The ratio of dietary diversity score versus energy density in relation to anthropometric and biochemical variables among patients with chronic kidney diseases

Main Article Content

Mohammad Hossein Rouhani
Mojgan Mortazavi Najafabadi
Firouzeh Moeinzadeh
Leila Azadbakht

Keywords

Dietary Diversity Score, Energy Density, Chronic Kidney Disease

Abstract

Background: Some evidence showed that dietary diversity score (DDS), a diet quality index, was not always related to healthy outcomes. It seems that DDS to energy density ratio (DDS/ED) can overcome limitations of DDS.  The aim of current study was to assess the association between either dietary DDS or DDS/ED and nutrient intake, anthropometric and biochemical measures in subjects with chronic kidney disease (CKD). Methods: Two hundred seventy patients with CKD were randomly selected for this cross-sectional study. Dietary intakes were assessed using a 168-item semi quantitative food frequency questionnaire. Moreover, anthropometric indices, lipid profile, blood urea nitrogen (BUN) and high sensitivity C-reactive protein were measured. Results: Body mass index (BMI) had a significant negative trend across quartiles of DDS and DDS/ED. Also, a negative trend for waist circumference was observed across quartiles of DDS/ED. Although the trends of selenium (P<0.01) and niacin (P=0.03) were significant across the quartiles of DDS, higher nutrient adequacy ratios for all important nutrients were observed among those in the top quartile of DDS/ED compared to the lowest quartile. We observed a significant trend of mean adequacy ratio just across quartiles of DDS/ED. Compared with the top quartile of DDS/ED (not DDS), the risk of overweight/obesity in the lowest quartiles was higher in adjusted model (P<0.001). The trend of the risk of elevated lipid profiles, BUN and hs-CRP across quartiles of DDS/ED and quartiles of DDS was not significant. Conclusion: Our results showed that DDS/ED corrected the failure of DDS in relation to risk of obesity. Moreover, it was observed that DDS/ED was better indicator of nutrient intake in comparison with DDS among patients with CKD. It is suggested that future studies use DDS/ED instead of DDS. Also, in clinical practice, dietitians should emphasize on diversity in low energy-dense food groups.

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