positively correlated with HGS in men (r = 0.387, P = 0.046). In addition, logistic regression analysis showed that the DASH score was negatively associated with low HGS, for all participants (odds ratio = 0.851, P = 0.049) and men (odds ratio = 0.716, P = 0.043), after adjusting for age, sex, and body weight. These findings suggest that the DASH dietary pattern may promote the preservation of muscle strength in ADPKD patients. The DASH diet can be considered as a nutritional strategy to maintain muscle strength and prevent sarcopenia in ADPKD patients.

Introduction

Autosomal dominant polycystic kidney disease (ADPKD) is a common inherited kidney disease typically caused by mutations in the polycystin-1 and -2 genes [1]. ADPKD is characterized by the presence of large cysts in the kidney and/or liver, which may cause organomegaly, ischemia, or organ dysfunction [1]. ADPKD is the fourth leading cause of end-stage renal disease (ESRD), and the most common genetic cause of that disease [2].

Protein-energy wasting (PEW) and malnutrition are common in advanced chronic kidney disease (CKD) [3]. The protein and energy intake are significantly below the body's requirements in patients with PEW, and PEW may result from reduced protein and energy intake, hypercatabolism, decreased anabolism, and increased levels of uremic toxins and inflammation [4]. Muscle wasting, due to increased muscle protein catabolism, contributes to the reduced muscle strength and performance observed in PEW patients [4,5]. Sarcopenia was previously defined as a state of low muscle mass, strength, or performance by the European Working Group on Sarcopenia in Older People (EWGSOP) 1 [6]. The EWGSOP 2 subsequently modified the definition of sarcopenia to low muscle strength, quantity, or quality [7]. Sarcopenia is correlated with reduced kidney function [8,9], and the prevalence of sarcopenia is relatively high in CKD patients [10], [11], [12], [13]. CKD patients with PEW have a higher risk of sarcopenia [14], which in turn increases the risk of progression to ESRD and mortality [15]. Therefore, prevention or improvement of sarcopenia through dietary modifications may reduce the risk of CKD progression and mortality.

In patients with CKD, especially those with advanced disease and ADPKD, a low-protein diet and close monitoring of the levels of minerals (potassium, sodium, phosphorus, and calcium) are recommended [16], [17], [18]. However, strict protein restriction can increase the risk of sarcopenia. Increased rates of protein catabolism and protein loss in uremic conditions also increase the likelihood of reduced muscle mass and strength [19]. In addition to the characteristics of CKD, increased kidney and liver volumes are risk factors for malnutrition in ADPKD patients [20], leading to further reductions in muscle mass and strength. In a previous study of ADPKD patients, 30% were either malnourished or at increased risk of malnutrition [20]. Malnutrition should be treated to delay ADPKD progression and prevent moderate-to-severe PEW or sarcopenia. Therefore, regular nutritional assessments and timely interventions are recommended for ADPKD patients.

There are few studies on dietary interventions for ADPKD patients, although a recent review summarized the data on the effects of dietary interventions on ADPKD progression [18]. The review also summarized the current recommendations regarding food components (including protein, water, sodium, and phosphate) for ADPKD, and newly introduced dietary strategies with limited evidence (such as ketogenic diet, time-restricted feeding, and certain dietary patterns) [18]. Recently, the effects of various dietary patterns on health and disease have been studied [21,22]. Because protein intake is difficult to increase in CKD and ADPKD patients, adopting dietary patterns may be useful to prevent PEW and improve outcomes. In particular, Dietary Approaches to Stop Hypertension (DASH), Mediterranean (MED), and anti-inflammatory diets have been reported to be beneficial for CKD patients [23], [24], [25], [26], [27], [28], although evidence of their efficacy for sarcopenia is limited. Given the importance of nutrition in ADPKD patients, and limited evidence of the effects of diet and nutritional status on sarcopenia, the relationship between dietary patterns and sarcopenia in ADPKD patients needs to be investigated.

In this study, we hypothesized that certain dietary patterns would lower the risk for low muscle strength in ADPKD patients. To test this hypothesis, we analyzed the dietary intakes and nutritional status of ADPKD patients, and investigated whether dietary patterns were associated with reduced muscle strength. We also identified food groups associated with reduced muscle strength. The current findings could aid the development of dietary guidelines for ADPKD patients.

Section snippets

Study population and design

Study participants were enrolled between January, 2019 and January, 2020 from the ADPKD clinic at Seoul National University Hospital, Seoul, Republic of Korea. Pre-dialysis ADPKD patients aged ≥ 18 years were included in this study if they provided written informed consent. Participants with unreliable responses to a semi-quantitative food frequency questionnaire (SQ-FFQ) or implausible energy intake (< 500 kcal or > 4,000 kcal) were excluded. We included 68 (27 men and 41 women) of the 72

General characteristics of study participants according to the presence of low HGS

Table 2 summarizes the general characteristics of the study population. Of the 68 participants, 19 had low HGS (men, n = 6; women, n = 13). Body weights were lower in the low HGS groups in all patients (P = 0.006) and women (P = 0.007). However, the BMI and SGA score were not different between the groups. The proportions of patients reporting hypertension or diabetes, body weight changes over the past 6 months, physical activity, and the use of dietary supplements were not statistically

Discussion

The current study investigated the association between dietary patterns and muscle strength in ADPKD patients. More than a quarter of the ADPKD patients had low muscle strength, and the DASH diet was negatively associated with low muscle strength. These findings suggest that the DASH diet may reduce the risk of low muscle strength in ADPKD patients.

In CKD patients, sarcopenia is not an inevitable consequence of aging. Disease-induced protein catabolism, dialysis, and a low-protein diet (< 0.8

Author contributions

The authors’ responsibilities were as follows – Hyunjin Ryu: Conceptualization and study design, Formal analysis and investigation, Writing – original draft, Approval of the final version. Yun Jung Yang: Formal analysis and investigation, Writing – original draft, Approval of the final version. Eunjeong Kang: Writing – review and editing, Approval of the final version. Curie Ahn: Writing – review and editing, Approval of the final version. Soo Jin Yang: Conceptualization and study design,

Author declarations

The authors declare that they have no competing interests.

Sources of support

This research was supported by research grants from the Bio & Medical Technology Development Program of the National Research Foundation (NRF) by the Ministry of Science, ICT & Future Planning (2017M3A9E4044649) (K.H. Oh) and Seoul Women's University (2021-0135) (S.J. Yang). The funder had no role in study design, data collection, analysis and interpretation, decision to publish, or manuscript preparation.

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    Abbreviations: ADPKD, autosomal dominant polycystic kidney disease; aMED, alternate Mediterranean diet; BMI, body mass index; CKD, chronic kidney disease; CKD-EPI, Chronic Kidney Disease Epidemiology Collaboration; DASH, Dietary Approaches to Stop Hypertension; DII, dietary inflammatory index; eGFR, estimated glomerular filtration rate; ESRD, end-stage renal disease; EWGSOP, European Working Group on Sarcopenia in Older People; HGS, handgrip strength; MAC, mid-arm circumference; PEW, protein-energy wasting; SGA, subjective global assessment; SMI, skeletal muscle mass index; SMM, skeletal muscle mass; SQ-FFQ, semi-quantitative food frequency questionnaire.

    These authors contributed equally to the writing of this article.

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