FP787CHARACTERIZATION OF EATING PATTERNS IN HEMODIALYSIS PATIENTS

Abstract

Introduction and Aims: Previous research has shown that < 20% of hemodialysis (HD) patients in the U.S. achieve the KDOQI recommendations for daily protein (1.2g/ kg/day) and total energy (35kcal/kg/day) intake. This low intake may contribute to excessively high rates of muscle wasting in HD patients. Moreover, eating patterns throughout the day also may influence muscle stores. Typical eating patterns in the U.S. include higher protein and energy intakes later in the day, specifically at dinner, whereas research has shown that a more equal distribution of protein and energy throughout the day may be optimal for increasing muscle protein synthesis. The purpose of this study was to examine feeding patterns in HD patients to determine if skewed patterns of feeding exist, if they are influenced by the time of day the patients dialyze, and if these patterns are related to markers of nutritional status and physical performance. Methods: 24 Hour dietary recalls were collected by a dietician from 94 HD patients (43% African American, 56% male, average age = 54+/- 13.0 years) on both a dialysis and non-dialysis day. Total kcal and protein intake at meals defined by the patients as breakfast, lunch, and dinner were determined using Nutritionist Pro software. Serum albumin levels were obtained from monthly lab reports as a marker of nutritional status, lean body mass was determined by DXA, and an incremental shuttle walk test (ISWT) was used to estimate aerobic capacity. Analysis of variance (ANOVA) was used to compare differences in energy and protein intake on non-dialysis and dialysis days, as well as difference in intake levels between patients attending different dialysis shifts (morning, afternoon, or evening). Pearson correlation analysis was used to examine relationships between variables of interest. Results: Mean protein and total kcal intake for the entire patient group was 0.94 +/-0.04 g/kg/day and 21.6 +/-1.0 kcal/kg/day, respectively, and did not differ significantly between non-dialysis (NDD) and dialysis (DD) days. However, the distribution of protein and total kcal intake was significantly different between meals, and these patterns were also influenced by the dialysis patient's treatment shift. Specifically, protein intake at breakfast, lunch and dinner averaged across DD and NDD was 13.6 +/- 1.3 g/meal, 19.7 +/- 2.3 g/meal, and 32.9 +/- 2.4 g/meal, respectively (p<0.05), while total kcal intake averaged 350 +/- 30.5 kcal/meal, 431 +/- 46.6 kcal/meal, and 686 +/- 49.8 kcal/meal, respectively (p<0.05). Furthermore, there were significant group x time interactions for protein and energy intake, such that patients dialyzing in the morning ingested the least amount of protein and total kcal at breakfast, while patients dialyzing in the afternoon shift ingested the least amount of protein and total kcal at lunch. Lastly, total protein intake on both DD and NDD were significantly correlated with whole body lean mass and performance on the ISWT (p< 0.05 for all), but were not correlated with serum albumin levels. Conclusions: These data indicate that HD patients not only fail to meet KDOQI requirements for daily protein and kcal intake, but the distribution of their meals are skewed heavily toward greater intake in the afternoon and evening hours. Furthermore, patients dialyzing in the morning and afternoon shifts tend to eat less at breakfast and lunch, respectively. We hypothesize that these aberrant eating patterns may be related in part to restrictions placed on eating during dialysis in many U.S. clinics, and could be contributing to protein energy wasting in the U.S. dialysis population.