Centre for Kidney Research and Innovation, Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, Royal Derby Hospital, Uttoxeter Rd, DerbyDE22 3NE, UK.
Department of Renal Medicine, University Hospitals of Derby and Burton NHS Foundation Trust, Royal Derby Hospital, Uttoxeter Rd, DerbyDE22 3NE, UK.
Br J Nutr. 2022 Jun 14;127(11):1647-1655. doi: 10.1017/S000711452100249X. Epub 2021 Jul 5.
Health-related quality of life (HRQoL) is severely impaired in persons receiving dialysis. Malnutrition has been associated with some measures of poor HRQoL in cross-sectional analyses in dialysis populations, but no studies have assessed the impact of malnutrition and dietary intake on change in multiple measures of HRQoL over time. We investigated the most important determinants of poor HRQoL and the predictors of change in HRQoL over time using several measures of HRQoL. We enrolled 119 haemodialysis and thirty-one peritoneal dialysis patients in this prospective study. Nutritional assessments (Subjective Global Assessment (SGA), anthropometry and 24-h dietary recalls) and HRQoL questionnaires (Short Form-36 (SF-36) mental (MCS) and physical component scores (PCS) and European QoL-5 Dimensions (EQ5D) health state (HSS) and visual analogue scores (VAS)) were performed at baseline, 6 and 12 months. Mean age was 64 (14) years. Malnutrition was present in 37 % of the population. At baseline, malnutrition assessed by SGA was the only factor independently (and negatively) associated with all four measures of HRQoL. No single factor was independently associated with decrease in all measures of HRQoL over 1 year. However, prevalence/development of malnutrition over 1 year was an independent predictor of 1-year decrease in EQ5D HSS, and 1-year decrease in fat intake independently predicted the 1-year decline in SF-36 MCS and PCS, and EQ5D VAS. These findings strengthen the importance of monitoring for malnutrition and providing nutritional advice to all persons on dialysis. Future studies are needed to evaluate the impact of nutritional interventions on HRQoL and other long-term outcomes.
健康相关生活质量（HRQoL）在接受透析的患者中严重受损。在透析人群的横断面分析中，营养不良与一些 HRQoL 较差的指标相关，但尚无研究评估营养不良和饮食摄入对随时间变化的多个 HRQoL 指标的影响。我们使用几种 HRQoL 指标来研究 HRQoL 较差的最重要决定因素和随时间变化的 HRQoL 的预测因素。我们在这项前瞻性研究中招募了 119 名血液透析和 31 名腹膜透析患者。进行了营养评估（主观整体评估（SGA）、人体测量和 24 小时饮食回忆）和 HRQoL 问卷（简短表格-36（SF-36）心理（MCS）和身体成分评分（PCS）以及欧洲 QoL-5 维度（EQ5D）健康状况（HSS）和视觉模拟评分（VAS））在基线、6 个月和 12 个月时进行。平均年龄为 64（14）岁。营养不良存在于 37%的人群中。在基线时，SGA 评估的营养不良是所有四个 HRQoL 指标的唯一独立（且负面）相关因素。没有单一因素与所有四项 HRQoL 指标在 1 年内的下降独立相关。然而，1 年内营养不良的患病率/发展是 EQ5D HSS 下降 1 年的独立预测因素，1 年内脂肪摄入量的减少独立预测了 SF-36 MCS 和 PCS 下降 1 年，以及 EQ5D VAS。这些发现强调了监测所有透析患者营养不良并提供营养建议的重要性。需要进一步的研究来评估营养干预对 HRQoL 和其他长期结局的影响。
