Selection of an Acceptable Method of Evaluating Nutritional Status in Hemodialysis Patients Compared to Subjective Global Assessment: A Cross-Sectional Study

Abstract Background: Protein-energy wasting (PEW) is prevalent among hemodialysis (HD) patients and is associated with poor outcomes. There are various methods for evaluating nutritional status in HD patients that each has its own advantages and disadvantages. We aimed at comparing the methods of normalized protein catabolic ratio (nPCR) and malnutrition universal screening tool (MUST) with subjective global assessment (SGA) in HD patients. Method: We examined 88 HD patients using SGA and MUST questionnaires, and also nPCR were calculated using predialysis and post-dialysis BUN, and Kt/v. Also, patients were assessed for PEW based on the Criteria of the International Society of Renal Nutrition and Metabolism. Methods’ specificity, sensitivity, and precision rates were assessed. Correlations between methods were analyzed using Pearson-correlation. Results: Based on the SGA, MUST, and nPCR methods, almost 41, 30, and 60 percent of patients had malnutrition, respectively. According to the criteria by International Society of Renal Nutrition and Metabolism, more than 90 percent of patients had PEW. SGA was positively and significantly associated with MUST (P≤0.001). Sensitivity for SGA, MUST, and nPCR methods were 100,100, 1.8 %, and their specificity were 98, 98, and 4 %, respectively and their precision rates were 99.7, 98.7, and 3%, respectively. Conclusion: From various methods of nutritional assessment (SGA, MUST, and nPCR), compared to SGA as the common method of nutrition assessment in hemodialysis patients, MUST had the nearest specificity, sensitivity, and precision rate compared to SGA and nPCR method had the lowest ones. nPCR seems to be a flawed marker of malnutrition and it should be more investigated whether MUST can be used instead of SGA or not.

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The importance of dysphagia screening and nutritional assessment in hospitalized patients

Einstein (São Paulo) ◽

10.1590/s1679-45082018ao4189 ◽

2018 ◽

Vol 16 (2) ◽

Cited By ~ 5

Author(s):

Patrícia Amaro Andrade ◽

Carolina Araújo dos Santos ◽

Heloísa Helena Firmino ◽

Carla de Oliveira Barbosa Rosa

Keyword(s):

Nutritional Status ◽

Global Assessment ◽

Assessment Tool ◽

Nutritional Assessment ◽

Cross Sectional Study ◽

Hospitalized Patients ◽

The Body ◽

Subjective Global Assessment ◽

Cross Sectional ◽

Knee Height

ABSTRACT Objective: To determine frequency of dysphagia risk and associated factors in hospitalized patients as well as to evaluate nutritional status by using different methods and correlate the status with scores of the Eating Assessment Tool (EAT-10). Methods: This was a cross-sectional study including 909 inpatients of a philanthropic hospital. For the diagnosis of dysphagia we used an adapted and validated Brazilian version of the Eating Assessment Tool (EAT-10). The nutritional status was evaluated through the subjective global assessment, and anthropometric measurements included weight, calf and arm circumference, and knee height. The Mann-Whitney test, associations using the Pearson’s χ2 and Spearman’s correlation were used to verify differences between the groups. Results: The prevalence of dysphagia risk was 10.5%, and aging was the associated factor with this condition. Patients at risk presented lower values of arm and calf circumference, variables that correlated inversely with the Eating Assessment Tool (EAT-10) score. Malnutrition was observed in 13.2% of patients based on the subjective global assessment and in 15.2% based on the Body Mass Index. Conclusion: Screening for dysphagia and malnutrition should be introduced in hospitals routine to avoid or minimize damages caused by dysphagia or malnutrition, especially among older people.

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Assessment of nutritional status of hemodialysis patients by subjective global assessment score: a single centre study from Karachi, Pakistan

Journal of the Pakistan Medical Association ◽

10.47391/jpma.1935 ◽

2022 ◽

Vol 71 (12) ◽

pp. 2761-2765

Author(s):

Lubna Ghazi ◽

Murtaza Dhrolia ◽

Aamna Hamid ◽

Ruqaya Qureshi ◽

Kiran Nasir ◽

...

Keyword(s):

Nutritional Status ◽

Global Assessment ◽

Practical Method ◽

Hemodialysis Patients ◽

Normal Weight ◽

Maintenance Hemodialysis ◽

P Value ◽

Binary Logistic Regression Analysis ◽

Subjective Global Assessment ◽

Cross Sectional

Objective: Despite being an important predictor of morbidity and mortality, routine screening for malnutrition in dialysis patients is not a common practice in Pakistan. Modified Subjective Global Assessment (SGA) is a convenient, inexpensive and practical method to assess nutritional status particularly in resource limited setup. Methods: This cross sectional study was conducted in The Kidney Center Post Graduate Training institute (TKC-PGTI). Patients on maintenance hemodialysis (MHD) were included through non-probability consecutive sampling. A one-time SGA score was calculated based on the history and physical examinations using modified SGA or Dialysis Malnutrition Score (DMS). Chi square test was applied to find association between variables, while to observe the amount of effect of factors on SGA score; binary logistic regression analysis was run. P value of ? 0.05 considered significant. Results: Mild-Moderately malnourished patients were the most frequent in our study 96(64%).None of patient had severe malnourishment. Females were 2.6 times more prone for malnourishment (p value=0.009). More than 5- years on hemodialysis also increased the risk of malnourishment by 12.5 times (p value <0.001). Overweight patients had 85 % less chance of being malnourished as compare to patients with normal weight (p value=0.004). Conclusion: Malnutrition is quite common in hemodialysis patients, which necessitates its regular assessment and monitoring. There is a need to assess the reasons of more malnourishment in female as compared to male. Similarly, the longer duration (> 5 years) on hemodialysis also need attention for prevention and cure of malnourishment. Continuous...

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Association of subjective global assessment of nutritional status with gut microbiota in hemodialysis patients: a case–control study

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa019 ◽

2020 ◽

Cited By ~ 2

Author(s):

Ting-Yun Lin ◽

Szu-Chun Hung

Keyword(s):

Nutritional Status ◽

Gut Microbiota ◽

Global Assessment ◽

Hemodialysis Patients ◽

Adverse Outcomes ◽

Subjective Global Assessment ◽

Protein Energy Wasting ◽

Β Diversity ◽

Protein Energy ◽

Α Diversity

Abstract Background Protein-energy wasting (PEW) is prevalent and associated with adverse outcomes in patients with chronic kidney disease (CKD). However, the pathogenesis of PEW in CKD patients has not been fully identified. The gut microbiota has been implicated in the regulation of host metabolism and energy balance. Therefore, we aimed to explore the association between nutritional status and the composition of the gut microbiota in hemodialysis patients. Methods Gut microbial diversity and taxonomy were examined in 88 hemodialysis patients with PEW (n = 22) and normal nutritional status (n = 66) who were matched 1:3 for age and sex. Nutritional status was assessed by using the 7-point subjective global assessment (SGA) score (1–3 = severe PEW; 4–5 = moderate PEW and 6–7 = normal nutrition). The gut microbiota was assessed by 16S ribosomal RNA gene sequencing. Results Patients with normal nutritional status had a significantly higher body mass index and physical activity and serum albumin levels, but significantly lower levels of inflammatory cytokines than patients with PEW. The most striking finding was that the α-diversity of the gut microbiota was significantly lower in patients with PEW. In a multivariate analysis, the SGA score was independently and positively associated with α-diversity (P = 0.049). Patients with or without PEW were different with respect to the principal coordinate analysis of β-diversity. Notably, the relative abundance of Faecalibacterium prausnitzii, a butyrate-producing bacteria, was markedly reduced in patients with PEW. Conclusion In hemodialysis patients, PEW assessed with the SGA was associated with gut dysbiosis.

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The Nutritional Status Sensitivity of the Assessment of Nutritional Status Based on Mini Nutritional Assessment (MNA) Was Compared with Patient-Generated Subjective Global Assessment (PG-SGA) in Cancer Patients Undergoing Chemotherapy in RSUP Dr Wahidin Sudirohusoda Makassar

NurseLine Journal ◽

10.19184/nlj.v4i2.11234 ◽

2020 ◽

Vol 4 (2) ◽

pp. 76

Author(s):

Khoirul Anam ◽

Takdir Tahir ◽

Ilkafah Ilkafah

Keyword(s):

Body Mass Index ◽

Nutritional Status ◽

Cancer Patients ◽

Body Mass ◽

Global Assessment ◽

Nutritional Assessment ◽

Subcutaneous Fat ◽

Mini Nutritional Assessment ◽

Subjective Global Assessment ◽

Cross Sectional

Background: Chemotherapy is highly recommended for cancer treatment, however can cause some side effects such as nausea and vomiting. This will affect food intake and nutritional status in cancer patients who undergo chemotherapy. Aim: To describe nutritional status based on anthropometry Body Mass Index (BMI), hemoglobin (Hb), Patient-Generated Subjective Global Assessment (PG-SGA) and Mini Nutritional Assessment (MNA) in cancer patients undergoing chemotherapy in RSUP. Dr. Wahidin sudirohusodo Makassar. Methode: This experiment uses a quantitative non-experimental research method with cross sectional approach on 1010 patients, nonprobability sampling with purposive sampling technique on 70 respondents, data collection with interview and observation techniques. Results: Nutritional status based on Body Mass Index (BMI) shows that 39 people (55.7%) had normal BMI values. About 37 people (52.9%) had good / normal nutritional status based on Patient-Generated Subjective Global Assessment (PG-SGA) while Mini Nutritional Assessment (MNA) reveals 100% of respondents experienced nutritional status problems. Conclusion: Mini Nutritional Assessment (MNA) is the best tool to identify nutritional status of cancer patients that undergo chemotherapy since this instrument is very sensitive and practical. Patient-Generated Subjective Global Assessment (PG-SGA) is good to assess nutritional status in subject who have lost weight drastically and shows signs of subcutaneous fat loss and muscle mass loss. Keyword: Cancer, chemotherapy, body mass index (BMI), Patient-Generated Subjective Global Assessment (PG-SGA), Mini Nutritional Assessment (MNA).

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IMMEDIATE PREOPERATIVE NUTRITIONAL STATUS OF PATIENTS WITH COLORECTAL CANCER: a warning

Arquivos de Gastroenterologia ◽

10.1590/s0004-28032014000400012 ◽

2014 ◽

Vol 51 (4) ◽

pp. 331-336 ◽

Cited By ~ 15

Author(s):

Luiza Regina L S BARBOSA ◽

Antonio LACERDA-FILHO ◽

Livia Cristina L S BARBOSA

Keyword(s):

Colorectal Cancer ◽

Nutritional Status ◽

Global Assessment ◽

Evaluation Method ◽

Nutritional Assessment ◽

Demographic Data ◽

Disease Stage ◽

Poor Correlation ◽

Subjective Global Assessment ◽

Cross Sectional

Context Weight loss and malnutrition are disorders observed in colorectal cancer patients. Objectives We sought to evaluate the immediate preoperative nutritional status of patients with colorectal cancer. Methods This is a cross-sectional clinical study conducted at a single center. Sixty-six consecutive patients in preoperative for elective surgical treatment were studied. The clinical history, socio-demographic data and nutritional status of the patients were evaluated using Subjective Global Assessment and objective (anthropometry) methods. The primary outcome measures were nutritional status classification as nourished or malnourished and the relationship between nutritional status and socio-demographic and clinical features. Results Most of patients exhibited left colon tumors and disease stage II. According to the Subjective Global Assessment, 36.4% of patients were malnourished. Malnutrition ranged from 7.6% to 53% depending on the evaluation method used, with poor correlation to Subjective Global Assessment. The prevalence of malnutrition was significantly greater in females and non-married patients and in those with two or more symptoms of colorectal cancer. Conclusions More than a third of patients in the immediate preoperative period for colorectal cancer exhibited malnutrition. Therefore, routine nutritional assessment is highly advisable so that appropriate measures may be taken to minimize the potential postoperative complications.

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Nutritional assessment and hand grip strength of candidates for surgery of the gastrointestinal tract

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/s0102-67202014000200005 ◽

2014 ◽

Vol 27 (2) ◽

pp. 104-108 ◽

Cited By ~ 5

Author(s):

Thalita Morgana Guimarães SILVEIRA ◽

Juliana Barbosa de SOUSA ◽

Maria Luiza Ferreira STRINGHINI ◽

Ana Tereza Vaz de Souza FREITAS ◽

Paulla Guimarães MELO

Keyword(s):

Gastrointestinal Tract ◽

Nutritional Status ◽

Global Assessment ◽

Nutritional Assessment ◽

Low Cost ◽

Subjective Assessment ◽

Nutritional Risk ◽

Dominant Hand ◽

Subjective Global Assessment ◽

Cross Sectional

BACKGROUND: The assessment of nutritional status in clinical practice must be done with simple, reliable, low cost and easy performance methods. The power of handshake is recognized as a useful tool to evaluate muscle strength, and therefore, it is suggested that can detect malnutrition. AIM: To evaluate the nutritional status by subjective global assessment and power of handshake preoperatively in patients going to gastrointestinal surgeries and to compare the diagnosis obtained by subjective global assessment with traditional anthropometric methods and power of handshake. METHODS: A cross-sectional study was conducted with patients for surgery in the gastrointestinal tract and related organs. Socioeconomic and anthropometric data, applied to subjective global assessment and checked the power of handshake, were collected. The force was obtained by the average of three measurements of the dominant and non-dominant hand and thus compared with reference values of the population by sex and age, for the classification of nutritional risk. RESULTS: The sample consisted of 40 patients, 24-83 years, and most women (52.5%) housewives (37,5%) and diagnosed with cancer (45%). According to subjective global assessment, 37.5% were classified as moderately malnourished; 15% were underweight by BMI measurements; 25% had arm circumference at risk for malnutrition (<percentil 5); 60% reported recent weight loss; and 37.5% low clamping force in power of handshake on non-dominant hand (left). CONCLUSION: A significant association was observed for the diagnosis of nutritional subjective assessment with anthropometric methods and strength of the handshake only at the non-dominant limb.

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Nutritional Status of Out-patient Hemodialysis Patients in a Hospital-based Hemodialysis Centre in Nepal

Nepalese Medical Journal ◽

10.3126/nmj.v1i1.20392 ◽

2018 ◽

Vol 1 (1) ◽

pp. 12-16 ◽

Cited By ~ 1

Author(s):

Ruju Khadka ◽

Nabin Bahadur Basnet ◽

Rishi Kumar Kafle

Keyword(s):

Nutritional Status ◽

Global Assessment ◽

Dietary Habits ◽

Nutritional Assessment ◽

Hemodialysis Patients ◽

Chronic Hemodialysis ◽

Anthropometric Measurements ◽

Assessment Tools ◽

Subjective Global Assessment ◽

Biochemical Assessment

Introduction: Malnutrition is common among patients on chronic hemodialysis and is a risk factor. Nutritional assessment ensures early recognition and appropriate intervention. Dietary interview, physical and anthropometric measurements, biochemical assessment, bio-impedance, and structured assessment tools like subjective global assessment are modalities for identifying and monitoring of nutritional assessment of hemodialysis patients. This study was conducted to assess the nutritional status of hemodialysis patients and identify various factors related to malnutrition.Materials and Methods: A cross-sectional study of 72 chronic hemodialysis patients at a hemodialysis unit in Lalitpur was done. Detailed dietary and personal interview, anthropometric measurements, biochemical assessment, and subjective global assessment were used to collect the data to determine the prevalence of malnutrition among the hemodialysis patients as well as identify various factors related.Results: Malnutrition was prevalent among the respondents. The respondents were mostly male with average age of 50.2 1.9 years and majority being on hemodialysis for more than two years. Though severe malnutrition was absent among the hemodialysis patients assessed, mild to moderate malnutrition was seen in 52.78%. Most of these patients were female and were of older age group. Patients who had malnutrition had experienced a significant weight loss in previous six months. Anthropometric profile, dietary habits, and biochemical profile did not correlate with occurrence of malnutrition in hemodialysis patients.Conclusions: Malnutrition is fairly prevalent in chronic hemodialysis patients which can be identified by subjective global assessment. Elderly patients and patients who are losing weight are risk factors for mild to moderate malnutrition.Nepalese Medical Journal, vol.1, No. 1, 2018, Page: 12-16

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