Applying Integrative Analysis of Dietary Patterns to Understand Ramadan-Induced Nutritional Status Alterations in Hemodialysis Patients

Abstract

Objective: The changes in dietary behaviors and food choices during Ramadan lead to significant nutritional status alterations in hemodialysis (HD) patients. Routine dietary assessment may not capture disruptions in food behaviors of Muslim HD patients during Ramadan. This study aimed to elucidate changes in nutritional status affected by Ramadan food choices using a dietary pattern (DP) approach. Methods: This 6-week, multicenter, prospective longitudinal study included 102 Malaysian Muslim HD patients who observed fasting during Ramadan. Nutritional assessments, including anthropometry and biochemical parameters, were conducted at 2 timepoints: 2 weeks prior to Ramadan (V0) and during the fourth week of Ramadan (V1). DPs were derived from 3-day diet records collected at V1 using principal component analysis (PCA) and reduced rank regression (RRR). A general linear model with repeated measures was applied to evaluate the variations in Ramadan-induced nutritional status changes across tertiles within each DP. Further, the integrative analysis between the DPs identified the specific foods that contributed to these changes. Results: PCA identified 4 DPs: Home-FoodsDP, Chicken-MeatDP, Carbohydrate-basedDP, and TraditionalDP. Meanwhile, RRR yielded 1 DP, which is Quick-FoodsDP. Significant interactions between DPs and serum phosphate changes were observed in the Chicken-MeatDP (P = .020) and Quick-FoodsDP (P = .004), where high adherence to either pattern was associated with increased serum phosphate during Ramadan. The Quick-FoodsDP showed a significant interaction with serum potassium (P < .001), where high adherence was linked to an increasing trend during Ramadan. Additionally, the Home-FoodsDP exhibited a significant interaction with serum albumin (P = .035), where low adherence was associated with a greater reduction during Ramadan. Conclusion: Dietary pattern analysis reveals the synergistic effects of food-food interaction on Ramadan-induced nutritional alterations in HD patients, providing a foundation for evidence-based dietary guidance for Muslim HD patients during Ramadan.