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Assessing protein energy wasting in a Malaysian haemodialysis population using self-reported appetite rating: a cross-sectional study.

Sahathevan S, Se CH, Ng SH, Chinna K, Harvinder GS, Chee WS, Goh BL, Gafor HA, Bavanandan S, Ahmad G, Karupaiah T - BMC Nephrol (2015)

Bottom Line: Nutritional markers were compared against appetite ratings.Serum albumin did not differ significantly across appetite ratings.However, after dichotomization, a positive but marginally significant association was observed between diminished appetite and PEW diagnosis.

View Article: PubMed Central - PubMed

Affiliation: Dietetics Program, School of Healthcare Sciences, Faculty of Health Sciences, National University of Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia. sham_0901@yahoo.com.

ABSTRACT

Background: Poor appetite could be indicative of protein energy wasting (PEW) and experts recommend assessing appetite in dialysis patients. Our study aims to determine the relationship between PEW and appetite in haemodialysis (HD) patients.

Methods: HD patients (n=205) self-rated their appetite on a scale of 1 to 5 as very good (1), good (2), fair (3), poor (4) or very poor (5). Nutritional markers were compared against appetite ratings. Using logistic regression analysis associations between dichotomized appetite with PEW diagnosis were determined as per the International Society of Renal Nutrition and Metabolism (ISRNM) criteria and alternate objective measures. Data was adjusted for socioeconomic and demographic characteristics.

Results: Poorer appetite ratings were significantly associated with lower income (P = 0.021), lower measurements (P < 0.05) for mid-arm muscle circumference, mid-arm muscle area and lean tissue mass (LTM), serum urea (P = 0.007) and creatinine (P = 0.005). The highest hsCRP (P = 0.016) levels occurred in patients reporting the poorest appetite. Serum albumin did not differ significantly across appetite ratings. Poor oral intake represented by underreporting (EI/BMR < 1.2) was evident for all appetite ratings. PEW was prevalent irrespective of appetite ratings (very good: 17.6 %, good: 40.2 %, fair: 42.3 % and poor: 83.3 %). After dichotomizing appetite ratings into normal and diminished categories, there was a marginal positive association between diminished appetite and overall PEW diagnosis (OR adj: 1.71; 95 % CI: 0.94-3.10, P = 0.079). Amongst individual ISRNM criteria, only BMI < 23 kg/m2 was positively associated with diminished appetite (OR adj: 2.17; 95 % CI: 1.18-3.99). However, patients reporting diminished appetite were more likely to have lower LTM (OR adj: 2.86; 95 % CI: 1.31-6.24) and fat mass (OR adj: 1.91; 95 % CI: 1.03-3.53), lower levels of serum urea (OR adj: 2.74; 95 % CI: 1.49-5.06) and creatinine (OR adj: 1.99; 95 % CI: 1.01-3.92), higher Dialysis Malnutrition Score (OR adj: 2.75; 95 % CI: 1.50-5.03), Malnutrition Inflammation Score (OR adj: 2.15; 95 % CI: 1.17-3.94), and poorer physical (OR adj: 3.49; 95 % CI: 1.89-6.47) and mental (OR adj: 5.75; 95 % CI: 3.02-10.95) scores.

Conclusions: A graded but non-significant increase in the proportion of PEW patients occurred as appetite became poorer. However, after dichotomization, a positive but marginally significant association was observed between diminished appetite and PEW diagnosis.

No MeSH data available.


Related in: MedlinePlus

Study flow of participants. Abbreviations: BMI = Body Mass Index; DEI = dietary energy intake; DMS = Dialysis Malnutrition Score; EI:BMR = energy intake to basal metabolic rate ratio; FM = fat mass; HIV = human immunodeficiency virus; hsCRP = high sensitivity C-reactive protein; IBW = ideal body weight; LTM = lean tissue mass; MAC = mid-arm circumference; MAMA = mid-arm muscle area; MAMC = mid-arm muscle circumference; MIS = Malnutrition Inflammation Score; PEW = protein energy wasting; QoL = Quality of life; SF-36 = short-form (36-item) questionnaire; TG = triglyceride; TIBC = total iron binding capacity; TLC = total lymphocyte count; TSF = triceps skinfold. a EI:BMR cut-offs based on Black [27]. b PEW assessment based on ISRNM diagnostic criteria [7]
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Fig1: Study flow of participants. Abbreviations: BMI = Body Mass Index; DEI = dietary energy intake; DMS = Dialysis Malnutrition Score; EI:BMR = energy intake to basal metabolic rate ratio; FM = fat mass; HIV = human immunodeficiency virus; hsCRP = high sensitivity C-reactive protein; IBW = ideal body weight; LTM = lean tissue mass; MAC = mid-arm circumference; MAMA = mid-arm muscle area; MAMC = mid-arm muscle circumference; MIS = Malnutrition Inflammation Score; PEW = protein energy wasting; QoL = Quality of life; SF-36 = short-form (36-item) questionnaire; TG = triglyceride; TIBC = total iron binding capacity; TLC = total lymphocyte count; TSF = triceps skinfold. a EI:BMR cut-offs based on Black [27]. b PEW assessment based on ISRNM diagnostic criteria [7]

Mentions: This cross-sectional study was part of a baseline screening protocol for an oral protein supplementation program which aimed at recruiting malnourished HD patients [14]. Patient recruitment was conducted between February 2011 to May 2012 from HD units at two government tertiary referral hospitals and one teaching hospital in the Klang Valley, with a combined patient pool of 255. Initial recruitment criteria were inclusive of patients dialyzing for ≥6 months, aged ≥18 years, clinically stable, able to consume food orally, not dysphagic, able to self-report appetite in either language- Malay or English and provide written consent. Patients with cognitive impairment or terminal illnesses such as HIV/AIDS or malignancy were excluded during the recruitment period. Additional exclusion criteria included patients with repeated history of hospitalization or inter-current illnesses in the six months prior to the recruitment. A total of 205 patients consented to participate, giving a response rate of 80.4 %. However, two subjects refused to participate for body composition analysis. The stock flow of patients included in the final analysis is presented in Fig. 1. This study was approved by the Medical Research and Ethics Committee, Ministry of Health, Malaysia (NMRR-11-355-9148) and Medical Research Ethics Committee of National University of Malaysia (FF-274-2012).Fig. 1


Assessing protein energy wasting in a Malaysian haemodialysis population using self-reported appetite rating: a cross-sectional study.

Sahathevan S, Se CH, Ng SH, Chinna K, Harvinder GS, Chee WS, Goh BL, Gafor HA, Bavanandan S, Ahmad G, Karupaiah T - BMC Nephrol (2015)

Study flow of participants. Abbreviations: BMI = Body Mass Index; DEI = dietary energy intake; DMS = Dialysis Malnutrition Score; EI:BMR = energy intake to basal metabolic rate ratio; FM = fat mass; HIV = human immunodeficiency virus; hsCRP = high sensitivity C-reactive protein; IBW = ideal body weight; LTM = lean tissue mass; MAC = mid-arm circumference; MAMA = mid-arm muscle area; MAMC = mid-arm muscle circumference; MIS = Malnutrition Inflammation Score; PEW = protein energy wasting; QoL = Quality of life; SF-36 = short-form (36-item) questionnaire; TG = triglyceride; TIBC = total iron binding capacity; TLC = total lymphocyte count; TSF = triceps skinfold. a EI:BMR cut-offs based on Black [27]. b PEW assessment based on ISRNM diagnostic criteria [7]
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4492004&req=5

Fig1: Study flow of participants. Abbreviations: BMI = Body Mass Index; DEI = dietary energy intake; DMS = Dialysis Malnutrition Score; EI:BMR = energy intake to basal metabolic rate ratio; FM = fat mass; HIV = human immunodeficiency virus; hsCRP = high sensitivity C-reactive protein; IBW = ideal body weight; LTM = lean tissue mass; MAC = mid-arm circumference; MAMA = mid-arm muscle area; MAMC = mid-arm muscle circumference; MIS = Malnutrition Inflammation Score; PEW = protein energy wasting; QoL = Quality of life; SF-36 = short-form (36-item) questionnaire; TG = triglyceride; TIBC = total iron binding capacity; TLC = total lymphocyte count; TSF = triceps skinfold. a EI:BMR cut-offs based on Black [27]. b PEW assessment based on ISRNM diagnostic criteria [7]
Mentions: This cross-sectional study was part of a baseline screening protocol for an oral protein supplementation program which aimed at recruiting malnourished HD patients [14]. Patient recruitment was conducted between February 2011 to May 2012 from HD units at two government tertiary referral hospitals and one teaching hospital in the Klang Valley, with a combined patient pool of 255. Initial recruitment criteria were inclusive of patients dialyzing for ≥6 months, aged ≥18 years, clinically stable, able to consume food orally, not dysphagic, able to self-report appetite in either language- Malay or English and provide written consent. Patients with cognitive impairment or terminal illnesses such as HIV/AIDS or malignancy were excluded during the recruitment period. Additional exclusion criteria included patients with repeated history of hospitalization or inter-current illnesses in the six months prior to the recruitment. A total of 205 patients consented to participate, giving a response rate of 80.4 %. However, two subjects refused to participate for body composition analysis. The stock flow of patients included in the final analysis is presented in Fig. 1. This study was approved by the Medical Research and Ethics Committee, Ministry of Health, Malaysia (NMRR-11-355-9148) and Medical Research Ethics Committee of National University of Malaysia (FF-274-2012).Fig. 1

Bottom Line: Nutritional markers were compared against appetite ratings.Serum albumin did not differ significantly across appetite ratings.However, after dichotomization, a positive but marginally significant association was observed between diminished appetite and PEW diagnosis.

View Article: PubMed Central - PubMed

Affiliation: Dietetics Program, School of Healthcare Sciences, Faculty of Health Sciences, National University of Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia. sham_0901@yahoo.com.

ABSTRACT

Background: Poor appetite could be indicative of protein energy wasting (PEW) and experts recommend assessing appetite in dialysis patients. Our study aims to determine the relationship between PEW and appetite in haemodialysis (HD) patients.

Methods: HD patients (n=205) self-rated their appetite on a scale of 1 to 5 as very good (1), good (2), fair (3), poor (4) or very poor (5). Nutritional markers were compared against appetite ratings. Using logistic regression analysis associations between dichotomized appetite with PEW diagnosis were determined as per the International Society of Renal Nutrition and Metabolism (ISRNM) criteria and alternate objective measures. Data was adjusted for socioeconomic and demographic characteristics.

Results: Poorer appetite ratings were significantly associated with lower income (P = 0.021), lower measurements (P < 0.05) for mid-arm muscle circumference, mid-arm muscle area and lean tissue mass (LTM), serum urea (P = 0.007) and creatinine (P = 0.005). The highest hsCRP (P = 0.016) levels occurred in patients reporting the poorest appetite. Serum albumin did not differ significantly across appetite ratings. Poor oral intake represented by underreporting (EI/BMR < 1.2) was evident for all appetite ratings. PEW was prevalent irrespective of appetite ratings (very good: 17.6 %, good: 40.2 %, fair: 42.3 % and poor: 83.3 %). After dichotomizing appetite ratings into normal and diminished categories, there was a marginal positive association between diminished appetite and overall PEW diagnosis (OR adj: 1.71; 95 % CI: 0.94-3.10, P = 0.079). Amongst individual ISRNM criteria, only BMI < 23 kg/m2 was positively associated with diminished appetite (OR adj: 2.17; 95 % CI: 1.18-3.99). However, patients reporting diminished appetite were more likely to have lower LTM (OR adj: 2.86; 95 % CI: 1.31-6.24) and fat mass (OR adj: 1.91; 95 % CI: 1.03-3.53), lower levels of serum urea (OR adj: 2.74; 95 % CI: 1.49-5.06) and creatinine (OR adj: 1.99; 95 % CI: 1.01-3.92), higher Dialysis Malnutrition Score (OR adj: 2.75; 95 % CI: 1.50-5.03), Malnutrition Inflammation Score (OR adj: 2.15; 95 % CI: 1.17-3.94), and poorer physical (OR adj: 3.49; 95 % CI: 1.89-6.47) and mental (OR adj: 5.75; 95 % CI: 3.02-10.95) scores.

Conclusions: A graded but non-significant increase in the proportion of PEW patients occurred as appetite became poorer. However, after dichotomization, a positive but marginally significant association was observed between diminished appetite and PEW diagnosis.

No MeSH data available.


Related in: MedlinePlus