Adaptation and Validation of Alternative Healthy Eating Index in Hemodialysis Patients (AHEI-HD) and Its Association with all-Cause Mortality: A Multi-Center Follow-Up Study
by
Tuyen Van Duong 1
, 
I-Hsin Tseng 1, 
Te-Chih Wong 2, Hsi-Hsien Chen 3,4, Tso-Hsiao Chen 3,5, Yung-Ho Hsu 3,6, Sheng-Jeng Peng 7, Ko-Lin Kuo 8, Hsiang-Chung Liu 9, En-Tzu Lin 10, Yi-Wei Feng 1 and Shwu-Huey Yang 1,11,12,*
Tuyen Van Duong 1, I-Hsin Tseng 1, Te-Chih Wong 2, Hsi-Hsien Chen 3,4, Tso-Hsiao Chen 3,5, Yung-Ho Hsu 3,6, Sheng-Jeng Peng 7, Ko-Lin Kuo 8, Hsiang-Chung Liu 9, En-Tzu Lin 10, Yi-Wei Feng 1 and Shwu-Huey Yang 1,11,12,*
1
School of Nutrition and Health Sciences, Taipei Medical University, Taipei 110, Taiwan
2
Department of Nutrition and Health Sciences, Chinese Culture University, Taipei 110, Taiwan
3
Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
4
Division of Nephrology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei 110, Taiwan
5
Department of Nephrology, Taipei Medical University-Wan Fang Hospital, Taipei 110, Taiwan
6
Division of Nephrology, Department of Internal Medicine, Taipei Medical University- Shuang Ho Hospital, Taipei 110, Taiwan
7
Division of Nephrology, Cathay General Hospital, Taipei 110, Taiwan
8
Division of Nephrology, Taipei Tzu-Chi Hospital, New Taipei 231, Taiwan
9
Department of Nephrology, Wei Gong Memorial Hospital, Miaoli 351, Taiwan
10
Department of Nephrology, Lotung Poh-Ai Hospital, Yilan 265, Taiwan
11
Research Center of Geriatric Nutrition, Taipei Medical University, Taipei 110, Taiwan
12
Nutrition Research Center, Taipei Medical University Hospital, Taipei 110, Taiwan
*
Author to whom correspondence should be addressed.
Nutrients 2019, 11(6), 1407; https://doi.org/10.3390/nu11061407
Received: 15 May 2019 / Revised: 1 June 2019 / Accepted: 20 June 2019 / Published: 21 June 2019
(This article belongs to the Special Issue Targeted Nutrition in Chronic Disease)
A valid diet quality assessment scale has not been investigated in hemodialysis patients. We aimed to adapt and validate the alternative healthy eating index in hemodialysis patients (AHEI-HD), and investigate its associations with all-cause mortality. A prospective study was conducted on 370 hemodialysis patients from seven hospital-based dialysis centers. Dietary data (using three independent 24-hour dietary records), clinical and laboratory parameters were collected. The construct and criterion validity of original AHEI-2010 with 11 items and the AHEI-HD with 16 items were examined. Both scales showed reasonable item-scale correlations and satisfactory discriminant validity. The AHEI-HD demonstrated a weaker correlation with energy intake compared with AHEI-2010. Principle component analysis yielded the plateau scree plot line in AHEI-HD but not in AHEI-2010. In comparison with patients in lowest diet quality (tertile 1), those in highest diet quality (tertile 3) had significantly lower risk for death, with a hazard ratio (HR) and 95% confidence intervals (95%CI) of HR: 0.40; 95%CI: 0.18 – 0.90; p = 0.028, as measured by AHEI-2010, and HR: 0.37; 95%CI: 0.17–0.82; p = 0.014 as measured by AHEI-HD, respectively. In conclusion, AHEI-HD was shown to have greater advantages than AHEI-2010. AHEI-HD was suggested for assessments of diet quality in hemodialysis patients.
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Keywords:
alternative healthy eating index; all-cause mortality; diet quality; diet quantity; hemodialysis; end-stage renal disease; principal component analysis; complex and multidimensional; validation; prospective cohort
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MDPI and ACS Style
Van Duong, T.; Tseng, I.-H.; Wong, T.-C.; Chen, H.-H.; Chen, T.-H.; Hsu, Y.-H.; Peng, S.-J.; Kuo, K.-L.; Liu, H.-C.; Lin, E.-T.; Feng, Y.-W.; Yang, S.-H. Adaptation and Validation of Alternative Healthy Eating Index in Hemodialysis Patients (AHEI-HD) and Its Association with all-Cause Mortality: A Multi-Center Follow-Up Study. Nutrients 2019, 11, 1407.
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