Self‐Reported, Interview‐Assisted Diet Records Underreport Protein and Energy Intake in Maintenance Hemodialysis (MHD) Patients

Abstract

Some studies state that MHD patients underreport energy intake (EI) although energy needs are normal and weight is stable over time. Body mass may not reflect changes in energy stores in MHD patients who cannot regulate water balance normally. Validity of dietary data was evaluated by comparing reported EI with actual dietary EI (aEI) in 13 MHD patients participating in a 93‐day N balance study in a research ward to determine protein needs. Resting energy expenditure (REE) was measured prior to admission to estimate total energy expenditure (TEE) and dietary needs to maintain stable weight. Protein intake was changed ~ every 19 days; aEI was constant throughout the study. Total energy requirements were estimated by aEI corrected for changes in body fat measured by DXA over the 93 day study. Underreporting of EI was determined by a EI:REE ratio <1.27 and EI:TEE ratio<1.0.Age was 47.9±9.7 years; BMI, 25.7 ± 4.7 kg/m2. Self‐reported Intake REE (kcals/d ay) TEE (kcals/d ay) EI: RE E EI: TEE kcals/d ay kcals/kg Protei n (g/kg) 1712±4 98 25.4± 7.4 1.03± 0.3 1676±3 31 2134±3 54 1.0 ± 0.2 0.8±0 .2 Body mass and fat were essentially unchanged (−0.87 kg ± 2.02 kg; 0.74 kg ±1.62 kg) during the study suggesting that pre‐study EI was underreported by ~20%. Variance of reported protein and EI was twice that of aEI. Widespread energy underreporting severely compromises the validity of self‐reported, interview‐assisted diet records in MHD patients.