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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

Adjusted odds ratio for patients with diminished appetite having PEW as per traditional PEW criteria. Abbreviations: ORadj = adjusted odds ratio; BMI = Body Mass Index; CI = confidence interval; DEI = dietary energy intake; IBW = Ideal body weight; MAMC = mid-arm muscle circumference; PEW = protein energy wasting. a Patients were identified with PEW if fulfilling any 3 of 4 criteria for clinical diagnosis of PEW such as serum albumin <3.8 g per 100 ml (bromocresol green method), BMI <23 kg/m2, reduced MAMC (reduction >10 % in relation to 50th percentile of reference population) and unintentional low DEI <25 kcal/kg per/day for at least 2 months [7]. b The ORadj were adjusted for age, gender, ethnicity, income level, co-morbidity and dialysis vintage by means of logistic regression analysis. c A vertical line represents odds ratio of 1. A value of 1 indicates no association between diminished appetite and PEW criteria, whether individual or combined. In the figure, the 95 % interval is also presented. If the value of 1 falls within the interval, there is no significant association between diminished appetite and PEW
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Fig3: Adjusted odds ratio for patients with diminished appetite having PEW as per traditional PEW criteria. Abbreviations: ORadj = adjusted odds ratio; BMI = Body Mass Index; CI = confidence interval; DEI = dietary energy intake; IBW = Ideal body weight; MAMC = mid-arm muscle circumference; PEW = protein energy wasting. a Patients were identified with PEW if fulfilling any 3 of 4 criteria for clinical diagnosis of PEW such as serum albumin <3.8 g per 100 ml (bromocresol green method), BMI <23 kg/m2, reduced MAMC (reduction >10 % in relation to 50th percentile of reference population) and unintentional low DEI <25 kcal/kg per/day for at least 2 months [7]. b The ORadj were adjusted for age, gender, ethnicity, income level, co-morbidity and dialysis vintage by means of logistic regression analysis. c A vertical line represents odds ratio of 1. A value of 1 indicates no association between diminished appetite and PEW criteria, whether individual or combined. In the figure, the 95 % interval is also presented. If the value of 1 falls within the interval, there is no significant association between diminished appetite and PEW

Mentions: Appetite ratings were dichotomized into 2 categories: normal appetite (very good and good) and diminished appetite (fair and poor). Associations between appetite categories with PEW prevalence based on traditional PEW diagnostic criteria as well as potential markers of PEW are presented in Figs. 3 and 4. The distribution of PEW patients in these two categories was similar [diminished, n = 38 (45.2 %); normal, n = 41 (33.9 %)] (see Additional file 1). Amongst the 4 traditional PEW diagnostic criteria, only BMI <23 kg/m2 showed significant association with appetite (P < 0.05) (Fig. 3). Patients reporting diminished appetite were more likely to have BMI <23 kg/m2 [adjusted odds ratio (ORadj: 2.17; 95 % CI: 1.18-3.99]. Diminished appetite had a marginal positive association with PEW diagnosis (ORadj: 1.71; 95 % CI: 0.94-3.10, P = 0.079). However, sensitivity (40–49 %), specificity (57–68 %) and accuracy (46–58 %) values for the various PEW diagnostic criteria compared to diminished appetite were below 80 % (see Additional file 1).Fig. 3


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)

Adjusted odds ratio for patients with diminished appetite having PEW as per traditional PEW criteria. Abbreviations: ORadj = adjusted odds ratio; BMI = Body Mass Index; CI = confidence interval; DEI = dietary energy intake; IBW = Ideal body weight; MAMC = mid-arm muscle circumference; PEW = protein energy wasting. a Patients were identified with PEW if fulfilling any 3 of 4 criteria for clinical diagnosis of PEW such as serum albumin <3.8 g per 100 ml (bromocresol green method), BMI <23 kg/m2, reduced MAMC (reduction >10 % in relation to 50th percentile of reference population) and unintentional low DEI <25 kcal/kg per/day for at least 2 months [7]. b The ORadj were adjusted for age, gender, ethnicity, income level, co-morbidity and dialysis vintage by means of logistic regression analysis. c A vertical line represents odds ratio of 1. A value of 1 indicates no association between diminished appetite and PEW criteria, whether individual or combined. In the figure, the 95 % interval is also presented. If the value of 1 falls within the interval, there is no significant association between diminished appetite and PEW
© Copyright Policy - open-access
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC4492004&req=5

Fig3: Adjusted odds ratio for patients with diminished appetite having PEW as per traditional PEW criteria. Abbreviations: ORadj = adjusted odds ratio; BMI = Body Mass Index; CI = confidence interval; DEI = dietary energy intake; IBW = Ideal body weight; MAMC = mid-arm muscle circumference; PEW = protein energy wasting. a Patients were identified with PEW if fulfilling any 3 of 4 criteria for clinical diagnosis of PEW such as serum albumin <3.8 g per 100 ml (bromocresol green method), BMI <23 kg/m2, reduced MAMC (reduction >10 % in relation to 50th percentile of reference population) and unintentional low DEI <25 kcal/kg per/day for at least 2 months [7]. b The ORadj were adjusted for age, gender, ethnicity, income level, co-morbidity and dialysis vintage by means of logistic regression analysis. c A vertical line represents odds ratio of 1. A value of 1 indicates no association between diminished appetite and PEW criteria, whether individual or combined. In the figure, the 95 % interval is also presented. If the value of 1 falls within the interval, there is no significant association between diminished appetite and PEW
Mentions: Appetite ratings were dichotomized into 2 categories: normal appetite (very good and good) and diminished appetite (fair and poor). Associations between appetite categories with PEW prevalence based on traditional PEW diagnostic criteria as well as potential markers of PEW are presented in Figs. 3 and 4. The distribution of PEW patients in these two categories was similar [diminished, n = 38 (45.2 %); normal, n = 41 (33.9 %)] (see Additional file 1). Amongst the 4 traditional PEW diagnostic criteria, only BMI <23 kg/m2 showed significant association with appetite (P < 0.05) (Fig. 3). Patients reporting diminished appetite were more likely to have BMI <23 kg/m2 [adjusted odds ratio (ORadj: 2.17; 95 % CI: 1.18-3.99]. Diminished appetite had a marginal positive association with PEW diagnosis (ORadj: 1.71; 95 % CI: 0.94-3.10, P = 0.079). However, sensitivity (40–49 %), specificity (57–68 %) and accuracy (46–58 %) values for the various PEW diagnostic criteria compared to diminished appetite were below 80 % (see Additional file 1).Fig. 3

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