NUTRITION INTAKE AND COMPLIANCE WITH DIETARY GUIDELINES AMONG ISRAELI HEMODIALYSIS PATIENTS, COMPARED BY ETHNICITY

 

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NUTRITION INTAKE AND COMPLIANCE WITH DIETARY GUIDELINES AMONG ISRAELI HEMODIALYSIS PATIENTS, COMPARED BY ETHNICITY

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Mona
Boaz
Mona Boaz monabo@ariel.ac.il Ariel University Nutrition Sciences Ariel Israel *
Najib Abid nagiba@ariel.ac.il Ariel University Nutrition Sciences Ariel Israel -
Younes Bathish younes.b@ziv.gov.il Bar Ilan University Azrieli Faculty of Medicine Safed Israel -
Talia Weinstein tweinste@tauex.tau.ac.il Tel Aviv University Sackler Faculty of Medicine Tel Aviv Israel -
Etty Kruzel-Davilla ETTYK@gmc.gov.il Bar Ilan University Azrieli Faculty of Medicine Safed Israel -
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Elevated malnutrition risk is frequently observed in individuals with chronic kidney disease (CKD) receiving hemodialysis (HD) as their renal replacement therapy. In a recent survey, elevated malnutrition risk was detected in 46% of HD patients in Israel. This survey identified by-ethnicity differences in the distribution of malnutrition risk, but this was not the question for which the survey was designed. The present study was designed to compare dietary intake and compliance with International Society for Renal Nutrition and Metabolism (ISRNM) nutrition guidelines for HD patients by ethnicity.

Included were all HD patients treated at the Western Galilee Medical Center (WGMC) in Nahariya, and The Ziv Medical Center in Tzfat, Israel who provided signed informed consent between January 1 and May 31, 2023. Each participant underwent a 24-hour diet recall interview in his or her preferred language. Nutrition intake was analyzed using NutRatio software. Medical and demographic data were extracted from patient electronic medical records. All data were analyzed on SPSS v. 29. Linear and logistic regression analyses were used to model outcomes (energy intake per kg/ideal body weight and compliance with ISRNM dietary guidelines).

A total of 133 HD patients participated in the present study: 35 Druze, 32 Arabs and 66 Jews. Druze and Arabs were grouped together as “Arabic-speaking Minority” (ASM), and ASM members were compared to Jews. Significant differences between ASM and Jewish patients were detected in nutrient intake, presented as median (interquartile range): Compared to Jewish participants, ASM patients consumed more niacin: 16.2 (13.5) vs. 27.4 (29.4) mg, p<0.001; more sodium: 2938.4 (2401.2) vs. 4903.3 (4078.8) mg, p<0.001; and more iron: 6.8 (5.5) vs.9.2 (6.9) mg, p=0.03; but less protein as a percentage of total kcal: 15.9 (7.6) % vs. 18.7 (7.6 )%, p<0.001). Compliance with ISRNM guidelines for kcal intake per kg body weight was 13.3 (4.0) % vs. 30.8 (10.0) % among Jewish vs. ASM patients respectively, p=0.02. More Jewish than ASM patients regularly consumed their meals alone: 20.6% vs. 3.1%, p=0.002.  In a linear regression model of energy intake per kilogram ideal body weight, ethnicity emerged as the only significant predictor, indicating that ASM was associated with better energy intake/kg. Jewish ethnicity, on the other hand, reduced the odds of compliance with ISRNM dietary energy guidelines by 54%, and eating alone increased odds of elevated malnutrition risk. In a secondary analysis of only ASM participants comparing Druze and Arab patients, significant differences in nutrition intake were not identified.

with ISRNM nutrition guidelines was poor across all ethnic groups. Ethnicity was a significant predictor of energy intake. Differences in nutrition status and malnutrition risk by ethnicity suggest that specific interventions tailored to ethnicity might improve malnutrition risk in HD patients in Israel.

Kewords