Molfino Alessio, Kaysen George A, Chertow Glenn M, Doyle Julie, Delgado Cynthia, Dwyer Tjien, Laviano Alessandro, Rossi Fanelli Filippo, Johansen Kirsten L
Division of Nephrology, Department of Internal Medicine, University of California, Davis, California; Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy.
Division of Nephrology, Department of Internal Medicine, University of California, Davis, California.
J Ren Nutr. 2016 Mar;26(2):103-10. doi: 10.1053/j.jrn.2015.09.002. Epub 2015 Oct 28.
To test the performance of appetite assessment tools among patients receiving hemodialysis (HD).
Cross-sectional.
Two hundred twenty-one patients receiving HD enrolled in seven dialysis facilities in Northern California.
We assessed 5 appetite assessment tools (self-assessment of appetite, subjective assessment of appetite, visual analog scale [VAS], Functional Assessment of Anorexia/Cachexia Therapy [FAACT] score, and the Anorexia Questionnaire [AQ]).
Reported food intake, normalized protein catabolic rate, and change in body weight were used as criterion measures, and we assessed associations among the appetite tools and biomarkers associated with nutrition and inflammation. Patients were asked to report their appetite and the percentage of food eaten (from 0% to 100%) during the last meal compared to usual intake.
Fifty-eight (26%) patients reported food intake ≤ 50% (defined as poor appetite). The prevalence of anorexia was 12% by self-assessment of appetite, 6% by subjective assessment of appetite, 24% by VAS, 17% by FAACT score, and 12% by AQ. All the tools were significantly associated with food intake ≤ 50% (P < .001), except self-assessment of appetite. The FAACT score and the VAS had the strongest association with food intake ≤ 50% (C-statistic 0.80 and 0.76). Patients with food intake ≤ 50% reported weight loss more frequently than patients without low intake (36% vs 22%) and weight gain less frequently (19% vs 35%; P = .03). Normalized protein catabolic rate was lower among anorexic patients based on the VAS (1.1 ± 0.3 vs 1.2 ± 0.3, P = .03). Ln interleukin-6 correlated inversely with food intake (P = .03), but neither interleukin-6 nor C-reactive protein correlated with any of the appetite tools. Furthermore, only the self-assessment of appetite was significantly associated with serum albumin (P = .02), prealbumin (P = .02) and adiponectin concentrations (P = .03).
Alternative appetite assessment tools yielded widely different estimates of the prevalence of anorexia in HD. When considering self-reported food intake as the criterion standard for anorexia, the FAACT score and VAS discriminated patients reasonably well.
测试食欲评估工具在接受血液透析（HD）患者中的性能。
横断面研究。
在北加利福尼亚州七个透析机构登记的221例接受HD的患者。
我们评估了5种食欲评估工具（食欲自我评估、食欲主观评估、视觉模拟量表[VAS]、厌食/恶病质治疗功能评估[FAACT]评分和厌食问卷[AQ]）。
报告的食物摄入量、标准化蛋白分解代谢率和体重变化用作标准指标，并且我们评估了食欲工具与营养和炎症相关生物标志物之间的关联。要求患者报告其食欲以及与平常摄入量相比最后一餐所吃食物的百分比（从0%至100%）。
58例（26%）患者报告食物摄入量≤50%（定义为食欲不佳）。根据食欲自我评估，厌食患病率为12%；根据食欲主观评估为6%；根据VAS为24%；根据FAACT评分为17%；根据AQ为12%。除食欲自我评估外，所有工具均与食物摄入量≤50%显著相关（P <.001）。FAACT评分和VAS与食物摄入量≤50%的关联最强（C统计量分别为0.80和0.76）。食物摄入量≤50%的患者比摄入量不低的患者更频繁地报告体重减轻（36%对22%），而体重增加则较少（19%对35%；P =.03）。根据VAS，厌食患者的标准化蛋白分解代谢率较低（1.1±0.3对1.2±0.3，P =.03）。白细胞介素-6的对数与食物摄入量呈负相关（P =.03），但白细胞介素-6和C反应蛋白均与任何食欲工具无关。此外，只有食欲自我评估与血清白蛋白（P =.02）、前白蛋白（P =.02）和脂联素浓度（P =.03）显著相关。
替代食欲评估工具对HD患者厌食患病率的估计差异很大。当将自我报告的食物摄入量作为厌食的标准时，FAACT评分和VAS能较好地区分患者。
