Validating Appetite Assessment Tools Among Patients Receiving Hemodialysis

Abstract

Objective To test the performance of appetite assessment tools among patients receiving hemodialysis. Design Cross-sectional. Setting Seven dialysis facilities in Northern California. Subjects 221 patients receiving hemodialysis. Intervention We assessed five appetite assessment tools [self-assessment of appetite, subjective assessment of appetite, visual analogue scale (VAS), Functional Assessment of Anorexia/Cachexia Therapy (FAACT) score and the Anorexia Questionnaire (AQ)]. Main outcome measures Reported food intake, normalized protein catabolic rate (nPCR), and change in body weight were used as criterion measures, and we assessed associations among the appetite tools and biomarkers associated with nutrition and inflammation. Patients were asked to report their appetite and the percentage of food eaten (from 0% to 100%) during the last meal compared to usual intake. Results Fifty-eight (26%) patients reported food intake ≤50% (defined as poor appetite). The prevalence of anorexia was 12% by self-assessment of appetite, 6% by subjective assessment of appetite, 24% by VAS, 17% by FAACT score, and 12% by AQ. All tools were significantly associated with food intake ≤50% (p<0.001), except self-assessment of appetite. The FAACT score and the VAS had the strongest association with food intake ≤50% (c-statistic 0.80 and 0.76). Patients with food intake ≤50% reported weight loss more frequently than patients without low intake (36% vs 22%) and weight gain less frequently (19% vs 35%; p=0.03). nPCR was lower among anorexic patients based on the VAS (1.1 ± 0.3 vs 1.2 ± 0.3, p=0.03). Ln IL-6 correlated inversely with food intake (p=0.03), but neither IL-6 nor CRP correlated with any of the appetite tools. Furthermore, only the self-assessment of appetite was significantly associated with serum albumin (p=0.02), prealbumin (p=0.02) and adiponectin concentrations (p=0.03). Conclusions Alternative appetite assessment tools yielded widely different estimates of the prevalence of anorexia in hemodialysis. When considering self-reported food intake as the criterion standard for anorexia, the FAACT score and VAS discriminated patients reasonably well.

Concurrent validity of an appetite questionnaire in peritoneal dialysis

“…Indeed, in a recent review about the performance of appetite assessment tools among patients receiving hemodialysis, it has been shown that the prevalence of poor appetite varies considerably from 6% to 24%. 13 In the present study, besides LTI and BCMI, phase angle, a direct measure of bioimpedance, was also lower among patients with poor appetite. The phase angle has been validated as a prognostic indicator in critically ill patients 28,29 and in patients on dialysis, the lower phase angle was associated with worse nutritional parameters and mortality.…”

“…A variety of tools have been developed and used to evaluate appetite in patients with CKD. Some studies used the question about food intake from the subjective global assessment (SGA), 8,15 while other investigators assessed the discomfort caused by the lack of appetite in a given period of time, 11,13 and most of them used part or the entire content of the ADAT. 6,9,10,[16][17][18] ADAT is an extensive questionnaire (44 questions) about appetite developed in the United States and validated for the population on hemodialysis.…”

Cancer anorexia: hypothalamic activity and its association with inflammation and appetite‐regulating peptides in lung cancer

“…Approximately 30 min before recording hypothalamic activity, the presence/absence of anorexia was investigated using the Functional Assessment of Anorexia/Cachexia Therapy (FAACT) questionnaire, which has been recently endorsed by the European Society for Clinical Nutrition and Metabolism (ESPEN) as a reliable tool to assess disease‐associated anorexia . As recently shown, a FAACT score ≤ 30 is indicative of the presence of anorexia …”

“…The time frame of reference for the three appetite tools was represented by the moment they were completed (current appetite). We additionally administered the self‐assessment of appetite changes, which investigates present appetite vs. appetite over the last month (increased, decreased, or unchanged) …”

Association Between Metabolic and Hormonal Derangements and Professional Exposure to Urban Pollution in a High Intensity Traffic Area

“…We additionally utilized leptin/BMI and adiponectin/BMI ratios in our analyses accounting for the well-known associations between leptin and adiponectin with adiposity, as previously shown (22,23).…”