Ratio of dietary ω-3 and ω-6 fatty acids—independent determinants of muscle mass—in hemodialysis patients with diabetes

Objective: n-3 and n-6 polyunsaturated fatty acids (PUFAs) are essential nutrients in the human diet and possibly affect muscle mass. We evaluated the association between the dietary ratios of n-3 and n-6 PUFAs and muscle mass, indicated as skeletal muscle mass (SMM) and appendicular skeletal muscle mass (ASM), in patients with diabetes undergoing hemodialysis (HD). Methods: In this cross-sectional study, data on 69 patients with diabetes who underwent standard HD therapy were analyzed. For estimating muscle mass, anthropometric and bioelectrical impedance analyses were conducted following dialysis. In addition, routine laboratory and 3-d dietary data were obtained. The adequate intake (AI) cut-off for n-3 PUFAs was 1.6 g/d and 1.1 g/d for male and female patients, respectively. Results: The average age of the participants was 63.0 ± 10.4 y. The mean ratios of n-3/n-6 PUFA intake, n-6/n-3 PUFA intake, SMM, and ASM of the patients were 0.13 ± 0.07, 9.4 ± 6.4, 24.6 ± 5.4 kg, and 18.3 ± 4.6 kg, respectively. Patients who had AI of n-3 PUFAs had significantly higher SMM and ASM than did their counterparts. Linear and stepwise multivariable adjustment analyses revealed that insulin resistance and the n-6/n-3 PUFA ratio were the independent deleterious determinants of ASM normalized to height in HD patients. Conclusions: Patients with AI of n-3 PUFAs had total-body SMM and ASM that were more appropriate. A higher dietary ratio of n-6/n-3 PUFAs was associated with reduced muscle mass in HD patients.