Applied nutritional investigationRatio of dietary ω-3 and ω-6 fatty acids—independent determinants of muscle mass—in hemodialysis patients with diabetes
Introduction
Diabetes mellitus (DM), the most common cause of end-stage renal disease (ESRD), has been a major risk factor for body protein loss and muscle wasting, which are associated with increased morbidity and mortality in patients undergoing hemodialysis (HD) [1], [2]. In 1970 [3], Thage reported that patients with diabetes undergoing dialysis have a higher prevalence and forms of uremic-induced skeletal myopathy that are more severe. Pupim et al. demonstrated that patients with diabetic ESRD exhibited higher loss of lean body mass than did their age-, sex-, and race-matched counterparts without diabetes [4]. Identifying an approachable treatment for maintaining muscle mass or mitigate the consequences associated with muscle wasting in HD patients is expected to improve patient function, because the coexistence of DM and potential stressful conditions result in protein-energy wasting, which may synergistically increase the death risk in patients undergoing HD [5].
A large body of evidence now shows that unbalanced ratio of ω-3 and ω-6 polyunsaturated fatty acids (PUFAs), as is found in today's Western diets, leads to the pathogenesis of many diseases [6], [7], [8], [9], including vascular disease, cancer, osteoporosis, autoimmune diseases, cognitive decline, and incidence of dementia; however, studies investigated the ratio between these two PUFAs in muscle science is less well known. Both ω-3 and ω-6 PUFAs are essential fatty acids for human body. These two PUFAs not only play critical roles in cell membrane integrity, but potentially contribute to muscle hypertrophy and atrophy; they also have catabolic and anabolic effects on muscle cells [10]. Helge et al. demonstrated that participants with improved leg muscle functioning had significantly lower ω-6/ω-3 ratio of muscle phospholipid fatty acid composition [11]. In a population-based study on older Italians [12], a higher plasma ω-6/ω-3 ratio was associated with age-related decline in physical performance. If the ratios between ω-3 and ω-6 PUFAs were associated with indices of muscle mass, the effective nutrition therapy strategies for patients with diabetes undergoing dialysis are warranted.
Because of the health benefits of ω-3 PUFAs in the general population, the American Heart Association recommends the consumption of fish at least twice a week [13]. Sakuma and Yamaguchi (2012) affirmed that adequate intake (AI) of ω-3 PUFAs is 1.6 g/d for men and 1.1 g/d for women [14]. Nevertheless, no specific recommendations currently exist regarding the dietary intake of ω-3 PUFAs for patients with ESRD. Friedman et al. found that 67% of HD patients who did not follow the American Heart Association fish-consumption guidelines had low plasma ω-3 PUFA concentrations [15]; therefore, they considered patients undergoing HD to be ideal for exemplifying the effects of ω-3 PUFAs [16].
According to our review of relevant literature, few studies have investigated how muscle mass is affected by dietary ω-3 and ω-6 PUFAs, particularly in HD patients. We hypothesized that patients with diabetic ESRD having a higher dietary ratio of ω-3/ω-6 PUFAs have a lower risk of muscle mass decline. The broad aims of this study were 1) to investigate the relationship between dietary PUFAs and muscle mass; and 2) to evaluate the possible univariate significant and nonsignificant relevant predictors of muscle mass in patients with diabetes undergoing HD.
Section snippets
Study subjects
This study used cross-sectional data in a completed study design for investigating the association between improved nutritional care and the prognosis of cardiovascular disease (CVD) in HD populations. In brief, participants ages 20 and older undergoing HD for at least 3 mo were recruited from three hospital-based HD centers of Taipei Medical University (TMU) during September 2013 to January 2015. Dialysis patients regularly underwent a thrice weekly HD regimen, for achieving an equilibrated
Patient characteristics
Baseline characteristics of the studied participants are shown in Table 1. In total, 69 subjects with ESRD diabetes (41 men and 28 women) were identified. The mean age and dialysis vintage of the patients were 63.0 ± 10.4 y (range: 27–86 y) and 3.8 ± 2.7 y (range: 3.6 mo–12 y), respectively. An adequate dialysis dose according to the eKt/V was administered to the patients. Regarding complications, 37.7% and 58.7% of the patients with diabetes undergoing HD had hypertension and a history of CVD,
Discussion
Our study indicated that dietary PUFAs, a higher ratio of ω-6/ω-3 PUFAs was independently associated with muscle mass decline in patients with diabetes undergoing HD. It has long been speculated that unbalanced ratio of ω-3 and ω-6 PUFAs, as is found in today's Western diets, associated with many chronic diseases [6], [7], [8], [9], but the effects on muscle mass are less well known. The rate of muscle protein synthesis is associated with increased ω-3 PUFAs in human [24], [25], [26] and animal
Conclusion
Given the high prevalence of protein-energy wasting in ESRD, we found that the ratios of dietary ω-3 and ω-6 PUFAs are modifiable contributors toward muscle wasting in patients with diabetes undergoing HD; a high ω-6/ω-3 ratio may be independently associated with a reduced muscle mass. In addition, IR, indicated as HOMA-IR, was observed to be an independent risk determinant of reduced muscle mass. Therefore, increasing ω-3 PUFA dietary quantities is an approach to normalizing a high ratio of
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Cited by (0)
The authors acknowledge the study participants and staff at the HD Centers of Taipei Medical University Hospital, Wan Fang Hospital, and Shuang Ho Hospital for their contribution. Moreover, the authors acknowledge the Ministry of Science and Technology (Taiwan) for funding this research (Grant Number: NSC-102-2320-B-038-026).