Dwyer Johanna T, Larive Brett, Leung June, Rocco Michael, Burrowes Jerrilynn D, Chumlea Wm Cameron, Frydrych Anne, Kusek John W, Uhlin Leigh
Frances Stern Nutrition Center, Tufts-New England Medical Center, Boston, MA 02111, USA
J Ren Nutr. 2002 Oct;12(4):213-23. doi: 10.1053/jren.2002.35297.
To evaluate associations between frequently used indicators for assessing nutritional status and health-related quality of life in hemodialysis patients after controlling for demographics, comorbidity, and dialysis dose.
Survey of 1,387 hemodialysis patients enrolled at baseline in the Hemodialysis (HEMO) Study. Nutritional status indicators included dietary energy intake, equilibrated normalized protein catabolic rate (enPCR), serum creatinine (SCr), serum albumin (SAlb), body mass index (BMI), calf circumference, and appetite. Health-related quality of life was measured by the Medical Outcomes Study Short Form-36 (MOS-SF-36) summary measures: the Physical Component Scale (PCS) and Mental Component Scale (MCS).
Fifteen clinical sites throughout the United States providing in-center hemodialysis.
The mean PCS score was 36.1 +/- 10 SD, lower than normative data in healthy populations. PCS scores were lower among women, whites, and those with diabetes, severe comorbidities, and poor appetites. Appetite, dietary energy intake, SAlb, and SCr were strongly associated with PCS scores even after controlling for demographics and comorbidity. The sum of the parameter estimates for the effects of nutritional status on PCS was large, 7 points or more depending on the individual's nutritional status indicators. The mean MCS score was 49.7 +/- 10.1 SD, similar to scores in healthy populations, but lower among those with severe comorbidities, poor appetites, advanced age, and more years on dialysis. Appetite, age, and years on dialysis were significantly associated with MCS after controlling for other demographics and comorbidity. Dialysis dose did not significantly alter these relationships.
Easy-to-use indicators for assessing nutritional status (appetite, energy intake, SAlb, and SCr) together are strongly associated with health-related quality of life, even after controlling for comorbidities and dose of dialysis in hemodialysis patients, providing an additional reason for maximizing patients' nutritional status and health.
在控制人口统计学因素、合并症和透析剂量后，评估血液透析患者中用于评估营养状况的常用指标与健康相关生活质量之间的关联。
对血液透析（HEMO）研究中1387名基线入组的血液透析患者进行调查。营养状况指标包括饮食能量摄入、平衡标准化蛋白分解代谢率（enPCR）、血清肌酐（SCr）、血清白蛋白（SAlb）、体重指数（BMI）、小腿围和食欲。健康相关生活质量通过医学结局研究简明健康调查问卷（MOS-SF-36）汇总指标进行测量：身体成分量表（PCS）和精神成分量表（MCS）。
美国各地的15个临床站点提供中心血液透析服务。
PCS平均得分是36.1±10标准差，低于健康人群的标准数据。女性、白人以及患有糖尿病、严重合并症和食欲差的患者PCS得分较低。即使在控制了人口统计学因素和合并症后，食欲、饮食能量摄入、SAlb和SCr与PCS得分仍密切相关。营养状况对PCS影响的参数估计总和很大，根据个体的营养状况指标，可达7分或更高。MCS平均得分是49.7±10.1标准差，与健康人群得分相似，但在患有严重合并症、食欲差、高龄以及透析年限较长的患者中得分较低。在控制其他人口统计学因素和合并症后，食欲、年龄和透析年限与MCS显著相关。透析剂量并未显著改变这些关系。
即使在控制血液透析患者的合并症和透析剂量后，用于评估营养状况的易于使用的指标（食欲、能量摄入、SAlb和SCr）共同与健康相关生活质量密切相关，这为最大化患者的营养状况和健康提供了另一个理由。
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