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Perez L, Gendelman S, Kendrick J. Home-Delivered Medically Tailored Meal Engagement Among Hemodialysis Patients and Providers. J Ren Nutr 2024; 34:40-46. [PMID: 37640277 DOI: 10.1053/j.jrn.2023.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/03/2023] [Accepted: 08/20/2023] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVE Hemodialysis patients face one of the most difficult diets among clinical patient populations. Furthermore, dialysis dietary adherence is generally reported as low with providers generally lacking the time and resources to implement effective behavior change. The purpose of this study was to elucidate measures of patient and provider engagement with home-delivered medically tailored meals (MTMs). METHODS We surveyed patients and staff at dialysis centers within the Denver metropolitan area. Surveys focused on 1) patient dietary intake, 2) awareness, support, and utilization of meal programs, and 3) nutritional challenges and barriers (including food security). RESULTS We surveyed 118 patients (mean age 61.0 ± 14.2 year, 58.5% male, and dialysis vintage of 4.6 ± 4.9 years) and 26 staff across the included dialysis facilities. Patients were 20.3% White/Non-Hispanic, 35.6% Hispanic/Latin, and 31.4% Black/African American. Most patients reported eating 2 meals per day (N = 53, 44.9%) and 52.2% reported difficulty with following a kidney diet. The most cited reasons for not following the diet were behavioral or knowledge (38.5%), taste (26.3%), time/convenience (26.9%) and food autonomy (16.9%). Sixty participants (52.2%) reported living in a food desert and 26.3% reported food insecurity. Seventy-one patients (61.2%) were aware of MTMs but only 40.5% had been referred. Most (76.9%) dialysis providers were aware of MTMs but only 15 (57.7%) had actually referred patients to such a service. Black individuals were less likely to be referred for MTMs than White or Hispanics/Latin (29.7% vs 48.1% White and 45.0% Hispanic/Latin) individuals. CONCLUSION Medically tailored meals (MTMs) represent a potential method to alleviate or bypass some of the many barriers expressed by patients. Our findings reveal a critical need for education around MTMs for both patients and providers. Medically tailored meals (MTMs) could potentially demonstrate health kidney dietary patterns that might translate to altered dietary preferences or toward future behavior change.
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Affiliation(s)
- Luis Perez
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Sam Gendelman
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Jessica Kendrick
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO.
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2
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Jackson H. Enhancing nutrition screening in patients with kidney disease. Nurs Stand 2023; 38:77-81. [PMID: 37547939 DOI: 10.7748/ns.2023.e11934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2023] [Indexed: 08/08/2023]
Abstract
Malnutrition is common in patients with kidney disease, and can exacerbate the individual and economic burden of the condition. The identification of malnutrition is essential to inform management interventions and improve patient outcomes, and nutrition screening can be considered the first stage in this process. The development of simple nutrition screening tools has assisted nurses in undertaking widespread, rapid assessments of patients' malnutrition risk. However, generic tools may not be appropriate or accurate in patients with kidney disease. This article explains some of the challenges of identifying malnutrition in this patient group and outlines some disease-specific tools that nurses can use to enhance nutrition screening.
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Affiliation(s)
- Helena Jackson
- St George's University Hospitals NHS Foundation Trust, London, England
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3
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Helliesen JS, Kristiansen I, Brekke HK, Støkket RS, Bye A. Nutrition impact symptoms and the risk of malnutrition in people with Parkinson's disease: A cross-sectional study. J Hum Nutr Diet 2023; 36:40-50. [PMID: 35897145 DOI: 10.1111/jhn.13070] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 07/05/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND People with Parkinson's disease (PD) often experience symptoms that affect their ability to eat. This may contribute to weight loss and increased risk of malnutrition. The present study aimed to quantify the extent of nutrition impact symptoms (NIS) in the population and a scoring system of NIS was incorporated in the tool used to identify malnutrition. METHODS In this cross-sectional study, members of the Norwegian Parkinson's Association, with any PD diagnosis and stage of illness, were invited to respond to an online 24-item questionnaire. Questions from two validated questionnaires, comprising the abridged Patient-Generated Subjective Global Assessment (aPG-SGA) and the Radboud Oral Motor Inventory for Parkinson's disease (ROMP), were adapted to an online format. RESULTS The questionnaire was sent to 3047 members, of which 508 persons (17%) responded (61% men). In total, 59% were categorised as well-nourished, 34% at risk of malnutrition and 6.5% as malnourished. One quarter of all participants reported symptoms that affected food intake. The most frequent symptoms were constipation (14.2%) and dry mouth (13.4%). Malnourished participants reported a mean ± SD of 3.4 ± 1.4 symptoms versus 0.1 ± 0.3 per well-nourished participant. Malnourished participants had more swallowing problems than well-nourished participants, with a mean ± SD total ROMP score of 15.5 ± 6.0 versus 9.0 ± 2.9 (p < 0.001). As the number of points in the ROMP score increased by one, the points in the aPG-SGA score increased with 37% (95% confidence interval = 0.309-0.428). CONCLUSIONS Risk of malnutrition was largely related to NIS, especially dysphagia in people with PD. Symptoms affecting food intake should be systematically mapped and treated in conjunction with PD to prevent malnutrition.
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Affiliation(s)
- Julie Sørbø Helliesen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Ida Kristiansen
- The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway
| | - Hilde Kristin Brekke
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | | | - Asta Bye
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet-Oslo Metropolitan University, Oslo, Norway.,Department of Oncology, European Palliative Care Research Centre (PRC), Oslo University Hospital, Oslo, Norway
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Caruana L, Nichols L, Lambert K. Malnutrition, symptom burden and predictive validity of the Patient-Generated Subjective Global Assessment in Central Australian haemodialysis patients: A cross sectional study. Nutr Diet 2022; 79:555-562. [PMID: 35903960 PMCID: PMC9796483 DOI: 10.1111/1747-0080.12763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 06/12/2022] [Accepted: 06/23/2022] [Indexed: 01/01/2023]
Abstract
AIM To (i) describe the prevalence of malnutrition among a cohort of central Australian, predominantly Indigenous, haemodialysis patients and (ii) determine the sensitivity and specificity of the Patient Generated Subjective Global Assessment total score for identification of malnutrition in these patients. METHODS Cross-sectional observational study of all patients attending haemodialysis units within the Central Australia Health Service. Patients were assessed using the Patient-Generated Subjective Global Assessment. Chi-Square tests were used to determine the association between nutritional status and location, age and gender. Receiver Operator Characteristic curves were used to ascertain the predictive validity for malnutrition of the total score. RESULTS Indigenous patients comprised 98% of study haemodialysis patients (n = 249/253). One third were male, and 72% were aged between 30 and 59 years. Approximately 29% (74/253) were malnourished, and 93% (69/74) had a total score ≥ 4. The most frequently reported problems that kept malnourished patients from eating were early satiety (32%), no appetite (31%), diarrhoea (26%) and dental problems (24%). Money problems were reported by 32%, as were transport (20%) and depression (19%). The traditional tool cut off score of ≥9 had low sensitivity (50%) for detecting malnutrition. Instead, a score ≥ 3 is suggested due to a higher sensitivity (96%) and specificity (45%). CONCLUSION Malnutrition was found to be common, and we suggest using a Patient-Generated Subjective Global Assessment total score of ≥3 to improve the identification of malnourished individuals in this cohort of predominantly Indigenous haemodialysis patients. This will significantly increase referrals for dietetic intervention.
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Affiliation(s)
| | - Liz Nichols
- Department of Nutrition & DieteticsAlice Springs HospitalThe GapNorthern TerritoryAustralia
| | - Kelly Lambert
- University of WollongongWollongongNew South WalesAustralia
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5
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Malnutrition Screening and Assessment. Nutrients 2022; 14:nu14122392. [PMID: 35745121 PMCID: PMC9228435 DOI: 10.3390/nu14122392] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/01/2022] [Accepted: 06/06/2022] [Indexed: 01/04/2023] Open
Abstract
Malnutrition is a serious problem with a negative impact on the quality of life and the evolution of patients, contributing to an increase in morbidity, length of hospital stay, mortality, and health spending. Early identification is fundamental to implement the necessary therapeutic actions, involving adequate nutritional support to prevent or reverse malnutrition. This review presents two complementary methods of fighting malnutrition: nutritional screening and nutritional assessment. Nutritional risk screening is conducted using simple, quick-to-perform tools, and is the first line of action in detecting at-risk patients. It should be implemented systematically and periodically on admission to hospital or residential care, as well as on an outpatient basis for patients with chronic conditions. Once patients with a nutritional risk are detected, they should undergo a more detailed nutritional assessment to identify and quantify the type and degree of malnutrition. This should include health history and clinical examination, dietary history, anthropometric measurements, evaluation of the degree of aggression determined by the disease, functional assessment, and, whenever possible, some method of measuring body composition.
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Estimates of malnutrition associated with chronic kidney disease patients globally and its contrast with India: An evidence based systematic review and meta-analysis. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021. [DOI: 10.1016/j.cegh.2021.100855] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
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7
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De Groot LM, Lee G, Ackerie A, van der Meij BS. Malnutrition Screening and Assessment in the Cancer Care Ambulatory Setting: Mortality Predictability and Validity of the Patient-Generated Subjective Global Assessment Short form (PG-SGA SF) and the GLIM Criteria. Nutrients 2020; 12:nu12082287. [PMID: 32751724 PMCID: PMC7468976 DOI: 10.3390/nu12082287] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/16/2020] [Accepted: 07/21/2020] [Indexed: 01/07/2023] Open
Abstract
Background: A valid malnutrition screening tool (MST) is essential to provide timely nutrition support in ambulatory cancer care settings. The aim of this study is to investigate the validity of the Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF) and the new Global Leadership Initiative on Malnutrition (GLIM) criteria as compared to the reference standard, the Patient-Generated Subjective Global Assessment (PG-SGA). Methods: Cross-sectional observational study including 246 adult ambulatory patients with cancer receiving in-chair intravenous treatment at a cancer care centre in Australia. Anthropometrics, handgrip strength and patient descriptive data were assessed. Nutritional risk was identified using MST and PG-SGA SF, nutritional status using PG-SGA and GLIM. Sensitivity (Se), specificity (Sp), positive and negative predictive values and kappa (k) were analysed. Associations between malnutrition and 1-year mortality were investigated by Cox survival analyses. Results: A PG-SGA SF cut-off score ≥5 had the highest agreement when compared with the PG-SGA (Se: 89%, Sp: 80%, k = 0.49, moderate agreement). Malnutrition risk (PG-SGA SF ≥ 5) was 31% vs. 24% (MST). For malnutrition according to GLIM, the Se was 76% and Sp was 73% (k = 0.32, fair agreement) when compared to PG-SGA. The addition of handgrip strength to PG-SGA SF or GLIM did not improve Se, Sp or agreement. Of 100 patients who provided feedback, 97% of patients found the PG-SGA SF questions easy to understand, and 81% reported that it did not take too long to complete. PG-SGA SF ≥ 5 and severe malnutrition by GLIM were associated with 1-year mortality risk. Conclusions: The PG-SGA SF and GLIM criteria are accurate, sensitive and specific malnutrition screening and assessment tools in the ambulatory cancer care setting. The addition of handgrip strength tests did not improve the recognition of malnutrition or mortality risk.
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Affiliation(s)
- Lynette M. De Groot
- Dietetics and Foodservices, Mater Health, Brisbane, 4101 QLD, Australia; (L.M.D.G.); (A.A.)
- Mater Research Institute, University of Queensland, Brisbane, 4101 QLD, Australia
| | - Gahee Lee
- Bond University Nutrition and Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, 4226 QLD, Australia;
| | - Antoinette Ackerie
- Dietetics and Foodservices, Mater Health, Brisbane, 4101 QLD, Australia; (L.M.D.G.); (A.A.)
| | - Barbara S. van der Meij
- Dietetics and Foodservices, Mater Health, Brisbane, 4101 QLD, Australia; (L.M.D.G.); (A.A.)
- Mater Research Institute, University of Queensland, Brisbane, 4101 QLD, Australia
- Bond University Nutrition and Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, 4226 QLD, Australia;
- Correspondence:
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Lindqvist C, Slinde F, Majeed A, Bottai M, Wahlin S. Nutrition impact symptoms are related to malnutrition and quality of life – A cross-sectional study of patients with chronic liver disease. Clin Nutr 2020; 39:1840-1848. [DOI: 10.1016/j.clnu.2019.07.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 06/19/2019] [Accepted: 07/31/2019] [Indexed: 02/08/2023]
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van Vliet IMY, Gomes-Neto AW, de Jong MFC, Jager-Wittenaar H, Navis GJ. High prevalence of malnutrition both on hospital admission and predischarge. Nutrition 2020; 77:110814. [PMID: 32442829 DOI: 10.1016/j.nut.2020.110814] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 01/16/2020] [Accepted: 03/01/2020] [Indexed: 01/12/2023]
Abstract
OBJECTIVES In Dutch hospitals malnutrition screening is routinely performed at admission, but not during follow-up or before discharge. Therefore we evaluated nutritional status during hospitalization and predischarge in a routine care setting. METHODS The Patient-Generated Subjective Global Assessment (PG-SGA) was used to assess nutritional status (PG-SGA Categories: A = well nourished, B = moderate/suspected malnutrition, C = severely malnourished) in adult patients on four wards of a university hospital at admission, day 5, day 10, and day ≥15. Because data were obtained in the context of clinical routine, not all data points are available for all patients. Last assessment before discharge (within ≤4 d) was taken as predischarge measurement. RESULTS PG-SGA data at admission were obtained in 584 patients (age 57.2 ± 17.3 y, 51.4% women, body mass index 27.0 ± 5.5 kg/m2). Prevalence of PG-SGA stage B/C was 31% at admission, 56% on day 5 (n = 292), 66% on day 10 (n = 101), and 79% on day ≥15 (n = 14). PG-SGA predischarge data were available in 537 patients, 36% of whom were PG-SGA stage B/C. Of the 91 patients assessed both at admission and predischarge, 30% of well-nourished patients became malnourished and 82% of malnourished patients remained so. CONCLUSIONS Prevalence of malnutrition in hospitalized patients is high at admission (31%) and, importantly, also high predischarge (36%). Malnutrition is more prevalent in patients with a longer length of stay. These findings underscore the importance of follow-up of nutritional status in hospitalized patients and adequate transmural nutrition care after discharge to prevent malnutrition from remaining undetected and untreated.
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Affiliation(s)
- Iris M Y van Vliet
- Department of Dietetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - António W Gomes-Neto
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Margriet F C de Jong
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Harriët Jager-Wittenaar
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Research Group Healthy Ageing, Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands
| | - Gerjan J Navis
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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10
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The effect of an arteriovenous fistula and haemodialysis on anthropometric measurements of the upper arm. Eur J Clin Nutr 2020; 74:1240-1242. [PMID: 31896824 DOI: 10.1038/s41430-019-0548-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 11/29/2019] [Accepted: 12/11/2019] [Indexed: 11/09/2022]
Abstract
Haemodialysis (HD) patients are at increased risk of sarcopenia. Measurements of triceps skinfold thickness (TSFT) and mid-upper arm circumference (MUAC) are used to estimate muscle mass. An arteriovenous fistula is the preferred vascular access for HD patients, and we wished to determine whether anthropometric measurements were affected by the fistula and HD treatment. One hundred and forty-four HD patients, 90 (62.5%) males, mean age 63.1 ± 15.4 years, had measurements pre- and post-HD. TSFT was similar in the arms, whereas MUAC and corrected mid-upper arm muscle circumference (CMUAMC) were greater in the fistula compared with the non-fistula arm (MUAC pre-HD 30.0 ± 5.2 vs 29.2 ± 4.7 and post-HD 29.6 ± 5.1 vs 28.5 ± 4.7, p < 0.001; MUAMC 23.5 ± 4.0 vs 22.5 ± 4.1, and post-HD 22.9 ± 4.0, and 22.0 ± 3.7 cm p < 0.01). Following HD; TSFT did not change, but MUAC and CMUAMC fell significantly in both arms (p < 0.01). When screening for sarcopenia in HD patients, anthropometric measurements should be taken post-HD in the non-fistula arm.
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11
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Sensitive and practical screening instrument for malnutrition in patients with chronic kidney disease. Nutrition 2019; 72:110643. [PMID: 31926378 DOI: 10.1016/j.nut.2019.110643] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 08/03/2019] [Accepted: 11/01/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The aims of this study were to examine the diagnostic accuracy of the Malnutrition Universal Screening Tool (MUST) and the Patient-Generated Subjective Global Assessment Short Form (PG-SGA-SF) for detecting malnutrition in chronic kidney disease (CKD), study individual contributions of MUST and PG-SGA screening items to the explained variance in nutritional status (NS), and examine whether the PG-SGA-SF score, in combination with one of the items of the clinician's part of the cPG-SGA, can be used as a valid and compact nutrition assessment tool in patients with CKD. METHODS This was a cross-sectional observational study with 123 patients with CKD who were screened for malnutrition risk by MUST and PG-SGA-SF. NS was determined by complete PG-SGA. Overall accuracy was calculated by the receiver operating curve area under the curve (ROC-AUC). Explained variance of individual screening items was assessed by Nagelkerke's R2, total explained variance was assessed by the increase of R2 after addition of items in manual stepwise forward selection. RESULTS Of the patients, 44% were malnourished, which was detected by MUST in 24% and by PG-SGA-SF in 78%. Items "body mass index (BMI)" and "no food intake" of the MUST together explained only 3.7% of the variance in NS, whereas the item "nutrition impact symptoms" (NIS) of the PG-SGA-SF explained 57%. Total explained variance in NS by MUST and PG-SGA-SF were 15% and 74%, respectively. The PG-SGA-SF combined with the "metabolic stress" item explained most (87%) and had a sensitivity of 94% to detect malnutrition. CONCLUSIONS Most malnourished patients with CKD failed to be identified with the MUST, whereas the PG-SGA-SF detected the majority of them with the screening item "NIS" having the highest individual contribution to the explained variance in NS. Combination of PG-SGA-SF with the item "metabolic stress" had the highest overall accuracy to detect malnutrition.
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Wright M, Southcott E, MacLaughlin H, Wineberg S. Clinical practice guideline on undernutrition in chronic kidney disease. BMC Nephrol 2019; 20:370. [PMID: 31619185 PMCID: PMC6796390 DOI: 10.1186/s12882-019-1530-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 08/21/2019] [Indexed: 01/12/2023] Open
Affiliation(s)
| | | | | | - Stuart Wineberg
- Patient Representative, c/o The Renal Association, Bristol, UK
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13
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Carrero JJ, Thomas F, Nagy K, Arogundade F, Avesani CM, Chan M, Chmielewski M, Cordeiro AC, Espinosa-Cuevas A, Fiaccadori E, Guebre-Egziabher F, Hand RK, Hung AM, Ikizler TA, Johansson LR, Kalantar-Zadeh K, Karupaiah T, Lindholm B, Marckmann P, Mafra D, Parekh RS, Park J, Russo S, Saxena A, Sezer S, Teta D, Ter Wee PM, Verseput C, Wang AY, Xu H, Lu Y, Molnar MZ, Kovesdy CP. Global Prevalence of Protein-Energy Wasting in Kidney Disease: A Meta-analysis of Contemporary Observational Studies From the International Society of Renal Nutrition and Metabolism. J Ren Nutr 2018; 28:380-392. [DOI: 10.1053/j.jrn.2018.08.006] [Citation(s) in RCA: 135] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 08/14/2018] [Accepted: 08/14/2018] [Indexed: 01/09/2023] Open
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MacLaughlin HL, Twomey J, Saunt R, Blain S, Campbell KC, Emery P. The nutrition impact symptoms (NIS) score detects malnutrition risk in patients admitted to nephrology wards. J Hum Nutr Diet 2018; 31:683-688. [DOI: 10.1111/jhn.12553] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- H. L. MacLaughlin
- Department of Nutritional Sciences; King's College London; London UK
- Nutrition and Dietetics; King's College Hospital NHS Foundation Trust; London UK
| | - J. Twomey
- Department of Nutritional Sciences; King's College London; London UK
- Nutrition and Dietetics; King's College Hospital NHS Foundation Trust; London UK
| | - R. Saunt
- Nutrition and Dietetics; King's College Hospital NHS Foundation Trust; London UK
| | - S. Blain
- Department of Nutritional Sciences; King's College London; London UK
| | - K. C. Campbell
- Faculty of Health Sciences and Medicine; Bond University; Gold Coast, QLD Australia
| | - P. Emery
- Department of Nutritional Sciences; King's College London; London UK
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Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF) is a valid screening tool in chemotherapy outpatients. Support Care Cancer 2016; 24:3883-7. [DOI: 10.1007/s00520-016-3196-0] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 03/28/2016] [Indexed: 01/04/2023]
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16
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Young V, Balaam S, Orazio L, Bates A, Badve SV, Johnson DW, Campbell KL. APPETITE PREDICTS INTAKE AND NUTRITIONAL STATUS IN PATIENTS RECEIVING PERITONEAL DIALYSIS. J Ren Care 2016; 42:123-31. [PMID: 27060338 DOI: 10.1111/jorc.12156] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Sub-optimal nutrition status is common amongst patients receiving peritoneal dialysis (PD) and leads to poor clinical outcome. This population experiences multi-factorial challenges to achieving optimal nutritional status, particularly driven by inadequate intake. OBJECTIVES The aim of this investigation was to identify factors associated with inadequate protein intake and sub-optimal nutritional status in patients undergoing PD. DESIGN/PARTICIPANTS This was a cross-sectional study of 67 adult patients receiving PD (mean age 59 ± 14 years; 57% male) within a single centre. Participants were consecutively recruited and interviewed by renal dietitians, collecting: Subjective Global Assessment (SGA); quality of life (using EQ-5D); dietary intake (via dietary interview); and appetite (using Appetite and Diet Assessment Tool). Participant demographics were obtained via survey or medical charts. Main outcome measures were inadequate dietary protein intake (<1.1 g/kg adjusted body weight/day) and malnutrition (as defined by SGA rating B or C). RESULTS Overall, 15 (22%) patients were malnourished and 29 (43%) had inadequate protein intake. Poor appetite (anorexia) was reported in 62% (18/29) of participants with inadequate protein malnourished patients reported anorexia versus 12 (23%) of the well-nourished patients (p = 0.0001). CONCLUSION Anorexia was a key risk factor for inadequate protein intake and malnutrition in patients undergoing PD. These findings highlight a need to closely monitor patients with appetite disturbances.
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Affiliation(s)
- Valerie Young
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Sarah Balaam
- Queensland University of Technology, Brisbane, Queensland, Australia
| | - Linda Orazio
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Annerley Bates
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Sunil V Badve
- University of Queensland, Brisbane, Queensland, Australia
| | - David W Johnson
- Princess Alexandra Hospital, Brisbane, Queensland, Australia.,University of Queensland, Brisbane, Queensland, Australia.,Translational Research Institute, Centre for Kidney Disease Research, Brisbane, Queensland, Australia.,Metro South and Ipswich Nephrology and Transplant Services, Brisbane, Queensland, Australia
| | - Katrina L Campbell
- Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
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Abstract
OBJECTIVE To construct a quickly and easily administered nutrition screening tool using variables believed to be predictive of malnutrition risk in the wound patient population. DESIGN A prospective pilot study assessed patients on a list of suspected variables, as well as the Scored Patient-Generated Subjective Global Assessment (PG-SGA), chosen as the criterion standard. Variables were analyzed to select the most appropriate items for inclusion on a new nutrition screening tool using preliminary bivariate correlations and χ tests of association. Items significantly associated with malnutrition were dichotomized, and binary logistic regression analyses were performed to arrive at a final model. A sum score was computed, and receiver operating characteristic analysis was used to determine designation of risk. SETTING An outpatient wound center in Northeast Ohio. PARTICIPANTS The pilot study included a convenience sample of 105 outpatients with at least 1 active wound. MAIN OUTCOME MEASURES Malnutrition as assessed by the Scored PG-SGA. MAIN RESULTS The final nutrition screening tool, the MEAL Scale, is composed of 4 dichotomous elements: multiple wounds (number of wounds), eats less than 3 meals per day, appetite decrease (eats less than usual), and level of activity. These variables predicted 83.7% of the malnutrition cases assessed by the Scored PG-SGA. The receiver operating characteristic analysis showed an acceptable area under the curve (0.8581), and a cutoff score of 2 or greater was selected to indicate risk (median sensitivity = 91.4%, median specificity = 60.9%). CONCLUSIONS Although further studies of validity and reliability are necessary to establish the tool before widespread use, the MEAL Scale is a needed step toward nutrition screening in a wound patient population.
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Santin FGDO, Bigogno FG, Dias Rodrigues JC, Cuppari L, Avesani CM. Concurrent and Predictive Validity of Composite Methods to Assess Nutritional Status in Older Adults on Hemodialysis. J Ren Nutr 2016; 26:18-25. [DOI: 10.1053/j.jrn.2015.07.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 07/07/2015] [Accepted: 07/09/2015] [Indexed: 01/02/2023] Open
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Lægreid IK, Aasarød K, Bye A, Leivestad T, Jordhøy M. The impact of nutritional status, physical function, comorbidity and early versus late start in dialysis on quality of life in older dialysis patients. Ren Fail 2013; 36:9-16. [PMID: 24028283 DOI: 10.3109/0886022x.2013.830206] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND For the majority of the older patients in dialysis, the treatment will be lifelong. Thus, quality of life (QoL) is a crucial outcome. Our aim was to assess the QoL of older Norwegian dialysis patients and to investigate the impact of early (estimated glomerular filtration rate, eGFR ≥10 mL/min) versus late (eGFR <10 mL/min) start in dialysis, comorbidity, nutritional status and physical capacity. METHODS A self-report questionnaire including SF-36 (QoL) and the Subjective Global Assessment (SGA; nutritional status) was mailed to all patients (n = 320) ≥75 years registered in the Norwegian Renal Registry (NRR) as being in dialysis by September 2009. Reply was received from 233 patients (73%). Medical data including comorbidities and eGFR at dialysis start (obtained for 194 patients) were retrieved from the NRR. Functional capacity was determined from the SGA. RESULTS Compared to reports from younger dialysis patients, our patients scored poorer on all SF-36 subscales. Early start in dialysis was registered for 52 patients, 142 patients started late, 51.4% were well nourished (SGA A), 32.3% moderately malnourished (SGA B) and 16.4% were severely malnourished (SGA C). No significant association between any SF-36 scores and early versus late start, nutritional status or comorbidity was found. Better physical function was significantly associated with better scores on all SF-36 scales. CONCLUSIONS Our results indicate that physical function is important to all QoL aspects. Increased focus on physical rehabilitation seems pertinent. Early start of dialysis treatment was not associated with better long term QoL scores.
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Affiliation(s)
- Inger Karin Lægreid
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, NTNU , Trondheim , Norway
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