接受肾脏替代疗法患者的营养与循环中肠道微生物群衍生的尿毒症毒素之间的关系：一项观察性横断面研究。

IF 2.9 Q3 NUTRITION & DIETETICS

Clinical nutrition ESPEN Pub Date : 2024-11-20 DOI:10.1016/j.clnesp.2024.11.022

Sylwia Czaja-Stolc , Marta Potrykus , Jakub Ruszkowski , Daniel Styburski , Alicja Dębska-Ślizień , Sylwia Małgorzewicz

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引用次数: 0

摘要

背景：肠道微生物群会产生一系列生物活性代谢物，这些代谢物可转化为尿毒症毒素，如三甲胺-N-氧化物（TMAO）、对甲酚硫酸盐（pCS）和吲哚硫酸盐（IS）。该研究旨在探讨饮食与上述肠道微生物群衍生的尿毒症毒素浓度之间的关系：方法：研究人员进行了一项横断面观察研究，共有 210 人参与：84 名血液透析（HD）患者、44 名腹膜透析（PD）患者、52 名肾移植受者（KTR）和 30 名健康对照者。膳食摄入量通过 3 天食物日记和 6 种答案的食物频率问卷（FFQ-6）进行评估。根据 3 天食物日记和 FFQ-6 获得的数据计算出备用地中海饮食（aMED）得分。采用液相色谱-质谱法（LC-MS/MS）分析血液样本中的 TMAO、pCS 和 IS 浓度：结果：研究组之间的 TMAO、pCS 和 IS 浓度存在显著差异。与 KTR 和健康对照组相比，HD 和 PD 患者的这些代谢物含量更高。HD 组的 aMED 评分中位数为 4（3-5）分，PD 组为 4.5（4-6）分，KTR 为 5（4-6）分，对照组为 6（5-7）分。透析患者较高的地中海饮食坚持率（aMED 评分）与较低的 pCS 水平相关。每天多次摄入蔬菜可减轻苯丙氨酸和酪氨酸摄入量对透析患者 pCS 浓度的影响：结论：接受肾脏替代疗法（KRT）的患者的饮食会显著影响肠道微生物群衍生的尿毒症毒素的浓度。这些发现强调了饮食管理在减轻这些毒素对慢性肾脏病（CKD）患者的不良影响方面的重要性。

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The associations between nutrition and circulating gut microbiota-derived uremic toxins in patients undergoing kidney replacement therapy: An observational, cross-sectional study

Background

Gut microbiota generates a series of bioactive metabolites that can be converted into uremic toxins such as trimethylamine-N-oxide (TMAO), p-cresyl sulfate (pCS), and indoxyl sulfate (IS). The aim of the study was to examine the association between diet and the concentrations of the mentioned gut microbiota-derived uremic toxins.

Methods

An observational cross-sectional study was conducted involving 210 participants: 84 hemodialysis (HD) patients, 44 peritoneal dialysis (PD) patients, 52 kidney transplant recipients (KTR), and 30 healthy controls. Dietary intake was assessed using a 3-day food diary and a food frequency questionnaire with 6 answers (FFQ-6). The alternate Mediterranean diet (aMED) score was calculated based on data obtained from the 3-day food diary and FFQ-6. Blood samples were analyzed for TMAO, pCS, and IS concentrations using liquid chromatography-mass spectrometry (LC-MS/MS).

Results

Significant differences in TMAO, pCS, and IS concentrations were observed among the study groups. HD and PD patients exhibited higher levels of these metabolites compared to KTR and healthy controls. The median aMED score was 4 (3−5) points in the HD group, 4.5 (4−6) points in the PD group, 5 (4−6) points in the KTRs, and 6 (5−7) points in the control group. Higher adherence to the Mediterranean diet (aMED score) was associated with lower pCS levels in dialysis patients. Vegetable intake several times a day was found to mitigate the effects of phenylalanine and tyrosine intake on pCS concentration among dialysis patients.

Conclusions

The diet of patients undergoing kidney replacement therapy (KRT) significantly affects the concentrations of gut microbiota-derived uremic toxins. These findings highlight the importance of dietary management in mitigating the adverse effects of these toxins in patients with chronic kidney disease (CKD).

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来源期刊

Clinical nutrition ESPEN NUTRITION & DIETETICS-

CiteScore

4.90

自引率

3.30%

发文量

512

期刊介绍： Clinical Nutrition ESPEN is an electronic-only journal and is an official publication of the European Society for Clinical Nutrition and Metabolism (ESPEN). Nutrition and nutritional care have gained wide clinical and scientific interest during the past decades. The increasing knowledge of metabolic disturbances and nutritional assessment in chronic and acute diseases has stimulated rapid advances in design, development and clinical application of nutritional support. The aims of ESPEN are to encourage the rapid diffusion of knowledge and its application in the field of clinical nutrition and metabolism. Published bimonthly, Clinical Nutrition ESPEN focuses on publishing articles on the relationship between nutrition and disease in the setting of basic science and clinical practice. Clinical Nutrition ESPEN is available to all members of ESPEN and to all subscribers of Clinical Nutrition.