title: Effects of protein and omega-3 supplementation, provided during regular dialysis sessions, on nutritional and inflammatory indices in hemodialysis patients.
abstract: OBJECTIVE
  Malnutrition and chronic inflammation in dialysis patients negatively impacts prognosis. However, intervening to correct this problem (through nutritional supplementation) is often hampered by poor compliance due to both medical and socioeconomic barriers. We have therefore performed a pilot study to investigate the technical feasibility of "directly observed treatment" of nutritional supplementation (protein and omega-3 fatty acids), administered during regular dialysis sessions. Secondary end points included observation of nutritional and inflammatory status of hypoalbuminemic patients undergoing hemodialysis.
  
  
  METHODS
  Main inclusion criteria were serum albumin ≤ 3.9 g/dL (3 months prior to the study). Sixty-three eligible patients agreed to participate. Two intervention groups received 30 mL of a liquid protein supplement plus either 2.4 g omega-3 (1800 mg eicosapentaenoic acid + 600 mg docosahexaenoic acid) or a placebo, three times per week after their routine dialysis session for 6 months. Serum albumin, plasma lipids, and other indicators of nutritional and inflammatory status were measured.
  
  
  RESULTS
  Directly observed nutritional supplementation resulted in a significant improvement in the low density lipoprotein cholesterol/high density lipoprotein cholesterol ratio in the omega-3 group as compared to the placebo group (P = 0.043). For the omega-3 group, serum albumin was also marginally higher after 6 months as compared to baseline (P = 0.07). The observed increase in C-reactive protein in the placebo group over 6 months was not apparent in the omega-3 group, although there was no significant difference between groups. Nuclear factor kappa B, malnutrition-inflammation score, normalized protein nitrogen appearance, body mass index, and hemoglobin were unaffected by the intervention.
  
  
  CONCLUSIONS
  "Directly observed treatment" with an omega-3 based supplement (as opposed to a pure protein supplement) showed beneficial effects on the lipid profile, and C-reactive protein levels. Further studies using a combination of outpatient and inpatient "directly observed treatment" of omega-3 based supplementation is warranted.
authors.affiliation: Department of Nutrition and Food Science, Wayne State University, Detroit, MI, USA.
authors.forename: Zulfitri A Mat
authors.initials: ZA
authors.lastname: Daud
authors.forename: Boniface
authors.initials: B
authors.lastname: Tubie
authors.forename: Judy
authors.initials: J
authors.lastname: Adams
authors.forename: Tracey
authors.initials: T
authors.lastname: Quainton
authors.forename: Robert
authors.initials: R
authors.lastname: Osia
authors.forename: Sharon
authors.initials: S
authors.lastname: Tubie
authors.forename: Deepinder
authors.initials: D
authors.lastname: Kaur
authors.forename: Pramod
authors.initials: P
authors.lastname: Khosla
authors.forename: Marina
authors.initials: M
authors.lastname: Sheyman
mesh_terms: D000368:Aged; D001628:Beverages; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000378:metabolism; D002214:Capsules; D004044:Dietary Proteins / Q000008:administration & dosage* / Q000009:adverse effects; D019587:Dietary Supplements / Q000009:adverse effects; D023801:Directly Observed Therapy; D004281:Docosahexaenoic Acids / Q000008:administration & dosage; D015118:Eicosapentaenoic Acid / Q000008:administration & dosage; D015525:Fatty Acids, Omega-3 / Q000008:administration & dosage* / Q000009:adverse effects; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000209:etiology / Q000276:immunology / Q000628:therapy*; D018836:Inflammation Mediators / Q000097:blood*; D007674:Kidney Diseases / Q000150:complications / Q000628:therapy*; D008055:Lipids / Q000097:blood; D008297:Male; D044342:Malnutrition / Q000097:blood / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D008824:Michigan; D008875:Middle Aged; D016328:NF-kappa B / Q000097:blood; D009752:Nutritional Status; D010349:Patient Compliance; D010865:Pilot Projects; D006435:Renal Dialysis / Q000009:adverse effects; D012709:Serum Albumin / Q000378:metabolism; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D002214:Capsules; D004044:Dietary Proteins; D015525:Fatty Acids, Omega-3; D018836:Inflammation Mediators; D008055:Lipids; D016328:NF-kappa B; D012709:Serum Albumin; D004281:Docosahexaenoic Acids; D002097:C-Reactive Protein; D015118:Eicosapentaenoic Acid