Modified Quantitative Subjective Global Assessment Research Articles

Varying association of nutrient intakes with quality of life in patients receiving different modes of dialysis.

Nutrients are crucial for dialysis patients, especially elderly patients. Nutrition-related complications in dialysis patients are often closely related to cardiovascular aging. However, we know little about the effect of different nutrients on the commonly used outcome predictor, health-related quality of life (HRQOL). Therefore, this study investigated the associations between different nutrients and HRQOL among dialysis patients. A cross-sectional study was conducted on 123 dialysis adults at multiple dialysis centers. The Short Form-36 Health Survey (SF-36) assesses HRQOL. Modified quantitative subjective global assessment (MQSGA) evaluates nutritional status. A 3-day dietary record evaluated nutrient intakes. Among the 123 participants, 79 received hemodialysis (HD), and 44 were on peritoneal dialysis (PD). Patients with PD had a higher SF-36 score than HD (525 ± 136 vs. 375 ± 179, P < 0.001). A negative association between nutrition status and HRQOL was observed in HD (regression coefficient β = -17.4, P < 0.001) but not in PD (β = -12.3, P = 0.07). For HD patients, the nutrition status was negatively correlated with intakes of carbohydrates, fiber, selenium, copper, and Manganese (β = -0.02, P = 0.032; β = -0.3, P = 0.031; β = -0.1, P = 0.006; β = -2.3, P = 0.025; β = -1.3, P = 0.003, respectively). Their HRQOL was positively associated with calories, fat, niacin, and vitamin E (β = 2.19, P = 0.035; β = 2.4, P = 0.043; β = 8.5, P = 0.044; β = 6.9, P = 0.017, respectively). Conversely, for patients with PD, only vitamin B2 was found to be adversely correlated with their nutritional status (β = -5.2, P = 0.037), and increased intakes of vitamin A, vitamin C and fiber (β = 0.1, P = 0.031; β = 0.8, P = 0.028; β = 15.8, P = 0.045, respectively) were associated with a better HRQOL. The nutritional intake of PD patients and HD patients affects their quality of life differently. Macronutrients significantly impact HRQOL in HD patients, while vitamins have a more substantial impact on PD patients.

Effects of health concept model-based detailed behavioral care on mood and quality of life in elderly patients with chronic heart failure.

With the intensification of social aging, the susceptibility of the elderly population to diseases has attracted increasing attention, especially chronic heart failure (CHF) that accounts for a large proportion of the elderly. To evaluate the application value of health concept model-based detailed behavioral care in elderly patients with CHF. This study recruited 116 elderly CHF patients admitted from October 2018 to October 2020 and grouped them according to the nursing care that they received. The elderly patients who underwent health concept model-based detailed behavioral care were included in a study group (SG; n = 62), and those who underwent routine detailed behavioral nursing intervention were included as a control group (CG; n = 54). Patients' negative emotions (NEs), quality of life (QoL), and nutritional status were assessed using the self-rating anxiety/ depression scale (SAS/SDS), the Minnesota Living with Heart Failure Ques-tionnaire (MLHFQ), and the Modified Quantitative Subjective Global Assessment (MQSGA) of nutrition, respectively. Differences in rehabilitation efficiency, NEs, cardiac function (CF) indexes, nutritional status, QoL, and nursing satisfaction were comparatively analyzed. A higher response rate was recorded in the SG vs the CG after intervention (P < 0.05). After care, the left ventricular ejection fraction was higher while the left ventricular end-diastolic dimension and left ventricular end systolic diameter were lower in the SG compared with the CG (P < 0.05). The post-intervention SAS and SDS scores, as well as MQSGA and MLHFQ scores, were also lower in the SG (P < 0.05). The SG was also superior to the CG in the overall nursing satisfaction rate (P < 0.05). Health concept model-based detailed behavioral care has high application value in the nursing care of elderly CHF patients, and it can not only effectively enhance rehabilitation efficiency, but also mitigate patients' NEs and improve their CF and QoL.

Oral energy supplementation improves nutritional status in hemodialysis patients with protein-energy wasting: A pilot study.

Background: Protein-energy wasting (PEW) is highly prevalent in hemodialysis (HD) patients, which is associated with poor quality of life, complications, and an increased risk of mortality. A prospective study in HD patients with 2months of oral energy supplements (OESs) was performed. Methods: A total of 37 HD patients with PEW were finally enrolled in this prospective study and were randomized into the OES group (n = 19), which received oral energy supplementation (300kcal) and dietary recommendations, while patients in the non-OES group (n = 18) received only dietary recommendations. The study duration was 2months. The nutritional status of the patients was evaluated by laboratory indexes, body composition parameters, and the modified quantitative subjective global assessment (MQSGA) and malnutrition-inflammation score (MIS). Quality of life was evaluated by the Short Form Health Survey Questionnaire (SF-36). Results: After 2months of therapy, a significant increase in serum albumin [39.6 (37.6-45.8) vs. 43.4 (39.1-46.7) g/L; p = 0.018], hemoglobin (101.0 ± 13.6g/L vs. 111.8 ± 11.7g/L; p = 0.042), and dietary energy intake (29.17 ± 3.22kcal/kg/day vs. 33.60 ± 2.72kcal/kg/day, p < 0.001) was observed in the comparisons of baseline in the OES group. Moreover, the OES group demonstrated significant amelioration in MQSGA [9 (8-13) vs. 8 (7-12), p < 0.001] and MIS [5 (3-10) vs. 3 (2-8), p < 0.001], physical functioning (p < 0.001), and mental health (p = 0.046) subsections of SF-36 compared with the baseline. No electrolyte disorders or dyslipidemia were observed in the OES group. Conclusion: OES in HD patients with PEW can significantly ameliorate energy supply, nutritional status, anemia, and quality of life.

Association of the modified creatinine index with muscle strength and mortality in patients undergoing hemodialysis

Background In the updated consensus, low muscle strength overtook the role of low muscle mass, and probable sarcopenia was diagnosed once low muscle strength was detected. Whether the modified creatinine index (mCI) could identify persons with probable sarcopenia who may be at risk of adverse outcomes remains unknown. We aimed to evaluate the association of the mCI with probable sarcopenia and mortality in patients undergoing hemodialysis. Methods In the cross-sectional study (n = 346), univariate and multivariable logistic regression analyses were performed to study the association of mCI with probable sarcopenia. Modified Quantitative Subjective Global Assessment (MQSGA) was used to evaluate the nutritional status. The performance of the mCI value for identifying probable sarcopenia was analyzed using receiver operating characteristic (ROC) curve analysis. The appropriate cutoff points were determined using Youden’s method. In the longitudinal cohort study composed of an independent hemodialysis cohort (n = 218), cox proportional regression models were used to evaluate crude and adjusted hazard ratios and 95% confidence intervals (CIs) of death by mCI and MQSGA. Results Cross-sectional results showed that after adjusting for confounders, the association of mCI with low muscle strength remained significant. The area under the curve (AUC) of the mCI to predict probable sarcopenia was 0.804 (95% CI, 0.744–0.863; p < 0.001) for men and 0.787 (95% CI, 0.711–0.864; p < 0.001) for women. The optimal mCI cutoff values were 21.07 mg/kg/d for men and 19.57 mg/kg/d for women, respectively. Longitudinal results showed that compared with those in the high mCI group, subjects in the low mCI group had a higher risk of death for all causes (adjusted HR, 2.51; 95% CI, 1.16–5.41; p = 0.019). Adding the mCI significantly improved the predictive accuracy for death with an increase in C-index from 0.785 to 0.805 (p = 0.026) and improved the net reclassification index (38.6%, p = 0.021), while adding MQSGA did not. Conclusion The mCI is a predictor of muscle strength and survival in hemodialysis patients, and is preferable to the MQSGA for predicting death. Assessment of mCI could provide additional predictive and prognostic information to sarcopenia.

Clinical assessment of nutritional status using the modified quantified subjective global assessment and anthropometric and biochemical parameters in patients undergoing hemodialysis in Macao

ObjectiveMalnutrition is widespread among patients undergoing hemodialysis and is linked to high morbidity and mortality rates. We evaluated the nutritional status and malnutrition markers in patients undergoing hemodialysis in Macao.MethodsWe performed a cross-sectional analysis of 360 patients in a hemodialysis center. The modified quantitative subjective global assessment (MQSGA), anthropometric indices and related biochemical test data were used to evaluate nutritional status.ResultsThe sample's mean age was 63.47 ± 13.95 years. There were 210 well-nourished (58.3%), 139 mild-to-moderately malnourished (38.6%) and 11 severely malnourished (3.1%) patients. Older patients had a higher incidence of severe malnutrition, but there were no significant differences between diabetic and non-diabetic patients. Mid-arm circumference (MAC); mid-arm muscle circumference; body mass index; triceps skin fold thickness; serum albumin, creatinine and urea; and hemoglobin were all valid for assessing nutritional status. MAC and the serum albumin and creatinine concentrations significantly negatively correlated with MQSGA.ConclusionsMalnutrition is commonplace in patients undergoing hemodialysis in Macao, but their nutritional status is not affected by diabetes. Serum creatinine, serum albumin and MAC, and especially pre-dialysis creatinine concentration, represent effective, readily available, and easily remembered screening measures of nutritional status for patients undergoing maintenance dialysis.

Effect of Nutritional Nursing on the Quality of Life, Nutritional Status, and Complications in Elderly Uremic Patients Receiving Peritoneal Dialysis

Objective: The aim of this study is to explore the role of nutritional nursing in the quality of life, nutritional status, and complications in elderly uremic patients receiving peritoneal dialysis (PD). Methods: We enrolled 205 uremic patients who were treated with PD in our hospital from March 2018 to April 2019 as the research subjects. Then we grouped them according to different nursing methods: 116 cases receiving nutritional nursing were assigned to the research group (RG) while the other 89 cases receiving routine nursing to the control group (CG). Clinical biochemical markers were detected by the biochemistry analyzer, the nutritional status determined by the Modified Quantitative Subjective Global Assessment (MQSGA), the anxiety and depression intensity assessed by Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS), the sleep quality assessed by the Pittsburgh Sleep Quality Index(PSQI), the nursing satisfaction level assessed by the hospital’s self-made nursing satisfaction questionnaire, and the quality of life evaluated by the Quality of Life Questionnaire (QLQ-C30 ). The complication rate in patients was monitored. Results: The improvement of clinical biochemical markers after nursing was better in RG than in CG. The decrease in the MQSGA score, SAS score, SDS score, and PSQI score after nursing was sharper in RG than in CG. Compared with CG, RG had a remarkably lower complication rate, a notably higher nursing satisfaction level, and a remarkably better quality of life. Conclusion: Nursing intervention for elderly uremic patients receiving PD can enhance the quality of life of patients, improve the nutritional status, promote the recovery from the disease, and reduce the complication rate.

Elucidating the relationship between nutrition indices and coronary artery calcification in patients undergoing maintenance hemodialysis.

Cardiovascular diseases (CVD) are common in maintenance hemodialysis (MHD) patients, and vascular calcification is associated with the incidence of CVD. Malnourished MHD patients are particularly prone to CVD events. Thus far, there is no clear explanation for the relationship of nutrition status with vascular calcification; therefore, we investigated the relationship between malnutrition and vascular calcification. One hundred thirty-one patients underwent laboratory testing, assessment of vascular calcification, modified quantitative subjective global assessment (MQSGA), bioelectrical impedance analysis (BIA), and anthropometric measurements. The patients were divided into two groups based on the presence or absence of coronary artery calcification (CAC), and nutritional statuses were compared between the two groups. The MQSGA score was higher in the CAC group (mean 10.9 ± 1.81) than in the no-CAC group (mean 10.2 ± 1.51); in addition, the mean phase angle (PA) value was significantly lower in the CAC group than in the no-CAC group. Stratification according to CAC score showed that age, Kt/V, incidence of valve calcification, incidence of abdominal aortic calcification, MQSGA score, and blood cell mass were related to the severity of CAC. In addition, quartile analysis revealed that MQSGA score and PA value were related to the incidence and severity of vascular calcification. Binary regression analysis showed that MQSGA score, age, hemoglobin level, and high-density lipoprotein level were independent risk factors for dialysis-related CAC. Patients on MHD who exhibited malnutrition were more likely to have vascular calcification, especially CAC. Namely, the higher the MQSGA score, the lower the PA, and the more likely the occurrence of CAC.

MON-142 Cross-sectional study of nutritional status in Chinese maintenance hemodialysis patients

Protein-energy malnutrition are common in maintenance hemodialysis (MHD) patients and are associated with increased morbidity and mortality. To evaluate the nutritional status of Chinese MHD patients, we performed a cross-sectional study in unselected patients treated with hemodialysis thrice weekly. The subjects were MHD patients in our outpatient hemodialysis center. The physical measurement, laboratory values and three-day food diaries were collected. Body composition was measured by bioelectrical impedance analysis (BIA). Global nutritional status was evaluated by the modified quantitative subjective global assessment (MQSGA). 159 MHD patients (males 83, females 76, mean age 64.09±13.55 years, mean dialysis age 46.83±53.65 months) were enrolled. The mean body mass index (BMI) was 21.42±3.01kg/m2 in men and 20.35±2.73kg/m2 in women. The upper arm muscle circumference (23.72±2.75cm in men, 22.52±2.78cm in women) and hand-grip strength (26.23±9.61 in men, 17.16±7.76 in women) were lower than normal population standard values. By using BIA, the body fat mass percent (17.89±7.98 in men, 24.06±6.90 in women) was within the standard range of the normal population, but the body muscle mass percent (77.71±8.51 in men, 71.17±7.36 in women) was lower than the standard range of the normal population. Both the calorie intake (27.66±11.99kcal/kg) and protein intake (1.11±0.42g/kg) were lower than the K/DOQI guideline recommendation. The dietary sodium intake (2935.75±1495.50mg) was higher than K/DOQI guideline recommendation and the dietary phosphorus intake (903.25±300.38mg) was within the range of the K/DOQI guideline recommendation. The mean levels of serum albumin, serum phosphate and serum calcium were 39.34±3.12g/l, 1.76±0.62mmol/l and 2.35±0.26mmol/l, respectively. The mean level of MQSGA was 11.34±2.43. The total nutritional status of MHD patients in our hemodialysis center were not bad, except for body muscle mass and hand-grip strength. Despite the lower dietary calorie and protein intake, the nutritional status and normal serum phosphate level were maintained, which suggested the amount of dietary calorie and protein intake for Chinese MHD patients needs to be further investigated.

Sarcopenia in patients undergoing maintenance hemodialysis: incidence rate, risk factors and its effect on survival risk

Background Sarcopenia is a degenerative syndrome mainly characterized by the atrophy of skeletal muscle, along with the decrease of muscle strength and function. However, there are currently few studies concerning sarcopenia in patients undergoing maintenance hemodialysis dialysis (MHD). This study was aimed to investigate the incidence of sarcopenia in MHD patients and its influencing factors, as well as its impact on survival risk. Method All 131 MHD patients enrolled in our study were tested with bioelectrical impedance analysis (BIA) and grip strength. Demographic data was collected and anthropometric measurement and laboratory examination were conducted. Results The total incidence of sarcopenia within the 131 MHD patients was 13.7% and the incidence of sarcopenia in patients over 60 years was 33.3%. The dialysis duration, with or without diabetes, serum phosphorus and pre-albumin levels of sarcopenic patients were significantly different from those of non-sarcopenicones; the modified quantitative subjective global assessment (MQSGA) scores of sarcopenic patients were higher than those without sarcopenia. Multivariate analysis showed that dialysis duration, diabetes and serum phosphorus level were independent risk factors for sarcopenia in MHD patients. Kaplan–Meier survival analysis showed a one-year survival of 88.9% in sarcopenic patients, which was significantly lower than non-sarcopenic patients. Conclusion The incidence of sarcopenia in MHD patients was high and increased gradually with age. Dialysis duration, diabetes, serum phosphorus level and malnutrition predisposed the patients to sarcopenia. One-year follow-up found that the mortality risk of sarcopenic patients was higher than that of non-sarcopenic patients.

Evaluation of nutritional status using anthropometric measurements and MQSGA in geriatric hemodialysis patients.

OBJECTIVE:Malnutrition is common among hemodialysis patients and is associated with higher rates of morbidity and mortality. The aim of this study was to evaluate nutritional status of geriatric hemodialysis patients.METHODS:Total of 163 hemodialysis patients were initially screened, and 55 patients (28 males, 27 females; mean age: 72.9±8.4 years) met the criteria for inclusion. Patients were divided into 3 groups according to modified quantitative subjective global assessment (MQSGA) scores: Group I (n=22) normal nutrition, Group II (n=20) mild-to-moderate malnutrition, and Group III (n=13) severe malnutrition.RESULTS:When we assessed the correlation between MQSGA nutrition score and data of malnourished patients (n=33), positive significant correlation was found between age, C-reactive protein level, and malnutrition-inflammation score. Negative significant correlation was found between body mass index, bicep skinfold, tricep skinfold, mid-arm circumference, mid-arm muscle circumference, and phosphate and albumin levels.CONCLUSION:Malnutrition is very common and increasing with aging in geriatric hemodialysis patients. MQSGA score and anthropometric measurements can be used to assess nutritional status in geriatric hemodialysis patients.

Assessment of Nutritional Status of Nepalese Hemodialysis Patients by Anthropometric Examinations and Modified Quantitative Subjective Global Assessment.

OBJECTIVETo assess the nutritional status of patients on maintenance hemodialysis by using modified quantitative subjective global assessment (MQSGA) and anthropometric measurements.METHODWe Conducted a cross sectional descriptive analytical study to assess the nutritional status of fifty four patients with chronic kidney disease undergoing maintenance hemodialysis by using MQSGA and different anthropometric and laboratory measurements like body mass index (BMI), mid-arm circumference (MAC), mid-arm muscle circumference (MAMC), triceps skin fold (TSF) and biceps skin fold (BSF), serum albumin, C-reactive protein (CRP) and lipid profile in a government tertiary hospital at Kathmandu, Nepal.RESULTSBased on MQSGA criteria, 66.7% of the patients suffered from mild to moderate malnutrition and 33.3% were well nourished. None of the patients were severely malnourished. CRP was positive in 56.3% patients. Serum albumin, MAC and BMI were (mean + SD) 4.0 + 0.3 mg/dl, 22 + 2.6 cm and 19.6 ± 3.2 kg/m2 respectively. MQSGA showed negative correlation with MAC (r = −0.563; P = <0.001), BMI (r = −0.448; P = <0.001), MAMC (r = −0.506; P = <.0001), TSF (r = −0.483; P = <.0002), and BSF (r = −0.508; P = <0.0001). Negative correlation of MQSGA was also found with total cholesterol, triglyceride, LDL cholesterol and HDL cholesterol without any statistical significance.CONCLUSIONMild to moderate malnutrition was found to be present in two thirds of the patients undergoing hemodialysis. Anthropometric measurements like BMI, MAC, MAMC, BSF and TSF were negatively correlated with MQSGA. Anthropometric and laboratory assessment tools could be used for nutritional assessment as they are relatively easier, cheaper and practical markers of nutritional status.

Evaluation of nutritional status with different methods in geriatric hemodialysis patients: impact of gender.

This study investigated the frequency of malnutrition in geriatric hemodialysis patients according to biochemical, anthropometric, bioelectrical impedance analysis (BIA), modified quantitative subjective global assessment (MQSGA), and geriatric nutritional risk index (GNRI) methods, and the effect of gender on these different parameters. A total of 160 chronic hemodialysis patients (older than 65 years old) were included in this study. There were 82 males (51.2 %) and mean age was 72.8 ± 6.1 years. Nutritional status of patients was evaluated by using serum albumin, body mass index (BMI), triceps skinfold (TSF), mid-arm circumference (MAC), mid-arm muscle circumference (MAMC), calf circumference (CC), BIA, MQSGA, and GNRI. The prevalence of malnutrition according to the aforementioned methods were as following: MAC 62.5 %, MQSGA 60 %, MAMC 50 %, CC 43.1 %, TSF 39.4 %, body fat percentage 33.8 %, albumin 29.1 %, GNRI 15 %, and BMI 8 %. While malnutrition was found to be more prevalent among women according to MQSGA, TSF, and body fat percentage (p = 0.008, p < 0.001, p = 0.042, respectively), it was more frequent in men when we used MAC and MAMC (p = 0.012, p < 0.001, respectively). Our data indicated that while there was a difference in malnutrition prevalence between female and male geriatric hemodialysis patients according to MQSGA, TSF, MAC, and body fat percentage, there was no difference between genders in terms of malnutrition prevalence according to GNRI, albumin, BMI, and CC.

Malnutrition, a new inducer for arterial calcification in hemodialysis patients?

BackgroundArterial calcification is a significant cardiovascular risk factor in hemodialysis patients. A series of factors are involved in the process of arterial calcification; however, the relationship between malnutrition and arterial calcification is still unclear.Methods68 hemodialysis patients were enrolled in this study. Nutrition status was evaluated using modified quantitative subjective global assessment (MQSGA). Related serum biochemical parameters were measured. And the radial artery samples were collected during the arteriovenous fistula surgeries. Hematoxylin/eosin stain was used to observe the arterial structures while Alizarin red stain to observe calcified depositions and classify calcified degree. The expressions of bone morphogenetic protein 2 (BMP2) and matrix Gla protein (MGP) were detected by immunohistochemistry and western blot methods.Results66.18% hemodialysis patients were malnutrition. In hemodialysis patients, the calcified depositions were mainly located in the medial layer of the radial arteries and the expressions of BMP2 and MGP were both increased in the calcified areas. The levels of serum albumin were negatively associated with calcification score and the expressions of BMP2 and MGP. While MQSGA score, serum phosphorus and calcium × phosphorus product showed positive relationships with calcification score and the expressions of BMP2 and MGP.ConclusionsMalnutrition is prevalent in hemodialysis patients and is associated with arterial calcification and the expressions of BMP2 and MGP in calcified radial arteries. Malnutrition may be a new inducer candidate for arterial calcification in hemodialysis patients.

Combination with Anthropometric Measurements and MQSGA to Assess Nutritional Status in Chinese Hemodialysis Population

Aims: To assess the nutritional status, combination with anthropometric measurements and modified quantitative subjective global assessment (MQSGA) was used in multi-center hemodialysis population in South China.Methods: A cross-sectional, descriptive-analytic study was performed in 4 teaching hospitals in South China, dated from January 2010 to December 2011. Nutritional status was assessed with MQSGA and related anthropometric indexes. Serum albumin and transthyretin were also determined for nutritional assessment.Results: Eighty-two randomly selected hemodialysis patients participated in the nutritional assessment, of which 75 hemodialysis patients completed all assessments. The average age was 62.70 ± 14.21 years. The mean duration of hemodialysis was 3.29 ± 1.08 years. Of the included patients, 32% patients were well nourished, 60% were mild to moderately malnourished, and 8% were severely malnourished. Along with the malnutrition severity, the serum transthyretin significantly decreased. However, no obvious changes were found in serum albumin. The mean value (Mean ± SD; 25.78 ± 4.09 cm) of mid arm circumference (MAC) was negatively correlated with MQSGA (r = -0.365; P = 0.002). Body mass index (BMI) (Mean ± SD; 21.6 ± 3.1 kg/m2) was also significantly negatively correlated with MQSGA (r = -0.392; P = 0.001). The areas under the receiver operating characteristic curve were 0.664 and 0.726, respectively.Conclusions: Malnutrition is very common in South China hemodialysis population. Both BMI and MAC were effective markers for assessing nutritional status.

Application of transtheoretical model and stages of change in malnutrational hemodialysis patients

Objective To explore the health education methods in malnutritional patients on maintenance hemodialysis using the transtheoretical model and stages of change (TTM).And also to help patients to set up scientific behavioral patterns to improve their self- management ability and reduce the incidence of complications.Methods 72 maintenance hemodialysis patients were included in this study.Taking TTM as intervention,we compared the nutritional status and the modified quantitative subjective global assessment (MQSGA) at 4 different time points:before intervention,1month,3 months and 6 months after intervention respectively,and statistically analyzed the data.Results Compared with before intervention,HGB level elevated significantly 1month after intervention ( q =2.08,P ＜ 0.05 ),while ALB was not changed significantly(q =1.22,P ＞ 0.05 ),HCRP dropped significantly ( q =3.06,P ＜ 0.01) and Kt/V increased significantly(q =4.12,P ＜0.01).HGB and Kt/V level increased significantly 3 months after intervention(q =8.20,6.13;P＜0.01),ALB level increased(q =2.81,P ＜0.05),while HCRP dropped significantly(q =8.85,P ＜0.01).HGB,ALB and Kt/V levels all increased significantly 6 months after intervention compared with 3 months after intervention (q =10.89,7.06,9.68,respectively; All P ＜ 0.01),and HCRP dropped significantly(q =13.26,P ＜0.01).The MQSGA improved significantly at both 3 months( x2 =15.84,P ＜0.01)and 6 months( x2 =86.26,P ＜0.01)after intervention compared with before intervention.Conclusions By using the TTM,we can change the life style of the hemodialysis patients,and improve their nutritional status and life quality. Key words: Hemodialysis; Health education; The transtheoretical model and stages of change

Comparison of different assessments for evaluating malnutrition in Chinese patients with end-stage renal disease with maintenance hemodialysis

Nutritional status can be evaluated by the malnutrition-inflammation score (MIS), bioelectrical impedance analysis (BIA), and modified quantitative subjective global assessment (MQSGA). This study sought to determine the value of these methods for detecting malnutrition in patients with end-stage renal disease (ESRD) who were undergoing maintenance hemodialysis. A total of 84 patients with ESRD with maintenance hemodialysis were recruited for the evaluation of their nutritional states by MQSGA, MIS, and BIA. The potential correlation among these methods was analyzed, and there was a significant difference in the percentage of patients with malnutrition as determined by these methods. Although only 1 of 84 patients had a body fat percentage that was below normal, based on the BIA, all of the patients displayed malnutrition as analyzed by MIS, and 56 of 84 patients had malnutrition as determined by MQSGA. Importantly, the MQSGA scores were positively correlated with the MIS scores (r = 0.924, r² = 0.855, P < .05), whereas no close association was found in results obtained by MQSGA score and BIA (r = -0.169, r² = 0.029, P > .05) in this population. Our data indicate that MIS, not BIA, is a sensitive method for the evaluation of malnutrition in Chinese patients with ESRD with maintenance hemodialysis.

A New weighted scoring system for Subjective Global Assessment

Objective Subjective Global Assessment (SGA) is a widely used and validated method for identifying and classifying malnutrition. Recently, in effort to assess nutritional status more accurately, quantitative systems have been devised in which scores are assigned for items or components of the SGA. In addition to validation of conventional SGA in our patient population, this prospective study investigated the association of a recently devised quantitative SGA (Q-SGA) method and an invented modified Q-SGA (MQ-SGA) scoring system with conventional SGA. Methods A total of 2197 patients was evaluated. Each subject was assessed for malnutrition by SGA, anthropometric measurements, and laboratory testing. The items of SGA were scored by assigning 1 point for each increasing severity level to obtain the Q-SGA score. In the invented MQ-SGA system, the items were entered into the logistic regression model and weighted scores were calculated according to the weighted effect of the SGA items. The efficiencies of Q-SGA and MQ-SGA were compared to predict malnutrition according to SGA. Results Eighty-nine percent of patients were classified as well nourished according to conventional SGA, whereas 27 patients (1.2%) were classified as severely malnourished. When patients were grouped according to binary SGA outcome (well nourished versus malnourished), receiver operating characteristics curve areas for the Q-SGA and MQ-SGA scores were 0.897 (95% confidence interval = 0.875–0.919) and 0.952 (95% confidence interval = 0.939–0.964), respectively. The cutoff points for Q-SGA and MQ-SGA were identified as 10 and 18, respectively. Although the sensitivity of these systems in identifying malnutrition were similar (90.0% and 90.9%, respectively), the specificity of MQ-SGA was greater than that of Q-SGA (85.6% versus 67.0%). Conclusions The findings suggest that MQ-SGA outperforms Q-SGA in identifying malnutrition according to SGA. Future nutrition scoring studies need to take into account the weighted effects of items on outcome.