Clin J Am Soc Nephrol. 2025 Sep 5. doi: 10.2215/CJN.0000000811. Online ahead of print.
ABSTRACT
BACKGROUND: Children with chronic kidney disease (CKD) experience poor growth and development via multiple mechanisms. We aimed to describe deficiencies in dietary micronutrient intake and associate dietary micronutrient intake with metabolic pathways.
METHODS: The Chronic Kidney Disease in Children cohort study enrolled participants six months to 16 years with CKD stage 2-4 across North America. Micronutrient intake (three trace minerals, eight water-soluble vitamins, four fat-soluble vitamins) was quantified by food frequency questionnaires at six-month, two- and four-year visits. Blood was collected at those timepoints for untargeted metabolomic profiling. Associations between 990 plasma metabolite features and dietary micronutrient intake were quantified with multiple linear regression using mixed effects regression models.
RESULTS: There were 575 participants with available data at the 6-month visit (mean age 12 years, 39% female, estimated glomerular filtration rate 53 ml/min/1.73 m2, body mass index Z-score 0.7). The most common deficiency of micronutrient intake was vitamin D (90% of participants), followed by Vitamin E (77%), and more than 45% of participants did not meet the dietary reference intake (DRI) of iron and folate. Children with lower eGFR had lower intake of zinc and vitamins B5 and B6. Micronutrient intake was associated with 99 total and 42 unique metabolites. Dietary intake of vitamins D and B12 were associated with many metabolites involved in lipid superpathways and phosphatidylcholine, plasmalogen, and lysophospholipid subpathways. Dietary intake of iron, folate, vitamins C, A, and K were associated with metabolites primarily belonging to the xenobiotic, cofactor/vitamin, and amino acid superpathways. The strongest associations between dietary micronutrient intake and plasma metabolites were between intake of vitamin C with stachydrine and 3-hydroxystachydrine.
CONCLUSION: The majority of children with CKD have intake below dietary reference intake of at least one micronutrient despite normal BMI, which was associated with alterations in lipid metabolism.
PMID:40911368 | DOI:10.2215/CJN.0000000811
