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Assessing protein energy wasting in a Malaysian haemodialysis population using self-reported appetite rating: a cross-sectional study.
BMC Nephrol. 2015 Jul 07; 16:99.BN

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.

Links

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Authors+Show Affiliations

Sahathevan S
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.
Se CH
Dietetics Program, School of Healthcare Sciences, Faculty of Health Sciences, National University of Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia. jeremysch3232@gmail.com.
Ng SH
Dietetics Program, School of Healthcare Sciences, Faculty of Health Sciences, National University of Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia. seehoe88@gmail.com.
Chinna K
Epidemiology and Biostatistics Unit, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia. karuthan@gmail.com.
Harvinder GS
Division of Nutrition and Dietetics, School of Health Sciences, International Medical University, No.126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000, Kuala Lumpur, Malaysia. harvin3386@yahoo.com.
Chee WS
Division of Nutrition and Dietetics, School of Health Sciences, International Medical University, No.126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000, Kuala Lumpur, Malaysia. winnie_chee@imu.edu.my.
Goh BL
Department of Nephrology, Serdang Hospital, Jalan Puchong, 43000, Kajang, Selangor, Malaysia. bak.leong@gmail.com.
Gafor HA
Nephrology Unit, Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur, 56000, Malaysia. halimgafor@gmail.com.
Bavanandan S
Department of Nephrology, Kuala Lumpur Hospital, Jalan Pahang, 50586, Kuala Lumpur, Malaysia. sbavanandan@gmail.com.
Ahmad G
Department of Nephrology, Kuala Lumpur Hospital, Jalan Pahang, 50586, Kuala Lumpur, Malaysia. ghazaliahmad@moh.gov.my.
Karupaiah T
Dietetics Program, School of Healthcare Sciences, Faculty of Health Sciences, National University of Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia. tilly_karu@yahoo.co.uk.

MeSH

AdultAgedAnorexiaAppetiteArmC-Reactive ProteinCross-Sectional StudiesDietary ProteinsFemaleHand StrengthHumansIncomeKidney Failure, ChronicMalaysiaMaleMiddle AgedMuscle, SkeletalOrgan SizeProtein-Energy MalnutritionRenal DialysisSelf ReportSerum AlbuminThinnessWasting Syndrome

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26149396

Citation

Sahathevan, Sharmela, et al. "Assessing Protein Energy Wasting in a Malaysian Haemodialysis Population Using Self-reported Appetite Rating: a Cross-sectional Study." BMC Nephrology, vol. 16, 2015, p. 99.
Sahathevan S, Se CH, Ng SH, et al. Assessing protein energy wasting in a Malaysian haemodialysis population using self-reported appetite rating: a cross-sectional study. BMC Nephrol. 2015;16:99.
Sahathevan, S., Se, C. H., Ng, S. H., Chinna, K., Harvinder, G. S., Chee, W. S., Goh, B. L., Gafor, H. A., Bavanandan, S., Ahmad, G., & Karupaiah, T. (2015). Assessing protein energy wasting in a Malaysian haemodialysis population using self-reported appetite rating: a cross-sectional study. BMC Nephrology, 16, 99. https://doi.org/10.1186/s12882-015-0073-x
Sahathevan S, et al. Assessing Protein Energy Wasting in a Malaysian Haemodialysis Population Using Self-reported Appetite Rating: a Cross-sectional Study. BMC Nephrol. 2015 Jul 7;16:99. PubMed PMID: 26149396.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Assessing protein energy wasting in a Malaysian haemodialysis population using self-reported appetite rating: a cross-sectional study. AU - Sahathevan,Sharmela, AU - Se,Chee Hee, AU - Ng,See Hoe, AU - Chinna,Karuthan, AU - Harvinder,Gilcharan Singh, AU - Chee,Winnie Siew Swee, AU - Goh,Bak Leong, AU - Gafor,Halim A, AU - Bavanandan,Sunita, AU - Ahmad,Ghazali, AU - Karupaiah,Tilakavati, Y1 - 2015/07/07/ PY - 2015/01/26/received PY - 2015/05/21/accepted PY - 2015/7/8/entrez PY - 2015/7/8/pubmed PY - 2016/3/16/medline SP - 99 EP - 99 JF - BMC nephrology JO - BMC Nephrol VL - 16 N2 - 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. SN - 1471-2369 UR - https://www.unboundmedicine.com/medline/citation/26149396/Assessing_protein_energy_wasting_in_a_Malaysian_haemodialysis_population_using_self_reported_appetite_rating:_a_cross_sectional_study_ DB - PRIME DP - Unbound Medicine ER -