{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T07:48:06Z","timestamp":1783064886686,"version":"3.54.6"},"reference-count":65,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2022,12,2]],"date-time":"2022-12-02T00:00:00Z","timestamp":1669939200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Military Hospital 103","award":["MOST 111-2410-H-038-008-MY2"],"award-info":[{"award-number":["MOST 111-2410-H-038-008-MY2"]}]},{"name":"Thai Nguyen National Hospital","award":["MOST 111-2410-H-038-008-MY2"],"award-info":[{"award-number":["MOST 111-2410-H-038-008-MY2"]}]},{"name":"Taipei Medical University","award":["MOST 111-2410-H-038-008-MY2"],"award-info":[{"award-number":["MOST 111-2410-H-038-008-MY2"]}]},{"name":"National Science and Technology Council, Taiwan","award":["MOST 111-2410-H-038-008-MY2"],"award-info":[{"award-number":["MOST 111-2410-H-038-008-MY2"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Osteoporosis is a common bone health disorder in hemodialysis patients that is linked with a higher morbidity and mortality rate. While previous studies have explored the associated factors of osteoporosis, there is a lack of studies investigating the impacts of health literacy (HL) and digital healthy diet literacy (DDL) on osteoporosis. Therefore, we aimed to investigate the associations of HL, DDL, and other factors with osteoporosis among hemodialysis patients. From July 2020 to March 2021, a cross-sectional study was conducted on 675 hemodialysis patients in eight hospitals in Vietnam. The data were collected by using the osteoporosis self-assessment tool for Asians (OSTA) and the 12-item short form of the health literacy questionnaire (HLS-SF12) on digital healthy diet literacy (DDL) and hemodialysis dietary knowledge (HDK). In addition, we also collected information about the socio-demographics, the clinical parameters, the biochemical parameters, and physical activity. Unadjusted and adjusted multinomial logistic regression models were utilized in order to investigate the associations. The proportion of patients at low, medium, and high levels of osteoporosis risk was 39.6%, 40.6%, and 19.8%, respectively. In the adjusted models, women had a higher likelihood of osteoporosis risk than men (odds ratio, OR, 3.46; 95% confidence interval, 95% CI, 1.86, 6.44; p &lt; 0.001; and OR, 6.86; 95% CI, 2.96, 15.88; p &lt; 0.001). The patients with rheumatoid arthritis (OR, 4.37; 95% CI, 1.67, 11.52; p = 0.003) and stomach ulcers (OR, 1.95; 95% CI, 1.01, 3.77; p = 0.048) were more likely to have a higher likelihood of osteoporosis risk than those without. The patients who had a higher waist circumference (WC), HL, and DDL were less likely to have a medium level of osteoporosis risk (OR, 0.95; 95% CI, 0.92, 0.98; p = 0.004; OR, 0.92; 95% CI, 0.88, 0.96; p &lt; 0.001; OR, 0.96; 95% CI, 0.93, 0.99; p = 0.017, respectively) and a high level of osteoporosis risk (OR, 0.93; 95% CI, 0.89, 0.97; p = 0.001; OR, 0.89; 95% CI, 0.84, 0.94; p &lt; 0.001; OR, 0.95; 95% CI, 0.91, 0.99; p = 0.008, respectively) compared with a low level of osteoporosis risk and to those with a lower WC, HL, and DDL. In addition, higher levels of hemoglobin (Hb) (OR, 0.79; 95% CI, 0.66, 0.95; p = 0.014), hematocrit (Hct) (OR, 0.95; 95% CI, 0.92, 0.99; p = 0.041), albumin (OR, 0.91; 95% CI, 0.83, 0.99; p = 0.030), and education (OR, 0.37; 95% CI, 0.16, 0.88; p = 0.025) were associated with a lower likelihood of a high level of osteoporosis risk. In conclusion, osteoporosis risk is highly prevalent in hemodialysis patients. Improved HL, DDL, education, WC, albumin, Hb, and Hct levels should be considered in preventing hemodialysis patients from developing osteoporosis.<\/jats:p>","DOI":"10.3390\/nu14235122","type":"journal-article","created":{"date-parts":[[2022,12,2]],"date-time":"2022-12-02T03:00:36Z","timestamp":1669950036000},"page":"5122","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Osteoporosis Risk in Hemodialysis Patients: The Roles of Gender, Comorbidities, Biochemical Parameters, Health and Diet Literacy"],"prefix":"10.3390","volume":"14","author":[{"given":"Lan T. H.","family":"Le","sequence":"first","affiliation":[{"name":"Training and Direction of Healthcare Activity Center, Thai Nguyen National Hospital, Thai Nguyen City 241-24, Vietnam"},{"name":"Biochemistry Department, Thai Nguyen National Hospital, Thai Nguyen City 241-24, Vietnam"},{"name":"Director Office, Thai Nguyen National Hospital, Thai Nguyen City 241-24, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9686-334X","authenticated-orcid":false,"given":"Loan T.","family":"Dang","sequence":"additional","affiliation":[{"name":"School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 112-19, Taiwan"},{"name":"Faculty of Nursing and Midwifery, Hanoi Medical University, Hanoi 115-20, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8714-5530","authenticated-orcid":false,"given":"Tsae-Jyy","family":"Wang","sequence":"additional","affiliation":[{"name":"School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 112-19, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tuyen G.","family":"Do","sequence":"additional","affiliation":[{"name":"Hemodialysis Department, Nephro-Urology-Dialysis Center, Bach Mai Hospital, Hanoi 115-19, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dung H.","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Hemodialysis Department, Nephro-Urology-Dialysis Center, Bach Mai Hospital, Hanoi 115-19, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5748-5035","authenticated-orcid":false,"given":"Trung A.","family":"Hoang","sequence":"additional","affiliation":[{"name":"Hemodialysis Department, Nephro-Urology-Dialysis Center, Bach Mai Hospital, Hanoi 115-19, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minh D.","family":"Pham","sequence":"additional","affiliation":[{"name":"Department of Nutrition, Military Hospital 103, Hanoi 121-08, Vietnam"},{"name":"Department of Nutrition, Vietnam Military Medical University, Hanoi 121-08, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1377-3921","authenticated-orcid":false,"given":"Binh N.","family":"Do","sequence":"additional","affiliation":[{"name":"Department of Military Science, Vietnam Military Medical University, Hanoi 121-08, Vietnam"},{"name":"Department of Infectious Diseases, Vietnam Military Medical University, Hanoi 121-08, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hoang C.","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Director Office, Thai Nguyen National Hospital, Thai Nguyen City 241-24, Vietnam"},{"name":"President Office, Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen City 241-17, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7769-814X","authenticated-orcid":false,"given":"Tu T.","family":"Tran","sequence":"additional","affiliation":[{"name":"International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei 110-31, Taiwan"},{"name":"Department of Internal Medicine, Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen 241-17, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7107-1496","authenticated-orcid":false,"given":"Linh V.","family":"Pham","sequence":"additional","affiliation":[{"name":"Department of Pulmonary & Cardiovascular Diseases, Hai Phong University of Medicine and Pharmacy Hospital, Hai Phong 042-12, Vietnam"},{"name":"President Office, Hai Phong University of Medicine and Pharmacy, Hai Phong 042-12, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4625-456X","authenticated-orcid":false,"given":"Lien T. H.","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Department of Pulmonary & Cardiovascular Diseases, Hai Phong University of Medicine and Pharmacy Hospital, Hai Phong 042-12, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hoi T.","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Director Office, Hai Phong International Hospital, Hai Phong 047-08, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nga T.","family":"Trieu","sequence":"additional","affiliation":[{"name":"Hemodialysis Division, Hai Phong International Hospital, Hai Phong 047-08, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thinh V.","family":"Do","sequence":"additional","affiliation":[{"name":"Director Office, Bai Chay Hospital, Ha Long 011-21, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manh V.","family":"Trinh","sequence":"additional","affiliation":[{"name":"Director Office, Quang Ninh General Hospital, Ha Long 011-08, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tung H.","family":"Ha","sequence":"additional","affiliation":[{"name":"Director Office, General Hospital of Agricultural, Hanoi 125-16, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dung T.","family":"Phan","sequence":"additional","affiliation":[{"name":"Faculty of Nursing, Hanoi University of Business and Technology, Hanoi 116-22, Vietnam"},{"name":"Nursing Office, Thien An Obstetrics and Gynecology Hospital, Hanoi 112-06, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3707-1166","authenticated-orcid":false,"given":"Shwu-Huey","family":"Yang","sequence":"additional","affiliation":[{"name":"School of Nutrition and Health Sciences, Taipei Medical University, Taipei 110-31, Taiwan"},{"name":"Nutrition Research Center, Taipei Medical University Hospital, Taipei 110\u201331, Taiwan"},{"name":"Research Center of Geriatric Nutrition, Taipei Medical University, Taipei 110\u201331, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ngoc N. M.","family":"Le","sequence":"additional","affiliation":[{"name":"College of Medicine, Hanoi Medical University, Hanoi 115-20, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7176-8055","authenticated-orcid":false,"given":"Kien T.","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Department of Health Promotion, Faculty of Social and Behavioral Sciences, Hanoi University of Public Health, Hanoi 119-10, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2287-0723","authenticated-orcid":false,"given":"Tuyen Van","family":"Duong","sequence":"additional","affiliation":[{"name":"International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei 110-31, Taiwan"},{"name":"School of Nutrition and Health Sciences, Taipei Medical University, Taipei 110-31, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,12,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1975","DOI":"10.1016\/S0140-6736(14)61601-9","article-title":"Worldwide access to treatment for end-stage kidney disease: A systematic review","volume":"385","author":"Liyanage","year":"2015","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1159\/000514550","article-title":"Global Epidemiology of End-Stage Kidney Disease and Disparities in Kidney Replacement Therapy","volume":"52","author":"Thurlow","year":"2021","journal-title":"Am. 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