Original ResearchDesign and Development of a Dialysis Food Frequency Questionnaire
Section snippets
Design and Development of the FFQ
One of the original goals of the NIED study7 was to design and develop a dialysis patient-specific FFQ in collaboration with Gladys Block, PhD, and the team in NutritionQuest, Berkeley, CA. The task started with developing the appropriate food list followed by the general steps used for all Block questionnaires or dietary screeners.8, 9 In general, detailed 24-hour recall or multiple-day record data are used to identify which foods are the key contributors to the nutrients of interest. For the
Patients
The original NIED Study patient cohort was derived over a period of 5 years from a pool of over 3,000 MHD outpatients in 8 DaVita chronic dialysis clinics in the South Bay Los Angeles area (see the NIED Study website at www.NIEDStudy.org for more details).7, 18, 19 The study included outpatients who were ≥18 years, undergoing MHD treatment for at least 8 weeks, and had signed the Institutional Review Board approved consent form. Participants with acute infections or an anticipated life
Dietary Data Recording and Analyses
The 154 patients undergoing hemodialysis in the NIED substudy provided a 3-day diet diary that included the last hemodialysis treatment day of the week (either Friday or Saturday) and 2 subsequent nondialysis days (Saturday, Sunday, and/or Monday) A trained dietitian from General Clinical Research Center reviewed the diet record data while in personal contact with the patients and conducted a supplementary dietary interview to fill in missing data. Collected dietary data, including oral
The Dialysis-FFQ
The resulting “Dialysis FFQ” is approximately 100 items long, and takes approximately 30 to 40 minutes to complete. Portion size is requested for each food item. Unitary items are requested for their numbers (“How many”).A portion size graphic aids the respondent in portion size assessment for nonunitary items. Portion size is considered important in those undergoing dialysis patients, in relation to controlling liquids, sodium, phosphorus, and potassium intake, as well as for assessing
Validity of Dialysis-FFQ
Predictive validity may be examined to determine whether the results of the FFQ are related to other outcomes of interest such as survival. The earlier Block’s FFQ has been recently tested in the NIED Study and shown to be associated with survival, whereas the higher dietary phosphorus or potassium intake are reported as predictors of increased death risk.5, 6 The exact version of the Dialysis-FFQ presented here has not undergone de novo validation against other forms of dietary assessments in
Conclusions
Dietary evaluation and nutritional management are essential to provide optimal care to the patients with CKD, particularly those undergoing dialysis.. Accurate assessment of dietary intake is also important for outcomes research in patients with CKD including studies related to the putative relationship between food intake and clinical outcomes.2 Imposed dietary restrictions are used routinely in dialysis patients, some of which may cause harm rather than help, such as restricting protein
Acknowledgments
The manuscript was supported by Dr. Kalantar-Zadeh’s research grants from the National Institute of Diabetes, Digestive and Kidney Disease of the National Institute of Health (K2361162 and R21 DK078012), a research grant from DaVita Clinical Research, and a philanthropic grant from Mr. Harold Simmons.
References (21)
- et al.
Dietary potassium intake and mortality in long-term hemodialysis patients
Am J Kidney Dis
(2010) - et al.
The Nutritional and Inflammatory Evaluation in Dialysis patients (NIED) study: overview of the NIED study and the role of dietitians
J Ren Nutr
(2005) - et al.
Comparing body composition assessment tests in long-term hemodialysis patients
Am J Kidney Dis
(2010) - et al.
Association of relatively low serum parathyroid hormone with malnutrition-inflammation complex and survival in maintenance hemodialysis patients
J Ren Nutr
(2010) - et al.
Association of soluble endotoxin receptor CD14 and mortality among patients undergoing hemodialysis
Am J Kidney Dis
(2009) - et al.
Association of malnutrition-inflammation score with quality of life and mortality in hemodialysis patients: a 5-year prospective cohort study
Am J Kidney Dis
(2009) - et al.
Association of serum prealbumin and its changes over time with clinical outcomes and survival in patients receiving hemodialysis
Am J Clin Nutr
(2008) - et al.
HDL-inflammatory index correlates with poor outcome in hemodialysis patients
Kidney Int
(2007) - et al.
Food intake characteristics of hemodialysis patients as obtained by food frequency questionnaire
J Ren Nutr
(2002) - et al.
Is controlling phosphorus by decreasing dietary protein intake beneficial or harmful in persons with chronic kidney disease?
Am J Clin Nutr
(2008)
Cited by (37)
Nutritional Epidemiology and Dietary Assessment for Patients With Kidney Disease: A Primer
2023, American Journal of Kidney DiseasesDevelopment and Validation of a Food Frequency Questionnaire to Assess Potassium Intake of Patients on Hemodialysis
2023, Journal of Renal NutritionCitation Excerpt :The Cronbach's standardized alpha calculated with the 85 items was 0.71, which is considered adequate and indicates acceptable internal consistency and reliability among the food items.30 We chose to develop a quantitative FFQ because it allows to estimate potassium intake as per the portion size, what is considered important for the control and the adequacy of nutrient intake of patients on dialysis.15 Although the reference portion was determined by the most frequently reported by the patients, it reflects the dietary behavior of this population and increase the accuracy of the estimative of nutrient intake.10
Nutritional approaches and plant-dominant diets for conservative and preservative management of chronic kidney disease
2021, Nutritional Management of Renal Disease, Fourth EditionA Review of Dietary Intake Studies in Maintenance Dialysis Patients
2015, Journal of Renal NutritionCitation Excerpt :The initial search yielded 2,374 articles, of which 29 were included in this review. Table 1 lists DI studies in MDPs.22-50 Antunes et al.24 studied 79 adult patients on HD and PD with a follow-up period of 38 months.
Relevant Potential Conflict of Interest: TB, GB and JN are related to NutritionQuest (Berkeley, CA), which owns and provides Block FFQs including the Dialysis FFQ. Other authors have declared none.