title: Comparison of Nutrition Profile and Diet Record Between Veteran and Nonveteran End-Stage Renal Disease Patients Receiving Hemodialysis in Veterans Affairs and Community Clinics in Metropolitan South-Central Texas.
abstract: BACKGROUND
  U.S. military veterans have high rates of chronic disease and social disadvantage, which are risk factors for protein-energy wasting (PEW). It is not known whether this translates into high prevalence of PEW in veterans with end-stage renal disease.
  
  
  METHODS
  We compared the clinical, socioeconomic, and nutrition status and the diet of 33 veteran and 38 nonveteran clinically stable patients receiving maintenance hemodialysis (MHD) in south-central Texas.
  
  
  RESULTS
  The whole cohort included 82% Mexican Americans (MAs), 72% type 2 diabetics, and 73% males. The body mass index was 28.9 ± 6.2, while energy intake was 21.5 ± 8.2 kcal/kg/d and protein intake was 1.0 ± 0.4 g/kg/d. Serum albumin (bromocresol purple) was 3.5 ± 0.4 g/dL, transferrin was 171.9 ± 27.8 mg/d, C-reactive protein was 2.9 (1.4-6.5) mg/L, interleukin-6 (IL-6) was 8.3 (4.2-17.9) pg/mL, neutrophil gelatinase-associated lipocalin was 729 (552-1256) ng/mL, and the malnutrition-inflammation score was 8.8 ± 3.0. In group comparison that adjusted for sex and ethnicity, the veterans had better household income, less MAs (60% vs 100%), more males (94% vs 55%), more use of a renin-angiotensin-aldosterone system blockade (66% vs 33%), and lower IL-6 levels (4.4 [3.1-5.8] vs 15.4 [8.3-20.5] pg/mL; P = .01) than nonveterans. In regression analysis, the lower serum IL-6 level in veterans was independently explained by dialysis clinic, sex, and, possibly, household income (intermediate significance).
  
  
  CONCLUSIONS
  In a relatively small cohort of clinically stable MHD patients, the veterans showed equivalent nutrition status and dietary intake and less inflammation than the nonveterans, thus not supporting the possibility that veteran MHD patients may have worse nutrition than the nonveteran counterpart.
authors.affiliation: Divisions of Nephrology, University of Texas Health Science Center San Antonio, San Antonio, Texas School of Health Professions, University of Texas Health Science Center San Antonio, San Antonio, Texas.
authors.forename: Sue E D
authors.initials: SE
authors.lastname: Cunningham
authors.affiliation: Audie L. Murphy Veterans Memorial Hospital, STVHCS, San Antonio, Texas.
authors.forename: Darlene
authors.initials: D
authors.lastname: Verkaik
authors.affiliation: School of Health Professions, University of Texas Health Science Center San Antonio, San Antonio, Texas.
authors.forename: Georgiana
authors.initials: G
authors.lastname: Gross
authors.affiliation: Divisions of Nephrology, University of Texas Health Science Center San Antonio, San Antonio, Texas Division of Nephrology, Western Galilee Hospital, Nahariya, Israel.
authors.forename: Khalid
authors.initials: K
authors.lastname: Khazim
authors.affiliation: Divisions of Nephrology, University of Texas Health Science Center San Antonio, San Antonio, Texas.
authors.forename: Padam
authors.initials: P
authors.lastname: Hirachan
authors.affiliation: Divisions of Nephrology, University of Texas Health Science Center San Antonio, San Antonio, Texas.
authors.forename: Gurav
authors.initials: G
authors.lastname: Agarwal
authors.affiliation: Clinical Epidemiology, School of Medicine, University of Texas Health Science Center San Antonio, San Antonio, Texas.
authors.forename: Carlos
authors.initials: C
authors.lastname: Lorenzo
authors.affiliation: Division of Endocrinology, University of Pisa, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Matteucci
authors.affiliation: Audie L. Murphy Veterans Memorial Hospital, STVHCS, San Antonio, Texas.
authors.forename: Shweta
authors.initials: S
authors.lastname: Bansal
authors.affiliation: Divisions of Nephrology, University of Texas Health Science Center San Antonio, San Antonio, Texas Audie L. Murphy Veterans Memorial Hospital, STVHCS, San Antonio, Texas fanti@uthscsa.edu.
authors.forename: Paolo
authors.initials: P
authors.lastname: Fanti
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D003153:Community Health Services; D004032:Diet; D015930:Diet Records; D004044:Dietary Proteins / Q000008:administration & dosage; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000150:complications / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications* / Q000208:ethnology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015596:Nutrition Assessment; D009752:Nutritional Status; D015995:Prevalence; D011502:Protein-Energy Malnutrition / Q000097:blood / Q000150:complications / Q000453:epidemiology; D006435:Renal Dialysis; D012959:Socioeconomic Factors; D013781:Texas / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs; D014728:Veterans; D019282:Wasting Syndrome / Q000097:blood / Q000150:complications / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D004044:Dietary Proteins
keywords: diabetes mellitus; ethnic groups; healthcare disparities; inflammation; socioeconomic factors; wasting syndrome