Hemodiyaliz Hastalarında Diyetin Besin Ögesi İçeriği ve Total Antioksidan Kapasitesi ile Serum Oksidatif Stres İndeksi Arasındaki İlişkinin İncelenmesi
Erçim, Rüveyda Esra
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The aim of this study was to assess the relationship between nutrient content, diet diversity and dietary total antioxidant capacity with serum antioxidant indexes (serum TAC, PON1 and ARES) and antioxidant indexes (serum TOS, OSI and MDA) of hemodialysis patients; to detect changes of antioxidant and oxidant indices before and after dialysis and to compare these parameters with healthy individuals. It is an experimental randomized controlled human study. In the stduy, aged between 19-64 who accepted to participate the study, 46 hemodialysis patients and 46 control in 92 total individual were participated (Male: 38, 41.3%, Female: 54, 58.7%), With the questionnaire, subjects’ sosio-demographic information, nutrition habits, 7 day-24 hours food consumption records, 3 day- physical activity record and IPAQ questionnaire were applied. In addition, anthropometric measurements of individuals were taken and diet diversity score (DÇS) and dietary total antioxidant capacity values were calculated from databases of ORAC, FRAP, TRAP, TEAC and equation of VCEAC. The mean age of the individuals was 49.7 ± 11.6 and 48.7 ± 9.7 for the males and 52.1 ± 12.2 and 52.6 ± 7.6 years for females in the hemodialysisand control groups, respectively. According to the BMI classification, 57.9% of men in the control group and 96.3% of the women were mildly obese, while in the hemodialysisgroup 73.7% of the men were normal and 70.4% of the women were mildly obese or obese p<0,05). According to IPAQ results, 84.2% of the male subjects in the hemodialysisgroup were sedentary and 63.2% of the male subjects in the control group were active; 88.9% of the women in the hemodialysisgroup and 59.3% of the women in the control group were sedentary (p <0.05). While, 57.9% of men and 63.0% of the women in the hemodialysisgroup were carrying the risk of severe malnutrition, all of the individuals in the control group were well fed and there was no risk of malnutrition (p <0.05). The FRS-BMI classification ratios were high in 42.1% of male and were medium and high risk 48.1% in women subjects in the hemodialysisgroups, while 73.7% of men and 85.2% of the women were in the control group are in the low risk group (p <0.05). All of the individuals participating in the study are in the low DÇS group (p> 0.05). According to the SF-36 score, the quality of life of the patients in the hemodialysisgroup was significantly lower than the control group (p <0.05). The values of T-ORAC, H-ORAC, TEAC, TRAP, FRAP-2, FRAP-3 and FRAP-4 and VCEAC dTAC were lower in the hemodialysis group than in the control group in men (p <0.01). The values of T-ORAC, H-ORAC, TEAC, TRAP, FRAP-1, FRAP-2, FRAP-3 and FRAP-4 and VCEAC dTAC values of the female subjects were lower in the hemodialysis group than in the control group in women (p < 0.01). In addition, when the serum TAC, TOS, PON, ARES, MDA and OSI values were compared before and after dialysis, the changes in PON1, ARES and MDA values were found to be statistically insignificant in men before and after dialysis, while TAC, TOS and OSI values were found to be significant 0.05). While the changes in ARES, TOS and MDA values were not statistically significant in women before and after dialysis, the decrease in TAC, PON1 and OSI values was significant (p <0.05). There was no significant relationship between DÇS-TÖBR and serum antioxidant and oxidant markers in male and female subjects. The ORAC, H-ORAC, FRAP1 and FRAP2 values of the individuals participating in the study and the ascorbic acid and tocopherols subgroups calculated via VCEAC were similar between TAC and PON1; there was a significant positive correlation between TOS and OSI (p <0.01). In conclusion, hemodialysis patients have severe risk of malnutrition, low physical activity level, low serum antioxidant parameters and high serum oxidant parameters and low dTAC values. By following good nutrition, malnutrition should be corrected, physical activity should be supported, dietary TAC content should be increased by providing dietary proper nutrition, morale and motivation of individuals should be supported and quality of life should be increased.