Hemodialysis (HD) majorly represents the global treatment option for patients with chronic kidney disease stage 5, and, despite advances in dialysis technology, these patients face a high risk of morbidity and mortality from malnutrition. We aimed to provide a novel view that malnutrition susceptibility in the global HD community is either or both of iatrogenic and of non-iatrogenic origins. This categorization of malnutrition origin clearly describes the role of each factor in contributing to malnutrition. Low dialysis adequacy resulting in uremia and metabolic acidosis and dialysis membranes and techniques, which incur greater amino-acid losses, are identified modifiable iatrogenic factors of malnutrition. Dietary inadequacy as per suboptimal energy and protein intakes due to poor appetite status, low diet quality, high diet monotony index, and/or psychosocial and financial barriers are modifiable non-iatrogenic factors implicated in malnutrition in these patients. These factors should be included in a comprehensive nutritional assessment for malnutrition risk. Leveraging the point of origin of malnutrition in dialysis patients is crucial for healthcare practitioners to enable personalized patient care, as well as determine country-specific malnutrition treatment strategies.
A single macronutrient approach with WPS in malnourished CAPD patients was shown to achieve DPI adequacy and improvements in weight, BMI, skin fold measures, serum urea and nPCR level. CLINICAL TRIAL REGISTRY: www.clinicaltrials.gov (NCT03367000).
BackgroundTelevision food advertising (TVFA) is the most dominant medium in the obesogenic environment promoting unhealthy food choices in children.MethodsThis cross-sectional study investigated children’s attitudes towards TVFA by examining four well-cited induction factors namely advertisement recognition, favourite advertisement, purchase request, and product preference. Malaysian urban schoolchildren (7 to 12 years) of equal ethnic distribution were voluntarily recruited (n = 402). Questionnaire administration was facilitated using a food album of 24 advertised food products.ResultsMajority of children were older (66.2 %), girls (56.7 %) with one-third either overweight or obese. TV viewing time for weekend was greater than weekdays (4.77 ± 2.60 vs 2.35 ± 1.40 h/day) and Malay children spent more time watching TV compared to Chinese (p < 0.001) and Indian (p < 0.05) children. Chinese children spent significantly more time surfing the internet compared to either Malay or Indian (p < 0.01). Median score trend was advertisement recognition > favourite advertisement and product preference > purchase request, and significantly greater (p < 0.001) for non-core than core food advertisements. TV viewing time and ethnicity significantly influenced all induction factors for non-core foods. After correcting for all influencing factors, ‘favourite advertisement’ (IRRfinal adj: 1.06; 95 % CI: 1.04 to 1.08), ‘purchase request’ (IRRfinal adj: 1.06; 95 % CI: 1.04 to 1.08) and ‘product preference’ (IRRfinal adj: 1.04; 95 % CI: 1.02 to 1.07) still were significantly associated with TV viewing time. For every additional hour of TV viewing, the incidence rates increased significantly by 1.04 to 1.06 for ‘favourite advertisement’, ‘purchase request’ and ‘product preference’ related to non-core foods amongst Malay and Indian children. However, Chinese children only demonstrated a significant association between TV viewing time and ‘favourite advertisement’ (IRRadj: 1.06; 95 % CI: 1.01 to 1.10).ConclusionThis study highlights TVFA as a powerful medium predisposing the mind of children to non-core foods through appealing TV commercials, promoting purchase request and generating unhealthy food preferences in early childhood.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-2392-z) contains supplementary material, which is available to authorized users.
BackgroundPoor appetite could be indicative of protein energy wasting (PEW) and experts recommend assessing appetite in dialysis patients. Our study aims to determine the relationship between PEW and appetite in haemodialysis (HD) patients.MethodsHD patients (n=205) self-rated their appetite on a scale of 1 to 5 as very good (1), good (2), fair (3), poor (4) or very poor (5). Nutritional markers were compared against appetite ratings. Using logistic regression analysis associations between dichotomized appetite with PEW diagnosis were determined as per the International Society of Renal Nutrition and Metabolism (ISRNM) criteria and alternate objective measures. Data was adjusted for socioeconomic and demographic characteristics.ResultsPoorer appetite ratings were significantly associated with lower income (P = 0.021), lower measurements (P < 0.05) for mid-arm muscle circumference, mid-arm muscle area and lean tissue mass (LTM), serum urea (P = 0.007) and creatinine (P = 0.005). The highest hsCRP (P = 0.016) levels occurred in patients reporting the poorest appetite. Serum albumin did not differ significantly across appetite ratings. Poor oral intake represented by underreporting (EI/BMR < 1.2) was evident for all appetite ratings. PEW was prevalent irrespective of appetite ratings (very good: 17.6 %, good: 40.2 %, fair: 42.3 % and poor: 83.3 %). After dichotomizing appetite ratings into normal and diminished categories, there was a marginal positive association between diminished appetite and overall PEW diagnosis (ORadj: 1.71; 95 % CI: 0.94–3.10, P = 0.079). Amongst individual ISRNM criteria, only BMI <23 kg/m2 was positively associated with diminished appetite (ORadj: 2.17; 95 % CI: 1.18–3.99). However, patients reporting diminished appetite were more likely to have lower LTM (ORadj: 2.86; 95 % CI: 1.31–6.24) and fat mass (ORadj: 1.91; 95 % CI: 1.03–3.53), lower levels of serum urea (ORadj: 2.74; 95 % CI: 1.49–5.06) and creatinine (ORadj: 1.99; 95 % CI: 1.01–3.92), higher Dialysis Malnutrition Score (ORadj: 2.75; 95 % CI: 1.50–5.03), Malnutrition Inflammation Score (ORadj: 2.15; 95 % CI: 1.17–3.94), and poorer physical (ORadj: 3.49; 95 % CI: 1.89–6.47) and mental (ORadj: 5.75; 95 % CI: 3.02–10.95) scores.ConclusionsA graded but non-significant increase in the proportion of PEW patients occurred as appetite became poorer. However, after dichotomization, a positive but marginally significant association was observed between diminished appetite and PEW diagnosis.Electronic supplementary materialThe online version of this article (doi:10.1186/s12882-015-0073-x) contains supplementary material, which is available to authorized users.
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