Foods with added fiber improve stool frequency in individuals with chronic kidney disease with no impact on appetite or overall quality of life

BMC Research Notes

Wendy J Dahl¹  Gordon A Zello²  Younis A Salmean¹ 

[1] Food Science and Human Nutrition, University of Florida, 359 FSHN Building Newell Drive, Gainesville, FL 32611, USA;College of Pharmacy and Nutrition, University of Saskatchewan, 110 Science Place, Saskatoon SK S7N 5C9, Canada

关键词: ESS;    SNAQ;    GSRS;    Appetite;    Gastrointestinal function;    Quality of life;    Fiber;    Chronic kidney disease;   

Others  :  1140593
DOI  :  10.1186/1756-0500-6-510

 received in 2013-03-18, accepted in 2013-11-29,  发布年份 2013

【 摘 要 】

Background

Fiber intake may be low in individuals with chronic kidney disease (CKD) due to diet restriction and/or poor appetite associated with uremic symptoms, contributing to constipation and reduced quality of life. This report describes the effects of foods with added fiber on gastrointestinal function and symptoms, clinical markers, and quality of life in CKD patients.

Findings

Adults with CKD (n = 15; 9 F, 6 M; 66 ± 15 y) were provided with cereal, cookies and snack bars without added fiber for 2 weeks, followed by similar foods providing 23 g/d of added fiber for 4 weeks, to incorporate into their usual diets. Participants completed the Kidney Disease Quality of Life (KDQOL-36) questionnaire, the Simplified Nutritional Appetite Questionnaire (SNAQ) and the Epworth Sleepiness Scale (ESS) bi-weekly, the Gastrointestinal Symptom Rating Scale (GSRS) weekly, and daily stool frequency and compliance. Control and intervention serum cholesterol and glucose were assessed. Providing 23 g/d of added fiber increased stool frequency (1.3 ± 0.2 to 1.6 ± 0.2 stools/d; P = 0.02), decreased total cholesterol (175 ± 12 to 167 ± 11 mg/dL; P = 0.02) and improved TC:HDL ratio (4.0 ± 0.3 to 3.7 ± 0.2; P = 0.02). GSRS and SNAQ scores did not change, but SNAQ scores suggested poor appetite in 7 participants with or without added fiber. KDQOL Mental Health Composite decreased from 53 ± 2 to 48 ± 2 (P = 0.01) while Physical Health Composite increased from 31 ± 2 to 35 ± 3 (P = 0.02), with no change in overall QOL. The ESS score decreased from 10 ± 1 to 8 ± 1 (P = 0.04).

Conclusion

Consuming foods with added fiber may be an effective means of increasing fiber intakes, improving stool frequency, and lipid profile in individuals with CKD.

Trial registration

ClinicalTrials.gov, # NCT01842087

【 授权许可】

   
2013 Salmean et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]USDA: What We Eat in America National Health and Nutritional Examination Survey (NHANES) 2005–2006. Edited by Beltsville MD. Washington, DC: Food Surveys Research Group Beltsville Human Nutrition Research Center, Agricultural Research Service, USDA; 2003.
• [2]Stevens J, Ahn K, Juhaeri , Houston D, Steffan L, Couper D: Dietary fiber intake and glycemic index and incidence of diabetes in African-American and white adults: the ARIC study. Diabetes Care 2002, 25:1715-1721.
• [3]NIH US Renal Data System: USRDS 2012 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2012.
• [4]Nelms M, Sucher KP, Lacey K, Long Roth S: Nutrition Therapy and Pathophysiology. 2nd edition. Belmont, CA: Thomson Brooks/Cole; 2010.
• [5]Institute of Medicine: Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids (Macronutrients). Washington, D.C: The National Academies Press; 2005.
• [6]Rizkalla SW, Bellisle F, Slama G: Health benefits of low glycaemic index foods, such as pulses, in diabetic patients and healthy individuals. Br J Nutr 2002, 88:S255-S262.
• [7]Zhang Z, Lanza E, Kris-Etherton PM, Colburn NH, Bagshaw D, Rovine MJ, Ulbrecht JS, Bobe G, Chapkin RS, Hartman TJ: A high legume low glycemic index diet improves serum lipid profiles in men. Lipids 2010, 45:765-775.
• [8]Pittaway JK, Robertson IK, Ball MJ: Chickpeas may influence fatty acid and fiber intake in an ad libitum diet, leading to small improvements in serum lipid profile and glycemic control. J Am Diet Assoc 2008, 108:1009-1013.
• [9]Perazella MA, Khan S: Increased mortality in chronic kidney disease: a call to action. Am J Med Sci 2006, 331:150-153.
• [10]Gorodetskaya I, Zenios S, McCulloch CE, Bostrom A, Hsu CY, Bindman AB, Go AS, Chertow GM: Health-related quality of life and estimates of utility in chronic kidney disease. Kidney Int 2005, 68:2801-2808.
• [11]Meyer TW, Hostetter TH: Uremia. N Engl J Med 2007, 357:1316-1325.
• [12]Younes H, Egret N, Hadj-Abdelkader M, Remesy C, Demigne C, Gueret C, Deteix P, Alphonse JC: Fermentable carbohydrate supplementation alters nitrogen excretion in chronic renal failure. J Ren Nutr 2006, 16:67-74.
• [13]Bliss DZ, Stein TP, Schleifer CR, Settle RG: Supplementation with gum arabic fiber increases fecal nitrogen excretion and lowers serum urea nitrogen concentration in chronic renal failure patients consuming a low-protein diet. Am J Clin Nutr 1996, 63:392-398.
• [14]Rampton DS, Cohen SL, Crammond VD, Gibbons J, Lilburn MF, Rabet JY, Vince AJ, Wager JD, Wrong OM: Treatment of chronic renal failure with dietary fiber. Clin Nephrol 1984, 21:159-163.
• [15]Verhoef SP, Meyer D, Westerterp KR: Effects of oligofructose on appetite profile, glucagon-like peptide 1 and peptide YY3-36 concentrations and energy intake. Br J Nutr 2011, 106:1757-1762.
• [16]Salmean YA, Segal MS, Langkamp-Henken B, Canales MT, Zello GA, Dahl WJ: Foods with added fiber lower serum creatinine levels in patients with chronic kidney disease. J Ren Nutr 2013, 23:e29-e32.
• [17]Hays RD, Kallich JD, Mapes DK, Coons SJ, Carter WB: Development of the Kidney Disease Quality of Life (KDQOL™) Instrument. Qual Life Res 1994, 3:329-338.
• [18]Wilson MM, Thomas DR, Rubenstein LZ, Chibnall JT, Anderson S, Baxi A, Diebold MR, Morley JE: Appetite assessment: simple appetite questionnaire predicts weight loss in community-dwelling adults and nursing home residents. Am J Clin Nutr 2005, 82:1074-1081.
• [19]Johns MW: A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 1991, 14:540-545.
• [20]Revicki DA, Wood M, Wiklund I, Crawley J: Reliability and validity of the Gastrointestinal Symptom Rating Scale in patients with gastroesophageal reflux disease. Qual Life Res 1998, 7:75-83.
• [21]Dahl WJ, Whiting SJ, Healey A, Zello GA, Hildebrandt SL: Increased stool frequency occurs when finely processed pea hull fiber is added to usual foods consumed by elderly residents in long-term care. J Am Diet Assoc 2003, 103:1199-1202.
• [22]Kleessen B, Sykura B, Zunft HJ, Blaut M: Effects of inulin and lactose on fecal microflora, microbial activity, and bowel habit in elderly constipated persons. Am J Clin Nutr 1997, 65:1397-1402.
• [23]Carrero JJ, Stenvinkel P, Cuppari L, Ikizler TA, Kalantar-Zadeh K, Kaysen G, Mitch WE, Price SR, Wanner C, Wang AY, ter Wee P, Franch HA: Etiology of the protein-energy wasting syndrome in chronic kidney disease: a consensus statement from the International Society of Renal Nutrition and Metabolism (ISRNM). J Ren Nutr 2013, 23:77-90.
• [24]Chow FY, Briganti EM, Kerr PG, Chadban SJ, Zimmet PZ, Atkins RC: Health-related quality of life in Australian adults with renal insufficiency: a population-based study. Am J Kidney Dis 2003, 41:596-604.
• [25]Lowrie EG, Curtin RB, LePain N, Schatell D: Medical outcomes study short form-36: a consistent and powerful predictor of morbidity and mortality in dialysis patients. Am J Kidney Dis 2003, 41:1286-1292.
• [26]Higgins PD, Johanson JF: Epidemiology of constipation in North America: a systematic review. Am J Gastroenterol 2004, 99:750-759.