Nephrology Dialysis Transplantation, Vol 14, Issue 7 1732-1738, Copyright © 1999 by Oxford University Press
K Kalantar-Zadeh, M Kleiner, E Dunne, G Lee and F Luft
Background: Malnutrition, a predictor of increased
mortality in dialysis patients, can be estimated using the subjective
global assessment (SGA), a semi-quantitative scale with three severity
levels. This semi-quantitative feature restricts the SGA's reliability and
precision. Methods: Using the components of the
conventional SGA, we developed a fully quantitative scoring system (the
dialysis malnutrition score) consisting of seven variables: weight change,
dietary intake, gastrointestinal symptoms, functional capacity,
comorbidity, subcutaneous fat and signs of muscle wasting. Each component
was assigned a score from 1 (normal) to 5 (very severe). The sum of all
seven components in this malnutrition score lies between 7 (normal) and 35
(severely malnourished). To evaluate nutritional status in chronic dialysis
patients, anthropometric measurements including mid-arm circumference
(MAC), triceps skin-fold thickness, calculated mid-arm muscle circumference
(MAMC), body mass index (BMI, ratio of weight to square of height) and
laboratory parameters were used. Forty-one patients (20 men and 21 women)
were randomly selected from a pool of 120 haemodialysis patients. Patients
were aged between 27 and 81 years (mean±SD, 57±12
years) and had undergone haemodialysis for between 7 months and 12 years
(mean±SD, 3.0±2.1 years).
Results: The malnutrition score of each patient was
assessed by a dietitian within 5-20 min (12.0±305 min) with no
knowledge of anthropometric findings. Pearson correlation coefficients
between the malnutrition score and biceps skin-fold (r=-0.32) MAC
(r=-0.55), MAMC (r=-0.66), BMI (r=-0.35), total iron-binding capacity
(TIBC, r=-0.77), the serum albumin concentration (r=-0.36) and total
protein (r=-0.33) were all significant, whereas the conventional SGA had
significant correlation only with TIBC (r=-0.35) and MAMC (r=-0.37).
Malnutrition score showed a significant correlation with age (r=+0.34) and
years dialysed (r=+0.28). Multiple regression analysis showed a significant
correlation between the malnutrition score and the combination of the MAMC,
BMI, serum albumin concentration and TIBC (r=0.81, P<0.001). There
was no correlation between the malnutrition score and sex, urea reduction
ratio, protein catabolic rate, and the absolute lymphocyte count.
Conclusions: We conclude that our invented
malnutrition score, which can be performed in minutes, reliably assesses
the nutritional status of haemodialysis patients. We suggest that our
malnutrition score may be superior to the SGA. More comparative and
longitudinal studies are needed to confirm the validity of this scoring
system in nutritional evaluation of dialysis patients. Key
words: albumin; anthropometric measurements; dialysis;
malnutrition score; subjective global assessment (SGA); transferrin
PRELIMINARY REPORTS
A modified quantitative subjective global assessment of nutrition for dialysis patients
UCSF Renal Division, University of California, San Francisco, CA, USA; Department of Internal Medicine, Staten Island University Hospital New York, USA; Department of Pharmacy, San Francisco Veteran Affairs Medical Centre, CA, USA; Franz Volhard Clinic, Universitatsklinikum-Charité, Humbold University, Wiltberg Strasse 50, D-13122 Berlin, Germany; Corresponding author
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