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Journal of Nutritional Health & Food Science

Research Article

Open AccessSeasonal Variation of Nutritional Intake from 24-HourUrine Collection and Adherence in Patients with Chronic
Kidney Disease
Rie Onda1, Yume Nagaoka2, Yoshitaka Miyaoka2, Tomonari Okada2, Asako Gondo2, Miho Nagai2, Eiichiro Kanda3,
Yoshihiko Kanno2
1

Department of Clinical Nutrition and Dietetics, Kagawa Nutrition University, Sakado, Japan2

Department of Nephrology, Tokyo Medical University, Japan

3

Medical Science, Kawasaki Medical School, Okayama, Japan

Received: 18 November, 2019; Accepted: 28 December, 2019; Published: 7 January, 2020
*Corresponding author: Yoshihiko kanno, Department of Nephrology, Tokyo Medical University, 6-7-1 Nish iShinjuku, Shinjuku, Tokyo 1600023,
Japan, Tel: +81-33342-6111 exe.5000, E-mail: kannoyh@tokyo-med.ac.jp

Abstract
Background: For appropriate diet therapy, it is desirable to determine urine volume and excreted urinary components using 24-hour urine
volume (24hUV) and compare these data with indications. 24hUV allows an accurate measurement of excreted urinary protein, glucose, and salt
per day, which are important for assessment of renal function and diet intake. In particular, urine volume may be seasonal variations because of theeffect of perspiration.

Methods: The subjects were 37 (29 males and 8 females) outpatients with chronic kidney disease (CKD) who underwent 24-hour urine
collection and were given nutrition education (consultation) continuously for 2 years or more. The survey period was January 2012 to July 2014.
Patients were divided into 3groups according to their adherence to indicated intake as A, <15% difference, B, ≥15%.
Results: There was no significant difference in 24hUV and urinalysis between seasons. Mean Na throughout the year was 82±29 mEq/L, andMean K throughout the year was 20.4±9.4 mEq/L. Estimated protein and salt intake were lower in group A throughout the year.
Conclusion: Urine 24hUV and urinalysis were not influenced by seasonal variations, and these findings were due to the influence of diet intake.
Key Word: diet therapy; estimated intake; protein; salt; energy

Introduction

Protein intake restriction is widely used in patients withrenal impairment as therapy for inhibiting disease progression.
A low-protein diet inhibits progression of renal impairment andintroduction of dialysis through relief of uremia and release from
Glomerular hyper filtration [1, 2]. Effects of renin-angiotensin
system inhibitors, sodium bicarbonate and phosphorus
adsorbents have also been found and these drugs are widelyused; however, protein intake restriction remains important,and is described and recommended in worldwide and Japaneseguidelines [3]. Salt intake restriction is involved in prevention of
hypertension and cardiovascular disease in patients with Chronic
Kidney Disease (CKD). In patients with chronic nephritis anddiabetic nephropathy, salt intake correlates with excreted urine
protein, and salt intake restriction has been suggested to degrade
progression of nephropathy [4].
Given the above findings, it is important for patients with CKD
to have a diet that focuses on protein and salt intake restriction.
For appropriate diet therapy, it is desirable to determine urine
volume and excreted urinary components using 24-hour urine
volume (24hUV) and compare these data with indications [5].
Such assessment and estimation using spot urine is possible, but
Symbiosis Group

most urinary components increase during the day and decreaseat night, and are influenced by diet, posture and movement.
Kawasaki et, al. examined salt intake using spot urine, and foundthat the T method was most accurate for estimating excreted
urinary sodium using urine during a hospital visit. However, thedifference between estimation of excreted urinary sodium andsalt intake exceeding 2 g/day was 45% in all tests, which indicatesa problem obtaining accurate data [6]. In contrast, 24hUV allows
an accurate measurement of excreted urine volume, urine protein
and urine glucose per day, which are important for accurate
assessment of renal function and diet intake [7]. However, 24hUV
may be a cause of nosocomial infection and many specialists do
not use this approach because of an increased burden on patients[8, 9].
Estimation of dietary intake is limited because salt intake
per day cannot be accurately determined due to acute changes
in salt intake, severe diarrhea and vomiting, and the start ordiscontinuation of diuretics. Spot 24hUV in healthy subjects has
been shown not to match mean daily sodium excretion [10]. In
particular, urine volume depends on perspiration volume andthere may be seasonal variations in urine volume [11]. Few
studies have examined the relationship of 24hUV with seasonal*Corresponding author email: kannoyh@tokyo-med.ac.jp

Seasonal Variation of Nutritional Intake from 24-Hour Urine Collection and Adherence in Patients with Chronic Kidney Diseasevariations in patients with CKD, but accurate assessment throughimprovement of the accuracy of 24hUV test is necessary toestablish appropriate diet therapy in these patients.

Methods

The subjects were male and female outpatients with CKD who
underwent 24-hour urine collection and were given nutrition
education (consultation) continuously for 2 years or more. The
survey period was 2 months from July to August 2014 and clinicaldata were obtained from medical records of 201 patients (127males and 74 females) for 2 years from January 2012 to July
2014. Of these patients, the subjects in the final analysis were 37
patients (29 males and 8 females) with data for four seasons fromJanuary 2012 to July 2014.

Sex, age, height, body weight, systolic blood pressure (SBP)
and diastolic blood pressure (DBP) were collected on the survey,
and primary disease, complications, diuretics and prescription
data were obtained from clinical records. Body mass index (BMI)
was calculated from height and body weight. Blood and urine data
determined at the beginning of the survey in July 2014 were also
taken from clinical records. The hematological and biochemical
test data included Red Blood Cell Count (RBC), Hemoglobin(Hb), Hematocrit (Ht), White Blood Cell Count (WBC), Platelet
Count (Plt), Total Protein (TP), Serum Albumin (Alb), Total
Cholesterol (TC), Low-Density Lipoprotein Cholesterol (LDL-C),
Fasting Plasma Glucose (FPG), Gamma-Glutamyl Transpeptidase(γ-GTP), Blood Urea Nitrogen (BUN), Serum Creatinine (Cr),Uric Acid (UA), Estimated Glomerular Filtration Rate (eGFR),
Serum Sodium (Na), Serum Potassium (K), Calcium (Ca), Serum
Inorganic Phosphorus (P), Voluntary Cr (Spot Urine), and Urine
Protein (UP) (spot urine).
Blood pressure, hematology, urine volume and urinalysis
data from January 2012 to July 2014 were obtained from clinicalrecords. These data included SBP, DBP, WBC, TP, Alb, BUN, Cr,
UA, TC, triglyceride (TG), hemoglobin A1c using the National
Glycohemoglobin Standardization Program (HbA1c (NGSP)), Na,
K, Ca and P. The urine data included 24hUV, UP, urea nitrogen(UN), Cr, UA, Na, K and P.

Indicated energy per day (E: kcal), E intake (kcal), E
assessment, indicated protein (Pro: g), Pro intake (g), Pro
assessment, indicated salt (NaCl: g), NaCl intake (g) and NaClassessment were obtained from nutrition education records.
E, Pro and NaCl were assessed from the difference between
the indication and intake, with groups defined based on thisdifference as A, <15%; B, ≥15%. Patients in group A had good
adherence to diet and those in group BC had poorer adherence.
Nutrition education was offered as close as possible to tests
for blood pressure, hematology, urine volume and urinalysis
within the same season. Four seasons were chosen before July
2014, the date of the survey. The classification of seasons referredto the website of the Japan Meteorological Agency: 3 months (Julyto September) with a high mean temperature in 2012 and 2013
were defined as summer, 3 months (December to February) with

Copyright:© 2019 Kanno Y, et al.

a low temperature were defined as winter, and then March to June
was defined as spring, and October to November as autumn [12].

Characteristics of patients and test results for blood pressure,hematology, urine volume and urinalysis are shown as mean ±standard deviation or with a range (minimum to maximum).
The number and percentage of patients for primary disease,
complications and prescribed diuretics are shown in crosstabulations. Statistical analysis was performed using “4 Step
Excel Statistics” (OMS publishing Inc.). Results for blood pressure,hematology, 24hUV and urinalysis by season were analyzed by
one-way analysis of variance, Kruskal-Wallis test and multiple
comparisons. The same results and adherence to the indicateddiet were analyzed by two-way analysis of variance for repeatedmeasures. Differences in test results by adherence were analyzed
by F test. The significance level was 5% in all statistical tests.
This study was approved by the research ethics committeeof Tokyo Medical University (No. 2716, June 3, 2014). Patientswere informed by attending physicians that information inclinical records could be used in a study. Information was posted
in the outpatient department stating that patients could exclude
themselves from the study based on their decision or that of theirfamily. The study results are presented as tables with eliminationof personal information.

Results

The characteristics of the patients are shown in Table 1.
The mean age of the subjects in the survey was 67±11 years old(range: 37 to 88 years), mean BMI was 24.2±3.3 kg/m2 (19.0 to
30.6 kg/m2), and obesity assessed by BMI was normal, but 15(41%) subjects were considered to be obese based on BMI ≥25.0
kg/m2 and no subject was lean [13]. Mean SBP was 129±16mmHg (88 to 185 mmHg) and mean DBP was 73±10 mmHg (44to 109 mmHg), which is within the hypotensive goal for patientswith CKD (SBP: 130 mmHg, DBP: 80 mmHg) [14].
The major primary disease was glomerulonephritis in 16(43%) subjects, followed by diabetic nephropathy in 11 (30%),connective tissue disease in 6 (16%), nephrotic syndrome in 4(11%), nephrosclerosis in 3 (8%), and renal artery stenosis in
2 (5%). The major complication was hypertension in 35 (95%)
subjects, followed by dyslipidemia and diabetes mellitus in 21(57%), hyperuricemia in 19 (51%), and renal anemia 17 (46%).

Diuretics were prescribed in 12 subjects (33%) in spring, 12(32%) in summer, 11 (29%) in autumn, and 10 (26%) in winter;and all were given as monotherapy. Furosemide was prescribedin 4 subjects (11%) in spring and 3 (8%) in summer, autumn andwinter. Azosemide was prescribed in 3 (8%) in spring, summer
and winter, and 2 (5%) in autumn. Trichlormethiazide wasprescribed in 3 (8%) in spring, summer and autumn, and 2 (5%)
in winter. Blood and urine data determined at the beginning ofsurvey are shown in Table 2.
Results for 24hUV and urinalysis by season are shownin Table 3. There was no significant difference in 24hUV and

Citation: Kanno H, Onda R, Nagaoka Y, Miyaoka Y, Okada T, et al. (2019) Seasonal Variation of Nutritional Intake from 24-HourUrine Collection and Adherence in Patients with Chronic Kidney Disease. J Nutrition Health Food Sci 7(4):1-9. DOI: 10.15226/
jnhfs.2019.001167

Page 2 of 6

Copyright:© 2019 Kanno Y, et al.

Seasonal Variation of Nutritional Intake from 24-Hour Urine Collection and Adherence in Patients with Chronic Kidney Disease

Table 1: Patients profile

Age(years old)

Weight(kg)

Height
BMI
SBP

DBP

(cm)

(kg/m2)(mmHg)(mmHg)

Total(n=37)

Table 2: Clinical laboratory data of the patients at registration

M

±

SD

Max

Min

164.1

±

6.7

174.5

152.0

67

65.3
24.2
129
73

±
±
±
±
±

11

10.6
3.3
16
10

88

92.0
30.6
185
109

37

45.0
19.0
88
44

urinalysis between seasons. The mean 24hUV was 1785±491
mL/day throughout the year, 1850±446 mL/day in spring,1690±479 mL/day in summer, 1785±576 mL/day in autumn, and
1815±457 mL/day in winter. All these volumes were higher than
the reference range of 1500 mL/day [15]. Mean Na throughout
the year was 82±29 mEq/L, within the reference range of 40-90
mEq/L. Mean K throughout the year was 20.4±9.4 mEq/L, which
was also within the reference range of 20-60 mEq/L except insummer [16].
Results for 24hUV and urinalysis by season and adherence tothe indicated E are shown in Table 4. There was no significant
difference in 24hUV and urinalysis by season and adherence toindicated E among seasons. In comparison by adherence to the E
indication, UN in Group A was 281±118 mg/dL in spring, 300±121mg/dL in summer, 329±166 mg/dL in autumn, and 290±120 mg/
dL in winter, while UN in Group B was 429±169 mg/dL in spring,
376±160 mg/dL in summer, 378±157 mg/dL in autumn, and
390±124 mg/dL in winter. Thus, UN in Group A was significantly
lower in all seasons (p<0.001). Similarly, urine K in Group A wasall significantly lower than those in Group B. Variance of all was
significantly higher in Group A than in Group B.
Results for 24hUV and urinalysis by season and adherence tothe indicated Pro are shown in Table 5. There was no significant
difference in 24hUV and urinalysis by season and adherence to
Pro indication among seasons. In comparison by adherence to
Pro indication, UN in Group A was significantly lower than thosein Group B, and urine Na and K in Group A in all seasons weresignificantly lower than those in Group B. Variance of 24hUV in
autumn was significantly higher in Group A than in Group B.

Results for 24hUV and urinalysis by season and adherence
to indicated NaCl are shown in Table 6. There was no significant
difference in 24hUV and urinalysis by Season and adherence to
NaCl indication among seasons. In comparison by adherence to
NaCl indication, UN, urine Na, K in all seasons in Group A weresignificantly lower than those in Group B.

Total(n=37)

RBC(×10²/μL)

Ht

(%)

Hb

WBC
PLt
TP

Alb
TC

LDL-C
FPG

γ-GTP
BUN
Cr

UA

eGFR
Na
K

Ca
P

Cr(spot urine)TP(spot urine)

3.9(mg/dL)181(mg/dL)97(mg/dL)

129

(U/L)

29

(mg/dL)38.4(mg/dL)

3.22(mL/min/1.73m )(mg/dL)(mg/dL)

Discussion

1.7

6.7

(g/dL)(mg/dL)±

200.7(g/dL)(mg/dL)

11.8
6.0(×10²/μL)(mEq/L)SD

35.0(×10³/μL)(mEq/L)±

3.8(g/dL)(mg/dL)

M

2

7.0
22

141
4.7
8.6
3.7

89.6
117

±
±
±
±
±
±
±
±
±
±
±
±
±
±
±
±
±
±
±
±

0.6
4.8
1.7

72.0
0.4
0.4
35
25
61
18

18.2
1.88
1.3
16
2

0.6
0.5
0.7

34.1
102

Seasonal variations of blood pressure, hematology, 24hUV
and excreted urinary components and the relationship withadherence to diet therapy in patients with CKD were examinedin this study. The mean age of the subjects was 67±11 years old,
and the accuracy of 24hUV in such elderly patients is likely to be
low, which may cause errors in the results. However, the subjects
measured 24hUV for 2 years or longer; therefore, they were apopulation with a good technique of urine collection with lesserror. There were no significant differences in blood pressure,hematology, urine volume, and urinalysis by season. These
results show that the test data determined by 24hUV in patientswith CKD were not influenced by seasonal variations.
There were seasonal variations of blood pressure, hematology,
urine volume and urinalysis, and adherence to diet indication. For
adherence to the energy indication, BUN, urine UN, K in GroupA were significantly lower than those in Group B, and Na also
showed a decreasing tendency. These results show that subjects
with good adherence to the indicated energy had low excreted
urinary components. Energy intake in Group B varied, which

Citation: Kanno H, Onda R, Nagaoka Y, Miyaoka Y, Okada T, et al. (2019) Seasonal Variation of Nutritional Intake from 24-HourUrine Collection and Adherence in Patients with Chronic Kidney Disease. J Nutrition Health Food Sci 7(4):1-9. DOI: 10.15226/
jnhfs.2019.001167

Page 3 of 6

Copyright:© 2019 Kanno Y, et al.

Seasonal Variation of Nutritional Intake from 24-Hour Urine Collection and Adherence in Patients with Chronic Kidney Disease

Table 3: 24hUV and urinalysis by season

M
(mL/

24hUV

day)

±

SD

Max

Min

M

1785

±

491

2910

570

71

±

64

290

0

±

21.4

135.7

±

29

173

TP

(mg/dL)Cr(mg/dL)

66.0

Na(mEq/L)82

P(mg/dL)UN

UA

K(mg/dL)(mg/dL)(mEq/L)

Total(n=37×4)

355

15.1

20.4
31.3

±

±

±
±

149

8.3

9.4

13.7

838

45.2

61.3

113.8

Spring(n=37)
±

SD

Max

Min

M

1850

±

446

2710

970

75

±

63

262

0

23.0

64.6

±

20.6

115.5

26

82

±

30

146

70

4.2

6.5

13.2

361

±

15.0

164

±

20.5

8.9

±

32.3

822

43.2

11.0

±

61.3

17.5

113.8

Summer(n=37)
±

SD

Max

Min

M

1690

±

479

2910

990

62

±

57

239

0

34.3

69.8

±

23.2

128.4

37

79

±

29

135

82

5.0

6.5

14.2

335

14.8

19.9
30.5

±

143

±

838

7.1

±

7.8

±

10.9

SD

Max

Min

M

±

SD

Max

Min

1785

±

576

2900

570

1815

±

457

2780

1150

0.370

70

±

65

253

0

78

±

73

290

0

0.647

25.9

65.8

±

22.6

135.7

30.3

63.8

±

19.2

113.1

23.0

0.728

30

80

±

30

173

26

85

±

27

140

41

360

4.2

35.8

±

16.2

6.5

60.2

±

20.2

13.7

±

31.5

±

There was no significant difference (probability <0.05) in all measured items among 4 seasons
Table 4: 24hUV and urinalysis by season and adherence to the indicated energy
Adherencegroup

Total(A=60 B=88)
M

24hUV

(mL/
day)

A

1822

UN

(mg/dL)

A

299.9

Na

(mEq/L)A

76

K(mEq/L)

A

*

B
B
B
B

±

1759

±

466

±

129.6

±

29

±

393.0

±

85

SD

149.4
28

±

17.1

6.8

±

22.6

0.368

508

±

10.3

express comparison between A and B

pvalue
*

0.001
0.054
0.001

Spring(A=17
B=20)
M

±

2018
1707
429

342

1680

±

118

300

±

67

±

95

7.7

±

Total(A=58
B=90)

M

24hUV

(mL/
day)

A

1746

UN

(mg/dL)

A

275

Na

(mEq/L)A

K(mEq/L)

A

*

B
B
B
B

1810
407
67
91

17.4
22.3

express comparison between A and B

±

SD

±

421

±

143

±
±
±
±
±
±

532
128
26
26

8.5
9.5

P value*

0.519<0.001<0.001<0.001

Spring(A=17
B=20)

M

1835
1863
301
413
69
94

18.2
22.4

±

SD

M

180

256

±
±
±
±

30
27

10.8
11.1

8.2

90.2

20.9

13.2

31.0

M

±

121

329

±

±

512
160
31
29

7.3
7.7

±

1775

290

±

±

18.6

±

21.1

M

166
157
33
29

6.1

12.0

1680
388
68
87

17.0
21.8

±

SD

M

±

473

1626

±

108

291

±
±
±
±
±
±

494
141
30
27

6.5
8.2

1893
406
66
89

18.2
21.5

±

SD

1819
390
80
86

15.5
22.7

M

±

348

1826

±

169

240

±
±
±
±
±
±

676
139
26
29

9.6

10.6

7.8

57.2

±

SD

±

566

±

120

±
±
±
±

±
±

429
124
26
27

4.9
8.7

1810
419
64
93

15.4
23.3

±

SD

±

445

±

75

±

471

±

108

±

25

±
±
±

Citation: Kanno H, Onda R, Nagaoka Y, Miyaoka Y, Okada T, et al. (2019) Seasonal Variation of Nutritional Intake from 24-HourUrine Collection and Adherence in Patients with Chronic Kidney Disease. J Nutrition Health Food Sci 7(4):1-9. DOI: 10.15226/
jnhfs.2019.001167

19

5.6
8.5

0.764

0.993
0.763

15.2

Winter(A=9
B=28)

±

629

4.2

51.4

10.7

1804

±

79

±

value*

129

35.1

8.5

498

±

80

±

613

7.0

±
±

378

SD

±

129

Winter(A=11
B:26)

±

132

14.4

±

Autumn(A=15
B=22)

1705

±

5.3

56.6

15.1

366

Summer(A=15
B=22)

421
476

10.2

1800

±

22.7

±
±

122

45.2

462

±

17.5

SD

Table 5: 24hUV and urinalysis by season and adherence to the indicated protein intake
Adherence
group

10.1

±

±

80

12.3

±

±

79

27

±

24.0

376

27

±

16.4

1702

169

694

Autumn(A=14
B=23)

M

481

160

Summer(A=20
B=17)

±
±

281

SD

p

±

70

32.5

Winter(n=37)

Autumn(n=37)

0.823
0.977

pvalue*0.446<0.001
0.060<0.001

P value*

0.441<0.001<0.001
0.002

Page 4 of 6

Copyright:© 2019 Kanno Y, et al.

Seasonal Variation of Nutritional Intake from 24-Hour Urine Collection and Adherence in Patients with Chronic Kidney Disease

Table 6: 24hUV and urinalysis by season and adherence to indicated NaCl
Adherencegroup

Total(A=58
B:90)

M

±

1811

±

24hUV

(mL/
day)

A

1744

UN

(mg/dL)

A

269

Na

(mEq/L)A

K(mEq/L)

A

*

B
B
B
B

411
64
93

16.8
22.7

express comparison between A and B

SD

Spring(A=12
B=25)

Summer(A=18
B=19)

Autumn(A=16
B=21)

Winter(A=12
B=25)

0.421

1932
255

p
value *

±

450

±

114

<0.00125<0.001

6.7<0.001

±
±
±
±
±

516
142
25

10.1

M

±

1811

±

412
60
93

14.3
23.5

SD

M

±

1721

±

±

394

1658

±

122

277

±
±
±
±
±

suggests that these subjects mixed excessive and low energy
intake. Consequently, there was no significant difference inenergy intake between Groups A and B.

For adherence to protein indication, WBC, BUN, TC, LDL-C,
UP, UN, UA, Na, K and P in Group A were significantly lower
than those in Group B. These results show that good adherence
to the indicated protein kept excreted urinary components low.
Protein intake in Group A was significantly lower than that inGroup B (34±8 vs. 51±11 g/day). Thus, protein intake in GroupB was excessive, which led to high BUN, UN, K and P. There wasno significant difference in urine Cr by adherence to protein
indication. An increase or decrease in urine Cr does not dependon diet or urine volume, but urine Cr is proportional to muscle
development and momentum [13]. However, these results showthat Cr is independent of protein intake.

For adherence to the salt indication, WBC, BUN, TC, LDL-C,
UP, UN, UA, Na, K and P in Group A were significantly lower thanthose in Group B. These results show that good adherence tothe salt indication maintained a low level of excreted urinary
components. It is notable that items with a significant difference
between Groups A and B by adherence to the salt indication were
almost the same as those by adherence to the protein indication.
In healthy subjects, energy correlates strongly with salt intake
and there is a relationship between salt and protein intake [14].
Based on these results, good adherence to protein indication
appears to be proportional to that for salt indication, leading tosimilar results for excreted urine components.
The results of this study show that blood pressure, hematology,
24hUV and urinalysis in patients with CKD did not show seasonalvariations, and it suggested diet intake of the subjects were stablethroughout year. Healthy subjects have seasonal variety of foodintake in daily life, but nutrients except vitamin C and iron haveno seasonal variation [15]. Diet intake may effect on urine volume
by amount of water intake, but water intake obtained from diet in

472
158
24
27

5.9

11.7

389
66
92

18.4
21.2

SD

M

±

1805

±

±

480

1758

±

123

259

±
±
±
±
±

489
142
29
24

7.9
7.7

436
61
94

15.7
23.6

SD

M

±

1885

±

±

540

1669

±

119

282

±
±
±
±
±

613
146
23
26

5.4

11.7

406
71
91

18.1
22.3

SD

p value *

±

286

±

95

<0.00124<0.001

7.2<0.001

510

±

125

±

25

±
±
±

8.9

0.425

healthy elderly people has been shown not to change in summer
and winter [16, 17]. Subjects in Group A were in compliancewith the dietary indication and the mean age was 67±11 years
old; therefore, seasonal variations due to diet appeared to be few,
similarly to the results of the previous study. The subjects in thisstudy were given nutrition education continuously for 2 years or
more, and this may have kept a stable dietary intake, leading toless seasonal variation. Dietary intake in Group A was close to
the indication throughout the year. Based on the above, 24hUV inpatients who maintain appropriate diet therapy shows accurate
dietary contents.
A several limitations are considered in this study. First, thepatients recruited in this study were well-trained to our procedure
to 24h urine collection. Therefore, the present results may not beapplied to the general patients. Secondly season was defined bycalendar month. Temperature and humidity that relate much to
sweating were not considered in data analysis.

Conclusion

This study was conducted to examine seasonal variationsof blood pressure, hematology, 24hUV, excreted urinary
components, and their relation with adherence to diet therapy
in patients with CKD. The results showed that blood pressure,hematology, urine 24hUV and urinalysis were not influenced byseasonal variations, and these findings were due to the influenceof diet. In patients with CKD who require diet therapy, diet isstable throughout the year, and consequently, urine volume andexcreted urinary components showed no seasonal variations. On
the other hand, some hematology items depended on adherence
to diet therapy, and these results in Group A with good adherence
were significantly lower than those in Group BC. Dietary intake
in Group A was close to the diet indication throughout the year.
Based on these findings, hematology determined by 24hUV inpatients who maintain an appropriate diet gives accurate dietary
contents.

Citation: Kanno H, Onda R, Nagaoka Y, Miyaoka Y, Okada T, et al. (2019) Seasonal Variation of Nutritional Intake from 24-HourUrine Collection and Adherence in Patients with Chronic Kidney Disease. J Nutrition Health Food Sci 7(4):1-9. DOI: 10.15226/
jnhfs.2019.001167

Page 5 of 6

Seasonal Variation of Nutritional Intake from 24-Hour Urine Collection and Adherence in Patients with Chronic Kidney Disease

Funding Statement
No financial grants and other funding to be disclosed.

Acknowledgement

We wish to express our appreciation to Miho Inoue, Haruka
Kudo, and Chie Miyata, Kagawa Nutrition University, for theirsupports in data processing.

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Citation: Kanno H, Onda R, Nagaoka Y, Miyaoka Y, Okada T, et al. (2019) Seasonal Variation of Nutritional Intake from 24-HourUrine Collection and Adherence in Patients with Chronic Kidney Disease. J Nutrition Health Food Sci 7(4):1-9. DOI: 10.15226/
jnhfs.2019.001167

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