A case in which an unbalanced and unhealthy diet caused a low bone mineral content in a premenopausal female who was undergoing hemodialysis

Abstract

A premenopausal non-diabetic female in her early 40 s was diagnosed with a low bone mineral content while she was undergoing hemodialysis treatment (for 4.5 years). Her total hip T and Z scores (dual-energy X-ray absorptiometry) were 68% (−2.4 standard deviation [SD]) and 70% (−2.2 SD), respectively. The low bone mineral content was caused by renal osteodystrophy, being female, a low body mass index (16.0 kg/m²), smoking, low levels of physical exercise, short-term steroid therapy, and an unbalanced and unhealthy diet. A nutritional survey, involving a questionnaire examining the consumption frequency of various food groups and a 3-day meal record, was performed. It revealed a high energy intake of 61 kcal/kg body weight, caused by high lipid intake due to the consumption of cakes and fried foods. A low protein intake (10.8% of total energy intake) and the absence of fish from the patient’s diet were also noted. The patient’s serum 25-dihydroxyvitamin D level was 7.5 μg due to extremely low vitamin D intake (0.9〜2.7 μg/day). Carbohydrates accounted for 51.5% of her energy intake, partly due to the consumption of up to 1 L/day of soft drinks. She had maintained similar eating and exercise habits since childhood. She had a low calcium intake of 143〜415 mg/day. Her phosphate intake was elevated (873 mg/day), partly due to the inorganic phosphate content of her favorite beverages. She was exposed to normal levels of sunlight. Her low bone mineral content was considered to be a secondary effect of an unbalanced diet.