Afshar Reza, Sanavi Suzan, Izadi-Khah Akram
Shahed University, Mostafa Khomeini Hospital, Tehran, Iran.
Saudi J Kidney Dis Transpl. 2007 Sep;18(3):397-404.
Malnutrition is a relatively common problem in patients on hemodialysis (HD) and is associated with increased morbidity and mortality in affected patients. With the aid of subjective global assessment (SGA), a semi-quantitative scale for estimating nutritional status, the malnutrition score (MS), has been developed. The MS incorporates advantages of the SGA while extending the reliability and precision. This study was performed to assess the nutritional status in patients on HD at the Mostafa Khomeini Hospital, Tehran, Iran. Based on the MS, which consists of seven components--weight change, dietary intake, gastrointestinal (GI) symptoms, functional capacity, comorbidity, subcutaneous fat, and muscle wasting--we conducted a cross-sectional descriptive-analytic study on 54 HD patients (35 males, 19 females) with age range of 18 to 82 years (mean 44.2 +/- 19.8 years). Each component of the MS has a score from one (normal) to five (very severe). Anthropometric measurements including triceps skin-fold thickness (TSF), mid-arm circumference (MAC) and mid-arm muscle circumference (MAMC) were taken on all patients. Also, the body mass index and TSF/MAC ratio were calculated. Relevant laboratory parameters were checked. The duration of HD of the study patients ranged between 5 and 36 months (mean 19.5 +/- 1.5 months). Data analysis was carried out using the SPSS, Pearson correlation, 't' test and regression. Based on the MS, 40.7% of patients had malnutrition (mean score 13.8 +/- 2.8). There were statistically significant correlations between TSF (p < 0.01), MAC (p = 0.02), MAMC (p = 0.01), TSF/MAC ratio (p < 0.001), BMI (p = 0.028), serum albumin concentration (p = 0.021) and MS. No statistically significant correlation was found between the MS and urea reduction ratio, protein catabolic rate, age, gender, or duration of dialysis. After 1 year, 20.4% of patients died because of dialysis-related complications. The mortality rate did not show significant correlation with age, presence of diabetes mellitus, biochemical parameters, and anthropometric measures. A significant correlation was found between the protein catabolic rate (nPCR) and the mortality rate (regression analysis, p = 0.016); lower values of nPCR were associated with increased mortality. Our study suggests that the MS is a reliable, precise, and rapid method for estimating the nutritional status in patients on HD. The nPCR can be used as a predictor of increased mortality. Further studies with larger sample size and longer duration are required to confirm this observation.
营养不良在血液透析（HD）患者中是一个相对常见的问题，并且与受影响患者的发病率和死亡率增加相关。借助主观全面评定法（SGA），一种用于评估营养状况的半定量量表，已经开发出了营养不良评分（MS）。MS融合了SGA的优点，同时提高了可靠性和精确度。本研究旨在评估伊朗德黑兰穆斯塔法·霍梅尼医院HD患者的营养状况。基于由体重变化、饮食摄入、胃肠道（GI）症状、功能能力、合并症、皮下脂肪和肌肉消瘦七个部分组成的MS，我们对54例年龄在18至82岁（平均44.2±19.8岁）的HD患者（35例男性，19例女性）进行了一项横断面描述性分析研究。MS的每个部分都有一个从1（正常）到5（非常严重）的评分。对所有患者进行了人体测量，包括肱三头肌皮褶厚度（TSF）、上臂中部周长（MAC）和上臂中部肌肉周长（MAMC）。此外，还计算了体重指数和TSF/MAC比值。检查了相关的实验室参数。研究患者的HD持续时间在5至36个月之间（平均19.5±1.5个月）。使用SPSS、Pearson相关性分析、t检验和回归分析进行数据分析。基于MS，40.7%的患者存在营养不良（平均评分13.8±2.8）。TSF（p<0.01）、MAC（p = 0.02）、MAMC（p = 0.01）、TSF/MAC比值（p<0.001）、BMI（p = 0.028）、血清白蛋白浓度（p = 0.021）与MS之间存在统计学显著相关性。未发现MS与尿素清除率、蛋白质分解代谢率、年龄、性别或透析持续时间之间存在统计学显著相关性。1年后，20.4%的患者因透析相关并发症死亡。死亡率与年龄、糖尿病的存在、生化参数和人体测量指标之间未显示出显著相关性。发现蛋白质分解代谢率（nPCR）与死亡率之间存在显著相关性（回归分析，p = 0.016）；nPCR值较低与死亡率增加相关。我们的研究表明，MS是一种可靠、精确且快速的评估HD患者营养状况的方法。nPCR可作为死亡率增加的预测指标。需要进行更大样本量和更长时间的进一步研究来证实这一观察结果。
