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

Sharmela Sahathevan, Chee Hee Se, Hoe Ng See, Karuthan Chinna, Gilcharan Singh Harvinder, Winnie Siew Swee Chee, Bak Leong Goh, Abdul Halim Abdul Gafor, Sunita Bavanandan, Ghazali Ahmad, Tilakavati Karupaiah

Research output: Contribution to journalArticle

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Abstract

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<inf>adj</inf>: 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<inf>adj</inf>: 2.17; 95% CI: 1.18-3.99). However, patients reporting diminished appetite were more likely to have lower LTM (OR<inf>adj</inf>: 2.86; 95% CI: 1.31-6.24) and fat mass (OR<inf>adj</inf>: 1.91; 95% CI: 1.03-3.53), lower levels of serum urea (OR<inf>adj</inf>: 2.74; 95% CI: 1.49-5.06) and creatinine (OR<inf>adj</inf>: 1.99; 95% CI: 1.01-3.92), higher Dialysis Malnutrition Score (OR<inf>adj</inf>: 2.75; 95% CI: 1.50-5.03), Malnutrition Inflammation Score (OR<inf>adj</inf>: 2.15; 95% CI: 1.17-3.94), and poorer physical (OR<inf>adj</inf>: 3.49; 95% CI: 1.89-6.47) and mental (OR<inf>adj</inf>: 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.

Original languageEnglish
Article number73
JournalBMC Nephrology
Volume16
Issue number1
DOIs
Publication statusPublished - 7 Jul 2015

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Appetite
Renal Dialysis
Cross-Sectional Studies
Population
Proteins
Malnutrition
Dialysis
Urea
Creatinine
Logistic Models
Fats
Regression Analysis
Demography
Inflammation
Kidney

Keywords

  • Anorexia
  • Appetite
  • Haemodialysis
  • Nutritional status
  • Protein energy wasting

ASJC Scopus subject areas

  • Nephrology

Cite this

Assessing protein energy wasting in a Malaysian haemodialysis population using self-reported appetite rating : a cross-sectional study. / Sahathevan, Sharmela; Se, Chee Hee; See, Hoe Ng; Chinna, Karuthan; Harvinder, Gilcharan Singh; Chee, Winnie Siew Swee; Goh, Bak Leong; Abdul Gafor, Abdul Halim; Bavanandan, Sunita; Ahmad, Ghazali; Karupaiah, Tilakavati.

In: BMC Nephrology, Vol. 16, No. 1, 73, 07.07.2015.

Research output: Contribution to journalArticle

Sahathevan, Sharmela ; Se, Chee Hee ; See, Hoe Ng ; Chinna, Karuthan ; Harvinder, Gilcharan Singh ; Chee, Winnie Siew Swee ; Goh, Bak Leong ; Abdul Gafor, Abdul Halim ; Bavanandan, Sunita ; Ahmad, Ghazali ; Karupaiah, Tilakavati. / Assessing protein energy wasting in a Malaysian haemodialysis population using self-reported appetite rating : a cross-sectional study. In: BMC Nephrology. 2015 ; Vol. 16, No. 1.
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abstract = "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 (ORadj: 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 (ORadj: 2.17; 95{\%} CI: 1.18-3.99). However, patients reporting diminished appetite were more likely to have lower LTM (ORadj: 2.86; 95{\%} CI: 1.31-6.24) and fat mass (ORadj: 1.91; 95{\%} CI: 1.03-3.53), lower levels of serum urea (ORadj: 2.74; 95{\%} CI: 1.49-5.06) and creatinine (ORadj: 1.99; 95{\%} CI: 1.01-3.92), higher Dialysis Malnutrition Score (ORadj: 2.75; 95{\%} CI: 1.50-5.03), Malnutrition Inflammation Score (ORadj: 2.15; 95{\%} CI: 1.17-3.94), and poorer physical (ORadj: 3.49; 95{\%} CI: 1.89-6.47) and mental (ORadj: 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.",
keywords = "Anorexia, Appetite, Haemodialysis, Nutritional status, Protein energy wasting",
author = "Sharmela Sahathevan and Se, {Chee Hee} and See, {Hoe Ng} and Karuthan Chinna and Harvinder, {Gilcharan Singh} and Chee, {Winnie Siew Swee} and Goh, {Bak Leong} and {Abdul Gafor}, {Abdul Halim} and Sunita Bavanandan and Ghazali Ahmad and Tilakavati Karupaiah",
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TY - JOUR

T1 - Assessing protein energy wasting in a Malaysian haemodialysis population using self-reported appetite rating

T2 - a cross-sectional study

AU - Sahathevan, Sharmela

AU - Se, Chee Hee

AU - See, Hoe Ng

AU - Chinna, Karuthan

AU - Harvinder, Gilcharan Singh

AU - Chee, Winnie Siew Swee

AU - Goh, Bak Leong

AU - Abdul Gafor, Abdul Halim

AU - Bavanandan, Sunita

AU - Ahmad, Ghazali

AU - Karupaiah, Tilakavati

PY - 2015/7/7

Y1 - 2015/7/7

N2 - 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 (ORadj: 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 (ORadj: 2.17; 95% CI: 1.18-3.99). However, patients reporting diminished appetite were more likely to have lower LTM (ORadj: 2.86; 95% CI: 1.31-6.24) and fat mass (ORadj: 1.91; 95% CI: 1.03-3.53), lower levels of serum urea (ORadj: 2.74; 95% CI: 1.49-5.06) and creatinine (ORadj: 1.99; 95% CI: 1.01-3.92), higher Dialysis Malnutrition Score (ORadj: 2.75; 95% CI: 1.50-5.03), Malnutrition Inflammation Score (ORadj: 2.15; 95% CI: 1.17-3.94), and poorer physical (ORadj: 3.49; 95% CI: 1.89-6.47) and mental (ORadj: 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.

AB - 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 (ORadj: 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 (ORadj: 2.17; 95% CI: 1.18-3.99). However, patients reporting diminished appetite were more likely to have lower LTM (ORadj: 2.86; 95% CI: 1.31-6.24) and fat mass (ORadj: 1.91; 95% CI: 1.03-3.53), lower levels of serum urea (ORadj: 2.74; 95% CI: 1.49-5.06) and creatinine (ORadj: 1.99; 95% CI: 1.01-3.92), higher Dialysis Malnutrition Score (ORadj: 2.75; 95% CI: 1.50-5.03), Malnutrition Inflammation Score (ORadj: 2.15; 95% CI: 1.17-3.94), and poorer physical (ORadj: 3.49; 95% CI: 1.89-6.47) and mental (ORadj: 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.

KW - Anorexia

KW - Appetite

KW - Haemodialysis

KW - Nutritional status

KW - Protein energy wasting

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