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ORIGINAL ARTICLE
1
Department of Nutrition, Faculty of
Medicine, Mashhad University of Medical Abstract
Sciences, Mashhad, Iran
Introduction: Protein-energy wasting (PEW) is common in hemodialysis patients and
2
Research Center for Gastroenterology
and Liver Disease, Shahid Beheshti
is linked with a high rate of morbidity and mortality. Regarding importance of nutri-
University of Medical Sciences, Tehran, tion in these patients, a recent study was administered to evaluate the nutritional
Iran
status of hemodialysis patients.
Correspondence Materials: In this cross-sectional study 540 HD patients from 15 dialysis centers
Abdolreza Norouzy, Mashhad University
of Medical Sciences (MUMS), Paradise
were evaluated. The nutritional status of the patients was determined by Subjective
Daneshgah , Azadi Square, Post code Global Assessment (SGA), Dialysis Malnutrition Score (DMS), and Malnutrition
91779-48564 Mashhad, Iran.
Email: norouzya@mums.ac.ir
Inflammation Score (MIS). Their dietary intakes were assessed using a Food Frequency
Questionnaire (FFQ).
Funding information
Mashhad University of Medical Sciences
Result: Based on DMS, 66.7% of HD patients were well nourished and the prevalence
of mild-to-moderate and severe PEW were 32.4% and 0.9% in HD patients, respec-
tively. Based on MIS, 65.2% of HD patients were well nourished and the prevalence of
mild-to-moderate and severe PEW was 34.0%. The prevalence of mild-to-moderate
and severe malnutrition based on SGA was 35.0% and 1.1%, respectively. Energy and
protein intake in 85.6% and 80.6% of patients respectively were less than the mini-
mum recommended amount.
Conclusion: HD patients are at risk of malnutrition and in this regard training the
patient, periodic assessment of nutritional status, and referring them to a dietitian
seems necessary.
Subjective Global Assessment (SGA), Dialysis Malnutrition Score indicates the normal nutritional status to severe malnutrition (pro-
(DMS), Malnutrition Inflammation Score (MIS), and dietary intake tein-energy malnutrition).19
assessment.
TA B L E 5 Prevalence of protein-energy
Well Mild-to-moderate Severe
malnutrition by sex, age dialysis vintage,
Variables nourished malnutrition malnutrition P-Value
dialysis adequacy, protein, and energy
Sex intake in hemodialysis patients based on
Men 189 (66.3) 93 (32.6) 3 (1.1) NS SGA
Energy and protein intakes in 85.6% and 80.6% of patients revealed a significant association between the prevalence of PEW
on dialysis were less than the minimum recommended amount. with dietary intakes of energy (P < .002) and protein (P < .003).
Mean (±SD) energy and protein intakes in HD patients were Energy and protein intakes in patients with malnutrition were
26.3 ± 27.0 kcal/kg/d and 0.9 ± 0.8g/kg/d, respectively, which were significantly lower than other patients, which is similar to the
less than recommended intakes of energy and protein.1,28 These findings of As'habi et al.1 In our study, there was no significant
findings are similar to those of previous studies. Tabibi et al in a association between the prevalence of PEW (SGA score) and sex
study in Tehran-Iran showed that 88% and 84.5% of HD patients (P = .463). Besides this study showed that there is no significant
had inadequate energy and protein intakes, respectively. 24 In a association between SGA score and dialysis adequacy (P > .05).
study from the United States, in the study of Kalantar-Zadeh et al, We found a significant association between the patient's age and
the mean of energy intake was 26.4 ± 15.3 kcal/kg/d and protein the SGA score (P = .000). Mild and moderate malnutrition was
intake was 0.88 ± 0.57 g/kg/d in HD patients.13 In Bossola et al’s significantly higher in HD patients with age ≥ 60 years, compared
study, the mean of energy intake was 25 ± 10.1 kcal/kg/d and pro- to patients with age less than 60 years. Also, the association be-
tein intake was 0.64 ± 0.4 g/kg/d.9 tween SGA score and the patient's age was marginally significant.
In HD patients, intake of dietary energy and protein lower than Some factors such as the high prevalence of infections, emotional
recommended results in malnutrition and poor quality of life and en- disorders, especially depression, physical or economic inability to
hanced morbidity and mortality. The most important reason for not provide food, and dental problems in the elderly can explain the
receiving enough dietary nutrients is anorexia. Anorexia may be due reason for this relationship.1 This finding is similar to the finding
to serum amino acid patterns, inflammation, uremic toxins, changes of As'habi et al.1 We found no significant association between
in the level of hormones and neurotransmitters related to appetite, dialysis vintage and SGA score. The prevalence of malnutrition
and underlying diseases such as infections and emotional disorders, was higher in HD patients who had dialysis vintage ≥5 years and
especially depression, which is common in patients with chronic was significantly higher compared with those with dialysis vin-
renal disorders. Other reasons for energy-protein malnutrition in HD tage <5 years. This could be a result of continuous loss of amino
patients are inability to provide food physically and economically, acid, protein, water-soluble vitamins, and minerals through he-
also underlying illnesses such as diabetes leads to further dietary modialysis, while this losing is not compensated, and the patient
restrictions. Dental problems and hyperkalemia or hyperphosphate- will have become malnourished in long term. This finding is in dis-
1
mia reduce food consumption. agreement with that of As'habi et al.1 The relationship between
85.6% and 80.6% of patients had dietary energy and protein serum albumin levels and malnutrition was not significant in our
intake lower than recommended values, respectively. This finding study, which is consistent with the findings of Espahbodi et al. 29
ZAHRA et al. | 5
The results of our study were probably due to the influence of 8. Araujo IC, Kamimura MA, Draibe SA, et al. Nutritional param-
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This study was supported by the Mashhad University of Medical of Sabzevar University of Medical Sciences., Vol. 19(1), Spring
Sciences of Iran. The authors thank the staff of the Mashhad he- 2012(1):69–75.
13. Kalantar-Zadeh K, Kopple JD, Deepak S, Block D, Block G. Food
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14. Fouque D, Kalantar-Zadeh K, Kopple J, et al. A proposed nomencla-
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The authors have disclosed that they have no significant relation-
15. Jeejeebhoy KN. Nutritional assessment. Nutrition.
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ORCID
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Zahra Akhlaghi https://orcid.org/0000-0002-9529-021X 17. National Kidney Foundation/Kidney Disease Outcome Quality
Farzaneh Sharifipour https://orcid.org/0000-0003-1536-5451 Initiative. National Kidney Foundation Clinical practice guidelines
Mohsen Nematy https://orcid.org/0000-0001-5919-0687 for nutrition in chronic renal failure. Am J Kidney Dis. 2000;35:
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Mohammad Safarian https://orcid.org/0000-0002-0583-0412
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Mahsa Malekahmadi https://orcid.org/0000-0002-6707-6929 tion. Nephrol Dial Transplant. 2007;22:ii45-ii87.
Bahareh Barkhidarian https://orcid.org/0000-0002-3604-4406 19. Kalantar-Zadeh K, Kleiner M, Dunne E, Lee GH, Luft FC. A modified
Abdolreza Norouzy https://orcid.org/0000-0001-6740-5502 quantitative subjective global assessment of nutrition for dialysis
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