Osteoporosis Risk in Hemodialysis Patients: The Roles of Gender, Comorbidities, Biochemical Parameters, Health and Diet Literacy
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Sample
2.2. Measurements
2.2.1. The Risk of Osteoporosis
2.2.2. Socio-Demographics
2.2.3. Clinical Parameters
2.2.4. Biochemical Parameters
2.2.5. Physical Activities
2.2.6. Health Literacy, Digital Healthy Diet Literacy, and Hemodialysis Diet Knowledge
2.3. Data Collection Procedure
2.4. Data Analysis
3. Results
3.1. Participants’ Socio-Demographics
3.2. Associated Factors of Osteoporosis
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variables | Total n (%) | OSTA | p | ||
---|---|---|---|---|---|
Low (n;% = 267; 39.6) | Medium (n;% = 274; 40.6) | High (n;% = 134; 19.8) | |||
Socio-demographics | |||||
Gender | <0.001 a | ||||
Male | 337 (50.1) | 176 (65.9) | 119 (43.6) | 42 (31.6) | |
Female | 336 (49.9) | 91 (34.1) | 154 (56.4) | 91 (68.4) | |
Education | 0.001 a | ||||
Illiterate or elementary | 316 (50.5) | 101 (41.4) | 142 (55.7) | 73 (57.5) | |
Junior high school | 182 (29.1) | 91 (31.3) | 67 (26.3) | 24 (18.9) | |
Senior high school or above | 128(20.4) | 52 (21.3) | 46 (18.0) | 30 (23.6) | |
Working status | 0.660 a | ||||
Not working | 249 (36.9) | 93 (34.8) | 104 (38.0) | 52.0 (38.8) | |
Working | 426 (63.1) | 174 (65.2) | 170 (62.0) | 82 (61.2) | |
Marital status | 0.009 a | ||||
Without partner | 52 (7.8) | 13 (4.9) | 21 (7.8) | 18 (13.6) | |
With partner | 616 (92.2) | 253 (95.1) | 249 (92.2) | 114 (86.4) | |
Social status | 0.318 a | ||||
Low | 198 (29.3) | 70 (26.2) | 88 (32.1) | 40 (29.9) | |
Middle and high | 477 (70.7) | 197 (73.8) | 186 (67.9) | 94 (70.1) | |
Medication payment ability | 0.035 a | ||||
Very or fairly difficult | 521 (782) | 219 (82.3) | 209 (77.7) | 93 (71.0) | |
Very or fairly easy | 145 (21.8) | 47 (17.7) | 60 (22.3) | 38 (29.0) | |
Hemodialysis vintage, years (Median, IQR) | 4.4 (2.2, 7.9) | 4.4 (2.4, 7.9) | 4.4 (2.4, 8.2) | 4.2 (2.0, 7.9) | 0.966 b |
Clinical Parameters | |||||
S-COVID-19-S | 0.057 a | ||||
Without S-COVID-19-S | 204 (30.2) | 94 (35.2) | 77 (28.1) | 33 (24.6) | |
With S-COVID-19-S | 471 (69.8) | 173 (64.8) | 197 (71.9) | 101 (74.4) | |
Rheumatoid arthritis | <0.001 a | ||||
No | 606 (89.8) | 251 (94.0) | 248 (90.5) | 107 (79.9) | |
Yes | 69 (10.2) | 16 (6.0) | 26 (9.5) | 27 (20.1) | |
Stomach ulcers | 0.068 a | ||||
No | 538 (79.7) | 224 (83.9) | 208 (75.9) | 106 (79.1) | |
Yes | 137 (20.3) | 43 (16.1) | 66 (24.1) | 28 (20.9) | |
Diuretic usage | 0.002 a | ||||
No | 351 (73.1) | 156 (81.3) | 135 (69.9) | 60 (63.2) | |
Yes | 129 (26.9) | 36 (18.8) | 58 (30.1) | 35 (36.8) | |
HBsAg | 0.853 a | ||||
Negative | 425 (91.6) | 164 (91.6) | 170 (90.9) | 91 (92.9) | |
Positive | 39 (8.4) | 15 (8.4) | 17 (9.1) | 7 (7.1) | |
HCV | 0.678 a | ||||
Negative | 330 (71.1) | 127 (70.9) | 130 (69.5) | 73 (74.5) | |
Positive | 134 (28.9) | 52 (29.1) | 57 (30.5) | 25 (25.5) | |
WC, cm (Mean ± SD) | 76.9 ± 9.9 | 78.9 ± 9.7 | 75.7 ± 9.8 | 75.5 ±10.4 | 0.001 c |
Biochemical parameters | |||||
Hb, g/dL (Median, IQR) | 9.7 (8.4, 11.1) | 9.8 (8.6, 11.1) | 9.8 (8.3, 11.3) | 9.4 (7.9, 10.7) | 0.064 b |
WBC, 103/μL (Median, IQR) | 5.9 (4.5, 7.3) | 5.8 (4.5, 7.0) | 6.0 (4.5, 7.5) | 6.0 (4.6, 7.4) | 0.606 b |
RBC, 106/μL (Median, IQR) | 3.3 (2.7, 3.7) | 3.3 (2.8, 3.8) | 3.3 (2.7, 3.8) | 3.1 (2.7, 3.7) | 0.593 b |
MCV, fL (Median, IQR) | 90.0 (83.0, 94.6) | 89.7 (83.4, 94.2) | 89.9 (80.7, 94.1) | 91.6 (85.3, 95.9) | 0.099 b |
Hct, % (Mean ± SD) | 30.0 ± 5.8 | 30.1 ± 5.3 | 30.5 ± 6.3 | 28.9 ± 5.7 | 0.095 c |
PLT, 103/μL (Median, IQR) | 205.0 (163.0, 245.0) | 197.0 (163.0, 236.0) | 206.0 (168.0, 252.0) | 208.0 (157.0, 251.0) | 0.200 b |
PO4, mg/dL (Median, IQR) | 1.8 (1.4, 2.6) | 1.8 (1.4, 2.4) | 1.7 (1.4, 2.8) | 2.0 (1.3, 3.4) | 0.800b |
PTH, pg/mL (Median, IQR) | 23.9 (16.4, 45.8) | 23.4 (16.5, 43.5) | 25.2 (14.1, 46.5) | 25.2 (19.1, 51.0) | 0.568 b |
K+, mEq/L (Mean ± SD) | 4.2 ± 0.9 | 4.2 ± 0.9 | 4.3 ± 0.9 | 4.2 ± 0.8 | 0.817 c |
Na+, mmol/L (Mean ± SD) | 135.9 ± 4.7 | 136.3 ± 3.1 | 135.7 ± 5.3 | 135.9 ± 5.9 | 0.518 c |
Cl−, mmol/L (Mean ± SD) | 97.8 ± 5.1 | 97.3 ± 4.4 | 97.9 ± 5.9 | 98.5 ± 4.7 | 0.193 c |
Albumin, mg/dL (Mean ± SD) | 38.7 ± 5.6 | 39.3 ± 6.3 | 38.7 ± 4.9 | 37.3 ± 5.6 | 0.047 c |
Physical activity, MET-min/wk | 0.895 a | ||||
Tertile 1 (MET ≤ 180) | 168 (33.5) | 67 (34.5) | 68 (33.0) | 33 (32.4) | |
Tertile 2 (180 < MET ≤ 723) | 164 (32.7) | 59 (30.4) | 72 (35.0) | 33 (32.4) | |
Tertile 3 (MET > 723) | 170 (33.9) | 68 (35.1) | 66 (32.0) | 36 (35.3) | |
Health/diet literacy and diet knowledge | |||||
HL index (Mean ± SD) | 25.2 ± 9.2 | 25.6 ± 8.6 | 22.9 ± 9.3 | 22.2 ± 9.3 | <0.001 c |
DDL index (Mean ± SD) | 24.1 ± 11.4 | 25.1 ± 11.1 | 21.2 ± 11.3 | 20.6 ± 1.7 | <0.001 c |
HDK (Mean ± SD) | 5.4 ± 2.5 | 5.2 ± 2.5 | 5.3 ± 2.4 | 5.3 ± 2.6 | 0.788 c |
Associated Factors | Medium Risk of Osteoporosis * | High Risk of Osteoporosis * | ||||||
---|---|---|---|---|---|---|---|---|
Unadjusted Model | Adjusted Model | Unadjusted Model | Adjusted Model | |||||
OR (95% CI) | p | OR (95% CI) | p | OR (95% CI) | p | OR (95% CI) | p | |
Socio-demographics | ||||||||
Gender | 1.00 | |||||||
Male | 1.00 | 1.00 | 1.00 | |||||
Female | 2.50 (1.77, 3.55) | <0.001 | 3.46 (1.86, 6.44) | <0.001 a | 4.19 (2.69, 6.54) | <0.001 | 6.86 (2.96, 15.88) | <0.001 a |
Education | ||||||||
Illiterate or elementary | 1.00 | 1.00 | 1.00 | 1.00 | ||||
Junior high school | 0.52 (0.35, 0.79) | 0.002 | 0.63 (0.33, 1.20) | 0.158 a | 0.37 (0.21, 0.63) | <0.001 | 0.37 (0.16, 0.88) | 0.025 a |
Senior high school or above | 0.63 (0.39, 1.01) | 0.054 | 1.02 (0.41, 2.53) | 0.963 a | 0.80 (0.47, 1.37) | 0.414 | 0.82 (0.27, 2.53) | 0.731 a |
Working status | ||||||||
Not working | 1.00 | 1.00 | ||||||
Working | 0.87 (0.62, 1.24) | 0.450 | 0.84 (0.55, 1.29) | 0.435 | ||||
Marital status | ||||||||
Without partner | 1.00 | 1.00 | 1.00 | |||||
With partner | 0.61 (0.30, 1.24) | 0.173 | 0.82 (0.09, 6.97) | 0.817 a | 0.33 (0.15, 0.69) | 0.003 | 0.60 (0.06, 6.46) | 0.674 a |
Social status | ||||||||
Low | 1.00 | 1.00 | 1.00 | 1.00 | ||||
Middle and high | 0.75 (0.52, 0.09) | 0.132 | 1.15 (0.60, 2.23) | 0.673 a | 0.84 (0.53, 1.32) | 0.442 | 1.07 (0.46, 2.50) | 0.874 a |
Medication payment ability | ||||||||
Very or fairly difficult | 1.00 | 1.00 | 1.00 | 1.00 | ||||
Very or fairly easy | 1.34 (0.87, 2.05) | 0.181 | 1.63 (0.69, 3.84) | 0.265 a | 1.90 (1.16, 3.11) | 0.010 | 0.98 (0.32, 2.97) | 0.968 a |
Hemodialysis vintage, years | 1.01 (0.97, 1.05) | 0.620 | 0.99 (0.94, 1.04) | 0.609 | ||||
Clinical parameters | ||||||||
S-COVID-19-S | ||||||||
Without S-COVID-19-S | 1.00 | 1.00 | 1.00 | 1.00 | ||||
With S-COVID-19-S | 1.39 (0.97, 2.00) | 0.076 | 1.18 (0.62, 2.24) | 0.620 b | 1.66 (1.04, 2.65) | 0.033 | 2.37 (0.93, 6.07) | 0.071 b |
Rheumatoid arthritis | ||||||||
No | 1.00 | 1.00 | 1.00 | 1.00 | ||||
Yes | 1.65 (0.86, 3.14) | 0.132 | 0.92 (0.37, 2.33) | 0.865 b | 3.96 (2.05, 7.65) | <0.001 | 4.37 (1.67, 11.52) | 0.003 b |
Stomach ulcers | ||||||||
No | 1.00 | 1.00 | 1.00 | 1.00 | ||||
Yes | 1.65 (1.08, 2.54) | 0.021 | 1.95 (1.01, 3.77) | 0.048 b | 1.38 (0.81, 2.34) | 0.237 | 1.53 (0.66, 3.54) | 0.322 b |
Diuretic usage | ||||||||
No | 1.00 | 1.00 | 1.00 | 1.00 | ||||
Yes | 1.86 (1.16, 2.99) | 0.010 | 1.22 (0.63, 2.34) | 0.562 b | 2.53 (1.46, 4.39) | 0.001 | 2.19 (0.99, 4.86) | 0.053 b |
HBsAg | ||||||||
Negative | 1.00 | 1.00 | ||||||
Positive | 1.09 (0.53, 2.26) | 0.810 | 0.84 (0.33, 2.14) | 0.716 | ||||
HCV | ||||||||
Negative | 1.00 | 1.00 | ||||||
Positive | 1.07 (0.68, 1.68) | 0.765 | 0.84 (0.48, 1.46) | 0.530 | ||||
WC | 0.97 (0.95, 0.99) | 0.001 | 0.95 (0.92, 0.98) | 0.004 b | 0.97 (0.94, 0.99) | 0.008 | 0.93 (0.89, 0.97) | 0.001 b |
Biochemical parameters | ||||||||
Hb | 0.99 (0.87, 1.09) | 0.779 | 0.98 (0.86, 1.13) | 0.802 c | 0.85 (0.75, 0.97) | 0.017 | 0.79 (0.66, 0.95) | 0.014 c |
WBC | 1.05 (0.97, 1.14) | 0.248 | 1.06 (0.96, 1.18) | 0.266 | ||||
RBC | 1.07 (0.85, 1.35) | 0.569 | 0.89 (0.66, 1,21) | 0.465 | ||||
MCV | 0.99 (0.98, 1.01) | 0.814 | 0.99 (0.97, 1.01) | 0.411 c | 1.02 (0.99, 1.04) | 0.124 | 1.01 (0.98, 1.04) | 0.549 c |
Hct | 1.01 (0.98, 1.05) | 0.592 | 1.01 (0.97, 1.06) | 0.679 c | 0.96 (0.92, 1.01) | 0.089 | 0.95 (0.92, 0.99) | 0.041 c |
PLT | 1.01 (0.99, 1.01) | 0.221 | 1.01 (0.99, 1.01) | 0.441 | ||||
PO4 | 1.08 (0.89, 1.32) | 0.435 | 1.06 (0.84, 1.35) | 0.610 | ||||
PTH | 1.01 (0.98, 1.02) | 0.876 | 1.01 (0.99, 1.03) | 0.311 | ||||
K+ | 1.09 (0.84, 1.40) | 0.524 | 1.05 (0.77, 1.43) | 0.768 | ||||
Na+ | 0.97 (0.92, 1.02) | 0.257 | 0.98 (0.92, 1.04) | 0.506 | ||||
Cl− | 1.03 (0.98, 1.08) | 0.200 | 1.02 (0.96, 1.07) | 0.538 c | 1.05 (0.99, 1.11) | 0.083 | 1.02 (0.96, 1.10) | 0.503 c |
Albumin | 0.98 (0.96, 1.02) | 0.395 | 0.98 (0.91, 1.05) | 0.286 c | 0.93 (0.88, 0.98) | 0.012 | 0.91 (0.83, 0.99) | 0.030 c |
Physical activity | ||||||||
Tertile 1 (MET ≤ 180) | 1.00 | 1.00 | ||||||
Tertile 2 (180 < MET ≤ 723) | 1.20 (0.74, 1.95) | 0.454 | 1.14 (0.63, 2.06) | 0.676 | ||||
Tertile 3 (MET > 723) | 0.96 (0.59, 1.54) | 0.855 | 1.08 (0.60, 1.92) | 0.807 | ||||
Health/diet literacy and diet knowledge | ||||||||
HL index | 0.97 (0.95, 0.99) | 0.001 | 0.92 (0.88, 0.96) | <0.001 d | 0.96 (0.94, 0.98) | 0.001 | 0.89 (0.84, 0.94) | <0.001 c |
DDL index | 0.97 (0.95, 0.98) | <0.001 | 0.96 (0.93, 0.99) | 0.017 d | 0.97 (0.95, 0.98) | <0.001 | 0.95 (0.91, 0.99) | 0.008 c |
HDK | 1.02 (0.95, 1.09) | 0.668 | 1.03 (0.95, 1.12) | 0.502 |
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Le, L.T.H.; Dang, L.T.; Wang, T.-J.; Do, T.G.; Nguyen, D.H.; Hoang, T.A.; Pham, M.D.; Do, B.N.; Nguyen, H.C.; Tran, T.T.; et al. Osteoporosis Risk in Hemodialysis Patients: The Roles of Gender, Comorbidities, Biochemical Parameters, Health and Diet Literacy. Nutrients 2022, 14, 5122. https://doi.org/10.3390/nu14235122
Le LTH, Dang LT, Wang T-J, Do TG, Nguyen DH, Hoang TA, Pham MD, Do BN, Nguyen HC, Tran TT, et al. Osteoporosis Risk in Hemodialysis Patients: The Roles of Gender, Comorbidities, Biochemical Parameters, Health and Diet Literacy. Nutrients. 2022; 14(23):5122. https://doi.org/10.3390/nu14235122
Chicago/Turabian StyleLe, Lan T. H., Loan T. Dang, Tsae-Jyy Wang, Tuyen G. Do, Dung H. Nguyen, Trung A. Hoang, Minh D. Pham, Binh N. Do, Hoang C. Nguyen, Tu T. Tran, and et al. 2022. "Osteoporosis Risk in Hemodialysis Patients: The Roles of Gender, Comorbidities, Biochemical Parameters, Health and Diet Literacy" Nutrients 14, no. 23: 5122. https://doi.org/10.3390/nu14235122