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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

PEW distribution as per 4-scaled appetite ratings. Abbreviation: PEW = Protein energy wasting. Note-The number of patients in very poor rating was very few (n = 2). Hence, data in very poor and poor ratings were merged, thereby yielding the 4-scaled appetite ratings. The proportion of PEW patients increased significantly from 17.6 % in very good rating to 83.3 % in poor rating (P = 0.005, Pearson χ2 test for trend, 2 cell counts less than 5)
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Fig2: PEW distribution as per 4-scaled appetite ratings. Abbreviation: PEW = Protein energy wasting. Note-The number of patients in very poor rating was very few (n = 2). Hence, data in very poor and poor ratings were merged, thereby yielding the 4-scaled appetite ratings. The proportion of PEW patients increased significantly from 17.6 % in very good rating to 83.3 % in poor rating (P = 0.005, Pearson χ2 test for trend, 2 cell counts less than 5)

Mentions: Patients diagnosed with PEW were found in all appetite ratings with: 17.6 % (n = 6) in very good, 40.2 % (n = 35) in good, 42.3 % (n = 33) in fair and 83.3 % (n = 5) in poor ratings (Fig. 2). Based on Pearson χ2 analysis, the number of patients identified with PEW was significantly different across the appetite ratings (P = 0.005). However, the minimum expected count was less than 5 where the number of PEW patients in the very good and poor appetite ratings was very small. Hence, the 4-scaled appetite ratings were dichotomized to normal and diminished appetite categories.Fig. 2


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)

PEW distribution as per 4-scaled appetite ratings. Abbreviation: PEW = Protein energy wasting. Note-The number of patients in very poor rating was very few (n = 2). Hence, data in very poor and poor ratings were merged, thereby yielding the 4-scaled appetite ratings. The proportion of PEW patients increased significantly from 17.6 % in very good rating to 83.3 % in poor rating (P = 0.005, Pearson χ2 test for trend, 2 cell counts less than 5)
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig2: PEW distribution as per 4-scaled appetite ratings. Abbreviation: PEW = Protein energy wasting. Note-The number of patients in very poor rating was very few (n = 2). Hence, data in very poor and poor ratings were merged, thereby yielding the 4-scaled appetite ratings. The proportion of PEW patients increased significantly from 17.6 % in very good rating to 83.3 % in poor rating (P = 0.005, Pearson χ2 test for trend, 2 cell counts less than 5)
Mentions: Patients diagnosed with PEW were found in all appetite ratings with: 17.6 % (n = 6) in very good, 40.2 % (n = 35) in good, 42.3 % (n = 33) in fair and 83.3 % (n = 5) in poor ratings (Fig. 2). Based on Pearson χ2 analysis, the number of patients identified with PEW was significantly different across the appetite ratings (P = 0.005). However, the minimum expected count was less than 5 where the number of PEW patients in the very good and poor appetite ratings was very small. Hence, the 4-scaled appetite ratings were dichotomized to normal and diminished appetite categories.Fig. 2

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