Malnutrition score and Body Mass Index as nutritional screening tools for hemodialysis patients

Hassanin, Islam A.; Hassanein, Hazem; Elmenshawy, Pillar; El-Gameel, Dina; Elsheikh, Aya A.; El-Kobrosly, Aya; Samir, Bassant; Emil, Rafael; Alaa, Merihan; Selim, Dina H.

doi:10.1016/j.clnesp.2021.01.044

Cited by 11 publications

(9 citation statements)

References 9 publications

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“…On the basis of World Health Organization (WHO) classifications [ 15 ], 7.3% of the HD patients presented underweight (BMI < 18.5), 41.9% of the subjects had a normal body weight (BMI 18.5–24.99), 32,4% had overweight (BMI 25–29.99), and 18.4% were obese (BMI > 30). Based on the ISRNM criteria regarding the recommended BMI [ 8 , 16 ], 35.2% were malnourished (BMI < 23). In the group of patients under 65 years of age, excessive weight was found in 43.2% of the group, while in the group of older patients it was 56.1%.…”

Section: Resultsmentioning

confidence: 99%

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Adherence to Caloric and Protein Recommendations in Older Hemodialysis Patients: A Multicenter Study

Czaja-Stolc

Puchalska-Reglińska²,

Małgorzewicz

et al. 2022

Nutrients

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Hemodialysis (HD) patients are characterized by malnutrition, which adversely affects their survival. The development of malnutrition is influenced, among other factors, by improper diet and the advanced age of patients. The study aimed to assess the nutritional status and adherence to dietary recommendations among older patients. The multicenter study included 179 stable HD patients. The nutritional status was assessed by a 7-point Subjective Global Assessment (SGA). Anthropometry and body composition was analyzed. The diet was assessed based on the 3-day food diary and the Food Frequency Questionnaire with 6 answers (FFQ-6). Blood laboratory tests were performed. Based on the 7-point SGA, malnutrition was diagnosed in 38.5% of HD patients. The decreased content of the muscle tissue (LTI < 14 kg/m2) was observed in 70.4% of the examined patients and the decreased concentration of s-albumin was observed in 44.1% of patients. Older patients had significantly lower LTI. 26% of patients consumed less than 25 kcal/kg body weight and less than 0.8 g protein/kg body weight. Older patients’ diets contained significantly fewer calories. There were significant differences between nutrient intake on a weekday with dialysis, a weekday without dialysis, and a weekend day without dialysis. The lowest intake of nutrients was observed on the day of dialysis. Nutritional education and the determination of whether food is permitted during hemodialysis are necessary to improve patients’ nutrition.

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Section: Resultsmentioning

confidence: 99%

“…The mean dietary protein content/kg body weight in 59.3% of patients was below the recommended level [ 16 ]. 28% of patients consumed less than 0.8 g of protein/kg of body weight.…”

Section: Resultsmentioning

confidence: 99%

Adherence to Caloric and Protein Recommendations in Older Hemodialysis Patients: A Multicenter Study

Czaja-Stolc

Puchalska-Reglińska²,

Małgorzewicz

et al. 2022

Nutrients

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“…This result is consistent with previous studies, where malnutrition and obesity prevalence in maintenance hemodialysis patients were simultaneously assessed 37,38 . These studies have shown an overlap between patients with malnutrition and those with obesity, indicating a problem with nutritional assessment methodologies, further supporting the fact that BMI may not be a reliable indicator for nutritional assessment among maintenance hemodialysis patients [39][40][41][42][43][44][45] , but BMI is relatively easy, inexpensive and less time consuming to measure than modified SGA score 23,46…”

Section: Discussionmentioning

confidence: 99%

Comparison of Body Mass Index with Modified Subjective Global Assessment for Detection of Malnutrition Among Patients Under Maintenance Hemodialysis: A Multi-Center Cross-Sectional Study

Rahman

Haque

Sultana

et al. 2022

JOPSOM

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Background: Patients under maintenance hemodialysis are at increased risk of malnutrition, causing from multitude of factors. Present study aims to assess the prevalence of malnutrition among maintenance hemodialysis patients using both modified subjective global assessment score and body mass index, compare them and assess the sensitivity and specificity of body mass index for detecting malnutrition, along with determining a new cutoff value for BMI that better represent the maintenance hemodialysis patient’s nutritional status. Methods: This was a cross-sectional study conducted in the hemodialysis unit of Bangabandhu Sheikh Mujib Medical University, Sir Salimullah Medical College Mitford Hospital, BIRDEM General Hospital and National Institute of Kidney Diseases & Urology; among 80 adult CKD patients who were on regular (≥2 sessions per week) maintenance hemodialysis for more than 3 months without any acute infection, during the period of July 2016 to June 2017. Nutritional assessment was done for each patient using modified SGA score along with BMI. Sensitivity analysis of WHO recommended cutoff value for BMI was done among the study population using modified SGA score as gold standard test for detection of malnutrition among the respondents. ROC curve was used to estimate the best fitting cutoff value of BMI that showed highest sensitivity, specificity and accuracy for detracting malnutrition among maintenance hemodialysis patients. Results: The study participants were predominantly male (66.3%) and from age group 45 to 59 years (36.3%). Modified SGA score detected 90.0% of the study population as malnourished. WHO recommended 18.5 kg/m2 cutoff value was also used to detect malnutrition among study population and 13.8% were found to be malnourished, with a sensitivity and specificity of 12.5% and 75.0% respectively. Accuracy was found to be 18.8%. Using ROC curve, 23.1 kg/m2 was found to be the best fitting cutoff value of BMI for the study population to detect malnutrition. With a sensitivity of 47.2%, specificity of 37.5% and accuracy of 46.3%. Conclusion: BMI showed low sensitivity for detecting malnutrition among patients under maintenance hemodialysis, compared to modified SGA score and should be avoided as a screening tool, but 23.1 kg/m2 cutoff value for BMI showed potential to be used as an easy to use and quick tool for detecting malnutrition among such patients. Further study with larger sample size could shed more light on this. JOPSOM 2021; 40(1): 14-21

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“…In addition, a study by Hassanin et al (2021) (n = 98 HD patients) utilised the Patient-Generated Subjective Global Assessment (PG-SGA) as a reference standard and compared with use of the dialysis malnutrition score (DMS) (similar to the PG-SGA but has additional elements on dialysis history and subjective assessment of the loss of muscle and fat mass), and different cut off points for BMI (<23 kg/ m 2 (ISRNM) and 18.5 kg/m 2 (ESPEN)) [25]. They found that 72.4% were diagnosed as having malnutrition by DMS which was very similar to the PG-SGA (71.4%).…”

Section: Prevalence and Screening/assessmentmentioning

confidence: 99%

Disease-related malnutrition in chronic kidney disease

Slee¹,

Reid

2022

Current Opinion in Clinical Nutrition &Amp; Metabolic Care

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Purpose of reviewDisease-related malnutrition has complex and multifactorial pathophysiology. It is common in patients with chronic kidney disease (CKD) and has a devastating impact on morbidity and mortality. Given the rising numbers of patients diagnosed with CKD, disease-related malnutrition is an escalating clinical challenge. This review summarises current knowledge in relation to the development, screening and treatments for disease-related malnutrition in CKD Recent findingsNew research has identified other potential causes for the development of malnutrition in CKD, including changes in taste and smell, and effects of polypharmacy. Screening and assessment studies have investigated different tools in relation to the new Global Leadership Initiative on Malnutrition (GLIM) criteria. Different modalities of low protein diets and the potential use of pre and probiotics are being explored. Furthermore, the importance of nutritional support, and possibly exercise during dialysis is being examined in terms of reducing anabolic resistance and catabolism. SummaryFurther research is required to better understand the nuances of the pathophysiology of disease-related malnutrition in CKD. This work should inform not only consistent terminology and the application of assessment tools specific to disease-related malnutrition in CKD but also the development of novel interventions that reflect its multifaceted pathophysiology and impact.

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Malnutrition score and Body Mass Index as nutritional screening tools for hemodialysis patients

Cited by 11 publications

References 9 publications

Adherence to Caloric and Protein Recommendations in Older Hemodialysis Patients: A Multicenter Study

Adherence to Caloric and Protein Recommendations in Older Hemodialysis Patients: A Multicenter Study

Comparison of Body Mass Index with Modified Subjective Global Assessment for Detection of Malnutrition Among Patients Under Maintenance Hemodialysis: A Multi-Center Cross-Sectional Study

Disease-related malnutrition in chronic kidney disease

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