By Deborah Brauser
NASHVILLE, Tenn -- March 30, 2009 -- High levels of dietary fibre intake can help decrease inflammation both in patients with chronic kidney disease (CKD) and those who do not have CKD (non-CKD), according to research presented here at the National Kidney Foundation (NKF) 2009 Spring Clinical Meetings.
Study author Jennifer Zitterkoph, RD, University Health Care Dialysis Program, University of Utah, Salt Lake City, Utah, reported the results in a poster session on March 26.
The study was designed to examine the effect of dietary fibre intake on inflammation, as defined by levels of C-reactive protein (CRP) greater than 3 mg/L both in patients with CKD and in non-CKD patients.
CKD was diagnosed defined as a Modification of Diet in Renal Disease glomerular filtration rate of <60 mL/min/1.73 m2.
Zitterkoph and colleagues examined data from 1,103 patients with CKD and 14,874 non-CKD patients enrolled in the National Health and Nutrition Examination Survey III.
All participants were randomised into 1 of 3 groups based on fibre intake according to high intake (>=17.35 g), medium intake (10.45-17.34 g), or low intake (<10.45 g).
Dietary fibre intake was estimated from patients' 24-hour dietary recalls. CRP was measured by latex-enhanced nephelometry and the svy suite of commands in Stata X was used to analyse the data. In addition, contingency table analysis and multivariable logistic regression statistical methods were used.
Overall results showed that when compared with patients in the high dietary fibre intake group, those in the low intake group had significantly increased odds of inflammation in both the CKD and non-CKD subgroups.
In the low fibre intake group, CKD patients showed 51% inflammation versus 37% in the high intake group (P < .05). The non-CKD population showed 29% inflammation with low fibre intake versus 20% with high intake (P < .001).
Using the high fibre intake groups as reference, the logistic regression models showed an association of inflammation of 1.96 (odds ratio [OR], 95% confidence interval [CI], 1.17-3.29) in the low fibre intake CKD group and 1.36 (OR, 95% CI, 1.17-1.63) in the non-CKD group.
"We need to really encourage CKD patients to increase their fibre intake despite what they've been hearing from their dietician," said Zitterkoph. "It's kind of a balancing act in terms of checking out white bread versus whole wheat bread and watching phosphorous. It's important to now pay attention to fibre as well. We just have to decide which is more important at this point."
"My advice would be to not go too far in any one direction," Zitterkoph continued. "But it might be a good idea to maybe add some whole grain bread and not to overdo it. With each patient, it's going to be a little different. So slowly add the fibre and see how they do and then increase it a little bit more based on how the patient does."
Zitterkoph noted, "We did this study based on total dietary fibre, so we'd like to break that down in the future into soluble [fibre] versus insoluble [fibre] groups to show exactly what we should pay most attention to and then go on to other clinical trials to examine that."
[Presentation title: High Dietary Fibre Intake Is Associated With Decreased Inflammation in Chronic Kidney Disease (CKD) and Non-CKD Populations: NHANES III. Abstract 62]
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