{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T05:05:47Z","timestamp":1784005547446,"version":"3.55.0"},"reference-count":34,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T00:00:00Z","timestamp":1783468800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: Geographic peripherality in Israel is linked to poorer health outcomes and may disproportionately affect patients requiring chronic therapies such as hemodialysis (HD). Though malnutrition and inflammation are strong predictors of morbidity and mortality in HD patients, regional differences in nutritional status and dietary adherence are unclear. Objectives: To examine the association between peripherality and malnutrition risk, dietary intake, and adherence to nutrition guidelines among Jewish Israeli adults on HD. Methods: In this multi-center, cross-sectional study, 154 adult Jewish HD patients were recruited from the northern periphery (n = 66) and central regions of Israel (n = 88). Demographic, clinical, laboratory, and anthropometric data were obtained from medical records. Nutrient intake was assessed using the multi-pass 24 h dietary recall method. Malnutrition risk was classified using BMI and serum albumin; the C-reactive protein-to-albumin ratio (CAR) was also calculated. Adherence to International Society of Renal Nutrition and Metabolism (ISRNM) dietary guidelines was evaluated. Between-group comparisons and multivariable regression analyses were conducted. Results: Overall, participant characteristics were similar between groups; however, coronary heart disease prevalence and dialysis vintage were higher in the periphery. Participants from the periphery had lower serum albumin, blood urea nitrogen, hemoglobin, and blood pressure, but higher LDL cholesterol. Sodium intake was significantly higher and adherence to ISRNM sodium guidelines markedly lower in the periphery. In multivariable analysis, peripherality reduced the odds of meeting sodium recommendations by 92.8%. Adherence to energy and protein guidelines was low in both groups. Nearly half of participants had some level of elevated malnutrition risk using the categorized variable, and an overall difference in the categories of malnutrition risk was detected, driven by the increase in the moderate risk category in the periphery. The composite malnutrition risk variable (any increase in risk vs. no increase in risk) did not differ by peripherality. Peripherality was independently associated with higher percent ideal body weight (%IBW), but not with CAR. Conclusions: Peripherality among Jewish Israeli HD patients is associated with differences in nutrition biomarkers, cardiovascular burden, and dietary adherence, especially sodium intake. Interventions considering peripherality should be explored.<\/jats:p>","DOI":"10.3390\/nu18142222","type":"journal-article","created":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T15:40:09Z","timestamp":1783525209000},"page":"2222","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Peripherality and Indicators of Nutrition Status in Jewish Israeli Hemodialysis Patients: A Cross-Sectional Study"],"prefix":"10.3390","volume":"18","author":[{"given":"Moran","family":"Kohavi","sequence":"first","affiliation":[{"name":"Department of Nutrition Sciences, Ariel University, Kiryat Hamada 3, Ramat Hagolan St. 36, Ariel 40700, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-7512-9492","authenticated-orcid":false,"given":"Chen","family":"Oren Makmal","sequence":"additional","affiliation":[{"name":"Department of Nutrition Sciences, Ariel University, Kiryat Hamada 3, Ramat Hagolan St. 36, Ariel 40700, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nagib","family":"Abid","sequence":"additional","affiliation":[{"name":"Department of Nutrition Sciences, Ariel University, Kiryat Hamada 3, Ramat Hagolan St. 36, Ariel 40700, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3190-4187","authenticated-orcid":false,"given":"Vered","family":"Kaufman-Shriqui","sequence":"additional","affiliation":[{"name":"Department of Nutrition Sciences, Ariel University, Kiryat Hamada 3, Ramat Hagolan St. 36, Ariel 40700, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2376-7645","authenticated-orcid":false,"given":"Younes","family":"Bathish","sequence":"additional","affiliation":[{"name":"Azrieli School of Medicine, Bar-Ilan University, Safed 1311502, Israel"},{"name":"Nephrology Department, Ziv Medical Center, Safed 1311001, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Talia","family":"Weinstein","sequence":"additional","affiliation":[{"name":"Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7208-5707","authenticated-orcid":false,"given":"Etty","family":"Kruzel Davilla","sequence":"additional","affiliation":[{"name":"Azrieli School of Medicine, Bar-Ilan University, Safed 1311502, Israel"},{"name":"Medical Center of the Galilee, Nahariya 22100, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3920-7549","authenticated-orcid":false,"given":"Mona","family":"Boaz","sequence":"additional","affiliation":[{"name":"Department of Nutrition Sciences, Ariel University, Kiryat Hamada 3, Ramat Hagolan St. 36, Ariel 40700, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,8]]},"reference":[{"key":"ref_1","unstructured":"Organisation for Economic Co-operation and Development (OECD) (2026, June 15). Health at a Glance 2025: Country Notes\u2014Israel. Available online: https:\/\/www.oecd.org\/content\/dam\/oecd\/en\/publications\/reports\/2025\/11\/health-at-a-glance-2025-country-notes_2f94481e\/israel_23aa66e2\/b3600fbc-en.pdf."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1093\/eurpub\/ckv211","article-title":"Arab-Jewish gap in life expectancy in Israel","volume":"26","author":"Saabneh","year":"2016","journal-title":"Eur. J. Public Health"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2531","DOI":"10.1016\/S0140-6736(17)30574-3","article-title":"Inequalities in non-communicable diseases between the major population groups in Israel: Achievements and challenges","volume":"389","author":"Muhsen","year":"2017","journal-title":"Lancet"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e2539","DOI":"10.1002\/psp.2539","article-title":"Health inequalities between Palestinians and Jews in Israel: The role of extreme spatial segregation","volume":"28","author":"Saabneh","year":"2022","journal-title":"Popul. Space Place"},{"key":"ref_5","unstructured":"Israel Ministry of Health (2026, June 15). Report on Health Equity: Indices, Gaps and Policy Recommendations 2023 (Hebrew), Available online: https:\/\/www.gov.il\/BlobFolder\/reports\/health-equity-report-2023\/he\/files_publications_units_financial-strategic-planning_publications_inequality_health-equality-2023.pdf."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1559","DOI":"10.1001\/jama.2024.16338","article-title":"Dialysis for Chronic Kidney Failure: A Review","volume":"332","author":"Flythe","year":"2024","journal-title":"JAMA"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1115","DOI":"10.1007\/s10900-025-01496-0","article-title":"Travel Distance to Dialysis and Mortality Among Hemodialysis Patients in a Geographically Small Country","volume":"50","author":"Dichtiar","year":"2025","journal-title":"J. Community Health"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"29658","DOI":"10.1038\/s41598-024-80900-6","article-title":"Predicting early mortality in hemodialysis patients: A deep learning approach using a nationwide prospective cohort in South Korea","volume":"14","author":"Noh","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Yip, W., Ng, S.H.X., Kaur, P., George, P.P., Guan, J.H.C., Lee, G., Koh, T.J.K., Tan, W.S., and Hum, A.Y.M. (2024). Risk factors for short-term all-cause mortality in patients with end stage renal disease: A scoping review. BMC Nephrol., 25.","DOI":"10.1186\/s12882-024-03503-3"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1093\/ageing\/afm197","article-title":"A comparison of measured height and demi-span equivalent height in the assessment of body mass index among people aged 65 years and over in England","volume":"37","author":"Hirani","year":"2008","journal-title":"Age Ageing"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Bonner, M., and Wright, D. (2017). Practical Pharmaceutical Calculations, Routledge.","DOI":"10.1201\/9781315383934"},{"key":"ref_12","unstructured":"Keinan-Boker, L., Shohat, T., Shimony, T., Goldsmith, R., and Nitsan, L. (2026, June 15). Rav Mabat Adult Second National Health and Nutrition Survey Ages 18\u201364 2014\u20132016. Israel Center for Disease Control (ICDC) Medical Technology, Information and Research Division Ministry of Health. Publication No, Available online: https:\/\/www.gov.il\/BlobFolder\/reports\/mabat-adults-2014-2016-383\/en\/files_publications_units_ICDC_mabat_adults_2014_2016_383_en.pdf."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1096","DOI":"10.1038\/ki.2013.147","article-title":"Prevention and treatment of protein energy wasting in chronic kidney disease patients: A consensus statement by the International Society of Renal Nutrition and Metabolism","volume":"84","author":"Ikizler","year":"2013","journal-title":"Kidney Int."},{"key":"ref_14","first-page":"166","article-title":"Malnutrition Risk in Hemodialysis Patients in Israel: Results of the Status of Nutrition In Hemodialysis Patients Survey Study","volume":"141","author":"Boaz","year":"2019","journal-title":"Nephrology"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Li, M., Jiang, Z., and Zhang, D. (2025). The C-reactive protein\/albumin ratio as a nutritional biomarker in maintenance hemodialysis patients: A cross-sectional study of malnutrition-inflammation status assessment. Front. Med., 12.","DOI":"10.3389\/fmed.2025.1637536"},{"key":"ref_16","unstructured":"Global Burden of Cardiovascular Diseases and Risks 2023 Collaborators (2025). Global, Regional, and National Burden of Cardiovascular Diseases and Risk Factors in 204 Countries and Territories, 1990\u20132023. J. Am. Coll. Cardiol., 86, 2167\u20132243."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Britt-Spells, A.M., Buford, J., Kelty, C., Manjal, P., Ross-Driscoll, K., Fridell, J.A., Pastan, S., Patzer, R.E., and Wilk, A.S. (2026). Association Between Rurality and Evaluation Start Among Referred Patients with End Stage Kidney Disease. Am. J. Nephrol., 1\u201317.","DOI":"10.1159\/000552281"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1159\/000515137","article-title":"Cumulative C-Reactive Protein Levels and Progression of Malnutrition in Dialysis Patients: A Longitudinal Study","volume":"52","author":"Asai","year":"2023","journal-title":"Blood Purif."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"3568","DOI":"10.1093\/ndt\/gfm424","article-title":"Factors associated with mortality in patients new to haemodialysis","volume":"22","author":"Spiegel","year":"2007","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Huang, J., Li, Y., Shen, S., Yu, L., and Sun, Q. (2025). Study on causes of death and influencing factors in hemodialysis patients with End-Stage renal disease. BMC Urol., 25.","DOI":"10.1186\/s12894-025-01981-7"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1097\/MNH.0000000000001131","article-title":"The obesity and lipid paradoxes in chronic kidney disease: Mechanisms, interventions, and future directions","volume":"35","author":"Takahashi","year":"2026","journal-title":"Curr. Opin. Nephrol. Hypertens."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"293","DOI":"10.5414\/CN111681","article-title":"Age and sex-specific association between dyslipidemia treatment and mortality in elderly Korean hemodialysis patients: A retrospective cohort study by the Korean Society of Geriatric Nephrology","volume":"104","author":"Kim","year":"2025","journal-title":"Clin. Nephrol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e71399","DOI":"10.1002\/fsn3.71399","article-title":"Salt Intake Among the Iranian Population and Public Attitudes Toward Salt Consumption: National and Subnational Report From STEPS 2021","volume":"14","author":"Nosratinia","year":"2025","journal-title":"Food Sci. Nutr."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"253","DOI":"10.3126\/kumj.v19i2.49657","article-title":"Control of Dietary Salt Intake at Family Level by Housewives in Tripura, India: A Rural\u2014Urban Comparison","volume":"19","author":"Karmakar","year":"2021","journal-title":"Kathmandu Univ. Med. J. (KUMJ)"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1007\/s40620-023-01817-3","article-title":"From ultra-processed foods towards healthy eating for CKD patients: A proposal of educational infographics","volume":"37","author":"Padial","year":"2024","journal-title":"J. Nephrol."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Bossola, M., Mariani, I., Strizzi, C.T., Piccinni, C.P., and Di Stasio, E. (2025). How to Limit Interdialytic Weight Gain in Patients on Maintenance Hemodialysis: State of the Art and Perspectives. J. Clin. Med., 14.","DOI":"10.3390\/jcm14061846"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Elmansy, F.M., Elbqry, M.G., Qalawa, S.A.A., AlQasem, W.A., Alotni, M.A., Alharbi, M., and Shalby, A.Y.M. (2026). Nutritional indicators and fluid self-efficacy among hemodialysis patients in the Qassim region, Saudi Arabia: A multicenter descriptive cross-sectional study. Front. Nutr., 13.","DOI":"10.3389\/fnut.2026.1820274"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"101624","DOI":"10.1016\/j.tjnut.2026.101624","article-title":"Urbanicity and the diets and nutritional status of adolescents and their mothers in Vietnam1\u20134","volume":"156","author":"Nguyen","year":"2026","journal-title":"J. Nutr."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Wathanavasin, W., Kaewput, W., Thongprayoon, C., Tangpanithandee, S., Suppadungsuk, S., and Cheungpasitporn, W. (2026). Association of Obesity and Malnutrition with In-Hospital Mortality and Clinical Outcomes in Patients Receiving Maintenance Dialysis: A National Database Study. Nutrients, 18.","DOI":"10.3390\/nu18010157"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Motofelea, A.C., Olariu, N., Pecingina, R., Marc, L., Chisavu, L., Bob, F., Mihaescu, A., Apostol, A., Schiller, O., and Motofelea, N. (2026). BMI Category and Survival in Incident Hemodialysis Patients: The Overweight Advantage in an Eastern European Cohort. J. Clin. Med., 15.","DOI":"10.3390\/jcm15082856"},{"key":"ref_31","first-page":"5485","article-title":"Improving access to phosphorus- and sodium-restricted foods for people living with chronic kidney disease in remote First Nations","volume":"20","author":"Schiff","year":"2020","journal-title":"Rural Remote Health"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Chen, S., Qiu, X., Dai, Y., Deng, Z., Liu, N., Xie, R., Qiu, X., and Zhang, L. (2026). Factors influencing sodium restriction behavior among patients with chronic heart failure: A cross-sectional study based on the value co-creation theory. BMC Cardiovasc. Disord., 26.","DOI":"10.1186\/s12872-026-05652-9"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.nutres.2017.11.001","article-title":"Methodological considerations and future insights for 24-hour dietary recall assessment in children","volume":"51","author":"Foster","year":"2018","journal-title":"Nutr. Res."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Lew, S.Q., Asci, G., Rootjes, P.A., Ok, E., Penne, E.L., Sam, R., Tzamaloukas, A.H., Ing, T.S., and Raimann, J.G. (2023). The role of intra- and interdialytic sodium balance and restriction in dialysis therapies. Front. Med., 10.","DOI":"10.3389\/fmed.2023.1268319"}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/14\/2222\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T04:28:31Z","timestamp":1784003311000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/14\/2222"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,8]]},"references-count":34,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["nu18142222"],"URL":"https:\/\/doi.org\/10.3390\/nu18142222","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,8]]}}}