Abstract
Studies suggest that maintenance hemodialysis (MHD) patients report dietary energy intakes (EIs) that are lower than what is actually ingested. Data supporting this conclusion have several important limitations. The present study introduces a novel approach of assessing underreporting of EI in MHD patients. Comparisons of EI of free-living MHD patients determined from food records to their measured energy needs. Metabolic research ward. Thirteen clinically stable MHD patients with unchanging weights whose EI was assessed by dietitian interview-assisted 3-day food records. EI was compared with (1) patients' resting energy expenditure (REE), measured by indirect calorimetry, and estimated total energy expenditure (TEE) and (2) patients' dietary energy requirements (DER) measured while patients underwent nitrogen balance studies and consumed a constant energy diet in a research ward for a mean duration of 89.5 days. DER was calculated as the actual EI during the research study corrected for changes in body fat and lean body mass measured by Dual X-Ray Absorptiometry. Underreporting of EI was determined by an EI:REE ratio <1.27 and an EI:TEE ratio or EI:DEE ratio <1.0. Seven of the 13 MHD patients studied were male. Patient's ages were 47.7 ± standard deviation 9.7 years; body mass index averaged 25.4 ± 2.8 kg/m2, and dialysis vintage was 53.3 ± 37.1 months. The EI:REE ratio (1.03 ± 0.23) was significantly less than the cutoff value for underreporting of 1.27 (P = .001); 12 of 13 patients had EI:REE ratios <1.27. The mean EI:TEE ratio was significantly less than the cutoff value of 1.0 (0.73 ± 0.17, P < .0001), and 12 MHD patients had EI:TEE ratios <1.0. The EI:DER ratio was also <1.0 (0.83 ± 0.25, P = .012), and 10 MHD had EI:DER ratios <1.0. Dietitian interview-assisted diet records by MHD patients substantially underestimate the patient's dietary EI.
Highlights
Protein-energy wasting (PEW) is a highly prevalent complication of maintenance hemodialysis (MHD) patients[1,2,3,4] and is associated with much higher mortality.[5, 6] Since reduced energy intake may contribute to PEW, it is important to assess dietary energy intake in MHD patients in their normal outpatient environment
The mean energy intakes (EI):Total Energy Expenditure (TEE) ratio was significantly less than the cut-off value of 1.0 (0.73±0.17, p
One older study demonstrated that in MHD patients whose reported calorie intakes were lower than the intakes routinely provided for hospitalized individuals, little change in their body weight was observed over a period of several months.[7]
Summary
Protein-energy wasting (PEW) is a highly prevalent complication of maintenance hemodialysis (MHD) patients[1,2,3,4] and is associated with much higher mortality.[5, 6] Since reduced energy intake may contribute to PEW, it is important to assess dietary energy intake in MHD patients in their normal outpatient environment. A question arises as to the degree of accuracy of dietary food records or dietetic interviews for assessing energy intake in MHD patients. One older study demonstrated that in MHD patients whose reported calorie intakes were lower (below 30 kcal/kg/day) than the intakes routinely provided for hospitalized individuals, little change in their body weight was observed over a period of several months.[7] Three subsequent studies have more directly assessed the question of underreporting of energy intake in MHD patients.[8,9,10] All three of these studies were limited by comparing reported energy intake to previously published estimates of energy expenditure based upon the patients’ body weights. This is an essential component of a study assessing accuracy of reported dietary energy intakes, since a low reported energy intake is consistent with an accurate report of energy intake with weight loss
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