Dietary omega-3 fatty acid, ratio of omega-6 to omega-3 intake, inflammation, and survival in long-term hemodialysis patients

Nazanin Noori, Ramanath Dukkipati, Csaba P. Kovesdy, John J. Sim, Usama Feroze, Sameer B. Murali, Rachelle Bross, Debbie Benner, Joel D. Kopple, Kamyar Kalantar-Zadeh

Research output: Contribution to journalArticle

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Abstract

Background: Mortality in long-term hemodialysis patients is high, mostly attributed to cardiovascular events, and may be related to chronic inflammation. We hypothesized that the anti-inflammatory benefits of higher dietary intake of omega-3 compared with omega-6 polyunsaturated fatty acids may modulate the inflammatory processes and decrease death risk. Study Design: Prospective cohort study using linear and Cox proportional regressions. Setting & Participants: 145 hemodialysis patients from 8 DaVita dialysis clinics in Southern California in 2001-2007. Predictors: Intake of dietary omega-3 and ratio of omega-6 to omega-3 using 3-day food record supplemented by dietary interview. Outcomes: 1-year change in serum C-reactive protein (CRP) level and 6-year survival. Results: Patients were aged 53 ± 14 years (mean ± SD) and included 43% women and 42% African Americans. Median dietary omega-3 intake, ratio of omega-6 to omega-3 intake, baseline serum CRP level, and change in CRP level over 1 year were 1.1 (25th-75th percentile, 0.8-1.6) g/d, 9.3 (25th-75th percentile, 7.6-11.3), 3.1 (25th-75th percentile, 0.8-6.8) mg/L, and +0.2 (25th-75th percentile, -0.4 to +0.8) mg/L, respectively. In regression models adjusted for case-mix, dietary calorie and fat intake, body mass index, and history of hypertension, each 1-unit higher ratio of omega-6 to omega-3 intake was associated with a 0.55-mg/L increase in serum CRP level (P = 0.03). In the fully adjusted model, death HRs for the first (1.7-<7.6), second (7.6-<9.3), third (9.3-<11.3), and fourth (11.3-17.4) quartiles of dietary omega-6 to omega-3 ratio were 0.39 (95% CI, 0.14-1.18), 0.30 (95% CI, 0.09-0.99), 0.67 (95% CI, 0.25-1.79), and 1.00 (reference), respectively (P for trend = 0.06). Limitations: 3-day food record may underestimate actual dietary fat intake at an individual level. Conclusions: Higher dietary omega-6 to omega-3 ratio appears to be associated with both worsening inflammation over time and a trend toward higher death risk in hemodialysis patients. Additional studies including interventional trials are needed to examine the association of dietary fatty acids with clinical outcomes in these patients.

Original languageEnglish (US)
Pages (from-to)248-256
Number of pages9
JournalAmerican Journal of Kidney Diseases
Volume58
Issue number2
DOIs
StatePublished - Aug 1 2011

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Omega-3 Fatty Acids
Renal Dialysis
C-Reactive Protein
Inflammation
Survival
Blood Proteins
Dietary Fats
Omega-6 Fatty Acids
Fortified Food
Diet Records
Diagnosis-Related Groups
Unsaturated Fatty Acids
African Americans
Dialysis
Body Mass Index
Cohort Studies
Anti-Inflammatory Agents
Fatty Acids
Prospective Studies
Interviews

All Science Journal Classification (ASJC) codes

  • Nephrology

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Dietary omega-3 fatty acid, ratio of omega-6 to omega-3 intake, inflammation, and survival in long-term hemodialysis patients. / Noori, Nazanin; Dukkipati, Ramanath; Kovesdy, Csaba P.; Sim, John J.; Feroze, Usama; Murali, Sameer B.; Bross, Rachelle; Benner, Debbie; Kopple, Joel D.; Kalantar-Zadeh, Kamyar.

In: American Journal of Kidney Diseases, Vol. 58, No. 2, 01.08.2011, p. 248-256.

Research output: Contribution to journalArticle

Noori, N, Dukkipati, R, Kovesdy, CP, Sim, JJ, Feroze, U, Murali, SB, Bross, R, Benner, D, Kopple, JD & Kalantar-Zadeh, K 2011, 'Dietary omega-3 fatty acid, ratio of omega-6 to omega-3 intake, inflammation, and survival in long-term hemodialysis patients', American Journal of Kidney Diseases, vol. 58, no. 2, pp. 248-256. https://doi.org/10.1053/j.ajkd.2011.03.017
Noori, Nazanin ; Dukkipati, Ramanath ; Kovesdy, Csaba P. ; Sim, John J. ; Feroze, Usama ; Murali, Sameer B. ; Bross, Rachelle ; Benner, Debbie ; Kopple, Joel D. ; Kalantar-Zadeh, Kamyar. / Dietary omega-3 fatty acid, ratio of omega-6 to omega-3 intake, inflammation, and survival in long-term hemodialysis patients. In: American Journal of Kidney Diseases. 2011 ; Vol. 58, No. 2. pp. 248-256.
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T1 - Dietary omega-3 fatty acid, ratio of omega-6 to omega-3 intake, inflammation, and survival in long-term hemodialysis patients

AU - Noori, Nazanin

AU - Dukkipati, Ramanath

AU - Kovesdy, Csaba P.

AU - Sim, John J.

AU - Feroze, Usama

AU - Murali, Sameer B.

AU - Bross, Rachelle

AU - Benner, Debbie

AU - Kopple, Joel D.

AU - Kalantar-Zadeh, Kamyar

PY - 2011/8/1

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N2 - Background: Mortality in long-term hemodialysis patients is high, mostly attributed to cardiovascular events, and may be related to chronic inflammation. We hypothesized that the anti-inflammatory benefits of higher dietary intake of omega-3 compared with omega-6 polyunsaturated fatty acids may modulate the inflammatory processes and decrease death risk. Study Design: Prospective cohort study using linear and Cox proportional regressions. Setting & Participants: 145 hemodialysis patients from 8 DaVita dialysis clinics in Southern California in 2001-2007. Predictors: Intake of dietary omega-3 and ratio of omega-6 to omega-3 using 3-day food record supplemented by dietary interview. Outcomes: 1-year change in serum C-reactive protein (CRP) level and 6-year survival. Results: Patients were aged 53 ± 14 years (mean ± SD) and included 43% women and 42% African Americans. Median dietary omega-3 intake, ratio of omega-6 to omega-3 intake, baseline serum CRP level, and change in CRP level over 1 year were 1.1 (25th-75th percentile, 0.8-1.6) g/d, 9.3 (25th-75th percentile, 7.6-11.3), 3.1 (25th-75th percentile, 0.8-6.8) mg/L, and +0.2 (25th-75th percentile, -0.4 to +0.8) mg/L, respectively. In regression models adjusted for case-mix, dietary calorie and fat intake, body mass index, and history of hypertension, each 1-unit higher ratio of omega-6 to omega-3 intake was associated with a 0.55-mg/L increase in serum CRP level (P = 0.03). In the fully adjusted model, death HRs for the first (1.7-<7.6), second (7.6-<9.3), third (9.3-<11.3), and fourth (11.3-17.4) quartiles of dietary omega-6 to omega-3 ratio were 0.39 (95% CI, 0.14-1.18), 0.30 (95% CI, 0.09-0.99), 0.67 (95% CI, 0.25-1.79), and 1.00 (reference), respectively (P for trend = 0.06). Limitations: 3-day food record may underestimate actual dietary fat intake at an individual level. Conclusions: Higher dietary omega-6 to omega-3 ratio appears to be associated with both worsening inflammation over time and a trend toward higher death risk in hemodialysis patients. Additional studies including interventional trials are needed to examine the association of dietary fatty acids with clinical outcomes in these patients.

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