Self-Reported Interview-Assisted Diet Records Underreport Energy Intake in Maintenance Hemodialysis Patients

Abstract

Objective Studies suggest that maintenance hemodialysis (MHD) patients report dietary energy intakes (EI) that are lower than what is actually ingested. Data supporting this conclusion have several important limitations. The present study introduces a novel approach of assessing underreporting of EI in MHD patients. Design Comparisons of EI of free-living MHD patients determined from food records to their measured energy needs. Setting Metabolic research ward. Subjects 13 clinically stable MHD patients with unchanging weights whose EI was assessed by dietitian-interview-assisted 3-day food records. Intervention EI was compared to 1) patients’ resting energy expenditure (REE), measured by indirect calorimetry, and estimated total energy expenditure (TEE), and 2) patients’ dietary energy requirements (DER) measured while patients underwent nitrogen balance studies and consumed a constant energy diet in a research ward for a mean duration of 89.5 days. DER was calculated as the actual EI during the research study corrected for changes in body fat and lean body mass measured by Dual X-Ray Absorptiometry (DEXA). Main Outcome Measure Underreporting of energy intake was determined by an EI:REE ratio <1.27 and an EI:TEE ratio or EI:DEE ratio <1.0. Results Seven of the 13 MHD patients studied were male. Patient’s ages were 47.7±SD 9.7 years; BMI averaged 25.4±2.8 kg/m2, and dialysis vintage was 53.3±37.1 months. The EI:REE ratio (1.03±0.23) was significantly less than the cut-off value for under-reporting of 1.27 (p=0.001); 12 of 13 patients had EI:REE ratios <1.27. The mean EI:TEE ratio was significantly less than the cut-off value of 1.0 (0.73±0.17, p<0.0001), and 12 MHD patients had EI:TEE ratios <1.0. The EI:DER ratio was also less than 1.0 (0.83±0.25, p=0.012), and 10 MHD had EI:DER ratios <1.0. Conclusion Dietitian interview-assisted diet records by MHD patients substantially underestimate the patient’s dietary energy intake.

Association of Processed Meat Intake with Hypertension Risk in Hemodialysis Patients: A Cross-Sectional Study

“…According to the cut-off points, 11.1% of female patients, 4.9% of male patients, and 7.8% of all patients were classified as under-reporters. This proportion was lower than that in a previous study [ 27 , 30 ]. The dry body weight of all 77 participants was the same in the two 3-dietary records within 1 month.…”

“…Fourth, although a dietary record over multiple days was used to evaluate the validity of other dietary assessment tool [ 66 , 67 ], dietary records may underestimate the actual food intake [ 68 ]. However, the under-reported bias was lower in this study [ 27 , 30 ], more than 7% of participants under reported their dietary intake. Fifth, this study did not include all confounding factors for pre-HD blood pressure in HD patients, such as the concentration of sodium in the dialysis solution [ 69 ].…”

Diet quality in patients with end‐stage kidney disease undergoing dialysis

“…; Mafra et al ; Shapiro et al . ). This finding may also be related to the increasing body of evidence suggesting that the current energy requirements used in EBPG actually overestimate requirements in a predominately sedentary group (Kamimura et al .…”

Inadequate dietary energy intake associates with higher prevalence of metabolic syndrome in different groups of hemodialysis patients: a clinical observational study in multiple dialysis centers

“…Inadequate dietary energy intake was defined as patients consumed less than the recommended levels. In order to enhance the reliability of measures and analysis, the under-reported dietary energy intake (EI) data were excluded from the final analysis if the ratio of EI:REE < 1.27 [ 41 ]. The results of the analysis were not affected by excluding the under-reporters in the study [ 42 ].…”